Aim:To compare onset , duration and analgesic efficacy of axillary block when dexamethasone or ketorolac added to local anaethetic . . Patient and Methods: 60 patients aged 18-65 years with ASA I-II who were candidate for distal upper limb surgeries by axillary nerve block were enrolled in this randomized controlled double blinded study , in sohag university hospital . .Patients were Randomly allocated to( 3) groups (20) patients each ( using sealed envelope technique ) as : -Dexamethasone (group D): patient received 30 ml of 0.375 bupivacaine plus 8 mg dexamethasone in 2 ml . -ketorolac (group K):patient received 30 ml of 0.375 bupivacaine plus 30mg ketorolac in 2ml.-control (group C) : patient received 30 ml of 0.375 bupivacaine and normal saline 2ml).Immediately after administration; the patients were turned into the supine position. Patients were monitored for: Heart rate; NIBP and Oxygen Saturation. Patients were observed for onset, duration of sensory block and motor block; In the post-anesthesia care unit (PACU), the patients were asked to assess their level of pain based on a visual analog scale (VAS). Complications also were observed .Results: Dexamethasone had a faster Onset of sensory block onset than Magnesium Sulphate; Dexamethasone had a longer duration of regard Duration of motor block than Magnesium Sulphate; Magnesium Sulphate group had a longer analgesic effect stayed longer than Dexamethasone group .No Significant difference Between Two groups in rate of Complications ; Hypotension and Bradycardia were the most frequent complications in the two groups .Conclusion: The addition of dexamethasone to bupivacaine resulted in significant reduction in onset time of sensory and motor blocks, prolonged duration of post operative analgesia, lower analgesic consumption and lower incidence of complications PDF created with pdfFactory Pro trial version www.pdffactory.com SOHAG MEDICAL JOURNAL Dexamethasone and Ketorolac as an adjuvant to Bupivacne

Background: Dexmedetomidine, a highly selective α2-adrenoceptor agonist, is widely used in clinical anaesthesia, and intensive care unit. The aim of this study is to evaluate the hemodynamic and analgesic effects of dexmedetomidine in major abdominal surgeries. Patients and methods: 40 patients for radical cystectomy in the age range of 40-65 years participated in this prospective, randomized, double blinded, placebo controlled clinical study. Patients were randomly assigned to receive either Dexmeditomidine (Dex group) or normal saline (0.9%) (Control group).patients hemodynamics, Recovery profile, and Pain intensity were evaluated. Results Intraoperative mean arterial pressure and heart rate were significantly lower but stable in Dex group. Patients in Dex group had lower VAS scores. Conclusion: Dexmedetomidine is effective in attenuating hemodynamic response to surgical stimulation. Patients in Dex group experienced less postoperative pain.

Background: Surgical injury to tissue as in major abdominal surgeries causes a variety of profound inflammatory response which may lead to postoperative complications with significant co morbidity. Dexmedetomidine, a highly selective α2adrenoceptor agonist, is widely used in clinical anaesthesia, and intensive care unit. The aim of this study is to evaluate the anti inflammatory effect of dexmedetomidine in major abdominal surgeries. Patients and methods: 40 patients for radical cystectomy in the age range of 40 -65 years participated in this prospective, randomized, double blinded, placebo controlled clinical study. Patients were randomly assigned to receive either Dexmeditomidine (Dex group) or normal saline (0.9%) (Control group). Serum tumor necrosis factor (TNF-α), Interleukin-6 (IL-6), glucose, cortisol, and C-reactive protein (CRP) were analyzed before the start of the study drug infusion, after complete recovery and the day one postoperatively. Results: inflammatory markers were significantly higher in both groups compared to baseline measurements. TNF-α, IL-6, glucose, and cortisol measurements were less in Dex group in postoperative period. Conclusion: Dexmedetomidine is effective in attenuating the postoperative rise of the proinflammatory cytokine interleukin-6 and tumor necrosis factor (TNF-α) and resulted in lower levels of markers of stress response to surgery as cortisol and blood glucose.