Comparative study between tramadol and pethidine when added to lidocaine for intravenous regional anesthesia

Both pethidine and tramadol have a local anesthetic effect and thus can be used for intravenous regional anesthesia [IVRA], is to compare the local anesthetic and analgesic action of lidocaine alone, tramadol added to Lidocaine and pethidine added to lidocaine in IVRA for surgeries on the upper limb. A prospective nonrandoinized case series study included 60 patients ASA physical status I and II scheduled for forearm surgery using IVRA. The patients were classified into three groups:- Lidocaine group [L]:- Included 20 patients, as a control group, and they received lidocaine hydrochloride 200 mg [0.5%] diluted in 40 ml normal saline, Pethidine group [P]:- Included 20 patients who received Pethidine hydrochloride 100 mg [0.25%] added to lidocaine hydrochloride 200 mg [0.5%] diluted in 40 ml normal saline and Tramadol group [T]:- Included 20 patients who received tramadol hydrochloride 100 mg [0.25%] added to lidocaine, hydrochloride 200 mg [0.5%] diluted in 40 ml normal saline. The patients were assessed for onset and recovery of sensory and motor block, visual analogue scale [VAS]] for tourniquet and forearm pain, presence or absence of postoperative pain and time to first analgesic requirement. The onset of pinprick and touch loss was significantly shorter in pethidine and tramadol groups in comparison to lidocaine group [p <0.001], while their recovery was longer [p<0, 001 and p<0.05 respectively]. The onset of pinprick and touch loss in pethidine group was significantly shorter in comparison to tramadol group [p <0.05]. The pinprick recovery in pethidine group was significantly shorter than in tramadol group [p <0.05]. The onset of motor block in tramadol and pethidine groups was significantly shorter in comparison to lidocaine group [p <0.01, p <0.05 respectively]. There was no significant difference in the onset of motor block between tramadol and pethidine groups. The motor recovery in all three groups was comparable and the difference was [statistically non significant. For tourniquet pain VAS was significantly less at 10 min. and 20 min in the pethidine group in comparison to the lidocaine group [p<0.01 and p<0.05 respectively]. For foreann pain, VAS was significantly less in tramadol and pethidine at 10 minutes in comparison to lidocaine group [p <0.01, p < 0 001 respectively]. At 20 min there was no pain in all groups postoperative analgesic requirements The mean time to the first analgesic requirement in pethidine and tramadol groups was greater than in lidocaine group [P < 0 001]. The mean time to the first analgesic requirements in tramadol group was greater than in pethidine group [P <0.05]. Recorded side effects the incidence of tachycardia was more significant in pethidine group [40%] in comparison to the other groups. Our results suggest that, both tramadol and pethidine have a local anaesthetic effect on the peripheral nerves. Both of them enhance the speed of onset of sensory and motor block, induce better anesthesia and analgesia for tourniquet and forearm pain, improve postoperative analgesia and reduce postoperative analgesic requirements after tourniquet deflation when added to lidocaine. But tramadol is considered to be safer than pethidine

Effects of recruitment maneuvre on atelectasis during prolonged paediatric microvascular anaesthesia: a computed Tomography study

Atelectasis is an unavoidable effect of general anaesthesia. The aim of this study was to identify lung atelectasis which could occur during general anaesthesia in children with healthy lungs during microscopic reconstruction of brachial plexus and to evaluate the efficacy of alveolar recruitment strategy [ARS] in treating such atelectasis guided by CTscanning, The study included 30 patients aged 4 months to 2 years, ASA I physical status. Three cases were excluded. 27 children were enrolled into two groups: control group [n=16] and Alveolar recruitment strategy [ARS] group [n=11]. After induction of anesthesia in the ARS group PEEP of 5 cm H[2]O was applied from the start of the operation and the recruitment manoeuvre was performed 1 hour after induction of anesthesia and repeated at the end of surgery and was performed for 10 breaths by increasing PEEP progressively to 10 cm H[2]O, and the tidal volume [TV] until 15 ml/kg or a peak inspiratory pressure [PIP] of 35 cm H[2]O. In the control group, arterial blood gas samples were withdrawn at the 1[st] hour, 4[th] hour and before extubation. In the ARS group, they were withdrawn at 1[st] hour [Control], after the 1[st] and the 2[nd] recruitment manoeuvres, and shunt fraction was mathematically calculated in both groups. Three computed tomography scans were performed in both groups; preoperatively, early and late postoperatively, and atelectatic area was identified and measured using the [Region-of-interest] program. The recruitment manoeuvre used in this study had succeeded to decrease the incidence of anesthesia induced atelectasis from 87.5% in the control group to 27.3% in the [ARS] group. Even in cases presented with atelectasis in the [ARS] group, the mean atelectatic area size was smaller, and its' resolution was earlier. In the control group, the mean atelectatic area size was 6.86 +/- 0.71 cm[2] in the early postoperative CT which further increased to 8.76 +/- 0.92 Cm[2] in the late postoperative CT, and 4 cases were complicated by pneumonia. In the [ARS] group, the mean area size was 3.82 +/- 1.55 cm[2] in the early postoperative CT, and reduced to 1.63 +/- 1.65 cm[2] in the late postoperative CT [3[rd] day], with no cases complicated by pneumonia. Furthermore, the degree of gas exchange impairment was improved in the [ARS] group versus the control group. The mean shunt fraction calculated from arterial blood gas in the control group was 14.76 +/- 1.63% versus 9.67 +/- 1.63% in the [ARS] group. The current study revealed a high incidence of anaesthesia-induced atelectasis in children with healthy lungs exposed to prolonged general anaesthesia for microscopic recostruction of brachial plexus birth injuries. The combined use of Alveolar recruitment manoeuvres and PEEP of 5 cm H[2]O before and afterwards is effective in reducing the incidence of anesthesia induced atelectasis with no reported complications

Reduction of occurrence of hypotension during spinal anaesthesia for cesarean section: prophylactic intramuscular ephedrine versus fluid preload

In this study, 40 women undergoing elective cesarean surgery [CS] at term were allocated randomly to receive either a preload of 20 ml/kg of normal saline over 10-15 min immediately before spinal anesthesia [fluid group] or prophylactic ephedrine 50 mg in 10 min before spinal anesthesia [ephedrine group]. The two techniques were compared for their maternal and neonatal effects. Moderate hypotension was defined as >20% reduction in systolic blood pressure [SAP] and severe hypotension as >30% reduction in SAP. The study concluded that ephedrine e 50 mg given intramuscularly ten minutes before induction of spinal anesthesia reduced the incidence of hypotension and the total dose of rescue ephedrine therapy than preloading with 20 ml/kg crystalloid during spinal anesthesia for CS. The incidence of nausea and vomiting was also reduced and the fetal outcome was improved. However, this dose of ephedrine did not completely eliminate hypotension, nausea and vomiting