The assessment of quality of recovery after surgery and anesthesia is considered an important issue because it provides information that could help to identify problems that

Background Finding adjuvants to local anesthetic used in interscalene block that could efficiently extend the analgesia duration has recently been the focus of researchers. The aim of the work was to determine whether the addition of perineural dexamethasone to bupivacaine in-ultrasound guided interscalene block would prolong the duration of sensory analgesia in patients undergoing shoulder surgery. Results This prospective, randomized, double-blinded study comprised 50 patients. They were randomly subdivided into 2 groups: group C [control] and group D [dexamethasone]. We noted a significant difference regarding the timing for the first rescue analgesia being shorter in group C than in group D with a P value < 0.001. Regarding postoperative analgesia, higher Ketolac consumption was noticed in group C than in group D. Patients from both groups showed excellent analgesic effects with VAS score less than 2 points up to 6 h postoperative then patients in group C had a higher VAS score compared to group D, and the difference was statistically significant (P value < 0.05). We also noticed an increase in the heart rate and mean arterial blood pressure in group C than in group D at 12 h and 24 h postoperatively. Conclusion We concluded that the addition of 8 mg of perineural dexamethasone to 30 ml of 0.5% bupivacaine showed improvement in the postoperative analgesia in shoulder surgery without obvious complications.

Background Management of sepsis is a time critical procedure; the consequences of improperly managed sepsis and septic shock can cause multiple organ dysfunction and death. The aim of this study was to evaluate of the role of hydrocortisone either alone or with fludrocortisone on the outcome septic shock in adults. This study was conducted on 66 patients who were assigned randomly to 3 groups each containing 22 patients. Control group had received standard therapy for sepsis, and H group had received standard therapy for sepsis plus hydrocortisone. HF group had received standard therapy for sepsis plus hydrocortisone and fludrocortisone. Results It showed that the use of corticosteroids (the hydrocortisone or the hydrocortisone plus fludrocortisone) in septic patients was associated with significant reduction in the time to wean from vasopressors and length of intensive care unit stay. Meanwhile, there were no significant effect of the mortality rate, Sepsis-Related Organ Failure Assessment (SOFA) score reduction, gastrointestinal bleeding, and superinfection as corticosteroids adverse effects between the three groups. Conclusions The corticosteroids in septic shock have significant positive impacts on some aspects in treatment of septic shock but it does not affect the mortality rate of the patients.

Background Ultrasound (US)-guided quadratus lumborum block (QLB) and transversus abdominis plane block (TAP) are used as a part of multimodal analgesia for postoperative pain after abdominal procedures, as they improve postoperative pain. Results QLB group showed significantly better visual analog score (VAS) scores from 6 h till 24 h postoperative. Time for the first request for pethidine was significantly longer in the QLB group (398.3 ± 23.7 min) than in the TAP group (80.3 ± 20.7 min), (p < 0.0001 and its total consumption was significantly lesser (p = 0.007) in the QLB group (68.33 ± 66.28) than in TAP group (120.0 ± 76.11). Also, the sensory level was higher in the QLB group (8.3 ± 0.63 segments) than in the TAP group (6.2 ± 0.79 segments), (p < 0.001). Moreover, only 2 patients (6.67%) in the QLB group experienced nausea and/or vomiting versus 9 (30%) in TAP group with significant value. Conclusions QLB was more effective in providing visceral and somatic pain analgesia after total abdominal hysterectomy (TAH) in comparison to TAP block, QLB resulted in wider sensory blockade compared to TAP block with less incidence of postoperative nausea and/or vomiting.

Background Inguinal hernia considered the third common disease in surgeries for adult after acute appendicitis and proctologic disorders. About 20 millions of inguinal hernia repairs are performed globally. Inguinal herniorrhaphy is frequently associated with persistent postoperative pain. A significant proportion of pain experienced by patients undergoing abdominal surgeries is related to somatic pain signals derived from the abdominal wall. Aim of the Work The aim of this study is to assess the postoperative analgesic efficacy of Magnesium sulfate added to Bupivacine verus Morphine to Bupivacaine in ultrasound guided transversus abdominis plane (TAP) block after inguinal herniorraphy regarding the pain relief and the amount of rescue analgesia used postoperative. Patients and Methods The study was conducted on 45 randomly chosen patients in Ain Shams University Hospitals after approval of the medical ethical committee. They were allocated in three groups of 15 patients each: Group - I (B): received TAP block with Bupivacaine only as a “Control Group”. Group - II (B-MO): received TAP Block with Bupivacaine plus Morphine. Group - III (B-Mg): received TAP block with Bupivacaine plus Magnesium Sulfate. The three groups were adequately monitored and assessed intra- and post-operatively and they were compared regarding analgesic outcome by using the visual analogue scaling system, besides, recording time for first call for rescue analgesia and total consumption of it in the 1st 24 postoperative hours. Demographic data and post-operative hemodynamics were also assessed. Results The results of the study revealed that Magnesium added to bupivacaine better than Morphine added to Bupivacaine in transversus abdominis plane block regarding the postoperative analgesia after inguinal Herniorraphy. Conclusion In Conclusion the addition of MgSo4 as an adjuvant to bupivacaine in TAP block has shown superiority over either mono-therapy with bupivacaine or bupivacaine-Morphine combination in many aspects such as postoperative analgesic outcome assessed by VAS score, 1st time of rescue analgesia and without the pronounced side effects of the conventional postoperative opioids and less side effect than Morphine.