Anesthesiology and Pain Medicine
Year:2018 | Volume:8 | Issue:6|Papers Count:13

Background: There are different methods used for anesthesia during a colonoscopy procedure. Objectives: The aim of this study was to compare the analgesic effect and hemodynamic changes due to dexmedetomidine and fentanyl during elective colonoscopy. Methods: This double-blind clinical trial was conducted on 80 patients aged 20-70 years, candidates for elective colonoscopy, who were randomly divided into two equal groups. In the intervention group (group D), dexmedetomidine 1 mcg/kg was given 10 minutes before starting the colonoscopy and then, 0. 5 mcg/kg/hour during colonoscopy was prescribed. In the control group (group F), fentanyl 0. 5 mcg/kg was prescribed three minutes before starting the colonoscopy and then, the normal saline infusion was used as maintenance. Propofol 20 mg was prescribed as the rescue dose if needed (pain or severe discomfort during colonoscopy) during the procedure. Demographic and basic clinical data and blood pressure, heart rate, respiratory rate, peripheral oxygen saturation (SpO2), and pain score (based on the visual analogue scale) were recorded from the start of the colonoscopy (time 0) and every 5 minutes until the recovery. Results: The two groups had no significant difference in the duration of colonoscopy, colonoscopist's satisfaction, and patients' satisfaction (P > 0. 05). The mean pain score during colonoscopy was lower in the dexmedetomidine group (P = 0. 039). Heart rate was less in the dexmedetomidine group than in the fentanyl group and this difference was statistically significant. The mean arterial pressure had no difference between the two groups. Conclusions: The results of the present study showed pain score was lower in the dexmedetomidine group than in the fentanyl group.

Background: Cardiac injury is one of the significant perioperative complications in major orthopedic surgeries and its early diagnosis is useful in the reduction of postoperative comorbidity. The cardiac troponin is a sensitive and specific biomarker for detecting this damage. Objectives: The aim of this study was to evaluate the levels of perioperative cardiac troponin I (cTnI) before and after arthroplasty in patients undergoing total hip arthroplasty (THA) and total knee arthroplasty (TKA). The effects of related variables and probable major cardiac complications were evaluated in this study. Methods: For one year, in a prospective, cross-sectional study, the serum levels of cTnI before and 48 hours after arthroplasty were evaluated in 52 patients. Possible contributing factors including age, gender, body mass index (BMI), daily activity, history of hospitalization due to cardiovascular diseases, underlying illness, and medications were recorded. The Chi-square test, Pearson correlation, and Spearman test were used to examine the relationship between variables. Results: The mean cTnI increased significantly after arthroplasty (P < 0. 001). There was no significant relationship between age (P = 0. 708), gender (P = 0. 225), BMI (P = 0. 195), daily activity (0. 441), underlying illness (P = 0. 244), and cTnI levels after arthroplasty. Linear regression showed BMI was significantly correlated with troponin changes (P = 0. 006). Five patients had heart palpitations and one had chest pain, but none of the patients had any findings in favor of cardiac injury. Conclusions: cTnI levels after THA and TKA increased significantly, but this elevation was in the normal range. In addition, none of them had a new cardiac complication after arthroplasty.

Objectives: The aim of this study was to compare the effect of intra-rectal administration of lidocaine gel alone versus lidocaine gel plus topical fentanyl on pain reduction in prostate biopsy. Methods: In a double-blind randomized clinical trial, 96 patients who met the inclusion criteria were randomly assigned into two groups. 1) The treatment group: Lidocaine gel (2%) 50 g and 2) the intervention group: Lidocaine gel (2%) 50 g and fentanyl gel 50 µ g. During the prostate biopsy, the VAS score was recorded. Blood pressure, heart rate, and patient level of consciousness were also analyzed. Results: The mean VAS score was 5. 1 ± 2 and 3. 0 ± 2, which was lower in the intervention group (P value < 0. 001). In terms of consciousness after biopsy, there was no difference between the two groups (P value = 0. 358). There was no difference between the groups in terms of mean blood pressure and heart rate before and during the prostate biopsy. Finally, in terms of consciousness after the prostate biopsy, there was no difference between the current treatment and intervention groups. Conclusions: The combination of lidocaine gel and fentanyl with a dose of 50 µ g has a significant effect on reducing the pain associated with prostate biopsy in comparison with lidocaine gel alone. The antinociceptive effect of the above regimens is not associated with hemodynamic changes and changes in patients' consciousness.

Background: Daily clinical practice shows us how diametrically different surgical outcomes can occur in particular groups of patients sharing the same diagnosis and being subjected to the same treatment. Patient-reported outcomes appear to be significantly influenced by social factors and patients' emotional status. Data on such variables were collated and analyzed statistically with the aim of confirming our clinical observations. Methods: We analyzed a group of 100 patients following cervical disc surgery. The clinical evaluation was based on a visual analog scale (VAS) for pain and the neck disability index (NDI). Non-clinical data comprised education status, employment status, body mass index (BMI), and history of depressive episodes in the period immediately preceding the surgery, which was investigated using the Beck Depression Inventory (BDI). Results: Patients who had completed university or secondary school education had a significantly lower BMI and lower BDI scores and they reported less pain at 12 months postoperatively than patients with vocational or elementary school education only. Patients who were employed at the time of the study or were retired demonstrated significantly lower NDI scores both before the surgery and at 12 months postoperatively, as well as lower BDI scores compared to those who were unemployed or drew disability pensions. Factors such as age or BMI score did not exert a direct effect on treatment outcomes assessed as changes in the VAS and NDI scores. Conclusions: Surgical treatment for the cervical disc disease decreases pain and improves patients' quality of life. Treatment outcomes are also influenced by social factors and patients' emotional status.

Background: Primary headaches are the most common cause of absence from work and school and one of the most common reasons for referring to the neurologists. Objectives: The present study was designed to investigate the relationship of cognitive processing style and mindfulness with pain intensity and the ultimate aim was to provide the role of pain-related cognitive processes and mindfulness in the prediction of headache intensity. Methods: The study was conducted descriptively by using the correlation method. The statistical population of this study was composed of 85 patients (56 females and 29 males) with one type of primary headache, which were selected through purposive sampling after the diagnosis of a headache by a neurologist at Imam Hossein Hospital in Tehran province. To measure the variables of the study, the numeric pain rating scale (NRS) and the pain-related cognitive processes questionnaire (PCPQ) were used. All data were analyzed using descriptive statistics (frequency and percentages). Bivariate correlation matrix and hierarchical stepwise linear regression statistics were used. Results: The results showed that there was a significant and negative association between pain intensity (NRS) and mindfulness (P < 0. 01) and all pain-related cognitive processes, except pain focus (P < 0. 01). The results of stepwise linear regression indicated that mindfulness only explains 39% of total score changes in pain intensity (P < 0. 05 and Δ F (1 and 83) = 53. 63, Δ R = 0. 385). Adding cognitive processing styles to the model led to an 18% increase of the explained variance (R2 change = 0. 179). In total, the present research model justifies 54% of the severity of headache variance (P < 0. 01, Δ R = 0. 54). Conclusions: The results suggest that pain-related cognitive processes and mindfulness are effective on pain intensity prediction. In other words, this result can explain the role of mindfulness and adaptive cognitive processing in primary headache pain management.

Introduction: Churg-Strauss syndrome (CSS; or eosinophilic granulomatosis with polyangiitis) is an extremely rare autoimmune condition characterized by hypereosinophilia and vasculitis of small or medium-sized blood vessels, occurring in patients with asthma and allergic rhinitis. Case Presentation: A 47-year-old man (height, 175. 8 cm and weight, 74. 8 kg) complained of a tingling sensation in his leg. He had a history of hypertension and asthma in the previous two years, and history of sinus surgery for sinusitis in the previous one year. He showed weight loss of 6 kg during the last month, and the signal intensity of the bone marrow on magnetic resonance imaging was diffusively reduced to be less than or equal to the disc. These findings indicated a hematologic disease and the possibility of malignancy. However, a nerve conduction study suggested multiple mononeuropathies. In addition, his laboratory findings showed peripheral eosinophilia and positivity for myeloperoxidase anti-neutrophil cytoplasmic autoantibody. Therefore, CSS was strongly suspected. Conclusions: Churg-Strauss syndrome is considered to be a condition with variable presentation and is difficult to diagnose because it has various clinical symptoms and disease progression. This study reports on a case with CSS, who underwent nerve biopsy and cholecystectomy for pathological confirmation because of various symptoms, and early diagnosis was difficult.

Background: Identification of painful procedures is essential for the development of procedure-specific pain-treatment schedules. The aim of this study was firstly, to analyze the prevalence of acute postsurgical pain (APSP) after various types of day surgery on the fourth postoperative day, and secondly, to assess the predictive value of preoperative pain for the development of APSP after different types of surgical procedures. Methods: From November 2008 to April 2010, patients scheduled for elective day surgery were enrolled in this prospective cohort study. Data were collected one week preoperatively and four days postoperatively. The 11-point Numeric Rating Scale (NRS) was used for pain measurement. Moderate pain was defined as an NRS 4 to 5, and severe pain as an NRS > 5. The predictive value of preoperative pain for development of APSP was analyzed using a univariate logistic regression, stratified for the surgical procedure. Results: From a total of 1123 included patients, 182 patients experienced moderate pain (16. 3%) and 136 patients experienced severe pain (12. 1%) on the fourth postoperative day. A large procedure-specific variability in APSP was observed, with shoulder, anal and dental surgery associated with the highest pain levels. Overall, preoperative pain significantly predicted postoperative pain on the fourth day (OR 4. 45). This predictive value showed a procedure-specific variation and was not noted after various well-defined procedures. Conclusions: The prevalence of moderate to severe APSP was high four days after day surgery and showed a significant procedure-specific variation. Furthermore, there was a strong relationship between preoperative and postoperative pain, likewise characterized by a significant procedure-specific variation.

Sepsis is an important health problem with a high burden on health systems. Finding new aspects of immune system function in sepsis showed a new role for flow cytometry in the diagnosis of sepsis. We made a review on the role of CD64, HLA-DR, CD25, and TLRs as more useful flow cytometric tools in diagnosing sepsis, both in adults, and neonates. According to our results, we concluded that for diagnosis and treatment of the septic, flow cytometry can play an important role so that it can be used as a novel method in individualized treatment of septic patients based on their immune system situation.

Background: Postoperative pain is one of the major concerns about a cesarean in pregnant women that can lead to serious complications and delayed recovery for patients. Objectives: The objective is to investigate the effect of low power laser on acute pain after elective cesarean. Methods: In this randomized, double-blind clinical trial, 80 candidates for an elective cesarean were divided randomly into two groups, control and laser. The type of surgery was the same for both groups, which contained the spinal anesthesia technique. At the end of surgery, the surgical incision in patients who were treated with laser, (GaAlAs: 804 nm and GaAlInp: 650 nm) was irradiated by laser. The control group also received laser off by the same method. Patients were monitored for 24 hours to assess the severity of postoperative pain by VAS, the first request for analgesic and the total consumption of analgesic. Results: The results demonstrated significant reduction of pain in the laser group 1, 4, 8, 12, 16, 24 hours after surgery, compared with the control group (P value < 0. 05). Additionally, the average of total received analgesic in the group laser was less than the controls (P value = 0. 006). The first request for analgesic in the laser received group was significantly longer than the controls (P value = 0. 005). Conclusions: Low power laser therapy is a good method to reduce postoperative pain due to the fact that it is a safe and non-invasive method which is also accepted by patients.

Background: Total hip arthroplasty is a common procedure being performed at an increasing rate in the United States. Recovering from this surgery to the extent that one can participate in criteria for discharge relies heavily on effective postoperative analgesia. Many regional anesthetic techniques are deployed in this realm. The recent utilization of quadratus lumborum (QL) blocks with success in other procedures warrants investigation in the hip arthroplasty population. Methods: Twenty patients received general anesthesia for elective total hip arthroplasty. Ten cases included a preoperative ultrasound-guided transmuscular quadratus lumborum block with 30 cc 0. 5% ropivacaine. Ten cases that lacked this regional procedure. The primary outcome was length of hospital stay. Secondary outcomes include total procedure time, intraoperative and postoperative fentanyl administration, and mean postoperative visual analog pain scores (VAS 1-10). Results: Length of stay was shorter in patients receiving QL block (2. 9 days) versus patients not receiving QL block (5. 1 days) (P value 0. 0146). Intra-operative use of fentanyl was lower in patients receiving QL block (183. 5 mcg) versus patients not receiving QL block (240 mcg) (P value 0. 0376). PACU narcotic utilization, 24-hour VAS score, and length of operative procedure lacked statistical significance, though the study was not powered for these outcomes. Conclusions: QL block employment in hip surgery produces significant reduction in length of stay and intraoperative fentanyl use. While quadratus lumborum blocks are rapidly becoming a popular option due to its quality and spread of analgesia, more adequately powered prospective research must be performed to appropriately elucidate significant trends.

Background: Postoperative cognitive dysfunction (POCD) is commonly observed following cardiac surgery. The utilization of cardiopulmonary bypass (CPB) is associated with many possible mechanisms to cause POCD. However, there is no evidence confirming that CPB alone is the cause of POCD. Objectives: The current study aimed at evaluating several factors suspected to cause POCD following cardiac surgery in Cipto Mangunkusumo Hospital, Jakarta, Indonesia. Methods: The current prospective cohort study was conducted on 54 patients who were candidates for cardiac surgery. The assessment of memory, attention, and executive functions was performed by neuropsychological tests, before and after the surgery. Cognitive decline was defined as a 20% decrease in cognitive function in at least one of the tests. Inclusion criteria were adults spokeing Bahasa Indonesia fluently, literate, and giving consent to participate in the study. The analyzed risk factors included age, diabetes, educational level, duration of aortic cross clamp, and duration of cardio-pulmonary bypass. Results: POCD occured in 40. 7% of subjects that underwent cardiac surgery using cardiopulmonary bypass. Age was the only influential factor through bivariate test and logistic regression analysis (P = 0. 001). The current study conducted a logistic regression test on age variable; the obtained result indicated an increasing trend of POCD in accordance with age group. Conclusions: Durations of CPB, cross clamp, diabetes, and educational level were not the main risks of POCD. Old age was a significant predictor to POCD.

Musculoskeletal disorders are the leading source of pain and disability globally but are especially prevalent in the industrialized nations including the U. S. In addition to the substantial individual suffering caused the rising monetary costs of these disorders are noteworthy. In the U. S. alone the annual costs have been estimated to be $874 billion 5. 7% of the annual U. S. G. D. P. Despite these expenditures the care provided to patients with musculoskeletal disorders is highly variable and has regularly been shown to have suboptimal outcomes. The many reasons for this ineffective care include the mutable nature of the prevailing syndromes and their limited and variable understanding. The care rendered by a broad and incongruent group of providers who practice disparate methodologies and employ variable treatments. Disorderedly triage comprised of arbitrary selection of providers, care methodologies, and treatments, which is prone to a range of extraneous influences. Treatments that are unable to apprehend the causative pathological processes, which are therefore progressive, cause irreversible damage to the respective musculoskeletal structures, and result in enduring pain and disability. The overall lack of preventative care and the consequent prevalence of these disorders especially in specific work environments and with certain high-risk life styles. This article makes recommendations for better understanding, prevention, early recognition, timely employment of disease altering therapies, streamlining the existing care, and policy initiatives for waste confinement and improvement. These discernments may improve the overall quality of care provided to these patients, diminish the staggering pain and disability caused, and can reduce the immense costs incurred.

Background: There were numerous studies using acupuncture for pain relief and in most, the effect of this technique on preventing migraine attacks has been investigated. In those several studies that surveyed the effect of acupuncture on treatment of migraine headaches, the conclusion was not completely persuaded and they suggested further researches on this topic. Objectives: The purpose of this study is to examine the effect of acupuncture on controlling acute migraine attacks. Methods: This study was a single blinded randomized clinical trial that was conducted on patients with a diagnosis of acute migraine attacks. At the time of reference, the patient's pain intensity was measured and recorded in a written checklist. Acupuncture was done in the intervention group with thin metallic needles, which enter certain points in the ear's skin; including shen men, autonomic, thalamus, frontal, and temple. In the placebo group, similar needles were used, however, they were inserted into unusual points. Thereafter, in 30 minutes, one, two, and four hours after the treatment, the pain intensity was also asked and compared with the reference time's score. Results: A total of 60 patients with the mean age of 31. 4 ± 7. 6 years were enrolled and 83. 3% of them were women. There was no significant difference between two groups in terms of the baseline characteristics of participants including age, sex and pain duration before admission (P > 0. 05). According to the results, there was a significant difference between the two groups on the checkpoints of 15, 30, 45, and 60 minutes after acupuncture (P < 0. 05); however, the pain scores were not statistically different between the two groups on two, three, and four hours after intervention (P > 0. 05). Conclusions: Based on the findings of our study, although the pain score was lower in the intervention group than the control group during first hour after the acupuncture, there was no significant change in pain score thereafter. Comparison of the two groups showed no differences between acupuncture and placebo acupuncture on decreasing the mean pain score.