Effect of dexmedetomidine added to spinal bupivacaine for urological procedures

To determine the effect of adding dexmedetomidine to bupivacaine for neuraxial anesthesia. Sixty-six patients were studied between April and May 2008 in the University of Jordan, Amman Jordan. They were randomly assigned into 3 groups, each receiving spinal bupivacaine 12.5mg combined with normal saline [group N] Dexmedetomidine 5ug [group D5], or dexmedetomidine 10ug [group D10]. The onset times to reach T10 sensory and Bromage 3 motor block, and the regression times to reach S1 sensory level and Bromage 0 motor scale, were recorded. The mean time of sensory block to reach the T10 dermatome was 4.7 +/- 2.0 minutes in D10 group, 6.3 +/- 2.7 minutes in D5, and 9.5 +/- 3.0 minutes in group N. The mean time to reach Bromage 3 scale was 10.4 +/- 3.4 minutes in group D10, 13.0 +/- 3.4 minutes in D5, and 18.0 +/- 3.3 minutes in group N. The regression time to reach S1 dermatome was 338.9 +/- 44.8 minutes in group D10, 277.1 +/- 23.2 minutes in D5, and 165.5 +/- 32.9 minutes in group N. The regression to Bromage 0 was 302.9 +/- 36.7 minutes in D10, 246.4 +/- 25.7 minutes in D5, and 140.1 +/- 32.3 minutes in group N. Onset and regression of sensory and motor block were highly significant [N vesus D5, N versus D10, and D5 versus D10, p<0.001]. Dexmedetomidine has a dose dependant effect on the onset and regression of sensory and motor block when used as an adjuvant to bupivacaine in spinal anesthesia

Bladder endometriosis, 5-year follow up period

Endometriosis is a common gynecological disease. Although endometriosis is a pelvic disease, extrapelvic involvement has been reported in few cases. We report a 32-year old lady, who had bladder endometriosis, underwent total abdominal hysterectomy, bilateral salpingo-oophorectomy and partial cystectomy. After a 5-year follow up period, the patient is doing well and she has no gynecological or urinary complaint

Does prolonged semi-erection in prepubertal high flow priapism result in increased penile size?

High flow priapism is a rare pathology resulting mainly from trauma to the perineum leading to arterial-lacunar fistula. Management includes arterial embolization using absorbable material, as well as conservative approach. In this case, the effect of prolonged semi-erection in prepubertal high flow priapism on increased penile size is discussed

Pain relief using continuous bupivacaine infusion in the paravertebral space after loin incision

Continuous bupivacaine paravertebral nerve block after thoracotomy has been shown to reduce postoperative pain. This study was designed to determine whether paravertebral nerve block using bupivacaine infused through a catheter placed intraoperatively, can reduce postoperative pain, and analgesia requirements after loin incision. Thirty-four patients undergoing renal surgery through loin incision at Jordan University Hospital, Amman, Jordan, from October 2001 to March 2003, were randomized either to receive bupivacaine 0.5% or normal saline through a catheter positioned intraoperatively against the costovertebral joints in the paravertebral space. The infusions were continued until the evening of the third postoperative day. Patients had access on request to intramuscular Morphine sulphate 5-15 mg, or Diclofenac sodium 50-100 mg, or both depending on body weight. Pain after operation was assessed at rest using linear visual analogue scale. Patient scores were recorded in the recovery room, at 4 hours, 8 hours, and at 9 am, and 5 pm. The analgesia requirements for each patient were recorded. Pain scores in the recovery room were significantly lower in the bupivacaine group [mean 4.5 versus 8.0, p=0.001]. At 4 hours, the pain score was lower in the bupivacaine group though not significant [mean 3.5 versus 4.37, p=0.393]. Thereafter, the pain scores were significantly lower in the bupivacaine group. Mean morphine requirement in the bupivacaine group was 13.3 mg [ranges 0-50], while in the saline group 40.13 mg [range 10-112.5], p<0.001. Morphine requirements in the first and second postoperative days were significantly less in the bupivacaine group [p=0.015 and p=0.03]. Paravertebral blockade using bupivacaine is an effective and safe method for pain relief following renal surgery through loin incision