Comparative Efficacy of 3 Adjuvant Medications Used in Combination with Intrathecal Bupivacaine for Caesarian Section Anesthesia: A Randomized, Double-Blind Clinical Trial.

Background: A number of different medications are used in combination with intrathecal bupivacaine for cesarean section anesthesia, but their relative efficacy has not been well established. Objective: To study the relative efficacy of adding either intrathecal fentanyl, intrathecal sufentanil, or intravenous acetaminophen-morphine-fentanyl to intrathecal bupivacaine spinal anesthesia for pain control in elective cesarean section operations. Methods: In this randomized, double-blinded, controlled trial, 105 pregnant women eligible for cesarean section received 10 mg intrathecal bupivacaine (0.5%) in combination with 2 µg intrathecal sufentanil (group 1), 10 µg intrathecal fentanyl (group 2), and an intravenous cocktail of 1 g acetaminophen, 5 mg morphine, and 100 µg fentanyl (group 3). Patients were assessed for analgesia, time to block, and adverse effects. Results: The 3 groups were similar in terms of the time to onset of sensory block and the duration of both sensory and motor block. Groups 1 and 3 differed significantly in the time to peak sensory block, whereas group 1 differed significantly from groups 2 and 3 in the time to peak motor block. The sensory block level reached T4 in most patients. Significant differences in pain (visual analog scale) were demonstrated between groups 1 and 3 at 5 minutes after spinal injection, between groups 1 and 2 at the end of the surgery and upon arrival to the recovery room, and between all groups in the recovery room. Conclusions: When used in addition to 10 mg intrathecal bupivacaine, an intravenous cocktail of 1 g acetaminophen-5 mg morphine-100 µg fentanyl was as efficient as either 10 µg intrathecal fentanyl or 2 µg intrathecal sufentanil in terms of sensory and motor block duration and produced a higher dermatomal level of sensory block. However, intrathecal sufentanil provided better anesthesia quality (less time to onset of motor block and peak sensory-motor block) and better pain control. (Curr Ther Res Clin Exp. 2023; 84:XXX-XXX).

The Effect of Melatonin on the Serum Level of Interleukin 6 and Interleukin 9 in Coronary Artery Bypass Grafting Surgery.

OBJECTIVE: Cardiopulmonary bypass has been recognized as one of the main causes of systemic inflammatory response syndrome, leading to post-operative complications. The aim of this study was to investigate the effect of melatonin on the serum levels of interleukin 6 (IL-6) and IL-9 in patients undergoing coronary artery bypass grafting surgery. METHODS: Forty-four patients undergoing elective coronary artery bypass surgery were randomly allocated into two study groups of melatonin (n = 23) and placebo (n = 21). Patients in the melatonin group received two melatonin tablet, 5 mg daily for 3 days before surgery, 10 mg tablet (two doses of 5 mg) 1 h before induction of anesthesia and finally, 10 mg melatonin tablet in the intensive care unit, placebo group patients received placebo at the same time periods. Serum levels of IL-9 and IL-6 were measured as baseline (T1), before induction of anesthesia (T2), 6 and 24 h after off pump (T3, T4). Data were analyzed using SPSS 23 software (IBM Corp., Armonk, NY, USA). RESULTS: The mean serum level of IL-6 was significantly lower in the melatonin group at T3 and T4 (p ＜ 0.05). Also, in both groups, serum levels of IL-6 in T3 showed a significant increase compared to T1. Serum levels of IL-9 had no significant difference between the two groups at T1, T2, T3, and T4. CONCLUSION: The results of this study showed that pre-operative melatonin administration could modify inflammatory cytokines secretion such as IL-6 while it has no significant effect on the serum levels of IL- 9. Neither of the changes was clinically significant.