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Background: Fast-track and ultra-fast-track anesthesia techniques can be facilitated with opioid requirements' reduction and multi-modal analgesia techniques that include the regional anesthesia techniques. The study aimed to assess the preoperative effect of single-shot bilateral ultrasound-guided erector spinae plane block (ESPB) on the extubation time and postoperative pain of patients undergoing on-pump CABG surgery. Results: The ESPB group was statistically significant decreased regarding the extubation time, ICU length stay, intraoperative fentanyl, and postoperative morphine consumption than the control group (p < 0.0001 for all the previous measurement). The 1st time of rescue analgesia of the ESPB group was longer than the control group (p < 0.0001). The numerical rating score (NRS) after extubation of the ESPB group was lower at 2 and 4 h after extubation (P = ˂ 0.0001 and 0.0006 respectively) than the control group. The number of patients who required rescue analgesia after extubation was significantly decreased in the ESPB group in comparison to the control group, 2 and 4 h after extubation (P = < 0.0001 and 0.004 respectively). Conclusions: The preoperative single-shot ultrasound-guided ESPB in patients scheduled for on-pump CABG surgery shortened the extubation time and the length of ICU, decreased intraoperative fentanyl and postoperative morphine consumption and postoperative pain scores, and prolonged 1st time of rescue analgesia without significant effect on the incidence of complications, re-intubation, or mortality. Trial registration: Approval was obtained from the Research Ethics Committee of the Faculty of Medicine (approval code of 33702/02/20) registered at February 2, 2020, and written informed consent was obtained from the patients. The trial was registered at 17 March 2020 in the Pan African Clinical Trial Registry with a unique identification number for the registry which is PACTR202003822626676. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to evaluate the ability to use opioid-free anesthesia (OFA) technique in morbid obese patients., Design: A prospective randomized double-blinded study., Setting: This study was carried out at Tanta University Hospitals (tertiary hospitals)., Patients: Eighty morbid obese patients scheduled for laparoscopic bariatric surgeries., Intervention: Patients were allocated randomly into two groups: Group C, in which fentanyl was used during induction and maintenance of anesthesia, and group OFA, in which dexmedetomidine, ketamine, magnesium, and lidocaine were started before the induction of anesthesia and continued throughout the surgery., Main Outcome Measure: The post-operative morphine consumption in the first 24 hours (primary outcome) and the intraoperative fentanyl consumption (secondary outcome)., Results: In comparison to the control group, OFA technique significantly decreased the post-operative morphine consumption (p = 0.003; 95 percent CI: 0.505; 2.396), shortened the time for the first request of rescue analgesia (p < 0.0001; 95 percent CI: 54.14; 99.11), decreased the post-operative pain score 4 and 6 hours after surgery (p < 0.05), and decreased the post-operative nausea and vomiting (PONV) impact scale (p = 0.022). Furthermore, it significantly decreased the intraoperative fentanyl consumption (p < 0.0001) with the improvement of all parameters of the recovery profile (p < 0.05)., Conclusion: OFA in patients undergoing bariatric surgeries significantly decreased the post-operative morphine consumption, the post-operative pain score, the intraoperative fentanyl consumption, and the PONV impact scale with the improvement of the recovery profile.

Background and Aim: The best analgesic technique after hip surgeries is a matter of debate. This clinical trial aimed to assess the effect of transmuscular ultrasound-guided quadratus lumborum (QL) block on post-operative analgesic consumption after hip arthroplasty in elderly patients., Methods: This prospective randomised double-blind study was carried out on 60 patients aged 60-80 years presented for total hip replacement under unilateral spinal anaesthesia. Patients were randomly allocated to one of two groups: A control group, receiving sham transmuscular QL block (QLB) (1 ml of normal saline), and a QL group, receiving real transmuscular QLB (30 ml of plain bupivacaine 0.25%). Post-operative morphine consumption (primary outcome), post-operative pain score (secondary outcome), time to the first request of rescue analgesia, patient's satisfaction and the occurrence of post-operative complications were measured., Results: Compared to the control group, the use of QLB in the second group significantly decreased intravenous morphine consumption postoperatively from 8.50 ± 3.06 mg to 5.60 ± 3.22 mg ( P = 0.0007) with a significant prolongation of the time to the first call for analgesia ( P < 0.0001). It also decreased the post-operative visual analogue score 4 h, 6 h and 8 h postoperatively ( P < 0.05). However, there was no difference between both the groups regarding patient's satisfaction and the occurrence of complications ( P > 0.05)., Conclusion: The use of transmuscular QLB in patients undergoing total hip replacement decreased post-operative analgesic consumption and post-operative pain score and prolonged post-operative analgesia. It did not affect patients' satisfaction and occurrence of post-operative complications., Competing Interests: There are no conflicts of interest., (Copyright: © 2020 Indian Journal of Anaesthesia.)

Background: Flexible laryngeal mask airway may be used instead of the endotracheal tube in children presented for elective repair of tongue trauma, as it may shorten the time for extubation and recovery with the amelioration of stress response to airway management., Objectives: This study aimed to evaluate the extubation time and hemodynamic response to the endotracheal tube or flexible laryngeal mask airway in children presented for tongue trauma repair., Methods: The study recruited 90 children presented for elective repair of tongue trauma that were randomly assigned into the following groups: the ETT group for which the airway was controlled by a cuffed endotracheal tube and the LMA group for which the airway was controlled by a flexible laryngeal mask. The intubation time, surgical time, total anesthesia time, extubation time, recovery time, changes in the hemodynamic parameters, and the incidence of complications were measured., Results: The use of flexible laryngeal mask airway instead of endotracheal tube significantly decreased the extubation time to 7.47 ± 2.74 min (P < 0.0001) and the recovery time to 52.67 ± 11.16 min (P = 0.001) while no significant differences were observed in the intubation time (P = 0.874), surgical time (P = 0.411), and total anesthesia time (P = 0.725). In addition, the changes in the hemodynamic parameters were significantly lower with flexible laryngeal mask airway both during airway securing and at the start of the surgery (P < 0.05). Moreover, it significantly decreased the incidence of postoperative cough, stridor, and sore throat (P = 0.039, 0.006, and 0.027, respectively)., Conclusions: The flexible laryngeal mask airway can be used instead of the endotracheal tube in children undergoing the repair of tongue trauma, as it decreases the extubation time, recovery time, and hemodynamic changes to the airway control., (Copyright © 2019, Author(s).)