Pub Date : 2023-07-01DOI: 10.4103/roaic.roaic_23_23
Hosam Marie, F. Soliman, B. Refaie
Background Ventilation with low tidal volume (VT) is advised for critically ill patients to protect against ventilator-induced lung injury and provide better clinical outcomes. Previous studies showed poor compliance with using height to predict VT. Ulna length has been used successfully to predict protective low VT. Our study aims to evaluate the ability of ulna length measurement to predict accurate protective lung VT in Egyptian people in reference to their standing height. Methods This study included healthy adult volunteers aged greater than or equal to 18 years. The height of each patient was measured while standing upright against a wall. Then, the left ulna was measured with a measuring tape from the olecranon to the mid-point of the styloid process. From ulna length, height was estimated, and protective lung VT was calculated using predicted body weight (PBW). Results Total 102 participants were enrolled in this study. The agreement between the calculated VT from standing height and ulna length was analyzed with Bland Altman analysis and showed a bias of (-5.7) ml, and limits of agreements (±1.96 SD) −91 ml to 76 ml in females; when the calculated VT of ulna length was compared with predicted body weight from height, the predicted mean VT was 6.2 ml/kg (95% confidence interval CI 4.5-7.8 ml/kg). In males, using ulna length, the predicted mean VT was 6.1 ml/kg (95% CI 4.8-7.4 ml/kg). Conclusion Ulna length can be used to predict protective lung VT in Egyptian people compared with their standing height.
{"title":"Prediction of protective lung tidal volume using the ulna length in Egyptian adults","authors":"Hosam Marie, F. Soliman, B. Refaie","doi":"10.4103/roaic.roaic_23_23","DOIUrl":"https://doi.org/10.4103/roaic.roaic_23_23","url":null,"abstract":"Background Ventilation with low tidal volume (VT) is advised for critically ill patients to protect against ventilator-induced lung injury and provide better clinical outcomes. Previous studies showed poor compliance with using height to predict VT. Ulna length has been used successfully to predict protective low VT. Our study aims to evaluate the ability of ulna length measurement to predict accurate protective lung VT in Egyptian people in reference to their standing height. Methods This study included healthy adult volunteers aged greater than or equal to 18 years. The height of each patient was measured while standing upright against a wall. Then, the left ulna was measured with a measuring tape from the olecranon to the mid-point of the styloid process. From ulna length, height was estimated, and protective lung VT was calculated using predicted body weight (PBW). Results Total 102 participants were enrolled in this study. The agreement between the calculated VT from standing height and ulna length was analyzed with Bland Altman analysis and showed a bias of (-5.7) ml, and limits of agreements (±1.96 SD) −91 ml to 76 ml in females; when the calculated VT of ulna length was compared with predicted body weight from height, the predicted mean VT was 6.2 ml/kg (95% confidence interval CI 4.5-7.8 ml/kg). In males, using ulna length, the predicted mean VT was 6.1 ml/kg (95% CI 4.8-7.4 ml/kg). Conclusion Ulna length can be used to predict protective lung VT in Egyptian people compared with their standing height.","PeriodicalId":151256,"journal":{"name":"Research and Opinion in Anesthesia and Intensive Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139365009","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 : 2023-07-01DOI: 10.4103/roaic.roaic_3_23
Mohamed Abdelhady, Sherif Omar, Monir Afifi, Kariman Salah Eldin
Background Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage. Aim The aim was to compare ultrasound (US)-guided quadratus lumborum block and transversus abdominis plane block in abdominal surgeries as regards duration of analgesia, postoperative opioid consumption, and visual analog scale score. Patients and methods A randomized-controlled trial study was carried out at Alexandria University Hospital on 40 American Society of Anesthesiology (ASA)-I and II adult patients scheduled for elective abdominal surgery. The recorded data were analyzed using IBM SPSS software package version 20.0. The Kolmogorov–Smirnov test was used to verify the normality of distribution. Quantitative data were described using range (minimum and maximum), mean, SD, and median. Significance of the obtained results was judged at the 5% level. Results There was no significant difference between the two groups as regards age, sex, heart rate, mean arterial blood pressure, and complications. There was a highly significant difference between the two groups as regards duration of analgesia, visual analog score value, and the opioid analgesic requirements. Conclusion US-guided quadratus lumborum block is superior to US-guided transversus abdominis plane block for control of postoperative pain in abdominal surgeries in terms of pain scores, duration of analgesia, and total analgesic consumption.
背景 疼痛是一种不愉快的感觉和情绪体验，与实际或潜在的组织损伤有关，或以这种损伤来描述。目的 对腹部手术中超声（US）引导下的腰椎四头肌阻滞和腹横肌平面阻滞的镇痛持续时间、术后阿片类药物消耗量和视觉模拟评分进行比较。患者和方法 亚历山大大学医院对 40 名美国麻醉学会（ASA）-I 级和 II 级成人腹部手术患者进行了随机对照试验研究。记录的数据使用 IBM SPSS 软件包 20.0 版进行分析。采用 Kolmogorov-Smirnov 检验来验证分布的正态性。定量数据采用范围（最小值和最大值）、平均值、标准差和中位数进行描述。所得结果的显著性以 5%为标准。结果 两组在年龄、性别、心率、平均动脉血压和并发症方面无明显差异。两组在镇痛持续时间、视觉模拟评分值和阿片类镇痛剂需求量方面存在非常显著的差异。结论 就疼痛评分、镇痛持续时间和镇痛剂总用量而言，在腹部手术中使用 US 引导的腰方肌阻滞在控制术后疼痛方面优于 US 引导的腹横肌平面阻滞。
{"title":"Comparison between quadratus lumborum and transversus abdominus plane blocks for analgesia in abdominal surgeries","authors":"Mohamed Abdelhady, Sherif Omar, Monir Afifi, Kariman Salah Eldin","doi":"10.4103/roaic.roaic_3_23","DOIUrl":"https://doi.org/10.4103/roaic.roaic_3_23","url":null,"abstract":"Background Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage. Aim The aim was to compare ultrasound (US)-guided quadratus lumborum block and transversus abdominis plane block in abdominal surgeries as regards duration of analgesia, postoperative opioid consumption, and visual analog scale score. Patients and methods A randomized-controlled trial study was carried out at Alexandria University Hospital on 40 American Society of Anesthesiology (ASA)-I and II adult patients scheduled for elective abdominal surgery. The recorded data were analyzed using IBM SPSS software package version 20.0. The Kolmogorov–Smirnov test was used to verify the normality of distribution. Quantitative data were described using range (minimum and maximum), mean, SD, and median. Significance of the obtained results was judged at the 5% level. Results There was no significant difference between the two groups as regards age, sex, heart rate, mean arterial blood pressure, and complications. There was a highly significant difference between the two groups as regards duration of analgesia, visual analog score value, and the opioid analgesic requirements. Conclusion US-guided quadratus lumborum block is superior to US-guided transversus abdominis plane block for control of postoperative pain in abdominal surgeries in terms of pain scores, duration of analgesia, and total analgesic consumption.","PeriodicalId":151256,"journal":{"name":"Research and Opinion in Anesthesia and Intensive Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139365210","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 : 2023-07-01DOI: 10.4103/roaic.roaic_12_23
A. Aly, Mohamed Rifky, Adnan Adwibi, Khadeja M. Elhossieny
Background Pediatric Emergence Agitation (PEA) Emergence agitation (EA) is a state of anxiety, irritability, non-purposeful movement, thrashing, and disorientation during early recovery from general anesthesia. it can be harmful for the children and their family, causing bleeding at the surgical site, parental unhappiness, and anxiety. Aim To decrease the incidence of emergence agitation (EA) in pediatrics undergoing adenotonsillectomy under sevoflurane anesthesia, by using ketamine-dexmedetomidine (KD) or ketamine-propofol (KP). Patients and methods In this prospective randomised controlled clinical trial, 63 children were randomly assigned to one of three groups of similar size: group C (Control group) (n=21), who received a single intravenous bolus of 10 ml 0.9% normal saline; group KD (n=21), who received 0.15 mg/kg ketamine and 0.3 μg/kg dexmedetomidine; 10 min before the end of surgery, and group KP (n=21), who received 0.15 mg/kg ketamine and 0.5 mg/kg propofol, 10 min before the end of surgery. The primary outcome was the post anesthesia EA which was evaluated using the pediatric anesthesia emergence agitation scale (PAED) score out come was assessment of OPS and complications. Results There were significant difference between the groups regarding the heart rate which was faster in the control group immediately, 5, 10, and 15 min post extubation. In the KD group the extubation time was the longest compared with the KP group and the control group. The PAED scores were significantly different among the three studied groups at 10, 20, 25, 30, 35, 40, 45, 50, 55, and 60 min. Conclusion The combination of ketamine (0.15 mg/kg) and dexmedetomidine (0.3 μg/kg) given 10 min before the completion of surgery was more effective in preventing emerging agitation than ketofol.
{"title":"Comparison between the effect of ketamine-dexmedetomidine versus ketamine-propofol on emergence agitation in pediatrics undergoing adenotonsillectomy by sevoflurane anesthesia","authors":"A. Aly, Mohamed Rifky, Adnan Adwibi, Khadeja M. Elhossieny","doi":"10.4103/roaic.roaic_12_23","DOIUrl":"https://doi.org/10.4103/roaic.roaic_12_23","url":null,"abstract":"Background Pediatric Emergence Agitation (PEA) Emergence agitation (EA) is a state of anxiety, irritability, non-purposeful movement, thrashing, and disorientation during early recovery from general anesthesia. it can be harmful for the children and their family, causing bleeding at the surgical site, parental unhappiness, and anxiety. Aim To decrease the incidence of emergence agitation (EA) in pediatrics undergoing adenotonsillectomy under sevoflurane anesthesia, by using ketamine-dexmedetomidine (KD) or ketamine-propofol (KP). Patients and methods In this prospective randomised controlled clinical trial, 63 children were randomly assigned to one of three groups of similar size: group C (Control group) (n=21), who received a single intravenous bolus of 10 ml 0.9% normal saline; group KD (n=21), who received 0.15 mg/kg ketamine and 0.3 μg/kg dexmedetomidine; 10 min before the end of surgery, and group KP (n=21), who received 0.15 mg/kg ketamine and 0.5 mg/kg propofol, 10 min before the end of surgery. The primary outcome was the post anesthesia EA which was evaluated using the pediatric anesthesia emergence agitation scale (PAED) score out come was assessment of OPS and complications. Results There were significant difference between the groups regarding the heart rate which was faster in the control group immediately, 5, 10, and 15 min post extubation. In the KD group the extubation time was the longest compared with the KP group and the control group. The PAED scores were significantly different among the three studied groups at 10, 20, 25, 30, 35, 40, 45, 50, 55, and 60 min. Conclusion The combination of ketamine (0.15 mg/kg) and dexmedetomidine (0.3 μg/kg) given 10 min before the completion of surgery was more effective in preventing emerging agitation than ketofol.","PeriodicalId":151256,"journal":{"name":"Research and Opinion in Anesthesia and Intensive Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139366219","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 : 2023-07-01DOI: 10.4103/roaic.roaic_15_23
Hani Ali, Naglaa Elatief Elnegeery
Background Spinal anesthesia is the most common anesthetic technique applied for patients undergoing surgery for pilonidal disease. However, it has multiple disadvantages like hypotension and headache. This prospective study was designed to compare the outcomes of sacrococcygeal local anesthesia technique versus spinal anesthesia for surgical treatment of patients with pilonidal disease. Patients and methods The included 220 patients diagnosed with the pilonidal disease were assigned into two groups according to the method of anesthesia, the spinal and local groups. The primary outcome was pain score, whereas other outcomes included duration of stay in the operative theater, recovery room, postoperative opioid consumption, time to first analgesic request, complications, and patient satisfaction. Results Age and sex distribution showed no significant difference between the two groups. Time spent inside the operative room and total hospital stay showed a significant decrease in the local group. Postoperative pain was statistically comparable between our groups, apart from the six-hour reading, which was higher in the local group. The spinal group showed superior analgesic outcomes regarding the first analgesic request and total opioid consumption. Likewise, patient satisfaction was significantly higher in the same group. Postoperative nausea was more encountered in the local group. Conclusion When compared with spinal anesthesia, sacrococcygeal local anesthesia seems to have a weaker analgesic profile manifested in increased opioid requirements and earlier rescue analgesia. However, it is associated with comparable pain scores, less operative time, and shorter hospitalization.
{"title":"Sacrococcygeal local anesthesia versus spinal anesthesia for pilonidal sinus surgery: a prospective randomized controlled study","authors":"Hani Ali, Naglaa Elatief Elnegeery","doi":"10.4103/roaic.roaic_15_23","DOIUrl":"https://doi.org/10.4103/roaic.roaic_15_23","url":null,"abstract":"Background Spinal anesthesia is the most common anesthetic technique applied for patients undergoing surgery for pilonidal disease. However, it has multiple disadvantages like hypotension and headache. This prospective study was designed to compare the outcomes of sacrococcygeal local anesthesia technique versus spinal anesthesia for surgical treatment of patients with pilonidal disease. Patients and methods The included 220 patients diagnosed with the pilonidal disease were assigned into two groups according to the method of anesthesia, the spinal and local groups. The primary outcome was pain score, whereas other outcomes included duration of stay in the operative theater, recovery room, postoperative opioid consumption, time to first analgesic request, complications, and patient satisfaction. Results Age and sex distribution showed no significant difference between the two groups. Time spent inside the operative room and total hospital stay showed a significant decrease in the local group. Postoperative pain was statistically comparable between our groups, apart from the six-hour reading, which was higher in the local group. The spinal group showed superior analgesic outcomes regarding the first analgesic request and total opioid consumption. Likewise, patient satisfaction was significantly higher in the same group. Postoperative nausea was more encountered in the local group. Conclusion When compared with spinal anesthesia, sacrococcygeal local anesthesia seems to have a weaker analgesic profile manifested in increased opioid requirements and earlier rescue analgesia. However, it is associated with comparable pain scores, less operative time, and shorter hospitalization.","PeriodicalId":151256,"journal":{"name":"Research and Opinion in Anesthesia and Intensive Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139364773","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 : 2023-07-01DOI: 10.4103/roaic.roaic_7_23
Khadeja M. Elhossieny, M. Medhat, Heba Elasser, Heba M Fathi
Purpose The present study aimed to evaluate the effectiveness of a combination of pulsed radiofrequency and transforaminal steroid injection to the dorsal root ganglion for the treatment of postherpetic neuralgia (PHN). Patients and methods Forty-six patients suffering from thoracic PHN with a duration of between 1 and 3 months were enrolled and were randomly assigned to either steroid group (n=23) or combination group (n=23). The efficacy was assessed by visual analog scale and by recording the dose of anticonvulsant before and after the procedure. Results Visual analog scores decreased in both groups in the postintervention period (2 h, 1 week, and 1 month) with no significant difference found between them. Throughout assessments, visual analog scale in the combination group was significantly lower than in the steroid group in third and sixth months. Regarding the dosage of anticonvulsant, in the first follow-up visit 1 week from intervention, the same preintervention dose of pregabalin was prescribed and then the dose was gradually decreased until the first month in both groups. In the steroid group, the dose was increased again after the first month, while in the combination group there was a gradual decease in the dose. The dose was significantly lower in the combination group compared with the steroid group in third and sixth months. Conclusion Pulsed radiofrequency in combination with steroid injection is more effective and lasting for a longer duration than the transforaminal steroid injection alone when used for controlling of pain in patients with thoracic PHN.
{"title":"Effectiveness of combined pulsed radiofrequency and steroid injection to the dorsal root ganglion in the treatment of postherpetic neuralgia: a prospective randomized clinical trial","authors":"Khadeja M. Elhossieny, M. Medhat, Heba Elasser, Heba M Fathi","doi":"10.4103/roaic.roaic_7_23","DOIUrl":"https://doi.org/10.4103/roaic.roaic_7_23","url":null,"abstract":"Purpose The present study aimed to evaluate the effectiveness of a combination of pulsed radiofrequency and transforaminal steroid injection to the dorsal root ganglion for the treatment of postherpetic neuralgia (PHN). Patients and methods Forty-six patients suffering from thoracic PHN with a duration of between 1 and 3 months were enrolled and were randomly assigned to either steroid group (n=23) or combination group (n=23). The efficacy was assessed by visual analog scale and by recording the dose of anticonvulsant before and after the procedure. Results Visual analog scores decreased in both groups in the postintervention period (2 h, 1 week, and 1 month) with no significant difference found between them. Throughout assessments, visual analog scale in the combination group was significantly lower than in the steroid group in third and sixth months. Regarding the dosage of anticonvulsant, in the first follow-up visit 1 week from intervention, the same preintervention dose of pregabalin was prescribed and then the dose was gradually decreased until the first month in both groups. In the steroid group, the dose was increased again after the first month, while in the combination group there was a gradual decease in the dose. The dose was significantly lower in the combination group compared with the steroid group in third and sixth months. Conclusion Pulsed radiofrequency in combination with steroid injection is more effective and lasting for a longer duration than the transforaminal steroid injection alone when used for controlling of pain in patients with thoracic PHN.","PeriodicalId":151256,"journal":{"name":"Research and Opinion in Anesthesia and Intensive Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139364411","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 : 2023-07-01DOI: 10.4103/roaic.roaic_11_23
Ayman I. Tharwat, Heba A. Labib, Rania Ali
Aim To investigate the characteristics and clinical outcomes among critically-ill pregnant patients with COVID-19 and compare them to non-pregnant critically-ill COVID-19 patients. Settings and design This retrospective cohort study was carried out at the ICUs of both Ain Shams University Quarantine Hospital and the Obour Specialized Hospital between April 2020 and September 2021. Methods and material The study included critically-ill, COVID-19 patients above 18 years old. The enrolled participants were divided into two groups, pregnant patients, and a control group of non-pregnant patients. Patient data were retrieved from the medical records. Outcomes included general outcomes (length of ICU stay, need for mechanical ventilation, thromboembolic events, and mortality), obstetric outcomes (pre-eclampsia and mode of delivery), and neonatal outcomes (preterm delivery, neonatal intensive care unit [NICU] admission, intrauterine fetal death, and total perinatal mortality). Results The levels of ferritin and D-dimer, length of ICU stay, need for mechanical ventilation, incidence of thromboembolic events, and mortality showed significant differences between pregnant and non-pregnant women. Women who were critically ill in the second and third trimesters had significantly higher D-dimer and ferritin levels compared to the first trimester critically ill patients. They also had significantly longer ICU stay, higher rate of cesarean delivery, and more incidence of neonatal admission to NICU. Conclusions Pregnant, critically ill women are more prone to adverse pregnancy and neonatal outcomes compared to non-pregnant women. Critical illness in the second and third trimesters poses a higher risk in terms of length of ICU stay and NICU admission.
{"title":"Characteristics and clinical outcomes of critically ill pregnant patients with COVID-19 disease","authors":"Ayman I. Tharwat, Heba A. Labib, Rania Ali","doi":"10.4103/roaic.roaic_11_23","DOIUrl":"https://doi.org/10.4103/roaic.roaic_11_23","url":null,"abstract":"Aim To investigate the characteristics and clinical outcomes among critically-ill pregnant patients with COVID-19 and compare them to non-pregnant critically-ill COVID-19 patients. Settings and design This retrospective cohort study was carried out at the ICUs of both Ain Shams University Quarantine Hospital and the Obour Specialized Hospital between April 2020 and September 2021. Methods and material The study included critically-ill, COVID-19 patients above 18 years old. The enrolled participants were divided into two groups, pregnant patients, and a control group of non-pregnant patients. Patient data were retrieved from the medical records. Outcomes included general outcomes (length of ICU stay, need for mechanical ventilation, thromboembolic events, and mortality), obstetric outcomes (pre-eclampsia and mode of delivery), and neonatal outcomes (preterm delivery, neonatal intensive care unit [NICU] admission, intrauterine fetal death, and total perinatal mortality). Results The levels of ferritin and D-dimer, length of ICU stay, need for mechanical ventilation, incidence of thromboembolic events, and mortality showed significant differences between pregnant and non-pregnant women. Women who were critically ill in the second and third trimesters had significantly higher D-dimer and ferritin levels compared to the first trimester critically ill patients. They also had significantly longer ICU stay, higher rate of cesarean delivery, and more incidence of neonatal admission to NICU. Conclusions Pregnant, critically ill women are more prone to adverse pregnancy and neonatal outcomes compared to non-pregnant women. Critical illness in the second and third trimesters poses a higher risk in terms of length of ICU stay and NICU admission.","PeriodicalId":151256,"journal":{"name":"Research and Opinion in Anesthesia and Intensive Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139365032","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 : 2023-07-01DOI: 10.4103/roaic.roaic_62_22
Hitham M. A. Elsayed, F. Badawy, Mohammed Raheem
Background Inguinal hernia repair is associated with severe postoperative pain. Transversus abdominus plain block has been proved to provide effective analgesia for somatic lower abdominal pain. Several adjuvants have been added to local anesthetic to improve the quality of analgesia. This study compares the additive effect of hyaluronidase versus dexamethasone to improve the quality of analgesia of transversus abdominus plain block for inguinal hernia repair. Patients and methods This prospective, randomized, controlled, and double-blind study was carried out in Sohag University Hospital between November 2020 and February 2021. Seventy-five participants scheduled for inguinal hernia repair were included and randomly assigned into control, hyaluronidase, and dexamethasone groups. Exclusion criteria were neurological, psychiatric, neuromuscular, cardiovascular, pulmonary, renal, hepatic disease, alcoholism or drug abuse, pregnancy or lactating women, and patients receiving adrenoceptor agonist or antagonist therapy or chronic analgesic therapy, patients with morbid obesity, coagulopathy, and known allergy to study medications, and sepsis surgical scar at the site to be operated upon and those who refuse. We targeted from this study to assess time to first analgesia, consumption of morphine, and visual analog scale at rest and during physical activity. Also, we targeted to assess heart rate, noninvasive blood pressure, SpO2%, and adverse effects (nausea and vomiting, respiratory depression). Results Our study showed comparable analgesic efficacy for hyaluronidase versus dexamethasone with longer time to the first request of analgesia, less morphine consumption, and less side effects compared with these two groups to the control group. Conclusion Adding hyaluronidase or dexamethasone to bupivacaine not only prolonged the duration of analgesia and decreased the consumption of opioids but also decreased the incidence of adverse effects.
{"title":"Postoperative analgesic effect of hyaluronidase versus dexamethasone as additives to bupivacaine in transversus abdominis plane block for inguinal hernia repair: prospective, randomized, and double-blinded controlled study","authors":"Hitham M. A. Elsayed, F. Badawy, Mohammed Raheem","doi":"10.4103/roaic.roaic_62_22","DOIUrl":"https://doi.org/10.4103/roaic.roaic_62_22","url":null,"abstract":"Background Inguinal hernia repair is associated with severe postoperative pain. Transversus abdominus plain block has been proved to provide effective analgesia for somatic lower abdominal pain. Several adjuvants have been added to local anesthetic to improve the quality of analgesia. This study compares the additive effect of hyaluronidase versus dexamethasone to improve the quality of analgesia of transversus abdominus plain block for inguinal hernia repair. Patients and methods This prospective, randomized, controlled, and double-blind study was carried out in Sohag University Hospital between November 2020 and February 2021. Seventy-five participants scheduled for inguinal hernia repair were included and randomly assigned into control, hyaluronidase, and dexamethasone groups. Exclusion criteria were neurological, psychiatric, neuromuscular, cardiovascular, pulmonary, renal, hepatic disease, alcoholism or drug abuse, pregnancy or lactating women, and patients receiving adrenoceptor agonist or antagonist therapy or chronic analgesic therapy, patients with morbid obesity, coagulopathy, and known allergy to study medications, and sepsis surgical scar at the site to be operated upon and those who refuse. We targeted from this study to assess time to first analgesia, consumption of morphine, and visual analog scale at rest and during physical activity. Also, we targeted to assess heart rate, noninvasive blood pressure, SpO2%, and adverse effects (nausea and vomiting, respiratory depression). Results Our study showed comparable analgesic efficacy for hyaluronidase versus dexamethasone with longer time to the first request of analgesia, less morphine consumption, and less side effects compared with these two groups to the control group. Conclusion Adding hyaluronidase or dexamethasone to bupivacaine not only prolonged the duration of analgesia and decreased the consumption of opioids but also decreased the incidence of adverse effects.","PeriodicalId":151256,"journal":{"name":"Research and Opinion in Anesthesia and Intensive Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139365959","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 : 2023-07-01DOI: 10.4103/roaic.roaic_24_23
F. Soliman, Elhadad Mousa, Shehab Ahmed, Ahmed Hassan
Background Opioids are frequently added to neuroaxial local anesthetics (LAs). Intrathecal (IT) opioid is not devoid of adverse effects such as postoperative nausea and vomiting (PONV), respiratory depression, and pruritis. IT atropine also carries a significant antiemetic effect, and this can be a valuable modality for the prevention of IT opioid-related PONV. The antagonist of 5-HT3 receptors such as ondasetron which is usually used to decrease the incidence of nausea and vomiting was considered for the prevention and treatment of neuroaxial opioid-induced (PONV). Method 100 cases of ASA I-II aged 18 and 45 who planned to do elective perineal surgery, and receiving bupivacaine spinal anesthesia were randomly divided into two equal groups. Group (A) cases received IT hyperbaric bupivacaine (10 mg 0.5%) in combination with morphine 250 μg and atropine sulphate 100 μg. Before anesthesia, group (B) participants received IT hyperbaric bupivacaine (10 mg 0.5%) and 250 μg of morphine and 4 mg IV ondansetron. Follow-up for PONV attacks, vital signs, and side effects in the two groups. Results The occurrence of postoperative nausea were 4 and 18% in group A and B, respectively (P value=0.049) while postoperative vomiting was 0 and 12% in group A and B, respectively (P value=0.027). The occurrence of sedation, mouth dryness, headache, and drowsiness were more in group A compared with group B. Conclusion IT atropine is more effective than IV ondasetron preoperative in relieving PONV related to IT morphine, sedation is the frequent side effect occurred in IT atropine, headache is the frequent side effect occurred in the ondasetron group
背景 阿片类药物经常被添加到神经轴局部麻醉剂（LAs）中。鞘内注射（IT）阿片类药物并非没有不良反应，如术后恶心呕吐（PONV）、呼吸抑制和瘙痒症。IT 阿托品也有明显的止吐作用，这可能是预防 IT 阿片相关 PONV 的一种重要方式。5-HT3受体拮抗剂如昂达司琼通常用于降低恶心和呕吐的发生率，我们考虑将其用于预防和治疗神经轴阿片类药物引起的（PONV）。方法 将 100 例年龄在 18-45 岁之间、计划进行会阴部择期手术并接受布比卡因脊髓麻醉的 ASA I-II 级患者随机分为两组。A组病例接受IT高压布比卡因（10 毫克 0.5%），同时使用吗啡 250 微克和硫酸阿托品 100 微克。在麻醉前，B 组参与者接受 IT 高压氧布比卡因（10 毫克 0.5%）、250 微克吗啡和 4 毫克静脉注射昂丹司琼。对两组患者的 PONV 发作、生命体征和副作用进行随访。结果 A 组和 B 组的术后恶心发生率分别为 4% 和 18%（P 值=0.049），而 A 组和 B 组的术后呕吐发生率分别为 0% 和 12%（P 值=0.027）。A 组与 B 组相比，镇静、口干、头痛和嗜睡的发生率更高。 结论 IT 阿托品比静脉注射昂达司琼更有效地缓解术前与 IT 吗啡相关的 PONV，镇静是 IT 阿托品组经常出现的副作用，头痛是昂达司琼组经常出现的副作用。
{"title":"Intrathecal atropine versus preoperative intravenous ondasetron for prevention of postoperative nausea and vomiting due to intrathecal morphine in perineal surgery","authors":"F. Soliman, Elhadad Mousa, Shehab Ahmed, Ahmed Hassan","doi":"10.4103/roaic.roaic_24_23","DOIUrl":"https://doi.org/10.4103/roaic.roaic_24_23","url":null,"abstract":"Background Opioids are frequently added to neuroaxial local anesthetics (LAs). Intrathecal (IT) opioid is not devoid of adverse effects such as postoperative nausea and vomiting (PONV), respiratory depression, and pruritis. IT atropine also carries a significant antiemetic effect, and this can be a valuable modality for the prevention of IT opioid-related PONV. The antagonist of 5-HT3 receptors such as ondasetron which is usually used to decrease the incidence of nausea and vomiting was considered for the prevention and treatment of neuroaxial opioid-induced (PONV). Method 100 cases of ASA I-II aged 18 and 45 who planned to do elective perineal surgery, and receiving bupivacaine spinal anesthesia were randomly divided into two equal groups. Group (A) cases received IT hyperbaric bupivacaine (10 mg 0.5%) in combination with morphine 250 μg and atropine sulphate 100 μg. Before anesthesia, group (B) participants received IT hyperbaric bupivacaine (10 mg 0.5%) and 250 μg of morphine and 4 mg IV ondansetron. Follow-up for PONV attacks, vital signs, and side effects in the two groups. Results The occurrence of postoperative nausea were 4 and 18% in group A and B, respectively (P value=0.049) while postoperative vomiting was 0 and 12% in group A and B, respectively (P value=0.027). The occurrence of sedation, mouth dryness, headache, and drowsiness were more in group A compared with group B. Conclusion IT atropine is more effective than IV ondasetron preoperative in relieving PONV related to IT morphine, sedation is the frequent side effect occurred in IT atropine, headache is the frequent side effect occurred in the ondasetron group","PeriodicalId":151256,"journal":{"name":"Research and Opinion in Anesthesia and Intensive Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139365263","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 : 2023-07-01DOI: 10.4103/roaic.roaic_19_23
Tamer Habib, A. Fayed, A. Deghady, Osama Maklad, Islam Ahmed
Background Platelet-rich plasma (PRP) is a mixture of cytokines, thrombocytes as well as multiple growth factors which are produced mainly by α-granules of platelets which enhance the process of natural healing process with less time. The role of autologous PRP in managing nonhealing pressure ulcers has been questioned as it enhances tissue healing by providing the necessary growth factors. Objectives Determining the relative efficacy of autologous PRP in treating grade III skin ulcers compared with standard care. Methods In this pilot randomized-controlled trial, 28 patients with grade III pressure ulcers in the critical care units of Alexandria Main University Hospital were enrolled and randomized into two groups. Patients of group A were subjected to PRP injections in the periphery of their pressure ulcers along with the standard care, while group B were subjected only to the standard care of pressure ulcers. Results PRP group showed significantly reduced mean ulcer volume at week 1 (18.88 vs. 21.42, P=0.047), week 2 (17.14 vs. 21.15, P=0.017), week 3 (14.92 vs. 19.99, P=0.020) and week 4 (10.68 vs. 17.35, P=0.019) than control group. PRP group showed significantly reduced mean ulcer surface area at week 1 (13.76 vs. 14.81, P=0.047), week 2 (10.64 vs. 14.11, P=0.032), week 3 (8.00 vs. 14.17, P=0.013) and week 4 (6.30 vs. 12.94, P=0.023) than control group. Conclusion Adding weekly autologous PRP injections to the standard care of noninfected grade III pressure ulcers may be a potentially effective approach. In critically ill patients, it was associated with reduced ulcer volumes, reduced ulcer surface areas, and better healing starting from the first week of injections.
背景 富血小板血浆（PRP）是一种细胞因子、血小板以及多种生长因子的混合物，主要由血小板的α-颗粒产生，可在较短时间内促进自然愈合过程。由于自体 PRP 可通过提供必要的生长因子促进组织愈合，因此它在治疗未愈合压疮中的作用受到了质疑。目标 与标准护理相比，确定自体 PRP 治疗 III 级皮肤溃疡的相对疗效。方法 在这项随机对照试验中，亚历山大主大学医院重症监护室的 28 名 III 级压疮患者被纳入试验并随机分为两组。A 组患者在接受标准护理的同时在压疮外围注射 PRP，而 B 组患者只接受压疮标准护理。结果 PRP 组在第 1 周（18.88 对 21.42，P=0.047）、第 2 周（17.14 对 21.15，P=0.017）、第 3 周（14.92 对 19.99，P=0.020）和第 4 周（10.68 对 17.35，P=0.019）的平均溃疡面积均比对照组明显减少。与对照组相比，PRP 组在第 1 周（13.76 vs. 14.81，P=0.047）、第 2 周（10.64 vs. 14.11，P=0.032）、第 3 周（8.00 vs. 14.17，P=0.013）和第 4 周（6.30 vs. 12.94，P=0.023）的平均溃疡表面积明显减少。结论 在治疗非感染性 III 级压疮的标准护理中加入每周一次的自体 PRP 注射可能是一种潜在的有效方法。在重症患者中，自注射第一周起，溃疡面积减少，溃疡表面积缩小，愈合情况改善。
{"title":"Autologous platelet-rich plasma in the treatment of third-degree pressure ulcers; pilot randomized-controlled trial","authors":"Tamer Habib, A. Fayed, A. Deghady, Osama Maklad, Islam Ahmed","doi":"10.4103/roaic.roaic_19_23","DOIUrl":"https://doi.org/10.4103/roaic.roaic_19_23","url":null,"abstract":"Background Platelet-rich plasma (PRP) is a mixture of cytokines, thrombocytes as well as multiple growth factors which are produced mainly by α-granules of platelets which enhance the process of natural healing process with less time. The role of autologous PRP in managing nonhealing pressure ulcers has been questioned as it enhances tissue healing by providing the necessary growth factors. Objectives Determining the relative efficacy of autologous PRP in treating grade III skin ulcers compared with standard care. Methods In this pilot randomized-controlled trial, 28 patients with grade III pressure ulcers in the critical care units of Alexandria Main University Hospital were enrolled and randomized into two groups. Patients of group A were subjected to PRP injections in the periphery of their pressure ulcers along with the standard care, while group B were subjected only to the standard care of pressure ulcers. Results PRP group showed significantly reduced mean ulcer volume at week 1 (18.88 vs. 21.42, P=0.047), week 2 (17.14 vs. 21.15, P=0.017), week 3 (14.92 vs. 19.99, P=0.020) and week 4 (10.68 vs. 17.35, P=0.019) than control group. PRP group showed significantly reduced mean ulcer surface area at week 1 (13.76 vs. 14.81, P=0.047), week 2 (10.64 vs. 14.11, P=0.032), week 3 (8.00 vs. 14.17, P=0.013) and week 4 (6.30 vs. 12.94, P=0.023) than control group. Conclusion Adding weekly autologous PRP injections to the standard care of noninfected grade III pressure ulcers may be a potentially effective approach. In critically ill patients, it was associated with reduced ulcer volumes, reduced ulcer surface areas, and better healing starting from the first week of injections.","PeriodicalId":151256,"journal":{"name":"Research and Opinion in Anesthesia and Intensive Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139365840","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 : 2023-07-01DOI: 10.4103/roaic.roaic_73_19
Kesmat ElBarragah, Mohamed Elrewiny, Ezzat Ahmed, Ahmed A. Sabry
Background Acute upper gastrointestinal bleeding (UGIB) is a common medical emergency presented to the emergency department that requires early assessment and management. Many risk stratification scores have been developed to predict the clinical outcomes in patients with UGIB. The commonly used risk scores the Rockall scoring systems (PRS and FRS), Glasgow–Blatchford score (GBS) and AIMS65 score. Aim The aim of the present study was to assess and compare the ability of the wildly used risk scores the RS, GBS, and AIMS65 to predict the clinical outcomes in UGIB patients Patients and methods One hundred patients (age >18 years) with acute UGIB in the emergency department of Alexandria Main University Hospital were prospectively studied. All the study scores were calculated and compared using the area under the receiver operating characteristic curve (AUC) method to evaluate the performance of each score to predict the mortality, blood transfusion, endoscopic intervention, ICU admission, rebleeding, and length of hospital stay. Results Among the one hundred patients included in the study, 65% were males with a median of age 58 years. 56% had esophageal varices and 63% with liver disease. All the used scores were statistically significant in predicting all clinical outcomes. GBS had the best AUC among the AIMS65, PRS, and FRS scores in predicting mortality with (AUC= 0.80 vs. 0.76, 0.69), blood transfusion need with (AUC= 0.92 vs. 0.88, 0.87), ICU admission with (AUC= 0.86 vs. 0.83, 0.81), rebleeding with (AUC= 0.81 vs. 0.77, 0.69), and length of hospital stay with (AUC= 0.81 vs. 0.75. 0.79). Conclusion All the study scores (GBS, AIMS65, PRS, and FRS) were able to predict the clinical outcomes in the UGIB patients. GBS was the best performing risk score among the four scores for predicting all the clinical outcomes (mortality, blood transfusion, rebleeding, ICU admission, and length of hospital stay) except the prediction of endoscopic intervention in our study population.
{"title":"Assessment of risk stratification scoring systems in upper gastrointestinal bleeding patients in the emergency department","authors":"Kesmat ElBarragah, Mohamed Elrewiny, Ezzat Ahmed, Ahmed A. Sabry","doi":"10.4103/roaic.roaic_73_19","DOIUrl":"https://doi.org/10.4103/roaic.roaic_73_19","url":null,"abstract":"Background Acute upper gastrointestinal bleeding (UGIB) is a common medical emergency presented to the emergency department that requires early assessment and management. Many risk stratification scores have been developed to predict the clinical outcomes in patients with UGIB. The commonly used risk scores the Rockall scoring systems (PRS and FRS), Glasgow–Blatchford score (GBS) and AIMS65 score. Aim The aim of the present study was to assess and compare the ability of the wildly used risk scores the RS, GBS, and AIMS65 to predict the clinical outcomes in UGIB patients Patients and methods One hundred patients (age >18 years) with acute UGIB in the emergency department of Alexandria Main University Hospital were prospectively studied. All the study scores were calculated and compared using the area under the receiver operating characteristic curve (AUC) method to evaluate the performance of each score to predict the mortality, blood transfusion, endoscopic intervention, ICU admission, rebleeding, and length of hospital stay. Results Among the one hundred patients included in the study, 65% were males with a median of age 58 years. 56% had esophageal varices and 63% with liver disease. All the used scores were statistically significant in predicting all clinical outcomes. GBS had the best AUC among the AIMS65, PRS, and FRS scores in predicting mortality with (AUC= 0.80 vs. 0.76, 0.69), blood transfusion need with (AUC= 0.92 vs. 0.88, 0.87), ICU admission with (AUC= 0.86 vs. 0.83, 0.81), rebleeding with (AUC= 0.81 vs. 0.77, 0.69), and length of hospital stay with (AUC= 0.81 vs. 0.75. 0.79). Conclusion All the study scores (GBS, AIMS65, PRS, and FRS) were able to predict the clinical outcomes in the UGIB patients. GBS was the best performing risk score among the four scores for predicting all the clinical outcomes (mortality, blood transfusion, rebleeding, ICU admission, and length of hospital stay) except the prediction of endoscopic intervention in our study population.","PeriodicalId":151256,"journal":{"name":"Research and Opinion in Anesthesia and Intensive Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139366244","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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