bluuebunny/crossref_metadata_2025_split huggingface dataset:
Efficacy of peritonsillar infiltration of levobupivacaine-dexamethasone versus levobupivacaine-dexmedetomidine in children undergoing tonsillectomy surgery
Authors: Hayes Salwa M.S. , Atef Ebada Hisham , El Bendary Hanaa M. 
Published: September 2024

Purpose
We evaluated the quality of analgesia produced by peritonsillar infiltration of levobupivacaine with either dexamethasone or dexmedetomidine in children undergoing tonsillectomy surgery.

Patients and methods
Patients scheduled for tonsillectomy were randomly allocated into three groups with 27 patients in each group. Group L received peritonsillar infiltration of 5 ml in volume of 0.4 mg/kg of 0.5% levobupivacaine, while group D received peritonsillar infiltration of 5 ml in volume of 0.4 mg/kg of 0.5% levobupivacaine mixed with dexamethasone 0.5 mg/kg and group X received peritonsillar infiltration of 5 ml in volume of 0.4 mg/kg of 0.5% levobupivacaine mixed with dexmedetomidine 1 μg/kg (with infiltration of 2.5 ml in each tonsil in all groups) with the first postoperative analgesic request as the primary outcome.

Results
Postoperative time to first analgesic paracetamol request was prolonged in group D (19.51±2.34 h) compared with group L (4.15±0.53 h) and group X (15.74±2.29 h). Face, leg, activity, cry, consolability (FLACC) Behavioral Pain Assessment score at rest and during swallowing decreased in group D compared with group L and group X. Total postoperative analgesic consumption decreased in group D (581.48±165.7 mg) compared with group L (1303.51±90.10 mg) and group X (680.50±160.67 mg).

Conclusions
We concluded that peritonsillar infiltration of levobupivacaine when mixed with either dexamethasone or dexmedetomidine for patients undergoing tonsillectomy produced prolonged analgesia; however, dexamethasone was superior to dexmedetomidine with more prolonged time to first paracetamol request and prolonged late postoperative pain relief.
Comparison between quadratus lumborum and transversus abdominus plane blocks for analgesia in abdominal surgeries
Authors: Abdelhady Mohamed M. , Omar Sherif Y. , Afifi Monir K. , Salah Eldin Kariman M.I. 
Published: September 2024

Background
Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.

Aim
The aim was to compare ultrasound (US)-guided quadratus lumborum block and transversus abdominis plane block in abdominal surgeries as regards duration of analgesia, postoperative opioid consumption, and visual analog scale score.

Patients and methods
A randomized-controlled trial study was carried out at Alexandria University Hospital on 40 American Society of Anesthesiology (ASA)-I and II adult patients scheduled for elective abdominal surgery. The recorded data were analyzed using IBM SPSS software package version 20.0. The Kolmogorov–Smirnov test was used to verify the normality of distribution. 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 significant difference between the two groups as regards age, sex, heart rate, mean arterial blood pressure, and complications. There was a highly significant difference between the two groups as regards duration of analgesia, visual analog score value, and the opioid analgesic requirements.

Conclusion
US-guided quadratus lumborum block is superior to US-guided transversus abdominis plane block for control of postoperative pain in abdominal surgeries in terms of pain scores, duration of analgesia, and total analgesic consumption.
High-flow nasal cannula versus noninvasive positive pressure ventilation in patients with acute respiratory failure
Authors: Ali Mohammed Ahmed S. , El Maraghi Sameh K. , Saber Hamdy M. , Mohammed Ahmed Y. 
Published: September 2024

Introduction
Acute hypoxic respiratory failure (AHRF) is a serious complication of various diseases, which leads to 30% of ICU admissions; ∼42% of patients often requires endotracheal intubation and mechanical ventilation, and it has a mortality rate reaching to 50%. Noninvasive ventilation (NIV) as a respiratory supportive therapy is commonly used in patients with acute respiratory failure, which decreased the need for endotracheal intubation and improved the clinical outcomes but still has many disadvantages and failure reaching 30.6%. Recently, high-flow nasal cannula (HFNC) as an alternative is being used increasingly with critically ill patients, where it has been successfully applied to a variety of patients.

Aim
To evaluate the effect of HFNC on the rate of endotracheal intubation as a primary outcome and also oxygenation, tolerance, ICU stay, and mortality as secondary outcomes in adult patients with AHRF in comparison with NIV.

Patients and methods
A total of 40 patients with AHRF were randomly included in the study: patients were treated in a randomized order with either NIV, comprising 20 patients, or with HFNC, comprising 20 patients. Intubation rate, mortality rate, oxygenation, and patient’s tolerance were evaluated in both groups.

Results
There was no statistically significant difference between the two groups regarding the need of intubation (P=0.677) and mortality rate (P=0.677). Although there was a significant difference between the two groups regarding patient tolerance in favor of HFNC (P=0.002), there was no statistically significant difference between the two groups regarding the ICU days (7.4±3.4 days in group A vs. 7.3±3.1 days in group B; P>0.05). There was a statistically significant difference between both groups after 12 h of therapy regarding the PaO2/FiO2 ratio (233.2±22.1 in group B vs. 184.3±15 in group A; P<0.001).

Conclusions
HFNC showed a trend to improve the clinical outcomes and was as effective as NIV in terms of decreasing the need of intubation, mortality, or length of ICU stay. HFNC demonstrated a better tolerance and a higher degree of patient comfort than NIV but NIV demonstrated better oxygenation improvement.
Changes in carotid corrected flow time in guiding fluid resuscitation in septic patients
Authors: Sabri Sherif , Abdelbasset Ahmed , Yassien Ahmed , Nashaat Ahmed 
Published: September 2024

Introduction
Accurate estimation of intravascular volume status is important in the resuscitation of patients in ICUs. Although intensive fluid therapy in patients with life-threatening volume depletion can prevent death and end-organ damage, volume overload is known to result in increased mortality, morbidity, and duration of hospital stay. Ultrasonography has become a common diagnostic choice in assessment of fluid status in septic patients. This method is noninvasive, easy to learn, and provides real-time assessment at the patient’s bedside. Various ultrasound modalities have been developed to provide accurate and minimally invasive assessment of volume status. In this regard, one of the most promising methods is the evaluation of the blood flow velocity waveform in the descending thoracic aorta via a nonimaging Doppler probe. This modality is based on calculating the systolic flow time with cycle time correction [corrected flow time (FTc)]. FTc is known to be directly associated with volume status. FTc measurement in carotid artery is a completely noninvasive and much more feasible approach.

Aim
To compare the use of ultrasonography in the measurement of the changes in carotid FTc with echocardiography in the assessment of changes in heart dynamics to assess changes in volume status before and after passive leg raising (PLR) in septic patients.

Patients and methods
A total of 40 septic patients, including 18 (45.5%) patients as fluid responders and 22 (54.5%) patients as nonfluid responders, were included. Increased FTc by 7 ms, as well as 10% increase in stroke volume was considered to be fluid responsive.

Results
Our study results showed that 45.5% (n=18) of study population were fluid responders. The PLR test could assess fluid responsiveness with a specificity of 100% and sensitivity of 95% at a cutoff of 10.6% change in CO to predict fluid responsiveness. The study showed a statistically significant moderate positive correlation between CCA FTc and the percent of change in CO measured by echocardiography. An agreement analysis was formed. We concluded that there was a strong relation between change in carotid corrected blood flow and change in COP before and after PLR, with P value less than 0.001. Therefore, we can use this parameter to predict fluid responsiveness after PLR.

Conclusions
Carotid artery blood flow is a promising noninvasive and easy-to-perform tool for the evaluation of fluid responsiveness in critically ill septic patients. The PLR maneuver has demonstrated excellent performance for predicting fluid responsiveness. It is simple to perform but requires a reliable system of carotid corrected blood flow (COP) monitoring able to quantify the short-term changes.
Comparative study between the use of bupivacaine alone or with nalbuphine in ultrasound-guided supraclavicular brachial plexus block for upper limb surgeries
Authors: El-Medany Said M. , Shaaban Hisham A. , Ateba Kareem M. , Abdel Razek Ahmed A. 
Published: September 2024

Background
Brachial plexus block is a well-studied method of providing reliable anesthesia or analgesia for the upper extremity. Many approaches for brachial plexus block are present. These approaches are classified according to the level of local anesthetic injection into interscalene, supraclavicular, infraclavicular, and axillary blocks. By providing a rapid onset of dense anesthesia of the arm with a single injection, the supraclavicular block is perfect for operations involving the arm and forearm, from the distal humerus down to the hand. Ultrasound guidance has resulted in a better practice of supraclavicular approach to the brachial plexus, with decreasing the risk of complications. There has always been a search for adjuvants to local anesthetics used in regional nerve block with drugs that prolong the duration of analgesia but with lesser adverse effects.

Objective
To compare the effect of nalbuphine as an additive to bupivacaine versus bupivacaine alone in supraclavicular brachial plexus block with ultrasound guidance in upper limb surgeries regarding onset and duration of sensory and motor blocks, duration of analgesia, and postoperative analgesic requirements, as well as the effects on hemodynamics and possible complications with each technique.

Patients and methods
This study was carried out in Alexandria Main University Hospital on 50 adult patients of both sexes, American Society of Anesthesiology I and II, scheduled for surgeries of the hand and forearm under supraclavicular brachial plexus block with ultrasound guidance. Patients were randomly categorized into two equal groups (25 patients each) using the sealed envelope technique. Group I patients received bupivacaine only for the block, and group II patients received bupivacaine and nalbuphine as an adjuvant for the block.

Results
The results of our study showed that patients in nalbuphine group (group II) had significantly longer sensory and motor blocks duration, with longer duration of postoperative analgesia, when compared with patients in group I, who were received bupivacaine only for the block.

Conclusion
Coadministration of nalbuphine with bupivacaine in supraclavicular brachial plexus block leads to a significant increase in the duration of sensory and motor blocks and provides prolonged postoperative analgesia without causing adverse hemodynamic instability.
Erector spinae plane block versus thoracic epidural block as analgesic techniques for chest trauma
Authors: El-Sherbiny Sameh M. , Kamal Ragab A. , Elhadary Islam H. , Abdallah Maha Y.Y. 
Published: September 2024

Background
Effective analgesia, early mobilization, and respiratory support are the main goals for managing patients with rib fractures. The purpose of this study was to compare the differences between either continuous thoracic epidural and erector spinae plane (ESP) block in patients with chest trauma.

Patients and methods
This prospective study included 50 patients with American Society of Anesthesiologists status I and II, aged between 18 and 65 years old, admitted with chest trauma. The patients were randomly allocated into two equal groups: ESP block group and thoracic epidural analgesia group. A bolus dose of 15 ml of 0.125% bupivacaine was received in both groups and then continuous infusion was done by using 0.25% bupivacaine at the rate of 0.1 ml/kg/h for 48 h. The primary outcome was to evaluate analgesic efficacy all over the 48 h. Secondary outcomes were the total analgesic requirements during the 48 h, the time of first analgesic request, the effect on hemodynamic parameters, in addition to assessment of the amelioration in respiratory functions and inflammatory substance level between the two groups.

Results
Both groups had statistically significant decrease in the visual analog scale score after intervention compared with their pre-interventional values (P<0.01), without statistically significant difference between them (P≥0.05). Moreover, hemodynamic parameter, pulmonary functions, and inflammatory substance levels showed statistical improvement (P<0.01), but it was not statistically different between both groups (P≥0.05), except only mean arterial pressure values showed statistical significance between the two groups(P<0.01).

Conclusions
ESP block is comparable to thoracic epidural in providing analgesia for patients with thoracic trauma.
Comparison between ultrasound-guided serratus anterior plane block and thoracic epidural for postoperative analgesia after modified radical mastectomy
Authors: Omar Sherif Y.A. , Afify Mounir K. , Abd El-Hameed Mohamed A.E.-H. , Abd El-Hady Mohamed M. 
Published: September 2024

BackgroundPatients undergoing breast surgery require a multimodal postoperative pain treatment regimen that provides high-quality analgesia with minimal side effects. The aim of this study was to compare between the efficiency of serratus anterior plane block and thoracic epidural analgesia in terms of postoperative pain relief in the first 24 h determined by the visual analog scale (VAS) score. The second aim was to compare between the two methods as regards duration of the procedure in minutes, incidence of adverse effects, total analgesic consumption in the first 24 h, and patient satisfaction.Patients and methodsForty female patients aged 25–50 years, American Society of Anesthesiologists class II or III scheduled for elective unilateral modified radical mastectomy were studied. Patients were randomly allocated to two groups; group E (epidural group) (n=20) received 20 ml of 0.25% bupivacaine and group S (serratus anterior block group) (n=20) received 20 ml of 0.25% bupivacaine.ResultsThere was no difference between both groups as regards demographic data, heart rate, systolic blood pressure, SpO2, and end-tidal CO2and associated complications. Moreover, group E had a significant lower VAS score than group S. Group E took longer time to perform the analgesic technique. Group E required significantly less rescue analgesia in the first 24 h. Group S analgesic duration was significantly shorter than in group E.ConclusionsSerratus anterior plane block is a good, simple alternative and a safe technique than thoracic epidural analgesia both providing effective intraoperative analgesia and prolonged postoperative pain relief after breast surgery with comparable postoperative VAS score in the first 24 h.
Pre-emptive ultrasound-guided transversus abdominis plane block in open appendicectomy
Authors: Fawzy Asmaa , Aleem Omar A. , Rayan Ayman A. , Aiad Alaaeldin A. 
Published: September 2024

Background
Transversus abdominis plane (TAP) block is a newly effective peripheral block which involving mainly the nerves of the anterior abdominal wall in lower abdominal surgery. The present study aimed to evaluate the postoperative analgesic efficacy of right-sided ultrasound guided TAP block by using 20 millimeters of bupivacaine 0.25% in patients undergoing open appendicectomy.

Patients and methods
After taking informed consent, fifty patients (ASA I and II) undergoing open appendicectomy were randomized into 2 groups (25 each). After induction of general anesthesia; Group B received right side ultrasound guided TAP block using 20 ml bupivacaine 0.25%. Group S (standard group) received general anesthesia without TAP block. Postoperative analgesia by ketorolac and paracetamol was given as required. Postoperative VAS at rest and movement, intra and post operative hemodynamics, analgesic requirements and their side effects were recorded for 24 hours.

Results
A significant reduction of VAS up to twelve hours postoperatively detected in the TAP block group with bupivacaine 0.25%. There was also significant elongation of time to the first analgesia, significant reduction in number of rescue analgesics, as will as there were significant decrease in nausea, vomiting and pruritus between two groups.

Conclusion
Right-sided ultrasound guided TAP block using 20 ml of bupivacaine 0.25% had effective postoperative analgesia for twelve hours after the open appendicectomy.
Comparison between low-dose intravenous and caudal dexamethasone as adjuvants to caudal bupivacaine in children undergoing lower abdominal surgeries
Authors: Abdelrazik Amr N. , Raouf Mina M. , Mousa Sarah O. 
Published: September 2024

Background
Caudal block is the most common regional anesthetic technique performed for analgesia for pediatric surgeries. The aim of this study was to evaluate dexamethasone through intravenous and caudal routes as adjuvants to caudal block for postoperative analgesia for pediatric patients who underwent lower abdominal surgeries.

Patients and methods
This prospective, randomized, double-blinded controlled study included 150 children who were divided into three equal groups. All patients received caudal analgesia with 0.125% hyperbaric bupivacaine 1 ml/kg. Group C received an intravenous injection of 10 ml normal saline, group D received 0.1 mg/kg dexamethasone added to the caudal analgesia, and 10 ml normal saline intravenous, while group IV received dexamethasone 0.1 mg/kg in 10 ml normal saline intravenous. The primary outcomes were the duration and severity of postoperative pain. The amount of rescue analgesic doses, residual motor block, and side effects such as nausea, vomiting, and hyperglycemia (secondary outcomes) were monitored.

Results
Dexamethasone groups (D, IV) showed a significantly prolonged duration of postoperative analgesia in comparison to the control group (C) and group D showed a longer duration of analgesia and delayed analgesic rescue when compared with the dexamethasone IV group. CHIPPS was the least in group D compared with group C and group IV at 3, 6, 12, and 24 h. Postoperative nausea and vomiting were significantly lower in group IV compared with the other two groups.

Conclusions
Dexamethasone either caudal or low-dose intravenous was effective for prolonging the duration of analgesia from caudal blockade with bupivacaine, while caudal dexamethasone was more effective. Intravenous dexamethasone had the upper hand in decreasing postoperative nausea and vomiting.
The neutrophil-to-lymphocyte ratio as a prognostic index for short-term outcome in the ICU admitted COVID-19 adult patients
Authors: Kamel Emad Zarief , Sayed Jehan Ahmed , Hashem Maiada K. , Elagan Moataz , Soliman Omar M. 
Published: September 2024

Context
The neutrophil-to-lymphocyte ratio (NLR), which can be easily computed from a standard blood test, has been found to be useful in determining a patient’s overall inflammatory condition.

Aim
To find out if the NLR cut-off point could be used to predict mortality in coronavirus disease 2019 (COVID-19) patients admitted to the intensive care unit (ICU).

Setting and design
A prospective cohort study, carried out between March and August 2021, and included 92 COVID-19 ICU admitted patients of Assiut University Hospital.

Methods and material
The NLR, platelet-to-lymphocyte ratio (PLR), ventilation assessment, and short-term outcome were assessed throughout the study period.

Results
Receiver operating characteristic curves analysis on the 7th day was done for NLR and PLR in relation to mortality rate. There was a high AUC for both NLR and PLR (0.946 and 0.931, respectively). The cut-off points were NLR 6.9 and PLR 258.35; above these, the mortality was increased. Patients who were discharged to home were 62 (67.39%), those who were transferred to an intermediate care unit were 9 (9.78%), and those who died were 21 (22.8%).

Conclusion
NLR and PLR levels above a certain threshold were linked to severe COVID-19 and mortality. Prior to clinical application, more research is needed to determine the best cut-off value for NLR.
Continuous sciatic nerve block as preoperative care for lower-limb revascularization surgery
Authors: Linhares Rafael M. , Souza de Lima Marcelo F. , Bersot Carlos D. , Pereira José E.G. , Lobo Clara A. 
Published: September 2024

Background
The prevalence of peripheral arterial disease increases with age and it is highly prevalent (15–20%) over 70 years. Surgery can be the best option to resolve the disabling pain. The Anesthesiology and Acute Pain Service routinely adopts continuous popliteal nerve-analgesic block as preoperative care.

Patients and methods
This case series analyzes the medical records of patients under continuous ultrasound-guided sciatic block, during 2 years (2017–2018) before lower-limb revascularization surgery. From a total number of 25 records identified, 15 were selected for analysis. The primary outcome was pain relief from basal line to 24 h postcatheter placement, measured by the Numerical Rating Pain Scale, and the secondary outcomes were reduction of Numerical Pain Rating Scale after 72 h, complications, and possible technical difficulties.

Results
We found pain reduction in the first 24 h of catheter placement, with median Numerical Rating Pain Scale reduction from 10 [interquartile range (IIQ) 10–10] to 0 (IIQ 0–2) (P<0.001); and from 0 to 72 h of catheter placement, with Numerical Rating Pain Scale decreasing median from 10 (IIQ 10–9) to 2 (IIQ 0–2) (P<0.0001). Four (26.7%) patients had their catheters displaced, and in another four (26.7%) patients, hyperemia was observed around the catheter’s introduction ostium on the skin.

Conclusion
Preoperative continuous sciatic nerve block seems to be an effective and safe approach for pain management of peripheral vascular occlusive disease patients waiting for surgery.
Lidocaine versus dexamethasone for reduction of sore throat after general anesthesia
Authors: Mohammed Mohammed N. , El Said Rashad Ali 
Published: September 2024

Background
Postoperative sore throat (POST) is commonly reported by patients after endotracheal intubation. This study was conducted to compare the efficacy of intravenous lidocaine and dexamethasone in the prevention of such problem.

Patients and methods
We included a total of 394 cases who were randomly divided using the closed-envelope method into two groups: group D that included 197 cases who received intravenous dexamethasone (8 mg), and group L that included the remaining 197 cases who received intravenous lidocaine (1.5 mg/kg). Both the incidence and risk factors for POST were assessed.

Results
Sore throat was reported by 115 (58.4%) cases in group L, whereas it was reported by 82 (41.6%) cases of cases in the other group. There was a marked reduction of sore-throat sensation in group D (P<0.001). Logistic regression revealed that the presence of blood on suction was a significant risk factor for developing sore throat after intubation.

Conclusion
Intravenous administration of dexamethasone appears to be more promising than lidocaine in decreasing the incidence of POST.