The purpose of this study was to compare the effect of adding different doses of dexmedetomidine to local anesthetic mixture for peribulbar block in vitreoretinal surgeries as regards duration, efficacy and pain relief. Materials and methods: In this prospective randomized double blind clinical study, 160 patients were equally divided into four groups: Group C (the control group) (n = 40) received 10 ml mixture of lidocaine 2% and bupivacaine 0.5% with 120 IU of hyaluronidase, group D15 (n = 40) received a 10 ml mixture of lidocaine 2% and bupivacaine 0.5% with 120 IU of hyaluronidase + 15 lg dexmedetomidine, group D20 (n = 40) received a 10 ml mixture of lidocaine 2% and bupivacaine 0.5% with 120 IU of hyaluronidase + 20 lg dexmedetomidine and group D25 (n = 40) also received a 10 ml mixture of lidocaine 2% and bupivacaine 0.5% with 120 IU of hyaluronidase + 25 lg dexmedetomidine. The onset of globe anesthesia and akinesia and their duration, the intraocular pressure (IOP), patient comfort and surgeon satisfaction were all assessed. Data were analyzed and the results were presented as mean ±SD (Standard Deviation) and Ranges, number (%) and median (IQR) (Inter quartile range). Chi-square test (x2) was used to compare nonparametric variables. Comparison between groups was done using Analysis of Variance (ANOVA-One Way) as a parametric test and Kruskal Wallis Analysis of Variance by ranks as a nonparametric test. P values less than 0.05 (p < 0.05) was considered to be significant. Results: The onset of globe anesthesia was shorter in dexmedetomidine groups in comparison with control group. The difference was statistically significant in group D25 and group D20 in comparison with the control group (p > 0.05). Regarding the duration of globe analgesia, adding dexmedetomidine to the local anesthetic mixture prolonged the duration of globe analgesia, and this difference was statistically significant in group D25 in comparison with the control group (p > 0.05). Regarding the duration of globe akinesia although there was prolongation of the
Background: Although pregabalin and gabapentin have been used to control pain after spinal surgery, there is little evidence comparing their analgesic advantages to opioids. Objective: The current study aimed to assess efficacy and safety of analgesia with pregabalin versus gabapentin compared to opioids in patients undergoing elective lumbar microdiscectomy. Methods: This randomized-controlled trial included 72 patients scheduled for elective lumbar microdiscectomy. The patients were randomly allocated to three groups. Each group enrolled 24 patients who received 0.1 mg/kg of morphine intramuscularly 30 minutes before the surgery. One hour before the surgery, 150 mg of pregabalin was given orally for the pregabalin (P) group, meanwhile, in the gabapentin (G) group, 400 mg of gabapentin were given orally, and in the control (C) group, 100 micrograms of vitamin B12 were given orally. The primary outcome was the time to first rescue analgesia. The secondary outcomes were the intraoperative hemodynamics, visual analogue score, total consumption of morphine during the first postoperative 24 h, and morphine complications. Results: Groups P and G had significantly longer time to first analgesia and significantly lower total morphine consumption during the first 24 h and visual analogue scores at 10, 12, 16, 20, and 24 hours postoperatively. All groups had comparable hemodynamic parameters and postoperative complications. Conclusion:In elective lumbar microdiscectomy, preoperative administration of pregabalin provided longer time to first rescue analgesia with better acute pain control and lower total analgesic consumption compared to gabapentin and opioid analgesia.
Background: Inferomedial injection has been suggested as a more comfortable alternative to medial peribulbar block. Aim: We aimed to explore inferomedial injection technique efficacy in minimizing pain during injection as well as intubation compared to the classic medial canthal injection technique during peribulbar block. Methods: This randomized, controlled trial included adult (18 to 70 year-old) patients scheduled for lacrimal intubation surgery. Eligible patients were divided in a random way into two groups. Group 1 (n=24) received inferomedial peribulbar injection using a 25G/ 1" length needle to inject 3 ml of lidocaine: bupivacaine (1: 1) with 30 IU hyaluronidase enzyme to improve the infiltration of the small volume of the local anesthetic drugs. The classic medial canthus injection was applied in Group 2 (n=24) using the same types and amounts of local anesthesia (LA) and the same needle length. The pain was assessed during local anesthetics injection and intubation using the verbal rating scale. Results:In group 1 a low pain score was more frequent than in group 2 (83.3% vs. 16.7%). The median pain score at the LA injection was significantly lower in group 1 (1.0: IQR=1.0-1.0) than in group 2 (2.0: IQR=2.0-2.5). Alternatively, a comparison of the Verbal Rating Scale at intubation revealed comparable results between groups 1 and 2, with no significant differences (p>0.05). Conclusions: Inferomedial LA injection technique is feasible and less painful than the medial canthal injection. Otherwise, both techniques provided adequate intraoperative analgesia during lacrimal intubation and comparable surgeon satisfaction.
Background: In squint and buckle surgeries, the intraoperative pain of muscle traction might not be completely prevented by local anesthetic (LA) drugs. Adding fentanyl to LA can avoid systemic opioids side effects. Objectives: The aim of the current work was to evaluate the safety and efficacy of adding fentanyl to peribulbar block to abolish or decrease muscle traction pain during squint or buckle operations. Patients and methods: This randomized clinical trial study included a total of 60 adult patients (18-65-year-old) of both genders booked for either squint or scleral buckle surgeries, attending at Research Institute of Ophthalmology, Giza, Egypt. Patients were allocated randomly into two groups (30 patients each); fentanyl group and control group. Intraoperative pain was the primary outcome, whereas secondary outcomes included the onset of complete akinesia and patient satisfaction. Results:The median pain score was 1 for both groups. Two patients of the fentanyl group and 5 patients of the control group required general anesthesia. The mean time to achieving complete akinesia was shorter in the fentanyl group with a significant statistical difference (134.2±35.8 vs. 156.3±34.7, p = 0.018). The patient satisfaction was more with fentanyl use but with no statistical significance. Conclusions: It could be concluded that fentanyl added to the local anesthesia mixture of peribulbar block in squint and scleral buckle surgeries shorten the time needed to achieve complete akinesia. However, it does not improve the intraoperative pain resulting from muscle traction. Also, it does not affect the need for general anesthesia or postoperative patient satisfaction.
Background Interaction with medical providers is a stressful experience for a child. The current study aimed to assess the efficacy and safety of intranasal midazolam alone versus midazolam/ketamine combination for preoperative sedation prior to ophthalmic procedures in preschool children. This randomized, controlled trial included male and female children (3 to 7 years old) who were American Society of Anesthesiologists (ASA) physical status I or II, with either disability or special needs (such as autism or Down syndrome) or were undergoing multiple operative procedures. Participants were given either intranasal midazolam (0.5 mg/kg) or a combination of intranasal midazolam (0.25 mg/kg) and ketamine (1 mg/kg). Primary outcome measures were the preoperative level of sedation, agitation, and easiness of separation. Secondary outcomes included oxygen saturation and pulse rate. Any adverse effects, such as nausea and vomiting were reported. Results The mean rank of the Six-point Pediatric Sedation Scale was significantly (p = 0.001) higher in the midazolam/ketamine group compared to the midazolam group (28.15 vs 18.85, respectively). The median pulse rate was significantly (p < 0.001) lower in the midazolam group than the combination group at 5, 10, 15, and 20 min after induction of anesthesia. Conclusions These findings indicate that intranasal ketamine and midazolam combination produced better sedation than intranasal midazolam alone in preschool children prior to ophthalmic procedures. Moreover, ketamine and midazolam combination was safer with less incidence of bradycardia.
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