Journal of Anesthesiology http://www.hindawi.com The latest articles from Hindawi Publishing Corporation © 2014 , Hindawi Publishing Corporation . All rights reserved. Ultrasound Guided Stellate Ganglion Block in Postmastectomy Pain Syndrome: A Comparison of Ketamine versus Morphine as Adjuvant to Bupivacaine Mon, 21 Jul 2014 00:00:00 +0000 http://www.hindawi.com/journals/jan/2014/792569/ Background. The postmastectomy pain syndrome (PMPS) is chronic pain after breast cancer surgery and is reported to influence quality of life. The aim of this study was to provide long term reduction of PMPS, improve range of motion of the shoulder, and decrease the need for postoperative analgesia using ultrasound guided stellate ganglion block. Method. Sixty patients with PMPS were randomly allocated into 1 of 3 groups: bupivacaine group (group 1), bupivacaine plus ketamine group (group 2), and bupivacaine plus morphine group (group 3). Each patient received 3 blocks with an interval of one week in between. Patients were assessed for: pain visual analogue score (VAS), movement of the shoulder, skin temperature, and the need for analgesic drugs. Results. The pain VAS was significantly decreased in group 2 as compared to the other two groups. Shoulder movement improved significantly in the three studied groups with the best results observed after the third block. The need for the analgesic drugs in the form of gabapentin was more in the bupivacaine and bupivacaine plus morphine groups than in bupivacaine plus ketamine group. Conclusion. Treatment of PMPS with ultrasound guided stellate ganglion block using ketamine (0.5 mg/kg) as adjuvant to bupivacaine (0.25%) successfully decreased pain VAS and the need for analgesic drugs. Ola T. Abdel Dayem, Mostafa M. Saeid, Olfat M. Ismail, Adel M. El Badrawy, and Nevert A. Abdel Ghaffar Copyright © 2014 Ola T. Abdel Dayem et al. All rights reserved. Comparison of Intrathecal Use of Isobaric and Hyperbaric Bupivacaine during Lower Abdomen Surgery Wed, 05 Feb 2014 11:39:54 +0000 http://www.hindawi.com/journals/jan/2014/141324/ Objective. The ideal local anesthetic solution for intrathecal use has rapid onset and reliable duration, with less incidence of adverse events. This study was aiming to compare the onset of anesthesia and duration of action of isobaric and hyperbaric bupivacaine for subarachnoid block (SAB). Methods. Sixty patients who underwent lower abdominal, hips, and lower extremity surgeries were randomized into two groups. Group I received 20 mg of 0.5% isobaric bupivacaine, while Group H received 20 mg of 0.5% hyperbaric bupivacaine. Injection was made intrattecally in midline position at L3-4 interspace in sitting position. Results. The onset of analgesia and motor blocks with isobaric was faster when compared to hyperbaric bupivacaine (4.8 ± 2.2 versus 7.5 ± 2.2 minutes and 4.1 ± 2.1 versus 6.4 ± 2.4 minutes, resp., ). The duration of sensory and motor blocks was longer in isobaric when compared to hyperbaric bupivacaine (276 ± 30 versus 163 ± 22 minutes and 266 ± 32 versus 163 ± 24 minutes, ). In both groups, hemodynamic changes were not clinically relevant, and the adverse effects were comparable. Conclusion. Isobaric produced more rapid onset and longer duration when compared to hyperbaric bupivacaine. Mochamat Helmi, Yusmein Uyun, Bambang S. Suwondo, and Untung Widodo Copyright © 2014 Mochamat Helmi et al. All rights reserved. An Audit of Fibreoptic Intubation Training Opportunities in a UK Teaching Hospital Thu, 02 Jan 2014 09:16:02 +0000 http://www.hindawi.com/journals/jan/2014/703820/ Airway management is the foundation upon which anaesthesia is built, and fibreoptic intubation (FOI) is a key facet of this skill. Despite this, many trainee anaesthetists in the UK have been unable to perform sufficient FOIs to gain competence. We aimed to establish the incidence of FOI in adult patients, in a UK teaching hospital, in order to determine what FOI training opportunities actually exist. During the study period (from October 1st, 2008, to September 30th, 2009) an estimated 11 712 general anaesthetics were undertaken that necessitated tracheal intubation. In 141 of these cases FOIs were performed giving an incidence of FOI of 1.2% (95% confidence interval 1%–1.4%). Of these, 86 (61%) were in awake and 55 (39%) in anaesthetised patients. Only 16 (11%) of the FOIs were done solely for the purposes of training. We suggest that a greater number of FOIs should be undertaken to allow trainees to gain and consultants to maintain the FOI expertise necessary for the provision of safe anaesthesia. M. D. Wiles, R. A. McCahon, and J. A. M. Armstrong Copyright © 2014 M. D. Wiles et al. All rights reserved.