Journal of Anesthesiology and Pain
Year:2013 | Volume:3 | Issue:2|Papers Count:10

Aim and Background: Adding new supplements when performing spinal anesthesia can increase the duration of analgesia. The aim of the present study has been to compare intrathecal midazolam and tramadol with the conventional method for postoperative pain and shivering control after elective caesarean section.Methods and Materials: In this double-blind clinical trial, 210 ASA class I, II women, aged 20-35 years, candidate for elective caesarean section were randomly allocated to three groups. All patients received hyperbaric intrathecal lidocaine and additionally group I received 2 mg subarachnoid midazolam, group II received 25 mg subarachnoid tramadol and the control group received 5cc normal saline. Postoperative pain score, the painless duration and postoperative shivering were assessed in the three groups.Findings: The mean painless duration in tramadol, midazolam and the control group were 192.5±12.2, 111.3±16.6 and 86.1±9.9 minutes, respectively (p<0.001). The mean painless duration in the midazolam group was significantly more than two other groups and this duration in the tramadol group was also more than the control one. The mean postoperative pain score, shivering occurrence and the frequency of requested painkiller in the first 24 hours, were also compared. In the midazolam group, they were all significantly less than the two other groups. In the meanwhile, these indexes in the tramadol group were less than the control one (p<0.001). Conclusions: Adding intrathecal midazolam and tramadol to lidocaine 5% in elective caesarean section can increase the painless duration and lead to a reduction in postoperative shivering. Midazolam demonstrates a stronger effect.

Aim and Background: Controlling pain in the post-operative period is still one of the challenging issues for anaesthesiologists as it tremendously helps patients to return to their daily life as soon as possible. In this survey we have tried to compare the efficacy of %0.5 bupivacaine and %2 lidocaine with normal saline for controlling pain after PCNL.Methods and Materials: In a double blind clinical trial, 60 patients were enrolled being divided into 3 groups. %0.5 Bupivacaine in a dose of 0.5 mg/kg diluted in 20 cc normal saline was injected, into the insertion site and also the tract of the PCNL probe in group one. In our second group, %2 lidocaine (4mg/kg) diluted in 20 cc normal saline, and in the third group, just 20cc NS were injected in the same manner and direction. VAS was measured at 0, 3, 6, 9, 12, 15, and 18 hours post-operatively in order to evaluate pain control. Findings: The mean VAS measured 0, 3, and 6 hours post-operatively in the bupivacaine and lidocaine groups was less than the normal saline group (P<0.05). The average time to injection of the first dose of pethedine was longer in the bupivacaine and lidocaine groups than the normal saline group (p<0.05).Conclusions: Injection of 0.5% bupivacaine and %2 lidocaine in the puncture site of PCNL is effective for pain control after PCNL surgery according to our results.

Aim and Background: The main purpose of this study was to investigate effectiveness of Mindfulness-Based Stress Reduction (MBSR) on decreasing depression in patients with chronic low back pain.Methods and Materials: The statistical population included patients with chronic low back pain who appointed the pain clinics in Tehran. Among whom 23 participants were enrolled with convenience sampling and randomly assigned into two equal experimental and control groups. The questionnaire was consisted of the depression subscale of short form known as the depression anxiety stress scale (DASS-21) which was completed by the patients in pre-test and post-test formats.Findings: The results of this research, using Mann-Whitney test, showed that the mean depression score in the experimental group has reduced significantly in comparison with the control group.Conclusions: According to the findings of our study, the Mindfulness-Based Stress Reduction Therapy is significantly effective in decreasing depression in patients with chronic low back pain.

Aim and Background: Safe airway maintenance in patients under general anesthesia is the most important duty of anaesthesiologists. Classic laryngeal mask airway (CLMA) is a supra-glottic device to achieve this aim. There are different insertion techniques for this device, but the best of them is unknown.Methods and Materials: Two hundred patients were included in this mono-blinded clinical trial. Patients were divided into four groups. The CLMA was inserted by the index finger in the standard group, by 45 degree rotation into lateral position in the lateral technique group, by 180 degree rotation in the rotational technique, and finally in the modified standard group we used a standard like method without using the index finger. We evaluated the number of insertion trials, ease of insertion and the time needed for successful trial. Airway sealing pressure and post operative complications were also assessed.Findings: With the lateral technique, CLMA was more easily inserted, and the time needed for insertion was also significantly decreased. In the meanwhile, we encountered less blood stained LMA with the lateral technique (p<0.05). The first-trial success rate was more in the lateral technique group but the difference was not shown to be significant. Conclusions: Lateral insertion of CLMA increases ease and first-attempt success rate and at the same time, it reduces insertion time and bleeding .As a result, this technique can be recommended whenever LMA insertion is necessary in patients undergoing general anesthesia.

Aim and Background: The assessment of patient satisfaction with anesthesia, the balance between expectations and perception of what was received, is an essential component of continuous quality improvement in anesthesiology. In our center there have been few studies conducted in the anesthesia field, which have assessed patient’s satisfaction. In this prospective study we have evaluated patient satisfaction with anesthesia in patients 24 h after surgery. Methods and Materials: This study was performed in Sina hospital in Tehran, Iran on patients aged more than 18 yr. They all underwent elective surgical procedures with anesthesia. One of the anesthesia staff members took the interview one day after surgery and asked the patients questions for the structured questionnaire designed to measure patient satisfaction with anesthesia. At the same time, some specific questions were also asked to find factors that could be associated with such satisfaction.Findings: The data was gathered from 500 patients (mean age: 41±16 yr; and males: 65.2%). The overall satisfaction (complete and relative) was high (98.8%); although 6 patients (1.2%) were dissatisfied with their anesthesia care. After analysis of several factors related to the patients’ surgery and anesthesia, a strong relation was found between spinal anesthesia and satisfaction (p=0.003).There was not any relation between age, gender, education, duration of anesthesia and kind of surgery with patients’ satisfaction. Conclusions: Our study found that patient satisfaction with anesthesia was very high in our center and the only factor that increased patient's satisfaction was spinal anesthesia.

Aim and Background: Pain management is very important in tonsillectomy in order to reduce the suffering and restlessness in children. The aim of this study was to investigate the effect of peritonsillar injection of lidocaine and placebo preoperatively on postoperative pain relief. Methods and Materials: This randomized triple blind clinical trial conducted on sixty 3-12- year-old children who were candidate for tonsillectomy. Children were randomly assigned to lidocaine and placebo groups. Anesthesia inducted similarly for all patients and peritonsillary 1 mg/kg lidocaine (per 2 ml volume) in the first group and 2 ml normal saline in the second group was injected. Pain assessment was performed using the self-report Oucher Scale and CHEOPS. Findings: The mean pain score in lidocaine group in 5, 15, 30, 60,120 and 240 minutes after surgery was lower than placebo group but this difference (in Oucher scale) was only statistically significant at 240 minuets after surgery (P=0.03). Conclusions: The preoperative peritonsillar injection of lidocaine is an effective method of reducing post-tonsillectomy pain in children.

Aim and Background: Hypotension and nausea are common side effects during spinal anesthesia. This study compared the incidence of hypotension and nausea-vomiting induced by bupivacaine and lidocaine in parturients undergoing caesarean section under spinal anaesthesia.Methods and Materials: In this clinical trial, 120 parturients undergoing caesarean section were randomly allocated into two groups. 60 patients received subarachnoid lidocaine 5% (75-100 mg) and the other group of patients received bupivacaine 0.5% (12-15 mg). If systolic blood pressure decreased to 80 mm Hg or less than 70% of the pre-anesthesia value, 5mg ephedrine was injected. We evaluated Blood pressure each 3 minutes up to 15 min and every 5 min thereafter till the end of the recovery stay.Findings: There was no statistically significant difference in the incidence of nausea –vomiting between the two groups after spinal anesthesia. On the other hand, there was significant difference in systolic blood pressure 12 minutes after the procedure and also a significant difference was noted in diastolic blood pressure 3, 9, 15, and 40 minutes after performing spinal anesthesia (P<0.05). The amount of ephedrine used in both groups did not show either any significant difference.Conclusions: Intrathecal bupivacaine may yield more hemodynamic stability than intrathecal lidocaine in elective cesarean section.

Considering the risk associated with general anesthesia in especially ill neonates (under 30 days of age), performing regional anesthesia in this group of patients would be of great benefit for the patients and the anaesthesiologists, simultaneously.In this investigation, we performed caudal anesthesia in a 25 day neonate who had electrolyte imbalance and nutritional deficits, after informing the parents about the risk-benefit ratio of this procedure and taking an informed consent. He had to undergo illeostomy and colostomy prior to definitive surgery for Hirschsprung’s disease. By using caudal anesthesia after electrolyte correction, the neonate underwent the surgical procedure and in this way, our patient had a rapid recovery with no serious side effect, fortunately.