bluuebunny/crossref_metadata_2025_split huggingface dataset:
Non-inferiority trial of Channa striata extract on endothelial glycocalyx layer protection in septic patients
Authors: Permana Septian Adi , Hartono Hartono , Purwanto Bambang , Indarto Dono 
Published: February 2024

Background: Sepsis causes significant damage to the endothelial glycocalyx layer, which albumin can protect against. Unfortunately, human albumin is quite expensive, so cheaper substitutes must be found without sacrificing effectiveness. Albumin extract called snakehead fish extract (SHFE) is one that is commonly used in Indonesia It is also called Channa striata extract. We conducted a non-inferiority study between human albumin and SHFE in protecting the glycocalyx layer through syndecan-1 levels.
Methodology: It was a prospective cohort study of adult patients with early sepsis, treated at ICU of Dr Moewardi Hospital, between May and October 2021. The study group was divided by giving Channa striata extract 15 mg/day for two days and the control group was given 20 grams of human albumin on the other day, and then syndecan-1 levels were compared before treatment and on the third day of the study.
Results: We discovered a statistically significant decrease in syndecan-1 levels in both the study (P = 0.013) and control groups (P = 0.027) from the 44 samples we obtained.
Conclusion: In both groups, there was a significant decrease in syndecan-1 levels, proving that Channa striata extract is not inferior to human albumin in terms of glycocalyx layer protection. And it has a higher economic value because the price is lower.
Key words: Sepsis; Channa striata; Albumin; Syndecan-1; Glycocalyx
Citation: Permana SA, Hartono H, Purwanto B, Indarto D. Non-inferiority trial of channa striata extract on endothelial glycocalyx layer protection in septic patients. Anaesth. pain intensive care 2023;27(4):523−527; DOI: 10.35975/apic.v27i4.2278
Received: May 15, 2023; Reviewed: June 22, 2023; Accepted: June 22, 2023
Effect of ketamine versus sevoflurane on the right ventricular pressure during balloon dilatation of congenital pulmonary valve stenosis
Authors: Sayed Amr Gaber , El Moez Walaa Adel Abd , Shoukry Aktham , Elshafeey Ahmed Elsayed 
Published: February 2024

Background & Objective: Congenital pulmonary stenosis (PS) is a prevalent cardiac anomaly that is commonly treated with balloon dilatation. The procedure can be successfully completed under appropriate anesthetic technique, depending upon the choice of the anesthetist and the patients’ physical status. We compared the effect of IV ketamine with sevoflurane inhalational anesthesia on right ventricular pressure in infants undergoing balloon dilatation for congenital pulmonary valve stenosis.
Methodology: This double-blinded, randomized, clinical trial included 40 infants, aged from 1 to 12 months, with congenital PS undergoing balloon dilatation. They were randomly allocated to one of the two groups. In the ketamine group, 20 patients received 2 mg/kg of ketamine intravenously till being unconscious. In the sevoflurane group, 20 patients received 3% sevoflurane and were maintained using the open circuit technique till losing consciousness. The right ventricular pressure was the primary outcome. Secondary outcomes were the hemodynamics and oxygen saturation.
Results: Compared to sevoflurane, ketamine showed a non-significant difference in the right ventricular pressure before and after induction of anesthesia and after balloon dilatation. The mean arterial blood pressure significantly dropped immediately after sevoflurane induction and after the initial 10 min (P = 0.031 and 0.041, respectively). The heart rate significantly decreased immediately after sevoflurane induction (P = 0.028). The oxygen saturation remained comparable in both groups at 10 and 20 min after induction, and at postoperative anesthesia care unit.
Conclusion: Intravenous ketamine is considered a safe and effective alternative to sevoflurane for infants with congenital pulmonary stenosis undergoing balloon dilatation. It maintains the right ventricular pressure with stable hemodynamic effects, compared to sevoflurane inhalational anesthesia.
Abbreviations: PS - Pulmonary Stenosis; TS – Tricuspid Stenosis; PACU – Post Anesthesia Care Unit; TTE - Transthoracic Echocardiography
Key words: Balloon Dilatation; Infants; Ketamine; Pulmonary Stenosis; Sevoflurane.
Citation: Sayed AG, Abd el Moez WA, Shoukry A, Elshafeey AE. Effect of ketamine versus sevoflurane on the right ventricular pressure during balloon dilatation of congenital pulmonary valve stenosis. Anaesth. pain intensive care 2023;27(5):451−457; DOI: 10.35975/apic.v27i5.2210
Received: April 18, 2023; Reviewed: July 18, 2023; Accepted: August 21, 2023
Discovering a combination of natural compounds for treatment of chronic cancer pain based on bioinformatics
Authors: Si Weichen 
Published: February 2024

Background & Objective: The incidence of malignant disease has been increasing the world over, and with it the number of patients suffering from severe cancer pain is also increasing with every passing day. We aimed to find a potentially effective combination of natural compounds for the treatment of chronic cancer pain (CCP) using bioinformatics methods, and provide a theoretical basis for subsequent laboratory experiments and clinical trials.
Methodology: Six natural compounds, including bakuchiol, cinnamaldehyde, curcumin, eugenol, salicin and xanthoxylin, were selected as candidates for new drugs by consulting a large number of relevant literatures. Their targets were obtained from the Swiss Target Prediction database. The related targets of CCP were obtained from GeneCards, OMIM and DisGent databases. Cytoscape software was used to construct the "compound-target-disease" network. Protein-protein interaction network (PPI) was constructed by STRING platform; GO function and KEGG pathway enrichment analysis were performed by R language software.
Results: A total of 197 targets were obtained from the Swiss Target Prediction database; 10767 CCP of disease targets were obtained after searching and removing duplications in the disease database. Twelve core targets, AKT1, SRC, STAT3, ESR1, RELA, EP300, MAPK1, MAPK14, CCNA2, EGFR, GSK3B and PRKCZ, were identified by PPI analysis. GO functional enrichment analysis yielded 1950 entries. KEGG enrichment analysis revealed 134 pathways with statistical significance, among which pathways related to CCP were more than those related to nerve.
Conclusion: The mechanism of action of these six compounds in the treatment of chronic cancer pain is multi-target and multi-pathway related. Through protein-protein interaction analysis, GO function and KEGG pathway enrichment analysis, it is found that these six compounds can be used as candidate drugs for the treatment of chronic cancer pain, which will be further studied in the future.
Key words: Bioinformatics; Natural Compounds; Chronic Cancer Pain; New Drug Discovery
Citation: Si W. Discovering a combination of natural compounds for treatment of chronic cancer pain based on bioinformatics. Anaesth. pain intensive care 2023;27(5):431−439; DOI: 10.35975/apic.v27i5.2293
Received: February 21, 2023; Reviewed: March 06, 2023; Accepted: April 28, 2023
"Resilience unveiled: empowering Pakistani anesthetists in challenging low-resource environment"
Authors: Zahid Muhammad Arslan , Ali Pervaiz , Saddique Faisal , Khan Bahram , Rehman Muhammad Abdul , Kumar Ajeet 
Published: February 2024

This review paper explores the difficulties that the Pakistani anesthetists experience while working in settings with limited resources and emphasizes the need of offering them support, help, and encouragement. Similar to many other poor nations, Pakistan has substantial shortages of the healthcare resources, which can have a negative influence on anesthetists' working conditions. The paper emphasizes the need for efforts to improve Pakistani anesthetist’s well-being and professional growth, while also inviting attention to the special challenges they have to confront during discharge of their professional duties. This narrative review suggests that encouraging, assisting, and supporting anesthetists who operate under such demanding circumstances can improve their motivation, job satisfaction, and generally, their ability to offer high level of patient care.
Key words: Low Resource Settings; Limited Resources; Encouragement; Professional Growth; Challenges; Motivation; Job Satisfaction; Workload; Continuing Education; Training; Psychological Stress; Emotional Support
Citation: Zahid MA, Ali P, Saddique F, Khan B, Rehman MA, Kumar A. "Resilience unveiled: empowering Pakistani anesthetists in challenging low-resource environment". Anaesth. pain intensive care 2023;27(5):592−598; DOI: 10.35975/apic.v27i5.2299
Received: Jul 29, 2023; Reviewed: Aug 07, 2023; Accepted: Aug 10, 2023
Comparative study on analgesia duration with bupivacaine-buprenorphine combination vs. bupivacaine alone for cesarean delivery
Authors: Memon Muhammad Saleh , Malik Shoaib , Memon Ghulam Nabi , Rehman Memoona 
Published: February 2024

BACKGROUND: Spinal anesthesia has been the preferred type of anesthesia for cesarean sections and other obstetric operations. Bupivacaine has been used for this purpose being long acting. Lately various narcotic analgesics have been added to prolong the analgesia and reduce the expected toxicity of bupivacaine alone. We evaluated the duration of analgesia achieved with the combination of bupivacaine-buprenorphine versus bupivacaine alone in cesarean delivery under spinal anesthesia.
Methods: A comparative study was conducted at a tertiary care teaching healthcare center in Karachi, Pakistan. One hundred patients scheduled for elective cesarean section were enrolled and divided into two groups. Group A received 10 mg of hyperbaric bupivacaine 0.5% along with normal saline, while Group B received the same dose of bupivacaine along with buprenorphine 75 µg. Preoperative assessment, intraoperative procedures, and postoperative management were performed following standard protocols of our institution. Statistical analysis was conducted using independent t-tests and chi-square tests.
Results: The findings revealed significantly longer mean time to request for analgesia in Group B compared to Group A (825.33 min vs. 166.78 min; P = 0.182), Only 14 patients in Group B (28%) required analgesia within 24 h, while all patients in Group A requested analgesia within that time frame (P = 0.0001). Moreover, an insignificantly lower incidence of hypotension and reduced need for phenylephrine administration was observed in Group B compared to Group A (P = 0.585). Group B also demonstrated a lower incidence of nausea (P = 0.380) and vomiting (P = 0.370) compared to Group A, but the difference was statistically not significant.
Conclusion: This study suggests that the addition of buprenorphine to bupivacaine in spinal anesthesia for cesarean delivery provides prolonged analgesia, reduces the incidence of nausea and vomiting, and decreases the need for vasopressor administration. These findings support the potential benefits of using the bupivacaine-buprenorphine combination in cesarean deliveries.
Key words: Cesarean Delivery; Opioids, Intrathecal; Anesthesia, Spinal; Bupivacaine; Buprenorphine; Analgesia, Duration
Citation: Saleh M, Malik S, Memon GN, Rehman M. Comparative study on analgesia duration with bupivacaine-buprenorphine combination vs. bupivacaine alone for cesarean delivery. Anaesth. pain intensive care 2023;27(5):501−505; DOI: 10.35975/apic.v27i5.2303
Received: July 29, 2023; Reviewed: August 10, 2023; Accepted: August 10, 2023
Bilateral ultrasound guided erector spinae plane block vs. preoperative pregabalin for postoperative pain management in lumbar spine surgery
Authors: Mohamed Rabab Mohamed , Morsy Islam , Hamed Jehan Mohammad Darwish 
Published: February 2024

Background & Objective: Injecting local anesthetics into the erector spinae plane and obstructing the dorsal and ventral rami could reduce the pain. Pregabalin and gabapentin are used to reduce neuropathic pain; however, pregabalin has demonstrated greater analgesic potency than gabapentin. This work aimed to compare the analgesic effects and complications between preoperative pregabalin and erector spinae plane block (ESPB) for lumbar spine surgery under general anesthesia.
Methodology: Sixty patients were allocated to the 2 groups using a computer-generated random number that was hidden in sealed, opaque envelopes. In Group 1, the patients received pregabalin 150 mg twice daily for 3 days before surgery. After preoxygenation and before induction of anesthesia, dexmedetomidine 1 µg/kg was given in both of the groups. In Group 2, after the patient was placed in the prone position for the operation and after the induction of general anesthesia, ESPB was carried out bilaterally under ultrasound guidance. Ropivacaine hydrochloride was administered at a quantity of 20 mL upon confirmation of the needle's proper insertion. Numerical Rating Scale (NRS) was used to assess the pain intensity.
Results: There was a longer-lasting analgesia in the ESPB group with significantly lower NRS only at 12 h and 18 h (P = 0.001) compared to the pregabalin group, but they were comparable at 24 h (P = 0.407). The time to request first rescue analgesic and the total morphine consumption were significantly different; a significantly longer time for the first rescue analgesic (17.10 vs. 11.73 h) and a significantly reduced amount of morphine consumption (6.30 vs. 10.33 mg) in ESPB group.
Conclusion: Both bilateral erector spinae plane block and preoperative pregabalin seem to be helpful for providing adequate pain management postoperatively for lumbar spine surgery; however, bilateral erector spinae plane block was superior in pain management during the first 24 h postoperatively with fewer side effects.
Abbreviations: ESPB - Erector Spinae Plane Block; α2-AR - Alpha 2 Adrenoreceptors; NRS - Numerical Rating Scale; ACE - Angiotensin Converting Enzyme; NaCl - Normal Saline; MAP - Mean Arterial Blood Pressure; IV - Intravenous; PACU - Post-Anesthesia Care Unit; X2 - Chi-square; IQR - Interquartile Range; MAC - Minimum Alveolar Concentration;
Preregistration: The study had approval from the Ethical Committee and Institutional Review Board of the Faculty of Medicine, Tanta University with approval code (35692/9/22).
Key words: US-ESPB; Ultrasound Guided; Erector Spinae Plane Block; Pregabalin; Lumbar Spine Surgery
Citation: Mohamed RM, Morsy I, Hamed JMD. Bilateral ultrasound guided erector spinae plane block vs. pregabalin for postoperative pain management in lumbar spine surgery. Anaesth. pain intensive care 2023;27(5):513−520; DOI: 10.35975/apic.v27i5.2306
Received: April 07, 2023; Reviewed & Accepted: July 01, 2023
Clinical effect of cervical vs. targeted epidural blood patch in spontaneous intracranial hypotension with unclear leakage sites
Authors: Ryu Hansung , Lee Hyeon Seung , Kim Hyuckgoo 
Published: February 2024

Background and Aims: Epidural blood patch (EBP) is the most commonly used treatment for spontaneous intracranial hypotension (SIH). EBP is generally targeted at the cerebrospinal fluid (CSF) leakage site; in unclear leakage sites, it is performed blindly in the lumbar region. Therefore, to investigate effectiveness of cervical EBP in SIH patients having unclear CSF leakage sites, we conducted a retrospective case control study to compare the effectiveness of cervical EBP for unclear leakage site and targeted EBP at leakage sites.
Methodology: We reviewed the records of SIH patients who had undergone EBP at a single hospital. Patients were divided into Group CE (cervical EBP for unclear leakage site) and Group TE (targeted EBP at leakage site). the demographics, clinical characteristics, leakage site, EBP injection level, injected volume, and change in pain score (numeric rating scale [NRS]) were analysed for both groups.
Results: We analysed 54 patients, with 13 and 41 patients in the CE and TE groups, respectively. EBP regions in the TE group included the cervical, thoracic, and lumbar regions. There were no significant differences in demographic data between the groups. The baseline NRS scores for headache were 7.8 ± 0.9 and 7.7 ± 0.8 (P = 0.771); scores after EBP were 2.9 ± 1.7 and 2.2 ± 1.1 (P = 0.195) in groups CE and TE, respectively. NRS changes of 4.9 ± 2.0 and 5.6 ± 1.5 (P = 0.348) occurred in groups CE and TE, respectively. The mean blood volume in the CE group was 10.4 ml. Clinical effectiveness did not differ significantly between the groups.
Conclusion: Cervical EBP is as effective as targeted EBP when the CSF leakage site is unclear. Therefore, cervical EBP is appropriate for SIH in patients with unclear CSF leakage.
Abbreviations: CSF - Cerebrospinal Fluid; EPB - Epidural Blood Patch; NRS - Numeric Rating Scale; SIH - Spontaneous Intracranial Hypotension
Key words: Epidural Blood Patch; Spontaneous Intracranial Hypotension; Headache
Citation: Ryu H, Lee HS, Kim H. Clinical effect of cervical vs. targeted epidural blood patch in spontaneous intracranial hypotension with unclear leakage sites. Anaesth. pain intensive care 2023;27(5):521−525; DOI: 10.35975/apic.v27i5.2307
Received: July 07, 2023; Reviewed: August 28, 2023; Accepted: September 01, 2023
Comparison of low dose ropivacaine plus dexmedetomidine vs. low dose bupivacaine for spinal anesthesia in transurethral resection of prostate
Authors: Hassan Jawad Ul , Zafar Ehsan , Ameer Khalid , Saleem Muhammad Asif , Akram Muhammad , Sami Aqeela 
Published: February 2024

Background & Objective: Spinal anesthesia (SA) has been preferred for transurethral resection of prostate (TURP) due to various advantages over general anesthesia. The most commonly used drug for SA is bupivacaine, but recently ropivacaine has been introduced with better hemodynamic profile. Dexmedetomidine is sedative-analgesic, and can be used through multiple routes. We compared low dose ropivacaine plus dexmedetomidine vs. low dose bupivacaine for SA in TURP.
Methodology: This comparative, cross-sectional study was conducted at Anesthesia Department of Combined Military Hospital, Lahore, from December 2021 to June 2022.
A total of 197 patients, planned to undergo TURP under SA were included in the study. The patients were randomly allotted to one of the two groups by lottery method and using concealed envelops. Group RD took low dose ropivacaine (7.5 to 10 mg) plus dexmedetomidine (5 µg) and in Group B low dose bupivacaine (7.5 to 10 mg) was used for spinal anesthesia. Parameters of efficacy and safety were compared in both groups during and immediately after the surgery to look for better option among the two regimes.
Results: Out of 197 patients randomized into two groups, Group RD, 99 (50.2%) took low dose ropivacaine (7.5 to 10 mg) plus dexmedetomidine (5 µg) and 98 (49.8%) took low dose bupivacaine (7.5 to 10 mg) for spinal anesthesia. Mean age of patients who underwent TURP in our study was 61.66 ± 7.88 y. Hemodynamic instability and requirement of opiate analgesia was not significantly different in both the groups (P > 0.05) while all other efficacy parameters were better in patients who took low dose ropivacaine plus dexmedetomidine (P < 0.05) as compared to those who only took low dose bupivacaine.
Conclusion: Both groups showed no difference in safety parameters related to hemodynamic stability but the anesthesia profile was better in patients who took low dose ropivacaine plus dexmedetomidine as compared to the bupivacaine group.
Abbreviations: SA - Spinal anesthesia; TURP - Transurethral resection of prostate
Key words: Bupivacaine; Dexmedetomidine; Ropivacaine; Anesthesia, Spinal; Transurethral Resection of Prostate
Citation: Ul Hassan J, Zafar E, Akram M, Saleem MA, Sami A. Comparison of low dose ropivacaine plus dexmedetomidine vs. bupivacaine for spinal anesthesia in transurethral resection of prostate. Anaesth. pain intensive care 2023;27(5):535−538; DOI: 10.35975/apic.v27i5.2309
A randomized clinical trial of addition of IPACK block or selective tibial nerve block to adductor canal block for postoperative pain management after total knee arthroplasty
Authors: Abogabal Marwa Ahmed , Zahra Shaimaa Waheed , Abdel-Elsalam Wafaa Mohamed , Abdelwahed Wafaa Madhy 
Published: February 2024

Background & Objective: Postoperative pain after total knee arthroplasty (TKA) is a significant factor influencing the surgical outcome. Adductor canal block (ACB) has no analgesic effect on the posterior knee capsule, which is innervated by the terminal branches of the tibial nerve and the posterior branch of the obturator nerve. We compared ACB plus IPACK block (infiltration of the interspace between the popliteal artery and the posterior capsule of the knee) versus ACB with selective tibial nerve block (TNB) for pain management after TKA.
Methodology: We enrolled 70 patients, aged 40-80 y, body mass index of 18.5-35 kg/m2, scheduled for TKA in the study. Patients were randomly allocated to one of the two equal groups; Group 1 to receive ACB with IPACK block and Group 2 to receive ACB with TNB. Duration of sensory block, motor block, time to first rescue analgesic request, time to ambulation, and hospital length were noted in both groups. The 0-10 numeric rating scale (NRS) was used to measure the pain intensity in the patients.
Results: Duration of sensory block, motor block, time to first rescue analgesic request, time to ambulation, and hospital length were significantly increased in Group 2 than in Group 1 (P < 0.001). The numeric rating scale was significantly lower in Group 2 at 8 h only but was comparable in other measurements. Range of motion and the strength of quadriceps were comparable between both groups at 24, 48, and 72 h postoperatively.
Conclusions: Adductor canal block with IPACK preserved motor function better and reduced the time to ambulation and hospital stay compared to tibial nerve block with adductor canal block. However, adductor canal block with selective tibial nerve block prolongs sensory block, the time to first analgesia request, and reduces postoperative opioid consumption at first 24 h. Both methods had a comparable effect on quadriceps strength.
Abbreviations: ACB - Adductor Canal Block; IPACK - Infiltration of local anesthetic between the Popliteal Artery and Capsule of the Knee; TNB - Tibial Nerve Block; TKA - Total Knee Arthroplasty
Key words: Total Knee Arthroplasty; Adductor Canal Block; IPACK; Selective Tibial Nerve Block.
Citation: Abogabal MA, Zahra SW, Abdel-ElsalamWM, Wafaa Madhy Abdelwahed WM. A randomized clinical trial of addition of IPACK block or selective tibial nerve block to adductor canal block for postoperative pain management after total knee arthroplasty. Anaesth. pain intensive care 2023;27(5): 567−574. DOI: 10.35975/apic.v27i5.2313
Received: July 25, 2023; Reviewed: August 18, 2023; Accepted: August 26, 2023