Preincisional ipsilateral stellate ganglion block for acute post operative pain control in unilateral mastectomy

To evaluate the effect of preincisional ipsilateral stellate ganglion block for acute post operative pain control in unilateral mastectomy. In a randomized clinical trial, 62 patients selected for unilateral mastectomy were recruited in Tabriz Imam Reza educational Hospital during 18-month period. They were randomly divided into two equal groups; receiving either preincisional ipsilateral stellate ganglion block using bupivacaine [study group] or without these blocks [control group]. Postoperative pain was evaluated based on visual analogue scale [VAS]. The total dose of analgesics were also compared between the two groups. Thirty one female patients with a mean age of 48.7 +/- 7.4 [36-60] years and 31 other female patients with a mean age of 50.7 +/- 6.9 [36-60] years were enrolled in the study and control groups, respectively [p=0.292]. The number of patients with decrease in postoperative pain was significantly higher in the case study group comparing with that of the control group [p < 0.001]. Decrease in total dose of postoperative analgesics was also significantly lower in the case study group compared with control group [P < 0.001]. Forty eight hours after operation, there were 15 pain-free patients in the study group with no pain-free patients in the control group. This difference was statistically significant [P < 0.001]. Based on our findings, the preincisional ipsilateral stellate ganglion block is an effective method in controlling the postoperative pain after unilateral mastectomy. This approach had also got a considerable analgesic-sparing effect

[Effect of thoracic epidural anesthesia on oxygen saturation during one-lung ventilation in pulmonary resection surgery]

The perfusion in the nonventilated, operative lung during one-lung ventilation [OLV] in patients undergoing thoracic surgery increases intrapulmonary shunt and decreases systemic arterial oxygenation. The anesthesia with OLV may affect oxygenation. The aim of this study was comparing the effect of total intravenous anesthesia [TIVA] and thoracic epidural anesthesia [TEA] combined with TIVA on saturation of oxygen during OLV in patients undergoing pulmonary resection. In a randomized double-blind clinical trial, 60 patients undergoing elective pulmonary resection were Divided in to two groups. The intervention group received TEA [bupivacaine 0.25%] plus TIVA [propofol+remifentanil] while the control group received TEA [saline] plus TIVA.The hemodynamic parameters, Aldrete score and possible complications were compared between the two groups, within the study period. The change of hemodynamic parameters, as well as SaO2, PaO2 and ETCO2 within the study period was not significantly different between the two groups. The mean Aldrete score was comparable between the two groups upon entering recovery and after getting discharged from there. During the recovery stay, frequency of patients with pain and shivering was significantly higher in the group with sole TIVA. There was no significant difference in nausea and hypotension between the two groups. TEA plus TIVA does not have a significant effect on O2 saturation in OLV in patients comparing with sole TIVA. However, this combination significantly decreases the post-operative pain and shivering and so may be recommended