Background: Knee arthroscopy is usually associated with a variable degree of pain ranging from moderate-to-severe pain in about 70% of patients. Objective: This trial was designed to assess the efficacy of intra-articular administration of dexamethasone versus fentanyl as adjuncts to bupivacaine in patients undergoing arthroscopic knee surgery. Patients and methods: Eighty-nine patients of either sex were enrolled in this study. The patients were randomly divided into three equal groups. Group F that received intra-articular (IA) injection of 1 μg/kg fentanyl (In 2 ml saline) added to 18 ml of 0.25% bupivacaine, group D, which received IA injection of 8 mg (2 ml) dexamethasone added to 18 mL of 0.25% bupivacaine and group S that received IA injection of 2 ml normal saline added to 18 mL of 0.25% bupivacaine. Results:The time required for the first request of analgesia in group F, group D, and group S was 5.7 ± 0.7 vs 4.5 ± 0.5 vs 3.3 ± 0.5 hours respectively. There were significant differences between both treatment groups and the control group (p < 0.001) and in between both treatment groups (p < 0.001) in favor of group F. There was a significantly lower median visual analogue score in group F when compared to group D and S at 6 hours (p = 0.006 & 0.01, respectively), 12 hours (p < 0.001 & < 0.001, respectively), and 18 hours (p = 0.003 & 0.007, respectively) postoperatively. Conclusion:The addition of fentanyl or dexamethasone to IA bupivacaine in knee arthroscopic surgery provided a better quality of analgesia with less consumption of systemic analgesics without significant adverse effects.

Background: Fracture neck femur is a common cause of hospital admission among the elderly population. Many patients admitted with fracture femur have long-standing cardiac, hepatic or renal problems. This makes a challenge to balance adequate analgesia with side effects of opioids. Fascia iliaca compartment block (FICB) is one of the peripheral nerve block techniques. It became widely used in providing postoperative analgesia for patient with fracture neck femur either in emergency department or in the operating room. Objective: To evaluate the efficacy of addition of dexmedetomidine to bupivacaine on the duration and quality of postoperative analgesia in ultrasound guided fascia iliaca compartment block in proximal end femur surgeries. Patients and methods: Sixty patients with American Society of Anesthesiologists (ASA) physical status I -II of both sexes aged from 20-60 years scheduled for proximal end femur surgeries. They were randomly assigned to one of two equal groups (n=30 each), using closed envelope technique: Bupivacaine group (B group), and Bupivacaine + dexmedetomidine (BD group). Result: Our study demonstrated prolongation of postoperative analgesia in bupivacaine-dexmedetomidine group (BD) compared to bupivacaine group (B). It showed statistically significant reduction in cumulative pethidine doses and prolongation in the time till first rescue analgesic is required in the BD group in comparison with the B group in the first 24 hours. Hemodynamic changes and incidence of side effects, were statistically insignificant among the two groups. Conclusion: Addition of dexmedetomidine, as an adjuvant to the local anesthetic bupivacaine, in ultrasound fascia iliaca compartment block provides prolongation of the duration of postoperative analgesia with less opioid consumption without remarkable side effects.

Background: Peritonsillar infiltration of local anesthetics has efficient pain relief in children undergoing tonsillectomy. We hypothesize that lidocaine plus dexmedetomidine will potentiate the analgesic effect of each other rather than.Objectives: This study aimed to compare the analgesic effect of peritonsillar infiltration of lidocaine, dexmedetomidine, or lidocaine/dexmedetomidine on post-tonsillectomy pain. The primary outcome is the time of analgesia. The secondary outcomes are postoperative pain score, the effect of study medications on postoperative hemodynamic, and complications. Patients and Methods: Ninety patients were randomly allocated to three groups, 30 patients each. L group, patients received 2mg/kg lidocaine. D group, patients received 1 μg/kg of dexmedetomidine. LD group, patients received 1 μg/kg of dexmedetomidine plus 2 mg/kg lidocaine. Results:The time of the first analgesia request (h.) was longer in the LD group (13.70 ± 2.91) when compared with the L and D groups. Postoperative pain score was significantly lower in LD and D groups compared with the L group (P <0.05) On the other hand, there was a significantly lower median VAS score in the LD group when compared with the D group (P1 <0.05) Postoperative paracetamol consumption was significantly lower in LD group (0.55 ± 0.51 gm/24h) when compared with D and L groups (0.65 ± 0.59, 2.25 ± 0.44 gm/24h respectively). Conclusion: the use of lidocaine with dexmedetomidine is better than using each drug alone in decreasing posttonsillectomy pain and increasing the time to first request for analgesia with no significant postoperative side effects.

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Background: Posterior spinal surgery is considered one of the most painful surgeries. Erector Spinae Block is likely to produce effective pain management as it causes blockade of the dorsal rami . Objective: This study was conducted to assess the efficacy of ESPB in controlling intraoperative and POP and surgical field during lumbar spine fixation. Patients and methods: A total of 70 cases were enrolled, and they were haphazardly divided into two groups; ESPB group which comprised 35 cases who underwent the blockade technique, and the control group which included the remaining 35 cases that underwent surgery without blockade. The primary outcome was POP, while secondary outcomes involved intraoperative bleeding, and surgeon satisfaction. Results: No significant differences were detected among both groups concerning patient demographic features. Operative bed bleeding was significantly decreased in the ESPB group. Also, ESPB group expressed lower pain scores during the initial 6 hours after surgery with no difference detected between both studied groups on subsequent assessment. Surgeon satisfaction was significantly better in the ESPB group. Conclusion: ESPB appears to be safe and efficacious technique not only in decreasing POP, but also in improving operative bed bleeding, and surgeon satisfaction.