Pub Date : 2023-09-04DOI: 10.1080/11101849.2023.2253641
Mona Raafat Elghamry, Mohamed Samir AbdElghafar, M. Afandy
ABSTRACT Background In patients at high risk, regional anesthesia (RA) is a viable substitute for general anesthesia (GA). For a modified radical mastectomy that included axillary lymph node dissection (MRM-ALND), we assumed that a combination erector spinae plane block (ESPB) and interscalene block (IBPB) could offer a sufficient anesthesia. Methods After clinical trial registration (No. NCT04239716), this pilot study included thirteen consecutive female, 40–85 years old, and scheduled for MRM-ALND. Patients received ESPB at T4 level (5 ml of 2% lidocaine, 10 ml of 0.5% bupivacaine, and 5 ml of normal saline), IBPB (5 ml each of 2% lidocaine and 0.5% bupivacaine), and sedation with dexmedetomidine. The primary aim was to assess the success rate of our technique as a sole anesthesia for MRM-ALND in high-risk patients. Secondary outcomes included intraoperative vital signs measurements. Postoperative measurements were numeric rating scale (NRS) score, analgesic duration, the consumption of morphine, patients’ satisfaction, and adverse effects. Results Our technique succeeded in 11 out of 13 patients. In whom RA were succeeded, the analgesia lasted 360–720 minutes, they received morphine 3–9 mg and had low NRS scores. The two failure cases received GA, the analgesia lasted 60–120 minutes postoperative, they received morphine 9 mg and had high NRS scores. The reduction of hemodynamic parameters intraoperative responded to reduce dexmedetomidine infusion rate. Two patients had postoperative vomiting treated with ondansetrone. Conclusions The combined ESPB and IBPB could be utilized as an alternative to GA for MRM-ALND, which reduced the potential risks of GA in high-risk patients; furthermore, it provides satisfactory postoperative analgesia with limited opioid consumption.
{"title":"Feasibility of combined ultrasound guided interscalene and erector spinae plane block for regional anesthesia in modified radical mastectomy with axillary lymph node dissection: A pilot study","authors":"Mona Raafat Elghamry, Mohamed Samir AbdElghafar, M. Afandy","doi":"10.1080/11101849.2023.2253641","DOIUrl":"https://doi.org/10.1080/11101849.2023.2253641","url":null,"abstract":"ABSTRACT Background In patients at high risk, regional anesthesia (RA) is a viable substitute for general anesthesia (GA). For a modified radical mastectomy that included axillary lymph node dissection (MRM-ALND), we assumed that a combination erector spinae plane block (ESPB) and interscalene block (IBPB) could offer a sufficient anesthesia. Methods After clinical trial registration (No. NCT04239716), this pilot study included thirteen consecutive female, 40–85 years old, and scheduled for MRM-ALND. Patients received ESPB at T4 level (5 ml of 2% lidocaine, 10 ml of 0.5% bupivacaine, and 5 ml of normal saline), IBPB (5 ml each of 2% lidocaine and 0.5% bupivacaine), and sedation with dexmedetomidine. The primary aim was to assess the success rate of our technique as a sole anesthesia for MRM-ALND in high-risk patients. Secondary outcomes included intraoperative vital signs measurements. Postoperative measurements were numeric rating scale (NRS) score, analgesic duration, the consumption of morphine, patients’ satisfaction, and adverse effects. Results Our technique succeeded in 11 out of 13 patients. In whom RA were succeeded, the analgesia lasted 360–720 minutes, they received morphine 3–9 mg and had low NRS scores. The two failure cases received GA, the analgesia lasted 60–120 minutes postoperative, they received morphine 9 mg and had high NRS scores. The reduction of hemodynamic parameters intraoperative responded to reduce dexmedetomidine infusion rate. Two patients had postoperative vomiting treated with ondansetrone. Conclusions The combined ESPB and IBPB could be utilized as an alternative to GA for MRM-ALND, which reduced the potential risks of GA in high-risk patients; furthermore, it provides satisfactory postoperative analgesia with limited opioid consumption.","PeriodicalId":11437,"journal":{"name":"Egyptian Journal of Anaesthesia","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2023-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44090233","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 : 2023-08-30DOI: 10.1080/11101849.2023.2253074
M. S. Abbas, Asmaa Shabaan Ahmed, Nawal Abd El-Aziz Gad El-Rab, Ahmed MA Sobh, A. Aboulfotouh
ABSTRACT Background The unopposed vagal activity with sympathetic block and maternal bradycardia that is likely to occur with phenylephrine infusion might be some causes of intraoperative nausea and vomiting (IONV) during spinal anaesthesia. We aimed at comparing hyoscine butyl-bromide (HBB) and ondansetron in reduction of intraoperative bradycardia and thus IONV in women undergoing caesarean delivery (CD). Methods In a randomized, double-blind, placebo-controlled trial, women undergoing elective CD were randomly assigned to administer either IV HBB 20 mg, ondansetron 8 mg, or the same volume of 0.9% saline right before spinal anaesthesia. The primary endpoint was the incidence of IONV. Secondary endpoints included intraoperative maternal bradycardia and hypotension and postoperative nausea and vomiting (PONV). Results 55 subjects in each group received the assigned intervention. During the intraoperative period, HBB decreased only the incidence of emesis when compared to the control group (P = 0.046) while ondansetron statistically decreased the incidence of IONV when compared to the control group (P = 0.034). HBB statistically decreased the incidence of intraoperative maternal bradycardia when compared to the controls (1.8% vs 14.5%; OR = 0.1, 95% CI = [0.01, 0.90]; P < 0.039). Compared to the control group, ondansetron was superior to HBB in reducing PONV (P = 0.001 & 0.57), respectively. Conclusions In women scheduled for CD with spinal anaesthesia, prophylactic HBB was as effective as ondansetron in reducing intraoperative emesis, with the added benefit of the less incidence of intraoperative bradycardia than ondansetron. Meanwhile, Ondansetron reduced the incidence of PONV significantly.
{"title":"Hyoscine butyl-bromide versus ondansetron for nausea and vomiting during caesarean delivery under spinal anaesthesia. A randomized clinical trial","authors":"M. S. Abbas, Asmaa Shabaan Ahmed, Nawal Abd El-Aziz Gad El-Rab, Ahmed MA Sobh, A. Aboulfotouh","doi":"10.1080/11101849.2023.2253074","DOIUrl":"https://doi.org/10.1080/11101849.2023.2253074","url":null,"abstract":"ABSTRACT Background The unopposed vagal activity with sympathetic block and maternal bradycardia that is likely to occur with phenylephrine infusion might be some causes of intraoperative nausea and vomiting (IONV) during spinal anaesthesia. We aimed at comparing hyoscine butyl-bromide (HBB) and ondansetron in reduction of intraoperative bradycardia and thus IONV in women undergoing caesarean delivery (CD). Methods In a randomized, double-blind, placebo-controlled trial, women undergoing elective CD were randomly assigned to administer either IV HBB 20 mg, ondansetron 8 mg, or the same volume of 0.9% saline right before spinal anaesthesia. The primary endpoint was the incidence of IONV. Secondary endpoints included intraoperative maternal bradycardia and hypotension and postoperative nausea and vomiting (PONV). Results 55 subjects in each group received the assigned intervention. During the intraoperative period, HBB decreased only the incidence of emesis when compared to the control group (P = 0.046) while ondansetron statistically decreased the incidence of IONV when compared to the control group (P = 0.034). HBB statistically decreased the incidence of intraoperative maternal bradycardia when compared to the controls (1.8% vs 14.5%; OR = 0.1, 95% CI = [0.01, 0.90]; P < 0.039). Compared to the control group, ondansetron was superior to HBB in reducing PONV (P = 0.001 & 0.57), respectively. Conclusions In women scheduled for CD with spinal anaesthesia, prophylactic HBB was as effective as ondansetron in reducing intraoperative emesis, with the added benefit of the less incidence of intraoperative bradycardia than ondansetron. Meanwhile, Ondansetron reduced the incidence of PONV significantly.","PeriodicalId":11437,"journal":{"name":"Egyptian Journal of Anaesthesia","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2023-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45649747","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 : 2023-08-28DOI: 10.1080/11101849.2023.2248738
Nevein Fawzy El Sayed Abdelmaksoud, Gamal Eldin Mohammad Ahmad Elewa, Mayar El Sersi, Dalia F. Ali Nawar, Ahmed Eldemerdash
ABSTRACT Sepsis being a chief prominent fatal condition in critically ill patients. In septic-shocked patients, the first-line therapeutic intervention is fluid resuscitation in an attempt to improve their cardiac output (COP). However, fluids must be given only if the chance of improving COP exists. So, assessing fluid responsiveness is crucial. To our knowledge, yet no studies comparing the end-expiratory occlusion (EEO) test and the variation of the inferior vena cava (IVC) diameter with respiration (ΔIVC) in hypovolemic cases. So, our aim is to use both tests as indices for responsiveness to fluid in septic mechanically ventilated (MV) patients. The Patients and Method: Thirty-four MV septic patients were enrolled and baseline COP assessment was performed followed by an EEO test applied to each patient, after which, COP was measured to detect the probable responders (defined as an increased COP by ≥ 15%) and non-responders. Then, ΔIVC was assessed for the same patients to predict the probable responders (with ΔIVC >12%) and non-responders. Finally, fluid therapy was initiated as per the guidelines of surviving sepsis campaign (2021) followed by COP re-assessment to determine actual fluid respondersnon-responders. Results: 67% of the cases was responding to fluid. Receiver operating characteristic showed areas under curve for EEO and ΔIVC in predicting responsiveness to fluid were 0.597 and 0.925, respectively. EEO (32.4%) was predictive with 47.8% sensitivity and 100% specificity. The ΔIVC (64.7%) was predictive with 91.3% sensitivity and 100% specificity. Conclusion: IVC-respiratory variation showed better values in prediction of response to fluid in MV patients with sepsis than EEO test.
{"title":"The use of end-expiratory occlusion test vs. inferior vena cava respiratory variation for the prediction of volume responsiveness in mechanically ventilated patients with sepsis: A comparative study","authors":"Nevein Fawzy El Sayed Abdelmaksoud, Gamal Eldin Mohammad Ahmad Elewa, Mayar El Sersi, Dalia F. Ali Nawar, Ahmed Eldemerdash","doi":"10.1080/11101849.2023.2248738","DOIUrl":"https://doi.org/10.1080/11101849.2023.2248738","url":null,"abstract":"ABSTRACT Sepsis being a chief prominent fatal condition in critically ill patients. In septic-shocked patients, the first-line therapeutic intervention is fluid resuscitation in an attempt to improve their cardiac output (COP). However, fluids must be given only if the chance of improving COP exists. So, assessing fluid responsiveness is crucial. To our knowledge, yet no studies comparing the end-expiratory occlusion (EEO) test and the variation of the inferior vena cava (IVC) diameter with respiration (ΔIVC) in hypovolemic cases. So, our aim is to use both tests as indices for responsiveness to fluid in septic mechanically ventilated (MV) patients. The Patients and Method: Thirty-four MV septic patients were enrolled and baseline COP assessment was performed followed by an EEO test applied to each patient, after which, COP was measured to detect the probable responders (defined as an increased COP by ≥ 15%) and non-responders. Then, ΔIVC was assessed for the same patients to predict the probable responders (with ΔIVC >12%) and non-responders. Finally, fluid therapy was initiated as per the guidelines of surviving sepsis campaign (2021) followed by COP re-assessment to determine actual fluid respondersnon-responders. Results: 67% of the cases was responding to fluid. Receiver operating characteristic showed areas under curve for EEO and ΔIVC in predicting responsiveness to fluid were 0.597 and 0.925, respectively. EEO (32.4%) was predictive with 47.8% sensitivity and 100% specificity. The ΔIVC (64.7%) was predictive with 91.3% sensitivity and 100% specificity. Conclusion: IVC-respiratory variation showed better values in prediction of response to fluid in MV patients with sepsis than EEO test.","PeriodicalId":11437,"journal":{"name":"Egyptian Journal of Anaesthesia","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2023-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41734844","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 : 2023-08-22DOI: 10.1080/11101849.2023.2248740
Mona Gad Mostafa Elebieby, A. Elshazli, Ahmed Medhat Ahmed Mohasseb, Mohammed Nashaat Mohammed
ABSTRACT Background “Ilioinguinal/iliohypogastric nerve block” (IINB) has been described as effective regional anesthetic method for providing analgesia after inguinal hernia operations. Other studies have also reported that the “posterior quadratus lumborum block” (PQLB) is an effective analgesic option for lower abdominal surgeries. Herein, we compared the previous two block techniques for postoperative pain management in adults undergoing unilateral inguinal hernia repair. Methods According to the block technique, 76 adult patients scheduled for inguinal hernioplasty under general anesthesia were randomly enrolled into two groups; the PQLB and IINB groups. The block was performed after skin closure and before patient extubation. Postoperative analgesic profiles were recorded in both groups. Results The PQLB had lower heart rate and mean arterial pressure readings during postoperative assessment compared to the other group. Pain scores showed a significant decline in association with the PQLB during the first postoperative day, which resulted in a significant decline in pethidine consumption (49.17 vs. 70 mg in the IINB group) and better patient satisfaction. The duration to the first analgesic request significantly increased in association with the PQLB (13.25 vs. 8.42 hours in the IINB group). The incidence of nausea and vomiting increased significantly in the IINB group secondary to increased pethidine requirements. Conclusion PQLB is superior to IINB in providing analgesia for patients undergoing inguinal hernia repair.
{"title":"Ultrasound-guided ilioinguinal/iliohypogastric nerve block compared to posterior quadratus lumborum block in patients undergoing inguinal hernia repair","authors":"Mona Gad Mostafa Elebieby, A. Elshazli, Ahmed Medhat Ahmed Mohasseb, Mohammed Nashaat Mohammed","doi":"10.1080/11101849.2023.2248740","DOIUrl":"https://doi.org/10.1080/11101849.2023.2248740","url":null,"abstract":"ABSTRACT Background “Ilioinguinal/iliohypogastric nerve block” (IINB) has been described as effective regional anesthetic method for providing analgesia after inguinal hernia operations. Other studies have also reported that the “posterior quadratus lumborum block” (PQLB) is an effective analgesic option for lower abdominal surgeries. Herein, we compared the previous two block techniques for postoperative pain management in adults undergoing unilateral inguinal hernia repair. Methods According to the block technique, 76 adult patients scheduled for inguinal hernioplasty under general anesthesia were randomly enrolled into two groups; the PQLB and IINB groups. The block was performed after skin closure and before patient extubation. Postoperative analgesic profiles were recorded in both groups. Results The PQLB had lower heart rate and mean arterial pressure readings during postoperative assessment compared to the other group. Pain scores showed a significant decline in association with the PQLB during the first postoperative day, which resulted in a significant decline in pethidine consumption (49.17 vs. 70 mg in the IINB group) and better patient satisfaction. The duration to the first analgesic request significantly increased in association with the PQLB (13.25 vs. 8.42 hours in the IINB group). The incidence of nausea and vomiting increased significantly in the IINB group secondary to increased pethidine requirements. Conclusion PQLB is superior to IINB in providing analgesia for patients undergoing inguinal hernia repair.","PeriodicalId":11437,"journal":{"name":"Egyptian Journal of Anaesthesia","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2023-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48461798","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 : 2023-08-18DOI: 10.1080/11101849.2023.2246232
Emad Zarief Kamel, Nagwa M Ibrahem, Hazem Abu Zeid Yousef, Mohammed Gaber Farghly, Shady Safwat Hassan, Khaled Tolba Younes, Yasser Ashraf Gamal, Mina Maher Raouf, Omar Makram Soliman
ABSTRACT Background Traumatic brain injury (TBI) is a quite common health problem. A lot of delayed complications are related to inflammatory responses that occurred within the brain itself. Atorvastatin is related to lipid lowering drugs carrying some anti-inflammatory properties and upon this fact this study hypothesis was built. Methods Twenty adult patients with TBI, Glasgow coma scale (GCS) 9–11. Patients were equally and randomly allocated into two groups (group C as control group and group S received atorvastatin 40 mg once daily for 48 h). After 48 h, participants have undergone magnetic resonance imaging brain spectroscopy examination (MRS). The spectral peaks of N-Acetyl aspartate (NAA), Choline, and Creatinine (Cr) were assessed in brain tissue. The primary outcome was presented as ratios of NAA/Cr), Cho/Cr, and NAA/Cho. Other outcomes included GCS and ICU stay. Results There were insignificant variations between groups were found in the MRS results for metabolite alterations (NAA, Cr, and Cho). Contrasted with the control group, the statin group’s Cho/Cr ratio was significantly lower (P = 0.005), and NAA/Cho was significantly greater in the statin group than control group (P = 0.022). Statin group showed higher GCS the 1st day (P = 0.01), and lesser ICU stay (P = 0.04) Conclusion Atorvastatin can be used safely in mild-to-moderate TBI patients with a favourable outcome in the form of decreased Cho/Cr ratio and increased NAA/Cho ratio, higher GCS, and decreased ICU length of stay.
{"title":"The anti-inflammatory effects of atorvastatin upon the outcome of traumatic brain injury patients: A randomized-controlled double-blind clinical trial","authors":"Emad Zarief Kamel, Nagwa M Ibrahem, Hazem Abu Zeid Yousef, Mohammed Gaber Farghly, Shady Safwat Hassan, Khaled Tolba Younes, Yasser Ashraf Gamal, Mina Maher Raouf, Omar Makram Soliman","doi":"10.1080/11101849.2023.2246232","DOIUrl":"https://doi.org/10.1080/11101849.2023.2246232","url":null,"abstract":"ABSTRACT Background Traumatic brain injury (TBI) is a quite common health problem. A lot of delayed complications are related to inflammatory responses that occurred within the brain itself. Atorvastatin is related to lipid lowering drugs carrying some anti-inflammatory properties and upon this fact this study hypothesis was built. Methods Twenty adult patients with TBI, Glasgow coma scale (GCS) 9–11. Patients were equally and randomly allocated into two groups (group C as control group and group S received atorvastatin 40 mg once daily for 48 h). After 48 h, participants have undergone magnetic resonance imaging brain spectroscopy examination (MRS). The spectral peaks of N-Acetyl aspartate (NAA), Choline, and Creatinine (Cr) were assessed in brain tissue. The primary outcome was presented as ratios of NAA/Cr), Cho/Cr, and NAA/Cho. Other outcomes included GCS and ICU stay. Results There were insignificant variations between groups were found in the MRS results for metabolite alterations (NAA, Cr, and Cho). Contrasted with the control group, the statin group’s Cho/Cr ratio was significantly lower (P = 0.005), and NAA/Cho was significantly greater in the statin group than control group (P = 0.022). Statin group showed higher GCS the 1st day (P = 0.01), and lesser ICU stay (P = 0.04) Conclusion Atorvastatin can be used safely in mild-to-moderate TBI patients with a favourable outcome in the form of decreased Cho/Cr ratio and increased NAA/Cho ratio, higher GCS, and decreased ICU length of stay.","PeriodicalId":11437,"journal":{"name":"Egyptian Journal of Anaesthesia","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2023-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48396779","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 : 2023-08-18DOI: 10.1080/11101849.2023.2247870
Mohamed F. Mostafa, H. Youssef, Rehab Okely, A. Aboulfotouh
ABSTRACT Background Postoperative agitation is characterized by increased recovery time, irritability, and disorientation. This study hypothesized that adding nalbuphine to caudal bupivacaine could improve postoperative emergence agitation (EA). Methods Eighty children (2-12 years and ASA I-II) undergoing sub-umbilical abdominal surgeries were randomly allocated into two equal groups. Group-B received caudal bupivacaine 0.125 of 1 ml/kg plus 2 ml normal saline, whereas Group-N received caudal bupivacaine 0.125 of 1 ml/kg plus 0.2 mg/kg nalbuphine diluted in 2ml normal saline. We evaluated postoperative EA according to the pediatric anesthesia emergence delirium scale (PAED) on admission to the PACU and every 30 minutes for two hours postoperatively. Postoperative pain, sedation, rescue analgesia complications, and parents’ satisfaction were also recorded. Results No statistically significant difference between both groups regarding the postoperative PAED scale at different times (p > 0.05), but inside each group, there was a significant decrease PAED scale at different times of assessment (p < 0.001) as compared to baseline data. Group-N had significantly better results concerning postoperative sedation and analgesia. No significant differences between study groups as regardingthe hemodynamic parameters. Group-N had a significantly prolonged time to 1st analgesic request, lower total rescue analgesia consumption, and more parents’ satisfaction scores. No serious adverse effects were recorded during the study. Conclusion Adding nalbuphine to bupivacaine during pediatric caudal block had no significantly different effects on postoperative EA (PAED score). Both drugs decreased the incidence of EA with less severity in the nalbuphine group. Nalbuphine also decreases postoperative pain with more sedation.
{"title":"Effect of caudal nalbuphine on postoperative emergence agitation in pediatrics undergoing infra-umbilical surgeries: Randomized double-blind study","authors":"Mohamed F. Mostafa, H. Youssef, Rehab Okely, A. Aboulfotouh","doi":"10.1080/11101849.2023.2247870","DOIUrl":"https://doi.org/10.1080/11101849.2023.2247870","url":null,"abstract":"ABSTRACT Background Postoperative agitation is characterized by increased recovery time, irritability, and disorientation. This study hypothesized that adding nalbuphine to caudal bupivacaine could improve postoperative emergence agitation (EA). Methods Eighty children (2-12 years and ASA I-II) undergoing sub-umbilical abdominal surgeries were randomly allocated into two equal groups. Group-B received caudal bupivacaine 0.125 of 1 ml/kg plus 2 ml normal saline, whereas Group-N received caudal bupivacaine 0.125 of 1 ml/kg plus 0.2 mg/kg nalbuphine diluted in 2ml normal saline. We evaluated postoperative EA according to the pediatric anesthesia emergence delirium scale (PAED) on admission to the PACU and every 30 minutes for two hours postoperatively. Postoperative pain, sedation, rescue analgesia complications, and parents’ satisfaction were also recorded. Results No statistically significant difference between both groups regarding the postoperative PAED scale at different times (p > 0.05), but inside each group, there was a significant decrease PAED scale at different times of assessment (p < 0.001) as compared to baseline data. Group-N had significantly better results concerning postoperative sedation and analgesia. No significant differences between study groups as regardingthe hemodynamic parameters. Group-N had a significantly prolonged time to 1st analgesic request, lower total rescue analgesia consumption, and more parents’ satisfaction scores. No serious adverse effects were recorded during the study. Conclusion Adding nalbuphine to bupivacaine during pediatric caudal block had no significantly different effects on postoperative EA (PAED score). Both drugs decreased the incidence of EA with less severity in the nalbuphine group. Nalbuphine also decreases postoperative pain with more sedation.","PeriodicalId":11437,"journal":{"name":"Egyptian Journal of Anaesthesia","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2023-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43790763","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 : 2023-08-18DOI: 10.1080/11101849.2023.2247231
Y. Dabour, Ahmed Said Elnoury, Ahmed Abouelgheit Daoud
ABSTRACT Objectives Determination of the efficacy of postoperative (PO) infusion of orphenadrine/ketorolac (O/KT) combination for 24-h as PO analgesia and its opioid-sparing rate (OSR) compared to orphenadrine/diclofenac (O/D) and Placebo infusions for women undergoing Modified Radical Mastectomy. Patients & Methods A total of 129 women with operable cancer breast received the same anesthetic procedure and were randomly divided into groups I–III according to the PO infusion. Infusions were started before skin closure for 60-min and were repeated for 8-hourly for 24-h. Pain severity was assessed using the numeric rating scale (NRS) and at NRS scores >4, morphine 5 mg was given. The OSR was defined as the number of patients who required no PO morphine in the study outcome. Results The OSR was significantly higher with O/KT than with O/D infusion (72.1% vs. 51.2%, respectively) and the frequency of requesting multiple doses of morphine was significantly lower with O/KT than other infusions with significant difference in favor of O/D infusion than placebo. The frequency of early requests of morphine was significantly lower with O/KT having a significantly longer duration till the first request. The average pain scores were significantly lower with O/KT infusion. PO morphine-related side effects were significantly higher, while patient and surgeon’s satisfaction scores were significantly lower among patients of the placebo group. Conclusion Cocktails of ketorolac or diclofenac with orphenadrine infusions for 24-h after mastectomy improve PO pain sensation with a reduction of opioid consumption. The O/KT infusion was superior to the O/D infusion with regard to OSR and pain scores.
{"title":"Twenty-four-hour postoperative orphenadrine and ketorolac infusion efficiently precedes orphenadrine-diclofenac infusion as an opioid-sparing analgesic modality after mastectomy","authors":"Y. Dabour, Ahmed Said Elnoury, Ahmed Abouelgheit Daoud","doi":"10.1080/11101849.2023.2247231","DOIUrl":"https://doi.org/10.1080/11101849.2023.2247231","url":null,"abstract":"ABSTRACT Objectives Determination of the efficacy of postoperative (PO) infusion of orphenadrine/ketorolac (O/KT) combination for 24-h as PO analgesia and its opioid-sparing rate (OSR) compared to orphenadrine/diclofenac (O/D) and Placebo infusions for women undergoing Modified Radical Mastectomy. Patients & Methods A total of 129 women with operable cancer breast received the same anesthetic procedure and were randomly divided into groups I–III according to the PO infusion. Infusions were started before skin closure for 60-min and were repeated for 8-hourly for 24-h. Pain severity was assessed using the numeric rating scale (NRS) and at NRS scores >4, morphine 5 mg was given. The OSR was defined as the number of patients who required no PO morphine in the study outcome. Results The OSR was significantly higher with O/KT than with O/D infusion (72.1% vs. 51.2%, respectively) and the frequency of requesting multiple doses of morphine was significantly lower with O/KT than other infusions with significant difference in favor of O/D infusion than placebo. The frequency of early requests of morphine was significantly lower with O/KT having a significantly longer duration till the first request. The average pain scores were significantly lower with O/KT infusion. PO morphine-related side effects were significantly higher, while patient and surgeon’s satisfaction scores were significantly lower among patients of the placebo group. Conclusion Cocktails of ketorolac or diclofenac with orphenadrine infusions for 24-h after mastectomy improve PO pain sensation with a reduction of opioid consumption. The O/KT infusion was superior to the O/D infusion with regard to OSR and pain scores.","PeriodicalId":11437,"journal":{"name":"Egyptian Journal of Anaesthesia","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2023-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48986863","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 : 2023-08-18DOI: 10.1080/11101849.2023.2246236
S. Amr, A. Othman, Rania Mohamed Mohamed Bakri El-Aton, Mohammed Farghaly Abd-El-Hamed, Diab Hetta
ABSTRACT Background Cancer patients undergoing major noncardiac surgery are more likely to experience perioperative morbidity and mortality due to myocardial damage. Methods Comparative study enrolled 80 patients with upper abdominal malignancies subjected to major abdominal surgeries. Of them, seventy-two patients were eligible and randomly assigned into two groups; Epidural catheter group (n = 37), received thoracic epidural infusion of levobupivacaine, and pre-peritoneal catheter group (n = 35), received preperitoneal infusion of levobupivacaine postoperatively. Primary endpoint was pain severity by NRS immediately after recovery, at 2, 4, 6, 12, 24, 36, and 48 hours. Secondary endpoints were: (1) Patient`s hemodynamics monitored for postoperative 48 hours. (2) Myocardial injury, confirmed by troponin I & BNP levels preoperatively and on postoperative day 1 and 2 (3) Time of first analgesic demand and total postoperative 48 h morphine consumption. (4) Cardiovascular side effects; hypotension, bradycardia & arrhythmia. (5) Morphine side effects; PONV Results NRS scores showed non-significant reduction at most study times between both groups with significant reduction in the ECI group at 6-, 12-, and 24-hour than other group. First analgesic demand was earlier in PCI group than ECI without significant difference, while total 48 h morphine consumption showed a significant reduction in ECI group than PCI group. Hemodynamics were comparable in both groups. Cardiac enzymes, Troponin I and BNP, showed non-significant differences over study time between both groups. Postoperative complications, PONV, were similar in both groups without any significance, but with more cases of hypotension and bradycardia in epidural group. No cases of myocardial injury or heart failure were reported. Conclusions Preperitoneal analgesia is an effective analgesic method comparable to epidural analgesia limiting the occurrence of major cardiovascular events in cancer patients undergoing major abdominal surgeries and can be utilized when epidural analgesia is not desired or forbidden.
{"title":"Influence of pre-peritoneal vs. epidural levobupivacaine infusion on troponin I and BNP as predictors of cardiac injury in cancer patients undergoing major upper abdominal operations: A randomized controlled clinical trial","authors":"S. Amr, A. Othman, Rania Mohamed Mohamed Bakri El-Aton, Mohammed Farghaly Abd-El-Hamed, Diab Hetta","doi":"10.1080/11101849.2023.2246236","DOIUrl":"https://doi.org/10.1080/11101849.2023.2246236","url":null,"abstract":"ABSTRACT Background Cancer patients undergoing major noncardiac surgery are more likely to experience perioperative morbidity and mortality due to myocardial damage. Methods Comparative study enrolled 80 patients with upper abdominal malignancies subjected to major abdominal surgeries. Of them, seventy-two patients were eligible and randomly assigned into two groups; Epidural catheter group (n = 37), received thoracic epidural infusion of levobupivacaine, and pre-peritoneal catheter group (n = 35), received preperitoneal infusion of levobupivacaine postoperatively. Primary endpoint was pain severity by NRS immediately after recovery, at 2, 4, 6, 12, 24, 36, and 48 hours. Secondary endpoints were: (1) Patient`s hemodynamics monitored for postoperative 48 hours. (2) Myocardial injury, confirmed by troponin I & BNP levels preoperatively and on postoperative day 1 and 2 (3) Time of first analgesic demand and total postoperative 48 h morphine consumption. (4) Cardiovascular side effects; hypotension, bradycardia & arrhythmia. (5) Morphine side effects; PONV Results NRS scores showed non-significant reduction at most study times between both groups with significant reduction in the ECI group at 6-, 12-, and 24-hour than other group. First analgesic demand was earlier in PCI group than ECI without significant difference, while total 48 h morphine consumption showed a significant reduction in ECI group than PCI group. Hemodynamics were comparable in both groups. Cardiac enzymes, Troponin I and BNP, showed non-significant differences over study time between both groups. Postoperative complications, PONV, were similar in both groups without any significance, but with more cases of hypotension and bradycardia in epidural group. No cases of myocardial injury or heart failure were reported. Conclusions Preperitoneal analgesia is an effective analgesic method comparable to epidural analgesia limiting the occurrence of major cardiovascular events in cancer patients undergoing major abdominal surgeries and can be utilized when epidural analgesia is not desired or forbidden.","PeriodicalId":11437,"journal":{"name":"Egyptian Journal of Anaesthesia","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2023-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45186379","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 : 2023-08-18DOI: 10.1080/11101849.2023.2246731
Ahmed Said, M. Salah, Marwa Samir, Rami Magdy
ABSTRACT Introduction Shock index (SI) is defined as a ratio of heart rate and systolic blood pressure. It was originally employed to evaluate hemorrhage and acute circulatory failure. Recently, SI has been used as a morbidity and mortality predictor in various fields. An elevated SI was associated with higher morbidity. Objective To detect the sensitivity and specificity of SI in predicting major cardiac events. Methods We randomly enrolled 100 patients who were set to undergo on-pump coronary artery bypass graft (CABG) surgery in the study. The primary outcome was to detect the sensitivity and specificity of SI to predict the occurrence of major adverse cardiac events, occurrence of acute kidney injury (AKI) and the need for ventilator support for >48 h. The secondary outcome was to correlate between SI and need of inotropic support, length of hospital stay and in-hospital mortality. Results The main findings of our study were the presence of a good correlation between SI and occurrence of postoperative cardiovascular (CV) collapse, AKI and prolonged postoperative mechanical ventilation after on-pump CABG as primary outcomes as well as the presence of a significant correlation between the occurrence of in-hospital mortality and morbidities and high values of SI as secondary outcomes. Conclusions We believe that SI has a good prediction of postoperative CV collapse, AKI and prolonged postoperative mechanical ventilation >48 h.
{"title":"Correlation between shock index and postoperative outcomes for patients undergoing on-pump coronary artery bypass graft surgery (an observational study)","authors":"Ahmed Said, M. Salah, Marwa Samir, Rami Magdy","doi":"10.1080/11101849.2023.2246731","DOIUrl":"https://doi.org/10.1080/11101849.2023.2246731","url":null,"abstract":"ABSTRACT Introduction Shock index (SI) is defined as a ratio of heart rate and systolic blood pressure. It was originally employed to evaluate hemorrhage and acute circulatory failure. Recently, SI has been used as a morbidity and mortality predictor in various fields. An elevated SI was associated with higher morbidity. Objective To detect the sensitivity and specificity of SI in predicting major cardiac events. Methods We randomly enrolled 100 patients who were set to undergo on-pump coronary artery bypass graft (CABG) surgery in the study. The primary outcome was to detect the sensitivity and specificity of SI to predict the occurrence of major adverse cardiac events, occurrence of acute kidney injury (AKI) and the need for ventilator support for >48 h. The secondary outcome was to correlate between SI and need of inotropic support, length of hospital stay and in-hospital mortality. Results The main findings of our study were the presence of a good correlation between SI and occurrence of postoperative cardiovascular (CV) collapse, AKI and prolonged postoperative mechanical ventilation after on-pump CABG as primary outcomes as well as the presence of a significant correlation between the occurrence of in-hospital mortality and morbidities and high values of SI as secondary outcomes. Conclusions We believe that SI has a good prediction of postoperative CV collapse, AKI and prolonged postoperative mechanical ventilation >48 h.","PeriodicalId":11437,"journal":{"name":"Egyptian Journal of Anaesthesia","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2023-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46018571","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 : 2023-08-18DOI: 10.1080/11101849.2023.2247872
Mona Gad Mostafa Elebieby, M. Abdelkhalek, Zenat Eldadamony Mohamed Eldadamony, Mohammed Nashaat Mohammed
ABSTRACT Background The best technique to manage intraoperative fluids during colorectal surgery has never been universally agreed upon. Key organ function is hampered by excessive intraoperative fluid administration: It lengthens and raises the expense of hospitalization by increasing the risk of heart failure that goes along with it, causing gastrointestinal membrane edema, and impeding the recovery of gastrointestinal functions. Aim and objectives Thestudy’s objective was to evaluate the impacts of goal-directed fluid therapy (GDFT) and liberal fluid therapy (LFT) using cardiometry in candidates with colorectal abnormalities. Subjects and methods 100 patients were allocated into two equal groups in a random pattern for this prospective, randomized, controlled trial at the Mansoura oncology center; GDFT group) 50 patients): by using stroke volume optimization and the LFT group (50 patients): by using the traditional technique of fluid administration. Results Crystalloid and total fluids were significantly lower among GDFTgroup compared to LFT group. Both lactate and creatinine levels were slightly higher among the GDFT group than the LFT group but without a statistically significant difference. Postoperative complications were comparable between the studied groups. Conclusions However, GDFT needs lower total volume of fluids given to the patients it may not enhance patients’ postoperative outcomes after colorectal surgery compared to liberal fluid treatment. Moreover, both studied strategies did not affect organ perfusion, although serum lactate and serum creatinine were slightly higher with GDFT.
{"title":"Goal-directed fluid therapy compared to liberal fluid therapy in patients subjected to colorectal surgery","authors":"Mona Gad Mostafa Elebieby, M. Abdelkhalek, Zenat Eldadamony Mohamed Eldadamony, Mohammed Nashaat Mohammed","doi":"10.1080/11101849.2023.2247872","DOIUrl":"https://doi.org/10.1080/11101849.2023.2247872","url":null,"abstract":"ABSTRACT Background The best technique to manage intraoperative fluids during colorectal surgery has never been universally agreed upon. Key organ function is hampered by excessive intraoperative fluid administration: It lengthens and raises the expense of hospitalization by increasing the risk of heart failure that goes along with it, causing gastrointestinal membrane edema, and impeding the recovery of gastrointestinal functions. Aim and objectives Thestudy’s objective was to evaluate the impacts of goal-directed fluid therapy (GDFT) and liberal fluid therapy (LFT) using cardiometry in candidates with colorectal abnormalities. Subjects and methods 100 patients were allocated into two equal groups in a random pattern for this prospective, randomized, controlled trial at the Mansoura oncology center; GDFT group) 50 patients): by using stroke volume optimization and the LFT group (50 patients): by using the traditional technique of fluid administration. Results Crystalloid and total fluids were significantly lower among GDFTgroup compared to LFT group. Both lactate and creatinine levels were slightly higher among the GDFT group than the LFT group but without a statistically significant difference. Postoperative complications were comparable between the studied groups. Conclusions However, GDFT needs lower total volume of fluids given to the patients it may not enhance patients’ postoperative outcomes after colorectal surgery compared to liberal fluid treatment. Moreover, both studied strategies did not affect organ perfusion, although serum lactate and serum creatinine were slightly higher with GDFT.","PeriodicalId":11437,"journal":{"name":"Egyptian Journal of Anaesthesia","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2023-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46441338","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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