Background Shivering is known to be a frequent complication in patients undergoing surgery under neuraxial anesthesia with incidence of 40–70%. Although many pharmacological agents have been used to treat or prevent postspinal anesthesia shivering (PSAS), the ideal treatment wasn’t found. This study evaluated the efficacy of paracetamol and dexamethasone to prevent PSAS in patients undergoing lower abdominal and lower limb surgeries. Methods Three hundred patients scheduled for surgeries under spinal anesthesia (SA) were allocated into three equal groups to receive a single preoperative dose of oral paracetamol 1 g (P group), dexamethasone 8 mg intravenous infusion (IVI) in 100 ml normal saline (D group) or placebo (C group), 2 h preoperatively, in a randomized, double-blind trial. The primary endpoint was the incidence of clinically significant PSAS. Secondary endpoints included shivering score, the change in hemodynamics, adverse events (e.g., nausea, vomiting and pruritis) and patients` satisfaction. Results Clinically significant PSAS was recorded as (15%) in P group, (40%) in D group and (77%) in C group (P < 0.001). The mean blood pressure values obtained over a 5-25 min observation period were significantly higher in the D group (P < 0.001). Core temperature 90 min after SA was significantly lower in the 3 groups compared to prespinal values (P < 0.001). Nausea, vomiting and pruritis were significantly higher in the C group (P < 0.001). P and D groups were superior to C group regarding the patients’ satisfaction score (P < 0.001). Conclusion Paracetamol and dexamethasone were effective in prevention of PSAS in patients undergoing lower abdominal and lower limb surgeries compared to placebo controls. Trial registration ClinicalTrials.gov Identifier: NCT03679065 / Registered 20 September 2018 - Retrospectively registered, http://www.ClinicalTrial.gov.

Background General anaesthesia is a real challenge for the anaesthetist when anaesthetizing obstetric patients due its well-known complications of difficult intubation and thereby increasing morbidity and mortality of pregnant women. These risks can be easily avoided by regional anaesthesia. Spinal anaesthesia is frequently associated with hypotension which can have detrimental effects both on the mother and the neonate. Prophylactic phenylephrine administration had been widely practiced to prevent post-spinal hypotension during caesarean section. The goal of this study is to prove and determine that it is not always necessary to use a vasoconstrictor to avoid hypotension after spinal anesthesia for parturients undergoing caesarean section. Methods We enrolled 100 patients in this randomized controlled study who were having elective caesarean delivery. Spinal anaesthesia was performed under aseptic conditions. Immediately following spinal blockade, patients were randomly allocated to receive either a single bolus of phenylephrine 100μg in a volume of 10 ml, or equivalent volume of normal saline 0.9%. Incidence of post-spinal hypotension was used as the primary outcome. Maternal haemodynamic parameters, intraoperative nausea and vomiting, the need for phenylephrine or glycopyrrolate administration, neonatal Apgar score at 1, 5 minutes, and base excess (BE) value of the neonatal umbilical venous blood were all recorded and reflected the secondary outcome Results There was no significant difference regarding the incidence of post-spinal hypotension in phenylephrine and placebo group. There was no difference in neonatal Apgar score at 1, 5 minutes, and base excess in both groups. Conclusion The present study had demonstrated that it is not always necessary to provide a vasoconstrictor to avoid hypotension that results from spinal anaesthesia in caesarean sections.

Background:Levobupivacaine is an effective local anesthetic agent with less systemic toxicity than racemic bupivacaine, but it has short postoperative analgesic duration. Dexmedetomidine and fentanyl are promising adjuncts to provide excellent and prolonged postoperative caudal analgesia. This study compared the effects of caudal levobupivacaine plus dexmedetomidine and levobupivacaine plus fentanyl for postoperative analgesia and sedation in children undergoing lower limb orthopedic surgery.Patients and Methods:Ninety children, whose age ranged from 1 to 7 years, American Society of Anesthesiologists I-II, undergoing orthopedic lower limb surgery under general anesthesia received caudal block for postoperative analgesia. The children were randomly allocated into three groups: Group L (control) received 0.75 ml/kg levobupivacaine 0.25% diluted in saline; Group LD received 0.75 ml/kg levobupivacaine 0.25% with dexmedetomidine 1 μg/kg; and Group LF received 0.75 ml/kg levobupivacaine 0.25% with fentanyl 1 μg/kg. Following the administration of the drugs; hemodynamic variables, the total anesthesia time, sedation score, Face, Legs, Activity, Cry, Consolability score, duration of analgesia, and side effects were recorded.Results:Demographically, all the groups were comparable, both the baseline and the intraoperative hemodynamic profile were similar in all groups. The mean duration of analgesia and the mean sedation score in the Group LD were significantly greater as compared to both the other groups.Conclusion:Dexmedetomidine may be a better additive to levobupivacaine than fentanyl for caudal postoperative analgesia, arousable sedation with comparable hemodynamic and side effect profile in children.

Background: Spinal anesthesia is the preferred anesthetic technique for elective Cesarean deliveries. Hypotension is the most common side-effect and has both maternal and neonatal consequences. This study aims to determine the minimum effective volume of hyperbaric bupivacaine 0.5% with fentanyl in 90% of parturients (MEV90) with different height groups undergoing cesarean section. Patients and Methods: Parturients scheduled for elective cesarean section under spinal anesthesia were divided into 3 groups according to their height (ht), group 1 including those with height between 150 and 159 cm, group 2 with ht between 160 and 169 cm and group 3 patients with ht between 170 and 179 cm. The starting volumes were 2.5, 2.6 and 2.7 ml respectively. We identified 3 responses to the injected volume and the volume given to each parturient depends on the response of the previous one. Every patient was assessed for hemodynamics, degree of sensory and motor blocks. Results: Demographically, all the groups were comparable. The study was completed after recruiting 201 patients. The MEV90 for group 1 was approximately 2.62 ml (95% CI, 2.59-2.65 ml), 2.76 ml for group 2 (95% CI, 2.73-2.77 ml) and 2.80 for group 3 (95% CI, 2.76-2.81 ml). None of the babies had an Apgar score below 7 at 1 and 5 min after birth in the 3 groups. Conclusion: The volumes of hyperbaric 0.5% bupivacaine with fentanyl which produced effective spinal block in 90% of parturients undergoing cesarean deliveries were 2.62, 2.76 and 2.8 ml in the 3 different height groups respectively.

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