الفهرس 
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Abstract
Purpose: The aim of this prospective randomized study was to evaluate the effect of preperotineal dexmedetomidine, bupivacaine via multi hole catheter compared to dexamethasone, bupivacaine on postoperative pain in patients subjected to open abdominal cancer surgeries The primary outcome evaluates the postoperative pain by visual analogue pain scores. The secondary outcomes include time to first rescue analgesia, analgesic requirements in 24 hrs postoperative and the complications. Materials and Methods:, The study was conducted at Oncology Center Mansoura University, as a randomized prospective study after obtaining approval from local ethics committee of Faculty of Medicine - Mansoura University. A written, informed consent was obtained from all patients included in the study. s study was submitted on 120 patients of ASA physical status I, II and III aged 16-70 years, scheduled for open abdominal surgeries at Oncology Center Mansura University (OCMU). All patients who were enrolled in this study were randomized using a computer- generated table of random numbers and numbered sealed opaque envelopes containing groups. Patients were allocated into three groups (40 patients in each group): (Group-P): preperitoneal wound infiltration with bupivacaine {0.70 mg /kg) + Precedex®-(Hospira) (1µg/kg) +5μg/ml (1:200.000) epinephrine diluted in 20ml volume of normal saline}. 2.(Group-D): preperitoneal wound infiltration with dexamethasone with {Bupivacaine (0.70mg/kg) + Dexamethasone (8mg) + 5μg/ml (1:200.000) epinephrine diluted in 20ml volume of normal saline} given to the patient once the surgeon closed the wound layer and the skin. Next doses were prepared by assessor in dose of (0.325 mg ⁄kg bupivacaine 10 ml volume). 3.(Group-C): The control group which received general anesthesia. Results: The number of injections after 1st injection showed highly significance decrease in P group (1.23 ±0 .53) when compared with D group (2.60 ± 0.55), also total dose of injected bupivacaine within 24h postoperative showed significant decrease in P group(92.48 ± 22.44) compared to D group (124.35 ± 30.63). The total number of patients required postoperative analgesia was highly significant increased in control group {100% for ketrolac (n=40), 82.5% ( n=33) for paracetamol and 42.5% (n=17) for nalbuphine} versus {35% (n=14)for ketorolac, 30% (n=12) for paracetamol and 12.5% (n=5) for nalbuphine} in D group and{ 32.5% (n=13) for ketorolac,15% (n=6) for paracetamol and 10% (n=4) for nalbuphine}in P group Conclusion: In our study we concluded that both preperitoneal dexmedetomedine and dexamethasone are effective on postoperative VAS, analgesia satisfaction, respiratory rates, MRSS, MAP and HR, better night sleep quality, decrease vomiting episodes and early return of bowel function when used as an adjuvant to bupivacaine in open abdominal surgery. Dexmedetomedine is a better adjuvant for bupivacaine than dexamethasone as regards VAS, analgesic duration, respiratory rates, MAP, HR and normal bowel function return.