Background: A straightforward and efficient anesthetic approach for hand and forearm surgery is intravenous regional anesthesia (IVRA), often known as the Bier Block. Dr. August Bier developed this method in 1908, and it offers total anesthesia as well as a bloodless operating room. Historically, the local anesthetic has been contained and a bloodless surgical field has been created by using an upper arm tourniquet. Major issues following IVRA with an upper arm tourniquet are uncommon, although they typically arise from systemic toxicity of local anesthetics upon tourniquet relaxation. Convulsions, coma, respiratory depression and arrest, and cardiovascular depression are signs of significant systemic local anesthetic responses, which might be lethal. Because of this, some medical professionals favor general anesthesia or other loco-regional procedures for hand and forearm surgery. Objective: The aim of this review was to compare the effects of early vs late distal tourniquet deflation during hand and forearm surgery under intravenous regional anesthetic with or without ketorolac. Methods: A comprehensive search was conducted in PubMed, Google Scholar, and Science Direct, from August 2000 to July 2021, using the keywords "Deflation, Distal tourniquet, Intravenous Regional Anesthesia, Ketorolac, Hand and Forearm Surgery". The reviewers evaluated relevant literature references as well. Only the most recent or complete study was taken into account. Examples of articles that weren't regarded as significant scientific research include unpublished manuscripts, oral presentations, conference abstracts, and dissertations. The lack of resources for translation has led to the ignoring of documents written in languages other than English. Results: The reviewed literature showed that alternative adjustments in extremities surgery can improve IVRA. In shortterm hand procedures, the forearm tourniquet may be chosen since it is simple to administer, has a minimal risk of toxicity, and offers an early block to healing. Conclusion: Depending on the patient's preferences, a Bier block with a forearm tourniquet can be utilized with or without further sedation or analgesics.

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Background: Regional anesthesia techniques as a caudal epidural block (CEB) are commonly used to help with pain control during pediatric surgeries, decrease parenteral analgesics requirement, and improve the quality of postoperative pain control and general satisfaction of patient parents. Transversus abdominis plane (TAP) block is an evolving modality of regional anesthetic techniques for the abdominal wall. Objective: The aim of the current study was to compare the analgesic effect of CEB versus TAP block in pediatrics undergoing infraumblical surgeries. Patients and methods: A total of 120 kids between the ages of 4 and 7 years old who needed infraumbilical procedures were divided into two groups of 60 patients. Group (1) received caudal epidural block using Plain bupivacaine 0.25 % 1 ml/kg, and Group (2) received ultrasound-guided TAP block using plain bupivacaine 0.25% 1 ml/kg. Follow up postoperative pain using Faces Pain Scale-Revised, vital signs, first rescue analgesia, the total dose of paracetamol needed, and complications. Results: At 8 and 18 hours postoperatively, Group (1) had substantially lower pain scores on the Faces pain scale-revised, reduced heart rate and mean arterial pressure compared to Group (2). Group (1) had a considerably later time to first rescue analgesia with less paracetamol use than Group (2). There was no discernible difference in postoperative complications between groups (1) and (2). Conclusion: At 6-24 hours after block placement, caudal block provides superior analgesia compared to TAP block in children undergoing lower abdominal surgeries. Caudal block is an effective, feasible, and safe option for postoperative analgesia, especially when compared to TAP block.

Aim of the work:The main objective will to compare fentanyl with Dexmedetomidine as regards; 1. Their efficacy 2. Provide better quality of surgical field during cochlear implantation. in including deliberate hypotension. 3. The effect of both drugs on postoperative pain. 4. Recovery time. 5. Emergence agitation.. Patient and Methods:The study was conducted after approval of the Ethical committee of Sohag university Hospital and obtaining informed written consent from the parents of the patients. 50 pediatric patients (ASA I or II), undergoing cochlear implantation were randomized into dexmedetomidine (D) group and fentanyl (F) group. Anesthesia was induced by I.V. dexmedetomidine in (D) group at a bolus dose of 2 micg/kg slowly infused over 10 min, then continuous infusion by a rate of 0.7 micg/kg/h until the end of surgery. In (F) group; anesthesia was induced by I.V. fentanyl at a dose of 1 micg/kg over 10 min, then continuous infusion by a rate of .0.1 mg/kg/h. This is followed by I.V. propofol and atracurium for both groups. Both groups were compared as regards the quality of the surgical field, intraoperative hemodynamics, recovery and discharge time, postoperative pain using objective pain score and the need for rescue analgesics and anti-emetics in post anesthesia care unit (PACU). .Results: Dexmedetomidine group showed a slight decrease in heart rate than fentanyl group. These parameters were significantly decreased compared to the baseline throughout the procedure in D group. Modified Aldrete Score is better with D group compared to F group . There was significant difference between both group as regard objective pain score. There was a significant difference between two groups, as the time for recovery was more rapid in D (group) than in F (group) the data is significant. Conclusion : Dexmedetomidine infusion in cochlear implantation in pediatric patients was better in inducing deliberate hypotension. It allowed rapid recovery from anesthesia and reduced need for pain medication in the PACU.