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: Although opioids are the main choice for acute POSTOPERATIVE pain control, many side effects have been reported for them. NSAIDs and paracetamol have been used extensively as alternatives, and it seems that they are more effective for minor to moderate pain control POSTOPERATIVEly when have been used alone or in combination with opioids. As laparoscopic cholecystectomy poses moderate pain POSTOPERATIVEly, this study was planned to assess whether paracetamol is able to provide effective ANALGESIA as a sole analgesic at least in the first few hours post operatively.Objectives: We evaluated the effect of intravenous Paracetamol on POSTOPERATIVE pain in patients undergoing laparoscopic cholecystectomy.Patients and Methods: This is a randomized double- blind clinical trial study. 30 patients ASA class I, aged 18 to 50 years, candidate for laparoscopic cholecystectomy were recruited, and randomly divided into two equal groups. Group A (paracetamol group) received 1 gr paracetamol and group B received placebo ten minutes after the induction of anesthesia. 0.1 mg/Kg Morphine was administered intravenously based on patients compliant and pain score>3. Pain score and the opioids consumption were recorded in the first six hours POSTOPERATIVE. Patient's pain was measured by the VAS (Visual Analog Scale).Results: The pain score was lower in group A (P= 0.01), but the morphine consumption showed no significant difference between the groups (P= 0.24) during the first 6 hours POSTOPERATIVEly.Conclusions: Although paracetamol (1gr) has caused a better pain relief quality but it is not a suitable analgesic for moderate pain control in acute phase after surgery alone.

Dear Editor: I read with interest the article by Mogadam et al. (1) in which the authors have compared the analgesic efficacy of gabapentin and diclofenac in patients undergoing tonsillectomy. They concluded that both gabapentin and diclofenac reduced POSTOPERATIVE pain and opioid consumption without side effects. Four additional points deserve commentary and clarification. Gabapentin is being increasingly used as a multimodal perioperative drug because of its ability to produce ANALGESIA, anxiolysis and sedation. Pre-treatment with gabapentin has been shown to allay preoperative anxiety (2).

Background: According to sever pain of laminectomy operation, this double blind clinical trial study was done for accompany POSTOPERATIVE analgrsia with preoperative IV dexamethasone and POSTOPERATIVE epidural dexamethasone in patients.Materials and methods: Two 45 patients groups that candidated for elective laminectomy under general anesthesia, according to double blind clinical trial study were randomly divided into two groups, one group received preoperative IV dexamethasone and second group received POSTOPERATIVE epidural dexamethasone and then data were gathered, analyzed with Chi-square and Mann-Whitney U and T-Student tests by spss software.Results: Two groups were similar with demographic parameres as age, weigh and sex (p>0.05). In the POSTOPERATIVE epidural dexamethasone severity of POSTOPERATIVE pain was lower (p<0.05). The time of free pain period in the POSTOPERATIVE epidural dexamethasone group was longer (p<0.05).Conclusion: Usage of POSTOPERATIVE epidural dexamethasone in laminectomy operation can decrease of severity of pain and cause longer free pain period in patients.

Aim and Background: The aim of this study is comparing ACTH changes in epidural and intravenous ANALGESIA technique after lower limb orthopedic surgery.Methods and Materials: In a randomized clinical trial in Hazrat Rasool Akram Hospital during 1387-88, 60 patients candidate for surgery on the lower extremities were randomly allocated to receive either POSTOPERATIVE ANALGESIA with epidural ANALGESIA (PCEA) or IV ANALGESIA (PCIA). Measurement of ACTH levels and Visual analogue scale (VAS) was performed in four relief phases including at the time of arrival to the operating room, immediately after surgery and 12 hours after intravenous pump functionary and 24 hours after surgery were recorded.Findings: The mean level of ACTH and VAS, 24 hours and 12 hours after surgery in the PCEA group were less than PCIA. Ramsey Sedation Score (RSS) in PCEA group at these intervals was more than PCIA cases.Conclusions: It seems that PCEA relieves pain more effectively than PCIA method. However, the proper method of anesthesia for each patient as well as patients' preferences should be considered in selecting the method of POSTOPERATIVE ANALGESIA.