Journal of Anesthesiology and Pain
Year:2014 | Volume:4 | Issue:3|Papers Count:10

Aim and Background: Although controversial, many studies have shown effectiveness of colloid loading as a substitute for crystalloids on reducing the incidence of hypotension in spinal anesthesia. This study was conducted to compare the effects of three intravenous fluid regimens on hemodynamic changes following spinal anesthesia in cesarean section. The regimens included 6% Hydroxy ethyl starch 130.0.4 (HES) as a colloid and two crystalloids (lactated ringer’s solution and sodium chloride 0.9%).Methods and Materials: In a double-blind clinical trial, 90 otherwise healthy parturients candidate for elective caesarean section, were randomly allocated to receive lactated ringer’s solution (1000 ml), sodium chloride 0.9% (1000 ml) or HES (7.5 mL/Kg) as preloading before spinal anesthesia. Hemodynamic parameters including blood pressure and heart rate, umbilical cord blood pH and the neonatal Apgar score were compared among the three groups.Findings: There was no difference in the basic hemodynamic measurements among the three groups. The incidence of hypotension and the required dose of ephedrine were lower in HES group (p=0.008). There was no significant difference in umbilical cord blood PH or Apgar scores among the intervention groups. Conclusions: Preloading with HES is more effective than crystalloids in preventing hypotension after spinal anesthesia without leading to a significant difference in Apgar score and umblical cord blood pH.

Aim and Background: Non-specific low back pain has direct impact on quality of life, active days at work and healthcare cost. The purpose of this investigation was to study the relationship between lumbar lordosis and lumbar range of motion with non-specific low back pain.Materials and Methods: 50 students of kharazmi University (mean age: 24 years, mean weight: 75.72 kg, mean height: 180.5 cm, and mean BMI: 22.33) took part in this study as subjects. They were divided to 3 groups according to the severity of low back pain which was measured by Oswestry questionnaire. Some of the anthropometric characteristics of subjects such as length of lower extremity and width of pelvic girdle were measured by body composition analyzer system and some other anthropometric instruments. For measuring the angle of lumbar lordosis and lumbar range of motion, we used the Spinal Mouse System. Findings: The result showed that there was not any significant relationship between anthropometric and individual characteristics and lumbar lordosis with severity of low back pain (p<0.05). According to our results, it has been revealed that there is a negative relationship between lumbar range of motion and severity of low back pain (p<0.05).Conclusion: Therefore, it is possible that decreased lumbar range of motion may increase the risk of low back pain.

Aim and Background: One of the major problems of tonsillectomy and adenotonsillectomy surgeries in children is postoperative pain control. Pain before tonsillectomy can be alleviated by local anesthetic injection into the area around the tonsils or prescription of analgesics before surgery. The purpose of this study was to investigate the effect of tramadol administered as local peritonsillar infiltration on reduction of pain after tonsillectomy surgery.Methods and Materials: This double-blind randomized clinical trial was performed on 72 patients who underwent elective tonsillectomy or adenotonsillectomy. Patients were divided into two equal groups randomly. After induction of anesthesia in a consistent way and at the end of tonsillectomy or adenotonsillectomy, for the case group, a small sterile gauze impregnated with 10 ml of 2mg/kg tramadol (5%) mixed with normal saline was applied in the tonsilar fossae. For the control group, a small sterile gauze impregnated with 10 ml normal saline was left in both tonsillar fossae for 5 min. Then, patients of both groups were compared in terms of pain reduction after surgery with Wong-Baker Visual Scale as pain rating scale. Findings: Pain score in all measured intervals since the end of anesthesia was significantly lower in the tramadol group than in the control group (pain score average 1.5±0.4 versus 2.4±0.4 with P<0.001). The incidence of side effects showed no statistical significant difference between the groups.Conclusions: Prescription of peritonsillar tramadol infiltration is a safe way which creates appropriate analgesia in children undergoing tonsillectomy / adenotonsillectomy, it provides good analgesia and its administration is recommended.

Aims and Background: Propofol is one of the newest and the most common drugs in anesthesia and intensive care unit which is used to produce sedative effects. One of its complications is the pain produced at the time of injection. The aim of this study is to compare the pain of Propofol injection with two techniques: Propofol mixed with lidocaine and Propofol injection after lidocaine.Materials and methods: This study is a randomized double-blind clinical trial, in which 172 patients undergoing elective surgery with ASA class one and two were enrolled. Three groups of patients had injections as follows: In the first group 40 mg Propofol mixed with 2% lidocaine, in the second one purified one percent propofol, and in the third group Propofol following injection of 40 mg lidocaine 2%, were injected. Venous catheter 20 gauge was used in all cases for injection, and pain intensity was measured by VRS (Verbal Rating Scale) criteria. The data were analyzed by SPSS V.18.Findings: Pain intensity in the second group (Propofol injection after lidocaine injection) was less than the first group (mixed injection) and there was a statistically significant difference between the two groups (P<0.05). The hemodynamic changes were similar in both groups, and there was no significant difference (P>0. 05). Conclusions: Pre-treatment by injecting 40 mg of lidocaine2% to reduce pain due to Propofol injection is more effective than mixed method of injecting 40 mg of Propofol with lidocaine 2%.

Aims and Background: Postoperative shivering after general anesthesia and spinal anesthesia is a common side effect. Besides, there are several medical methods to relieve shivering. Still on the issue of which method is most appropriate for patients after surgery, there is some controversy. The aim of this study was to determine the efficacy of Dexamethasone in reduction of post-operative shivering after elective surgery in the city of Ilam. Materials and Methods: This study is a randomized double blind clinical trial on patients admitted for elective surgery to Imam Khomeini hospital during summer 1392, in Ilam. The inclusion criteria were: age between 18 to 55 years, and ASA class 1 and 2 with no underlying disease. Otherwise, and in the case of patients’ dissatisfaction they were excluded from this study 60 patients of both sexes were randomly divided into two groups with a ratio of 1:1. An anesthesiologist injected placebo for the first group and 15 mc/kg Dexamethasone for the second one, after induction of anesthesia and before the incision. At the end of surgery, the frequency and the intensity of shivering among the two groups in the recovery room was examined by technicians who were unaware of the type of administered drug.Findings: In this study, 61.7% of patients were female. The most frequent degree of shivering intensity was grade 1 while grade 2 and 6 had the minimum frequency. There was no significant difference regarding gender and the type of drug administered (P value=0.79). Also no significant relationship between the type of surgery and the anti-shivering drug was found (P value=0.59).Conclusions: Our findings showed no significant difference regarding shivering control, between the Dexamethasone and the placebo groups.

Aims and Background: Hemodynamic changes during laparoscopy and postoperative pain after laparoscopic surgery are important issues. Therefore, in this study we examined the effect of oral clonidine on hemodynamics and postoperative pain control after laparoscopic cholecystectomy.Materials and Methods: The study was a randomized clinical trial. 61 patients, candidate for laparoscopic cholecystectomy, were randomly assigned into two groups. The intervention group received 0.2 mg oral clonidine one hour before anesthesia, and the control group was given placebo instead. The hemodynamic changes and postoperative pain were compared between the two groups.Findings: Variations of Mean Arterial blood Pressure (P=0.18) and heart rate (P=0.15) in the two groups were not statistically significant during surgery. Postoperative analgesic intake in the first 60 minutes of recovery (P=0.006), and 24 hours after surgery (P=0.005) were both significantly lower in the clonidine group. Conclusion: Although oral clonidine had no significant effect on hemodynamic changes during laparoscopic cholecystectomy but it caused a significant reduction in postoperative pain and analgesic requirement.

Aims and Background: Airway hyperactivity is one of the most important complications of tracheal extubation. This study was designed to compare the efficacy of intravenous acetaminophen as an alternative to remifentanil on airway response to tracheal tubes during and at the end of anesthesia in functional endoscopic sinus surgery. Methods and materials: This study was conducted as a double blind clinical trial on 70 patients 20 to 60 years old, candidate for endoscopic sinus surgery, in Rasoul-Akram hospital. They were randomly allocated into two groups: the Paracetamol (n=35) and the remifentanil (n=35) groups. Remifentanil infusion with a dose of 0.1mg/ kg/min was administered for both groups during anesthesia. Since the beginning of inserting the nose tampon until extubation, remifentanil infusion (0.1 mg/kg/min) was continued in group I, and in group II in the last 20 minutes of surgery, remifentanil infusion was discontinued and intravenous injection of acetaminophen was begun. Incidece of Cough, Arterial blood pressure, and heart rate were recorded.Findings: There was no significant difference in the incidence rate of cough during extubation between the two groups (P=0.7). Mean arterial pressure (MAP) variation, was significantly lower in the remifentanil group (P<0.001). Variations in heart rate were similar in both groups (P=0.74). Conclusions: Using intravenous acetaminophen has the same effect as remifentanil in controling airway reflexes after endoscopic sinus surgery as well as reducing symptoms such as restlessness and changes in heart rate.

Aim and Background: Postoperative acute pain management is necessary to prevent chronic pain. Pregabalin as a GABA analogue has been shown to have analgesic effects on postoperative pain. It has minimal side effects and is absorbed rapidly from the alimentary tract. The aim of this study was to evaluate the analgesic efficacy of single dose oral pregabalin on postoperative pain control after orthopedic surgeries performed under spinal anesthesia.Materials and Methods: Sixty patients, candidate for orthopedic surgery under spinal anesthesia, were randomly allocated into two groups. For the intervention group 150 mg oral Pregabalin and for the control group placebo were prescribed one hour before surgery. Visual Analogue Scale (VAS) for pain assessment and opioid consumption were evaluated in a 12 hour period after surgery. If pain score (VAS) was more than four, intravenous pethidine (0.5 mg/kg) was administered.Findings: No significant difference was found between the two groups, regarding demographic data. VAS in the post anesthesia care unit, 6, and 12 hours postoperatively in the pregabalin group was significantly less than the placebo group (p<0.05). Also pethidine consumption in the pregabalin group was significantly less than the placebo group (p=0.001).Conclusions: Administration of a single dose pregabalin orally (150 mg), one hour before orthopedic surgery reduced post operative pain and opioid consumption.

The patient was a 69 year-old man suffering from benign prostatic hypertrophy (BPH), who was candidate for transurethral resection of prostate (TURP) surgery with 980nm diode laser. At the end of the operation, the surgical team noticed abdominal distention. So with suspicion to an acute abdominal problem he underwent an exploratory laparotomy. During the surgery it was found that patient had extra -peritoneal bladder perforation, and after repairing the bladder perforation our patient was transferred to the intensive care unit (ICU). In the meanwhile and after 48 hours, he was at last successfully discharged from ICU.