European Journal of Molecular & Clinical Medicine

his study is aimed to compare the effects between 20ml of 0.5% Ropivacaine and 20ml of 0.5% Levobupivacaine in ultrasound guided supraclavicular brachial plexus block for Upper limb surgeries. Methodology: It was a prospective double blinded randomized controlled study in sixty adult patients undergoing upper limb surgeries admitted in Rajah Muthiah Medical college and hospital from November 2020 to November 2022. Result: Significant earlier onset of sensory blockade (p=0.001) and motor blockade (p=0.001), prolonged duration of sensory and motor blockade (p=0.001) was observed in group of patients receiving 0.5% levobupivacaine compared to 0.5% ropivacaine. Intraoperatively throughout the study heart rate (HR), systolic blood pressure (SBP) and diastolic blood pressure (DBP) were comparable in both the groups and found no statistically significant difference (p>0.05). The heart rate, systolic and diastolic blood pressure for both the groups were also compared postoperatively and observed no significant statistical difference (p>0.05). No adverse effects were observed in both the groups. Conclusion: 0.5% levobupivacaine used in ultrasound guided supraclavicular brachial plexus block for upper limb surgeries provides rapid onset of sensory and motor blockade and prolonged duration of analgesia compared to 0.5% ropivacaine.

Introduction: Effective eliminating the microorganisms from the root canal system is
the utmost objective which determines the intensity of the post-operative pain and
swelling. So, the aim of this study is that to evaluate the efficacy of water-based calcium
hydroxide, iodoform based calcium hydroxide, calcium hydroxide with chitosan as
vehicle and calcium hydroxide points as an intracanal medicament in reducing the postoperative
pain and swelling.
Materials and Methodology: This prospective study included two hundred patients
requiring root canal treatment on maxillary or mandibular anteriors, mandibular first
and second premolars were comprised totally. After clinical examination and
radiographic examination, patients were randomly assigned to five groups. Each group
had sample size (n= 40) depending upon intracanal medicament used as follows: Group
1: Calcium hydroxide paste (Ivoclar) Group 2: Calcium hydroxide paste with iodoform
(Metapex) Group 3: Calcium hydroxide points (Hygienic) Group 4: Calcium hydroxide
paste using chitosan (0.2%) as vehicle and Group 5: Control group containing dry
sterile cotton. The tooth that requires root canal treatment were anesthetised using
1.8ml, 2% lignocaine with 1:100,000 epinephrine.
Results: The present study results show that the application of calcium hydroxide with
propylene glycol based paste (Group 1) in root canal greatly reduces the post operative
pain after 12, 24 and 48 hour post-operative which is better in comparison to other
groups. The post operative pain was recorded least with (Group 3) calcium hydroxide
points and maximum in (Group 5) control group at 6 hour post-operatively. When
observed after 12 hours, the post-operative pain was recorded minimum with Group1
followed by Group 3 and maximum in Group 5 that is the control group.

Background: Fistula in ano is one of the common anorectal disorders which is defined as an abnormal track connecting the anal canal with perineum. The main objective of the treatment in fistula-in-ano is to minimize recurrence while maintaining anal continence. Present study was aimed to compare ligation of intersphincteric fistula tract versus conventional fistulectomy in management of low fistula in ano at a tertiary hospital.
Material and Methods: Present study was single-center, prospective, comparative study, conducted in patients of age >15 years, of either gender with low anal fistula identified by clinical examination and investigations.
Results: 60 patients were divided into two groups as group A underwent ligation of intersphincteric fistula tract (LIFT) procedure (n=30) and group B, underwent open fistulectomy (n=30). In present study among both groups majority patients were male & from 31-60 years age group. Mean duration of surgery was comparable & difference was not significant statistically (26.9 ± 9.4 minutes vs 30.7 ± 11.6 minutes). Duration of wound healing was less in LIFT group as compared to fistulectomy group & difference was statistically significant (12.6 ± 5.7 days vs 18.5 ± 8.7 days) (p value< 0.001). Post-operative pain scores were comparable among two groups on post-operative day 0 & 1. Less post-operative pain scores were noted among in LIFT group as compared to fistulectomy group on post-operative day 3 & 7, difference was statistically significant (p value < 0.05). Less complications were noted in LIFT group as compared to fistulectomy group; difference was not significant statistically.
Conclusion: Ligation of intersphincteric fistula tract (LIFT) procedure for the management low anal fistula is simple, safe and effective in management of low anal fistulas, produces less post-operative pain, faster wound healing and better fecal continence preservation compared to open fistulectomy.

Haemorrhoids are one of the most frequently encountered anorectal conditions in the clinical practice of a surgeon. Haemorrhoidectomy is the most effective approach for haemorrhoidal disease especially for grade III and grade IV disease and also in grade II disease which do not respond to conservative and non-invasive treatment. However, postoperative pain is a major concern, and the surgery itself is with complications including notably bleeding, wound sepsis, pain, and anal stenosis. The patients were explained about their disease and modalities of treatment as Open or closed haemorrhoidectomy with advantages and disadvantages of each. 25 patients were operated by open haemorrhoidectomy and another 25 patients by closed haemorrhoidectomy under spinal anaesthesia. Data was collected according to proforma which included detailed history, clinical examination and investigation. Data was tabulated, analyzed and results interpreted. The mean immediate post-operative pain score in open group was 2.88 ± 0.53 VAS and in closed group was 2.44 ± 1.9 VAS; these differences were significant with p value of 0.027. The mean duration hospital stay in open group was 4.64± 0.9 days and in closed group was 4.28 ± 0.9 days (p value= 0.18) the differences were not significant. People who underwent open procedure took 17.5 days and closed group patient took 16. 4 days to resume their normal activity, these differences were not significant (p Value = 0.42).

Introduction: The most common concern associated with TKR is post-operative pain for
both the patient and the surgeon. It is associated with multiple adverse physical and
psychological consequences, which hinder postoperative mobilisation, increase the incidence
of post-operative complications and the overall outcome.A number of modalities have been
recommended of which regional techniques are preferred. Current study aims to compare
post-operative management of pain in patients undergoing Total Knee arthroplasty (TKA)
with epidural analgesia versus femoral nerve block.
Material and methods: Study was done in 100 patients posted for unilateral TKA. After
obtaining written consent and ethical committee clearance patients were randomized in to two
groups. Group “CEA”-8 mL 0.2% ropivacaine was given epidurally and Group “CFB”-bolus
of 20 mL of 0.2% ropivacaine was given through femoral catheter.
Outcomes assessed were
1) Acute postoperative pain (during rest and movement).
2) Postoperative rescue analgesic consumption/rescue analgesia.
3) Quality of early postoperative rehabilitation (functional assessments).
4) Postoperative complications if any.
Results: There was no significant difference in Vas score during rest and activity in both the
groups at 6 hrs,12, 24, 48 and 72 hours. There was no significant difference in both the
groups with respect to rehabilitation indices and adverse events. Only 43.4% of patients
belonging to group CFB, received rescue analgesia which was less when compared to patients
in group CEA(57.6%) which was significant.
Conclusion: CFA have the advantage over CEA in terms of decreased need for rescue.
analgesia with no neuraxial side effects.

Aim and Objectives:To assess and compare the analgesic effects of adjuvants like
intravenous Ketorolac and Tramadol in laparoscopic surgeries on post-operative pain and
their side effects.
Methodology: In this quasi experimental study,after approval from ethical committee and
written informed consent taken from 90 patients of ASA physical status I,II of either sex
scheduled to undergo elective laparoscopic surgeries under general anaesthesia were
enrolled.Patients were randomly divided into one of the two groups of 45 patients each,
patient received either Ketorolac (Group K) or Tramadol (Group T) 30 minutes before
extubation. The degree of post-operative pain was assessed using VAS at 0, 2, 4 hours post
operatively upto 24 hours and the need of rescue analgesic and the side effects of both drugs.
Results: The pain score at 0 hours were more than 4 in both the groups.
Statisticalanalysisshowedasignificantdifferencebetweenthe2groups in the second and fourth
hour.Thereafter, the difference in pain scores in both Ketorolac group and Tramadol group
were not significant.
Conclusion: We conclude that both Ketorolac and Tramadol offer equal post-operative
analgesia while Ketorolac had lesser side effects when compared to Tramadol.

Hemorrhoids are one of the most common anorectal diseases. Hemorrhoidectomy still stands as the most effective treatment for high grade hemorrhoids and postoperative acute pain as an expected result of hemorrhoidectomy has been experienced by thousands of patients all over the world and hence its only obstacle. Pain control using various invasive and noninvasive methods after hemorrhoidectomy has been constantly under debate and investigation. During the study period, 100 consecutive patients undergoing open hemorrhoidectomy under spinal anesthesia are allotted alternatively to each group. So 50 patients in each group of topical 2% diltiazem and diclofenac suppository. The diltiazem group yielded the lowest visual analog scale (VAS) score on post-operative day zero after surgery (p<0.05). The diclofenac group reported the lowest VAS score on following post-operative day one, two after surgery (p<0.05). There were no complications after treatment with either of these drugs. Topical use of diltiazem gel is appropriate for short-term pain control following hemorrhoidectomy, while diclofenac yields a more sustainable pain control.