Background: Despite advances in breast conservation therapy, upper limb edema is still a typical concern for those who have undergone treatment for breast cancer. Objective: The purpose of this research was to evaluate the effects of a fixed dose of lidocaine combined with two different doses of ketorolac for stellate ganglion block (SGB) for decreasing pain and size of post mastectomy upper limb lymphedema after breast cancer surgery Patients and methods: Forty patients that underwent mastectomy were randomly assigned to one of two research groups in this prospective randomized study (20 patients in each group) received either ultrasound guided SGB with solution of 4 ml lidocaine 2% & 15 mg ketorolac in total volume 10 ml (group 1) or ultrasound guided SGB with solution of 4 ml lidocaine 2% & 30 mg ketorolac in total volume 10 ml (group 2). Assessment was done after SGB for 3 weeks by collecting data of total analgesic consumption as primary outcome, first analgesic request, VAS score and arm circumference. Results: Total analgesic dose /tablet was significantly decreased 19 (4-30) in group 2 versus 34 (20-63) in group 1, first analgesic request /hours 8 (5-54) in group 2 versus 4 (2-8) in group 1. At 2 and 3 weeks post-block, there was a significant reduction in group members' arm circumference both 5 and 10 centimeters above and below the elbow crease. Conclusion: Higher dose of ketorolac could be associated with better analgesia, lower VAS score and with more upper limb lymphedema size reduction post-mastectomy.

Background: Postoperative pulmonary problems from thoracic procedures are more likely to occur, which may lead to higher morbidity, a longer hospital stay, higher expenses, and a higher fatality rate. Objective: This study was done to compare efficacy of using either individualized or the conventional positive endexpiratory pressure (PEEP) for one-lung ventilation on postoperative pulmonary complications. Patients and Methods: This prospective randomized controlled study was done on 116 patients of age between 18 and 70 years with American Society of Anesthesiologists physical status II to Ш of either sex who underwent elective thoracic surgeries using one-lung ventilation. Patients were allocated randomly to either conventional PEEP group in which patients underwent thoracic surgeries using conventional PEEP (5 cmH2O) or individualized PEEP group in which patients underwent thoracic surgeries using individualized optimal PEEP which produces the best static lung compliance. Results:The incidence of postoperative pulmonary complications (PPCs) was lower in individualized PEEP group (12.1%) compared to conventional PEEP group (34.5%) with p (0.004). The most common complication incidence was lung collapse, which was greater in the conventional PEEP group (10.3%) than in the individualized PEEP group (27.6%). Arterial oxygen pressure/fraction of inspired oxygen (PaO2/FiO2) ratio was greater in the individualized compared to conventional PEEP group (p < 0.001). There were no significant differences in incidence of pneumonia, pleural effusion, pneumothorax, ARDS, or pulmonary embolism. Conclusion: Using individualized PEEP in patients receiving one-lung ventilation for thoracic surgeries resulted in decreased incidence of postoperative pulmonary complications, lower postoperative lung aeration score, better intraoperative respiratory mechanics, and oxygenation with no significant changes in hemodynamics.

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