Diabetic foot ulcer (DFU) continues to be one of the most distressing and economically draining complications of diabetes mellitus, frequently ending in prolonged hospitalisation or lower-limb amputation when management is delayed. Persistent neuropathic pain, chronic low-grade inflammation and polymicrobial colonisation together sustain the wound in a non-healing state, and none of the dressings in routine clinical use address the neuropathic pain component directly. Amitriptyline, a tricyclic antidepressant long used for neuropathic pain, has additionally been shown to possess antibacterial and anti-inflammatory activity against organisms commonly recovered from chronic wounds. The present work was undertaken to formulate, develop and evaluate an amitriptyline-loaded polymeric hydrogel intended for topical application to diabetic foot ulcers, combining local analgesia, antimicrobial support and a moist wound-healing environment in a single dosage form. Hydrogels were prepared by the cold dispersion method using Carbopol 934 and hydroxypropyl methylcellulose (HPMC K4M) as the gelling polymers, with propylene glycol as co-solvent/humectant, and were optimised through a series of nine trial batches (F1–F9). The gels were evaluated for physical appearance, pH, spreadability, viscosity and rheological behaviour, gel strength, swelling index, drug content uniformity, in vitro drug release using the Franz diffusion cell, release kinetics, ex vivo skin permeation, antimicrobial efficacy against Staphylococcus aureus and Pseudomonas aeruginosa, and short-term accelerated stability. The optimised batch (F6) containing 2% w/w Carbopol 934 and 1% w/w HPMC K4M showed a pH of 5.6 ± 0.2, a viscosity of 18,450 ± 340 cP, and cumulative drug release of 88.4 ± 2.1% over 12 hours, following a Korsmeyer–Peppas non-Fickian release pattern. The formulation retained acceptable physicochemical characteristics on storage at 40 °C/75% RH for 90 days. These findings suggest that an amitriptyline-loaded polymeric hydrogel is a technically feasible and promising adjunctive dosage form for the multimodal management of diabetic foot ulcers, warranting further ex vivo and in vivo confirmation.

Objectives: The present study was to compare post operative outcome of the the efficacy of SAB alone with the combination of SAB and intravenous infusion of dexmedetomidine in elective infra-umbilical surgeries. Methods: A total of 80 patients were undergone elective infra umbilical surgeries. All the cases were categorized into two groups. Group A- cases underwent subarachnoid block alone and Group B cases underwent Subarachnoid block and intravenous infusion of injection Dexmedetomidine. A full anaesthetic checkup was done. Post operative pain was assessed by Visual Analogue Scale (VAS score). Post operative sedation was assessed by using Ramsay sedation score. Results: Each group has 40 patients. Higher proportion of patients were in the age group of 46 to 60 years (40% in subarachnoid block versus 42.5% in SAB with dexmedetomidine). Mean NRS score was significantly lower among patients in SAB with dexmedetomidine group as compared to patients in subarachnoid block at 4 and 8 hours post-operatively (p = 0.01 and p = 0.01). VAS score was significantly lower among SAB with dexmedetomidine group at 4 hours post-operatively as compared to subarachnoid block group (p = 0.02). At 8 and 12 hours post-operatively, the difference was not statistically significant (p = 0.17 and p = 0.72). The mean Ramsay sedation score was significantly higher among patients in SAB with dexmedetomidine group (2.40 ± 1.06) as compared to patients in subarachnoid block (1.33 ± 0.53) (p = 0.01) at 4 hours post-operatively. At 8 hours post-operatively, the difference was also statistically significant (p = 0.01). At 12 hours postoperatively, it was not statistically significant (p = 1). Conclusion: Postoperatively, the dexmedetomidine group patients experienced significantly lower pain scores and higher sedation levels, which indicates better post-surgical recovery. Hence, SAB with dexmedetomidine provides enhanced post-operative pain management and sedation without increasing complications, making it a promising option for elective infra-umbilical surgeries.