To evaluate the outcome of priming by varying-doses of metoclopramide on propofol injection pain in comparison to lidocaine as a standard control.
320 patients were randomly allocated into 4 equal ...groups: Group C received 50 mg lidocaine and Groups M1-3 received metoclopramide 2.5, 5 and 10 mg, respectively. An elastic tourniquet was applied to the mid of left arm, the priming solution was injected over 10 s and 1-min later, tourniquet was removed and one fourth of the total calculated dose of Propofol was injected over 30 s and pain assessment was made, during initial and at end of injection of Propofol trial dose, using the 4-point verbal rating scale: no, mild, moderate or severe pain. Then, the reminder of the full calculated induction dose of Propofol was completed.
Lidocaine and metoclopramide mostly relieved pain of initiation of Propofol injection 174 patients (54.4%) had no pain 94 patients (29.4%) had mild pain and only 68 patients (21.25%) had moderate pain, while no patient had severe injection pain. At the end of injection of the total trial dose, 40% had no pain totally, 31.3% had mild pain, 19.3% had moderate pain and 9.4% had severe pain. Lidocaine provided significantly better analgesia compared to metoclopramide (2.5 mg), while the difference was non-significantly better compared to metoclopramide, 5 and 10 mg. Metoclopramide provided dose-dependent stepwise pain relieve peaking with 10 mg dose that showed significant superiority compared to 2.5 mg dose, but non-significantly compared to 5 mg dose. Moreover, the effect of 10 mg priming dose extended till completion of injection of the trial dose with significant difference Compared to the other two doses of metoclopramide.
venous priming with metoclopramide 10 mg with mid-arm tourniquet applied for one minute is effective modality for alleviation of Propofol injection pain else Patients received Lidocaine showed significantly better analgesia compared to those received 2.5 mg metoclopramide.
Patients undergoing craniotomy operations are prone to various noxious stimuli, many strategies are commenced to provide state of analgesia, for better control of the stress response and to overcome ...its undesired effects on the haemodynamics and post-operative pain. Scalp nerves block are considered one of these strategies. This study was conceived to evaluate the effect of addition of hyaluronidase to the local anaesthetic mixture used in the scalp nerves block in patients undergoing elective craniotomy operations.
64 patients undergoing elective craniotomy operations were enrolled in this prospective randomized, double-blind comparative study. Patients were randomly assigned to two groups. Group LA, patients subjected to scalp nerves block with 15 ml bupivacaine 0.5%, 15 ml lidocaine 2%, in 1:400000 epinephrine. Group H as Group LA with15 IU /ml Hyaluronidase.
Patients in the H group showed lower VAS values for 8 h postoperative, compared to the LA group. The haemodynamic response showed lower values in the H group, compared to the LA group. Those effects were shown in the intraoperative period and for 6 h post-operative. No difference was detected regarding the incidence of complications nor the safety profile.
Our data supports the idea that addition of hyaluronidase to the local anesthetic mixture improves the success rates of the scalp nerves block and its efficacy especially during stressful intraoperative periods and in the early postoperative period. No evident undesirable effects in relation to the addition of hyaluronidase.
Clinical Trial registry on ClinicalTrials.gov , NCT 03411330 , 25-1-2018.
We assessed whether at admission plasma circulating cell free mitochondrial DNA (ccf-mtDNA) is related to injury severity and can predict morbidity and mortality in acute trauma patients.
Patients ...were evaluated at Emergency Department (ED) using Injury Severity Scale (ISS), but only patients required ICU admission were studied (Group B). At ED arrival, blood samples were obtained for quantitative real-time PCR estimation of plasma level of ccf-mtDNA. Study outcome was the correlation between morbidity and mortality and at admission plasma ccf-mtDNA level and its predictability for morbidity and mortality. Ten healthy volunteers gave blood samples as control group (Group B).
Twenty-seven patients passed smooth ICU stay and were discharged alive (Group B1), while 34 patients developed additional morbidities (Group B2) and 11 patients (18%) of Group A2 died. Mean estimated plasma ccf-mtDNA levels were significantly higher in Group B than in Group A, but patients of Group B1 had significantly lower ccf-mtDNA levels than patients of Group B2. Patients developed adult respiratory distress syndrome (ARDS) had significantly higher ccf-mtDNA levels than patients developed sepsis or acute myocardial infarction (AMI) with significantly higher levels in patients developed sepsis. Estimated plasma ccf-mtDNA levels at time of admission showed positive significant correlation with morbidity rate. Odds ratio (OR) for relative risk for development of additional morbidities in patients who had a high plasma ccf-mtDNA level was 26.35. At admission plasma ccf-mtDNA levels in survivors were significantly lower than in non-survivors, and OR was 4.0806. High plasma ccf-mtDNA showed high sensitivity as predictor for ICU mortality.
High at ED admission plasma ccf-mtDNA levels could predict development of additional morbidities during ICU stay of acute trauma patients and showed high sensitivity for prediction of their survival. Very high plasma ccf-mtDNA levels could predict patients liable to develop ARDS.
Background
Despite being a well-described intervention, the optimal anatomical approach to perform a stellate ganglion block (SGB) has been disputed. We compared the subfascial and extrafascial ...ultrasound-guided (USG) SGB.
Methods
A randomised clinical trial was conducted, consisting of 50 patients in two groups. Group I received SGB via the subfascial approach while Group II received an SGB via the extrafascial approach. The primary endpoint was successful sympathetic blockade (as indicated by a measured temperature rise of ≥2°C). Secondary endpoints included analgesic efficiency (extent of early onset of pain relief as indicated by >50% improvement in Visual Analogue Scale (VAS) score at 300’s post-procedure); occurrence of Horner’s syndrome; extent of local anaesthetic distribution; and adverse events.
Results
The mean increase in sympathetic blockade was significantly higher in the subfascial group (2.6 ± 0.6°C; p = .003). Analgesic efficacy was also significantly higher in the subfascial group (p < .001). The difference in the average dermatomal spread of local anaesthetic down to T2 and up to C4 between the groups was also statistically significant (p = .021 and p = .019, respectively).
Conclusions
The degree of temperature rise, pain relief and occurrence of Horner's syndrome were higher in the subfascial than the extrafascial group. The subfascial approach to SGB, with a limited volume of local anaesthetic agent, is a more reliable technique when compared to the extrafascial approach.
•Liver resection surgery is associated with substantial postoperative pain.•Subcostal transversus abdominis plane block is the suggested regional block.•Erector spinae plane block reduced opioid ...consumption.•Erector spinae plane block prolonged the duration of analgesia.
The aim of this study was to compare the analgesic efficacy of erector spinae plane block (ESPB) in relation to subcostal transversus abdominis plane block (TAPB) in patients undergoing open liver resection surgery.
In this randomized controlled trial, we included adult patients undergoing open liver resection surgery. After induction of general anaesthesia, the included patients were randomized to receive either ESPB (n = 30) or subcostal TAPB (n = 30). Postoperative pain was assessed using the numeric rating scale (NRS) at rest and during cough. Intravenous morphine boluses were used for management of breakthrough pain intra- and postoperatively. The study’s primary outcome was morphine consumption during the first 24 h postoperatively. Secondary outcomes included intraoperative morphine consumption, time to first postoperative morphine requirement, incidence of complications, and patient satisfaction.
Sixty patients were included and were available for the final analysis in this study. The intra-and postoperative morphine consumption were less in the ESPB group than the subcostal TAPB group (median quartiles morphine dose: 0 0−0 vs 2 0−5 mg, p = 0.007 and 20 15–20 vs 25 20−30 mg, p = 0.006, respectively). The time to first morphine requirement was longer in the ESPB group (median quartiles: 6.5 5.5−6.5 h) than the subcostal TAPB group (median quartiles: 4.3 1.0−6.5 h), P = 0.013. Patients in the ESPB group had lower incidence of sedation and higher level of satisfaction than the subcostal TAPB group.
In patients undergoing open liver resection surgery, ESPB provided superior analgesic properties than subcostal TAPB.
Clinical trial registration: NCT05253079, Principal investigator: Maha Mostafa, Date of registration: February 23, 2022.
URL: https://clinicaltrials.gov/ct2/show/NCT05253079
Objective: To compare effectiveness and tolerability of carbetocin versus syntometrine in prevention of postpartum hemorrhage (PPH) after cesarean section (CS).
Methods: A double-blind randomized ...study conducted on 300 pregnant subjected randomly either to single 100 μg IV dose of carbetocin (150 women) or combination of 5 IU oxytocin and 0.2 mg ergometrine (150 women) after fetal extraction and before placental removal. Primary outcome parameter was the occurrence of PPH. Other parameters were hemoglobin and hematocrit changes, the need of additional oxytocic, hemodynamic changes and occurrence of side effects.
Results: There was no significant difference between the two study groups regarding hemoglobin and hematocrit at start of CS and after 2 days of surgery and mean blood loss during the operation (p > 0.05). There was a highly significant difference between the two study groups regarding incidence of primary PPH (2.7% versus10%) and the need of additional oxytocic (3.3% versus17.3%). Women in oxytocin group showed a statistically significant lower systolic and diastolic blood pressure at 1, 5 and 30 min than women in carbetocin group. Women in carbetocin group experienced more metallic taste, flushing, headache, dizziness, dyspnea and itching, while women in oxytocin methergine group experienced more palpitations.
Conclusions: Carbetocin is a reasonable effective alternative to syntometrine in prevention of PPH after cesarean delivery.
This article has been retracted. Please see retraction notice available here: https://www.tandfonline.com/doi/abs/10.1016/j.egja.2018.04.002; ...https://www.tandfonline.com/doi/full/10.1080/11101849.2020.1730638
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