Pub Date : 2016-10-01DOI: 10.4103/1687-7934.198261
Medhat Messseha Gerges
Background The use of intravenous regional anesthesia has increased significantly in recent years. Adjuvants are frequently added to local anesthetics to prolong analgesia following peripheral nerve blockade. Objective This randomized double-blind prospective study was designed to compare the effectiveness of adding dexmedetomidine (α2 adrenoceptor agonist) or verapamil (calcium channel antagonist) as an adjunct to lidocaine in upper limb orthopedic surgery. Patients and methods Sixty adult patients scheduled for elective upper limb orthopedic surgery were divided into three groups: the lidocaine group, in which patients received 3 mg/kg of lidocaine 2% diluted with saline to a total volume of 40 ml; the lidocaine dexmedetomidine group, in which patients received 0.5 µg/kg of dexmedetomidine plus 3 mg/kg of lidocaine 2%; and the lidocaine verapamil group, in which patients received 2.5 mg of verapamil plus 3 mg/kg of lidocaine 2%. The onset and duration of sensory and motor block were recorded. Postoperative Visual Analog Score, onset of tourniquet pain, duration of analgesia, and total analgesic requirements at the 12th postoperative hour were monitored. Results Adding dexmedetomidine or verapamil to lidocaine causes faster onset and prolonged recovery of sensory and motor block and improvement of postoperative analgesia, without causing side effects compared with lidocaine alone. Conclusion The use of either verapamil or dexmedetomidine as an adjuvant to lidocaine solution causes equal improvement of the quality of anesthesia in intravenous regional anesthesia of upper limb orthopedic surgeries.
{"title":"Comparison between dexmedetomidine and verapamil as an adjuvant to local anesthesia in intravenous regional anesthesia in upper limb orthopedic surgery: a randomized double-blind prospective study","authors":"Medhat Messseha Gerges","doi":"10.4103/1687-7934.198261","DOIUrl":"https://doi.org/10.4103/1687-7934.198261","url":null,"abstract":"Background The use of intravenous regional anesthesia has increased significantly in recent years. Adjuvants are frequently added to local anesthetics to prolong analgesia following peripheral nerve blockade. Objective This randomized double-blind prospective study was designed to compare the effectiveness of adding dexmedetomidine (α2 adrenoceptor agonist) or verapamil (calcium channel antagonist) as an adjunct to lidocaine in upper limb orthopedic surgery. Patients and methods Sixty adult patients scheduled for elective upper limb orthopedic surgery were divided into three groups: the lidocaine group, in which patients received 3 mg/kg of lidocaine 2% diluted with saline to a total volume of 40 ml; the lidocaine dexmedetomidine group, in which patients received 0.5 µg/kg of dexmedetomidine plus 3 mg/kg of lidocaine 2%; and the lidocaine verapamil group, in which patients received 2.5 mg of verapamil plus 3 mg/kg of lidocaine 2%. The onset and duration of sensory and motor block were recorded. Postoperative Visual Analog Score, onset of tourniquet pain, duration of analgesia, and total analgesic requirements at the 12th postoperative hour were monitored. Results Adding dexmedetomidine or verapamil to lidocaine causes faster onset and prolonged recovery of sensory and motor block and improvement of postoperative analgesia, without causing side effects compared with lidocaine alone. Conclusion The use of either verapamil or dexmedetomidine as an adjuvant to lidocaine solution causes equal improvement of the quality of anesthesia in intravenous regional anesthesia of upper limb orthopedic surgeries.","PeriodicalId":7492,"journal":{"name":"Ain-Shams Journal of Anaesthesiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77995158","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 : 2016-10-01DOI: 10.4103/1687-7934.197569
E. Mahran, Ahmed Abou El-Soud, A. Ragab, Fatma Elshamy
Background Children suffer postoperative pain in the same way as adults. Pediatric pain management is a challenge. Patient-controlled analgesia (PCA) is a flexible, reliable, and individualized method in postoperative pain therapy. However, young children are not able to use PCA themselves, and hence they need to receive PCA by proxy (parent or nurse). The guidelines for PCA by proxy in pediatrics are still insufficient. Aim The aim of this study was to determine the safety and efficacy of PCA by proxy after major pediatric cancer surgery. Patients and methods We studied 330 pediatric cancer patients between 1 and 10 years of age scheduled for major surgery. They were divided into three equal groups: group C (child PCA), group P (parent proxy), and group N (nurse proxy). In each group we measured vital signs, pain intensity, total morphine consumption, side effects, and specific PCA monitoring for the first 72 h postoperatively. Results We found that pain scores were higher in the nurse group compared with the other two groups on days 2 and 3 (P < 0.001); morphine consumption was higher in the child group (older age). Vital signs were comparable between groups. There were no significant differences in sedation scale, and there were limited complications with no difference between groups. Conclusion Parent-controlled PCA is a safe and effective method of analgesia for children between 1 and 6 years of age. Nurse-controlled proxy is safe but not effective in controlling child pain. Child-controlled analgesia is safe and effective in children above 6 years of age.
{"title":"Patient-controlled analgesia versus patient-controlled analgesia by proxy for the management of postoperative pain in major pediatric cancer surgery","authors":"E. Mahran, Ahmed Abou El-Soud, A. Ragab, Fatma Elshamy","doi":"10.4103/1687-7934.197569","DOIUrl":"https://doi.org/10.4103/1687-7934.197569","url":null,"abstract":"Background Children suffer postoperative pain in the same way as adults. Pediatric pain management is a challenge. Patient-controlled analgesia (PCA) is a flexible, reliable, and individualized method in postoperative pain therapy. However, young children are not able to use PCA themselves, and hence they need to receive PCA by proxy (parent or nurse). The guidelines for PCA by proxy in pediatrics are still insufficient. Aim The aim of this study was to determine the safety and efficacy of PCA by proxy after major pediatric cancer surgery. Patients and methods We studied 330 pediatric cancer patients between 1 and 10 years of age scheduled for major surgery. They were divided into three equal groups: group C (child PCA), group P (parent proxy), and group N (nurse proxy). In each group we measured vital signs, pain intensity, total morphine consumption, side effects, and specific PCA monitoring for the first 72 h postoperatively. Results We found that pain scores were higher in the nurse group compared with the other two groups on days 2 and 3 (P < 0.001); morphine consumption was higher in the child group (older age). Vital signs were comparable between groups. There were no significant differences in sedation scale, and there were limited complications with no difference between groups. Conclusion Parent-controlled PCA is a safe and effective method of analgesia for children between 1 and 6 years of age. Nurse-controlled proxy is safe but not effective in controlling child pain. Child-controlled analgesia is safe and effective in children above 6 years of age.","PeriodicalId":7492,"journal":{"name":"Ain-Shams Journal of Anaesthesiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72942013","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 : 2016-10-01DOI: 10.4103/1687-7934.198247
D. Salah
Preoperative malnutrition is a major risk factor for increased postoperative morbidity and mortality. Patients at risk for malnutrition should be identified early. The Nutritional Risk Score is a validated tool to identify patients who should benefit from nutritional support. The adoption of total parenteral nutrition followed by the extraordinary progress in parenteral and enteral feedings, in addition to the increased knowledge of cellular biology and biochemistry, has allowed clinicians to treat malnutrition and improve surgical patient’s outcomes. Periods of prolonged fasting should be minimized and nutrition should be commenced as early as possible after surgery, preferably through the enteral route. The surgical patient with established malnutrition should begin aggressive nutrition at least 7–10 days before surgery. Those patients in whom eating is not anticipated beyond the first 5 days following surgery should receive the benefits of early enteral or parenteral feeding depending on whether the gut can be used. Many patients may benefit from newer enteral formulations, such as those designed to enhance immune function (immunonutrition).
{"title":"Perioperative nutrition to enhance recovery after surgery","authors":"D. Salah","doi":"10.4103/1687-7934.198247","DOIUrl":"https://doi.org/10.4103/1687-7934.198247","url":null,"abstract":"Preoperative malnutrition is a major risk factor for increased postoperative morbidity and mortality. Patients at risk for malnutrition should be identified early. The Nutritional Risk Score is a validated tool to identify patients who should benefit from nutritional support. The adoption of total parenteral nutrition followed by the extraordinary progress in parenteral and enteral feedings, in addition to the increased knowledge of cellular biology and biochemistry, has allowed clinicians to treat malnutrition and improve surgical patient’s outcomes. Periods of prolonged fasting should be minimized and nutrition should be commenced as early as possible after surgery, preferably through the enteral route. The surgical patient with established malnutrition should begin aggressive nutrition at least 7–10 days before surgery. Those patients in whom eating is not anticipated beyond the first 5 days following surgery should receive the benefits of early enteral or parenteral feeding depending on whether the gut can be used. Many patients may benefit from newer enteral formulations, such as those designed to enhance immune function (immunonutrition).","PeriodicalId":7492,"journal":{"name":"Ain-Shams Journal of Anaesthesiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84475469","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 : 2016-10-01DOI: 10.4103/1687-7934.198262
G. Samir, Niven Gerges-Fahmy, Heba A. Labib
Background The aim of this study was to assess the effectiveness of adding lidocaine hydrochloride nasal spray (10%) to xylometazoline nasal drops (0.1%) as an anesthetic approach in patients undergoing functional endoscopic sinus surgery. Patients and methods A total of 52 patients of American Society of Anesthesiologist physical status I were included in the study and divided into two groups: the first group (group X) received xylometazoline hydrochloride nasal drops (0.1%) and lidocaine hydrochloride nasal spray (10%), whereas the second group (group S) received xylometazoline hydrochloride nasal drops (0.1%) only. The total blood loss (TBL) during surgery, the hemodynamic changes up to 30 min following incision of the nasal mucous membrane (m.m.) and in the immediate postoperative period, the need to add propranolol and the dose of propranolol given, as well as the duration of surgery and the quality of the surgical field were recorded. Results TBL and the duration of surgery were statistically significantly lower in group X than in group S. On comparing the grades given by the surgeon for the surgical field assessment, we found the results to be statistically highly significant for each group in favor of a better surgical field in group X than in group S. As for the hemodynamic parameters, the systolic blood pressure, diastolic blood pressure, mean blood pressure, and heart rate in group S were higher than the values at baseline after induction of anesthesia, after incision of the nasal m.m., and during the 30 min after incision of the nasal m.m., and were also higher than those recorded in group X at the same time periods and this was statistically and clinically significant as propranolol was given to patients in group S after induction of anesthesia. Conclusion Better intraoperative hemodynamic control ensuring patient safety with decreased intraoperative TBL and duration of surgery, with better grades for the quality of the surgical field during functional endoscopic sinus surgery, can be achieved with the use of lidocaine hydrochloride nasal spray (10%) with xylometazoline nasal drops (0.1%).
{"title":"The effects of adding lidocaine hydrochloride nasal spray (10%) to xylometazoline nasal drops (0.1%) in functional endoscopic sinus surgery: a comparative study","authors":"G. Samir, Niven Gerges-Fahmy, Heba A. Labib","doi":"10.4103/1687-7934.198262","DOIUrl":"https://doi.org/10.4103/1687-7934.198262","url":null,"abstract":"Background The aim of this study was to assess the effectiveness of adding lidocaine hydrochloride nasal spray (10%) to xylometazoline nasal drops (0.1%) as an anesthetic approach in patients undergoing functional endoscopic sinus surgery. Patients and methods A total of 52 patients of American Society of Anesthesiologist physical status I were included in the study and divided into two groups: the first group (group X) received xylometazoline hydrochloride nasal drops (0.1%) and lidocaine hydrochloride nasal spray (10%), whereas the second group (group S) received xylometazoline hydrochloride nasal drops (0.1%) only. The total blood loss (TBL) during surgery, the hemodynamic changes up to 30 min following incision of the nasal mucous membrane (m.m.) and in the immediate postoperative period, the need to add propranolol and the dose of propranolol given, as well as the duration of surgery and the quality of the surgical field were recorded. Results TBL and the duration of surgery were statistically significantly lower in group X than in group S. On comparing the grades given by the surgeon for the surgical field assessment, we found the results to be statistically highly significant for each group in favor of a better surgical field in group X than in group S. As for the hemodynamic parameters, the systolic blood pressure, diastolic blood pressure, mean blood pressure, and heart rate in group S were higher than the values at baseline after induction of anesthesia, after incision of the nasal m.m., and during the 30 min after incision of the nasal m.m., and were also higher than those recorded in group X at the same time periods and this was statistically and clinically significant as propranolol was given to patients in group S after induction of anesthesia. Conclusion Better intraoperative hemodynamic control ensuring patient safety with decreased intraoperative TBL and duration of surgery, with better grades for the quality of the surgical field during functional endoscopic sinus surgery, can be achieved with the use of lidocaine hydrochloride nasal spray (10%) with xylometazoline nasal drops (0.1%).","PeriodicalId":7492,"journal":{"name":"Ain-Shams Journal of Anaesthesiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79627815","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 : 2016-10-01DOI: 10.4103/1687-7934.198267
M. Abdel Aziz, Amr M. Abdelfatah, H. A. Abdel Hamid
Introduction Single-shot caudal analgesia is a useful technique in controlling postoperative pain in infraumbilical pediatric surgeries, although of a limited duration. The aim of this study was to evaluate the analgesic efficacy and rate of success when incorporating dexmedetomidine or fentanyl to levobupivacaine in ultrasound (U/S)-guided caudal block for infraumbilical surgeries. Patients and methods This prospective, randomized, double-blinded study was conducted on 63 pediatric patients undergoing infraumbilical surgeries, allocated into three groups to receive inhalational anesthesia with an appropriately sized laryngeal mask airway, followed by U/S-guided caudal epidural block using either only 0.25% levobupivacaine (L), or incorporating it with 1 μg/kg fentanyl (LF) or 1 μg/kg dexmedetomidine (LD) in a total volume of 0.7 ml/kg. Pain assessment using Children’s and Infants’ Postoperative Pain Scale (CHIPPS) score, time to first analgesic, and total analgesia required in the three groups and Ramsay sedation score were recorded. Hemodynamics and any adverse effects were also documented. Results None of the patients required intraoperative additional analgesia. A statistically significantly lower postoperative CHIPPS values with prolonged analgesic duration and time to rescue analgesia was observed in the levobupivacaine–fentanyl and levobupivacaine–dexmedetomidine groups (275±20.62 and 304.75±25.2, respectively) as opposed to the levobupivacaine only group (203.1±18), with an evident reduction in the total paracetamol dose required postoperatively (P<0.001). Arousable sedation time was significantly prolonged in the levobupivacaine–fentanyl and levobupivacaine–dexmedetomidine groups. Apart from pruritus and urine retention in the levobupivacaine–fentanyl group, no adverse events were recorded in all groups. Conclusion Caudal levobupivacaine combined with dexmedetomidine 1 μg/kg in pediatric patients undergoing infraumbilical surgeries provides prolonged postoperative analgesia comparable to levobupivacaine–fentanyl and superior to levobupivacaine alone, with reduced postoperative analgesic requirements and extended arousable sedation time. The use of U/S raises the safety and ensures the success of caudal block.
{"title":"Ultrasound-guided caudal analgesia using fentanyl versus dexmedetomidine as an adjuvant for levobupivacaine in infraumbilical pediatric surgeries","authors":"M. Abdel Aziz, Amr M. Abdelfatah, H. A. Abdel Hamid","doi":"10.4103/1687-7934.198267","DOIUrl":"https://doi.org/10.4103/1687-7934.198267","url":null,"abstract":"Introduction Single-shot caudal analgesia is a useful technique in controlling postoperative pain in infraumbilical pediatric surgeries, although of a limited duration. The aim of this study was to evaluate the analgesic efficacy and rate of success when incorporating dexmedetomidine or fentanyl to levobupivacaine in ultrasound (U/S)-guided caudal block for infraumbilical surgeries. Patients and methods This prospective, randomized, double-blinded study was conducted on 63 pediatric patients undergoing infraumbilical surgeries, allocated into three groups to receive inhalational anesthesia with an appropriately sized laryngeal mask airway, followed by U/S-guided caudal epidural block using either only 0.25% levobupivacaine (L), or incorporating it with 1 μg/kg fentanyl (LF) or 1 μg/kg dexmedetomidine (LD) in a total volume of 0.7 ml/kg. Pain assessment using Children’s and Infants’ Postoperative Pain Scale (CHIPPS) score, time to first analgesic, and total analgesia required in the three groups and Ramsay sedation score were recorded. Hemodynamics and any adverse effects were also documented. Results None of the patients required intraoperative additional analgesia. A statistically significantly lower postoperative CHIPPS values with prolonged analgesic duration and time to rescue analgesia was observed in the levobupivacaine–fentanyl and levobupivacaine–dexmedetomidine groups (275±20.62 and 304.75±25.2, respectively) as opposed to the levobupivacaine only group (203.1±18), with an evident reduction in the total paracetamol dose required postoperatively (P<0.001). Arousable sedation time was significantly prolonged in the levobupivacaine–fentanyl and levobupivacaine–dexmedetomidine groups. Apart from pruritus and urine retention in the levobupivacaine–fentanyl group, no adverse events were recorded in all groups. Conclusion Caudal levobupivacaine combined with dexmedetomidine 1 μg/kg in pediatric patients undergoing infraumbilical surgeries provides prolonged postoperative analgesia comparable to levobupivacaine–fentanyl and superior to levobupivacaine alone, with reduced postoperative analgesic requirements and extended arousable sedation time. The use of U/S raises the safety and ensures the success of caudal block.","PeriodicalId":7492,"journal":{"name":"Ain-Shams Journal of Anaesthesiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90915987","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 : 2016-10-01DOI: 10.4103/1687-7934.198257
Udita Naithani, Sneha Arun Betkekar, D. Verma, R. Gehlot, Rajkumar Sundararaj
Despite a number of preventive mechanisms, inadvertent administration of nitrous oxide in place of oxygen can lead to fatal hypoxemia. Here we report two cases of hypoxia that occurred when we switched to the emergency cylinder for oxygen supply after exhaustion of the main oxygen cylinder. The urgency shown by the anesthetist and operating room staff to restore the main oxygen supply prevented any fatalities from occurring in our case. We found that there was incorrect painting of the nitrous oxide cylinder with the color code of oxygen. Further, damaged pins on the yoke assembly allowed the attachment of the faulty E cylinder to the machine. Even though such errors are made by the supplier we suggest that all equipment including the cylinder be thoroughly checked by the anesthetist. This also highlights the role of respiratory gas monitoring in the prevention of such mishaps.
{"title":"Pin index safety system and color coding: is it enough?","authors":"Udita Naithani, Sneha Arun Betkekar, D. Verma, R. Gehlot, Rajkumar Sundararaj","doi":"10.4103/1687-7934.198257","DOIUrl":"https://doi.org/10.4103/1687-7934.198257","url":null,"abstract":"Despite a number of preventive mechanisms, inadvertent administration of nitrous oxide in place of oxygen can lead to fatal hypoxemia. Here we report two cases of hypoxia that occurred when we switched to the emergency cylinder for oxygen supply after exhaustion of the main oxygen cylinder. The urgency shown by the anesthetist and operating room staff to restore the main oxygen supply prevented any fatalities from occurring in our case. We found that there was incorrect painting of the nitrous oxide cylinder with the color code of oxygen. Further, damaged pins on the yoke assembly allowed the attachment of the faulty E cylinder to the machine. Even though such errors are made by the supplier we suggest that all equipment including the cylinder be thoroughly checked by the anesthetist. This also highlights the role of respiratory gas monitoring in the prevention of such mishaps.","PeriodicalId":7492,"journal":{"name":"Ain-Shams Journal of Anaesthesiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79115176","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 : 2016-10-01DOI: 10.4103/1687-7934.198260
A. Waleed
Background Arthroscopic shoulder surgery is often associated with severe postoperative pain that is often significant enough to interfere with initial recovery and rehabilitation − the pain that can be difficult to manage without large-dose opioids. Opioids can cause nausea, vomiting, sedation, and/or failure to control pain. Supplementing general anesthesia with a regional nerve block might improve the quality of postoperative pain relief. The use of interscalene blockade (ISB) is gaining popularity, but it is associated with infrequent but potentially serious complications. Combined suprascapular nerve block and axillary nerve block (SSNB+ANB) can offer a safe alternative to ISB. Objective This study was designed to compare between ISB and SSNB+ANB in arthroscopic shoulder surgery as regards postoperative analgesia Patients and methods Sixty American Society of Anesthesiologist physical status I and II patients, aged between 18 and 40 years, scheduled for arthroscopic shoulder surgery were randomized to receive ISB or SSNB+ANB. After performing the blocks, general anesthesia was standardized in all groups. All the patients in the two groups were compared as regards postoperative pain assessed by the visual analog scale score at postanesthesia care unit, 4, 6, 12, and 24 h, occurrence of complications, and patient’s satisfaction. Results In the postoperative period, there were no statistically significant differences between the two groups as regards visual analog scale and analgesic requirements. Complications such as Horner’s syndrome, hoarseness of voice, major weakness of the upper arm, and dyspnea were recorded in the ISB group. Conclusion For certain procedures of shoulder arthroscopic surgery, SSNB+ANB is a safe and effective alternative to ISB as postoperative analgesia.
{"title":"Postoperative analgesia for arthroscopic shoulder surgery: comparison between ultrasound-guided interscalene block and combined suprascapular and axillary nerve blocks","authors":"A. Waleed","doi":"10.4103/1687-7934.198260","DOIUrl":"https://doi.org/10.4103/1687-7934.198260","url":null,"abstract":"Background Arthroscopic shoulder surgery is often associated with severe postoperative pain that is often significant enough to interfere with initial recovery and rehabilitation − the pain that can be difficult to manage without large-dose opioids. Opioids can cause nausea, vomiting, sedation, and/or failure to control pain. Supplementing general anesthesia with a regional nerve block might improve the quality of postoperative pain relief. The use of interscalene blockade (ISB) is gaining popularity, but it is associated with infrequent but potentially serious complications. Combined suprascapular nerve block and axillary nerve block (SSNB+ANB) can offer a safe alternative to ISB. Objective This study was designed to compare between ISB and SSNB+ANB in arthroscopic shoulder surgery as regards postoperative analgesia Patients and methods Sixty American Society of Anesthesiologist physical status I and II patients, aged between 18 and 40 years, scheduled for arthroscopic shoulder surgery were randomized to receive ISB or SSNB+ANB. After performing the blocks, general anesthesia was standardized in all groups. All the patients in the two groups were compared as regards postoperative pain assessed by the visual analog scale score at postanesthesia care unit, 4, 6, 12, and 24 h, occurrence of complications, and patient’s satisfaction. Results In the postoperative period, there were no statistically significant differences between the two groups as regards visual analog scale and analgesic requirements. Complications such as Horner’s syndrome, hoarseness of voice, major weakness of the upper arm, and dyspnea were recorded in the ISB group. Conclusion For certain procedures of shoulder arthroscopic surgery, SSNB+ANB is a safe and effective alternative to ISB as postoperative analgesia.","PeriodicalId":7492,"journal":{"name":"Ain-Shams Journal of Anaesthesiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83110416","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 : 2016-10-01DOI: 10.4103/1687-7934.198254
E. Mahran, M. Hassan
Background and objective Transversus abdominis plane (TAP) block is a recently developed method for analgesia that is now widely used in a variety of abdominal surgeries. Robotic laparoscopy is being increasingly adopted for surgical resection of abdominal cancers. We studied the efficacy and safety of TAP block to control pain after robot-assisted laparoscopic abdominal cancer surgery. Methods Totally, 30 patients scheduled for robot-assisted laparoscopic abdominal cancer surgery (hysterectomy, colorectal cancer resection, or cystectomy) received general anesthesia. Before extubation the patients were randomized into two equal groups: group T, in which TAP block was performed by means of an ultrasound-guided subcostal approach, and group C (control group), in which no TAP block was performed or other regional anesthesia was induced. We measured visual analog scale (VAS) both at rest and during episodes of coughing at 1, 2, 6, 12, and 24 h postoperatively. We measured total 24 h morphine consumption, in addition to complications and postoperative nausea and vomiting. Results VAS both at rest and during coughing was lower in the T group at all time intervals until 12 h (P<0.001). At 24 h there was no significant difference in VAS but there was marked difference in the total morphine consumption between the T group (26.0±1.8) and the C group (64.3±4.3). Except for two cases of postoperative nausea and vomiting in each group there were no complications detected. Conclusion Ultrasound-guided TAP block by subcostal approach is an effective and safe method for providing analgesia that markedly reduces morphine consumption after robot-assisted laparoscopic abdominal cancer surgery
{"title":"Ultrasound-guided transversus abdominis plane block for control of postoperative pain after laparoscopy-assisted robotic abdominal cancer surgery","authors":"E. Mahran, M. Hassan","doi":"10.4103/1687-7934.198254","DOIUrl":"https://doi.org/10.4103/1687-7934.198254","url":null,"abstract":"Background and objective Transversus abdominis plane (TAP) block is a recently developed method for analgesia that is now widely used in a variety of abdominal surgeries. Robotic laparoscopy is being increasingly adopted for surgical resection of abdominal cancers. We studied the efficacy and safety of TAP block to control pain after robot-assisted laparoscopic abdominal cancer surgery. Methods Totally, 30 patients scheduled for robot-assisted laparoscopic abdominal cancer surgery (hysterectomy, colorectal cancer resection, or cystectomy) received general anesthesia. Before extubation the patients were randomized into two equal groups: group T, in which TAP block was performed by means of an ultrasound-guided subcostal approach, and group C (control group), in which no TAP block was performed or other regional anesthesia was induced. We measured visual analog scale (VAS) both at rest and during episodes of coughing at 1, 2, 6, 12, and 24 h postoperatively. We measured total 24 h morphine consumption, in addition to complications and postoperative nausea and vomiting. Results VAS both at rest and during coughing was lower in the T group at all time intervals until 12 h (P<0.001). At 24 h there was no significant difference in VAS but there was marked difference in the total morphine consumption between the T group (26.0±1.8) and the C group (64.3±4.3). Except for two cases of postoperative nausea and vomiting in each group there were no complications detected. Conclusion Ultrasound-guided TAP block by subcostal approach is an effective and safe method for providing analgesia that markedly reduces morphine consumption after robot-assisted laparoscopic abdominal cancer surgery","PeriodicalId":7492,"journal":{"name":"Ain-Shams Journal of Anaesthesiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78831195","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 : 2016-10-01DOI: 10.4103/1687-7934.198265
S. Anis, G. Samir, H. ElSerwi
Background The aim of this study was to assess the effectiveness of intraoperative lidocaine versus dexmedetomidine infusion on hemodynamic stability during pneumoperitoneum, as well as the recovery profile of diagnostic laparoscopic gynecologic surgeries. Patients and methods A total of 60 female patients of American Society of Anesthesiologist (ASA) physical status I were included in the study and divided into two groups: group L and group D. Group L received lidocaine hydrochloride 2%, and group D received dexmedetomidine hydrochloride. The hemodynamic changes during pneumoperitoneum as well as the recovery profile (postoperative sedation, pain scores, and analgesic requirements) were recorded. Results During pneumoperitoneum, group D patients showed a statistically significant decrease in mean heart rate compared with group L patients. However, the mean systolic blood pressure, diastolic blood pressure, and mean blood pressure in group L patients showed statistically and clinically nonsignificant changes compared with those of group D patients. As regards the recovery profile, group D patients recorded a significantly higher median sedation score compared with group L patients, and the postoperative pain scores were significantly better in group L than in group D patients after 30 min, 1 h from arrival at the postanesthesia care unit, and at 2 h in the ward. However, this resulted in a statistically nonsignificant number of patients requiring pethidine in the postanesthesia care unit, as well as statistically nonsignificant total pethidine requirements of less than 50 mg. Conclusion Lidocaine offers hemodynamic stability during pneumoperitoneum, as well as a decrease in the intensity of postoperative pain with opioid sparing, offering a less sedated patient than dexmedetomidine during day-case diagnostic laparoscopic gynecologic surgery.
{"title":"Lidocaine versus dexmedetomidine infusion in diagnostic laparoscopic gynecologic surgery: a comparative study","authors":"S. Anis, G. Samir, H. ElSerwi","doi":"10.4103/1687-7934.198265","DOIUrl":"https://doi.org/10.4103/1687-7934.198265","url":null,"abstract":"Background The aim of this study was to assess the effectiveness of intraoperative lidocaine versus dexmedetomidine infusion on hemodynamic stability during pneumoperitoneum, as well as the recovery profile of diagnostic laparoscopic gynecologic surgeries. Patients and methods A total of 60 female patients of American Society of Anesthesiologist (ASA) physical status I were included in the study and divided into two groups: group L and group D. Group L received lidocaine hydrochloride 2%, and group D received dexmedetomidine hydrochloride. The hemodynamic changes during pneumoperitoneum as well as the recovery profile (postoperative sedation, pain scores, and analgesic requirements) were recorded. Results During pneumoperitoneum, group D patients showed a statistically significant decrease in mean heart rate compared with group L patients. However, the mean systolic blood pressure, diastolic blood pressure, and mean blood pressure in group L patients showed statistically and clinically nonsignificant changes compared with those of group D patients. As regards the recovery profile, group D patients recorded a significantly higher median sedation score compared with group L patients, and the postoperative pain scores were significantly better in group L than in group D patients after 30 min, 1 h from arrival at the postanesthesia care unit, and at 2 h in the ward. However, this resulted in a statistically nonsignificant number of patients requiring pethidine in the postanesthesia care unit, as well as statistically nonsignificant total pethidine requirements of less than 50 mg. Conclusion Lidocaine offers hemodynamic stability during pneumoperitoneum, as well as a decrease in the intensity of postoperative pain with opioid sparing, offering a less sedated patient than dexmedetomidine during day-case diagnostic laparoscopic gynecologic surgery.","PeriodicalId":7492,"journal":{"name":"Ain-Shams Journal of Anaesthesiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85416828","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 : 2016-10-01DOI: 10.4103/1687-7934.198251
Malik Sunny, P. Arun, Bhandari Hricha, Malik Shraddha
Reported is a case of left mainstem bronchus carcinoid that was managed by means of a modified technique using a microlaryngeal tube for right lung ventilation and laser resection using an AMBU Ascope. The upper lobe of the left lung showed dramatic improvement on postoperative chest radiograph and computed tomography scan. Precautions for laser surgery and sharing of the airway by the surgeon and the anesthetist were taken care of during ventilation of the right lung. Soiling and tumor migration of the opposite lung were prevented intraoperatively and postoperatively.
{"title":"Endobronchial tumor laser resection: handling anesthetic challenges through a modified technique","authors":"Malik Sunny, P. Arun, Bhandari Hricha, Malik Shraddha","doi":"10.4103/1687-7934.198251","DOIUrl":"https://doi.org/10.4103/1687-7934.198251","url":null,"abstract":"Reported is a case of left mainstem bronchus carcinoid that was managed by means of a modified technique using a microlaryngeal tube for right lung ventilation and laser resection using an AMBU Ascope. The upper lobe of the left lung showed dramatic improvement on postoperative chest radiograph and computed tomography scan. Precautions for laser surgery and sharing of the airway by the surgeon and the anesthetist were taken care of during ventilation of the right lung. Soiling and tumor migration of the opposite lung were prevented intraoperatively and postoperatively.","PeriodicalId":7492,"journal":{"name":"Ain-Shams Journal of Anaesthesiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89332079","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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