Effect of magnesium sulfate with ketamine infusions on intraoperative and postoperative analgesia in cancer breast surgeries: a randomized double-blind trial.

BACKGROUND: Opioids are the cornerstone in managing postoperative pain; however, they have many side effects. Ketamine and Magnesium (Mg) are NMDA receptor antagonists used as adjuvant analgesics to decrease postoperative opioid consumption. OBJECTIVE: We assumed that adding Mg to ketamine infusion can improve the intraoperative and postoperative analgesic efficacy of ketamine infusion alone in cancer breast surgeries. METHODS: Ninety patients aged between 18 and 65 years and undergoing elective cancer breast surgery were included in this prospective randomized, double-blind study. Group K received ketamine 0.5.ßmg.kg...1 bolus then 0.12.ßmg.kg...1.h...1 infusion for the first 24.ßhours postoperatively. Group KM: received ketamine 0.5.ßmg.kg...1 and Mg sulfate 50.ßmg.kg...1, then ketamine 0.12.ßmg.kg...1.h...1 and Mg sulfate 8.ßmg.kg...1.h...1 infusions for the first 24.ßhours postoperative. The primary outcome was the morphine consumption in the first 24.ßhours postoperative, while the secondary outcomes were: intraoperative fentanyl consumption, NRS, side effects, and chronic postoperative pain. RESULTS: Group KM had less postoperative opioid consumption (14.12.ß...ß5.11.ßmg) than Group K (19.43.ß...ß6.8.ßmg). Also, Group KM had less intraoperative fentanyl consumption. Both groups were similar in postoperative NRS scores, the incidence of side effects related to opioids, and chronic neuropathic pain. CONCLUSION: Adding Mg to ketamine infusion can safely improve intraoperative and postoperative analgesia with opioid-sparing effect in cancer breast surgery.

Serratus anterior plane block and erector spinae plane block in postoperative analgesia in thoracotomy: A randomised controlled study.

Background and Aims: Managing pain after thoracic surgery is crucial and the traditional methods have many adverse effects. We aimed to evaluate serratus anterior plane block (SAPB) and erector spinae plane block (ESPB) in acute pain control in thoracic cancer surgeries. Methods: This randomised controlled, triple-blind study was performed on 90 patients, between 18 and 70 years old, scheduled for elective thoracic cancer surgery. Patients were allocated into three equal groups: Control group: received sham ESPB and sham SAPB. SAPB group received SAPB (20 ml bupivacaine 0.5%) and sham ESPB. ESBP group received ESPB (20 ml bupivacaine 0.5%) and sham SAPB. Results: Postoperative morphine consumption was significantly lower in ESBP and SAPB groups than control group [ESPB (8.52 ± 4.29 mg) < SAPB (19.57 ± 7.63 mg) < control (36.37 ± 8.27 mg)] (P < 0.001). Numerical rating scale pain score was comparable among the groups at rest, but was significantly lower at 30 min, 2, 4 h in ESPB and SAPB groups, than control group on coughing. The scores were better in SAPB compared to control group till 4 h. At 8, 12, 24 h, the difference between control and SAPB groups became insignificant, but it remained the least in ESPB group. Postoperative forced vital capacity and forced expiratory volume in the first second after 24 h were the best in ESPB group and better in SAPB group compared to the control group. Conclusion: Both ESPB and SAPB reduced intraoperative and postoperative opioid consumptions and postoperative dynamic pain scores with improved postoperative pulmonary functions in thoracic surgery with the ESPB being superior.

Effect of magnesium sulfate with ketamine infusions on intraoperative and postoperative analgesia in cancer breast surgeries: a randomized double-blind trial

Abstract Background Opioids are the cornerstone in managing postoperative pain; however, they have many side effects. Ketamine and Magnesium (Mg) are NMDA receptor antagonists used as adjuvant analgesics to decrease postoperative opioid consumption. Objective We assumed that adding Mg to ketamine infusion can improve the intraoperative and postoperative analgesic efficacy of ketamine infusion alone in cancer breast surgeries. Methods Ninety patients aged between 18 and 65 years and undergoing elective cancer breast surgery were included in this prospective randomized, double-blind study. Group K received ketamine 0.5 mg.kg-1 bolus then 0.12 mg.kg-1.h-1 infusion for the first 24 hours postoperatively. Group KM: received ketamine 0.5 mg.kg-1 and Mg sulfate 50 mg.kg-1, then ketamine 0.12 mg.kg-1.h-1 and Mg sulfate 8 mg.kg-1.h-1 infusions for the first 24 hours postoperative. The primary outcome was the morphine consumption in the first 24 hours postoperative, while the secondary outcomes were: intraoperative fentanyl consumption, NRS, side effects, and chronic postoperative pain. Results Group KM had less postoperative opioid consumption (14.12 ± 5.11 mg) than Group K (19.43 ± 6.8 mg). Also, Group KM had less intraoperative fentanyl consumption. Both groups were similar in postoperative NRS scores, the incidence of side effects related to opioids, and chronic neuropathic pain. Conclusion Adding Mg to ketamine infusion can safely improve intraoperative and postoperative analgesia with opioid-sparing effect in cancer breast surgery.

Evaluation of different doses of dexmedetomidine alone versus the combination of dexmedetomidine and fentanyl in sedation during awake fiberoptic intubation in oral cancer surgery patients: A prospective, randomized, double-blind clinical trial.

BACKGROUND: Awake fiberoptic intubation (AFOI) is one of the principal techniques in the management of difficult airway in oral cancer surgery. We hypothesized that the addition of a small dose of fentanyl could improve the sedative criteria of dexmedetomidine during AFOI technique, without the need to increase the dose of dexmedetomidine which may be associated with airway compromise. PATIENTS AND METHODS: One hundred and fifty American Society of Anesthesiologists physical status 1 and 2 patients planned for AFOI for oral cancer surgery patients were allocated into three groups (fifty patients each). Group D1: Received an infusion of 1 µcg/kg dexmedetomidine diluted in 50 ml saline over 20 min. Group D2: Received an infusion of 2 µcg/kg dexmedetomidine diluted in 50 ml saline over 20 min. Group DF: Received an infusion of 1 µcg/kg dexmedetomidine added to 1 µcg/kg fentanyl diluted in 50 ml saline over 20 min. AFOI was done by topical anesthesia and with the same technique in all patients. All patients were assessed for: airway obstruction, intubation scores (vocal cord movement, coughing, and limb movement), fiberoptic intubation scores, and hemodynamic variables. Any episode of bradycardia or hypoxia was recorded and managed. RESULTS: Group D2 showed more incidence of airway obstruction than the other two groups. Limb movement scores were more in Group D1 compared to the other two groups. All groups were comparable as regard fiberoptic intubation scores, coughing, and vocal cord opening scores. CONCLUSION: Adding a low dose of fentanyl (1 µcg/kg) to a low dose of dexmedetomidine can prevent the risk of airway obstruction associated with increasing the dose of dexmedetomidine while achieving the same favorable intubation scores.

Evaluation of the role of dexmedetomidine in improvement of the analgesic profile of thoracic paravertebral block in thoracic surgeries: A randomised prospective clinical trial.

BACKGROUND AND AIMS: Thoracic paravertebral block (TPB) is one of the effective methods for management of post-operative pain in thoracic surgeries. The aim of the study was to evaluate effectiveness of addition of dexmedetomidine to paravertebral block with bupivacaine in improving the postoperative pain relief and pulmonary functions in patients undergoing thoracic surgeries. METHODS: A prospective randomized double-blinded study was performed on forty patients scheduled for thoracic surgery. A paravertebral catheter was secured under ultrasound guidance preoperatively for all patients. Group B (n = 20) received a bolus dose of 0.25% bupivacaine at 0.3 mL/kg followed by continuous infusion of 0.125% bupivacaine 0.1 mL/kg/h. Group (BD) received a bolus dose of 0.25% bupivacaine + dexmedetomidine 1 µg/kg at 0.3 mL/kg followed by continuous infusion of dexmedetomidine 0.2 µg/kg/h + 0.125% bupivacaine 0.1 mL/kg/h. Anaesthesia technique was standardized for all patients. Postoperatively, all patients were assessed during first 24 hours for intraoperative fentanyl and post-operative morphine requirements, Visual Analogue Scores (VAS) scores at rest and during cough, and postoperative pulmonary functions. RESULTS: Post-operative morphine consumption in the first 24 hours and intraoperative fentanyl requirement were significantly less in group BD (2.95 ± 1.986 mg, 80.75 ± 31.551µg respectively) compared to group B (9.85 ± 3.468 mg, 186 ± 39.683 µg respectively). Group BD showed less VAS scores during cough and better postoperative pulmonary functions (P < 0.05). CONCLUSION: Addition of dexmedetomidine to paravertebral bupivacaine in patients undergoing thoracic surgeries provides more effective analgesia with improvement in post-operative pulmonary functions.

Management of Hard Palatine Fistula Caused by Granulocytic Sarcoma: Case Report.

Granulocytic Sarcoma (GS) is a rare condition with a wide list of differential diagnosis and debatable guidelines of treatment in different cancer centers. Most of literature recommended systemic chemotherapy with or without radiation therapy and small role of surgery. One of the rarest sites for myeloid sarcoma is hard palate, which usually worsen the quality of life of the patient due to difficulty in feeding, drinking and speaking. We are reporting a case of hard palatine fistula caused by granulocytic sarcoma, in which we tried to get local control of disease with 3 dimension conformal radiation therapy 3DCRT and surgery with systemic control with chemotherapy using recommendation of multidisciplinary team and targeting mainly patient quality of life.

Comparative randomised study of GlideScope® video laryngoscope versus flexible fibre-optic bronchoscope for awake nasal intubation of oropharyngeal cancer patients with anticipated difficult intubation.

BACKGROUND AND AIMS: Awake flexible fibre-optic bronchoscope (FFS) is the standard method of intubation in difficult airway in oral cancer patients. We decided to evaluate GlideScope® video laryngoscope (GL) for intubation as compared to the standard FFS for nasal intubation in such patients. METHODS: After the ethical committee approval, we included 54 oropharyngeal cancer patients divided randomly into two equal groups: Group G and Group F. After pre-medication and pre-oxygenation, awake nasal intubation was performed using GL in Group G and FFS in Group F. In both groups, we compared intubation time in seconds (mean ± standard deviation) (primary outcome), success rate of the first intubation attempt, percentage of Cormack and Lehane glottic score and incidence of complications. We assumed that GL could be a suitable alternative for the standard FFS in nasal intubation of patients with oropharyngeal cancer. Success rate of the first attempt and Cormack and Lehane glottic score were compared using Chi-square test. RESULTS: Intubation time in seconds was significantly shorter in Group G (70.85 ± 8.88 S) than in Group F (90.26 ± 9.41 S) with (P < 0.001). The success rate of the first attempt intubation was slightly higher in Group G (81.5%) than Group F (78.8%). Cormack and Lehane glottic Score I and II showed insignificant difference between both Group G (92.6%) and Group F (96.3%). We detected three cases of sore throat in each group. CONCLUSION: GlideScope® could be a suitable alternative to FFS in nasal intubation of oropharyngeal cancer patients.

Comparison of pregabalin versus ketamine in postoperative pain management in breast cancer surgery.

BACKGROUND: Breast surgery compromises one of the most common cancer surgeries in females and commonly followed by acute postoperative pain. Pregabalin and ketamine have been used in many previous studies and was found to have a good analgesic profile. We assumed that pregabalin and ketamine can be used in control of postoperative pain in female patients undergoing breast cancer surgery. MATERIAL AND METHODS: Ninety female patients scheduled for cancer breast surgery were allocated in three groups (30 patients each), control group (group c) received preoperative placebo, pregabalin group (group p) received oral 150 mg pregabalin 1 h before surgery, ketamine group (group k) received intravenous (IV) 0.5 mg/kg ketamine with induction of anesthesia followed by 0.25 mg/kg/h IV throughout the surgery. All patients received general anesthesia and after recovery, the three groups were assessed in the first postoperative 24 h for postoperative visual analog scale (VAS), total 24 h morphine consumption, incidence of postoperative nausea and vomiting (PONV), sedation score >2 and any complications from the drugs used in the study. RESULTS: The use of pregabalin or ketamine was found to reduce total postoperative morphine consumption with P < 0.001. There was no difference between pregabalin and ketamine groups in opioid requirement. There was no difference between the three groups in postoperative VAS scores or incidence of PONV and sedation score >2. CONCLUSION: The use of preoperative oral 150 mg pregabalin 1 h before surgery or IV 0.5 mg ketamine with induction of anesthesia can reduce postoperative opioid consumption in breast cancer surgery without change in sedation or PONV and with a good safety profile.