Assessment of cyclone risk and case study of Gaja cyclone using GIS techniques and machine learning algorithms in coastal zone of Tamil Nadu, India

Cyclones can cause devastating impacts, including strong winds, heavy rainfall, storm surges, and flooding. The aftermath includes infrastructure damage, loss of life, displacement of communities, and ecological disruptions. Timely response and recovery efforts are crucial to minimize the socio-economic and environmental consequences of cyclones. To accelerate the time-consuming risk assessment process, particularly in geographically diverse regions, a blend of multi-criteria decision-making and machine learning models was utilized. This novel approach swiftly assessed cyclone risk and the impact of the Gaja cyclone in Nagapattinam, India. The method involved assigning weights to distinct criteria, unveiling notable vulnerability aspects like elevation, slope, proximity to the coast, distance from cyclone tracts, Lu/Lc, population density, proximity to cyclone shelters, household density, accessibility to healthcare facilities, NDVI, and levels of awareness. Daddavari, Ettugudi, Kodikarai, Vedharanyam, Velankanni, and Thirupoondi face high/extreme cyclone risk. Nagore, Nagapattinam, Pillai, Enangudi, and Sannanllur have low/no threat. To further enhance the precision of the study, machine learning algorithms like SVM, SAM, and MLC were deployed. These models were instrumental in generating pre- and post-cyclone land use maps. The influence of Gaja cyclones effects shows decreasing of agriculture land from 34% to 30%, aquaculture increase 1%, barren land decrease from 8% to 6%, Built-up land decrease from 15% to 13%, land with scrub and salt pan also decrease from 21% to 17% and 10%-8%. Mostly effect of Gaja cyclone is dramatic increase of water body from 8% to 21%. Conducting cyclone risk zone analysis and pre/post-cyclone Land Use Land Cover (LULC) detection in Nagapattinam offers valuable insights for disaster preparedness, infrastructure planning, and climate resilience. This study can enhance understanding of vulnerability and aid in formulating strategies to mitigate cyclone impacts, ensuring sustainable development in the region.

Comparative evaluation of pre-emptive analgesic efficacy of Posterior Transversus Abdominis Plane block with Fascia Transversalis Plane Block in adult patients undergoing unilateral inguinal hernia repair: A prospective, randomized, single-blind, two-arm parallel study

Introduction

Abdominal wall blocks, in conjunction with multimodal analgesia, have demonstrated efficacy in providing post-operative analgesia, reducing opioid requirements in patients undergoing inguinal hernia repair. The inguinal region is primarily innervated by the ilioinguinal nerve (IIN) and iliohypogastric nerve (IIH). Posterior transverse abdominis plane block (pTAP) and fascia transversalis plane block (TFP) have been observed to reliably block IIN and IIH. We hypothesized that posterior TAP block (pTAP) owing to its potential paravertebral spread will provide better post-operative analgesia than TFP block in patients undergoing unilateral open inguinal hernia repair.

Methods

This prospective, randomized, single-blind, two-arm parallel study was conducted over a duration of one year for which sixty patients undergoing unilateral open inguinal hernia repair under spinal anesthesia were enrolled. They were equally and randomly assigned to receive either preoperative pTAP block or TFP block. The primary aim of the study was to compare median static and dynamic NRS scores during a 24-hour period, with the secondary aim to compare the number of patients who required rescue analgesics in each group.

Results

All enrolled patients completed the study. Results showed no statistically significant difference in median static NRS scores between Group pTAP and Group TFP at the designated time of observation during the 24-hour period [1.2 (0.4-1.60 vs. 1 (0.6-1)]. Group pTAP reported a higher median dynamic NRS scores during the 24-hour period [2.6 (1.2-3) v/s 2 (1.6-2.4); P < 0.035], although this difference was clinically insignificant. The mean time to request for the first rescue analgesia was comparable (11.7 h v/s 12 h; P = 0.99). In all the patients of both groups, loss of pinprick and cold touch sensation was observed at T10, T12, and L1 dermatomal levels. However, sensory assessment at T6 and T8 levels showed variability between the two groups (P > 0.05).

Conclusion

In conjunction with background analgesia and the use of dexamethasone as an adjuvant, both blocks (pTAP and TFP) were observed to be equally effective for post-operative pain relief with similar patient satisfaction scores.

Evaluation of the GCS-Pupils Score for PrOgnosis in trauMatic brAin injury- The COMA Study

OBJECTIVES

Glasgow Coma Scale-Pupils (GCS-P) score has been found to be strongly related to in-hospital mortality in retrospective studies. We hypothesized that GCS-P would be better prognosticator than Glasgow Coma Scale (GCS) in patients with traumatic brain injury (TBI).

METHODS

In this prospective, multicentric, observational study, GCS and GCS-P scores were noted in adult TBI patients at ICU admission. Demographic variables, relevant clinical history, clinical/radiological findings and ICU complications were also noted. Extended Glasgow Outcome scale was noted at hospital discharge and at 6 months post-injury. Logistic regression analysis was carried out to estimate the odds for poor outcome adjusted for covariates. Sensitivity, specificity, area under curve (AUC) and odds ratio are reported for poor outcome at estimated cutoff point.

RESULTS

A total of 573 patients were included in this study. The predictive power for mortality, shown by the AUC, was 0.81 [95% CI: 0.77-0.85] for GCS and 0.81 [95% CI: 0.77-0.86] for GCS-P score, both being comparable. Similarly, the predictive ability for outcome at discharge and 6 months, the AUC-ROC for both GCS and GCS-P were comparable.

CONCLUSIONS

GCS-P is a good predictor of mortality and poor outcome. However, the predictive performance of GCS and GCS-P for in-hospital mortality and functional outcome at discharge and at 6 months remains comparable.

Peri-operative management of diabetes mellitus - A survey of current practices among Indian anesthesiologists

Background and Aims

Increased burden of diabetes in India has resulted in a spurt in the number of patients with diabetes posted for surgeries. The paucity of national guidelines can lead to marked practice variations in the peri-operative management of diabetes. This survey intends to discern current peri-operative practices among anesthesiologists working in medical colleges, tertiary care government, and private health care institutes of the country.

Material and Methods

An anonymous online survey comprising of 25 closed-ended questions was conducted using Google Forms® and disseminated through social media, emails, and messaging platforms. The questionnaire dealt primarily with the peri-operative management of diabetes in patients scheduled for elective surgery. The survey was conducted over a period of 1 month and targeted anesthesia resident trainees with more than 1-year experience, senior residents, and consultants working in India.

Results

Statistically significant difference was observed between the three types of health facilities with respect to prior evaluation for diabetes (P = 0.007), prioritizing operative list (P = 0.006), hospital encouragement of day care surgery (P < 0.001), glycated hemoglobin level (HbA1c) level >8.5 for postponement of surgery (P < 0.05), insulin infusion preference (P < 0.001), hourly intra-operatively capillary blood glucose (CBG) assessment (P = 0.021), and avoiding peri-operative use of Ringer's lactate (RL) (P = 0.025).

Conclusion

This survey primarily highlights the lack of prioritizing the operative list, early discontinuation of metformin, and reduced tendency to consider diabetics for day care surgeries.

A study on development of silicone rubber with conductive carbon, polyaniline, MWCNT composite for EMI shielding

The multiwall carbon nanotubes (MWCNTs) were grown by CVD method and using Ni impregnated zeolite as a substrate. The prepared MWCNT diameter varied from 10 to 60 nm and length in few microns. The silicone rubber (SR) was mixed well with conductive carbon, Polyaniline (PANI) and MWCNTs in two roll mill. The prepared silicone rubber materials were fabricated in the form of sheets with dimensions of 200 mm × 200 mm × 2 mm by using compression molding technique. The prepared sheets were subjected for EMI shielding efficiency measurements at low frequency (< 1.5 GHz) and high frequency range from 1 GHz to 18 GHz. At high frequency the shielding effectiveness of the Conducting Silicone Rubber and Conductive silicone rubber with MWCNT was found to be 24 dB and 48 dB. The volume resistivity measurements were also carried for all the prepared silicone rubber sheets, the results reveals that SR + MWCNT, CSR + MWCNT composites shows volume resistivity 4032 and 20.7 Ω.cm respectively. This confirms the conductivity of CSR + MWCNT is enough to exhibit good Shielding Effectiveness.

Colistimethate sodium-chitosan hydrogel for treating Gram-negative bacterial wound infections

The drug resistance is higher among Gram-negative bacteria and demands the usage of strong antibiotics which can in turn result in systemic toxicity. In the treatment of the chronic wounds harboring pathogenic Gram-negative bacteria, the demand for an antimicrobial product that can be topically administered has been on the rise. In an effort to address the above issue, we have developed Colistimethate sodium (a high-end antibiotic) loaded chitosan hydrogel and characterized. The prepared hydrogel is very stable and observed to be bio- and hemo-compatible in nature. The antibacterial activity of the prepared hydrogel was studied against both ATCC (American Type Culture Collection) strains and clinical isolates of Escherichia coli, Pseudomonas aeruginosa and Klebsiella pneumoniae. The CMS incorporated hydrogel is also capable of inhibiting the biofilm formation. The developed hydrogel can be potentially being used for the treatment of Gram-negative bacterial infected wounds.

Comparison of Airway Ultrasound Indices and Clinical Assessment for the Prediction of Difficult Laryngoscopy in Elective Surgical Patients: A Prospective Observational Study

Background:

Ultrasound is evolving as a probable tool in airway assessment. The upper airway is a superficial structure and has sonographically identifiable structures which makes it ideal for evaluation with the ultrasound.

Aims:

The aim of this study was to evaluate the role of skin to hyoid and skin to thyrohyoid membrane distance in prediction of difficult laryngoscopy.

Settings and Design:

This is a prospective observational study included 150 patients aged 18–60 years of American Society of Anesthesiologists Physical Status I and II scheduled to undergo surgery under general anesthesia requiring laryngoscopy and endotracheal intubation.

Materials and Methods:

The modified Mallampati score, mouth opening, mentohyoid distance, thyromental distance were noted. Skin to hyoid bone distance and skin to thyrohyoid membrane distance were measured by ultrasound. Patients were clubbed retrospectively into easy and difficult laryngoscopy groups on the basis of Cormack Lehane grading, and the characteristics of both groups were compared.

Statistical Analysis:

Statistical Package for the Social Sciences, Version 23 was used for statistical analysis. Independent samples t-test was used to compare the means between difficult and easy laryngoscopy patients. Diagnostic accuracy of the significant (P < 0.05) variables between difficult and easy laryngoscopy patients was calculated using receiver operating characteristics curve in terms of their area under curve. Appropriate cutoff values (with corresponding sensitivity, specificity, and overall accuracy) were also identified.

Results:

Out of 150 patients, 13 (8.7%) were identified as difficult laryngoscopy whereas 137 patients (91.3%) were identified as easy laryngoscopy. The demographics of both groups were comparable. Mentohyoid distance, skin to hyoid bone distance, and skin to thyrohyoid distance were statistically different between easy and difficult laryngoscopy patients, with lower mentohyoid distance and higher skin to hyoid bone distance and skin to thyrohyoid distance in difficult laryngoscopy patients. Diagnostic accuracy of the mentohyoid distance (70.3%) was slightly superior to skin to hyoid bone distance (67.1%) and skin to thyrohyoid distance (68.1%).

Conclusion:

Ultrasound measurements of skin to hyoid bone and skin to thyrohyoid membrane distance fail to eclipse clinical parameters in accurately predicting a difficult laryngoscopy.

Ultrasound-Guided Suprainguinal Fascia Iliaca Compartment Block for Postoperative Analgesia in Patients Undergoing Hip and Femur Surgeries: A Retrospective Analysis

Context:

Fractures of femur and hip surgeries pose a challenge because of excruciating pain. Fascia iliaca compartment block is an effective and easily learned procedure to decrease postoperative pain score and dosage of opioid. Many adjuvants are combined with local anesthetics to prolong the postoperative analgesia.

Aims:

The aim was to study duration of postoperative analgesia in terms of Numeric Rating Scale (NRS), number of times rescue analgesic used, any adverse effect, and patient satisfaction score.

Settings and Design:

Operation theatre of Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow.

Materials and Methods:

The present study was retrospective study with 203 patients evaluated. Based on the combination of the anesthesia and drugs, study patients were divided into six groups. Pain scores were assessed at 6 hourly intervals for 24 h.

Statistical Analysis Used:

Kruskal–Wallis H-test used to compare NRS as well as age and duration of anesthesia. Chi-square test/Fisher's exact test used to compare the proportions.

Results:

Postoperative analgesia was comparable and insignificant (P > 0.05) at 0, 6, 12 h in all six groups. Better postoperative analgesia was observed with dexmedetomidine and dexamethasone as adjuvant at 18 h, dexmedetomidine as adjuvant in comparison to dexamethasone as adjuvant at 24 h. Rescue analgesia in postoperative period was required maximum in plain bupivacaine. Satisfaction levels were good and excellent in dexmedetomidine and dexamethasone as adjuvant.

Conclusions:

Addition of dexmedetomidine to bupivacaine provides longer duration, good quality postoperative analgesia, reduced requirement for rescue analgesic, lesser postoperative nausea and vomiting, and better satisfaction levels.

A fuzzy based high-resolution multi-view deep CNN for breast cancer diagnosis through SVM classifier on visual analysis

Breast cancer should be diagnosed as early as possible. A new approach of the diagnosis using deep learning for breast cancer and the particular process using segmentation strategies presented in this article. Medical imagery is an essential tool used for both diagnosis and treatment in many fields of medical applications. But, it takes specially trained medical specialists to read medical images and make diagnoses or treatment decisions. New practices of interpreting medical images are labour exhaustive, time-wasting, expensive, and prone to error. Using a computer-aided program which can render diagnosis and treatment decisions automatically would be more beneficial. A new computer-based detection method for the classification between compassionate and malignant mass tumours in mammography images of the breast proposed. (a) We planned to determine how to use the challenging definition, which produces severe examples that boost the segmentation of mammograms. (b) Employing well designing multi-instance learning through deep learning, we validated employing inadequately labelled data of breast cancer diagnosis using a mammogram. (c) The study is going through the Deep Lung method incorporating deep multi-dimensional automated identification and classification of the lung nodule. (d) By combining a probabilistic graphic model in deep learning, it authorizes how weakly labelled data can be used to improve the existing breast cancer identification method. This automated system involves manually defining the Region Of Interest (ROI), with the region and threshold values based on the next region. The High-Resolution Multi-View Deep Convolutional Neural Network (HRMP-DCNN) mainly developed for the extraction of function. The findings collected through the subsequent in available public databases like mammography screening information database and DDSM Curated Breast Imaging Subset. Ultimately, we’ll show the VGG that’s thousands of times quicker, and it is more reliable than earlier programmed anatomy segmentation.

Images super-resolution by optimal deep AlexNet architecture for medical application: A novel DOCALN1

In the last decade, numerous researches have been focused on Image Super-Resolution (SR); this recreation or improvement model is vital in different research areas. Recently, deep learning algorithm finds useful to advance in the resolution of the medical output. Here, we devise a novel Deep Convolutional Network model along with the optimal learning rate of the Rectified Linear Unit (ReLU) intended for Medical Image Super-Resolution (MISR). For getting the optimal values of Deep Learning AlexNet structure, Modified Crow Search (MCS) is utilized, which is mainly depends on the behavior of crow sets. The chosen Alexnet lacks in a sort of suitable supervision for upgrading execution of the proposed model that effectively aims to overfit. The proposed design, i.e., MISR, named Deep Optimal Convolutional AlexNet (DOCALN), derives the optimal values of learning rates of the ReLU activation function. Based on this optimal deep learning structure, the Low Resolution (LR) medical images can be applied. Experimentation results of our proposed model are compared with variants of Convolution Neural Networks (CNN) concerning different measures such as image quality assessment, SR efficiency analysis, and execution time.

Aspect-based summarisation using distributed clustering and single-objective optimisation

In the user reviews of various domains, there is an increase in the accumulation of reviews in the web that presents a lot of difficulties to the readers. So it becomes necessary to generate a summary which represents the entire review in a concise manner. It is required for each feature or aspect in the reviews for the ease of users. The aspect-based summarisation plays a vital role in the field of opinion mining. This article proposes an aspect summarisation framework using sentence scoring clustering and weight-based single-objective optimisation technique by utilising evolutionary algorithm. The system uses MapReduce framework to incorporate the proposed combiner–based optimised clustering approach. Then a novel single-objective optimisation with genetic algorithm is developed. Its purpose is to retrieve top sentences from each cluster to generate feature-based summary. The accuracy of the system-generated summary is evaluated using the Recall Oriented Understanding for Gisting Evaluation tool kit using human standard reference summaries. The system is able to achieve more promising results when compared with other standard feature–based summarisation systems.

Comparative Evaluation of Three Different Doses of Spinal Isobaric Ropivacaine in Patients Undergoing Day Care Perineal Surgeries: A Randomized Double-blind Study

Background and objective:

Ropivacaine owing to its propensity of causing motor blockade of reduced duration, is preferred for ambulatory day care surgery. Intrathecal ropivacaine has shown effective analgesia for lower limb surgery. Our study plans to evaluate spinal ropivacaine in three different doses in patients undergoing day care perineal surgery.

Methodolgy:

90 ASA-I patients scheduled to undergo day care perineal surgery were randomized to receive intrathecal ropivacaine. Group I (n=30) received 15mg of intrathecal ropivacaine, Group II (n=30) received 18.75 mg of intrathecal ropivacaine and Group III (n=30) received 22.5 mg of intrathecal ropivacaine. Onset of sensory block at T 10, peak sensory block level, duration of sensory block, onset and duration of motor block and relevant safety data were recorded.

Result:

Onset of analgesia was significantly shorter in Group III (3.5 min ; P <0.0001). However, time taken for peak sensory blockade was comparable in group II and III (12.76 and 11.93 mins). Duration of analgesia was longer and statistically significant in Group III (201.6 mins: P <0.0001) when compared to Group I and II. Onset of motor block was observed to be shortest in Group III (6.7 mins) and duration of motor block was longest in Group III (153.73 mins). These two parameters were statistically significant than Group I and II (P <0.0001).

Conclusion:

Intrathecal ropivacaine in a dose of 18.75 and 22.5 mg were observed to be equally effective in providing satisfactory analgesia. However, higher dose was associated with profound sensory and motor block.

Contrasting effects of pre-training on acquisition of operant and radial arm maze tasks in rats

Performing multiple tasks either simultaneously, in rapid alternation or in succession, is routine in daily life. Further, testing rodents in a battery of tests is common both in drug discovery and behavioral phenotyping research. However, learning of new tasks can be influenced by prior experience(s). There has been some research on 'switching cost' involved in the transition from one behavior to another. However, there has been no specific assessment of the effect of learning an operant paradigm on performance in a spatial memory task and vice versa. Accordingly, we evaluated task switching between two forms of learning paradigms, operant conditioning and radial arm maze (RAM) tasks. In experiment 1, rats were trained for operant conditioning with food reward followed by a partially baited RAM task. In experiment 2, rats were trained first on a RAM task followed by operant learning. Pre-training on the operant task, impaired the acquisition of the RAM. On the contrary, pre-training on the RAM enhanced operant performance. Our study reveals significant effects of the test order on task-switching in rats. This knowledge can be useful when framing test sequences in test batteries for drug discovery research and screening genetically modified mice.

Ultrasound guided internal jugular vein cannulation in infants: Comparative evaluation of novel modified short axis out of plane approach with conventional short axis out of plane approach

Background and Aims:

Central venous cannulation (CVC) through right internal jugular vein (IJV) route is routinely performed in paediatric patients undergoing major surgery and in those admitted to intensive care units. A novel technique (modified short-axis out-of-plane [MSA-OOP]) to improve first pass success rate of ultrasound-guided IJV CVC in neonates and infants is being compared with conventional SA-OOP method.

Methods:

A total of 120 patients were enroled in the study over a period of 6 months. All paediatric patients with age <1 year and weight <10 kg who underwent a major surgery requiring CVC were included. Patients were randomised to either of the two approaches of ultrasound-guided IJV cannulation; SA-OOP and modified SA-OOP (MSA-OOP). In modified approach, the midline of probe footprint was marked with a radio-opaque barium wire that casted a central acoustic shadow on ultrasound screen.

Results:

In MSA-OOP group, 83.1% of patients were cannulated in the first attempt as compared to 49.2% patients in group SA-OOP. Patients in MSA-OOP group required significantly fewer attempts for successful CVC as compared to patients in the SA-OOP group ( MSA-OOP: median = 1, interquartile range [1-1]; SAOOP: median = 2, interquartile range [1-2], P < 0.001, Mann–Whitney U-test).

Conclusion:

The use of MSA-OOP ultrasound technique for IJV CVC cannulation results in a higher first-attempt success rate and reduces the number of cannulation attempts.

Comparative Evaluation of Sevoflurane, Propofol, and Combination of Sevoflurane and Propofol on Insertion Characteristics of Reusable Classic Laryngeal Mask Airway

Background and Aim:

Adequate depth of anaesthesia is needed for successful placement LMA. under lighter plane of anaesthesia inadequate mouth opening,coughing,body movements can lead to rejection of LMA and may be associated with breath holding and bronchospasm. Use of propofol in doses which allow adequqate jaw relaxation and prevent patient reaction to LMA commonly results in hypotension and prolonged apnoea. Apart from minimal respiratory irritant properties sevoflurane as compared to propofol has the advantage of providing better hemodynamic stability and a smoother transition to the maintainance phase without a period of apnea. However sevoflurane is associated with delayed jaw relaxation and a longer time for the insertion of the LMA.Our hypothesis is that induction of anaesthesia with the combination of sevoflurane and small dose of propofol may optimize the insertion conditions of LMA and decrease the side effects of individual drugs.

Methods:

90 patients aged 18-65 yrs ASA physical status I and II undergoing elective procedures were randomly allocated into 3 groups of 30 patients each. No patient had been given any premedication. Patients in group P were induced with iv inj propofol 3 mg/kg. Patients in group S an SP were induced with tidal volume breathing induction technique using sevoflurane 8% along withN20: 02: 67:33 @ 6L/MIN In addition, in group SP after loss of eye lash reflex patients were given IV propofol 1.5 mg/kg. An independent observer assessed insertion characteristics.

Results:

our results showed that induction of anesthesia using the combination of sevoflurane and propofol resulted in the most frequent successful LMA insertion at first attempt as compared with induction of anesthesia with either sevoflurane or propofol alone.

Paediatric VIPoma: A Jamboree of Electrolytes

Vasoactive intestinal peptide secreting tumour (VIPoma) is a rare type of neuroendocrine tumour (NET), primarily located in the tail of pancreas. This type of tumour presents with myriad of metabolic and electrolyte misbalances in the preoperative period, mainly due to increased vasoactive intestinal peptide (VIP) levels. Perioperative management of patients with VIPoma is challenging, especially when dealing with paediatric patients. The anaesthetic management of a two-year-old girl who was selected for VIPoma resection is hereby presented.

Secondary metabolites of Cynodon dactylon as an antagonist to angiotensin II type1 receptor: Novel in silico drug targeting approach for diabetic retinopathy

OBJECTIVES

To study the ability of the secondary metabolites of Cynodon dactylon to serve as an antagonist to angiotensin II type 1 receptor (AT(1)); activation of this receptor plays a vital role in diabetic retinopathy (DR).

MATERIALS AND METHODS

In silico methods are mainly harnessed to reduce time, cost and risk associated with drug discovery. Twenty-four compounds were identified as the secondary metabolites of hydroalcoholic extract of C. dactylon using the GCMS technique. These were considered as the ligands or inhibitors that would serve as an antagonist to the AT(1). The ACD/Chemsketch tool was used to generate 3D structures of the ligands. A molecular file format converter tool was used to convert the generated data to the PDB format (Protein Data Bank) and was used for docking studies. The AT(1) structure was retrieved from the Swissprot data base and PDB and visualized using the Rasmol tool. Domain analysis was carried from the Pfam data base; following this, the active site of the target protein was identified using a Q-site finder tool. The ability of the ligands to bind with the active site of AT(1) was studied using the Autodocking tool. The docking results were analyzed using the WebLab viewer tool.

RESULTS

Sixteen ligands showed effective binding with the target protein; diazoprogesteron, didodecyl phthalate, and 9,12-octadecadienoyl chloride (z,z) may be considered as compounds that could be used to bind with the active site sequence of AT(1).

CONCLUSIONS

The present study shows that the metabolites of C. dactylon could serve as a natural antagonist to AT(1) that could be used to treat diabetic retinopathy.

Efficacy of intravenous ketoprofen for pre-emptive analgesia

AIM

To determine whether intravenous ketoprofen is effective as pre-emptive analgesia for breast surgery.

DESIGN

Randomised, controlled, double blind study.

PATIENTS AND METHODS

50 patients undergoing breast surgery under general anaesthesia randomised to receive either 100 mg intravenous ketoprofen 30 minutes before (Group I), or immediately after surgical incision (Group II). Postoperatively, pain scores (Visual Analogue Scale, VAS) and time to rescue analgesic were recorded by an independent, blinded observer. The study was terminated when rescue analgesic was required (VAS > or =4 or demand for analgesic).

STATISTICAL ANALYSIS

Continuous variables were analysed by the unpaired 't' test, discrete variables with the chi square test, and survival curves by the log-rank test.

RESULTS

Pain scores were significantly lower in Group I till 10 hours after surgery. The number of patients requiring analgesia at 4, 6, 8 and 10 hours was significantly lower in group I (0% vs. 47% [P <0.0001], 0% vs. 44% [P <0.003], 0% vs. 80% [P <0.0001], 0% vs. 100% [P <0.0001] respectively). The mean time for rescue analgesic was 15.47 -/+ 2.87 hours in group I versus 4.22 -/+ 2.55 hours in group II (P <0.0001).

CONCLUSION

Pre-emptive analgesia with Intravenous ketoprofen (100mg) produces better postoperative pain-relief in patients undergoing breast surgery.