No abstract

Background: In neuroaxial anesthesia, there was many adjuvants used with the purpose of increasing anesthesia duration and reduction of postoperative analgesia. Objective: comparison between dexmedetomidine and fentanyl when added to 0.5% hyperbaric bupivacaine, for lower limb amputation on early stump and phantom pain after spinal anesthesia. Patients and Methods: Ninety patient arranged for lower limb amputation surgery were randomly allocated into three groups (each 30 patients). Each patient received 2 ml of hyperbaric bupivacaine (0.5%) plus 0.5 ml normal saline in control group (Group B) or 5µ dexmedetomidine diluted in 0.5 ml normal saline in BD group or 25 µ fentanyl diluted in 0.5 ml normal saline in BF group. Anesthesia, analgesia, sedation, hemodynamic changes, adverse effects and post-operative pain up to one month were recorded. Results: The studied groups showed no significant differences regarding demographic characteristics and hemodynamic (heart rate and mean arterial pressure). Patients in group BD had significant increase of sensory and motor block time compared to BF B groups. Postoperatively, there was a significant decrease of pain in BD group in the first 24 hours when compared to control or BF group. The postoperative mean total consumption of analgesics during the first day was significantly decreased in BD when compared to BF and control groups. Conclusions: dexmedetomidine (5μg) represents a good alternative to fentanyl (25μg) as a spinal adjuvant to bupivacaine in surgery for the lower limb.

Background: The leading cause of death in the first 4 decades of life is trauma, and it remains a serious public health concern in all countries, whether rural or urban areas. While in Egypt damage is several times higher because of misclassification and under-reporting. The aim of this research was to compare between POCUS and other traditional imaging (x-ray, CT) in diagnosis of shock following blunt polytrauma patients and evaluate RUSH protocol in diagnosis of shock and follow up. Methods: This prospective research was conducted on 100 patients aged from 18 to 65 years old, with blunt polytrauma presented with shock and hypotension. All patients underwent full history taking, and radiological investigations when needed, clinical examination according to Advanced Trauma Life Support (ATLS), management was consisted of primary and secondary survey, routine laboratory investigations and RUSH assessment for trauma. Results: Systolic and diastolic blood pressure, respiration rate and heart rate were significant clinical predictors of shock. The time taken by RUSH protocol to assess shock was significantly lower compared to the time taken by Pan-CT and X- rays (P < 0.0001). Conclusions: This study has focused on the point-of-care ultrasound (RUSH protocol) role for the early identification of the causes of shock in the department of emergency medicine. Diagnosis made by RUSH protocol is strongly agree with right medical diagnosis. It demonstrates the high efficacy of (RUSH protocol) in detecting and classifying distinct types of shock aetiology with high accuracy.