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).
Background: Patients with chronic liver disease and liver cirrhosis have many anesthetic considerations with general anesthesia and limitation of ability to receive regional anesthesia due to coagulopathy and low platelets count.Our study aims to compare the combination of the Ilioinguinal-iliohypogastric (ILIH) nerve block with the Transverse Abdominis Plane block (TAB) versus the Ilioinguinal-iliohypogastric (ILIH) nerve block alone as a sole anesthetic technique in hepatic patients with liver cirrhosis for surgical repair of inguinal hernia. Methods: Sixty patients known to have chronic liver disease and liver cirrhosis undergoing unilateral repair of inguinal hernia were randomly assigned to two equal groups: Group (T) received ipsilateral transverse abdominis plane block (TAB) ultrasound-guided (US) in combination with Ilioinguinal-iliohypogastric (ILIH) nerve block intraoperatively.Group (I) received US-guided ipsilateral Ilioinguinal-iliohypogastric nerve block only intraoperatively.The degree of pain was evaluated using the VAS score for pain hourly for the first 6 h and at 12, 18, and 24 h postoperatively. Need for LA infiltration into surgical field or the conversion to GA was assessed. Onset of sensory block, duration of analgesia, the use of rescue analgesia and its total dose in 24 hours, the patient's and surgeon's satisfaction and any adverse events were recorded. Liver functions were measured 24 h postoperatively. Results: The duration of analgesia was significantly longer in group (T) (14.27 ± 2.5 hours) than in group (I) (11.81 ± 2.9 hours; p = 0.039). The total required dose of acetaminophen in first 24 hours was higher in group (I) (1.1 ± 0.81 gm) than in group (T) (0.6 ± 0.94 gm; p = 0.021). There was no significant difference between groups in onset of sensory block, need for LA infiltration, need for GA, or incidence of postoperative side effects. Patients' satisfaction was statistically better in group T compared to group I whereas there was no statistical significant difference between both groups regarding surgeon's satisfaction.
Conclusion:Combined Transverse Abdominis plane block (TAB) with Ilioinguinaliliohypogastric (ILIH) nerve block has longer duration of analgesia and less dose of rescue analgesia with more patient satisfaction than the use of Ilioinguinal-iliohypogastric (ILIH) nerve block in surgical repair of inguinal hernia in chronic hepatic patients with liver cirrhosis.
Background: Gabapentin has great efficacy in the treatment of neuropathic pain as a nonopioid alternative. It has been reported to prevent nausea and vomiting postoperatively. Our study compared different dosing regimens to evaluate their effectiveness and frequency of side effects in patients scheduled for laparoscopic abdominal surgery. Methods: 150 adult patients scheduled for elective abdominal laparoscopic surgery were randomly assigned to three equal groups. Group G300 received 300 mg gabapentin orally 1 h before surgery. Group G600 received 600 mg gabapentin orally 1 h before surgery. Group G900 received 900 mg gabapentin orally 1 h before surgery. Incidence and severity of PONV, need for rescue antiemetics, need for rescue analgesia, and incidence of side effects were assessed. Results: Incidence and severity of PONV were statistically higher in G300 versus G600, and G900 (8/50, 4/50, 3/50, respectively) and the total number of patients who received antiemetics, the overall dose of given granisetron, VAS scores for pain, and the total required rescue analgesia were higher in G300 versus G600, and G900. The time needed for first rescue analgesia was statistically longer in G600 and G900 versus G300. G900 was associated with a higher incidence of somnolence/sedation and dry mouth than G300 and G600. Conclusion: Gabapentin 600 mg administered 1 hr before laparoscopic abdominal surgery is as effective as gabapentin 900 mg for PONV control and VAS reduction of 24-hour postoperative pain scores with fewer side effects. On the other hand, gabapentin 300 mg did not demonstrate good control of PONV, or pain control compared to higher doses.
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