Diclofenac sodium versus paracetamol preoperatively for tonsillectomy: effects on pain and haemostasis

Sixty children and adolescents [6-16 y] were randomized in this study to receive rectal paracetamol 13-20 mg kg-1 [group I] or diclofenac sodium 0.65-1.0 mg kg-1 [group II] preoperatively. Pain was evaluated postoperatively by means of the visual analogue scale and by recording the use of pethidine for rescue analgesia. Perioperative blood loss was estimated from The measured intraoperative blood loss, bleeding time, use of drugs to achieve haemostasis and the incidence of reoperations. Surgical duration was prolonged and blood loss was more in group II than those in group I, but nonsignificant. Bleeding time was prolonged [but within the normal range] in group II than group I. The postoperative pain was significantly less with diclofenac [group II] than paracetamol [group I]. This was clear from time from extubation to 1st pethidine dose [34 + 15 in group II vs. 25 + 11 in group I]. Pethidine consumption was 21.7 +/- 7.4 in group III vs. 29.5 +/- 8.1 group I. Desmopressine use was more with diclofenac and vomiting was more in group II

Total intravenous remifentanil/propofol combination [TIVA] versus sevoflurane [VIMA] for day-case surgery

The aim of this study was to evaluate total intravenous anesthesia [TIVA] by propofol / remifentanil versus sevoflurane [VIMA] in order to achieve these requirements for day case surgery. The study included 40 patients [ASA I and II] undergoing day case surgery. They classified into two equal groups: Group I received TIVA in the form of propofol [2 mg/kg] for induction of anesthesia, followed by continuous infusion of 9 mg/kg/h in combination with remifentanil 1 mug/kg for induction, followed by 0.5 mug/kg for maintenance of anesthesia; while group II received VIMA by sevoflurane [8%] for induction, followed by [1.5 MAC] for maintenance of anesthesia. General parameters including pulse rate/min, mean arterial blood SaO2 and PETCO2 were continuously monitored. The intubation score and the time required for full recovery from anesthesia were also recorded. The results showed that there were no significant differences between the two groups as regards the general parameters, pulse rate/min, arterial blood pressure, SaO2 and PETCO2. The TIVA group showed more attenuation of the hemodynamic response to intubation than VIMA group, but this was statistically insignificant. The intubation score was more favorable in TIVA group, but VIMA group was characterized by rapid recovery, which was statistically significant. No side effects were observed in both groups

Prevention of postanesthetic shivering using nefopam and clonidine, a double-blind, placebo controlled study

Recovery from anesthesia is frequently accompanied by shivering [incidence up to 65 percent]. Post-anesthetic shivering [PAS] can exacerbate postoperative pain and also may induce many complications. Intraoperative hypothermia is the major risk factor from postanesthetic shivering, but shivering can occur in patients who are normothermic at the end of surgery. Various drugs and maneuvers were used to reduce or stop PAS. The aim of this study is to evaluate the effect of nefopam, and clonidine as inhibitors of PAS in comparison with placebo. Sixty patients of both sexes, ASA 1 and II. aged 17 to 60 years were scheduled for elective surgical procedures under general anesthesia. All patients received, midazolam [premedication] 0.04 mg/Kg. Then fentanyl [1 micro g/Kg], Thiopental [5mg/Kg] and atracurium [0.5 mg/Kg], endotracheal intubations, controlled ventilation with a mixture of isoflurane [1.1-2 percent] and N[2]O 60 percent in oxygen. End-tidal CO2 is kept at 30-35 mmHg. Warmed i.v. solutions were not used and patients were not actively warmed. Temperature was monitored by the use of nasopharyngeal thermocouple probe and temperature registered at 15 min, 30 min, and 60 min after exctubation. At the end of surgery, using a double-blind random protocol patients given either saline 0.9 percent [placebo], nefopam, 0.15 mg/Kg [nefopam group] or clonidine, 1.5 micro g/Kg [clonidine group]. Post anesthetic shivering [PAS] was assessed at 5 min.,15 min., 30 min and 60 min after extubation using 5-point scale. Recovery time, H.R. Mean arterial blood pressure and oxygen saturation are also assessed. The incidence of post-anesthetic shivering was lower in nefopam group [10 percent], and in clonidine group [20 percent]. than in placebo group which was about 75 percent. Recovery time was prolonged in clonidine group [12.2 min], than in nefopam group [7.9 min], while in placebo group it was 6 min Nefopam and clonidine are both effective for prevention of PAS but nefopam may be a better drug to use than clonidine

Postoperative pain relief in pediatric patients after subumbilical operations: regional versus systemic analgesia

This study was done to evaluate the postoperative pain relief produced by either caudal block, nerve blocks [ilioinguinal, iliohypogastric, and dorsal nerve of the penis], or instillation of bupivacaine locally into the operative wound, in pediatric patients. These effects were compared with the effect of systemic analgesia using acetaminophen alone postoperatively. Eighty children [mean age 44.8 +/- SD 22. 7 months, range 6 to 118 months] undergoing elective subumbilical operations under general anesthesia, were randomly allocated into four equal groups. Group I was given a caudal block with bupivacaine 0.25 percent [0.75mg/kg]. Group II had selected nerve blocks with the same solution. In group III, their wounds were irrigated with the same anesthetic before closure of the wound. Group IV did not receive any local anesthetic during operation. Postoperative systemic analgesia, in the form of acetaminophen pediatric suppository, was administered according to the requirement. The differences in pain scores among the different groups were assessed. All groups were comparable regarding the demographic data with no statistically significant difference. Our results demonstrated that caudal block was the most effective method for pediatric postoperative pain relief. Nerve block was as effective as local instillation. These results were demonstrated by early recovery, better pain scores, less analgesic consumption during the first 24 hours postoperatively, and early discharge