Comparison of Nitroglycerine- and prostaglandin E1 -induced controlled hypotension for functional endoscopic sinus surgery [FESS]

Induced hypotension is often used in surgery to reduce blood loss and to provide a relatively bloodless surgical field to facilitate surgery and to reduce operative time. The purpose of this study was to compare the intraoperative bleeding and quality of the surgical field for FESS, using controlled hypotension induced with either nitroglycerine or prostaglandin E1.Patients and methods: Thirty patients [ASA I - II] scheduled for FESS were enrolled in the study. Patients were randomly allocated into three groups where normotensive group [C] received saline infusion, nitroglycerine hypotensive group [NTG]: received NTG infusion at a rate of [0.5-5 micro g/kg/min] and, prostaglandin hypotensive group [PGEI]: received PGE1 infusion at a rate of [0.04-0.08 micro g/kg/min]. The same surgeon used a categorical scale score[0-S] to assess surgical field condition. Heart rate and invasive mean arterial blood pressure, peripheral oxygen saturation and end- tidal carbon dioxide were monitored intraoperatively. there was statistically significant decrease of blood loss in both PGE1 and NTG groups as compared to group C. Moreover there was statistically significant decrease of blood loss in PGE1 group as compared to NTG group. Intraoperative heart rate of NTG group displayed significant increased when compared to basal value of the same group, C group and PGE1 groups values. Both PGE1 and NTG groups showed significantly reduced MAP than C group except one value in NTG group where it significantly increased at 30 min, Induced hypotension with PGE1 infusion is interesting in providing consistent and sustained controlled hypotension with hemodynamic stability as well as it is effective in providing dry surgical field during FESS under general anaesthesia when compared with NTG

Effect of addition of fentanyl to intra-articular ketorolac for pain management in patients undergoing arthroscopic knee surgery

Arthroscopic Knee surgery is now one of the most commonly performed surgical procedures as its major advantage is the minimal surgical trauma to the knee joint. It is not associated with severe postoperative pain but providing the patients with adequate analgesia may affect the recovery profile. The goal of this study was to evaluate the effect of addition of fentanyl to ketorolac intra-articularly on the haemodynamic parameters, postoperative analgesia, possible postoperative complications and optimum discharge criteria in patients undergoing arthroscopic knee surgery. The study was conducted on 40 adult patients of either sex admitted at Mansoura university hospital knee unit for elective knee arthroscopy. Patients were randomly allocated into two equal groups [20 patients each] according to intra-articulary injected solution: Ketorolac group [K] [10 mg ketorolac] and Ketorolac Fentanyl group [KF] [5 mg ketorolac + 50microg fentanyl] diluted in 20 ml 0.9% saline. All patients received general anaesthesia and all received the intra-articular study solution at the end of knee arthroscopy. Ten minutes before release of the tourniquet. Every patient was monitored intraoperativeiy and postoperatively for 24 hours with ECG non invasive blood pressure, and pulse oximetry. Duration of postoperative analgesia, Verbal Rating Pain Score, postoperative analgesic consumption and postoperative complications [sedation, respiratory depression, pruritus, nausea and vomiting] were recoded postoperatively for 24 hours. The patient's characteristics were comparable in the two groups regarding age, body weight, height and sex with no significant differences between the two groups. The duration of postoperative analgesia was significantly longer in KF group when compared with K group. Also the lotal consumption and the number of postoperative supplemental diciofenac doses were significantly decreased in KF group when compared with K group. Verbal Rating Scale Pain Score were significantly increased in K group at 12 hours when compared with the basal value, and significantly decreased in KF group when compared with K group at 12 hours. Haemodynamic parameters [mean arterial blood pressure and heart rate], oxygen saturation, sedation score and modified Al-dret score showed no significant differences either within each group or in between the two groups. No patient complained from nausea/ vomiting, pruritus or respiratory depression. No patient had a respiratory rate less than 10/minute. All patients in the two groups were discharged from hospital after the first 24 hours following surgery. Based on the previous results of our study, we can conclude that the addition of fentanyl to ketorolac intra-articularly significantly produces more prolonged duration of postoperative analgesia without any undesirable side effects in patients undergoing arthroscopic knee surgery