RESUMO
BACKGROUND AND AIMS: The addition of dexmedetomidine to spinal anesthesia decreases the incidence of tourniquet pain but may aggravate hypotension after tourniquet deflation. METHODS: Fifty patients were included in this prospective, double-blinded, randomized study, randomly divided into two equal groups of 25 patients each. Spinal anesthesia was performed using 2.5 mL of 0.5% hyperbaric bupivacaine plus 0.5 mL of normal saline in control group (Group C) or 2.5 mL of 0.5% hyperbaric bupivacaine plus 0.5 mL (5 µg) of dexmedetomidine in (Group D). Tourniquet pain was treated by 50 mg of meperidine and repeated in a dose of 20 mg, and the total meperidine consumption was calculated. After tourniquet deflation, heart rate and mean blood pressure were measured for 15 min in the operating room and at these times: before induction of anesthesia (baseline), after inflating tourniquet (inflation), 1 min before deflating tourniquet (predeflation), after tourniquet deflation (10 min postdeflation), and maximum blood pressure and heart rate changes. Duration of time that started before the minimum blood pressure and maximum heart rate was changed until recovery was recorded. RESULTS: Pain after torniquet inflation was significantly higher in the Group C compared to the Group D. The maximal change of blood pressure was lower in the dexmedetomidine than in the control group. The mean time between the maximal change in blood pressure reached and started to recover was 135 ± 14 s in the dexmedetomidine group and 80 ± 31 s in the control group (P < 0.01) and maximal heart rate change was lower in dexmedetomidine group than the control group. The time between the maximal heart rate changes until recovery was 113.2 ± 19 s in the dexmedetomidine group and 53.2 ± 11 s in the control group P < 0.01. CONCLUSION: Adding dexmedetomidine to spinal anesthesia decreases the incidence of tourniquet pain but aggravates the hemodynamic effect of tourniquet deflation.
RESUMO
BACKGROUND AND AIM: Different adjuncts have been utilized to promote the quality and prolong the duration of local anesthetics for a variety of regional block techniques. This study aimed to assess the effects of midazolam coadministered with bupivacaine in transversus abdominis plane (TAP) block on the 24-h morphine consumption, the postoperative analgesia duration and adverse effects. SETTINGS AND DESIGN: A prospective, randomized, controlled double-blind trial that was carried out at a university hospital. PATIENTS AND METHODS: Eighty-two females subjected to open total abdominal hysterectomy under general anesthesia were involved in this trial. Participants were allocated randomly to either of two groups (41 each). Control group: received TAP block with 20 mL of 0.25% bupivacaine or midazolam group: received TAP block using the same volume of bupivacaine plus 50 µg/kg midazolam/side. Postoperative cumulative 24-h morphine consumption, analgesia duration, pain score, sedation score, and adverse events were recorded. STATISTICAL ANALYSIS: Student's t-test, Mann-Whitney U-test, and Chi-square test were used. RESULTS: Patients in the midazolam group had a lower cumulative 24-h morphine consumption [median doses (interquartile range): 15 (10-19.50) mg compared to 25 (17.50-37) mg, P < 0.001], lower postoperative pain score at rest at the 4th, 6th, and 12th h (P = 0.01, 0.02, and 0.02, respectively) and on movement at 2, 4, 6, and 12 h (P < 0.001), longer time till the first postoperative demand for rescue analgesia (430.11 ± 63.02 min) compared to 327.78 ± 61.99 min (P < 0.001), and less sedation, nausea and/or vomiting, and pruritus. CONCLUSIONS: Adding midazolam as a bupivacaine adjuvant for TAP block reduces the 24-h morphine consumption, extends the postoperative analgesia duration, and decreases the incidence of adverse effects following abdominal hysterectomy.
RESUMO
BACKGROUND: Lumbar puncture is a difficult medical skill and is used for administering subarachnoid anesthetic medications. Estimation of skin to subarachnoid space depth (SSD) helps to reduce post spinal anesthetic complications. AIMS: To measure the SDD in overall Egyptian population and to find a formula for predicting SSD in Egyptian patients. SETTINGS AND DESIGN: Four hundred patients of American Society of Anesthesiologist class I and II adult Egyptian patients undergoing surgery using spinal anesthesia in general and obstetric surgery unit, Mansoura University main hospital, were included in this prospective, observational study. SUBJECTS AND METHODS: Patients were divided into three groups: Males (Group M), nonpregnant females (Group F), and pregnant females (Group PF). SSD was measured after performing lumbar puncture. The relationship between SSD and patient characteristics was studied; correlated and statistical analysis was used to find a formula for predicting SSD. STATISTICAL ANALYSIS USED: Statistical analysis was done using Statistical Package for Social Sciences (SPSS 19.0, Chicago, IL, USA). One-way ANOVA with post hoc (Bonferroni correction factor) analysis was applied to compare the three groups. All the covariates in the study further were taken for multivariate analysis. Multivariate regression analysis was performed to evaluate important covariates influencing SSD for each group separately. RESULTS: Mean SSD was 4.99 ± 0.48 cm in the overall population. SSD in adult males (4.93 ± 0.47 cm) was significantly longer than that observed in females (4.22 ± 0.49 cm) but was comparable with SSD in parturient (4.32 ± 0.47 cm). Formula for predicting SSD in the overall population was 2.1+ (0.009 × height) + (0.03 × weight) + (0.02 × body mass index [BMI]) + (0.15 × body surface area [BSA]). Craig's formula when applied correlated best with the observed SSD. CONCLUSIONS: SSD in adult males was significantly longer than that in both pregnant and nonpregnant females, but it was nearly the same in pregnant and nonpregnant females. SSD in Egyptian population can be calculated based on height, weight, BMI, and BSA. Craig's formula was the most suitable to be applied to Egyptian population.
