The addition of ketamine to lidocaine in patients receiving IVRA significantly reduced intraoperative and postoperative analgesic requirements and improved patient satisfaction without causing significant adverse effects.

Background: N-methyl-D-aspartate (NMDA) receptors are thought to be for pain memory, and blocking them can help to reduce pain. We aimed to assess the preventive effects of small doses of ketamine administered prior to the skin incision in abdominal surgery, to assess analgesic efficacy and intra-operative and post-operative side effects. Methods: 60 adult patients with ASA I and II who were scheduled for abdominal surgery were randomly divided into two groups in a prospective, double-blind study. Before the skin incision, group K received 1 mg/kg ketamine intravenously, followed by a 0.12 mg/kg/h ketamine infusion till the skin was closed. Instead of ketamine, group C received normal saline. After extubation, both groups received morphine 5 mg IV. The visual analogue scale (VAS) was used to measure analgesic effectiveness at rest and after exercise, as well as the duration to the first analgesic and morphine intake in 24 h, and analyze changes in serum CRP and IL6 levels as indicators of its impact. Also, side effects of opioid or ketamine have been recorded. Results: Within 24 h, patients in the ketamine group had a significantly lower VAS score, a longer time to the first analgesic (326.3 ± 49.5 minutes), and lower morphine consumption (6.9 ± 2.91 mg). Also, postoperative interleukin 6 and CRP showed significant difference between the two groups (p ≤ 0.05). In group K, no side effects were detectable. Conclusion: Ketamine may be a promising drug in low doses that can limit and even prevent worsened inflammation. It also resulted in decreased postoperative opioid use, decreased pain rating, earlier retains of bowel motility, and decreased incidence of side effects.

Background Intra-arterial chemotherapy has shown promising results and improved the prognosis of retinoblastoma in the developed countries. Here, we aim to report our initial experience, in Egypt, in the treatment of all stages of naïve retinoblastoma with ophthalmic artery chemosurgery (OAC), using melphalan. Results The technique was successful in 23 out of 26 eyes. Overall, a total of 63 treatment sessions were performed. Ophthalmic artery catheterization was performed in 59 treatment sessions, whereas middle meningeal artery catheterization was performed in 4 treatment sessions. Adequate tumor control was achieved in 95.6%. Progression has developed in one eye after the third OAC session. The mean follow-up period was 18.5 months. Recurrence of the main tumor as well as vitreous and subretinal seeds was reported in one eye after 19-month duration. A globe salvage rate of 91.3% was attained. No metastasis was recorded, and all patients were alive within the stated follow-up period. Conclusion A high globe salvage rate along with metastasis free survival and mild complications were achieved. Therefore, our initial experience with OAC in primary retinoblastoma proved to be safe and effective.