Journal of Anesthesiology and Pain
Year:2012 | Volume:3 | Issue:1|Papers Count:9

Aim and Background: One of the problems with the implementation of spinal anesthesia is not to achieve an appropriate sensory level and sensory level decline before the end of operation that can cause pain and stress for the patient and surgeon dissatisfaction. In this study, the effects of transdermal TNG on the level of spinal anesthesia in knee arthroscopy patients were investigated. Methods and Materials: In a randomized clinical trial 46 patients randomly allocated in two groups of TNG or placebo. All of patients were premedicated with 10 mg diazepam before operation and then spinal anesthesia was performed with 1.5cc lidocaine 5%. After 20 minutes, one group received a transdermal placebo and the second group received transdermal TNG. The level of sensory block was measured by a blunt needle and alcohol swab. Findings: After 20 minutes a two level increase of sensory level in 82.6% of patients in the TNG group was observed but only 4.3% of the placebo group showed this raise (p<0.05). Conclusions: In spinal anesthesia, transdermal TNG can increase the sensory level via some theoretical mechanisms.

Aim and Background: A routine method to control post-operative pain is patient-controlled intravenous analgesia (PCIA) using opioids. Regarding complications of opioids, it seems necessary to reduce their dosage and to improve the quality of analgesia using adjuvants. We aimed to assess the effect of adding ketamine to morphine in PCIA pumps for post-operative pain control in orthopedic patients.Methods and Materials: Sixty patients, being 20-60 years old (ASA class I-II) and undergoing orthopedic surgery in lower extremity, were enrolled They had no history of opioid addiction or epilepsy. Our patients were randomly allocated to three groups 20 mg morphine sulfate, 100 mg ketamine plus 20 mg morphine and 200 mg ketamine plus 10 mg morphine in their PCIA pump. The pain score was evaluated using VAS (0-10) and VRS (0-5); besides the sedation score and the degree of nausea-vomiting were assessed with Ramsay scale (0-5) and N&V score (1-4), respectively. All these measurements were performed 2, 4, 12, 24, and 48 hours postoperatively.Findings: The incidence of adverse drug reactions was not different among the three groups (p>0.05), but pain control was significantly better in the second and third group (ketamine plus morphine) in comparison with the first one (p<0.05). There was no difference in the quality of pain control between the second and the third groups. Also, the need for additional opioid was significantly reduced in the two latter groups compared with the first one (p<0.05).Conclusions: Adding ketamine to morphine in PCIA pumps would result in better pain control and less need for additional break-through analgesic.

Aim and Background: Background and aims: Although laparoscopy itself is a new step to improve the quality of different types of surgery, reducing their complications; postoperative pain remains a major problem. This study compares the effects of low dose oral gabapentin with placebo to control postoperative pain in patients undergoing laparoscopic cholecystectomy. Methods and Materials: In this double-blind randomized clinical trial, 70 patients aged 20-65 years old with ASA classes I and II, have been selected and divided into two groups. One hour before surgery, an oral capsule of 300 mg gabapentin and placebo have been given to the two groups, separately. All Patients underwent general anesthesia in a similar way. Pain plus nausea and vomiting were evaluated based on the visual pain scale and frequency, respectively. The interval for these assessments was every 2 to 6 hours after surgery and every 4 to 12 hours thereafter.Findings: The difference in Average pain intensity between placebo and gabapentin groups is statistically significant (P=0.01) .This significant difference has also been shown in the reduced need for additional drug in the gabapentin group. The average severity of nausea and the frequency of vomiting were at the same time lower in the gabapentin group (P=0.01). Conclusions: Gabapentin can be effective in reducing pain after surgery and in various studies; no major side effect has been reported. As a result, this drug can be used in various surgeries as an analgesic.

Aim and Background: Pain diagnosis is a frustrating effort especially due to the barriers in communication with patients in low level of consciousness; therefore this study, aimed at the evaluation of utilizing BPS by nurses for patients who are unable to express their pain because of their low level of consciousness, has been designed.Methods and Materials: This research is a semi-empirical study on sixty eight nurses chosen with a census method from the staff of ICU in selected hospitals of Hamadan University of Medical Sciences. The subjects’ abilities in diagnosis and determining the intensity of pain have been measured in three phases of resting, changing position and secretion suction in ICU patients before and after utilizing behavioral pain scale (BPS).Findings: In Resting phase %25.5 in BPS pre-training, %56 in BPS post training, in changing position phase %58 in BPS pre-training, %76 in post training, and in secretion suction phase %60 in BPS pre-training and %80 in BPS post training of the nurses were able to determine the pain intensity. After being trained, also the number of the nurses who reported the intensity of pain in the mentioned phases was increased compared to BPS pre-training (P<0.05). Conclusions: The results of this study in utilizing BPS indicate that this scale has been effective in diagnosing and monitoring pain in patients with low levels of consciousness Therefore teaching and utilizing this kind of scale can be effective to raise the quality of medical treatment and pain management in ICU.

Aim and Background: Infraclavicular nerve block (ICNB) is one of the most efficacious peripheral nerve blocks for upper extremity procedures, associated with several potential complications. Recently, some authors have recommended ultrasound-guided ICNB. The current study is aimed to compare the outcomes of ICNB utilizing combined ultrasound guidance and neurostimulation with the outcomes of ICNB using neurostimulation alone.Methods and Materials: There were 60 patients, candidate for elective upper extremity surgery, who contributed in the current double-blinded randomized clinical trail. Patients were randomly allocated into 2 groups of either ultrasound plus neurostimulation (UN) guided block or neurostimulation (N) group. The procedure time, time interval between injection and drug effect, the rate of successful blocks, sensory and motor block duration, and complications were compared between the two groups.Findings: The mean procedure time and the time interval between injection and drug effect were comparable. We found significantly longer sensory (66.8±11.7 V.s 60.9±10.2 min; p=0.04) and motor (57±11.4 V.s 50.8±10.4 min; p=0.032) block duration in UN group. ICNB failed in 10 patients in the N group and 2 patients in the UN group (p=0.021). There were one patient with subcutaneous hematoma in the UN group and 3 patients in the N group. Conclusions: ICNB utilizing ultrasound guidance combined with neurostimulation is a safe and efficacious technique with a higher success rate compared to neurostimulation alone.

Aim and Background: Using methods such as pulsed radiofrequency (PRF) and nerve blocks are among the methods used in pain clinics to treat facet-originating low back pain. This study compares two methods of pulsed radiofrequency and facet joint block (FJB) regarding pain recovery and improving disability of patients suffering from facet-originating low back pain. Methods and Materials: 50 patients with low back pain and positive response to diagnostic nerve block test with 0.5 ml of 2% lidocaine in L1-L3 and L3-L5 were included. The patients were randomly assigned to two groups of either pulsed radiofrequency at a temperature below 40 degrees or facet joint nerve block. Demographic data including age, sex, pain intensity (based on VAS), motor ability (based on ODI) and patient satisfaction (0=none, 10=Excellent) before the treatment and at weeks 6 and 12 thereafter were recorded.Findings: Patients’ pain and ODI significantly improved in PRF group compared with FJB group at week 6 and 12 (p<0.05). Patients’ satisfaction in PRF group at week 6 and 12 was significantly more than the FJB group (p<0.05). Using analgesics in PRF group at week 6 and 12 was significantly lower than FJB group (p<0.05).Conclusions: Pulsed radiofrequency more favorably alleviates pain and improves ability in shortterm.

Aim and Background: Stellate ganglion is a sympathic ganglion in the neck area which by effective blocking a lot of chronic pain syndromes at upper limbs, head, neck and chest can be treated. In this study, results of ultrasound-guided Stellate ganglion block in 44 patients have been reviewed.Methods and Materials: In this case series, 44 patients candidate for stellate ganglion block due to chronic pain were enrolled. Ultrasound-guided block was perfoemed with bupivacaine 0.5% on level of C-6 tubercle. Successful blockage was diagnosed in the presence of horner syndrome and variation in temperature in two hands. Any Complications were recorded. Findings: Among 44 recruited patients, 18 cases were excluded for unsuccessful block. In the 26 remaining patients, a total of 101 Stellate ganglion blocks were performed. Among these, one had hoarseness, and three cases had cough. There was no life threatening side effect, vessel puncture, paresthesia or neuroaxial injection.Conclusions: The use of sonography in order to perform Stellate ganglion block may improve the success rate and reduce the complications attributable to blind needle insertion.

Aim and Background: Laryngeal mask is an airway control equipment which is replaced by endotracheal tube in general anesthesia in many surgical procedure. This study compares the efficacy and safety of LMAc and SLIPA.Methods and Materials: This study was a single-blind, randomized clinical trial that was conducted on 320 patients between the age of 15-70, ASA I -II, BMI less than 35, in general surgery, orthopedic surgery, urologic and gynecologic surgery. With the operating time less than an hour. Insertion of LMA and SLIPA, insertion time, determining the gastric air insufflation and the easiness difficulty of removing the mask and the severity of sore throat was recorded.Findings: Insertion was straightforward in 74.38% and slightly difficult in 25.62% for SLIPA cases versus straightforward in 66.87% and slightly difficult in 28.75% and obviously difficult in 4.38% for the LMAc cases. Average insertion time was also significantly shorter in SLIPA than LMAc (34.57 seconds vs. 45.56 seconds). Between two groups in the amount of air entering the stomach and difficulty in removing the device Sore throat with a higher intensity of 5 was more in LMAc than SLIPA but cases without sore throat were higher in LMAc group (20% vs. 13%). Blood contamination of the device after its removal was significantly higher in LMAc group.Conclusions: Suitability of the SLIPA in small and short term surgery has been proved, but its effectiveness in longer surgery requiring mechanical ventilation needs more investigation.