Journal of Anesthesiology and Pain
Year:2015 | Volume:5 | Issue:2|Papers Count:9

Aim and Background: Chronic radicular low back pain is usually temporarily relieved by transforaminal epidural (TFE) injection of steroids; our aim was to evaluate the effect of TFE dexmedetomidine injection in comparison with steroids in patients with chronic lumbar radicular pain.Methods and Materials: Patients with 3 months of low back and leg pain due to intervertebral disc herniation were randomized to receive transforaminal epidural (TFE) injection(s) of 0.2% bupivacaine and either dexmedetomidine (1 mcg/kg) or triamcinolone (20mg). Patients, investigators and study coordinators were blinded to treatment. Primary outcome was visual analogue score (VAS) after the procedure, and functional improvement according to Oswestry disability index (ODI) after 2 weeks, 1, and 6 months.Findings: Twenty-two patients were screened and enrolled; 11 received dexmedetomidine and 11 triamcinolone. Both groups showed significant improvement in pain score after the injection compared to baseline (p<0.05). The dexmedetomidine group showed additional functional improvement at 1 and 6 months relative to triamcinolone based upon ODI (p=0.001). However, as target enrollment was not reached in our study, we cannot say with confidence that dexmedetomidine would surely result in better outcome in patients. Regarding side-effects, there were no serious complications.Conclusions: Radicular pain due to disc herniation improved rapidly with TFE injection of either dexmedetomidine or triamcinolone. Dexmedetomidine resulted in greater functional improvement, with better side effect profile. Future studies however, would probably determine if dexmedetomidine is superior to placebo and of particular use in those at risk for corticosteroid complications.

Aim and Background: Coronary Artery Bypass Graft (CABG) is one of the most common cardiac surgeries. Patients undergoing cardiac surgery experience physiologic stress caused by anesthesia, thoracotomy, surgical manipulation and cardio-pulmonary pump; therefore a substantial proportion of these patients have respiratory complications after cardiac surgery. If the patient is a heavy smoker, lung symptoms would be worsened and could lead to increased pulmonary complications and increased hospital costs and mortality. The main aim of this study was to determine the effect of preparing therapy for heavy smoker patients with normal spirometry on complications following CABG.Materials and Methods: In this study, 225 heavy smokers (20 Pack/ year) with normal spirometry index (FEV1/FVC³70%, FEV1>2 Lit), and without respiratory symptoms were scheduled for CABG. Patients were divided into 3 groups (each group=75) .Group I were heavy smokers, Group II were heavy smokers but had undergone SAB spray (salbutamol-Atrovent-Beclomethazon) therapy, and Group III were heavy smokers but had cessation of smoking for 8 week.Findings: 35, 23, and 31 patients in the first, second, and third groups, respectively experienced one of the respiratory complications: Coughing (P=0.039), wheezing (P=0.0001), increased mechanical ventilation time (P=0.007), and incidence of reoperation due to the dehiscence of the sternum because of repetitive coughs (P<0001). All these results have been statistically significant.Conclusion: This study showed that the group treated with Salbutamol-Atrovent-Beclomethazon mixture had a lower incidence of pulmonary complications than other two groups.

Aim and Background: One of the most common clinical symptoms is pain. Nurses are among the key people who have the most communication with patients; in the meanwhile pain assessment and control, comfort providing and discomfort prevention are their important responsibilities. This study aimed to determine the impact of the nurse-patient communication skill’s training on pain reduction in patients.Methods and Materials: An experimental study was carried out by random selection of 30 nurses who worked in the Medical and surgical wards of Ghaem and Imam Reza hospitals in Mashhad city. A two-day workshop based on Nurse-Patient communication training for 8hours was held for the nurses. The data collection tools were the demographic information, paying attention to communication and control of pain questionnaires which were filled out by the nurses and 3 patients per nurse before and 4 weeks after the intervention. The data were analyzed by SPSS software version 16 and using analytical statistics.Findings: The nurse-patient communication scores from the nurses’ perspective, were 21.6±5.95 pre-training and 35.7±4.11 post- training; and the mean scores of attention to pain were 13.8±0.35 pre-training and 19.5±2.57 post-training which were significantly different (p<0.001) .The mean score of nurses’ communication with patients according to the patients’ opinion, were 21.3±5.78 pre- training and 35.9±4.09 post- training; also the mean scores of paying attention to pain were 15.4±3.76 pre-training and 27.2±3.01 post- training; showing again a significant difference as well (p<0.001).Conclusions: Communication skill’s training and establishing an effective nurse–patient communication reduces the patients’ pain, therefore it is essential that nursing managers and nursing education administrators consider this skill to be improved in future.

Aims and Background: Aims and Background: With respect to the importance of assessing chronic pain acceptance in the elderly, access to a presice instrument for this purpose is essential. Hence, the current study aimed to develop and evaluate a chronic pain acceptance instrument in the elderly.Materials and methods: This study is a mixed method research, implemented in three stages. The grounded theory approach was applied for concept exploration of chronic pain acceptance in the first stage. It was based on the viewpoints of 30 elderly people with chronic pain, 3 relatives and 29 health care providers who participated with purposeful and theoretical sampling methods. In the second stage, instrument sentences were extracted and developed by qualitative part results and review of the valid and related literature, respectively. Psychometric evaluation of the instrument in the third stage was based on face, content, and construct validities, internal consistency and stability reliabilities.Findings: The concept of Chronic pain acceptance was explored in the first stage. Based on participants’ viewpoints in the qualitative part of the study, pain acceptance was to believe in pain, and its related limitations and disabilitites in order to controll it. An elementary instrument with 38 sentencess was developed in the second stage. During the third phase of the study, face and content validities by quality and quantity methods (Content validity ratio average = 0.94, and content validity index average= 0.92) were performed, respectively. Moreover, construct validity was assessed by exploratory factor analysis, and instrument sentences were decreased to 7 item, in which two factors were obtained: the first factor (awareness of pain) including two items and the second one (trying to decrease pain) including 5 items. Finaly, internal consistency (a =0.83) and stability (0.85) were determined for reliability evaluation by retest method.Conclusions: Regarding the precise development process, suitable validity, and reliability of chronic pain acceptance assessment instrument, its application is suggested for pain acceptance assessment and effective pain management in the elderly.

Aims and Background: Annually about 200-500 million amputations occur around world because of disease, trauma and congenital defects among which approximately 85% are in limbs. For those with amputation, the phantom limb pain is a serious problem and causes therapeutic challenges for those who need therapy. The present study was conducted to identify the efficacy of Eye Movement Desensitization and Reprocessing on phantom limb pain in patients with amputation during 18 months.Materials and Methods: The present study is semi-experimental in nature. A total of 40 patients suffering from phantom limb pain, and under pharmacological therapy for long time, were selected by available sampling (2012-2014) and were divided by random assignment into experimental and control groups. Eye Movement Desensitization and Reprocessing (EMDR) method was applied for each patient individually in consultation room during 12 sessions of one hour each, for one month. In order to collect data, demographic data and Numeric Rating Scale (NRS) questionnaire were used. Data were gathered on phantom limb pain before treatment, after treatment, and after 18 months of follow up and were analyzed using descriptive statistics and repeated measures.Findings: Mean phantom limb pain before, after and at 18 months’ follow up after the intervention were 7.15(±1.08), 3.40(±1.23) and 1.75(±1.01), respectively. Using repeated measures we showed a significant difference among them (p<0.001).Conclusions: These results suggest that EMDR therapy was successful in the treatment of phantom limb pain in patients suffering from amputation after 18 months of follow-up. Therefore its use as a therapeutic and alleviative method could be suggested for patients suffering from phantom limb pain.

Aims and Background: The purpose of this study was to compare the effects of massage therapy, stability exercise and combination exercise on improvement of chronic low back pain.Materials and Methods: In this study, 30 patients with chronic low back pain with an average age of 33.44±9.02 years participated. Patients were randomly divided into three groups: massage, stability and combination. The protocol consisted of training patients for 8 weeks, three days a week and each session was about an hour. Patients received protocols of massage, stability, and combination exercises for 12 sessions (4 weeks, or every other day) under supervision of therapists.Findings: The results of this study showed that the studied methods significantly (P<0.05) decreased the pain and improved the function in patients when compared to the pre-test values. Also significant difference was observed between the three groups.Conclusion: The results showed that stabilization method is more effective, when combined with massage therapy than being used alone.

Aims and Background: Pain is a common problem encountered after spinal surgery. As we prefer to use effective non-pharmacological methods before using drugs, therefore the purpose of this study was to assess the effect of foot Reflexology massage on reducing pain in scoliosis patients undergoing spinal surgery.Methods and materials: This study was a randomized controlled trial, conducted on 56 scoliosis patients undergoing spinal surgery hospitalized in the Shafa hospital in 2013. The reflexology group received massage the second day after surgery for 4 consecutive days. In the control group, just an ointment was used on patients’ foot for one minute without applying any pressure. The pain scores before and after the intervention were recorded by the use of short form of McGill pain questionnaire.Findings: Our results showed that there is a significant difference in all components of McGill pain questionnaire after using the intervention, between the experimental and control groups (P=0).Conclusions: According to the study results, foot Reflexology massage, as one of the branches of complementary alternative methods, can be recommended in patients after spinal surgery to reduce their pain.

Aims and backgrounds: Hemodynamic monitoring of critical patients in intensive care units is the cornerstone of care. It constitutes an extensive part of care and is helpful in determination of the causes and the response to treatment of hemodynamic instability. The aim of this review article is to evaluate noninvasive hemodynamic monitoring in critical care units.Materials and Methods: 61 articles were allocated to this study with the time frame covered from 1890 to 2010. The references of this review article were obtained from Pubmed, Elsevier, Google scholar, Elsevier mason, Science direct, and JAMA. The authors have also used the keywords including: cardiac output, non-invasive, intensive care unit, oxygenation, upstream, downstream markers, hemodynamic monitoring, minimally invasive methods, and circulatory shock.Findings: The results of this study show that the desirable and premium monitoring of serious patients in intensive care units have yet remained as a challenge. Awareness of cardiac output which is the most important indicator of cardiac function is of vital importance for deciding on the method of clinical management, selecting treatment method, clinical assessment, and prognosis of the patients suffering from cardiac problems.Conclusions: A lot of such studies show that the Non-invasive monitoring system of cardiac output is easier, safer, cheaper, and more effective than the invasive monitoring system .If this method is used properly, it could reduce the mortality and morbidity rate.

Background and Aim: Since electrocardiography (ECG) is essential for the diagnosis of pediatric asymptomatic Complete Heart Block (CHB) and it is not usually done in the preoperative evaluation of asymptomatic children, physicians might confront with asymptomatic cases of CHB at anesthesia induction.Case Report: In this study, we introduced a 31-month-old boy who faced CHB after anesthesia induction. The mentioned 15-kg-weighted child who had got involved in bradycardia after the induction of anesthesia for renal anti-reflex surgical procedure. Anesthesia was reversed after diagnosis of CHB and emergency cardiology consultation was performed and referred to pediatric cardiac ICU for further evaluation. In the primary ECG, atrial and ventricular beats were 150 and 70 rhythms, respectively, and ventricular complexes were also narrow. A temporary transcutaneous cardiac pacemaker was placed and a normal echocardiography was detected. After the preparation of Angiography Unit, he was provided with a temporary intravenous pacing. A 24-hour Holter Monitoring with the underlying heart rate of 40 bpm was implemented for the patient as an indication of his CHB with an average heart rate of 90 bpm. No other positive finding was obtained. Regarding lack of the patient's improvement after several days, his probable congenital CHB was posed. Subsequently, the patient with a intravenous temporary pacemaker was referred to the referral hospital for surgical procedure and then readmitted at ICU. Two days after the surgery, his pacemaker was removed and he was discharged and recommended for follow-up visits Since anesthetic drugs can intensify bradycardia, preparation of chemical pacemaker, temporary pacemaker, and a skilled physician for their utilization in case of confrontation with such undiagnosed problems is necessary. Moreover, for instances of diagnosed cases, pacemakers should be positioned before commencing anesthesia induction after confirmation of their proper performance.