Background: Perioperative pain management can improve surgery results and patient outcomes. Moreover, multimodal methods for pain control have been advised so this study was conducted to assess the beneficial impact of preoperative ultrasound-guided femoral nerve blocks in hip replacement surgery. Methods: This study is a double-blinded clinical trial including 60 individuals who were candidates for joint replacement surgery. The intervention group (n = 30) received a femoral nerve block prior to general anesthesia. Results: After surgery, patients received morphine, Apotel, and morphine + Apotel, all of which were administered at lower doses in the intervention group (femoral nerve block) than in the control group. Pain intensity in first hour (P= 0.01), 4 hours (P= 0.003), 8 hours (P= 0.01), 12 hours (P= 0.001), and 24 hours (P= 0.01) after surgery and average pain 4 hours (P= 0.01), 8 hours (P = 0.01), 12 hours (P = 0.02), and 24 hours (P= 0.01) after surgery was significantly less in the intervention group (femoral nerve block) than in the control group. Conclusion: The findings of our investigation demonstrated the efficacy of ultrasound-guided femoral nerve blocks in the improvement of pain control following hip replacement surgery.

Postoperative analgesia is one of the important basics of practical recovery after surgery. Pain relief has an important physiological advantage in preventing acute pain turning into a chronic pain and aims at early mobilization with decreasing infection, healing wound time, and hospital stay and /or hospital readmission in addition to eliminating adverse effect related to over sedation. Estimation of postoperative analgesia technique depends on the intensity of dynamic pain and the possible side effects of analgesic medications and techniques which can delay discharge. The key role in improving postoperative pain relates to three steps; 1. Patient education in the decision concerning their specific treatment. 2. Team skills and knowledge for different drugs and technique like acute pain services available towards 24 hours/ day. 3, Physician in communication with the patient is the essential point. Using low dose of opioid drug with NSAIDs or synergistic analgesia or multimodal analgesia at various points along pain pathway to support pain relief with less adverse effect is becoming increasingly common for post-operative pain relief.

Background & Aim: The use of OPIOIDS to control pain during and after surgeries is a current method in anesthesia, but the side effects of these drugs like nausea, vomiting and respiratory depression have made us decrease their use. One proposal is to use NSAIDs in order to decrease the doses of opioid drugs. One of these drugs is paracetamol which can be used INTRAVENOUSly. In this study we administered two different doses of INTRAVENOUS paracetamol to help control pain in patients who had upper limb surgeries. The aim of the present study is to investigate whether INTRAVENOUS paracetamol has a role in decreasing the use of OPIOIDS for pain control during and after surgeries. And if the answer is positive, what dose might be effective.Patients and Method: This is a double-blind study which was carried out on 60 ASA (American Society of Anesthesiology) class I patients between the ages of 20 and 40. The subjects were divided into 3 groups, each of which included 20 patients. Group A received 15mg/kg and group B received 30mg/kg INTRAVENOUS paracetamol before the induction of anesthesia. Group C was the control group. The method of induction and maintenance of anesthesia and pain control during and after surgery was the same in the three groups. The amount of recommended OPIOIDS in the three groups was measured and recorded according to a similar protocol.Results: The obtained results were assessed by Chi-square, ANOVA and Scheffe tests. With regard to the amount of administered fentanyl at the time of surgery, the difference between groups A and C and groups A and B was not significant, but the difference between groups B and C was significant (P=0.01). With regard to the amount of administered pethedin for pain control 6 hours after surgery, the difference between groups A and C and groups A and B was not significant, but the difference between groups B and C was significant (P=0.01).Conclusion: It is recommended that 30mg/kg INTRAVENOUS paracetamol be administered before the induction of anesthesia to decrease the doses of OPIOIDS for pain control during and until 6 hours after upper limb surgeries.

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.