Comparison of Analgesic Efficacy between Bupivacaine with Dexamethasone and Bupivacaine Alone in Caudal Block for Pediatric Patients Undergoing Open Inguinal Hernia Repair

Abstract Background Open inguinal hernial repair surgeries are one of the most frequently performed surgical procedures in the pediatric population. Using optimal analgesic regimen provide safe and effective analgesia, reduce postoperative stress response and accelerate recovery from surgery. Regional anesthetic techniques are commonly used to facilitate pain control in pediatric surgical procedures. The most used techniques in pediatrics is caudal block. Objective To evaluate the analgesic effect of dexamethasone when given caudally as an adjuvant to caudal block vs bupivacaine alone in caudal block for children undergoing open inguinal hernial repair surgeries. Methods The study is a prospective double – blinded randomized controlled trial conducted on 50 randomly chosen patients in Ain Shams University Hospitals after approval of the medical ethical committee. Patients were divided randomly into two groups; each group consisted of 25 patients. After preoperative assessment and obtaining baseline vital data, all patients received general anesthesia. Group BD who would receive caudal dexamethasone added to Bupivacaine and Group B who would receive caudal block with Bupivacaine. Results Dexamethasone addition shows statistically significance difference between two groups according to FLACC scale at 4h, 8h and 12h. The duration of adequate analgesia (FLACC pain score 4 or less) was significantly higher in group BD compared to group B. Conclusion Dexamethasone 0.1 mg/kg, when used as an adjuvant to caudal anesthesia, can significantly prolong the duration of postoperative analgesia. It is better than bupivacaine alone in caudal block at similar doses in controlling postoperative pain.

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Comparison of Analgesic Efficacy of Caudal Dexamethasone versus Intravenous Dexamethasone as an Adjuvant to Caudal Block in Pediatric Patients Undergoing Lower limb orthopedic Surgeries

QJM ◽

10.1093/qjmed/hcaa039.048 ◽

2020 ◽

Vol 113 (Supplement_1) ◽

Author(s):

G S Mohamed ◽

A A Abdelatif ◽

M Menshawey ◽

A A S Mansour

Keyword(s):

Postoperative Pain ◽

Surgical Procedures ◽

Postoperative Analgesia ◽

Lower Limb ◽

Pediatric Population ◽

Anesthetic Techniques ◽

Caudal Block ◽

Caudal Anesthesia ◽

Analgesic Regimen ◽

Better Than

Abstract Background Lower limb orthopedic surguries are one of the most frequently performed surgical procedures in the pediatric population. Using optimal analgesic regimen provide safe and effective analgesia, reduce postoperative stress response and accelerate recovery from surgery. Regional anesthetic techniques are commonly used to facilitate pain control in pediatric surgical procedures. The most commonly used techniques in pediatrics is caudal block. Aim of the Work This study is conducted to evaluate the analgesic effect of dexamethasone when given systemically versus caudally as an adjuvant to caudal block for children undergoing lower limb orthopedic surgeries. Patients and Methods The study was conducted on 50 randomly chosen patients in Ain Shams University Hospitals after approval of the medical ethical committee. Patients were divided randomly into two groups, each group consisted of 25 patients. Results The results of the study revealed that dexamethasone 0.1 mg/kg, when used as an adjuvant to caudal anesthesia, can significantly prolong the duration of postoperative analgesia. It is better than IV dexamethasone at similar doses in controlling postoperative pain. Conclusion From our study, we can conclude that dexamethasone 0.1 mg/kg, when used as an adjuvant to caudal anesthesia, can significantly prolong the duration of postoperative analgesia. It is better than IV dexamethasone at similar doses in controlling postoperative pain.

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A comparative study between Levobupivacaine alone and in combination with Dexmedetomidine in caudal analgesia of hernia repair in pediatrics

QJM ◽

10.1093/qjmed/hcab086.010 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Ahmed K Kamar ◽

Hala G Awad ◽

Hanan Mahmoud F Awad ◽

Mohammed M Maarouf

Keyword(s):

Hernia Repair ◽

Pediatric Population ◽

P Value ◽

General Anesthesia Group ◽

Caudal Anesthesia ◽

Analgesic Regimen ◽

Caudal Analgesia ◽

Significant Difference ◽

Group A ◽

Group B

Abstract Background Inguinal hernia repair is one of the most frequently performed surgical procedures in the pediatric population. Using optimal analgesic regimen provides safe and effective analgesia, reduce postoperative stress response and accelerate recovery from surgery. Aim of the Work to examine the effect of Dexmedetomidine as an adjuvant to Levobupivacaine in caudal anesthesia, mainly its effect in enhancing and prolonging post-operative analgesia. Patients and Methods The study was conducted on 50 randomly chosen patients in Ain Shams University Hospitals after approval of the medical ethical committee. Patients were divided randomly into two groups, each group consisted of 25 patients. After preoperative assessment and obtaining baseline vital data, all patients received general anesthesia. Group A: Patients in this group received caudal anesthesia with Levobupivacaine 0.25% at a dose of 2 mg·kg−1 (0.8 ml·kg−1) before the beginning of the procedure. Group B: Patients in this group received Levobupivacaine 0.25% at a dose of 2 mg·kg−1 (0.8 ml·kg−1) in addition to Dexmedetomidine 1 μg·kg−1 in 1 ml normal saline before the beginning of the procedure. Results The results of the study revealed that there was significant reduction in FLACC score in group B at 4, 8, and 12 hours postoperatively compared to group A, at the twenty-fourth hour there was no significant difference. Regarding the duration of analgesia postoperatively we found statistically significant increase in group B compared to that in group A (p-value <0.001). Regarding the number of doses of analgesia required post operatively (Paracetamol 15ml/kg/dose) there was a statistically significant decrease in patients requirement in group B compared to that in group A (p-value <0.001). Conclusion Dexmedetomidine as adjuvant to Levobupivacaine provided significantly prolonged postoperative analgesia, reduced the postoperative analgesic requirements and better parents’ satisfaction as compared with caudal analgesia using Levobupivacaine alone in children undergoing hernia repair.

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Caudal block versus penile block for postoperative analgesia in children undergoing hypospadias repair

QJM ◽

10.1093/qjmed/hcaa052.006 ◽

2020 ◽

Vol 113 (Supplement_1) ◽

Cited By ~ 1

Author(s):

H G Salama ◽

M H Elsersi ◽

T S Shabana ◽

J M Mahanna

Keyword(s):

Postoperative Analgesia ◽

Pediatric Patients ◽

Pediatric Population ◽

Randomized Study ◽

Hypospadias Repair ◽

Caudal Block ◽

Analgesic Requirement ◽

Analgesic Regimen ◽

Significant Difference ◽

Penile Block

Abstract Background Hypospadias repair is one of the most frequently performed surgical procedures in the pediatric population. Using optimal analgesic regimen provides safe and effective analgesia, reduce postoperative stress response and accelerate recovery from surgery. Aim of the Work The aim of this work is to evaluate the success rate and the effectiveness of penile block for hypospadias repair in pediatric patients in comparison with caudal block. Patients and Methods This prospective randomized study was conducted in Ain Shams University Hospitals; Pediatric Surgery Unit. It included 80 ASA I or II patients undergoing hypospadias (distal penile and mid penile) repair. They were divided into two groups: Group P: Group P penile block (n = 40) received dorsal penile nerve block by using the subpubic approach technique. Group C: Group C caudal block (n = 40) received caudal epidural block using a 22-G needle in the lateral decubitus position. Results There was no statistically significant difference between two groups regarding haemodynamics including MBP (P < 0.05) and HR (P < 0.05). FLACC pain scores were significantly lower in group C compared with group P (P< 0.01). Also, the time to first need for analgesia was significantly lower in group C compared with group P (P< 0.001) .The total rescue analgesic requirement was also significantly lower (P< 0.001) in group C compared with group P.Postoperative time of ambulation was also significantly lower (P< 0.05) in group P compared with group C. Conclusion the current study revealed that caudal block provided significantly prolonged postoperative analgesia, reduced the postoperative analgesic requirements and prolonged time of ambulation as compared with penile block in pediatric patients undergoing hypospadias repair.

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Ultrasound Guided Transversus Abdominis Plane (TAP) Block versus Caudal Block in Pediatrics Undergoing Inguinal Hernia Repair

QJM ◽

10.1093/qjmed/hcaa039.012 ◽

2020 ◽

Vol 113 (Supplement_1) ◽

Author(s):

N M A Fahmy ◽

A M Hazem ◽

M A A Tolba ◽

S A Mostafa

Keyword(s):

Inguinal Hernia ◽

Hernia Repair ◽

Inguinal Hernia Repair ◽

Surgical Procedures ◽

Postoperative Analgesia ◽

Pediatric Patients ◽

Transversus Abdominis ◽

Anesthetic Techniques ◽

Tap Block ◽

Caudal Block

Abstract Background Inguinal hernia repair is one of the most frequently performed surgical procedures in the pediatric population. Using optimal analgesic regimen provides safe and effective analgesia, reduce postoperative stress response and accelerate recovery from surgery. Regional anesthetic techniques are commonly used to facilitate pain control in pediatric surgical procedures. The most commonly used techniques in pediatrics are caudal block and TAP block. Objective This study was to compare the effectiveness and safety of US guided TAP block versus caudal block as a part of multimodal analgesia in pediatric patients undergoing inguinal hernia repair. Patients and Methods The study was conducted on 90 randomly chosen patients in Ain Shams University Hospitals after approval of the Medical Ethical Committee. Patients were divided randomly into two groups, each group consisted of 45 patients. After preoperative assessment and obtaining baseline vital data, all patients received general anesthesia. Results The results of the study revealed that US guided TAP block provided significantly prolonged postoperative analgesia, reduced the postoperative analgesic requirements and better parents’ satisfaction as compared with caudal block in pediatric patients undergoing inguinal hernia. Both analgesic techniques are safe. Conclusion The current study revealed that US guided TAP block provided significantly prolonged postoperative analgesia, reduced the postoperative analgesic requirements and better parents’ satisfaction as compared with caudal block in pediatric patients undergoing inguinal hernia. Both analgesic techniques are safe.

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Efficacy of bupivacaine vs ropivacaine in caudal block for children: A randomized controlled trial

MedPulse International Journal of Anesthesology ◽

10.26611/101512222 ◽

2019 ◽

Vol 12 (2) ◽

pp. 171-175

Author(s):

Natasha Gupta ◽

◽

Madiha Shadab ◽

Umesh Kumar Badani ◽

◽

...

Keyword(s):

Randomized Controlled Trial ◽

Controlled Trial ◽

Caudal Block ◽

Randomized Controlled

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Oral Tranexamic Acid for the Treatment of Melasma

Kathmandu University Medical Journal ◽

10.3126/kumj.v10i4.10993 ◽

2014 ◽

Vol 10 (4) ◽

pp. 40-43 ◽

Cited By ~ 26

Author(s):

D Karn ◽

S KC ◽

A Amatya ◽

EA Razouria ◽

M Timalsina

Keyword(s):

Tranexamic Acid ◽

Controlled Trial ◽

Severity Index ◽

Sustained Improvement ◽

Treatment Measures ◽

Group A ◽

Group B ◽

Novel Concept ◽

High Treatment

Background Melasma poses a great challenge as its treatment is unsatisfactory and recurrence is high. Treatment of melasma using tranexamic acid (oral, topical or intralesional) is a novel concept. Objective To compare the efficacy of oral tranexamic acid with routine topical therapies for the treatment of melasma. Methods It is a prospective, interventional, randomized controlled trial conducted among 260 melasma patients. Patients were divided into two groups consisting of 130 patients each. First group (Group A) was given routine treatment measures and oral Tranexamic Acid while second group (Group B) was treated only with routine topical measures. Capsule Tranexamic Acid was prescribed at a dose of 250 mg twice a day for three months and cases were followed for three months. Response was evaluated on the basis of Melasma Assessment Severity Index (MASI). Mean scores between the two groups were then compared. Results Statistically significant decrease in the mean Melasma Assessment Severity Index from baseline to 8 and 12 weeks was observed among group A patients (11.08±2.91 vs 8.95±2.08 at week 8 and vs. 7.84±2.44 at week 12; p<0.05 for both). While among group B patients the decrease in mean score was significant at 8 weeks and insignificant at 12 weeks follow up (11.60±3.40 vs 9.9±2.61 at 8 weeks and vs. 9.26±3 at 12 weeks; p<0.05 for former but p>0.05 for later). Conclusion Addition of oral tranexamic acid provides rapid and sustained improvement in the treatment of melasma. DOI: http://dx.doi.org/10.3126/kumj.v10i4.10993 Kathmandu Univ Med J 2012;10(4):40-43

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Radiofrequency ablation for markedly incompetent perforators versus compression therapy in the management of post-phelebtic venous ulcers: A randomized controlled trial

Vascular ◽

10.1177/17085381211010022 ◽

2021 ◽

pp. 170853812110100

Author(s):

Mohamed Shukri Abdelgawad ◽

Amr M El-Shafei ◽

Hesham A Sharaf El-Din ◽

Ehab M Saad ◽

Tamer A Khafagy ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Radiofrequency Ablation ◽

Controlled Trial ◽

Compression Therapy ◽

Randomized Controlled ◽

Venous Ulcers ◽

Group A ◽

Group B ◽

To Receive

Background Venus ulcers developed mainly due to reflux of incompetent venous valves in perforating veins. Patients and methods In this randomized controlled trial, 119 patients recruited over two years, with post-phelebtic venous leg ulcers, were randomly assigned into one of two groups: either to receive radiofrequency ablation of markedly incompetent perforators (Group A, n = 62 patients) or to receive conventional compression therapy (Group B, n = 57 patients). Follow-up duration required for ulcer healing continued for 24 months post randomization. Results Statistically significant shorter time to healing (ulcer complete healing or satisfactory clinical improvement) between both groups (56 patients, 90.3% of cases in Group A versus 44 patients 77.2% of cases in Group B) over the follow-up period of 24 months was attained ( p = 0.001). Also, significantly different ulcer recurrence was recorded between both groups, 8 patients (12.9%) in Group A versus 19 patients (33.3%) in Group B ( p = 0.004). Conclusion In absence of deep venous obstruction, the monopolar radiofrequency ablation for incompetent perforators is a feasible and effective method that surpasses the traditional compression protocol for incompetent perforator-induced venous ulcers in terms of time required for healing even in the presence of unresolved deep venous valvular reflux.

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Effect of Cooling Irrigating Saline in Tongue Base Ablation in Obstructive Sleep Apnea

OTO Open ◽

10.1177/2473974x21989599 ◽

2021 ◽

Vol 5 (1) ◽

pp. 2473974X2198959

Author(s):

Ahmed Yassin Bahgat

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Controlled Trial ◽

Tongue Base ◽

Control Group ◽

University Hospitals ◽

Energy Field ◽

Obstructive Sleep ◽

Prospective Randomized Controlled Trial ◽

Significant Difference

Objective Plasma is formed by creating a high-density energy field within an electrically conductive fluid such as saline. Sometimes ablated bits of tissue get stuck between the electrodes of the wand, obstructing the suction channel. The purpose of this study is to investigate the effect of cooling the irrigating saline during ablation of the hypertrophied tongue base in patients with obstructive sleep apnea. Study Design Prospective randomized controlled trial. Setting An otorhinolaryngology department in Main University hospitals. Methods Sixty adult patients with obstructive sleep apnea and tongue base hypertrophy underwent tongue base ablation surgery. Patients were randomly divided into 2 groups of 30 patients each: cooled saline and room temperature saline. The Coblation wand used was the EVac 70 Xtra HP (Smith & Nephew). Results In this study, a significant difference in operative time (mean ± SD) was seen between groups: 21.2 ± 5.5 minutes in the cold group and 47 ± 9.5 minutes in the control group ( P = .001). The wands in the cold group did not obstruct, while all the wands in the control group were obstructed by tissue clogs with variable degrees, hence wasting more time to clean the wands’ tips. Conclusion Cooling the irrigating saline overcame the problem of wand clogs, and the wand tip did not occlude at all during the procedures, thus saving time lost in wand cleaning and demonstrating a faster and safer surgical procedure. Further studies are needed to identify the hemostatic effect of the cooled saline over the regular one.

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Effects of different thermal insulation methods on the nasopharyngeal temperature in patients undergoing laparoscopic hysterectomy: a prospective randomized controlled trial

BMC Anesthesiology ◽

10.1186/s12871-021-01324-7 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Guanyu Yang ◽

Zefei Zhu ◽

Hongyu Zheng ◽

Shifeng He ◽

Wanyue Zhang ◽

...

Keyword(s):

Thermal Insulation ◽

Primary Outcome ◽

Controlled Trial ◽

Laparoscopic Hysterectomy ◽

Control Group ◽

Prospective Randomized Controlled Trial ◽

Warming Blanket ◽

Group A ◽

Insulation Effect ◽

Group B

Abstract Background This study explored the comparison of the thermal insulation effect of incubator to infusion thermometer in laparoscopic hysterectomy. Methods We assigned 75 patients enrolled in the study randomly to three groups: Group A: Used warming blanket; group B: Used warming blanket and infusion thermometer; group C: Used warming blanket and incubator. The nasopharyngeal temperature at different time points during the operation served as the primary outcome. Results The nasopharyngeal temperature of the infusion heating group was significantly higher than that of the incubator group 60 min from the beginning of surgery (T3): 36.10 ± 0.20 vs 35.81 ± 0.20 (P<0.001)90 min from the beginning of surgery (T4): 36.35 ± 0.20 vs 35.85 ± 0.17 (P<0.001). Besides, the nasopharyngeal temperature of the incubator group was significantly higher compared to that of the control group 60 min from the beginning of surgery (T3): 35.81 ± 0.20 vs 35.62 ± 0.18 (P<0.001); 90 min from the beginning of surgery (T4): 35.85 ± 0.17 vs 35.60 ± 0.17 (P<0.001). Regarding the wake-up time, that of the control group was significantly higher compared to the infusion heating group: 24 ± 4 vs 21 ± 4 (P = 0.004) and the incubator group: 24 ± 4 vs 22 ± 4 (P = 0.035). Conclusion Warming blanket (38 °C) combined infusion thermometer (37 °C) provides better perioperative thermal insulation. Hospitals without an infusion thermometer can opt for an incubator as a substitute. Trial registration This trial was registered with ChiCTR2000039162, 20 October 2020.

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Management of walled-off necrosis with nasocystic irrigation with hydrogen peroxide versus biflanged metal stent: randomized controlled trial

Endoscopy International Open ◽

10.1055/a-1480-7115 ◽

2021 ◽

Vol 09 (07) ◽

pp. E1108-E1115

Author(s):

Sudhir Maharshi ◽

Shyam Sunder Sharma ◽

Sandeep Ratra ◽

Bharat Sapra ◽

Dhruv Sharma

Keyword(s):

Hydrogen Peroxide ◽

Adverse Events ◽

Clinical Success ◽

Controlled Trial ◽

Procedure Time ◽

Metal Stent ◽

Technical Success ◽

Group A ◽

Group B ◽

Walled Off Necrosis

Abstract Background and study aims Walled-off necrosis (WON) is a known complication of acute necrotizing pancreatitis (ANP). There is no study comparing nasocystic irrigation with hydrogen peroxide (H2O2) versus biflanged metal stent (BMS) in the management of WON. The aim of this study was to compare the clinical efficacy of both the treatment strategies. Patients and methods This study was conducted on patients with symptomatic WON who were randomized to nasocystic irrigation with H2O2 (Group A) and BMS placement (Group B). Primary outcomes were clinical and technical success while secondary outcomes were procedure time, adverse events, need for additional procedures, duration of hospitalization, and mortality. Results Fifty patients were randomized into two groups. Group A (n = 25, age 37.8 ± 17.6 years, 16 men) and Group B (n = 25, age 41.8 ± 15.2 years, 17 men). There were no significant differences in baseline characteristics between the two groups. The most common etiology of pancreatitis was alcohol, observed in 27 (54 %) patients. Technical success (100 % vs 96 %, P = 0.98), clinical success (84 % vs 76 %, P = 0.76), requirement of additional procedures (16 % vs 24 %, P = 0.70) and adverse events (4 vs 7, P = 0.06) were comparable in both the groups. The duration to clinical success (34.4 ± 12 vs 14.8 ± 10.8 days, P = 0.001) and procedure time (36 ± 15 vs 18 ± 12 minutes, P = 0.01) were longer in Group A compared to Group B. Conclusions Nasocystic irrigation with H2O2 and BMS are equally effective in the management of WON but time to clinical success and procedure time is longer with nasocystic irrigation.

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