Effect of addition of fentanyl to intra-articular ketorolac for pain management in patients undergoing arthroscopic knee surgery

Arthroscopic Knee surgery is now one of the most commonly performed surgical procedures as its major advantage is the minimal surgical trauma to the knee joint. It is not associated with severe postoperative pain but providing the patients with adequate analgesia may affect the recovery profile. The goal of this study was to evaluate the effect of addition of fentanyl to ketorolac intra-articularly on the haemodynamic parameters, postoperative analgesia, possible postoperative complications and optimum discharge criteria in patients undergoing arthroscopic knee surgery. The study was conducted on 40 adult patients of either sex admitted at Mansoura university hospital knee unit for elective knee arthroscopy. Patients were randomly allocated into two equal groups [20 patients each] according to intra-articulary injected solution: Ketorolac group [K] [10 mg ketorolac] and Ketorolac Fentanyl group [KF] [5 mg ketorolac + 50microg fentanyl] diluted in 20 ml 0.9% saline. All patients received general anaesthesia and all received the intra-articular study solution at the end of knee arthroscopy. Ten minutes before release of the tourniquet. Every patient was monitored intraoperativeiy and postoperatively for 24 hours with ECG non invasive blood pressure, and pulse oximetry. Duration of postoperative analgesia, Verbal Rating Pain Score, postoperative analgesic consumption and postoperative complications [sedation, respiratory depression, pruritus, nausea and vomiting] were recoded postoperatively for 24 hours. The patient's characteristics were comparable in the two groups regarding age, body weight, height and sex with no significant differences between the two groups. The duration of postoperative analgesia was significantly longer in KF group when compared with K group. Also the lotal consumption and the number of postoperative supplemental diciofenac doses were significantly decreased in KF group when compared with K group. Verbal Rating Scale Pain Score were significantly increased in K group at 12 hours when compared with the basal value, and significantly decreased in KF group when compared with K group at 12 hours. Haemodynamic parameters [mean arterial blood pressure and heart rate], oxygen saturation, sedation score and modified Al-dret score showed no significant differences either within each group or in between the two groups. No patient complained from nausea/ vomiting, pruritus or respiratory depression. No patient had a respiratory rate less than 10/minute. All patients in the two groups were discharged from hospital after the first 24 hours following surgery. Based on the previous results of our study, we can conclude that the addition of fentanyl to ketorolac intra-articularly significantly produces more prolonged duration of postoperative analgesia without any undesirable side effects in patients undergoing arthroscopic knee surgery

Effects of locally applied lidocaine or ropivacaine on occulocardiac reflex in pediatric strabismus surgery

Thirty children aged from 3-14 years, ASA I or II, requiring the correction of strabismus under general anesthesia were included in this study. A preoperative assessment was performed, the children were fasted for 6-8 hours from solid food and 3-4 hours for clear liquid. No premeditation was given. Anesthesia was induced by thiopentone 3-5 mg/kg and tracheal intubation was facilitated by atracurium 0.5-0.6 mg/kg and anesthesia was maintained with N2O oxygen 2:1 with the addition of isoflurane 0.6-1%. Controlled ventilation was used to maintain end-tidal carbon dioxide [EtCO2] at an accepted level. The patients were randomly categorized into three groups [10 patients each] according to the drug applied locally on the extra ocular muscle as follows: Group I [control group] received saline, group II [lidocaine group] received 1 mg/kg lidocaine [2%] and group III [ropivacaine group] received ropivacaine [0.75%] 1 mg/kg [4-5 ml volume]. It was concluded that lidocaine and ropivacaine [in a dose of 1 mg/kg] applied locally to the extra ocular muscles can be used to reduce the incidence of the oculocardiac reflex [OCR] during strabismus surgery in children

optimal sedation of propofol versus midazolam in geriatrics during regional anaesthesia for hip orthopedic surgery

The main goals of intraoperative sedation are anxiolysis, hypnosis and amnesia. These objectives are required to produce a calm comfortable, but communicative patient. The sedation of a geriatric represents a continuum. These patients can move easily from light level of sedation to obtundation. The distinction between conscious sedation and deep sedation is made for the purpose of describing the proper level of physiologic monitoring. Midazolam and propofol are the most popular sedative agents due to their attractive pharrnacokinetic profile and wide therapeutic index. This study was carried out on 40 old patients above 60 years scheduled for hip surgical correction under spinal anaesthesia. They were randomely class into two equal groups according to the sedative regimen used. The propofol was used in one group at initial dose 1-1.5 mg/kg followed by ascending infusion scale5-50 ug/ kg/min. every 5 minutes. The midazolam was used in the second group at initial dose 10-20 ug/kg followed by ascending infusion scale 0.2-2 ug/kg/min every 5 minutes. The infusion rate adjusfed till reach the optimum sedation score [=3] in both groups. Sedation and recovery [durations and degrees] were assessed by Ramsay sedation scale and recovery room score respectively. The haemodynamics and concomitent events were recorded. This study showed the sign lower haemodynamic data of propofol group in comparison with the midazolam one, but with superior titrability, at the optimum sedation level, and faster recovery time. The midazolam group is superior in its amnestic action with less paradoxical agitation but with delayed recovery and difficult titrability at the desired sedation level like propofol

Evaluation of neuromuscular blocking effect of cisatracurium in patients with liver cirrhosis

Cisatracurium is one of the ten stereoisomers of atracurium, it is a potent intermediate duration non-depolarizing neuromuscular blocking agent. and its pharmacokinetics and pharmacodynamics are similar to atracurium. it is degraded in plasma by Hofmann degradation and ester hydrolysis. In this study we evaluated its neuromuscular blocking effect in patients with bilharzial liver cirrhosis. We studied 20 patients which were divided into 2 groups, 10 patients each, the patients of the first group were ASA, I or II and patients of the second group had hepatic cirrhosis child II all patients received thiopentone sodium, cisatracurium 0.1mg/kg, then intubation was done and anaesthesia was maintained with N20: O2 and halothane with controlled ventilation. There was significant prolongation in the onset time of relaxation after injection of the bolus dose in hepatic patients, however there was insignificant difference between the two groups as regard the duration of neuromascular block or total dose of cisatracurium. So, we can conclude that cisatracurium is a suitable muscle relaxant in patients with liver cirrhosis