Day 1 :
The Libyan International Medical University, Libya
Keynote: Local wound in ltration versus bilateral super cial cervical plexus block for prevention of postthyroidectomy pain
Time : 10:20-11:05
Mohammed Naji has completed his MBBS from University of Benghazi, Libya and Post-graduate studies from The Arab Board of Medical specility. He has published more than 20 papers in reputed journals.
Background: Regional anesthesia for post-thyroidectomy pain management has recently become as a new trend that provides a good quality of analgesia with more prolonged duration and lesser side effects than IV analgesia.
Aim of the Study: We aimed to assess the bilateral superficial cervical plexus block (BSCB) versus local wound infiltration (LWI) after thyroid surgery with regard to postoperative analgesic efficacy.
Patients & Methods: Sixty adult patients of both sexes scheduled for elective thyroid surgery were randomly categorized into three equal groups. In the first group no regional block was performed (group-C), in the second group (group-L) the wound was infiltrated with 0.5% bupivacaine at the end of surgery, and the third group (group-B) received BSCB immediately after the induction of general anesthesia. Pain intensity was evaluated by the eleven-category numerical rating scale (NRS) and the four-category verbal rating scale (VRS) at the first hour after surgery, and then every 4 hours for the 24 hours postoperatively.
Results: NRS and VRS mean scores were significantly lower in groups (L) and (B) compared with the (C) group. The mean (± SD) of postoperative NRS scores was 3.82 (± 0.65), 2.01 (± 0.61), and 1.36 (± 0.70) in the (C), (L), and (B) groups respectively. The corresponding values measured by VRS were 2.49 (± 0.20), 1.71 (± 0.22), and 1.55 (± 0.23).
Conclusion: Although both techniques are effective for post-thyroidectomy pain management during the first postoperative 24 hours, BSCB provides a better analgesia and effectively decreases postoperative pethidine consumption more than LWI.
Networking & Refreshments Break 11:10-11:30 @ Foyer
Dr Ram Manohar Lohia Institute of Medical Sciences, India
Keynote: Functional analysis of ulnar collateral ligament reconstruction of thumb using free tendon graft by pull out suture technique in neglected skiers thumb
Time : 11:30-12:15
Swagat Mahapatra is currently working as Assistant Professor in Orthopedics at Ram Manohar Lohia Institute of Medical Sciences, India. His research interests are Pediatric Trauma, Trauma & Reconstructive Surgery and Orthopedic Trauma.
Injury to the ulnar collateral ligament (UCL) is referred to as game keeper’s thumb and is a rare injury in paediatric age group. Excessive valgus stress to the base of the thumb may result in disruption of the (UCL) complex with or without an avulsion fracture of the base of the proximal phalanx. We present a 14 years old girl with history of twisting injury to the right thumb two years back. She had a weakness of pincer grip, holding a pen, grasping objects and unscrewing jar lids. On clinical examination, tenderness was present in MCP joint, thumb instability test was positive. There was laxity of <35° on stressing the thumb without a firm end point. Stress radiograph showed opening up of the joint. MRI showed complete tear of ulnar collateral ligament. Patient underwent UCL reconstruction with palmaris longus graft using a pull-out suture technique with a transosseous non absorbable suture tied over a button on the radial side of the MCP Joint. Intra operatively thumb was stable. Thumb spica was applied for six weeks. After six weeks button was removed. At the final follow up of six months, joint was stable and she was able to do her daily activities. A pull-out suture technique UCL reconstruction has a satisfactory fixation, faster healing rate and results in good joint stability. We report this case due to the rarity of ulna collateral ligament injury of thumb in children.
VIMS Hospital, India
Keynote: Point-of-care transcranial sonography for detection of midline shift in Neuro-emergencies in the emergency department
Time : 12:15-13:00
Gayatri L Madhavan is a final year Emergency Medicine Resident at Vinayaka Institute of Medical Sciences, Salem, India. In addition to MEM, she has also completed her fellowship in Intensive Care Medicine, and is currently working on her fellowship in Clinical Cardiology.
Introduction: Midline shift (MLS) in the brain is a life-threatening emergency, which requires immediate intervention following prompt diagnosis. Currently, CT brain is accepted as the gold standard in detection of MLS. Frequent CT is not possible due to various factors like radiation exposure, transport difficulties, unavailability of bedside CT in most hospitals, and challenges in the micro-economics. This has led to a constant endeavour to identify and develop other methods for detection of MLS, among which Transcranial Sonography (TCS) is included.
Objective: The objective of the study is to validate point-of-care TCS for detection of MLS in neuro-emergency patients in the Emergency Department, and compare it to CT values of MLS.
Methodology: This prospective double-blinded study was conducted from March 2018 to October 2018 in the Emergency Department of VIMS Hospital, Salem. All patients who required a CT brain were included, and a TCS was performed. MLS on TCS was calculated by measuring the distance between the outer table of the skull and the third ventricle on both sides, through the temporal window using a 2.8 MHz Sector Probe. TCS was done by a trained Emergency Physician who was unaware of the patient’s clinical status, prior to doing CT brain. CT report was obtained, and another Emergency Physician who was blinded to the patient’s status compared both values. MLS on CT was defined as the difference between the ideal midline and the septum pellucidum.
Observations: A total of 87 patients were included in this study. The MLS (mean±SD) was 0.21cm±0.31cm using TCS, and 0.20cm±0.34cm using CT. The Pearson’s and Spearman’s correlation co-efficient between CT and TCS was 0.971 and 0.87 respectively (p<0.01). The area under the ROC curve for detection of a significant MLS using TLS was 83.7%. Using 0.5cm as a cut-off (significant MLS), the sensitivity, specificity and positive likelihood ratio were 86.7%, 98.6% and 61.92 respectively.
Conclusion: This study concludes that Transcranial Sonography could detect Midline Shift with a reasonable accuracy, and can be used as a point-of-care tool in the Emergency Department to facilitate early diagnosis of MLS and intervene accordingly in neuro-emergencies.
Dr Ram Manohar Lohia Institute of Medical Sciences, India
Keynote: Therapeutic evaluation of tranexamic acid in reducing perioperative blood loss in total hip replacement
Time : 14:00-14:45
Shiv Shanker Tripathi is currently working as Associate Professor in the Department of Emergency Medicine at Ram Manohar Lohia Institute of Medical Sciences, India. His research interests are Critical Care, Trauma and Emergency Medicine.
Objective & Design: This study was conducted to evaluate the efficacy of tranexamic acid in relation to blood loss in total hip arthroplasty surgery. This was a prospective, randomized, double-blind, placebo-controlled study.
Materials & Methods: Fifty patients of ASA 1 and 2 were included in the study. Test group
(T) was administered tranexamic acid 30 min before surgical incision and was repeated three hrs later. Control group (C) was given equal amount of 0.9% normal saline. We measured vitals pre and post administration in test group and compared hemoglobin, hematocrit, blood loss, transfusions needed in test and control group. Side effects after tranexamic acid administration were also noted.
Results: Pre-operative values for hemoglobin and hematocrit were almost equal in both groups. Post operatively the control group showed a marked decrease with extremely significant p value of <0.0001. Intraoperative and post-operative blood loss was found to be significantly less in the test group. Post-operative transfusion requirements were less in test group by approximately 50%. Post-operative nausea, vomiting or complications such as pulmonary embolism or deep venous thrombosis were absent in test group.
Conclusion: Tranexamic acid is a cost-effective and safe means of minimizing blood loss and reductions in hemoglobin concentrations reduces the need for allogenic blood transfusion, without increasing the risk of thromboembolic events.