Abstract Background: Serum albumin is a marker of nutrition and inflammation. Currently, hypoalbuminemia is used as a marker of inflammation and a predictor of outcome in post-surgical patients. It is associated with increased morbidity and mortality in patients having surgery for cancer disease. Objectives: to evaluate the implication of hypoalbuminemia on early postoperative complications in major cancer surgery. Methods: 40 patients undergoing elective major cancer surgery were included in the study. Patients were divided according to their serum albumin level into two groups. Group I: with serum albumin >35 g/L and Group II: with serum albumin ≤ 35 g/L. Major postoperative complications and length of stay in ICU (Intensive care unit) were documented. Results: Postoperative complications were higher in number and percentage in group II (serum albumin ≤ 35 g/L) compared to group I (serum albumin > 35 g/L). Furthermore, the length of ICU was significantly longer in group II (serum albumin ≤ 35 g/L) (9.60±3.59 days) compared to group I (serum albumin > 35 g/L) (6.95±0.69 days) (P= 0.002). Conclusion: The current study revealed that preoperative hypoalbuminemia increases the risk of postoperative complications and length of stay in ICU after major cancer surgery, as such, accounts for high proportion of ICU budget.

Abstract Background: Serum albumin is a marker of nutrition and inflammation. Currently, hypoalbuminemia is used as a marker of inflammation and a predictor of outcome in post-surgical patients. It is associated with increased morbidity and mortality in patients having surgery for cancer disease. Objectives: to evaluate the implication of hypoalbuminemia on early postoperative complications in major cancer surgery. Methods: 40 patients undergoing elective major cancer surgery were included in the study. Patients were divided according to their serum albumin level into two groups. Group I: with serum albumin >35 g/L and Group II: with serum albumin ≤ 35 g/L. Major postoperative complications and length of stay in ICU (Intensive care unit) were documented. Results: Postoperative complications were higher in number and percentage in group II (serum albumin ≤ 35 g/L) compared to group I (serum albumin > 35 g/L). Furthermore, the length of ICU was significantly longer in group II (serum albumin ≤ 35 g/L) (9.60±3.59 days) compared to group I (serum albumin > 35 g/L) (6.95±0.69 days) (P= 0.002). Conclusion: The current study revealed that preoperative hypoalbuminemia increases the risk of postoperative complications and length of stay in ICU after major cancer surgery, as such, accounts for high proportion of ICU budget.

Abstract Background: Serum albumin is a marker of nutrition and inflammation. Currently, hypoalbuminemia is used as a marker of inflammation and a predictor of outcome in post-surgical patients. It is associated with increased morbidity and mortality in patients having surgery for cancer disease. Objectives: to evaluate the implication of hypoalbuminemia on early postoperative complications in major cancer surgery. Methods: 40 patients undergoing elective major cancer surgery were included in the study. Patients were divided according to their serum albumin level into two groups. Group I: with serum albumin >35 g/L and Group II: with serum albumin ≤ 35 g/L. Major postoperative complications and length of stay in ICU (Intensive care unit) were documented. Results: Postoperative complications were higher in number and percentage in group II (serum albumin ≤ 35 g/L) compared to group I (serum albumin > 35 g/L). Furthermore, the length of ICU was significantly longer in group II (serum albumin ≤ 35 g/L) (9.60±3.59 days) compared to group I (serum albumin > 35 g/L) (6.95±0.69 days) (P= 0.002). Conclusion: The current study revealed that preoperative hypoalbuminemia increases the risk of postoperative complications and length of stay in ICU after major cancer surgery, as such, accounts for high proportion of ICU budget.

Abstract Background: Serum albumin is a marker of nutrition and inflammation. Currently, hypoalbuminemia is used as a marker of inflammation and a predictor of outcome in post-surgical patients. It is associated with increased morbidity and mortality in patients having surgery for cancer disease. Objectives: to evaluate the implication of hypoalbuminemia on early postoperative complications in major cancer surgery. Methods: 40 patients undergoing elective major cancer surgery were included in the study. Patients were divided according to their serum albumin level into two groups. Group I: with serum albumin >35 g/L and Group II: with serum albumin ≤ 35 g/L. Major postoperative complications and length of stay in ICU (Intensive care unit) were documented. Results: Postoperative complications were higher in number and percentage in group II (serum albumin ≤ 35 g/L) compared to group I (serum albumin > 35 g/L). Furthermore, the length of ICU was significantly longer in group II (serum albumin ≤ 35 g/L) (9.60±3.59 days) compared to group I (serum albumin > 35 g/L) (6.95±0.69 days) (P= 0.002). Conclusion: The current study revealed that preoperative hypoalbuminemia increases the risk of postoperative complications and length of stay in ICU after major cancer surgery, as such, accounts for high proportion of ICU budget.

Abstract Background: Serum albumin is a marker of nutrition and inflammation. Currently, hypoalbuminemia is used as a marker of inflammation and a predictor of outcome in post-surgical patients. It is associated with increased morbidity and mortality in patients having surgery for cancer disease. Objectives: to evaluate the implication of hypoalbuminemia on early postoperative complications in major cancer surgery. Methods: 40 patients undergoing elective major cancer surgery were included in the study. Patients were divided according to their serum albumin level into two groups. Group I: with serum albumin >35 g/L and Group II: with serum albumin ≤ 35 g/L. Major postoperative complications and length of stay in ICU (Intensive care unit) were documented. Results: Postoperative complications were higher in number and percentage in group II (serum albumin ≤ 35 g/L) compared to group I (serum albumin > 35 g/L). Furthermore, the length of ICU was significantly longer in group II (serum albumin ≤ 35 g/L) (9.60±3.59 days) compared to group I (serum albumin > 35 g/L) (6.95±0.69 days) (P= 0.002). Conclusion: The current study revealed that preoperative hypoalbuminemia increases the risk of postoperative complications and length of stay in ICU after major cancer surgery, as such, accounts for high proportion of ICU budget.

Abstract Background: It is the basic duty of all healthcare professionals to relieve pain, and the most important indication for treating pain after surgery is humanitarian. Objectives: Comparing the effects of intravenous morphine, tramadol and ketorolac on post operative pain in patients undergoing modified radical mastectomy Study design: A randomized, double blind trial. Methods: Sixty patients randomly were assigned to receive either IV morphine 5mg (Group I, n = 20), tramadol 100 mg (Group II, n = 20), or ketorolac 60 mg (Group III, n = 20) at the end of surgery. Assessment parameters included hemodynamics, respiratory rate, oxygen saturation, sedation score, VAS score, time of first analgesic request, total amount of analgesics consumption, and side effects in the first 24 hours. Results: The mean time to the first request for rescue analgesia was significantly prolonged in group II (11.00± 2.49 hrs ranged from 8- 15 hrs) and group III (8± 1.89 hrs ranged from 6.0 -10.0 hrs) in comparison to group I (3.75± 0.89 hrs ranged from 3 – 5 hrs) (P 0.001). Total post-operative amount of analgesics consumption over 24 hrs in the three studied groups was (7.00 ± 2.51 mg ranged from 5- 10 mg of morphine) in group I;(160.00± 68.06 mg ranged from 100-300 mg of tramadol) in group II;(80.00± 19.47 mg ranged from 60– 120 mg of ketorolac) in group III. The mean (VAS) score in studied groups, showed no significant difference between the three studied groups at all time periods(P >0.05), but there was a significant decrease in the (VAS) in each group separately over the course of 24 hrs in comparison to base line values (P 0.007). No significant differences were observed in the mean systolic and diastolic blood pressure values, respiratory rate and oxygen saturation between groups. Conclusion: intravenous morphine, tramadol and ketorolac had similar analgesic efficacy on the post-operative pain in patients undergoing modified radical mastectomy. Key words: Breast Cancer Surgery; Postoperative Pain; morphine, tramadol, ketorolac

Abstract Background: It is the basic duty of all healthcare professionals to relieve pain, and the most important indication for treating pain after surgery is humanitarian. Objectives: Comparing the effects of intravenous morphine, tramadol and ketorolac on post operative pain in patients undergoing modified radical mastectomy Study design: A randomized, double blind trial. Methods: Sixty patients randomly were assigned to receive either IV morphine 5mg (Group I, n = 20), tramadol 100 mg (Group II, n = 20), or ketorolac 60 mg (Group III, n = 20) at the end of surgery. Assessment parameters included hemodynamics, respiratory rate, oxygen saturation, sedation score, VAS score, time of first analgesic request, total amount of analgesics consumption, and side effects in the first 24 hours. Results: The mean time to the first request for rescue analgesia was significantly prolonged in group II (11.00± 2.49 hrs ranged from 8- 15 hrs) and group III (8± 1.89 hrs ranged from 6.0 -10.0 hrs) in comparison to group I (3.75± 0.89 hrs ranged from 3 – 5 hrs) (P 0.001). Total post-operative amount of analgesics consumption over 24 hrs in the three studied groups was (7.00 ± 2.51 mg ranged from 5- 10 mg of morphine) in group I;(160.00± 68.06 mg ranged from 100-300 mg of tramadol) in group II;(80.00± 19.47 mg ranged from 60– 120 mg of ketorolac) in group III. The mean (VAS) score in studied groups, showed no significant difference between the three studied groups at all time periods(P >0.05), but there was a significant decrease in the (VAS) in each group separately over the course of 24 hrs in comparison to base line values (P 0.007). No significant differences were observed in the mean systolic and diastolic blood pressure values, respiratory rate and oxygen saturation between groups. Conclusion: intravenous morphine, tramadol and ketorolac had similar analgesic efficacy on the post-operative pain in patients undergoing modified radical mastectomy. Key words: Breast Cancer Surgery; Postoperative Pain; morphine, tramadol, ketorolac

Abstract Background: It is the basic duty of all healthcare professionals to relieve pain, and the most important indication for treating pain after surgery is humanitarian. Objectives: Comparing the effects of intravenous morphine, tramadol and ketorolac on post operative pain in patients undergoing modified radical mastectomy Study design: A randomized, double blind trial. Methods: Sixty patients randomly were assigned to receive either IV morphine 5mg (Group I, n = 20), tramadol 100 mg (Group II, n = 20), or ketorolac 60 mg (Group III, n = 20) at the end of surgery. Assessment parameters included hemodynamics, respiratory rate, oxygen saturation, sedation score, VAS score, time of first analgesic request, total amount of analgesics consumption, and side effects in the first 24 hours. Results: The mean time to the first request for rescue analgesia was significantly prolonged in group II (11.00± 2.49 hrs ranged from 8- 15 hrs) and group III (8± 1.89 hrs ranged from 6.0 -10.0 hrs) in comparison to group I (3.75± 0.89 hrs ranged from 3 – 5 hrs) (P 0.001). Total post-operative amount of analgesics consumption over 24 hrs in the three studied groups was (7.00 ± 2.51 mg ranged from 5- 10 mg of morphine) in group I;(160.00± 68.06 mg ranged from 100-300 mg of tramadol) in group II;(80.00± 19.47 mg ranged from 60– 120 mg of ketorolac) in group III. The mean (VAS) score in studied groups, showed no significant difference between the three studied groups at all time periods(P >0.05), but there was a significant decrease in the (VAS) in each group separately over the course of 24 hrs in comparison to base line values (P 0.007). No significant differences were observed in the mean systolic and diastolic blood pressure values, respiratory rate and oxygen saturation between groups. Conclusion: intravenous morphine, tramadol and ketorolac had similar analgesic efficacy on the post-operative pain in patients undergoing modified radical mastectomy. Key words: Breast Cancer Surgery; Postoperative Pain; morphine, tramadol, ketorolac

Abstract Background: It is the basic duty of all healthcare professionals to relieve pain, and the most important indication for treating pain after surgery is humanitarian. Objectives: Comparing the effects of intravenous morphine, tramadol and ketorolac on post operative pain in patients undergoing modified radical mastectomy Study design: A randomized, double blind trial. Methods: Sixty patients randomly were assigned to receive either IV morphine 5mg (Group I, n = 20), tramadol 100 mg (Group II, n = 20), or ketorolac 60 mg (Group III, n = 20) at the end of surgery. Assessment parameters included hemodynamics, respiratory rate, oxygen saturation, sedation score, VAS score, time of first analgesic request, total amount of analgesics consumption, and side effects in the first 24 hours. Results: The mean time to the first request for rescue analgesia was significantly prolonged in group II (11.00± 2.49 hrs ranged from 8- 15 hrs) and group III (8± 1.89 hrs ranged from 6.0 -10.0 hrs) in comparison to group I (3.75± 0.89 hrs ranged from 3 – 5 hrs) (P 0.001). Total post-operative amount of analgesics consumption over 24 hrs in the three studied groups was (7.00 ± 2.51 mg ranged from 5- 10 mg of morphine) in group I;(160.00± 68.06 mg ranged from 100-300 mg of tramadol) in group II;(80.00± 19.47 mg ranged from 60– 120 mg of ketorolac) in group III. The mean (VAS) score in studied groups, showed no significant difference between the three studied groups at all time periods(P >0.05), but there was a significant decrease in the (VAS) in each group separately over the course of 24 hrs in comparison to base line values (P 0.007). No significant differences were observed in the mean systolic and diastolic blood pressure values, respiratory rate and oxygen saturation between groups. Conclusion: intravenous morphine, tramadol and ketorolac had similar analgesic efficacy on the post-operative pain in patients undergoing modified radical mastectomy. Key words: Breast Cancer Surgery; Postoperative Pain; morphine, tramadol, ketorolac