Evaluation of the dose - response potency of intrathecally administered clonidine by itself during first stage of labor with respect to analgesia and maternal and fetal side effects

Intrathecal clonidine produces dose-dependent postoperative analgesia and enhances labor analgesia from intrathecal sufentanil. We evaluated the dose-response potency of intrathecally administered clonidine by itself during first stage of labor with respect to analgesia and maternal and fetal side effects. Forty-five parturients requesting labor analgesia were studied. In a combined spinal-epidural technique, patients with <5 cm cervical dilatation were assigned to receive one of the following intrathecal solutions: either 75 micro g clonidine [n = 15]; 150 micro g clonidine [n = 15]; and 250 micro g clonidine [n = 15]. Visual analog scores for pain, blood pressure, heart rate, ephedrine requirements, sensory levels, incidence of nausea, pruritus and sedation, fetal heart rate tracings continuously, and maternal and cord blood concentrations of clonidine were recorded. Duration of analgesia was defined as time from intrathecal clonidine administration until request for additional analgesia. We found that clonidine produced a reduction in VAPS with all three doses. The duration of analgesia was significantly longer in patients receiving 250 micro g [median, 150; range, 85-220 min] and 150 micro g [median, 120; range; 65-190 min] than 75 micro g [median 50; range, 30 - 160 min], and VAPS was lower in the 250 micro g than in the 75 micro g group. As regards the sensory levels, no patient in any group had sensory changes above T[3]. In the 250 micro g group, hypotension required significantly more often treatment with ephedrine than in the other groups. Also, bradycardia and sedation were more in 250 micro g group than the other two groups. No adverse events or fetal heart rate abnormalities occurred. Clonidine levels were undetectable in maternal and cord serums. In conclusion, the current study showed that 75 micro g to 250 micro g intrathecal clonidine produces dose-dependent analgesia during first stage of labor. Although duration and quality of analgesia were more pronounced with 150 and 250 micro g than with 75 micro g, the high incidence of hypotension, bradycardia and sedation requires caution with the use of 250 micro g for labor analgesia

Safety and efficacy of intracameral injections of preservative - free lidocaine as an adjuvent to topical anesthesia to reduce intraocular sensation versus peribulbar anesthesia

This study was done to evaluate the efficacy and safety of intracameral lidocaine in cataract surgery compared to peribulbar anesthesia. This study was carried out on rabbits [n = 20] and patients [n = 160]. Our primary concern was the potential for corneal toxicity from the intracameral lidocaine. The preliminary study with rabbits showed no significant difference in corneal endothelial toxicity between the 20 rabbit eyes injected with 1% preservative-free lidocaine and the 20 eyes injected with BSS [p = 0.42]. As regards the human studies, a total of 160 cataract patients [160 eyes] participated. Eyes were classified to two groups: one group [n = 80] received 0.2 ml intracameral 1% unpreserved lidocaine combined with topical anesthesia [bupivacaine]; the other group [n = 80] received a peribulbar block with a sharp 26-gauge needle using a solution of lidocaine 2% [3 ml], bupivacaine 0.5% [2 ml], and hyaluronidase [wydase] 150 U before phacoemulsification with sclerocorneal tunnel incision .Duration of surgery was measured; implicit time and amplitudes of the b-waves of the photopic electroretinogram [ERG] potentials [single-flash ERG and the 30-Hz flicker ERG] were recorded; frequencies of intraoperative problems, complications, intraoperative, and postoperative pain were evaluated. Surgeon assessments of operative conditions and patient cooperation were recorded. The attending anesthesiologist recorded any increase in pulse or increase in blood pressure. After lidocaine anesthesia combined with topical anesthesia, similar complications were found, longer operation time [p < 0.001], and significantly better visual acuity immediately after surgery [p < 0.001]. The ERG amplitudes were not significantly reduced after 0.2 ml intracameral lidocaine half an hour after surgery [p > 0.05]. The surgeon assessment showed more patient cooperation in the peribulbar group [p = 0.012]. No patient in either group was rated as poorly cooperative. Intracameral lidocaine 1% combined with topical anesthesia can be recommended as an alternative procedure to peribulbar anesthesia in cataract surgery especially in the following situations: in patients with high myopia, fear of syringes, or prolonged coagulation

Hepatorenal integrity following a long anesthetic exposure: a comparative study between low - flow and high - flow sevoflurane anesthesia

This study assessed the effects of low-flow sevoflurane anesthesia on renal function using BUN, serum creatinine, creatinine clearance and urinary excretion of kidney-specific enzymes, and it compared these values with those obtained in high-flow sevoflurane anesthesia. We also studied the effects of low-flow sevoflurane anesthesia and high flow on the hepatic functions. Forty male patients undergoing oculoplasty or rhinoplasty were studied. Patients were randomized to receive sevoflurane anesthesia with fresh gas flow of 1 L/min [low-flow sevoflurane group; n= 20] or 6-8 L/min [high-flow sevoflurane group; n= 20]. In both groups the carrier gas was oxygen/nitrous oxide. Soda lime was used is the low-flow sevoflurane anesthesia group, The compound A concentration was measured by gas chromatography. Blood samples were obtained before and on days 1, 2 and 3 after anesthesia to measure hepatic functions, serum electrolytes, BUN and serum creatinine. Twenty-four-hour urine samples were collected before anesthesia and for each 24-h period from 0 to 72 h after anesthesia to measure creatinine, NAG and AAP. The maximum compound A concentration was 24,7 +/- 10.1 ppm [mean +/- 80], and the average duration of exposure to this concentration was 4.55 +/- 1.88 h in the low-flow sevoflurane group, Post-anesthesia BUN and serum creatinine concentrations decreased, creatinine clearance increased, and urinary NAG and AAP excretion increased in both groups compared with preanesthesia values, but there were no significant differences between the two groups for any renal function parameter at any time after anesthesia. Total and direct bilirubin increased in the first day postanesthesia in both groups of sevoflurane anesthesia and no significant changes among the two groups, AST increased in the 2nd and 3rd postanesthesia days than the peranesthesia value but there were no significant changes among both groups of sevoflurane anesthesia. LDH increased in the three postanesthesia days than the preanesthesia values but no significant differences among both groups of sevoflurane anesthesia. We concluded that, the only difference between the low-flow and high flow sevoflurane groups was compound A formation, and postanesthesia laboratory data showed no significant effects of compound A formation during sevoflurane anesthesia on renal and hepatic functions

Three modalities for control of cancer pain: efficacy and safety

We have studied 60 patients suffering from intractable upper abdominal cancer pain. They were classified into 3 equal groups. Group I [oral morphine]: patients were given oral sustained-release morphine tablets [MST] every 12 hours with short-acting morphine tablets as required for breakthrough pain. The dose was adjusted every week to achieve pain relief without maximal recommended dose. Group II [neurolytic celiac plexus block]: patients were scheduled for neurolytic celiac plexus block, under X-ray screening, using alcohol 100%. Oral MST was given as a supplement if there was any residual pain after the block. Group III [epidural morphine]: patients were scheduled for epidural morphine injection via an epidural catheter, 0.03 - 0.05 mg/kg every 4-6 hours as required. No oral MST supplementation was given. The success of each treatment was evaluated by comparing pre-treatment [baseline] and post-treatment [for 12 weeks] scores: pain intensity using visual analogue scale and functional status using Karnofsky performance scale. Opioid consumption per day and side effects of each treatment were recorded. Our results showed that all modalities produced adequate pain relief. There was gradual and significant [p<0.05] increase in the oral morphine dose from the first to last week [from 48 to 227 mg/day] with gradual deterioration in the patient's functional status. Drug-related side effects were nausea, vomiting and constipation. Neurolytic celiac plexus block was associated with a reduction in analgesic drug administration, drug related side effects and insignificant improvement of the functional status of the patients during the first 2 weeks. Complications related to the block were transient diarrhea and hypotension without any neurological complications. With epidural morphine, all patients had adequate pain relief from 11 mg morphine/day, but the daily epidural morphine requirement showed a three fold increase at the 12[th] week [p<0.05]. The functional status of the patients was significantly [p<0.05] high during the first 2 weeks. Pruritus was the main subjective complaint, in addition to the technical complications, such as dislodgment or occlusion of the epidural catheter, or infection. Respiratory depression was not detected in any of our patients. We conclude that no single modality is capable of providing complete relief of intractable upper abdominal cancer pain. Combination therapy should be the rule rather than the exception as each one offers its own advantages and disadvantages

Intraperitoneal lidocaine for pain ralief during and after tubal sterilization

We conducted a randomized, blinded, placebo-controlled study to evaluate the effectiveness of intraperitoneal lidocaine, IM meperidine, or both drugs together for pain relief [intraoperative and postoperative] in postpartum tubal ligation. Sixty postpartum patients scheduled to have tubal ligation were randomly divided into four groups to receive IM isotonic sodium chloride solution [2 mL] and intraperitoneal instillation of 40 mL of isotonic sodium chloride solution [Group I]; IM meperidine [100 mg in 2 mL] and intraperitoneal instillation of 40 mL of isotonic sodium chloride solution [Group II]; IM injection of isotonic sodium chloride solution and intraperitoneal instillation of 1% lidocaine in 40 mL [Group III] and both imeperidine and intraperitoneal lidocaine instillation [Group IV]. The rninilaparotomy was performed after local infiltration with 20 ml of lidocaine. A numerical rating score was used to rate pain on a 0 - 10 scale during and after the surgical procedures. During the surgical procedures, the mean pain scores were 1.8 in group III and 0.7 in group IV. These pain scores were significantly lower than those in groups I and II, which were 6.4 and 6.0, respectively [p < 0.001]. Postoperative mean pain scores at 24 h rest were 2.1 in group III and 0.8 in group IV. These pain scores were significantly lower than those in groups I and II, which were 6.5 and 6.4, respectively [p < 0.001]. Postoperative mean pain scores at 24 h movement were 2.9 in group III and 1.6 in group IV. These pain scores were significantly lower than those in groups I and II, which were 7.5 and 7.3 respectively [p < 0.001]. The plasma lidocaine concentrations reached a maximum in groups III and IV 30 min after instillation begun. The highest mean plasma lidocaine level was 2.6 ug/ml [range 1.2 - 3.6]. In conclusions pain relief was inadequate in patients undergoing post-partum tubal ligation under local anesthesia, even after the administration of IM meperidine. Intraperitoneal lidocaine, however, effectively, decreased intraoperative and postoperative pain in these patients

Intraconal [Retrobulbar] anesthesia: evaluation of two different techniques

Two types of needles either straight or curved were used for retrobulbar block during eye surgery the study included 1000 patients classified into 2 groups [group I: 480 patients] we used straight needle for retrobulbar block, [group II: 520 patients] we used curved needle for their retrobulbar block. No major complications occurred in both groups. Side effects in group I [straight needle] were chemosis 30.21%, subconjuntival hemorrhage 4.17%, lid hemorrhage 2.08%, Side effects in group II [curved needle] were chemosis 48.08%, subconjuntival hemorrhage 5.77% and lid hemorrhage 3.85%. We concluded that retrobullbar route using straight or curved needle was a safe and a successful technique