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Background: Percutaneous nephrolithotripsy is a technique used for the treatment of renal stones during which an irrigation fluid is used which may cause hypothermia and shivering if not prevented. The aim of this prospective randomized placebo controlled double blinded study was designed to evaluate the efficacy of preoperative hydrocortisone versus tramadol for attenuation of postoperative shivering after percutaneous nephrolithotripsy under general anesthesia Method: 90 ASA I males and females patients aged 20-50 years, planned for percutaneous nephrolithotripsy under general anesthesia were randomly divided into three groups: Group S (n = 30) received 10 ml normal saline IV before induction of general anesthesia Group H (n = 30) received IV hydrocortisone 2 mg/kg before induction of general anesthesia Group T (n = 30) received IV tramadol hydrochloride 1 mg/kg before induction of general anesthesia The following parameters were recorded: Core temperature, heart rate and mean arterial blood pressure before induction of anesthesia, then every 15 min after induction of anesthesia, and every 30 min in the PACU, shivering intensity in the first 2 h postoperative, the incidence of shivering, the number of patients required meperidine and side effects. Results: The number of patients who had shivering was statistically significantly higher in S group (12) than in H group (8) and in T group (7) with no statistically significant differences between H and T groups. Intraoperative heart rate, mean arterial blood pressure and side effects showed no statistically significant difference between the study groups.Conclusion: Preoperative IV hydrocortisone and tramadol were effective in attenuation of postoperative shivering compared to placebo after percutaneous nephrolithotripsy without increasing the incidence of side effects.

Background: Mastectomy is a common surgical procedure associated with intra and postoperative pain if untreated adequately will lead to chronic pain. Objectives: This study aimed to evaluate the efficacy of serratus anterior plane block using bupivacaine/magnesium sulfate versus bupivacaine/ nalbuphine for mastectomy. Methods: 40 ASA I and II female patients age 25 - 60 years underwent breast cancer surgery received the block before induction of general anesthesia were divided into two groups GBM (n = 20): (bupivacaine/magnesium sulphate): received bupivacaine 30 mL 0.25% and 500 mg magnesium sulphate, GBN (n = 20): (bupivacaine/nalbuphine): received bupivacaine 30 mL 0.25% and nalbuphine 0.2 mg/kg. The following parameters were recorded: The sensory block, motor block, postoperative heart rate, noninvasive mean blood pressure: at 1, 6, 12, 24 h, postoperative time to first request of analgesics (hours), VAS at rest and movement at 1, 6, 12, 24 h, postoperative analgesic requirements (pethidine mg/24 h). Results: The sensory block was statistically significantly lower in the GBM group than the GBN group at 24 hours postoperatively. The Medical Research Council scale was statistically significantly lower in the GBN group than the GBM group at 24 hours postoperatively. Postoperative time to first request of analgesics (hours) was statistically significantly longer in the GBN group than the GBM group, VAS at rest was statistically significantly lower in the GBN group than GBM group at 6th and 24th hours, VAS at movement showed no statistically significant differences between the two groups. Intraoperative fentanyl and postoperative analgesic requirements (pethidine mg/24 h) showed no statistically significant differences between the two groups. Conclusions: Serratus anterior plane block using bupivacaine/nalbuphine provided effective postoperative analgesia, reduced postoperative pain than bupivacaine/magnesium sulfate in a mastectomy.

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