Search

Introduction: The sensory innervation below the knee is provided by the saphenous nerve and sciatic nerve. Drugs deposited in the Adductor Canal (AC) at the Adductor Hiatus (AH) level spread both proximally up to the mid-canal and distally to the popliteal fossa through the perivascular space. The Adductor Canal Block (ACB) is a newer technique by which both nerves can be blocked in a single procedure. Aim: To evaluate the efficacy of ACB for postoperative pain management in below knee surgeries. Materials and Methods: This randomised controlled study was conducted in a tertiary care hospital. A total of 81 patients with American Society of Anaesthesiologists (ASA) I and II physical status were randomly allocated to either group A (ACB) or group B (Control), scheduled for below knee orthopaedic surgery. Group A patients received a mixture of 40 mL of 0.125% bupivacaine and 8 mg dexamethasone in the AC at the hiatus level under ultrasound guidance. Group B patients received standard care for pain management. The duration of sensory and motor block, mean Visual Analogue Scale (VAS) scores, amount of opioid drug requirement, drug-related side-effects, and satisfaction scores were compared between the two groups. Data were presented as mean±Standard Deviation (SD) for continuous variables and frequency (%) for categorical data and were analysed using t-tests and Chi-square tests. Results: The mean age in group A was 42.9±13.5 years and in group B was 46.3±13.1 years. In group A, there were 30 males and 11 females, while in group B, there were 32 males and 8 females. The mean Body Mass Index (BMI) between group A and B was 27.4±3.2 kg/m2 and 26.3±3.1 kg/m2, respectively. The mean duration of sensory block was longer in group A (12.3±4.6 hours) compared to group B (4.7±0.7 hours). The mean VAS scores (1.351±0.659 vs 3.240±0.590) were significantly lower in group A. The total opioid requirement was 42.9±73.6 mg vs 205.9±26.0 mg between the two groups, which was significantly lower in group A. Conclusion: In distal ACB, a single procedure with 40 mL of 0.125% bupivacaine significantly reduces postoperative VAS scores and analgesic requirements while increasing patient satisfaction levels. Therefore, this block is safe and recommended for postoperative pain management in below knee surgeries. [ABSTRACT FROM AUTHOR]

Objectives: Diabetes is more prevalent in middle- and higher-income groups and is spreading at an alarming rate. Drug therapy is compulsory because of the chronic and progressive nature of the disease. With such multifactorial background of high prevalence, progressive nature of the disease leading to various complications, increased healthcare cost, and availability of multiple therapeutic regimens prescribed, this study has been done to evaluate the cost-effective analysis of oral hypoglycemic agents. Materials and Methods: This is a prospective, parallel group, and comparative observational study conducted by the Department of Pharmacology in collaboration with the Department of Endocrinology at Kalinga Institute of Medical Sciences, Bhubaneswar. The duration of the study was of 2 years. A total number of 220 patients were selected and based on body mass index, patients were categorized into preobese (new and old diabetic patients) and obese (new and old diabetic patients) categories. In this study, cost-effectiveness analysis (CEA) was done to evaluate the cost differences between two or more medication groups, with a similar clinical effect. Results of CEA are expressed as an average cost-effectiveness ratio or as an incremental cost-effectiveness ratio. Results: From this study, it is observed that in terms of benefit, dual therapy of Metformin and Dapagliflozin was most efficacious followed by Metformin and Sitagliptin as well as Metformin and Glimepiride combinations. If cost is considered, Metformin montherapy and metformin and Glimepiride dual therapy was most cost-effective. In triple regimen, MET+VOG+GLIM combination was seen to be more cost effective than gliptin combination, both in terms of control of FBS as well as PPBS. The cost of treatment goes parallel with duration of disease, being higher in the old cases of long-standing duration. Conclusion: The present study shows that SGLT2 inhibitors are better class of oral hypoglycemics in terms of longterm benefits and this group is prescribed as dual therapy more frequently but cost of therapy is the greatest barrier. Metformin and Sulfonylureas remain the most beneficial combination, both in terms of efficacy and cost. The cost of treatment was varying, depending on the duration of disease, being higher in old cases and lower in new cases. [ABSTRACT FROM AUTHOR]