Background Bariatric surgery depends on the development of novel anesthetic techniques to reduce the incidence of complications and improve postoperative outcomes. Ketamine and dexmedetomidine have been used for perioperative analgesia and we hypothesized that they would decrease postoperative morphine requirements. The objective of this trial is to study whether choice of ketamine or dexmedetomidine infusion would affect postoperative total morphine consumption. Methods Ninety patients were equally randomized into three groups. The ketamine group received a bolus dose (0.3 mg/kg) of ketamine over 10 min, followed by an infusion of the same drug (0.3 mg/kg/h). The dexmedetomidine group received a bolus dose (0.5 mcg/kg) of dexmedetomidine over 10 min, followed by an infusion of this drug (0.5 mg/kg/h). The control group received a saline infusion. All infusions were given till 10 min before the end of surgeries. Intraoperative fentanyl was given when patient developed hypertension and tachycardia despite adequate anesthesia and muscle relaxation. Postoperative pain was managed by a rescue dose of 4 mg of IV morphine, with a minimum interval of 6 h between morphine doses if the numerical rating scale (NRS) score was ≥ 4. The primary outcome was the total morphine dose, and the secondary outcomes were intraoperative fentanyl requirement, time to extubation, postoperative nausea and vomiting (PONV), NRS scores, and modified observer’s agitation/sedation scale (MOASS) scores. Results Compared with ketamine, dexmedetomidine decreased the need for fentanyl intraoperatively (160 ± 42 µg), shortened the time to extubation (3 ± 1 min), and improved MOASS and PONV scores. In turn, ketamine decreased postoperative NRS scores and the need for morphine (3 ± 3 mg). Conclusions Dexmedetomidine treatment was associated with lower fentanyl doses, a shorter time to extubation, and better MOASS and PONV scores. Ketamine treatment was associated with significantly lower NRS scores and morphine doses. These results indicated that dexmedetomidine effectively decreased intraoperative fentanyl requirement and the time to extubation, while ketamine decreased the need for morphine. Trial registration This trail was registered on the clinicaltrials.gov registry (NCT04576975) on October 6, 2020.

Background: The development of different techniques in bariatric surgeries has required the development of novel anesthetic techniques to reduce the incidence of complications and improve post-operative patient outcomes. Ketamine and dexmedetomidine have been used for their peri-operative analgesic profiles in different studies. Methods: Ninety patients were studied and randomized equally into three groups. The Ketamine group received a bolus dose (0.3 mg/kg) of ketamine over 10 min followed by an infusion (0.3 mg/kg/h). The Dexmedetomidine group received a bolus dose (0.5 mcg/kg) of dexmedetomidine over 10 min followed by an infusion (0.5 mcg/kg/h). The control group received normal saline infusion. The total morphine dose was the primary outcome ,and intra-operative fentanyl requirements, time to extubation, post-operative nausea and vomiting (PONV), Numerical Rating Scale (NRS) scores, and Modified Observer’s Agitation/Sedation Scale (MOASS) scores were secondary outcomes of the study. Results: The Dexmedetomidine group showed decreased intra-operative fentanyl requirements (160.000 ± 42.345 µcg), less time to extubation (3.700 ± 0.925 min), and better scores on MOASS than the other groups. Post-operative NRS scores and the morphine requirement in the Ketamine group (1.867 ± 2.921 mg) were lower than in the other groups. The Dexmedetomidine group showed the lowest scores for PONV. Conclusions: The Dexmedetomidine group showed lower total fentanyl doses, a significantly shorter time to extubation, better MOASS scores, and lower PONV. The Ketamine group showed significantly lower NRS scores and morphine doses than the other two groups. Dexmedetomidine was effective on the reduction of intraoperative fentanyl requirement with early extubation, and ketamine was effective on the reduction of postoperative pain. Trial Registration: this trail has been registered on clinicaltrials.gov registry (NCT04576975) since 06/10/2020

Background: Stable hemodynamics in hip arthroscopy is one of the most important tasks. Recently, dexmedetomidine has been considered a safe analgesic and sedative adjuvant in different surgeries. Ultrasound-guided fascia iliaca compartment block (FICB) is a technique used to produce postoperative analgesia for hip surgery. FICB will be a promising technique for postoperative analgesia in hip arthroscopy. Objective: We designed a prospective, randomized, double-blind, parallel-group trial to evaluate the effect of administration of dexmedetomidine intravenously and perineurally on hemodynamic stability intraoperatively and on narcotics consumption postoperatively, as well as to evaluate the effect of dexmedetomidine as an adjuvant to FICB. Patients: A total of 88 patients scheduled for elective hip arthroscopy, aged 18 to 65 years, 70-80 kg, both sexes. Patients were randomized into Group A (intravenous Dexmedetomidine) and Group B (perineural Dexmedetomidine). The Main outcome measure was to detect effectiveness of dexmedetomidine infusion without loading dose in achieving intraoperative hemodynamic stability with minimal need for rescue agents and its analgesic effect postoperatively, if added to bupivacaine in fascia iliaca block. Results: Dexmedetomidine significantly maintained mean arterial blood pressure and heart rate (P-value <0.001); with lower intraoperative fentanyl consumption in group A (53.85 ± 13.87 µg) when compared to group B (150.00 ± 40.35 µg) and no significant difference between the two groups in VAS scores postoperatively. Conclusions: Dexmedetomidine infusion provided stable intraoperative hemodynamics in patients undergoing hip arthroscopy with reduced intraoperative narcotics requirement, while addition of dexmedetomidine to bupivacaine had no role in prolonging the effect of FICB.

Background Peripheral nerve blocks provide prolonged analgesia restricted to the site of surgery e.g. penile block for circumcision or sciatic nerve block for pediatric surgery. The drawback is not all anesthesiologists are familiar with the necessary spectrum of peripheral nerve blocks in children. That is why Caudal block is preferred as all types of surgery below the umbilicus can be covered by it: ‘one technique fits all’. The main goal of caudal block is to provide postoperative pain relief, in addition it can be effective intraoperative and it is accepted that the block is performed in anesthetized children. Objectives The aim of this work is to compare Bupivacaine with Neostigmine and Bupivacaine alone as regard intraoperative hemodynamics and postoperative pain control for lower abdominal surgery in pediatrics. Patients and Methods Prospective randomized controlled clinical Trial. Conclusion In conclusion, caudal bupivacaine plus 2μg/kg neostigmine provided excellent analgesia lasting up to 24 hours post-operative, without serious side effects and minimal additional analgesics thus providing a safe, simple and effective postoperative analgesia for children undergoing lower abdominal surgery.

Background Epidural anesthesia is one of the preferred modes of regional anesthesia for lower limb orthopedic surgeries. This technique provides not only peri-operative anesthesia but also post-operative analgesia. Bupivacaine is commonly used local anesthetic in epidural anesthesia, many adjuvants added to local anesthetics to enhance the quality and duration of surgical anesthesia, among them are opioids, alpha 2 agonists. Opioids like fentanyl have been a popular choice, it offers faster onset and prolongs the duration of analgesia. Recently, alpha 2 agonists like clonidine and dexmedetomidine have been also used in prolonging the duration of epidural analgesia. Aim of the Work To compare the efficacy of using fentanyl and dexmedetomidine with bupivacaine in epidural block for knee surgeries, the time of onset of sensory, motor blockade and the duration of this blockade. Patients and Methods After obtaining approval from the Research Ethical Committee of Ain Shams University, this study was conducted in the operating theatres of Ain Shams University Hospital. It was a prospective double-blind randomized clinical study. Study period was 6 months. Results A total of 50 patients out of 71 consecutive patients met the inclusion criteria and consented for study. These 50 patients were randomized into two groups of 25 each. Out of the total patients, 33 were male and 17 were female. Conclusion Dexmedetomidine as an adjuvant to epidural bupivacaine is a better alternative to fentanyl as it shows faster onset of sensory and motor block, lesser time to attain maximum sensory level and prolonged duration of anesthesia.