SRMS JOURNAL OF MEDICAL SCIENCE

The Effect of Intrathecal Fentanyl on Postdural Puncture Headache in Parturients Undergoing Cesarean Section: Prospective Double-Blinded Study

Purva Gupta — 2025-10-28

Introduction: Post-dural puncture headache (PDPH) is one of
the most common side effects of spinal anesthesia, particularly
in parturients undergoing cesarean section. Intrathecal fentanyl,
often administered as an adjunct to local anaesthetic, has been
proposed as a potential mitigating agent for PDPH. However,
the evidence regarding its efficacy remains inconclusive. The
purpose of this study is to evaluate the effect of intrathecal
fentanyl on the incidence and severity of PDPH in parturients
undergoing cesarean section.
Material and Methods: About 124 patients were randomly
allocated using a simple randomization technique into 2
groups, with 62 patients in each group. Group A – 2.5 mL 0.5%
Bupivacaine + 0.5 mL NS, Group B –2.5 mL 0.5% Bupivacaine
+ 0.5 mL fentanyl (25 mcg). Categorical variables are presented
as absolute numbers and percentages. The software used for
the statistical analysis was SPSS v21.0 (IBM, USA).
Results: The parturient was monitored for post-dural puncture
headache PDPH during the post-operative period until
discharge. Patients were questioned about the onset, duration,
and severity of headache. Severity was evaluated using the
visual analogue scale. There was no significant difference in
the incidence of PDPH. There was a significant difference in
severity between the two groups. More hypotension was seen
in group A compare to group B.
Conclusion: We concluded that the women who were
impacted by the addition of IT fentanyl to bupivacaine for spinal
anesthesis (SA) in obstetric patients reported better postpartum
recovery and a reduction in the intensity and duration of their
headaches, improved hemodynamic stability, and lengthened
the period of post-operative analgesia. Further well-designed
RCTs with larger sample sizes are warranted to confirm these
findings and elucidate optimal dosing strategies for intrathecal
fentanyl in this population.

Comprehensive Evaluation of Symptoms and Risk Factors in Adhesive Small Bowel Obstruction

Kolli Loknadh — 2025-06-30

Introduction: Adhesive small bowel obstruction (ASBO) is a significant condition often encountered in surgical emergencies, characterized by the blockage of the small intestine due to fibrous bands called adhesions. These adhesions typically form after abdominal surgeries, leading to substantial morbidity, prolonged hospital stays, and increased healthcare costs. Understanding the symptoms and risk factors associated with ASBO is crucial for enhancing patient outcomes and developing effective prevention and management strategies. Material & Methods: This prospective observational study was conducted at the Department of General Surgery, Shri Ram Murti Smarak Institute of Medical Sciences, Bareilly, from August 1, 2022, to January 31, 2024. Patients aged 18 years and older with an episode of adhesive small bowel obstruction were included, excluding those with large bowel obstruction, incarcerated hernia, early post-operative small bowel obstruction, inflammatory bowel disease, radiationinduced fibrosis, and peritoneal carcinomatosis. Data were collected through patient histories, clinical examinations, and investigations, and analyzed using SPSS version 23. The sample size was calculated to include 60 patients, accounting for a 10% dropout rate. Results: The study found that the majority of ASBO patients were between 18-29 years (25.4%) and 45 to 59 years (23.7%), with a predominance of females (55%). Diabetes Mellitus (DM) was the most common past medical condition (30.0%), followed by DM with Tuberculosis (25.0%). Alcohol consumption (36.7%) and combined smoking and alcohol use (31.7%) were also prevalent. Systemic examination revealed that 45.0% had tenderness, while 51.6% were within normal limits. Abdominal pain was a common symptom in both operated (63.3%) and non-operated (35.0%) patients. Significant associations were found for age (adjusted OR 1.79, p = 0.045) and tenderness (adjusted OR 0.75, p = 0.036). Conclusion: The study highlighted the demographic and clinical characteristics of ASBO patients, emphasizing the importance of recognizing risk factors such as age, medical history, and lifestyle habits. Identifying these factors can aid in better managing and preventing ASBO, ultimately improving patient care and reducing healthcare burdens. The findings underscore the necessity for targeted interventions and refined surgical techniques to minimize adhesion formation and subsequent bowel obstructions.

Maternal and Neonatal Outcomes of Delayed Cord Clamping vs Early Cord Clamping in Term Delivered Newborns

Manjari Kumari

Introduction: During the first minutes after birth, the newborn infant receives a substantial blood transfusion from the placenta. Delayed cord clamping (DCC) is associated with decrease incidence of anemia in childhood, less intraventricular hemorrhage and lower risk of necrotizing enterocolitis as compared to early cord clamping. The present study was conducted to study maternal and neonatal outcomes of delayed cord clamping (DCC) vs early cord clamping (ECC) in termdelivered newborns. Material and Methods: This prospective study was conducted in terms of low-risk pregnant women admitted for safe confinement in the labour room of SRMS IMS Bareilly, between August 2022 to January 2024. A total of 60 patients, who fulfilled the inclusion-exclusion criteria, were subjected to the study and divided into two groups of 30 each: Group A with ECC and Group B with DCC. Mothers and their newborns were evaluated with reference to maternal and neonatal outcomes. Statistical analysis was carried out using Microsoft Excel and Epic Info 7.1 software. Results: In this study, ECC was performed on 30 (Group A), and DCC was performed on 30 (Group B). A significant increase in haemoglobin level without any significant increase in neonatal serum bilirubin level in the case of DCC, as compared to ECC. On the basis of this study, the delayed cord clamping shows significant positive effects on infants’ health. Conclusion: Delayed cord clamping improves haemoglobin levels and iron stores in term infants, which have major positive effects on infants’ health and development and decrease incidence of childhood anaemia.