Ml Of Normal Saline Research Articles

Effect of Adding Dexamethasone to Bupivacaine in Ultrasound Guided Adductor Canal Block for Post-operative Analgesia Following Knee Arthroscopy

Abstract Background Arthroscopic knee surgery refers to a large variety of surgical interventions in the knee, and numerous analgesic regimens have been investigated in order to find the best combination of analgesics for these procedures. The post-operative pain response depends on the type and duration of surgical intervention, and it can be challenging to predict which analgesic regimen will be the most appropriate for each patient until after surgery. Aim of the Work Assessing the effect of adding dexamethasone perineurally to bupivacaine in adductor canal block for post operative analgesia following knee arthroscopy under spinal anaesthesia regarding; duration of postoperative analgesia as a primary objective and one-day postoperative analgesic and opioid consumption as a secondary objective. Patients and Methods The type of study was a randomized prospective double blinded controlled clinical trial at Ain Shams University Hospitals, Cairo, Egypt. Study Period: Six months, Adult patients undergoing Knee Arthroscopy under Spinal Anaesthesia will be randomly assigned into one of the following groups using computer generated codes and opaque sealed envelopes: Group A (study group): The patients received ACB with 20 ml plain bupivacaine (0.25%) + 8 mg dexamethasone (2 ml), Group B (control group): The patients received ACB with 20 ml plain bupivacaine (0.25%) + 2 ml of Normal saline. Results There was a highly statistically significant difference between groups according to analgesic duration (time of first call for analgesics) (min) with p-value (p < 0.001). The highest value was found in group A(study) and group B(control) (241.02±36.15 and 188.49±28.27) respectively, this indicates that that the needs of analgesic in the group B were earlier compared to group A. There was a highly statistically significant difference between groups according to cumulative morphine consumption “mg” with p-value (p < 0.001). The highest value was found in Group B and Group A 4 (3-4) and 2 (1-2) respectively, this indicates much higher needs of analgesic in the Group B than group A. Conclusion We concluded that ACB is a good postoperative analgesic choice for arthroscopic knee surgery under spinal anaesthesia. However, adding (8 mg)dexamethasone to(0.25%) bupivacaine in ACB provided better prolonged postoperative analgesia and less analgesic consumption than bupivacaine alone.

Comparative Study between Intravenous and Intrathecal Dexmedetomidine in Spinal Anaesthesia in Patients Undergoing Elective Infra-Umbilical Surgery: The Effect on Haemodynamic Parameters and Postoperative Analgesia

Abstract Background One of the main objectives of anaesthesia is to alleviate the patient’s pain and agony, by ensuring the performance of surgical procedures without any discomfort. Elimination of postoperative pain is indispensable due to the central, peripheral and immunological stress response to tissue injury. So there is a need for extended analgesia without any side effects to achieve this goal. The use of opioids in intrathecal or epidural anaesthesia has become common to increase postoperative analgesia. However, opioid-induced side effects, such as respiratory depression, nausea, vomiting, urinary retention and pruritus, limit their use. Objective The objective of this study was to compare the efficacy of intrathecal dexmedetomidine as an adjuvant to hyperbaric bupivacaine to the intravenous route in patients who are undergoing elective infra-umbilical surgeries under spinal anaesthesia. The duration of analgesia and effect on haemodynamic parameters were evaluated. Moreover, undesirable side effects along with the effect on Ramsay sedation score were studied. Patients and Methods The purpose of this study was to evaluate the effect of intravenous versus intrathecal dexmedetomidine with subarachnoid anaesthesia in patients undergoing elective infraumbilical surgery. The duration of analgesia and effect on haemodynamic parameters were compared. Moreover, undesirable side effects along with the effect on Ramsay sedation score were studied. Hundred patients were randomly allocated into two equal groups (50 patients): group (A) and group (B). Group A received 3 ml of bupivacaine 0.5% plus 0.5 ml of normal saline (Total volume: 3.5 ml) along with 1µg/kg intravenous dexmedetomidine 10 minutes before the blockade. Group B received 3 ml of bupivacaine 0.5% plus intrathecal 5 µg dexmedetomidine (Precedex ©) diluted in normal saline up to the volume of 0.5 ml (Total volume: 3.5 ml). Results The results of the study revealed that the duration of the motor blockade was significantly longer in intrathecal than intravenous group (253.80 ± 20.94 vs. 205.00 ± 19.08; P < 0.001). Also, the duration of the recovery time of sensory blockade in the intrathecal group was significantly longer than those of the intravenous group (230.48 ± 17.21 vs. 181.48 ± 21.12; P < 0.001). The incidence of bradycardia was equivalent in both the groups. Although, the incidence of hypotension was greater in Group A (34.0%) in comparison to Group B (26.0%), it was not statistically significant (P > 0.05). Pain intensity especially at t6 and t12 was significantly lower in the intrathecal group as compared with the intravenous group (3.5 versus 5 at t6 and 2 versus 3 at t12, respectively). Intravenous dexmedetomidine provided a higher intraoperative sedation level and both routes provided a similar sedation level in the postoperative period. The mean dose of diclofenac consumption over a period of 24 h was less in the intrathecal group as compared to the intravenous group (100.30 ± 21.63 mg vs. 135.80 ± 23.02 mg respectively, P = 0.000) Conclusion Intrathecal dexmedetomidine prolonged the duration of sensory and motor blockade along with the postoperative analgesia, compared to IV dexmedetomidine without any significant adverse effects and hemodynamic perturbation. So, we concluded that the addition of 5 µg dexmedetomidine as an adjuvant to 0.5% hyperbaric bupivacaine intrathecally can be a better alternative to provide a satisfactory and longer duration of analgesia as compared to IV dexmedetomidine.

Comparison between the Effects of Ultrasound Guided Local Insulin Injections versus Hydrodissection of Normal Saline in Carpal Tunnel Syndrome Patients with Diabetes Mellitus

Background Hydrodissection is a minimally invasive procedure of injecting fluid into anatomic spaces to facilitate dissection and adhesiolysis in peripheral nerve entrapments. The near-nerve local insulin injection is thought to promote neuronal growth and regeneration, and could be important in restoring nerve function following metabolic or vascular damage. Aim of the Work to compare the short-term effects of insulin and normal saline local injections in the treatment of patients with diabetes mellitus who have mild-to-moderate carpal tunnel syndrome. Patients and Methods A comparative study was conducted on 30 carpal tunnel syndrome patients with diabetes mellitus during recruited from Ain Shams University Hospital, Neurosonology, neurology department during the period January 2020 to March 2021 according to the regulation of Ain Shams University ethical and scientific committee. The privacy of participants and confidentiality of the data were guaranteed during various phases of the study. Results the Hydrodissection (10 ml of normal saline) of the median nerve is significantly effective in the treatment of mild to moderate carpal tunnel syndrome in patients with diabetes mellitus and alleviates the symptoms of CTS. Also the study showed that the local insulin injection (10 IU of NPH) alone is significantly effective in the management of mild to moderate carpal tunnel syndrome of diabetic patients, which shows significant response within two weeks of follow up. The study shows that Hydrodissection is slightly superior to insulin for treatment of CTS. Furthermore our current study compares the failure rate of both treatment modalities which implies that Hydrodissection group are less failure rate than insulin group, but this difference is insignificant due small sample size of both groups. Conclusion Hydrodissection and local insulin injection are effective methods in the management of mild to moderate Carpal Tunnel Syndrome of diabetic patients with superiority of ultrasound guided hydrodissection to Insulin. It is noteworthy this study is considered a pioneer in comparing HD and Insulin in managing CTS.

Relation between 25-Hydroxy Vitamin D Deficiency and Success of Cardioversion for Lone Atrial Fibrillation (AF)

Abstract Aim and objectives The aim of this study was to assess the relationship between vitamin D deficiency and extent of success of cardioversion in patients with lone atrial fibrillation (AF). Patients and Methods This observational cross-sectional study included 50 patients (18-60 years old) who presented to the cardiology department of Ain Shams university hospitals with lone atrial fibrillation with structurally normal heart for cardioversion after fulfilling the inclusion criteria, considering that failure of cardioversion was defined as failure of restoration to normal sinus rhythm after applying the cardioversion protocol that is being used in our cardiology department in Ain Shams University hospitals. Serum vitamin D level on admission was sampled for all patients before cardioversion, and cardioversion was assessed after then whether success or failure. Cardioversion success was restoration of normal sinus rhythm and that the patient was discharged in sinus rhythm. Cardioversion protocol that was being used was applied as Loading dose of Intravenous (IV) Amiodarone of 300 mg diluted in 250 ml 5% dextrose over 30-60 minutes, then follow up dose of 900 mg IV over 24 hours diluted in 500-1000 ml of normal saline, then if failed, application of biphasic synchronized direct current electrical cardioversion at 200 joules at anteriorlateral electrode positions. Results The success rate of cardioversion was 80% (40 out of 50) in all the patients presented, and the failure rate was 20% (10 out of 50). In the success group, majority of patients 23 (57.5%) had sufficient Vitamin D levels (≥30 ng/ml), 15 patients (37.5%) had insufficient vitamin D levels (21-29 ng/ml) and 2 patients (5%) had deficient vitamin D levels (≤20 ng/ml). Meanwhile, in the failure group, the majority of patients 8 (80%) had deficient vitamin D levels (≤20 ng/ml), 1 patient (10%) had insufficient vitamin D level (21-29 ng/ml), and 1 patient (10%) had sufficient vitamin D level (≥30 ng/ml).This difference was statistically significant with a P value of < 0.01. Vitamin D level measured (25-OH vitamin D) had values of mean ± SD of 29.41 ± 4.89 ng/ml in the success group vs 19.22 ± 4.68 ng/ml in the failure group, which was statistically significant with a P value of <0.01. A-P (antero-posterior) LAD (left atrial diameter) measured in parasternal long axis view during routine pre-cardioversion work-up study by echocardiography that has been done, had values of mean ± SD of 37.60 ± 3.20 mm in the success group vs 37.80 ± 2.86 mm in the failure group, which was statistically non- significant with a P value of 0.858. There was not a statistically significant difference between the 2 groups regarding age, sex, BMI, smoking, duration of AF(duration of onset of symptoms), number of previous trials of cardioversion, previous antiarrythmic drugs that have been administered and heart rate at time of cardioversion. Conclusion Failure rate of cardioversion was found to be higher in patients with vitamin D deficiency in comparison to patients with sufficient and insufficient vitamin D levels. Abbreviations AF: Atrial Fibrillation; A-P: Antero-posterior; BMI: Body mass index; LAD: Left atrial diameter; SD: Standard deviation

The histological effects of different doses of methidathion pesticide on the lungs of Mus musculus mice

The current study investigated the effect of two doses of the organophosphorous pesticide methidathion on the lungs of laboratory mice Mus musculus L. The animals were divided into three equal groups: the first group represented the control group injected through the intraperitonial membrane with 0.1 ml of normal saline, and the second and third groups were injected with 0.1 ml of methcathinone solution at a concentration of (1.2, 2.4 mg/kg) respectively. The histological study of the lung of groups treated with methadone showed the presence of histological changes in the low-dose group represented by hyperplasia represented by the enlargement and swelling of the lining of the alveoli and the narrowing of its cavities as well as congestion, bleeding and infiltration of inflammatory cells. Whereas the second treated group showed more histological changes in lung composition, represented by the infiltration of inflammatory cells near the respiratory channels and around the walls of blood vessels that appeared congested with blood, edema and bleeding between the alveoli were noted. Key Words: Lung, Histological changes, Organophosphorous methidathion pesticide.

Study the role of eques extract of Eucalyptus on some blood and biochemical parameters in laboratory rate .(Rattus Rattus)

present study was conducted at Veterinary Medicine college_ University of Basra to evaluated the effect and activation of eques extract of Eucalyptus globulus plant on some blood and biochemical parameters as well as on body weight in laboratory white rats. The experiments was divided into three group each group consist of six animal, the first group treated with 0.2 ml of normal saline(0.9%) for 15 The days and the second and third group treated with(0.2 and 0.4 )ml from eques extract of Eucalyptus globulus for 15 days, the experiment showed that significant decrease (p≤0.05) in body weight ,red blood cell, hemoglobin ,packed cell volume and white blood cell as well as significant decrease in the level of glucose in the blood , the experiment showed significant increase in the liver enzyme ALT and AST and increase the level of urea and creatinine .

Pericapsular nerve group block in hip arthroplasty: A prospective randomized trial.

This study aimed to evaluate the analgesic effect of the ultrasound-guided pericapsular nerve group (PENG) block in hip arthroplasty (HA) surgery. A prospective double-blinded, randomized study. Tertiary institutional clinical care. Fifty patients, more than 50 years old of both genders, were chosen according to the American Society of Anesthesiologists classification, with physical status I-III, and scheduled for unilateral HA surgeries. Patients were randomized to receive either a sham PENG block with 20 mL of normal saline (control group) or a PENG block with 20 mL of bupivacaine 0.25 percent (PENG group). From the onset of the first request for rescue opioid analgesia, preoperative pain scores before and after block (at rest and with a raised straight leg), the incidence of quadriceps weakness after the block, intraoperative fentanyl consumption, post-operative pain scores, and morphine consumption, besides the presence and frequency of adverse events, were recorded. The patients undergoing PENG block with bupivacaine had prolonged durations before the first analgesic request, lower perioperative pain scores, less intraoperative rescue fentanyl, and less post-operative morphine consumption than the control group, with nonsignificant motor weakness after the block and similar adverse events. The PENG block provided effective perioperative analgesia for HA with prolonged duration of analgesia, nonsignificant motor effects, reduced perioperative opioids consumption, and no major side effects.

Comparison of Nalbuphine Versus Clonidine as an Adjuvant to Intrathecal Hyperbaric Bupivacaine in Orthopedic Lower Limb Surgeries: A Randomized Controlled Double-Blind Study.

Nalbuphine and clonidine are used as adjuvants to intrathecal local anesthetics, but studies on their comparative efficacy have shown inconsistent results. This study aimed to compare nalbuphine, clonidine, or normal saline as adjuvants to intrathecal hyperbaric bupivacaine in orthopedic lower limb surgeries. Method: Sixty-threeAmerican Society of Anesthesiologists (ASA) I/II patients between 18 and 60 years old with lower limb fractures were randomized into three groups (n=21 each). Patients with contraindications to spinal block, bilateral lower limb fractures, or long-term opioid therapy were excluded. The subarachnoid block was given in L3-L4 interspace. Group N received 1 mg of nalbuphine, group Cl received 30 mcg of clonidine, and group C received 0.5 ml of normal saline with 15 mg (0.5%) of hyperbaric bupivacaine. Sensory and motor block characteristics, hemodynamic variables and side effects were noted, and the data were analyzed using Student's t-test, Mann-Whitney test, Chi-square test, and ANOVA followed by Tukey's test. Patients receiving intrathecal nalbuphine (group N) and clonidine (group Cl) had a faster onset of the sensory and motor block than controls (group C) (p=0.000). The time to two-segment regression was more prolonged in group Cl when compared to group N (p=0.000). Duration of spinal analgesia was 216.75 ± 25.96 minutes, 292.86 ± 24.92 minutes, and 178.50 ± 16.06 minutes in groups N, Cl, and C, respectively (p=0.000). The 24-hour rescue analgesic requirement was maximum in group C and least in group Cl (p=0.000). The three groups were comparable to each other in terms of side effects. Clonidine was found to be superior to nalbuphine as an intrathecal adjuvant with no significant side effects.

A comparative study of efficacy of ropivacaine (0.75%) with adjuvants – dexmedetomidine and fentanyl in supraclavicular brachial plexus block

Background: Brachial plexus block is preferred to general anesthesia (GA) as it reduces many complications of GA, provides good intra and postoperative analgesia, adequate muscle relaxation. Addition of adjuvants along with LA is used to prolong block with improved quality of anesthesia and decrease dose of LA. This study was done to see the efficacy of Ropivacaine with dexmedetomidine and fentanyl in terms of duration of action and pain relief. Aims and Objectives: Dexmedetomidine and Fentanyl along with Ropivacaine in patients undergoing upper limb surgeries, the onset and duration of sensory and motor blockade as well as post op analgesia is compared. Materials and Methods: Prospective Randomized Comparative study with three groups randomly divided received total volume of 30 mL of drug in peripheral nerve stimulator guided supraclavicular blocks in patients undergoing upper limb surgeries. Group Dexmedetomidine received 28 cc of 0.75% Ropivacaine and Dexmedetomidine (1 mcg/kg), Group Fentanyl patients received 28 cc of 0.75% Ropivacaine and fentanyl (1 mcg/kg), whereas, group plain Ropivacaine patients received 28 cc of 0.75% Ropivacaine and 2 mL of normal saline. Haemodynamics, sensory and motor block (MB) were evaluated by VAS and modified Bromage scale. Results: The onset of sensory block and MB in the dexmedetomidine group, fentanyl group, and ropivacaine groups was 3.57±0.50 min and 4.47±0.51 min, 5.50±0.51 min and 7.53±0.51 min, and 8.07±0.79 min and 10.07±0.79 min respectively which were statistically significant. The duration of MB in the dexmedetomidine group, fentanyl group, and ropivacaine group were 6.57±0.50 h, 4.47±0.51 h, and 2.50±0.51 h respectively which was statistically significant (P=0.0000). The duration at which first postoperative analgesia was required in the dexmedetomidine group, fentanyl group, and ropivacaine group were 8.57±0.50 h, 6.57±0.50 h, and 5.30±0.47 h respectively. Conclusion: Dexmedetomidine is better as an adjuvant to Ropivacaine for brachial plexus block in terms of onset and duration.

Emblica officinalis Reduces Copper Mediated Inflammation And Preserves Liver Morphology InThe Murine Model

Introduction: Copper (Cu) is a metal widely used in agriculture and in industries. Its hepatotoxicity is established in literature. Emblica officinalis, locally known as Amla, has many beneficial health effects and is scientifically reported to be a powerful antioxidant. Aim & Objective: To determine the role of Emblica officinalis fruit in reducing Cu induced inflammation and distortion of hepatic lobules of adult albino rats. Place and duration of Study: The study was done in the Department of Anatomy, Shaikh Zayed Medical College, Lahore for a period of 4 weeks. Material & Methods: 36 Adult male albino rats were equally divided into three groups (A, B, C) by randomization and acclimatized for 1 week. 1.5 ml of normal saline was given to rats of Group A (control) and CuSO4 (200mg/kg b.w./day) was given to those in group B (Cu treated) once daily via orogastric tube. Rats in group C (Cu+EO treated) were given both CuSO4 (200mg/kg bw) and Emblica officinalis fruit extract (300mg/kg bw) once daily by orogastric intubation. The animals were sacrificed after 28 days and livers were dissected out for histological study. Data was entered and analyzed using SPSS version 22. Results: Cu treated rats developed significant distortion of liver architecture and inflammation while Emblica officinalis co-treatment lead to decreased inflammation with preservation of shape of hepatic lobule. These findings were further confirmed by difference in diameters of hepatic lobules between control, Cu-, Cu+EO- treated groups. Conclusion: Emblica officinalis, by limiting oxidative damage, ameliorates hepatic inflammation and preserves liver architecture. Therefore, its use as a hepatoprotective agent should be encouraged.

Laparoscopic administration of bupivacaine at the uterosacral ligaments during benign laparoscopic and robotic hysterectomy: a randomized controlled trial

Postoperative pain continues to be an undermanaged part of the surgical experience. Multimodal analgesia has been adopted in response to the opioid epidemic, but opioid prescribing practices remain high after minimally invasive hysterectomy. Novel adjuvant opioid-sparing analgesia to optimize acute postoperative pain control is crucial in preventing chronic pain and minimizing opioid usage. This study aimed to determine the effect of direct laparoscopic uterosacral bupivacaine administration on opioid usage and postoperative pain in patients undergoing benign minimally invasive (laparoscopic and robotic) hysterectomy. This was a single-blinded, triple-arm, randomized controlled trial at an academic medical center between March 15, 2021, and April 8, 2022. The inclusion criteria were patients aged >18 years undergoing benign laparoscopic or robotic hysterectomy. The exclusion criteria were non-English-speaking patients, patients with an allergy to bupivacaine or actively using opioid medications, patients undergoing transversus abdominis plane block, and patients undergoing supracervical hysterectomy or combination cases with other surgical services. Patients were randomized in a 1:1:1 fashion to the following uterosacral administration before colpotomy: no administration, 20 mL of normal saline, or 20 mL of 0.25% bupivacaine. All patients received incisional infiltration with 10 mL of 0.25% bupivacaine. The primary outcome was 24-hour oral morphine equivalent usage (postoperative day 0 and postoperative day 1). The secondary outcomes were total oral morphine equivalent usage in 7 days, last day of oral morphine equivalent usage, numeric pain scores from the universal pain assessment tool, and return of bowel function. Patients reported postoperative pain scores, total opioid consumption, and return of bowel function via Qualtrics surveys. Patient and surgical characteristics and primary and secondary outcomes were compared using chi-square analysis and 1-way analysis of variance. Multiple linear regression was used to identify predictors of opioid use in the first 24 hours after surgery and total opioid use in the 7 days after surgery. Of 518 hysterectomies screened, 410 (79%) were eligible, 215 (52%) agreed to participate, and 180 were ultimately included in the final analysis after accounting for dropout. Most hysterectomies (70%) were performed laparoscopically, and the remainder were performed robotically. Most hysterectomies (94%) were outpatient. Patients randomized to bupivacaine had higher rates of former and current tobacco use, and patients randomized to the no-administration group had higher rates of previous surgery. There was no difference in first 24-hour oral morphine equivalent use among the groups (P=.10). Moreover, there was no difference in numeric pain scores (although a trend toward significance in discharge pain scores in the bupivacaine group), total 7-day oral morphine equivalent use, day of last opioid use, or return of bowel function among the groups (P>.05 for all). The predictors of increased 24-hour opioid usage among all patients included only increased postanesthesia care unit oral morphine equivalent usage. The predictors of 7-day opioid usage among all patients included concurrent tobacco use and mood disorder, history of previous laparoscopy, estimated blood loss of >200 mL, and increased oral morphine equivalent usage in the postanesthesia care unit. Laparoscopic uterosacral administration of bupivacaine at the time of minimally invasive hysterectomy did not result in decreased opioid usage or change in numeric pain scores.

Early Posttraumatic Antifibrinolysis Reduces Perioperative Hidden Blood Loss in Elderly Patients with an Intertrochanteric Fracture: A Randomized Controlled Trial.

This study aimed to determine the efficacy and safety of posttraumatic antifibrinolysis with multidose tranexamic acid (TXA) in reducing perioperative hidden blood loss (HBL) in elderly intertrochanteric fracture patients. Ninety-six elderly intertrochanteric fracture patients admitted to our department from June 2021 to September 2022 were randomized into two groups. The control group (Group A) received 100 mL of normal saline, while the experimental group (Group B) received 1.5 g of TXA intravenously q12 h from postadmission Day 1 (PAD1) to the day before surgery, and both groups received 1.5 g of TXA q12 h from postoperative Day 1 (POD1) to POD3. Haemoglobin (Hb), haematocrit (Hct), coagulation parameters, fibrinogen degradation product (FDP), and D-dimer (D-D) were recorded from PAD1 to POD3. HBL was calculated using the gross formula and recorded as the primary outcome. In all-over analyses, the patients in Group B had lower perioperative HBL (on PAD3, POD1, and POD3), preoperative HBL (HBLpre), decline of haemoglobin (ΔHb-on PAD3), allogeneic blood transfusion (ABT) rate, FDP (on PAD3), and D-D (on PAD3) compared with Group A. No significant differences were exhibited in postoperative HBL (HBLpost) between the 2 groups. In subgroup analyses, for patients who received intervention within 24 h, the result is consistent with the whole. For patients who received intervention over 72 h of injury, there were no significant differences in perioperative HBL, ΔHb, ABT rate, FDP, and D-D between the 2 groups. There were no significant differences in APTT, PT, the rate of venous thromboembolism, wound complications, or 90-day mortality between the 2 groups. For elderly intertrochanteric fracture patients, early posttraumatic antifibrinolysis with multidose TXA is effective in reducing perioperative HBL, which mainly manifests as the reduction of preoperative HBL, especially for patients injured within 24 h. Application of TXA beyond 72 h of injury was ineffective.

RETRACTED ARTICLE: Oxytocin versus a combination of tranexamic acid and ethamsylate in reducing intraoperative bleeding during abdominal myomectomy: a randomized clinical trial

ObjectiveMyomectomy is the preferred surgical approach to manage uterine fibroids. However, uterine fibroids are highly vascular tumors and, consequently, extremely susceptible to problems from myomectomy-related hemorrhage. Hence, we aim to compare oxytocin efficacy and safety profile versus tranexamic acid (TA) with ethamsylate for reducing bleeding during myomectomy.MethodsThis randomized, double-blinded multicenter study was performed between 20th August 2020 and 20th October 2020 at El-Galaa Teaching Hospital, El Hussein University Hospital, Al-Azhar University Hospitals of Assiut, and Al-Azhar University Hospitals of Damietta. One hundred and eighty patients were enrolled and divided into three groups: group (1) received an injection of 30 IU of oxytocin in 500 ml of normal saline; group (2) received injections of 1 g of TA, 250 mg of Ethamsylate, and 110 ml of normal saline IV; and group (3) received an injection of 110 ml of normal saline IV just before surgical incision.ResultsIn 180 premenopausal women, oxytocin and TA with ethamsylate had no significant value in lowering intraoperative blood loss compared with the placebo for abdominal myomectomy (666.25 ± 183.03, 630.72 ± 145.83, and 646.67 ± 168.92, respectively (P = 0.506)). Non-significant trends were observed for a reduction in operation time (P = 0.760), intra/postoperative blood transfusion (P = 0.624), hospital stay (P = 0.986), postoperative fever (P = 0.659), and wound infection (P = 1).ConclusionOxytocin and TA with ethamsylate had no significant value in lowering intraoperative blood loss compared with the placebo for abdominal myomectomy which opens a new question about the role of the use of the hemostatic drug during myomectomy especially in centers with limited resources and had higher rates.Trial registrationThe study was registered on Pan African Clinical Trials Registry with the following number: PACTR202008739887429 and was approved on 24/08/2020.

Comparison of amikacin lung delivery between AKITA® and eFlow rapid® nebulizers in healthy controls and patients with CF: A randomized cross-over trial

IntroductionNebulization plays a key role in the treatment of cystic fibrosis. The Favorite function couple to jet nebulizers (AKITA®) emerged recently. The aim of this study was to assess the efficiency of the lung delivery by the AKITA® by comparing the urinary concentration of amikacin after nebulization with the AKITA® and the eFlow rapid®, in healthy subjects and patients with CF (PwCF). MethodThe two samples (healthy subjects and PwCF) were randomized (cross-over 1:1) for two nebulizations (500 mg of amikacin diluted in 4 mL of normal saline solution), with the AKITA® and with the eFlow rapid®. The primary endpoint was the amount of urinary excretion of amikacin over 24 h. The constant of elimination (Ke) was calculated based on the maximal cumulative urinary amikacin excretion plotted over time. ResultsThe total amount of urinary amikacin excretion was greater when AKITA® was used in PwCF (11.7 mg (8.2–14.1) vs 6.1 mg (3.7–13.3); p = 0.02) but not different in healthy subjects (14.5 mg (11.7–18.5) vs 12.4 mg (8.0–17.1); p = 0.12). The duration of the nebulization was always shorter with eFlow rapid® than with AKITA® (PwCF: 6.5 ± 0.6 min vs 9.2 ± 1.8 min; p = 0.001 – Healthy: 4.7 ± 1.3 min vs 9.7 ± 1.6 min; p = 0.03). The constant of elimination was similar between the two modalities in CF subjects (0.153 (0.071–0.205) vs 0.149 (0.041–0.182); p = 0.26) and in healthy subjects (0.166 (0.130–0.218) vs 0.167 (0.119–0.210), p = 0.25). Conclusionthe Favorite inhalation is better to deliver a specific amount of drug than a mesh nebulizer (eFlow rapid®) in PwCF but not in healthy subjects.

Effect of Intravenous Dexamethasone on the Duration of Analgesia Provided by Supraclavicular Brachial Plexus Block for Upper Limb Surgery

Background: Pain is associated with increased sympathetic activity leads to tachycardia, elevated blood pressure and myocardial insults so pain control is necessary during the surgery and in the postoperative period. Aim of the study was to study the effect of intravenous dexamethasone on the duration of analgesia provided by supraclavicular block (SCB) for upper limb surgery.
 Methods: 75 patients, age between 18 to 70 years of either sex, ASA class I and II, who were undergoing upper limb surgery randomized into three groups of 25 patients each by computer generated random number. Group S - 25 patients were given 5ml of normal saline intravenously along with ultrasound-guided SCB with 25ml 0.5% bupivacaine. Group DF - 25 patients were given 4mg intravenous dexamethasone in 5ml normal saline along with ultrasound-guided SCB with 25ml 0.5% bupivacaine. Group DE - 25 patients were given 8mg intravenous dexamethasone in 5ml normal saline along with ultrasound-guided SCB with 25ml 0.5% bupivacaine.
 Results: The demographic data were comparable in all groups. The VAS score was significantly lower in Group DF and DE compared to Group S at 3,4,6,8,10,12 and 24 hours, with p values < 0.0001 at 3,4,5,6,8,10 and 12 hours and p value 0.0002 at 24 hours. The VAS scores between the groups DF and DE were comparable at 3,4,5,6,8,10,12 and 24 hours without any significant difference. The time for first rescue analgesia was significantly in Group DF and DE compared to Group S (p value <0.0001). There was no significant difference between the groups DF and DE in the time for first rescue analgesia (p value 0.75).
 Conclusion: We conclude that dexamethasone used intravenously even in lower doses as 4mg along with supraclavicular brachial plexus block effectively increases the duration of analgesia and motor blockade, shortens the onset of sensory and motor blockade, reduces the total analgesic requirement in the first 24 hours after surgery.

Evaluation of Histopathologic Findings and Safety of Intravitreal Ketamine Administration on Vitreoretinal Tissue in Rat Model: A Pilot Study.

To evaluate the safety and histological findings of intravitreal injection of ketamine in rats. Each rat received a total volume of 0.1 ml of ketamine 0.01 mol/L (5 rats as ketamine group) or a total of 0.1 ml of normal saline 0.9% (5 rats as control group) under general anesthesia in a sterile condition. A histology assessment was performed 1 month after the intravitreal injection. Lens opacity, necrosis, and atrophy of retinal layers and optic disc were not seen in five specimens in the ketamine group and five in the normal saline group. There was no inflammation in the vitreous, retinal layers, choroid, optic disc, and optic nerve in both groups. Intravitreal injection of ketamine in a special dose has no obvious adverse effect on diverse intraocular tissue.

Effect of lignocaine versus sodium bicarbonate on reducing pain due to intravenous injection of propofol: a prospective randomised double-blinded, controlled study

Context Propofol is the most commonly used intravenous (IV) anesthetic drug for induction of anaesthesia and for sedation, but pain which occur during its injection still remains a problem. Approximately 70 to 90% of patients who receive propofol for anaesthesia induction experience pain during injection and this pain can be quite severe. The most frequently used drug to alleviate pain in propofol injection is IV Lignocaine which acts through the local anesthetic effect on the veins. Administration of sodium bicarbonate with lidocaine was proved to reduce pain in propofol injection through increasing sodium ions concentration as well as increasing serum pH through its buffering effect. Aims To compare the effect of adding lignocaine vs sodium bicarbonate to propofol in reducing pain on propofol injection. Settings and design A randomized, controlled, double-blinded trial. Methods and material One hundred and eighty patients underwent conscious sedation during surgical procedures were randomly divided into three equal groups as follows: Group (L) 3 ml (60 mg) of lignocaine 2% premixed with propofol, group (B) 3 ml of sodium bicarbonate 8.5% premixed with propofol and group (S) 3 ml of normal saline premixed with propofol. The 3 groups were compared regarding pain intensity immediately after IV injection of propofol using the four-point verbal rating and BP. Results The incidence of pain and the pain score were significantly lower in the lignocaine group (43%) in comparison to both group (Saline 81% and bicarbonate 71%) P value < 0.001. However, no difference in pain score or the incidence of pain were found between Group S and Group B. Conclusions Our study demonstrated that mixing lignocaine with propofol appears to be effective in reducing both the incidence and severity of the pain during propofol injection when compared to mixing propofol with sodium bicarbonate or normal saline.

Effectiveness of Dexmedetomidine as premedication to modify the heart rate response to modified electroconvulsive therapy: a randomized controlled trial

Abstract Background: The present study aims to examine whether using Dexmedetomidine as a premedication can reduce heart rate (HR) and peak HR during modified electroconvulsive therapy (ECT). It is known that the acute hemodynamic stress induced by ECT may elevate the risk of cardiovascular complications in psychiatric patients. Previous research has suggested that β-blockers and α-2 adrenergic agonists effectively alleviate the hyperdynamic responses to ECT. Therefore, the current study seeks to determine whether Dexmedetomidine can offer similar benefits in regulating HR fluctuations during the modified ECT procedure. Materials and Methods: In this prospective, double-blinded, randomized controlled study, a total of 60 psychiatric patients aged between 18 and 50 years, categorized as per the American Society of Anaesthesiologists score I and II, and scheduled for ECT, were included. These patients were randomly divided into two groups: Group D, which received 50 mL of normal saline (NS) with 1 µg/kg of Dexmedetomidine, and Group C, which received 50 mL of NS only. HR measurements were taken every 15 s for 5 min following the modified ECT, and any changes in peak HR were carefully recorded and analyzed. Results: The mean age (years) and weight (kg) in groups C and D were 29.5 ± 7.82 and 32.5 ± 8.37, 59.4 ± 5.33 and 58.6 ± 4.57, respectively. Both groups did not differ significantly concerning age (P = 0.157) and weight (P = 0.519). Statistically, no significant difference in mean HR (baseline, before ECT, and peak HR following ECT within 5 min) was observed between study groups. In group D, the rise in HR was significantly less when compared to group C (P = 0.001). The groups had a significant (P = 0.001) difference in HR before ECT. Conclusions: The administration of Dexmedetomidine at a dose of 1 µg/kg as premedication resulted in a notable decrease in HR and peak HR responses during the modified ECT.

Intraoperative local infiltration anesthesia effect on post-operative pain after total knee replacement

Background: Pain following TKA renders rehabilitation difficult. Local infiltration anesthesia (LIA) could significantly decrease post-operative pain. Aim was to assess the effect of peri-articular intraoperative LIA during primary TKA on post-operative pain. Methods: This prospective, randomized and double-blind study included 150 patients, aged 65-74 years, of both sexes with stage 4 knee osteoarthritis who were assigned for primary TKA at Queen Alia Military hospital, Amman-Jordan, during the period May 2022–December 2022. Patients were divided into two groups. LIA group (GI, n=75) received a single peri-articular LIA during surgery. The cocktail comprised 75 mg diclofenac sodium, 100 mg bupivacaine, and 0.5 mg adrenaline. The cocktail was diluted in 100 ml of normal saline and split into two syringes, 50 ml each. Patients in control group (GII, n=75) received only 100 ml of normal saline. When patients had pain postoperatively, 1 mg morphine was given intravenously at 15-minute intervals. Primary outcomes were verbal analog scale (VAS) pain score from day 1 to 6 after surgery and overall morphine administration. Results: On day 1 after surgery, the average VAS was 4.19 in the LIA group vs. 6.08 in group II (p<0.002), while it was 4.01 versus 4.78 (p>0.05) on day 6. Overall morphine requirement and pain scores from day 1 to day 6 after surgery were less in the LIA group than in the other group, 13.06 mg versus 20.75 mg (p<0.004). Conclusions: Peri-articular LIA during TKA significantly improve post-operative pain and decreases morphine use.

Electromotive Drug Administration Chemotherapy with Mitomycin C Versus Bacillus Calmette-Guerin for the Treatment of Non-Muscle Invasive Bladder Cancer.

Devices that increase the penetrance of intravesical chemotherapeutics are emerging as alternatives to classical Bacillus Calmette Guérin (BCG) treatment. To compare the efficacy of mitomycin C applied with the electromotive drug delivery device (MMC-EMDA) versus BCG in patients with intermediate and high-risk non-muscle-invasive bladder cancer (NMIBC) without carcinoma in situ (CIS). Prospective non-randomized study in which 47 patients received MMC-EMDA (40 mg of MMC diluted in 50 mg of distilled water at 20 mA for 30 min. Regimen of 6 weekly and then 6 monthly instillations) and 48 patients received BCG (50 mg of OncoCITE® diluted in 50 ml of normal saline for 60 min. Regimen of 6 weekly instillations and then 3 weekly instillations at months 3, 6 and 12). The primary endpoint was the recurrence-free rate (RFR) at 24 months. Secondary endpoints were time to recurrence and progression-free rate (PFR) at 24 months follow-up. Baseline patient assessment and mean follow-up time were similar in both groups (MMC-EMDA group: 26.4 months; BCG group: 28.4 months (p = 0.44)). The RFR at 24 months was 80.9% for the MMC-EMDA group and 77.1% for the BCG group (p = 0.969). The mean time to recurrence was 12.5 months in the MMC-EMDA group and 14 months in the BCG group (p = 0.681). At 24 months, PFR was 97.9% in the MMC-EMDA group and 93.8% in the BCG group (p = 0.419). No differences were found between MMC-EMDA and BCG treatments in patients with high-risk and intermediate-risk NMIBC without CIS.