Journal of Anesthesiology and Pain
Year:2017 | Volume:7 | Issue:2|Papers Count:9

Aim and Background: Different types of drugs are used as pharmacologic prophylaxis for migraineheadache. Each of them has its own efficacy and side effects. In addition to pharmacological drugs, somestudies have also suggested the use of the alternate and herbal remedy in migraine. Peppermint has a longhistory of use in some disorders, including headache. In this study we evaluate the effectiveness of oralpeppermint extract (menthol) in migraine.Materials and methods: This study is a randomized clinical trial held in Sadaf pain clinic, Pars Hospitaland Amir-al-momenin Hospital in Tehran. In this study 40 patients, aged between 18 to 65 years with 2 to 8attacks per month who were on prophylactic treatment, have been observed for one month. Oral menthol 2%was also added for 1 month to their usual treatment (5 drops after lunch and dinner). Patients were followedfor frequency of attacks, headache severity, and duration of attacks and associated symptoms of attacks, onemonth before and one month after consumption of the peppermint extracts.Findings: Peppermint caused a significant decrease in frequency, severity and duration of attacks (P-value<0.05). Among symptoms, photophobia and phono-phobia were improved significantly (P-value<0.05), whereas no significant change was observed in nausea and vomiting (P-value>0.05).Conclusion: Our study showed that peppermint extract (menthol) could significantly reduce the intensity, duration and frequency of migraine attacks in combination with prophylactic pharmacologic therapy.

Aim and Background: Several methods have been proposed for treatment of knee osteoarthritis pain such as platelet rich plasma injection. The aim of this study is to compare adding intraarticular growth hormone to platelet rich plasma under sonographic guidance on joint function in patients with knee osteoarthritis.Materials and methods: Fifty four patients with knee osteoarthritis were divided into two equal groups including 27 individuals. Injection solution in the first group (P) was 5 ml of platelet rich plasma and in the second group(PS), it was 4 units of growth hormone (Somatropin) added to platelet rich plasma. Intra-articular injection wasdone at two times; the onset of study, and one month later. Demographic data were recorded. Knee joint function was evaluated based on WOMAC Score at time 0, 1 and 2 months later and complications were evaluated.Findings: WOMAC Score in both groups was significantly reduced after injections (P=0.0001). WOMAC score reduction in second group (PS) after 1 month was significantly higher than the first group (P) but at 2 months, the difference between the two groups was not significant. (P=0.235). No complication was observed.Conclusion: Adding intraarticular growth hormone to platelet rich plasma can be effective for knee joint function in osteoarthritis patients at short time basis.

Aim and Background: One of the disadvantages of axillary block is a long time gap between performing the block and the appearance of anesthesia required for surgery. This study aimed to examine the effect of adding0.5% dextrose water (DW) to bupivacaine in brachial plexus block under the guide of nerve stimulator and ultrasonography in hand and forearm surgeries.Methods and Materials: A total of 60 candidates for axillary block were studied, being randomly divided in totwo groups. In both groups bupivacaine 0.5% was used to achieve anesthesia with 0.9% normal saline (NS) in the first group and 0.5% DW in the second group as solvents. Sensory and motor blocks were documented af terlocal anesthesia every 5 minutes within the first 30 minutes, every 10 minutes within the second 30 minutes, and every 15 minutes thereafter.Findings: The time interval between drug injection and anesthesia between the two groups was different statistically only for the median nerve (p=0.03), whereas the difference for the remaining nerves was not significant.Conclusions: In the present study adding 5% DW was only effective in the sensory block of the median nerve, with no significant difference with NS for the other nerves.

Aim and Background: Iatrogenic recurrent laryngeal nerve (RLN) injury is an uncommon but serious complication of Head and neck surgery and also thoracic procedures. Laryngoscopy is an invasive and uncomfortable procedure; therefore the use of sonography as a noninvasive method of screening patients for impaired vocal-cord mobility is more desirable. The aim of this study was to assess the efficiency of ultrasonography as a screening tool for detection of impaired vocal-cord movement and comparing two sonographic views (supra-thyroid and trans-thyroid) to find the preferred view to observe the movement of vocal cord among different ages and sexes.Methods and Materials: In this clinical trial 144 patients were evaluated. All patients underwent vocal cord sonography in two sonographic views, Trans-thyroid and supra-thyroid, before and after surgery. After high risk surgery for vocal cord damage like thyroidectomy, parathyroidectomy, Carotid endartrectomy, anterior approach of cervical spine fixation and thoracic procedures, patients underwent direct laryngoscopy. To assess accuracy of ultrasound, transcutaneous sonography findings were correlated with direct laryngoscopy findings afterextubation. Vocal cord paresis or palsy was defined as abnormal vocal cord movement during respiration.Findings: The quality of sonographic images in trans-thyroid view was better than the supra-thyroid view. The quality of sonographic image was better in women compared with men. Moreover aging diminished the quality of the image.Conclusions: Ultra sonographic evaluation of vocal cord movement after high risk surgery seems to be an ideal and painless method for RLN injury screening. Application of this method particularly in non elderly women, conveys to more favorable results.

Aim and Background: Renal colic is a complex of symptoms which indicates an obstruction in the urinarytract. Pain resulting from stone passage is one of the most severe and intractable pain experiences. For pain control different agents have been used such as opioids, NSAIDs, calcium channel blockers, intravenous acetaminophen and various other drugs.Methods and Materials: After considering inclusion and exclusion criteria, 300 patients with renal colic entered this study among the patients admitted to Firoozgar and Hazrat Rasoul e Akram hospitals in Tehtan. Questionnaire was filled for each patient including demographic data and study variables. Patients were divided into two groups randomly and they were treated with intravenous ketorolac or intravenous morphine. Pain score was documented by Numeric Pain Intensity Scale before, 20, 40 and 60 minutes after the injection. The decrease in pain score and rescue therapy requirement were compared between the groups.Findings: There was no difference between two groups regarding sex and age. Moreover, there was no significant difference in mean size of the stone between the two groups. Mean pain free time in morphine group was 27.7±10.1 minutes and in ketorolac group it was 17.4 ± 10.2 minutes showing a significant difference (p<0.001). Also Rescue therapy was significantly more in morphine group (p=0.001).Besides, pain score decrease at 20, 40 and60 minutes after the injection was significantly higher in ketorolac group. (p<0.01).Conclusions: Intravenous ketorolac had more effectiveness and speed of action than intravenous morphine.However, ketorolac had no significant complication.

Aim and Background: Achieving a practical model for effective chronic pain management in the elderly is of high importance. Hence, the current study aimed to test some parts of comprehensive chronic pain management model (CCPMM) in elderly people.Methods and Materials: This study is a correlational testing model in which 205 elderly patients with chronic pain were selected by multistage random sampling. Vulnerability, living with pain and the pain suffering degree were evaluated with special questionnaires for vulnerability related chronic pain, living with pain, and McGill questionnaire, respectively as parts of the main components of CCPMM. The structural equation modeling (SEM) and Path analysis by Smart PLS (version 2) software were conducted respectively for data analysis.Findings: The results showed a positive relation between vulnerability related chronic pain and feeling pain (P<0.01, b=0.39). Also there was a negative significant relation between feeling pain and living with pain (P<0.01, b=- 0.26). Finally a negative significant relation was found between vulnerability related chronic pain and living with pain (P<0.01, b=-0.18).Conclusions: In order to use CCPMM in the elderly for effective chronic pain management, how to live with chronic pain should be considered first. Then, causes and patterns of pain which represent themselves under the concept of feeling pain should be investigated. Next, vulnerability to chronic pain should be identified and controlled which seems to be a barrier in pain management.

Aims and background: The purpose of this study was to compare the consciousness level based on time of tracheostomy in patients with traumatic brain injury (TBI).Materials and Methods: 71 TBI patients who had Glasgow Coma Scale (GCS) lower or equal to 8 onadmission were studied. All patients received percutaneous dilational tracheostomy (PDT). They were placed in two groups of early (first week) or late (after the first week) tracheostomy. Consciousness level of patients was measured according to GCS on admission and six times until the 15th day. The data for analysis was entered into SPSS software version 16.Findings: Comparing the level of consciousness in both groups showed that the average level of consciousness in patients on days 6, 9, 12 and 15 after tracheostomy was higher in early than in late tracheostomy groups. The observed differences in measuring times was not statistically significant (p>0.05). The level of consciousness of patients in each group significantly increased over time (p<0.05).Conclusion: Although no statistically significant difference was observed regarding the level of consciousness between early and late tracheostomy groups, the level of consciousness in early tracheostomy was higher than that of late tracheotomy patients. This can be considered clinically significant in caring for TBI patients.

Aims and Background: Visceral pain is an unpleasant feeling. Besides there are same serious side effects associated with using synthetic drugs for its treatment, such as psychological dependence, gastric ulcer and blood dyscrasia. In order to decrease these side effects administration of herbal medicine can be an appropriate approach. The aim of this study was to evaluate the palliative effect of Commiphora mukul hydro alcoholic extract on visceral pain.Materials and Methods: This experimental study was done on 40 NMRI male mice. (36±4g). The mice were divided randomly into negative control group, positive control group (Ketoprofen), treatment 1, treatment 2, and treatment 3 groups. The control group and positive group received normal saline and Ketoprofen (25mg/ kg), respectively. The treatment groups received 100, 200, 300 mg/kg of Commiphora mukul intraperitoneally, respectively. Acetic acid 0.6% (10mg/kg) was injected for visceral pain induction 15minute after each treatment.After 30 minutes the analgesic effect was recorded by counting the number of Writhing test. Data was analyzed by SPSS statistical software including One-Way ANOVA and Tukey test with the significant level of P<0.05.Findings: Hydro alcoholic extracts of Commiphora mukul at 100, 200 and 300 mg/kg doses induced a significant reduction in pain response when compared to negative control group (p<0.05), also there was not any significant difference between treatments groups and positive control group (p>0.05).Conclusion: This study confirmed the palliative properties of Commiphora mukul on visceral pain but further clinical studies are necessary to find out a suitable place for it among the other visceral analgesics.

Aims and Background: Maigne’s or thoracolumbar syndrome is an almost common disease with simple diagnosis based on symptoms and corrects physical examination; besides there are very effective therapeutic methods available for this syndrome. However as there is no special radiologic sign and para-clinic data isnormal in these patients, the diagnosis is usually challenging. Sometimes the patient’s symptoms are very severedespite normal radiography and EMG-NCV findings; therefore early treatment prevents later complications.Case report: A 47 year-old woman complaining of low Back pain, buttock pain, and anterolateral leg painfrom a year ago was referred to pain clinic. After Maigne syndrome was diagnosed, Dorsal and Lateral rami block of 11th and 12th thoracic nerves was performed for her and she had pain relief.Conclusion: Maigne’s syndrome is among illnesses which does not have any specific radiologic or labarotorysign despite specific pain symptoms in the areas mentioned, so pain physicians may become confused encountering such patients.