Background The use of opioids in epidural anesthesia has become popular to optimize postoperative analgesia. The present study was designed to compare the analgesic efficiency of epidural infusion of (magnesium sulfate added to levobupivacaine) compared to (fentanyl added to levobupivacaine) and (levobupivacaine) alone. Objective The aim of this study was to assess the post-operative analgesic efficiency of Magnesium Sulphate as an additive to Levobupivacaine in comparison with either Levobupivacaine alone or the combination of Levobupivacaine and Fentanyl. Patients and Methods Ain Shams university hospitals. After obtaining an informed consent; 45 patients admitted for open reduction and internal fixation of Pott's fracture, were blindly randomized into three groups; group N, group M or group F. Group N receive levobupivacaine, group M receive levobupivacaine and magnesium, and group F receive levobupivacaine and fentanyl. Results The study showed that the onset of both sensory and motor blocks was significantly faster in the group receiving magnesium and levobupivacaine in comparison with the other two groups. In addition, heart rate was significantly lower in the 2 groups receiving magnesium and fentanyl as adjuvant to levobupivacaine compared to the third group. Conclusion It was concluded that using magnesium sulphate as an additive to epidural levobupivacaine infusion produces good analgesia without side effects; it proved to fasten the epidural block in comparison to both the levobupivacaine and the levobupivacaine and fentanyl groups, besides it increased the duration of post operative analgesia in comparison with levobupivacaine group.

Background Interscalene approach for brachial plexus block is recognized as the gold standard technique for postoperative pain control after shoulder scope surgeries. However, it is associated with major adverse effects and patient discomfort due to paralysis of the hand muscles. The suprascapular nerve block is considered to be a safe and effective alternative to interscalene nerve block for shoulder surgery without affecting the motor function of the hand muscles and other serious complications of interscalene nerve block, especially in ambulatory surgery. The aim of this study is to compare interscalene and suprascapular nerve block in terms of postoperative pain, opioid consumption, and hand grip strength in shoulderscopic surgeries. This prospective, randomized trial was done in Ain Shams University Hospitals. A sample of 50 patients was divided into two groups; 25 patients in each group, namely Group ISB (interscalene approach of brachial plexus block) and Group SSNB (suprascapular nerve block). Visual analogue scale (VAS) was used to assess shoulder pain at rest and upon flexion in the first 24 h. The degree of hand motor power affection, the total amount of opioids used as rescue analgesia, and the incidence of complications were also recorded. Results The findings revealed no statistically significant difference between groups (P-value > 0.05) in pain control all over the 24 h by VAS score at rest and at arm flexion. SSNB received a larger total narcotic dose (60 ± 26.02) mg of pethidine than ISB (52 ± 22.73). However, there was no statistical difference between them throughout the 24 h regarding total narcotic consumption and 1st time for pethidine administration. The ISB group showed a statistically significant reduction in the hand power grip strength postoperatively (83.68 ± 4.75%). Conclusions The results of the present study favor SSNB as the first choice of pain control after shoulderscopic surgeries for a patient scheduled for early home discharge because of the complete recovery of the hand muscles’ motor power. Trial registration This study was registered on PACTR (www.pactr.org) database; identification number for the registry is PACTR202201840526231.

Background Spinal anesthesia is a common technique for lower abdomen and lower limb surgery, but the use of local anesthetics alone may produce unwanted side effects such as prolonged motor and autonomic block, limited duration of action, besides, excessive local anesthetics can cause cardiac toxicity and central nervous system side effects. For these reasons, local anesthetics combined with other drugs, to utilize their synergistic analgesia and to reduce the dose of local anesthetics, has become a new option for anesthesiologists. Objectives This study is designed to assess and compare the effect of intrathecal Fentanyl and Dexmedetomidine as adjuvants to hyperbaric Levobupivacaine 0.5% regarding the onset, duration of sensory and motor block, duration of post operative analgesia and possible side effects in patients undergoing infra umbilical surgeries. Materials and Methods The study was performed at Ain Shams university hospitals. After obtaining ethical committee approval and informed consent from the patients. The study protocol was obtaining an informed consent; 75 patients admitted for infraumbilical surgeries in Ain Shams University hospitals operation theatre, were blindly randomized into three groups, using their medical record number (MRN) and subjected to a comparative study. A for Fentanyl group, group B for Dexmedetomidine group and group C for Levobupivacaine control group in the duration of 6 months from March to August 2019. Results The study showed that the quality of intraoperative analgesia was significantly better with dexmedetomidine than fentanyl group, and the requirement for opioids was significantly lower with dexmedetomidine than fentanyl group. The degree of motor block and postoperative analgesia was significantly denser with dexmedetomidine than fentanyl group. Conclusion From the current study we can conclude that using intrathecal 5 µg dexmedetomidine seems to be a suitable alternative to 25 µg fentanyl as adjuvants to 0.5% hyperbaric levobupivacaine in spinal anaesthesia. Its associated with prolonged motor and sensory block and provides good quality of intraoperative analgesia and extended duration of post operative analgesia as compared to fentanyl.

Background Pneumonia is consistently among the leading causes of morbidity and mortality worldwide. Defined as acute infection of the lung parenchyma, it is caused by a wide variety of microorganisms, including bacteria, viruses, and fungi. However, pneumonia is often misdiagnosed even now. Early and effective antibiotic treatment is important. An adequate treatment is thus reliant on an early diagnosis of pneumonia, yet the diagnosis is not always clear at presentation to the emergency department (ED). In a retrospective chart review of patients admitted with pneumonia, 22% of patients presented some reason for diagnostic uncertainty that could result in delayed antibiotics delivery. Objective The aim of the study was to evaluate the efficacy of LUS in the diagnosis of pneumonia. Methods This is a prospective observational study which was conducted on 36 consecutive patients with suspected pneumonia. All patients were admitted to the Hospital, in the period from May 2019 to January 2020. Results Chest x-ray diagnosed pneumonia in 66.7% of patients, while lung U/S diagnosed pneumonia in 75% of patients. Lung ultrasound was more sensitive and highly specific for diagnosis of pneumonia as sensitivity and specificity of lung ultrasound was 96.3% and 88.9% respectively while for chest xray was 81.5% and 77.8% respectively. Accuracy of lung ultrasound was 94.4% and that of chest x-ray was 80.6% in relation to CT chest the gold standard with accuracy 100%. Superiority of lung US findings over CXR findings could be explained by high sensitivity & specificity of lung US in diagnosing pneumonia in comparison with chest x ray as high resolution CT is a gold standred for the study. Conclusion LUS is a sensitive and highly specific diagnostic tool in pneumonia. Therefore, we hypothesize that Lung US may be considered as the first imaging test inpatients with suspicion of pneumonia. It should be noted, however, that the ability of LUS to detect lung consolidations located in peri-hilar regions is limited. A diagnostic algorithm of pneumonia which includes Lung US should be validated in prospective studies. Monitoring there solution of pneumonia can be another application of Lung US inpatients with pneumonia.