Local wound ketamine instillation provided superior postoperative analgesia with lower incidence of side effects in comparison with IM ketamine and placebo following total thyroidectomy.
Objectives: Continuous wound infiltration of local anesthetics has been proposed as an alternative to epidural analgesia during abdominal surgery. Cytokines have a major role in inflammatory changes caused by surgery. This study aimed to compare the effects of continuous preperitoneal versus epidural analgesia on inflammatory cytokines postoperatively. Materials and Methods: Forty patients scheduled for radical cystectomy were included in this observer-blinded, randomized trial; patients were randomly assigned into 2 groups to receive; continuous preperitoneal wound infiltration (PPB) or epidural analgesia (EDB). Serum levels of interleukins (IL1β, IL6, IL10, and tumor necrosis factor α) were measured at baseline (before induction of anesthesia), preinfusion (before the start of local anesthetic infusion), 6 and 24 hours postoperatively. Visual Analog Scale at rest/movement (VAS-R∕M), time to the first request of analgesia, total morphine consumption, sedation score, hemodynamics, and side effects were observed 24 hours postoperatively. Results: There was a significant reduction in IL6, IL1β and increase in IL10 in PPB compared with EDB at 6 and 24 hours postoperatively and compared with preinfusion levels (P≤0.001). In EDB, a significant increase in IL1β, IL10, and tumor necrosis factor α at 6 hours compared with preinfusion levels (P≤0.002). VAS-R∕M was significantly decreased at 2, 4, 6, 8, and 12 hours in EDB compared with PPB (P≤0.014), with no significant difference in the mean time to the first request of analgesia and total morphine consumption between the 2 groups. Conclusion: Continuous preperitoneal analgesia better attenuated postoperative inflammatory response and provided a comparable overall analgesia to that with continuous epidural analgesia following radical cystectomy.
Background: Pediatric patients have remained undertreated for postoperative pain because of the difficulty of pain assessment and apprehension. Intrathecal opioids-including morphine-have become a popular method for providing post-operative analgesia in children. Objectives: To compare different doses of morphine via intrathecal route (2 μg/kg, 5 μg/kg, and 10 μg/kg) for post-operative analgesia in pediatric patients following for abdominal neuroblastoma surgery. Methods: This randomized, double-blinded, study was approved by local ethics committee of South Egypt Cancer Institute, Assiut University, Assiut-Egypt, and registered at https://www.clinicaltrials.gov/ at no.: "NCT03158584". Forty-five patients scheduled for surgical excision of abdominal neuroblastoma were divided into 3 groups (15 patients each); group (I): received intrathecal morphine 2 μg/kg added to normal saline (3 mL volume). Group (II): received intrathecal morphine 5 μg/kg. Group (III): received intrathecal morphine 10 μg/kg. Intra-, and post-operative hemodynamics, FLACC score, time to first request of rescue analgesia, total analgesic consumption, and side effects were recorded for 24 hours. Results: there was a significant reduction in FLACC score in groups II and III starting immediately till 24 hours postoperatively compared to group I (P < 0.05). None of the patients in groups II and III (n = 15 each), while all the patients in group I (n = 15) required postoperative rescue analgesia. In group (I), time to first request of rescue analgesia, cumulative perfalgan, and fentanyl consumptions were 5.47 ± 1.60 hours, 613 ± 182.92 mg, and 10.37 ± 3.78 µg respectively. There was no significant difference among groups regarding postoperative sedation (P > 0.05). No significant difference was observed between groups in side effects.
Background: Intrathecal ketamine has been studied extensively in animals, but rarely in humans. Intrathecal dexmedetomidine prolongs the duration of spinal anesthesia. Objective: To investigate the efficacy and safety of intrathecal dexmedetomidine, ketamine, or both when added to bupivacaine for postoperative analgesia in major abdominal cancer surgery. Design: Double-blinded, randomized, controlled trial. Setting: Academic medical center. Methods: Ninety patients were randomly allocated to receive either intrathecal 10 mg of hyperbaric bupivacaine 0.5% and 5 µg of dexmedetomidine (group I, n = 30), 10 mg of hyperbaric bupivacaine 0.5% and 0.1 mg/kg ketamine (group II, n = 30), or 10 mg of hyperbaric bupivacaine 0.5% and 5 µg of dexmedetomidine plus 0.1 mg/kg of ketamine (group III, n = 30). Hemodynamics, pain score, time to first request of analgesia, total PCA morphine consumption, sedation score, and adverse effects in the first 24 hours postoperatively were recorded. Results: Time to first request of analgesia was longer in group II (7.42 ± 1.43 h) and group III (13.00 ± 7.31h) compared to group I (3.50 ± 1.57 h). PCA morphine consumption was less in group III (6.67 ± 2.8 mg) compared to group I (9.16 ± 3.63 mg) and group II (8.66 ± 3.49 mg). Group III showed lower postoperative pain scores, and a higher incidence of postoperative sedation (P < 0.03). Limitations: This study is limited by its relatively small sample size. Conclusion: In conclusion, the combination of intrathecal dexmedetomidine and ketamine provided superior postoperative analgesia, prolonged the time to first request of rescue analgesia, and reduced the total consumption of PCA morphine, without serious side effects compared to either drug alone. Key words: Intrathecal, ketamine, dexmedetomidine, lower abdominal cancer surgery
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