Background Opioids have historically been a first-line therapy for surgical pain control. They were considered optimum and the mainstay of balanced anesthesia, but recently, concerns about their side effects have been raised. The concept of opioid free anesthesia (OFA) was introduced to provide a safer alternative that would provide benefits as well as enhance recovery after surgery. Results Sixty patients were enrolled in the study, 30 patients in each group. The two groups, TBA and OFA, were comparable in demographic data (age, sex, body mass index (BMI), lean body weight (LBW)) and duration of surgery. The TBA group showed a statistically significant reduction in the time needed for extubation (P value 0.018) and reaching an Aldrete score of 9 (P value 0.02). There was a significant decrease in pain scores, and nalbuphine consumption in the OFA group that extended to 24 h post-operative. Conclusions OFA has a better profile than TBA with regard to post-operative pain score and opioid consumption post-operative, but they have a relative increase in time to extubation and time to reach an Aldrete score of 9.

Background Pain relief after knee arthroscopy is very important for early recovery and rehabilitation. The study was conducted to evaluate the effects of adding dexamethasone (8 mg) to intra-articular morphine (10 mg) and bupivacaine (25 mg) combination on postoperative pain after knee arthroscopy. Results We enrolled 40 patients, 18–65 years-old of both sexes, ASA I and II scheduled for minor arthroscopic knee surgeries. The study group showed a lower visual analog score at rest and movement, prolonged postoperative analgesia, and decreased total analgesic consumption compared with the control group (P value < 0.05). Conclusions Adding dexamethasone to intra-articular combination of morphine and bupivacaine after knee arthroscopy prolongs the duration of analgesia, lowers pain scores, and decreases total analgesic consumption with no detected adverse effects.

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Background: Nephrectomy is a particularly painful procedure especially the open type rather than the laparoscopic type. There are multiple techniques for postoperative pain management after nephrectomy; opioid therapy, neuraxial analgesia and Quadratus lumborum block.Aim of the study: to evaluate the preemptive analgesic efficacy of ultrasound guided lateral quadratus lumborum block during the intraoperative period of nephrectomy regarding opioids sparing effect and at the early postoperative period regarding pain relief, early mobilization and opioids sparing effect. Patients and Methods:This study included forty patients aging 18-65 years old, admitted to operating room in Ain Shams University hospitals for elective open and simple nephrectomy. The patients were divided into two equal groups, Group 1: The patients received general anesthesia with conventional pain management by intravenous opioids, Group 2: received preoperative unilateral ultrasound guided quadratus lumborum block using 0.4 ml/kg bupivacaine 0.25% combined with general anesthesia. Results:The current study showed significant decrease of the opioid consumption in the patients of the quadratus lumborum block group in both the intraoperative and postoperative periods with less pain score compared to the patients of the opioid group. Conclusion:Our results showed that the ultrasound guided quadratus lumborum block was an effective technique in providing preemptive analgesia in patients undergoing nephrectomy surgery. The patients who received QLB required less intraoperative and postoperative analgesic requirements, as well as postoperative rescue analgesia.