Comparison of Post-Operative Analgesic Effects of Peritonsillar Infiltration of Dexmedetomidine, Lidocaine or Both in Children Following Tonsillectomy

Background: Peritonsillar infiltration of local anesthetics has efficient pain relief in children undergoing tonsillectomy. We hypothesize that lidocaine plus dexmedetomidine will potentiate the analgesic effect of each other rather than. Objectives: This study aimed to compare the analgesic effect of peritonsillar infiltration of lidocaine, dexmedetomidine, or lidocaine/dexmedetomidine on post-tonsillectomy pain. The primary outcome is the time of analgesia. The secondary outcomes are postoperative pain score, the effect of study medications on postoperative hemodynamic, and complications. Patients and Methods: Ninety patients were randomly allocated to three groups, 30 patients each. L group, patients received 2mg/kg lidocaine. D group, patients received 1 μg/kg of dexmedetomidine. LD group, patients received 1 μg/kg of dexmedetomidine plus 2 mg/kg lidocaine. Results: The time of the first analgesia request (h.) was longer in the LD group (13.70 ± 2.91) when compared with the L and D groups. Postoperative pain score was significantly lower in LD and D groups compared with the L group (P <0.05) On the other hand, there was a significantly lower median VAS score in the LD group when compared with the D group (P1 <0.05) Postoperative paracetamol consumption was significantly lower in LD group (0.55 ± 0.51 gm/24h) when compared with D and L groups (0.65 ± 0.59, 2.25 ± 0.44 gm/24h respectively). Conclusion: the use of lidocaine with dexmedetomidine is better than using each drug alone in decreasing posttonsillectomy pain and increasing the time to first request for analgesia with no significant postoperative side effects

Analgesic Effect of Intra-Articular Dexamethasone versus Fentanyl added as an adjuvant to Bupivacaine for Postoperative Pain Relief in Knee Arthroscopic Surgery

Background: Knee arthroscopy is usually associated with a variable degree of pain ranging from moderate-to-severe pain in about 70% of patients. Objective: This trial was designed to assess the efficacy of intra-articular administration of dexamethasone versus fentanyl as adjuncts to bupivacaine in patients undergoing arthroscopic knee surgery. Patients and methods: Eighty-nine patients of either sex were enrolled in this study. The patients were randomly divided into three equal groups. Group F that received intra-articular (IA) injection of 1 μg/kg fentanyl (In 2 ml saline) added to 18 ml of 0.25% bupivacaine, group D, which received IA injection of 8 mg (2 ml) dexamethasone added to 18mL of 0.25% bupivacaine and group S that received IA injection of 2 ml normal saline added to 18 mL of 0.25% bupivacaine. Results: The time required for the first request of analgesia in group F, group D, and group S was 5.7 ± 0.7 vs 4.5 ± 0.5 vs 3.3 ± 0.5 hours respectively. There were significant differences between both treatment groups and the control group (p < 0.001) and in between both treatment groups (p < 0.001) in favor of group F. There was a significantly lower median visual analogue score in group F when compared to group D and S at 6 hours (p = 0.006 & 0.01, respectively), 12 hours (p < 0.001 & < 0.001, respectively), and 18 hours (p = 0.003 & 0.007, respectively) postoperatively. Conclusion: The addition of fentanyl or dexamethasone to IA bupivacaine in knee arthroscopic surgery provided a better quality of analgesia with less consumption of systemic analgesics without significant adverse effects