The Medical journal of Malaysia
-
Randomized Controlled Trial Comparative Study
Comparison of 0.5% ropivacaine and 0.5% levobupivacaine for infraclavicular brachial plexus block.
A prospective randomized double-blind study was conducted which involved, 60 ASA 1-2, aged 18-65 years patients, who had elective or emergency orthopaedic surgeries of the upper limbs. They were randomly divided into two groups: Group I received 30 mls of 0.5% ropivacaine; and Group II received 0.5% levobupivacaine for infraclavicular brachial plexus block based on the coracoid approach. The onset time required for sensory block of all required dermatomes (C5-T1) and the onset time of motor block were documented. ⋯ In conclusion, there were statistically significant differences in the onset-time for sensory and motor block. However, there was no statistically significant difference in terms of effectiveness of analgesia at the 6th hour. Although the clinical advantage of levobupivacine is not substantial, its safety profile becomes a major consideration in the choice of local anaesthetic for brachial plexus block where a large volume is required for an effective result.
-
Scoring systems such as POSSUM and P-POSSUM have been developed to help predict mortality and morbidity in patients. The ratio of observed-to-predicted (O/P ratio) mortality and morbidity has been used as a performance indicator to compare different procedures, clinicians or hospitals. The aim of this study was to assess the predictive value of POSSUM compared with P-POSSUM in patients undergoing laparotomy in Queen Elizabeth Hospital, Sabah. ⋯ P-POSSUM is a better overall predictor of mortality in patients undergoing laparotomy in this hospital compared to POSSUM. POSSUM is fairly accurate in predicting morbidity. However, further refinement is needed to improve its predictive value in specific areas, and so increase its utility in our local setting.
-
Computed tomography (CT) is widely used in assessing clinically stable patients with blunt abdominal trauma. In these patients, liver is one of the commonest organs being injured and CT can accurately identify and assess the extent of the injury. ⋯ Widespread use of CT has notably influenced the management of blunt liver injury from routine surgical to nonsurgical management. We present pictorial illustrations of various liver injuries depicted on CT in patients with blunt trauma.