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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]