Background: Thoracic epidural analgesia (TEA) was considered as the gold standard for postoperative analgesia in thoracic surgeries, particularly in bilateral procedures. However, it isn't routinely used as it is associated with some haemodynamic side effects. Erector spinae plane (ESP) block is recognized as a promising postoperative analgesia technique. Aim of the study: The primary outcome was to compare post-mastectomy pain control in TEA and ESP block groups, and secondary outcomes were to compare post-operative hypotension, number of morphine boluses, and patient satisfaction. Patient and Methods: Sixty female patients scheduled for elective mastectomy were enrolled in this study. Patients were allocated into 2 groups, 30 patients each. Group (TE) patients underwent ultrasoundguided single-shot TEA, while group (ES) were handled with ultrasoundguided single-shot ESP block. Peri-operative details, Post-operative hypotension, visual analog scale (VAS) assessment of pain, number of postoperative morphine boluses, and patient satisfaction were recorded. Results: Time needed to give block was shorter in the group (ES) (p<0.001). Group (ES) patients reported significantly lower pain scores according to VAS (P<0.001). Hypotension was more recorded in group (TE) patients, with statistical significance at 0 point (p<0.001). Required post-operative morphine boluses were significantly lower in the group (ES), as 3.3% of patients received 3 boluses compared to 27% in the group (TE) (p=0.01). More patients were highly satisfied with group ES (60%) than group TE (30%) (p=0.037). Conclusion: Ultrasound-guided ESP block is a choice with a better outcome in patients undergoing elective mastectomy as regards the lower frequency of hypotension, better efficiency, and patient satisfaction.
Background: Percutaneous dilatational tracheostomy (PDT) is an inevitable procedure indicated for mechanically ventilated critically ill patients. Ultrasound (US) assisted PDT has emerged increasing safety issues. Case series were reported to confirm the advantages of USPDT. Aim: The present study aimed to compare patients subjected to USPDT with those subjected to bronchoscope guided PDT only, regarding the easiness of technique, efficacy and safety. Materials and Methods: A prospective, randomized, comparative clinical study carried on 49 adults mechanically ventilated critically ill patients in need to maintain a secure airway through elective PDT, using Ciaglia's Blue Rhino percutaneous dilatational tracheostomy technique. 5 patients were excluded for surgical conversion, and the remaining 44 were randomly divided into 2 groups; PDT group: patients subjected to fiber optic guided PDT, and USPDT group: patients underwent pre-procedural US imaging followed by fiber optic guided PDT. Time of the technique, procedure failure, procedure difficulty, and complications were documented, our follow up ends 24-hours after the technique. Results: Pre-procedural US guided PDT was found to be easier (P<0.05), 1 puncture was needed in the USPDT group (P<0.05) with shorter time (P<0.001). The puncture site was changed in 31.8% of the PDT group of patients but not in the USPDT group. The pre-procedural US group showed less bleeding, transient hypoxemia (P<0.05) and total number of patients with minor complications (P<0.05). Conclusion: Pre-procedural ultrasound assessment of trachea and Para-tracheal soft tissues can be considered as a reliable tool to increase safety and improve outcomes of percutaneous tracheostomy.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.