Pakistan Journal of Medical Sciences最新文献

{"title":"Correlation between Prenatal Fetal Hemodynamic Parameters and Growth Indices in Pregnant Women with Preeclampsia and Neonatal Ultrasound Indicators of Organ Development.","authors":"Shudan Yin, Jianhong Wang, Jinying Liu","doi":"10.12669/pjms.42.9.16320","DOIUrl":"https://doi.org/10.12669/pjms.42.9.16320","url":null,"abstract":"<p><strong>Objectives: </strong>This retrospective study aimed to explore the associations between prenatal fetal hemodynamics and growth parameters in pregnant women with preeclampsia and neonatal ultrasound assessment indicators of organ development.</p><p><strong>Methodology: </strong>Clinical parameters of 296 pregnant women and their neonates admitted to Xi'an Fourth Hospital from December 2024 to December 2025 were collected. Those women diagnosed with preeclampsia were included in the study group (n=148). During the same period, age-matched healthy pregnant women and their neonates were included in the control group (n=148). Clinical data of prenatal and neonatal ultrasound examinations, fetal hemodynamic parameters, growth parameters, and neonatal organ development indicators were collected and analyzed.</p><p><strong>Results: </strong>Compared with the control group, the study group had significantly lower peak systolic velocity (PSV) and end diastolic velocity (EDV) of the umbilical artery, middle cerebral artery (MCA), renal artery (RA), biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC), femur length (FL), bilateral renal volume, and liver thickness (P<0.05), whereas the myocardial performance index (MPI) was higher in the study group (P<0.05). Pearson correlation analysis showed that PSV, EDV, MCA, RA, BPD, HC, AC, and FL were positively correlated with bilateral renal volume and liver thickness, and negatively correlated with MPI (P<0.05).</p><p><strong>Conclusion: </strong>Preeclampsia was associated with insufficient fetal blood perfusion and growth retardation. Prenatal ultrasound indicators are closely related to neonatal developmental status and can be used to predict neonatal organ development.</p>","PeriodicalId":19958,"journal":{"name":"Pakistan Journal of Medical Sciences","volume":"42 9","pages":"2269-2275"},"PeriodicalIF":1.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13624491/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149113584","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimizing Curriculum Integration: Development and Validation of the Tool of Integration Practices (TIP) in Health Professions Education - A Mixed Methods Study.","authors":"Syeda Rabbab Hasan, Madiha Sajjad, Rehan Ahmed Khan","doi":"10.12669/pjms.42.9.14806","DOIUrl":"https://doi.org/10.12669/pjms.42.9.14806","url":null,"abstract":"<p><strong>Objective: </strong>Curriculum integration is increasingly adopted in medical and dental education, yet only a few validated tools exist to measure it objectively. Existing curriculum integration frameworks, including Harden's ladder, are primarily descriptive and challenging to apply for systematic evaluation. Therefore, this study aimed to develop a valid and reliable tool to assess the level of integration in medical and dental curricula.</p><p><strong>Methodology: </strong>A multiphase mixed-method approach was employed over nine months from July 2023 to March 2024 at Riphah International University, Pakistan. Literature review identified eight domains representing curriculum integration, each structured on a five-point scale informed by Harden's integration ladder. Content validity was established through expert reviews (n = 17), followed by cognitive interviews with faculty (n = 6) to obtain response process validity. Medical and dental faculty (n = 150) participated in pilot testing. Internal structure validity evidence was evaluated by Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). Reliability was assessed using Cronbach's alpha.</p><p><strong>Results: </strong>Content validation yielded a seven-domain instrument with a mean content validity index of 0.89 and an average content clarity score of 3.46. Cognitive interviews led to minor revisions in four items. The final tool demonstrated good reliability (Cronbach's alpha = 0.88). EFA supported a one-factor model, confirmed by CFA (GFI = 0.96, RMSEA = 0.052, normed χ² = 1.4), indicating a good model fit.</p><p><strong>Conclusion: </strong>The Tool of Integration Practices (TIP) demonstrated adequate validity and reliability. It provides a practical, psychometrically sound framework for assessing and comparing curriculum integration practices based on faculty perceptions at the course and program levels in health professions education.</p>","PeriodicalId":19958,"journal":{"name":"Pakistan Journal of Medical Sciences","volume":"42 9","pages":"2381-2392"},"PeriodicalIF":1.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13624443/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149113436","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of general and central obesity with asthma attacks: A cross-sectional study based on NHANES 2021-2023.","authors":"Haoran Zhu, Yuansong Zhang, Xuebo Jiang, Wei Jiang","doi":"10.12669/pjms.42.9.19822","DOIUrl":"https://doi.org/10.12669/pjms.42.9.19822","url":null,"abstract":"<p><strong>Background & objectives: </strong>Obesity has been linked to increased asthma severity, but its direct role in triggering asthma attacks remains unclear. This study examined how general and central obesity are associated with asthma attacks using recent data from the National Health and Nutrition Examination Survey (NHANES).</p><p><strong>Methodology: </strong>This cross-sectional study analysed NHANES data from August 2021 to August 2023 by the National Centre for Health Statistics for adults aged 18 and older with active asthma. The main outcome was self-reported asthma attacks in the past year. The exposures were body mass index (BMI; categorised as normal, overweight, or obese) and central obesity, defined by waist circumference. Survey-weighted logistic regression accounted for the complex sampling design and adjusted for variables including age, sex, race/ethnicity, education, poverty-income ratio, physical activity, alcohol use, diabetes, and hypertension.</p><p><strong>Results: </strong>Out of 908 adults with active asthma, 436 reported experiencing at least one attack. Fully adjusted models showed that being overweight was not significantly associated with asthma attacks (adjusted OR 1.14, 95% CI 0.49-2.62), while obesity had a higher but statistically non-significant association (adjusted OR 1.56, 95% CI 0.89-2.72). Central obesity was not independently linked to asthma attacks (adjusted OR 0.95, 95% CI 0.55-1.65). Female sex and hypertension consistently correlated with increased odds of attacks.</p><p><strong>Conclusions: </strong>Among current U.S. adults with asthma, body measurements alone do not serve as strong independent predictors of asthma attacks after full adjustment, although the results did show a positive trend. The risk of an asthma attack likely involves a complex interplay of social, clinical, and biological factors beyond obesity alone.</p>","PeriodicalId":19958,"journal":{"name":"Pakistan Journal of Medical Sciences","volume":"42 9","pages":"2433-2440"},"PeriodicalIF":1.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13624445/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149113446","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"FPN1-8C>G Polymorphism as a potential genetic modifier of iron overload in transfusion-dependent β-Thalassemia major patients receiving HbF augmentation therapy.","authors":"Maeesa Wadood, Muhammad Younus Jamal Siddiqi, Iram Nazir, Muhammad Rizwan","doi":"10.12669/pjms.42.9.15478","DOIUrl":"https://doi.org/10.12669/pjms.42.9.15478","url":null,"abstract":"<p><strong>Objectives: </strong>To assess the association of the FPN1-8C>G polymorphism with iron overload and iron-regulatory biomarkers in transfusion-dependent β-thalassemia major patients receiving fetal hemoglobin (HbF) augmentation therapy.</p><p><strong>Methodology: </strong>This cross-sectional study was conducted from January 2024 to May 2025 at Fatima Hospital, Baqai Medical University, and Muhammadi Thalassemia Centre, Karachi, Pakistan. A total of 120 transfusion-dependent β-thalassemia major patients receiving hydroxyurea-based HbF augmentation therapy for at least six months were recruited through consecutive sampling. Conventional iron indices and serum hepcidin, erythroferrone (ERFE), growth differentiation factor-15 (GDF-15), and soluble transferrin receptor (sTfR) were measured. PCR-RFLP was performed for FPN1-8C>G genotyping, with Sanger sequencing confirmation.</p><p><strong>Results: </strong>The FPN1-8C>G variant was present in 39 (32.5%) patients. Iron overload was significantly associated with genotype (<i>p</i>=0.012). Variant carriers (CG+GG) had higher odds of iron overload than CC carriers (OR=5.67; 95% CI: 1.60-20.14; <i>p</i>=0.003), and the association remained significant after adjustment for iron-chelation regimen and duration of transfusion exposure (aOR=5.26; 95% CI: 1.43-19.31; <i>p</i>=0.012). Serum iron, ferritin, transferrin saturation, ERFE, and GDF-15 increased across CC, CG, and GG genotypes, whereas TIBC, UIBC, hepcidin, and sTfR decreased (all <i>p</i><0.001).</p><p><strong>Conclusions: </strong>FPN1-8C>G was significantly associated with greater iron burden and altered iron-regulatory biomarkers. It may represent a potential genetic marker of susceptibility to iron overload in transfusion-dependent β-thalassemia major; however, prospective validation is required.</p>","PeriodicalId":19958,"journal":{"name":"Pakistan Journal of Medical Sciences","volume":"42 9","pages":"2567-2573"},"PeriodicalIF":1.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13624431/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149113460","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Relationship of ABO blood groups with metabolic syndrome and its metabolic abnormalities in a population in North Lahore.","authors":"Mohammad Perwaiz Iqbal, Hijab Sarfraz Ahmad, Saleem Perwaiz Iqbal, Muhammad Khurram","doi":"10.12669/pjms.42.9.13447","DOIUrl":"https://doi.org/10.12669/pjms.42.9.13447","url":null,"abstract":"<p><strong>Objectives: </strong>To examine the relationship of ABO blood groups with metabolic syndrome (MetS) and its metabolic abnormalities in an urban population in Lahore.</p><p><strong>Methodology: </strong>A cross-sectional study was carried out at the Department of Life Sciences, University of Management and Technology, Lahore from August 2022 to August 2024 on 890 healthy subjects recruited from localities in Northern Lahore with informed consent. Blood samples were analyzed for ABO blood groups and three metabolic abnormalities, namely: fasting hyperglycemia, hypertriglyceridemia and low HDL cholesterol. In addition, central obesity and blood pressure were determined. A brief questionnaire covering demographic characteristics was also administered. Chi-square test and logistic regression were used for determining the association between ABO blood groups and MetS and its metabolic abnormalities.</p><p><strong>Results: </strong>Adults from 18 years to 75 years had a Mean ± SD age of 40.87±11.84 years. Percentages of A, B, AB and O blood groups were 22%, 41%, 11% and 26%, respectively. No association was found between ABO blood groups and MetS (p-value=0.88), however the adjusted odds of having hypertriglyceridemia in blood group A subjects was 1.8 times higher compared to subjects with blood group AB [AOR: 1.80; 95% CI: 1.02-3.18].</p><p><strong>Conclusion: </strong>There was a lack of association between ABO blood groups and MetS. Blood group A individuals appear more vulnerable to having hypertriglyceridemia in this population.</p>","PeriodicalId":19958,"journal":{"name":"Pakistan Journal of Medical Sciences","volume":"42 9","pages":"2352-2357"},"PeriodicalIF":1.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13624459/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149113592","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Presentation, Management and Outcome of adult congenital heart disease at tertiary care hospital in Pakistan.","authors":"Aliya Kemal Ahsan, Usman Tauseef, Muhammad Ayyaz, Abdul Sattar Shaikh","doi":"10.12669/pjms.42.9.11435","DOIUrl":"https://doi.org/10.12669/pjms.42.9.11435","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the clinical presentation, management and outcomes of adult congenital heart disease (ACHD).</p><p><strong>Methodology: </strong>This cross-sectional study was conducted at the department of pediatric cardiology and Intensive Care Unit (ICU) of NICVD, Karachi, Pakistan, from April 2021 to December 2023. Patients of either gender, aged 18 years and above and diagnosed with CHDs were analyzed. Outcomes were noted in the form of intra-operative or post-surgery mortality, and post-surgical complications.</p><p><strong>Results: </strong>In a total of 129 patients, 68 (52.7%) were male. The median age was 22.00 years. There were 10 (7.8%) ACHD cases who were newly diagnosed. The most common CHD types were found to be tetralogy of Fallot (TOF), atrial septal defect (ASD), and ventricular septal defect (VSD), noted in 32 (24.8%), 25 (19.4%), and 22 (17.1%) patients, respectively. Shortness of breath, cyanosis, and palpitation, were the most frequent complaints at the time of presentation, reported in 120 (93.0%), 48 (37.2%), and 44 (34.1%) patients, respectively. Cardiac catheterization was the most adopted procedure performed in 41 (31.8%) patients. Total correction, VSD closure, and ASD closure were performed in 9 (7.0%), 7 (5.4%), and 7 (5.4%) patients, respectively. No intra-operative or post-operative mortality was reported. The most frequently observed post-operative complications were left ventricular dysfunction, right ventricular dysfunction, biventricular dysfunction, and ventricular hypertrophy, noted in 39 (30.2%), 23 (17.9%), 6 (4.7%), and 3 (2.3%) patients, respectively.</p><p><strong>Conclusion: </strong>The most prevalent ACHD types were TOF, ASD, and VSD. Most patients required surgical or catheter-based interventions with favorable short-term outcomes.</p>","PeriodicalId":19958,"journal":{"name":"Pakistan Journal of Medical Sciences","volume":"42 9","pages":"2206-2212"},"PeriodicalIF":1.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13624463/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149113519","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tailoring Analgesia in Oesophagectomy: One Size Does Not Fit All.","authors":"Faraz Mansoor, Zubair Shabbir Khanzada, Zala Saleem","doi":"10.12669/pjms.42.9.16314","DOIUrl":"https://doi.org/10.12669/pjms.42.9.16314","url":null,"abstract":"","PeriodicalId":19958,"journal":{"name":"Pakistan Journal of Medical Sciences","volume":"42 9","pages":"2485-2486"},"PeriodicalIF":1.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13624477/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149113537","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pattern and Outcome Trends in Pregnancy Related Acute Kidney Injury over 35 years: A study of 2,275 cases.","authors":"Rubina Naqvi, Sehar Qureshi, Uzma Farooq, Rashid Shaikh","doi":"10.12669/pjms.42.9.16972","DOIUrl":"https://doi.org/10.12669/pjms.42.9.16972","url":null,"abstract":"<p><strong>Objectives: </strong>Pregnancy related acute kidney injury (PRAKI) is a serious complication during or soon after child birth where sudden onset renal dysfunction occurs, often requiring renal replacement therapy. Its incidence and prevalence vary widely across the globe. We, at a tertiary renal care unit, while providing all renal care free of cost to patient, receive large number of patients from all over country. Present study which expands over 35 years describes largest number of PRAKI series, highlighting causes, course of illness and outcome.</p><p><strong>Methodology: </strong>This is a retrospective cohort performed at Sindh Institute of Urology and Transplantation (SIUT), Karachi, Pakistan. From January 1990 to December 2024 case records of all patients who satisfy KDIGO definition of AKI, developing it during pregnancy or soon after child birth, were reviewed and data collected and analyzed on SPSS Version26.0.</p><p><strong>Results: </strong>During this 35-year period, total 2,275 cases of PRAKI were seen at this institution, these were 24% of total AKI registered here. Mean age was 28.46 ±5.83 (range from 15-46 years). Oligo-anuria was frequent symptom found in 90.19%. main causes were peripartum excessive blood loss, intra uterine fetal death, sepsis, pre-eclampsia/ eclampsia, lower segment caesarean section and hemolytic uremic syndrome/ thrombotic Microangiopathy. The last has shown rising trends over last decade. Many women had more than one contributing factor. Renal replacement therapy required in 94%. Complete renal recovery was seen in 27%. End stage renal failure in 19%, Chronic kidney disease in 29% and follow up was missing in 14% patients. Overall mortality was 248 (10.9%), and was high in patients who were anuric, had abnormal platelet counts, and/or marked liver dysfunction and/or deranged coagulation, and/or required mechanical ventilation. Many of those who died had combination of the mentioned parameters.</p><p><strong>Conclusion: </strong>PRAKI is serious complication of pregnancy, it requires immediate address to the problem. Its markedly different (high) prevalence in developing world indicates impact of socioeconomic status and provision of basic health services in this part of world. Training of health care providers at basic health units with improved antenatal care, skilled birth attendance, timely addressing the problem and referrals to appropriate services must be considered seriously.</p>","PeriodicalId":19958,"journal":{"name":"Pakistan Journal of Medical Sciences","volume":"42 9","pages":"2235-2242"},"PeriodicalIF":1.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13624446/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149112118","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Digital delivery of the GDS method for chronic lumbosacral discogenic pain: A pilot study aligning Sustainable development Goals three and four.","authors":"Haroon Mansha, Saleh Shah, Muhammad Naveed Babur, Muhammad Junaid Ijaz","doi":"10.12669/pjms.42.9.16255","DOIUrl":"https://doi.org/10.12669/pjms.42.9.16255","url":null,"abstract":"<p><strong>Background and objectives: </strong>A person's quality of life and everyday functioning may be significantly restricted by chronic back pain including lumbosacral discogenic pain. The purpose of this study is to evaluate the GDS method's initial effects on patients with chronic lumbosacral discogenic pain in terms of both pain and quality of life delivered through a smart phone application in a pilot study.</p><p><strong>Methodology: </strong>Between July 2025 and September 2025, a one-group pretest-posttest design was chosen, and a total of fifteen patients (six male and nine female; mean age 45± 9.0 years; range, 35 to 65 years) were enrolled in the study. Study was Designed at Superior University, Lahore and conducted at Seyal Medical Center. A free local designed smartphone application was used to deliver the 6-week GDS program. Daily reminders, video instructions, and guided postural exercises were all part of the intervention aligning it with SDG three and four. The SF-36 Quality of Life Survey and the ODI scale for pain were used as outcome measures both before and after the intervention. Data on adherence and user engagement were also gathered.</p><p><strong>Results: </strong>From pre-intervention to post-intervention, all SF-36 short form domains showed a statistically significant increase (p <.05). A small scale change (40%) was seen in the ODI scale after the intervention. Eighty percent of participants completed at least five sessions per week on average.</p><p><strong>Conclusion: </strong>Small percentage of patients with chronic discogenic pain showed improvements in pain intensity, functional disability, and certain quality-of-life domains after completing a six-week digitally delivered GDS program. Platforms for digital physiotherapy need to define more parameters, so it could provide a scalable and affordable addition to conventional care.</p>","PeriodicalId":19958,"journal":{"name":"Pakistan Journal of Medical Sciences","volume":"42 9","pages":"2546-2550"},"PeriodicalIF":1.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13624410/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149112966","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perioperative analgesic management using conventional versus regional nerve block in craniotomy surgeries in lower middle-income countries.","authors":"Dileep Kumar, Aqsa Rasheed, Mohsin Nazir","doi":"10.12669/pjms.42.9.19519","DOIUrl":"https://doi.org/10.12669/pjms.42.9.19519","url":null,"abstract":"<p><strong>Objectives: </strong>This study's primary objective was to assess the efficacy of systemic opioids with pre-incision bilateral scalp nerve block for supratentorial craniotomy pain via intraoperative hemodynamic variables at different intervals. The secondary objective was to assess the postoperative pain, rescue analgesia requirement, sedation, nausea and vomiting in first 24 hours of surgery.</p><p><strong>Methodology: </strong>This double-blinded randomized controlled trial, conducted at Aga Khan University Hospital, Karachi. The 62 adult patients (ASA I-III), recruited for elective supratentorial craniotomy via randomization into two groups (n=31/group). Group-M received intravenous morphine (0.1 mg/kg) at induction. Group-S received bilateral SNB with lidocaine, ropivacaine, adrenaline, and dexamethasone. The heart rate, systolic, diastolic, and mean arterial pressures were recorded at predefined intraoperative intervals. Postoperatively, both participants received PCIA morphine, and pain was assessed by visual analogue scale (VAS), along with sedation, nausea and vomiting incidences, which were recorded in first 24 hours at various intervals.</p><p><strong>Results: </strong>The demographic and surgical characteristics were insignificant in both groups (<i>p</i><0.05). The hemodynamic variables such as heart rate was only increased on intense stimulation in both groups, relatively was higher in group-S compared to group-M. However, statistically it was insignificant. The systolic, diastolic, and mean arterial pressures were significantly stable in group-S, compared to Group-M, at various intraoperative intervals (<i>p</i><0.05). The sedation, nausea and vomiting incidence were equivocal in both groups. The VAS pain score was significantly lower in group-S, compared to group-M, postoperatively from 2 to 24 hours.</p><p><strong>Conclusion: </strong>Pre-incisional scalp nerve block provides better attenuation of intraoperative noxious stimuli via hemodynamic control, and it shows superior postoperative analgesia, without risking the sedation, nausea and vomiting in supratentorial craniotomy surgeries.</p>","PeriodicalId":19958,"journal":{"name":"Pakistan Journal of Medical Sciences","volume":"42 9","pages":"2558-2566"},"PeriodicalIF":1.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13624456/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149113082","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}