RESUMO
Background and Aims: Many drugs have been tried as adjuvant to local anesthetic in different nerve blocks. Ketorolac is one of them, but it has never been used in pectoral nerve block. In this study, we evaluated its adjuvant effect with local anesthetic on postoperative analgesia in ultrasound (US)-guided pectoral nerve (PECS) blocks. The aim was to assess the quality and the duration of analgesia by the addition of ketorolac in the PECS block. Material and Methods: 46 patients who underwent modified radical mastectomies under general anesthesia were randomized into two groups: control group, where pectoral nerve block was given with bupivacaine 0.25% only; and ketorolac group, where the block was given with bupivacaine 0.25% and ketorolac 30 mg. Results: Patients who needed postoperative supplemental analgesia were significantly less in the ketorolac group (9 vs 21 patients, P = 0.00) and that first-time analgesic requirement was significantly later in the ketorolac group (14 hrs) postoperatively compared to the control group (9 hrs) postoperatively. Conclusion: Adding ketorolac to bupivacaine in pectoral nerve block safely increases postoperative duration of analgesia.
RESUMO
The objective of this study is to assess the safety and efficacy of forced diuresis as an antiretropulsion strategy during the pneumatic disintegration of solitary lower ureteric stones with semi-rigid ureteroscopy (URS). A prospective randomized double-blind study was carried out from March 2019 to June 2021 for patients presented with unilateral solitary radiopaque lower ureteric stones ≤ 20 mm. Patients were randomized for URS into two groups, according to the use of forced diuresis using furosemide 1 mg/kg (GII) or not (GI). Perioperative parameters were compared between both groups, including retropulsion rate, stone-free rate (SFR), and need for auxiliary procedures and complications. A total of 148 patients were included; 72 (48.6%) in GI and 76 in the GII (51.4%), with respective stone size of 11.8 ± 2.6 vs.12.1 ± 2.4 mm. Both groups were comparable in demographic and baseline data, with a mean age of 47 ± 16 and 50 ± 14 years for GI and GII, respectively. GII had a significantly shorter disintegration time (10.5 ± 1.3 vs. 4.2 ± 2.1 min, p < 0.001), shorter operative time (33.1 ± 10.1 vs. 40.8 ± 9.1 min, p < 0.001), lower stone fragments migration rate during disintegration (6.5% vs. 18.1%, p = 0.04), lower retropulsion rate (1.3% vs. 11%, p = 0.02), higher SFR (96.1% vs. 86.1%, p = 0.04), and lower auxiliary procedures (3.9% vs. 13.8%, p = 0.03). Intraoperative and 6-h postoperative changes in heart rate and mean systolic blood pressure were comparable between both groups. Ephedrine injection (6-18 mg) was needed in significantly more GII patients (39.5% vs. 20.8%, p ≤ 0.01). It seems that forced diuresis during pneumatic lithotripsy of the lower ureteric stones is a safe and effective antiretropulsion technique. This would expand the alternative options to the antiretropulsion strategy, especially in centers where the laser and flexible ureteroscopes are not available.
