Background: The control of postoperative pain following major lumbar spine surgeries remains a major challenge for anesthesiologists, and many new strategies and methods have been developed for pain control. This study's main objective was to evaluate the efficacy of the bilateral ultrasound-guided erector spinae plane block (US-ESPB) as a method for perioperative pain management in patients undergoing lumbar spine surgeries. Methods: This double-blinded prospective randomised controlled study was conducted on 140 patients aged between 18 and 65 years; all were scheduled for elective lumbar spine surgeries. Patients were randomly allocated into one of the two groups: the ESPB group (n = 70) or the control group (n = 70). All patients received bilateral US-ESPB after induction of general anaesthesia, in the ESPB group; 20 mL of levobupivacaine 0.25% were used, while 20 mL normal saline was given to the control group instead. The primary endpoint was the total amount of morphine consumed during the intraoperative and the first 24 postoperative hours. Secondary endpoints included, time to first request of rescue analgesia as well as incidence of adverse effects. Results: The total amount of morphine consumed during the intraoperative and the first 24 postoperative hours was found to be significantly lower in the ESPB group compared to the control group (P < 0.001). Moreover, the time to first analgesic request was significantly longer in patients receiving ESPB as analgesia (P < 0.001). No statistically significant differences were observed between the two groups regarding complications. Conclusion: Bilateral US-ESPB is useful intervention for providing adequate pain management in lumbar spine surgeries.

Background: With the increased number of abdominoplasty all over the world, and the need to manage postoperative pain, it is a must to find proper and effective drugs to decrease opioid consumption in the postoperative period. Objectives: In this double-blind randomized controlled clinical trial, we assumed that low-dose ketamine infusion will reduce the postoperative pain profile than the conventional method of morphine. Methods: The scheduled patients for abdominoplasty under general anesthesia were recruited in two groups: group (K) with low-dose ketamine infusion intra-operatively (80 patients) and group (M) with morphine infusion intra-operatively (80 patients). Both groups were monitored intraoperatively and postoperatively for rescue doses of fentanyl, visual analogue scale (VAS), and side effects. Results: There were no statistical differences between both groups regarding the fentanyl rescue doses intra- and postoperative with no remarkable side effects. Conclusions: Low-dose ketamine has a useful analgesic effect in abdominoplasty similar to morphine without remarkable side effects, such as sedation or hallucinations.

Background: Some situations compel anesthetists to execute endotracheal intubation in the lateral position. We compared elective endotracheal intubation in the lateral decubitus position using the video stylet (VS) device with the fiberoptic (FO) bronchoscope device in patients undergoing abdominal surgery.Methods: Overall, 50 patients were enrolled in this prospective, randomized study. They were randomly classified into the VS intubation or FO intubating bronchoscope group. After anesthesia induction, patients were placed in the lateral decubitus position, and a single investigator well-versed with the use of the VS and FO bronchoscope performed the intubation. The primary outcome was the time taken for intubation. Secondary outcomes included the intubation success rate, hemodynamic response at specific time points and perioperative complications.Results: The average time taken for intubation was significantly lesser in the VS group than in the FO group, with values of 39.5 ± 10.0 and 75.6 ± 16.2 s, respectively (P < 0.001). Incidences of a successful first attempt of intubation in the VS and FO groups were 88% and 100%, respectively, showing no significant difference. There was a negligible difference in complications between the groups, except sore throat, which showed a higher incidence in the VS group than in the FO group (P = 0.002).Conclusions: In laterally positioned patients, elective endotracheal intubation with VS provides less intubation time; however, its use is accompanied by a significant increase in the hemodynamic response after intubation and an increased incidence of sore throat.

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Background and Objective:This is a randomized controlled trial aiming at comparing the effectiveness of levobupivacaine alone versus a levobupivacaine with dexamethasone in the epidural injection for painless labor.Patients and Methods:This is a comparative randomized controlled double-blinded clinical trial with 49 patients were included in this study, all of them were primigravidas and were during vaginal delivery with a cervical dilatation ≥4 cm. Patients were included randomly in one of two groups either Group C (26 cases) with epidural levobupivacaine 0.125% in normal saline or Group D (23 cases) with epidural levobupivacaine 0.125% in normal saline combined with dexamethasone 8 mg. The duration of a second dose request, total dose given, neonatal outcome and adverse effects of epidural were recorded.Results:Group D showed a longer duration of analgesia than Group C (80.5 ± 12.39 min in Group D vs. 61.75 ± 10.74 min in Group C) with a P < 0.05 (0.001). Furthermore, the patients in Group D received smaller dose of levobupivacaine than those in Group C with a statistically significant difference (90.87 ± 33.42 vs. 127.21 ± 40.68 mg with P = 0.002). There were no statistical differences between the two groups regarding hemodynamics, pain score, neonatal outcome, and complications.Conclusion:Dexamethasone in epidural analgesia for painless labor has a prolonged duration of analgesia with no complications for both the mother and the infant.