Objectives
To evaluate analgesic and hemodynamic outcome of fentanyl or midazolam as additives to local anesthetic mixture (LAM) for peribulbar block (PBB) during posterior chamber surgery.
Methods
...One hundred thirty-two ASA status I to III adult patients aged 50–75 years scheduled for posterior segment surgery (intraocular foreign body and elective vitrectomy) were enrolled in this prospective, randomized, double-blind trial from which 12 patients were excluded. After signing a written fully informed consent for study participation, patients were grouped into 3 groups (40 patients in each group); group C received local anesthetic mixture plus 1 ml plain saline, group F received local anesthetic mixture plus 25 μg fentanyl in 1 ml saline and group M received local anesthetic mixture plus 1 mg midazolam in 1 ml saline. The primary outcome was the onset time of eyelid and globe akinesia. Also, the duration of the block was assessed in the three studied groups. Intraoperative and postoperative hemodynamic measures were assessed. Postoperative analgesia was hourly-assessed using Visual analogue scale (VAS) and rescue analgesia was provided at visual analogue score of > 3.
Results
The number of patients who had fast eyelid and globe akinesia was significantly higher with significantly lower total 15-min score in group F than the other groups. Intraoperative and postoperative hemodynamic measures were non-significantly different between studied groups. Duration of the block was significantly longer in groups F and M than group C with significantly longer duration in group F. The number of patients who required postoperative rescue analgesia was significantly lower with significantly lower number of requests in group F than the other groups.
Conclusion
Additives to local anesthetic mixture during peribulbar block provided satisfactory anesthetic outcome than local anesthetic mixture alone. Fentanyl was superior to midazolam in terms of significantly speed up onset, longer block duration with significantly longer postoperative analgesia and lesser consumption of rescue analgesia. Both additives provided adjusted hemodynamic measures comparable to the control group.
Trial registration
Pan African Clinical Trials Registry (
PACTR201708002496243
) registered 03/08/2017 retrospectively.
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.
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.
To compare the analgesic effects of thoracic paravertebral block versus lidocaine infusion for management of post-thoracotomy pain.
60 patients who were scheduled for thoracotomy were randomly ...divided into two equal groups: IV group received 1.5 mg/kg of 1% lidocaine over 10 min then infusion of 1.5 mg/kg/h, and thoracic paravertebral group (PVB) received 10 ml lidocaine 1% over 30 s then infusion of 1.5 mg/kg/h through catheter was inserted under ultrasound guidance. Hemodynamic and respiratory variables, frequency and duration of postoperative mechanical ventilation, duration of ICU stay, time till start of respiratory exercise and till chest tube removal, analgesia was assessed using 100-point visual analogue scale and defined as VAS <30 mm at rest, and in case of inadequate analgesia, IV morphine 2 mg bolus was given. Frequencies of complications and postoperative hospital stay were also recorded.
17 patients of both groups were maintained on MV for mean duration of 1.5 ± 0.5 days. PVB group was successfully weaned from MV and extubated after significantly shorter duration. Mean duration of ICU stay, time till start of respiratory exercise, and till removal of chest tube were significantly shorter in PVB group. All patients requested analgesia, but the frequency of consumption and mean number of requests were significantly higher in IV group. VAS scores determined at 1, 2, 12, 36 and cumulative 48 hours were significantly lower in PVB group compared to IV group.
Ultrasound guidance allowed safe paravertebral space catheterization. PVB using continuous lidocaine infusion provided adequate analgesia for post-thoracotomy pain with significant reduction of rescue analgesia, shorter time till respiratory exercises start, minimal complications and shorter hospital stay.
To estimate plasma monoethylglycinexylidide (MEGX) level at 15 and 30min after intravenous injection of lidocaine as a measure for detoxification and excretory function of the liver in cirrhotic ...patients in comparison with non-cirrhotic patients assigned for laparoscopic cholecystectomy (LC).
The study included 50 cirrhotic and 10 non-cirrhotic patients assigned for LC. Only Child-Pugh (CP) class A or B patients with adjusted liver functions were included in the study. Both patients and controls received anesthesia using a similar protocol. Intravenous lidocaine (1mg/kg) was injected over 1min, and blood samples were obtained immediately before lidocaine injection (S0) to assure absence of MEGX in plasma and 15min (S15) and 30min (S30) after lidocaine administration. MEGX values>90ng/ml are considered normal. The extent of MEGX extraction was calculated as plasma MEGX level at S30 minus S15.
Mean operative and anesthesia times were 59.3±10.4 and 73.9±12.2min, respectively. Mean sevoflurane 18.1±2.4ml/h. Operative and anesthetic data showed non-significant difference between patients categorized according to CP class and in comparison with controls. Estimated plasma MEGX levels at 15-min and 30-min after lidocaine injection were significantly higher in controls compared to patients and in patients of CP class A compared to those of class B. The extent of extraction was significantly lower in patients of CP class B compared both to controls and patients of class A with non-significantly lower extraction level in patients of class A compared to controls.
Laparoscopic cholecystectomy is safe and feasible in cirrhotic patients and MEGX test as a measure of detoxification and excretory function of the liver is a reliable test that showed a relationship to the extent of hepatic derangement.
Objectives: To evaluate the prophylactic effect of norepinephrine (NE) and vasopressin (VP) infusion on frequency and severity of spinal anaesthesia-induced hypotension (SAIH). Patients and methods: ...A total of 240 young male patients were randomly allocated into three equal groups: Group C received plain saline infusion, Group NE received NE infusion (0.1 mg/ml; 3 ml/h) and Group VP received VP infusion (0 5 U/ml; 1 U/h); all infusions started synchronously with spinal injection (SI). Systolic arterial pressure (SAP) and heart rate (HR) measures were determined at 1, 4, 7 and 10-min; then every 5-min for 30 min. SAP reduction of >10% was treated by supplementary fluid therapy and resistant cases or patients who had SAP reduction of ≥20% received ephedrine (10 mg). Results: In comparison with baseline SAP, SAP was decreased by > 20% in eight control patients, by 10%, while 15 patients had increased SAP of > 10% and 145 patients showed no SAP change with significant difference between the two groups (p = 0.0003). Throughout the 30 min after spinal block, all SAP and HR measures of control patients were significantly (p = 0.001) lower compared with their baseline measures and with corresponding measures of patients of the NE and VP groups with non-significant difference between the two groups. Seven patients (8.8%) in the control group had nausea and three (3.8%) had nausea and vomiting, while no patient in the NE and VP groups had nausea or required anti-emetic therapy. Conclusion: Vasopressor infusion given synchronously with spinal injection is an appropriate prophylactic policy against SAIH. NE infusion did better than VP infusion and provided better haemodynamic stability after spinal injection. However, VP infusion allowed control of blood pressure despite the significant decrease till 7 min after SI.
Objectives: To evaluate the prophylactic effect of norepinephrine (NE) and vasopressin (VP) infusion on frequency and severity of spinal anaesthesia-induced hypotension (SAIH).
Patients and methods: ...A total of 240 young male patients were randomly allocated into three equal groups: Group C received plain saline infusion, Group NE received NE infusion (0.1 mg/ml; 3 ml/h) and Group VP received VP infusion (0.5 U/ml; 1 U/h); all infusions started synchronously with spinal injection (SI). Systolic arterial pressure (SAP) and heart rate (HR) measures were determined at 1, 4, 7 and 10-min; then every 5-min for 30 min. SAP reduction of >10% was treated by supplementary fluid therapy and resistant cases or patients who had SAP reduction of ≥20% received ephedrine (10 mg).
Results: In comparison with baseline SAP, SAP was decreased by > 20% in eight control patients, by < 10% in 22 patients and in 50 control patients SAP decrease ranged between 10% and 20%. In the NE and VP groups, no patient had decreased SAP of > 10%, while 15 patients had increased SAP of > 10% and 145 patients showed no SAP change with significant difference between the two groups (p = 0.0003). Throughout the 30 min after spinal block, all SAP and HR measures of control patients were significantly (p = 0.001) lower compared with their baseline measures and with corresponding measures of patients of the NE and VP groups with non-significant difference between the two groups. Seven patients (8.8%) in the control group had nausea and three (3.8%) had nausea and vomiting, while no patient in the NE and VP groups had nausea or required anti-emetic therapy.
Conclusion: Vasopressor infusion given synchronously with spinal injection is an appropriate prophylactic policy against SAIH. NE infusion did better than VP infusion and provided better haemodynamic stability after spinal injection. However, VP infusion allowed control of blood pressure despite the significant decrease till 7 min after SI.
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
To evaluate the predictability of intracranial pressure (ICP), cerebral perfusion pressure (CPP) and hemodynamic monitoring for outcome of children with severe traumatic brain injury (TBI).
The study ...included 53 children with severe TBI. All the patients were immediately admitted to Neurosurgical Intensive Care Unit (NICU) for determination of baseline data and to receive first aid management and assessment of head injury severity according to post-resuscitation Glasgow coma scale (GCS) and patients were enrolled if they had GCS of ⩽8. All the patients had insertion of the intraventicular ICP sensor either at the end of surgery if indicated or through Kocher's pathway and were maintained for a maximum of 5days. All the patients had non-invasive monitoring for heart rate (HR), blood pressure measures and CPP. Glasgow outcome scale (GOS) was determined at discharge time and 6months thereafter.
Thirty-seven patients continued their ICU stay and were discharged alive for a survival rate of 75.8% and 28 of survivors (75.7%) had favorable outcome. Hemodynamic parameters estimated at the time of catheter removal showed significant changes in survivors compared to their levels estimated at the time of catheter insertion and to non-survivors. Patients having favorable outcome showed more stable hemodynamic changes, while those who had unfavorable outcome showed autonomic instability manifested as significantly lower SBP, DBP and MAP with non-significantly lower ICP and CPP. Statistical analysis defined CPP as the highly significant predictor of outcome with CPP as the significant predictor for survival and favorable outcome. Analysis of the variability of estimated hemodynamic parameters, as predictors for survival defined disturbed ICP as the significant sensitive predictor and disturbed SBP as a significant predictor.
Hemodynamic stability for children had TBI mandatory for improvement of their outcome with high and low CPP with concomitant large range of SBP variability which could be considered as predictors for bad outcome.
PDF
