BackgroundTumescent mastectomy refers to usage of a mixture of lidocaine and epinephrine in a diluting saline solution that makes flaps firm and tense, thus minimizing systemic drugs toxicity and making surgery possible with minimal bleeding. This technique is very useful in elder women and those with American Society of Anesthesiologists; score III and IV. The objective was to establish an alternative safe technique to general anesthesia in some selected mastectomy patients.Patients and methodsTwenty candidate women for total mastectomy and axillary dissection were enrolled and consented to participate. After preparation, an anatomically directed infiltration was made under sedation, using a cocktail of lidocaine, bupivacaine, and epinephrine, followed after 20 minutes by the surgical incision and completion of mastectomy. All intraoperative and postoperative outcomes were recorded.ResultsAlthough 7 cases required added analgesic medications, no conversion for general anesthesia was recorded. Mean operative time was 81±15.8 minutes. Mean blood loss was 95.8±47.5 mL. There was no recorded intraoperative hemodynamic instability. Postoperative visual analog score was not exceeding 4 till the end of the first 24 hours. Opioids were not required in any case, and the mean dosage of Ketorolac used was 30±8.75 mg. Drains output and the incidence of postoperative complications were acceptable.ConclusionWe can consider tumescent mastectomy in well-selected patients a safe alternative for performing mastectomy when general anesthesia is hazardous, with minimal blood loss and long lasting postoperative analgesia without an additive effect on the operative time, hospital stay, and intraoperative and postoperative complications.

Background: Spinal anesthesia is efficient but of limited duration. Intrathecal dexmedetomidine prolongs the sensory and motor blockade of bupivacaine. Dexmedetomidine-opioids combination displayed a clinically controversial interaction. Our proposal is that fentanyl may augment the block characteristics of dexmedetomidine using proper doses. Patient and methods: This is a randomized double-blinded study. The included patients were scheduled for orthopedic procedures expected to extend more than 4 h. Patients were allocated into two groups each of 23. Group D received intrathecal bupivacaine 20 mg 0.5% + dexmedetomidine 10 μg. Group DF received bupivacaine 20 mg 0.5% + dexmedetomidine 10 μg + fentanyl 25 μg. The spinal block characteristics and adverse effects were determined. Data were compared by t test, Mann-Whitney, and chi-square tests as appropriate. Results: There was no significant difference between the two groups as regards spinal block and hemodynamic characteristics. The addition of fentanyl provided earlier time to T10 sensory block, lower midazolam and ephedrine utilization, but occasional mild itching. Postoperatively, the time to the first analgesic request, morphine consumption, and patient's satisfaction were not different. Conclusion: The addition of fentanyl does not prolong the sensory and motor block characteristics of dexmedetomidine. In favor of dexmedetomidine-fentanyl combination was the less hypotension and less sedative requirement.

Background:The thyroid gland surgery is a common and painful procedure demanding analgesia. Many regional techniques are applied for anterior neck surgeries mostly assigned in relation to the involved cervical fascia. Dexmedetomidine (Precedex) is a selective alpha 2 adrenoceptor agonist which prolongs the sensory blockade duration of local anesthetics. Our study hypothesis is that ultrasound (US)-guided bilateral superficial cervical plexus block (BSCPB) may provide longer analgesia when adding dexmedetomidine to bupivacaine-epinephrine.Purpose:The aim of this study is to evaluate the analgesic efficacy and possible side effects of US-guided BSCPB and the effect of dexmedetomidine addition to bupivacaine-epinephrine in patients undergoing thyroid surgery.Methods:This prospective, double-blind, randomized study was performed on 42 patients randomized into two equal groups each of 21; bupivacaine Group B and dexmedetomidine Group D. Patients with contraindications to regional anesthesia or uncontrolled comorbidities were excluded from the study. Total pethidine consumption in 24 h is the primary outcome. The visual analog scale, timing of the first opioid request, and hemodynamics are the secondary outcomes.Results:In Group D, there was a longer time to the first request of opioid postoperatively, a lower total pethidine consumption and pain score postoperatively, and lower fentanyl requirements intraoperatively.Conclusions:Sonographic-guided bilateral SCPB using a combination of bupivacaine, dexmedetomidine, and epinephrine was superior to bupivacaine for prolonged analgesia with less intra- and postoperative opioid consumption and lower side effect profile during thyroid surgery.

Background:The peritoneal wound is frequently neglected during laparotomy. The preperitoneal local anesthetics and many adjuvants were effective for postcesarean analgesia. Analgesia may involve somatic and autonomic components. The preperitoneal bupivacaine and the promising adjuvants dexamethasone or dexmedetomidine were compared in this study.Patients and Methods:Sixty patients subjected to a cesarean section (CS) under general anesthesia divided into two groups using a bolus of preperitoneal bupivacaine 0.7 mg/kg with either 1ug/kg dexmedetomidine (Group P) or 8 mg dexamethasone (Group D). The time to the first analgesic request was the primary outcome.Results:There was a significantly prolonged time to the first analgesic request in the Group P than the Group D and less required preperitoneal injections in the Group P, also pain assessed by Numerical Rating Scale (NRS) was lower in the Group P than the Group D after 6 h postoperatively up to 24 h.Conclusions:Dexmedetomidine provided better analgesia than dexamethasone as an adjuvant to preperitoneal bupivacaine post-CS.

HighlightsPleomorphic adenoma can attain huge sizes if neglected.It could cause facial disfigurement and compromise the airway.Surgical resection is the main stay of treatment.

Background and Aims: Local anesthetic (LA) infiltration is one of the analgesic techniques employed during scoliosis correction surgery. However, its efficacy is controversial. In the present study for optimizing analgesia using the infiltration technique, we proposed two modifications; first is the preemptive use of high volume infiltration, second is applying three anatomical multilevel infiltrations involving the sensory, motor, and sympathetic innervations consecutively. Material and Methods: This prospective study involved 48 patients randomized into two groups. After general anesthesia (GA), the infiltration group (I) received bupivacaine 0.5% 2 mg/kg, lidocaine 5 mg/kg, and epinephrine 5 mcg/mL of the total volume (100 mL per 10 cm of the wound length) as a preemptive infiltration at three levels; subcutaneous, intramuscular, and the deep neural paravertebral levels, timed before skin incision, muscular dissection, and instrumentation consecutively. The control group (C) received normal saline in the same manner. Data were compared by Mann-Whitney, Chi-square, and t -test as suitable. Results: Intraoperatively, the LA infiltration reduced fentanyl, atracurium, isoflurane, nitroglycerine, and propofol consumption. Postoperatively, there was a 41% reduction in morphine consumption, longer time to the first analgesic request, lower VAS, early ambulation, and hospital discharge with high-patient satisfaction. Conclusion: The preemptive, high-volume, multilevel infiltration provided a significant intra and postoperative analgesia in scoliosis surgery.

Background and AimsIn the current study we serched the outcome of circumcisions performed with a new plastic clamp. The results were compared to those who underwent conventional circumcision. Methods We analyzed the short-term complications of the procedure among the 3650 children who were consecutively circumcised by plastic Alis klamp technique. The results were compared to those of 1275 children who were circumcised by conventional technique. Results The rate of infection (0.4%) and bleeding (0.2%) after plastic clamp were significantly lower compared to those children circumcised by conventional technique (3.2% and 4.1%; p<0.0001). Buried penis occured in similar rates among both groups. We did not encounter any penile injury in either groups. The total complication rates of plastic clamp and conventional techniques were found as 1.8% and 8.7%, respectively (p<0.0001). The mean duration of circumcision time with plastic clamp and conventional technique was 4.1 ± 1.2 min and 24 ± 3.6 min, respectively (p<0.0001). Conclusion Plastic Alis klamp technique is suggested as the circumcision procedure of choice due to reduced complications, as well as short duration and ease of application.

Background Thoracic paravertebral block (TPVB) and segmental thoracic spinal anesthesia (STSA) can be used as sole anesthesia techniques alternative to general anesthesia for modified radical mastectomy in some critical patients. Both techniques were compared for efficacy and safety including detailed block characteristics, analgesia, patient’s and surgeon’s satisfaction, hemodynamics, respiration, and side effects. Results Both techniques were successful, but fentanyl requirements were higher in TPVB group. The sensory loss was faster, wider, and longer in STSA group; however, it was associated with more hypotension. There was no motor block in the upper or lower limbs in TPVB group, while all patients in STSA group showed ipsilateral handgrip affection and to less extent wrists and then elbow flexion. While the ipsilateral lower limbs motor block was partial and short. Postoperatively, there was no difference in analgesic requirements or side effects. Satisfaction was higher in STSA group. Conclusions Both TPVB and STSA were effective and safe as sole techniques for mastectomy providing adequate anesthesia with low complications, considerable analgesia, and satisfaction. Anesthesia was faster, wider, and longer in STSA group, with lower fentanyl requirements; however, it was associated with more hypotension.