The effect of adding dexmedetomidine or dexamethasone to bupivacaine-fentanyl mixture in spinal anesthesia for cesarean section.

Background and Aims: Many strategies are available to prevent spinal-induced hypotension in cesarean section, especially the use of a low dose of spinal anesthesia combined with adjuvants. This study investigated the effect of adding either dexmedetomidine or dexamethasone to the intrathecal bupivacaine-fentanyl mixture on the postoperative analgesia duration, after elective cesarean section. Material and Methods: This prospective, randomized, double-blind study was conducted on 90 full-term parturients undergoing elective cesarean section, who were randomly distributed into three groups. They all received spinal anesthesia with the bupivacaine-fentanyl mixture (2.5 ml), in addition to 0.5 ml normal saline (control group), 5 µg dexmedetomidine dissolved in 0.5 ml normal saline (dexmedetomidine group), or 2 mg dexamethasone (dexamethasone group). The time to the first request of morphine rescue analgesia was recorded, in addition to the total dose of morphine consumed in the first 24 h after surgery, the postoperative numerical rating score (NRS), and maternal and fetal outcomes. Results: As compared to the control group and the dexamethasone group, the use of dexmedetomidine as an additive to the bupivacaine-fentanyl mixture significantly prolonged the time to the first request of rescue analgesia, decreased postoperative morphine consumption, and decreased the pain score 4 and 6 h after surgery. There was an insignificant difference between the control and dexamethasone groups. Conclusion: The use of dexmedetomidine as an additive to bupivacaine-fentanyl mixture in spinal anesthesia for cesarean section prolonged the postoperative analgesia and decreased the postoperative opioid consumption in comparison to the addition of dexamethasone or normal saline.

The effect of opioid-free anesthesia on the post-operative opioid consumption in laparoscopic bariatric surgeries: A randomized controlled double-blind study.

OBJECTIVE: This study aimed to evaluate the ability to use opioid-free anesthesia (OFA) technique in morbid obese patients. DESIGN: A prospective randomized double-blinded study. SETTING: This study was carried out at Tanta University Hospitals (tertiary hospitals). PATIENTS: Eighty morbid obese patients scheduled for laparoscopic bariatric surgeries. INTERVENTION: Patients were allocated randomly into two groups: Group C, in which fentanyl was used during induction and maintenance of anesthesia, and group OFA, in which dexmedetomidine, ketamine, magnesium, and lidocaine were started before the induction of anesthesia and continued throughout the surgery. MAIN OUTCOME MEASURE: The post-operative morphine consumption in the first 24 hours (primary outcome) and the intraoperative fentanyl consumption (secondary outcome). RESULTS: In comparison to the control group, OFA technique significantly decreased the post-operative morphine consumption (p = 0.003; 95 percent CI: 0.505; 2.396), shortened the time for the first request of rescue analgesia (p < 0.0001; 95 percent CI: 54.14; 99.11), decreased the post-operative pain score 4 and 6 hours after surgery (p < 0.05), and decreased the post-operative nausea and vomiting (PONV) impact scale (p = 0.022). Furthermore, it significantly decreased the intraoperative fentanyl consumption (p < 0.0001) with the improvement of all parameters of the recovery profile (p < 0.05). CONCLUSION: OFA in patients undergoing bariatric surgeries significantly decreased the post-operative morphine consumption, the post-operative pain score, the intraoperative fentanyl consumption, and the PONV impact scale with the improvement of the recovery profile.

The effect of post-operative ultrasound-guided transmuscular quadratus lumborum block on post-operative analgesia after hip arthroplasty in elderly patients: A randomised controlled double-blind study.

BACKGROUND AND AIM: The best analgesic technique after hip surgeries is a matter of debate. This clinical trial aimed to assess the effect of transmuscular ultrasound-guided quadratus lumborum (QL) block on post-operative analgesic consumption after hip arthroplasty in elderly patients. METHODS: This prospective randomised double-blind study was carried out on 60 patients aged 60-80 years presented for total hip replacement under unilateral spinal anaesthesia. Patients were randomly allocated to one of two groups: A control group, receiving sham transmuscular QL block (QLB) (1 ml of normal saline), and a QL group, receiving real transmuscular QLB (30 ml of plain bupivacaine 0.25%). Post-operative morphine consumption (primary outcome), post-operative pain score (secondary outcome), time to the first request of rescue analgesia, patient's satisfaction and the occurrence of post-operative complications were measured. RESULTS: Compared to the control group, the use of QLB in the second group significantly decreased intravenous morphine consumption postoperatively from 8.50 ± 3.06 mg to 5.60 ± 3.22 mg (P = 0.0007) with a significant prolongation of the time to the first call for analgesia (P < 0.0001). It also decreased the post-operative visual analogue score 4 h, 6 h and 8 h postoperatively (P < 0.05). However, there was no difference between both the groups regarding patient's satisfaction and the occurrence of complications (P > 0.05). CONCLUSION: The use of transmuscular QLB in patients undergoing total hip replacement decreased post-operative analgesic consumption and post-operative pain score and prolonged post-operative analgesia. It did not affect patients' satisfaction and occurrence of post-operative complications.

Evaluation of Flexible Laryngeal Mask Airway® in Tongue Trauma Repair: A Randomized Trial.

BACKGROUND: Flexible laryngeal mask airway may be used instead of the endotracheal tube in children presented for elective repair of tongue trauma, as it may shorten the time for extubation and recovery with the amelioration of stress response to airway management. OBJECTIVES: This study aimed to evaluate the extubation time and hemodynamic response to the endotracheal tube or flexible laryngeal mask airway in children presented for tongue trauma repair. METHODS: The study recruited 90 children presented for elective repair of tongue trauma that were randomly assigned into the following groups: the ETT group for which the airway was controlled by a cuffed endotracheal tube and the LMA group for which the airway was controlled by a flexible laryngeal mask. The intubation time, surgical time, total anesthesia time, extubation time, recovery time, changes in the hemodynamic parameters, and the incidence of complications were measured. RESULTS: The use of flexible laryngeal mask airway instead of endotracheal tube significantly decreased the extubation time to 7.47 ± 2.74 min (P < 0.0001) and the recovery time to 52.67 ± 11.16 min (P = 0.001) while no significant differences were observed in the intubation time (P = 0.874), surgical time (P = 0.411), and total anesthesia time (P = 0.725). In addition, the changes in the hemodynamic parameters were significantly lower with flexible laryngeal mask airway both during airway securing and at the start of the surgery (P < 0.05). Moreover, it significantly decreased the incidence of postoperative cough, stridor, and sore throat (P = 0.039, 0.006, and 0.027, respectively). CONCLUSIONS: The flexible laryngeal mask airway can be used instead of the endotracheal tube in children undergoing the repair of tongue trauma, as it decreases the extubation time, recovery time, and hemodynamic changes to the airway control.

The Effect of Glossopharyngeal Nerve Block on Post-Tonsillectomy Pain of Children; Randomized Controlled Trial.

BACKGROUND: Sensory fibers of the glossopharyngeal nerve supply the tonsillar and peritonsillar areas. Thus, bilateral glossopharyngeal nerve block may alleviate post-tonsillectomy pain and improve postoperative analgesia. OBJECTIVES: The purpose of this clinical trial was to evaluate the effect of glossopharyngeal nerve block on postoperative analgesia in children undergoing adeno-tonsillectomy. METHODS: Ninety ASA I-II pediatric patients presented for adeno-tonsillectomy were included in this trial. They were equally divided and randomly assigned to one of two groups: A control group, in which children did not receive a nerve block, and a glossopharyngeal nerve block group, in which children received bilateral glossopharyngeal nerve block after surgery. The postoperative pain score (FLACC score) during rest and swallowing, the time for the first request for rescue analgesia, the total dose consumption of pethidine rescue analgesia, and the incidence of postoperative complications were all assessed. Moreover, response to gag reflex, degree of difficulty in swallowing, and parents' satisfaction were recorded. RESULTS: Bilateral glossopharyngeal nerve block in children presented for adeno-tonsillectomy significantly prolonged the time for the first request of rescue analgesia, compared to the control group, reaching 5.833 ± 2.667 hours (P < 0.0001). It also decreased postoperative pethidine consumption to 0.878 ± 0.387 mg/kg (P = 0.0009). Moreover, it significantly decreased the postoperative FLACC score assessed two, four, six, and twelve hours after surgery, during rest and swallowing (P < 0.05). The response to gag reflex and difficulty in swallowing were also significantly decreased (P ≤ 0.0001 and 0.006, respectively). In addition, glossopharyngeal nerve block significantly increased parents' satisfaction (P = 0.0002), with no significant increase in the incidence of postoperative complications (P > 0.05). CONCLUSIONS: Bilateral glossopharyngeal nerve block in children undergoing adeno-tonsillectomy improved the duration and the quality of postoperative analgesia, decreased swallowing difficulties, and improved parents' satisfaction.

Randomized Controlled Study Comparing Use of Propofol Plus Fentanyl versus Midazolam Plus Fentanyl as Sedation in Diagnostic Endoscopy in Patients with Advanced Liver Disease.

OBJECTIVES: We aimed to investigate the safety and efficacy of propofol plus fentanyl versus midazolam plus fentanyl as sedative for patients with advanced liver disease presented for gastrointestinal endoscopy. METHODS: A total of 100 patients with liver cirrhosis referred for upper endoscopy were enrolled and divided equally in two groups, midazolam plus fentanyl group and propofol plus fentanyl group. All patients were subjected to history taking, estimation of level of sedation, endoscopist rating, and hemodynamic parameters including oxygen saturation, heart rate, mean arterial pressure, incidence of side effect as (bradycardia, hypotension, hypoxia, nausea and vomiting, cough, shivering, or diplopia), time needed for complete recovery, and time needed for discharge. RESULTS: There was no statistical significant difference between the studied groups regarding age, sex, weight, Child-Pugh classification score, type and duration of endoscopic intervention, time needed for complete recovery, or time needed for discharge. Complication rates were similar in both groups except for mean arterial blood pressure which was significantly lower in group of patients receiving propofol and fentanyl (P = 0.001). CONCLUSION: The use of either propofol or midazolam in combination to fentanyl is effective in sedation of patients with advanced liver diseases presented for upper GIT endoscope. The trial is registered with ClinicalTrials.gov Identifier: NCT03063866.