No abstract

Background: Anaesthesia for patients with chronic renal failure (CRF) is a challenge. We compared combined interscalene (ISB) and supraclavicular (SCB)block using ultrasound guidance versus general anesthesia in patients with CRF undergoing brachioaxillay graft surgery. Methods: This randomized open label blind end-point pilot study was conducted in Mansoura University-Hospital, Egypt from January 2018 to July 2019. We enrolled 60 patients with CR Funder going brachioaxillary graft surgery. GA group(n=30) received general anaesthesia while RA group (n=30) received combined ISB and SCB. We evaluated numerical rating scale (NRS), surgeon and patient satisfaction, onset and duration of motor and sensory block, duration of surgery and complications. Results: NRS statistically decreased in RA group. The first need of analgesia significantly delayed, and the frequencies of analgesia requirement were less in RA group. Surgeon and patient satisfaction were similar in both groups. The onset of sensory block was 4.37 minutes and lasted for 9.5 hours while the onset of motor block was 6.73 minutes and lasted for 6 hours. No complications were detected in both groups. Conclusion: Combined ISB and SCB technique is an excellent alternative to general anaesthesia in patients with CRF undergoing brachioaxillary graft. It implies better surgeon and patient satisfaction with lower NRS and frequency of analgesia requirement with delayed first need of analgesia.

Background: Paediatric tracheal intubation represents a challenge to many anaesthesiologists and requires considerable expertise. We assessed re-intubation frequency and the time needed for intubation in children undergoing elective surgical operations. Methods: A prospective randomised single blinded study was conducted in Mansoura University Children’s Hospital, Egypt from April 2016 till April 2017. We enrolled 50 children scheduled for elective surgery not exceeding 90 minutes with general anaesthesia using an uncuffed endotracheal tube. They were randomly allocated into one of two groups (age-based group versus ultrasoundbased group). Primary outcome variables were re-intubation frequency and the time taken for intubation. Secondary outcome variables were optimum tube selection and complications after extubation. Results: In the ultrasound-based group, the frequency of re-intubation frequency was decreased due to an endotracheal tube which was too large (p = 0.047). The optimum tube selection was higher (p = 0.034) and the time taken for intubation was longer (p = 0.004). A significant correlation was found between the outer diameter of the endotracheal tube and the transverse diameter of the subglottic airway (r = 0.988, p < 0.001). No significant differences were detected between groups regarding complications after extubation (p > 0.05). Conclusion: Ultrasonography was superior to the use of an age-based formula in reducing re-intubation frequency but intubation was slower.

Background: Adhesive capsulitis of the shoulder is common after breast cancer treatment. We aimed to compare the effects of using stellate ganglion block (SGB) with bupivacaine and ketamine alone versus its combined use with intra-articular platelet rich plasma (PRP) injection in patients with post-mastectomy shoulder pain. Methods: A prospective randomized open blinded end-point pilot study was conducted in Mansoura University Oncology Center, Egypt during the period from August 2017 till April 2018. Sixty-four patients with chronic post-mastectomy frozen shoulder were enrolled and allocated into one of two groups. Group A received ultrasound guided SGB with ketamine (0.5mg/kg) plus 5ml bupivacaine 0.5% and group B received ultrasound guided SGB using ketamine and bupivacaine in the same dose and intervals as group A plus posterior approach shoulder injection with PRP (3 times with 1-week interval). Numerical rating scale (NRS) at rest and at shoulder movement, range of motions (ROM) of shoulder and disability of arm, shoulder and hand (DASH) questionnaire were recorded. T-test and ANOVA test (for parametric data) and Mann-Whitny test, Wilcoxon rank test and Kruskal-Wallis test (for non-parametric data) were used for analysis. Results: Group B showed statistically significant improvement in NRS with shoulder movement and DASH score at one, two and three months after injection in comparison to group A (P≤0.001). Also, ROM improved significantly with PRP shoulder injection after one month from injection. Conclusion: The combination of intra-articular PRP injection with SGB using ketamine as adjuvant to bupivacaine produces dramatic improvement in post-mastectomy chronic shoulder pain. Their combined use reduces the need for analgesia.

Background.The postmastectomy pain syndrome (PMPS) is chronic pain after breast cancer surgery and is reported to influence quality of life. The aim of this study was to provide long term reduction of PMPS, improve range of motion of the shoulder, and decrease the need for postoperative analgesia using ultrasound guided stellate ganglion block.Method.Sixty patients with PMPS were randomly allocated into 1 of 3 groups: bupivacaine group (group 1), bupivacaine plus ketamine group (group 2), and bupivacaine plus morphine group (group 3). Each patient received 3 blocks with an interval of one week in between. Patients were assessed for: pain visual analogue score (VAS), movement of the shoulder, skin temperature, and the need for analgesic drugs.Results.The pain VAS was significantly decreased in group 2 as compared to the other two groups. Shoulder movement improved significantly in the three studied groups with the best results observed after the third block. The need for the analgesic drugs in the form of gabapentin was more in the bupivacaine and bupivacaine plus morphine groups than in bupivacaine plus ketamine group.Conclusion.Treatment of PMPS with ultrasound guided stellate ganglion block using ketamine (0.5 mg/kg) as adjuvant to bupivacaine (0.25%) successfully decreased pain VAS and the need for analgesic drugs.