Journal of Anesthesiology and Pain
Year:2013 | Volume:3 | Issue:4|Papers Count:11

Aim and Background: Acute post-operative pain is the most frightening aspect of a surgical procedure. This study has been designed to evaluate post-operative pain after common abdominal surgeries, and also to assess patient satisfaction with pain management in the department of surgery in order to understand whether enough attention has been paid to this type of treatment.Methods and Materials: In a prospective cross-sectional study, a questionnaire with 20 items including kind of surgery, intensity of pain using a verbal analogue scale (VAS), type of consumed analgesics and patient satisfaction with post-operative pain management, was given to the patients within 24 hours after surgery.Findings: Participants were 390 patients (56% male and 44% female), with the age range between 10 and 85 years. The average maximum post-operative pain score was 8.2±2 using VAS. Most of the patients (92.3%) were partially or moderately satisfied with the pain relief method, while 7.7% had some degree of dissatisfaction. Methadone was the most commonly administered analgesic.Conclusions: To achieve higher levels of pain control and patient satisfaction we should pay more attention to pain relief and other effective factors such as kind of incision and analgesics.

Aim and Background: One of the most common surgical procedures is hemorrhoidectomy and pain is a common problem in patients after this surgery. Therefore postoperative pain control could have a significant impact on reducing complications and increasing patients' satisfaction. In this study, the effect of perianal block with bupivacaine on declining pain after hemorrhoidectomy has been studied.Methods and Materials: This study is a double-blind clinical trial in which, patients undergoing hemorrhoidectomy were randomly divided into two groups. The study group received perianal block with bupivacaine 0.25% after surgery and the control group did not recieve any block. In order to assess postoperative pain and nausea-vomiting, VAS and VDS scales were used, respectively. In the meanwhile, the duration of postoperative analgesia and patient satisfaction were evaluated.Findings: The two groups were sigificantly different considering the mean change in pain score (based on VAS), the average amount of pethidine recieved, the rate of post-operative nausea and vomiting (VDS) and the percentage of patient satisfaction after the surgery. (P=0.0001).Conclusions: Perianal block with bupivacaine in elective surgical hemorrhoidectomy effectively reduces postoperative pain.

Aim and Background: This clinical trial was conducted to evaluate the effectiveness of adding midazolam or S-Ketmine to caudal bupivacaine in order to prolong the postoperative analgesis duration.Methods and Materials: 60 children with ASA physical status I or II and scheduled for elective surgery below the umbilicus, were enrolled in this double blinded clinical trial. The patients were placed in three different groups. In the 1st group 1 ml/kg of 0.25% bupivacaine, in the 2nd group 1 ml/kg of 0.25% bupivacaine with 0.5 mg/kg ketamine, and in the 3rd group 1 ml/kg of 0.25% bupivacaine with 50 mg/kg midazolam were used.Findings: There were no differences between the groups in demographic and haemodynamic state, duration of surgery and anaesthesia, time to extubation or sedation score. The mean duration of postoperative analgesia were 19 h, 14.5 h, and 8 h in the 3rd, 2nd, and the 1st groups, respectively. Although there were more episodes of nausea and vomiting emergence reaction in the 2nd group, the difference did not seem significant.Conclusions: Addition of preservative-free S-Ketamine (0.5 mg/kg) or midazolam (50 mg/kg) to caudal bupivacaine provides significant prolongation of analgesia without producing significant negative side-effects.

Aim and Background: Memantine is one of NMDA receptor antagonists with a rapid onset and limited side effects; its inhibitory effects on neuropathic pain has mentioned while using before nerve injury. Few studies were done on evaluating oral memantine effects on acute post-orthopedic surgery pain.Methods and Materials: In a double blind clinical trial, 60 patients with ASAI, II and upper limb fracture in two groups were enrolled in this study. After signing informed consent by the patients, 1 hour before surgery 20mg memantine prescribed for case group and control group received placebo. The patients received fentanyl and midazolam as premedication then anesthesia induction with propofol and cisatracurium performned. Maintenance of anesthesia was propofol and remifentanil. Pain score with Visual Analogue Scale (VAS) and sedation score measured and recorded in recovery and 6, 8, 24, 36 and 48 hours later. Also total dose of opioid consumption and nausea and vomiting incidence was measured.Findings: No demographic differences exist between them. Pain score in recovery and 6, 24 hours later were lower in case group. Sedation score was significantly different in hour 24 (P=0.04) Morphine dosage in case group was lower in recovery (P=0.01) Incidence of nausea and vomiting was not different between groups.Conclusions: Prescribing 20 mg memantine 1 hour before surgery, has been effective on pain reduction, also could decrease morphine demands in recovery.

Aim and Background: Acetaminophen, in both oral and intravenous forms (Apotel), is a safe drug in controlling mild to moderate pain. However, Opioids are still a part of routine plan. We compared the effectiveness of Apotel with oral acetaminophen codeine and oxycodone for postoperative pain control.Methods and Materials: In this single blind clinical control trial, 75 patients, being candidate for elective septorhinoplasty, were enrolled and divided into 3 groups. All groups received 1000 mg Apotel in the recovery room; then the first group received 900.30 mg oral acetaminophen codeine after 6 hours QID, the second group received 10 mg oxycodone after 8 hours TDS and the third group received 1000 mg Apotel after 8 hours TDS.Findings: All three regimens resulted in a significant pain reduction and there was no significant difference in the pain score at different intervals; however Systolic blood pressure and Diastolic Blood pressure showed significant reduction in the aceminophen codeine and oxycodone group.Conclusions: Considering the significant pain reduction in all the three groups, selection between the 3 regimens should be based on other factors.

Aim and Background: Nerve stimulator and Sonography are both used for nerve localization and block, either alone or in combination. This study compares these methods regarding the speed of onset and quality of brachial pleuxus block in Supraclavicular area.Methods and Materials: In this double blind clinical trial, 30 patients with upper extremity fracture were recruited. They were divided into two groups. In the nerve stimulation group, block was performed with the plumb-bob approach, using nerve stimulator only. In the second group, block was done using nerve stimulatoin plus Sonography. After the procedure, the quality and onset of motor plus sensory block were recorded and analyzed.Findings: The patients had a mean age of 33.66±11.05 years. Regarding quality of motor block, the difference between the two groups was statistically significant (p=0.04), while no difference was found in sensory block quality. There was a significant statistical difference in the onset of motor block between the two groups (18.26±0.96 using Sonography and stimulatoin, and 22.4±0.98 in the nerve stimulation group).Conclusions: Using nerve stimulation and ultrasonography together for Supraclavicular block, increases the quality and reduces the onset of block for upper extremity.

Aim and Background: Nowadays, ultrasound-guided infraclavicular block has led to impressive results in improving upper extremity anesthesia and patient satisfaction.The aim of this study was to compare the results of infraclavicular block as single injection versus multiple injectons in upper extremity surgery.Methods and Materials: In this randomized clinical trial, patients undergoing upper limb surgery were enrolled. After localizing the axillary artery under the guide of ultrasound; 30 ml lidocaine (1.5%) was injected in the single injection group. In the multiple injections group, 10 ml lidocaine was injected in posterior, medial and latral position.Findings: The mean duration of procedure in single injection and multiple injections groups were 3.29±1.21 minutes and 4.81±1.90 minutes, respectively. The mean time to reach complete anesthesia, was not siginificantly different between the groups. In Single injection group, all patients achieved complete anesthesia after 15 minutes of injection. However partial anesthesia was observed in one case in the multiple injections group.Conclusions: Single injection ultrasound-guided infraclavicular block is a fast, simple and safe method of anesthesia for upper extremity surgery. Regarding its simplicity and effectiveness, this technique is preferred to multiple injections technique.

Aim and Background: Rapid and Confident induction of anesthesia is a goal for the anesthesiologist. In the meanwhile, most of anesthetic drugs are not without complication. In this study we evaluated the effects of anesthesia induction with halothane by single breath on hemodynamic parameters in pediatric patients.Methods and Materials: In this study 50 children were enrolled. For induction of anesthesia the single breath method with 5% halothane and O2- N2O (30-70%) mixture was used. Systolic blood pressure, diastolic blood pressure and heart rate were recorded before induction, 1 minute after induction, 1 minute after using muscle relaxant, and 3 minutes after intubation. The heart rate and QT interval were recorded by ECG.Findings: Halothane significantly prolonged the corrected QT (QTC); it caused a mild increase in heart rate which reduced again after using muscle relaxant. However, another heart rate elevation occurred three minutes after intubation. Blood pressure decreased after induction and even after intubation which was statistically significant.Conclusions: Halothane is an arrhythmogenic drug which can prolong QTC in pediatric patients. Moreover, our study shows that it can decrease blood pressure and heart rate at the same time.

Aim and Background: Many of patients candidate for Transurethral Resection of Prostate (TURP) due to Benign Prostatic Hyperplasia (BPH), also suffer from cardiovascular diseases and are under medication with low dose aspirin (80 mg/daily). Aspirin withdrawal may result in acute cardiovascular syndrome, while its continuation may expose the patient to the risk of postsurgical excessive bleeding. There is not any guideline about whether to discontinue aspirin before TURP or not. This short communication aims to determine the impact of aspirin on intraoperative blood loss.Methods and Materials: A prospective study on 105 TURP candidates was designed, with 26 cases (24.8%) under aspirin medication and 79 cases (75.2%) not. Intra operative bleeding in two groups was compared together.Findings: There is no significant differences in intraoperative blood loss (P>0.05), hemoglobin concentration drop (P>0.05), hematocrit drop (P>0.05), time to urine clearance and blood transfusion between two groups. Blood loss does not have a significant correlation with type of anesthesia.Conclusions: Aspirin does not increase bleeding in TURP. As withdrawal of aspirin can lead to cardiovascular complications; routinely aspirin discontinuation in these patients is not recommended.

Bier block anesthesia is an intravenous regional anesthesia technique in which an extremity is made numb for surgery by injecting a local anesthetic solution into a vein after the blood has been squeezed out of the extremity and a tourniquet has been placed on it. The tourniquet prevents the local anesthetic from leaving the extremity and blood from entering it, giving the patient a numb (anesthetic) extremity and the surgeon a bloodless field to work in. The technique is named for August Bier.The advantages of the technique is that it is simple to perform, and provides a bloodless field that is easy to work in and minimizes blood loss. The disadvantages are that there is a practical time limit on its use of about 1 hour due to tolerance of the awake patient for the pain of the tourniquet and 2 hours due to the maximum time blood flow can be restricted to the extremity without anoxic tissue damage.In this case we performed bier block in a high risk diabetic patient for below knee amputation. We added mg sulfate as an adjuvant drug in order to improve block quality and to prolong patient analgesia.