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Background: Systemic analgesics should be used carefully when treating patients following renal surgery since these patients often have compromised renal function. Therefore, in such individuals, the localized nerve block may be a useful choice. This study's objective was to assess the effectiveness of transmuscular and anterior subcostal QLBs as a secure substitute for thoracic paravertebral blocks guided by ultrasonography for treating immediate postoperative pain in patients having open kidney operations. Methods: This prospective randomized double blinded study was carried out on 54 adult patients who underwent elective open renal surgeries. Patients were randomly classified into three equal groups, all were guided by ultrasonography: Group I: Transmuscular QLB, group II: Anterior Subcostal Quadratus Lumborum (ASQL) Block, and group III: Thoracic Paravertebral (TPV) Block. Results: Regarding the beginning of sensory block, overall intraoperative fentanyl usage, period to first rescue analgesic demand, and overall morphine consumption, there was a substantially significant difference between the three groups (P-value <0.001). VAS revealed a substantial difference between the three groups (P<0.001) at T0 before discharging from PACU, 2, 4 and 6 hours. There was statistically significant increase in patients’ satisfaction in group II&III compared to group I where (P =0.03). Conclusions: Ultrasound-guided anterior subcostal QLB produced safe and adequate analgesia during and after open renal surgeries that was comparable to thoracic paravertebral block, but the transmuscular QLB failed to provide adequate analgesia compared to anterior subcostal QLB and thoracic paravertebral block.

Background: Early recognition and appropriate treatment of shock have been shown to decrease mortality. Incorporation of bedside ultrasound in patients with undifferentiated shock allows for rapid evaluation of reversible causes of shock and improves accurate diagnosis in undifferentiated hypotension. The aim of the present study was to evaluate efficacy of fluid administration followed by lung sonography in hemodynamic assessment in acute circulatory failure in critically ill patients. Materials and Methods: This prospective cohort controlled randomized study was carried out on 50 Critically ill Patients who had acute circulatory failure in intensive care unit Tanta university hospital Critically ill patients of either sex aged 21-60 years when mean blood pressure was below 65 mmHg were included. Patients have been uniformly distributed in 2 categories, The patients assigned either to the Control Group (group I) or to the FALLS (fluid administration limited by lung sonography) protocol group (group II). Results: Comparison between two groups revealed that, the heart rate showed that heart  rate  is  lower  in  group  II  in  comparison  to  group  I  .Comparison between two groups revealed that, the mean arterial blood pressure changes showed that it is higher in group II in comparison to group I .Comparison between two groups revealed that, the Central venous pressure showed that no significant difference in the base line .Intensive care unit stay in group I ranged between 5 – 11 days while in group II ranged between 3 – 8 days .Survival analysis (Kaplan Mier curve), Mortality at 28 days found in group I mean 21.28 days with SE 1.898 and in group II mean 24 days with SE 1.64 with no significant difference in time but there was significant difference in number of mortalities as discussed before. Conclusion: We conclude from this study that bedside Lung Ultrasound has a good accuracy and superiority in assessment over other traditionally used methods for detecting early signs of pulmonary congestion and thus guides the fluid administration in shock management to decrease complications, mortality and intensive care stay.

Background: Magnesium, the fourth most common cation in the body, has an ‎antagonistic effect at the N-methyl-D-aspartate (NMDA) receptor, as ‎well as calcium-channel blocker properties. Antagonism at the ‎NMDA receptor is thought to alter the mechanism of central ‎hypersensitivity and to subsequently decrease analgesic requirements ‎including opioid consumption.‎‎ This study aimed to assess the effects of preoperative administration of intravenous magnesium sulphate on the intubation stress response as a primary outcome and uterine, fetal middle cerebral and umbilical arterial blood flow, Apgar score and postoperative analgesia as secondary outcomes in participants undergoing elective caesarian section under general anesthesia. Methods: This prospective randomized controlled double blinded study ‎was carried out on 65 pregnant females between 21-35 years old undergoing elective caesarian section under general anesthesia. who were randomly classified randomly into two groups: Magnesium sulphate (Mg) group: received 25 mg/kg magnesium sulphate in 100 ml isotonic saline over 10 minutes before induction of anesthesia. Control group (C):  received the same volume of isotonic saline over the same period. Results: Heart rate and mean arterial blood pressure were decreased significantly at post induction to the end of surgery in mg sulphate compared to control group and was insignificantly different between the studied groups at T0 and T1. VAS was significantly lower in mg sulphate group compared to control group at 1, 2, 4, 8, 12 and 24 hours and was insignificantly different among the two groups at PACU admission and 30 min. preoperative administration of magnesium sulphate (25 mg/kg) was associated with lower postoperative pain scores, less post-operative analgesic consumption, better hemodynamic stability without significant difference in umbilical, middle cerebral and uterine arteries blood flow or Apgar score compared to control group in patients undergoing cesarean section under general anesthesia. There was no statistically significant difference in the incidence of sedation and hypotension. No cases showed respiratory depression in the two groups. Conclusion: Preoperative administration of ‎magnesium sulphate (25mg/kg) was associated with better ‎hemodynamic stability, lower postoperative pain scores, less post-‎operative analgesic consumption without significant difference in ‎umbilical, middle cerebral and uterine arteries blood flow or Apgar ‎score with nil complications except for PONV compared to control ‎group in patients undergoing cesarean section under general ‎anesthesia.‎‎