Journal of Anesthesiology and Pain
Year:2014 | Volume:4 | Issue:2|Papers Count:10

Aim and Background: The most common invasive painful procedure during childhood is injective vaccination. Failure to relieve pain causes lack of timely referral for immunization and reduction of vaccine coverage. The purpose of this study was to determine the effect of injection order on infant’s pain response after diphtheria, pertussis, and tetanus (DTP) and hepatitis B vaccination.Methods and Materials: In this single-blind clinical trial study, 140 healthy infants with inclusion criteria at the age of 2 months referred to health centers of Zahedan city, Iran, during 2012 were randomly divided into two groups of control and intervention. In the control group, first the DTP vaccine and later, the hepatitis B vaccine were injected and in the intervention group, the order was vice versa. Using the Modified Behavioral Pain Scale (MBPS) and a demographic information checklist, the infant’s pain response was evaluated. Data were analyzed using descriptive statistics and independent t-test via SPSS15 software. Findings: The mean pain score after injecting hepatitis B vaccine was significantly less in the intervention group (7.12±0.91) than injecting DTP vaccine in the control group (7.70±0.62) (P=0.001). The mean total pain score was significantly lower in the intervention group (7.59±0.83) compared with the control group (8.27±0.62) (P=0.010).Conclusions: According to results of this study, to decrease pain during multiple immunizations in infants, injecting hepatitis B vaccine first and then, the DTP vaccine could be done.

Aim and Background: The purpose of this study was to compare the effects of hydrotherapy, relaxation and McKenzie exercise on improvement of chronic low back pain in athletes.Methods and Materials: The athletes with chronic low back pain formed our statistical research society. Forty subjects aged 32.25±3.6 years were selected purposefully from sport fields such as Track and Field, Badminton, Wrestling, Volleyball and Weightlifting at the professional level with more than six month history of low back pain. Subjects were randomly divided into four groups (hydrotherapy, relaxation, McKenzie program and control). The protocol consisted of training for 8 weeks, three days a week and each session was about an hour. We used McGill Pain Questionnaire, and Oswestry disability index for evaluation.Findings: The results of this study showed that the studied methods significantly (P<0.05) decreased the pain in athletes, and improved their performance compared to the pre-test state and the control group but no significant difference between the groups and their effectiveness level was found.Conclusions: The treatment methods used in this study are useful to improve the back pain and to decrease weakness and disability with no significant difference between their effectiveness.

Aim and Background: The analgesic effect of perioperative low doses of intravenous lidocaine has been demonstrated in some studies. Sodium channel blockers are approved for IV administration in the treatment of neuropathic pain states. Our objective in this study was to determine the analgesic, antiemetic and sedative effect of perioperative lidocaine administration in strabismus surgery.Methods and Materials: In a randomized and double blinded clinical trial, forty patients undergoing strabismus surgery were evaluated. Twenty patients received lidocaine (bolus injection of 1.5 mg/kg) at the end of operation, before tracheal extubation and 20 patients received saline as placebo. Postoperative pain scorr, pethidine requirement, nausea -vomiting and sedation were assessed in the recovery room. Findings: Patients who received lidocaine reported less pain and needed less pethidine during their recovery state. There were also fewer incidences of nausea and vomiting in the lidocaine group. Patients in the lidocaine group were more sedated than the ones in the control group.Conclusions: Intravenous lidocaine has analgesic activity, besides its preventing effect on nausea and vomiting after strabismus surgery.

Aim and Background: One of the problems that may occur in Intensive care units is unplanned extubation, which has major potential for complications and mortality and is an important complication of endotracheal intubation.Materials and Methods: This prospective analytical study was performed on 150 patients admitted to intensive care unit at Urmia Imam Khomeini hospital who all needed mechanical ventilation. Among them 123 patients were intubated and 27 patients had tracheostomy. Their total days of intubation were calculated and all the unplanned extubations were registered. Then the ratio of this event to the total days of intubation was measured.Findings: From 150 patients, 10% suffered from unplanned extubation with a prevalence of 1.34%) during 1114 days of Intubation). The mean time of intubation was 25.13±5.93 days and the mean time of mechanical ventilation was 24.20±5.94 days. Among other patient groups, these figures were 13.10±1.48 and 12.76±7.42 days, respectively. The measured figures for unplanned extubation were statistically significant compared with other groups, when t- test was used (P=0.01).Conclusion: The frequency of unplanned extubation at intensive care units of Urmia Emam Khomeini hospital is similar to other centers according to the similar studies which have been performed.

Aim and Background:Our goal to perform this study was to evaluate the effect of adding lidocaine to the irrigation solution during knee arthroscopy on decreasing patient’s degree of pain.Methods and Materials: This was a randomized double blind study, in which 41 patients were enrolled in each group. In the control group, the irrigation solution in arthroscopy was just normal saline without any adjuvant. However in our cases, the solution contained 0.5 mg per ml lidocaine. The patients were compared according to their degree of pain and opioid request in the ward up to 6 hours thereafter.Findings: The visual analogue pain scale showed that the score of pain was significantly decreased in the case group in comparison with the control one. Moreover, the patients in the case group had significantly less request for opioids after arthroscopy.Conclusions: Adding lidocaine to the irrigation solution in knee arthroscopy could be an effective method to lower the degree of pain in patients.

Aim and Background: The estimation systems of mortality based on severity of disease are increasingly popular in the last 20 years, especially in the field of medical care. The purpose of this study is to evaluate the prognosis of hospitalized ICU patients according to Apache 2 scoring system in educational hospitals in Ilam city during 2013.Methods and Materials: In order to perform this prospective and analytic study, 150 patients admitted to the ICU ward of Imam and Mustafa Khomeini hospitals, were evaluated during 2013. A questionnaire that included demographic information and the Apache 2 criteria was completed for each patient and finally all of the data were analyzed by using statistical methods (SPSS software).Findings: The mean age of patients was 47.56±2.103 patients (68.7%) were male, and overall the mean Apache 2 score was 13.54 and was higher in women (16.6 VS 12.1) as well as the mean. 27.4% of patients died. The observed mortality rate was higher than the predicted mortality (12.7). Area under the ROC curve (AUC) of the Apache 2 model was 70% for the study.Conclusions: Generally, the Apache 2 system has a good discrimination power, but for good calibration of the model regarding mortality prediction, more studies are recommended.

Aim and Background: Identifying and relieving pain is one of the main responsibilities of nurses in the surgical wards. So in order to move toward higher quality care and to improve the performance of nurses in surgical wards, more information is needed on the current status of pain management in hospitals. Therefore, this study was performed to assess pain management qualification of nurses in teaching hospitals affiliated to Shiraz University of Medical Sciences during 2012.Methods and Materials: In this study, using convenience sampling 100 patients were enrolled. Follow-up and evaluation of the patients’ pain were done every 6 hours. To assess pain Visual Analog Scale (VAS) was used. The Data collected included demographic characteristics, chart, pulse rate, and blood pressure of the patients. The VAS score in six consecutive hours, and questions regarding pain management were asked by the nurses. The information gathered was recorded in sheets by nurses according to a PRN order (whenever the surgeon ordered to have painkillers if needed).Findings: According to our findings, in general, pain evaluation and management were not appropriately done by the nurses.Conclusions: It seems necessary that there is a need to improve the quality of pain management in the medical centers, and the nurses should be trained and has sufficient authority to prescribe analgesics whenever required.

Aim and Background: Acute pain after operation is one of the common side effects. Prescription of systemic analgesics and narcotics has however also various side effects; therefore, a more appropriate method is the creation of local pain relief, and it is desirable to provide better and longer-lasting analgesia by the infusion of lower doses of drugs. This study compared the effects of adding tramadol to subfascial space with systemic injection of bupivacaine on pain after hernia repair surgery.Methods and Materials: In this randomized Single Blind study, 90 patients, candidate for one-way inguinal hernia repair, were divided into three groups. In the first group, bupivacaine and tramadol, in the second group bupivacaine and normal saline were injected below the fascia of external oblique muscle at the end of the operation; and the third group received intramuscular tramadol at the mentioned location in addition to bupivacaine and normal saline. After operation, patients were compared in terms of pain intensity, nausea, vomiting, and need for analgesic. Data analysis was done by use of SPSS 20 software.Findings: The dynamic pain intensity in group 1 was lower than group 2 within 4 hours after operation. Moreover, within 8 hours after operation, the dynamic and static pain intensities in group 1 were lower than the other groups. No significant difference was observed between groups in terms of Nausea and vomiting (p=0.11). Besides, no significant difference was observed between the three groups in terms of need for analgesia and consciousness level.Conclusion: Tramadol addition to bupivacaine reduces postoperative pain in hernia surgery without being associated with any additional side effect such as nausea, vomiting, and loss of consciousness.

Aim and Background: Percutaneous tracheostomy, a common surgical procedure in the field of otolaryngology, is associated with complications, such as bleeding, infection, subcutaneous emphysema, pneumothorax, recurrent laryngeal nerve injury and tracheal ring fracture. However, the incidence of pneumothorax and pneumoperitoneum in a single individual is rare.Case report: A 70-year-old woman was scheduled to undergo an urgent tracheostomy with dyspnea and severe respiratory distress due to incomplete superior airway obstruction following relapse of medullary thyroid cancer. Approximately two minutes after insertion of the tracheostomy tube, her blood pressure and O2 saturation decreased but airway pressure increased. Physical examinations revealed decreased bilateral breath sounds and diffuse expansion of the abdomen. Immediately an orotracheal tube was inserted up to 10 cm through the orifice of tracheostomy into the trachea. After puncture of the chest and abdomen the air was evacuated and the patient was discharged from ICU after 2 days hospitalization without any adverse event. The proposed mechanisms include: complications related to lack of proper placement of tracheostomy tube due to tumor location, tube dislocation, and barotrauma. Rupture of alveolar walls or bronchial and bronchioles lead to air leakage into the pleural cavity and can cause pneumothorax. Although the thoracic and peritoneal cavities are separated by the diaphragm, they may communicate through congenital defects, such as a pleuroperitoneal canal or defects adjacent to the aorta or esophagus.Conclusions: Performing tracheostomy, especially in patients with a cervical mass, can be associated with serious and life-threatening events. Attention to the risk of these complications and prompt treatment would reduce the mortality and morbidity rate.