To Study the effect of combination of of general anesthesia and local anesthesia in anesthesia for external dacryocystorhinostomy and assess quality of the procedure
* calculate the total requirement for anaesthetic agents to maintain satisfactory operating conditions * calculate total anesthetic time * assess intraoperative changes in hemodynamics * assess intraoperative blood loss * evaluate surgeon and patient satisfaction * recognize whether this was related with changes in postoperative analgesia . * Also occurrence of postoperative nausea was recorded and compared with general anaesthesia combined with intravenous opioid for (EXT-DCR) surgery.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
SUPPORTIVE_CARE
Masking
QUADRUPLE
Enrollment
24
all patients were assigned randomly to receive either general anesthesia with intravenous opioids and local infiltration of saline (Group G) or general anesthesia with intravenous saline and local infiltration of a mixture of lidocaine/epinephrine (Group L). In both groups, general anesthesia was induced with 2 mg/kg propofol and tracheal intubation was facilitated by 0.1 mg/kg cisatracurium. All patients underwent mechanical ventilation with 100% oxygen. Anesthesia was maintained with isoflurane, and muscle relaxation was provided by an injection of cisatracurium 0.02 mg/kg every 20 minutes.
Zagazig University
Zagazig, Sharqia Province, Egypt
RECRUITINGpostoperative pain assessment
To quantify the intensity of postoperative pain, the patients were asked to use a 10-cm visual analog scale (VAS) grade from 0-cm (no pain) to 10-cm (the worst possible pain) 1, 2, 4, 6, 8, 12, and 24 h after extubation
Time frame: change in visual analogue scale at 1, 2, 4, 6, 8, 12, and 24 hours postoperative after extubation
hemodynamic assessment
Change in heart rate were recorded preoperatively, after induction of general anesthesia, after IV injection of 10 ml syringe and after local infiltration, then every 5 min intraoperatively, and during early recovery, and every 30 min, thereafter for 24 hours
Time frame: for 24 hours
hemodynamic assessment
Change in arterial blood pressure were recorded preoperatively, after induction of general anesthesia, after IV injection of 10 ml syringe and after local infiltration, then every 5 min intraoperatively, and during early recovery, and every 30 min, thereafter for 24 hours
Time frame: for 24 hours
extubation time
Extubation time was calculated from time of anesthesia off till extubation and recorded in each patient
Time frame: intraoperative (from time of anesthesia ended till extubation and recorded in each patient in minutes)
mean isoflurane %
Isoflurane concentration was adjusted according to hemodynamics by increase or decrease concentration when heart rate or mean arterial blood pressure increase or decrease more than 20-30% of the basal preoperative record, respectively and after nalbuphine dose failed to adjust hemodynamics
Time frame: intraoperative ( recorded every 5 minutes)
time to rescue analgesia
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The time from the end of anaesthesia to first use of rescue analgesia (nalbuphine)
Time frame: up to 24 hours of postoperative
The number of patients who required nalbuphine in the postoperative period,
to calculate the number of patients who required nalbuphine in the postoperative period,
Time frame: up to 24 hours of postoperative
intraoperative bleeding
to the nearest milliliter) was determined by the amount of blood in the suction containers and gauze sponges, based on assessment by the surgeon.
Time frame: at the end of surgery
patient and surgeon satisfaction
An overall satisfaction score according to postoperative analgesia . * nil = 0 * mild = 1 * good = 2 * excellent = 3 was recorded on the first postoperative day from both patients and surgeons. The acceptance of combination of LA and GA was questioned and the patients who applied for a successive operation on the other eye were recorded
Time frame: assessed on the first postoperative day from both patients and surgeons.