ABSTRACT
Background and Aims: Acute pain management in drug addicts is a critical yet understudied topic. Drug addicts have a decreased pain threshold, impairing anaesthetic pain control. This study aimed to evaluate the postoperative quality of recovery in addicts and non-addicts after receiving erector spinae plane block (ESPB) with general anaesthesia. Methods: Sixty males, aged 18-60 years, with an American Society of Anesthesiologists physical status I/II, scheduled for elective lumbar decompression surgery, were divided into two equal groups. Group A included 30 addicts and group N included 30 non-addicts. Both groups received bilateral ultrasound-guided ESPB with 20 mL bupivacaine (0.25%) before induction of general anaesthesia. The primary outcome was comparison of the 24-hour postoperative quality of recovery (QoR-15) score. The secondary outcomes were time to first analgesic requirement, postoperative pain scores, morphine consumption, and adverse events. Results: The QoR-15 score was higher in group N (median = 128.5, interquartile range = 107-136) than in group A (118 [99-130]), indicating a better recovery in group N. The visual analogue scale pain score was lower in group N than in group A, especially in the first 12 hours postoperatively. Time to first analgesic request was significantly longer in group N than in group A (mean ± standard deviation: 8.67 ± 2.74 and 5.53 ± 1.64 hours, respectively, P =0.001), Morphine consumption was significantly higher in group A than in group N (9.62 ± 3.2 and 7.08 ± 2.57 mg, respectively, P =0.041). Conclusion: Drug addicts experienced decreased analgesic efficacy of ESPB compared to non-addicts, with comparable postoperative QoR-15 score following lumbar decompression surgery.
ABSTRACT
Aim: The aim of this study was to assess the prevalence of micro- and macrovascular disease in Egyptian patients with diabetes mellitus (DM) and peripheral arterial disease (PAD). Methods: The study included 161 Egyptian patients with DM and PAD (91.3% had type 2 DM and 67.1% were females). Mean diabetes duration was 14.2 ± 5.2 years. Full history, clinical and fundus examination as well as laboratory investigations were done. PAD was diagnosed through assessment of ankle/brachial index (ABI) by Doppler ultrasonography. Results: ABI was <0.9 in 33.5% and >1.3 in 66.5% of patients. A significant positive correlation was found between abnormal ABI and diabetes duration, ischemic heart disease (IHD), diabetic retinopathy and neuropathy, foot ulcers, elevated blood pressure (BP), creatinine, urine albumin/creatinine ratio (ACR) and triglycerides and a significant negative correlation with HDL. Multivariate regression analysis revealed that the independent predictors for PAD in patients with ABI< 0.9 were neuropathy, creatinine, triglyceride, LDL, urine ACR and low HDL, and in patients with ABI >1.3 were IHD, neuropathy, elevated diastolic BP and triglyceride. Conclusion: The risk of micro- and macrovascular disease is high in Egyptian patients with diabetes and PAD. Early diagnosis and good control of risk factors could reduce PAD progression.
