bluuebunny/crossref_metadata_2025_split huggingface dataset:
Erector Spinae Plane Block Combined with Continuous Dexmedetomidine and Lidocaine Infusions as an Opioid-Free Anesthesia in Posterior Spinal Fusion Surgery
Authors: Salama Awad Hala Gomaa , Wasfy Sanaa Farag Mahmoud , Hafez Helmy Amr Fouad , Abbas Hassan Aya Mohamed 
Published: November 2024

Abstract

Background
Lumbar spine surgery is a common type of orthopedic surgery and mostly elective in nature. Conventional spine surgeries (non-minimally invasive) often involve extensive dissection of subcutaneous tissues, bones, and ligaments, laminectomies, discectomies, and instrumentations thus result in a considerable degree of postoperative pain, that can hinder the postoperative recovery, and it includes a high risk of persistent postsurgical pain, with a frequency ranging from 20 % to 40%.

Aim of the Work
We aim to assess intraoperative variation of heart rate (HR) and systolic blood pressure (SBP) as a monitor to guide the antinociceptive component of OFA and if it can provide adequate hemodynamic control and stability during the perioperative period with the impact on patient satisfaction.

Patients and Methods
This interventional, randomized and double–blinded controlled trial study was conducted in the institute Hospitals, Ain Shams University Hospitals from 1 February, 2023 to 31 July, 2023. The purpose of the study was clarified to all patients in full detail, along with details of the anaesthesia technique to be used by both the surgeon and anaesthetist. Moreover, informed consent was signed by all patients who were scheduled for lumbar spine procedures on any levels between L1 and L5. Subjects were eliminated from the study if they refused to participate, were unable to evaluate their level of pain or had an allergy to the study drugs.

Results
Our results indicate that there were no significant differences in SBP and episodes of hypertension between the two groups during various stages of the surgical procedure. However, HR values showed less fluctuations in OFA group starting from after skin incision and throughout different stages of the surgery. Our population who are at high risk of postoperative nausea and vomiting due to previous opioid use on chronic back pain. In our study, incidence of PONV in group OFA was lower than that of in group OA in a period of 24h after surgery (5.7%, 15.7%).

Conclusion
Compared to OA technique, OFA technique, which is represented by non-opioid drugs, lidocaine and dexmedetomidine, may be an alternative anesthesia in patients undergoing posterior lumbar spine fusion surgery. With its non-inferiority of analgesic effect, safe anesthesia, and lower incidence of intraoperative hemodynamics fluctuations and PONV.
Comparative Study between Bupivacaine versus Bupivacaine with Dexmedetomidine in Ultrasound Guided Transversus Abdominis Plane Block as Postoperative Analgesia in Open Inguinal Hernia
Authors: Galal Mahmoud Hadeer Ahmed , Hassan AlaaEid Mohamed , Hussein El Derh Maha Sadek , El Rab Ahmed Ihab Ahmed Gad 
Published: November 2024

Abstract

Background
A recent myofascial plane block, the transversus abdominal plane block (TAP), has been shown to lessen not only postoperative discomfort after surgery of inguinal hernia but also hospital stay. It is our objective to achieve postoperative satisfaction regarding the pain with the least side effects as related with opioids.

Methods
The study was registered at Pan African-Clinical Trial Registry.org with ID of (PACTR 202301487176282), randomized clinical trial, after obtaining approval from the Research Ethical Committee of Ain Shams University, this study was done in the general surgery theatres of Ain Shams University Hospitals for 12 months.

Results
In this study, TAP block with dexmedetomidine was more effective than TAP alone as measured by visual analog scale (VAS) scores, regarding first analgesic request and change in vital data. Significant differences in VAS scores were observed at 6 hours up to 24 hours postoperatively (p &lt; 0.01), but not during the first 6 hours. Heart rate was obviously diminished in the Bupivacaine with Dexmedetomidine (BD) group compared to the Bupivacaine (B) group starting at 2 hours postoperatively, while mean blood pressure was eased from 6 hours up to 24 hours postoperatively. Total analgesic consumption and time to first analgesic request were decreased in the BD group, while the incidence of nausea and vomiting were similar between the two groups.

Conclusions
The addition of dexmedetomidine to bupivacaine in TAP block extends the duration of time at which first dose of rescue analgesia and also reduced the total dose of opioid requirement in the first 24-h postoperatively.
Comparative Study Between Ultrasound Guided Serratus Anterior Plane Block versus Thoracic Erector Spinae Plane Block as Postoperative Pain Management in Modified Radical Mastectomy
Authors: Ibrahim Sherif Farouk , El Azeem Labib Heba Abd , Sayed Amr Gaber , Elias Abd El Malak Mina Anwar 
Published: November 2024

Abstract

Background
Breast cancer is the most common malignancy in women, and its incidence continues to increase. Surgery is one of the mainstays of treatment of breast cancer, and Modified Radical Mastectomy (MRM) is one of the standard treatments for multi-centric disease or tumors with extensive coexistent ductal carcinoma in situ, where achieving a clear surgical margin becomes difficult with a segmental mastectomy.

Objective
This Study compared between Serratus Anterior Plane block and Thoracic Erector spinae block as efficacy of postoperative analgesia in Modified Radical Mastectomy.

Patients and Methods
This was a prospective controlled double blinded randomized clinical study that was conducted at Ain Shams University hospitals, Cairo, Egypt on Adult female patients undergoing modified radical mastectomy and were randomly assigned into two equal groups by computer generated method: Group A (control group): patients received general anaesthesia followed by Serratus Anterior plane block using only 20 ml 0.25% Bupivacaine (safety dose 3mg/kg). Group B(study group): patients received general anaesthesia followed by Thoracic Erector Spinae block using only 20ml bupivacaine 0.25 %. (safety dose 3mg /kg).

Results
In this study, we found that the postoperative VAS scores were better in Group SAP at 2nd, 4th, 6th and 12th hr as compared to group TES. The incidence of PONV and the requirement of Ondansetron were found to be similar in both groups. None of the patients in either group developed technique-related complications like hemodynamic instability, intravascular injection, pneumothorax, local anaesthetic systemic toxicity, and adverse effects like pruritus and respiratory depression.

Conclusion
USG-SAPB was effective and safe technique which provides better pain relief compared with the USG-TESP and reduced post operative opioid consumption. Therefore, the SAP can be used safely for post operative analgesia for patients undergoing MRM surgery to avoid the risk of developing chronic post mastectomy pain which reduces quality of life.
Hybrid Anesthesia for Ambulatory Knee Arthroscopy Using Intrathecal Prilocaine and Adductor Canal Block vs Intrathecal Bupivacaine Alone: A Randomized Controlled Trial
Authors: Nashed Mina Magdy , Elnasr Mohamed Gihan Seif , Esmat Ibrahim Mamdouh , Ashoor Tarek Mohamed 
Published: November 2024

Abstract

Background
One of the most popular orthopedic surgeries is knee arthroscopy. It is challenging to provide adequate analgesia with motor preservation to allow for a shorter hospital stay and a faster recovery. Good pain control and side effects reduction can be done easily using the multimodal analgesia methods. There are various analgesic drugs and techniques can be used as patient education, pre-emptive analgesia, pharmacological methods and regional analgesia technique.

Aim of the Work
To compare between combined intrathecal prilocaine and adductor canal block vs intrathecal bupivacaine alone regarding the duration of motor block in ambulatory knee arthroscopy.

Patients and Methods
The study was conducted on eighty random patients who were scheduled to undergo knee arthroscopy and were divided into two equal groups (40 each).

Results
Patients were monitored and assessed post-operatively for 24 hours and they were compared regarding time of motor block regression to Bromage score 1 starting from spinal block, sensory block duration, postoperative analgesic effect (pain scale), postoperative opioid consumption, spontaneous bladder voiding, postoperative patient satisfaction level and the incidence of PONV and headache. The side effects were also monitored, managed and compared.

Conclusion
the spinal anesthesia for knee arthroscopic surgeries, using the hyperbaric prilocaine 2%, causes shorter motor block duration than using the bupivacaine, which leads to earlier post-operative ambulation and discharge and better patient satisfaction. Additionally, using the ACB reduces the need for opiods during the first 24 hours following the surgery in conjunction with other pain management techniques for knee arthroscopy. Also, it preserves the quadriceps muscle power, which is important for early ambulation and patient satisfaction.
Serum Ferritin versus C-Reactive Protein in Predicting Outcome and Mortality in Corona Virus Disease 2019 (Covid-19) A Retrospective Observational Study
Authors: Eldin Shokeir Mohamed Hossam , Mohamed Abu Sinna Rasha Gamal , Nassif George Maher , Kader El-Sayed Mansy Mohammed Ahmed Abdel 
Published: November 2024

Abstract

Background
In coronavirus disease 2019 (COVID-19), finding sensitive biomarkers is critical for detecting severe cases early and intervening effectively. Very few studies evaluated how ferritin and CRP are altered in COVID-19. Therefore, it is of clinical significance to evaluate the disease severity and investigate ferritin and CRP in patients with COVID-19.

Objective
To explore the infection biomarkers, including ferritin and CRP in ICU patients with COVID-19. We will aim to describe the clinical characteristics of infection markers in patients with COVID-19.

Patients and Methods
After approval of anesthesiology department and scientific and ethical committees, this retrospective observational study was carried out on 105 consecutive patients with confirmed COVID-19 status attending Ain Shams University Hospital, intensive care units during a 6-month period from January 2020 to July 2020; divided into 2 groups; severe and critically ill cases.

Results
As regards the follow-up laboratory data, there was a significant increase in follow-up CRP, ferritin, D-dimer and PTT in critical group; compared to severe group. Our study showed that there was a highly significant difference between the 2 groups as regards the need of mechanical ventilation and mortality rate, as 68.3% of critical cases need mechanical ventilation and 58.5% died. As regard the length of stay in the ICU, the critical group had longer stay in the ICU in comparison to the severe group, although this difference was not statistically significant.

Conclusion
High baseline and follow up laboratory tests of CRP and serum ferritin both can be used as a predictor of outcome and mortality in COVID 19 infection. There is significant positive correlation between age, CRP and duration of stay in the ICU. Also there was a significant positive correlation between CRP, ferritin and duration of stay in the ICU. The increase in age and CRP; had an independent effect on increasing ICU stay. Increase in CRP levels; had an independent effect on increasing the probability of severity of COVID-19 infection. While ferritin shows a significant effect on increasing the probability of severity of COVID-19 infection in univariate analysis. Ferritin level at a cut-off point (&gt;598) predict mortality outcome, with good (89%) accuracy, sensitivity (93.8%) and specificity (42.9%). Also, CRP level at cut-off point (&gt;25) predict mortality outcome, with lower (80%) accuracy, sensitivity (87%) and specificity (33.3%).
Analgesic Efficacy and Safety of Ultrasound Guided Scalp Nerve Blocks in Supratentorial Craniotomies: A Randomized Controlled Trial
Authors: Ibrahim Sherif Farouk , Labeb Heba abdelazem , Metwally Aboelnile Diaaeldin Badr , Abdelalem Eldaoushy Mostafa Ibrahem 
Published: November 2024

Abstract

Background
Multimodal analgesia is considered the cornerstone in controlling intraoperative and post operative pain in patients undergoing brain surgeries. A good control of strong noxious stimulations in supratentorial craniotomies allows a maintenance of an intraoperative hemodynamic stability and a post operative pain relief. Scalp sensory nerve block is considered one of the multimodal techniques to control intra and post operative pain, preventing the increase in intracranial pressure (ICP) and hypertension, which may be harmful, especially for patients with cerebral aneurysms. Also decreasing systemic analgesia and opioid that may alter conscious level of the patients allows better assessment and examination after surgery.

Objective
To compare the analgesic efficacy and safety of ultrasound use in performing scalp sensory nerve block compared to blind classical infiltration technique.

Methods
This randomized prospective controlled trial was conducted on 40 randomly chosen patients American Society of Anesthesiologists (ASA) class I or II scheduled for elective supratentorial craniotomy (supratentorial mass lesion or aneurysm clipping) under general anesthesia in Ain Shams University Hospitals after approval of the medical ethical committee.

Results
Intraoperative hemodynamic monitoring showed that there was a statistically significant decrease in HR, SINBP values in SBU group at time of skin incision (SI) compared to baseline values (before performing scalp block). Also Rates of both propofol and Fentanyl consumption showed a statistically significant decrease in SBU group at all time points of concern compared to baseline values. Postoperatively, patients received ultrasound guided scalp block had significantly lower pain scores after operation, with a significant increase in time for rescue analgesia and significant decrease in total amount of morphine needed in the first 24 hr post-operative compared to patients who received blind scalp block by local infiltration.

Conclusion
Ultrasound use in performing scalp block, is considered of choice for maintaining patient safety, intraoperative hemodynamic control and enhancing post-operative recovery.
Effect of Adding Dexamethasone to Bupivacaine in Ultrasound Guided Adductor Canal Block for Post-Operative Analgesia Following Knee Arthroscopy
Authors: Mohammed Nada Sami Abdelfattah , Mohammed Hadil Magdy Abdelhamid , Habashi Samuel Habashi Daniel , Saleh Sara Hossameldin Taha 
Published: November 2024

Abstract

Background
In arthroscopic knee surgery, managing postoperative pain is crucial for patient outcomes. Dexamethasone, combined with local anesthetics in adductor canal block, offers potential advantages, such as vasoconstriction and anti-inflammatory effects. This approach proves safe, prolongs sensory block duration, delays the need for analgesics, and enhances patient satisfaction, addressing challenges associated with epidural analgesia and femoral nerve block. Overall, it signifies a valuable strategy in anesthesia practice, contributing to prolonged analgesia, reduced opioid use, and faster recovery in knee arthroscopy.

Aim of the Work
The study aims to assess the effectiveness of perineural dexamethasone combined with bupivacaine in adductor canal block for postoperative pain control following knee arthroscopy with spinal anesthesia. The primary focus is on determining the duration of postoperative analgesia. Secondary objectives involve evaluating the effectiveness of analgesia one day after surgery and assessing opioid consumption.

Patients and Methods
This randomized, double-blinded controlled trial at Ain Shams University hospitals investigates the efficacy of adductor canal block with dexamethasone in knee arthroscopy under spinal anesthesia. Sixty adult patients are randomly assigned to receive either bupivacaine with dexamethasone (Group A) or bupivacaine with saline (Group B). Primary outcomes include postoperative analgesia duration, and secondary outcomes involve morphine use, patient demographics, surgical time, and complication rates. Ethical considerations and detailed study procedures are outlined, ensuring patient safety and methodological rigor.

Results
In a randomized study for arthroscopic knee surgery, dexamethasone added to bupivacaine in adductor canal block significantly extended sensory block duration and delayed the time to first analgesic requirement. Visual analog scale scores were lower, and morphine consumption was reduced over 24 hours postoperatively. While systemic effects of dexamethasone were not assessed, consistent with other studies, its addition to local anesthetics in various nerve blocks demonstrated prolonged analgesia. Patient satisfaction was notably higher in the dexamethasone group, likely influenced by increased pain relief duration and reduced side effects.

Conclusion
We concluded that ACB is a good postoperative analgesic choice for arthroscopic knee surgery under spinal anaesthesia. However, adding (8 mg) dexamethasone to (0.25%) bupivacaine in ACB provided better prolonged postoperative analgesia and less analgesic consumption than bupivacaine alone.
Effect of Dexamethasone versus Low Dose Ketamine on Post Spinal Hypotension in Caesarian Section
Authors: Mohamed Khairy Noha Tarek , Saied Hatem , Anis Sherif George , Elfattah Elwaraky Mohamed Maher Abd 
Published: November 2024

Abstract

Background
Spinal anesthesia is the preferred method for elective cesarean sections due to considerable risks regarding airway management associated with physiological changes of pregnancy. Cesarean sections normally require an anesthetic block at T4 level, so hypotension is reported in up to 80% of spinal anesthesia cases.

Aim of the Work
To assess the effect of prophylactic sub-anesthetic dose of ketamine versus the effect of Dexamesathone to prevent maternal hypotension after spinal anaesthesia in cesarean section.

Patients and Methods
This study is a randomized controlled study this study done in obstetrics and Gynecology Department, Ain Shams hospitals at 3 months and the females undergoing caesarian section under spinal anesthesia.

Results
The study revealed that ketamine group showed significant lower incidence of postspinal hypotension compared to the control group 5, 10, 15, 20 minutes. Whereas the dexamethasone group showed significant reduction in incidence of postspinal hypotension when compared to the control group only at the first 5 minutes, while comparing both ketamine and dexamethasone groups the incidence of hypotension was not significant. Also, observed that total ephidren dose significantly decreased in ketamine group compared to control group. And sedation scores in the first 30 min were higher in ketamine group. HR wasn’t affected. No changes in APGAR score were noticed between the two groups. No side effects from ketamine except for nystagmus.

Conclusion
the randomized controlled study conducted in the Obstetrics and Gynecology Department at Ain Shams hospitals investigated the effects of dexamethasone and low-dose ketamine on post-spinal hypotension in caesarean deliveries. The study compared three groups: a ketamine group, a dexamethasone group, and a control group.
The Incidence of Acute Kidney Injury and Its Correlation to Serum Lactate as a Predictive Value for in Hospital Mortality in Patients with Sepsis
Authors: Meselhy Ibrahim Rasha Taha El , Wahba Sherif Samir , Abdelmoneem Alhadidy Mohamed Alaaeldin , Farrag Ossama Mohamed 
Published: November 2024

Abstract

Background
Sepsis-induced acute kidney injury (S-AKI) is a frequent outcome in hospitalized and critically ill patients, increasing the risk of developing chronic comorbidities. The recent Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) now recommends using the Sequential Organ Failure Assessment (SOFA) and the quick SOFA (qSOFA) as screening tools for sepsis and prognosis, replacing serum lactate.

Objective
To investigate the relationship between sepsis-associated acute kidney injury (S-AKI) and serum lactate levels as potential predictors of in-hospital mortality in hospitalized and critically ill patients.

Methods
This Prospective observational study study was conducted in Intensive Care Units of Ain Shams University Hospitals and research committee over 6 months from December 2022 to June 2023. 75 patients was admitted to Ain Shams intensive care unit

Results
Elevated lactate levels in septic patients, especially in combination with AKI, were associated with a higher incidence of organs impairment and a poorer clinical outcome. Early detection and management of elevated lactate levels and organs impairment may improve clinical outcomes in these patients. The study showed higher lactate level is accompined by more organ failure and increase mortality as in group A which had mortality rate higher than group B and C. It also correlates with long stay in ICU and hospital.

Conclusion
The study findings indicate that elevated lactate levels in septic patients, particularly when accompanied by AKI, are linked to a greater occurrence of more organs impairment and unfavorable clinical outcome of patients who were classified into 3 groups the first had sepsis and developed aki and high serum lactate and the second had sepsis and developed aki with normal lactate and the third group had sepsis without aki.
Comparative Study between Ultrasound Guided Quadratus Lumborum versus Ilioingunial/Iliohypogastric Nerves Block as Post-Operative Analgesia for Patients Undergoing Inguinal Hernia Repair Surgeries
Authors: Wahba Rezk-Allah Sherif Samir , Abdelsalam Ehab Hamed , Ahmed Sally Hamdy Abdelaziz , Abdelhalim Elsonbati Reem Ashraf 
Published: November 2024

Abstract

Background
Poorly controlled acute pain after abdominal surgery is related to somatic pain signals derived from the abdominal wall and is associated with a variety of unwanted post-operative consequences, including patient suffering, distress, respiratory complications, delirium, myocardial ischemia, prolonged hospital stay, an increased likelihood of chronic pain, increased consumption of analgesics, delayed bowel function and increase the requirement for rescue analgesics. Appropriate pain treatment protocols to reduce postoperative morbidity, improve the results of the surgery and decrease hospital costs.

Aim of the Work
The aim of this study was to assess the analgesic efficacy of ultrasound-guided trans- muscular QLB compared with ilioinguinal-iliohypogastric nerve block in the postoperative period after inguinal hernia repair surgeries regarding pain relief, provision of comfort, and improved respiratory functions.

Patients and Methods
After approval of anesthesiology department scientific and ethical committees in Ain Shams University Hospitals, patients were divided into two groups (n = 22; each); group QLB and group ILI/IHG.

Results
The present study showed that the quadratus lumborum block was more efficient than the ilioinguinal-iliohypogastric nerves block. The first rescue for analgesia (pethidine), total pethidine consumption and pain scores (Numerical Rating Scale) indicated that the superiority of the quadratus lumborum block technique affected the ilioinguinal-iliohypogastric nerves block technique. The patients of group ilioinguinal-iliohypogastric nerves block had higher pain scores and were the first to ask for rescue analgesia; therefore, they had highest total pethidine consumption in the first 24 hours postoperatively in comparison to patients of group quadratus lumborum block. Regarding NRS score postoperatively, our study found that NRS score was significantly lower in group A when compared with group B.

Conclusion
Quadratus Lumborum block was the most effective technique in providing analgesia after inguinal hernia repair surgeries in comparison to Ilioinguinal/Iliohypogastric nerves block and even more time covering to rescue opioid.