Fast tracking possibility after outpatient anorectal surgery using "pregabalin" within multimodal analgesic regimen and monitored anaesthesia care technique

Pregabalin is a gabapentinoid compound, which has been alleged to possess anxiolytic, analgesic and anticonvulsant properties. Therefore, we designed a study to evaluate if the routine use of oral Pregabalin 150 mg within multimodal analgesic regimen [Dexamethasone-ketorolac-surgical field infiltration with local anesthetic mixture] would facilitate the early recovery process after anorectal surgery. Sixty adult outpatients undergoing anorectal surgery with standardized monitored anesthesia care technique were studied with one half of them receiving oral Pregabalin 150 mg. The other half of the Sixty patients is control group. All patients were received dexamethasone 4 mg IV and ketoraic 30 mg IV before induction. All patients were premedicated with midazolam 2 mg IV. A propofol infusion, 50 micro g kg[-1]. Min[-1] IV, was initiated and subsequently titrated to maintain an observer's assessment of alertness/sedation score 2 or 3 [with 5 awake/alert to 1=a sleep]. Fentanyl 25 micro g IV was administered 3-5 mm before infiltrating the surgical field with 30 ml local anesthetic mixture containing 15 ml of lidocaine 1% and 15 ml of bupivacaine 0.25% [with epinephrine 1:200.000]. All patients were fast-tracked directly from the operating room to the step-down recovery area. Even thought the incidences of postoperative pain and postoperative nausea and vomiting were small in both treatment groups, the time to "home readiness" was significantly shorter in the Pregabalin group. Pregabalin 150 mg PO within multimodal analgesic regimen. Shortened the time to home readiness after outpatient anorectal surgery

value of intraperitoneal meperidine for analgesia postlaparoscopic ovarian and tubal surgey

Patients undergoing laparoscopic procedures may experience postoperative pain. The intraperitoneal [IP] administration of drugs is controversial but has proven effective in some studies for the relief of postoperative pain.. However, some investigators have not been able to confirm the analgesic efficacy of IP local anesthetics. The administration of IP opioids for the relief of postoperative pain has received little attention. At the end of pelvic laparoscopic surgery, 40 patients received 80 mL of 0.125% bupivacaine with 1:400, 000 epinephrine IP and 80 mg of meperidine either IP or IM. Postoperative pain scores were measured at rest and with movement. Pain scores were significantly lower in the group receiving the IP meperidine both at rest [P<0.01] and with movement [P<0.05]. The combination of bupivacaine and meperidine delivered to the intraperitoneal cavity proved superior to equivalent doses of intraperitoneal bupivacaine and IM meperidine for postoperative pain relief in patients undergoing laparoscopic surgery. Intraperitoneal delivery of analgesia proved effective in this study and merits further study and more widespread use

Prophylactic intervention for renal protection of patients with extra-hepatic cholestasis submitted to endoscopic retrograde cholangio pancreatography [E.R.C.P]

The Jaundiced patient is critically dependent on kidneys for Survival. If Renal function declines due to prerenal reasons, bilirubinemia mounts to very high levels, complicating established acute renal failure[ARF].We performed this randomized study to compare the effectiveness of proper hydration [group c] and dopamine alone [group D] by pump infusion [2.5 micro g/kg/min] or combined either manitol [0.25 mg/kg] [group D+M] or furosemide [1-5 mg/kg] [group D+F] by drip infusion to provide renal protection in the patients with extra-hepatic cholestasis. This study was carried out on forty patients. Patients were randomly distributed into four groups. 10 patients each, submitted to [E.R.C.P] for relief of obstruction was included. Moderate to deep sedation with propofol and midazolam was performed in all patients with standard non-invasive monitors and central venous pressure [C.V.P] immediately before the procedure and continued for two days after. Renal assessment was done by hourly urine output [U.O.P], serial serum creatinine [S.Cr] every 12[hs] and 24[hs] creatinine clearance [Cr.CL] before the procedure. I day and 2[nd] post-procedure. there was no significant difference [S.D] in the 24hs [U.O.P] and [Cr.CL] on the 1[st] and 2[nd] days after [E.R.C.P] between the four groups except that the [Cr. CL] was significantly lower in [group D+F] than [group D] on the 2nd day P<0.01 .Also [S.Cr] significantly elevated in [group D+F] on the 1[st] and 2[nd] days of the procedure p<0.01. No single patient of the four groups developed A.R.F. Adequate volume expansion avoiding hypovolaernia and relief of biliaryobstruction is the only proven strategy to be of value in the prevention of acute renal failure [A.R.F] in patients of extrehepatic cholestasis

Postoperative nearly opioids free analgesia possibility] after panhystrectomy. a triad of perioperative "lidocaine". "ketamine" and "ketorolac" immediately postoperatively have impressive effects on pain, bowel function and hospital stay

Both iv Lidocaine and Ketamine were able to decrease postoperative pain, duration of ileus and analgesic requirements. Ketorolac is potent non steroidal antiinflammatory analgesic drug [NSAID].40 patients undergoing abdominal panhystrectomy were stuied, with one half of them receiving lidocain bolus [1.5 mg/kg in 10 mm] and infusion [1.5 mg/kg/h].And bolus Ketamine 0, 5 mg/kg followed by continuous infusion [42, micro g/ kg/h] .[UK. group].The other half of the 40 patient is control group [C .group]. Ketorolac 30 mg l.M were administered at the end of surgery to all patients.[UK. group]first experienced flatulence in a significantly shorter time [P<0.01] than control patient. UK patients hospital stay was also significantly shorter [P<0.05].[UK. group] also more comfortable postoperatively. UK patients has shorter hospital stay, less pain, faster return of bowel function

Comparison of prophylactic use of intrathecal meperidine and intravenous ketamine plus midazolam for preventing of shivering during spinal anesthesia

Shivering associated with spinal anesthesia is uncomfortable and may interfere with monitoring, we performed this randomized study to compare the efficacy of intrathecal [IT] 0.2 mg/kg meperidine [group M] with that of intravenous [I.V] low dose combination of ketamine 0.25 mg and midazolam 37.5 microg/kg [group KM] in the preventing of shivering caused by spinal anesthesia .This study was carried out on forty patients [ASA I - II]. patients were randomly distributed into two groups 20 patients each submitted to orthopedic surgery were included. Spinal anesthesia was performed in all with bupivacaine and fentanly. During Surgery a Shivering Score was recorded at 5 min intervals. Tympanic and axillary temperature was recoded at 10 min intervals during the perioperative period. After 15 min the incidences of shivering in groups [M] and [K.M] were 25%, 10% respectively. The differences between group KM and group M were statistically significant p=0.026 No patient with shivering Score of >/= 3 was reported in this study. Prophylactic use of ketamine 0.25 mg/kg + midazolam 37.5 microg/kg I.V. was more effective than meperidine 0.2 mg/kg IT in preventing shivering developed during spinal anesthesia

Fast tracking possibilities after selective spinal anesthesia [SSA] and total intra venous anesthesia [TIVA] for out patient knee arthroscopy

In this randomized trial, 60 adult ambulatory knee arthroscopy patients received either selective spinal anesthesia [SSA] with 4 mg of hyperbaric bupivacaine or TIVA with fantanyl and propofol. We conducted the study to determine whether SSA with small-dose bupivacaine provides equal fast-tracking possibilities, a shorter stay in the postanesthesia care unit, and earlier discharge home compared with TIVA [fantanyl and propofol]. Patients with a high risk for postoperative nausea and vomiting received prophylaxis in the TIVA group. No difference was seen in the fast-tracking possibilities or time in the postanesthesia care unit between the groups. Home readiness was achieved after 114 [31-174] and 129 [28-245] min [NS] in the SSA and TIVA groups, respectively. In the hospital, the pain scores were significantly [P < 0.001] lower in the SSA group compared with the TIVA group and the need for postoperative opioids was significantly [P = 0.008] larger after TIVA. The incidence of postoperative nausea and vomiting was 0% versus 19% in the SSA and TIVA groups [P = 0.024], respectively. We conclude that for outpatients undergoing knee arthroscopy, SSA with hyperbaric bupivacaine provides equal recovery times with less frequent side effects compared with TIVA groups