Labor analgesia in preeclampsia:remifentanil patient controlled intravenous analgesia versus epidural analgesia

Epidural analgesia is considered to be the preferred method of labor analgesia in preeclamptic patients. Systemic opioids are another good effective, easy to administer alternative but may cause maternal and fetal respiratory depression. Remifentanil's rapid onset and offset of effects, should make it an ideal drug for the intermittent painful contraction during labor. 30 preeclamptic patients were randomly assigned to one of two equal groups; Epidural Group: received epidural analgesia according to a standardized protocol using bupivacaine plus fentanyl. Remifentanil Group: PCA was set up to deliver remlfentanil 0.5 micro g/kg as a loading bolus infused over 20 seconds, lockout time of 5 minutes, PCA bolus of 0.25 micro g/kg, continuous background infusion of 0.05 micro g/kg/min, and maximum dose is 3 mg in 4 hours. Women were advised to start the PCA bolus when they feel the signs of a coming uterine contraction. All women demonstrated a significant decrease in VAS score in the first hour after administration of analgesia [P<0.05]. Analgesic quality as regard Visual Analog Pain Scores, sedation score, and post-delivery patient satisfaction in both groups, are comparable [P>0.05]. PCA remifentanil infusion until time of delivery produce no observable maternal, fetal or neonatal side effects [P<0.05]. PCA intravenous remifentanil is an effective option for pain relief with minimal maternal and neonatal side effects in labor for preeclamptic patients with contraindications to epidural analgesia or requesting opioid analgesia

Comparative study of different doses and routes of administration of lornoxicam for peri-operative analgesia in patients undergoing intravenous regional anesthesia for minor upper arm surgery

The use of perioperative NSAIDs has become popular in operation ranging from minor outpatient to major inpatient surgery. A systemic review suggested that NSAIDs have the most to offer as adjuncts to intravenous regional anesthesia. Lornoxicam has demonstrated clinical efficacy in relieving pain, through different routes of administrations, oral, IM, IV, and local infiltration. In this study comparison of different doses and routes of administration of Lornoxicam for peri-operative analgesia in patients undergoing intravenous regional anesthesia for minor upper arm surgery was done. 60 patients ASA 1 and 2 undergoing minor upper limb surgeries were studied Patients were randomly divided into six groups; Group I: Total volume of 40ml of pre-prepared Local intravenous solution mixed with 8mg of Lornoxicam. Group 2: Total volume of 40ml of pre-prepared Local intravenous solution mixed with 16mg of Lornoxicam. Group 3: Total volume of 40ml of pre-prepared Local intravenous solution plus Lornoxicam 8mg intramuscular. Group 4: Total volume of 40ml of pre-prepared Local intravenous solution plus Lornoxicam 16mg intramuscular. Group 5: Total volume of 40ml of pre-prepared Local intravenous solution plus Lornoxicam 8mg intravenously. Group 6: Total volume of 40ml of pre-prepared Local intravenous solution plus Lornoxicam 16mg intravenously. Better qualities of block, less tourniquet pain, and better quality of postoperative analgesia were found in groups 1, 2 that had lornoxicam combined with lidocaine compared with other groups used lornoxicam intravenously or intramuscular [p<0.05]. Moreover, using lornoxicam 16mg proved to be better than lornoxicam 8mg when combined with total intravenous solution [p<0.05]. Lornoxicam used in the local intravenous solution gave better quality of intraoperative condition and postoperative analgesia without increase in the incidence of side effects compared with lornoxicam used intramuscularly or intravenously. Also lornoxicam 16mg provide better intraoperative analgesia compared to lornoxicam 8mg when both were used locally with local intravenous regional analgesia

Analgesic requirements for patients undergoing lower extremity orthopedic surgery: the effect of combined spinal and epidural magnesium

Polypharmacological approach is the most common practice to treat perioperative pain, as no single agent has yet been identified to specifically inhibit nociception without associated side effects[1]. Opioids such as Fentanyl is commonly added to local anesthetics to produce spinal and epidural anesthesia. However, significant adverse effects, such as pruritus, respiratory depression, hemodynamic instability and occasionally severe nausea and vomiting, may limit their use[3, 4, 5]. Our present study was designed to assess the effectiveness of using combined intrathecal and epidural magnesium [Mg] in reducing intra-and postoperative analgesic requirements and improving the quality of analgesia. Eighty patients ASA I, II, III who scheduled for lower extremity orthopedic surgery were included in the study. Patients were randomly allocated to one of two groups, 40 patients each. The Control Group: patients received intrathecal 10 mg of Bupivacaine 0.5% [2 ml], plus 25 micro g of Fentanyl [0.5 ml], plus 0.9% NaCl solution [1 ml] and an epidural infusion of 0.9% NaCl at a rate of 5 ml/hr. The Magnesium Group: patients received intrathecal 10 mg of Bupivacaine 0.5% [2 ml], plus 25 micro g of Fentanyl [0.5 ml], plus 50 mg of 5% Mg [1 ml] and an epidural infusion of 2% Mg at a rate of 100 mg/hr [5 ml/hr]. Intrathecal Mg prolonged fentanyl analgesia as indicated by increased duration of anesthesia in the Mg group, and thus improving the quality of spinal anesthesia. The effectiveness of the postoperative analgesia was confirmed by markedly lower perioperative analgesic requirements [38.3% less than the Control group], the patient's low VAS score, the longer time for the patients first requirements of post-operative analgesia in the Mg group. For lower extremity orthopedic procedure, supplementation of spinal anesthesia with combined intrathecally injected and epidurally infused Mg, considerably reduced the perioperative analgesic requirements without any side effects

influence of two different hydroxyethyl starch solutions [6 % HES 130/0.4 and 200/0.5] on postoperative pulmonary functions in patients undergoing elective abdominal aortic surgery

Major surgery may alter the physiologic immune balance and initiate systemic inflammatory processes which may progress to severe postoperative complication e.g. multiple organ dysfunction syndrome [MODS] or adult respiratory distress syndrome [ARDS]. The colloid used for intra vascular volume replacement in surgical patients may affect the inflammatory response during major surgery. Thirty six patients scheduled for elective abdominal aortic aneurysm surgery were randomized to receive either 6% hydroxyethly starch HES 200/0.5 or 6% hydroxyethyl starch HES 130/0.4 for colloid replacement. Lung function was assessed with PO[2]/FiO[2]ratio, respiratory compliance, chest X-ray and a score for lung injury. Serum concentrations of interleukin [IL]-6, IL-8 and IL-10 were measured. After aortic cross clamp release the PO[2]/FiO[2] ratio was 354.6 +/- 7.95 mmHg for the HES 130/0.4 compared with318 +/- 9.52 mmHg for the HES 200/0.5 treated patients. Twelve hours after aortic cross clamp release, PO[2]/FiO[2]ratio for the HES 130/0.4 patients was 316 +/- 9.04 compared with 259.44 +/- 6.92 for HES 200/0.5 patients [p<0.001]. In the first postoperative day it was 251.6 +/- 4.2 for HES 130/0.4 patients compared with 217 +/- 9.74 for HES 130/0.4 treated patients. Respiratory compliance was greater for HES 200/0.5 treated patients compared with HES 130/0.4 treated patients. Peak values of IL-6 and IL-8 were significantly lower in HES 200/0.5 treated patients compared with HES 130/0.4 treated patients serum IL-6 were 52.9 +/- 10.2pg/dl in HES 200/0.5 group compared with 46 +/- 11.8pg/dl for HES 130/0.4 group serum IL-8 were 45 +/- 8.9pg/ml in HES 200/0.5 group compared with 37 +/- 9.8pg/ml in HES 130/0.4 group. Intravascular volume replacement with HES 130/0.4 resulted in better perioperative pulmonary function and reduced inflammatory response in patients undergoing abdominal aortic surgery compared with HES 200/0.5

Hyperbaric bupivacaine and fentanyl for elective cesarean section: effect of a height and weight adjusting dose

There are large varieties of dosage regimens which are in use for spinal anesthesia for Cesarean section [3]. All aiming for limiting the dose of Bupivacaine to reduce incidence of maternal hypotension and vasopressor requirements, decreasing nausea and vomiting, reducing time to discharge from post anesthesia unit, and improving maternal satisfaction [4]. This study was designed to assess the validity of adjusting the dosage of intrathecal hyperbaric bupivacaine according to the patient's height and weight would provide adequate surgical anesthesia for elective cesarean section while decreasing the incidence of maternal hypotension and the use of vasopressor to treat hypotension and consequently fetal outcome. Patients were randomly assigned to be involved into two groups. Group 1: The fixed dose group, patients received fentanyl 20 microgram [0.4ml] added to hyperbaric bupivacaine 0.5% 2.4ml. Group 2: The adjusting dosage group, patients receive fentanyl 20 microgram [0.4ml] added to a volume of hyperbaric bupivacaine 0.5% that is determined by referencing to the dosage regimen detailed Table. All the cardiovascular data measured plus the incidence of nausea and vomiting were statistically significantly lower in the adjusted group compared to the fixed one [p<0.05]. Time to loss of cold [T4] and to pinprick sensation to T64 on both sides were significantly slower in the adjusted group [p<0.05]. There were no significant differences as regard the visual analogue scale, number of patients needed supplementary analgesia, or the fetal outcome between the two groups at different time intervals [p>0.05]. Adjusting the intrathecal hyperbaric Bupivacaine dose to patient's height and weight combined with 20 microgram Fenatnyl provide adequate anesthesia with less maternal side effects for patients undergoing elective cesarean section

Combined great auricular nerve block and general anesthesia for tympanomastoid surgery

The effects of the great auricular nerve [GAN] block combined with general anaesthesia [GA] in patients undergoing tympanomastoid surgery have been evaluated with respect to the quality of the surgical field, isoflurance consumption, postoperative pain and recovery profile. Thirty adult patients were randomly allocated to receive GA alone [group I, n=15] or combined GA and GAN block [group II, n=15]. After stabilization of GA with isoflurane, N[2]O/O[2] the patients in group II received GAN block The mean arterial pressure [MAP] intraoperatively was maintained at 60-65 mmHg by adjusting the concentration of isoflurane and the use of hypotensive agent [esmolol]. The consumption of isoflurane, and the frequency of esmolol use were evaluated in both groups. The surgeon evaluated the quality of surgical field. The pain intensity, postoperative morphine consumption and incidence of nausea were evaluated in PACU. Intraoperatively, isoflurane consumption was less in group II than group I [P<0.005]. The number of patients requiring esmolol were significantly higher in group I. The average category scale for quality of surgical field was better in group II than group I in the range of MAP 60-65 mmHg .In the PACU, the total morphine consumption were significantly reduced in group II than group I [P