A comparison of epidural magnesium and/or morphine with bupivacaine for postoperative analgesia after cesarean section

BackgroundMagnesium can potentiate the antinociceptive effect of morphine. This prospective randomized double-blinded study was undertaken to establish the analgesic effect of adding magnesium to epidural morphine during cesarean section.MethodsTwo hundred patients undergoing cesarean section under combined spinal–epidural anesthesia were recruited. After administration of intrathecal bupivacaine 10 mg, patients were randomly assigned to receive one of four epidural study solutions: 0.1% bupivacaine 10 mL (Group B); 0.1% bupivacaine 10 mL and morphine 1.5 mg (Group B+Mor); 0.1% bupivacaine 10 mL and magnesium 500 mg (Group B+Mg); or 0.1% bupivacaine 10 mL morphine 1.5 mg and magnesium 500 mg (Group B+Mor+Mg). The primary outcome was the area under the curve for visual analog scale pain scores during 36 h postoperatively. Secondary outcomes included time to the use of rescue analgesics, patient satisfaction and side effects.ResultsPatients in Group B+Mor+Mg had lower for pain scores and area under the curve pain scores both at rest and on movement, increased time for first analgesic request, and increased satisfaction score at 24 h after surgery.ConclusionAddition of magnesium 500 mg and morphine 1.5 mg to epidural 0.1% bupivacaine 10 mL reduced postoperative pain compared with addition of morphine or magnesium alone or no additive.     

Obesity deleteriously affects anesthetic and surgical outcome in body mass index-dependent fashion

ObjectivesTo evaluate obesity effect on anesthetic and surgical outcome of patients of varying BMI assigned for open abdominal surgery.Patients and methodsSixty patients were categorized according to WHO classification of obesity into three classes: class I (n = 30), class II (n = 18) and class III (n = 12). All patients underwent open laparotomy under combined anesthesia using continuous remifentanil infusion and balanced sevoflurane anesthesia. Hemodynamic variables, duration of surgery, intraoperative bleeding, frequency of blood transfusion, recovery times and intraoperative anesthetic or surgical problems were recorded. The occurrence of postoperative complications, admission to ICU, duration till 1st ambulation, 1st oral intake, hospital stay period and rates of morbidity and mortality were recorded.ResultsInduction of anesthesia significantly decreased arterial pressures and heart rate compared both to preoperative and pre-induction measures. After extubation all parameters returned to preoperative levels. Mean operative time was significantly longer and mean intraoperative blood loss was significantly more in patients of class III compared to those of class I and II. All recovery times showed BMI dependence as all were significantly prolonged in class II and III patients compared to class I patients with significantly shorter awakening and extubation times in class II patients than class III patients. Mean time till 1st walk was significantly longer in class III patients than class I and II patients, but time till 1st oral intake was non-significantly different. Sixteen patients developed PO complications. Mean PO hospital stay was significantly longer in class III patients compared to class I and II patients with significantly shorter duration in class II patients than those of class III.ConclusionObesity caused deleterious anesthetic and surgical effects with prolonged operative and recovery times and more need for blood transfusion, ICU admission and prolonged hospital stay duration. The used anesthetic regimen allowed controlled hypotension without compromising patients’ general condition.     

Continuous infusion of magnesium–lidocaine mixture for prevention of ventricular arrhythmias during on-pump coronary artery bypass grafting surgery

BackgroundDuring on-pump coronary artery bypass grafting (CABG) surgery, the incidence of reperfusion ventricular fibrillation (VF) is high and post-bypass ventricular arrhythmias are common. Both reperfusion VF and ventricular arrhythmias can cause additional myocardial injury to the already ischemic myocardium. This trial aimed to test the assumption that continuous combined magnesium and lidocaine infusion would be efficient and long lasting for the prevention of post-myocardial vascularization ventricular arrhythmias including VF.MethodsEighty ASA III patients, who were candidates for CABG surgery, were randomly assigned into two groups: Group I (control group, n = 40) and Group II (Group ML, n = 40). After endotracheal intubation, patients of control group were infused with plain normal saline in a volume equivalent to study drugs’ mixture volume. Patients of Group ML were infused with magnesium–lidocaine mixture to achieve a bolus of magnesium sulfate 2 g and lidocaine 100 mg followed by continuous infusion of Mg sulfate 500 mg/h and lidocaine 1 mg/min. The initial cardiac rhythm after aortic cross clamp (ACC) release and the occurrence of post-CPB significant ventricular arrhythmias were recorded.ResultsThe incidences of reperfusion VF and post-CPB ventricular arrhythmias in Group ML were significantly lower than that in control group (22.5% vs. 72.5%) (P < 0.001) and (7.5% vs. 25%) (P < 0.05), respectively. However, in Group ML, this beneficial effect was associated with higher incidence of sinus bradycardia (72.5% vs. 17.5%) and hence pacing needs (22.5% vs. 0.0%) when compared with control group.ConclusionOur study concluded that, during on-pump CABG surgery, the combined administration of magnesium and lidocaine as a bolus dose starting after intubation followed by continuous infusion reduced the incidence of reperfusion VF by 62% and post-CPB ventricular arrhythmias by 70% on expense of increased the incidence of sinus bradycardia and pacing.     

Preemptive use of epidural magnesium sulphate to reduce narcotic requirements in orthopedic surgery

Background and objectivesAs pain is one of the most common problems challenging the anesthetist, and as regional anesthesia is a safe, inexpensive technique with the advantage of prolonged postoperative analgesia. Also, we all know that Magnesium is the fourth most plentiful cation in the body with antinociceptive properties arising from being the natural physiological calcium antagonist and the antagonism to N-methyl-d-aspartate (NMDA) receptor. Thus, the study is a prospective, randomized, double-blind study designed to evaluate analgesic efficacy of magnesium sulphate when added to epidural bupivacaine in patients undergoing orthopedic surgery in the lower limb.MethodsAfter approval of the ethical committee and informed written consent 60 patients ASA I and II, undergoing orthopedic surgery in the lower limb were enrolled to receive either bupivacaine 0.5% or bupivacaine 0.5% plus magnesium sulphate 50 mg as an initial bolus dose followed by a continuous infusion of 10 mg/h as intraoperative epidural analgesia. Postoperatively, all patients were equipped with a patient-controlled epidural analgesia device. Heart rate, mean arterial pressure, oxygen saturation, respiratory rate, pain assessment using a visual analogue scale (VAS), sedation score, the first time patient ask for analgesics and postoperative fentanyl consumption were recorded.ResultsVAS was significantly less in the magnesium group during 15 and 30 min intra-operatively and in the first and third hour post-operatively. The postoperative rescue analgesia, as well as the PCEA fentanyl consumption, was significantly reduced in the magnesium group.ConclusionCo-administration of epidural magnesium provides better intraoperative analgesia as well as the analgesic-sparing effect on PCEA consumption without increasing the incidence of side-effects.     

Effect of systemic lidocaine infusion on train-of-four ratios during recovery from general anesthesia

IntroductionIn spite of introduction of intermediate-acting neuromuscular blocking drugs (NMBDs), incidence of postoperative residual muscle weakness is still high. The aim of this trial is to study the effect of systemic lidocaine infusion on intraoperative consumption of rocuronium and TOF ratios at extubation and on arrival to postanesthesia care unit (PACU).MethodsForty-six ASA I–III patients aged 16–60 yr were randomly allocated into two groups: lidocaine (L) group (n = 23) and control (C) group (n = 23). After induction of standard endotracheal general anesthesia with fentanyl, propofol and rocuronium, patients of group L were given i.v. lidocaine bolus (1.5 mg kg^?1) followed by continuous infusion (1.5 mg kg^?1 h^?1) till time of endotracheal extubation while patients in group C were given equal volumes of normal saline. Rocuronium was titrated based on clinical signs. On conclusion of surgery, neostigmine was given to reverse the effects of rocuronium if TOF count was two or more. Immediately before extubation, TOF ratio was measured and recorded and considered the primary outcome.ResultsThere were no significant differences between the two study groups regarding intraoperative fentanyl doses or core temperature at the end of surgery. End-tidal sevoflurane concentrations were significantly lower in group L than in group P (P < 0.01). The dose of rocuronium was significantly less in group L than in group C (P = 0.001). Train-of four ratios were significantly higher in group L than in group C either before extubation (P < 0.001) or on arrival to PACU (P = 0.001).ConclusionThe current study shows that intraoperative use of i.v. lidocaine infusion in generally anesthetized patients can result in higher TOF ratios at time of extubation and on arrival to PACU when rocuronium was given based on clinical signs.     

Effect of preoperative Mg sulfate infusion on serum cardiac troponin (cTn) in moderate preeclamptic undergoing elective cesarean section under spinal anesthesia

This study was designed to investigate and compare the effect of preoperative Mg sulfate infusion on serum cardiac troponin (cTn) in moderate preeclampsia undergoing elective cesarean section. A total of fifty parturients having moderate preeclampsia scheduled for elective cesarean section were included. They were randomly allocated into two equal groups 25 each, magnesium group (GMg) received preoperative magnesium sulfate infusion and control group (GC) then both received spinal anesthesia, serum troponin measured preoperative then at 6, 12 and 24 h postoperative. Mean arterial pressure and heart rate were also recorded. Baseline serum cardiac troponin was higher above normal and was comparable at the rest of times in both groups. Mean arterial pressure readings were significantly lower in GMg compared to GC at induction of spinal, skin incision and skin closure (P < 0.05) and were comparable at the rest of times. Serum cardiac troponin (cTn) levels were comparable in parturients received magnesium sulfate infusion preoperatively with those did not receive magnesium sulfate.     

Single shot spinal anesthesia with very low hyperbaric bupivacaine dose (3.75 mg) for hip fracture repair surgery in the elderly. A randomized,double blinded study

PurposeSingle shot spinal anesthesia is used worldwide for hip fracture repair surgery in the elderly. Arterial hypotension is a frequent adverse effect. We hypothesized that lowering local anesthetics dose could decrease the incidence of arterial hypotension, while maintaining quality of surgical anesthesia.MethodsIn a randomized double blinded study, 66 patients over the age of 65 years, with hip fracture needing surgical repair, were assigned to B0.5 group 7.5 mg hyperbaric bupivacaine 5 mg/ml (control group), and B0.25 group 3.75 mg hyperbaric bupivacaine 2.5 mg/ml (study group). Sensory and motor block level, and hemodynamic parameters including blood presure, heart rate and vasopressor dose administration were registered, along with rescue anesthesia needs, the feasibility of surgery, its duration, and regression time of sensory anesthesia to T12.ResultsAfter exclusions, 61 patients were included in the final analysis. Arterial hypotension incidence was lower in the B0.25 group (at the 5, 10, and 15 min determinations), and a lower amount of vasopressor drugs was needed (mean accumulated ephedrine dose 1.6 mg vs. 8.7 mg in the B0.5 group, p < 0.002). Sensory block regression time to T12 was shorter in the B0.25 group, mean 78.6 ± 23.6 (95% CI 51.7–110.2) min vs. 125.5 ± 37.9 (95% CI 101.7–169.4) min in the B0.5 group, p = 0.033. All but one patient in the B0.25 group were operated on under the anesthetic procedure first intended. No rescue anesthesia was needed.ConclusionLowering bupivacaine dose for single shot spinal anesthesia for hip fracture repair surgery in elderly patients was effective in decreasing the occurrence of arterial hypotension and vasopressor use, while intraoperative quality remained.     

Preoperative gabapentin augments intraoperative hypotension and reduces postoperative opioid requirements with functional endoscopic sinus surgery

BackgroundFunctional Endoscopic sinus surgery (FESS) is a delicate and time consuming procedure; it is performed routinely under general anesthesia. Hypotensive techniques should be employed for best visualization of operative field. Gabapentin is a structural analog of gamma amino butyric acid. The aim of this study was to determine the analgesic efficacy of gabapentin and its role in deliberate hypotension during and after FESS.MethodsEighty patients ASA physical status I–II patients were scheduled to undergo elective FESS under general anesthesia. Patients were randomly assigned to one of two groups using a computer-generated table. Patients in the control group (40 patients) received oral placebo capsules and the study group (40 patients) patients received oral gabapentin (Conventin 400 mg; Evapharma Egypt) 1.2 g 1 h before surgery. Intraoperative, mean arterial blood pressure, infusion rates of the hypotensive agent (sodium nitroprusside) were recorded at 15 min interval. Assessments of pain, opioid usage, and side effects were performed at 1 h interval after arrival in the PACU.ResultsGabapentin group patients required significantly lower (p value <0.05) infusion rates and total doses of hypotensive agent (sodium nitroprusside) than the placebo group patients at all measured intervals. Postoperative assessment of pain scores revealed that gabapentin group recorded significantly lower mean values of VAS than the control group (p value <0.05).ConclusionOral gabapentin, 1200 mg decreased dose requirements of intraoperative hypotensive agent (sodium nitroprusside) and postoperative morphine. In addition, patients receiving gabapentin had suffered less from opioid side effects (nausea, vomiting and urinary retention) than those receiving placebo.     

Prophylactic vs. therapeutic magnesium sulfate for shivering during spinal anesthesia

IntroductionShivering is one of the most common complications of neuraxial blockade. Some patients find shivering sensation worse than surgical pain. Therefore, both prevention and treatment of established shivering should be regarded as clinically relevant intervention in the perioperative period. The aim of our study is to compare the efficacy of magnesium sulfate when used for prevention or treatment of shivering following spinal anesthesia.MethodsIn this prospective, double blind, placebo controlled study, 120 ASA I, II patients undergoing surgery under spinal anesthesia were randomized into 3 groups. Following intrathecal injection, Group P (prophylactic) was given MgSO₄, 50 mg/kg I.V. bolus + 2 mg/kg/h infusion. Group T (therapeutic) was given MgSO₄ 50 mg/kg I.V. bolus as a therapy when shivering occurred. If shivering persisted, they received 25 mg/kg I.V. bolus. Group C (control) received saline at identical times. Meperidine was given as rescue if shivering persisted. Shivering grade 3/4 was regarded as significant. Core temperatures, incidence of shivering, and side effects were recorded.Main resultsTotal incidence of shivering, grade 3/4, was 15% in Group P, 45% in Group T, and 50% in Group C (p < 0.01). Magnesium sulfate significantly reduced the incidence and gain of shivering. The use of rescue meperidine was more in Group P (20%) and Group C (50%) compared to none in Group T (p < 0.05, p < 0.01, respectively). Significant reduction in core temperature occurred in the Mg groups compared to the control group p < 0.05. No correlation was found between patients who shivered and core temperature or ΔT. Hypotension was more frequent in Group P; nausea and vomiting were more in Mg groups than control group p < 0.05.ConclusionFollowing spinal anesthesia, prophylactic MgSO₄ infusion lowered incidence of shivering. When shivering did occur, MgSO₄ proved to be an effective treatment with minimal side effects.     

Comparação dos efeitos de sulfato de magnésio e da dexmedetomidina sobre a qualidade da visibilidade em cirurgia endoscópica sinusal: estudo clínico randomizado

Background and objectivesEven a small amount of bleeding during endoscopic sinus surgery can corrupt the endoscopic field and complicate the procedure. Various techniques, including induced hypotension, can minimize bleeding during endoscopic sinus surgery. The aim of this study was to compare the surgical vision quality, haemodynamic parameters, postoperative pain, and other effects of magnesium, a hypotensive agent, with that of dexmedetomidine, which was initially developed for short‐term sedation in the intensive care unit but also is an alpha 2 agonist sedative.Method60 patients between the ages of 18 and 45 years were divided into either the magnesium group (Group M) or the dexmedetomidine group (Group D). In Group M, magnesium sulphate was given at a pre‐induction loading dose of 50 mg kg⁻¹ over 10 min and maintained at 15 mg kg⁻¹ h⁻¹; in Group D, dexmedetomidine was given at 1 mcg kg⁻¹ 10 min before induction and maintained at 0.6 mcg kg⁻¹ h⁻¹. Intraoperatively, the haemodynamic and respiratory parameters and 6‐point intraoperative surgical field evaluation scale were recorded. During the postoperative period, an 11‐point numerical pain scale, the Ramsay sedation scale, the nausea/vomiting scale, the adverse effects profile, and itching parameters were noted.ResultsGroup D showed a significant decrease in intraoperative surgical field evaluation scale scale score and heart rate. The average operation time was 50 min, and Group M had a higher number of prolonged surgeries. No significant difference was found in the other parameters.ConclusionsDue to its reduction of bleeding and heart rate in endoscopic sinus surgery and its positive impacts on the duration of surgery, we consider dexmedetomidine to be a good alternative to magnesium.     

Preoperative use of gabapentin decreases the anesthetic and analgesic requirements in patients undergoing radical mastectomy

Background/aimGabapentin is an anticonvulsant drug that is safe and effective for the treatment of neuropathic pain syndrome, as well as postoperative pain with good results. This prospective randomized study was done to evaluate the effects of preoperative administration of oral gabapentin (1200 mg) on the intraoperative fentanyl and isoflurane consumption, postoperative analgesic requirements and postoperative pain in patients undergoing radical mastectomy.MethodsSixty ASA I and II patients were randomly allocated into two equal groups to receive oral gabapentin 1200 mg, 2 h before surgery (G group) or control (C group). General anesthesia was induced and maintained at bispectral index value between 40 and 60. During surgery the end-tidal isoflurane concentrations required to maintain adequate depth of anesthesia and the required incremental doses of intraoperative fentanyl were recorded. Postoperative pain was assessed using visual analogue scale (VAS) at rest for 24 h. Postoperatively, whenever visual analogue scale (VAS) was more than 5 or on patients’ demand, analgesia in both groups was provided with diclofenac sodium (1 mg/kg IM) or tramadol hydrochloride (1 mg/kg IV) as needed. VAS, analgesics requirements, and side-effects were assessed for 24 h postoperatively.ResultsIntraoperative fentanyl and postoperative analgesic consumption were significantly lower in G group than C group (P < 0.001). Patients in the G group had significantly lower end-tidal concentrations of isoflurane required to maintain adequate depth of anesthesia (P < 0.05). VAS was significantly lower in G group than C group at the first three measurement times (P < 0.01). The incidence of postoperative nausea and vomiting was significantly lower in G group than C group (30% versus 60% of patients, respectively, P < 0.05). The incidence of dizziness was significantly higher in the G group than C group (26% versus 3.3% of patients, respectively, P < 0.05).ConclusionGabapentin (1200 mg) administered orally 2 h before surgery decreased the intraoperative fentanyl and isoflurane consumption, postoperative analgesic requirements, postoperative pain, and the incidence of postoperative nausea and vomiting, but increased dizziness.     

The effect of Dexmedetomidine on the incidence of postoperative cognitive dysfunction in elderly patients after prolonged abdominal surgery

BackgroundPostoperative cognitive dysfunction (POCD) in elderly patients is a common complaint after prolonged surgeries. In the present study, we aimed to investigate the effect of intraoperative infusion of Dexmedetomidine on POCD.Methods50 patients aged more than 60 years old undergoing elective abdominal surgery expected to last more than 2 hours were randomized into 2 groups of 25 patients each: those receiving Dexmedetomidine at a dose of 0.4 μg/kg/h, group (A) and those receiving 0.9% normal saline as placebo group (B). All patients underwent neuropsychometric tests (Montreal cognitive assessment and Stroop color word interference tests) the day before the surgery and 24 h after the surgery, and one week postoperatively.ResultsThe use of Dexmedetomidine as an adjuvant during Sevoflurane anesthesia did not have significant effect on protection against POCD in one day and one week postoperatively. The anesthetic and analgesic sparing effect of Dexmedetomidine was significantly proved by lower Sevoflurane need and significant lesser amount of total 24 hours postoperative Fentanyl requirements, but with significant prolonged extubation and orientation times in Dexmedetomidine group than placebo group.ConclusionsThe findings of this pilot study suggest that intraoperative use of Dexmedetomidine as an adjuvant in major surgery in elderly patients was not associated with significant protection against POCD.     

The value of epidural magnesium sulfate as an adjuvant to bupivacaine and fentanyl for labor analgesia

ObjectiveWe conducted this clinical study to assess the adjuvant effects of single dose magnesium sulfate (Mg) when administered epidurally during labor with fentanyl and bupivacaine.MethodsEighty healthy nulliparous women in labor requesting epidural analgesia were divided into two groups. Group 1 received bupivacaine 0.125% with magnesium sulfate 50 mg and fentanyl 50 μg as a loading dose; group 2, received bupivacaine 0.125% and fentanyl 50 μg only. Hemodynamic parameters, motor and sensory evaluation, cervical dilation at time of consenting, the progress of labor, the visual analog pain score (VAS), Apgar score, cord blood acid base status, side effects as nausea, vomiting, itching and respiratory depression were recorded. Fetal heart rate tracings were also documented.ResultsEpidural single dose magnesium sulfate added to bupivacaine and fentanyl in labor resulted in significantly faster onset and longer duration of epidural analgesia (169 ± 50 min) in comparison to those patients who received bupivacaine and fentanyl only (105 ± 41 min), also there was a significant reduction in the number of women requiring additional boluses of bupivacaine when Mg was added (P = 0.016). The two groups had no significant differences as regards maternal satisfaction score, maternal and neonatal adverse effects.ConclusionMagnesium sulfate added to bupivacaine and fentanyl for labor epidural analgesia resulted in faster onset, longer duration of action and reduced the break through pain.     

Postoperative continuous-flow cryocompression therapy in the acute recovery phase of hip fracture surgery—A randomized controlled clinical trial

BackgroundThe acute recovery phase after hip fracture surgery is often complicated by severe pain, postoperative blood loss with subsequent transfusion, and delirium. Prevalent comorbidity in hip fracture patients limit the use of opioid-based analgesic therapies, yielding a high risk for inferior pain treatment. Postoperative cryotherapy is suggested to provide an analgesic effect, and to reduce postoperative blood loss. In this prospective, open-label, parallel, multicentre, randomized controlled, clinical trial, we aimed to determine the efficacy of continuous-flow cryocompression therapy (CFCT) in the acute recovery phase after hip fracture surgery.MethodsPatients with an intra or extracapsular hip fracture scheduled for surgery were included. Subjects were allocated to receive postoperative CFCT or usual care. The primary endpoint was numeric rating scale (NRS) pain the first 72 postoperative hours. Secondly, analgesic use; postoperative haemoglobin change and transfusion incidence; functional outcome; length of stay; delirium incidence; location of rehabilitation; patient-reported health outcome; complications and feasibility were assessed.ResultsSixty-one subjects in the control group, and 64 subjects in the CFCT group were analysed. Within the CFCT group, post treatment NRS pain declined 0.31 (p = 0.07) at 24 h, 0.28 (p = 0.07) at 48 h, and 0.47 (p = 0.002) at 72 h relative to pre treatment NRS pain. Sensitivity analysis at 72 h showed that NRS pain was 0.92 lower in the CFCT group when compared to the control group (1.50 vs. 2.42; p = 0.03). Postoperative analgesic use was comparable between groups. Between postoperative day one and three haemoglobin declined 0.29 mmol/l in the CFCT group and 0.51 mmol/l in controls (p = 0.06), and transfusion incidence was comparable. The timed up and go test and length of stay were also comparable between both groups. Complications, amongst delirium and cryotherapy-related adverse events were not statistically significantly different. Discharge locations did not differ between groups. At outpatient follow-up subjects did not differ in patient-reported health outcome scores. Subjects rated CFCT satisfaction with an average of 7.1 out of 10 points.ConclusionsNo evidence was recorded to suggest that CFCT has an added value in the acute recovery phase after hip fracture surgery. If patients complete the CFCT treatment schedule, a mild analgesic effect is observed at 72 h.     

Effect of preoperative oral amantadine on intraoperative anesthetic and analgesic requirements in female patients during abdominoplasty

BackgroundWe hypothesized that NMDA antagonist, amantadine, may be beneficial in reducing the intraoperative anesthetic and analgesic requirements. The aim of this study to evaluate the effect of preoperative oral amantadine on induction doses of propofol, intraoperative anesthetic and analgesic requirements.MethodsIn a prospective, randomized, double-blinded controlled study 60 female patients ASA I or II aged 18–60 years old, planned for abdominoplasty surgery divided into two groups (30 patients each). Group A: received oral amantadine 200 mg on the evening before surgery and 200 mg 60 min prior to surgery. Group P (control group): the patients received placebo capsules. Propofol and isoflurane were titrated guided by BIS during induction and maintenance of anesthesia where the total dose of propofol and the time elapsed between injection of propofol to achieve BIS value 60 were recorded. Also, the inspired isoflurane concentrations required to maintain BIS between 40 and 60 and the total dose of fentanyl needed to maintain adequate analgesia were recorded.ResultsThe induction dose of propofol and the time from propofol injection till BIS value reached 60, the total intraoperative fentanyl requirements and the inspired isoflurane concentration required to maintain BIS reading between 40 and 60 were statistically significant lower in amantadine group compared to placebo treated group. The two groups were similar regarding the occurrence of side effects.ConclusionPreoperative oral amantadine reduced the induction time, induction dose of propofol, intraoperative anesthetic and analgesic requirements compared to placebo without serious side effects in female patients during abdominoplasty.     

The analgesic efficacy of continuous fascia iliaca block vs. continuous psoas compartment block after hip surgery: A comparative study

BackgroundBoth psoas compartment block and fascia iliaca compartment block have been shown to be reliable blocks for postoperative pain relief for procedures involving the hip joint. This study evaluated the efficacy of continuous psoas compartment block with continuous fascia iliaca block for postoperative analgesia after hip surgery.MethodsIn randomized blinded study Forty, ASA I–III patients aged 30–75 years, with BMI less than 40, scheduled for hip surgery, were divided to one of two groups. Group P: continuous psoas compartment block (n = 18) and group F: continuous fascia iliaca block (n = 19). Standard general anesthesia was induced after finishing the block technique. After recovery 30 ml of 0.125% levobupivacaine was injected through the catheter to all patients. Postoperative 24 h meperidine consumption, patient satisfaction, visual analogue scale pain scores at (1, 6, 12, 18, and 24 h) postoperative, postoperative hemodynamics (HR and MAp), evidence of sensory and motor blockades, and incidence of adverse effects were recorded.ResultsThere was no significant difference between the two groups in 24 h postoperative meperidine requirements, postoperative VAS, patient satisfaction, postoperative hemodynamics, and distribution of sensory and motor block of (femoral, lateral femoral cutaneous, and obturator nerves). The epidural anesthesia occurred in two patients in psoas group (11%).ConclusionBoth continuous fascia iliaca block and continuous psoas compartment block were comparable in providing safe and effective analgesia after hip surgery.     

Influence of intraoperative fluid administration on creatine kinase,and its effect on kidney function after laparoscopic nephrectomy

BackgroundCreatine kinase (CK) is a muscle-specific enzyme, which can be associated with muscle tissue damage. Rhabdomyolysis is a serious postoperative complication following severe muscle destruction. Lengthy procedures, high body mass index and lateral decubitus position are common risk factors.ObjectivesThe objective of this study was to investigate the effect of intraoperative fluid administration with two different volumes on CK levels, kidney function and the incidence of rhabdomyolysis after laparoscopic nephrectomy.MethodsIn this prospective randomized study, 100 adult patients, ASA physical status II and III scheduled for laparoscopic nephrectomy were included and, randomized into two equal groups. Patients in Group I received maintenance infusion of Lactated Ringer's solution 4 ml kg^?1 h^?1, while patients in Group II received intraoperative infusion 8 ml kg^?1 h^?1 till the end of surgery. Total intraoperative fluid, urine output and, blood loss were all calculated. CK was measured preoperative (T₀), immediately postoperative (T₁), 12 h postoperative (T₂) and at 24, 48, 72 and, 96 h postoperative (T₃–T₆). Serum creatinine was measured preoperative {baseline (T₀)}, 12 h postoperative (T₁) then, daily for 3 days (T₂–T₄). Skin changes as erythema and, induration were monitored.ResultsInsignificant differences were reported between the two groups in terms of patient demographics, operative time, intraoperative blood loss and serum creatinine. Intraoperative fluid intake was significantly higher among patients of Group II {2388 (308.8) vs 1284 (233.3) ml}. CK levels were higher in Group I patients in the first 72 h after surgery. Rhabdomyolysis was diagnosed in six patients (6%); only one had elevated serum creatinine and oliguria.ConclusionsIntraoperative administration of 8 ml kg^?1 h^?1 compared with 4 ml kg^?1 h^?1 Lactated Ringer's solution led to significant reduction in CK levels as a marker of rhabdomyolysis during laparoscopic nephrectomy.     

Ultrasound guided transversus abdominis plane block in pediatric patients undergoing laparoscopic surgery

ObjectiveTo assess safety and effectiveness of ultrasound-guided TAP block in children undergoing laparoscopic surgery for undescended testis.Subjects and methodsThis randomized controlled trial involved 108 children, 3–7 years old, randomly allocated into one of two equal groups; TAP Group and Control Group. All children received general anesthesia using propofol 1.5–2.5 mg/kg, atracurium 0.5 mg/kg and fentanyl 2 μg/kg. TAP Group received 0.5 ml/kg of ropivacaine 0.375% bilaterally under ultrasound guidance and control group received regular analgesics. Quality of analgesia was assessed using Children’s Hospital Eastern Ontario Pain Scale (CHEOPS) and Objective behavioral pain score (OPS). The primary outcome measures were hemodynamic parameters and degree of pain. Secondary outcome measures were intraoperative fentanyl requirement, postoperative rescue analgesia (time and dose), complications, hospital stay and degree of satisfaction of patients and their parents.ResultsTAP block group had significantly lower intraoperative fentanyl dose (p < 0.001), significantly longer time to first postoperative request of analgesic (p < 0.001), lower analgesic dose during the first postoperative 24 h (p < 0.001) and lower pain scores along the whole 24 postoperative hours. Mean arterial pressure and heart rate were within the clinically accepted range in the two groups. Parents’ satisfaction was significantly higher (p < 0.001) in the TAP block group.ConclusionTAP block under ultrasound guidance was easy, safe, reliable and effective analgesic in children undergoing laparoscopic surgery for undescended testis.     

Effect of intravenous lidocaine infusion on sevoflurane requirements as monitored by bispectral index: A randomized double-blinded controlled study

IntroductionSystemic administration of lidocaine significantly decreased propofol requirements when compared to patients receiving placebo. Several studies conducted on animals have proved that systemic local anesthetics reduced minimum alveolar concentration (MAC) of inhalational anesthetics. The aim of this investigation is to study the effect of intravenous administration of lidocaine on the minimum alveolar concentration of sevoflurane required to keep BIS between 40 and 60 during maintenance of anesthesia in humans.MethodsTwenty-eight ASA I–II adults planned to undergo laparoscopic procedures expected to last <2 h under general anesthesia were randomly assigned to 2 groups. After standardized induction of general anesthesia, patients were given IV lidocaine bolus (1.5 mg kg^?1) followed by 2 mg kg^?1 h^?1 infusion (group L, n = 14) or equal volumes of saline (group C, n = 14). Primary outcome of the study was end-tidal sevoflurane at bispectral index (BIS) values of 40–60. Secondary outcomes included doses of opioids, BIS values, and extubation time.ResultsThe median doses of intraoperative fentanyl (range) in group C were similar to group L (P = 0.08). There were no significant differences between the 2 groups regarding BIS at any time point. End-tidal sevoflurane concentrations were significantly higher in group C than in group L at all intraoperative time points (P < 0.05). Extubation time was longer in group L than in group C (P = 0.04).ConclusionIn conclusion, intravenous lidocaine administration, during maintenance of general anesthesia, can decrease BIS-guided sevoflurane requirements.     

Ultrasound guided single injection caudal epidural anesthesia of isobaric bupivacaine with/without dexamethasone for geriatric patients undergoing total hip replacement surgery

BackgroundDexamethasone has anti-inflammatory properties that can affect postoperative analgesia when added to caudal bupivacaine.MethodsSeventy-two geriatric patients scheduled for elective total hip replacement under ultrasound guided caudal anesthesia were randomized blindly into two groups: Group BD received caudal isobaric bupivacaine 0.25% (20 ml) and dexamethasone 8 mg (2 ml) and Group BS received caudal isobaric bupivacaine 0.25% (20 ml) and normal saline (2 ml). Postoperative analgesia was assessed by recording time to first rescue analgesia and the analgesic doses (paracetamol and meperidine hydrochloride) required during the first 24 h postoperatively as a primary outcome. Secondary outcomes were the time taken to the onset of sensory analgesia at T10, time to the onset of complete motor block, VAS pain score at rest and on movement at 1, 2, 4, 6, 8, 12 and 24 h, and postoperative adverse events.ResultsGroup BD had a significantly longer time to first rescue analgesia [402 (63) vs 213 (53)] min and significantly lower doses of paracetamol [3389 (728) vs 2833 (697)] mg meperidine hydrochloride [78 (30) vs 142 (28)] mg than Group BS. VAS scores were significantly lower in Group BD than Group BS both at rest and on movement respectively at 4, 6, 8, 12 and 24 h.ConclusionAdding dexamethasone with isobaric bupivacaine caudal anesthesia prolongs the duration of postoperative analgesia and decreased postoperative analgesic requirement in geriatric patients undergoing total hip replacement surgery in comparison isobaric bupivacaine alone.