Background Inguinal hernia repair is one of the most frequently performed surgical procedures in the pediatric population. Using optimal analgesic regimen provides safe and effective analgesia, reduce postoperative stress response and accelerate recovery from surgery. Aim of the Work to examine the effect of Dexmedetomidine as an adjuvant to Levobupivacaine in caudal anesthesia, mainly its effect in enhancing and prolonging post-operative analgesia. Patients and Methods The study was conducted on 50 randomly chosen patients in Ain Shams University Hospitals after approval of the medical ethical committee. Patients were divided randomly into two groups, each group consisted of 25 patients. After preoperative assessment and obtaining baseline vital data, all patients received general anesthesia. Group A: Patients in this group received caudal anesthesia with Levobupivacaine 0.25% at a dose of 2 mg·kg−1 (0.8 ml·kg−1) before the beginning of the procedure. Group B: Patients in this group received Levobupivacaine 0.25% at a dose of 2 mg·kg−1 (0.8 ml·kg−1) in addition to Dexmedetomidine 1 μg·kg−1 in 1 ml normal saline before the beginning of the procedure. Results The results of the study revealed that there was significant reduction in FLACC score in group B at 4, 8, and 12 hours postoperatively compared to group A, at the twenty-fourth hour there was no significant difference. Regarding the duration of analgesia postoperatively we found statistically significant increase in group B compared to that in group A (p-value <0.001). Regarding the number of doses of analgesia required post operatively (Paracetamol 15ml/kg/dose) there was a statistically significant decrease in patients requirement in group B compared to that in group A (p-value <0.001). Conclusion Dexmedetomidine as adjuvant to Levobupivacaine provided significantly prolonged postoperative analgesia, reduced the postoperative analgesic requirements and better parents’ satisfaction as compared with caudal analgesia using Levobupivacaine alone in children undergoing hernia repair.

Background & objective: Patients with chronic sinusitis, not responding to medical treatment are managed with functional endoscopic sinus surgery (FESS) by ENT specialists. The surgery demands a bloodless field for its success. Even minimal amount of blood can obscure the surgical field to the operating surgeon. We compared three drugs, propofol, dexmedetomidine, and nitroglycerin as hypotensive agents and their effect on blood loss in FESS. Methodology: Our study included sixty adult patients scheduled for FESS at Ain Shams University hospitals from September 2018 to September 2019. All patients were ASA I and II and they were distributed into three groups in a random manner, twenty patients in each group. Patients in Group D were administered dexmedetomidine 1 μg/kg as a loading dose over 10 min (in 100 ml normal saline) just after induction, then 0.5 μg/kg/h was infused. Group P patients were administered propofol infusion 8 mg/kg/h. Group N patients were administered nitroglycerin infusion of 2 μg/kg/min. Hemodynamic parameters were recorded every 15 min. We used bleeding score to examine the quality of operating field. We recorded the time to achieve target mean arterial blood pressure. Duration of operation was recorded. Results: In Groups D and P, our target of mean arterial pressure of 55-65 mmHg was achieved. The hypotensive drugs used in these groups offered good quality of surgical field and shorter duration of surgery. Group D also achieved target blood pressure faster than Group P with significantly lower heart rate in Group D. Conclusion: Dexmedetomidine and propofol had more favorable effects for attaining the desired blood pressure than nitroglycerin with lower heart rate in dexmedetomidine group. Dexmedetomidine and propofol were associated with less bleeding and shorter duration of surgery in patients undergoing FESS. Also dexmedetomidine was faster in achieving target blood pressure than propofol. Trial Registry: PACTR202202877370804 Abbreviations: FESS - Functional endoscopic sinus surgery; CSF - Cerebrospinal fluid; GABA - γ-aminobutyric acid’ MAP - Mean arterial blood pressure Key words: Anesthesia; Anesthesia, General; Endoscopy / methods; Humans; Propofol; Dexmedetomidine; Nitroglycerin; Controlled hypotension; FESS. Citation: Saleh SAEM, Awad HGS, Shonoda AMF, ElShorbagy MS, Doaa Mohammed Kamal ElDin DMK. A comparison between propofol, dexmedetomidine and nitroglycerin as hypotensive agents and their effect on blood loss in functional endoscopic sinus surgery (FESS). Anaesth. pain intensive care 2022;26(3):338-346. DOI: 10.35975/apic.v26i3.1908 Received: March 10, 2022; Reviewed: April 07, 2022; Accepted: May 05, 2022 Background & objective: Patients with chronic sinusitis, not responding to medical treatment are managed with functional endoscopic sinus surgery (FESS) by ENT specialists. The surgery demands a bloodless field for its success. Even minimal amount of blood can obscure the surgical field to the operating surgeon. We compared three drugs, propofol, dexmedetomidine, and nitroglycerin as hypotensive agents and their effect on blood loss in FESS. Methodology: Our study included sixty adult patients scheduled for FESS at Ain Shams University hospitals from September 2018 to September 2019. All patients were ASA I and II and they were distributed into three groups in a random manner, twenty patients in each group. Patients in Group D were administered dexmedetomidine 1 μg/kg as a loading dose over 10 min (in 100 ml normal saline) just after induction, then 0.5 μg/kg/h was infused. Group P patients were administered propofol infusion 8 mg/kg/h. Group N patients were administered nitroglycerin infusion of 2 μg/kg/min. Hemodynamic parameters were recorded every 15 min. We used bleeding score to examine the quality of operating field. We recorded the time to achieve target mean arterial blood pressure. Duration of operation was recorded. Results: In Groups D and P, our target of mean arterial pressure of 55-65 mmHg was achieved. The hypotensive drugs used in these groups offered good quality of surgical field and shorter duration of surgery. Group D also achieved target blood pressure faster than Group P with significantly lower heart rate in Group D. Conclusion: Dexmedetomidine and propofol had more favorable effects for attaining the desired blood pressure than nitroglycerin with lower heart rate in dexmedetomidine group. Dexmedetomidine and propofol were associated with less bleeding and shorter duration of surgery in patients undergoing FESS. Also dexmedetomidine was faster in achieving target blood pressure than propofol. Trial Registry: PACTR202202877370804 Abbreviations: FESS - Functional endoscopic sinus surgery; CSF - Cerebrospinal fluid; GABA - γ-aminobutyric acid’ MAP - Mean arterial blood pressure Key words: Anesthesia; Anesthesia, General; Endoscopy / methods; Humans; Propofol; Dexmedetomidine; Nitroglycerin; Controlled hypotension; FESS. Citation: Saleh SAEM, Awad HGS, Shonoda AMF, ElShorbagy MS, Doaa Mohammed Kamal ElDin DMK. A comparison between propofol, dexmedetomidine and nitroglycerin as hypotensive agents and their effect on blood loss in functional endoscopic sinus surgery (FESS). Anaesth. pain intensive care 2022;26(3):338-346. DOI: 10.35975/apic.v26i3.1908 Received: March 10, 2022; Reviewed: April 07, 2022; Accepted: May 05, 2022

Background & objective: Spinal anesthesia (SA) is preferred for fractured femur surgery but it requires proper positioning which is often very difficult to achieve due to pain. Different methods have been used to control the pain during patient positioning, but the results are inconsistent about the superiority of one over the other. We compared femoral nerve block (FNB) and intravenous ketamine for pain control during positioning for SA in elderly patients with femur fracture. Methodology: A total of 66 patients above 60 y of age were randomly divided into two equal groups; FNB group to receive ultrasound guided FNB with 15-20 ml of bupivacaine 0.25% and ketamine group to receive IV ketamine 0.25 mg/kg. Assessment of VAS scores during positioning before SA was done. Rescue analgesia for pain during positioning was achieved by inj fentanyl IV, and after the surgery by inj morphine IV. Postoperative VAS scores, calculation of total morphine consumption during the first 24 h and any complications were recorded. Results: The VAS score during positioning was lower in FNB group compared to ketamine group (P < 0.001). This was evident by lower recorded doses of pre-spinal rescue fentanyl. FNB group showed better postoperative analgesia, less morphine consumption and less complications. Conclusion: FNB provided better analgesia during positioning for spinal blockade in fractured femur patients. Furthermore, FNB was associated with less adverse effects, better postoperative analgesia and less opioid consumption. Trial Registry: PACTR202112605652525. Abbreviations: SA - Spinal anesthesia; FNB - Femoral nerve block; NSAIDS - Nonsteroidal anti-inflammatory drugs; VAS - Visual Analog Scale Key words: Pain; Spinal anesthesia; Femoral nerve block; Ketamine; Femur surgery Citation: Moussa MEM, Awad HGS, Hamid HSA, Abdellatif AE, Sharaf AGS. A comparative study between femoral nerve block and intravenous ketamine for pain management during positioning for spinal anesthesia in elderly patients with femur fracture. Anaesth. pain intensive care 2022;26(3):297-303. DOI: 10.35975/apic.v26i3.1895 Received: January 25, 2022, Reviewed: March 16, 2022, Accepted: March 23, 2022

Background The primary goal of modified radical mastectomy is to remove cancerous cells and reduce the risk of breast cancer spreading. This operation is associated with considerable acute postoperative pain and restricted shoulder movement. If this acute pain is neglected most patients will develop chronic post-mastectomy pain, which reduces the quality of life. Regional anesthesia using ultrasound-guided paravertebral nerve block or pectoral nerve block has become an ideal addition to general anesthesia for providing analgesia after breast cancer surgery. This was a randomized clinical trial conducted between February 2018 and February 2019. This study compared between the two nerve blocks regarding the efficacy in terms of analgesic consumption. Results The study included 30 female patients who were undergoing modified radical mastectomy under general anesthesia and randomly divided into 2 groups of 15 patients in each. This study showed there was a statistically significant increase in the amount of total fentanyl used intraoperatively in TPVB group than PECs group with p value = 0.008. Less VAS score in PECS group with statistically significant difference between groups at 4 h, 5 h, 6 h, and 8 h. More time needed for 1st requested rescue analgesia in PECS group with P value = 0.013. Patients in PECS group received a less total dose of fentanyl in the first 24 h postoperative with P value = 0.040. There was no statistically significant difference found between groups regarding postoperative complications. Conclusions In female patients undergoing breast surgeries, the PECs block can be used efficiently and safely, providing better pain relief than the TPVB and reducing intraoperative and postoperative opioids use.