The Efficacy of Transverse Abdominis Plane Block for Postoperative Analgesia in Laparoscopic Hysterectomy: A Randomized Prospective Study.

BACKGROUND AND AIM: Postoperative pain is an inevitable acute pain for which a multimodal analgesic approach is required. The aim of this study was to quantify and compare the efficacy of transverse abdominis plane (TAP) block as a postoperative analgesic for patients undergoing laparoscopic hysterectomies versus intravenous opioid analgesics. METHOD: Sixty female patients were enrolled and randomized into two groups following a computer-generated sequence of numbers. In group T (n=30) patients received an ultrasound-guided bilateral TAP block with 20 of 0.375% levobupivacaine on each side immediately after surgery. Patients in group O (opioid group, n = 30) received intravenous (i.v.) tramadol (100mg) immediately after surgery. Rescue analgesic (inj. tramadol 50mg) i.v. bolus given in both groups if visual analog scale (VAS) >4. In the postanesthesia care unit (PACU), the vital signs, episodes of nausea, vomiting, and VAS score of each patient were recorded every two hours for the first 24 hours. RESULT: Total consumption of rescue analgesic (inj. tramadol 50 mg i.v.) during the first 24 hours was significantly higher in group O (186.47+37.48mg) than in group T (107.28+26.34mg). No significant difference was observed in intraoperative vital parameters (HR, NIBP, SPO2). The VAS scores were significantly low in group T. Incidence of postoperative nausea and vomiting (PONV) was significantly higher in group O (13 out of 28 patients) than in group T (five out of 28 patients) with P value =0.043. CONCLUSION: Our study indicated bilateral ultrasound-guided TAP block is a good alternative to opioids for postoperative analgesia.

Premedication with Diclofenac and Precurarization with Atracurium on Succinylcholine-Induced Myalgia in Laparoscopic Cholecystectomy: A Double-Blinded Randomized Study.

Background and Aims: Succinylcholine is the only available depolarizing neuromuscular blocker that has been widely used in the induction of anesthesia, and it is the drug of choice for rapid-sequence induction of anesthesia due to its rapid onset of effect and ultrashort duration of action owing to its rapid hydrolysis by acetyl-cholinesterase. Postoperative muscle pain (myalgia) and muscle stiffness are the most common side effects and are observed most frequently on the 1st postoperative day in ambulatory surgery. The use of succinylcholine in the induction of anesthesia and intubation in routine cases has been discouraged because of such adverse effects. However, because of its cost-effectiveness and easy availability, it is still used by some institutions routinely. This study aimed to study the efficacy of preoperative diclofenac along with atracurium precurarization in alleviating succinylcholine-induced myalgia. Materials and Methods: It is a double-blind randomized comparative study carried out in a tertiary care hospital. The study sample was 60 and divided into two equal groups. All data entered in MS-Excel Sheet and Wilcoxon signed-rank test were done for nonparametric data and one-way ANOVA for the parametric data. The normal distribution of the study sample was tested by the Shapiro - Wilk test. Results: The fasciculations in the test group were much less than in the control group with P < 0.00001. The results for the incidence of myalgia in the two groups were as follows: P value at 24 h was 0.00018 and at 48 h was 0.0028, respectively. Creatine kinase levels at preoperative and 24 h postoperative periods were 49.47 ± 7.24 in Group D, 53.30 ± 7.98 in Group B and 87.38 ± 15.16 in Group D, and 188.41 ± 33.27 in Group B, respectively. Conclusion: Succinylcholine-induced myalgia has a complex pathophysiology. However, the preemptive use of diclofenac in combination with precurarization can alleviate the incidence and severity of succinylcholine-induced myalgia. Therefore, its use may be considered in routine cases for induction of anesthesia for facilitating laryngoscopy and endotracheal intubation.

Use of Paravertebral Block as an Alternative to General Anesthesia for Breast Surgeries: A Randomized Control Study.

BACKGROUND: General anaesthesia (GA) is the conventional technique used for surgical treatment of breast lumps. However, various side effects and complications of GA, such as postoperative pain, nausea, vomiting, and increased hospital stay increase morbidity in patients. Regional anaesthesia using multiple injection paravertebral block is an ideal alternative to GA for breast surgeries. METHODS: Sixty female patients posted for unilateral breast surgery were randomly divided into two groups, Group P for paravertebral block and group G for GA, and compared on the basis of time taken for induction of anaesthesia, postoperative pain relief on basis of Visual Analogue Scale (VAS) score, postoperative nausea and vomiting (PONV) and duration of hospital stay. RESULTS: Duration of surgery in group P was 64.75±18.07 and 67.32±17.64 in group G respectively (P>0.05). Time for inducing anaesthesia was significantly longer in group P (17.15±3.92min) compared to group G (5.90±1.75min) with P<0.05. Significant difference (P<0.001) was observed in the mean duration of postoperative analgesia of group P (298.34±67.02min) and group G (107.68±27.28min). The VAS scores in immediate postoperative period and after two and four hours in the postoperative period were significantly higher in group G (P<0.05). The incidence of postoperative nausea and vomiting was significantly higher in group G (13 out of 30 patients) than group P (four out of 28 patients) with P<0.05. CONCLUSION: The efficacy and safety of paravertebral block for operative treatment of breast tumors, excellent analgesia in early postoperative period, requirement of significantly lesser amount of postoperative analgesics, decreased incidence of PONV and negligible complications along with early ambulation and hospital discharge makes it an afferent cost-effective block of choice for unilateral breast surgeries.

Factors affecting the prevalence of stress, anxiety, and depression in undergraduate Indian dental students.

BACKGROUND: The objective was to assess the prevalence and the associated demographic factors of stress, anxiety, and depression among undergraduate (UG) Indian dental students and determine whether the pattern is different in government-run institutions and those managed by private authorities. MATERIALS AND METHODS: A cross-sectional study was conducted among dental UG students from five dental colleges. Snowball sampling was used to approach 776 potential participants, resulting in a complete response from 507 students. The questionnaire consisted of demographic data; year of study; type of college; accommodation; and Depression, Anxiety, and Stress Scale (DASS)-42. Descriptive data and inferential statistics were obtained. Chi-square test was applied for categorical data to test for significance, and higher analysis was done using multiple linear regression. RESULTS: Females and males comprised 71.8% (n = 364) and 28.2% (n = 143) of the study population, respectively. The prevalence of anxiety was highest (66.86%, n = 339), followed by depression (57.39%, n = 291) and stress (43.99%, n = 223). In terms of severity also, anxiety was the most prevalent condition as more than one-fourth of the students presented with severe and very severe scores in this aspect (25.43%, n = 129) compared to depression (14.39%, n = 73) and stress (10.09%, n = 51). Regression analysis revealed age as a strong positive predictor for all the three conditions, while staying in the hostel was a positive predictor for anxiety and stress. Being female was also an independent predictor for the high prevalence of stress. CONCLUSION: Stress, anxiety, and depression are highly prevalent among Indian dental students. Clinical students and interns have a higher prevalence of stress than preclinical students. Age, being female, and staying in the hostel are positive predictors for the severity of stress. There is no significant difference between government and private colleges, regarding the prevalence of any psychological condition.

Pattern of buccal and palatal bone density in the maxillary premolar region: an anatomical basis of anterior-middle superior alveolar (AMSA) anesthetic technique.

BACKGROUND: The anterior-middle superior alveolar (AMSA) anesthetic technique has been reported to be a less traumatic alternative to several conventional nerve blocks and local infiltration for anesthesia of the maxillary teeth, their periodontium, and the palate. However, its anatomic basis remains controversial. The present study aimed to determine if the pattern of cortical and cancellous bone density in the maxillary premolar region can provide a rationale for the success of the AMSA anesthetic technique. METHODS: Cone-beam computed tomography scans of 66 maxillary quadrants from 34 patients (16 men and 18 women) were evaluated using a volumetric imaging software for cortical and cancellous bone densities in three interdental regions between the canine and first molar. Bone density was measured in Hounsfield units (HU) separately for the buccal cortical, palatal cortical, buccal cancellous, and palatal cancellous bones. Mean HU values were compared using the Mann-Whitney U test and one-way ANOVA with post-hoc analysis. RESULTS: Cancellous bone density was significantly lower (P ≤ 0.001) in the palatal half than in the buccal half across all three interdental regions. However, there was no significant difference (P = 0.106) between the buccal and palatal cortical bone densities at the site of AMSA injection. No significant difference was observed between the two genders for any of the evaluated parameters. CONCLUSIONS: The palatal half of the cancellous bone had a significantly lower density than the buccal half, which could be a reason for the effective diffusion of the anesthetic solution following a palatal injection during the AMSA anesthetic technique.

Current status of the anterior middle superior alveolar anesthetic injection for periodontal procedures in the maxilla.

Periodontal procedures require adequate anesthesia not only to ensure the patient's comfort but also to enhance the operator's performance and minimize chair time. In the maxilla, anesthesia is often achieved using highly traumatic nerve blocks, apart from multiple local infiltrations through the buccal vestibule. In recent years, anterior middle superior alveolar (AMSA) field block has been claimed to be a less traumatic alternative to several of these conventional injections, and it has many other advantages. This critical review of the existing literature aimed to discuss the rationale, mechanism, effectiveness, extent, and duration of AMSA injections for periodontal surgical and non-surgical procedures in the maxilla. It also focused on future prospects, particularly in relation to computer-controlled local anesthetic delivery systems, which aim to achieve the goal of pain-free anesthesia. A literature search of different databases was performed to retrieve relevant articles related to AMSA injections. After analyzing the existing data, it can be concluded that this anesthetic technique may be used as a predictable method of effective palatal anesthesia with adequate duration for different periodontal procedures. It has additional advantages of being less traumatic, requiring lesser amounts of local anesthetics and vasoconstrictors, as well as achieving good hemostasis. However, its effect on the buccal periodontium appears highly unpredictable.

Comparative study of antidiabetic activity of Cajanus cajan and Tamarindus indica in alloxan-induced diabetic mice with a reference to in vitro antioxidant activity.

BACKGROUND: Oxidative stress not only develops complications in diabetic (type 1 and type 2) but also contributes to beta cell destruction in type 2 diabetes in insulin resistance hyperglycemia. Glucose control plays an important role in the pro-oxidant/antioxidant balance. Some antidiabetic agents may by themselves have antioxidant properties independently of their role on glucose control. OBJECTIVE: The present investigation draws a comparison of the protective antioxidant activity, total phenol content and the antihyperglycemic activity of the methanolic extract of Cajanus cajan root (MCC) and Tamarindus indica seeds (MTI). MATERIALS AND METHODS: Antidiabetic potentials of the plant extracts were evaluated in alloxan-induced diabetic Swiss albino mice. The plant extracts at the doses of 200 and 400 mg/kg body weight was orally administered for glucose tolerance test during 1-hour study and hypoglycemic effect during 5-day study period in comparison with reference drug Metformin HCl (50 mg/kg). In vitro antioxidant potential of MCC and MTI was investigated by using 1, 1- diphenyl-2-picrylhydrazyl (DPPH) free radical scavenging activity at 517 nm. Total phenolic content, total antioxidant capacity and reducing power activity was also assayed. RESULTS: There was a significant decrease in fasting serum glucose level (P < 0.001), reduction in blood glucose level (P < 0.001) in 5-days study, observed in the alloxan-induced diabetic mice. The reduction efficacy of blood glucose level of both the extracts is proportional to their dose but MCC is more potent than MTI. Antioxidant study and quantification of phenolic compound of both the extracts revealed that they have high antioxidant capacity. CONCLUSION: These studies showed that MCC and MTI have both hypoglycemic and antioxidant potential but MCC is more potent than MTI. The present study suggests that both MCC and MTI could be used in managing oxidative stress.

Pesticidal and pest repellency activities of a plant derived triterpenoid 2α, 3ß, 21ß, 23, 28-penta hydroxyl 12-oleanene against Tribolium castaneum

BACKGROUND: Tribolium castaneum (Herbst) is a major pest of stored grain-based products, and cause severe damage to cereal grains throughout the world. The present investigation was aimed to determine the pesticidal and pest repellent activities of 2α,3ß,21ß,23,28-penta hydroxyl 12-oleanene against T. castaneum. The compound 2α,3ß,21ß,23,28-penta hydroxyl 12-oleanene is a triterpenoid which was isolated from the roots of Laportea crenulata Gaud. Surface film technique was used for pesticidal screening, whereas, pest repellency property of the triterpenoid was determined by filter paper disc method. RESULTS: At 24 hours of exposure duration, significant mortality records (80% and 86%) were observed at doses 0.88 and 1.77 mg/cm². No significant change in mortality records was observed when duration of exposure was increased up to 48 hours. The triterpenoid showed significant repellency activity at doses 0.47 and 0.94 mg/cm². CONCLUSION: These data suggest that the triterpenoid 2α,3ß,21ß,23,28-penta hydroxyl 12-oleanene possess both pesticidal and pest repellency activities against T. castaneum and can be used in controlling the pest of grain-based products.

Antioxidant, analgesic and anti-inflammatory activities of the methanolic extract of Piper betle leaves.

OBJECTIVE: The present study was designed to evaluate the antioxidant, analgesic, and anti-inflammatory activities of the methanolic extract of Piper betle leaves (MPBL). MATERIALS AND METHODS: MPBL was evaluated for anti-inflammatory activity using carrageenan-induced hind paw edema model. Analgesic activity of MPBL was evaluated by hot plate, writhing, and formalin tests. Total phenolic and flavonoids content, total antioxidant activity, scavenging of 1,1-diphenyl-2-picrylhydrazyl (DPPH) radical, peroxynitrate (ONOO) as well as inhibition of total ROS generation, and assessment of reducing power were used to evaluate antioxidant potential of MPBL. RESULTS: The extract of MPBL, at the dose of 100 and 200 mg/kg, produced a significant (p<0.05) increase in pain threshold in hot plate method whereas significantly (p<0.05) reduced the writhing caused by acetic acid and the number of licks induced by formalin in a dose-dependent manner. The same ranges of doses of MPBL caused significant (p<0.05) inhibition of carrageenan-induced paw edema after 4 h in a dose-dependent manner. In DPPH, ONOO(-), and total ROS scavenging method, MPBL showed good antioxidant potentiality with the IC50 value of 16.33±1.02, 25.16±0.61 , and 41.72±0.48 µg/ml, respectively with a significant (p<0.05) good reducing power. CONCLUSION: The findings of the study suggested that MPBL has strong analgesic, anti-inflammatory, and antioxidant effects, conforming the traditional use of this plant for inflammatory pain alleviation to its antioxidant potentiality.

Estimating bulk density of compacted grains in storage bins and modifications of Janssen's load equations as affected by bulk density.

Janssen created a classical theory based on calculus to estimate static vertical and horizontal pressures within beds of bulk corn. Even today, his equations are widely used to calculate static loadings imposed by granular materials stored in bins. Many standards such as American Concrete Institute (ACI) 313, American Society of Agricultural and Biological Engineers EP 433, German DIN 1055, Canadian Farm Building Code (CFBC), European Code (ENV 1991-4), and Australian Code AS 3774 incorporated Janssen's equations as the standards for static load calculations on bins. One of the main drawbacks of Janssen's equations is the assumption that the bulk density of the stored product remains constant throughout the entire bin. While for all practical purposes, this is true for small bins; in modern commercial-size bins, bulk density of grains substantially increases due to compressive and hoop stresses. Over pressure factors are applied to Janssen loadings to satisfy practical situations such as dynamic loads due to bin filling and emptying, but there are limited theoretical methods available that include the effects of increased bulk density on the loadings of grain transmitted to the storage structures. This article develops a mathematical equation relating the specific weight as a function of location and other variables of materials and storage. It was found that the bulk density of stored granular materials increased with the depth according to a mathematical equation relating the two variables, and applying this bulk-density function, Janssen's equations for vertical and horizontal pressures were modified as presented in this article. The validity of this specific weight function was tested by using the principles of mathematics. As expected, calculations of loads based on the modified equations were consistently higher than the Janssen loadings based on noncompacted bulk densities for all grain depths and types accounting for the effects of increased bulk densities with the bed heights.

Antimicrobial, antileishmanial and cytotoxic compounds from Piper chaba.

The petroleum ether and chloroform extracts of the root of Piper chaba showed antimicrobial, antileishmanial and cytotoxic activities. Further bioactivity-guided fractionation led to the isolation of Bornyl piperate (1), piperlonguminine (2) and piperine (3). This is the first report of isolation of compounds (1) and (2) from P. chaba. It was observed that the isolated compounds (1 and 2) showed potent antifungal activity when compared with standard drug Nystatin, and significant cytotoxic activity with the IC50 values of 0.76 and 0.83 µg mL⁻¹, respectively. These compounds were also found to have weak antibacterial and antileishmanial activities. This is the first report about the antileishmanial activity of Piper isolates.

A new triterpenoid from roots of Laportea crenulata and its antifungal activity.

A new triterpenoid 2alpha,3beta,21beta,23,28-penta hydroxyl 12-oleanene and two known compounds were isolated from the roots of Laportea crenulata Gaud. The structures of all compounds were elucidated on the basis of various spectroscopic data. The two known compounds beta-sitosterol and beta-sitosterol 3-beta-D-glucopyranoside are also the first report of isolation from this plant. The antifungal activity of new triterpenoid was studied against Aspergillus flavus, Aspergillus niger, Candida albicans, and Rhizopus aurizae, and compared with the activity of nystatin (30 microg disc(-1)). This compound has shown moderate activity against tested fungi.