Journal of Anesthesiology and Pain
Year:2012 | Volume:2 | Issue:7|Papers Count:10

Aim and Background: Blood loss reducing approaches improve surgery outcomes through producing an appropriate operation field and reducing transfusion need. In this study two blood loss reducing techniques were compared.Methods and Materials: In a randomized clinical trial study 60 patients candidate for elective femoral shaft operation were devided in two groups. The first group went under induced hypotensionand the second group received tranexamic acid. Anesthesia technique and surgeon were the same in both groups. Bleeding amount was measured based on site operation site and reservoir observing, pads counting. Traputic interventions such as crystalloids or colloids and blood transfusion were done as needed. Results were evaluated by Mann-witney U test.Findings: Dry field and surgeons satisfaction was good in 23 patinets of the hypotention group (76%) and was moderate in the rest of the group. In the tranexamic group the results were good in 21 patients (70%). There was no significant difference in reducing blood loss between the groups.Conclusions: Both of the studied techniques can reduce bleeding and improve operation field and surgeon satisfaction, meanwhile there was no significant difference in two approaches.

Aim and Background: As general anesthesia is not a suitable choice in elderly ASA>II patients candidate for cataract surgery performored by ophthalmology Residents and lack of cooperation in these patients, sedative effect and hemodynamic status and side effects of two drugs, Remifentanil & propofol are compared in this study.Methods and Materials: In a Randomized clinical trial 60 patient candidates for cataract surgery were divided in two groups each containing 30 patients. In group A (remifentanil group), patients were sedated with a bolus dose of 0.5 mg/kg within 1 minute, and maintenance dose of 0.05 mg/kg/min. In group B (propofol group), patients were sedated with a bolus dose of 0.25 mg/kg, and maintenance dose of 25 mg/kg/min. After retro bulbar blockage was performored on all the patients by residents, Hemodynamic responses, including HR, DBP, SBP and O2Sat and sedation level according to MOAA/SS were measured. Modified Observers Assessment of Awareness/Sedation Scale=MOAA/SS.Findings: Sedation was deeper in group A (Remifentanil) were statistically meaningful during the measured times after blockage. The heart rate was reduced in group A 20 minutes after blockage and were statistically meaningful (p<0.05).7 patients in group A (Remifentanil) had nausea after drug administration (P=0.011).Conclusions: Remifentanil can induce high level of sedation for patients compare to propofol.But Nausea could be troublesome and in this point propofol has less adverse effect.

Aim and Background: After cesarean section surgery, routine pharmacologic methods of analgesia, opioids and benzodiazepines may impair the immediate close contact of mother and neonate for their sedative and emetic effects. The aim of this study was to explore the effect of patient-selected music on postoperative pain, anxiety, opioid requirement, and hemodynamic profile.Methods and Materials: A total of 80 patients, American Society of Anesthesiologists (ASA) physical status I-II, scheduled to undergo general anesthesia and elective cesarean section surgery were enrolled. Patients were randomly allocated to receive 30 minutes of music or silence via headphones postoperatively. Pain and anxiety were measured with a visual analogue scale. Total postoperative morphine requirement as well as blood pressure and heart rate were recorded after the intervention period.Findings: Pain score and postoperative cumulative opioid consumption were significantly lower among patients in the music group (p<0.05), while there were no group differences in terms of anxiety score, blood pressure, or heart rate (p>0.05).Conclusions: Postoperative use of patient-selected music in cesarean section surgery would alleviate the pain and reduce the need for other analgesics, thus improving the recovery and early contact of mothers with their children.

Aim and Background: Shivering is a common post anesthesia complication. Intravenous Clonidine administration at induction of anesthesia is a useful drug for decreasing of incidence and severity of post-anesthesia shivering. As Clonidine injection can induce side effects therefore we evaluated the oral Clonidine premedication on post-anesthesia shivering.Methods and Materials: In a RCT, 60 adult patients in ASA class 1 & 2 scheduled for cholecystectomy were assigned to 2 groups.2 hours before anesthesia, 0.2 mg oral Clonidine was administrated and to the other group placebo was administered. Surgery room temperature was adjusted for 21-23oc. At the end of the anesthesia, the patients' shivering was evaluated in the recovery room by "Crossley & Mahajan shivering score".Findings: There was no difference at decrease of SpO2 & H.R. & MAP between 2 groups. There was no difference in average time of emergence between 2 groups. Overall 75% of the patients shivered after anesthesia. Median shivering score in clonidine group was 1.97 and in placebo were 2.87. It became revealed that there was clear difference at shivering score between 2 groups (less severe or generalized shivering patients in test group).Conclusions: 0.2 mg Clonidine tablet, 2 hours before anesthesia is similar to injecting drug and is effective in prevention of post-anesthesia shivering but its complication is less. Lack of difference at hemodynamics & SpO2 & emergence in our study may be due to slow absorption of oral Clonidine.

Aim and Background: Cesarean operation is the most common surgery which its prevalence is growing daily in our country. Despite the technological advances in postoperative pain management, these routines remains inadequate and thus requires complementary therapies and intervention. On account of the inadequate postoperative pain management wound complication ratio, infection, and health care costs have steadily increased. The aim of this study is to determine the efficiency of foot and hand massage on reducing postoperative pain in patient who went under cesarean operation.Methods and Materials: This clinical trial study was carried out on 90 women ongoing elective cesarean operation in the Yahyanejad hospital of Babol. Subjects selected by random allocated method were divided into three groups: a control group, a foot and hand massage group, and foot massage group, each of which included 30 patients. In the evening of the day surgery, the pain intensity and vital findings of the patients were measured 1 to 4 hours after a dose of pain medication, and then massage techniques were applied. Again, the pain intensity and vital findings were measured right after the massage, 60 minutes and 90 minutes after the massage. In the control group, the data's were guttered only.Findings: The statistical analysis of pain intensity were evaluated by NRS and VRS, which showed a significant decrease in both intervention groups. In comparison to the initial measurements, vital findings in both intervention groups were similar found to be higher in the measurements performed right after the massage, which was considered to be statistically significant.Conclusions: Foot and hand massage can be used as an effective nursing initiative in post operative pain management.

Aim and Background: Intravenous regional anesthesia is easy to administer, reliable, and cost effective so it is notable for limb surgery. slow onset, tourniquet pain, and minimal postoperative pain are this methods limitation. This study evaluate the effect of adding nitroglycerine to lidocaine on sensory and motor block onset time, tourniquet pain, first time of analgesic requirement and dose of opiate.Methods and Materials: In a randomized, double blinded, clinical trial thirty patients of 18 to 60 years old ASA class I, II undergoing upper limb surgery were randomly allocated into group A (3 mg/kg lidocaine diluted with saline to total volume of 40ml) and group B (300 mg nitroglycerine added to 3 mg/kg lidocaine diluted with saline to total volume of 40 ml). Sensory and motor block onset time, tourniquet pain, first time of analgesic requirement, dose of opiate, hemodynamic changes and complications have been recorded and assessed.Findings: Sensory block onset time, motor block onset time, tourniquet pain and analgesic requirement were significantly lower in group B than group A. The first time of analgesic requirement was longer in group B than group A. No complication was seen in both groups.Conclusions: Addition of nitroglycerine to lidocaine to intravenous regional anesthesia can hastens the onset time of sensory and motor block and decreases tourniquet pain and opioid.

Aim and Background: Poor controlled postoperative pain not only causes acute and chronic consequences but also increases mortality and morbidity. Local anesthesic drug infiltrations in the incision site is another method of managing the postoperative pain. This study aims to evaluate the effect of bupivacaine wound infiltration in improving postoperative pain managing in abdominal surgeries.Methods and Materials: In a randomized double-blind clinical trial, 50 patients scheduled for abdominal surgery enrolled into two equal groups.20 ml of bupivacaine 0.5% for the study group and an equal volume of normal saline for the control group was infiltrated sub-cutanesly on both sides after closure of incision wound Intensity of pain was assessed by Visual Analogue Scale in recovery room and at 2, 4 hours postoperatively. Whenever VAS was more than 4, meperidine 0.7 mg/kg IV was injected.Findings: VAS scores and opioid consumption between two groups in recovery room and at 2, 4 hours postoperatively were statistically significant. In study group, VAS scores and meperedine consumption were less.Conclusions: Local anesthetic wound infiltration in abdominal surgeries decreases postoperative pain and lowers opioid consumption. As a method of postoperative pain management, infiltration analgesia may be considered in abdominal surgeries along with other modalities of acute pain management.

Aim and Background: Epidural anesthesia is an appropriate technique for managing labour pain, which is a common problem in acute pain management. Intact motor function, less hemodynamic changes and decreased maternal catecholamines are the other pearls in epidural anesthesia. Patient Control Epidural Analgesia (PCEA) is a safe and effective technique with minimal motor block, with more patients’ satisfaction and stability and least drug requirement for analgesia. Epidural analgesia is the most effective technique among routine methods for labour pain control.Methods and Materials: In volunteers with vertex position of single fetus which were in active phase of pregnancy epidural catheter was implicated. After loading the first injection doseage, catheters were attached to the disposable silicone balloon pumps, which delivered maximum of 2ml of solution contained 0.1% marcaine plus 4 microgram per milliliter fentanyl every 15 minutes with patient control button. The patients were monitored for pain severity and vital signs. Subsidiary methods and drugs used for pain were also recorded during the labour.Findings: 45 parturient entered the study. Mean VAS in 96% was less than 4 during all times.23 of the mothers (51%) had the score of 5 to 8 in MEPAS scale and were able to walk either with or without any help just 30 minutes after receiving the loading epidural dose.Conclusions: PCEA is a safe and effective method which showed effective pain reduction in 96% of cases.

Frequent simulation and irritation of NMDA receptors by glutamate mediators can lead to burning pain, allodynia and hyperalgesia, even after stopping the irritant factor. Opioid-induced hyperalgesia and peripheral nerve injuries in lower extremities orthopedic surgeries can also make the same symptoms, which sometimes make it difficult to diagnose it from causalgia (type II complex regional pain syndrome). Post-traumatic neuralgia is not so common, often does not respond well to usual medications and prolongs the patient's stay in hospital. Noting the anatomical and physiological aspects of pain transmission pathways and also role of pain transmission inhibitors via NMDA receptors in pain management, opens us a new window to the role of medicines such as ketamine in prevention and treatment of neuropathic or chronic postoperative pains. We report a case involving refractory neuropathic pain which is eventually controlled with low dose of ketamine.