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

Aim and Background: Inadequate postoperative pain control results in many complications. A feasible and effective modality is warranted. In this study we evaluated the analgesic efficacy of preoperative pregabalin in lower limb orthopedic surgery.Methods and Materials: This double blind clinical trial study was carried out on 60 patients candidate for lower limb orthopedic surgery. Patients were randomly allocated to receive either 150 mg pregabalin capsule or placebo two hours before surgery. Severity of pain, nausea and Ramsay sedation scores were evaluated 2, 6, 12 and 24 hours, postoperatively. Findings: Visual analog pain scores, administered dose of pethidine and nausea scores in the pregabalin group were significantly lower than placebo group. Patients in the pregabalin group were more sedated in the 2nd and 6th hour postoperatively.Conclusions: Preoperative administration of pregabalin can effectively reduce pain and required dose of opioids after lower limb orthopedic surgery.

Aim and Background: Several methods have been applied for reduction of bleeding during the surgery. As vasopressin constricts the vessels and affects the coagulation system, it may reduce bleeding during the operation. The aim of this study was to evaluate the systemic administration of vasopressin on reduction of bleeding during hip arthroplasty.Methods and Materials: In this clinical trial patients scheduled for hip arthroplasty under regional anesthesia, were randomly allocated to two groups, one group received 0.01 unit per minute vasopressin and isotonic saline was administered for the control group, respectively. The patients’ data regarding the amount of blood units transfused and hemoglobin, hematocrit and platelet changes were recruited. After statistical analysis, the effect of vasopressin on reduction of bleeding was evaluated.Findings: The changes in hematocrit and platelet count and transfused blood units were not significantly different between the two groups. After controlling for demographic data and duration of surgery in multiple regression analysis, vasopressin infusion did not change outcome measures.Conclusions: Vasopressin administration has no effect on the reduction of bleeding during hip arthroplasty. The duration of surgery is the onlypredictive factor for the amount of bleeding.

Aim and Background: Opiate and analgesic drug use is common in patients with osteomalacia due to the chronic pain in this group of patients. In this study we determine the frequency of opioid and analgesic consumption in patients with osteomalacia and we would compare them with each other.Methods and Materials: This cross-sectional study has been performed on patients who have been admitted to the Poursina orthopedic clinic during the year 2012 with the confirmed diagnosis of osteomalacia. For all patients a questionnaire containing demographic questions, the used drugs and kind of used drugs was completed.Findings: In this study, 123 patients were studied, 30 (24.4%) patients were male and 93 (75.6%) were female. Eighty eight patients had history of chronic analgesic use of either kind. Of these, “Only NSAID” consumption was reported in 63 (71.5%) patients. Thirteen patients (14.8%) reported the use of either opiate drugs or substances without NSAIDs.Conclusions: High prevalence of opiate use in our patients may be due to the lack of information about the stepwise and safe analgesic use in chronic pain conditions. Providing knowledge about pain control modalities would prevent immature opioid consumption in these patients.

Aim and Background: This clinical trial was conducted to evaluate the effectiveness of adding neostigmine or S-Ketmine to caudal bupivacaine to prolong analgesia.Methods and Materials: 60 pediatric patients scheduled for elective surgery below umbilicus with ASA physical status I or II were enrolled in this double blinded clinical trial. The patients were placed in three different groups based on local anesthetic solution prepared for caudal anesthesia. In the 1st group 1 ml/kg of 0.25% bupivacaine, in the 2nd group 1 ml/kg of 0.25% bupivacaine plus 0.5 mg ketamine and finally in the 3rd group 1 ml/kg of 0.25% bupivacaine with 2 mg/kg neostigmine were used. Postoperative pain was evaluated using Face pain scale in the postoperative recovery unit.Findings: The mean duration of postoperative analgesia was 23 h in Neostigmine group, 14.5 h in keamine group, and 8 h in control patients. Although there were more episodes of nausea and vomiting plus emergence reaction in group 2, no statistical significant difference was observed. Conclusions: Addition of preservative-free S-Ketamine (0.5 mg/kg) or 2mg/kg neostigmine, to caudal bupivacaine provides significant prolongation of analgesia without producing profound negative side-effects.

Aim and Background: Eosinopenia has recently been shown to be a good predictor for mortality in chronic obstructive pulmonary disease exacerbation and sepsis. In this study we examined the usefulness of eosinophil count for predicting inpatient mortality and length of intensive care unit stay.Methods and Materials: The first day eosinophil count and its trend in the timeframe, were compared in 203 medical patients who died in ICU and 203 similar patients who were discharged alive from ICU and hospital. We also recorded the main demographic, clinical and laboratory data of the patients. All the recorded data were analyzed to reach the results.Findings: At ICU admission, the mean eosinophil count remained significantly lower in the dead patients in comparison to the alive ones (42.14±133.13 vs. 128.09±190.27) (p=0.001). The mean eosinophil count in the first CBC from admission to the seventh day was 109.66±194.158 in the alive group and 42.07±139.208 in the dead group. With categorical analysis eosinopenia (eosinophil count£40) was found in 225 patients and 181 patients had eosinophil count>40 (p=0.001). The frequency of eosinopenia was 30.7% vs. 69.3% in the alive and the dead groups, respectively (p=0.001). With repeated measurment analysis, the trend of eosinophil count was raising in the alive group in contrast to the dead group. Conclusions: Blood eosinophil count can be considered as a simple inexpensive marker for severity of disease and mortality in medical patients admitted to ICU.

Aim and Background: Prolonged use of tourniquet for orthopedic surgery patient may cause a severe pain and hyperdynamic responses, which are mainly caused by CNS stimulus. We conducted this study to evaluate the effect of oral gabapentin on tourniquet-induced hemodynamic changes in orthopedic surgery under general anesthesia.Methods and Materials: Thirty six patients candidate for orthopedic surgery on lower limb under general anesthesia with tourniquet inflation were enrolled. Patients were randomly allocated to oral gabapentin 600 mg or placebo groups. We compared hemodynamic changes before and after inflation and defilation in both groups.Findings: After tourniquet inflation, systolic and diastolic pressure in control group gradually raised. Heart rate monitoring did not show significant differences between the two groups.Conclusions: Preoperative oral gabapentin may prevent blood pressure increase in patients under general anesthesia with prolonged tourniquet administration.

Aim and Background: There is a worldwide epidemic of obesity. For anesthesiologists this means that we will be seeing an increasing number of these patients as they come to the operating rooms for a variety of procedures. The purpose of this study is to compare the airway reflexes after propofol or isoflurane anesthesia in overweight patients.Methods and Materials: Fifty patients enrolled in this study and randomly allocated to propofol or isoflurane for maintenance of anesthesia. T1 (the time interval from discontinuation of maintenance anesthesia to face movement) and T2 (the time interval between face movement to extubation) were measured.Findings: The average time to the first reflex in the propofol group was 10.23±3.21 min and in the isoflurane group was 9.96±4.11min (P=0.67). The average time of T2 in the propofol group was 6.72±2.22 min and in the isoflurane group was 10.12±3.22 min (P=0.57). Conclusions: Maitenance of anesthesia with either isoflurane or propofol shows comparable return of airway reflexes in overweight patients under general anesthesia.

Aim and Background: Osteoarthritis is the most common chronic articular disorder. Several pharmacologic therapies including non-steroidal anti-inflammatory drugs (NSAIDs) are used clinically for symptomatic relief in patients with knee osteoarthritis. However, inadequate pain control and also side effects are the most challenges for this type of treatment. The aim of this study is evaluation of intra-articular pulsed radiofrequency (PRF) on knee pain and range of motion (ROM).Methods and Materials: Twenty-four patients with primary knee osteoarthritis were enrolled after local anesthesia, a 22G PRF needle with 100mm length and 10mm active tip was introduced by 45o angulation through upper and lateral wedge of patella into the knee articular space. The location of the target point was confirmed by fluoroscopic guidance. Then, PRF treatment, with 20 msec and 2 Hz, was applied at 42oC for 15 minutes by two cycles. Pain score (VAS), ROM (by Goniometry method), side effects of treatment, satisfaction of patients and demographic variables were recorded before PRF, and 1, 4, and 12 weeks thereafter.Findings: The mean VAS score was 7.08±1.4 before the treatment. After 1 week it was 3.41±2.24, and after 4 weeks it was 4.2±2.26, which showed a significant difference (p<0.0001). VAS, 12 weeks after the procedure was 5.95±2.15, and this difference was not statistically significant (p=0.09). ROM of knee joint did not improve during the study period. No side effects were reported.Conclusions: Intra-articular knee PRF may be considered for reducing knee osteoarthritis pain with short time benefits, but long term benefit may not be yielded. This method may not improve the ROM of involved joint.

Placenta Acreta is one of the two major causes of peri-partum hemorrhage and one of the most common indications of cesarean-induced hysterectomy. In this disease more invasion of the placenta causes considerable risk of hemorrhage. In this case report we introduce a patient with placenta acreta who was brought emergently to the operation room for termination of pregnancy.