Ibrahim, M., and hossam el shamaa, "Efficacy of ultrasound-guided oblique subcostal transversus abdominis plane block after laparoscopic sleeve gastrectomy: A double blind, randomized, placebo controlled study", Egyptian Journal of Anaesthesia, vol. 30, no. 3, pp. 285 - 292, 2014. AbstractWebsite

AbstractIntroduction Pain control in the morbidly obese can be especially challenging because of increased sensitivity to opioid-induced respiratory depression. The subcostal transversus abdominis plane block is associated with a large area of spread (T7-L1). The aim of the study was to test the hypothesis that US-guided \{TAP\} blocks can reduce opioid consumption during the first 24 h after of laparoscopic sleeve gastrectomy in comparison with port site local anesthetic infiltration and systemic analgesia. Method Sixty-three \{ASA\} II/III adult patients listed for elective laparoscopic sleeve gastrectomy were randomly allocated in one of three groups: Group I (OSTAP) received bilateral \{OSTAP\} block. Group İI\} (Local) received local anesthetic infiltration at trocar port sites. Group İII\} (Control) placebo group received \{TAP\} block and port site infiltration by same volumes of sterile normal saline. Twenty-four hours postopetrative morphine consumption, the dose of fentanyl (μg) required during surgery, equivalent morphine dose in the recovery unit (PACU) and first morphine dose were recorded. The quality of analgesia is assessed by Visual Analogue Scale for 24 h at rest and movement. Results The mean opioid consumptions in \{PACU\} showed significant difference between the three groups, P = 0.02. The mean 24 h morphine consumption showed statistically significant difference between groups (P value < 0.001). Significant differences were found between both \{OSTAP\} and Local groups with control group (P < 0.001) and also between \{OSTAP\} and Local groups (P = 0.02). Pain score of \{OSTAP\} group was significantly lower than local infiltration group at 6 and 4 h at rest and movement respectively. \{OSTAP\} group had faster extubation time than other groups. Postoperative nausea and vomiting were not significant between groups. No signs or symptoms of local anesthetic systemic toxicity or complications were detected. Conclusion Oblique subcostal \{TAP\} block is a good alternative for providing analgesia during the postoperative period. The block is easily performed using ultrasound guidance. It is safe, provides effective analgesia with significant morphine-sparing effect with reduced side-effects of opioids.

ELShamaa, H. A., and M. Ibrahim, "A comparative study of the effect of caudal dexmedetomidine versus morphine added to bupivacaine in pediatric infra-umbilical surgery.", Saudi journal of anaesthesia, vol. 8, issue 2, pp. 155-60, 2014 Apr. Abstract

BACKGROUND: One of the most commonly used regional anesthetic techniques in pediatric surgeries is the caudal epidural block. Its main disadvantage remains the short duration of action. Hence, different additives have been used. Dexmedetomidine is a potent as well as highly selective α2 adrenergic receptor agonist. The aim of this randomized, double-blinded, study was to compare the duration of postoperative analgesia of caudal dexmedetomidine versus morphine in combination with bupivacaine in pediatric patients undergoing lower abdominal or perineal surgery.

PATIENTS AND METHODS: A total of 50 pediatric patients 1-5 years old The American Society of Anesthesiologists status I, II scheduled for lower abdominal and perineal surgeries were included in the study. The patients were enrolled into 2 equal groups: Group A patients (n = 25) received dexmedetomidine with bupivacaine while Group B patients (n = 25) received morphine with bupivacaine. Patients were placed in a supine position then inhalational general anesthesia was induced, and laryngeal mask airway (LMA) was placed. Patients were then given caudal epidural analgesia. By the end of surgery reversal of muscle relaxation was done and the LMA was removed. Post-operatively, the sedation as well as pain score were observed and recorded.

RESULTS: The current study showed that minor complications were recorded in the post-anesthesia care unit; in addition, significantly longer periods of analgesia and sedation were detected in Group A. However, no significant differences in demographic data, as well as in the duration of surgery, and the time of emergence from anesthesia and patient condition during recovery were detected.

CONCLUSION: The present study suggested that use of dexmedetomidine, during single dose injection, as an additive to the local anesthetic bupivacaine in caudal epidural analgesia prolongs the duration of post-operative analgesia following lower abdominal as well as perineal surgery compared with caudal morphine with no side-effects on the vital signs. Postoperative side effects were seen with caudal morphine injection rather than with dexmedetomidine.

Ibrahim, M., A. Ragab, and hossam el shamaa, "I-gel vs cuffed tracheal tube during volume controlled ventilation in elective laparoscopic cholecystectomy", Egyptian Journal of Anaesthesia, vol. 27, no. 1, pp. 7 - 11, 2011. AbstractWebsite

Background In this study we tested the new, single-use supraglottic airway device; i-gel with a non-inflatable cuff as an effective airway as conventional endotracheal tube. Gas leak was measured and compared with that of cuffed tracheal tube during volume controlled ventilation in elective laparoscopic cholecystectomy. Methods Sixty patients, \{ASA\} I–II, were randomly selected to the study. Standard anaesthetic technique was used for all patients. The i-gel was then inserted. The lungs were ventilated at three different tidal volumes (6, 8 and 10 ml kg−1) using volume controlled ventilation (VCV). The leak volume was calculated as the difference between the inspired and expired tidal volumes. The leak fraction was also calculated as the leak volume divided by the inspired tidal volume. These observations were recorded with every tidal volume before and after pneumoperitoneum with the i-gel and the conventional tracheal tube. Results Before pneumoperitoneum there was no significant difference in leak fraction between i-gel and tracheal tube at 6 and 8 ml kg−1 tidal volume. Significant differences were found after pneumoperitoneum at 8 and at 10 ml kg−1 before and after pneumoperitoneum. Conclusion We suggest that i-gel can be used as an alternative device to endotracheal tube during \{VCV\} for laparoscopic cholecystectomy provided that peak pressure does not exceed leak pressure.

ELShamaa, H. A., M. Ibrahim, and H. l. Eldesuky, "Magnesium sulfate in femoral nerve block, does postoperative analgesia differ? A comparative study", Egyptian Journal of Anaesthesia, vol. 30, no. 2, pp. 169 - 173, 2014. AbstractWebsite

AbstractBackground N-methyl-D-aspartate (NMDA) receptors play a major role in central nociceptive transmission. Recent studies identified \{NMDA\} receptors peripherally. Magnesium (Mg) has antinociceptive effects due to its antagonistic effect of \{NMDA\} receptors. The aim of this randomized, double-blinded, placebo-controlled study was to assess the potential analgesic effect of Mg when directly applied on the peripheral nerves, as well as to evaluate the efficacy of Mg to facilitate the local anesthetic effect of Bupivacaine during peripheral nerve block. Methods Sixty patients, \{ASA\} physical status I, İI\} & III, undergoing laser photocoagulation were randomly divided into 2 equal groups. Both groups received femoral nerve block using nerve stimulator. Patients of group A were given Bupivacaine and Magnesium sulfate, while patients of group B were given Bupivacaine and saline. Pain was assessed using Visual analogue scale (VAS). The duration of action of Bupivacaine was determined by assessing the duration of sensory block, as well as, assessing the motor block of the quadriceps muscle in both groups. 75 mg of Diclofenac sodium was administered İM\} as a rescue analgesic. The total dose of the Diclofenac sodium used was recorded. Results The current study showed a significantly shorter duration of action of Bupivacaine, with a significantly lower pain scores among patients of group A. On the other hand, bearable pain period was significantly shorter, and the total consumption of Diclofenac sodium in the 24 h postoperatively was significantly higher in group B. Conclusion The current study concluded that the admixture of magnesium to bupivacaine provides a profound prolongation of the femoral nerve block, in addition to a significant decrease in postoperative pain scores and total dose of rescue analgesia, with a longer bearable pain periods in the first postoperative day.

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