Background Many thyroidectomy patients suffer from pain after surgery that may delay early hospital discharge and place a significant burden on both the patient and the healthcare team. The aim of this study was to evaluate dexmedetomidine as adjuvant to bupivacaine in superficial and ultrasound-guided intermediate cervical plexus block for postoperative analgesia in patients undergoing total thyroidectomy. Patients and methods This prospective, randomized, double-blinded, and controlled study included 50 adult patients of either sex, aged 20–60 years, with American Society of Anathesiologists (ASA) class I or II, scheduled for elective total thyroidectomy under general anesthesia. Results Adding dexmedetomidine to bupivacaine significantly decreased the pain intensity as measured by the visual analog scale compared with group II. Heart rate levels in group I were significantly lower than that in group II in most periods of measurement. The duration of analgesia was prolonged in group I compared with group II, as the time to first dose of rescue analgesia ranged from 12 to 20 h in group I and from 4 to 12 h in group II. The total postoperative nalbuphine consumption was significantly lower in group I than group II. Postanesthesia recovery was significantly faster in group I than group II as measured by the modified Aldrete score 4 min postoperatively. Conclusion Adding dexmedetomidine to bupivacaine for bilateral superficial and ultrasound-guided intermediate cervical plexus block is considered to be an effective and safe method that efficiently managed acute postoperative pain, prolonged the time to first rescue analgesia, and reduced the needed for opioid consumption.

Background and aims Shivering is distressing to the patient and discomforting to the attending anesthesiologist, with a varying degree of success. Various drugs and regimens have been used to abolish the occurrence of shivering. This study aims to study and compare the efficacy of dexmedetomidine and tramadol in the prevention of post general anesthesia shivering in patients undergoing major maxillofacial surgery. Patients and methods The study was carried out on 64 adult patients, in the age group from 20 to 60 years of both sexes, American Society of Anesthesiology physical status I and II, admitted at the Maxillofacial Surgery Department at Alexandria Main University Hospital and scheduled for major maxillofacial surgery lasting for more than 4 h. Patients were randomly divided into two equal groups of 32 patients each, using sealed envelopes. This study was a single-blinded study. Group I patients received intravenous dexmedetomidine 1.0 μg/kg 15 min before wound closure. Group II patients received intravenous tramadol 0.1 mg/kg 15 min before wound closure. Vital signs such as heart rate, blood pressure, oxygen saturation, core body temperature, and surface body temperature were observed and recorded on arrival to the postanesthesia care unit, 5, 10, 15, 20, 30 min, 1, 3, 6 h after surgery. Any incidence, occurrence, and duration of shivering was recorded and intensity of shivering using the four-point scale. Statistical analysis of the data were fed to the computer and analyzed using IBM SPSS software package, version 20.0. Qualitative data were described using number and percent. Quantitative data were described using range (minimum and maximum), mean, SD, and median. Significance of the obtained results was judged at the 5% level. Results There was no statistically significant difference between the two groups regarding demographic data, duration of anesthesia and oxygen saturation. Heart rate was statistically significantly lower in group I (dexmedetomidine) than in group II (tramadol group) (P≤0.001). There was a statistically significant difference in blood pressure between the two groups being lower in group I (dexmedetomidine). Core and surface body temperature were statistically significantly lower in group I (dexmedetomidine); there was no significant difference in either occurrence, intensity, or duration of shivering. Conclusions intravenous dexmedetomidine and tramadol seems to possess antishivering properties and were found to reduce the occurrence of shivering in patients undergoing general anesthesia.