NBE CME programme for DNB consultants - National Board Of ...

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NBE CME programme for DNB consultantsAnesthesiologyA comparative study of post operative analgesia with epicural Tramadol and epidural byprenorphine in gynecological surgical patient using combined.Introduction-The technique of post operative pain relief was first advocated by Cleland in 1949 andsince then many experiments has been done to explore its possibilities.Pain is a protectivemechanism that occurs when tissue are being damaged. Surgery produces tissue injury withconsequent release of inflammatory mediators that activates peripheral nociceptors, which initiatenociceptive information to the central nervous system to ultimately produce perception of pain.Pain causes reflex, motor & psychic reaction, which include involuntary reflex withdrawal reaction,anxiety, depression, anger and skeletal muscle excitability.The discovery of opiate receptors in thedorsal horn of spinal cord led to the idea that the subarchnoid injection of small amount of opiatescould provide segmental analgesia by direct action on these receptors. So, of the many methodsavailable for post operative pain relief, one is epidural analgesia. Recent revolution in painrelief by newer opioids has improved our control on post operative pain, making them the mostpopular drugs for epidural analgesia. So, the need to compare Tramadol and Buprenorphine.Which are frequently used today.The present study is to evaluate the efficacy and complications of epidural Tramadol andBuprenorphine in relieving the post operative pain in Gynaecological surgeries. Where, the surgeryis major one and involves cutting deeper structures, intense analgesia is required in these casesin post operative period.Aims and objectives-To evaluate and compare efficacy of epidural Tramadol and Buprenorphinein ynaecological surgeries with combined spinal epidural technique.‣ To compare the efficacy of drugs.‣ To compare the vital parameters in terms of pulse rate, blood pressure and respiratoryrate in each group.‣ To compare the on set of analgesia.‣ To compare the duration of analgesia.‣ To compare the complications if any.Materials and method-An open comparative randomized study that included 50 patients of ASAGrade I and II between 30-60 years who underwent Gynaecological surgeries under combinedspinal epidural technique.Ethics committee’s permission has been taken, patient belonged toASA Grade I and II and age of patients between 30-60 years randomly allocated in twogroups.Patients were divided into two groups of twenty five each.Group A – Tramadol 2 mg/kg.Group B – Buprenorphine 3 µ /kg.The study was to compare Tramadol and Buprenorphine for analgesic efficacy, on set of analgesia,duration of analgesia and side effects of two drugs.Inclusion criteria of patients for study-The patients aged between 30-60 years belonging to ASAI and II under going elective gynaecological surgeries under combined spinal epidural technique.Exclusion criteria-Patients with severe or controlled systemic disease, metabolic disorders,neurological, congenital or cardiovascular diseases are excluded from this study.Parameters Observed‣ Time of on set of analgesia.‣ Vital parameters like-pulse rate, blood pressure, respiratory rate, SPO2‣ Efficacy of analgesia based on visual analogue scale.‣ Side effects of the drugs.166
NBE CME programme for DNB consultantsHandout-4 , guidelines for writing thesis/dissertationResearch shall form an integral part of the education programme of all candidates registered forDiplomat of NB degrees of the Board. The Basic aim of requiring the candidates to write a thesis/dissertation is to familiarize him/her with research methodology. The members of the faculty guidingthe thesis/dissertation work for the candidate shall ensure that the subject matter selected for thethesis/dissertation is feasible, economical and original. The thesis may be normally restricted tothe size to 100 pages. To achieve this, following points may be kept in view:Only contemporary and relevant literature may be reviewed. The relevant techniques may bedescribed in detail and reference may be given. Illustrative material may be restricted.Since most of the difficulties faced by the residents relate to the work in clinical subject or clinicallyoriented laboratory subjects the following steps are suggested:‣ For prospective study, as far as possible, the number of cases should be such thatadequate material, judged from the hospital attendance, will be available and the candidatewill be able to collect the case material within a period of 6-12 months so that he/she is ina position to complete the work within the stipulated time.‣ The objectives of the study should be well defined.‣ As far as possible, only clinical or laboratory data of investigations of patients or suchother material easily accessible in the existing facilities should be used for the study.‣ Technical assistance, wherever necessary, may be provided by the department concerned.The resident of one speciality taking up some problem related to some other specialityshould have some basic knowledge about the subject and he/she should be able toperform the investigations independently, wherever some specialised laboratoryinvestigations are required a co-guide may be co-opted from the concerned investigativedepartment, the quantum of laboratory work to be carried out by the candidate should bedecided by the guide and co-guide by mutual consultation.‣ The Clinical residents may not ordinarily be expected to undertake experimental work orclinical work involving new techniques, not hitherto perfected or the use of chemicals orradio isotopes not readily available. They should however, be free to enlarge the scope oftheir studies or undertake experimental work on their own initiative but all such studiesshould be feasible within the existing facilities.‣ The residents should be able to use freely the surgical pathology/autopsy data if it isrestricted to diagnosis only, if however, detailed historic data are required the resident willhave to study the cases himself with the help of the guide/co-guide. The same will apply incase of clinical data.‣ Statistical methods used for analysis should be described in detail.Rules for Submission of Thesis/ Dissertation by candidates for DNB‣ The protocol of Thesis/ Dissertation should be submitted to the office of the NBE throughhead of the institutions within three (3) months of joining the training in Medical college/university/DNB accredited institution.‣ No correspondence will be made in regard to acceptance of the protocol except only in thecase of rejected protocols for which individual will be informed by office through mail/website.‣ The guide will be a recognized PG teacher in Medical college or university or NBE Accreditedinstitutions. The teacher should have the experience of 5 years in speciality after obtainingthe post graduate degree. The certificate of PG teaching and being Guide recognized byUniversity/NBE must be enclosed alongwith thesis/dissertation. The Guide can guide oneMD/MS candidate and one university diploma candidate desirous of taking the DNB167
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