RESUMO
OBJECTIVES: The current study aimed to find the relation between the changes in the common carotid artery (CCA) diameter and the central venous pressure (CVP) in response to a fluid challenge in spontaneously breathing adult patients. METHODS: This study included 65 adult patients aged 20 - 60 years who were admitted to the surgical ICU. The CCA diameter and CVP were measured before and after fluid challenge, and the percentage of increase in the CCA diameter and CVP were calculated. The correlation was assessed between changes in the CVP and CCA diameter. RESULTS: The CCA diameter before fluid administration had a significant strong positive correlation to the CVP (r = 0.8, P value < 0.001); the increase in the CCA diameter after fluid administration had a significant moderate positive correlation with the increase in the CVP (r = 0.4, P value < 0.001). The percentage of increase in CCA diameters was positively correlated to the percentage of increase in CVP (r = 0.589, P value = 0.001) following fluid administration. However, the Receiver Operating Characteristic (ROC) analysis was an invalid test (area under curve 0.513, P value = 0.885). CONCLUSIONS: After major surgeries, the change in the CCA diameter was positively correlated with the change in the CVP values in response to fluid administration in the spontaneously breathing adult patients, but the cut-off limit cannot be reached.
RESUMO
BACKGROUND: Mastectomy is a common surgical procedure associated with intra and postoperative pain if untreated adequately will lead to chronic pain. OBJECTIVES: This study aimed to evaluate the efficacy of serratus anterior plane block using bupivacaine/magnesium sulfate versus bupivacaine/ nalbuphine for mastectomy. METHODS: 40 ASA I and II female patients age 25 - 60 years underwent breast cancer surgery received the block before induction of general anesthesia were divided into two groups GBM (n = 20): (bupivacaine/magnesium sulphate): received bupivacaine 30 mL 0.25% and 500 mg magnesium sulphate, GBN (n = 20): (bupivacaine/nalbuphine): received bupivacaine 30 mL 0.25% and nalbuphine 0.2 mg/kg. The following parameters were recorded: The sensory block, motor block, postoperative heart rate, noninvasive mean blood pressure: at 1, 6, 12, 24 h, postoperative time to first request of analgesics (hours), VAS at rest and movement at 1, 6, 12, 24 h, postoperative analgesic requirements (pethidine mg/24 h). RESULTS: The sensory block was statistically significantly lower in the GBM group than the GBN group at 24 hours postoperatively. The Medical Research Council scale was statistically significantly lower in the GBN group than the GBM group at 24 hours postoperatively. Postoperative time to first request of analgesics (hours) was statistically significantly longer in the GBN group than the GBM group, VAS at rest was statistically significantly lower in the GBN group than GBM group at 6th and 24th hours, VAS at movement showed no statistically significant differences between the two groups. Intraoperative fentanyl and postoperative analgesic requirements (pethidine mg/24 h) showed no statistically significant differences between the two groups. CONCLUSIONS: Serratus anterior plane block using bupivacaine/nalbuphine provided effective postoperative analgesia, reduced postoperative pain than bupivacaine/magnesium sulfate in a mastectomy.