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Background: Adhesive capsulitis of the shoulder is common after breast cancer treatment. We aimed to compare the effects of using stellate ganglion block (SGB) with bupivacaine and ketamine alone versus its combined use with intra-articular platelet rich plasma (PRP) injection in patients with post-mastectomy shoulder pain. Methods: A prospective randomized open blinded end-point pilot study was conducted in Mansoura University Oncology Center, Egypt during the period from August 2017 till April 2018. Sixty-four patients with chronic post-mastectomy frozen shoulder were enrolled and allocated into one of two groups. Group A received ultrasound guided SGB with ketamine (0.5mg/kg) plus 5ml bupivacaine 0.5% and group B received ultrasound guided SGB using ketamine and bupivacaine in the same dose and intervals as group A plus posterior approach shoulder injection with PRP (3 times with 1-week interval). Numerical rating scale (NRS) at rest and at shoulder movement, range of motions (ROM) of shoulder and disability of arm, shoulder and hand (DASH) questionnaire were recorded. T-test and ANOVA test (for parametric data) and Mann-Whitny test, Wilcoxon rank test and Kruskal-Wallis test (for non-parametric data) were used for analysis. Results: Group B showed statistically significant improvement in NRS with shoulder movement and DASH score at one, two and three months after injection in comparison to group A (P=0.001). Also, ROM improved significantly with PRP shoulder injection after one month from injection. Conclusion: The combination of intra-articular PRP injection with SGB using ketamine as adjuvant to bupivacaine produces dramatic improvement in post-mastectomy chronic shoulder pain. Their combined use reduces the need for analgesia. [ABSTRACT FROM AUTHOR]

Study Objective: Adequate perioperative pain control in children undergoing cardiac surgery is mandatory. Intravenous opioids and neuraxial anesthetic techniques have been used but didn't gained any popularity. The aim of the current study was to evaluate the analgesic efficacy of transversus thoracis plane (TTP) block in pediatric cardiac surgery.Design: Superiority, randomized, double-blind, controlled study.Setting: Intraoperative and postoperative in intensive care unit (ICU), Mansoura university children hospital, Egypt.Patients: Eighty pediatric patients aged 2-12 years, undergoing cardiac surgery via median sternotomy, were randomly allocated into 2 equal groups, the control group and TTP block group.Interventions: Controlled group received only fentanyl for perioperative analgesia, while TTP block was performed in the intervention group (TTP group).Measurements: The primary outcome measure was the total dose of fentanyl in the first postoperative 24 h after extubation, while the secondary outcome measures were postoperative pain score, intraoperative fentanyl consumption, time to extubation and ICU length of stay.Main Results: During the first postoperative 24 h, total fentanyl consumption was significantly lower (P < 0.05) in the TTP block group (9.892 ± 3.397 μg/kg) than the control group (18.500 ± 3.401 μg/kg) and modified objective pain score was significantly (P < 0.05) lower in TTP block group than the control group all over the time. Total intraoperative fentanyl requirement was significantly (P < 0.05) lower in TTP block group (8.27 ± 1.170 μg/kg) than the control group (13.72 ± 1.186 μg/kg).Conclusion: The use of TTP block decreased perioperative fentanyl consumption and reduced postoperative pain intensity. [ABSTRACT FROM AUTHOR]