Article informationBackground: Postoperative pain has a significant direct relationship to morbidity of female patients after caesarean section. Adequate post caesarean section pain management is fundamental.Objectives: To compare the postoperative analgesic effect of both ibuprofen and diclofenac sodium on pain score, rescue opioid requirement and patient satisfaction in female patients after caesarean section. Patients and methods:This prospective, randomised, double-blind comparative study was conducted over a period of eight months in Kafr Elsheikh University Hospital, obstetric unit. The study included any American Society of Anaesthesiologists [ASA] physical status II female patients aged 18-40 years who were scheduled for elective and emergency caesarean section under spinal anaesthesia. Patients were randomly allotted into two groups: Group D [intravenous diclofenac group] and Group I [intravenous ibuprofen group].Results: First request of analgesics, total opioid consumption and VAS showed no significant differences between two groups except after 4hours and 8 hours postoperatively which showed significant decrease in diclofenac group than ibuprofen group. Also patient satisfaction was higher in Diclofenac group. There was increase in bleeding tendency [APTT, BT, and HB results] and abnormal abdominal bleeding attacks in diclofenac group. Conclusion:Diclofenac decreases postoperative pain with higher potency than ibuprofen but unfortunately with more tendency to gastrointestinal complications and bleeding tendency.

Background: Although thoracoscopic sympathectomy is made via small incisions, it is associated with severe postoperative pain. Both Rhomboid intercostal block (RIB) and serratus anterior plane block (SABP) are recent techniques used for pain control after such procedures. Herein, we compared RIB and SAPB regarding pain control in patients undergoing thoracoscopic sympathectomy for palmar hyperhidrosis. Patients and methods: Three groups were enrolled in this prospective randomized study (71 patients in each group); Group S received SAPB, Group R received RIB and Group C as controls. The block procedures were performed after general anesthesia and prior to the skin incision. Results: The three groups showed comparable demographics and operative time (P ˃ 0.05). Pain scores showed a significant decline with the two block procedures compared to controls during the first day following surgery (P ˂ 0.05), but Group R had better scores compared to Group S. Both block techniques were associated with a significant prolongation of the time to first rescue analgesic and less fentanyl consumption compared to controls (P ˂ 0.05). However, both parameters were improved with RIB rather than SAPB (P ˂ 0.05). Both blocks led to a significant improvement in patient satisfaction, which was comparable between the two approaches P ˃ 0.05), and better than Group C (P ˂ 0.05). Conclusion: Both RIB and SAPB are safe and effective in pain reduction after thoracoscopic sympathectomy procedures in patients with hyperhidrosis. However, RIB is superior to SAPB as it is associated with better analgesic outcomes. Clinical trial registration number: Pan African Trial Registry PACTR202203766891354. https://pactr.samrc.ac.za/Researcher/TrialRegister.aspx?TrialID=21522

Background: Although the transversus abdominis plane block (TAP) has yielded excellent pain management outcomes in ladies undergoing cesarean section (CS), it only covers the somatic component of the pain, not the visceral one, and that could be distressing for some ladies with low pain threshold. Herein, we evaluated the clinical efficacy of adding peritoneal to the TAP block in such cases. Patients and methods: This prospective randomized study included 180 pregnant ladies scheduled for elective CS, who were randomly allocated into three groups; Group A (TAP block alone), Group B (combined TAP and peritoneal block), and Group C (no block). Results: All general patient characteristics, along with operative time, showed no significant difference between the three study groups. Pain scores expressed significantly higher values in Group C compared to the other two groups, and that was evident starting from three hours after surgery till the end of the first postoperative day. Group B tended to express lower scores compared to Group A. Group C expressed a significant decline in the duration of the first analgesic request compared to the other two groups. The degree of patient satisfaction was strongly in favor of the two block groups. Group B had a better satisfaction profile compared to Group A. Conclusion: Although the TAP block alone could provide excellent pain relief after CS, the addition of a concomitant peritoneal block enhanced this effect, as it was associated with lower pain scores and better patient satisfaction.

Background Although thoracoscopic sympathectomy is made via small incisions, it is associated with severe postoperative pain. Both Rhomboid intercostal block (RIB) and serratus anterior plane block (SABP) are recent techniques used for pain control after such procedures. Herein, we compared RIB and SAPB regarding pain control in patients undergoing thoracoscopic sympathectomy for palmar hyperhidrosis. Patients and methods Three groups were enrolled in this prospective randomized study (71 patients in each group); Group S received SAPB, Group R received RIB and Group C as controls. The block procedures were performed after general anesthesia and prior to the skin incision. Results The three groups showed comparable demographics and operative time (P ˃ 0.05). Pain scores showed a significant decline with the two block procedures compared to controls during the first day following surgery (both P ˂ 0.05), but Group R had better scores compared to Group S. Both block techniques were associated with a significant prolongation of the time to first rescue analgesic and less fentanyl consumption compared to controls (both P ˂ 0.05). However, both parameters were improved with RIB rather than SAPB (both P ˂ 0.05). Both blocks led to a significant improvement in patient satisfaction than in the control group (both P ˂ 0.05), but it was comparable between the two approaches (P ˃ 0.05). Conclusion Both RIB and SAPB are safe and effective in pain reduction after thoracoscopic sympathectomy procedures in patients with hyperhidrosis. Moreover, RIB is superior to SAPB as it is associated with better analgesic outcomes. Trial registration Pan African Trial Registry PACTR202203766891354. https://pactr.samrc.ac.za/Researcher/TrialRegister.aspx?TrialID=21522