Background: Effective pain management after caesarean delivery is essential to promote maternal recovery, facilitate early mobility, and support mother-infant bonding. Traditionally, intrathecal morphine (ITM) has been widely used due to its strong analgesic effects, but concerns about opioid-related side effects have led to growing interest in alternative regional techniques such as the quadratus lumborum block (QLB). Comparative evidence on the efficacy of these approaches in obstetric patients remains limited. Methods: In a randomized trial, 70 cesarean patients underwent spinal anesthetic at Assiut University Hospital. The study compared bilateral posterior QLB with 0.25 % bupivacaine to 100 μg ITM. Secondary outcomes included pain scores, time to first morphine request, side effects, quality of recovery, and functional outcomes; the primary outcome was 24-hour IV morphine consumption. Results: Morphine consumption over 24 h was similar between the ITM and QLB groups, averaging 6.4 mg and 8.5 mg, respectively. Pain levels at rest and during movement did not differ significantly between the two groups at any time point. However, a subgroup analysis showed that QLB patients with a BMI of 30 kg/m² or higher required more morphine and reported higher peak pain scores compared to those in the ITM group (10.5 mg vs 7.4 mg, p < 0.05). No such difference was seen in patients with a BMI below 30 kg/m². In a multivariate analysis, BMI emerged as the only significant predictor of 24-hour morphine consumption (p = 0.016). Conclusion: ITM and posterior QLB provide comparable postoperative analgesia after cesarean delivery for the general population. However, patient factors such as BMI and age may influence postoperative opioid requirements and should be considered when selecting an analgesic technique to optimize recovery and minimize side effects.

Background: Postoperative pain control after knee arthroscopy improves recovery and alleviates opioid-related complications. The adductor canal block is considered a promising method for providing effective analgesia with minimal motor impairment, but the most effective site for injection has yet to be determined. Aim: This randomized controlled trial evaluated the effectiveness of ultrasound-guided proximal versus distal ACB compared with standard care without nerve block for pain management after knee arthroscopy. Patients and Methods: Seventy-five patients undergoing elective knee arthroscopy were randomly divided into three groups, each consisting of 25 individuals: Proximal ACB, Distal ACB, and Control. The ACB groups received 20 mL of 0.375% bupivacaine administered at their respective locations under ultrasound guidance. Assessments were conducted over 24 hours to evaluate postoperative pain intensity (VAS scores), opioid use (tramadol), motor function (Bromage scale), and recovery indicators. Statistical analysis was conducted using ANOVA and Chi-square tests, with a threshold of P < 0.05 for significance. Results: The cumulative tramadol consumption was the lowest in the Proximal ACB group, with a consumption of 95.2 ± 18.6 milligrams, followed by the Distal ACB group at 108.4 ± 19.5 milligrams and the Control group at 165.8 ± 25.4 milligrams, with a highly significant difference of P < 0.001. Pain scores based on the Visual Analogue Scale were significantly lower for both ACB groups compared with the Control group, with a highly significant difference of P < 0.001, and the Proximal ACB group demonstrated the best pain relief. Motor function was maintained in all groups, with a Bromage score of 0 observed in 100% of patients at 24 hours. The proximal ACB group exhibited a significantly longer delay in initial pain medication requests, with a mean time of 385 ± 112 minutes, compared withwind distal ACB (298 ± 95 minutes) and the Control group (145 ± 65 minutes, P < 0.001). Both groups had higher patient satisfaction ratings and experienced fewer opioid-related side effects, such as nausea and vomiting. Conclusion: Proximal ultrasound-guided ACB was associated with better postoperative pain relief, lower opioid usage, and faster recovery than distal ACB and typical treatment protocols. The motor-sparing characteristics of this technique make it a valuable component in multimodal pain management strategies for knee arthroscopic procedures.

Background: Episodic migraine significantly impairs quality of life, and some cases fail to respond to conventional prophylactic treatments. Alternative therapy approaches are provided by interventional nerve blocks, such as sphenopalatine ganglion (SPG) and greater occipital nerve (GON) blockades. This work compared the effectiveness of GON blockade and SPG blockade in reducing headache intensity, duration, frequency, and disability in cases with episodic migraine.
Methods: This study was prospective, randomized, controlled, and single-blind and was conducted on 60 cases, both sexes, aged 18-65 years, diagnosed with episodic migraine per the international classification of headache disorders, 3rd edition criteria, and failed to achieve adequate relief with at least one prophylactic migraine treatment. Cases were randomly assigned into two groups to receive either the GON blockade in the GON group or the SPG blockade in the SPG group. Blocks were performed using 2 mL of 2% lidocaine.
Results: Intensity, migraine disability assessment scores, and number of NSAIDs per day were significantly lower at 1, 2, and 3m in the GON Group as opposed to the SPG Group (P < 0.05). Migraine duration and the reduction in the number of NSAIDs per day were notably increased in the GON Group in contrast to the SGP Block Group (P< 0.05). Adverse events (nasal irritation, temporary difficulty in swallowing, vasovagal reaction) and patient satisfaction were comparable.
Conclusions: GON blockade is a superior short-term intervention for cases unresponsive to standard prophylactic therapy, offering greater reductions in headache intensity, frequency, and disability as opposed to SPG blockade.