Background: Pectoralis and serratus plane blocks (Pecs-II block) has successfully demonstrated a good quality of perioperative analgesia for breast surgery.Objective: This study aimed to compare the quality of postoperative pain control when adding either ketamine or dexmedetomidine to bupivacaine 0.25% for Pecs-II block.Methods: This prospective randomized double-blind study was conducted on 159 female patients with American Society of Anesthesiologist (ASA) physical status class I-III scheduled to have modified radical mastectomy. Patients were randomly assigned into 3 groups. Each group included 53 patients to receive ultrasound guided Pecs-II blocks with either 32 mL of 0.25% bupivacaine added to ketamine hydrochloride 1 mg/kg (BK group), 32 mL of 0.25% bupivacaine added to dexmedetomidine 1 ug/kg (BD group) or 32 mL of 0.25% bupivacaine only (B group). The primary outcome was the total postoperative morphine consumption for the first 24 hours postoperatively. The time of the first request of analgesia, the pain scores at rest of ipsilateral arm, and the intraoperative fentanyl requirements, were the secondary outcome measures. Any side effects occurred were recorded.Results: The total postoperative morphine consumption was significantly lower in patients received bupivacaine with addition of either ketamine (BK group), (10.3 ± 2.6 mg), or dexmedetomidine (BD group), (3.8 ± 0.2 mg) respectively, versus patients received only bupivacaine (B group), (16.9 ± 5.3 mg). Both ketamine (BK group) and dexmedetomidine (BD group) added to bupivacaine significantly prolonged the time to first analgesic request (16.7 ± 4.5 h), (21.6 ± 1.6 h) in both groups respectively compared with patients received bupivacaine alone (B group) (11.5 ± 1.2 h). The pain score was variable between the 3 groups during the first 24 hours postoperatively. There were no statistically significant differences in perioperative hemodynamics, O 2 saturation, sedation scores, or side effects observed between the 3 groups. Patient satisfaction was reported to be the best in patients received dexmedetomidine added to bupivacaine compared to the patients who received ketamine as an additive or those who received bupivacaine alone. Conclusion:Adding dexmedetomidine to bupivacaine provides more effective postoperative pain control than adding ketamine during Pecs-II blocks for breast cancer surgery.

Background: There is a relatively limited new information data overall the global situation with regard to the prevalence of illicit drug abuse which in turn is considered a major medical problem. Aim of the Work: The study aimed to highlight the magnitude of illicit drug abuse in Cairo, Egypt through investigating cases of illicit drug overdose presented to Poison Control Center Ain-Shams University Hospitals (PCCASUH) during 2014. In-addition, to compare the morbidities and mortalities between different illicit drug types among such cases. Patients and Methods: A cross sectional hospital based study investigated all cases diagnosed as acute illicit drug abuse overdose presented to PCCASUH during 2014 including both addict and non-addict patients. Socio-demographic, clinical, and management data were collected analyzed and comparative study between different types of illicit drug abuse was done for all studied cases as regards morbidities and mortalities. Results: The PCCASUH received 3022 cases of acute illicit drug abuse intoxications, 2291 were addict and 523 needed in-patient and ICU admission. Tramadol and benzodiazepine cases were more prevalent among illicit drug overdose followed by those diagnosed as methyl alcohol, cannabis and opiate and other opioids with male predominance. Morbidities and severity were more noticeable among cases of acute tramadol, opiate and other opioids and methyl alcohol overdose regarding cardiovascular, neurological and metabolic morbidities. Hence those cases mandated emergency treatment and intensive care department (ICU) admission. Deaths were more seen among cases of methyl alcohol, tramadol and opiate and other opioids overdose respectively. Conclusions and Recommendations: Egyptian community suffer from a major problem of illicit drug abuse mainly among young adults males. The more prevalent drugs were tramadol followed by benzodiazepines, methyl alcohol, cannabis and opiate and other opioids. The study showed that opiate and other opioids, tramadol and methyl alcohol represented the most severe cases that developed different forms of morbidities and mandated emergency management and ICU admission. Egyptian Street need more integrated banning program between health, police and social workers against drug abuse. Inaddition, awareness campaigns between adolescents and young adults in clubs, schools and universities should be done.