Assistant Professor of Anesthesia, ICU and Pain Relief, South Egypt Cancer Institute, Assiut University.
Assuit, Assuit | Egypt
Main Specialties: Anesthesiology, Critical Care Medicine, Pain Medicine
Additional Specialties: Anesthesia, ICU and Pain Relief, South Egypt Cancer Institute, Assiut University.
Since I obtained the MMBCH in September 2005 I am working in University Hospital and South Egypt Cancer Institute in Egypt. During internship I was working in Assiut University Hospitals. During that period I walked in General Surgery, Internal Medicine, Pediatric, Obstetric & Gynecology, Emergency and Anesthesia. In each department I spent 2 months. During the Residency in Anesthesia I was working in Assiut University Hospital in Egypt. During that period I was walking in General Surgery, Neuro-surgery, Vascular Surgery, Orthopedic Surgery, Urology, ENT Surgery, Ophthalmic Surgery, Gynecology & Obstetric Surgery, Trauma & Emergencies, Plastic Surgery, Chest Surgery, Remote Maneuvers (Radiotherapy ), ECT and Pediatric Surgery.
I obtained my MSc in Anesthesia, and then I was appointed as Assistant Lecturer in Anesthesia. & ICU in South Egypt Cancer Institute, Assiut University till April 2016 where I obtained my MD in Anesthesia and I was appointed in the same year as Lecturer of Anesthesia & ICU and Pain Management. Owing to my academic position, attendance of tutorials regularly held in my department as well as teaching my junior colleagues & nurses were and still part of my duty. In ICU I have experience in the management of acute & chronic respiratory failure, mechanical ventilation, all types of shock, poisoning, ARDS, MOF, TPN and management of post-operative patients with cardiac, thoracic, vascular and neurosurgery and management of polytraumatized patients. I have been through all branches of clinical anesthesia and I finished my MD thesis on Treatment Of cardiac patients with Upper Abdominal Cancer surgeries by thoracic epidural Block.
Primary Affiliation: Assistant Professor of Anesthesia, ICU and Pain Relief, South Egypt Cancer Institute, Assiut University. - Assuit, Assuit , Egypt
Local and Regional Anesthesia
Background: The purpose of this study is to evaluate the safety and efficacy of oralmelatonin administered with thoracic epidural analgesia in patients with multiple bilateralfractured ribs.Patients and Methods: A prospective, double-blind randomized control study was carriedout on 80 patients of either sex, American Society of Anesthesiologists (ASA) Grade I andII, aged above 18 years, presenting with multiple bilateral fractured ribs. They wererandomly divided into two groups, 40 patients each. Placebo group patients received oralplacebo tablets and melatonin group (TEA and melatonin) patients received oral melatonintablets (5 mg), about 1 hour before epidural infusion of local anesthetics and then every 12hours till the cessation of bupivacaine infusion.Results: Melatonin administration was associated with a significant decrease in total morphine analgesia consumption, from 31.8 ± 1.41 mg in the TE group to 13.03 ± 0.85 mg in themelatonin group (P < 0.001), with a significant decrease (P < 0.001) in the mean infusion rateof bupivacaine required for controlling the pain, from 0.17 ± 0.014 mL/kg/hour in the TEgroup to 0.12 ± 0.001 mL/kg/hour in the melatonin group. The duration of bupivacaineinfusion in the melatonin group was also significantly shorter than in the TE group (96.48 ±1.87 and 100.05 ± 3.39 hours, resp., P < 0.001).Conclusion: We conclude that premedication of patients with 5 mg melatonin is associatedwith significant prolongation of thoracic epidural analgesic effects compared to placebo.Registration: This clinical study was registered at Pan African Clinical Trial Registry withno. “PACTR 201711002741378” on 02-11-2017.Keywords: melatonin, thoracic epidural analgesia, fracture ribs, acute pain, visual analogue score
ARC Journal of Anesthesiology
Background: Osteoarthritis (OA) of knee is one of the most common debilitating conditions associated with pain
and limitation in daily living activities which negatively affect quality-of-life. It is a disease of the entire joint,
involving not only the joint lining but also cartilage, ligaments, and bone. It is characterized by brea kdown of the
cartilage, bony changes of the joints, deterioration of tendons and ligaments, and various degrees of inflammation
of the synovium.
Aim of the Work: To discuss the incidence and updates in Pathophysiology of Osteoarthritis (OA) of knee and
demonstrate updates in management to solve this problem.
Study Design: Narrative review article.
Conclusion: The current review revealed that Osteoarthritis (OA) of knee joint has multi mechanism and increases
the risk of complications bed redden as such, accounts for burden on economics budget.
Keywords: Osteoarthritis - knee joint – chronic pain management-VAS score.
Anaesthesiology and Pain Medicine
Background:Total knee replacements surgeries are very important to
improve mobility and quality of life and usually associated with sever
postoperative pain. Femoral nerve block has been studied to improve
post-operative pain. Adding adjuvant to local anesthesia (LA) as fentanyl
in femoral nerve block could be a method to prolong the duration of the
block. The aim of the study was to study the analgesic efficacy fentanyl
added to bupivicaine in ultrasound guided femoral nerve block for
patients undergoing elective total knee replacements surgeries.
Methods:sixty patients (ASA I-II) of either sex were scheduled for
elective total knee replacements surgeries. Patients were randomly
allocated into two groups (30 patients each), to receive ultrasound
guided femoral nerve block using; fentanyl 1 mic /kg added to 18 ml
bupivicaine 0.25% plus 2 ml normal saline (Group B) versus 18 ml
bupivicaine 0.25% plus fentanyl 1 mic /kg in 2 ml volume (Group BF).
Postoperative pain was assessed over 24 hours using VAS scale plus
time of first analgesic request and overall post-operative analgesics
consumption were recorded. The intra and post-operative HR, SBP, DBP
and MAP were recorded. Any concomitant complications were observed
Results:As regard patient demographic data and ASA grades, we found
there were no significant changes between the two groups, as shown
in. Patient hemodynamic parameters either intra or post-operative,
were comparable in both groups (P. value 0.19). There was a significant
decrease in VAS pain scores in group LF during first day postoperative
(P. value 0.00I*) and post-operative analgesic consumption much more
decreased in group LF in comparison to group F (P. value 0.001*). We
found that the time of the 1st request of analgesia in group L was (5.13
± 1.008) hours while it was (11.27 ± 0.9), hours in group LF after end
of operation, the difference between the two group was significant
Conclusion:Ultrasound guided FNB improve post-operative analgesia
and the addition of fentanyl to bupivicaine in femoral nerve block
prolonged the duration of block and decreased analge
Archives of Anesthesiology
AbstractBackground and Objectives: Major gastrointestinal cancer surgeries are associated with significantperioperative mortality and morbidity due to increased incidence of major perioperative cardiovascular event(MACEs). This study examined the effect of perioperative patient controlled epidural analgesia (PCEA) onreduction of MACEs in cardiac risky patients undergoing major gastrointestinal cancer surgery.Methods: 60 patients (ASA II and III) of either sex were scheduled for elective Upper gastrointestinal cancersurgeries. Patients were allocated randomly into two groups (30 patients each) to receive, beside GA: continuousintra and post -operative intravenous infusion with fentanyl for 72 hours post-operatively (control group) orcontinuous intra and post -operative epidural infusion with bupivacaine 0.125% and fentanyl (TEA group) for72 hours post-operativelyIntra-operative and post operative (HR and MAP) were recorded. Postoperative pain was assessed over72 h using numerical rating scale (NRS). All patients were screened for occurrence of MACEs by ECG andechocardiography. And other postoperative complications and duration of ICU stay were recorded.Results: There was a significant decrease in the incidence of MACEs with less pain scores in patients of TEAgroup in comparison to control group. Postoperative complications were comparable in both groups.Conclusion: Perioperative PCEA in cardiac risky patients subjected to major gastrointestinal cancer surgeryreduced significantly postoperative major adverse cardiac events with better pain control in comparison withperioperative PCIA analgesia.
Development inAnesthetics & Pain Management
AbstractIntroduction and objectives: Diagnostic and therapeutic procedures recently are done in gastroenterology setup as a part of fast-track concept.A major volume of gastrointestinal procedures are performed routinely on daycare basis under sedation as upper and lower GIT endoscopy. Manyanesthetic agents used to provide sedation for these procures. Propofol, opioids, and midazolam form the backbone of the various regimes employed inthe endoscopic suites all over the world. Dexmedetomidine is a pharmacologically active selective α 2-adrenergic receptor agonist. It was approved it inthe intensive care unit (ICU) for sedation and analgesia for the duration of less than 24 hours. The aim of this study was to study efficacy and safety ofDexmedetomidine efficacy as sole sedating agent versus propofol for sedation during upper and lower GIT endoscopy.Methods: This randomized controlled trial was carried out on 60 patients of either sex, aged 21-70 years of age undergoing upper and lower GITendoscopy, with ASA I-II. Patients were randomly assigned into two groups, (30 patients in each group).Dex group: Sedation was induced by loading dose of (dexmedetomidine 1µg/kg) followed by infusion of (dexmedetomidine 0.8µg/kg /h)Propofol group: Sedation was initially started by bolus dose of 0.5mg/kg propofol IV Then, infusion was started at the rate of 50µg /kg/min. Upperand lower GIT endoscopies were carried out in the usual standard manner for all patients, then patients were discharged to PACU after attaining anAldrete Recovery Scale Score of 9-10 Time taken to achieve this score was recorded. The patient’s vital signs, Respiratory complications, VAS score forpain measurement, PONV, and any other adverse events were recorded.Results: There was significant decrease in (HR and MAP) but not respiration rate (RR) and SpO2, in (Dex group) during the procedure and earlypost-operative (P. value 0.000**). But during the remaining of post-operative periods (HR and MAP) were comparable. VAS pain scores in both groupswere decreased in comparable manner at all measured time points. But complications (atthythmia, air way obstruction, nausea, and vomiting) wassignificantly increased in Propofol group (P. value 0.001**). Mean time to achieve RSS 3-4 was 6 (±1.5) min in Dex group versus 9 (±1.9) min in Propofolgroup (P<0.005) and to achieve an Aldrete Recovery Scale Score of 9-10 was 8 (±2.1) min in Dex group versus 6 10 (±1.6) min in Propofol group(P<0.029).Conclusion: In conclusion, there is evidence to support dexmedetomidine as a potential sole sedative agent in small diagnostic and therapeuticprocedures like GIT endoscopies, our study support these evidences and although dexmedetomidine resulted in longer onset and recovery, more sideeffects but sufficient levels of sedation and analgesia are good advantages to use it as sole sedating agent.Keywords: Dexmedetomidine; Sedation; Propofol; GIT endoscopy
Journal of Pain & Relief
AbstractBackground: Breast surgeries are among the common forms of surgeries that conducted daily in hospitals.Multimodal analgesia, which combines analgesics with variable pharmacodynamics to target multiple underlyingmechanisms of pain, is evolving as an acceptable approach to pain treatment for acute pain. So Transdermal fentanylpatch (TDF) can ameliorate severe pain in breast surgery.Objective: To examine the efficacy and safety of adding Transdermal fentanyl patch (TDF) to multimodal analgesiain controlling acute postoperative pain after breast surgery if applied 12 hours prior surgery.Methods: This randomized, blinded, study was conducted after approval of local ethics committee of South EgyptCancer Institute, Assiut University, Assiut–Egypt, and registered at www.clinicaltrials.gov at no.: “NCT03051503”. Afterobtaining written informed consent, Sixty four adult female patients (ASA II) were scheduled for elective breast cancersurgeries in the form of modified radical mastectomy. Patients were classified randomly into two groups (32 patientseach) to receive beside standard GA, Transdermal fentanyl patch (TDF) 50 µg/hr applied 12 hours prior surgery inone group (TDF group), while the second group (control group) received standard GA alone. Both group treated bymorphine PCA for postoperative pain. Visual analogue scale (VAS), side effects, and serum levels of cortisol andprolactin were assessed over 24 h. postoperatively. The intra and post-operative heart rate (HR) and mean arterialpressure (MAP), Ramsay sedation score and total morphine consumption via PCA postoperatively were also recorded.Results: MAP and heart rate during intra and early post-operative periods were significantly reduced in TDF groupin comparison to control group (P ≤ 0.005) but not over the remaining post-operative period (P>0.01). And, there wassignificant decrease in both VAS scores (p<0.05) and hence the total amount of morphine consumed postoperatively(7.43 ± 4.39) in TDF group in comparison to control group (13.47 ± 4.73) without significant change in side effects,except sedation scores, which were statistically increased but clinically not effective, in early post-operative hours.Finally, levels of prolactin and cortisol hormones were significantly decreased in TDF group indicating less stress andbetter pain control.Conclusion: Applying Transdermal fentanyl patch (TDF) 50 µg/hr 12 hours prior surgery as a part of multimodalanalgesia to control acute postoperative pain after modified radical mastectomy was associated with less stressresponse, better pain control and decreased total amount of postoperative morphine consumption.
AbstractIntroduction and Objectives: ERCP procedure is used for diagnosis and management of several biliary and pancreatic disorders. As it is alengthy and uncomfortable procedure, adequate sedation is required to assure patient cooperation and increase success rate of the procedure.Many agents are available to provide conscious sedation and Propofol is the most commonly used agent. Dexmedetomidine -a selective α 2adrenergic receptor agonist- is used recently for conscious sedation with analgesic effect also Ketamine has many effects such as; amnesia,analgesia and maintains spontaneous breathing.Our aim was to compare efficacy and safety of Dexmedetomidine versus Ketamine as an adjunct drug to propofol for sedation during ERCPprocedures.Methods: This randomized clinical trial was carried out on 48 patients aged 21-70 years old of either sex, undergoing ERCP (diagnostic ortherapeutic), with ASA II (- III). Patients were randomly assigned into two groups, (24 Patients each).Group D; Sedation started by dexmedetomidine 0.5µg/kg plus propofol 50 mg as loading followed by of dexmedetomidine 0.4 µg/kg pluspropofol 1 mg/kg/h infusion.Group K; Sedation started by a mixture of 8 mg propofol plus 2 mg ketamine administered as following; 5 ml loading then infusion titratedtill targeted RSS score of 5.ERCP was carried out in the standard manner for all patients, then patients were discharged to PACU after achieving score of 9-10 of anAldrete Recovery Scale and time taken to achieve this score was recorded.The patient’s HR, MAP, Respiratory complications, NRS score for pain measurement, PONV, Any other side effects and level of satisfactionof both surgeon and patients were recorded.Results: Demographic data and baseline vital signs were comparable between the two groups. There was significant decrease in HR, MAP,respiration rate (RR) and SpO2 in (group D) during the procedure and early post-operative (P. value 0.000**). But after that no significantdifference was found. Mean time to, achieve RSS 3-4 was 8 (±0.6) min in group K versus 6 (±1.1) min in group D (P<0.001) and to achievean Aldrete Recovery Scale Score of 9– 10 was 8 (±0.6) min in group K versus 6 (±1.1) min in group D (P<0.001) also, the total propofolrequirement during the procedure was statistically decreased the Group D (P. value 0.000**). Comparable reduction in NRS pain scores wasfound in both group, but side effects as; hallucinations, agitation, nausea and vomiting were significantly increased in (group K).Conclusion: Both combinations; dexmedetomidine plus propofol and Ketofol were effective for sedation and analgesia during ERCPprocedures, but dexmedetomidine plus propofol resulted in better recovery, lesser side effects, higher levels of analgesia and lower propofolrequirements than Ketofol.
Journal of Pain and Relief
AbstractBackground and Objectives: The gold standard for acute postoperative pain management in major abdominalsurgeries is thoracic epidural analgesia (TEA) and this was proved by a lot of studies, systematic reviews and metaanalyses. However, TEA is sometimes contraindicated and may cause serious risks. Rectus Sheath Block (RSB) iseffective for the abdominal surgeries with midline abdominal incisions as local anesthetics will be injected within theposterior rectus sheath bilaterally leading to intense pain relief for the middle anterior wall extending from the xiphoidprocess to the symphysis pubis. The aim of the study was to assess intra and post-operative RSB versus intra andpost-operative TEA, in patients undergoing elective major abdominal cancer surgery with midline incisions.Methods: This randomized, blinded, was registered at www.clinicaltrials.gov at no.: “NCT03460561” and wasapproved by local ethics committee of South Egypt Cancer Institute, Assiut University, Egypt. One hundred adultpatients, (ASA grade II and III), scheduled for major elective abdominal cancer surgery with Medline incision, wererandomly divided into two groups, (50 patients each); TEA group: patients in this group received TEA with standardGA and intra-operative analgesia was started before skin incision by injecting epidural bolus dose of 0.1 ml/kg of(0.125% levo-bupivacaine+fentanyl 2 µg/ml). Postoperative analgesia was provided through PCEA by injecting abolus dose of 3 ml then continuous infusion of 0.1 ml/kg of mixture of (0.0625% levo-bupivacaine+fentanyl 2 µg/ml)for 48 hours postoperative. RSB group: patients in this group received standard GA plus ultrasound (U/S) guidedrectus sheath block by a volume of 20 mL of (0.25% levo-bupivacaine+fentanyl 30 µg) in saline on either side.Before end of surgery and before closure of abdominal wall, bilateral surgically placed catheters in rectus sheathplane aiming to provide post-operative analgesia using the following; 20 mL of (0.125% levo-bupivicaine+Fentanyl30 μg) every 12 hours in to each catheter for 48 hours. Perioperative hemodynamics (MAP and HR) were recorded.Postoperative pain was assessed over 48 hour post operatively using (VAS). Total fentanyl consumption, Peakexpiratory flow rate (PEFR), postoperative and side effects of the drugs and duration of ICU and hospital stay wererecorded.Results: We found a significant reduction in VAS pain scores (at rest and during cough) in both group at all postoperative period but fentanyl consumption was significantly lower in TEA group. Also we found a significantreduction in intra-operative hemodynamics (mean arterial pressure and heart rate) in TEA group in comparison toRSB group while there was minimal statistically significant reduction in postoperative MAP and heart rate. Theincidence of other postoperative complications such as decreasing PEFR, sedation, nausea and vomiting werecomparable in both groups.Conclusion: Rectus sheath block was not inferior to thoracic epidural analgesia in reduction of pain intensityafter major abdominal cancer surgeries, and associated with hemodynamic stability along the 48 hourspostoperative without procedure related adverse events or decreasing PEFR
Journal of Pain Management & Medicine
AbstractBackground: PMPS nowadays is common due to advances in both; diagnosis and treatment of cancer breast.Choosing proper treatments can improve the patients’ quality of life. Cancer breast is common and quite importantdisease and female in our family must be aware of it. Improvement of the diagnosis and treatment PMPS lead toincreased patients satisfaction and decrease fear of cancer breast.Objective: Discuss different methods for management of PMPS with less side effects, adequate analgesia,improvement of quality of life, and better patient satisfaction in the future.Methods: Treatment approaches include both pharmacological interventions and non-pharmacologicalstrategies. However, current treatments of the PMPS are near-optimal and prevention much better than treatment.Conclusion: Continuous perioperative thoracic epidural Fentanyl–bupivacaine infusion was much better in painrelief, less sedating effect and shorter duration of hospital and ICU stay than continuous perioperative entanylintravenous infusion in patients undergoing major upper gastrointestinal cancer surgery
Journal of Pain Management & Medicine
AbstractBackground: Major upper gastrointestinal cancer surgeries induce postoperative pain, that if not controlled maycause various organ dysfunctions and prolonged hospital and ICU stay. Thus an appropriate pain therapy to thosepatients must be applicated.Objective: To compares the effects of continuous perioperative thoracic epidural Fentanyl-bupivacaine infusionversus continuous perioperative Fentanyl intravenous infusion in patients undergoing major upper gastrointestinalcancer surgery.Methods: 60 patients (ASA II) of either sex were scheduled for elective upper gastrointestinal cancer surgeries.Patients were allocated randomly into two groups (30 patients each) to receive: continuous peri-operative epiduralinfusion with bupivacaine 0.132 and fentanyl (TEA group), or continuous peri-operative intravenous infusion withfentanyl (control group). Postoperative pain was assessed over 72 h using visual analogue scale (VAS). The intraand post-operative haemodynamic, sedation score and overall patient fentanyl consumption were recorded. Anyconcomitant events like nausea; vomiting, pruritus or respiratory complications were recorded postoperatively.Results: There was a significant decrease in pain sensation in TEA group during first day postoperative. Patienthaemodynamics was significantly decreased in TEA group. As regard sedation scale, patients of the TEA group weresignificantly less sedated than control group at immediate postoperative only.Conclusion: Continuous perioperative thoracic epidural Fentanyl-bupivacaine infusion was much better inpain relief, less sedating effect and shorter duration of hospital and ICU stay than continuous perioperative fentanylintravenous infusion in patients undergoing major upper gastrointestinal cancer surgery
Archives of Anesthesiology
AbstractBackground: Enhanced Recovery After Surgery (ERAS) is a multimodal perioperative managementapproach that provides better outcomes for less expense. ERAS has been introduced to the practice toimprove patients’ perioperative performance and solve barriers to early discharge. ERAS protocol is formedof multiple components, implemented together in a synergistic way to maximize patients’ improvementand cost savings. Currently, many surgeries can be managed with ERAS protocol. However, the diversity ofsurgical procedures makes it difficult to manage every surgical specialty with a single uniform ERAS protocol.Multiplicity and complexity of ERAS components are considered main barriers to significant adherence andsuccessful adoption of the protocol in the clinical practice, rendering full protocol implementation a seriouschallenge.Objectives: This article is aiming to review the current ERAS components and its contribution to perioperativeoutcomes in the clinical practice.Contents: This article contains review on significance, guidelines and recommendations of current ERAScomponents in the perioperative pathway.Conclusion: ERAS is formed of multiple components that need to be refined to provide a procedure-specificERAS protocol rather than a single uniform protocol for different surgical specialties. ERAS is a multidisciplinaryprotocol that needs enormous collaborative efforts from patients, nurses, physicians, and administrativestaff involved in the perioperative care of surgical patients to ensure full and correct implementation ofERAS protocol.
J Pain Res 2017 12;10:887-895. Epub 2017 Apr 12.
Department of Anesthesia, ICU and Pain Relief.
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