Carbetocin versus syntometrine for prevention of postpartum hemorrhage after cesarean section., Maged, Ahmed Mohamed, Ragab Ahmed Shaker, Elnassery Noura, Mostafa Walaa A. I., Dahab Sherif, and amal Kotb , The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians, 2017 Apr, Volume 30, Issue 8, p.962-966, (2017) Abstract

OBJECTIVE: To compare effectiveness and tolerability of carbetocin versus syntometrine in prevention of postpartum hemorrhage (PPH) after cesarean section (CS).

METHODS: A double-blind randomized study conducted on 300 pregnant subjected randomly either to single 100 μg IV dose of carbetocin (150 women) or combination of 5 IU oxytocin and 0.2 mg ergometrine (150 women) after fetal extraction and before placental removal. Primary outcome parameter was the occurrence of PPH. Other parameters were hemoglobin and hematocrit changes, the need of additional oxytocic, hemodynamic changes and occurrence of side effects.

RESULTS: There was no significant difference between the two study groups regarding hemoglobin and hematocrit at start of CS and after 2 days of surgery and mean blood loss during the operation (p > 0.05). There was a highly significant difference between the two study groups regarding incidence of primary PPH (2.7% versus10%) and the need of additional oxytocic (3.3% versus17.3%). Women in oxytocin group showed a statistically significant lower systolic and diastolic blood pressure at 1, 5 and 30 min than women in carbetocin group. Women in carbetocin group experienced more metallic taste, flushing, headache, dizziness, dyspnea and itching, while women in oxytocin methergine group experienced more palpitations.

CONCLUSIONS: Carbetocin is a reasonable effective alternative to syntometrine in prevention of PPH after cesarean delivery.

Safety and efficacy of addition of hyaluronidase to a mixture of lidocaine and bupivacaine in scalp nerves block in elective craniotomy operations; comparative study., Mohamed, Ahmed Abdalla, Radwan Tarek Ahmed, Mohamed Mohamed Mahmoud, Mohamed Hatem Abdellatif, Mohamed Elemady Mohamed Farid, Osman Safinaz Hassan, Safan Tamer Fayez, Khair Tamer Mohamed, Ali Norhan Abdelaleem, Fahmy Rania Samir, et al. , BMC anesthesiology, 2018 Sep 15, Volume 18, Issue 1, p.129, (2018) Abstract

BACKGROUND: Patients undergoing craniotomy operations are prone to various noxious stimuli, many strategies are commenced to provide state of analgesia, for better control of the stress response and to overcome its undesired effects on the haemodynamics and post-operative pain. Scalp nerves block are considered one of these strategies. This study was conceived to evaluate the effect of addition of hyaluronidase to the local anaesthetic mixture used in the scalp nerves block in patients undergoing elective craniotomy operations.

METHODS: 64 patients undergoing elective craniotomy operations were enrolled in this prospective randomized, double-blind comparative study. Patients were randomly assigned to two groups. Group LA, patients subjected to scalp nerves block with 15 ml bupivacaine 0.5%, 15 ml lidocaine 2%, in 1:400000 epinephrine. Group H as Group LA with15 IU /ml Hyaluronidase.

RESULTS: Patients in the H group showed lower VAS values for 8 h postoperative, compared to the LA group. The haemodynamic response showed lower values in the H group, compared to the LA group. Those effects were shown in the intraoperative period and for 6 h post-operative. No difference was detected regarding the incidence of complications nor the safety profile.

CONCLUSION: Our data supports the idea that addition of hyaluronidase to the local anesthetic mixture improves the success rates of the scalp nerves block and its efficacy especially during stressful intraoperative periods and in the early postoperative period. No evident undesirable effects in relation to the addition of hyaluronidase.

TRIAL REGISTRATION: Clinical Trial registry on ClinicalTrials.gov , NCT 03411330 , 25-1-2018.

The impact of intravenous dexamethasone on the efficacy and duration of analgesia of paravertebral block in breast cancer surgery: a randomized controlled trial., Bakeer, Ahmed H., AbdAllah Nasr M., Kamel Mahmoud A., Abbas Dina N., and ahmed s ragab , Journal of pain research, 2019, Volume 12, p.61-67, (2019) Abstract

Purpose: The study aimed at the evaluation of the impact of intravenous (IV) dexamethasone on efficacy and duration of analgesia of paravertebral block (PVB) in patients undergoing modified radical mastectomy (MRM).

Patients and methods: This randomized, double-blind controlled trial included 50 patients with breast cancer scheduled for unilateral MRM. Ultrasound-guided PVB was performed in out-of-plane technique. The technique was repeated at each segment from C7 to T6. The participants were randomly allocated to one of two groups. Group BD (n=25) received IV 8 mg dexamethasone diluted with 8 mL of normal saline to reach 10 mL solution, while Group B received IV 10 mL normal saline. Top-up local infiltration analgesia into the surgical field was performed by the surgeon if needed using lidocaine 1% intraoperatively. Propofol infusion of 50-100 µg/kg/min was maintained throughout the surgery. The time to administration of the first postoperative analgesic dose, pain intensity as visual analog scale (VAS) score, number of patients who required rescue morphine analgesia, total morphine consumption, postoperative nausea and vomiting (PONV) impact scale, and the overall satisfaction of patients with pain management were measured.

Results: Fifty patients were randomized and analyzed. The time to first rescue analgesic dose was significantly longer in Group DB (<0.001). The VAS scores were significantly lower in Group DB compared to Group B up to 12 hours postoperatively. Morphine consumption was lower in Group DB compared to Group B. PONV Impact Scale score was significantly higher in Group B.

Conclusion: Systemic dexamethasone increased the efficacy and duration of the single-shot multilevel PVB in breast cancer surgery.

Trial registration: ISRCTN registry, study ID: ISRCTN15920148.

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