Pub Date : 2023-11-29DOI: 10.1080/11101849.2023.2280943
A. El-Sakka, N. El-Refai, Mohamed Sayed ElAraby, Reham Ali Abd El-Halim, Maha Ismaiel Youssef, Yahya Mohamed Hammad
ABSTRACT Background Effective analgesia following surgery promotes the delivery mother’s rapid recovery, improves early ambulation, promotes nursing, and lowers the risk of postoperative thromboembolism. The purpose of this work was to assess the postoperative analgesic efficiency of mixing local anesthetic with dexmedetomidine (DEX) in quadratus lumborum block (QLB) after a cesarean section (CS). Methods 50 patients who underwent a cesarean delivery under spinal anesthesia with an average body mass index (BMI) ranging from 18.5 to 34.9 Kg/m2 participated in this double-blinded randomized-controlled study. Two equally sized groups of patients were formed: Group B got QLB with 20 ml of 0. 25% bupivacaine on both sides in addition to DEX 0.5 μg/kg, while group A received QLB with 20 ml of 0.25% bupivacaine in each side alone. Results The total amount of morphine used in the initial 24 hours after surgery and the number of patients who require morphine at 8, twelve, and 24 hours later were substantially decreased in group B than in group A. There was a significant decrease in time to first ambulation and in the Numerical Rating Scale (NRS) after four hours postoperatively in group B than in group A. In group B, three individuals experienced bradycardia, and two patients experienced hypotension as DEX-related side effects. Conclusions The period of postoperative analgesia is prolonged, and the administration of opiates after surgery is decreased when DEX is added to local anesthetics in QLB.
{"title":"Evaluation of the analgesic efficacy of dexmedetomidine as an adjuvant to local anesthesia in quadratus lumborum block after cesarean section: A randomized controlled trial","authors":"A. El-Sakka, N. El-Refai, Mohamed Sayed ElAraby, Reham Ali Abd El-Halim, Maha Ismaiel Youssef, Yahya Mohamed Hammad","doi":"10.1080/11101849.2023.2280943","DOIUrl":"https://doi.org/10.1080/11101849.2023.2280943","url":null,"abstract":"ABSTRACT Background Effective analgesia following surgery promotes the delivery mother’s rapid recovery, improves early ambulation, promotes nursing, and lowers the risk of postoperative thromboembolism. The purpose of this work was to assess the postoperative analgesic efficiency of mixing local anesthetic with dexmedetomidine (DEX) in quadratus lumborum block (QLB) after a cesarean section (CS). Methods 50 patients who underwent a cesarean delivery under spinal anesthesia with an average body mass index (BMI) ranging from 18.5 to 34.9 Kg/m2 participated in this double-blinded randomized-controlled study. Two equally sized groups of patients were formed: Group B got QLB with 20 ml of 0. 25% bupivacaine on both sides in addition to DEX 0.5 μg/kg, while group A received QLB with 20 ml of 0.25% bupivacaine in each side alone. Results The total amount of morphine used in the initial 24 hours after surgery and the number of patients who require morphine at 8, twelve, and 24 hours later were substantially decreased in group B than in group A. There was a significant decrease in time to first ambulation and in the Numerical Rating Scale (NRS) after four hours postoperatively in group B than in group A. In group B, three individuals experienced bradycardia, and two patients experienced hypotension as DEX-related side effects. Conclusions The period of postoperative analgesia is prolonged, and the administration of opiates after surgery is decreased when DEX is added to local anesthetics in QLB.","PeriodicalId":11437,"journal":{"name":"Egyptian Journal of Anaesthesia","volume":"48 1","pages":"929 - 935"},"PeriodicalIF":0.8,"publicationDate":"2023-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139211591","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-28DOI: 10.1080/11101849.2023.2287892
A. Abedalmohsen, Abdelrahman H. Mohammed, M. Bakri, Ahmed H. Othman, Mohammed A. Osman, Ola M. Wahba
ABSTRACT Background About 30% of Egyptian females had breast cancer. Surgery is a cornerstone of the treatment plan. New fascial plane block techniques enhance recovery and improve intra-operative and post-operative pain control. Aim of the study Effect of combined pectoralis II plus transversus thoracic plane blocks (PECS II- TTP) versus erector spinae plane block (ESPB) on post-operative morphine consumption, and interleukin-6 (IL-6) levels 24 hours after surgery. Methods Sixty-four female patients 18–60 years of age, ASA I or II were divided into two equal groups (32 patients each). Group (P) received a combination of PECS II and TTP blocks (injection of 10 ml 0.25% bupivacaine between pectoralis major (PM) and minor (Pm) muscles and 10 ml between the Pm and serratus anterior (Sa) muscles) at the third or the fourth rib, then 10 ml and the internal inter-costal muscles and the transversus thoracic muscle. Group (E) received ESPB (30 ml of 0.25% bupivacaine injected deep to the erector spinae muscle at the transverse process of the fifth thoracic vertebrae). Results Morphine consumption was significantly lower in group (E) throughout the 24 hours period of post-operative follow-up (0.93 ± 0.63 vs. 2.13 ± 0.42 (mg); p = 0.03). Both groups had comparable time till the first analgesic request (p = 0.23). There was statistically non-significant difference between the two groups regarding the numeric rating scale (NRS) (P > 0.05), and post-operative IL6 either at baseline (10.03 ± 4.09 vs. 10.73 ± 3.54; p = 0.48) or at 24 hours after surgery (239.01 ± 122.11 vs. 278.08 ± 151.29; p = 0.30). Both groups had non-significant difference regarding post-operative nausea and vomiting. Conclusion ESPB is as effective as PECS II-TTP with lower morphine consumption in the first 24 hours and comparable NRS, time to first analgesic request, and interleukin-6 levels. Both blocks were safe without any major complications.
{"title":"Combined pectoralis II block and transversus thoracic plane block compared to erector spinae plane block for post-operative analgesia in patients undergoing modified radical mastectomy: A randomized clinical trial","authors":"A. Abedalmohsen, Abdelrahman H. Mohammed, M. Bakri, Ahmed H. Othman, Mohammed A. Osman, Ola M. Wahba","doi":"10.1080/11101849.2023.2287892","DOIUrl":"https://doi.org/10.1080/11101849.2023.2287892","url":null,"abstract":"ABSTRACT Background About 30% of Egyptian females had breast cancer. Surgery is a cornerstone of the treatment plan. New fascial plane block techniques enhance recovery and improve intra-operative and post-operative pain control. Aim of the study Effect of combined pectoralis II plus transversus thoracic plane blocks (PECS II- TTP) versus erector spinae plane block (ESPB) on post-operative morphine consumption, and interleukin-6 (IL-6) levels 24 hours after surgery. Methods Sixty-four female patients 18–60 years of age, ASA I or II were divided into two equal groups (32 patients each). Group (P) received a combination of PECS II and TTP blocks (injection of 10 ml 0.25% bupivacaine between pectoralis major (PM) and minor (Pm) muscles and 10 ml between the Pm and serratus anterior (Sa) muscles) at the third or the fourth rib, then 10 ml and the internal inter-costal muscles and the transversus thoracic muscle. Group (E) received ESPB (30 ml of 0.25% bupivacaine injected deep to the erector spinae muscle at the transverse process of the fifth thoracic vertebrae). Results Morphine consumption was significantly lower in group (E) throughout the 24 hours period of post-operative follow-up (0.93 ± 0.63 vs. 2.13 ± 0.42 (mg); p = 0.03). Both groups had comparable time till the first analgesic request (p = 0.23). There was statistically non-significant difference between the two groups regarding the numeric rating scale (NRS) (P > 0.05), and post-operative IL6 either at baseline (10.03 ± 4.09 vs. 10.73 ± 3.54; p = 0.48) or at 24 hours after surgery (239.01 ± 122.11 vs. 278.08 ± 151.29; p = 0.30). Both groups had non-significant difference regarding post-operative nausea and vomiting. Conclusion ESPB is as effective as PECS II-TTP with lower morphine consumption in the first 24 hours and comparable NRS, time to first analgesic request, and interleukin-6 levels. Both blocks were safe without any major complications.","PeriodicalId":11437,"journal":{"name":"Egyptian Journal of Anaesthesia","volume":"20 1","pages":"921 - 928"},"PeriodicalIF":0.8,"publicationDate":"2023-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139215730","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
ABSTRACT Background More than 50% of individuals who have breast surgery have acute postoperative pain, and 8% among those patients endure persistent severe pain. The purpose of this study was to evaluate the efficiency of ultrasound-guided thoracic inter-fascial plane block (US-guided TIFPB) and ultrasound guided erector spinae plane block (US-guided ESPB) on acute and chronic pain following modified radical mastectomy (MRM) surgeries. Methods 90 female participants who were hospitalized for unilateral MRM surgery underwent this prospective randomized controlled trial. Patients were split into three equal groups at random: Group I: received preoperative TIFPB, group II: received preoperative ESPB, group III: received preoperative sham block (control group). Results VAS was considerably lower in group I at 12 h (P1 = 0.029) and when group III is compared with groups I and II at 2, 4, 6, 12, 18 and 24 h (P < 0.05). First analgesic requires was greatly delayed in time and total morphine consumption was significantly decreased compared to group III in groups I and II (P < 0.001) and was insignificantly different between both groups I and II. Chronic pain 3, 6 months postoperative was markedly decreased in comparison to group III in groups I and II (P < 0.05). Conclusions TIFPB and ESPB were comparable, both were superior to control in terms of lower intraoperative fentanyl consumption, pain score, first analgesic requirement onset is delayed, lower total consumption of morphine, chronic pain 3 and 6 months postoperatively. TIFPB showed a lower pain score at 12 hr. postoperatively compared to ESPB.
ABSTRACT 背景 50%以上的乳腺手术患者会出现术后急性疼痛，其中 8%的患者会忍受持续性剧烈疼痛。本研究旨在评估超声引导下胸筋膜间平面阻滞（US-guided TIFPB）和超声引导下竖脊肌平面阻滞（US-guided ESPB）对改良根治性乳房切除术（MRM）术后急性和慢性疼痛的疗效。方法 90 名因单侧 MRM 手术住院的女性患者接受了这项前瞻性随机对照试验。患者被随机分成三个相同的组别：第一组：术前接受 TIFPB，第二组：术前接受 ESPB，第三组：术前接受假阻滞（对照组）。结果 I 组在 12 小时后的 VAS 显著降低（P1 = 0.029），III 组与 I 组和 II 组相比，在 2、4、6、12、18 和 24 小时后的 VAS 显著降低（P < 0.05）。与Ⅲ组相比，Ⅰ组和Ⅱ组的首次镇痛时间大大推迟，吗啡总用量明显减少（P < 0.001），Ⅰ组和Ⅱ组之间的差异不明显。I 组和 II 组与 III 组相比，术后 3、6 个月的慢性疼痛明显减少（P < 0.05）。结论 TIFPB 和 ESPB 具有可比性，两者在术中芬太尼消耗量、疼痛评分、首次镇痛需求开始时间延迟、吗啡总消耗量降低、术后 3 个月和 6 个月慢性疼痛方面均优于对照组。与 ESPB 相比，TIFPB 在术后 12 小时的疼痛评分更低。
{"title":"Effect of preoperative ultrasound-guided thoracic interfacial plane block versus preoperative thoracic erector spinae plane block on acute and chronic pain after modified radical mastectomy: A randomized controlled trial","authors":"Areeg Kotb Ghalwash, Naglaa Khalil Yousef, Sabry Mohammed Amin, Mohamed Alaa Elsaid Barrima, Taysser Mohmoud Abdalraheem","doi":"10.1080/11101849.2023.2285268","DOIUrl":"https://doi.org/10.1080/11101849.2023.2285268","url":null,"abstract":"ABSTRACT Background More than 50% of individuals who have breast surgery have acute postoperative pain, and 8% among those patients endure persistent severe pain. The purpose of this study was to evaluate the efficiency of ultrasound-guided thoracic inter-fascial plane block (US-guided TIFPB) and ultrasound guided erector spinae plane block (US-guided ESPB) on acute and chronic pain following modified radical mastectomy (MRM) surgeries. Methods 90 female participants who were hospitalized for unilateral MRM surgery underwent this prospective randomized controlled trial. Patients were split into three equal groups at random: Group I: received preoperative TIFPB, group II: received preoperative ESPB, group III: received preoperative sham block (control group). Results VAS was considerably lower in group I at 12 h (P1 = 0.029) and when group III is compared with groups I and II at 2, 4, 6, 12, 18 and 24 h (P < 0.05). First analgesic requires was greatly delayed in time and total morphine consumption was significantly decreased compared to group III in groups I and II (P < 0.001) and was insignificantly different between both groups I and II. Chronic pain 3, 6 months postoperative was markedly decreased in comparison to group III in groups I and II (P < 0.05). Conclusions TIFPB and ESPB were comparable, both were superior to control in terms of lower intraoperative fentanyl consumption, pain score, first analgesic requirement onset is delayed, lower total consumption of morphine, chronic pain 3 and 6 months postoperatively. TIFPB showed a lower pain score at 12 hr. postoperatively compared to ESPB.","PeriodicalId":11437,"journal":{"name":"Egyptian Journal of Anaesthesia","volume":"48 1","pages":"912 - 920"},"PeriodicalIF":0.8,"publicationDate":"2023-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139217095","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-28DOI: 10.1080/11101849.2023.2285137
Fatma Ahmed Mostafa Aref, Nabila Mohammed Abdelaziz, Hesham Mohammed Elazazzi, N. Fahmy
ABSTRACT Background Erector spinae plane (ESP) block has been evaluated in many studies in pediatric surgeries by the use of postoperative rescue analgesia which is the objective parameter assessing the efficacy of the technique in controlling postoperative pain. Adjuvants were used with ESP block to densify its postoperative analgesia. Magnesium sulfate was used for suppressing somatic, endocrine and autonomic reflexes induced by noxious stimuli during surgery. Dexamethasone is a highly potent glucocorticoid that has been used in different regional anesthesia to prolong the anesthetic effect of the local anesthesia by inducing local vasoconstriction. Methodology Sixty pediatric patients underwent inguinal hernia repair under general anesthesia, and then they were assigned randomly into three groups that received ESP block either with local anesthetic alone or with magnesium sulfate or dexamethasone. Results Our study revealed no statistical significance among the three groups as regards demographic and vital data. Children’s Hospital Eastern Ontario Pain Scale score for postoperative assessment of magnesium sulfate and dexamethasone which were added to bupivacaine in ESP block had a better score than bupivacaine alone with high statistical significance. Also, magnesium sulfate and dexamethasone had a delayed first-dose postoperative rescue analgesia with significant statistical value (P value = 0.002) and total postoperative doses of postoperative rescue analgesia were lesser in magnesium sulfate and dexamethasone groups with marked statistical significance (P value < 0.001). As regards complications, there were minor ones in the form of mild bruising and mild pain at injection site with no statistical significance between the three groups (P value = 0.108). Conclusion In our study, magnesium sulfate and dexamethasone added to bupivacaine in ESP block prolonged the duration of postoperative pain control and decreased the consumption of postoperative analgesia than bupivacaine alone. No major complications were recorded in our study in the three groups which solidify the safety of the technique.
{"title":"Effect of addition of different additives: Magnesium sulfate and dexamethasone versus plain bupivacaine in ultrasound-guided erector spinae plane block in pediatrics undergoing repair of inguinal hernia","authors":"Fatma Ahmed Mostafa Aref, Nabila Mohammed Abdelaziz, Hesham Mohammed Elazazzi, N. Fahmy","doi":"10.1080/11101849.2023.2285137","DOIUrl":"https://doi.org/10.1080/11101849.2023.2285137","url":null,"abstract":"ABSTRACT Background Erector spinae plane (ESP) block has been evaluated in many studies in pediatric surgeries by the use of postoperative rescue analgesia which is the objective parameter assessing the efficacy of the technique in controlling postoperative pain. Adjuvants were used with ESP block to densify its postoperative analgesia. Magnesium sulfate was used for suppressing somatic, endocrine and autonomic reflexes induced by noxious stimuli during surgery. Dexamethasone is a highly potent glucocorticoid that has been used in different regional anesthesia to prolong the anesthetic effect of the local anesthesia by inducing local vasoconstriction. Methodology Sixty pediatric patients underwent inguinal hernia repair under general anesthesia, and then they were assigned randomly into three groups that received ESP block either with local anesthetic alone or with magnesium sulfate or dexamethasone. Results Our study revealed no statistical significance among the three groups as regards demographic and vital data. Children’s Hospital Eastern Ontario Pain Scale score for postoperative assessment of magnesium sulfate and dexamethasone which were added to bupivacaine in ESP block had a better score than bupivacaine alone with high statistical significance. Also, magnesium sulfate and dexamethasone had a delayed first-dose postoperative rescue analgesia with significant statistical value (P value = 0.002) and total postoperative doses of postoperative rescue analgesia were lesser in magnesium sulfate and dexamethasone groups with marked statistical significance (P value < 0.001). As regards complications, there were minor ones in the form of mild bruising and mild pain at injection site with no statistical significance between the three groups (P value = 0.108). Conclusion In our study, magnesium sulfate and dexamethasone added to bupivacaine in ESP block prolonged the duration of postoperative pain control and decreased the consumption of postoperative analgesia than bupivacaine alone. No major complications were recorded in our study in the three groups which solidify the safety of the technique.","PeriodicalId":11437,"journal":{"name":"Egyptian Journal of Anaesthesia","volume":"28 1","pages":"906 - 911"},"PeriodicalIF":0.8,"publicationDate":"2023-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139217146","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-27DOI: 10.1080/11101849.2023.2280944
Radwa S. Raslan, Dorreya M. Fekry, Tarek M. Sarhan, Mohamed M. El Sawy, Moutaz E. Elabbasy
ABSTRACT Background Platelet-rich plasma injection has become an effective treatment for partial rotator cuff tears. This study evaluates the efficacy of PRP versus steroids injection in pain relief for partial rotator cuff tears. Study design Prospective clinical trial. Setting Alexandria Main University Hospital. Patients and methods Sixty patients with symptomatic partial RCTs undergoing US-guided subacromial injection were randomly allocated into two equal groups: either steroids or PRP. Pain score, shoulder function, failure rate after injection, and complications were recorded. Results VAS score was significantly lower in the steroid group at week 2 follow-up than the PRP group (p 0.001). However, it was shorter, extended for 8 weeks in steroid in comparison to 4 months in PRP group. There was an insignificant difference among groups in the simple shoulder test at 2 and 4 weeks follow-up, and the test was significantly higher in PRP group at 6, 8, 12 weeks, and 4 month follow-up (P = 0.049, 0.001, 0.001, 0.001). Pain did not improve in six patients in steroid group and one patient in PRP group. Pain on injection was reported by six patients in the steroid group and 13 patients in PRP group (p = 0.052). Elevated blood sugar was significantly higher in the steroid group after the injection (p 0.001). Conclusion Subacromial PRP injection may have a prolonged analgesic effect and superior shoulder functional improvement than steroids in patients with partial RCTs.
{"title":"Ultrasound-guided platelet-rich plasma injection versus steroids injection for pain relief in partial rotator cuff tears","authors":"Radwa S. Raslan, Dorreya M. Fekry, Tarek M. Sarhan, Mohamed M. El Sawy, Moutaz E. Elabbasy","doi":"10.1080/11101849.2023.2280944","DOIUrl":"https://doi.org/10.1080/11101849.2023.2280944","url":null,"abstract":"ABSTRACT Background Platelet-rich plasma injection has become an effective treatment for partial rotator cuff tears. This study evaluates the efficacy of PRP versus steroids injection in pain relief for partial rotator cuff tears. Study design Prospective clinical trial. Setting Alexandria Main University Hospital. Patients and methods Sixty patients with symptomatic partial RCTs undergoing US-guided subacromial injection were randomly allocated into two equal groups: either steroids or PRP. Pain score, shoulder function, failure rate after injection, and complications were recorded. Results VAS score was significantly lower in the steroid group at week 2 follow-up than the PRP group (p 0.001). However, it was shorter, extended for 8 weeks in steroid in comparison to 4 months in PRP group. There was an insignificant difference among groups in the simple shoulder test at 2 and 4 weeks follow-up, and the test was significantly higher in PRP group at 6, 8, 12 weeks, and 4 month follow-up (P = 0.049, 0.001, 0.001, 0.001). Pain did not improve in six patients in steroid group and one patient in PRP group. Pain on injection was reported by six patients in the steroid group and 13 patients in PRP group (p = 0.052). Elevated blood sugar was significantly higher in the steroid group after the injection (p 0.001). Conclusion Subacromial PRP injection may have a prolonged analgesic effect and superior shoulder functional improvement than steroids in patients with partial RCTs.","PeriodicalId":11437,"journal":{"name":"Egyptian Journal of Anaesthesia","volume":"1 1","pages":"900 - 905"},"PeriodicalIF":0.8,"publicationDate":"2023-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139228533","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-23DOI: 10.1080/11101849.2023.2285132
Hany A. Shehab, Ibrahim E.M. Mostafa, Samar A. Salman
ABSTRACT Objectives To compare using deep neuromuscular blockade during low abdominal insufflation pressure (DNMB/LAIP; n = 67) to conventional blockade and pressure (CNMB/CAIP; n = 68) for laparoscopic cholecystectomy and to evaluate the speed and efficacy of NMB recovery using sugammadex (SGX) as assessed by the Postoperative Quality Recovery Scale. Patients & Methods Rocuronium initiation and maintenance doses were 0.6 and 0.15 mg/Kg, respectively, and neostigmine or SGX was used as reverse agent for CNMB and DNMB, respectively. Abdominal insufflation was terminated at 15 and 8-mmHg, for CAIP and LAIP, respectively. The study outcome is the surgical feasibility under DNMB/LAIP, as judged by the frequency of shift-to-CAIP, surgical field visibility and operative time. Results The frequency of shift-to-CAIP was 2.9% due to surgeons’ inconvenience of LAIP. DNMB allowed significant control of intraoperative (IO) hemodynamic response to surgical manipulations. SGX allowed 3.2 times faster NMB-reversal with significantly higher percentages of patients returned to baseline physiologic statuses. The percentage of patients free of pain and nausea was significantly higher after DNMB/LAIP. At hospital discharge and day-7 PO, 86.6% and 98.5% of patients regained normalcy of their overall perspectives after DNMB/LAIP with a significant difference than after CNMB/CIAP. At 2-week PO, the frequency of shoulder-tip pain (STP) was significantly lower and surgeons’ satisfaction rate was significantly with DNMB/LAIP. Conclusion Laparoscopic cholecystectomy under DNMB/LAIP procedure is feasible and safe with lower incidence and severity of STP and high surgeons’ satisfaction. Sugammadex hastened the recovery of DNMB 3.2 times that of neostigmine-induced recovery of CNMB. Registration NO: RC.3.9.2023
{"title":"Deep neuromuscular blocking and sugammadex reversing-drug is an efficient strategy permitting successful laparoscopic surgery under low insufflation pressure: Prospective multicenter study","authors":"Hany A. Shehab, Ibrahim E.M. Mostafa, Samar A. Salman","doi":"10.1080/11101849.2023.2285132","DOIUrl":"https://doi.org/10.1080/11101849.2023.2285132","url":null,"abstract":"ABSTRACT Objectives To compare using deep neuromuscular blockade during low abdominal insufflation pressure (DNMB/LAIP; n = 67) to conventional blockade and pressure (CNMB/CAIP; n = 68) for laparoscopic cholecystectomy and to evaluate the speed and efficacy of NMB recovery using sugammadex (SGX) as assessed by the Postoperative Quality Recovery Scale. Patients & Methods Rocuronium initiation and maintenance doses were 0.6 and 0.15 mg/Kg, respectively, and neostigmine or SGX was used as reverse agent for CNMB and DNMB, respectively. Abdominal insufflation was terminated at 15 and 8-mmHg, for CAIP and LAIP, respectively. The study outcome is the surgical feasibility under DNMB/LAIP, as judged by the frequency of shift-to-CAIP, surgical field visibility and operative time. Results The frequency of shift-to-CAIP was 2.9% due to surgeons’ inconvenience of LAIP. DNMB allowed significant control of intraoperative (IO) hemodynamic response to surgical manipulations. SGX allowed 3.2 times faster NMB-reversal with significantly higher percentages of patients returned to baseline physiologic statuses. The percentage of patients free of pain and nausea was significantly higher after DNMB/LAIP. At hospital discharge and day-7 PO, 86.6% and 98.5% of patients regained normalcy of their overall perspectives after DNMB/LAIP with a significant difference than after CNMB/CIAP. At 2-week PO, the frequency of shoulder-tip pain (STP) was significantly lower and surgeons’ satisfaction rate was significantly with DNMB/LAIP. Conclusion Laparoscopic cholecystectomy under DNMB/LAIP procedure is feasible and safe with lower incidence and severity of STP and high surgeons’ satisfaction. Sugammadex hastened the recovery of DNMB 3.2 times that of neostigmine-induced recovery of CNMB. Registration NO: RC.3.9.2023","PeriodicalId":11437,"journal":{"name":"Egyptian Journal of Anaesthesia","volume":"18 1","pages":"883 - 893"},"PeriodicalIF":0.8,"publicationDate":"2023-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139244322","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-16DOI: 10.1080/11101849.2023.2280942
Sarah A. Elmetwally, Duaa Omran, Amel H Abo Elela, Ashraf M. Abdelrhaim, Samy. M.M. Amin, Dalia Saad
ABSTRACT Background and Objective Spinal cord ischemia with subsequent paraplegia secondary to aortic coarctation repair procedures is rare, but it has serious consequences that can affect quality of life. Infrared spectroscopy (NIRS) is used for non invasive spinal cord oxygenation monitoring to estimate cord perfusion and detect early cord ischemic changes. Several pharmacological agents have been used to improve cord perfusion, the main action of these agents is to improve regional/systemic perfusion and decrease ICP. In the current study, we studied magnesium sulphate and levosimendan for their vasodilating effect that might improve spinal cord perfusion as part of spinal cord protection. Methods Forty two infants undergoing aortic coarctectomy under general anaesthesia were registered in double blinded randomized controlled study, three groups were included; group C received i.v. saline, group L received levosimendan in loading dose 6ug/kg i.v. for 15 minutes then maintenance dose 0.1 ug/kg/min till end of surgery and group M received levosimendan in loading dose 6 ug/kg i.v. for 15 minutes then maintenance dose 0.1 ug/kg/min in combination with magnesium sulphate in loading dose 25 mg/kg i.v. for 15 minutes then maintenance dose 10 mg/kg/hr till the end of surgery. The vital signs and NIRS values assessed before, during and after clamping of aorta. Results All baseline demographic data were comparable among all groups except for height (cm), which was significantly lower in Group L compared to Group C (p = 0.013). NIRS values were comparable among the three groups throughout experimental protocol except after cross clamp at 20 minutes, where Group M was significantly higher compared to group C (P = 0.007).Heart rate, mean arterial blood pressure, total fluid intake, urine output, aortic cross clamp time and surgical time was comparable among all groups, were comparable among 3 studied groups. Conclusion Adding magnesium sulphate to levosimendan has showed improvement in spinal cord perfusion during cross clamping as monitored by NIRS when compared to use of levosimendan alone or placebo in coarctectomy operations without affecting hemodynamics.
{"title":"Efficacy of levosimendan vs its combination with magnesium sulphate on spinal cord protection in infants undergoing coarctectomy: A randomized controlled study","authors":"Sarah A. Elmetwally, Duaa Omran, Amel H Abo Elela, Ashraf M. Abdelrhaim, Samy. M.M. Amin, Dalia Saad","doi":"10.1080/11101849.2023.2280942","DOIUrl":"https://doi.org/10.1080/11101849.2023.2280942","url":null,"abstract":"ABSTRACT Background and Objective Spinal cord ischemia with subsequent paraplegia secondary to aortic coarctation repair procedures is rare, but it has serious consequences that can affect quality of life. Infrared spectroscopy (NIRS) is used for non invasive spinal cord oxygenation monitoring to estimate cord perfusion and detect early cord ischemic changes. Several pharmacological agents have been used to improve cord perfusion, the main action of these agents is to improve regional/systemic perfusion and decrease ICP. In the current study, we studied magnesium sulphate and levosimendan for their vasodilating effect that might improve spinal cord perfusion as part of spinal cord protection. Methods Forty two infants undergoing aortic coarctectomy under general anaesthesia were registered in double blinded randomized controlled study, three groups were included; group C received i.v. saline, group L received levosimendan in loading dose 6ug/kg i.v. for 15 minutes then maintenance dose 0.1 ug/kg/min till end of surgery and group M received levosimendan in loading dose 6 ug/kg i.v. for 15 minutes then maintenance dose 0.1 ug/kg/min in combination with magnesium sulphate in loading dose 25 mg/kg i.v. for 15 minutes then maintenance dose 10 mg/kg/hr till the end of surgery. The vital signs and NIRS values assessed before, during and after clamping of aorta. Results All baseline demographic data were comparable among all groups except for height (cm), which was significantly lower in Group L compared to Group C (p = 0.013). NIRS values were comparable among the three groups throughout experimental protocol except after cross clamp at 20 minutes, where Group M was significantly higher compared to group C (P = 0.007).Heart rate, mean arterial blood pressure, total fluid intake, urine output, aortic cross clamp time and surgical time was comparable among all groups, were comparable among 3 studied groups. Conclusion Adding magnesium sulphate to levosimendan has showed improvement in spinal cord perfusion during cross clamping as monitored by NIRS when compared to use of levosimendan alone or placebo in coarctectomy operations without affecting hemodynamics.","PeriodicalId":11437,"journal":{"name":"Egyptian Journal of Anaesthesia","volume":"34 4","pages":"876 - 882"},"PeriodicalIF":0.8,"publicationDate":"2023-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139269645","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background Regional analgesia provides adequate management of pain during mastectomies and early postoperative period. The erector spinae plane block (ESPB) is a promising regional technique. This study compared the efficacy of ESPB versus paravertebral block (PVB) catheters for pain management in modified radical mastectomy (MRM).
{"title":"Ultrasound continuous erector spinae catheter versus paravertebral catheter for pain management in modified radical mastectomy for cancer patients: A randomized double-blind","authors":"Suzan Adlan, Eman Sameh, Fatma Hanafi Mahmoud, Reham Mohamed Gamal, Taher Thabet","doi":"10.1080/11101849.2023.2281104","DOIUrl":"https://doi.org/10.1080/11101849.2023.2281104","url":null,"abstract":"Background Regional analgesia provides adequate management of pain during mastectomies and early postoperative period. The erector spinae plane block (ESPB) is a promising regional technique. This study compared the efficacy of ESPB versus paravertebral block (PVB) catheters for pain management in modified radical mastectomy (MRM).","PeriodicalId":11437,"journal":{"name":"Egyptian Journal of Anaesthesia","volume":"3 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134901518","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background The caudal block (CB) is a quick, and safe approach for pediatric analgesia. Numerous adjuvants were added to extend the analgesia duration. Our trial aims to evaluate the significance of CB by adding dexmedetomidine, ketamine, and MgSO₄ to bupivacaine to provide postoperative analgesia in children undergoing hypospadias repair.
{"title":"Role of adding dexmedetomidine, ketamine, and magnesium sulphate to caudal block as preemptive analgesia in hypospadias repair in pediatrics: A randomized double-blinded prospective trial","authors":"Basma M. Ghoniem, Gamal Hendawy Shams, Wafaa Abdelsalam, Sherif Medhat, Mahmoud Fawzy Elsharkawy","doi":"10.1080/11101849.2023.2281206","DOIUrl":"https://doi.org/10.1080/11101849.2023.2281206","url":null,"abstract":"Background The caudal block (CB) is a quick, and safe approach for pediatric analgesia. Numerous adjuvants were added to extend the analgesia duration. Our trial aims to evaluate the significance of CB by adding dexmedetomidine, ketamine, and MgSO₄ to bupivacaine to provide postoperative analgesia in children undergoing hypospadias repair.","PeriodicalId":11437,"journal":{"name":"Egyptian Journal of Anaesthesia","volume":"37 28","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134954622","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-09DOI: 10.1080/11101849.2023.2278865
Mohamed S. Shorbagy, Mona R. Hosny, Wael Abdelmoneim
Background Stellate ganglion block (SGB) is a successful technique that can potentially maintain hemodynamics and terminate fatal arrhythmia. We aimed to study the efficacy of SGB on hemodynamic changes after on pump coronary artery bypass grafting (CABG) surgery.
{"title":"Effects of stellate ganglion block on the perioperative hemodynamics for coronary artery bypass grafting surgery","authors":"Mohamed S. Shorbagy, Mona R. Hosny, Wael Abdelmoneim","doi":"10.1080/11101849.2023.2278865","DOIUrl":"https://doi.org/10.1080/11101849.2023.2278865","url":null,"abstract":"Background Stellate ganglion block (SGB) is a successful technique that can potentially maintain hemodynamics and terminate fatal arrhythmia. We aimed to study the efficacy of SGB on hemodynamic changes after on pump coronary artery bypass grafting (CABG) surgery.","PeriodicalId":11437,"journal":{"name":"Egyptian Journal of Anaesthesia","volume":" 6","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135242089","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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