Introduction Ultrasound-guided truncal blocks such as quadratus lumborum (QLB) and erector spinae plane block (ESPB) are increasingly used for opioid-sparing analgesia. We aimed to evaluate the postoperative analgesic outcome of ultrasound-guided unilateral QLB (lateral approach) and ESPB for use in adult patients undergoing unilateral lower abdominal surgery. Methods In this randomized comparative clinical trial, 48 adult patients scheduled for unilateral lower abdominal surgery were randomized to receive QLB (n = 24) and ESPB (n = 24) following induction of general anesthesia. The primary outcome was total morphine consumption in the first 24 postoperative hours. Results There was no statistical difference for total morphine consumption between the QLB and ESPB groups (5.26 ± 2.17 mg vs. 5.88 ± 2.51 mg; p = 0.376). The median time to first rescue analgesia was greater in the QLB (2 hours [0–18]) vs. the ESPB group (1 hour [0–21]; p = 0.251). Pain scores were not different between groups at 2, 4, 8, 12, and 24 hours post-op (median Visual Analogue Scale (VAS) at 24h: 3 [3–5] QLB, 3 [2–3] ESPB; p = 0.08). There were no differences between groups with respect to hemodynamic parameters, adverse events (nausea and vomiting: 4 in the QLB group, 6 in the ESPB group; p > 0.05) or block performance times (median time: 10min for both). Discussion We consider the clinical role of QLB and ESPB as an effective component of multimodal analgesia in unilateral lower abdominal surgeries. They have a similar safety profile considering the technique and the opioid sparing effects, similar performance characteristics and complication rates, which together suggest both blocks are safe and well-tolerated anesthetic procedures that can be daily practices. Conclusion Both QLB and ESPB provide significant, safe, and comparable postoperative analgesia for patients undergoing unilateral lower abdomen surgery. QLB may provide a slight time benefit to analgesia onset. Trial Registration This study was prospectively registered on ClinicalTrials.gov (NCT05524038; principal investigator: Rana Ahmed Abdelghaffar), registration date: 1/9/ 2022.
Preoperative anxiety is a common concern among surgical patients and a key focus for anesthesiologists. Premedication, such as melatonin—an emerging option for sedation before cataract surgery—and midazolam, a routinely used benzodiazepine, play a vital role in managing anxiety and ensuring effective anesthetic care. This study aimed to compare the effects of melatonin and midazolam on the anxiety of cataract surgery candidates under general anesthesia. This study included 40 patients scheduled for cataract surgery under general anesthesia at a surgical center in Birjand, Iran. Participants were randomly divided into two groups: one received 0.1 mg/kg oral melatonin, and the other received 70–80 µg/kg IV midazolam as premedication. Anesthesia was induced uniformly with fentanyl (1 µg/kg), propofol (2 mg/kg), and atracurium (0.5 mg/kg). Anxiety levels were assessed using the Beck Anxiety Inventory at two-time points: before premedication (baseline) and 1.5 hours after administration (30 minutes pre-surgery). There was no significant difference in the comparison of the average anxiety score after and before the premedication in the two investigated groups. The average anxiety score after the premedication in the midazolam group was not significantly different compared to before the premedication (P=0.817), but the average anxiety score in the melatonin group after the premedication was significantly reduced compared to before the premedication (P<0.001). Both melatonin and midazolam similarly reduced preoperative anxiety in cataract surgery patients, with melatonin potentially offering a safer profile. Further studies could explore its wider use as an alternative to benzodiazepines. Melatonin may serve as a suitable alternative to midazolam for reducing preoperative anxiety. Given its better safety profile, further investigation of its broader applications is recommended. IRCT 20190618043934N15
Background Following a sleeve gastrectomy, post-operative nausea and vomiting (PONV) is a typical issue. Furthermore, several prophylactic techniques have been developed, such as preventive antiemetic and accelerated recovery after surgery (ERAS). However, PONV has not entirely disappeared, and clinicians are still working to lower PONV incidence. Aim Our goal was to evaluate how adopting Enhanced Recovery Protocols (ERAS) affects postoperative nausea and vomiting (PONV) in comparison to standard care protocol after laparoscopic sleeve gastrectomy (LSG) while receiving triple antiemetic prophylaxis. Objective The objective of this study was to verify that the ERAS procedure is crucial for lowering PONV despite the use of an efficient and effective antiemetic. Methods This is a computer-generated randomized clinical trial. Haloperidol, dexamethasone, and ondansetron were administered to all patients undergoing elective LSG, 29 patients within an ERAS protocol, and 29 within a standard care protocol. The primary finding was the incidence of PONV within 36 hours following LSG. The time to initially administer rescue antiemetic medication, number of rescue antiemetic medication administrations, postoperative opioid consumption, oral fluid tolerance, complications, and QoR-15 questionnaire for quality of recovery were the secondary outcomes. Results Within the first 36 hours following LSG, the incidence of PONV in the ERAS group was 17.20%, while in the non-ERAS group, it was 51.7%, with P<0.012 and higher PONV severity (P<0.021) in the non-ERAS group. The ERAS group took a longer time (6 hours) for the first rescue antiemetic medicine than the Non-ERAS group (2 hours), with P<0.001 and significantly less number of patients (20.7%) needing rescue antiemetic, compared to the Non-ERAS group (65.5%), with P<0.001. The dosage of nalbuphine needed by the ERAS group was lower (2.7±2.8) than the non-ERAS group (19.9±6.0). Regarding the QoR-15 scores, there was a significant difference in the two groups' overall performance (P <0.001). Between the two groups, there were no significant complications following surgery. Conclusion This study reveals that even though triple antiemetic prophylaxis was used, the ERAS protocol had a beneficial effect on PONV when compared to the standard care approach.
Background: The utilization of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) for immunoadsorption has proven efficacious in reducing mortality rates among neonatal and pediatric patients afflicted with severe sepsis and septic shock. However, the effectiveness of this treatment in adult patients with septic shock remains controversial. Objective: This study was designed to assess the potential of VA-ECMO as an immunoadsorption therapy in patients with severe sepsis and septic shock. The primary objective of this study is to evaluate the efficacy of VA-ECMO in improving clinical outcomes, including acute respiratory distress syndrome (ARDS) and ventilator-associated pneumonia (VAP), weaning from mechanical ventilation, the length of intensive care unit (ICU) stay, and mortality rates in patients with concurrent severe pulmonary contusions, septic shock, and respiratory failure resulting from ARDS and VAP. Methods: This study enrolled a cohort of 100 adult patients with severe pulmonary contusions resulting in persistent respiratory failure despite ten days of mechanical ventilation. These patients subsequently developed severe sepsis, VAP with ARDS presentation, and high Murray score (>3 points), Sequential Organ Failure Assessment (SOFA) score (> 12 points), and Clinical Pulmonary Infection Score (CPIS) (> 6 points). The patients were then divided into two groups: group A (n = 50) received conventional management, while group B (n = 50) underwent VA-ECMO. Moreover, the outcomes, including improvement in ARDS and VAP, successful weaning from mechanical ventilation, length of ICU stay, improvement of one or all parameters of Murray, SOFA, and CPIS scores, morbidity rate, and mortality rate were compared between the two groups and recorded after 14 days of treatment. Results: This study revealed that patients in group B showed significant improvement in Murray, SOFA, and CPIS scores. Furthermore, a large percentage of patients in group B were successfully weaned from both inotropic support and mechanical ventilation and were discharged from ICU. However, no significant difference in the mortality rate was observed between the two groups. Conclusion: VA-ECMO notably impedes the progression of sepsis, shortens ICU stay, and expedites the weaning from inotropic support and mechanical ventilation. However, it has no impact on the mortality rate of adult patients with septic shock.
Introduction: Post Dural Puncture Headache is (PDPH) a relatively common complication of spinal anesthesia. This study aimed to compare the effect of oral administration of ergotamine and theophylline on PDPH in patients undergoing a cesarean section. Materials and Methods: This clinical trial was performed on 60 parturients undergoing cesarean section with PDPH. A tablet of theophylline (100 mg) or methyl ergotamine C (1 mg plus 100 mg caffeine) every 8 hours for 24 hours was administered randomly to patients referred to the hospital with PDPH. Using a checklist, demographic information, history of previous PDPH, number of punctures and intensity, location, and onset time of headache were collected. Intensity and duration of PDPH in the first 24 hours after surgery were the primary outcomes and nausea, vomiting, and vertigo were considered secondary outcomes. The intensity of the headache was assessed using Visual Analog Scale (VAS) before and within the first 24 hours after drug administration. Results and Discussion: In both groups, the VAS of headache significantly decreased at 2, 8, and 24 hours after administration of theophylline and ergotamine compared to pre-intervention time (theophylline from 8.6 ± 1.1 to 0.2 ± 0.1 and ergotamine from 8.6 ± 1.5 to 0.4 ± 0.2). However, the intensity of headaches was not different between the two groups at 2, 8, and 24 hours after the intervention. Duration of headache was similar in both groups (15.7 ± 5.9 in the theophylline group versus 17.5 ± 14.2 ergotamine group). In terms of secondary outcomes of nausea, vomiting, and vertigo, both groups were comparable. Conclusion: Oral administration of theophylline and ergotamine are similarly effective in reducing PDPH in cesarean sections. Clinical Trial Registration Number: IRCT20120915010841N14.
