ABSTRACT
Background and Aims: the aim of the study was to evaluate inguinal canal block together with intra-incisional injection of tramadol against bupivacaine 0.25% in cases undergoing inguinal hernioplasty under general anesthesia [GA]
Methodology: In this randomized controlled trial, 120 male patients were chosen for this study with ASA I or II criteria, between 18 and 60 years of age. They were divided into three groups: either control [Group A], 0.25% bupivacaine [Group B], or tramadol [Group C]. After induction of GA, the inguinal canal block and intraincisional infiltration were performed under ultrasound guidance, maintaining the heart rate [HR] and mean arterial blood pressure [MABP] within 20% of their values before induction by the use of Fentanyl bolus intraoperatively. The pain assessment was done postoperatively by visual analogue score [VAS], the time for the first analgesic requirement and the total amount of meperidine consumption was measured. The data analysis was carried out with unpaired Student's t-test and Chi-square test using software SPSS 22.0 version
Results: The fentanyl requirements intra-operatively, the postoperative VAS and total dose of postoperatively meperidine consumption were statistically higher in control group compared to both other groups. But the total amount of meperidine consumption postoperatively was statistically lower in tramadol group compared with other groups
Conclusion: An improved intra-operative and postoperative pain was provided by locally infiltrated tramadol, together with reducing the need of post-operative pain control agents with consequent beneficial reduction of narcotic side effects
ABSTRACT
HCC is the commonest liver malignancy all over the world including in Egypt. Many classification system for management of HCC have been proposed but none of them is implemented worldwide. In this work we propose a guideline for management of HCC which is suitable for the Egyptian patient. The suggested guideline of management includes assessment of four areas: The general clinical status of the patient, the liver status, the tumor status and options of therapy which are suitable for Egyptian circumstances. In one center, this design was prospectively applied on 79 patients who presented with HCC. The HCC patients showed that: Two [2.86%] had non-cirrhotic liver parenchyma, while all the rest had cirrhosis: 7 [10.0%] early stage or Child's A [one early and 6 late Child's A], 28 [40.0%] intermediate stage [Child's B] and 33 [47.14%] terminal end stage [Child's C]. Therapy was applied according to the suggested guideline as follows: surgical resection for four patients [5.71%], radio frequency ablation [RFA] for 6 [8.57%], percutaneous ethanol injection [PEI] for 39 [55.71%], selective arterial chemoembolization for 2 [2.86%], chemotherapy for 6 [5.57%] and symptomatic therapy for 13 [18.75%] patients. After two years of follow up: Fourty four [62.9%] were still living, 20 [28.6%] died while 6 [8.6%] were missed to follow up. Recurrence of HCC was found in 21 [30.0%] cases. The liver status progressed from Child's A to B in four cases out of 7 [57.1%] and from Child's B to C in 24 cases out of 28 [85.71%] within one year. The prognosis of the disease depended on many factors on top of which was the liver functional reserve. Most Egyptian patients with HCC present in a late stage of cirrhosis thus with a bad prognosis as predicted from their clinical status, the liver condition and the tumor status. The progress of the underlying liver disease is more rapid when HCC appears. PEI is a good option of therapy. The predictive factors of good prognosis and improvement in this study were HBV infection and the Child's class. Although the mortality rate was still high [28.5%], but the cost of therapy was reduced due to application of the suggested guideline system. This guideline is simple, easy to apply, covers most HCC presentations, is flexible and may be changed [updated] according to progress in technology, resources of therapeutics, skills of the operators and the patient's presentation. Thus other Egyptian centers can apply this guideline in management of HCC, reevaluating and updating it