Ahmed A. Badawy

Preoperative gabapentin alone or in combination with dexamethasone on postoperative pain relief after abdominal hysterectomies. A randomized controlled trial

Abstract Objectives To investigate the role of combining preoperative gabapentin with dexamethasone in the management of post-operative pain following abdominal hysterectomy. Methods This prospective randomized double blinded study included 60 females scheduled for abdominal hysterectomy under general anesthesia. They were randomized into three equal groups [20 patients each]; group C [Control]: received oral placebo and intravenous 2 cc normal saline 0.9%, group G [Gabapentin]: received 800 mg gabapentin orally and intravenous 2 cc normal saline 0.9% and group GD [Gabapentin/Dexamethasone]: received 800 mg gabapentin orally and intravenous 8 mg/2 cc dexamethasone. Intraoperative fentanyl requirement, postoperative pain, sedation and nausea and vomiting were assessed at 2, 6, 12 and 24 h postoperative. Time of the first request for analgesia and total postoperative meperidine dose over 24 h were calculated. Results Intraoperative fentanyl requirement, time of the first analgesic request, total 24 h meperidine consumption and VAS score at 2 and 6 h postoperatively showed highly statistically significant difference between group (GD) [added dexamethasone to gabapentin] and gabapentin (G) alone or control (C), meanwhile there was statistically significant difference between (G) and (C) groups. VAS score was statistically significant lower among the three studied groups when assessed at 12 h postoperatively. There were no statistically significant differences among the three groups as regards the postoperative sedation scale. PONV was highly statistically significant less observed in groups (GD) and (G) at 2 h and statistically significant less observed at 6 h postoperatively when compared to the control group (C). Conclusion Gabapentin alone reduced the intraoperative and postoperative opioid requirement as well as postoperative pain and PONV which was significant in comparison with the placebo effect in the control. Obviously these effects were more prominent and highly significant when dexamethasone was added to gabapentin.

Post-spinal anesthesia hypotension during cesarean delivery, a review article

Abstract Maternal hypotension is a common complication after spinal anesthesia for cesarean delivery. Prevention and treatment of post-spinal hypotension (PSH) in cesarean delivery has been frequently investigated. Fluid loading is superior to no-fluid regimen; however, the incidence of PSH is still high with all fluid loading protocols; thus, the use of fluid loading as a sole method for prophylaxis might be not satisfactory for many anesthetists. Phenylephrine is the preferred vasopressor for prevention and management of PSH in most cases. Ephedrine may be more beneficial in patients with bradycardia, patients with uteroplacental insufficiency and pre-eclamptic patients. Norepinephrine infusion was recently investigated as an alternative for prophylaxis of PSH with minimal cardiac side effects. The high incidence of PSH with most of the pharmacological and non-pharmacological methods suggests the need for multimodal protocols for prevention and management of this problem. PSH in cesarean delivery is a common daily situation facing all anesthetists; thus, future research should focus on simple and rapid protocols that can be easily applied by anesthetists with moderate and low experience with minimal need to complex devices or costly drugs.

Effect of tramadol gargle on postoperative sore throat: A double blinded randomized placebo controlled study

Abstract Background Postoperative sore throat is an undesirable complaint after general anesthesia with laryngeal mask airway. Tramadol is a synthetic codeine analogue with NMDA receptor antagonist and local anesthetic effects. We compared tramadol gargle to placebo given 5 min before surgery on attenuating postoperative sore throat for 24 postoperative hours. Method In a prospective randomized double blind study, fifty patients of ASA I and II, undergoing elective moderate urological surgery under general anesthesia using laryngeal mask airway were allocated into two groups (25 patients each); all patients were asked to gargle for 1 min with 30 ml apple juice containing tramadol 2 mg/kg in group (T), and nothing in group (P) 5 min before surgery. The incidence and the severity of postoperative sore throat were graded at 2, 6, 12, and 24 h after surgery using a four-point scale. Result Incidence and severity of postoperative sore throat were significantly less in tramadol treated group compared to placebo group at 2, 6, 12, and 24 h (p < 0.05). Conclusion Preoperative gargling with tramadol reduced the incidence and severity of POST compared to placebo group in patients undergoing elective moderate urological surgery, during general anesthesia with laryngeal mask airway for up to 24 h postoperatively.

Remifentanil vs dexmedetomidine for severely preeclamptic parturients scheduled for cesarean section under general anesthesia: A randomized controlled trial

Abstract Objectives To compare the effect of remifentanil vs dexmedetomidine on hemodynamic response of noxious stimuli and neonatal outcome in preeclamptic parturient underwent C.S. under G.A. Methods This blinded, prospective, randomized trial included 50 preeclamptic parturients underwent C.S under G.A., randomized into two equal groups [25 patients each]: group R [remifentanil]: received 1 μg/kg loading and 0.05 μg/kg/min infusion doses and group D [dexmedetomidine] received 1/kg loading and 0.2 μg/kg/h infusion doses. Maternal MAP and HR were assessed before medication (T0), just after induction of GA (TI), just after intubation (TT), two minutes after intubation (TT2), just after skin incision (TS), two minutes after skin incision (TS2), just after delivery of the baby (TD), and at the end of operation (TE). Time between induction and fetal delivery (I-D interval), time between incision of the uterus and delivery (U-D interval), and time between stop of the infusion of the tested drugs and delivery (D-D interval) were recorded. Neonatal Apgar score was recorded at 1 and 5 min and the need for resuscitative measures. Results Maternal MAP and HR in group R were statistically lower at (TI), (TT), (TT2), (TS) and (TS2). Neonatal Apgar score was statistically lower in group R with higher incidence for tactile stimulation. Conclusion Both remifentanil and dexmedetomidine were effective on blunting the pressor response to noxious stimuli in severely preeclamptic parturients. While remifentanil was marginally more effective in suppressing the pressor response, dexmedetomidine was safer for the neonates.

Comparison of the preemptive analgesia of low dose ketamine versus magnesium sulfate on parturient undergoing cesarean section under general anesthesia

Abstract Objective To investigate the efficacy of the preemptive analgesic effect of low dose ketamine versus MgSO4 on potentiating postoperative analgesia when compared to placebo in patients undergoing cesarean section under general anesthesia. Methods This prospective randomized blind study included 60 parturient females scheduled for cesarean section under general anesthesia. They were randomized into three equal groups [20 patients each]: group I [Control]: received 20 ml normal saline 0.9%, group II [Ketamine]: received ketamine 0.3 mg/kg in 20 ml normal saline and group III [MgSO4]: received MgSO4, 30 mg/kg in 20 ml normal saline. Investigated medications infused over 10 min before induction of anesthesia. Fentanyl requirement, mean BP and HR were measured intraoperatively. Pain, sedation and nausea and vomiting were assessed at 2, 6, 12 and 24 h postoperatively. Total postoperative pethidine dose over 24 h was calculated. Results MBP and HR showed statistically significantly lower value in group (K) and (M) compared to group (C) at postintubation and postincision readings. Intraoperative fentanyl requirement was statistically higher in (C) groups compared to (K) and (M) groups. The time for first request for postoperative analgesia was longer and the total postoperative pethidine dose over 24 h was lower in (K) group compared to (C) and (M) groups. Postoperative VAS scores at 2 and 6 h postoperatively showed statistically highly significantly lower values in (K) group compared to (C) and (M) groups. Apgar, postoperative sedation and PONV scores showed no statistically significant differences among the three groups. Conclusions Preemptive dose of either ketamine (0.3 mg/kg) or MgSO4 (30 mg/kg) in patients undergoing cesarean section under general anesthesia could suppress the pressor response to endotracheal intubation and skin incision and decreased the intraoperative fentanyl requirement. Ketamine showed a significant preemptive analgesic effect compared to MgSO4 at 2 and 6 h postoperatively.

Dose baixa de propofol versus lidocaína para alívio de laringoespasmo resistente pós‐extubação em paciente obstétrica

BACKGROUND Post-extubation laryngospasm is a dangerous complication that should be managed promptly. Standard measures were described for its management. We aimed to compare the efficacy of propofol (0.5mg.kg-1) vs. lidocaine (1.5mg.kg-1) for treatment of resistant post-extubation laryngospasm in the obstetric patients, after failure of the standard measures. METHOD This study was conducted over 2 years on all obstetric patients scheduled for cesarean delivery. Post-extubation laryngospasm was initially managed with a standard protocol (removal of offending stimulus, jaw thrust, positive pressure ventilation with 100% oxygen). When this protocol failed, the tested drug was the second line (lidocaine in the first year and propofol in the second year). Lastly, succinylcholine was used when the tested drug failed. RESULTS In lidocaine group, 5% of parturients developed post-extubation laryngospasm, 31.9% of them were successfully treated via standard protocol, and 68.1% required lidocaine treatment. 65.6% of patients treated with lidocaine responded successfully and 34.4% required succinylcholine to relieve laryngospasm. In propofol group, 4.7% of parturients developed post-extubation laryngospasm, 30.1% of them were successfully treated via standard protocol, and 69.9% required propofol treatment. 82.8% of patients treated with propofol responded successfully and 17.2% required succinylcholine to relieve laryngospasm. CONCLUSION Small dose of propofol (0.5mg.kg-1) is marginally more effective than lidocaine (1.5mg.kg-1) for the treatment of resistant post-extubation laryngospasm in obstetric patients, after failure of standard measures and before the use of muscle relaxants.

The role of ondansetron in prevention of post-spinal shivering (PSS) in obstetric patients: A double-blind randomized controlled trial

Abstract Background Elective cesarean delivery (C/D) under neuraxial anesthesia is commonly associated with shivering. Ondansetron is a widely used antiemetic during both pregnancy and surgery. Few controversial studies investigated its anti-shivering effect in C/D under spinal anesthesia. Objectives To study the efficacy of ondansetron to prevent post-spinal shivering in parturients underwent cesarean delivery under spinal Anesthesia. Methods This double-blinded, prospective, randomized, trial included 80 parturients underwent C/D under spinal anesthesia, randomized into two equal groups [40 patients each]; group O [Ondansetron]: received 8 mg/4 ml ondansetron and group S [Saline] received 4 ml normal saline as placebo. Post-spinal shivering and maximum shivering at any time were recorded on a (0–4) scale and total meperidine dose required to treat shivering at score ⩾ 3, was calculated. Maternal MAP assessed before spinal anesthesia (T0), just after spinal and lateral tilt positioning (T1), 2 min after positioning (T2), 5 min after positioning (T3), Just after delivery of the baby (T4), at the end of surgery (T5), together with total ephedrine (required to treat any hypotension) were recorded. Incidence of nausea and vomiting at any time during surgery was also recorded. Results Incidence of shivering, maximum shivering, total meperidine dose and incidence of nausea were lower in ondansetron group compared to saline group. Maternal MAP was lower at (T3) in placebo group, without difference in the total ephedrine dose between the two study groups. Conclusion Ondansetron (8 mg) was effective in reducing post-spinal shivering in parturients underwent elective cesarean delivery and decreasing the requirement to meperidine together with lower incidence of post-spinal hypotension and nausea when compared to placebo (saline).

Does tramadol or bupivacaine intraincisional infiltration with inguinal canal block during hernioplasty change the postoperative pain profile

Objective The study aimed to evaluate the effect of inguinal canal block together with intraincisional injection of tramadol against bupivacaine 0.25% on both intraoperative and postoperative pain relief in patients undergoing inguinal hernioplasty under general anesthesia. Patients and methods The study was conducted on 60 male patients scheduled for elective inguinal hernioplasty under general anesthesia in the Kasr Al-Ainy School of Medicine. Patients were randomly allocated into three groups: group C [control group (n = 20)], group B [bupivacaine 0.25% group (n = 20)], and group T [tramadol group (n = 20)]. During the surgery, the mean arterial blood pressure and the heart rate were traced every 5 min. The total intraoperative fentanyl requirement, postoperative visual analogue score and sedation scores, and nausea and vomiting were recorded; patient and surgeon satisfaction were assessed. Results The intraoperative mean arterial blood pressure, heart rate, and fentanyl requirement were statistically lower in both the bupivacaine and the tramadol groups compared with the control group. The postoperative visual analogue score was statistically lower in both the bupivacaine and the tramadol groups compared with the control group. Postoperative nausea and vomiting were statistically higher in the tramadol group compared with the control group and the bupivacaine groups. The scoring of postoperative patient satisfaction was statistically higher in the tramadol group compared with the bupivacaine and the control groups. Conclusion The study offered a new technique using tramadol as a locally infiltrated drug during inguinal hernioplasty aiming to decrease intraoperative and postoperative pain together with reducing analgesic needs to minimum during and after the operation with the consequent beneficial reduction of narcotic side effects.