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Background: Eliminating propofol injection pain (PIP) should be multimodal, including pharmacological and non-pharmacological interventions. Understanding risk factors -body mass index, menstrual cycle phase and age for example -leading to increased pain sensitivity will identify patients at most risk for PIP, permitting effective treatment strategies to be initiated at an early stage. Objective: Our goal is to determine occurrence and severity of propofol injection pain among female patients, whether they are obese or non-obese, during different menstrual cycle phases. Methods: Design: A prospective observational study. Setting: Single university teaching hospital's operating rooms. Patients: 84 female undergoing surgeries under general anesthesia, classified as American Society of Anesthesiologists (ASA) physical status I-II, between 18 and 65 years of age were enrolled. Interventions: We evaluated propofol injection pain using visual analogue scale (VAS) during induction of general anesthesia. Main outcome measure: The relation between propofol induced peripheral venous pain and female body mass index, menstrual cycle phase and age. Results: 71.4% of patients experienced PIP. Of those patients who experienced PIP; 40.5% (34/ 84 patients) had moderate to severe pain. Age <35 years was the only independent predictor of moderate/severe PIP (sensitivity 62%, specificity 78%). After adjustment for age category, there was no statistically significant association between occurrence of moderate/severe PIP and obesity or menstruation. Conclusion:Propofol injection pain prophylactic measures should be considered in young females <35 years as they may be more prone to moderate/severe PIP.

Background Semi-rigid uretroscopy (URS) is a common intervention approach for lower ureteric stones. Ureteral dilatation is frequently needed before URS to enable ureter accessing. Aminophylline is known by its muscle relaxant effect and has been suggested to be effective in ureteral dilation. Objectives To evaluate the effect of intravesical administration of aminophylline on ureteroscopy and to measure intraureteral pressure Methods This prospective randomized controlled study included 50 before and after aminophylline injection. patients with lower ureteral calculi. In group A, the ureter was dilated by intravesical aminophylline whereas in group B balloon dilator was used. Intraureteral pressure was measured using pressure transducer connected to invasive pressure monitor. Results No statistically significant difference was noticed between both groups in operative time, intra operative complication, need for ureteral stenting or stone free rate. However, post-operative pain and haematuria were statistically significantly higher among balloon group compared to aminophylline group. In group A, there was statistically significant decrease in intraureteral pressure after injection of aminophylline (7.80 ± 1.71) compared to before injection (12.2 ± 1.85) with p-value &lt; 0.001. Conclusion Aminophylline is effective in ureteral dilatation when intravesically injected with less frequent post-operative pain and hematuria.

Background One of the main objectives of anesthesia is to relieve the patient’s pain and agony, by ensuring the performance of surgical procedures without any discomfort. Elimination of postoperative pain is indispensable due to the central, peripheral and immunological stress response to tissue injury. So there is a need for extended analgesia without any side effects to achieve this goal. Aim of the Work To compare the post-operative analgesic effect of intrathecal-nalbuphine and fentanyl as adjuvant to bupivacaine during cesarean delivery. The secondary aim is to compare side effects between using nalbuphine and fentanyl as adjuvants to bupivacaine. Patients and Methods After Approval is obtained from the research Medical Ethical Committee of Faculty of Medicine, Ain Shams University. The study was conducted on 60 patients that were randomly selected. Randomly divided into 2 groups 30 patients each. Group F which received fentanyl as adjuvant while group N received nalbuphine as adjuvant. Results The addition of a small dose of nalbuphine or fentanyl to bupivacaine in spinal anesthesia prolonged the time of postoperative analgesia. In this study, there was no significant difference regarding the age, height, weight, and duration of operation, maximum sensory level, and maximum motor blockade level. The duration of the postoperative analgesia was prolonged with Nalbuphine group in comparison to the fentanyl group, the results were highly significant. Conclusion We concluded that either intrathecal nalbuphine (0.8 mg) or intrathecal fentanyl (25 µg) combined with Bupivacaine improves intraoperative analgesia and prolongs early post-operative analgesia in cesarean section. There was no significant difference with regard to: Peak sensory block level, Maximum motor block level, systolic blood pressure, diastolic blood pressure, oxygen saturation, and heart rate.