Background: Both intraoperative esmolol and transversus abdominis plane (TAP) block facilitate postoperative analgesia after laparoscopic cholecystectomy as part of multimodal analgesia. Both strategies can minimize the use of postoperative opioids. In current study, our goal was to assess if intra-operative esmolol infusion in association with TAP block can overcome the deficits of TAP block alone after laparoscopic cholecystectomy. Methods: This prospective, randomized and double-blinded clinical trial included 60 patients of either sex who scheduled for elective laparoscopic cholecystectomy; received either ultrasound-guided TAP block alone or in association with intravenous esmolol bolus (0.5 mg/kg) before induction followed by a maintenance infusion (0.05 mg/kg/min) till the end of operation. Intra-operative hemodynamic parameters were followed up. Postoperatively, in order to maintain visual analogue scale (VAS) scores ≤3, patients received IV morphine. The primary outcome was amount of opioid consumption during the first 24 hours postoperative. Pain scores, mean arterial pressure (MAP), heart rate (HR) and occurrence of nausea/vomiting were secondary outcomes. Results: The mean morphine consumption after surgery in patients receiving esmolol was (5.83) mg compared to (7.5) mg in TAP only group (p = 0.204). The mean pain scores at early postoperative hours were significantly lower in esmolol group (p < 0.05). MAP and HR were significantly lower in esmolol group intraoperative; however, no variance was detected later. Conclusion:In the first 24 hours following surgery, esmolol infusion increased the analgesic impact of TAP block in terms of opioid demand and pain severity.

Background and aim: Anesthetic premedication with dexmedetomidine helps to alleviate anxiety, reduces analgesic need, and prevents unfavorable postoperative psychological events. In addition, it helps in rapid inhalational induction and oro-tracheal intubation. This study aims to assess the premedication efficacy of oral paracetamol and intranasal dexmedetomidine regarding alleviating anxiety and tolerance to separation from the parents. Methods: This prospective, randomized, double-blinded, comparative clinical trial was done on 86 children ASAI or II of either sex who were scheduled for adeno-tonsillectomy and received either oral paracetamol or intranasal dexmedetomidine. The primary goal of our trial was to evaluate anxiety level and assess tolerance to separation from the parents; this was assessed by the modified Yale scale. Our secondary goals were perioperative hemodynamic parameters and SPO 2, which were followed up in the preoperative period and after receiving the drug. Intraoperatively, the anesthesiologist recorded child's heart rate and MAP.Postoperatively, parents' satisfaction was assessed. Results: Preoperative anxiety score showed no significant difference between both groups. Also, baseline HR, MAP, and SpO 2 were comparable. No significant differences were noted at 10 and 20 minutes after drug administration in all vitals (P > 0.05). However, 30 minutes later, till the operation ended, the blood pressure and heart rate were significantly higher in group P than in group D. No significant difference was reported between both groups regarding SpO2(P > 0.05). Conclusions: Oral paracetamol is similar to intranasal dexmedetomidine in reducing preoperative anxiety. As a result, paracetamol is a good substitute for dexmedetomidine.