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

Objective: to evaluate the eectiveness of selective nerve root block (SNRB) versus pulsed radiofrequency treatment to dorsal root

ganglion (PRFT) for treatment of chronic back pain (CBP) with radiculopathy and the correlation between CBP and serum cholesterol

level.

Keywords: Chronic Low Back pain; Radiculopathypulsed radiofrequency; Selective nerve root block

Design: Prospective, randomized, open label study.

Setting: Department of Anaesthesia, ICU, and Pain management, Pain unit, Assiut University.

Patient(s): 80 patients having chronic back pain with radiculopathy were recruited in the study.

Intervention(s): patients in the rst group (40 cases in total) were treated by SNRB via transforaminal approach on the aected nerve

root and patients in the second group (40 patients in total) were treated by PRFT to the aected DRG. Lumbosacral radicular pain (LRP) is a common symptom, its annual prevalence in the general population is reported to be from 9.9% to 25% [1] and it is characterized by a shooting, radiating pain to one or more dermatomes, which is oen caused

by irritation of the corresponding nerve root [2]. e initial treatment should be conservative with oral medications, exercise,

and physiotherapy. When conservative treatments fail, epidural steroid injections and other interventional treatments should be

considered [3]. Surgical interventions are indicated when all other treatments have failed.

Breast cancer is the most frequent neoplastic tumor in women, and surgical treatment is indicated in most patients. Complications related to this treatment, such as post-mastectomy pain syndrome (PMPS), a persistent pain that develops after surgery, have been reported. Although the genesis of the pain is multifactorial, sectioning of the intercostobrachial nerve is the nerve lesion diagnosed more often (1) ..

Pain relief using drugs with high efficacy provides significant improvement in the patients' lives. Drugs like lamotrigine (LTG) and gabapentin (GBP) have the ability to overcome the symptoms of neuropathic pain (4).

Both LTG and PGB have been extensively reviewed in the past for management of painful neuropathic conditions (5)

Postoperative nausea and vomiting is defined as any nausea, retching, or vomiting occurring during the first 24-48 h after surgery in inpatients. Postoperative nausea and vomiting is one of the most common causes of patient dissatisfaction after anesthesia, with reported incidences of 30% in all post-surgical patients and up to 80% in high-risk patients. In addition, postoperative nausea and vomiting is regularly rated in preoperative surveys, as the anesthesia outcome the patient would most like to avoid. While suture dehiscence, aspiration of gastric contents, esophageal rupture, and other serious complications associated with postoperative nausea and vomiting are rare, nausea and vomiting is still an unpleasant and all-too-common postoperative morbidity that can delay patient discharge from the post-anesthesia care unit and increase unanticipated hospital admissions in outpatients.