Auxiliary Nurse Midwives (ANMs) are the back bone of primary health care services in India. The horizontal integration of various national health programmes has increased their responsibility and workload. So a need was felt to conduct a study to assess the workload and performance of ANMs. The objective of the study was to explore the workload and performance of ANMs in selected health care settings in North India. An exploratory cross-sectional study was conducted in two selected health care settings of North India. The study was conducted on all the 7 ANMs working in the selected health care settings. Data was collected by observing the activities of ANMs using time activity record sheet. The nursing care procedures performed were observed and scored by using performance check list. T-test was used to compare actual time against standard time for performing procedures. ANMs spent 2/3rd of their time in indirect care activities. Direct care and personal activities accounted for 19 % of their time. Their performance was rated as good. Majority of the time spent by ANMs was utilized in performing indirect care activities. This study recommends that more time is needed to be devoted to direct care by ANMs.​

Background: Opioids administered as bolus doses or continuous infusions are widely used by anesthesiologists worldwide for major and day care surgeries. Opioid-free anesthesia is a multimodal anesthesia and analgesia technique that does not use opioid drugs, thereby benefitting patients from opioid-related adverse effects. In this study, we compared the postoperative analgesic requirements of patients scheduled for elective laparoscopic cholecystectomy under opioid-free and opioid-based anesthesia. Methods: This study included 88 patients aged 18–60 years with American Society of Anesthesiologists physical status 1 and 2 who underwent elective laparoscopic cholecystectomy. Participants were randomly divided into two groups with forty-four participants in each group. The opioid-free anesthesia group was administered an intravenous bolus of ketamine and dexmedetomidine, whereas the opioid-based group was administered fentanyl with conventional general anesthesia. The primary outcome was to compare the total amount of fentanyl consumed by both groups during the 6 h postoperative period following extubation. Episodes of postoperative nausea and vomiting (PONV) and vital signs were noted throughout the postoperative period to analyze the secondary outcomes. Results: Both the groups had similar demographic characteristics. The opioid-free group required less postoperative analgesia within the first 2 h (61.4 ± 17.4 vs. 79.0 ± 19.4 of fentanyl, P < 0.001), which was statistically significant. However, fentanyl consumption was comparable between the groups at the sixth postoperative hour (opioid-free group 152 ± 28.2 vs. opioid group 164 ± 33.4, P = 0.061). Compared with 4.5% of the participants in the opioid-free group, 34% of those in the opioid-based group developed moderate PONV. Conclusions The opioid-free anesthesia technique in patients undergoing laparoscopic cholecystectomy reduced the requirement of analgesia in the first two hours of the postoperative period and was associated with decreased PONV.