BackgroundDuloxetine, Etoricoxib and opioid are of the commonly administered drugs in Lumbar laminectomy. The aim of this study is to assess the effect of perioperative use of Duloxetine in combination with Etoricoxib on postoperative pain and opioid requirements.MethodsOne hundred twenty patients with ASA physical status were enrolled with age between 18 and 70 years. Patients were divided randomly into four groups of 30 patients: group P received placebo, group E received etoricoxib 120 mg, group D received duloxetine 60 mg and group D/E received duloxetine 60 mg capsules and etoricoxib 120 mg; 1 h before surgery and 24 h after.ResultsNeither Duloxetine nor etoricoxib individually had effect on pain with movement, while their combination revealed a significant reduction in pain scores over the entire postoperative period at rest and on movement. Etoricoxib showed a significant decrease in pain at all times at rest when compared with group P, while it showed significant pain decrease only at 0, 2 and 4 h when compared with group D. On the other hand duloxetine alone showed significant decrease in pain at rest at 24 h and 48 h when compared with group P. ConcerningMorphine requirement after 24 h.; it wassignificantly lower in the D/E group in comparison with groups P, E and D. It should be noted also that there was a significant decrease morphine requirement in both groups E and D.ConclusionThe perioperative administration of the combination of etoricoxib and duloxetine improved analgesia and reduced opioid consumption without significant side effects.Trial registration ISRCTN48329522. 17 June 2017

We developed a clinical neurologic and behavioral scoring system composed of 10 items to measure the post-operative pain levels in infants: (1) sleep during preceeding hour, (2) facial expression of pain, (3) quality of cry, (4) spontaneous motor activity, (5) Spontaneous excitability, (6) flexion of fingers and toes, (7) sucking, (8) global evaluation of tone, (9) consolability and (10) sociability. Using this system, a group of infants ranging from one to seven months in age and undergoing minor surgical procedures was studied. The infants were randomly assigned to two groups: Group I received Fentanyl intravenously (3 micrograms/kg) prior to surgery, and Group II received a placebo. The infants then were studied post-operatively in the recovery room at 30, 60, 90 and 120 min intervals. Over the entire post-operative observation period, 54% of the infants in Group I had satisfactory analgesia compared to 18% in Group II. There were no significant differences in Group I and Group II in oxygenation, carbon dioxide elimination, blood pressure, heart rate or temperature.

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Background. Orthopedic procedures are among the commonest surgeries in the elderly. On the other hand, those patients have many risk factors suitable for development of postoperative complication due to prolonged postoperative recumbent that decrease by using anesthesia technique allowed early ambulation as far as possible. Aim of the Work. The aim of this study was to evaluate whether washout of the local anesthesia with 0.9% normal saline with bicarbonate through the epidural catheter could provide early ambulation throughout the faster recovery of the motor block. Patient and Methods. Sixty adult patients were included in this study and divided into three groups. In group I, epidural injection of bupivacaine was carried out without wash (control group). In group II, epidural injection of bupivacaine was followed by wash. In group III, epidural injection of both bupivacaine and nalbuphine was followed by wash. Results. They were significantly faster in both group II and group III as compared with group I. In group I, sensory recovery was insignificantly faster than the motor recovery. In group II motor recovery was significantly faster than sensory recovery. In group III motor recovery was significantly faster than the sensory recovery. Conclusions. These results suggested that early ambulation with an adequate postoperative analgesia was reported in patient receiving epidural injection of both bupivacaine and nalbuphine.

Background.Spinal anaesthesia, which is one of the techniques for infraumbilical surgeries, is most commonly criticized for limited duration of postoperative analgesia.Aim of the Work.The aim of this study was to decrease bupivacaine dose used in spinal anesthesia in patients undergoing orthopedic lower limb surgery and reduce its possible side effects.Patient and Methods.Sixty adult patients of both sexes, divided into three.Group Creceived 2.5 mL bupivacaine and 0.5 mL saline 0.9%.Group Areceived 2.5 mL bupivacaine and 0.5 mL midazolam.Group Breceived 2.5 mL bupivacaine and 0.5 mL magnesium sulphate.Results.As regards onset of both motor and sensory blockade, there are a significant decrease in group A and a significant increase in group B as compared to group C, with a significant decrease in duration of motor blockade and significant increase in duration of sensory blockade in both group A and group B, respectively, as compared to group C, with a significant decrease in the duration of sensory blockade in group B as compared to group C.Conclusions.These results suggested that intrathecal midazolam as an adjuvant for bupivacaine increases the duration of both sensory and motor blockade more than that of magnesium sulphate.