Search

Same-day bidirectional endoscopy has been reported to reduce recovery time, and procedure-related cost. The safety of bidirectional endoscopy vs colonoscopy only, while using midazolam and pethidine, has never been evaluated. We reviewed 1,202 consecutive patients who underwent bidirectional endoscopy or colonoscopy only with administration of midazolam and pethidine in Toyoshima Ensdoscopy Clinic. We compared the clinical characteristics and adverse events associated with method of endoscopy (colonoscopy only vs bidirectional endoscopy). Furthermore, multivariate logistic regression analyses were conducted to study the role of age, sex, use of sedative, polypectomy, and bidirectional endoscopy in adverse events. In the bidirectional endoscopy group, the doses of pethidine and midazolam, and the incidence rates of hypoxia and posto-endoscopic nausea were significantly higher. On multivariate analysis, age (odds ratio = 1.061, p

We aimed to investigate the efficacy of preemptive analgesia of celecoxib on postoperative pain, patients’ global assessment (PGA) and hip function recovery compared to postoperative analgesia of celecoxib in femoroacetabular impingement (FAI) patients who underwent hip arthroscopy surgery (HAS). The 100 FAI patients underwent HAS were randomly allocated to preemptive analgesia group (N = 50) or postoperative analgesia group (N = 50) as a 1:1 ratio for 3 months. Pain visual analog scale (VAS) score, PGA score, rescue-use pethidine consumption and Harris hip score were assessed. Compared to postoperative analgesia group, pain VAS score decreased on day 1 (P = 0.036), day 2 (P = 0.046) and day 3 (P = 0.046), while was similar prior to operation (P = 0.587), on day 7 (P = 0.398), at month 1 (P = 0.461) and month 3 (P = 0.805) in preemptive analgesia group. Besides, rescue-use pethidine consumption was decreased in preemptive analgesia group than postoperative analgesia group within 3 days (P = 0.016) and within 7 days (P = 0.033) post-operation. For PGA score, it reduced on day 2 (P = 0.030) and day 3 (P = 0.048), while was similar prior to operation (P = 0.699), on day 1 (P = 0.699), day 7 (P = 0.224), at month 1 (P = 0.640) and month 3 (P = 0.400) in preemptive analgesia group than postoperative analgesia group. For Harris hip score, it was similar prior to operation (P = 0.372), on day 7 (P = 0.366), at month 1 (P = 0.466) and month 3 (P = 0.658) between the two groups. In conclusion, preemptive analgesia of celecoxib decreases short-term postoperative pain and PGA, but without effect on long-term hip function recovery than postoperative analgesia of celecoxib in FAI patients who underwent HAS.

Background: Intravenous regional anesthesia (IVRA) is used in outpatient hand surgery as an easily applicable and cost-effective technique but tourniquet pain is a limitation. Ketamine in subanesthetic dose is used as an adjuvant to IVRA to improve analgesia and to impair tourniquet pain.Aim of Study: Is to illustrate the effect of ketamine as adjuvant to lidocaine used for IVRA in patients undergoing upper limb surgery.Patients and Methods: This double-blind randomized controlled study was carried out on 60 patient, ASA I and II, 20-40 years, scheduled for elective minor upper limb surgery. Patients were classified into 2 groups (30 each): Group I (IVRA with lidocaine only) received 3mg/kg lidocaine 0.5% diluted with saline to 40ml and group II (IVRA with lidocaine and ketamine) received 3mg/kg lidocaine0.5% plus 50mg ketamine diluted with saline to 40ml. MAP, HR and SpO2 were measured before, after tourniquet application, during the surgery every 15 minute, and every 30 minutes after deflating the tourniquet. Type & duration of the operation, onset & duration of sensory & motor block were measured. VAS was recorded at 1, 2, 3, 6, 12, 18 and 24h after operation, time of first rescue analgesia, total analgesic given and any undesirable side effects.Results: Demographic data, duration of operation and hemodynamic changes (MAP, HR and SpO2) were comparable. Onset of sensory and motor block were shorter in Group II than in Group I, but the duration of sensory and motor block was prolonged. In Group II, first dose of IV analgesic was delayed and the amount of pethidine was significantly de-creased. VAS and severity of tourniquet pain in group II were significantly decreased.Conclusion: Adding ketamine 50mg to lidocaine for IVRA has faster and prolonged sensory and motor block and delayed tourniquet pain with better quality of postoperative analgesia.

Background: Total abdominal hysterectomy (TAH) is associated with substantial postoperative pain and discomfort. Transversus abdominis plane (TAP) block and rectus sheath (RS) block are used to block the sensory nerves of the anterior abdominal wall and thereby contributing in pain relief after lower abdominal surgeries.Aim of Study: The aim of this study is to evaluate the effect of postoperative bilateral US-guided RS block versus postoperative bilateral US-guided TAB on analgesic require-ments and hemodynamic changes after TAH.Patients and Methods: This prospective randomized study was carried out on 60 females, ASA I or II presented for elective TAH under general anesthesia (GA)and randomly classified into 2 equal groups (each of 30 patients); patients in group I received RS block with 40ml bupivacaine 0.25% (20ml each side) before the end of surgery and in group II, patients received TAP block with 40ml bupivacaine 0.25% (20 ml each side) before the end of surgery. HR and MABP were measured as baseline, after induction of GA, every 15 min till end of surgery, immediately after recovery, at 2h, 4h, 6h, 8h and 12h postoperatively. Operative time, the duration of anesthesia and Numeric Rating Scale (NRS) at 2h, 4h, 6h, 8h, and 12h after recovery. Time to first analgesic request, total 24h pethidine consumption and side-effects were meas-ured.Results: HR, MABP, and NRS score showed significant elevation at 6H and 8H postoperatively in group I. First time of analgesic request in group II was prolonged than group I. Pethidine consumption was reduced in group II compared to group I. Postoperative nausea and vomiting (PONV) showed elevation in group I compared to group II.Conclusion: Postoperative bilateral US-guided TAB block was more effective than US-guided RS block in patients undergoing TAH with prolonged postoperative analgesia, less pethidine consumption, and less PONV.

Background: Spinal anesthesia is used widely for many procedures, many adjuvants had been used to prolong duration of sensory and motor block and improve post-operative pain.Aim of Study: The aim of this study is to compare the effect of magnesium sulphate and ketorolac intravenous infusion on sensory and motor blockage, hemodynamic pa-rameters, duration of analgesia and side effects during spinal anesthesia.Patients and Methods: Patients were classified randomly into three groups (30 patients each) Group M (Magnesium sulphate Group), Group K (Ketorolac Group), Group C (Con-trol Group). Group M patients received a loading dose of magnesium sulphate 40mg/kg IV over 10min followed by 15mg/kg/h IV infusion, Group K patients received a loading dose of ketorolac (0.4mg/kg) (IV) over 10min followed by 0.8mg/kg/h IV infusion. Group C received 50ml of saline (IV) over 10min followed by saline infusion. After ensuring free flow of cerebrospinal fluid, 3mL of bupivacaine (0.5%) injected Pulse rate, electrocardiography, non-invasive blood pressure and SpO2 monitored continuously. Measurements: Demographic data (age, weight, BMI, ASA physical status). Hemodynamic (HR, MAP, SpO2) before giving study drugs, 10min after giving study drugs and after reaching the maximal level of spinal anesthesia and then every 30min till end of surgery. Onset of sensory blockade has been assessed by pinprick method. Onset of motor blockade has been assessed by modified Bromage Scale. Level of sensory and motor blockade has been checked at 3, 5, 10 and 15min after spinal anesthesia and then every 20min throughout the surgery. Time to achieve complete regression from sensory and motor blockade has been noted. All the durations were calculated considering the time of spinal injection as zero time. Post-operatively analgesia has been assessed by the Visual Analog Scale (VAS). The time at which analgesia was first received and total analgesic requirement in 24h was recorded. Patients observed for any adverse effects such as nausea, hypotension.Results: There were insignificant changes between the three groups in HR and MAP but there was significant decrease in HR and MAP in each group at 10min, maximal level and 30min in comparison with base line. There were insignificant changes in onset and duration of sensory and motor block in the three studied groups.The total dose of analgesic consumption (pethidine (mg)) showed significant decrease in Group M in comparison with Group K & Group C with insignificant change between Group K & Group C.The time of first rescue analgesia showed significant increase in Group M in comparison with Group K & Group C and insignificant changes in Group K in comparison with Group C.Conclusion: Addition of intravenous magnesium sulphate with spinal anaesthesia provides significant decrease in post-operative analgesic requirements and prolongs the time of the first rescue analgesia as compared to intravenous ketorolac with spinal anaesthesia.

Background: Spinal anesthesia is known to significantly impair thermoregulation; shivering associated with spinal anesthesia is reported up to 55%. Pethidine probably acts directly on the thermoregulatory center or via opioid receptors. Mechanism of action of 5HT antagonist as anti-shivering is thought to be related to inhibition of serotonin reuptake on the preoptic anterior hypothalamic region.Aim of Study: This study was designed to compare the effectiveness of intravenous Pethidine versus intravenous Ondansetron for prevention of post-spinal shivering (primary outcome), hemodynamic changes, side effects of both groups were also evaluated (secondary outcome).Material and Methods: Patients were randomly assigned allocated into two groups (Group P n=30 patients) received pethidine 0.4mg/kg and (Group O n=30 patients) received Ondansetron 4mg as premedication (each drug was mixed into 10ml isotonic saline and given to the patient, slowly IV).Results: Non-significant differences between two groups as regards episodes of shivering, grading of shivering and tympanic temperature, but there is delayed onset of shivering episodes in pethdine group. There was statistically significant decrease in patients had nausea and vomiting in O group. While there was no statistically significant difference as regard sedation in both groups.Conclusion: The use of Prophylactic 4mg Ondansetron (5HT3 antagonist) is equally effective as 0.4mg/kg pethidine in the prevention of perioperative shivering following spinal anesthesia, maintains core temperature and Prophylactic Ondansetron also reduces the need of antiemetics.

Introduction: Pharmacological methods using variety of drugs like pethidine, morhine, tramadol, clonidine, doxapram, ketansarine, nefopam, neostigmine, magnesium sulfate have been tried in post spinal shivering. Aim of the present study was to compare the two drugs pethidine and dexmedetomidine for the control of intraoperative shivering under spinal anaesthesia. Materials and Methods: A prospective randomized study where total 80 patients of either gender aged between 20-60 years, ASA grade of I -II and patients who develop shivering of grade 2-3 (Crossley and Mahajan scale) after spinal anaesthesia were enclosed within the study after getting informed consent. The patients were randomized into two groups of 40 patients each. Group D- Dexmedetomidine group received single intravenous bolus dose of dexmeditomidine 0.5mcg/kg over 5 min. Group P -Pethidine group patients received 0.5mg/kg Pethidine IV over 5 min. The time was accurately noted in seconds from drug administration to the disappearance of shivering. Patients were monitored at intervals of 1 minute, 3min, 5min and thenceforth 10, 20 and 30 minutes until finish of surgery. Patients were intently monitored for failure of the drug, recurrence of shivering and side effects such as nausea, vomiting, bradycardia (20% of baseline), giddiness and sedation score will be recorded. Chi-square test was accustomed to evaluate categorical factors. Results: Dexmedetomidine group had significant reduction in time needed to control shivering and disappearance of shivering after drug administration. Conclusion: Through this study we tend to found that the time taken for control of shivering was shorter with Dexmedetomidine as compared to Pethidine. Side effects were less with Dexmedetomidine as compared to Pethidine. Keywords: Pethidine, Dexmedetomidine, Spinal anaesthesia, Shivering.

Background: More than 230 million people undergo surgery each year worldwide, and the number is increasing annually. Surgery causes commonly postoperative pain that should be alleviated as soon as possible to reduce suffering, and to promote the healing process and rehabilitation, and to prevent complications. Pain after thyroid surgery is regarded as being of moderate intensity and short duration. However, during the first 24 h after surgery, some patients require opioid and non-opioid analgesics. Objectives: The aim of this work was to compare the effect of superficial cervical block combined with general anesthesia, intravenous morphine in patients undergo thyroidectomy operation as regard as the heamodynamics intraoperative and post-operative analgesia. Patients and Methods: After obtaining the approval of the Al-Azhar University Ethical Committee, eighty patients of American Society of Anethesiologists (ASA) physical status I or II, scheduled for thyroidectomy operation under general anesthesia were enrolled in this randomized, prospective, clinical trial study. Information about the study were given comprehensively both orally and in written forms to the patients. All patients gave their written informed consents prior to their inclusion in the study. The study was carried out in Al-Azhar University Hospitals (AL- Hussein &Sayed Galal Hospitals). Eighty patients were randomly divided into two equal groups: Group {A} received a bilateral superficial cervical block (15ml per side) with bupivacaine 0.25% after induction of general anesthesia, and Group {B} recived morphine (0.1 mg kg body weight) 15 minutes before induction of general anesthesia. Results: The results of the present study revealed that mean arterial pressure (MAP) and heart rate (HR) were significantly lower in Group (A) compared with group (B). Pethidine requirements during the first 24 h after thyroidectomy were significantly reduced in Group (A) compared with Group (B). At post-operative care unit (PACU) admission, pain scores were significantly lower in Group (A) than in Group (B). Pain scores decreased in the two groups during the 24 h after surgery. Thirty-four patients (42.2%) developed post-operative nausea and vomiting (PONV) in the post-operative care unit (PACU), 8 patients in Group (A), 26 patients in Group (B). Conclusion: Bilateral superficial cervical plexus block (BSCPB) was an effective technique to reduce analgesic requirements during and after thyroid surgery and improved the anethetic outcome more than intravenous injection of morphine.

Background and aims: Postoperative pain control decreases negative effects on the health domains of the patients and their relatives in addition to reducing the costs and the duration of hospitalization. The aim of the present study was to comparatively investigate the analgesic effects of ginger and diclofenac tablets. Materials and Methods: In this clinical trial, 80 patients undergoing inguinal hernia surgery were randomly divided into two groups of 40. One group received 250 mg ginger capsule while the other one received 100 mg diclofenac tablet. Then, the patients were examined within 6 hours (every two hours) and their pain was assessed using the standard 10-point visual analogue scale. Finally, the data were analyzed using the SPSS, version 22. Results: Based on the results, there was no significant difference in pain severity between the two groups at 0, 2, 4, and 6 hours after recovery (P>0.05). In addition, no significant difference was observed in the duration of pain since the time of patient recovery between the two groups (P>0.05). Further, as regards the number of patients receiving pethidine, no difference was found between the two groups (P>0.05). Conclusion: In general, both ginger capsule and diclofenac tablet were similarly effective in relieving the pain after inguinal hernia surgery

INTRODUCTION: Opioids and Non-steroidal anti-inflammatory drugs (NSAID) are used to manage low back pain. However, it has been reported in some researches that opioids have fewer side effects than NSAID. METHODS: Patient files of all the patients admitted to the emergency department of Ufuk University ethics committee on 23.03.2018 and applied with severe nontraumatic low back pain between 01.01.2015 and 01.01.2016 were examined retrospectively. It was aimed to evaluate the efficacy of these two drugs in the treatment of pain by evaluating the responses of these patients with visual analogue scale scales. RESULTS: A total of 138 patients among 911 patients experiencing low back pain were included in the study. 81 patients received 75 mg of diclofenac sodium therapy alone, 57 patients received only Petidin hydro- chloride treatment. 64 (46.4%) of the patients were male and 74 (53.6%) were female. It was found that there was no statistically significant correlation between pain scores of 75 mg of diclofenac sodium imide treatment applied and Pethidine hydrochloride applied patient groups (p > 0.05). There was no statistically significant correlation between pain scores and genders of 75 mg of diclofenac sodium imide treatment applied and Pethidine hydrochloride applied patient groups (p > 0.05). The difference between patients’ referral scores and pain scores after 45 minutes (75 mg diclofenac sodium imide and petidine hydrochloride imide) were found to be statistically insignificant (p > 0.05). There was no statistically significant difference in the analyzed results of the efficacy of 75 mg diclofenac sodium treatment related to gender (p > 0.05). There was no statistically significant difference in the analyzed results of the efficacy of Pethidine hydrochlo- ride treatment related to sex (p > 0.05). CONCLUSIONS: Opioids have fewer side effects than NSAIDs in short period management of the pain, and they may be used for low back pain management in emergency services instead of NSAIDs.

Objective: To relieve postoperative pain and nausea and vomiting, various drugs and methods, including intraoperative IV lidocaine infusion in different surgeries. However, the exact dose has not yet been determined. The purpose of this study was to evaluate and compare the effect of intraoperative 1 mg/kg/h and 2 mg/kg/h IV lidocaine infusion on postoperative pain and nausea-vomiting in laparoscopic gastric bypass surgery. Methods: This clinical trial study was performed on patients undergoing laparoscopic gastric bypass surgery in Rasoul-e-Akram Hospital, Iran. Patients were randomly assigned into two groups (1 mg/kg/h lidocaine) and (2 mg/kg/h lidocaine). Postoperative pain and nausea and vomiting were evaluated at times 0, 30 min, 1 h, 6 h, 12 h and 24 h after surgery. Data was analysed using statistical tests and SPSS 22. Results: There was no significant difference in the effect of intraoperative 1 mg/kg/h and 2 mg/kg/h IV lidocaine infusion on static and dynamic pain and nausea-vomiting, agitation, systolic BP, diastolic BP, pulse rate and postoperative administration of pethidine in laparoscopic gastric bypass (P>0.05). Conclusion: Based on results of this study, administration of low dose lidocaine (1 mg/kg/h) can be considered as an appropriate dose of IV lidocaine infusion in order to control postoperative pain and nausea and vomiting in laparoscopic gastric bypass surgery.

Background: shivering is a protective phenomenon which occurs when there is a drop in the core body temperature. As the patients plunge into anesthesia, shivering is always bound to happen, and its avoidance is of prime importance. Aim of the Work: compare the efficacy of intravenous dexmedetomidine 0.5 μg/kg body weight (bw) versus magnesium sulphate 30 mg/kg bw and meperidine 0.5 mg/kg bw in the management of shivering in patients undergoing elective surgery under neuraxial anesthesia in Al-Azhar University Hospitals. Patients and Methods: a prospective, double-blinded and controlled randomization study was conducted on 120 ASA grade I and II patients, posted for orthopedic, general surgeries and gynecological surgeries undergoing spinal and combined spinal-epidural anesthesia in Al-Azhar University Hospitals, following approval from the Ethics Committee of the Al-Azhar University. Results: dexmedetomidine was effective in the prevention of shivering throughout a period of 30 minutes. Bradycardia and hypotension were observed in 10 out of 40 patients who received dexmedetomidine and also in 6 out of 40 patients in the magnesium group and with no hypotension and bradycardia in the pethidine group. But of these how many occurred because of dexmedetomidine cannot be commented upon, as spinal and epidural anesthesia itself causes hypotension. Whereas it was observed in 8 out of 40 patients in the magnesium sulfate group. There was no nausea and/or vomiting in pethidine group. These were treated with ondansetron 0.08 mg/kg by the intravenous route. Conclusion: Dexmedetomidine is an effective drug in the prevention of shivering in patients undergoing neuraxial block.

Introduction: Shivering is a common side effect of central neuraxial anaesthesia. Intravenous pethidine is commonly used in reducing shivering but has been associated with significant opioid side effects. Dexamethasone as a powerful anti-inflammatory and analgesia agent is postulated to inhibit inflammatory mediators’ release thus inhibiting central thermoregulatory centre, potentially attenuating post spinal shivering. This double-blinded randomised controlled study was to determine the ability of intravenous dexamethasone in decreasing the incidence, severity and the need for treatment for post spinal shivering. Methods: We recruited 72 patients requiring spinal anaesthesia and randomised them to receive either dexamethasone 0.1 mg/kg (up to 8 mg) or normal saline (placebo). We observed their tympanic membrane temperatures, mean arterial pressures and shivering scores at regular intervals up to 2 hours post-spinal or till end of surgery (minimum 30 minutes post spinal). Results: Both groups showed consistent and comparable drop in tympanic membrane temperatures and mean arterial pressures after spinal anaesthesia, except at 15 minutes in which patients of dexamethasone group demonstrated significantly higher temperatures than saline group (p=0.04). There were also significantly less patients in the dexamethasone group reporting incidence of visible shivering as compared to the placebo group (p=0.003). No significant difference was seen in severity of shivering or usage of pethidine. Conclusion: Dexamethasone has the potential to mitigate the reduction in core body temperature, especially at 15 minutes post spinal. It can reduce the incidence of clinically significant visible grade of shivering post spinal.

Two distinctive alkaloids with 6/6/6/5/6/6 fused rings, in which a previously unidentified linkage of C-12/23 generates a rigid skeleton, resulting in a new subtype of steroidal alkaloid, were isolated from Veratrum grandiflorum. Compounds 1 and 2 showed potent analgesic effects in vivo, superior to the well-known analgesic, pethidine (Dolantin), likely by inhibiting CaV2.2 voltage-gated calcium channels.

Background: Shivering frequently occurs in cesarean section (CS) under spinal anesthesia (SA), resulting in several complications. To date, pethidine has been considered as the gold standard for post-SA shivering control, but it is contraindicated in breastfeeding women. Methods: This randomized, double-blind study was conducted at Alzahra hospital in Guilan, Iran, From January 2019 to November 2020. A total of 508 eligible term parturient women were enrolled and randomly divided into four groups of low dose ketamine (K), tramadol (T), ondansetron (O), and placebo (P). The incidence and severity of shivering and patients’ complications were recorded and compared among the groups. Results: The patients were homogenous in terms of demographic variables. Shivering was witnessed in 68 (53.5%), 26 (20.5%), 75 (59.1%), and 82 (64.6%) patients in K, T, O, and P groups, respectively (P = 0.0001). Regarding shivering severity, there was a significant difference among the four groups (P = 0.0001). In addition, a significant difference was seen regarding Apgar scores at the first minute, but not at the fifth minute (P = 0.168). Conclusions: Considering the high incidence of shivering in placebo group, prophylactic intervention in CS under SA seems to be necessary. Among the studied drugs, tramadol was the most effective one, followed by a low dose of ketamine and ondansetron.

This study aims to compare the prevalence and seriousness of adverse events (AEs) among sedatives used in critically ill patients or patients undergoing invasive procedures and to identify factors associated with serious AEs. Retrospective cross-sectional analysis of sedative-related AEs voluntarily reported to the Korea Adverse Event Reporting System from 2008 to 2017 was performed. All AEs were grouped using preferred terms and System Organ Classes per the World Health Organization—Adverse Reaction Terminology. Logistic regression was performed to identify factors associated with serious events. Among 95,188 AEs, including 3132 (3.3%) serious events, the most common etiologic sedative was fentanyl (58.8%), followed by pethidine (25.9%). Gastrointestinal disorders (54.2%) were the most frequent AEs. The most common serious AE was heart rate/rhythm disorders (33.1%). Serious AEs were significantly associated with male sex, pediatrics, etiologic sedative with etomidate at the highest risk, followed by dexmedetomidine, ketamine, and propofol, polypharmacy, combined sedative use, and concurrent use of corticosteroids, aspirin, neuromuscular blockers, and antihistamines (reporting odds ratio &gt, 1, p &lt, 0.001 for all). Sedative-induced AEs are most frequently reported with fentanyl, primarily manifesting as gastrointestinal disorders. Etomidate is associated with the highest risk of serious AEs, with the most common serious events being heart rate/rhythm disorders.

Background Pain management after caesarean delivery is important because acute pain in the postoperative period is associated with persistent pain, increased opioid use and postpartum depression, and delayed functional recovery. We investigated the role of nurse-supported care in acute pain management after caesarean delivery, which as far as we know has not previously been investigated in Gaza. Methods This was a comparative study done from March, 2018, to October, 2018, among women assigned to undergo caesarean delivery. Research nurses at the Al-Helal Al-Emirati Hospital, Rafah, Gaza Strip, occupied Palestinian territory, were trained to give supportive pain management care to women after caesarean delivery, including individualised care and educational sessions on pain, nutrition, exercise, and wound care. Women were randomly assigned to receive nurse-supported care or usual care. Pain assessment scales (range 1–5, where 1=no pain and 5=pain as bad as it could be) were used to record pain at 1, 6, 12, 18, and 24 h after caesarean delivery. The time from the end of the caesarean delivery to the first request for analgesia and the total amounts and types of analgesics (pethidine ampules, diclofenac ampules, or indometacin suppositories) used in the first 24 h were recorded as primary outcomes. Secondary outcomes were nausea and vomiting scores (0–3, where 0=no nausea or vomiting and 3=severe and unresponsive to antiemetic drugs), sedation scores (0–3, where 0=patient awake and 3=severe sedation and patient difficult to rouse), and pruritis scores (0–2, where 0=no pruritis and 2=severe pruritis needing treatment). Data were analysed with SPSS (version 22.0). Groups were compared by using the Student's t-test and χ2. P values less than 0·05 were significant. The study was approved by the Ministry of Health and Helsinki Committee, Gaza Strip. Women provided verbal informed consent for inclusion in the study when they were assigned to the caesarean delivery. Findings 108 women participated, with a mean age of 29·2 years (SD 5·50). 49 women were randomly assigned to nurse-supported care and 59 to usual care. Pain was reduced in the nurse-supported care group compared with in the usual care group at 12 h (mean score 1·15 [SD 0·25] vs 1·60 [0·67], p=0·002) and at 18 h (1·08 [0·22] vs 1·26 [0·21], p=0·049) but did not differ significantly at other times. The time to first requesting analgesia was shorter in the nurse-supported care group than in the usual care group (mean 3·38 h [SD 1·01] vs 6·16 h [2·01], p=0·038). The proportions of women who asked for a first analgesic were similar in the two groups (30 [61%] and 36 [61%]), whereas seven (14%) women in the nurse-supported care group requested a second analgesic compared with 13 (22%) in the usual care group (p=0·045). There were no significant differences between the two groups for nausea and vomiting, sedation, or pruritis. Interpretation Nurse-supported care provided better analgesia than usual care in women who had undergone caesarean delivery. A multicentre study is needed to explore the types, duration, and repeatability of the effects of nurse supportive care on pain perception and duration of hospital stay after caesarean delivery. Funding None.

ObjectiveDetermining the effect of discharge time after elective cesarean section on maternal outcomes.MethodsThis study is a randomized clinical trial that performed on 294 women who undergo elective cesarean section. The patients were randomized in two groups by simple randomization method: Group A (discharge 24 h after cesarean) and group B (discharge for 48 h after cesarean). In both groups, during the first 24 h, they received intravenous antibiotic (cefazolin as routine order) and pethidine at the time of pain. The patients were discharged with the hematinic and mefenamic acid. The main outcome variables were satisfaction of the patient, surgical site infection, separation of incision, endometritis, urinary tract infection, gastrointestinal complications, rehospitalization, secondary postpartum hemorrhage and pain of the patient on discharge day, one and six weeks after cesarean.ResultsSatisfaction scores and pain score at discharge day, one and six weeks after discharge were not significant different in the study groups (P > 0.05). Another key finding of this paper was no significant difference in the incidence of surgical site infection, separation of incision, endometritis, urinary tract infection, gastrointestinal complications, rehospitalization, secondary postpartum hemorrhage at one and six weeks after discharge in the study groups(P > 0.05).ConclusionThe time of discharge can be reduced to 24 h after surgery if the mother to be at good general condition, the vital signs are stable, the patient has no underlying problem and disease, and it is financed for the patient and the health system.

BackgroundPain is an inevitable part of the postoperative experience. Current study was designed to assess the pattern of analgesic use, the adequacy of post operative pain control by documenting pain scores, and patient satisfaction by documenting the pain perception score of the postoperative patients 48 hours after surgery.Materials and methodsThis was a formative research and includes a mix of descriptive cross-sectional study carried out in the department of Gynecology and Obstetrics, General surgery, and Orthopedics surgery of Chattagram Maa -O- Shishu Hospital Medical College (CMOSHMC) during the month of January, 2018 to July, 2019.ResultA total of 180 patients undergoing surgery were included in this study. Baseline data were collected both retrospectively and prospectively. Only analgesic used immediately after operation in three departments were Pethidine (100%). Diclofenac sodium suppository were used in appendectomy and cesarean section (50/60, 83%) and (26/60, 43%) respectively. Mostly, Diclofenac Sodium IV (55/60, 91%) was used in lower limb surgery. The maximum pain score were 5.3 (SD=2.3), 5.6 (SD =1.9), and 6.1 (SD =1.3) during coughing in the first 8 hour and minimum pain score 2.4 (SD =1.0), 2.2 (SD = 0.8) and 1.7 (SD=1.3) at rest 48 hours after cesarean section, appendectomy and lower limb surgery respectively. But pain score eventually increased during coughing 48 hours after surgery. After 48 hours of surgery maximum pain perception score 3.9 (SD = 0.9) in lower limb surgery and minimum perception score were 3.5 (SD =1.8) in cesarean section. Majority of the appendectomy patient (76%) satisfied with pain management where as only 43% satisfied in case of cesarean section.ConclusionThis study enabled the researchers to get a precise picture of the current state of POPM in different hospitals, as well as identify particular needs for improving such practices in health care facilities and implementing an educational intervention in order to improve the post operative pain management.

Background and Aim: Opioid analgesics had been used from time to time for treating labor pain. However, their use have been concerning. The aim of this study is to evaluate the effect of pethidine on duration of active phase of labor, labor pain and maternal-neonatal outcomes. Methods: In the present case-control study, the study group received a 50 mg pethidine intramuscular injection upon the start of active phase of labor, and the control group consisted of patients who receive placebo injeciton. In both groups, vital signs were measured before, and at 0, 5, 15, 30, 45 and 60 minutes after the injection. Pain intensity was evaluated with Visual Analogue Scale (VAS) prior to, and 1 hour and 2 hours after injection. Data regarding labor phase durations, maternal side effects, newborn APGAR scores and fetal respiratory problems were recorded. Results: 102 patients in Pethidine group and 92 patients in control group, were included into the study. Labor pain VAS-scores were significantly lower in the study group (p

To assess the use of single dose of paracetamol intravenously in management of labour pains.Pain during labour is a complex, subjective and multi-faceted physiological phenomenon that varies in intensity among women and is subjected to many social and cultural modifiers.This randomized clinical study was conducted in Obstetrics and gynecology department from March 2019 to March 2020 including 96 primiparous women randomized into paracetamol group (VAS score was highly significant improved gradually after 30 min, 1, 2 and 3 h of paracetamol and pethidine taken compared at start study, but participants in paracetamol group had lower pain after 2 and 3 h (3.92 ± 1.42 and 5.69 ± 1.07) than those of the pethidine groups (4.42 ± 1.87 and 5.38 ± 1.34). Also, 2.1% of paracetamol group developed dizziness and 4.2% developed nausea and vomiting, while there was 29.2% of pethidine group developed dizziness and 37.5% developed nausea and vomiting.Intravenous paracetamol as labour analgesia is effective, safe, inexpensive, available and with no maternal or fetal side effects as compared to Pethidine. Paracetamol needs to have more chance in comparison to other forms as a labour pain analgesia, especially in our communities.

Newborn hearing screening may fail due to some perinatal and neonatal factors. False positivity of newborn hearing screening increases costs, familial concerns and anxiety. The objective of this study was to determine the effects of pethidine administered in the mother for labor analgesia on the false positivity rates of the newborn hearing screening test.This study was designed as a retrospective and cross-sectional study. A total of 75 pregnant women scheduled for vaginal delivery who received 50 mg intramuscular pethidine at the beginning of the active phase of the labor were included as the patient group and 68 pregnant women who did not receive pethidine as the control group. A total of 143 infants born with vaginal delivery were evaluated with otoacoustic emission (OAE) test before discharge. Perinatal and neonatal variables and test outcomes were recorded, and the correlation between false positivity rate and pethidine usage was evaluated.Initially, system records of 148 healthy term newborns were screened. Four patients who failed in both OAE tests and were referred to the Automated Auditory Brainstem Response (AABR) test and one patient who failed in all tests (first OAE, control OAE and AABR) and was referred to an upper center for further investigations and treatment were excluded from the study. No statistically significant difference was found between the groups in terms of birth features. First stage OAE test was reported as 'passed' in 8 (10.7%) and 58 (85.3%) newborns in the study and control groups, respectively; while OAE was reported as 'referred' and 'passed' in the second test in 67 (89.3%) and 10 (14.7%) newborns in the study and control groups, respectively. There was a statistically significant difference between both groups in terms of false positivity ratio (Pethidine significantly decreases the duration of the active phase, providing a good analgesic effect for pain management during labor. Therefore, it seems that pethidine can be used as an acceptable agent during labor. However, it may have neonatal effects after the delivery, causing false positivity in newborn hearing screening tests. The results of this study support the opinion that the OAE test should be performed in postpartum later dates in order to increase OAE passing rates and minimize costs and parents' concerns.

Background: Postanesthesia shivering is one of the potential complications of anesthesia which may increase patient morbidity. Various methods have been employed to control postoperative shivering. This study assessed the effectiveness of prophylactic low-dose intravenous ketamine and pethidine for postoperative shivering after general anesthesia.Methods and materials: This prospective cohort study recruited 76 ASA I and II patients aged 18-65 years old and underwent elective surgery under general anesthesia. The patients were grouped based on either ketamine 0.5mg/kg or pethidine 0.5 mg/kg having been administered by the anaesthetist in charge as a prophylaxis for postoperative shivering 20 minutes before completion of the surgery. The incidence and severity of postoperative shivering were compared between the two groups every 10 minutes until one hour postoperatively. The side effects of the study drugs were also compared between the two groups in the recovery room. Categorical data were analyzed with the Chi-Square test. Parametric and nonparametric data between the groups were analyzed using independent samples t-test and Mann-Whitney U test, respectively. A p-value of Results: The incidence of shivering between the ketamine and pethidine groups was 11(28.2%) and 14(35.9%), respectively (p=0.467). The severity of shivering was not significantly different between the two groups (p=0.893). The occurrence of nausea and vomiting and sedation attributed to the drugs was significantly less in the ketamine group (p0.05)Conclusion and Recommendation: This study revealed administering low-dose IV ketamine (0.5mg/kg) 20 minutes before completion of surgery reduced postoperative shivering as nearly equally as pethidine. The study also showed clinically better outcomes in favor of ketamine since it was associated with fewer side effects. Thus, we recommend low-dose IV ketamine 20 minutes before completion of surgery under general anesthesia to prevent postoperative shivering.

Background Neural tube defects are among the most frequent congenital abnormalities of the central nervous system. Progression of neural tube deficits is affected by hereditary predilection and environmental determinants. Pethidine (meperidine) is a fast and powerful opioid analgesic in U.S. Food and Drug Administration category C. There are reports about developmental anomalies due to this medication. The aim of this study was to investigate the effects of different doses of pethidine hydrochloride on neural tube development in a chick embryo model resembling the first month of vertebral growth in mammals. Methods Seventy-five specific pathogen–free eggs were incubated for 28 hours and divided into 5 groups (including the control group), each consisting of 15 eggs. Pethidine hydrochloride was administered sub-blastodermically with a Hamilton microinjector in 4 different doses. Incubation was continued until the end of the 48th hour. Subsequently, all eggs were opened, and embryos were cut from the embryonic membranes and evaluated morphologically, genetically, and histopathologically. Results Crown-rump length, somite numbers, and silver-stained nucleolar organizer region (AgNOR) number averages, and total AgNOR/nuclear area ratios decreased in a dose-dependent manner. Examination of neural tube closure revealed statistically significant differences in all experimental groups (P

This randomized, controlled study compared the efficacy and safety between oxycodone–paracetamol tablet and celecoxib for postoperative analgesia in patients who underwent arthroscopic knee surgery (AKS). Totally, 232 patients scheduled to undergo AKS were enrolled and were randomly assigned to either the oxycodone–paracetamol (OPT group) or the celecoxib group (CEL group). Pain at rest/motion (based on pain visual analog scale (VAS) score), rescue analgesia consumption, satisfaction level and adverse events were assessed after AKS. Pain VAS score at rest was decreased at 6 h, 12 h post-AKS in the OPT group compared with the CEL group. Similarly, pain VAS score at motion was reduced at 6 h, 12 h, 24 h post-AKS in the OPT group compared to the CEL group. Furthermore, both rescue analgesia rate (14.7% vs. 33.6%) and accumulated pethidine consumption (3.7 ± 8.9 mg vs. 14.0 ± 21.2 mg) were lower in OPT group compared with the CEL group. Patients satisfaction score was either at 24 h, 48 h in OPT group compared with the CEL group. Further subgroup analyses indicated that the effect of oxycodone–paracetamol versus (vs. celecoxib) on post-AKS management was more apparent in the elderly patients and male patients. In addition, the adverse events were well tolerable (including nausea, constipation, vomiting, drowsiness and dizziness) and were of no different between the two groups. In conclusion, oxycodone–paracetamol tablet presents increased analgesic efficacy for acute postoperative pain, with higher patient satisfaction and comparable safety profiles compared with celecoxib in patients underwent AKS.

Background:besides an opioid analgesic, Multimodal analgesia using a non-opioid analgesic, in atrial to decrease opioid use and toincrease postoperative pain control. Objectives:To compare the effect of intra-operative infusion of ketamine and magnesium sulphate in open gynecological surgeries on post-operative pain, total morphine consumption, post-operative nausea, and vomiting inQena university hospitals. Patients and method(s):A prospective study. Conducted in Qena university hospital, South Valley University, Qena, Egypt. The study was conducted on fifty patients (ASA I or II) scheduled for open gynecological surgeries under general anesthesia: group A: Ketamine (0.2 mg/ kg) bolus than the continuous supply of ketamine (0.05 mg/kg/h), group B: Magnesium sulphate (50mg/ kg) bolus and followed by continuous infusion of magnesium sulfate(10mg/kg /h). Result(s): the visual analogue scale was found to be significantly higher in group B compared to group A in 2, 4, and 8 hrs time intervals. The mean opioid (Morphine/Pethidine) consumption doses over 24h were lower in group A compared to group B. There is no significant difference regarding adverse events between the two studied groups. Conclusion: Intraoperative magnesium sulfate and ketamine infusionin patients exposed to gynecological surgeries with general anesthesia could and decreased the post-operative opioid requirement. Ketamine showed a significant preemptive analgesic effect compared to MgSO4 at 2 and 8 h postoperatively. VAS was significantly lowered in Ketamine than MgSO4.

To evaluate the effectiveness of caudal block (CB) using dexmedetomidine and pethidine instead of local anesthesia (LA) for prostate needle biopsy and the effect of CB on urinary retention.A transrectal ultrasound-guided prostate needle biopsy (TRUS-Bx) was performed on 68 patients with a mean age of 65 ± 2.18 years. CB with a combination of dexmedetomidine and pethidine without LA was administered to the patients. The pain levels of the patients were determined using numeric rating scale (NRS) scores to evaluate the effectiveness of CB. Preoperative and postoperative postvoid residual urine volumes (PRUV) were also calculated.The CB success rate was 93.15%. The NRS scores were 0.79 ± 0.19 and 0.89 ± 0.22 during probe entry and manipulation and biopsy, respectively, without any significant differences between them (p = 0.382). The mean PRUVs before and after biopsy did not differ significantly (41 ± 15.6 vs. 71.93 ± 22.3, p = 0.379). The degree of sedation, as assessed using the Ramsay scale, was 2 or 3 in all patients.The combination of dexmedetomidine and pethidine for CB in TRUS-Bx provided quality analgesia for the patient and prevented the development of postoperative urinary retention.

Parecoxib, a selective cyclooxygenase-2 inhibitor, is a potential alternative analgesic to reduce opioid consumption after Pancreaticoduodenectomy (PD). Further, the safety and efficacy of long-term use of parecoxib for patients after PD remain a major concern.In this single-center, randomized clinical trial, 134 patients undergoing open PD were randomized into the parecoxib group (group P) and control group (group C) at a 1:1 ratio. Besides a routine patient-controlled epidural analgesia (PCEA) until 3 days postoperatively for both groups, patients in group P (n = 68) received parecoxib (40 mg, intravenously, Q 12 h) for the first 5 postoperative days and were encouraged to receive opioid analgesics to control severe pain as needed. Patients in group C (n = 66) received on-demand opioid analgesics (pethidine or morphine) postoperatively. The primary outcomes included the effectiveness of parecoxib in controlling pain (measured using the visual analog scale (VAS)) and reduction of opioid use (measured as accumulated doses). Secondary outcomes included the postoperative recovery process, rate of postoperative complications, and the anti-inflammatory effect of parecoxib.The VAS scores were not significantly different between the two groups. The number of doses of opioids for patients in group P (3.2 ± 0.3 doses) was significantly lower than in group C (8.5 ± 0.4 doses) (p = 0.0007). The incidence of opioid-related side effects was significantly lower in group P than in group C (p = 0.001). There were no significant differences in postoperative complications or readmission rates between the two groups. The postoperative time to first pass flatus, time to first mobilization out of bed, and time of removal of nasogastric tube in group P were significantly shorter than those in group C (P 0.05). The postoperative serum IL-6 levels of patients in group P were significantly lower than those in group C at each time point (P 0.05).Parecoxib effectively controls pain after PD. Prophylactic analgesia using parecoxib for up to 5 days after PD is safe, feasible, and can provide the same optimal pain control as opioids without adverse effects.

Objective Thoracic epidural analgesia (TEA) reduces pulmonary complications after thoracotomy. Hypothetically, this advantage is partially because of the preserved pulmonary function, which is achieved by the reduction of postoperative pain and immobility. This study aimed to compare the principal methods of analgesia through early postoperative spirometric performance and gas exchange parameters after elective lung cancer surgery. TEA or intravenous analgesia (IVA) involving pethidine was used as the principal method in our sample population. Material and methods A total of 62 patients operated via the posterolateral thoracotomy approach were enrolled. Postoperative analgesia was secured using multimodal analgesia with either TEA with 0.1% bupivacaine or IVA. Pain perception was assessed with the visual analog scale (VAS) while at rest and on coughing. Arterial blood samples were collected at 1, 24, and 72 hours postoperatively. Preoperative and third postoperative day spirometric measurements were recorded. Results There were no significant differences among the groups in terms of demographic characteristics, properties of surgical technique, and disease-associated conditions. VAS scores of the TEA group were lower at the 72-hour follow-up, but a considerable fraction of these differences did not reach statistical significance. Reduction in the forced expiratory volume in the first second and forced vital capacities was more prominent in the IVA group on the third postoperative day, but these were not statistically significant either. Oxygenation parameters favored TEA but remained comparable. Finally, the pH values were significantly lower in the IVA group at 1 and 72 hours postoperatively (p=0.008 and p=0.02, respectively). Conclusion We believe that TEA is advantageous over IVA with alteration of respiratory volumes during the early postoperative period.

Aim The number of therapeutic endoscopic procedures in elderly individuals keeps increasing and this population has a high risk of adverse events related to sedation and general anesthesia. However, there is a paucity on data about the efficacy and safety of endoscopic retrograde cholangiopancreatography (ERCP) in this population. Methods In total, 417 consecutive ERCP procedures were performed in 362 patients between September 2018 and January 2020. Of these, 59 patients (74 sessions) were aged >= 80 years (Group A) and 173 patients (193 procedures) were aged

Background Spinal surgery is associated with high incidence of severe postoperative pain difficult to easy control. Appropriate treatment modalities decreased the postoperative morbidity, increased patient satisfaction, allowed early mobility, and decreased hospital costs. Lidocaine was used as intravenous additives to control intraoperative pain and decrease postoperative pain. As lidocaine, dexmedetomidine infusion associated with lower postoperative pain scores decreased the opioid consumption and its related adverse events. The aim of this double blind randomized prospective comparative study was to compare the efficacy of intraoperative dexmedetomidine versus lidocaine infusion on hemodynamics, fentanyl requirements, and postoperative analgesia among 66 patients subjected to lumbar fixation surgery and randomized into group D which received dexmedetomidine 1 μg/kg infusion over 10 min as a loading dose then 0.3–0.5 μg/kg/h after induction of anesthesia as maintenance dose and group X which received lidocaine 0.3–0.5 mg/kg/h after induction of anesthesia. Results At 10, 15, 30, and 60 min, the mean arterial blood pressure and heart rate significantly decreased in group D compared to group X, and there was significantly higher total dose of intraoperative analgesic for fentanyl in group X than group D. There was significantly higher numeric rating scale in group X compared to group D at 2, 4, 6, 9, 12, 18, and 24 h postoperative with significant early request of the first analgesia, higher incidence of analgesic needs, and higher dose of postoperative analgesia paracetamol, voltaren, or pethidine in group X compared to group D. Conclusions The intraoperative use of dexmedetomidine IV infusion was an alternative mode to decrease the demands of analgesia following spine surgery.

INTRODUCTION: Owing to the coronavirus disease 2019 outbreak Hong Kong hospitals have suspended visiting periods and made mask wearing mandatory In obstetrics, companionship during childbirth has been suspended and prenatal exercises, antenatal talks, hospital tours, and postnatal classes have been cancelled The aim of the present study was to investigate the effects of these restrictive measures on delivery plans and risks of postpartum depression METHODS: We compared pregnancy data and the Edinburgh Postpartum Depression Scale (EPDS) scores of women who delivered between the pre-alert period (1 Jan 2019 to 4 Jan 2020) and post-alert period (5 Jan 2020 to 30 Apr 2020) in a tertiary university public hospital in Hong Kong Screening for postpartum depression was performed routinely using the EPDS questionnaire 1 day and within 1 week after delivery RESULTS: There was a 13 1% reduction in the number of deliveries between 1 January and 30 April from 1144 in 2019 to 994 in 2020 The EPDS scores were available for 4357 out of 4531 deliveries (96 2%) A significantly higher proportion of women had EPDS scores of ≥10 1 day after delivery in the post-alert group than the pre-alert group (14 4% vs 11 9%;P

This study aimed to compare the efficiency regarding postoperative pain control, consumption of rescue drug, patients’ satisfaction and the safety of preoperative analgesia versus postoperative analgesia using non-steroidal anti-inflammatory drugs (NSAIDs) in patients who received arthroscopic knee surgery (AKS). Four hundred and sixty-four patients who received AKS were recruited in this multicenter, randomized, controlled study. Subsequently, they were randomized into PRE group (N = 232) and POST group (N = 232). In PRE group, patients received celecoxib, meloxicam or rofecoxib from 2 h pre-operation (Pre (− 2 h)) to 48 h post-operation for analgesia. In POST group, patients received celecoxib, meloxicam or rofecoxib from 4 to 48 h post-operation for analgesia. h and 12 h; pain VAS at passive movement was reduced in PRE group than POST group at 6 h, 12 h and 24 h. Additionally, consumption of rescue drug (pethidine) was decreased, while overall satisfaction was increased in PRE group compared to POST group. As for adverse events, the incidences of nausea, vomiting, constipation, drowsiness and dizziness were similar between PRE group and POST group. In subgroup analysis, the pain VAS score at passive movement at 6 h and nausea and constipation incidences were distinctive among subgroups categorized by meloxicam, celecoxib and rofecoxib administration. However, no difference of other assessments was found among subgroups categorized by meloxicam, celecoxib and rofecoxib administration. Preoperative analgesia using NSAIDs is more efficient and equivalently tolerable compared to postoperative analgesia using NSAIDs in patients who receive AKS.