Objective:To evaluate the efficacy of lidocaine patch applied around wound in laparoscopic colorectal surgery in reduction of postoperative pain and illus compared to intravenous lidocaine infusion and placebo.Background:Postoperative illus and pain after colorectal surgery is a challenging problem associated with increased morbidity and cost. Inflammatory response to surgery plays crucial rule in inducing postoperative illus. Systemic local anesthetics proved to have anti-inflammatory properties that may be beneficial in preventing ileus added to its analgesic actions. The lidocaine patch evaluated in many types of pain with promising results. We try to evaluate the patch in perioperative field as a more simple and safe technique than the intravenous route.Materials and Methods:Prospective, randomized, controlled study was conducted, comparing three groups. Group 1 (placebo) received saline infusion, group 2 received i.v. lidocaine infusion after induction of anesthesia, 2 mg/min if body weight >70 kg or 1 mg/min if body weight <70 kg, group 3 received lidocaine patch 5%, three patches each one divided into two equal parts and applied around the three wounds just before induction. Data collected were, pain scores (VAS), morphine consumption, return of bowel function, pro-inflammatory cytokines plasma levels and plasma lidocaine level.Results:Pain intensity (VAS) scores at rest and during coughing were significantly lower during the first 72 h postoperative in i.v. lidocaine group and patch group compared to the placebo group. Mean morphine consumption were significantly lower in the i.v. lidocaine group and patch group compared to placebo group. Return of the bowel function was significantly earlier in i.v. lidocaine group in comparison to the other groups. Proinflammatory cytokines (IL6, IL8, and C3a) were significantly lower in i.v. lidocaine group compared to the other two groups.Conclusion:The lidocaine patch was equal to i.v. lidocaine infusion in decreasing pain scores and morphine consumption but not in acceleration of bowel function return.

Background: Femoral vein cannulation can be a routine process during major surgery in infants and children, and may prove to be lifesaving under certain conditions. This study compared ultrasound (US)-guided cannulation of the femoral vein in infants with the traditional anatomical landmark-guided technique.Method: Eighty infants who had been prepared for major elective surgery under general anaesthesia were randomly assigned either to Group I, in which the femoral vein cannulation was guided by anatomical landmarks in optimally positioned patients, or to Group II in which the US-guided technique was used for cannulation. Results:The procedure was successful in 35 cases in Group I, and in all cases in Group II. The number of needle passes was higher in Group I, compared to Group II [4 (1-22) vs. 1 (1-8); p-value = 0.001]. First-pass success was achieved in 20 cases in Group I, and in 35 cases in Group II. The time to complete cannulation was significantly shorter in Group II, compared to vs. 350 (40-1 600) seconds; p-value = 0.02]. Three cases of arterial puncture occurred in Group I, while there were no complications in Group II. Conclusion:The US-guided technique for femoral vein cannulation is useful as it results in greater success, shorter cannulation times, fewer attempts, and fewer complications.Peer reviewed.

Introduction:Daily interruption of sedation could minimize the problem of sedatives accumulation. Nevertheless, whatever is the sedation strategy; sedation, particularly deep levels, has been associated with high frequency of patient-ventilator asynchrony. Extending these findings, one would expect that no sedation protocol could reduce the frequency of patient-ventilator asynchrony.Aim:To assess the effect of no sedation protocol compared with daily interruption of sedation on patient-ventilator asynchrony in surgical intensive care patients.Materials and Methods:The study included 230 patients who expected to require mechanical ventilation for more than 48 h. They were randomized to receive either continuous sedation (1 mg/mL midazolam) to achieve a Ramsay score of 3-4 with daily interruption until awake (group D; n = 115), or no sedation (group N; n = 115). Both groups received bolus doses of morphine (2.5-5 mg) as needed to achieve a score of ≤2 on behavioral pain scale.Results:No sedation was associated with significantly lower ineffective triggering and asynchrony index but significantly higher double triggering. Patient's effort during triggering was significantly higher during no sedation. The respiratory rate increased and the PaCO2 decreased significantly in no sedation group.Conclusion:No sedation protocol reduces the asynchrony index and preserves the patient's effort during triggering.

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