Abdelhamid Karoui’s research while affiliated with University of Sfax and other places

Introduction: Few studies evaluated the treatment of postoperative pain in middle ear surgery. Materials and methods: We conducted a randomized clinical trial to evaluate the efficacy of dexamethasone in the management of postoperative pain in middle ear surgery. Group G1 received an intravenous injection of 2 ml of physiological saline 30 minutes before the end of the procedure. Group G2 received a 2 ml intravenous solution containing 8 mg of dexamethasone, 30 minutes before the end of the procedure. Pain perception was measured by the Visual analog scale (VAS) every 10 min during the first hour and then every 6 hours during the 24 hours postoperatively. The delay of the first analgesic demand and the consumption of analgesics use during the first 24 hours postoperatively, were recorded. Results: VAS values were lower in G2at all measurement points during the first hour, as well as the first 24h postoperatively (Mann-Whitney test, P<0.05).The delay of the analgesic request was (0 (0-60) for G1 versus 0 (0-80) for G2, P=0.04, Mann-Whitney test). Morphine was used in 44% of the patients in G1 against 19% for G2 (P = 0.031). There was a significant difference between G1 and G2 in terms of the total dose of morphine consumed (P= 0.028, Mann-Whitney test). Paracetamol demand was lower in group 2 at all points of assessment during the first 24 hours postoperatively. Conclusions: Intravenous dexamethasone is effective in decreasing pain and analgesic requirement, during the first 24 hours postoperatively, in patients undergoing middle ear surgery.

Introduction: the aim of our study was to evaluate the efficacy of dexamethasone added to bupivacaine and sufentanil in spinal anesthesia to improve postoperative analgesia after femur upper extremity surgery. Methods: we conducted a prospective controlled, randomized double-blinded clinical trial including patients proposed for surgery of the upper extremity of the femur under spinal anesthesia. The patients were randomly allocated to receive intrathecally 10 mg hyperbaric bupivacaine 0.5% with 5µg sufentanil and 2 ml normal saline (control group) or 10 mg hyperbaric bupivacaine 0.5% with 5 µg sufentanil and 8 mg dexamethasone (Dexa group). The patients were evaluated for onset time and duration of sensory block, duration of pain-free period, overage consumption of morphine in the 6 first postoperative hours, hemodynamic parameters, nausea, and vomiting, or other complications. Results: fifty-eight patients were analyzed. There were no signification differences in demographic data and onset time of the sensory block between the two groups. Sensory block duration was 121.55 ± 16.42 minutes in the control group and 183.62 ± 33.93 minutes in the Dexa group which was significantly higher in the Dexa group (P<0.001). The pain-free period was longer in the Dexa group than in the control group (P<0.001). There was a reduction in morphine consumption during the first 6 postoperative hours in the Dexa group against the control group (p=0.02). The frequency of complications was not different between the two groups. Conclusion: the addition of intrathecal dexamethasone in spinal anesthesia improved the postoperative analgesia after femur upper extremity surgery.

Purpose We evaluate ultrasonographic measurements and clinical criteria of difficult airway management to establish a new predictive score for difficult intubation. Methods We conducted a prospective observational double-blinded and monocentric study involving patients proposed for surgery under general anesthesia with orotracheal intubation. After collecting demographic and clinical data of difficult intubation, we evaluated 8 ultrasound measurements of airway assessment using an abdominal probe for the dimensions of the tongue and the hyomental distance. Then using a linear probe, we evaluated the thickness of the anterior neck soft tissues at three levels (hyoid bone, epiglottis, and trachea). After intubation, the sample was separated into 2 groups: easy laryngoscopy (EL) and difficult laryngoscopy (DL). Univariate comparisons between variables were performed using t student test, Mann-Whitney test, and Pearson's Chi-square test. Statistical significance was defined as p < 0.05. Logistic regression was then performed to test correlations between sonographic measurements, clinical criteria, and difficult laryngoscopy. These independent predictive criteria were the score parameters defined by values corresponding to their respective odd ratios. Then we established the cutoff value of the score from its ROC curve. Results Difficult laryngoscopy and difficult intubation were found in 20.5% and 14.5% of patients respectively. In univariate analysis, the coronal diameter of the tongue and the thickness of anterior neck soft tissues at 3 levels (hyoid bone, epiglottis, and trachea) had areas under the ROC curves 0.70, 0.87, 0.89, and 0.83 respectively with cut-off values of 4.57 cm, 1.54 cm, 2.69 cm, and 1.15 cm. In multivariable analysis, the clinical and sonographic criteria independently associated with DL were Mallampati score >2 (OR = 3), a TANST at the epiglottis >2.69 cm (OR = 23) and a TANST at the trachea> 1.15cm (OR = 8). We determined a predictive score of difficult laryngoscopy with a sensitivity = 88%, a specificity = 88%, and an AUC = 0,9298. A score strictly superior to 10 multiplied the risk of a difficult laryngoscopy by 53. Conclusion A combination of clinical criteria and ultrasound measurements increases the ability to predict difficult airway management. Clinical trial registration number This study was registered in the Pan African Clinical Trials Registry (PACTR) under the reference (PACTR202109682609409)

Introduction: we evaluate the effectiveness of lidocaine infusion compared to the intravenous dexamethasone and placebo on postoperative vomiting and first oral intake in children post tonsillectomy. Methods: we conducted a prospective double-blinded randomized and controlled clinical trial involving children aged between 3 and 13 years proposed for elective tonsillectomy without or with adenoidectomy under general anesthesia. They were randomized into 3 groups: lidocaine group included patients who received intravenous bolus of 2 mg/kg lidocaine over 5 minutes after the induction of anesthesia. Then, they received an infusion of 1.5 mg/kg/h until the end of the surgical procedure, dexamethasone group included patients who received intravenous dexamethasone 0.15 mg/kg administrated over 5 minutes after the induction of anesthesia followed by an identical rate of 0.9% saline and the saline group included patients who received an equivalent volume of 0.9% saline. For data analysis, we tested the normality of variables using the Shapiro-Wilk test. We used analysis of variance (ANOVA) or the Kruskal-Wallis test for between-group comparisons, as appropriate. The X2 test and Fisher´s exact test were used for inferences on proportions. A two-sided P-value was considered significant when p≤0.05. All analyses were performed with IBM SPSS≤ 25.0.0 for windows. Results: eighty-three (83) children were analyzed in our study and randomized into 3 groups: 27 children for each lidocaine and dexamethasone group and 29 children for the Saline group. The demographic data were not significantly different between the three groups such as age (p=0.246), gender (p=0.378), and body mass index (BMI) with p=0.233. The duration of surgery and anesthesia was also comparable in the 3 groups (p=0.893). Patients of the lidocaine and dexamethasone group had at least one episode of retching, vomiting, or both less than the saline group in the post-anesthetic care unit with p respectively 0.015 and 0,035, and in the ward with p respectively 0.004 and 0,038 Without a significant difference between the dexamethasone and the lidocaine group. The time to the first oral intake was significantly shorter in the dexamethasone group and the lidocaine group compared with the saline group (p=0.0001) with no statistical difference between the dexamethasone and lidocaine groups. Conclusion: lidocaine infusion is as effective as intravenous dexamethasone on postoperative vomiting as well as on oral intake in children post tonsillectomy.

La cholecystite gangreneuse alithiasique postoperatoire est une complication grave et severe, surtout chez les malades hospitalises en reanimation. Elle survient le plus souvent au decours d'une chirurgie vasculaire ou digestive majeure, d'un polytraumatisme, dans un contexte septique ou dans un contexte de choc. Nous rapportons l'observation d'un homme âge de 74 ans opere d'une fracture du col du femur, au sixieme jour postoperatoire il a developpe un tableau clinique d'une cholecystite aigue dont les explorations radiologiques ont confirme son caractere alithiasique. Apres une cholecystectomie en urgence, l'etude anatomopathologique a conclu a une cholecystite gangreneuse alithiasique.