Background:Transversus abdominis plane (TAP) block is a promising technique for analgesia after abdominal surgery. This prospective, randomized controlled trial assessed the effect of adding dexmedetomidine to bupivacaine in TAP block for donor hepatectomy. We hypothesized that this would improve postoperative morphine consumption and reduce analgesia related complication and inflammation.Methods:A total of 50 donor hepatectomy were enrolled in this study. Patients divided into two equal groups according to drugs used for TAP block. Group (B) received 20 ml of bupivacaine hydrochloride 0.25%, Group (BD) received 20 ml of bupivacaine hydrochloride 0.25% and 0.3 μg/kg dexmedetomidine, on both sides at the end of surgery and every 8 h for 48 h at right side only through inserted catheter. Primary outcome objective was morphine consumption at first 72 h. Secondary outcome objectives were morphine requirement, numbers of intake, time to first intake, pain score numerical analog scale (NAS), postoperative analgesia related complications, recovery of intestinal motility, and inflammatory markers.Results:Data were analyzed, rescue morphine analgesia was significantly lower in (BD) group compared with (B) groups as considering total morphine consumption (B 4 ± 1.9, BD 1.5 ± 0.5, P = 0.03), numbers of morphine intake (P = 0.04), morphine requirement (P = 0.03), and first time of analgesia intake (P = 0.04). NAS was significantly lower in group (BD) compared with group (B) group in the first 12 h (NAS 0 - P = 0.001, NAS 1 - P = 0.03). Adding dexmedetomidine improved gut motility, first oral intake without detectable anti-inflammatory effect.Conclusion:Adding dexmedetomidine to bupivacine in a surgically inserted catheter for TAP block in donor hepatectomy reduced morphine consumption without detectable anti-inflammatory effect.
Introduction: Diagnostic hysteroscopy-laparoscopy is an essential tool in management of infertility. Mainly, postoperative pain related to insufflated cold carbon dioxide (co2), as it creates acidic milieu causing mucosal, subdiaphragmatic and phrenic nerve irritation. Sodium bicarbonate is an alkaline solution, neutralizing the acidic effects, hence reduces postoperative pain and irritation symptoms. Objectives: This study aimed to assess the efficacy of adding sodium bicarbonate to washing warm saline in hysteroscopic-laparoscopic patients regarding incidence and intensity of postoperative pain and gastrointestinal irritation symptoms. Patients and methods: 66 patients were enrolled, one was excluded due to ovarian bleeding. 33 patients in sodium bicarbonate (Na) group received 50 ml sodium bicarbonate 8.4% in 1000 ml warm saline as peritoneal irrigation solution. While 32 patients in saline (S) group the peritoneal irrigation solution was 1000 ml warm saline only. Results: Patients' demographic, hemodynamic data were comparable. Postoperative pain profile regarding shoulder tip pain, visual analogue score (VAS), and total pethidine consumption were lower in Na group. Also, postoperative nausea and vomiting (PONV) was lower in Na group.
Conclusion:Adding sodium bicarbonate to warm saline as a peritoneal washing solution during hysteroscopylaparoscopy procedure resulted in better postoperative pain reduction specially shoulder tip pain and reduced the incidence of PONV. These results would improve patients' recovery and experience towards operative practice.
Background: Using of the pneumatic tourniquet is a common practice in many surgeries. While it creates bloodless field, it is not free of complications. Tourniquet deflation is a critical stage, greatly affecting hemodynamics. Till now, no strict guidelines have been developed for managing such a procedure. Methods: Sixty patients, >40 years old, undergoing total knee arthroplasty enrolled in this study. Tourniquet deflation done over 3 min before complete release, either by gradual pressure release 50 mmHg/30 s in gradual deflation (G) group or by three cycles of deflationreinflation (deflation for 10 s and reinflation for 50 s) in intermittent deflation (I) group. Results: No significant difference was found regarding patient demographics and basal data. Mean arterial pressure was significantly lower in G group at times of deflation and post deflation for 5 min (P values 0.011, 0.023, 0.024, 0.001, and 0.013, respectively). Also, heart rate and acid base parameters were more stable and convergent to basal data in I group.
Conclusion:Compared to gradual deflation, intermittent deflation of tourniquet in middle and old aged, total knee arthroplasty patients resulted in more stability in hemodynamics and acid base parameters.
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