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We hypothesized that increasing our intrathecal fentanyl dose for cesarean delivery from 10 µg to 15 µg would result in fewer patients receiving a rescue analgesia intervention. Patients who had a cesarean delivery from February 15, 2021 to February 14, 2023 and received a single injection spinal or combined spinal-epidural anesthetic for cesarean delivery were eligible for inclusion. We defined a rescue analgesia intervention as administration of local anesthetic through an epidural catheter, administration of systemic anesthetic adjuvant medication, or conversion to general anesthesia. A total of 520 and 556 patients received 10 µg and 15 µg of intrathecal fentanyl for cesarean delivery, respectively, of which 154 (29.6%) and 122 (21.9%) patients required rescue analgesia interventions, respectively (P = 0.004). The odds ratio for receiving a rescue analgesia intervention was 0.668 (95% confidence interval 0.507 to 0.880; P = 0.004) for patients who received 15 µg of intrathecal fentanyl compared to 10 µg. Following implementation of an increased dose of intrathecal fentanyl, patients who received 15 µg of intrathecal fentanyl for cesarean delivery were approximately 33% less likely to require a rescue analgesia intervention during cesarean delivery compared to patients who received 10 µg. [ABSTRACT FROM AUTHOR]

Fundamento: el efecto anestésico del sulfato de magnesio está relacionado con varios mecanismos, como antagonista de los receptores del N-metil-D-aspartato.Objetivo: evaluar la efectividad adyuvante del sulfato de magnesio en pacientes de 60 años y más intervenidos por fractura de cadera en el Hospital General Docente “Manuel Ascunce Domenech” de la provincia Camagüey, en el período de noviembre 2014 a septiembre 2018.Métodos: serealizó un estudio analítico, prospectivo de casos y controles en los pacientes, institución y periodo de tiempo declarados en el objetivo. La muestra fue de 180 pacientes distribuidos de forma aleatoria simple 1:1 en los grupos control y de estudio, a los incluidos en este último se les administró el sulfato de magnesio en el preoperatorio.Resultados: se constató mayor riesgo de fractura de cadera en las pacientes del sexo femenino y en los de 65 años y más; al mayor número de pacientes se les realizó técnica neuroaxial intratecal, sin cambios en los parámetros clínicos evaluados. La duración de la analgesia a las 12 horas del posoperatorio fue siete veces mayor en los del grupo de estudio con respecto al control.Conclusiones: la administración perioperatoria por vía parenteral del sulfato de magnesio en los pacientes con el diagnóstico de fractura de cadera resultó efectiva, ampliando la duración de la analgesia.

Background: The effect of dexmedetomidine on the potency of bupivacaine for transversus abdominis plane (TAP) block in pediatric patients has not been investigated.Study Objective: The primary objective of this study was to assess the effectiveness of dexmedetomidine to decrease the concentration of bupivacaine needed for analgesia for ultrasound-guided TAP block in a pediatric patient undergoing hernia repair or hydrocelectomy.Design: This is a randomized, double-blind, up-down, dose-finding study.Setting: Operating room.Patients: Sixty American Society of Anesthesiologists I and II patients aged 1-4 years scheduled for elective unilateral herniorrhaphy or hydrocelectomy.Interventions: Patients were randomly assigned to 1 of the 2 groups: group B (0.125% bupivacaine, 1mL/kg) TAP block or group BD (0.125% bupivacaine plus 2μg/kg dexmedetomidine, 1mL/kg) TAP block.Measurements: The response of each child was observed for 60 seconds after skin incision and evaluated as 'unsuccessful' when skin incision caused a change in hemodynamic parameters (heart rate and mean blood pressure) 20% more than the preincision values. If the response was determined to be unsuccessful, the concentration of bupivacaine administrated to the next patient was increased by 0.02%. If it was successful, the concentration of bupivacaine administrated to the next patient was decreased by 0.02%.Results: The minimum local anesthetic concentration of bupivacaine was 0.0839% (0.0137) in the B group and 0.0550% (0.0169) in the BD group. The difference was statistically significant (t=7.165, P=.0001). The total postoperative analgesic dosage of morphine was significantly higher in the B group (0.17±0.04 mg/kg) than the BD group (0.11±0.02 mg/kg, P=.001).Conclusions: The addition of 2μg/kg of dexmedetomidine reduced the minimum local anesthetic concentration of bupivacaine used for a TAP block and improved postoperative analgesia in children undergoing surgery for inguinal hernia repair or hydrocelectomy. [ABSTRACT FROM AUTHOR]

Background: Intrathecal pethidine provides excellent post-operative analgesia but is associated with significant nausea, vomiting and other side effects. Present study was done to evaluate the efficacy of intravenous dexamethasone to enhance post-operative analgesia and to reduce the side effects. Methodology: In this prospective, randomized, double blind, placebo controlled study a total of 80 patients of American Society of Anesthesiologists (ASA) grade I and II, undergoing elective lower limb orthopedic surgery under sub-arachnoid block were randomized into two groups. Group C (n=40) received 2 ml saline (as placebo) and Group D (n=40) received 0.1 mg/kg dexamethasone intravenously as a bolus before intrathecal anesthesia. In all patients spinal anesthesia was administered with 15 mg bupivacaine and 15 mg pethidine. After surgery, patients were asked to score their pain at 2, 4, 6, 12, 18 and 24 hr by VAS score. The presence of post-operative nausea vomiting (PONV), pruritus and respiratory depression were recorded and compared between the two groups. Results: The pain score on Visual Analogue Scale (VAS) at 6, 12, 18, 24 hours after surgery, mean number of rescue analgesic doses in 24 hours and the incidence of PONV were significantly lower (p<0.05) in dexamethasone group (Group D). Conclusion: Administration of intravenous dexamethasone (0.1 mg/kg) just before subarachnoid block is an effective mode of enhancing post-operative analgesia with intrathecal pethidine and it reduces incidence of PONV. [ABSTRACT FROM AUTHOR]

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