Purpose:The purpose of the study is to evaluate the most effective analgesic route of magnesium sulfate (MgSO4) either intravenous (i.v.) or pectoralis interfascial plane block.Patients and Methods:Fifty adult female patients were divided into two equal groups: i.v. MgSO4 and Pecs II block MgSO4 (Pecs MgSO4) group. After general anesthesia, in i.v. MgSO4 group, the local anesthetic (LA) for Pecs II block was prepared by adding 3 mL saline to 57 mL bupivacaine 0.25% divided equally for each side. A bolus i.v. solution of MgSO4 10% 0.5 mL.kg-1 diluted in saline in a total volume of 100 mL was given over 15 minutes. Then, the solution for continuous i.v. infusion; 30 mL MgSO4 10% and 70 mL saline was infused at the rate of 0.5 mL.kg-1.h-1 intraoperatively. For PecsMgSO4 group, LA formed of 3 mL MgSO4 10% added to 57 mL bupivacaine 0.25%. Whereas, 100 mL saline was given as bolus i.v. followed by continuous infusion of 100 mL normal saline at the rate of 0.5 mL.kg-1.h-1.Results:In the group received MgSO4-bupivacaine Pecs II block, there was a nonsignificant decrease in postoperative morphine consumption compared to i.v. administration of MgSO4. The two groups were comparable in the intensity of pain and sedation scores.Conclusion:The use of bupivacaine Pecs II block enhanced with addition of MgSO4 to pectoralis interfascial plane block or intravenously in patients underwent breast cosmetic surgeries under general anesthesia was associated with comparable results of the postoperative morphine requirements, intensity of postoperative pain, and extension of the duration of postoperative analgesia. The intraoperative hemodynamic effects i.v. MgSO4 were superior to the pectoralis interfascial plane route of administration.

Background: Rhinoplasty is considered a surgical technique used to repair various nose deformities. This is one of the most challenging procedures in face aestheticsurgery. It is performed under general anesthetic, and often particular areas of the nose are infiltrated with 2% xylocaine and epinephrine to induce vasoconstriction, reduce surgical bleeding, and provide analgesia. Objectives: The aim of the work was to determine the effect of combining ketamine with xylocaine and epinephrine in local infiltration. Patients and methods: This prospective randomized study included a total of 44 cases distributed into two equal groups (22 each); the xylocaine -epinephrine (XE) group where the local infiltrationwas done by xylocaine and epinephrine. The second group xylocaineepinephrine -ketamine (K) group includes the remaining patients in whom the local infiltration was done by xylocaine, epinephrine andketamine.Heart rate, blood pressure, visual analogue score (VAS), and morphine consumption were recorded. Results: When group K was compared to group XE at 1, 2 hours post-operatively, the VAS was substantially lower.In group K the period for the initial request for analgesia (3.30±1.04h) was longer than in group XE (2.14±0.94h).A statistically significant reduction of the morphine requirement was seen in group K (7.0±3.3 mg), in comparison to group XE (10.0±3.19 mg) during the first post-surgical 24 hours. Conclusion: It could be concluded that adding ketamine to xylocaine-epinephrine local infiltration for rhinoplasty lowered post-operative pain ratings, delayed the initial request for analgesia, and decreased overall analgesic intake in the first 24 hours post-operatively without causing severe adverse effects.

Purpose: The purpose of the study is to evaluate the analgesic effect of adding magnesium sulfate to bupivacaine in Fascia Iliaca Compartment Block (FI-CB). Patients and Methods: Ninety-six burn patients scheduled for skingrafting procedures were allocated into two equal groups. After induction of general anaethesia, forty-eight patients received US guided FICB using 35 ml bupivacaine 0.25% + 5 ml isotonic sodium chloride solution with a total volume of 40 ml. The other forty-eight patients received 35 ml bupivacaine 0.25% + 250 mg of magnesium sulfate with a total volume of 40 ml. Results: Total postoperative pethidine consumption in the first 24 h post-operative showed a highly statistically significant decrease in the magnesium group in comparison to the bupivacaine group. Conclusion: Adding magnesium sulfate to bupivacaine in FICB in skin grafting procedures decreased the pain scores post-operative, delayed the first request of analgesia and reduced the total analgesic consumption in the first 24 h post-operative without any significant side effects.

Background: Dexmedetomidine is known for its efficacy as a local anesthetic adjuvant. Herein, we studied the beneficial impact of adding dexmedetomidine to bupivacaine in combined intercostal and pararectus block in patients scheduled for abdominoplasty. Patients and methods: This prospective research enrolled 66 patients allocated into two groups; Group I included 33 patients who received combined intercostal and pararectus blocks using bupivacaine plus dexmedetomidine, and Group II included the remaining participants who received the same blocks using bupivacaine alone. Results: All preoperative patient demographic and clinical criteria expressed no significant difference between the two groups. Group I showed a significant decline in opioid requirements throughout the first postoperative day. The time to the first analgesic request showed a significant delay in Group I (14.73 vs 7.39 hours in Group II). Pain scores showed a significant decline in Group I during rest, cough, and movement, compared to Group II. O2 saturation, heart rate, and mean arterial pressure showed no significant difference between the two studied groups. Adding dexmedetomidine was not associated with a significant rise in the incidence of postoperative complications. Conclusion:The addition of dexmedetomidine to the local anesthetic agent during intercostal and pararectal blocks is associated with a better analgesic profile. It is associated with lower pain scores and lower morphine consumption without increased associated side effects.

Background: Deflation of the pneumatic tourniquet after orthopedic surgery is associated with multiple cardiovascular adverse effects [hypotension and tachycardia]. Trendelenburg position or passive leg raising [PLR] are commonly used as the initial treatment of shock and hypotension Aim of the work: To compare between Trendelenburg position 20˚ and passive leg raising 45° regarding the incidence of posttourniquet deflation cardiovascular adverse effects in patients undergoing unilateral knee arthroscopy. Patients and methods: This prospective study included 98 cases that underwent unilateral knee arthroscopy. Patients were randomly allocated into two groups; group [1] included 49 cases who were exposed to the Trendelenburg position after deflation, and group [2] included the remaining cases who had the straight leg raising test after deflation. Mean arterial pressure, heart rate, and need for vasoactive substances were recorded.Results: No significant difference was noticed between the two groups regarding demographic variables, heart rate before tourniquet deflation, and one-minute after its deflation. However, there was a significant difference between the same groups on the subsequent readings apart from the last one. Also, group [1] showed significantly higher mean arterial pressure [MAP] compared to group [2] after deflation. Hypotension was more significantly encountered in group [2], and thus ephedrine requirements were increased. Conclusion:Trendelenburg position appears to be more efficacious when compared to the straight leg raising, regarding the prevention of cardiovascular adverse effects associated with deflation.