The interest of intranasal clonidine in the prevention of perioperative children's anxiety: a prospective randomized trial.

Introduction: perioperative anxiety in children may lead to psychological and physiological side effects. Clonidine is in increasing use in the pediatric population as an anxiolytic, sedative, and analgesic because of its central alpha2-adrenergic agonist effect. Our study aimed to evaluate the effect of clonidine in the prevention of perioperative children´s anxiety. Methods: we conducted a prospective controlled randomized double-blinded clinical trial including children aged between 2 and 15 years undergoing tonsillectomy surgery. The patients were randomly allocated to receive either an intranasal dose of clonidine (4 µg/kg) (clonidine group) or an equal volume dose of saline solution (control group) 30 minutes before entering the operating room. The level of anxiety assessed using the m-YPAS score was recorded before premedication, at the time of parent-child separation, and at the time of installation in the operating room. Acceptance of premedication, degree of sedation on entering the operating room as well as agitation on awakening, and sedation on arrival post-anesthesia care unit were noted. Adverse effects were recorded during the surgical procedure and in the postoperative recovery room. Results: the number of patients analyzed was 78 with 39 patients in each group. There were no signification differences in demographic data and premedication acceptance between the two groups. Levels of anxiety before any premedication were similar in the two groups. However, the anxiety level 30 minutes after premedication and in the operating room was significantly lower in the clonidine group (p<0.001). Children who received clonidine showed better sedation on entering the operating room (p=0.002) as well as postoperatively on entering the post-anesthesia unit care (p=0.006). The hemodynamic and respiratory parameters recorded were statistically comparable. Conclusion: intranasal clonidine is an interesting premedication to prevent perioperative children´s anxiety with few side effects.

McGrath® versus Macintosh laryngoscopes on hemodynamic response to intubation in elderly patients: a randomized clinical trial.

Introduction: laryngoscopy and tracheal intubation induce catecholaminergic release. Our study aimed to evaluate the hemodynamic impact of orotracheal intubation by McGrath® compared to the Macintosh laryngoscope in the elderly. Methods: we conducted a prospective randomized clinical trial that included elderly patients proposed for a scheduled surgery under general anesthesia with orotracheal intubation and divided into 2 groups: patients who were intubated using the McGrath® (group V) and patients who were intubated using the Macintosh direct laryngoscope (group M). Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial blood pressure (MAP), were recorded before induction of anesthesia (baseline), and at 1 min, 3 min, and 5 min after intubation. Our outcomes were the increase of SBP (∆ SBP), MAP (∆ MAP), and HR (∆ HR) between the two groups, during the 5 minutes following the start of the orotracheal intubation, intubation time and the incidence of its related complications. Results: sixty patients were included and randomized into 2 groups of 30. The average age of our sample was 70±6 years with a sex ratio of 1.22. Most of the patients were operated on for orthopedic, urologic, or abdominal surgery. There were no statistically significant differences between the two groups in terms of demographic characteristics and the duration of anesthesia (p> 0.05). The intubation time was significantly increased in group M (p≤0.001). There was a significant difference in SBP, MAP, and HR values at 1 min after orotracheal intubation compared with the baseline values in Group V(P<0,05) and Group M (p < 0.05). There was a significant increase in the first minute after tracheal intubation in terms of SBP (151±42 vs 134.5±26 mmHg, p=0.012), MAP (114±4 vs 102±17 mmHg, p=0.015), DBP (89±32 vs 84±16 mmHg, p=0.01), and HR (99.5±10 vs 94.5±2 b/min, p=0.008) when group M was compared to group V. The ∆SBP was significantly different between group M (∆SBP = 36.2±23.5mmHg) and group V (∆SBP= 30.77±21.6mmHg) (p = 0.005). There were 4 ventricular arrhythmias in group M versus zero in group V (p <0.0001). The postoperative sore throat was significantly decreased in group M vs V (p=0.036). Conclusion: the McGrath® videolaryngoscope decreased the hemodynamic fluctuations due to endotracheal intubation in elderly patients.

[The effect of intraperitoneal administration of dexamethasone on postoperative analgesia after laparoscopic cholecystectomy: a prospective randomized controlled double-blind study]. / Intérêt de la déxaméthasone en intrapéritonéale dans l'analgésie post cholécystectomie laparoscopique: étude prospective contrôlée randomisée en double aveugle.

Introduction: the effect of intravenous corticosteroids on postoperative pain has been well demonstrated; however, few studies have focused on the efficacy of intraperitoneal corticosteroid use after laparoscopic surgery. The purpose of this study was to evaluate the effect of intraperitoneal administration of dexamethasone on postoperative analgesia after laparoscopic cholecystectomy. Methods: we conducted a prospective, randomised, double-blind, controlled study, including patients scheduled for laparoscopic cholecystectomy and randomised into two groups: the group D (receiving 16 ml: 12 ml saline and 4 ml solution containing 16mg dexamethasone) and the group T (receiving 16 ml saline). The primary endpoint was: Visual Analogue Scale (VAS) for abdominal pain during the first 24 hours after surgery. The secondary endpoints were the incidence of shoulder pain, time to first request for analgesia, the consumption of morphine in the post-intervention surveillance room (PACU), the consumption of non-opioid analgesics and the incidence of nausea and vomiting during the first 24 hours after surgery as well as the presence of complications. Results: sixty patients were included in the study and divided into two groups of 30. Demographic parameters, duration of surgical and anesthesia procedures, as well as intraoperative fentanyl consumption were comparable between the two groups. Abdominal pain VAS values (p≤0.001), the incidence of shoulder pain (p<0.001), opioid and analgesic consumption (p<0.001) and the incidence of nausea (p=0.002) and vomiting (p=0.012) during the first 24 hours after surgery were significantly lower in group D. No complications related to dexamethasone administration were noted. Conclusion: intraperitoneal dexamethasone reduces postoperative pain after laparoscopic cholecystectomy.

Pericapsular nerve group block versus fascia iliaca block for perioperative analgesia in hip fracture surgery: a prospective randomized trial.

The aim of our study was to evaluate the efficacy of the pericapsular nerve group block (PENG) versus the supra-inguinal fascia iliaca compartment block (SI-FICB) to improve analgesia during positioning for spinal anesthesia (SA) for hip fracture surgery. We conducted a prospective randomized clinical trial involving patients who will undergo hip fracture surgery under SA and randomized into two groups: the PENG group: patients who received PENG block with 10 ml of 0.25% bupivacaine and 10 ml of 2% lidocaine and the SI-FICB group: patients who received SI-FICB block with the same solution. Our primary outcome was the Visual Analogue Scale (VAS) score at positioning for SA. Secondary outcomes were VAS after the block, the ease of spinal positioning (EOSP), the time to perform the block, the postoperative morphine consumption, and the VAS score at the 3rd, 6th, 12th, and 24th postoperative hours. Eighty-nine patients were enrolled and randomized into two groups: 44 in the PENG group and 45 in the SI-FICB group. The time of block performance was comparable in both groups (p = 0.195). There was a significant decrease in pain scores in the 2 groups, 20 min after the blocks at rest and while positioning for SA. PENG block provided better analgesia than SI-FICB block at positioning (P=0.046) with no significant difference in the ease of positioning (p=0.328). The morphine consumption was comparable in the 2 groups (p = 0.842). There was no significant difference in VAS scores at the 3rd, 6th, 12th, and 24th postoperative hours with p respectively 0.061, 0.767, 0.198, and 0.130. Both PENG and SI-FICB blocks provided adequate perioperative analgesia with the superiority of the PENG block in the sitting position for SA.

The effect of dexamethasone as an adjuvant in spinal anesthesia for femur upper extremity surgery: a prospective randomized trial.

Introduction: the aim of our study was to evaluate the efficacy of dexamethasone added to bupivacaine and sufentanil in spinal anesthesia to improve postoperative analgesia after femur upper extremity surgery. Methods: we conducted a prospective controlled, randomized double-blinded clinical trial including patients proposed for surgery of the upper extremity of the femur under spinal anesthesia. The patients were randomly allocated to receive intrathecally 10 mg hyperbaric bupivacaine 0.5% with 5µg sufentanil and 2 ml normal saline (control group) or 10 mg hyperbaric bupivacaine 0.5% with 5 µg sufentanil and 8 mg dexamethasone (Dexa group). The patients were evaluated for onset time and duration of sensory block, duration of pain-free period, overage consumption of morphine in the 6 first postoperative hours, hemodynamic parameters, nausea, and vomiting, or other complications. Results: fifty-eight patients were analyzed. There were no signification differences in demographic data and onset time of the sensory block between the two groups. Sensory block duration was 121.55 ± 16.42 minutes in the control group and 183.62 ± 33.93 minutes in the Dexa group which was significantly higher in the Dexa group (P<0.001). The pain-free period was longer in the Dexa group than in the control group (P<0.001). There was a reduction in morphine consumption during the first 6 postoperative hours in the Dexa group against the control group (p=0.02). The frequency of complications was not different between the two groups. Conclusion: the addition of intrathecal dexamethasone in spinal anesthesia improved the postoperative analgesia after femur upper extremity surgery.

Intravenous lidocaine versus dexamethasone to prevent postoperative vomiting in children tonsillectomy: a prospective randomized controlled trial.

Introduction: we evaluate the effectiveness of lidocaine infusion compared to the intravenous dexamethasone and placebo on postoperative vomiting and first oral intake in children post tonsillectomy. Methods: we conducted a prospective double-blinded randomized and controlled clinical trial involving children aged between 3 and 13 years proposed for elective tonsillectomy without or with adenoidectomy under general anesthesia. They were randomized into 3 groups: lidocaine group included patients who received intravenous bolus of 2 mg/kg lidocaine over 5 minutes after the induction of anesthesia. Then, they received an infusion of 1.5 mg/kg/h until the end of the surgical procedure, dexamethasone group included patients who received intravenous dexamethasone 0.15 mg/kg administrated over 5 minutes after the induction of anesthesia followed by an identical rate of 0.9% saline and the saline group included patients who received an equivalent volume of 0.9% saline. For data analysis, we tested the normality of variables using the Shapiro-Wilk test. We used analysis of variance (ANOVA) or the Kruskal-Wallis test for between-group comparisons, as appropriate. The X2 test and Fisher´s exact test were used for inferences on proportions. A two-sided P-value was considered significant when p≤0.05. All analyses were performed with IBM SPSS≤ 25.0.0 for windows. Results: eighty-three (83) children were analyzed in our study and randomized into 3 groups: 27 children for each lidocaine and dexamethasone group and 29 children for the Saline group. The demographic data were not significantly different between the three groups such as age (p=0.246), gender (p=0.378), and body mass index (BMI) with p=0.233. The duration of surgery and anesthesia was also comparable in the 3 groups (p=0.893). Patients of the lidocaine and dexamethasone group had at least one episode of retching, vomiting, or both less than the saline group in the post-anesthetic care unit with p respectively 0.015 and 0,035, and in the ward with p respectively 0.004 and 0,038 Without a significant difference between the dexamethasone and the lidocaine group. The time to the first oral intake was significantly shorter in the dexamethasone group and the lidocaine group compared with the saline group (p=0.0001) with no statistical difference between the dexamethasone and lidocaine groups. Conclusion: lidocaine infusion is as effective as intravenous dexamethasone on postoperative vomiting as well as on oral intake in children post tonsillectomy.

Continuous external compression for the treatment of humeral pseudarthrosis: a single center experience.

Humeral pseudarthrosis are common with a non-union rate after fracture between 8% and 13%. Several operative methods have been described for the treatment of humeral pseudarthrosis. The aim of this study was to assess a new approach based on compression using a monoplane external fixator without graft. This study was conducted in the Department of Orthopedic Surgery, and Traumatology of Habib Bourguiba University Hospital in Sfax-Tunisia between April 2009 and September 2018. Fifty-eight patients were operated on using a dynamic monoplane axial fixation device with continuous compression by manipulating the compression system of the fixator. All the cases were evaluated according to the modified Stewart and Hundley classification. The fracture was located in the middle third in 53.4% of the cases. The pseudarthrosis was hypertrophic in 34.5% of the cases. Fifty-four patients were treated with this method as a first cure of non-union and four patients had previously a first cure for their pseudarthrosis. We noted 11 septic pseudarthrosis. The average follow-up was 47.2 months. We obtained consolidation in 98% of the cases. The average consolidation time was 5.1 months. Based on the modified Stewart and Hundley criteria, 75.8% had very good results. This study highlights that a continuous external compression is effective in the treatment of non-unions, as it allows consolidation without opening the pseudarthrosis site and without bone grafting while having satisfactory anatomical and functional results.