Background: Preemptive ANALGESIA is based on the idea that ANALGESIA which initiates before a nociceptive even will be more effective than the ANALGESIA commenced afterwards. This clinical trial compared postoperative ANALGESIA and comfort in patients with general anesthesia combined with preoperative or postoperative local anesthesia. Methods: 90 patients who had been scheduled for phacoemulcification in Farabi Eye Hospital, 2002-3, were enrolled in the study. Sixty patients received general anesthesia: 15 received preoperative local anesthesia (GA+LA+OP), 15 received postoperative local anesthesia (GA+OP+LA), and 30 did not get local anesthesia (only GA). Thirty patients only received local anesthesia (LA). Subjective postoperative pain was determined by a visual analogue scale. Frequency of oculocardiac reflex, postoperative nausea and vomiting (PONV), and patient's comfort were assessed. Results: Postoperative pain was less in local anesthesia (LA) compared to general anesthesia (GA) (p < 0.0001). Additional preoperative application of local anesthesia (GA+LA+OP) resulted in less pain than additional postoperative application (GA+OP+LA) (p <0.05). Additional postoperative peribulbar block did not differ from general anesthesia (Only GA). The incidence of intraoperative oculocardiac reflex and postoperative nausea and vomiting was significantly less in patients with peribulbar block (P = .0001) and in GA+LA+OP group, as compared with others (P= 0.001). Conclusion: We conclude that preoperative local anesthesia (Only LA ) or in combination with general anesthesia provides the best comfort for the patient in eye surgery.  

Purpose: Patients may control postoperative pain by self-administration of intravenous opioids using devices designed for this purpose (patient controlled ANALGESIA or PCA). This study set out to determine whether any of the two opioid administrations (i.e. PCA or conventional ANALGESIA) would provide superior pain relief among patients undergoing laparoscopic cholecystectomy or not.Materials and Methods: In a clinical trial the PCA group received self-administered intermittent intravenous morphine via PCA and the conventional group received intravenous Pethidine every 6 hours per day. The patients were assessed on an hourly basis for the first 4 hours after surgery, every 2 hours for the next 8 hours and every 4 hours for next 12 hours. Two methods were used in order to evaluate the degree of pain relief in patients: (1) facial pain scale; pain assessment based on the patient’s appearance and (2) numerical rating scale; based on patient ratings of their pain.Results: Forty eight patients (79.1% female, 20.1% male) with a mean age of 45.7±10.7 years old were enrolled into the study. During the first 24 hours after laparoscopic cholecystectomy, pain intensity based on facial pain scale was lower in the PCA group. However, the difference was significant only in the second hour (mean pain score in PCA group: 2.9, mean pain score in conventional group: 3.7, P=.007). Also, the mean pain scores based on numerical rating scale were significantly lower in PCA group except for the first hour. Although it was not significantly lower than conventional group (mean pain score in PCA group: 4.2, mean pain score in conventional group: 4.6, P=.45).Conclusion: Intravenous PCA resulted in better postoperative pain reduction compared to intermittent bolus opioid delivery in laparoscopic cholecystectomy.

Background: Childbirth pain and the resulting anxiety and fear are among the most challenging issues in women's life. Combined spinal-epidural ANALGESIA (CSE A) is one of the most popular methods of labor pain relief. However, few studies have compared the effect of CSE A on labor with non-pharmacological or no ANALGESIA methods. Objective: The aim of this study was to determine the differences between nulliparous women who received CSE A and nulliparous women who received no ANALGESIA in terms of labor and delivery. Materials and Methods: This observational retrospective study was conducted by surveying patient records related to natural delivery of term nulliparous women between March 20, 2016 and March 19, 2018. Overall, 320 cases were eligible for inclusion in the study. All records of singleton term nulliparous women with ASA I and II who were candidates for low-risk natural delivery were selected, of which 220 cases were related to deliveries without ANALGESIA and 100 cases were related to deliveries with CSE A. Specific variables including duration of stage I of active phase of labor, duration of stage II of active phase of labor, use of assistive devices during delivery, resuscitation of newborns using mask and ambo bag, Apgar score of newborns at 1 and 5 minutes after birth, and use of oxytocin were studied in the two groups. Results: In this study, the demographic characteristics showed acceptable homogeneity of the two groups. In the study of specific variables, it was found that CSE A did not increase the duration of stage I of active phase of labor, while it did slightly prolong the duration of stage II of active phase of labor. CSE ANALGESIA increased the rate of use of assisted labor, while it did not increase the rate of resuscitation of newborns. In addition, CSE ANALGESIA had not decreased the Apgar score of newborns in the first and fifth minutes. It was also found that in the CSE A group, the rate of labor induction by oxytocin infusion was higher. Conclusion: CSE A has no harmful effects on labor or neonate, and despite a slight increase in the duration of stage II of labor and rate of use of assistive devices, it can be chosen as a safe method in labor ANALGESIA if the current scientific principles are followed.

Objectives: This study aimed to compare the analgesic eff ect of single-dose spinal versus epidural ANALGESIA for labor pain to verify if applying a single dose spinal ANALGESIA is an effi cient technique for labor pain management as an alternative for epidural ANALGESIA. Methods: A total of 128 women in the active phase of labor were randomly allocated into two groups of spinal ANALGESIA (n = 64) and epidural ANALGESIA (n = 64). The latter received a bolus dose of 16 mL of 0. 125% bupivacaine and 50  g fentanyl and repeated 5 10 mL of bolus dose. The former received 2. 5 mg hyperbaric bupivacaine plus 50 g fentanyl. Pain intensity was measured using the visual analog scale (VAS). The duration of ANALGESIA, mode of delivery, the duration of labor, side eff ects, and maternal satisfaction were also compared. Results: There were no signifi cant diff erences in the rate of cesarean section, duration of labor, postpartum hemorrhage, and the frequency of the fetal heart deceleration until 30 min after ANALGESIA between the two groups. Measured pain after 30 (P = 0. 0001) and 90 min (P = 0. 01) was signifi cantly lower in the spinal group than the epidural group. However, there was no signifi cant difference between the spinal and epidural groups concerning the VAS scores at 150, 210, and 270 minutes. Maternal satisfaction was higher in the spinal group (P = 0. 002). The mean duration of ANALGESIA was longer in the spinal group than the epidural group (P = 0. 0001). Conclusions: According to the fi ndings, single-dose spinal ANALGESIA, compared to epidural ANALGESIA, is a safe, fast, and effi cient technique for labor ANALGESIA, which can be easily performed. In addition, it provides a high satisfaction level in the parturient.

Background: Prevention and treatment of acute postoperative pain have an important role in improvement of patients conditions. This study aimed to compare between two methods (IVpatient controlled ANALGESIA and Thoracic Epidural ANALGESIA) in terms of ANALGESIA and surgical complications in patients with upper abdominal surgery. Materials and Methods: In this clinical trial study, the subjects were chosen from the patients referred to Besat hospital in Hamadan for upper abdominal surgery. Sample size in each group was 72 patients. Data was collected by a questionnaire that included assessment of pulmonary function, pain levels (in both quantitative and qualitative scales), postoperative complications, analgesic usage, and patient satisfaction. After all data was analyzed by SPSS V: 21. Results: Postoperative pain during the first 24 hours after surgery was higher in epidural group by using quantitative and qualitative methods but in second 24 hours, pain in this group only by qualitative method was more (Which was statistically meaningful). Complications of analgesic techniques were similar in both groups, but nausea in the PCA group and paresthesia in the epidural group was higher. The respiratory parameters measured didn't show significant differences between two methods. Patient satisfaction was greater in the PCA group but there are no differences between groups in satisfaction of nurses. Conclusion: The PCA method is effective as the thoracic epidural ANALGESIA method in reducing post-operative pain, and since this method is simpler and less expensive, it can be used safely for post-operative ANALGESIA. Also, it's better not to use a thoracic epidural method in patients with spinal, neuromuscular and sensory disorders.