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Anesthesiology and Pain Medicine - Volume:7 Issue: 5, Oct 2017

Anesthesiology and Pain Medicine
Volume:7 Issue: 5, Oct 2017

  • تاریخ انتشار: 1396/08/30
  • تعداد عناوین: 13
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  • Jose M. Soliz*, Ian Lipski, Shannon Hancher-Hodges, Barbra Bryce Speer, Keyuri Popat Page 1
    The subcostal transverse abdominis plane (SCTAP) block is the deposition of local anesthetic in the transverse abdominis plane inferior and parallel to the costal margin. There is a growing consensus that the SCTAP block provides better analgesia for upper abdominal incisions than the traditional transverse abdominis plane block. In addition, when used as part of a four-quadrant transverse abdominis plane block, the SCTAP block may provide adequate analgesia for major abdominal surgery. The purpose of this review is to discuss the SCTAP block, including its indications, technique, local anesthetic solutions, and outcomes.
    Keywords: TAP Block, Subcostal TAP Block, Acute Pain, Four Point, Four Quadrant
  • Vinicius Tieppo Francio *, Robert S. Dima, Chris Towery, Saeid Davani Page 2
    Regenerative injection therapy and low level laser therapy are alternative remedies known for their success in the treatment and symptomatic management of chronic musculoskeletal conditions. In response to the growing demand for alternative therapies in the face of the opioid epidemic, the authors conduct a literature review to investigate the potential for prolotherapy and LLLT to be used adjunctively to manage chronic osteoarthritis (OA). OA is a degenerative chronic musculoskeletal condition on the rise in North America, and is frequently treated with opioid medications. The regenerative action of prolotherapy and pain-modulating effects of LLLT may make these two therapies well-suited to synergistically provide improved outcomes for osteoarthritis patients without the side effects associated with opioid use. A narrative descriptive review through multiple medical databases (Google Scholar, PubMed, and MedLine) is conducted, restricted by the use of medical subject headings. 71 articles were selected for reading in full, and 40 articles were selected for use in the study after reading in full. A review of the literature revealed good clinical results in the use of prolotherapy and LLLT separately to manage chronic musculoskeletal pain due to osteoarthritis and other chronic conditions. It is also recognized in the literature that prolotherapy works most effectively when used adjunctively with other treatments. Downsides to the use of prolotherapy include mild side effects of pain, stiffness and bruising and potential adverse events as a result of injection. This study is limited by the lack of clinical trials available involving both LLLT and prolotherapy injections used adjunctively, and by the low number of high impact literature concerning the treatment of (specifically) osteoarthritis by alternative methods. The authors suggest that practicing health care providers consider utilizing LLLT and prolotherapy together as a supplementary method in the management of chronic pain due to osteoarthritis, to minimize the long-term prescription of opioids and emphasize a less invasive treatment for this debilitating condition.
    Keywords: Laser Therapy, Prolotherapy, Pain Management, Chronic Pain, Osteoarthritis
  • Farnoush Farzi, Ali Mirmansouri *, Bahram Naderi Nabi, Zahra Atrkar Roushan, Samaneh Ghazanfar Tehran, Mona Nematollahi Sani, Soodabe Makhlooghi Azad, Maryam Nemati Page 3
    Background
    Spinal anesthesia is the method of choice for most elective and emergency Cesarean sections. To increase the duration of anesthesia and improve the quality of analgesia during and after surgery, intrathecal opioids, as adjuvant drugs, are used in combination with local anesthetics.
    Methods
    This was a double-blind clinical trial performed on 99 patients. Women were divided into 3 groups of fentanyl, sufentanil, and placebo. For fentanyl group, 12.5 mg of bupivacaine and 25 micrograms of fentanyl; for sufentanil group, 12.5 mg of bupivacaine and 2.5 micrograms of sufentanil; and for placebo group, 12.5 mg of bupivacaine and a half mL of normal saline were injected in subarachnoid space. The sensory and motor block, hemodynamic status (mean blood pressure and heart rate), and probable complications were assessed.
    Results
    There was no significant difference between the groups in demographic characteristics. Durations of analgesia were, respectively, 314 ± 42.95, 312.5 ± 34.44, and 116.1 ± 42.24 minutes in the fentanyl, sufentanil, and placebo groups (P = 0.0001). Duration of sensory and motor block was higher in fentanyl and sufentanil groups compared with the placebo group. The highest duration of sensory and motor block was noted in sufentanil group (P = 0.0001). No significant difference was found between the groups in the hemodynamic parameters (P > 0.05). The frequency of itching in the fentanyl group was higher than sufentanil and placebo groups (P = 0.003). Also, shivering was higher in the placebo group compared with other groups (P = 0.036).
    Conclusions
    According to the results, adding 25 microgram fentanyl or 2.5 microgram sufentanil to intrathecal bupivacaine increased the duration of analgesia and provided hemodynamic stability with no major complication. As administering intrathecal fentanyl had a similar duration of analgesia like sufentanil with faster return of motor block and ambulation, it seems that it is a preferred additive for Cesarean section surgery.
    Keywords: Fentanyl, Sulfentanil, Bupivacaine, Cesarean Sections, Spinal Anesthesia
  • Vali Imantalab, Ali Mirmansouri, Ali Mohammadzadeh Jouryabi *, Bahram Naderi Nabi, Gholamreza Kanani, Nassir Nassiri Sheikhani, Zahra Atrkarroushan, Samaneh Ghazanfar Tehran, Nastaran Samadpour Page 4
    Background
    Postoperative pain is a complex process commonly caused by surgical trauma. It is one of the major concerns of patients undergoing heart surgery. Despite new techniques and modern analgesic treatments, postoperative pain is still one of the most important controversial issues.
    Methods
    68 patients scheduled for elective CABG with CPB were included in a prospective, double-blind clinical trial. They were randomly divided into two groups. One group received PCA pump including morphine (group P) with underlying infusion of 0.02 mg/kg/Qh, bolus dose of 1 mg, lockout time of 15 minutes, and a maximum of 4 bolus of 0.02 mg/kg for one hour and the other group received morphine bolus (group B). Three patients were excluded from the study, and 33 and 32 patients participated in the groups P and B, respectively. Variables including age, gender, pump time, aortic clamp time, duration of surgery, complications (nausea and vomiting, GI Bleeding, and hypoxia), level of pain based on VAS, opioid consumption, hemodynamic, and sedation status were measured in both groups.
    Results
    There was no significant difference between the groups regarding age, gender, pump time, clamp time, duration of surgery, complication, sedation score, and hemodynamic status in most of the assessment periods. By assessing the pain severity in the groups at different periods, results showed a significant difference between the groups except at enrollment, and a lower severity of pain was noted in the group P compared to the group B. The consumed opioid was significantly higher in the group P than in the group B. However, higher doses of diclofenac and paracetamol were administered in the group B compared to the group P.
    Conclusions
    Results showed that higher morphine would be used in patients with PCA pump after extubation following heart surgery, and this increased dose of opioid was associated with better pain control and lack of complication. Therefore, PCA pump with underlying infusion could be effectively used in patients undergoing CABG that are directly assessed in intensive care unite.
    Keywords: Coronary Artery Bypass Graft, Patient Controlled Analgesia, Visual Analogue Scale
  • Masoumeh Albooghobeish, Ahmadreza Mohtadi *, Vahid Saidkhani, Habib Fallah, Kaveh Behaein, Sholeh Nesionpour, Roshan Nikbakht Page 5
    Background
    Gynaecological laparoscopy one ofthe most common operations thatis accompanied by postoperative nausea and vomiting (PONV). A non-pharmacological method of preventing PONV is acupuncture therapy.
    Objectives
    This study is conducted to compare the effects of acupuncture and metoclopramide on post-operative nausea and vomiting (PONV) after gynaecological laparoscopy
    Methods
    In this double-blind, randomized, clinical trial study,122female, ASA I, aged 19 - 46, who had been referred to the Imam Khomini Hospital (Ahvaz, Iran) and were candidates for gynaecological laparoscopy were enrolled. Eligible patients were randomly allocated into three groups group I (acupuncture; n = 40), group II (metoclopramide 0.2 mg/kg IV; n = 41), and group III (control; n = 41). In group I, acupuncture was done by inserting a special needle at point P6 in front of the elbow immediately after induction of anaesthesia and removing it before extubation and transfer of the patient to the recovery room. The occurrences of nausea and vomiting during the period of stay in the recovery room (one and two hours after surgery) were recorded through questions or clinical observation. Statistical analysis was conducted using SPSS V. 19, descriptive statistics, and the Chi-square test.
    Results
    The acupuncture group (11.1%) showed a significant decrease in the incidence of nausea one hour after surgery compared to the metoclopramide group (33.3%) (P = 0.02), but there was no significant difference between the acupuncture and metoclopramide groups in terms of postoperative vomiting (POV) incidence one and two hours after surgery. Incidence of PONV in the acupuncture group (2.7%) was statistically significantly lower than that in the control group (28.5%), two hours after surgery (P
    Conclusions
    Acupuncture is better for controlling nausea after laparoscopic surgery, compared to metoclopramide. Acupuncture is an effective method for reduction of PONV in gynaecological laparoscopy.
    Keywords: Acupuncture, PONV, Nausea, Vomiting, Metoclopramide, Gynaecological, Laparoscopy
  • Mohamadreza Ghodraty, Ali Khatibi *, Faranak Rokhtabnak, Mojtaba Maleki, Fatemeh Parsa Page 6
    Background
    Uncontrolled bleeding during surgery is one of the main predisposing factors for failure of the surgeon and complications following rhinoplasty. The current study aimed at comparing the effects of nitroglycerine and labetalol on the induction of controlled hypotension and bleeding volume during septorhinoplasty.
    Methods
    The current randomized, controlled, clinical trial enrolled 60 patients candidate for septorhinoplasty at Firoozgar hospital in Tehran, Iran, in 2 equal groups receiving either 0.1 to 1 mcg/kg/minute nitroglycerine or 2 to 4 mg/minute labetalol to achieve a mean arterial blood pressure of about 60 to 65 mmHg. In case the targeted blood pressure was not achieved, isoflurane was added. Degree of bleeding was evaluated by the volume of suctioned blood and the blood remaining in surgical gauzes. Additionally, the surgeon's satisfaction with the surgical field was evaluated by a scoring system. The collected data were, then, compared between the study groups by the statistical methods.
    Results
    Based on the current study findings, systolic (P
    Conclusions
    It was concluded that nitroglycerine had a better effect, in comparison to labetalol, on inducing the controlled hypotension in septorhinoplasty.
    Keywords: Bleeding, Controlled Hypotension, Labetalol, Nitroglycerine, Rhinoplasty
  • Vida Dinarvand, Iraj Abdollahi, Seyed Ahmad Raeissadat *, Mohammad Ali Mohseni Bandpei, Marzieh Babaee, Ailin Talimkhani Page 7
    Background
    This study was to evaluate the effect of hamate and scaphoid bone mobilization alongside splinting in women with carpal tunnel syndrome.
    Methods
    In this randomized clinical trial, 40 participants were randomly assigned into 2 groups. The intervention group received splinting with scaphoid and hamate mobilization, while the control group received splinting only. Outcome variables were pain (based on visual analogue scale), symptom severity and functional status (based on Boston questionnaire), and nerve conduction study measured before and 10 weeks after the treatments.
    Results
    At the end of study, both groups showed an improvement in pain and symptom severity, functional status as well as median nerve conduction study. Although there was no statistically significant difference between groups regarding changes in median nerve sensory and motor distal latencies; the improvement was significantly higher in pain and symptom severity as well as functional status in mobilization group (P-Value
    Conclusions
    Hamate and scaphoid mobilization can be used as an effective option in women with mild to moderate carpal tunnel syndrome. Further investigation is required for determining long-term effects and cost-effectiveness of mobilization in carpal tunnel syndrome.
    Keywords: Carpal Tunnel Syndrome, Scaphoid, Hamate, Mobilization, Splint
  • Behrooz Zaman, Siavash Hojjati Ashrafi, Seyedalireza Seyed Siamdoust, Valiollah Hassani, Siavash Mohammad Taheri, Samad Noorizad * Page 8
    Background
    Using peripheral nerve block compared to general anesthesia has gained more popularity due to reduced postoperative pain, less need for post-surgery analgesic drugs, reduced incidence of nausea, shortness of PACU time, and increased patient satisfaction.
    Objectives
    The aim of this study was to compare the effect of ketamine and dexamethasone as additives to lidocaine on duration and onset of axillary block action.
    Methods
    In this clinical trial, all patients who referred to Hazrat-e-Fatemeh hospital for forearm and hand soft tissue surgery with informed consent were randomly divided into three groups in order to examine the onset and duration of axillary block: lidocaine ketamine, lidocaine dexamethasone in axillary block, and lidocaine alone (control). Then, the onset and duration of sensory and motor blocks were measured and recorded every three minutes and after the surgery. Quantitative and qualitative variables were analyzed using ANOVA or Kruskal–Wallis test and Chi-square or Fisher exact test in SPSS v.22.
    Results
    Duration of sensory and motor block axillary was significantly higher in lidocaine dexamethasone group than in lidocaine ketamine group (P 0.05).
    Conclusions
    According to the results of our study, we can conclude that adding dexamethasone or ketamine to lidocaine could improve duration of sensory and motor axillary block in patients undergoing forearm and hand soft tissue surgery. However, dexamethasone had the highest effect on duration of block axillary. We proved that dexamethasone or ketamine added to lidocaine had no effect on the onset of block axillary.
    Keywords: Dexamethasone, Ketamine, Lidocaine, Axillary Block, Sonography
  • Seyed Hossein Hosseini, Mitra Ayyasi, Hooshang Akbari, Mohammad Ali Heidari Gorji * Page 9
    Background
    Traumatic brain injury (TBI) is a common cause of mortality and disability worldwide. Choosing an appropriate diagnostic tool is critical in early stage for appropriate decision about primary diagnosis, medical care and prognosis.
    Objectives
    This study aimed to compare the Glasgow coma scale (GCS), full outline of unresponsiveness (FOUR) and acute physiology and chronic health evaluation (APACHE II) with respect to prediction of the mortality rate of patients with TBI admitted to intensive care unit.
    Patients and
    Methods
    This diagnostic study was conducted on 80 patients with TBI in educational hospitals. The scores of APACHE II, GCS and FOUR were recorded during the first 24 hours of admission of patients. In this study, early mortality means the patient death before 14 days and delayed mortality means the patient death 15 days after admitting to hospital. The collected data were analyzed using descriptive and inductive statistics.
    Results
    The results showed that the mean age of the patients was 33.80 ± 12.60. From a total of 80 patients with TBI, 16 (20%) were females and 64 (80%) males. The mortality rate was 15 (18.7%). The results showed no significant difference among three tools. In prediction of early mortality, the areas under the curve (AUCs) were 0.92 (CI = 0.95. 0.81 - 0.97), 0.90 (CI = 0.95. 0.74 - 0.94), and 0.96 (CI = 0.95. 0.87 - 0.9) for FOUR, APACHE II and GCS, respectively. In delayed mortality, the AUCs were 0.89 (CI = 0.95. 0.81-0.94), 0.94 (CI = 0.95. 0.74 - 0.97) and 0.90 (CI = 0.95. 0.87 - 0.95) for FOUR, APACHE II and GCS, respectively.
    Conclusions
    Considering that GCS is easy to use and the FOUR can diagnose a locking syndrome along same values of subscales. These two subscales are superior to APACHI II in prediction of early mortality. Conversation APACHE II is more punctual in the prediction of delayed mortality.
    Keywords: Traumatic Brain Injury, APPACHE II, FOUR, GCS, ICU
  • Sussan Soltani Mohammadi *, Mohammadreza Piri, Alireza Khajehnasiri Page 10
    Background
    The most important point for performing a neuroaxial block in a sitting position is reducing lumbar lordosis, resulting in easier access to interspinous space and dura mater. There are a few studies comparing 2 different sitting positions including a traditional sitting position (TSP) versus forward bending or hamstring stretch position (HSP) as well as TSP versus squatting position (SP) for reversing the lumbar lordosis and improving access to intervertebral space for neuroaxial block.
    Objectives
    We compared 3 different sitting positions including traditional sitting position vs. hamstring stretch position vs. squatting position and hypothesized that squatting position reverses the lumbar lordosis and reduces the number of spinal needle bone contacts more than TSP and HSP.
    Methods
    A total of Thirty hundred and sixty ASA class I or II patients aged 18 to 60 years were scheduled for elective surgeries under spinal anesthesia were randomized into 3 groups. Our primary endpoint was the number of spinal needle-bone contacts and our secondary endpoint was ease of needle insertion or space identification.
    Results
    Demographic data were statistically different between the study groups. There was no statistical difference between the study groups regarding the number of needle bone contacts and the ease of finding intervertebral space (P = 0.63, P = 0.56, respectively).
    Conclusions
    There was no statistical difference between the TSP, HSP, and SP regarding the number of needle bone contacts and the ease of finding of intervertebral space. In this regard, each of these 3 positions can be used as an alternative sitting position for administration of spinal anesthesia.
    Keywords: Hamstring Stretch Position, Spinal Anesthesia, Spinal Needle, Squatting Position, Traditional Sitting Position
  • Mary Ellen Warner, David P. Martin, Mark A. Warner, Ralitza H. Gavrilova, Juraj Sprung, Toby N. Weingarten* Page 11
    Background
    Angelman syndrome is a rare neurodevelopmental disorder characterized by intellectual disability, severe speech impairment, ataxia, seizures, happy demeanor, distinctive craniofacial features, high vagal tone, and gamma-amino butyric acid receptor abnormalities. The aim of this report is to review our experience of patients with Angelman syndrome undergoing anesthetic management.
    Methods
    We retrospectively reviewed perioperative course of patients with Angelman syndrome who underwent procedures under anesthesia from 2000 to 2016.
    Results
    Six patients with Angelman syndrome underwent 18 procedures; 14 performed under general anesthesia, and 4 with monitored anesthetic care, many for minor procedures (e.g., dental and diagnostic). Five patients had profound developmental delay and were nonverbal and 4 of them had epilepsy. The perioperative courses were uncomplicated except a 2 year-old girl having an intraoperative bronchospasm, a 16 year-old girl requiring flumazenil administration, and 28 year-old man who was electively intubated with a videolaryngoscope because of airway management concerns. No patients were documented as having postoperative pain.
    Conclusions
    Angelman syndrome patients often require anesthesia for relatively innocuous procedures, and their speech impairment and happy demeanor can confound postoperative pain assessment. Patients can have atypical responses to benzodiazepines. Craniofacial abnormalities can complicate airway management. Although not encountered in this series, anesthesiologists need to be aware that Angelman syndrome patients have developed malignant bradydysrhythmias while anesthetized.
    Keywords: Angelman Syndrome, Anesthesia, Perioperative Complications
  • Behnam Hossieni, Payman Dadkhah, Siamak Moradi, Seyed Masoud Hashemi *, Farshad Safdari Page 12
    Background

    The optimal treatment of failed back surgery syndrome (FBSS) is controversial. Limited studies have demonstrated the satisfactory outcomes of percutaneous adhesiolysis in FBSS, which can be performed as a 1 day or 3 days procedure. In the current randomized clinical trial, we compared the clinical and functional outcomes of these 2 techniques.

    Methods

    In this study, 60 patients with FBSS were randomly assigned into 2 equal groups: 1 day group and 3 days group. Before and at 4 and 12 weeks after the procedure, pain intensity was measured using visual analogue scale (VAS). The Oswestry disability index (ODI) was also completed. Pain reduction of 50% or more was defined as treatment success.

    Results

    Significant pain relief and ODI improvement were obtained in the 2 groups with adhesiolysis (P

    Conclusions

    Adhesiolysis is an effective treatment for pain relief and functional improvement in FBSS. The results of 1 day and 3 days procedures are comparable. Based on these findings, the authors recommend using 1 day technique, which can potentially decrease the patient's discomfort, hospital stay, and cost of treatment.

    Keywords: Adhesiolysis, Failed Back Surgery Syndrome, Epidural Scar
  • Amir Poya Zanjani *, Azam Ghorbani, Babak Eslami, Babak Mirzashahi Page 13
    General anesthesia (GA) is associated with serious concerns in advanced cases of Charcot-Marie-Tooth (CMT). Despite several benefits of applying regional anesthesia (RA), recommendation for RA is controversial in CMT due to insufficient supporting documents and trials. We report combined epidural/general anesthesia for a 12-year-old boy with CMT disease undergoing major spine corrective surgery. This manuscript is presented not only to evaluate the costs and benefits of RA, but also to highlight the safety of neuraxial anesthesia and emphasis on the broad potential role of RA to reduce risks of GA in CMT patients.
    Keywords: Combined Anesthesia, Epidural Anesthesia, General Anesthesia, Charcot, Marie, Tooth, Kyphoscoliosis Correction