Background Tonsillectomy is one of the most common surgical procedures performed in otorhinolaryngology. Postoperative pain following tonsillectomy, which is especially aggravated by swallowing, can lead to various complications, such as impairment of food intake, possible dehydration, sleep disturbance and increased risk of secondary hemorrhage. Objectives The current study aims to evaluate the effectiveness of oral Gabapentin in decreasing the postoperative pain in pediatric patient undergoing tonsillectomy in the first 0,2,12 24 hours post-operative. Patients and Methods: Type of study Prospective randomized control study, study setting: Ain Shams university hospitals, Study period: 3 months from December 2018 to February 2019, Patients were divided randomly into two groups, each group consists of 25 patients: Group A Patients in this group received oral Gabapentin dose according to body weight (20mg/kg) at 0,2,12,24hrs post operative, Group B Patients in this group received oral paracetamol as analgesics (10-15 mg/kg every 12hours). Results The mean age of our study population was around7.2in group A and 7.08 in group B years. This study showed no statisticaly significance differance between group A and B regarding age. The mean body weight of the study was around27.79 for group A and 28.68 for group B.This study showed no statisticaly significance differance between group A and B regarding body weight. The mean HR of group A was lower than group B mean HR. The study shows statistically highly significant reduction of group A post operative heart rate compared to group B. The mean blood pressure of group A was lower than group B mean blood pressure. The study shows statistically highly significant reduction of group A postoperative blood pressure compared to group B. The median VAS score of group A was lower then group B. This study showed statisticaly significance reduction of VAS pain score post operative in group A compared to group B. The median analgesic rescue doses of group A was 2 and for group B was 3.5 so there was a statisticaly significance increase in rescue analgesia use in group B compared with group A.

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Background Brachial plexus is a network of nerves that arises from the neck passing through the axilla to supply the whole upper limb with motor and sensory supply. Our target in upper limb surgeries is to block this plexus using local anesthetics. Different adjuvants have been mixed with local anesthetics (LAs) for peripheral nerve blocks (PNBs). These drugs usually affect may delay the onset of action and prolong the duration of analgesia. Objective The aim of the present study was to compare the effect of Magnesium with bupivacine vesus bupivacine alone in supraclavicular nerve block ultrasound guided in upper limb surgeries Patients and Methods In our study 82 patients are randomly divide into two equal groups, control group received only bupivacine 0.5 % and magnesium group received 250 mg in addition to bupivacine 0.5% Results Our study showed that addition of 150 mg of magnesium to bupivacine in ultra sound guided supraclavicular block prolong the onset time of both sensory and motor block (p value >0.05) non significant. But it significantly prolonged their duration, p value <0.05 for sensory block and <0.001 for motor block which was highly significant Conclusion Addition of magnesium also did not affect the hemodynamics as regard systolic, diastolic blood pressure and o2 saturation. The previous findings proved that adding magnesium to bupivacine is more superior than the use of bupivacine alone.

Introduction Effective postoperative pain control in total knee arthroplasty is important, especially with starting physiotherapy and early ambulation, which enhances recovery and reduces hospital length of stay. The risk of postoperative complications, such as deep venous thrombosis and nosocomial infections, has also been shown to decrease with early mobilization. Aim The aim of this study is to assess the analgesic efficacy of epidural bupivacaine compared with intravenous patient controlled analgesia (opioid and NSAIDs) during postoperative period in total knee arthroplasty. Patients Forty patients, ranging in age from 20 to 70 yr, scheduled to receive total knee replacements with spinal anesthesia were randomly assigned to this study. Methods patients received epidural bupivacaine 0.125% alone in (group epa) or iv nalbuphine 50mg, ketorolac 60mg via pca device. The quality of postoperative analgesia was assessed by the anesthesiologist according to Visual Analogue Score (VAS), Cortisol level 24 hours preoperative and 2 hours postoperative for stress response. Results The efficacy of both epidural Bupivacaine and i.v nalbuphine & ketorolac via PCA device in controlling pain after total Knee arthroplasty however PCA was slightly less efficient especialy during the 12 hr after surgery. We found that one of the main draw backs of epidural analgesia using bupivacaine were arterial hypotension and urinary retention which required catheterization of many patients for voiding of urine. Results were comparable between the 2 groups and were against group EPA, Serum cortisol levels were elevated 2h post-surgery in all patients. This elevation is in accordance with the well-established stress response to surgery. Furthermore, cortisol levels were significantly less elevated in the group EPA, compared with group PCA. Conclusion The results of the study revealed both Epidural bupivacaine and systemic opioids combined with NASID via PCA device are effective of pain control post TKA.

Background Poorly controlled acute pain after abdominal surgery is related to somatic pain signals derived from the abdominal wall and is associated with a variety of unwanted post-operative consequences, including patient suffering, distress, respiratory complications, delirium, myocardial ischemia, prolonged hospital stay, an increased likelihood of chronic pain, increased consumption of analgesics, delayed bowel function and increase the requirement for rescue analgesics. Appropriate pain treatment protocols to reduce postoperative morbidity, improve the results of the surgery and decrease hospital costs. Aim of the Work to compare skin infiltration with bupivacaine-dexmedetomidine mixture versus bupivacainemagnesium mixture for analgesia in patients undergoing para-umbilical hernia repair under general anesthesia. magnesium. Results This study demonstrated that the addition of dexmedetomidine to wound infiltration with local anesthetics improves postoperative pain and reduces the need for analgesics which can be explained by different mechanisms: inhibition of painconduction in C -fibers, decreased in the production of inflammatory cytokines, the vasoconstrictive effect of 2 on vascular smooth muscle prolongs the time of analgesia, inhibition of tetrodotoxin-sensitive Na+ channels, and the absorption of dexmedetomidine to systemic circulation resulting in supraspinal analgesia. Patients and Methods A prospective randomized clinical trial study was conducted in Ain Shams university hospital on 44 adult patients undergoing para umbilical hernia or infra umbilical incisional hernia repair. The patients were randomly divided into two groups using their computer-generated random numbers will be enrolled in group D for bupivacaine-dexmedetomidine and group M for bupivacaine- Conclusion Pre-skin incision wound infiltration with dexmedetomidine–bupivacaine mixture provides prolonged local anesthetic effect, decreases the need for rescue analgesics, and provides better sedation than bupivacaine–magnesium sulfate mixture or bupivacaine alone in patients undergoing surgeries for hernia repair.