Dexmedetomidine as an adjuvant to bupivacaine in ultrasound fascia iliaca compartment block in proximal end femur surgeries

Background: Fracture neck femur is a common cause of hospital admission among the elderly population. Many patients admitted with fracture femur have long-standing cardiac, hepatic or renal problems. This makes a challenge to balance adequate analgesia with side effects of opioids. Fascia iliaca compartment block (FICB) is one of the peripheral nerve block techniques. It became widely used in providing postoperative analgesia for patient with fracture neck femur either in emergency department or in the operating room.Objective: To evaluate the efficacy of addition of dexmedetomidine to bupivacaine on the duration and quality of postoperative analgesia in ultrasound guided fascia iliaca compartment block in proximal end femur surgeries.Patients and methods: Sixty patients with American Society of Anesthesiologists (ASA) physical status I - II of both sexes aged from 20-60 years scheduled for proximal end femur surgeries. They were randomly assigned to one of two equal groups (n=30 each), using closed envelope technique: Bupivacaine group (B group), and Bupivacaine + dexmedetomidine (BD group). Result: Our study demonstrated prolongation of postoperative analgesia in bupivacaine-dexmedetomidine group (BD) compared to bupivacaine group (B). It showed statistically significant reduction in cumulative pethidine doses and prolongation in the time till first rescue analgesic is required in the BD group in comparison with the B group in the first 24 hours. Hemodynamic changes and incidence of side effects, were statistically insignificant among the two groups. Conclusion: Addition of dexmedetomidine, as an adjuvant to the local anesthetic bupivacaine, in ultrasound fascia iliaca compartment block provides prolongation of the duration of postoperative analgesia with less opioid consumption without remarkable side effects

Norepinephrine boluses for the prevention of post-reperfusion syndrome in living donor liver transplantation: A prospective, open-label, single-arm feasibility trial

Background and Aims: Post-reperfusion syndrome (PRS) is a serious haemodynamic event during liver transplantation (LT), which increases early graft dysfunction and mortality. This study aimed to test the efficacy and safety of norepinephrine (NE) boluses to prevent PRS during orthotopic LT. Methods: This feasibility phase II trial prospectively recruited a single arm of 40 patients undergoing living donor LT. The intervention was an escalated protocol of NE boluses starting at 20 μg. The primary outcome was the incidence of PRS. The secondary outcomes were arrhythmia, electrocardiographic (EKG) ischaemic changes, mean pulmonary pressure after reperfusion, 3-month survival and 1-year survival. Results: PRS occurred in 28 (70%) cases [95% confidence interval (CI) 54% to 83%, P < 0.001], with a relative risk reduction of 0.22 when compared to our previous results (90%). Twelve cases developed transient EKG ischaemic changes. All EKG ischaemic changes returned to baseline after correction of hypotension. There was no significant arrhythmia or bradycardia (95% CI 0 to 0.9). After reperfusion, the mean pulmonary artery pressure was not significantly higher than the normal limit (20 mmHg) (P = 0.88). The 3-month survival was 0.95 (95% CI 0.83 to 0.99), and the 1-year survival was 0.93 (95% CI 0.8 to 0.98). Conclusion: Our findings suggest that NE boluses starting with 20 μg is feasible and effective in lowering the risk of PRS during living donor LT. Additionally, NE boluses were not associated with significant myocardial ischaemic events, arrhythmia or a rise in pulmonary pressure