effects of "three in one" local anaesthetic block intra articular local anesthetic block and intravenous morphine on postoperative pain relief after diagnostic knee arthroscopy

The objective of this study was to compare between the efficacy, the duration and the side effects of three different analgesic techniques [three-in-one block, intra-articular local anesthetic and intravenous patient-controlled analgesia with morphine] on the patients who were scheduled for elective diagnostic Knee arthroscopic surgery under general anesthesia. Forty five patients scheduled for elective diagnostic knee arthroscopiy were randomly allocated into three equal groups. Group I three-in-one block, group II intra-articular block by injection of 30ml ropivacaine 0.5% and group III PCA with intravenous morphine. Pain scores [VAS], requirement of supplemental analgesia, and the side effects of each block were recorded. Groups I and III did not differ significantly regarding the pain score, while it was significantly higher in group II [p<0.01]. This was reflected by the requirement of supplementary analgesia in the three groups. Group III patients experienced more side effects when compared with patients of the other two groups. Three-in-one block provides effective analgesia with a low incidence of side-effects and a high patient satisfaction rate. PCA with morphine provide effective analgesia but with high incidence of side effects. On the contrary, intra-articular analgesia was associated with significantly higher pain scores and a lower degree of patient satisfaction

Does epidural analgesia for thoracotomy reduce biochemical,markers of myocardial damage in ischemic heart patients?

Cardiovascular morbidity and mortality after cardiac surgery continue to be an area of active investigative interest because of its clinical and economic impact. is prospective randomized controlled study, we investigate the effect of thoracic epidural anesthesia/analgesia] on the release of troponin I [cTnI] and creatine kinase enzyme [CK-MB], ECG changes and postoperative anal-during elective thoracie surgery in ischemic heart patients. 20 patients with stable ischemic heart disease scheduled for elective thoracic surgery were randomized into 2 equal groups, a general anesthesia [GA] group and a general :hesia plus thoracic epidural analgesia [TEA]. The GA > received an initial IV loading dose of morphine 0.1mg/kg before induction followed by infusion of 75 mg morphine 250 ml normal saline at a rate 5ml [l.5mg]/h till 48 hours] post operative. The TEA group received 8 ml ropivacaine 0.2% and fentanyl 50mcg epidurally. And then epidural infusion of ropivacaine 0.2% and fentanyl 2mcg/ml was Tienced at a rate 6ml/h till 48hours postoperative. We monitored [cTnI and CK-MB], ECG changes, visual analogue, cardiopulmonary parameters and any side effects. There were no differences in troponin I and CK-levels between both groups. There were transient ischemic episodes 30% in GA group and 10% in TEA group. Analgesia improved in the TEA group compared with the GA group. mean arterial blood pressure was significantly lower in iA group. Also there were no differences between both is as regard sedation score or nausea score and there was patients who developed itching in both groups. Thoracic epidural analgesia for elective [cic surgery in ischemic heart patients improved post operative analgesia but had no effect on the release of biochemical markers of myocardial damage [Troponin I and CK]

Effect of epidural Ropivacaine versus Ropivacaine plus Midazolam in intramedullary nailing of femur shaft fracture

Epidural opioids have the appeal of ease of administration of local anesthetic injection for surgical anesthesia. Nevertheless, the side effects linked to epidural opioid administration might retard their use in certain patient populations. Ropivacaine has both anesthetic and analgesic effects. At high dose it produces sensory and motor block, while at lower doses it produces sensory block [analgesia] with limited and non progressive motor block. Lumbar epidural anesthesia, which is the most commonly used form of this technique, is used for any lower limb surgical procedure. This combined with the avoidance of spinal headache, has made the technique increasingly popular. Non-opioid such as clonidine, ketamine, midazolam may be more suited as adjuvant rather than sole analgesics and there main role lies in reducing the dose requirements of other analgesics. Aim of the Work: To investigate the role of epidural combination of ropivacaine and midazolam versus epidural ropivacaine alone for anesthesia and postoperative analgesia in intramedullary nailing of femur shaft fracture. A total number of 32 patients with intramedullary nailing operations were included in this study. They were divided into two groups; control group [group I] included 16 patients received 1.5ml per segment epidural. ropivacaine 0.5% [total volume was 15ml] and study group [group II] included 16 patients received 1.5ml per segment [total volume was 15ml] epidural ropivacaine 0.5% plus 0.05mg/kg epidural midazolam available in Suez Canal University Hospital containing midazolam hydrochloride buffered to pH 3.5 with hydroxide and sodium hydrochloride. Patients were evaluated by history, physical examinations and laboratory investigations were requested preoperatively. Patients were being visited the day before surgery. Visual analogue scale was explained. The following parameters were assessed in this study; onset of anesthesia, duration of effective analgesic time from the onset of epidural analgesia, visual analogue scales [VAS] intraoperatively and at 2, 4, 6, 8, 10, 12 and 24 hours the top up dose, total consumption of analgesics in the first 24 hours the top up dose, modified bromage score at 6, 12, 24 hours the top up dose and sedation score at 6, 12, 24 hours postoperatively. The ropivacaine/midazolam group developed more marked degree of sedation than the ropivacaine group that develop mild sedative effect after 2, 4, and 6 hours from the top up dose due to PCA. The difference between the two groups regarding the sedative effect was statistically highly significant [p<0.001]. After 12 hours, there was no sedative effect in both groups. We concluded that epidural ropivacaine in combination with midazolam are more effective for adequate anesthesia and for prolongation of postoperative analgesia than epidural ropivacaine alone in intramedullary nailing of femur shaft fracture.