Inguinal hernia repair is one of the most commonly performed surgical procedures. Regional blocks might provide excellent analgesia and reduce complications in the postoperative period. We aimed to compare the postoperative analgesic effect of the ultrasound-guided transversalis fascia (TF) plane block versus the transmuscular quadratus lumborum (QL) block in patients undergoing unilateral inguinal hernia repair. Methods: Fifty patients enrolled in this comparative study and were randomly assigned into two equal groups. One group received an ultrasound-guided QL block. In comparison, the other group received an ultrasound-guided TF plane block. The primary outcome was the patient-assessed resting, and movement-induced pain on the numeric pain rating scale (NRS) measured at 30 minutes postoperatively. Secondary outcomes included the percentage of patients receiving rescue analgesia in the first postoperative day, ease of performance of the technique, and incidence of adverse effects. Results: There were no statistically significant differences in NRS at rest and with movement between the groups over the first 24 hours postoperatively. The proportion of patients that received postoperative rescue analgesics during the first 30 minutes postoperatively was 4% (n = 1) in the QL group compared to 12% (n = 3) in the TF group. However, the mean performance time of the TF block was shorter than that of the QL block, and the performance of the TF block appeared easier technically. Conclusions: The ultrasound-guided TF plane block could be as effective as the QL block in lowering pain scores and decreasing opioid consumption following nonrecurrent inguinal herniorrhaphy.
Background Operating rooms (OR) are noisy places, and proper control of intraoperative noise is advised by health care organizations to avoid its hazardous effects. Finding a smartphone application to measure and control intraoperative annoying sound is necessary. Objective To compare noise levels in Kasr Al Ainy Hospitals’ ORs with the World Health Organization (WHO) recommendations and to investigate their effects on patients. Methods and material Forty patients who underwent surgeries under regional anesthesia at six different theaters enrolled in this observational cohort study. Sound was recorded by TM-102 Sound Level Meter and NoiseCapture app simultaneously. They used to capture the maximum (Max) and minimum (Min) values of A-weighting and average (mean) values in decibel (dB). The 1ry outcome was a comparison of the equivalent sound pressure levels (Leq (A)) measured by TM-102 Sound Level Meter with WHO recommendation (i.e., 40 dB). Results Mean noise levels in different theaters were far away from the WHO recommendations. The mean (Leq (A)) level measured by TM-102 Sound Level Meter was 73.01 (± 5.74) compared to 72.15 (± 6.57) measured by NoiseCapture. These levels exceeded the WHO recommendation by around 1.8 times. Both tools showed a good correlation with no statistically significant differences in all readings. Four distressed patients (66.7%) reported the obstetric theater as the highest noisy OR (78 dB). Conclusions Intraoperative noise levels at Kasr Al Ainy Hospital reached critical values that exceeded the international recommendations. For intraoperative noise monitoring, NoiseCapture smartphone application appeared like a straightforward hand-held software appropriate for this purpose.
Intraoperative fluid management aims to maintain central euvolemia while avoiding salt and water excess. Excessive intravenous fluid administration leads to gut edema, bacterial translocation, prolonged ileus, and impaired gastrointestinal (GI) function and tolerance for enteral nutrition [1]. Several factors, such as preoperative fasting, hypertonic bowel preparations, anesthesia, and positive pressure ventilation, predispose surgical patients to a functional intravascular volume deficit [2]. How ever, optimal fluid management is difficult to achieve using standard parameters (e.g., heart rate, blood pressure, central venous pressure, or urine output) [3]. So, intraoperative fluid management should be guided by goal-directed therapy (GDT) rather than predetermined calculations [1].Pulse pressure variation (PPV) has an advantage over most of the dynamic measures of fluid responsiveness in not being affected by airway and pleural pressures [4]. Lactated Ringer's (LR) is a commonly
Background Platelet size and activity have a close correlation. The mean platelet volume (MPV) is related to the disease severity and prognosis, especially in critically ill patients. Objective To study the relation between MPV changes and postoperative morbidities and mortality in pediatric surgical intensive care unit (PSICU). Methods and material We enrolled in this descriptive observational study one hundred PSICU children aged from 1 month to 18 years and stayed for > 48 h for peri-operative or post-trauma management. The 1ry outcome was the association between percentage change in MPV (ΔMPV) value and mortality. We recorded MPV, ΔMPV, and platelet count as a baseline, at day 0, 1st, 2nd, 3rd, 5th, and 7th days and then once weekly until patients were discharged, died, or reached a maximum of 90 days in ICU stay. Statistical analysis used We used statistical package for the social science (SPSS) version 22. Non-parametric Mann-Whitney test made comparisons between quantitative variables. Repeated measures analysis of variance (ANOVA), non-parametric Friedman, and Wilcoxon signed-rank tests made the comparison within the same patients. We used receiver operating characteristic (ROC) curves for the detection of sensitivity and specificity. Results Patients who developed ICU complications showed higher ΔMPV compared with non-complicated cases, and this was statistically significant on days 2, 3, 5, and 7 of ICU stay. ROC curve analysis showed a sensitivity of 57.2% and 73% on days 2 and 3 and a specificity of 76.6% and 71% on days 2 and 3, respectively. Conclusions MPV dynamics have a prognostic role and worth a value in predicting several complications in PSICU.
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