Ultrasound-guided bilateral quadratus lumborum block vs. intrathecal morphine for postoperative analgesia after cesarean section: a randomized controlled trial / 대한마취과학회지

Background@# Adequate pain control after cesarean section (CS) is crucial for mothers caring for newborns, and early ambulation to avoid thromboembolism and chronic abdominal and pelvic pain. This randomized controlled trial compared the efficacy of quadratus lumborum block (QLB) and intrathecal morphine (ITM) for analgesia after CS. @*Methods@# Ninety women at ≥ 37 weeks pregnancy scheduled for elective CS were enrolled. All patients received spinal anesthesia and post-operative QLB. They were randomly allocated to Control (anesthesia: 0.1 ml saline, QLB: 24 ml saline), ITM (anesthesia: 0.1 mg morphine, QLB: 24 ml saline), or QLB groups (anesthesia: 0.1 ml saline, QLB: 24 ml 0.375% ropivacaine). Integrated analgesia score (IAS) and numerical rating scale (NRS) scores at rest and during movement, morphine requirements in the first 48 h, time to first morphine dose, and morphine-related side effects were recorded. @*Results@# IASs and NRS scores at rest and during movement were significantly lower in QLB and ITM group than in Control group. Moreover, IASs and NRS scores at rest and during movement were lower in QLB group than in ITM group. Time to first morphine dose was significantly longer in QLB group than in ITM and Control group. Furthermore, morphine requirements in the first 48 h were significantly lower in QLB group than ITM and Control group. Incidence of morphine-related side effects was significantly higher in ITM group than in QLB and Control group. @*Conclusions@# QLB and ITM are effective analgesic regimens after CS. However, QLB provides better long-lasting analgesia and reduced total postoperative morphine consumption.

study of retrograde degeneration of median nerve, forearm segment in carpal tunnel syndrome of variable seventies

Carpal tunnel syndrome [CTS] is a disorder of the hand which results from compression of the median nerve within its fibro-osseous tunnel at the wrist. The slowing in the forearm motor conduction velocity suggests the presence of retrograde degeneration. Existing studies conflict regarding a correlation between the seventies of the entrapment neuropathy in CTS and slowing of median motor nerve conduction velocity in the forearm. The objective of this work was to study retrograde degeneration [RGD] of the median nerve forearm segment in patients with CTS and its relation to variable severity of CTS in Egyptian patients. Twenty-four patients with CTS were included in this study. The Forearm mixed nerve conduction is presumed to be indicative of the conduction of the median nerve over the forearm and is used widely to assess causes of slowing forearm conduction velocity in CTS. In addition to conventional nerve conduction studies of the upper limb, forearm median mixed conduction studies were performed Median motor forearm amplitudes and nerve

Serum soluble intracellular adhesion molecules-1 [sICAM-1] and AST/ALT ratio in chronic hepatitis C are significant predictors of the disease severity judged by liver biopsy

This study was conducted to investigate the serum levels of soluble Fas [sFas] antigen, soluble intracellular adhesion molecules-1 [sICAM-1] and interleukin-18 [IL-18] in patients with chronic hepatitis C and to correlate their levels with the severity of pathological findings judged by liver biopsy interpreted as Scheuer score. The study included 30 patients with chronic hepatitis C [Study group] infection persisting for longer than 6 months with HCV antibody positive and increased serum alanine aminotransferase [ALT] values and 10 volunteers to donate blood samples as control group. After complete history taking and full clinical examination, all patients and controls gave a fasting blood sample for colorimetric estimation of serum aspartate transaminase [AST], ALT and total [TB] and direct [DB] bilirubin and for ELISA assays of serum sICAM-1, sFas and IL- 18 levels. Blind liver biopsies were done and histopathological inflammatory activity [grading, 0-4 scale] and fibrosis stage [0-4 scale] were assessed according to Scheuer classification. Pathological examination of Liver biopsy detected 21 chronic hepatitis specimens and 9 cirrhosis specimens with a significant [p<0.05] increase of Scheuer scores in patients with cirrhosis compared to patients with chronic hepatitis. Serum levels of AST and ALT were significantly [p<0.05] elevated in study compared to control group, with a non-significant [p>0.05] increase of AST/ALT ratio; however, serum AST levels and AST/ALT ratio were significantly [p<0.05] higher and serum ALT levels were non-significantly [p>0.05] higher in cirrhotic patients compared to those with chronic hepatitis. Serum sFas, sICAM-1 and IL-18 levels in study group were significantly [p<0.05] higher compared to controls levels with a significant [p<0.05] increase of sICAM-1 levels and non-significant [p>0.05] increase of sFas and IL-18 levels in cirrhotic patients compared to patients with chronic hepatitis. There was a positive significant correlation between the mean Scheuer necroinflammatory score and serum levels of ALT, sICAM-1 and AST/ALT ratio and between the mean Scheuer fibrosis score and serum levels of ALT, sFas, sICAM-1 and IL-18 and AST/ALT ratio. Logistic regression analysis showed that AST/ALT ratio [beta=0.679, p<0.001] and serum levels of sICAM-1, [beta=0.327, p=0.005] are the most significant predictors of disease severity. It could be concluded that serum levels of sICAM-1, sFas and IL- 18 and AST/ ALT ratio are closely correlated with histopathological results of liver biopsy and thus their elevated levels could be considered pathognomonic markers suggesting the severity of chronic hepatitis C