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Duloxetine, Etoricoxib and opioid are of the commonly administered drugs in Lumbar laminectomy. The aim of this study is to assess the effect of perioperative use of Duloxetine in combination with Etoricoxib on postoperative pain and opioid requirements. One hundred twenty patients with ASA physical status were enrolled with age between 18 and 70 years. Patients were divided randomly into four groups of 30 patients: group P received placebo, group E received etoricoxib 120 mg, group D received duloxetine 60 mg and group D/E received duloxetine 60 mg capsules and etoricoxib 120 mg; 1 h before surgery and 24 h after. Neither Duloxetine nor etoricoxib individually had effect on pain with movement, while their combination revealed a significant reduction in pain scores over the entire postoperative period at rest and on movement. Etoricoxib showed a significant decrease in pain at all times at rest when compared with group P, while it showed significant pain decrease only at 0, 2 and 4 h when compared with group D. On the other hand duloxetine alone showed significant decrease in pain at rest at 24 h and 48 h when compared with group P. ConcerningMorphine requirement after 24 h.; it wassignificantly lower in the D/E group in comparison with groups P, E and D. It should be noted also that there was a significant decrease morphine requirement in both groups E and D. The perioperative administration of the combination of etoricoxib and duloxetine improved analgesia and reduced opioid consumption without significant side effects. ISRCTN48329522 . 17 June 2017

Background Peripheral nerve block has gained increased popularity owing to less postoperative pain and reduced need for postoperative analgesic drugs. The aim of the study was to compare the effect of ketamine and dexmedetomidine on the supraclavicular nerve block. Patients and methods A total of 75 adult patients undergoing elective operations of the elbow, forearm, wrist, or hand were randomly allocated into three groups of 25 patients each. Group K (ketamine group) received 40 ml 0.25% bupivacaine contain 1 mg/kg ketamine, group D (dexmedetomidine group) received 40 ml 0.25% bupivacaine contain 1 μg/kg dexmedetomidine, and group C (control group) received 40 ml 0.25% bupivacaine. The outcome measures included visual analog scale (0=no pain and 10 cm=the most severe pain), time to first analgesic request, and total dose of diclofenac analgesia given postoperatively. Results Patients in D and K groups had reduced visual analog scale scores than the C group, at all time points after surgery during the first 24 h, with more reduction in group D than K group (P Conclusion The addition of ketamine or dexmedetomidine in the ultrasound-guided supraclavicular brachial plexus block could improve the postoperative pain and need for analgesia. Therefore, we can consider the low-price readily available ketamine as a comparable adjuvant in brachial plexus block to some extent as dexmedetomidine.

Objective To compare between two doses of ondansetron (2 mg, 4 mg) and ephedrine in prevention of maternal hypotension and bradycardia induced by spinal anesthesia, their effects on specifications of spinal blockade, neonatal outcome, and their side effects. Patients and methods One hundred twenty parturients ASA І or ІІ aged between 18 and 40 years, scheduled for elective cesarean section under spinal anesthesia. They were randomly divided into four equal groups. First group received intravenous I.V. 2 mg ondansetron, second group received I.V. 4 mg ondansetron, third group received 10 mg ephedrine, and the fourth group received normal saline. All the test drugs were administered as bolus dose five minutes before intrathecal injection. Mean blood pressure, heart rate, vasopressor use, spinal anesthesia specifications, neonatal outcome, and side effects were assessed. Results The fall in mean blood pressure after spinal anesthesia in ondansetron 4 mg group was the least and the greatest was in the control group. There was dropping in heart rate values after spinal anesthesia started from 5 minutes value with significance to the control group only. No significant difference between the four groups in the spinal anesthesia characters. Slight acidosis was noticed in the ephedrine group which doesn’t affect the clinical neonatal outcome. Conclusion Prophylactic bolus intravenous ondansetron 4 mg and to less extent 2 mg could decrease the fall in mean blood pressure of parturients following spinal anesthesia as well as intravenous ephedrine 10 mg with added advantage that it could decrease neonatal acidosis associated with ephedrine use.

Objective This study was designed to assess the effect of intrathecal midazolam on dexmedetomidine with a low-dose bupivacaine in elderly patients undergoing hip repair surgery. Materials and methods This is a double-blind study involving 75 patients with American Society of Anesthesiologists physical status II and III aged over 60 years scheduled for elective hip repair surgery under intrathecal anesthesia. They were randomly divided into three groups: control (C group) received 7.5 mg of 0.5% hyperbaric bupivacaine, dexmedetomidine group (D group) received 7.5 mg of 0.5% hyperbaric bupivacaine+5 μg of dexmedetomidine, and dexmedetomidine+midazolam group (DM) received 7.5 mg of 0.5% hyperbaric bupivacaine+5 μg of dexmedetomidine+1 mg of midazolam. The onset and duration of sensory and motor blockade, intraoperative hemodynamic change, and postoperative analgesia were recorded. Results Compared with group C, the groups D and DM had significantly faster onset of sensory block (P=0.032 and 0.0001, respectively), faster onset of motor block (P=0.024 and 0.006, respectively), prolonged duration of sensory block (P=0.003 and 0.0001, respectively), prolonged duration of motor block (P=0.015 and 0.002, respectively), prolonged duration of postoperative analgesia (P=0.0001), and significantly decreased postoperative visual analog scale sedation score for 12 h. Compared with group D, group DM had a significantly longer duration of sensory block (P=0.012), longer duration of postoperative analgesia (P=0.042), and postoperative visual analog scale significantly decreased for 12 h postoperatively. Conclusion Intrathecal addition of 1 mg midazolam to 5 µg dexmedetomidine and 7.5 mg 0.5% hyperbaric bupivacaine provided intraoperative hemodynamic stability, prolonged motor, and sensory block as well as potentiating the postoperative analgesic.

Background The aim of this study was to compare the effect of addition of tramadol and magnesium sulfate as adjuvants to local anesthetics lidocaine 2% and bupivacaine 0.5% in sciatic nerve block classic posterior approach. Patients and methods A total of 90 ASA I or II patients, aged 17–50 years, scheduled for lower extremities surgeries under sciatic nerve block classic posterior approach were randomized into three equal groups. All groups received 20 ml of local anesthetics, which consisted of 10 ml bupivacaine 0.5% and 8 ml lidocaine 2% mixed with 2 ml saline in the control (C) group, 2 ml of 150 mg magnesium sulfate made in saline in the magnesium (M) group, and 2 ml of 100 mg tramadol in the tramadol (T) group. The onset and duration of both sensory and motor blocks, the intraoperative pain assessment by visual analogue scale, intraoperative analgesic requirements, postoperative pain by visual analogue scale, time to first analgesic request after surgery, postoperative diclofinac consumption, and adverse effects were assessed. Results The onsets of sensory and motor blocks were rapid in the M group, then C group, and lastly, T group. Much more time was needed for group T until sensory and motor blocks faded away followed by group M and then group C. There was a significant delay in the time of first analgesic request in groups M and T when compared with group C. There was a significant decrease in the total dose of diclofinac consumption in groups T and M in comparison with group C, where the patients consumed more analgesia. Conclusion Magnesium sulfate and tramadol as adjuncts to local anesthetics increase the duration of sensory and motor sciatic nerve block. The time for first rescue analgesia was longer in groups M and T, and they both showed decreased postoperative analgesic consumption.

Background Hypotension during spinal block for cesarean section is secondary to the aortocaval compression by the uterus and sympathetic blockade and it can be deleterious to both the fetus and the mother. In this study, we compared the effect of leg wrapping, low-dose ephedrine infusion, and placebo on systolic blood pressure (SBP) during spinal block for cesarean section. Patients and methods In this randomized, double-blinded, placebo-controlled study, 90 American Society of Anesthesiology I and II women scheduled for elective cesarean section received either ephedrine (group E; n=29; initial bolus of 5 mg and infusion of 1.5 mg/min), leg wrapping (group L; n=30), or no treatment (group C; n=29). SBP and maximal decrease in SBP were the primary outcomes, and heart rate, neonatal acid–base status, Apgar score, and side effect as bradycardia, neausea, and vomiting were secondary outcome variables during the first 20 min after induction of spinal anesthesia. Results Fall in blood pressure in group C was more significant as compared with groups E and L (P 0.05). Conclusion An initial bolus of ephedrine followed by a low-dose ephedrine infusion was superior to leg wrapping and no intervention for the prevention of hypotension during spinal anesthesia for cesarean delivery. Leg wrapping prevented hypotension compared with no intervention by limiting modest early spinal anesthesia-mediated venodilation.

Background In this study, we compare the effect of dexamethasone and paracetamol when added to intravenous regional anesthesia (IVRA) on intraoperative and postoperative analgesia, sensory and motor block onset times, sensory and motor recovery times, and tourniquet pain. Patients and methods Sixty adult patients undergoing elective surgical operations on the upper limb were randomly and blindly divided into three groups. All groups received IVRA lidocaine 3 mg/kg diluted with saline to a total volume of 40 ml. Group 1 received lidocaine diluted with normal saline, group 2 received lidocaine and dexamethasone 8 mg admixture, and group 3 received lidocaine and 300 mg paracetamol. All patients were assessed as regards hemodynamics, O2 saturation, respiratory rate, intraoperative degree of analgesia, and onset of sensory anesthesia and motor block. After tourniquet deflation, time to recovery of sensory and motor block and the time to first analgesic requirement were assessed. Results The onset of sensory motor block occurred significantly earlier in group 2, followed by group 3 when compared with group 1. Patients in groups 2 and 3 tolerated tourniquet pain much better compared with group 1 patients. This led to prolonged time to first request for intraoperative analgesia and reduced the number of patients requiring fentanyl. As regards postoperative pain, patients in group 2 followed by group 3 patients tolerated the pain much better compared with group 1. This led to prolonged time to first request for analgesia. Conclusion Addition of dexamethasone to lidocaine in IVRA is superior to the addition of paracetamol.