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Background:Caudal analgesia is a safe technique that can be performed under fluoroscopy in lumbosacral spine surgeries. Studies have raised evidence supporting the use of epidural dexamethasone in such surgeries. Adding second adjuvant like dexmedetomidine or hyaluronidase to dexamethazone has not been investigated before. Methods: Sixty patients scheduled for lumbosacral spine surgery were randomized and allocated in 3 groups. All patients received 30ml of caudal mixture after insertion of caudal catheter. Group A received 0.125% bupivacaine with 8 mg dexamethasone. Group B received 50 µg dexmedetomidine in addition to the mixture given to group A. Group C received 1500 IU hyaluronidase in addition to the mixture given to group A. Results: Mean time to the first analgesic dose in group B was 589.5 min and in group C was 565.5 min, which is longer than mean time in group A (492 min), p = 0.021. Number of patients who needed intraoperative top-up doses of fentanyl was 5 (25%) in group B and 10 (50%) in group C versus 13 (65%) in group A, p = 0.038. Total pethidine dose in 24 hours was 50.75 ± 10 mg in group B and 55.25 ± 8 mg in group C versus 64.25 ± 22 mg in group A, p = 0.021. Post hoc analysis and pairwise comparisons were conducted to determine which intervention groups had significant differences. Conclusion: Dexmedetomidine and hyaluronidase addition to caudal bupivacaine and dexamethasone increased duration of analgesia after lumbosacral spine surgery, but dexmedetomidine was superior to hyaluronidase. [ABSTRACT FROM AUTHOR]

Background: Satisfactory analgesia is of great importance in the labor. The clinical efficacy and side effects of remifentanil in the management of labor pain had been evaluated. Dexmedetomidine (DMET) demonstrates an antinociceptive effect in visceral pain conditions. Aims of the study were to assess whether the combination of DMET with remifentanil would produce a synergistic effect that results in lower analgesic requirements. Furthermore, whether this combination would have less maternal and neonatal adverse effects. Patients and Methods: Sixty American Society of Anesthesiologists physical status I-II pregnant women had been enrolled into this study. All were full term (37- 40 weeks' gestation), singleton fetus with cephalic presentation in the first stage of spontaneous labor. They were divided into two groups group (I) Patient-controlled IV remifentanil analgesia (bolus dose 0.25 μg/kg, lockout interval 2 min) increased by 0.25 μg/kg to a maximum bolus dose 1 μg/kg in addition to a loading dose of DMET 1 μg/kg over 20 min, followed by infusion at 0.5 μg/kg/h group (II) Patient-controlled IV remifentanil analgesia (PCA) (bolus dose 0.25 μg/kg, lockout interval 2 min) increased by 0.25 μg/kg to a maximum bolus dose 1 μg/kg in addition to a the same volume of normal saline as a loading dose, followed by a continuous saline infusion. Visual analog scale score, maternal, and fetal complications and patients' satisfaction were recorded. Results: Patients receiving a combination of PCA remifentanil and DMET had a lower pain score compared with remifentanil alone in the second stage of labor (P = 0.001). The Total consumption of remifentanil was reduced by 53.3% in group I. There was an increased incidence of maternal complications and a lower patient satisfaction score in group II. Conclusion: DMET has an opioid sparing effect; a combination of DMET and remifentanil produces a synergistic effect that results in lower analgesic requirements and less maternal and neonatal adverse events. [ABSTRACT FROM AUTHOR]

Background: The use of opioid-free analgesic technique have the propensity to decrease and even avoid many of these side effects and lead to early oral intake, early ambulation, earlier hospital discharge, and lesser readmission rates to the hospital in the post-operative period. Aim of the Work: to compare the effect of opioid-free using Dexmedetomidine and opioid-based using Fentanyl on hemodynamics (inducing deliberate hypotension and providing a better surgical field exposure), post-operative pain intensity and the incidence of side effects in patients scheduled for rhinoplasty surgeries. Patients and Methods: This study included Fifty adult patients undergoing rhinoplasty surgery. Patients were randomly divided into two equal groups. Group D received Dexmedetomidine and Group F received Fentanyl. Patients are ASA physical status I, age group ranged from 18 to 45 years. Results: The study revealed a statistically significant decrease mean of group D compared to group F according to intraoperative mean arterial blood pressure. statistically significant decrease mean of group D compared to group F according to intraoperative heart rate (beat/min). Conclusion: We found that dexmedetomidine is better than fentanyl for patients who undergo rhinoplasty surgeries to achieve controlled hypotension, decrease dosages of postoperative analgesics, prolong the duration of postoperative analgesia and decrease postoperative nausea and vomiting. [ABSTRACT FROM AUTHOR]