ABSTRACT
Background: regional anesthesia is currently more preferable than general anesthesia in ophthalmic surgery and include many types as; peribulbar [extraconal] and retrobulbar [intraconal] anesthesia. Peribulbar block is commonly used because there is reduced risk of globe perforation and optic nerve damage in different to retrobulbar block, but it needs sometimes block supplementations to improve the quality of the block such as clonidine and hyaluronidase. Also, fentanyl and dexmedetomidine was added in this study as an adjuvant to local anesthetics in peribulbar block for cataract surgery
Objective: the aim of this study was to evaluate and compare the effect of adding fentanyl and dexmedetomidine as adjuvants to local anaesthetic mixture in peribulbar block as regards duration [anesthesia and akinesia], efficacy and pain relief
Patients and Methods: in this study sixty patients of ASA I-III of both gender, aged 30-60 years arranged into three equal groups [group S, group F and group D] received peribulbar block for phacoemulsification with intraocular lens implantation operation. Group F and group D received fentanyl and dexmedetomidine respectivly with local anaethetics [LA] solution and showed statistically significant difference in onset and duration of globe akinesia respectively compared to group C which received local anaethetics [LA] solution only
Results: the onset of globe analgesia was significant in group F and group D compared to Group S. Postoperative pain was assessed by using a 5-points verbal rating score and recorded data showed significant difference between the three groups with better postoperative pain control in group F and group D. There was no statistical significant difference between the two groups as regarding the hemodynamics [MBP, HR and SPO2] and the incidence of complications
Conclusion: the current study concluded that adding fentanyl or Dexmedetomidine to local anaethetics [LA] in peribulbar block significantly reduced the time of onset of globe akinesia and analgesia and reduced the need for second injection. Also, it increased the duration of globe akinesia and analgesia with better postoperative pain control
ABSTRACT
Background: regional anaesthesia techniques are now established in the practice of pediatric anaesthesia. It is one of the most common techniques used for post-operative pain management in pediatric patients especially for urogenital, rectal, inguinal and lower extremity surgeries
Objective: to compare caudal and spinal anaesthesia in paediatrics regarding haemodynamics, efficacy [sensory block characteristics, motor block characteristics] post-operative analgesia, surgeon's satisfaction, parents' satisfaction and complications incidence
Material and Methods: the present study was carried on100 patients, with age ranging from [6-12] and of ASA[american society of anaesthesia.] I, II classes undergoing infraubmliclal pediatric surgeries, patients in each group were randomly assigned to receive spinal or caudal epidural anaesthesia
Results: the demographic data of patients as regard age, sex and ASA classification showed no statistical significant difference between the two groups, where the study was designed to compare between the effectiveness of spinal anaesthesia with bupivacaine 0.3mg/kg and caudal anaesthesia with bupivacaine 2mg/kg[1ml/kg vol.] as a sole anaesthetic technique adequate for infraumblical pediatric surgeries below T10 as regard the sensory and motor block characteristics, perioperative haemodynamic effects, pain assessment, analgesic requirements, and both the surgeon ad parents satisfaction was assessed.the results showed the superiority of subarachnoid on achieving rapid onset of sensory blockade, intense motor blockade, on the other hand the caudal epidural had the advantage of longer post-operative analgesic effect and lower post-operative analgesic consumption, furthermore both techniques gained good degree of parent and surgeon satisfaction
Conclusion: if both techniques are correctly used and the anatomy of the patient is normal there is minimal risk of complications
ABSTRACT
The study comprised 30 children and 30 geriatric patients assigned to undergo short-duration lower abdominal surgery under general anesthesia, each group was divided into two equal subgroups according to opioid used: fentanyl [FP and FG] or remifentanil [RP and RG]. Light anesthesia responses were recorded at time of induction, 1 min and 5 min after intubation, skin incision, and at wound closure, and 5-min after transfer to post- anesthetic care unit [PACU]. Anesthetic recovery was assessed and the time the patients met PACU discharge criteria was recorded. Postoperative analgesia was assessed during the first 3 postoperative hours using observational pain-discomfort scale [OPS] in children and four-point verbal analogue scale [VrAS] for geriatric patients. Adverse events and the occurrence of postoperative nausea and vomiting [PONV] were recorded. Hemodynamic variables showed a non-significant difference [p>0.05] between studied groups despite the non-significant [p>0.05] hypotension occurred in fentanil group. All patients received remifentanil showed superior emergence off anesthesia compared to those received fentanyl in the form of significuntly [p<0.05] shorter time to respire spontaneously, eye opening, extubation and verbalization and to qualify for PACU discharge compared to those received fentanyl. Number of children approached the criteria for PACU discharge at /= 60 min was 33.3% and 66.7% in remifentanil and fentanyl groups, respectively, with a significant difference in favor of remifentanil. Fentanyl provided significantly [p<0.05] better postoperative analgesia than remifentanil. PONV had occurred in 5 and 4 patients in fentanyl and remifentanil groups, respectively. Despite the apparent increased incidence of adverse events in fentanyl group, the difference was non-significant [p>0.05]. We can conclude that remifentanil is appropriate for opioid-based anesthesia for patients in extremes of age for its hemodymic stability and rapid recovery characteristics, however, attention must be paid for prophylactic antiemesis and proper postoperative analgesia
ABSTRACT
We have evaluted the antiemetic effect of P6 acupressure compared with standard doses of commonly used prophylactic antiemetic [ondasetron 4mg i.v.] in the prevention of nausea and vomiting after laparoscopic cholecystectomy. We studied Sixty patients requireing general anaethesia for laparoscopic cholecystectomy in a randomized, placebo-controlled study. The anaesthetic technique and postoperative analgesia were standardized. Failure of treatment was defined as the occurrence of nausea and /or vomiting within the first 24h after anaesthesia. Data analysis showed that both P[6]acupressure and ondansetron [4mg i.v.] significantly reduced the incidence of nausea and vomiting from 48% to 16% and 19% respectively compared to placebo. Other variables were similar between groups. We conclude that P[6]acupressure is effective, safe procedure and considerably economic in preventing nausea and vomiting after laparoscopic cholecystectomy