Application of dezocine patient-controlled epidural analgesia in postoperative analgesia in patients with total myomectomy

BACKGROUND Uterine fibroids are common benign gynecological conditions.Patients who experience excessive menstruation,anemia,and pressure symptoms should be administered medication,and severe cases require a total hysterectomy.This procedure is invasive and causes severe postoperative pain,which can affect the patient’s postoperative sleep quality and,thus,the recovery process.AIM To evaluate use of dezocine in patient-controlled epidural analgesia(PCEA)for postoperative pain management in patients undergoing total myomectomy.METHODS We selected 100 patients undergoing total abdominal hysterectomy for uterine fibroids and randomized them into two groups:A control group receiving 0.2%ropivacaine plus 0.06 mg/mL of morphine and an observation group receiving 0.2%ropivacaine plus 0.3 mg/mL of diazoxide in their PCEA.Outcomes assessed included pain levels,sedation,recovery indices,PCEA usage,stress factors,and sleep quality.RESULTS The observation group showed lower visual analog scale scores,shorter postoperative recovery indices,fewer mean PCEA compressions,lower cortisol and blood glucose levels,and better polysomnographic parameters compared to the control group(P<0.05).The cumulative incidence of adverse reactions was lower in the observation group than in the control group(P<0.05).CONCLUSION Dezocine PCEA can effectively control the pain associated with total myomectomy,reduce the negative impact of stress factors,and have less impact on patients’sleep,consequently resulting in fewer adverse effects.

Safety and effectiveness of butorphanol in epidural labor analgesia:A protocol for a systematic review and meta-analysis

BACKGROUND Epidural analgesia is the most effective analgesic method during labor.Butorphanol administered epidurally has been shown to be a successful analgesic method during labor.However,no comprehensive study has examined the safety and efficacy of using butorphanol as an epidural analgesic during labor.AIM To assess butorphanol's safety and efficacy for epidural labor analgesia.METHODS The PubMed,Cochrane Library,EMBASE,Web of Science,China National Knowledge Infrastructure,and Google Scholar databases will be searched from inception.Other types of literature,such as conference abstracts and references to pertinent reviews,will also be reviewed.We will include randomized controlled trials comparing butorphanol with other opioids combined with local anesthetics for epidural analgesia during labor.There will be no language restrictions.The primary outcomes will include the visual analog scale score for the first stage of labor,fetal effects,and Apgar score.Two independent reviewers will evaluate the full texts,extract data,and assess the risk of bias.Publication bias will be evaluated using Egger's or Begg's tests as well as visual analysis of a funnel plot,and heterogeneity will be evaluated using the Cochran Q test,P values,and I2 values.Meta-analysis,subgroup analysis,and sensitivity analysis will be performed using RevMan software version 5.4.This protocol was developed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses(PRISMA)Protocols statement,and the PRISMA statement will be used for the systematic review.RESULTS This study provides reliable information regarding the safety and efficacy of using butorphanol as an epidural analgesic during labor.CONCLUSION To support clinical practice and development,this study provides evidence-based findings regarding the safety and efficacy of using butorphanol as an epidural analgesic during labor.

Comparison of bupivacaine, ropivacaine and levobupivacaine with sufentanil for patient-controlled epidural analgesia during labor： a randomized clinical trial

Ropivacaine and levobupivacaine have been introduced into obstetric analgesic practice with the proposed advantages of causing less motor block and toxicity compared with bupivacaine. However, it is still controversial whether both anesthetics are associated with any clinical benefit relative to bupivacaine for labor analgesia. This study aimed to compare the analgesic efficacy, motor block and side effects of bupivacaine, ropivacaine and levobupivacaine at lower concentrations for patient-controlled epidural labor analgesia. Methods Four hundred and fifty nulliparous parturients were enrolled in this randomized clinical trial. A concentration of 0.05%, 0.075%, 0.1%, 0.125% or 0.15% of either bupivacaine （Group B）, ropivacaine （Group R） or levobupivacaine （Group L） with sufentanil 0.5 ug/ml was epidurally administered by patient-controlled analgesia mode. Effective analgesia was defined as a visual analogue scale score was 〈30 mm. The relative median potency for each local anesthetic was calculated using a probit regression model. Parturients demographics, sensory and motor blockade, obstetric data, maternal side effects, hourly volumes of local anesthetic used, and others were also noted. Results There were no significant differences among groups in the numbers of effective analgesia, pain scores, hourly local anesthetic amount used, sensory and motor blockade, labor duration and mode of delivery, side effects and maternal satisfaction （P 〉0.05）. The relative median potency was bupivacaine/ropivacaine： 0.828 （0.602-1.091）, bupivacaine/levobupivacaine： 0.845 （0.617-1.12）, ropivacaine/levobupivacaine： 1.021 （0.774-1.354）, respectively. However, a significantly less number of effective analgesia and higher hourly local anesthetic use were observed in the concentration of 0.05% than those of 〉0.1% within each group （P 〈0.05）. Conclusions Using patient-controlled epidural analgesia, lower concentrations of bupivacaine, ropivacaine and levobupivacaine with s＇ufentanil produce similar analgesia and motor block and safety for labor analgesia. The analgesic efficacy mainly depends on the concentration rather than the type of anesthetics.

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

Objective To assess the efficacy and safety of lornoxicam, one non-steroidal anti-inflammatory drug (NSAID) in patient-controlled analgesia (PCA) in patients undergoing abdominal surgeries. Methods Thirty-nine patients scheduled for abdominal surgeries were randomly assigned to different PCA treatment groups using either lornoxicam or fentanyl postoperatively. Pain intensity difference (PID) and sum of pain intensity difference (SPID) were used to assess the analgesic efficacy of both drugs during a 24-hour period. Results The analgesic efficacy of lornoxicam is 1/66 of fentanyl, which was shown by SPID value of 3.250 and 3.058, respectively (P > 0.05). Lornoxicam caused fewer adverse events than fentanyl (33% vs. 68%, P < 0.05). Conclusion In clinic, we can use lornoxicam to treat postoperative pain effectively and with less adverse reactions com-pared with fentanyl.

Effects of Ropivacaine-sufentanil Epidural Analgesia on Labor and Maternal and Neonatal Outcomes

[Objectives]This study aimed to investigate the effects of ropivacaine-sufentanil epidural analgesia on labor and maternal and neonatal outcomes.[Methods]A total of 180 primiparas in full-term pregnancy were selected.They were randomly divided into treatment group(n=90)and control group(n=90).The primiparas in the treatment group were injected epidurally with ropivacaine and sufentanil for analgesia,and the primiparas in the control group were subjected to vaginal delivery.The VAS scores at 5,10,30 and 60 min of analgesia were observed.The vaginal bleeding amount,total labor duration,neonatal Apgar score and vaginal delivery rate of the two groups were compared.[Results]Compared with the control group,the VAS score in the treatment group differed insignificantly after 5 min of analgesia(P>0.05),and decreased significantly after 10,30 and 60 min of analgesia(P<0.05).The vaginal bleeding amount of the treatment group was significantly smaller than that of the control group(P<0.05).There was no significant difference in the neonatal Apgar score between the two groups(P>0.05).In the treatment group,the vaginal delivery rate increased(P<0.05),the second stage of labor was prolonged(P<0.05),and the first and third stages of labor did not change significantly(P>0.05).[Conclusions]Epidural analgesia with ropivacaine and sufentanil has a good analgesic effect and good safety,and is worthy of clinical promotion.

Combined lumbar muscle block and perioperative comprehensive patient-controlled intravenous analgesia with butorphanol in gynecological endoscopic surgery

BACKGROUND Laparoscopic surgery has become a common surgical approach for the clinical treatment of intra-abdominal lesions in recent years.We hypothesized that lumbar block with postoperative patient-controlled intravenous analgesia(PCIA)by butorphanol after gynecological surgery under general anesthesia would be more effective than PCIA by butorphanol alone.AIM To investigate the effect of lumbar block with PCIA by butorphanol after gynecological surgery under general anesthesia.METHODS This study assessed 120 women scheduled for laparoscopic surgery at our hospital between May 2017 and May 2020.They were divided using a random number table into a research group(those who received quadratus lumborum block combined with PCIA analgesia by butorphanol)and a control group(those who received only PCIA analgesia by butorphanol),with 60 patients in each group.Demographic factors,visual analog scale scores for pain,serum inflammatory markers,PCIA compressions,Ramsay scores,and adverse events were compared between groups using a t-test,analysis of variance,orχ2 test,as appropriate.RESULTS There were no significant differences in demographic factors between groups(all P>0.05).The visual analog scale scores of the research group in the resting state 12 h and 24 h postoperatively were significantly lower than those of the control group(P<0.05).Two hours after surgery,there were no significant differences in the levels of serum tumor necrosis factor-α,interleukin(IL)-6,or IL-8 between groups(P>0.05).The serum tumor necrosis factor-αlevels of the research group 24 h postoperatively were significantly lower than those of the control group(P<0.05).The levels of serum IL-6 and IL-8 in the study group 24 h and 48 h postoperatively were significantly lower than those in the control group(P<0.05).CONCLUSION Lumbar block with PCIA with butorphanol after gynecological surgery under general anesthesia significantly improves the analgesic effect and reduces the degree of inflammation,instances of PCIA compression,and adverse reactions.

Safety of applying midazolam-ketamine-propofol sedation combination under the supervision of endoscopy nurse with patient-controlled analgesia pump in colonoscopy

AIM To compare the results of midazolam-ketaminepropofol sedation performed by an endoscopy nurse and anaesthetist during colonoscopy in terms of patient satisfaction and safety.METHODS American Statistical Association(ASA) Ⅰ-Ⅱ 60 patients who underwent colonoscopy under sedation were randomly divided into two groups: sedation under the supervision of an anaesthetist(SSA) and sedation under the supervision of an endoscopy nurse(SSEN). Both groups were initially administered 1 mg midazolam, 50 mg ketamine and 30-50 mg propofol. Continuation of sedation was performed by the anaesthetist in the SSAgroup and the nurse with a patient-controlled analgesia(PCA) pump in the SSEN group. The total propofol consumption, procedure duration, recovery times, pain using the visual analogue scale(VAS) and satisfaction score of the patients, and side effects were recorded. In addition, the patients were asked whether they remembered the procedure and whether they would prefer the same method in the case of re-endoscopy.RESULTS Total propofol consumption in the SSEN group was significantly higher(P < 0.05) than that in the SSA group. When the groups were compared in terms of VAS score, recovery time, patient satisfaction, recall of the procedure, re-preference for the same method in case of re-endoscopy, and side effects, there were no significant differences(P > 0.05) between the two groups. No long-term required intervention side effects were observed in either group.CONCLUSION Colonoscopy sedation in ASA Ⅰ-Ⅱ patients can be safely performed by an endoscopy nurse using PCA pump with the incidence of side effects and patient satisfaction levels similar to sedation under anaesthetist supervision.

Preprocedure ultrasound imaging combined with palpation technique in epidural labor analgesia

BACKGROUND For parturients with paroxysmal uterine contraction pain,rapid analgesia is needed.We used preprocedure ultrasound imaging combined with the palpation technique in epidural analgesia for labor,and evaluated the usefulness of this technique in epidural labor analgesia.AIM To evaluate the usefulness of preprocedure ultrasound imaging in epidural analgesia for labor.METHODS In this prospective randomized observational study,72 parturients were assigned to two groups(combined or palpation group).The target interspace of all parturients was first identified by the palpation technique.Then in the combined group,preprocedure ultrasound imaging was used before epidural puncture.In the palpation group,only the traditional anatomical landmarks technique(palpation technique)was performed.The primary outcome was total duration of the epidural procedure(for the ultrasound group,the duration of the preprocedure ultrasound imaging was included).The secondary outcomes were the number of skin punctures,the success rate at first needle pass,the number of needle passes,the depth from the skin to epidural space,and the complications of the procedure.RESULTS Total duration of the epidural procedure was similar between the two groups(406.5±92.15 s in the combined group and 380.03±128.2 s in the palpation group;P=0.318).A significant improvement was demonstrated for epidural puncture and catheterization in the combined group.The number of needle passes was 1.14 in the combined group and 1.72 in the palpation group(P=0.001).The number of skin puncture sites was 1.20 in the combined group and 1.25 in the palpation group(P=0.398).The success rate at first needle pass was 88.89%in the combined group and 66.67%in the palpation group(P=0.045).CONCLUSION This study demonstrated that the total duration of epidural procedures with preprocedure ultrasound imaging combined with the palpation technique was not longer than the traditional anatomical landmarks technique,which were performed by six experienced anesthesiologists in parturients with normal weights undergoing labor analgesia.

Thoracic Epidural Morphine for Postoperative Analgesia after Hemiclamshell Incision in Castleman Disease

The hemiclamshell incision is a valid but infrequent surgical alternative for the resection of tumors from mediastinum. This point makes this approach impossible to be studied under a randomized controlled trial. The triple association of thoracotomy, sternotomy and cervicothomy makes the hemiclamshell approach a high intensity postoperative pain surgery. However, there is no published data on this topic, and the reviewed articles only mention the analgesic regimens as a secondary point. Indeed, no author defines the best epidural drugs mixture for the patients. Multimodal analgesic regimen based on regional anesthesia should be used. Based on the recent advances on spinal opioids, morphine could be a good choice as epidural coadjutant to local anesthetics for hemiclamshell incision.

Comparative efficacy of ketamine,lidocaine,acetaminophen,and dexmedetomidine combined with morphine patient-controlled analgesia in treating opium-addicted patients undergoing tibia fracture surgery:A randomized clinical trial

Objective:To compare the effect of ketamine,lidocaine,acetaminophen,and dexmedetomidine combined with morphine patient-controlled analgesia for opium addicts after tibial fracture surgery.Methods:This double-blind clinical trial included opium-addicted patients undergoing tibia fracture surgery.Patients were recruited and randomized to four different groups including the ketamine group,the lidocaine group,the acetaminophen group,and the dexmedetomidine group.The hemodynamic parameters such as heart rate(HR),mean arterial pressure,and arterial SaO2,alongside visual analog scale pain scores,sedation assessed by Ramsay score,nausea and vomiting,and opioid use were recorded and compared among the four groups.Results:This study included 140 patients,aged 37(32,41)years,with 92 males and 48 females,and each group had 35 patients.Dexmedetomidine-sedated subjects had the lowest blood pressure from 1 to 24 h after surgery,decreased HR at 12 and 24 h after surgery,and more satisfactory sedation(P<0.05).Notwithstanding no significant difference was noted in the pain scores,or nausea and vomiting among the groups(P>0.05).Conclusions:Dexmedetomidine has a better sedation effect compared to ketamine,lidocaine,and acetaminophen for pain control,but the final choice hinges on the patients’physical condition and the anesthesiologist's preference.Clinical registration:It is registered in Iranian Registry Clinical Trial by code IRCT20141209020258N146.

Epidural analgesia followed by epidural hydroxyethyl starch prevented post-dural puncture headache:Twenty case reports and a review of the literature

BACKGROUND Accidental dural puncture(ADP)and subsequent post-dural puncture headache(PDPH)remain common complications of epidural procedures for obstetric anesthesia and analgesia.No clear consensus exists on the best way to prevent PDPH after ADP.CASE SUMMARY We report our findings in twenty parturients who underwent an incorporated strategy of epidural analgesia followed by epidural hydroxyethyl starch(HES)to prevent PDPH after ADP with a 16-gauge Tuohy needle during epidural procedures.ADP with a 16-gauge Tuohy needle occurred in nine parturients undergoing a cesarean section(CS)and in eleven parturients receiving labor analgesia.An epidural catheter was re-sited at the same or adjacent intervertebral space in all patients.After CS,the epidural catheter was used for postoperative pain relief over a 48-h period.After delivery in eleven cases,epidural infusion was maintained for 24 h.Thereafter,15 mL of 6%HES 130/0.4 was administered via the epidural catheter immediately prior to catheter removal.None of the parturients developed PDPH or neurologic deficits over a follow-up period of at least two months to up to one year postpartum.CONCLUSION An incorporated strategy of epidural analgesia followed by epidural hydroxyethyl starch may have great efficacy in preventing PDPH after ADP.

Effects of labor analgesia on maternal and neonatal outcome by epidural low concentration of bupivacaine combined with anisodamine

Objective To observe the effects of labor analgesia on maternal and neonatal outcome by epidural application of 0.125% bupivacaine combined with anisodamine on the labor stage, and modes of delivery and neonatal Apgar’s score. Methods A total of 220 primiparaes with full-term pregnancy, monocyesis and fetal head presentation without any obstetrical or systematic complications were chosen and divided into analgesic group and control group (110 in each group). The mixture of bupivacaine and anisodamine was injected into the epidural space of the parturients in the analgesic group while those patients in the control group did not receive any analgesics. Results The analgesic effect was satisfactory (91.8%), and no side effects occurred in the second stage of labor. The instrument delivery rate was lower in the analgesic group, and there was no significant difference between the two groups in neonatal Apgar’s score. Conclusion The method is feasible in clinic for labor pain relief without increasing the rate of dystocia and complications of delivery.

Clinical Study of Epidural Analgesia with Clonidine andSumatriptan in Posthysterectomy

A clinical study was conducted to compare the analgestic effect of clonidine with those of sumatriptan and their mixture and their effects on hemodynamics. 40 patients undergoing elective total hysterectomy were randomly divided into 4 groups in terms of the epidurally administered drugs with 10 patients in each group (group C1: clonidine 150 μg, group C2: clonidine 75 μg, group S: sumatriptan 6 mg and group S+C:clonidine 75 μg + sumatriptan 3 mg). MAP, HR,SpO2, VT VAS, VRS and ePDT were measured in the initial 4 h. The demographic data and the doses of intraoperative local anesthetics among the 4 groups were not staistically different. It was found that no significant difference in the pre- and postadministration values of HR, SpO2 and VT. A obvious reduction of MAP appeared in the groups of C1 and C2, but in the other groups the hemodynamical parameters were stable. The groups of C1, C2 and S+C showed significant increase in VAS and VRS, along with increase of ePDT when comapred with the pre-drug level. There was no obvious alteration in group S after the drug administration. It was concluded that (1) single use of sumatriptan is ineffective in the dose given in this study; (2) small dose (150 μg and 75μg) of clonidine has epidurally analgesic effects; (3) combined use of sumatriptan and clonidine is an acceptable way in epidural analgesia, in terms of its analgesic effect and hemodynamic changes.

Postoperative Analgesia and Cesarean Section under General Anesthesia: Multicenter Study

Background: Neuraxial anesthesia with intrathecal morphine is the reference technique in cesarean section anesthesia for the management of postoperative analgesia. If there is a contraindication to this, general anesthesia is required. The objective of the study was to evaluate the analgesic effectiveness of 4 analgesic techniques performed during cesarean section under general anesthesia in two centers with different anesthetic practices (North Franche Comté Hospital and Omar Bongo Ondimba Army Training Hospital). Method: This is a retrospective and descriptive study over 2 years, from January 1, 2019 to December 31, 2020. It involved evaluating the analgesic effectiveness and tolerance of morphine in the epidural catheter, wound infiltration, intravenous analgesia and Transversus Abdominous Plane block (TAP block) from the post-anesthesia care unit (PACU) until the 4th post-operative day. Results: Of the 354 cesarean sections performed, 84 (11.14%) received general anesthesia. The average age was 32.27 years. Acute fetal distress was the first indication for cesarean section (45.2%), followed by hemorrhagic placenta previa (10.7%) and prolapse of the cord (8.33%). Morphine in the epidural catheter was the most used (47.6%) followed by parietal infiltration (36.9%), intravenous analgesia (13.1%) and TAP block (2.38%). The analgesic effectiveness was comparable between the techniques from postoperative day 0 to day 4. No difference in side effects. Postoperative morphine consumption was significantly reduced (p = 0.011) in the infiltration (9 mg) and TAP block (9mg) groups compared to the epidural catheter (16 mg) and intravenous analgesia (17 mg). No difference in 02 rehabilitation criteria (ambulation, first bowel movement). No difference in the occurrence of chronic pain. Conclusion: In the event of a cesarean section under general anesthesia, there are effective and well-tolerated alternatives to neuraxial anesthesia, particularly regional anesthesia techniques (nerve blocks), particularly in countries with low availability of morphine.

COMPARISON OF PATIENT-CONTROLLED ANALGESIA WITH TRAMADOL VS MORPHINE IN PATIENTS UNDERGOING ABDOMINAL GYNECOLOGICAL SURGERY

Objective.To c ompare the analgesic efficacy and adverse effects of patient-controlled analges iawith tramadol and with morphine for postoperative middle or severe pain .Methods.Fifty-nine patients,scheduled for elective hysterectomy or hystero myomectomy ,were ran-domly divided into Group Tand Group M.The2drugs were administered intravenously v ia a patient-controlled analgesia device till24h postoperatively.Efficacy wa s assessed by comparing total pain reliefand the sum of pain intensity differencevalues over24h.Results.Statistically significant equival ence of tramadol and morphine was shown by TOTPAR values(15.9±4.4and1 6.4±3.5,respectively)and SPID values(9.2±4.7and9.0±2.0, respectively).Tramadol caused fewer adverse events than morphin e(16.7%and26.7%of patients,respectively).Conclusion.The analgesic efficacy of PCA with tramadol and with morphine were equivalent in the treatme nt of postoperative pain,and tramadol can cause slighter gastrointestinal adve rse effects.

The effect of postoperative epidural analgesia in women possessing severe gestational hypertension undergoing cesarean delivery

Introduction: The purpose of this study was to examine the clinical usefulness of postoperative epidural analgesia in patients possessing severe gestational hypertension after Cesarean delivery. Methods: We reviewed the obstetric records of 99 patients possessing severe gestational hypertension undergoing singleton Cesarean delivery at ≥ 22 weeks’ gestation. Thirty patients were received continuous epidural analgesia with 0.2% ropivacaine for pain relief after Cesarean delivery with spinal anesthesia, 69 patients were not received epidural analgesia after Cesarean delivery with spinal anesthesia. Results: During the preoperative period, there were no measurable differences in the diastolic blood pressure between the 2 groups (108 vs± 7 vs. 106 mmHg ± 10 mmHg, p = 0.29). The diastolic blood pressure at 2 and 4 hours after Cesarean section in the epidural analgesia group were significantly lower than those in the non-epidural group (2 hours after Cesarean section: 88 vs ± 13 vs. 95 mmHg ± 8 mmHg, p < 0.01;4 hours after Cesarean section: 92 vs ± 15 vs. 102 mmHg ± 9 mmHg, p < 0.01). Conclusions: The current results indicated that the postoperative epidural analgesia can inhibit the rise in diastolic blood pressure in patients possessing severe gestational hypertension after Cesarean delivery. This electronic document is a “live” template. The various components of your paper [title, text, heads, etc.] are already defined on the style sheet, as illustrated by the portions given in this document.

Myofascial Foot Pain Following Uneventful Epidural Analgesia for Labor and Delivery

Following an uneventful delivery under epidural analgesia, a 17 year old female patient was referred to the Pain Clinic because of numbness and pain of the left big toe for 2 and a half Months. An Orthopedic consultation had ruled out foot injury and concluded that the pain was radicular and secondary to nerve damage from the epidural analgesia. A Pain Clinic evaluation made the diagnosis of myofascial pain which was successfully treated with trigger pint block using normal saline.

A Comparative Study on Safety and Efficacy of Caudal, Thoracic Epidural and Intra Venous Analgesia in Paediatric Cardiac Surgery: A Double Blind Randomised Trial

Introduction:Regional anaesthesia combined with general anaesthesia reduces stress response to surgery, duration of ventilation, intensive care unit (ICU) stay and promotes early recovery. Studies on thoracic epidural, caudal analgesia along with general anaesthesia (GA) in paediatric cardiac surgery are limited hence we aimed to compare efficacy and safety of caudal, thoracic epidural and intravenous analgesia in paediatric cardiac surgery. Methodology: This study was conducted in the Department of Anaesthesiology in a tertiary care teaching hospital in southern India from February 2019 to December 2019. 90 children were randomised into group A, group B, group C. Children in group A received caudal analgesia along with GA. Group B children received thoracic epidural along with GA. Group C patients received intravenous analgesia along with GA. Rescue analgesia 1 mcg/kg fentanyl given in all 3 groups if pain score is more than 4. Primary outcome assessed was post-op pain scores. Secondary outcome assessed was duration of ventilation, duration of intensive care unit stay. Results: All patients were comparable in terms of age, sex, weight, mean RACHS score, baseline heart rate and blood pressure. Pain scores were significantly lower in thoracic epidural group compared to other two grou ps. Duration of ventilation was lower in thoracic epidural group (91.17± 43.85) minutes and caudal (199.6 ± 723.59) minutes compared to intravenous analgesia groups (436.37 ± 705.51) minutes. Duration of ICU stay was significantly low in thoracic epidural group (2.73 ± 0.69) days compared to caudal (3.7 ± 2.8) and intravenous analgesia groups (4.33 ± 0.920). We didn’t have any complications like hematoma, transient or permanent neurological sequelae in regional anesthesia groups. Conclusion: Regional anaesthesia along with general anaesthesia was more effective in pain relief than intravenous analgesia with general anaesthesia in paediatric cardiac surgery.

Comparative Study between General Anesthesia versus General Anesthesia Combined with Thoracic Epidural Analgesia on Cytokine Response in Laparoscopic Cholecystectomy Patients

Background and Objectives: The main benefits of laparoscopic surgery in comparison to open surgery involve the rapid discharge from recovery room, decreased postoperative hospital stays, reduced postoperative discomfort, easier getting back to work and faster return to ordinary daily life as well as cosmetic surgical wounds. The anesthesia type has an essential role in attenuation of the surgical stress and achievement of these advantages. We aimed to determine the outcome of giving general anesthesia in conjunction with thoracic epidural analgesia (TEA) compared to general anesthesia alone on stress response to surgery and anesthesia by investigating cytokine reaction (interleukin 6 and 8 levels), hemodynamic changes (BP, HR, RR, SPO2), and Visual Analogue Scale (VAS) scores postoperatively in patients subjected for laparoscopic cholecystectomy. Methods: This study included 40 patients aged 20 - 60 years old with American Society of Anesthesiologists physical status (ASA) I and II. They were planned for laparoscopic cholecystectomy at Aswan University Hospital from April 2017 to March 2018. They were randomly allocated into two groups. Group A (n. 20) received general anesthesia only and Group B (n. 20) received general anesthesia in conjunction with thoracic epidural analgesia using fentanyl and bupivacaine in the epidural catheter. Chi-square was applied to differentiate categorical variables, whereas comparison between continuous variables was done by using t-test. Two-tailed p < 0.05 was estimated as statistically significant. Results: As regards IL-6 and IL-8 post-operative there is significant difference (p < 0.05) between two groups during 2nd and 4th hr and 24th hr postoperative, with significantly increased postoperative levels of IL-6 and IL-8 in comparison to their preoperative baseline values. The largest increase in IL6 & IL8 levels was in group A (GA group). VAS score showed significant lower values in TEA group in comparison to GA group. No significant difference between groups as regard intraoperative and postoperative hemodynamic changes. Conclusion: Regional techniques including TEA attenuate and decrease cytokine reaction secondary to surgery which decreases inflammatory process and improves patient outcome and reduces pain score postoperatively.