1
|
Aloweidi AS, Halaweh SAA, Al-Mustafa MM, Massad IM, Qudaisat IY, Khanfar AM, Ajlouni JM, Alhadidi ST, El-Share AI, Jarbeh MA, Al-Oweidi AA. Combining Stellate ganglion block and intravenous regional anesthesia to treat complex regional pain syndrome: A 19-years' experience in a tertiary center. Saudi Med J 2022; 43:1168-1172. [PMID: 36261198 PMCID: PMC9994496 DOI: 10.15537/smj.2022.43.10.20220318] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 09/07/2022] [Indexed: 06/16/2023] Open
Abstract
OBJECTIVES To study reduction in pain score after treatment with intravenous regional anesthesia (IVRA) and Stellate ganglion block (SGB) combination on complex regional pain syndrome (CPRS) patients and to quantify patients' satisfaction with treatment and occurrence of complications. METHODS This is a record-based retrospective review carried out in 2020, targeting patients treated in the University of Jordan Hospital, Amman, Jordan, over the years 2002-2020. RESULTS Among 99 patients, a significant drop in pain scores occurred in 88% of the patients' sample. Gender, age, type of CRPS, and duration of symptoms didn't affect statistical results. An average of 8.6 sessions needed to achieve 50% drop in pain score, and 2-3 sessions for first clinical improvement. Patients with previous application of plaster of Paris had increased success rates. CONCLUSION We find it practical, inexpensive, safe, and straightforward to combine SGB with IVRA for CRPS patients.
Collapse
Affiliation(s)
- Abdelkarim S. Aloweidi
- From the Department of Anesthesia and Intensive Care (Aloweidi, Abu Halaweh, Al-Mustafa, Massad, Qudaisat, El-Share, Jarbeh); from the Department of Orthopedics (Khanfar, Ajlouni Alhadidi), School of Medicine; and from the Department of Internal Medicine (Al-Oweidi), Faculty of Medicine, University of Jordan, Amman, Jordan.
| | - Sami A. Abu Halaweh
- From the Department of Anesthesia and Intensive Care (Aloweidi, Abu Halaweh, Al-Mustafa, Massad, Qudaisat, El-Share, Jarbeh); from the Department of Orthopedics (Khanfar, Ajlouni Alhadidi), School of Medicine; and from the Department of Internal Medicine (Al-Oweidi), Faculty of Medicine, University of Jordan, Amman, Jordan.
| | - Mahmoud M. Al-Mustafa
- From the Department of Anesthesia and Intensive Care (Aloweidi, Abu Halaweh, Al-Mustafa, Massad, Qudaisat, El-Share, Jarbeh); from the Department of Orthopedics (Khanfar, Ajlouni Alhadidi), School of Medicine; and from the Department of Internal Medicine (Al-Oweidi), Faculty of Medicine, University of Jordan, Amman, Jordan.
| | - Islam M. Massad
- From the Department of Anesthesia and Intensive Care (Aloweidi, Abu Halaweh, Al-Mustafa, Massad, Qudaisat, El-Share, Jarbeh); from the Department of Orthopedics (Khanfar, Ajlouni Alhadidi), School of Medicine; and from the Department of Internal Medicine (Al-Oweidi), Faculty of Medicine, University of Jordan, Amman, Jordan.
| | - Ibraheem Y. Qudaisat
- From the Department of Anesthesia and Intensive Care (Aloweidi, Abu Halaweh, Al-Mustafa, Massad, Qudaisat, El-Share, Jarbeh); from the Department of Orthopedics (Khanfar, Ajlouni Alhadidi), School of Medicine; and from the Department of Internal Medicine (Al-Oweidi), Faculty of Medicine, University of Jordan, Amman, Jordan.
| | - Aws M. Khanfar
- From the Department of Anesthesia and Intensive Care (Aloweidi, Abu Halaweh, Al-Mustafa, Massad, Qudaisat, El-Share, Jarbeh); from the Department of Orthopedics (Khanfar, Ajlouni Alhadidi), School of Medicine; and from the Department of Internal Medicine (Al-Oweidi), Faculty of Medicine, University of Jordan, Amman, Jordan.
| | - Jihad M. Ajlouni
- From the Department of Anesthesia and Intensive Care (Aloweidi, Abu Halaweh, Al-Mustafa, Massad, Qudaisat, El-Share, Jarbeh); from the Department of Orthopedics (Khanfar, Ajlouni Alhadidi), School of Medicine; and from the Department of Internal Medicine (Al-Oweidi), Faculty of Medicine, University of Jordan, Amman, Jordan.
| | - Shaher T. Alhadidi
- From the Department of Anesthesia and Intensive Care (Aloweidi, Abu Halaweh, Al-Mustafa, Massad, Qudaisat, El-Share, Jarbeh); from the Department of Orthopedics (Khanfar, Ajlouni Alhadidi), School of Medicine; and from the Department of Internal Medicine (Al-Oweidi), Faculty of Medicine, University of Jordan, Amman, Jordan.
| | - Ahmad I. El-Share
- From the Department of Anesthesia and Intensive Care (Aloweidi, Abu Halaweh, Al-Mustafa, Massad, Qudaisat, El-Share, Jarbeh); from the Department of Orthopedics (Khanfar, Ajlouni Alhadidi), School of Medicine; and from the Department of Internal Medicine (Al-Oweidi), Faculty of Medicine, University of Jordan, Amman, Jordan.
| | - Mohammad A. Jarbeh
- From the Department of Anesthesia and Intensive Care (Aloweidi, Abu Halaweh, Al-Mustafa, Massad, Qudaisat, El-Share, Jarbeh); from the Department of Orthopedics (Khanfar, Ajlouni Alhadidi), School of Medicine; and from the Department of Internal Medicine (Al-Oweidi), Faculty of Medicine, University of Jordan, Amman, Jordan.
| | - Anas A. Al-Oweidi
- From the Department of Anesthesia and Intensive Care (Aloweidi, Abu Halaweh, Al-Mustafa, Massad, Qudaisat, El-Share, Jarbeh); from the Department of Orthopedics (Khanfar, Ajlouni Alhadidi), School of Medicine; and from the Department of Internal Medicine (Al-Oweidi), Faculty of Medicine, University of Jordan, Amman, Jordan.
| |
Collapse
|
2
|
Alghanem SM, Massad IM, Almustafa MM, Al-Shwiat LH, El-Masri MK, Samarah OQ, Khalil OA, Ahmad M. Relationship between intra-operative hypotension and post-operative complications in traumatic hip surgery. Indian J Anaesth 2020; 64:18-23. [PMID: 32001904 PMCID: PMC6967359 DOI: 10.4103/ija.ija_397_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 06/19/2019] [Accepted: 09/03/2019] [Indexed: 12/04/2022] Open
Abstract
Background and Aims: The relationship between intra-operative hypotension and post-operative complications has been recently studied in non-cardiac surgery. Little is known about this relationship in traumatic hip surgery. Our study aimed to investigate this relationship. Methods: A retrospective study was conducted on patients who underwent surgical correction of traumatic hip fracture between 2010 and 2015. We reviewed the perioperative blood pressure readings and the episodes of intra-operative hypotension. Hypotension was defined as ≥30% decrease in the pre-induction systolic blood pressure sustained for ≥10 min. The relationship between intra-operative hypotension and post-operative complications was evaluated. Post-operative complications were defined as new events or diseases that required post-operative treatment for 48 h. Factors studied included type of anaesthesia, blood transfusion rate, pre-operative comorbidities and delay in surgery. We used the Statistical Package for Social Sciences (SPSS, IBM 25) to perform descriptive and non-parametric statistics. Results: A total of 502 patients underwent various types of traumatic hip surgery during the study period. Intra-operative hypotension developed in 91 patients (18.1%) and 42 patients (8.4%) developed post-operative complications. Significantly more patients with hypotension developed post-operative complications compared to patients with stable vitals (18.7% vs. 6.1; P < 0.001). There was no statistically significant difference in the incidence of post-operative complication in patients receiving general or spinal anaesthesia. Pre-operative comorbidities had no significant relationship with post-operative complications. Intra-operative blood transfusion was related to both intra-operative hypotension and post-operative complications. Conclusion: There was an association between intra-operative hypotension and post-operative complications in patients undergoing traumatic hip surgery.
Collapse
Affiliation(s)
- Subhi M Alghanem
- Department of Anesthesiology, Faculty of Medicine, The University of Jordan, Amman, Jordan
| | - Islam M Massad
- Department of Anesthesiology, Faculty of Medicine, The University of Jordan, Amman, Jordan
| | - Mahmoud M Almustafa
- Department of Anesthesiology, Faculty of Medicine, The University of Jordan, Amman, Jordan
| | - Luma H Al-Shwiat
- Department of Anesthesiology, Faculty of Medicine, The University of Jordan, Amman, Jordan
| | - Mohammad K El-Masri
- Department of Anesthesiology, Faculty of Medicine, The University of Jordan, Amman, Jordan
| | - Omar Q Samarah
- Department of Orthopedic, Faculty of Medicine, The University of Jordan, Amman, Jordan
| | - Osama A Khalil
- Department of Orthopedic, Faculty of Medicine, The University of Jordan, Amman, Jordan
| | - Muayyad Ahmad
- Department of Clinical Nursing, Faculty of Nursing, The University of Jordan, Amman, Jordan
| |
Collapse
|
3
|
Salameh MA, Shatarat AT, Badran DH, Abu-Abeeleh MA, Massad IM, Bani-Hani AM. The best vein to be accessed based on descriptive study of dorsal metacarpal vein. Anat Cell Biol 2019; 52:390-396. [PMID: 31949977 PMCID: PMC6952693 DOI: 10.5115/acb.19.142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 08/21/2019] [Accepted: 08/23/2019] [Indexed: 11/27/2022] Open
Abstract
It is well known that the most common sites for venous access are the superficial veins of the upper limb, particularly dorsal metacarpal veins and median cubital vein. Although dorsal metacarpal veins are the first choice for venous cannulation, there is scarce information about their anatomic variation. Hence, detailed anatomical information about these veins will improve the anatomic knowledge of the health care providers. Subsequently, this study was designed to study the dorsal metacarpal veins and to determine the most prominent dorsal metacarpal vein. A cross sectional study of 402 subjects (804 hands), was prepared to study the superficial veins on the dorsum of the hand among Jordanian students and staff of one of the major governmental medical colleges in Jordan, by using infrared illumination system. The obtained data was analyzed according to sex, sidedness, and handedness. Six locations of the most prominent dorsal metacarpal veins were identified. There was a significant relation between both females and males and the most prominent dorsal metacarpal vein (P=0.01). For the first time this study identified the most common location of the most prominent dorsal metacarpal vein in the fourth intermetacarpal space.
Collapse
Affiliation(s)
- Muna A Salameh
- Department of Basic Medical Science, Faculty of Medicine, Al Balqa Applied University, Al Salt, Jordan
| | - Amjad T Shatarat
- Department of Anatomy and Histology, Faculty of Medicine, University of Jordan, Amman, Jordan
| | - Darwish H Badran
- Dean of the Faculty of Medicine, Hashemite University, Zarqa, Jordan
| | - Mhmoud A Abu-Abeeleh
- Department of General Surgery, Faculty of Medicine, University of Jordan, Amman, Jordan
| | - Islam M Massad
- Department of Anesthesia and Intensive Care, Faculty of Medicine, University of Jordan, Amman, Jordan
| | - Amjad M Bani-Hani
- Department of General Surgery, Faculty of Medicine, University of Jordan, Amman, Jordan
| |
Collapse
|
4
|
Al-Mustafa MM, Al Oweidi AS, Al-Zaben KR, Qudaisat IY, Abu-Halaweh SA, Al-Ghanem SM, Massad IM, Samarah WK, Al-Shaer RA, Ismail SI. Remifentanil consumption in septoplasty surgery under general anesthesia. Association with humane mu-opioid receptor gene variants. Saudi Med J 2017; 38:170-175. [PMID: 28133690 PMCID: PMC5329629 DOI: 10.15537/smj.2017.2.16348] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Objectives: To evaluate the influence of the ORM1 variants in codon 118 on the intra-operative remifentanil consumption under general anesthesia. Methods: A prospective gene association study, performed at the Jordan University Jordan, Amman, Jordan from September 2013 to August 2014. It includes patients who underwent septoplasty surgery under general anesthesia. All patients received standard intravenous anesthesia. Anesthesia maintained with fixed dose of Sevoflurane and variable dose of Remifentanil to keep the systolic blood pressure between 90-100 mm Hg. The Remifentanil dose was calculated and correlated with ORM1 genotype variance. Results: Genotype and clinical data were available for 123 cases. The A118A genotype was seen in 96 patients (78%), the A118G genotype was seen in 25 patients (20.3%), and only 2 patients had genotype G118G (1.6%). The G118G variant was removed from the statistical analysis due to small sample size. There was a significant effect of ORM1 genotype variant and the amount of remifentanil consumed. The A118A genotype received 0.173 ± 0.063 µg kg-1 min-1 and the A118G genotype received 0.316 ± 0.100 µg kg-1 min-1 (p<0.0001). Conclusion: The ORM1 gene has a role in intra-operative remifentanil consumption in patients who underwent septoplasty surgery under general anesthesia. The A118G gene required higher dose of remifentanil compared with the A118A genotype.
Collapse
Affiliation(s)
- Mahmoud M Al-Mustafa
- Department of Anesthesia and Intensive Care, Jordan University Hospital, The University of Jordan, Amman, Jordan. E-mail.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
5
|
Elmegarhi SS, Amarin JZ, Hadidi MT, Badran DH, Massad IM, Bani-Hani AM, Shatarat AT. Dorsal metacarpal veins: anatomic variation and potential clinical implications. Anat Sci Int 2017; 93:238-243. [PMID: 28417223 DOI: 10.1007/s12565-017-0403-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 03/26/2017] [Indexed: 11/26/2022]
Abstract
The dorsal metacarpal veins are frequently cannulated. Cannulation success is determined by several variable anatomic features. The objective of this study is to classify, for the first time, the anatomic variants of the dorsal metacarpal veins. In this cross-sectional study, 520 university students and staff were conveniently recruited. The dorsal metacarpal veins in 1040 hands were studied. Venous visibility was enhanced by either tourniquet application or near-infrared illumination. Variant patterns of the dorsal metacarpal veins were classified. The final analysis included 726 hands, for an exclusion rate of 30 %. Eight pattern types were identified. Three anatomic features informed the variation. Bilateral symmetry of the dorsal metacarpal veins was present in 352 participants (83 % of the total). The overall frequency distribution of variants in both hands was similar (P = 0.8). The frequency distribution of variants was subject to sexual dimorphism (P = 0.001), ethnic variation (P < 0.001), and technical variation (P < 0.001). The anatomic variants of the dorsal metacarpal veins were sorted into decreasingly frequent primary, secondary, and tertiary groups. The groups may signify a progressive increase in difficulty of peripheral cannulation, in the mentioned order. As such, primary patterns are the most common and likely the easiest to cannulate, while tertiary patterns are the least common and likely the most difficult to cannulate. The preceding premise, in tandem with the bilateral asymmetry of the veins, is clinically significant. With cannulation difficulty likely signifying an underlying tertiary pattern, the contralateral dorsal metacarpal veins are probabilistically characterized by a primary pattern and are, as such, the easier option for peripheral venous cannulation.
Collapse
Affiliation(s)
- Sara S Elmegarhi
- Department of Anatomy and Histology, School of Medicine, University of Jordan, Queen Rania Al-Abdullah Street, Amman, 11942, Jordan
| | - Justin Z Amarin
- School of Medicine, University of Jordan, Queen Rania Al-Abdullah Street, Amman, 11942, Jordan
| | - Maher T Hadidi
- Department of Anatomy and Histology, School of Medicine, University of Jordan, Queen Rania Al-Abdullah Street, Amman, 11942, Jordan
| | - Darwish H Badran
- Department of Anatomy and Histology, School of Medicine, University of Jordan, Queen Rania Al-Abdullah Street, Amman, 11942, Jordan
| | - Islam M Massad
- Department of Anesthesia and Intensive Care, School of Medicine, University of Jordan, Queen Rania Al-Abdullah Street, Amman, 11942, Jordan
| | - Amjad M Bani-Hani
- Department of General Surgery, School of Medicine, University of Jordan, Queen Rania Al-Abdullah Street, Amman, 11942, Jordan
| | - Amjad T Shatarat
- Department of Anatomy and Histology, School of Medicine, University of Jordan, Queen Rania Al-Abdullah Street, Amman, 11942, Jordan.
| |
Collapse
|
6
|
Almustafa MM, Al-Oweidi AS, Al-Zaben KR, Qudaisat IY, Abu-Halaweh S, Alghanem SM, Massad IM, Samarah W, Al-Shaer RA, Ismail S, Khazawla F. Ephedrine requirements during spinal anesthesia for cesarean delivery in Jordanian parturients: association with b2 adrenoceptor gene variants. Ann Saudi Med 2016; 36:29-36. [PMID: 26922685 PMCID: PMC6074272 DOI: 10.5144/0256-4947.2016.29] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Maternal hypotension after spinal anesthesia for cesarean delivery is common. Many studies performed on the b2-adrenoceptor (b2AR) gene variants and their association with vasopressor requirements during and after neuroaxial block have contradictory conclusions. OBJECTIVES The aim of the study was to evaluate the influence of the b2AR in codons 16 and 27 on the incidence of maternal hypotension and ephedrine consumption after spinal anesthesia for cesarean delivery in an Arab ethnic group. DESIGN A prospective gene association study. SETTING Jordan University Hospital from 1 July 2013 to 31 January 2014. PATIENTS AND METHODS We enrolled parturients who underwent cesarean delivery under spinal anesthesia. Spinal anesthesia was performed with 10 mg plain bupivacaine along with 25 micro g fentanyl. Hypotension was treated with ephedrine and the amount consumed in the first 30 minutes after spinal anesthesia was calculated. The b2AR genotype at codons 16 and 27 was determined. We studied the correlation between the b2AR genotype and the amount of ephedrine consumption after spinal anesthesia. MAIN OUTCOME MEASURES Amount of ephedrine used. RESULTS Of 250 patients enrolled in the study, genotype and clinical data were available for 234 cases. Ephedrine was used in 94% of patients. There was a significant effect of b2AR genotype on ephedrine dose in the first 30 minutes after spinal anesthesia in codon 16 and 27. Arg16 homozygotes received less ephedrine (14.0 [11.2] mg) than Gly16 homozygotes (38.6 [25.7] mg) and Arg16Gly heterozygotes (33.42 [22.70] mg) (P < .0001). Gln27 homozygotes received less ephedrine (18.2 [12.8] mg) than Glu 27 homozygotes (47.5 [27.0] mg) and Gln27Glu heterozygotes (48.2 [23.7] mg). (P < .0001). CONCLUSION In an Arab ethnic group, the b2AR gene has a role in maternal hypotension after spinal anesthesia. The Gly16 and Glu27 alleles have a higher incidence of arterial hypotension and required a greater amount of vasopressor to treat hypotension compared with homozygous Arg16 and Gln27 carriers. LIMITATIONS Fasting time and hydration protocol, the use of a fixed dose of ephedrine, and relatively small sample size.
Collapse
Affiliation(s)
- Mahmoud M Almustafa
- Associate Professor Mahmoud Mansour Almustafa, King Faisal Specialist Hospital and Research Center,, Anesthesia Department MBC 22, PO Box 3354 Riyadh,11211,, Saudi Arabia, T: 966 146 47272 Ext: 32700,
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
7
|
Massad IM, Mahafza TM, Abu-Halawah SA, Attyyat BA, Al-Ghanem SM, Almostafa MM, Sal-Oweidi AS. Postoperative pain is undertreated: results from a local survey at Jordan University Hospital. East Mediterr Health J 2013; 19:485-489. [PMID: 24617129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Postoperative pain management is nowadays considered an integral part of modern surgical practice. An audit was made in 2010 to assess the status of acute postoperative pain management at Jordan University Hospital. Data were collected from patients' files and through face-to-face interviews of all patients aged over 16 years who underwent general, gynaecological, ear-nose-throat and orthopaedic surgery. Of 275 patients, 72.0% experienced moderate to severe pain postoperatively at rest and 89.3% on movement. No analgesics were prescribed to 4.7% of the patients and of the remainder, a single analgesic was prescribed to 51.5%. Pethidine and paracetamol were the drugs most commonly prescribed (to 66.9% and 42.5% of patients respectively), most often on a regular schedule rather than on-demand. Despite improvements in pain management worldwide, patients at this hospital were still suffering from postoperative pain. Awareness among professionals and the public is needed and a structured acute pain management programme is essential.
Collapse
|
8
|
Al-Mustafa MM, Massad IM, Al-Ghanem SM, Badran IZ. Horner's syndrome after lumbar epidural analgesia during labor. Middle East J Anaesthesiol 2010; 20:727-729. [PMID: 20803864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Horner's syndrome is rarely reported after epidural analgesia during labor. The use of Top-Up local anesthetic for controlling labor pain in the first stage of labor, or to dense the block in caesarean deliveries can result in this complication. We reported a cases of Horner's syndrome during epidural analgesia in labor in spite of not giving any Top-Up dose. The case was clinically evident and was successfully managed by stopping the epidural infusion, and reassuring the parturient as well as the family; until the disappearance of the signs and symptoms. The infusion was then restarted, delivery was uneventful and no consequent neurological or psychological problems were noticed after a one-month follow-up.
Collapse
Affiliation(s)
- Mahmoud M Al-Mustafa
- Department of Anesthesia and Intensive Care, Jordan University Hospital, University of Jordan, Amman-Jordan.
| | | | | | | |
Collapse
|
9
|
Al Oweidi AS, Klasen J, Al-Mustafa MM, Abu-Halaweh SA, Al-Zaben KR, Massad IM, Qudaisat IY. The impact of long-lasting preemptive epidural analgesia before total hip replacement on the hormonal stress response. A prospective, randomized, double-blind study. Middle East J Anaesthesiol 2010; 20:679-684. [PMID: 20803856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
UNLABELLED Recent studies suggest that preemptive analgesia may be effective in reducing postoperative pain. One physiologic explanation may be interference with the endogenous opioid response. We investigated whether long-lasting preoperative preemptive analgesia may have an effect on the hormonal stress response after total hip replacement. METHODS 42 patients scheduled for elective hip replacement for coxarthrosis were randomized to receive, on the day before the operation, either 5 ml*h(-1) ropivacaine 0.2% (study group, n = 21) or 5 ml*h(-1) saline (control group, n = 21). Postoperative analgesia was achieved in both groups by patient-controlled epidural analgesia (PCEA) with ropivacaine 0.2%. The main outcome measure was the concentration of authentic beta-endorphin [1-31] in plasma up to 4 days after surgery. Additional parameters included concentrations of adrenocorticotrope hormone and cortisol. RESULTS Both groups were comparable concerning preoperative parameters and pain scores. Epidural blocks were sufficient in all patients for operative analgesia. Preemptive analgesia was performed for 11-20 hours in both groups and led to significantly decreased pain scores before surgery. Preemptive analgesia with epidural ropivacaine did not lead to decreased concentrations of beta-endorphin [1-31] before the start of surgery or in the postoperative period. Furthermore, no differences could be detected in the time course of beta-endorphin and adrenocorticotrope hormone after surgery. However, cortisol concentrations differed significantly between groups before the operation, but showed a comparable rise after surgery. CONCLUSION Differences in postoperative pain after preemptive analgesia do not seem to be due to an altered endogenous opioid response.
Collapse
Affiliation(s)
- Abdelkarim S Al Oweidi
- Department of Anesthesiology and Intensive Care Medicine, Jordan University, Queen Rania Street, PO BOX 13046, Amman 11942, Jordan.
| | | | | | | | | | | | | |
Collapse
|
10
|
Massad IM, Mohsen WA, Basha AS, Al-Zaben KR, Al-Mustafa MM, Alghanem SM. A balanced anesthesia with dexmedetomidine decreases postoperative nausea and vomiting after laparoscopic surgery. Saudi Med J 2009; 30:1537-1541. [PMID: 19936416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
OBJECTIVE To evaluate the effect of adding dexmedetomidine to a balanced anesthetic technique on postoperative nausea and vomiting after laparoscopic gynecological surgeries. METHODS A prospective double-blind randomized study was designed at Jordan University Hospital, Amman, Jordan between December 2008 and February 2009. Eighty-one female patients in their child-bearing age (17-48 years); American Society of Anesthesiologists (ASA) clinical status I, who were scheduled for elective diagnostic laparoscopic surgeries under general anesthesia were divided into 2 groups. Group D (n=42) received dexmedetomidine infusion, while group P (n=39) received 0.9% sodium chloride infusion along with the balanced anesthesia. The incidence of early (up to 24 hours) postoperative nausea, vomiting, nausea and vomiting, and the need for postoperative rescue anti-emetic medications were recorded. RESULTS The total incidence of postoperative nausea and vomiting decreased significantly in group D; 13 out of 42 patients (31%), compared to group P; 23 out of 39 patients (59%), vomiting alone did not significantly change, the incidence of postoperative nausea, and the use of rescue anti-emetic medications were significantly different. A significant drop in overall consumption of fentanyl and sevoflurane was also noted in group D. CONCLUSION Combining dexmedetomidine to other anesthetic agents, results in more balanced anesthesia and a significant drop in the incidence of postoperative nausea and vomiting after laparoscopic gynecological surgeries.
Collapse
Affiliation(s)
- Islam M Massad
- Department of Anesthesia and Intensive Care, Faculty of Medicine and Jordan University Hospital, PO Box 13046, Amman 11492, Jordan.
| | | | | | | | | | | |
Collapse
|
11
|
Al-Ghanem SM, Massad IM, Al-Barazangi B, Al-Mustafa M, Daoud FS, Abu-Ali H. Effects of sevoflurane on postoperative liver functions in morbidly obese as compared to the non-obese patients. Middle East J Anaesthesiol 2009; 20:207-211. [PMID: 19583067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To assess the effect of sevoflurane anesthesia on hepatic function in morbidly obese versus non-obese patients undergoing abdominal surgeries. METHODS We prospectively evaluated the levels of the serum concentration of liver enzymes aspartate aminotransferase (AST), alanine aminotransferase (ALT), lactate dehydrogenase (LDH), gamma glutamyl transferase (GGT), alkaline phosphatase (ALP), and total bilirubin (TBil), in 42 morbidly obese and 40 non obese patients who were scheduled for elective abdominal surgery under sevoflurane anesthesia at the Jordan University Hospital, Amman, Jordan. Measurement of liver enzymes was done in the recovery room, and on the first, 3 and 7 days after sevoflurane anesthesia, and the results were compared between the morbidly obese and non obese patients. RESULTS ALT, AST, GGT and LDH increased significantly in the morbidly obese than they did in non obese patients. In morbidly obese patients TBil increased gradually peaking 7 days after anesthesia, LDH increased in the recovery room, AST and ALT increased in the recovery room and first day, while GGT increased 7th day after anesthesia. In non obese patients, AST, LDH increased in the recovery. ALP did not change in both groups. CONCLUSION Sevoflurane induces elevation of the serum liver enzymes in morbidly obese patients with variable onsets.
Collapse
Affiliation(s)
- Subhi M Al-Ghanem
- Dept. of Anesthesia & Intensive Care, Faculty of Medicine, Univ. of Jordan, Amman, Jordan.
| | | | | | | | | | | |
Collapse
|
12
|
Al-Ghanem SM, M. Massad I, Al-Mustaf MM, Al-Zaben KR, Y. Qudaisa I, M. Qatawn A, Abu-Ali HM. Effect of Adding Dexmedetomidine versus Fentanyl to Intrathecal Bupivacaine on Spinal Block Characteristics in Gynecological Procedures: A Double Blind Controlled Study. ACTA ACUST UNITED AC 2009. [DOI: 10.3844/ajas.2009.882.887] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
13
|
Al-Smady M, Hammdan FF, Abu-Abeeleh MM, Massad IM. Incidental invasive thymoma during coronary artery bypass surgery. Saudi Med J 2009; 30:140-142. [PMID: 19139788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
We encountered 2 incidental cases of invasive thymomas at Jordan University Hospital, Amman, Jordan; during routine coronary artery bypass graft surgery between 2005 and 2008 with an incidence of 0.6%. Both patients presented with angina pain. None of the 2 patients had pressure symptoms (cough, shortness of breath or superior vena cava syndrome) or Myasthenia Gravis symptoms. Total thymectomy with dissection of perithymic fat was performed on both cases. No radiotherapy was given. No recurrence of the tumor was seen in 2 years follow up. These cases are presented to emphasize the occurrence of this tumor.
Collapse
Affiliation(s)
- Moaath Al-Smady
- Department of General Surgery, Division of Cardiothoracic and Vascular Surgery, University of Jordan, PO Box 13046, Amman 11942, Jordan.
| | | | | | | |
Collapse
|
14
|
Massad IM, Abu-Ali HM, Al-Ghanem SA, Badran IZ, Ammari BA, Daradkeh SS. Duration of venous occlusion with lidocaine for preventing propofol induced pain. Saudi Med J 2008; 29:971-974. [PMID: 18626523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
OBJECTIVE To study the effect of the venous occlusion duration using lidocaine on the incidence and severity of propofol induced pain. METHODS A prospective double-blind randomized study was designed at Jordan University Hospital, Amman, Jordan between October 2007 and November 2007. One hundred and fifty patients aged 14-70 years, American Society of Anesthesiologists (ASA) clinical status I and II who underwent elective surgeries under general anesthesia, were divided into 3 groups. All 3 groups had propofol 1% infusion at a constant rate after applying venous occlusion with lidocaine. The occlusion was applied for 15 seconds (group I, n=50), 30 seconds (group II, n=50) and 60 seconds (group III, n=50). Pain was assessed during injection according to a verbal pain score. RESULTS Fourteen patients 28% had pain in group I, compared to 16 patients 32% in group II, and 9 patients 18% in group III. This difference did not reach statistical significance p>0.05 for the incidence and severity of pain. CONCLUSION While venous occlusion with lidocaine is an effective method in relieving propofol induced pain, we found no difference when the duration of venous occlusion was 15, 30, or 60 seconds.
Collapse
Affiliation(s)
- Islam M Massad
- Department of Anesthesia and Intensive Care, The University of Jordan, Jordan University Hospital, PO Box 13046, Amman, Jordan.
| | | | | | | | | | | |
Collapse
|
15
|
Abu-Halaweh SA, Massad IM, Abu-Ali HM, Badran IZ, Barazangi BA, Ramsay MA. Rapid sequence induction and intubation with 1 mg/kg rocuronium bromide in cesarean section, comparison with suxamethonium. Saudi Med J 2007; 28:1393-6. [PMID: 17768467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023] Open
Abstract
OBJECTIVE To demonstrate that Rocuronium Bromide can be used for rapid sequence induction in emergency conditions. METHODS Our study was performed between December 2005 and May 2006 in Jordan University Hospital, Jordan. We studied the efficacy and intubating conditions after administrating of Rocuronium Bromide 1 mg/kg at 60 second in group of 60 pregnant women undergoing elective or emergency cesarean section and compared the results with those obtained after giving Suxamethonium 1 mg/kg at 60 seconds in a group of patients similar to the Rocuronium group. RESULTS Intubating conditions after 1 mg /kg of Rocuronium Bromide were found to be acceptable (good and excellent) in 95% of patients and were similar to the Suxamethonium group (97%). The endotracheal tube could be passed through the vocal cards of all patients enrolled in the study. CONCLUSION Rocuronium Bromide 1 mg/kg can be safely used for rapid sequence induction in cesarean section and the intubating conditions are similar to those of Suxamethonium.
Collapse
Affiliation(s)
- Sami A Abu-Halaweh
- Department of General Surgery, Anesthesia and Intensive Care, College of Medicine, University of Jordan, PO Box 13046, Amman 11942, Jordan.
| | | | | | | | | | | |
Collapse
|
16
|
Massad IM, Khadra MM, Alkazaleh FA, Qatawneh AM, Saleh SS, Abu-Halaweh SA. Bupivacaine with meperidine versus bupivacaine with fentanyl for continuous epidural labor analgesia. Saudi Med J 2007; 28:904-8. [PMID: 17530108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023] Open
Abstract
OBJECTIVE To compare the efficacy of bupivacaine-meperidine and bupivacaine-fentanyl mixtures when continuously infused epidurally to relief the labor pain. METHODS We performed this prospective double-blinded study at Jordan University Hospital, Amman, Jordan between October 2005 and April 2006. Sixty-seven American Society of Anesthesia physical status I parturients were randomly divided into 2 groups, Group M (n=34) received a continuous infusion of 1 mg/ml of bupivacaine mixed with 1 mg/ml meperidine, and Group F (n=33) received a continuous infusion of 1 mg/ml bupivacaine mixed with 2 micrometer/ml fentanyl. Efficacy of analgesia, degree of motor block, hemodynamic variability, incidence of nausea and vomiting, pruritus, sedation, and the neonatal outcome were all compared between the 2 groups. A p value <0.05 was considered to be significant. RESULTS Highly effective analgesia was achieved in both groups with a similar incidence of motor block, sedation, pruritus, and neonatal outcome. The only significant difference was in the incidence of nausea and vomiting. Group M had 8 parturients with nausea, compared with only 2 parturients in Group F (p=0.003). CONCLUSION Bupivacaine-meperidine in a continuous epidural infusion is as efficient as bupivacaine-fentanyl for pain relief during labor, but associated with a higher incidence of nausea and vomiting.
Collapse
Affiliation(s)
- Islam M Massad
- Department of General Surgery, Anesthesia and Intensive Care, University of Jordan, Jordan University Hospital, PO Box 13046, Amman, Jordan.
| | | | | | | | | | | |
Collapse
|
17
|
Massad IM, Abu-Ali HM, Abu-Halaweh SA, Badran IZ. Venous occlusion with lidocaine for preventing propofol induced pain. A prospective double-blind randomized study. Saudi Med J 2006; 27:997-1000. [PMID: 16830018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023] Open
Abstract
OBJECTIVE Pain is a well-known complication of intravenous administration of propofol, and to find out the optimal method to decrease this pain, we studied 4 methods of delivering propofol. METHODS The study took place at Jordan University Hospital, Amman, Jordan between November 2004 and March 2005 on 200 patients. The patients were divided into 4 groups, group I (n=50), the control group, propofol 1% was given alone. Group II (n=50), patients received propofol 1% premixed with 40 mg of lidocaine. Group III (n=50), patients received propofol 1% 60 seconds after giving 40 mg of lidocaine. Group IV (n=50), patients had venous occlusion for 60 seconds with the use of lidocaine 1% (40 mg), followed by release of the occlusion and administration of the propofol. Pain was assessed during injection and categorized into: no pain, pain, and pain with behavioral changes. RESULTS In group I (control), 35 patient complained of pain, compared to 26 in group II, 23 in group III, and 7 patients in group IV, with a significant reduction in the incidence and intensity of pain in group II, III, and IV compared with the control (p<0.005). The best reduction of intensity and incidence was achieved in group VI, when compared with groups I, II and III (p<0.005), with no statistical difference between group II and III when compared with each other. CONCLUSION Of the 4 methods studied, the optimal method to decrease the incidence and intensity of pain resulting from propofol injection is to inject lidocaine while applying venous occlusion for 60 seconds prior to administering propofol.
Collapse
Affiliation(s)
- Islam M Massad
- Department of General Surgery, Division of Anesthesia and Intensive Care, Jordan University Hospital, PO Box 13046, Amman 11942, Jordan.
| | | | | | | |
Collapse
|