Comparative study of the analgesic profiles of a new intravenous paracetamol preparation, ketorolac, and their combination in day case otorhinolaryngologic surgeries

This study was done on 60 adult patients who had day case otorhinolarngologic surgeries. Patients were allocated into three groups, according to perioperative analgesic used: Group 1 [n =20] was given 30 mg ketorolac IV, Group 2 [n=20] was given a new solubilised paracetamol formulation [Perfalgan 10mg/mi] 1gm IV infusion, and Group 3 [n=20] was given 30mg ketorolac IV plus Perfalgan 1gm IV infusion. Analgesic profiles were evaluated using the sum of pain intensity difference after 6 and 12 hours of drug intake [SPID[6and12]], the total pain relief score after 6 and 12 hours of drug intake [TOTPAR[6and12]], global patient satisfactionwith pain control, and use of rescue analgesics. Surgeons' satisfaction with intraoperative bleeding and surgical field, in addition to bleeding time were also studied as indications of tolerability to the drugs. This study demonstrated no significant differences in pain scores between ketorolac and Perfalgan, while SPID[6and12] and TOTPAR[6and12] were significantly higher in the combination group [11.6 +/- 2.1 and 20.2 +/- 4.5, p=0.01 and 0.022 respectively for SPID[6and12] and 19.6 +/- 6.2 and 39.3 +/- 8.6, p=0.001 and 0.003 respectively for TOTPAR[6and12] indicating much less pain intensity and better pain relief with the combination. In addition, fewer patients in the combination group required rescue pethidine, while no significant difference was detected in the use of rescue pethidine between the other two groups. Fourteen patients in the combination group rated their satisfaction for the analgesic regimen as very good to excellent, while only one patient in the ketorolac group had a very good response, and none of the Perfalgan group had a very good to excellent response. Surgeons' satisfaction with intraoperative surgical bleeding and surgical field was satisfactory to excellent in all groups. In addition, postoperative bleeding times in all groups did not show any significant prolongation 12 hours after discharge from recovery room. This study has demonstrated that the use of a combination of paracetamol IV infusion in the new formulation known as 'Perfalgan' Ig and IV ketorolac 30mg for control of postoperative pain in day case otorhinologic surgeries was efficient and enough to avoid the use of additional narcotics, and had a better analgesic efficacy than either drug alone, without any significant side effects on intraoperative or postoperative surgical bleeding

Sedation for mechanically ventilated postoperative patients in the intensive care unit: comparative study between propofol and dexmedetomidine

Alpha 2 agonist dexmedetomidine is a new sedative and analgesic drug, which has been recently approved by FDA for use in ICU sedation. Dexmedetomidine is pharmacologically much more selective on alpha 2 receptors than clonidine. In the present study dexmedetomidine was compared to propofol as infusion for sedating 20 patients [10 patients in each group] admitted to ICU for postoperative short-term mechanical ventiiatory support [8-10 hrs] after major surgical procedures. Additional analgesics were supplied using nalbuphine iv bolus doses. Depth of sedation was measured continuously by using bispectral index neurosonic 1400 monitor. Hemodynamic and ventilator variables were recorded hourly Depth of sedation was equivalent in both groups by bispectral index scale 56 [44-67] for propofol group versus 49 [42-57] for dexmedetomidine group with non-significant difference [P= 0.41] between both groups. Although dexmedetomidine group showed more alertness and cooperation during ventiiator support and more rapid and easy extubation [extubation time 33 minutes in propofol group versus 32 minutes in dexmedetomidine group] [p= 0.7], but these changes were statistically non-significant Also propofol group required almost three times analgesic doses than for dexmedetomidine group [240 mg versus 80 mg]. No significant difference was found in mean arterial blood pressure or central venous pressure between both groups However heart rate showed significant reduction in dexmedetomidine group than in propofol group [p= 0.026]. No adverse events were recorded when related to the sedative infusions used in this study. It could be concluded that dexmedetomidine is a safe and an effective sedative agent in ICU postoperative patients as it provides safe profile and reduces analgesic requirements

efficacy of dexmedetomidine in supressing cardiovascular and sympathoadrenal response to endotracheal intubation in hypertensive patients undergoing elective surgery

The present study was conducted on 20 controlled hypertensive adult patients. They all received general anesthesia for elective surgery and dexmedetomidine infusion for 5 minutes before endotracheal intubation and for 10 minutes thereafter. It was found out that there was a significant mild reduction in systolic blood pressure, mean heart rate, and rate pressure product after start of infusion, P=0.01, 0.05, and 0.01, respectively. After intubation, there were insignificant changes in systolic blood pressure [P=0.05] and heart rate showed mild significant increase at 1, 2, and 4 minutes with back to normal values at 6, 8, and 10 minutes. Rate pressure products also showed insignificant increase at 2, 4, and 6 minutes and back to normal at 6, 8 and 10 minutes. Epinephrine plasma level showed insignificant change after 10 minutes of intubation from baseline value 79.5 +/- 21 Vs. 76.8 +/- 18 pg/ml [P=0.01], while norepinephrine level was 419 +/- 48 pg/ml as baseline Vs. 428 +/- 51 pg/ml at 10 minutes after intubation with also mild insignificant change. The total dose of propofol used for induction of anesthesia was less than calculated as evidenced by loss of eyelash reflex and apnea with a mean value of 159 mg [1.54 mg/kg Bwt.] indicating that dexmedetomidine infusion before induction significantly reduced the dose of propofol needed for induction of anesthesia

Pulmonary function changes after interscalene brachial plexus anaesthesia; comparison between 0.75% ropivacaine and 0.5% bupivacaine

This study was carried out on 20 adult patients, scheduled for shoulder and arm surgery. After monitoring of the patients for heart rate, non invasive blood pressure and pulse oximetery. They were allocated randomely to receive 20 ml of either 0.75% ropivacaine [group I] or 0,5% bupivacaine [group II] for interscalene bradial plexus [ISBP] block. The patients demographic data were similar in both groups, the onset of sensory block and motor block were significantly prolonged in group I in comparison to group II [12.08 +/- 0.69 min and 15.05 +/- .0.69 min in group I vs 10.10 +/- 0.70 min and 12.25 +/- 0.72 min respectively] P< 0.0001. A significant reduction in pulmonary function occurred in both groups after 5 minutes till 30 minutes of the block. Forced vital capacity [FVC] decreased by 9% after 5 min to 40% after 30 minutes in group I and by 13% to 39% in group II. forced expiratory volume after one seconds [FEVl] decreased by 12% to 18% in group I and from 13.5% to 18.5% in group II. The peak expiratory flow rate [PEFR] decreased from 11% to 26.3% in group I, and from 11% to 32% after 30 minutes. No significant difference between both groups as regard FVC. FEVI, and PEFR at any time of measurement. We concluded that both 0. 75% ropivacaine and 0.5% bupivacame can be used for interscalene brachial plexus block,, but owing to the less cardiac toxicity of ropivacaine. it is recommended to be widly used