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ABSTRACTBackground This study aimed to assess the safety and efficacy of analgesia with pericapsular nerve group (PENG) block as an adjuvant to morphine infusion for the management of preoperative pain in patients with proximal femur fractures.Methods This single-blinded, parallel-group, randomized trial enrolled 36 adult patients with proximal femur fractures who were prepared for surgery. The patients were randomly allocated to two groups. In the PENG group, 18 patients received a US-guided PENG block as an adjuvant to patient-controlled morphine analgesia (PCA), while in the PCA group, 18 patients received PCA only. The primary outcome was the total morphine consumption in 24 hours before the surgery. The secondary outcomes included the visual analogue scale (VAS), need for rescue analgesia, total sleep hours, incidence of respiratory depression, hemodynamic stability, and incidence of nausea and vomiting during the first 24 hours post-procedure.Results The PENG block significantly decreased the total dose of morphine, VAS score at one-hour post-procedure, need for rescue analgesia, incidence of respiratory depression and nausea but increased the sleeping hours. Vomiting was comparable in the two groups (p = 0.121). Significantly higher mean arterial pressures from 8 to 20 hours after the block as well as heart rates immediately after the block were observed in the PENG group compared to the PCA group.Conclusion In patients with proximal femur fractures, preoperative PENG block can be used as an adjuvant to morphine infusion for controlling the pain and the total dose of morphine usage.

ABSTRACTBackground This study aimed to assess the safety and efficacy of a special maternal care bundle as an alternative technique for the attenuation of hypotension following spinal anesthesia in parturients scheduled for CS.Methods This double-blinded, parallel-group, randomized trial enrolled 138 adult parturients who were scheduled for CS under spinal anesthesia. The patients were randomly allocated to two groups. In the care bundle group, 68 participants received a co-load of lactated Ringer’s solution and ondansetron infusion during administration of spinal anesthesia with a slow rate intrathecal bupivacaine injection and a V-shaped supine position. While in the best practice group, 70 participants received a co-loaded lactated Ringer’s solution during spinal anesthesia with early use of vasopressors and a left uterine tilting position. The primary outcome was the total ephedrine consumption. Secondary outcomes included the mean arterial blood pressure, heart rate, atropine usage, complications such as dizziness, nausea, and vomiting, as well as the baby’s Apgar score.Results Special maternal care bundle significantly reduced the need and the total dose of ephedrine (P = 0.042). The mean arterial blood pressure was significantly less affected by maternal bundle care, but the reduction in heart rate, the need for atropine, the incidence of dizziness, nausea, vomiting, and the Apgar score were comparable in both groups.Conclusion The special maternal care bundle including co-load of lactated ringer, ondansetron 4 mg IV infusion, slow intrathecal injection and v-shaped positions can reduce the incidence of hypotension resulting from spinal anesthesia and ephedrine usage during CS.

ABSTRACTBackground Although ultrasound-guided nerve blocks have lately been used to control pain, there is not much evidence assessing the outcome of trigeminal nerve block (TNB) in maxillofacial surgery. This study sought to evaluate the safety and efficacy of analgesia with an ultrasound-guided trigeminal nerve block (USGTNB) in patients undergoing unilateral maxillofacial surgery under general anesthesia.Methods This single-blinded, parallel-group, randomized clinical trial included 50 adult patients who had American Society of Anesthesiologists physical status I or II and were prepared for elective unilateral maxillofacial procedure under general anesthesia. The patients were randomized into two groups. In the intervention (TNB) group, 25 patients received USGTNB using 5 ml of bupivacaine 0.25%, while in the control group, 25 patients received only general anesthesia. Total intraoperative fentanyl consumption was the primary outcome. The secondary outcomes were the intraoperative hemodynamic parameters besides the postoperative pain, total opioid consumption, complications, and patient satisfaction.Results Compared to general anesthesia, USGTNB significantly reduced the intraoperative fentanyl consumption (2.38 ± 0.62 vs 0.36 ± 0.55, p

Background This study aimed to evaluate endotracheal tube (ETT) cuff inflation pressure (CIP) applied by anesthetists as well as the effect of an interview and feedback on their CIP accuracy.Methods This single-blind, controlled trial involved two series of CIP measurements in intubated patients before and after an interview and feedback of the participating anesthetists who were asked to inflate the cuffs for all intubated patients as per their clinical judgment. The cuff pressures were measured using a manometer and accordingly adjusted to 25 cm H2O by the researchers. For each anesthetist, 3 measurements were recorded, and the mean pressure values were calculated for each setting. The anesthetists were initially blinded, then they were informed about the pressure values and the adjustments. The primary outcome was the anesthetists’ accuracy regarding ETT inflation following the feedback. The secondary outcomes were pressure values in senior and junior anesthetists as well as in scheduled and emergency operations.Results The study enrolled 28 anesthetists; six registrars or senior registrars and 22 residents. Interview and feedback significantly lowered the mean pressure applied by the anesthetists. The cuff inflation pressure decreased from 33.8 ± 1.95 to 30.8 ± 3.24 and from 32.9 ± 2.38 to 29.9 ± 3.44 for emergency and scheduled surgeries, respectively. Furthermore, the frequency of safe CIP increased significantly for both emergency and scheduled surgeries. However, the senior staff showed no significant increase in safety CIP.Conclusion Anesthetists improved their accuracy of CIP after educational feedback. ETT cuff pressures should be routinely measured in intubated patients under general anesthesia.

Background This study aimed to assess the safety and efficacy of intravenous (IV) versus intrathecal (IT) dexmedetomidine as an additive to hyperbaric bupivacaine in spinal anesthesia in adult patients undergoing hip arthroplasty.Methods This randomized, controlled, triple-blinded trial enrolled 90 patients aged 18–65 years, American Society of Anesthesiologists physical status I–II who were scheduled for hip arthroplasty under spinal anesthesia. The study subjects were randomly assigned into three groups. The control group (group C) received IT hyperbaric bupivacaine (0.5%, 12.5 mg) plus 1 ml of normal saline. The IT group received IT hyperbaric bupivacaine (0.5%, 12.5 mg) plus 5 µg of dexmedetomidine diluted in 1 ml of normal saline. The IV group received hyperbaric bupivacaine (0.5%, 12.5 mg) plus 0.5 µg/kg of dexmedetomidine diluted in 20 ml of normal saline administered slowly IV. A modified Bromage scale was used to assess motor blocks. We used the Numerical Pain rating scale (NRS) for pain assessment. We used morphine for postoperative analgesia.Results Groups IT and IV had significantly lower total morphine consumption and higher time to the first analgesic request than group C. Durations to two-segment regression and motor block regression to Bromage 1 were significantly higher in groups IT and IV than in group C. Motor block regression to Bromage 1 showed a significant difference between the IT and IV groups with a more delayed motor recovery in the IT group.Conclusion Both IV and IT dexmedetomidine extend the effect of the sensorimotor impact of subarachnoid anesthesia, but IT dexmedetomidine was superior to IV dexmedetomidine in adult patients undergoing hip arthroplasty.

Background This study aimed to assess the safety and efficacy of intravenous granisetron as adjuvant therapy for spinal anesthesia-induced hypotension in type I diabetic parturients undergoing CS.Methods This double-blinded, parallel-group, randomized trial enrolled 68 adult parturients who were scheduled for CS under spinal anesthesia. The patients were randomly allocated to two groups (34 parturients each). In the granisetron (G) group, 1 mg of granisetron diluted in 10 mL of normal saline was administered intravenously 10 minutes prior to spinal anesthesia. While in the control (C) group, 10 mL of normal saline was administered in the same manner. The primary outcomes were total ephedrine consumption and frequency of use. Secondary outcomes included the total atropine consumption and frequency of use, nausea, vomiting, estimated intraoperative blood loss, patient satisfaction, Apgar score, and hemodynamic parameters.Results Group G had a significant reduction in the total ephedrine consumption (P = 0.009) and its frequency of use (P = 0.034). While the total atropine consumption and frequency of use, intraoperative blood loss, and patient satisfaction were not significantly different between the two groups. Nausea and vomiting were significantly reduced in group G. After 5 minutes of delivery, the Apgar score was significantly elevated in group G. The reduction of heart rate and hypotension was significantly lowered in group G.Conclusion In type I diabetic parturients, prophylactic use of granisetron can be effective in reducing ephedrine usage and attenuating the spinal anesthesia-induced hypotension during CS.

Background Glossopharyngeal nerve (GPN) block is a useful treatment option for acute post-tonsillectomy pain. This study aimed to assess safety and efficacy of the landmark (LM) technique versus the ultrasound (US)-guided technique for GPN block in children undergoing tonsillectomy.Methods This double-blinded, parallel-group, randomized trial enrolled 54 children of both genders who were American Society of Anesthesiologists physical status grade I–II and were scheduled for tonsillectomy under general anesthesia. All patients underwent percutaneous peristyloid GPN block. In the LM group, 27 patients were managed by insertion of the needle at midpoint of the line between the mastoid process and angle of the mandible. In the US group, 27 patients were managed with the US-guided technique to locate the styloid process. The outcomes were time to first analgesic requirement, pain in rest and during swallowing, easiness of the technique, time required for the technique performance, recovery time from anesthesia, and anesthetist, surgeon, parent, and staff satisfaction.Results The post-tonsillectomy pain score during rest and swallowing, rescue analgesic request, recovery time from general anesthesia, anesthetist’, surgeon’, staff nurses’, and parents’ satisfactions were comparable between the LM technique and US-guided percutaneous peristyloid GPN block (all p ˃ 0.05). However, the LM technique was significantly easier and required shorter duration than the US-guided technique (p ˂ 0.05).Conclusion In tonsillectomy surgery, both the LM technique and the percutaneous peristyloid US-guided GPN block were safe and effective in reducing postoperative pain. Furthermore, the LM technique was easier and had shorter duration to perform than the US-guided technique.