Postoperative catheter-related bladder discomfort (CRBD) can be a distressing complication for patients in whom a urinary catheter was inserted intraoperatively and is accompanied with patients' ...dissatisfaction. This trial investigated the efficacy of hyoscine and ketamine on treatment of postoperative CRBD in patients undergoing various surgeries.
This was a prospective randomized, double-blind study, which included 60 American Society of Anesthesiologists Class I-II male patients undergoing elective nonurological operations requiring intraoperative urinary catheterization under general anesthesia after ethical approval and written informed consent. Patients were allocated randomly into two groups: The hyoscine group (H group) (
= 30) received 20 mg of hyoscine intravenously and ketamine group (K group) (
= 30) received 0.25 mg/kg of ketamine intravenously immediately after the occurrence of CRBD. The severity of CRBD was assessed at 0, 1, 2, and 4 h postoperatively. Adverse effects of hyoscine and ketamine were also examined. Data were summarized using mean ± standard deviation, and comparisons between groups were done by unpaired
-test. For comparison of serial measurements within each group, ANOVA was used.
There was a significant difference between the two groups in the severity of CRBD measured by visual analog scale score only 30 min after drug administration where it was higher in ketamine group (44.50 ± 7.70) compared to hyoscine group (36.00 ± 8.55) (
< 0.001), otherwise there was no significant difference at other time points between the two groups, also there was a significant rise in heart rate in hyoscine group but no significant difference in mean arterial pressure.
Intravenous hyoscine 20 mg is more effective in control of CRBD than ketamine (0.25 mg/kg) in the first 30 min; later on they have the same effect.
Caudal analgesia is widely used in children; the aim of this trial was to evaluate the efficacy of adding nalbuphine to local anesthetic in pediatric patients undergoing hernia repair.
This ...randomized double-blind controlled trial was done in department of anesthesia, Cairo University hospitals, and 40 patients with ASA physical status classification I–II, aged 2–7years were enrolled in this study and randomly assigned into 2 groups; group L received caudal levobupivacaine 1ml/kg with concentration of 0.25% and group LN received caudal 0.125% levobupivacaine with volume of 1ml/kg plus 0.2mg/kg nalbuphine. Pain was evaluated immediately after emergence (FLACC 0h), after 1h in the PACU, after 2, 3, 4, 5, 6 and 12h by the FLACC pain score (Face, Leg, Activity, Crying, Consolability). First time of rescue analgesic, total dose of rescue analgesic and side effects were observed for 12h.
FLACC pain scores were much less in LN group compared to L group (p value<0.001) after the second hour. The first time for postoperative analgesic requirement was significantly longer in LN group (384±23.1min) compared to L group (202.20±23.42min) (p value>0.001). The total dose of postoperative supplementary analgesia (intravenous paracetamol infusion) in the first 12h was significantly lower in LN group (200.5±65.5mg) in comparison with L group (355.25±69.9mg) (P<0.05).
Combining caudal anesthesia using levobupivacaine and nalbuphine provided prolonged time of analgesia with no reported side effects.
Background: The control of postoperative pain following major lumbar spine surgeries remains a major challenge for anesthesiologists, and many new strategies and methods have been developed for pain ...control. This study's main objective was to evaluate the efficacy of the bilateral ultrasound-guided erector spinae plane block (US-ESPB) as a method for perioperative pain management in patients undergoing lumbar spine surgeries.
Methods: This double-blinded prospective randomised controlled study was conducted on 140 patients aged between 18 and 65 years; all were scheduled for elective lumbar spine surgeries. Patients were randomly allocated into one of the two groups: the ESPB group (n = 70) or the control group (n = 70). All patients received bilateral US-ESPB after induction of general anaesthesia, in the ESPB group; 20 mL of levobupivacaine 0.25% were used, while 20 mL normal saline was given to the control group instead. The primary endpoint was the total amount of morphine consumed during the intraoperative and the first 24 postoperative hours. Secondary endpoints included, time to first request of rescue analgesia as well as incidence of adverse effects.
Results: The total amount of morphine consumed during the intraoperative and the first 24 postoperative hours was found to be significantly lower in the ESPB group compared to the control group (P < 0.001). Moreover, the time to first analgesic request was significantly longer in patients receiving ESPB as analgesia (P < 0.001). No statistically significant differences were observed between the two groups regarding complications.
Conclusion: Bilateral US-ESPB is useful intervention for providing adequate pain management in lumbar spine surgeries.
Postoperative shivering (POS) is considered one of the most common complications that is encountered by the anaesthetists worldwide. Despite using several treatment options, there has not been a ...clear consensus regarding this issue. This trial was conducted to investigate the efficacy and safety of paracetamol and ondansetron in preventing POS in patients undergoing liposuction procedures under combined general epidural anaesthesia.
One hundred twenty patients scheduled for liposuction were randomly allocated to one of three groups: group P (paracetamol group) which received 1 g paracetamol intravenously, group O (ondansetron group) which received 8 mg of ondansetron intravenously, and group S (saline group), which received 100 mL normal saline intravenously; all medications were given postoperatively. The primary outcome was the incidence of POS, and the secondary outcomes included shivering score, tympanic temperature, and the occurrence of side effects.
The incidence of occurrence of POS was found to be lower in groups P and O compared to group S with values of 25% and 37.50% vs. 77.50%, respectively, with a
value <0.001. Additionally, the severity of POS was found to be lower in groups P and O compared to group S (
<0.001). Tympanic temperature and complications were comparable between the groups with no significant differences.
Prophylactic use of paracetamol or ondansetron at the end of the procedure was shown to be of great value in reducing the incidence and severity of POS, with no statistically significant difference between the paracetamol and ondansetron groups. Moreover, no significant drawbacks were reported as a result of using these medications.
Sleeve gastrectomy has become a popular and effective treatment for morbidly obese patients. The aim of this prospective randomized study was to assess the efficacy of multimodal analgesia using ...pregabalin and dexmedetomidine in morbidly obese patients undergoing laparoscopic sleeve gastrectomy.
After ethical approval 60 American Society of Anesthesiologists (ASA) physical status II patients were enrolled in this study and allocated randomly into 2 groups: group A received 75mg oral pregabalin 2h before surgery and dexmedetomidine infusion 0.4μg/kg/h and group B (control group) received placebo capsule 2h before surgery and saline infusion intraoperatively. Intraoperative fentanyl consumption, hemodynamics and postoperative opioid consumption, pain scores, level of sedation and any side effects were evaluated.
There was a significant decrease in heart rate, mean arterial blood pressure, pain score, intraoperative fentanyl use, postoperative morphine consumption and nausea verbal rating scale in group A compared to group B. There was a significant increase in sedation score in group A compared to group B.
The combination of preoperative oral pregabalin and intraoperative dexmedetomidine infusion decreased intraoperative fentanyl use and ensured postoperative better pain control and less postoperative opioid consumption.
Postoperative pain management remains a cornerstone in patient's management to ensure a better quality of life. Preemptive analgesia is reported to inhibit the persistence of postoperative pain.
The ...aim of this study is to assess the analgesic effectiveness of preincisional infiltration of ketamine following elective abdominal hysterectomy as compared to levobupivacaine.
This was a prospective, randomized, double-blind study.
This study included 48 patients undergoing abdominal hysterectomy under general anesthesia. They were randomized into two equal groups; Group K received subcutaneous infiltration of 20 ml containing ketamine 2 mg/kg and Group L received subcutaneous infiltration of 20 ml of levobupivacaine 0.25% along the Pfannenstiel incision 5 min before incision. Postoperative pain was assessed using visual analog scale (VAS) at rest and on coughing with evaluation of additional opioid analgesic requirements.
Numerical variables were presented as mean and standard deviation or median and range as appropriate. The intergroup differences were compared using the independent-sample Student's
-test or Mann-Whitney test for numerical variables.
VAS score decreased significantly in Group L from 10 to 24 h and in Group K from 8 to 24 h as compared to the immediate postoperative reading. VAS score in ketamine group was significantly lower than that in the levobupivacaine group 8, 10, and 24 h postoperatively. Ketamine group showed delayed request of additional opioid analgesia (
< 0.001) with significantly less opioid consumption (
< 0.001) as compared to levobupivacaine. The total dose of meperidine consumed during the 24 postoperative h was significantly smaller in ketamine group (
< 0.001).
Surgical site infiltration of ketamine is a promising preemptive analgesic method in the lower abdominal surgery with minimal sedation and adverse effects.
Many techniques to prevent spinal induced hypotension in cesarean section have been advocated; but no one technique proved to be totally effective. The aim of this cohort interventional study was to ...investigate the efficacy of application of multimodal approach to decrease the incidence of hypotension (defined as mean arterial blood pressure ⩽60mmHg) following spinal anesthesia in parturients undergoing elective or urgent cesarean section.
In this prospective cohort interventional study, 159 American Society of Anesthesiologists (ASA) classification I–II parturients undergoing elective or urgent cesarean section were enrolled. All patients received maternal care bundle which consisted of; fixed low dose of bupivacaine (7.5mg+fentanyl 25μg), coloading with 15ml/kg lactated Ringer’s, placement of the patient in the supine wedged position, administration of 9mg ephedrine sulphate IV after intrathecal injection and placement of graduated compression stockings (GCS) in the elevated leg position >45° and maintaining leg elevation at 20° following application of GCS. Demographic data, spinal anesthetic technique variables, fluid intake and urine output were documented. Mean arterial blood pressure, heart rate and oxygen saturation were recorded at baseline T0 (before spinal anesthesia administration), T1 (5min following intrathecal injection of local anesthetics), T2 (15min), T3 (30min) and at T4 (end of procedure prior to PACU transfer). Total dose of ephedrine and any complication was documented.
Incidence of hypotension after 5min (T1) was 17.6%, at 15min (T2) was 3.8% and at 30min (T3) was 5%.
The application of a maternal care bundle had significantly decreased the incidence of spinal induced hypotension in parturient undergoing elective or urgent Cesarean delivery.
Hyperhidrosis is the maladjustment of excess sweating in specific parts of the body. Radiofrequency (RF) therapy has been successfully used to treat hyperhidrosis with a success rate of 85% - 95% in ...patients refractory to sympathectomy. The main hypothesis was the association between reduced palmar hyperhidrosis and radiofrequency RF therapy. The RF therapy is a less invasive technique, including the utilization of electromagnetic energy that is deposited near the nerve tissue. The mechanism of action of continuous RF could be explained by the destruction of afferent nerve fibers on their way from a nociceptive focus to the central nervous system. Pulsed RF was invented to explore this possibility, with the sole purpose of finding a less destructive and equally effective technique for the application of RF to afferent pathways. Herein, we further evaluated whether the procedure was safe without any complications in routine follow-up in palmar hyperhidrosis.
Herein, we report the case of a male patient with an age of 22 years undergoing thermal RF sympathectomy therapy of thoracic T2 and T3 sympathetic ganglia for the palmar hyperhidrosis of his right hand observed for 3 months. The patient developed a contraction of the flexor involving the small muscles of the right hand with severe pain and congestion 17 days after the procedure without any other complications. The contraction was relieved by a sonar-guided median nerve block at the wrist with two injections of 2 mL lidocaine 2% and 2 mL dexamethasone.
This study has been the first clinical case report complicated by the development of a contraction of the flexor muscles of the right hand with severe pain and congestion. The spasm was gradually relieved by sonar-guided median nerve injection at the level of the wrist and intended to assess the role of RF ablation with a success rate of 85% - 95% in palmar hyperhidrosis.
Objectives: To evaluate the short-term outcome of a 3-in-1 procedure including percutaneous facet radiofrequency, percutaneous spinal fixation and steroid with hyaluronidase enzyme injection versus ...percutaneous spinal fixation alone for cases with failed back surgery syndrome (FBSS).
Patients and methods: The study included 50 patients who had had previous spinal surgery since a mean duration of 39.7 ± 8.5 months and developed recurrent back pain since a mean duration of 10 ± 2.1 months. Patients were randomly allocated into two groups; group A underwent percutaneous spinal fixation only and group B underwent the 3-in-1 procedure. Outcome was evaluated at the end of six months postoperatively (PO) using a pain numeric rating scale (NRS), the Oswestry Disability Index (ODI) and Odom's criteria for evaluation of surgical outcome with evaluation of patients' satisfaction by outcome.
Results: All patients showed progressive decrease of NRS pain and ODI scores compared with preoperative scores. However, patients in group B showed significantly lower postoperative NRS pain scores and ODI with significantly higher frequency of patients having had > 50% reduction of both scores compared with patients in group A. PO analgesic consumption rate in both groups was significantly lower than the preoperative rate with a significant reduction of mean total scoring compared with preoperative scoring. The frequency of patients who found the provided therapeutic procedure satisfactory and its outcome good-to-excellent was significantly higher among patients in group B compared with group A.
Conclusion: Short-term outcomes of the applied 3-in-1 procedure are promising for improvement of symptoms secondary to FBSS and may ultimately prove to be recommended as the therapeutic modality for such a challenging clinical problem.
INTRODUCTIONHyperhidrosis is the maladjustment of excess sweating in specific parts of the body. Radiofrequency (RF) therapy has been successfully used to treat hyperhidrosis with a success rate of ...85% - 95% in patients refractory to sympathectomy. The main hypothesis was the association between reduced palmar hyperhidrosis and radiofrequency RF therapy. The RF therapy is a less invasive technique, including the utilization of electromagnetic energy that is deposited near the nerve tissue. The mechanism of action of continuous RF could be explained by the destruction of afferent nerve fibers on their way from a nociceptive focus to the central nervous system. Pulsed RF was invented to explore this possibility, with the sole purpose of finding a less destructive and equally effective technique for the application of RF to afferent pathways. Herein, we further evaluated whether the procedure was safe without any complications in routine follow-up in palmar hyperhidrosis. CASE PRESENTATIONHerein, we report the case of a male patient with an age of 22 years undergoing thermal RF sympathectomy therapy of thoracic T2 and T3 sympathetic ganglia for the palmar hyperhidrosis of his right hand observed for 3 months. The patient developed a contraction of the flexor involving the small muscles of the right hand with severe pain and congestion 17 days after the procedure without any other complications. The contraction was relieved by a sonar-guided median nerve block at the wrist with two injections of 2 mL lidocaine 2% and 2 mL dexamethasone. CONCLUSIONSThis study has been the first clinical case report complicated by the development of a contraction of the flexor muscles of the right hand with severe pain and congestion. The spasm was gradually relieved by sonar-guided median nerve injection at the level of the wrist and intended to assess the role of RF ablation with a success rate of 85% - 95% in palmar hyperhidrosis.
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