Ketorolac versus magnesium sulphate as an adjuvant to lidocaine in intravenous regional anesthesia for upper limb surgeries

Background: intravenous regional anesthesia [IVRA] was first described almost a century ago by August Bier and has been used for the past 50 years. It is a safe anesthetic technique for upper or lower distal limb surgery

Purpose: to compare the onset time of sensory blockade when adding ketorolac versus adding magnesium to the IVRA solution, and to compare the duration of postoperative analgesia

Material and Methods: this is a randomized controlled trial in two groups. The study was performed in Ain Shams University Hospitals. Study period range was 1-2 years

Results: there are 146 patients participated in our study, patients were allocated to two groups 73 patients in each group, a group of which received magnesium sulphate solution and the other received ketorolac solution

Conclusion: we evaluated the effects of adding ketorolac and compared it to the effects of adding magnesium sulphate to the anesthetic solution used in IVRA and we found that magnesium sulphate addition can be of benefit in faster onset of sensory block in the operative limb. However, magnesium sulphate in the used concentration [10 ml MgSo4 10% in 40 ml solution] appeared to cause burning pain varying in intensity while injecting the anesthetic solution

Comparative study between the addition of pethidine vs fentanyl to hyperbaric bupivacaine for spinal anesthesia in caesarean section

Background: cesarean section is the most common obstetric surgery in the world. Spinal anesthesia is a preferred technique for cesarean delivery for its distinct advantages over general anesthesia as the simplicity of the technique, reliability, minimal fetal exposure to drugs, patients' awareness and minimization of the hazards of aspiration

Aim of the Work: to define first time require analgesia in postoperative among two groups

Patients and Methods: this prospective comparative study was carried on fifty patients, ASA physical status II, aged from 18 to 45 years. These patients were scheduled for elective caesarean delivery under spinal anesthesia and divided to two groups. This protocol was approved by Research Ethical Committee of Ain Shams University. Written informed and verbal consent was obtained from each patient before being included in this procedure

Results: the addition intrathecal 25mg pethidine make the total duration of analgesia 169.20 +/- 7.59 minute but adding 25Mug fentanyl intrathecal extended the period of effective analgesia up to 178.40 +/- 6.25 min with high significant P-value [0.000]. The rapid onset of sensory and motor blocks in [F] group than [P] group with P value=0.000, also increased duration of sensory and motor blocks in [F] group than [P] group with P value 0.000

Conclusion: intrathecal opioid is a good technique of labor analgesia, although pethidine was the most widely used opioid for obstetric analgesia, it has character of local anesthetics so adding pethidine intrathecal in dose 25mg enhanced effect of local anesthetics but associated with more complications as nausea, vomiting and hypotension