Hemodynamic and analgesic effect of intrathecal fentanyl with bupivacaine in patients undergoing elective cesarean section; a prospective cohort study.

BACKGROUND: Spinal anesthesia with bupivacaine has side effects such as hypotension, respiratory depression, vomiting, and shivering. The side effects are dose-dependent, therefore different approaches have been attempted to avoid spinal-induced complications including lowering the dose of local anesthetic and mixing it with additives like Neuraxial opioids. OBJECTIVE: To compare the Hemodynamic and analgesic effects of intrathecal fentanyl as an adjuvant with low and conventional doses of bupivacaine in patients undergoing elective cesarean section under spinal anesthesia. METHODOLOGY: An institutional-based prospective cohort study was conducted on 90 patients. Data was collected with chart review, intraoperative observation, and postoperatively patient interview. Data was entered into EPI INFO and transport to SPSS version 23 for analysis of variables using one-way ANOVA, Kruskal Wallis H rank test, and chi-square. RESULT: Hypotension but not bradycardia, was significantly frequent in a conventional dose of bupivacaine alone (CB) group and a conventional dose of bupivacaine with fentanyl (CBF) groups than that of the lower dose of bupivacaine with fentanyl (LBF) groups. Duration of analgesia was significantly longer in LBF (248± 35.6 minutes) and in CBF groups (260.3±40.3 minutes) than in CB group (167.10 ± 31.45 minutes). Time for the first analgesic request was significantly later in LBF (304±47.8 minutes) and CBF (294.6±99.5 minutes) groups than that in CB group (177±25.88 minutes). CONCLUSION: The Lower dose of bupivacaine is associated with less risk of hypotension and faster recovery. Adding fentanyl with the lower dose of bupivacaine in spinal anesthesia for cesarean section could provide comparable anesthesia with the lower risk of hypotension and longer postoperative analgesia.

Pattern and Outcomes of Injuries among Trauma Patients in Gedeo Zone, Dilla, South Ethiopia: A 5 Years Retrospective Analysis.

BACKGROUND: Injury has become a life threatening community health problem associated with significant mortality and morbidity worldwide. The aim of this study was to assess the burden of injury in Dilla University Hospital. METHODS: Institution-based retrospective cross-sectional study was conducted from January 2015 to June 2019. Data was collected using questionnaire adapted from WHO injury surveillance guideline. Bivariate and multivariate logistic regressions were performed to determine the factors associated with hospital mortality. RESULTS: Road traffic accident was the commonest cause of injury 178(47.3%) followed by interpersonal violence 113(30.1%). Revised trauma score (RTS) < 10 (AOR=2.5; 95% CI, 1.8-25.6), Glasgow coma scale (GCS) (AOR =0.3; 95% CI, 0.13-0.5), length of hospitalization (LOS) 1-7 days (AOR=0.1; 95% CI, 0.01-0.8) and time of arrival >24hr were predictors of mortality in a patient with injury. CONCLUSION: Lower extremity injury was common and mostly associated with RTA. Pre-hospital emergency medical service system and trauma registry need to be established to decrease the burden of injury.