Background:Intravenous lidocaine infusion is known to reduce postoperative pain for days or weeks beyond the infusion time, and plasma half-life in several types of surgical procedures.Objectives:To evaluate the effect of intravenous (IV) lidocaine infusion on long term postoperative pain intensity for 3 months in patients undergoing spinal fusion surgery.Study Design:Prospective randomized, double-blinded study.Setting:Assiut University Hospital, Assiut, Egypt.Methods:Forty patients undergoing spinal fusion surgery were randomized into 2 equal groups (n = 20 in each). Patients in the lidocaine group received IV lidocaine at a dosage of 2.0 mg/kg slowly before induction of anesthesia, followed by lidocaine IV infusion at a rate of 3.0 mg/kg/h until the end of surgery. Patients in the control group received an equal volume of normal saline. The following data were assessed: pain by Visual Analog Score (VAS) at 1 hour, 6 hours, 12 hours, 24 hours, 48 hours, at discharge time, and at 1 month, 2 months, and 3 months post-operation, time to first request for additional analgesia, and total morphine consumption in 24 hours.Results:Lidocaine significantly reduced the postoperative pain score (VAS) for up to 3 months (P < .05), and significantly reduced morphine consumption (4.5 mg vs. 19.85 mg) in the 1st 24 hours postoperative. Lidocaine also significantly, prolonged (P < .05) the time to first request for additional analgesia (9.56 ± 2.06 hours vs 1.82 ± 0.91 hours).Conclusion:Intra-operative lidocaine, when given intravenously as a bolus followed by an infusion, significantly decreased long term postoperative back pain intensity in patients undergoing spinal fusion surgery.

Adding dexamethasone to bupivacaine in adductor canal block significantly increases the duration of sensory block, time to first analgesic requirement and patients' satisfaction score in anterior cruciate ligament arthroscopic surgery.

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Introduction:Possible approaches for postoperative analgesia after pediatric inguinoscrotal surgery are caudal block by bupivacaine/ketamine (BK) and bupivacaine/magnesium sulfate (BM).Aim:The purpose of the following study is to compare the analgesic efficacy and safety of ketamine and magnesium sulfate in combination with bupivacaine for caudal blockade in pediatric patients after inguinoscrotal operations.Materials and Methods:Patients randomly received one of the two solutions for caudal epidural injection after induction of general anesthesia. Group-BK: Were given a mixture of 0.25% bupivacaine and 0.5 mg/kg of ketamine. Group-BM: Were given a mixture of 0.25% bupivacaine and 50 mg magnesium sulfate. Postoperatively, a blinded post-anesthesia care unit nurse assessed the quality of analgesia with a visual pain analog scale (VPAS). Significant pain is defined as one that has a VAPS of ≥3.Results:Forty American Society of Anesthesiologists I-II children (20 in each group) completed the study. The two groups were comparable regards age, sex, body mass index, anesthesia and surgery durations, recovery time and sevoflurane concentration. The mean duration of caudal analgesia ± standard deviation was 462 ± 17.2 min versus 398.05 ± 12.9 min for BK and BM groups, receptively (P < 0.001). Supplemental rectal paracetamol within 12 h postoperatively were 15% for BK group versus 25% for BM (P = 0.05). Four patients in BK group only experienced postoperative nausea and vomiting (P = 0.053).Conclusion:Caudal administration of BK is efficient and safe for pediatric inguinoscrotal operations with longer postoperative analgesia than BM sulfate.

Background: Intrathecal morphine can be considered as a gold standard for analgesia following cesarean section (CS), which is not devoid of complications namely postoperative nausea and vomiting. We evaluated the antiemetic effect of intravenous dexamethasone combined with intrathecal atropine after CS. Methods: 120 parturient undergoing elective CS under spinal anesthesia were randomized into three groups. Dexamethasone group (D): Received intrathecal hyperbaric bupivacaine (0.5% in 2 ml) mixed with morphine (200 µg in 0.5 ml) and normal saline (0.5 ml as placebo) and intravenous (iv) dexamethasone (8 mg in 2 ml). Atropine group (A): Received hyperbaric bupivacaine (0.5% in 2 ml) mixed with morphine (200 µg in 0.5 ml) and atropine (100 µg in 0.5 ml), in addition to iv normal saline (2 ml as placebo). Dexamethasone and Atropine group (DA): Received intrathecally as group A, and iv dexamethasone (8 mg in 2 ml). Follow-up of both nausea and vomiting was done during the first 24 hours postoperatively. Results: Nausea was noticed in 7 patients (17.5%) in group D, 8 patients (20%) in group A, and one patient (2.5%) group DA, with significant differences between DA and D (p = 0.025) and DA and A (p = 0.013). Regarding vomiting, there were 5 patients (12.5%) in group D, 4 patients (10%) in group A only, with significant differences between DA and D (p = 0.021) and DA and A (p = 0.041). Conclusions: Combination of intravenous dexamethasone and intrathecal atropine has additive antiemetic effect after spinal anesthesia for cesarean delivery using bupivacaine and morphine.

Background: The effect of adding alpha lipoic acid (ALA) to pulsed radiofrequency (PRF) for treatment of lumbar-sacral pain was evaluated. Objective: to evaluate the effect of using ALA as an adjuvant therapy with PRF for treatment of chronic lumbosacral radicular pain caused by herniated disc. Methods: One hundred twenty patients with lumbo-sacral radicular pain allocated into 2 groups. Group I: treated with PRF at 42°C for 120 seconds. Group II: treated as in group I, plus oral ALA 600 mg (Thiotacid 600 mg, EVA PHARMA, Egypt) three times per day (1800 mg/day) for 3 weeks then 600 mg once daily for 2 weeks. The lumbo-sacral radicular pain evaluated using the numerical rating pain score and Oswestry Disability Index. Results: Success rate was significantly higher in group II at 3 and 6 months after intervention. The median values of the numerical rating pain score and the Oswestry Disability Index were significantly lower in group II with no significant difference in Epworth Sleepiness Scale. No major complications were reported in both groups. Conclusion: The current study supports the use of ALA with PRF on the dorsal root ganglion for treating lumbosacral radicular pain.

Background: General anesthesia can affect postoperative cytokine levels, leading to cellular immune inhibition following surgery. The primary objective of this study was to evaluate the effect of bilateral rectus sheath block on serum levels of TNF-α and IL-6 after radical prostatectomy. Methods: Fifty patients undergoing radical prostatectomy, under general anesthesia were randomly allocated into two groups. Group RSB: A bilateral single shot of 20 ml plain bupivacaine 0.25% or 20 ml normal saline (Group C) in each side of rectus sheath. Postoperative pain was controlled by morphine as a rescue analgesia. Primary outcome was postoperative serum levels of TNF-α and IL-6. Secondary outcome measures: The total morphine consumption and evaluation of the visual analog pain score at 24 and 48 h postoperative. Results: Both TNF-α and IL-6 were significantly lower in the RSB group at 24 h postoperative, the mean value of TNF-α was 76.26 ± 4.07 pg/ml in RSB group and 93.15 ± 6.90 pg/ml in the control group (p < 0.001), while IL-6 was 89.65 ± 13.00 and 102.6 ± 24.70 pg/ml in both groups respectively (p = 0.01). In RSB group, the visual analog pain score and the total morphine consumption were significantly lower (p < 0.05) during the first 24 h postoperative while, the first time requested for rescue analgesia was significantly longer (p < 0.001). Conclusion: General anesthesia combined with bilateral rectus sheath block could decrease serum level of TNF-α and IL-6 after radical prostatectomy as well as decrease postoperative pain intensity with less opioid administration.Clinical trials.gov ID: NCT03074097. Research hypothesisWe hypothesized that an effective postoperative analgesia by sonar guided bilateral rectus sheath block, may help to inhibit the release of postoperative TNF-α and IL-6.