Objectives: The aim of this prospective randomized study was to evaluate the effects of platelet-rich plasma (PRP) and fresh frozen plasma (FFP) on homeostasis after cardiopulmonary bypass surgery in Mitral valve replacement patients.Design: Thirty patients were allocated into two groups, each of which contains fifteen patients receiving either platelet-rich plasma or fresh frozen plasma. Results: Platelet count, adenosine diphosphate (ADP) maximum aggregation rate and clotting Factor VIII were greater in the platelet-rich plasma group (n=15) than in the fresh frozen plasma group (n=15). Blood loss after heparin neutralization was less in the PRP group than in the FFP group. Blood loss from heparin neutralization to 12 hours after surgery was correlated with platelet count, fibrinogen, Factor VIII and ADP aggregation rate. The amount of homologous blood transfusion which required was less in the platelet-rich plasma group. Conclusions: We concluded that the use of platelet-rich plasma improves homeostasis after cardiopulmonary bypass, and may be better for cardiac surgery to be performed with platelet-rich plasma than fresh frozen plasma.

Objectives: The aim of this prospective randomized study was to evaluate the effects of platelet-rich plasma (PRP) and fresh frozen plasma (FFP) on homeostasis after cardiopulmonary bypass surgery in Mitral valve replacement patients.Design: Thirty patients were allocated into two groups, each of which contains fifteen patients receiving either platelet-rich plasma or fresh frozen plasma. Results: Platelet count, adenosine diphosphate (ADP) maximum aggregation rate and clotting Factor VIII were greater in the platelet-rich plasma group (n=15) than in the fresh frozen plasma group (n=15). Blood loss after heparin neutralization was less in the PRP group than in the FFP group. Blood loss from heparin neutralization to 12 hours after surgery was correlated with platelet count, fibrinogen, Factor VIII and ADP aggregation rate. The amount of homologous blood transfusion which required was less in the platelet-rich plasma group. Conclusions: We concluded that the use of platelet-rich plasma improves homeostasis after cardiopulmonary bypass, and may be better for cardiac surgery to be performed with platelet-rich plasma than fresh frozen plasma.

Objectives: The aim of this prospective randomized study was to evaluate the effects of platelet-rich plasma (PRP) and fresh frozen plasma (FFP) on homeostasis after cardiopulmonary bypass surgery in Mitral valve replacement patients.Design: Thirty patients were allocated into two groups, each of which contains fifteen patients receiving either platelet-rich plasma or fresh frozen plasma. Results: Platelet count, adenosine diphosphate (ADP) maximum aggregation rate and clotting Factor VIII were greater in the platelet-rich plasma group (n=15) than in the fresh frozen plasma group (n=15). Blood loss after heparin neutralization was less in the PRP group than in the FFP group. Blood loss from heparin neutralization to 12 hours after surgery was correlated with platelet count, fibrinogen, Factor VIII and ADP aggregation rate. The amount of homologous blood transfusion which required was less in the platelet-rich plasma group. Conclusions: We concluded that the use of platelet-rich plasma improves homeostasis after cardiopulmonary bypass, and may be better for cardiac surgery to be performed with platelet-rich plasma than fresh frozen plasma.

ABSTRACT Background: Intrathecal opioids are .frequently used in the management of postoperative pain, but may be associated with many adverse effects such as pruritus, nausea, vomiting, urinary retention, and respiratory depression, which may limit their use; Aim ofthis studywas to compare between six different doses of IT morphine (0.1 mg, 0.2 mg, 0.3 mg, 0.4 mg, 0.5 mg and 1 mg) as regarding postoperative analgesia and the side effects of IT morphine, and to determine the optimal dose of IT morphine that provides satisfactory analgesia to the patient with minimal side effects. Methods: This study was conducted in Anesthesiology Department, Assiut university hospital, after approval of the local ethics committee. Our study was performed on 95 patients of ASA physical status I and II aged from 20 to 40 scheduled for anorectal surgeries. Spinal anesthesia was performed, with the patient in the sitting position. at L4, 5. Each patient received 5 mg of hyperbaric bupivacaine with different doses of IT morphine in a total volume of 2 ml. patients were kept in the sitting position for five minutes to get sacral block. Intraoperative monitoring; Heart rate, 02 saturation, and non-invasive blood pressure were monitored. Postoperative monitoring: Patients were evaluated for any pain or side effect of IT morphine (Pruritus, PONV, urinary retention, and respiratory depression) during the first 24 hours. Supplemental analgesia in the form of 1. V tenoxicam was available on patient request, and the doses needed for each patient were recorded. Antipruritic and antiemetic therapy was available on patient request. Results: Increasing the dose of IT morphine decreases the incidence of pain during thefirst 24 hours and subsequently decreases the need for supplemental analgesia. The doses of O. 1 mg and 0.2 mg are comparable with each other as regard to pain relief 100% of the patients receiving 0.1 mg and 75% of the patients receiving 0.2 mg of IT morphine experienced pain during the first 24 hours and subsequently required supplemental analgesia and even with 40 mg of 1. V tenoxicam, some patient complained of postoperative pain. The doses of O. 3 mg, 0.4 mg or 0.5 mg are comparable with each other. Theses doses are enough to provide 24-hours analgesia in more than 50% of patients. This percentage increases to 100% with the use of 20-40 mg of tenoxicam intravenously. The dose of 1 mg provides 24-hours analgesia in 87% of patients. Increasing the dose of IT morphine causes significant increase in the incidence and severity of pruritus. Postoperative nausea and vomiting occurred in 30% of the patients in the control group. There is a non-Significant increase in both the incidence and severity of PONV by increasing the dose of IT morphine. Urinary retention occurred in 20% of the patients in the control group. Increasing the dose of IT morphine causes significant increase in the incidence of urinary retention. Respiratory depression was not detected in any patient. In conclusion: Our study clearly demonstrated that the use of IT morphine in a dose of 0.3 mg in adjuvant with intravenous tenoxicam in a dose of 20-40 mg provides excellent pain relieffor 24 hours after anorectal surgeries with minimal side effects of IT morphine.

ABSTRACT Background: Intrathecal opioids are .frequently used in the management of postoperative pain, but may be associated with many adverse effects such as pruritus, nausea, vomiting, urinary retention, and respiratory depression, which may limit their use; Aim ofthis studywas to compare between six different doses of IT morphine (0.1 mg, 0.2 mg, 0.3 mg, 0.4 mg, 0.5 mg and 1 mg) as regarding postoperative analgesia and the side effects of IT morphine, and to determine the optimal dose of IT morphine that provides satisfactory analgesia to the patient with minimal side effects. Methods: This study was conducted in Anesthesiology Department, Assiut university hospital, after approval of the local ethics committee. Our study was performed on 95 patients of ASA physical status I and II aged from 20 to 40 scheduled for anorectal surgeries. Spinal anesthesia was performed, with the patient in the sitting position. at L4, 5. Each patient received 5 mg of hyperbaric bupivacaine with different doses of IT morphine in a total volume of 2 ml. patients were kept in the sitting position for five minutes to get sacral block. Intraoperative monitoring; Heart rate, 02 saturation, and non-invasive blood pressure were monitored. Postoperative monitoring: Patients were evaluated for any pain or side effect of IT morphine (Pruritus, PONV, urinary retention, and respiratory depression) during the first 24 hours. Supplemental analgesia in the form of 1. V tenoxicam was available on patient request, and the doses needed for each patient were recorded. Antipruritic and antiemetic therapy was available on patient request. Results: Increasing the dose of IT morphine decreases the incidence of pain during thefirst 24 hours and subsequently decreases the need for supplemental analgesia. The doses of O. 1 mg and 0.2 mg are comparable with each other as regard to pain relief 100% of the patients receiving 0.1 mg and 75% of the patients receiving 0.2 mg of IT morphine experienced pain during the first 24 hours and subsequently required supplemental analgesia and even with 40 mg of 1. V tenoxicam, some patient complained of postoperative pain. The doses of O. 3 mg, 0.4 mg or 0.5 mg are comparable with each other. Theses doses are enough to provide 24-hours analgesia in more than 50% of patients. This percentage increases to 100% with the use of 20-40 mg of tenoxicam intravenously. The dose of 1 mg provides 24-hours analgesia in 87% of patients. Increasing the dose of IT morphine causes significant increase in the incidence and severity of pruritus. Postoperative nausea and vomiting occurred in 30% of the patients in the control group. There is a non-Significant increase in both the incidence and severity of PONV by increasing the dose of IT morphine. Urinary retention occurred in 20% of the patients in the control group. Increasing the dose of IT morphine causes significant increase in the incidence of urinary retention. Respiratory depression was not detected in any patient. In conclusion: Our study clearly demonstrated that the use of IT morphine in a dose of 0.3 mg in adjuvant with intravenous tenoxicam in a dose of 20-40 mg provides excellent pain relieffor 24 hours after anorectal surgeries with minimal side effects of IT morphine.

ABSTRACT Background: Intrathecal opioids are .frequently used in the management of postoperative pain, but may be associated with many adverse effects such as pruritus, nausea, vomiting, urinary retention, and respiratory depression, which may limit their use; Aim ofthis studywas to compare between six different doses of IT morphine (0.1 mg, 0.2 mg, 0.3 mg, 0.4 mg, 0.5 mg and 1 mg) as regarding postoperative analgesia and the side effects of IT morphine, and to determine the optimal dose of IT morphine that provides satisfactory analgesia to the patient with minimal side effects. Methods: This study was conducted in Anesthesiology Department, Assiut university hospital, after approval of the local ethics committee. Our study was performed on 95 patients of ASA physical status I and II aged from 20 to 40 scheduled for anorectal surgeries. Spinal anesthesia was performed, with the patient in the sitting position. at L4, 5. Each patient received 5 mg of hyperbaric bupivacaine with different doses of IT morphine in a total volume of 2 ml. patients were kept in the sitting position for five minutes to get sacral block. Intraoperative monitoring; Heart rate, 02 saturation, and non-invasive blood pressure were monitored. Postoperative monitoring: Patients were evaluated for any pain or side effect of IT morphine (Pruritus, PONV, urinary retention, and respiratory depression) during the first 24 hours. Supplemental analgesia in the form of 1. V tenoxicam was available on patient request, and the doses needed for each patient were recorded. Antipruritic and antiemetic therapy was available on patient request. Results: Increasing the dose of IT morphine decreases the incidence of pain during thefirst 24 hours and subsequently decreases the need for supplemental analgesia. The doses of O. 1 mg and 0.2 mg are comparable with each other as regard to pain relief 100% of the patients receiving 0.1 mg and 75% of the patients receiving 0.2 mg of IT morphine experienced pain during the first 24 hours and subsequently required supplemental analgesia and even with 40 mg of 1. V tenoxicam, some patient complained of postoperative pain. The doses of O. 3 mg, 0.4 mg or 0.5 mg are comparable with each other. Theses doses are enough to provide 24-hours analgesia in more than 50% of patients. This percentage increases to 100% with the use of 20-40 mg of tenoxicam intravenously. The dose of 1 mg provides 24-hours analgesia in 87% of patients. Increasing the dose of IT morphine causes significant increase in the incidence and severity of pruritus. Postoperative nausea and vomiting occurred in 30% of the patients in the control group. There is a non-Significant increase in both the incidence and severity of PONV by increasing the dose of IT morphine. Urinary retention occurred in 20% of the patients in the control group. Increasing the dose of IT morphine causes significant increase in the incidence of urinary retention. Respiratory depression was not detected in any patient. In conclusion: Our study clearly demonstrated that the use of IT morphine in a dose of 0.3 mg in adjuvant with intravenous tenoxicam in a dose of 20-40 mg provides excellent pain relieffor 24 hours after anorectal surgeries with minimal side effects of IT morphine.

ABSTRACT Background: Intrathecal opioids are .frequently used in the management of postoperative pain, but may be associated with many adverse effects such as pruritus, nausea, vomiting, urinary retention, and respiratory depression, which may limit their use; Aim ofthis studywas to compare between six different doses of IT morphine (0.1 mg, 0.2 mg, 0.3 mg, 0.4 mg, 0.5 mg and 1 mg) as regarding postoperative analgesia and the side effects of IT morphine, and to determine the optimal dose of IT morphine that provides satisfactory analgesia to the patient with minimal side effects. Methods: This study was conducted in Anesthesiology Department, Assiut university hospital, after approval of the local ethics committee. Our study was performed on 95 patients of ASA physical status I and II aged from 20 to 40 scheduled for anorectal surgeries. Spinal anesthesia was performed, with the patient in the sitting position. at L4, 5. Each patient received 5 mg of hyperbaric bupivacaine with different doses of IT morphine in a total volume of 2 ml. patients were kept in the sitting position for five minutes to get sacral block. Intraoperative monitoring; Heart rate, 02 saturation, and non-invasive blood pressure were monitored. Postoperative monitoring: Patients were evaluated for any pain or side effect of IT morphine (Pruritus, PONV, urinary retention, and respiratory depression) during the first 24 hours. Supplemental analgesia in the form of 1. V tenoxicam was available on patient request, and the doses needed for each patient were recorded. Antipruritic and antiemetic therapy was available on patient request. Results: Increasing the dose of IT morphine decreases the incidence of pain during thefirst 24 hours and subsequently decreases the need for supplemental analgesia. The doses of O. 1 mg and 0.2 mg are comparable with each other as regard to pain relief 100% of the patients receiving 0.1 mg and 75% of the patients receiving 0.2 mg of IT morphine experienced pain during the first 24 hours and subsequently required supplemental analgesia and even with 40 mg of 1. V tenoxicam, some patient complained of postoperative pain. The doses of O. 3 mg, 0.4 mg or 0.5 mg are comparable with each other. Theses doses are enough to provide 24-hours analgesia in more than 50% of patients. This percentage increases to 100% with the use of 20-40 mg of tenoxicam intravenously. The dose of 1 mg provides 24-hours analgesia in 87% of patients. Increasing the dose of IT morphine causes significant increase in the incidence and severity of pruritus. Postoperative nausea and vomiting occurred in 30% of the patients in the control group. There is a non-Significant increase in both the incidence and severity of PONV by increasing the dose of IT morphine. Urinary retention occurred in 20% of the patients in the control group. Increasing the dose of IT morphine causes significant increase in the incidence of urinary retention. Respiratory depression was not detected in any patient. In conclusion: Our study clearly demonstrated that the use of IT morphine in a dose of 0.3 mg in adjuvant with intravenous tenoxicam in a dose of 20-40 mg provides excellent pain relieffor 24 hours after anorectal surgeries with minimal side effects of IT morphine.

ABSTRACT Background: Intrathecal opioids are .frequently used in the management of postoperative pain, but may be associated with many adverse effects such as pruritus, nausea, vomiting, urinary retention, and respiratory depression, which may limit their use; Aim ofthis studywas to compare between six different doses of IT morphine (0.1 mg, 0.2 mg, 0.3 mg, 0.4 mg, 0.5 mg and 1 mg) as regarding postoperative analgesia and the side effects of IT morphine, and to determine the optimal dose of IT morphine that provides satisfactory analgesia to the patient with minimal side effects. Methods: This study was conducted in Anesthesiology Department, Assiut university hospital, after approval of the local ethics committee. Our study was performed on 95 patients of ASA physical status I and II aged from 20 to 40 scheduled for anorectal surgeries. Spinal anesthesia was performed, with the patient in the sitting position. at L4, 5. Each patient received 5 mg of hyperbaric bupivacaine with different doses of IT morphine in a total volume of 2 ml. patients were kept in the sitting position for five minutes to get sacral block. Intraoperative monitoring; Heart rate, 02 saturation, and non-invasive blood pressure were monitored. Postoperative monitoring: Patients were evaluated for any pain or side effect of IT morphine (Pruritus, PONV, urinary retention, and respiratory depression) during the first 24 hours. Supplemental analgesia in the form of 1. V tenoxicam was available on patient request, and the doses needed for each patient were recorded. Antipruritic and antiemetic therapy was available on patient request. Results: Increasing the dose of IT morphine decreases the incidence of pain during thefirst 24 hours and subsequently decreases the need for supplemental analgesia. The doses of O. 1 mg and 0.2 mg are comparable with each other as regard to pain relief 100% of the patients receiving 0.1 mg and 75% of the patients receiving 0.2 mg of IT morphine experienced pain during the first 24 hours and subsequently required supplemental analgesia and even with 40 mg of 1. V tenoxicam, some patient complained of postoperative pain. The doses of O. 3 mg, 0.4 mg or 0.5 mg are comparable with each other. Theses doses are enough to provide 24-hours analgesia in more than 50% of patients. This percentage increases to 100% with the use of 20-40 mg of tenoxicam intravenously. The dose of 1 mg provides 24-hours analgesia in 87% of patients. Increasing the dose of IT morphine causes significant increase in the incidence and severity of pruritus. Postoperative nausea and vomiting occurred in 30% of the patients in the control group. There is a non-Significant increase in both the incidence and severity of PONV by increasing the dose of IT morphine. Urinary retention occurred in 20% of the patients in the control group. Increasing the dose of IT morphine causes significant increase in the incidence of urinary retention. Respiratory depression was not detected in any patient. In conclusion: Our study clearly demonstrated that the use of IT morphine in a dose of 0.3 mg in adjuvant with intravenous tenoxicam in a dose of 20-40 mg provides excellent pain relieffor 24 hours after anorectal surgeries with minimal side effects of IT morphine.

Immunstimulatory properties of Tramadol mainly affects natural killer cells [NK] , and T- lymphocytes production . No proved evidence that Tramadol affects HLA-DR expression from activated monocytes .This study evaluate a combined approach using I.M tramadol 1.5 mg/kg and I.V paracetamol 15 mg/kg used for treatment of postcraniotomy pain in patients with supratentorial space occupying lesions. The analgesic efficacy and immunological status were our subject of interest. 40 patients ASA I or II scheduled for elective supratentorial craniotomy divided into two groups: Group Paracetamol received paracetamol 15 mg/kg i.v. before end of surgery for postcraniotomy pain relief repeated 6 hours postoperative. Group paracetamol+ received same dose of paracetamol + tramadol 1.5 mg/kg i.m. started 1 hour before end of surgery and repeated 6 hours postoperative. Analgesic efficacy was assessed by visual analogue scale "VAS" at 3, 6, 12 and 24 hours postoperative. Immunological parameters measured were HLA-Dr expression and γ-interferon. Venous blood samples were withdrawn at 4-time points: Preoperative, intraoperative, first and third day postoperative. HLA-Dr expression mean values showed no significant difference inside and in between the two groups. In group paracetamol they were 87.27 ± 1.65 , 86.73 ± 1.79, 85.28 ± 2.33 and 88.12 ± 1.66 at do, doo , d1 and d3, respectively while in group paracetamol+, they were 86.17 ± 1.77, 87.96 ± 1.91, 89.19 ± 1.37 and 89.92 ± 1.81 at d0, d00, d1 and d3, respectively. While γ-interferon mean values significantly decreased after induction of anesthesia in both groups. They were 3.6 ± 0.33 versus 3.55 ± 0.33, 3.25 ± 0.36 versus 3.14 ± 0.44, 3.55 ± 0.29 versus 3.93 ± 0.35 and 3.7 ± 0.41 versus 4.21 ± 0.36 at d0, d00, d1 and d3 in group paracetamol versus group paracetamol+, respectively. γ-interferon release recovered earlier in group paracetamol+ (by first day postoperative) rather in group paracetamol (by third day postoperative). The "VAS" mean values were significantly lower in group paracetamol+ patients than in group paracetamol ; 2.4 ± 0.11 versus 3.2 ± 0.17, 2.55 ± 0.11 versus 3.65 ± 0.18, 2.05 ± 0.05 versus 2.45 ± 0.11 and 1.05 ± 0.08 versus 1.8 ± 0.16 at the 3rd, 6th, 12 and 24 hours postoperative, respectively. In Group paracetamol+, eight patients experienced nausea and two vomited once. Tramadol when combined to paracetamol have yielded a better analgesia for post craniotomy pain and an improved immunological profile as regards to increased levels of γ-interferon. Although it had a negative effect on HLA-Dr expression, no infectious complications were reported in this study.

Immunstimulatory properties of Tramadol mainly affects natural killer cells [NK] , and T- lymphocytes production . No proved evidence that Tramadol affects HLA-DR expression from activated monocytes .This study evaluate a combined approach using I.M tramadol 1.5 mg/kg and I.V paracetamol 15 mg/kg used for treatment of postcraniotomy pain in patients with supratentorial space occupying lesions. The analgesic efficacy and immunological status were our subject of interest. 40 patients ASA I or II scheduled for elective supratentorial craniotomy divided into two groups: Group Paracetamol received paracetamol 15 mg/kg i.v. before end of surgery for postcraniotomy pain relief repeated 6 hours postoperative. Group paracetamol+ received same dose of paracetamol + tramadol 1.5 mg/kg i.m. started 1 hour before end of surgery and repeated 6 hours postoperative. Analgesic efficacy was assessed by visual analogue scale "VAS" at 3, 6, 12 and 24 hours postoperative. Immunological parameters measured were HLA-Dr expression and γ-interferon. Venous blood samples were withdrawn at 4-time points: Preoperative, intraoperative, first and third day postoperative. HLA-Dr expression mean values showed no significant difference inside and in between the two groups. In group paracetamol they were 87.27 ± 1.65 , 86.73 ± 1.79, 85.28 ± 2.33 and 88.12 ± 1.66 at do, doo , d1 and d3, respectively while in group paracetamol+, they were 86.17 ± 1.77, 87.96 ± 1.91, 89.19 ± 1.37 and 89.92 ± 1.81 at d0, d00, d1 and d3, respectively. While γ-interferon mean values significantly decreased after induction of anesthesia in both groups. They were 3.6 ± 0.33 versus 3.55 ± 0.33, 3.25 ± 0.36 versus 3.14 ± 0.44, 3.55 ± 0.29 versus 3.93 ± 0.35 and 3.7 ± 0.41 versus 4.21 ± 0.36 at d0, d00, d1 and d3 in group paracetamol versus group paracetamol+, respectively. γ-interferon release recovered earlier in group paracetamol+ (by first day postoperative) rather in group paracetamol (by third day postoperative). The "VAS" mean values were significantly lower in group paracetamol+ patients than in group paracetamol ; 2.4 ± 0.11 versus 3.2 ± 0.17, 2.55 ± 0.11 versus 3.65 ± 0.18, 2.05 ± 0.05 versus 2.45 ± 0.11 and 1.05 ± 0.08 versus 1.8 ± 0.16 at the 3rd, 6th, 12 and 24 hours postoperative, respectively. In Group paracetamol+, eight patients experienced nausea and two vomited once. Tramadol when combined to paracetamol have yielded a better analgesia for post craniotomy pain and an improved immunological profile as regards to increased levels of γ-interferon. Although it had a negative effect on HLA-Dr expression, no infectious complications were reported in this study.