ABSTRACT
Paravertebral block [PVB] has been an established technique for providing analgesia to the chest and abdomen. We conducted the current study to compare single-dose PVB versus single-dose epidural blockade [EP] for pain relief after renal surgery. Eighty patients scheduled for renal surgery were randomly assigned into two groups according to the analgesic technique, PVB group or EP group. General anesthesia was induced for all patients. Postoperative pain was assessed over 24 h using 10-cm visual analog scale [VAS]. Postoperative total pethidine consumption was recorded. Any postoperative events, such as nausea, vomiting, shivering, or respiratory complications, were recorded. Hemodynamics and blood gasometry were also recorded. EP group showed significant decrease of both heart rate and mean blood pressure at most of the operative periods when compared with PVB group. There was no difference in total rescue analgesic consumption. Postoperative VAS showed no significant difference between the studied groups. Postoperative events were comparable in both the groups. Single injection PVB resulted in similar analgesia but greater hemodynamic stability than epidural analgesia in patients undergoing renal surgery, therefore this technique may be recommended for patients with coexisting circulatory disease
Subject(s)
Humans , Female , Male , Anesthesia , Kidney/surgery , Analgesia, Epidural , Pain, Postoperative/prevention & control , Prospective StudiesABSTRACT
Background: This prospective, randomized, double blind study was designed to evaluate the effect of adding nalbuphine [mixed agonist antagonist opioid] to lidocaine spray [10%] on the hemodynamics as well as the laryngeal mask airway insertion conditions in patients scheduled for elective minor gynecological procedures
Methods: Forty adult female patients, ASA physical status I-II subjected for elective minor gynecological procedures at Mansoura University Hospital were enrolled in this study. Patients were randomly assigned using sealed envelope method into two groups [n= 20 for each group]. One group received lidocaine spray 10% in the oral cavity and oropharynx before LMA insertion while the other group received lidocaine spray in addition to IV nalbuphine 0.2 mg/kg. Anesthesia was induced in all patients with propofol injection in a sleep inducing dose [1-2 mg.kg-1], titrated to loss of consciousness with oxygen mask. Anesthesia was maintained with 1% isoflurane, nitrous oxide [60%] and oxygen [40%]. The following data were recorded during LMA insertion, six variables were noted on a 3-points scale, jaw relaxation [good-incomplete-poor], ease of insertion [easy-difficult-impossible], swallowing [nil-slight-gross], coughing/gagging [nil-slight-gross], limb movement [nil-slight-gross], laryngospasm [nilslight-gross] and blood pressure [MPB], heart rate [HR] and peripheral arterial oxygen saturation [basal and every one minute for 5 minutes]. Patients were monitored with electrocardiogram, noninvasive arterial blood pressure, pulse oximetry and capnogram. All noted and recorded before induction[basal] and every minute for 5 minutes
Results: As regard LMA insertion characteristics, there was statistical significance observed between both group in coughing/gagging and laryngospasm [p= 0.003 and 0.018respectively] favoring nalbuphine with lidocaine group. Comparison of hemodynamic parameters between groups has shown that nalbuphine plus lidocaine group had generally better control of blood pressure throughout and shortly after the insertion procedure. In addition, this group had significantly better control of heart rate in two time stations and remained better later in spite of lack of statistical significance
Conclusion: Nalbuphine administration with lidocaine spray has the advantage of better control of hemodynamics and improved some laryngeal mask airway insertion criteria like significant decrease in coughing/ gagging and laryngospasm. We can conclude that IV nalbuphine is a safe and cheap opioid that can be used for facilitation of LMA insertion