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Objective: Acute, severe pain following breast surgery affects about 40% of individuals. It has proven possible to lessen postoperative pain related to modified radical mastectomy (MRM) by developing several thoracic wall blocks. This study evaluated the analgesic benefit of pectoral nerve block type 2 (PECS II) in conjunction with ultrasonography-guided serratus anterior plane block (SAPB) as opposed to SAPB alone in patients undergoing MRM. Methods: In this randomized double-blind trial, female patients undergoing MRM under general anesthesia were randomly assigned to the SAPB Group (n = 30) or the Combined Group (n = 30). Along with block-related problems, the total amount of fentanyl consumed during the procedure and the amount of morphine consumed over in the first 24 hours after surgery were noted. During rest and movement, pain was measured using the Numeric Rating Scale (NRS). Results: The total intraoperative fentanyl consumption was reduced to 130.7 ± 44.4 µg in the combined group compared to 160.0 ± 53.2 µg in the SAPB group (p = 0.024). Also, postoperative morphine consumption was 1.5 mg (0–6) and 6 mg (3–9) in the two groups, respectively (p = 0.005). The Combined group showed significantly lower scores of NRS at rest and during movement than the SABP group throughout the postoperative period. Conclusion: Ultrasound-guided SAPB plus PECS II block provides safer and more efficient analgesia in MRM than SABP alone, as evidenced by decreased postoperative morphine consumption, pain scores, and intraoperative fentanyl consumption. [ABSTRACT FROM AUTHOR]

Background: Hypospadias is a wide-world congenital malformation that accounts for 1 of 300 live male births. Many procedures were considered for its management. As the tubularised incised plate (TIP) urethroplasty, the most prevalent technique, caused many complications, several modifications were applied to the original operation to improve the outcomes and alleviate complications. The aim of this study was to compare the outcome of the ordinary TIP urethroplasty with the technique modified without dissection of the glans penis. Materials and Methods: A total of 82 patients with a mean age of 18.8 (±14.8) months, were randomly assigned to undergo TIP with either complete glans wings mobilisation (Group A, n = 42 patients) or without glans dissection (Group B, n = 40 patients). To evaluate the effect of modified TIP urethroplasty without glanular dissection for treatment of distal hypospadias in contrast to classical TIP repair. Results: Both techniques showed similar outcomes regarding functional repair, with good to excellent results between 88% and 90% after 6 months of follow-up. Most confronted post-operative complications were wound infection, oedema, urethrocutaneous fistulas and meatal stenosis. Less frequently haematoma, post-operative bleeding and glans dehiscence were encountered. The differences in complication rates between the two studied groups were statistically insignificant except for oedema (P = 0.04), and need for urethral dilatation (P = 0.002) that were more prevalent among patients who were treated with classic TIP repair with complete glans wings mobilisation. Conclusion: From our point of view, it seems that TIP without glanular dissection technique does not outweigh TIP with complete glans wings mobilisation regarding functional outcomes and post-operative complications. [ABSTRACT FROM AUTHOR]

Background Children suffer postoperative pain in the same way as adults. Pediatric pain management is a challenge. Patient-controlled analgesia (PCA) is a flexible, reliable, and individualized method in postoperative pain therapy. However, young children are not able to use PCA themselves, and hence they need to receive PCA by proxy (parent or nurse). The guidelines for PCA by proxy in pediatrics are still insufficient. Aim The aim of this study was to determine the safety and efficacy of PCA by proxy after major pediatric cancer surgery. Patients and methods We studied 330 pediatric cancer patients between 1 and 10 years of age scheduled for major surgery. They were divided into three equal groups: group C (child PCA), group P (parent proxy), and group N (nurse proxy). In each group we measured vital signs, pain intensity, total morphine consumption, side effects, and specific PCA monitoring for the first 72 h postoperatively. Results We found that pain scores were higher in the nurse group compared with the other two groups on days 2 and 3 (P < 0.001); morphine consumption was higher in the child group (older age). Vital signs were comparable between groups. There were no significant differences in sedation scale, and there were limited complications with no difference between groups. Conclusion Parent-controlled PCA is a safe and effective method of analgesia for children between 1 and 6 years of age. Nurse-controlled proxy is safe but not effective in controlling child pain. Childcontrolled analgesia is safe and effective in children above 6 years of age. [ABSTRACT FROM AUTHOR]

Purpose: The study aimed at the evaluation of the impact of intravenous (IV) dexamethasone on efficacy and duration of analgesia of paravertebral block (PVB) in patients undergoing modified radical mastectomy (MRM)., Patients and Methods: This randomized, double-blind controlled trial included 50 patients with breast cancer scheduled for unilateral MRM. Ultrasound-guided PVB was performed in out-of-plane technique. The technique was repeated at each segment from C7 to T6. The participants were randomly allocated to one of two groups. Group BD (n=25) received IV 8 mg dexamethasone diluted with 8 mL of normal saline to reach 10 mL solution, while Group B received IV 10 mL normal saline. Top-up local infiltration analgesia into the surgical field was performed by the surgeon if needed using lidocaine 1% intraoperatively. Propofol infusion of 50-100 µg/kg/min was maintained throughout the surgery. The time to administration of the first postoperative analgesic dose, pain intensity as visual analog scale (VAS) score, number of patients who required rescue morphine analgesia, total morphine consumption, postoperative nausea and vomiting (PONV) impact scale, and the overall satisfaction of patients with pain management were measured., Results: Fifty patients were randomized and analyzed. The time to first rescue analgesic dose was significantly longer in Group DB ( P <0.001). The VAS scores were significantly lower in Group DB compared to Group B up to 12 hours postoperatively. Morphine consumption was lower in Group DB compared to Group B. PONV Impact Scale score was significantly higher in Group B., Conclusion: Systemic dexamethasone increased the efficacy and duration of the single-shot multilevel PVB in breast cancer surgery., Trial Registration: ISRCTN registry, study ID: ISRCTN15920148., Competing Interests: Disclosure The authors report no conflicts of interest in this work.

Introduction: About 50% of patients with cancer develop bone metastasis mainly presenting with distressing, drug-resistant pain., Aim of the Work: The study evaluated efficacy and safety of combined cementoplasty and bony radiofrequency ablation in palliation of intractable pain and disability in cancer patients with bony metastases., Patients and Methods: The study included 30 adult patients suffering from localized bony metastases causing refractory moderate to severe pain. Radiofrequency bony ablation performed followed by cementoplasty were done under computed tomography (CT) guidance with conscious sedation and local anesthesia. Final CT check was done to ensure adequate lesion filling and to exclude any cement leakage. Pain, hemodynamic variables, and neurological status were checked for a minimum of 2 h before discharge. The patients were followed up weekly in the pain clinic. The primary outcome measures pain severity and daily opioid consumption. The secondary outcome measures were quality of life and the degree of disability, and procedure-related adverse outcomes., Results: Pain score, daily morphine consumption, and Oswestry Disability Index score decreased significantly after 1 day, and 1, 4 and 12  weeks. None of the patients had serious complications during the postoperative follow up visits. Only 4 patients (13.3%) experienced discomfort during, and few days after the procedure, 3 patients (10%) suffered from local infection, and 2 patients (6.7%) reported cement leakage., Conclusion: Combined radiofrequency ablation and cementoplasty is a safe and effective pain relief modality in patients suffering from extraspinal painful bone metastases with improvement of the quality of life., (Copyright © 2018 National Cancer Institute, Cairo University. Production and hosting by Elsevier B.V. All rights reserved.)