Papers by Ahmad Abd El-Rahman
Local and Regional Anesthesia
A subcostal flank incision is required for open radical nephrectomy, which is a surgical procedur... more A subcostal flank incision is required for open radical nephrectomy, which is a surgical procedure used to remove tumors of the kidney that are malignant. The erector spinae plane block (ESPB) and continuous catheter use in children are receiving more and more support by paediatric regional anaesthesiologists. Our objective was to compare systemic analgesic to continuous ESPB for pain relief in paediatric patients undergoing open radical nephrectomy. Methods: Sixty children with cancer ASA I or II and undergoing open radical nephrectomy between the ages of two and seven participated in this prospective, randomized, controlled, and open label study. The cases were divided into two equal groups (E and T groups); Group E received ipsilateral continuous ultrasound-guided ESPB at T 9 (thoracic vertebrae), with a bolus of 0.4 mL/kg bupivacaine 0.25%. Immediately postoperatively, Group E (ESPB group) received continuous ESPB with a PCA (patient controlled analgesia) pump at a rate of 0.2 mL/kg/hour bupivacaine 0.125%. Group T (Tramadol group), Tramadol hydrochloride was administered intravenously at a dose of 2 mg/kg/8hour, which could be increased to 2 mg/kg/6hours. Then, we followed up on patients' total analgesic consumption for 48 hours following surgery, as well as the time it took for them to request rescue analgesic, their FLACC and sedation scores, and their hemodynamics and side effects immediately following surgery as well as at 2, 4, 6, 8, 12, 18, 24, 36, and 48 hours. Results: A highly significant difference in total tramadol consumed in group T 11.97 ± 1.13 mg/kg while group E was 2.07± 1.54 mg/ kg (p < 0.001). 100% patients in group T requested analgesia compared to 46.7% patients in group E (p < 0.001). From 2 to 48 hour, FLACC significantly decreased in E compared to T group (p≤ 0.006) at all-time points. Conclusion: Ultrasound-guided continuous ESPB significantly provided better postoperative pain relief, reduced postoperative tramadol consumption and reduced pain scores compared with the use of tramadol alone, in paediatric cancer patients undergoing nephrectomy.
Journal of Pain Research, 2020
Background: Serratus anterior plane (SAP) block, a novel regional anesthetic procedure, involves ... more Background: Serratus anterior plane (SAP) block, a novel regional anesthetic procedure, involves the anterolateral chest wall. Opioid receptors have been found on peripheral nerve terminals, so morphine may have a local action. Objective: This work aimed at exploring the analgesic efficacy of morphine added to bupivacaine in SAPB in patients for whom modified radical mastectomy was conducted and whether it is a mere local effect. Methods: Forty female patients were planned to have modified radical mastectomy participated in the study. Patients were randomly divided into two groups; Control group (C): received ultrasound-guided serratus anterior plane block with 20 mL of bupivacaine hydrochloride 0.25%; Morphine group (M): received the same in addition to 10 mg morphine sulfate. Intra-and postoperative blood samples were taken for the assessment of morphine serum levels. All patients were assessed for VAS scores during rest and movement (VAS-R and VAS-M). Time to the first request and the total amount of the rescue analgesia were recorded. Results: In group M, Morphine was not detected in the plasma of all patients. Both VAS-R and VAS-M were significantly higher in group C than in group M (P<0.001) and (P≤0.003), respectively. Time to the first request of rescue analgesia was 8.5 h in group C compared to 20 h in group M (P=0.005) with a median dose of acetaminophen consumption of 2 g in group C compared to 1 g in group M (P=0.006). Conclusion: Ten mg of morphine, when added to bupivacaine in SAPB, improved postoperative analgesia in patients to whom modified radical mastectomy was conducted. This effect seems to be attributed merely to local mechanisms. Registration: The registration number of this study is NCT02962024 at www.clinicaltrial. gov.
Open Journal of Anesthesiology, 2021
Background: Poor postoperative pain control leads to longer postoperative care, longer hospital s... more Background: Poor postoperative pain control leads to longer postoperative care, longer hospital stay and decreased patient overall satisfaction. Aim: To compare the efficacy and safety of bilateral ultrasound-guided quadratus lumborum block versus lumbar epidural block on the management of postoperative pain following major lower abdominal cancer surgery. Methods: The study was a double-blinded, and randomized study, conducted in South Egypt Cancer Institute, Assiut University, Egypt. It included cancer patients scheduled for major lower abdominal cancer surgery in the period from 2019 to 2020. They were divided into two groups: Group Ι received pre-emptive ultrasoundguided Quadratus Lumborum Block (QLB) with 25 mL of 0.25% bupivacaine on each side of the abdominal wall before induction of General Anesthesia (GA), and Group II received pre-emptive lumbar epidural block with 15 mL of 0.25% bupivacaine before induction of GA. VAS score, and time of the first analgesic request and postoperative total analgesic consumption were evaluated. Results: Sixty patients were included in our study. VAS score at rest was comparable between both studied groups in the first 6 h. At 8 and 10 h, Group II had a significantly higher VAS score at rest (P < 0.001 and 0.026 respectively). Meanwhile, at 12 h, patients in Group I had a significantly higher VAS score (P = 0.026). Mean time of the first request for rescue analgesia was significantly prolonged in Group I (13.27 ± 2.38 hrs.) compared to Group II (10.20 ± 1.42 hrs.
Delirium is the second most common psychiatric diagnosis among hospitalized cancer patients. Ther... more Delirium is the second most common psychiatric diagnosis among hospitalized cancer patients. There are no previous studies on postoperative delirium after radical cystectomy. The relation between postoperative delirium and mortality has not been studied in cancer patients. We designed this observational prospective cohort study in order to determine the incidence and risk factors for postoperative delirium in this particular patient group with bladder cancer undergoing radical cystectomy, and to investigate the relation of postoperative delirium to mortality in these patients. This study was carried out at South Egypt Cancer Institute, Assiut University, Assiut, Egypt in the period from January 2012 to June 2013. Patients undergoing radical cystectomy for management of bladder cancer in this period were included. Peri-operative data were recorded, and development of postoperative delirium was diagnosed with the aid of CAM-ICU (Confusion Assessment Method for Intensive Care Unit). Tw...
ACUTE & PERIOPERATIVE PAIN SECTION Original Research Articles Efficacy and Safety of Intraperitoneal Dexmedetomidine with Bupivacaine in Laparoscopic Colorectal Cancer Surgery, a Randomized Trial
Objective. Our objective is to investigate the efficacy and safety of intraperitoneal dexmedetomi... more Objective. Our objective is to investigate the efficacy and safety of intraperitoneal dexmedetomidine (Dex) combined with bupivacaine in patients undergoing laparoscopic colorectal cancer surgery. Design. Randomized double-blind study. Setting. Academic medical center.
Effect of Intrathecally Administered Ketamine, Morphine, and Their Combination Added to Bupivacaine in Patients Undergoing Major Abdominal Cancer Surgery a Randomized, Double-Blind Study
Pain medicine (Malden, Mass.), Jan 17, 2017
Effective postoperative pain control reduces postoperative morbidity. In this study, we investiga... more Effective postoperative pain control reduces postoperative morbidity. In this study, we investigated the effects of intrathecal morphine, ketamine, and their combination with bupivacaine for postoperative analgesia in major abdominal cancer surgery. Prospective, randomized, double-blind. Academic medical center. Ninety ASA I-III patients age 30 to 50 years were divided randomly into three groups: the morphine group (group M) received 10 mg of hyperbaric bupivacaine 0.5% in 2 mL volume and 0.3 mg morphine in 1 mL volume intrathecally. The ketamine group (group K) received 0.1 mg/kg ketamine in 1 mL volume instead of morphine. The morphine + ketamine group (group K + M) received both 0.3 mg morphine and 0.1 mg/kg ketamine in 1 mL volume intrathecally. Postoperative total morphine consumption, first request of analgesia, visual analog score (VAS), and side effects were recorded. Total PCA morphine was significantly decreased in group M + K compared with groups M and K. Time to first r...
British journal of pain, 2016
Pain control after bariatric surgery is a major challenge. Our objective was to study the efficac... more Pain control after bariatric surgery is a major challenge. Our objective was to study the efficacy and safety of intrathecal (IT) morphine 0.3 mg added to bupivacaine 0.5% for postoperative pain after laparoscopic bariatric surgery. After local ethics committee approval, 100 morbidly obese patients scheduled for laparoscopic bariatric surgery were enrolled in this study. Patients were randomly assigned into two groups: Group I received IT 0.3 mg morphine (0.3 mL) added to 1.2 mL of bupivacaine 0.5%; Group II received IT 0.3 mL saline added to 1.2 mL of bupivacaine 0.5%, immediately before induction of general anaesthesia. For both groups, 60 mg ketorolac and 1000 mg paracetamol were infused 30 minutes before the end of surgery. After wound closure, 20 mL bupivacaine 0.25% was infiltrated at wound edges. Visual Analogue Scale (VAS) score was significantly lower in group I immediately, 30 minutes and 1 hour postoperatively. Time to first ambulation, return of intestinal sounds and hos...
Egyptian Journal of Anaesthesia, 2016
Adding novel drugs like pregabalin to analgesic regimens might reduce postoperative pain, total o... more Adding novel drugs like pregabalin to analgesic regimens might reduce postoperative pain, total opioid consumption and side effects, this study compares multiple doses of pregabalin for postoperative analgesia following radical cystectomy. Methods: This study is registered at www.clinicaltrials.gov at no.: NCT02724293. Sixty patients were randomized into 4 groups: Group I: control (placebo) group, Group II: received pregabalin 300 mg 2 h preoperatively, Group III: received pregabalin 300 mg 2 h preoperatively and 12 h thereafter, Group IV: received pregabalin 600 mg 2 h preoperatively. Postoperative pain, time to first request of analgesia, and total morphine consumption were recorded. Results: VAS was significantly reduced in groups II, III, IV in comparison with group I immediately postoperative, and after 2 h (P < 0.05). Sedation score was significantly higher in groups II, III, IV compared to group I immediately postoperative (P < 0.05). First request of analgesia was significantly delayed in groups II, III, IV compared to control group (P = 0.000). Total analgesic consumption was significantly reduced in groups II, III, IV compared to group I (P = 0.000). Group IV showed a significantly higher incidence of dizziness compared to group I. Conclusion: Peri-operative pregabalin at doses of 300 mg and 600 mg reduced postoperative opioid consumption and prolonged time to first request of analgesia in patients who underwent radical cystectomy, and a single preoperative dose of 600 mg is superior in analgesia to others, without serious side effects.
Pulmonary embolism caused by cement leakage during percutaneous vertebroplasty. A case report of successful conservative management
The neuroradiology journal, 2012
Percutaneous vertebroplasty (PV) is considered a minimally invasive procedure, yet cement leakage... more Percutaneous vertebroplasty (PV) is considered a minimally invasive procedure, yet cement leakage into the circulation may result in serious complications. Here, we are reporting a case of pulmonary embolism following PV for treatment of osteoporotic compression vertebral fracture.
Analgesic Effect of Intrathecal Fentanyl vs Dexmedetomidine as Adjuvants to Bupivacaine Following Abdominal Surgery for Cancer in Children, a Randomized Trial
Pain Medicine
Background Intrathecal fentanyl in spinal anesthesia improves intra- and postoperative analgesia.... more Background Intrathecal fentanyl in spinal anesthesia improves intra- and postoperative analgesia. Dexmedetomidine is a fascinating adjuvant with regards to neuraxial anesthesia in children experiencing surgery for abdominal malignancy. Patients and Methods After endorsement by the institutional reviewing board (IRB) and guardians’ written informed consent, this research was carried out on 60 pediatric malignancy patients scheduled for major abdominal surgery. Children were randomly distributed into three groups (20 patients each): Group C: given 2 mL of bupivacaine 0.5% (0.4 mg/kg) intrathecally, injected gradually over 20 seconds. Group F: the same as group C, plus fentanyl 0.2 μg/kg. Group D: the same as group C, plus dexmedetomidine 0.2 μg/kg. Pain at zero, two, four, six, 12, 18, and 24 hours postoperatively was evaluated by Face, Legs, Activity, Crying, and Consolability (FLACC) score. First analgesic request and postoperative unfavorable effects were recorded for 24 hours post...
Effect of Pre-peritoneal versus Epidural Analgesia on Postoperative Inflammatory Response and Pain Following Radical Cystectomy, a Prospective, Randomized Trial
The Clinical Journal of Pain
Objectives: Continuous wound infiltration of local anesthetics has been proposed as an alternativ... more Objectives: Continuous wound infiltration of local anesthetics has been proposed as an alternative to epidural analgesia during abdominal surgery. Cytokines have a major role in inflammatory changes caused by surgery. This study aimed to compare the effects of continuous preperitoneal versus epidural analgesia on inflammatory cytokines postoperatively. Materials and Methods: Forty patients scheduled for radical cystectomy were included in this observer-blinded, randomized trial; patients were randomly assigned into 2 groups to receive; continuous preperitoneal wound infiltration (PPB) or epidural analgesia (EDB). Serum levels of interleukins (IL1&bgr;, IL6, IL10, and tumor necrosis factor &agr;) were measured at baseline (before induction of anesthesia), preinfusion (before the start of local anesthetic infusion), 6 and 24 hours postoperatively. Visual Analog Scale at rest/movement (VAS-R/M), time to the first request of analgesia, total morphine consumption, sedation score, hemodynamics, and side effects were observed 24 hours postoperatively. Results: There was a significant reduction in IL6, IL1&bgr; and increase in IL10 in PPB compared with EDB at 6 and 24 hours postoperatively and compared with preinfusion levels (P⩽0.001). In EDB, a significant increase in IL1&bgr;, IL10, and tumor necrosis factor &agr; at 6 hours compared with preinfusion levels (P⩽0.002). VAS-R/M was significantly decreased at 2, 4, 6, 8, and 12 hours in EDB compared with PPB (P⩽0.014), with no significant difference in the mean time to the first request of analgesia and total morphine consumption between the 2 groups. Conclusion: Continuous preperitoneal analgesia better attenuated postoperative inflammatory response and provided a comparable overall analgesia to that with continuous epidural analgesia following radical cystectomy.
Pain physician, Nov 1, 2017
Major abdominal surgeries are associated with severe pain, which can affect respiratory and cardi... more Major abdominal surgeries are associated with severe pain, which can affect respiratory and cardiac functions if insufficiently treated; this increases postoperative morbidity. We aim at evaluating the efficacy of magnesium sulfate as an adjuvant to local anesthetic in an ultrasound-guided transversus abdominis plane (TAP) block for postoperative analgesia in total abdominal hysterectomy. A prospective, randomized, double-blinded clinical trial. An academic medical center. This study is registered at https://clinicaltrials.gov (no.: NCT02930707). This randomized, double-blinded clinical trial included 60 women undergoing total abdominal hysterectomy that were divided into 2 groups (30 patients per group). Group I received a TAP block with 20 mL per side of 0.25% bupivacaine plus 2 mL magnesium sulphate 10% (200 mg). Group II received a TAP block with 20 mL per side of 0.25% bupivacaine. Visual analog scale (VAS) scores, the time of the first analgesic request, total morphine consump...
Efficacy of Postoperative Analgesia of Local Ketamine Wound Instillation Following Total Thyroidectomy; A Randomized, Double-blind, Controlled-clinical Trial
The Clinical Journal of Pain
Total thyroidectomy is recommended as a line of management of thyroid cancer in a lot of cases. O... more Total thyroidectomy is recommended as a line of management of thyroid cancer in a lot of cases. Our aim was to compare postoperative analgesic effect of local ketamine 1 mg/kg instilled in the wound to I.M ketamine and to placebo after total thyroidectomy. Ninety patients aged 18 - 60 years, American Society of Anesthesiologists (ASA) class I-II, with a body weight of 50-90 kg, scheduled for total thyroidectomy were enrolled after ethics committee approval in this prospective, randomized, double-blind, controlled study and divided randomly into three groups to receive after hemostasis: Group (I): 1 mg/kg ketamine in a total volume of 10 mL normal saline instilled in the wound. Group (II): 1 mg/kg of intramuscular (I.M) ketamine. Group (III): 10 mL of normal saline instilled in the wound. Total amount of morphine consumption, first request of analgesia, and side effects were recorded. Visual analogue scale at rest (VAS-R) and movement (VAS-M) and hemodynamics were assessed immediately, 1, 2, 4, 6, 12 and 24 hours postoperatively. Total morphine consumption was reduced and first request of analgesia was delayed in group I compared to groups II and III; and in group II compared to III (P=0.000). VAS-R and VAS-M were decreased immediately postoperatively in groups I and II in comparison to group III, group II had higher sedation scores. Local wound ketamine instillation provided superior postoperative analgesia with lower incidence of side effects in comparison to intramuscular ketamine and placebo following total thyroidectomy.
Pain physician
Breast surgery is an exceedingly common procedure with an increased incidence of acute and chroni... more Breast surgery is an exceedingly common procedure with an increased incidence of acute and chronic pain. Pectoral nerve block is a novel peripheral nerve block alternative to neuro-axial and paravertebral blocks for ambulatory breast surgeries. This study aims to compare the analgesic efficacy and safety of modified Pecs block with ketamine plus bupivacaine versus bupivacaine in patients undergoing breast cancer surgery. A randomized, double-blind, prospective study. Academic medical center. This study is registered at www.clinicaltrials.gov under number: (NCT02620371) after approval by the ethics committee of South Egypt Cancer Institute, Assuit University, Assuit, Egypt. Sixty patients aged 18 - 60 years scheduled for modified radical mastectomy were enrolled and randomly assigned into 2 groups (30 patients each): Control group patients were given ultrasound-guided, Pecs block with 30 mL of 0.25% bupivacaine only. Ketamine group patients were given ultrasound-guided, Pecs block wi...
Minerva anestesiologica, Jan 30, 2016
The majority of authors and the literature recommend sugammadex dose to be calculated according t... more The majority of authors and the literature recommend sugammadex dose to be calculated according to RBW without taking fat content into consideration. Our aim was to compare the efficacy and safety of sugammadex at doses of 1.5, 2, and 4 mg / kg, calculated according to ideal body weight basis, for the reversal of moderate rocuronium-induced neuromuscular blockade in laparoscopic bariatric surgery. 180 morbidly obese patients were randomly assigned into three groups according to sugammadex dose administrated (based on IBW after reaching T2 of TOF): Group I: patients were given 1.5 mg / kg. Group II: patients were given 2 mg / kg. Group III: patients were given 4 mg / kg. Both sugammadex and extubation times were recorded. RESULTS: Sugammadex time was significantly longer in groups I and II versus III (P = 0.000, 0.005 respectively). Difference between groups I and II was insignificant. The extubation time was insignificantly different in the three groups (P > 0.05). A dose of s...
Pain physician, Jul 1, 2016
Intrathecal ketamine has been studied extensively in animals, but rarely in humans. Intrathecal d... more Intrathecal ketamine has been studied extensively in animals, but rarely in humans. Intrathecal dexmedetomidine prolongs the duration of spinal anesthesia. To investigate the efficacy and safety of intrathecal dexmedetomidine, ketamine, or both when added to bupivacaine for postoperative analgesia in major abdominal cancer surgery. Double-blinded, randomized, controlled trial. Academic medical center. Ninety patients were randomly allocated to receive either intrathecal 10 mg of hyperbaric bupivacaine 0.5% and 5 µg of dexmedetomidine (group I, n = 30), 10 mg of hyperbaric bupivacaine 0.5% and 0.1 mg/kg ketamine (group II, n = 30), or 10 mg of hyperbaric bupivacaine 0.5% and 5 µg of dexmedetomidine plus 0.1 mg/kg of ketamine (group III, n = 30). Hemodynamics, pain score, time to first request of analgesia, total PCA morphine consumption, sedation score, and adverse effects in the first 24 hours postoperatively were recorded. Time to first request of analgesia was longer in group II (...
SECI Oncology, 2015
Hence, it is important to understand, assess and treat acute pain effectively [2]. Morphine remai... more Hence, it is important to understand, assess and treat acute pain effectively [2]. Morphine remains the most widely used opioid for the management of pain and the standard against which other opioids are compared [3]. Tramadol is commonly referred to as an atypical centrally acting analgesic because of its combined effects as an opioid agonist and a serotonin and noradrenaline reuptake inhibitor [3]. Injectable NSAIDs (non-steroidal anti-inflammatory drugs) have potential advantages for postoperative pain management. NSAIDs attack pain by a different
Pain Medicine, 2015
Objective. Our objective is to investigate the efficacy and safety of intraperitoneal dexmedetomi... more Objective. Our objective is to investigate the efficacy and safety of intraperitoneal dexmedetomidine (Dex) combined with bupivacaine in patients undergoing laparoscopic colorectal cancer surgery. Design. Randomized double-blind study. Setting. Academic medical center. Patients and methods. Forty-five patients scheduled for laparoscopic colorectal cancer surgery were randomly assigned for intraperitoneal administration of 50 mL saline (control group; GI, n 5 15), 50 mL bupiva-caine 0.25% (125 mg; GII, n 5 15), or 50 mL bupivacaine 0.25% (125 mg) 11 lg/kg Dex (GIII, n 5 15). Patients were assessed during the first 24 hours postoperatively for hemodynamics, visual analogue scale (VAS), time to first request of analgesia, total analgesic consumption, shoulder pain, and side effects. Results. A significant reduction was observed in VAS in GIII at base line, 2, 4, and 24 hours postoperatively in comparison to GI and GII (P < 0.05). The time to first analgesic requirement was significantly prolonged in GIII (P < 0.05). The mean total consumption of rescue analgesia was significantly reduced in GIII. Conclusion. We conclude that intraperitoneal administration of Dex 1 lg/kg combined with bupivacaine improves the quality and the duration of postoperative analgesia and provides an analgesic sparing effect compared to bupivacaine alone without significant adverse effects in patients undergoing laparoscopic colorectal cancer surgery.
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Papers by Ahmad Abd El-Rahman