Background: Gabapentin is a novel drug used for the treatment of postoperative pain. Oral morphine has gained acceptance as the treatment of choice for patients with chronic cancer pain but also can be used to treat acute postoperative pain. Objectives: The aim of this study was to compare the efficacy of pre-operative oral Gabapentin with oral morphine on post-operative pain relief and total analgesic consumption after major abdominal cancer surgeries. Study design: A randomized double blind study. Sitting: Academic medical center. Methods: 60 ASA I-III patients (age ≥18 years) who were scheduled for Elective major abdominal cacer surgery. Patients were randomly Divided into one of two groups. Group I (gabapentin group): patients Received gabapentin capsules 900mg 1 hr. pre-operatively. Group II (morphine group): patients received morphine sulphate 30mg tab 1 hr. Preoperatively. At the end of the operation patients were monitored for vital signs after 30 min, 1h, 2h, 4h, 6h, 12h, 24h hours. The severity of pain was assessed using visual Analog scale after 30min, 1h, 2h, 4h, 6h, 12h, 24h hours post-operative. The time of the first analgesic request and total morphine consumption in 24 hours were recorded. The level of sedation, incidence of side effects were recorded and treated. Results: The post-operative heart rate was reduced significantly in group I compared to group II in the first half an hour of the postoperative period (P 0.01),and there was statistically significant difference between studied groups as regards post-operative MAP in the first hour (P 0.01) The mean postoperative VAS score was significantly reduced in group I compared to group II in the first two hours post-operative period group I compared to group II in the first two hours post-operative period (P 0.01). There was significant prolongation in the first request of analgesia in the group I (7.65± 4.970) compared to that of group II (5.34±3.66). There was reduction in the total amount of postoperative morphine consumption in group I (7.43±4.39) in comparison to group II (13.47±4.73) with (p 0.044). there was significant reduction in number of patients developed nausea and vomiting in group I. Sedation score was higher in group I compared to group II. Limitations: This study is limited by its small sample size. Conclusion: pre-operative use of oral gabapentin 900mg significantly reduced postoperative pain and decreased the need for opioids with less side effect than 30 mg sustained release oral morphine.

Background: Release of pneumatic tourniquet causes hypotension, tachycardia and compensatory increase in cardiac index. Objectives: This study was conducted to assess the effect of tourniquet release on cardiovascular parameters while operated leg in 20 degrees up position. Design: Prospective randomized comparative study. Setting: University hospital. Methods: This study included 60 patients, ASA I scheduled for meniscal surgery through knee arthroscopy under general anesthesia. Patients were divided into two groups: group C (n=30) in which tourniquet was deflated with leg in neutral position while group S (n=30) tourniquet was released with leg in 20 degrees up position. Cardiovascular parameters displayed by ccNexfin monitor eg cardiac output (COP), cardiac index (CI), stroke volume (SV), mean arterial pressure (MAP), systemic vascular resistance (SVR), heart rate (HR), as well as arterial blood gas measurements. End tidal carbon dioxide, respiratory rate, end tidal sevoflurane and bispectral index values were also recorded before and after tourniquet deflation. Results: There was significant decrease in MAP and SVR at all intervals post deflation in group C compared to group S whereas COP, CI, SV and HR were significantly increased in group C post deflation compared to group S. But there were no significant differences between groups regarding metabolic and respiratory parameters. Conclusion: Tourniquet deflation while leg in elevated position caused attenuation in both the decrease in MAP, SVR and the compensatory increase in CI, COP and SV. Limitations: This study is limited by its small sample size.

Background: Hypoalbuminemia often reflects malnourishment. Malnourished patients have a higher risk of mortality; complications and prolonged hospital stay. Objectives: The effects of hypoalbuminemia in early postoperative complications, organ failure and immune function in patients undergoing major cancer surgery. Study design: A randomized double- blind trial. Setting: Academic medical center. Methods: Forty patients underwent elective major oncological surgery were divided into two groups. Group I: serum albumin >35 g/L and Group II: serum albumin ≤ 35 g/L. Preoperative level of IL1, total lymphocytic count and neutrophilic count were determined. patients were monitored daily for major postoperative complications, including, Acute Respiratory Distress Syndrome (ARDS), sepsis, multi-organ dysfunction syndrome (MODS), renal failure, heart failure, respiratory failure, pneumonia/respiratory tract infection, major thromboembolic event, wound infection / dehiscence, anastamotic leak and fistula formation. SOFA score recorded on the day of admission to the ICU and every 48 hours until discharge. The length of stay in the ICU was measured from admission to the ICU until discharge. Complete blood picture, arterial blood gas, liver function, interleukin IL1 and kidney function were done on first, third, fifth and seventh postoperative day. Results: Postoperative complications were higher in group II compared to group I. Also, the length of stay was proved to be statistically significant in group II (9.60 ± 3.59 days) compared to group I (6.95 ± 0.69 days) (P = 0.002). Serum level of IL1, were statistically significant increased in group II compared to group I on first, third and seventh postoperative days. There was no statistically significant difference between two groups in Total lymphocytic count in all follow up days and statistically significant increase in neutrophilic count on group II compared to group I on first, third and seventh postoperative days. Finally there was a statistically significant increase in SOFA score in group II compared to group I in all follow up days. Limitations: This study is limited by its small sample size. Conclusion: preoperative hypoalbuminemia increases the risk of postoperative complications and length of stay in ICU after major cancer surgery.

Background: Hypoalbuminemia often reflects malnourishment. Malnourished patients have a higher risk of mortality; complications and prolonged hospital stay. Objectives: The effects of hypoalbuminemia in early postoperative complications, organ failure and immune function in patients undergoing major cancer surgery. Study design: A randomized double- blind trial. Setting: Academic medical center. Methods: Forty patients underwent elective major oncological surgery were divided into two groups. Group I: serum albumin >35 g/L and Group II: serum albumin ≤ 35 g/L. Preoperative level of IL1, total lymphocytic count and neutrophilic count were determined. patients were monitored daily for major postoperative complications, including, Acute Respiratory Distress Syndrome (ARDS), sepsis, multi-organ dysfunction syndrome (MODS), renal failure, heart failure, respiratory failure, pneumonia/respiratory tract infection, major thromboembolic event, wound infection / dehiscence, anastamotic leak and fistula formation. SOFA score recorded on the day of admission to the ICU and every 48 hours until discharge. The length of stay in the ICU was measured from admission to the ICU until discharge. Complete blood picture, arterial blood gas, liver function, interleukin IL1 and kidney function were done on first, third, fifth and seventh postoperative day. Results: Postoperative complications were higher in group II compared to group I. Also, the length of stay was proved to be statistically significant in group II (9.60 ± 3.59 days) compared to group I (6.95 ± 0.69 days) (P = 0.002). Serum level of IL1, were statistically significant increased in group II compared to group I on first, third and seventh postoperative days. There was no statistically significant difference between two groups in Total lymphocytic count in all follow up days and statistically significant increase in neutrophilic count on group II compared to group I on first, third and seventh postoperative days. Finally there was a statistically significant increase in SOFA score in group II compared to group I in all follow up days. Limitations: This study is limited by its small sample size. Conclusion: preoperative hypoalbuminemia increases the risk of postoperative complications and length of stay in ICU after major cancer surgery.

Background: Hypoalbuminemia often reflects malnourishment. Malnourished patients have a higher risk of mortality; complications and prolonged hospital stay. Objectives: The effects of hypoalbuminemia in early postoperative complications, organ failure and immune function in patients undergoing major cancer surgery. Study design: A randomized double- blind trial. Setting: Academic medical center. Methods: Forty patients underwent elective major oncological surgery were divided into two groups. Group I: serum albumin >35 g/L and Group II: serum albumin ≤ 35 g/L. Preoperative level of IL1, total lymphocytic count and neutrophilic count were determined. patients were monitored daily for major postoperative complications, including, Acute Respiratory Distress Syndrome (ARDS), sepsis, multi-organ dysfunction syndrome (MODS), renal failure, heart failure, respiratory failure, pneumonia/respiratory tract infection, major thromboembolic event, wound infection / dehiscence, anastamotic leak and fistula formation. SOFA score recorded on the day of admission to the ICU and every 48 hours until discharge. The length of stay in the ICU was measured from admission to the ICU until discharge. Complete blood picture, arterial blood gas, liver function, interleukin IL1 and kidney function were done on first, third, fifth and seventh postoperative day. Results: Postoperative complications were higher in group II compared to group I. Also, the length of stay was proved to be statistically significant in group II (9.60 ± 3.59 days) compared to group I (6.95 ± 0.69 days) (P = 0.002). Serum level of IL1, were statistically significant increased in group II compared to group I on first, third and seventh postoperative days. There was no statistically significant difference between two groups in Total lymphocytic count in all follow up days and statistically significant increase in neutrophilic count on group II compared to group I on first, third and seventh postoperative days. Finally there was a statistically significant increase in SOFA score in group II compared to group I in all follow up days. Limitations: This study is limited by its small sample size. Conclusion: preoperative hypoalbuminemia increases the risk of postoperative complications and length of stay in ICU after major cancer surgery.

Background: Hypoalbuminemia often reflects malnourishment. Malnourished patients have a higher risk of mortality; complications and prolonged hospital stay. Objectives: The effects of hypoalbuminemia in early postoperative complications, organ failure and immune function in patients undergoing major cancer surgery. Study design: A randomized double- blind trial. Setting: Academic medical center. Methods: Forty patients underwent elective major oncological surgery were divided into two groups. Group I: serum albumin >35 g/L and Group II: serum albumin ≤ 35 g/L. Preoperative level of IL1, total lymphocytic count and neutrophilic count were determined. patients were monitored daily for major postoperative complications, including, Acute Respiratory Distress Syndrome (ARDS), sepsis, multi-organ dysfunction syndrome (MODS), renal failure, heart failure, respiratory failure, pneumonia/respiratory tract infection, major thromboembolic event, wound infection / dehiscence, anastamotic leak and fistula formation. SOFA score recorded on the day of admission to the ICU and every 48 hours until discharge. The length of stay in the ICU was measured from admission to the ICU until discharge. Complete blood picture, arterial blood gas, liver function, interleukin IL1 and kidney function were done on first, third, fifth and seventh postoperative day. Results: Postoperative complications were higher in group II compared to group I. Also, the length of stay was proved to be statistically significant in group II (9.60 ± 3.59 days) compared to group I (6.95 ± 0.69 days) (P = 0.002). Serum level of IL1, were statistically significant increased in group II compared to group I on first, third and seventh postoperative days. There was no statistically significant difference between two groups in Total lymphocytic count in all follow up days and statistically significant increase in neutrophilic count on group II compared to group I on first, third and seventh postoperative days. Finally there was a statistically significant increase in SOFA score in group II compared to group I in all follow up days. Limitations: This study is limited by its small sample size. Conclusion: preoperative hypoalbuminemia increases the risk of postoperative complications and length of stay in ICU after major cancer surgery.

Background: Hypoalbuminemia often reflects malnourishment. Malnourished patients have a higher risk of mortality; complications and prolonged hospital stay. Objectives: The effects of hypoalbuminemia in early postoperative complications, organ failure and immune function in patients undergoing major cancer surgery. Study design: A randomized double- blind trial. Setting: Academic medical center. Methods: Forty patients underwent elective major oncological surgery were divided into two groups. Group I: serum albumin >35 g/L and Group II: serum albumin ≤ 35 g/L. Preoperative level of IL1, total lymphocytic count and neutrophilic count were determined. patients were monitored daily for major postoperative complications, including, Acute Respiratory Distress Syndrome (ARDS), sepsis, multi-organ dysfunction syndrome (MODS), renal failure, heart failure, respiratory failure, pneumonia/respiratory tract infection, major thromboembolic event, wound infection / dehiscence, anastamotic leak and fistula formation. SOFA score recorded on the day of admission to the ICU and every 48 hours until discharge. The length of stay in the ICU was measured from admission to the ICU until discharge. Complete blood picture, arterial blood gas, liver function, interleukin IL1 and kidney function were done on first, third, fifth and seventh postoperative day. Results: Postoperative complications were higher in group II compared to group I. Also, the length of stay was proved to be statistically significant in group II (9.60 ± 3.59 days) compared to group I (6.95 ± 0.69 days) (P = 0.002). Serum level of IL1, were statistically significant increased in group II compared to group I on first, third and seventh postoperative days. There was no statistically significant difference between two groups in Total lymphocytic count in all follow up days and statistically significant increase in neutrophilic count on group II compared to group I on first, third and seventh postoperative days. Finally there was a statistically significant increase in SOFA score in group II compared to group I in all follow up days. Limitations: This study is limited by its small sample size. Conclusion: preoperative hypoalbuminemia increases the risk of postoperative complications and length of stay in ICU after major cancer surgery.

BACKGROUND: Most of the clinical experience gained in the use of intrathecal alpha-2- adrenoceptor agonists has been described with clonidine. Human studies using a combination of intrathecal dexmedetomidine and local anesthetics are lacking. OBJECTIVES: A safety investigation and comparison of the analgesic efficacy of intrathecally administered dexmedetomidine or dexmedetomidine combined with fentanyl in patients undergoing major abdominal cancer surgery. STUDY DESIGN: A randomized, double-blind trial. SETTING: Academic medical center. METHODS: Ninety patients were randomly assigned to receive intrathecally either 10 mg bupivacaine 0.5% (control group, n = 30), or 10 mg bupivacaine 0.5% plus 5 μg dexmedetomidine (dexmedetomidine group, n = 30), or 10 mg bupivacaine 0.5% plus 5 μg dexmedetomidine and 25 μg fentanyl (dexmedetomidine= group, n = 30). Assessment parameters included hemodynamics, sedation score, pain severity, time of first analgesics request, total analgesic consumption, and side effects in the first 24 hours. RESULTS: The mean intraoperative heart rate was significantly reduced in the dexmedetomidine group (P 0.05) and the dexmedetomidine= group (P 0.05) compared with the control group. Also, there was a significant reduction in mean intraoperative systolic and diastolic blood pressure in the dexmedetomidine group (P 0.05) and the dexmedetomidine= group (P 0.05) compared with the control group, with no significant differences in postoperative hemodynamics or sedation scores among all the study groups. The mean visual analog scale scores showed a significant reduction immediately and at 12 hours postoperatively in both the dexmedetomidine and dexmedetomidine= groups compared to the control group. The mean time of the first analgesic request was significantly prolonged in the dexmedetomidine group (3.30 ± 0.87 hours, P 0.01) and the dexmedetomidine= group (5.41 ± 1.23 hours, P 0.01) compared with the control group (0.23 ± 0.11 hours). Moreover, postoperative tramadol consumption was significantly reduced in the dexmedetomidine (142.85 ± 13.04 mg, P 0.01) and the dexmedetomidine= (131.25 ± 11.96 mg, P 0.01) groups, compared with the control group (310.0 ± 12.08 mg). No significant serious adverse effects were recorded during the study. LIMITATIONS: This study is limited by its sample size. CONCLUSION: Dexmedetomidine 5 μg given intrathecally improves the quality and the duration of postoperative analgesia and also provides an analgesic sparing effect in patients undergoing major abdominal cancer surgery. Furthermore, the addition of intrathecal fentanyl 25 μg has no valuable clinical effect.

BACKGROUND: Most of the clinical experience gained in the use of intrathecal alpha-2- adrenoceptor agonists has been described with clonidine. Human studies using a combination of intrathecal dexmedetomidine and local anesthetics are lacking. OBJECTIVES: A safety investigation and comparison of the analgesic efficacy of intrathecally administered dexmedetomidine or dexmedetomidine combined with fentanyl in patients undergoing major abdominal cancer surgery. STUDY DESIGN: A randomized, double-blind trial. SETTING: Academic medical center. METHODS: Ninety patients were randomly assigned to receive intrathecally either 10 mg bupivacaine 0.5% (control group, n = 30), or 10 mg bupivacaine 0.5% plus 5 μg dexmedetomidine (dexmedetomidine group, n = 30), or 10 mg bupivacaine 0.5% plus 5 μg dexmedetomidine and 25 μg fentanyl (dexmedetomidine= group, n = 30). Assessment parameters included hemodynamics, sedation score, pain severity, time of first analgesics request, total analgesic consumption, and side effects in the first 24 hours. RESULTS: The mean intraoperative heart rate was significantly reduced in the dexmedetomidine group (P 0.05) and the dexmedetomidine= group (P 0.05) compared with the control group. Also, there was a significant reduction in mean intraoperative systolic and diastolic blood pressure in the dexmedetomidine group (P 0.05) and the dexmedetomidine= group (P 0.05) compared with the control group, with no significant differences in postoperative hemodynamics or sedation scores among all the study groups. The mean visual analog scale scores showed a significant reduction immediately and at 12 hours postoperatively in both the dexmedetomidine and dexmedetomidine= groups compared to the control group. The mean time of the first analgesic request was significantly prolonged in the dexmedetomidine group (3.30 ± 0.87 hours, P 0.01) and the dexmedetomidine= group (5.41 ± 1.23 hours, P 0.01) compared with the control group (0.23 ± 0.11 hours). Moreover, postoperative tramadol consumption was significantly reduced in the dexmedetomidine (142.85 ± 13.04 mg, P 0.01) and the dexmedetomidine= (131.25 ± 11.96 mg, P 0.01) groups, compared with the control group (310.0 ± 12.08 mg). No significant serious adverse effects were recorded during the study. LIMITATIONS: This study is limited by its sample size. CONCLUSION: Dexmedetomidine 5 μg given intrathecally improves the quality and the duration of postoperative analgesia and also provides an analgesic sparing effect in patients undergoing major abdominal cancer surgery. Furthermore, the addition of intrathecal fentanyl 25 μg has no valuable clinical effect.

BACKGROUND: Most of the clinical experience gained in the use of intrathecal alpha-2- adrenoceptor agonists has been described with clonidine. Human studies using a combination of intrathecal dexmedetomidine and local anesthetics are lacking. OBJECTIVES: A safety investigation and comparison of the analgesic efficacy of intrathecally administered dexmedetomidine or dexmedetomidine combined with fentanyl in patients undergoing major abdominal cancer surgery. STUDY DESIGN: A randomized, double-blind trial. SETTING: Academic medical center. METHODS: Ninety patients were randomly assigned to receive intrathecally either 10 mg bupivacaine 0.5% (control group, n = 30), or 10 mg bupivacaine 0.5% plus 5 μg dexmedetomidine (dexmedetomidine group, n = 30), or 10 mg bupivacaine 0.5% plus 5 μg dexmedetomidine and 25 μg fentanyl (dexmedetomidine= group, n = 30). Assessment parameters included hemodynamics, sedation score, pain severity, time of first analgesics request, total analgesic consumption, and side effects in the first 24 hours. RESULTS: The mean intraoperative heart rate was significantly reduced in the dexmedetomidine group (P 0.05) and the dexmedetomidine= group (P 0.05) compared with the control group. Also, there was a significant reduction in mean intraoperative systolic and diastolic blood pressure in the dexmedetomidine group (P 0.05) and the dexmedetomidine= group (P 0.05) compared with the control group, with no significant differences in postoperative hemodynamics or sedation scores among all the study groups. The mean visual analog scale scores showed a significant reduction immediately and at 12 hours postoperatively in both the dexmedetomidine and dexmedetomidine= groups compared to the control group. The mean time of the first analgesic request was significantly prolonged in the dexmedetomidine group (3.30 ± 0.87 hours, P 0.01) and the dexmedetomidine= group (5.41 ± 1.23 hours, P 0.01) compared with the control group (0.23 ± 0.11 hours). Moreover, postoperative tramadol consumption was significantly reduced in the dexmedetomidine (142.85 ± 13.04 mg, P 0.01) and the dexmedetomidine= (131.25 ± 11.96 mg, P 0.01) groups, compared with the control group (310.0 ± 12.08 mg). No significant serious adverse effects were recorded during the study. LIMITATIONS: This study is limited by its sample size. CONCLUSION: Dexmedetomidine 5 μg given intrathecally improves the quality and the duration of postoperative analgesia and also provides an analgesic sparing effect in patients undergoing major abdominal cancer surgery. Furthermore, the addition of intrathecal fentanyl 25 μg has no valuable clinical effect.