Background: Rib fractures are very common and are detected in at least 10% of all injured patients, the majority of which are because of blunt thoracic trauma with road traffic collisions being the main cause. Pain management of the acutely injured patient with rib fractures can be difficult for even the most experienced emergency physician. Objective: To evaluate the safety and efficacy of serratus anterior muscle plane block as a regional analgesic technique performed in patient with fracture ribs. Patients and Methods: Randomized, controlled study was carried out in Department of Anesthesia and Intensive Care Unit, Sohag University Hospital. Forty patients with lateral multiple rib fractures were included in this study. All patients were suffering from excruciating pain and were not responding to conventional analgesics. The patients were randomly assigned into two groups, 20 patients each. Group A, for whom serratus anterior plane block (SAP) was done and Group B, for IV morphine infusion. Results: In Group A, the mean pain score decreased from 9.1 ± 0.7 to 0.6 ± 0.7 after intervention. In group B, the mean pain score improved from 9.3 ± 0.8 to 1.15 ± 0.8 after IV morphine infusion. Pain scores gradually decreased. There were no significant difference between the two groups when the other trauma surveys were compared. Conclusion: Ultrasound guided Serratus Anterior Plane block is an effective technique for providing analgesia in patients with anterior and lateral rib fractures with fewer risks of complications.

Background: Erector Spinae Plane Block (ESPB) belongs to the family of fascial plane blocks in which local anesthetic is injected into a plane between two layers of fascia and subsequently spreads to nerves located within that plane or within adjacent tissue compartments. ESPB has been used in pain management, cervical, thoracic and cardiovascular surgeries.Objective: The goal of this narrative review article is to go through the pertinent anatomy, explain how the injectant spreads, show several ways to erector spinae plane block, and summarise case studies and clinical trials. Conclusion:Because the craniocaudal and vertical spread of local anesthetics and sensory block are not well understood or predicted, it appears that, unlike other blocks, the mechanism of erector spinae plane block and spread of local anesthetics will be decided by clinical data.

Aim:The aim of the study is to evaluate the efficacy of 0.5%lidocaine when given intrathecally in perianal surgery in comparison to lidocaine 2% concentration, and to study the effect of change in patient position on sensory anesthesia.Patient and Methods: forty patients aged between 18-70 years with ASA I-II who were scheduled for perianal fistula surgeries under spinal anesthesia were enrolled in our study after written informed consent and approval of ethical committee; This Study was conducted in Sohag University Hospitals from August 2016 to March 2017. Patients Were divided into 2 equal groups:-(Group I) 20 received 8ml (0.5%) lidocaine (prepared by adding 2ml(40 mg) 2% lidocain to 6ml sterile distilled water ). Subarachnoid block will performed in jack-knife.-(Group II)20 patients received 2ml lidocaine 2% (40mg) with the same technique, After injection patient will turned to lithotomy Position with table in horizontal Level. Under complete aseptic conditions, spinal anesthesia was carried out in the sitting position, at level (L3-4 or L4-5). After a free flow of cerebrospinal fluid was confirmed, each patient received one of the coded spinal solutions (GI or GII).Immediately after administration; the patients were turned into the supine or jackknife position. Patients were monitored for: Heart rate; NIBP and Oxygen Saturation. Patients were observed for onset, duration of sensory block and motor block,hemo dynamic stability; In the post-anesthesia care unit (PACU). Complications also were observed . Results The onset of sensory is faster in hypobaric lidocain but duration and time needed to reach highest sensory level longer in isobaric, onset of motor block is faster in hypobaric but duration of motor block longer in iso baric lidocain hemo dynamic stability more in iso baric . Conclusion The use of hypo baric lidocain reveal early onset for sensory and motor block with early recovery than isobaric and hemo dynamic stability slight more in iso baric lidocain in short stay surgeries as perianal surgeries.

Background: cardiac dysfunction is frequently observed after severe traumatic brain injury (sTBI), however its significance is poorly understood. Our study sought to elucidate the association of cardiac troponin I (cTnI) elevation with all cause in-hospital mortality following isolated sTBI (brain AIS ≥ 3 and admission GCS ≤ 8, no AIS ≥3 to any other bodily regions). Patients and methods: After approval of this study from local ethical committee, and obtaining written informed consent from relatives, head trauma patients will be enrolled in this observational prospective study. study was conducted in the 10-bed trauma-surgical ICU in Sohag university hospital , Fifty patients with isolated TBI , were consecutively included between January 2015 and February 2017. Results: our study validated cTnI as a novel biomarker and independent predictor of all cause in-hospital mortality in patients with TBI. these findings have several implications. First, cTnI assay should be considered in patients with sTBI even in absence high suspicion of cardiac injury. Second, cTnI is a sufficiently prognostic biomarker of mortality in patients with sTBI. Third, cTnI elevation in patients with sTBI must be treated with caution. Conclusion: cTnI level was a significant indicator for stress cardiomyopathy , severity of trauma calculated by RTS had no relation with incidence of stress cardiomyopath. Our study provided important insights to the heart-brain interactions following TBI and possible schemes for subsequent optimization of management of these patients.

Background:During cardiac surgery, CPB machine pumps blood instead of the heart affecting blood flow and hence blood perfusion of all tissues. One important marker of blood perfusion is central venous oxygen saturation. Relationship between central venous oxygen saturation and patient morbidity and mortality is an indicator for the reliability of blood lactate as a perfusion marker.Objectives: This study aimed to assess the value of monitoring of central venous oxygen saturation in postoperative prognosis. The primary outcome was ICU length of stay, while the secondary outcomes were both duration of mechanical ventilation and postoperative complications. Methods: In a prospective observational study, 66 patients admitted to Sohag university hospital and Sohag Heart Institute in the period between October 2017 and April 2019 for open cardiac surgery were enrolled. Immediately after induction of anesthesia, the first sample of venous blood gas was obtained from central venous catheter. For measuring of central venous oxygen saturation, the next samples were obtained just before CPB weaning, the next after 24 hours of staying ICU and the last sample were obtained after 48 hours of staying ICU. Results: Central venous oxygen saturation in correlation to ICU length of stay showed patients stayed in the ICU less than 48 hours had significant p-value <0.001 and patients stayed in the ICU more than 48 hours had a non-significant p-value 0.693 indicating more significant change in central venous oxygen saturation in patients with favorable outcome. Central venous oxygen saturation in correlation to postoperative duration of mechanical ventilation showed patients stayed on mechanical ventilation less than 12 hours had significant p-value 0.004 and patients stayed on mechanical ventilation more than 12 hours had a non-significant p-value 0.724 indicating more significant change in central venous oxygen saturation in patients with favorable outcome. Central venous oxygen saturation in correlation to postoperative complications showed patients without postoperative complications had significant p-value 0.001 and patients with postoperative complications had a non-significant p-value 0.436 indicating more significant change in central venous oxygen saturation in patients with favorable outcome. Conclusion: Measuring ScvO2 at 4 points during and after open-heart surgery showed their prognostic value, regarding results for ScvO2: ICU length of stay, duration of mechanical ventilation and complications.