Objective: The aim of this study is to determine the role of preoperative low dose intravenous MgSO 4 when given adjuvant to ultrasound guided transversus abdominis plane (TAP) block in augmenting postcesarean analgesic effects and reducing opioid requirements during the first 24 hours. Subjects and Methods: In this prospective, randomized double blind study, a total of sixty full term pregnant women were recruited for the study underwent caesarean section. Thirty patients were assigned to MgSO 4 group (A) and another thirty to placebo group (B). Participants in group (A) received 50 mg/kg MgSO 4 in 100 ml isotonic saline intravenous (IV) over 20 minutes prior to induction of general anesthesia by 30 minutes while participants in group (B) received 100 ml isotonic saline (placebo) by the same route and over the same duration as control. Results: Visual Analogue Scale (VAS) was analysed within 24 hours postoperatively. The mean pain score at 6 and 12 hours postoperatively was significantly lower in MgSO 4 group compared to control group (40.4 ± 5.12 vs 53.6 ± 4.92; 26.1 ± 3.01 vs 35.5 ± 3.98 respectively, p = 0.012, 0.005). Comparing both groups regarding the mean time interval of first rescue analgesia (morphine sulphate) requested by the patients, it was longer in MgSO 4 group compared to control group. The total dose of rescue analgesia consumed during 24 hours was analysed and it was significantly higher in control group compared to MgSO 4 group (10.1 ± 0.95 vs 6.2 ± 0.87, p = 0.001). Conclusion: We concluded that preoperative low doses (50 mg/Kg) of MgSO 4 with general anesthesia combined with ultrasound guided TAP block offer longer postoperative pain free periods thus reducing total opioid consumption. In addition to the safety of the drug to the mother and fetus so we recommend IV MgSO 4 as an adjuvant therapy with TAP block.

No abstract

Dexmedetomidine-ketamine versus propofol-ketamine for sedation during upper gastrointestinal endoscopy in hepatic patients (a comparative randomized study), Egyptian

Background Side effects related to intraoperative opioid administration are well known. Recently, it was found that opioids may inhibit cellular immunity through their effects on natural killer cell activity, stimulate angiogenesis and accentuate cancer cell growth. Hence, peri-operative use of opioids might affect long-term oncological outcomes in cancer surgical patients. Opioid-free anaesthesia (OFA) is a methodology that dodges narcotic use during anaesthesia by using blends of several drugs added to common anaesthetic agents. The study aims to test the impact of OFA in transthoracic oesophagectomy in comparison with opioid-based anaesthesia technique (OBA) on postoperative analgesia and recovery criteria (hemodynamics, respiratory rate and haemoglobin oxygen saturation). Results The postoperative VAS was significantly lower in OFA group (A) than OBA group (B) in the measured time points (immediate postextubation, 30 min, 2 and 4 h postoperative) with P values 0.001, 0.001, 0.0012 and 0.0065 respectively. The time passed till first rescue analgesia requested was significantly longer in OFA group (A) than OBA group (B) and the total dose of rescue analgesia given to the patients were significantly higher in group B than group A. The recorded postoperative respiratory rate was significantly faster in OBA group (B) than OFA group (A), and the haemoglobin oxygen saturation (SPO2) showed statistically significant lower values in the OBA group (B) than the OFA group (A). Conclusions We emphasise the perioperative safety and efficacy of the opioid-free anaesthesia techniques provided for transthoracic oesophagectomy with better postoperative analgesia and other post recovery criteria. Trial registration We carried out our trial at Ain-Shams University Hospitals, Cairo, Egypt, between June 2020 and November 2020. The study was approved by the Research Ethics Committee at the Faculty of Medicine, Ain Shams University and then registered in the Pan African Clinical Trials Registry (https://pactr.samrc.ac.za/) with the following ID (PACTR202010907549506).

Objective: The aim of this study was to compare the effectiveness of two different protocols, labetalol with magnesium sulfate versus hydralazine with magnesium sulfate intravenous infusion with respect to their impact on maternal and fetal hemodynamics in severe preeclampsia. Patients and methods: In this prospective comparative randomized study, a total of 50 pregnant women in severe preeclampsia with gestational age ≥ 32 weeks were randomly recruited into two groups. Group A: 25 patients received labetalol with magnesium sulfate, and group B: 25 patients received hydralazine with magnesium sulfate by intravenous infusion in an escalating manner according to response until the target blood pressure ≤ 145/95 mmHg was achieved. Blood pressure, maternal heart rate, fetal heart rate, and Doppler ultrasound indices of umbilical and middle cerebral arteries were studied before and after treatment. Results: A significant reduction of the maternal blood pressure was achieved in both groups, with significant reduction of maternal heart rate in group A. No significant changes in the umbilical and middle cerebral arteries pulsatility index, resistance index, and systolic/diastolic ratio before and after treatment were noted in both groups. Conclusion:We concluded that both labetalol and hydralazine intravenous infusion regimens are well tolerated and effective in controlling severe hypertension in pregnant women with severe preeclampsia in combination with magnesium sulfate. Both drugs are reassuring as they are not related to any significant changes in fetoplacental circulation. Fetal heart rate did not change significantly after treatment in both groups.