فصلنامه بیهوشی و درد
سال ششم شماره 3 (پاییز 1394)

Aim and This study aimed to determine the efficacy of femoral nerve block in adductor canal and comparison it with the classical method of femoral nerve block in terms of pain relief after elective surgery of the knee. In this study clinical trial study، 92 patients who were candidate for knee arthroscopy in Rasool Akram hospital during 2014- 2015 were evaluated. All patients were blocked after surgery using femoral nerve block or adductor canal block. 1 g Apotel was infused in each group and in the case of no betterment، additional NSAID was administrated. Severity of pain and sedation was measured. Satisfaction level was also evaluated. Data then were entered to SPSS v. 16and were analyzed. We found significant difference between two groups from the point of pain in 3، 6 and 24 hour after the block. The highest VAS score was seen in recovery time in both groups، while pain score was 5 in 50% of patients of each group and 5- 6 in 25- 75% of patients. Sedation was statistically different between the two groups just immediately after the block. Satisfaction in femoral group patients was significantly higher than adductor canal group. Adductor canal group significantly received more additional NSAIDS compared to the femoral group. This study showed that patients with femoral nerve block received lower additive analgesic and had more satisfaction، so this method can be used as an effective treatment for elective surgery knee.

Aim and Spinal anesthesia is a very common anesthetic technique in cesarean section. It is usually applied through the median or paramedian approach among which the median approach is more common. The purpose of this study was to compare the median with paramedian approaches in elective cesarean section operations. Methods and Materials: This double -blind randomized clinical trial was performed on 150 patients between 15 to 45 years old. Patients were randomly assigned to receive either median or paramedian approach for spinal anesthesia. Vital signs were recorded before and after the procedure. The incidence of bradycardia and hypotension، nausea and vomiting، amount of ephedrine and atropine usage، post- dural puncture headache (PDPH)، and duration of recovery were collected and analyzed. The two groups were similar regarding age، weight and BMI. The other variables of the two groups were not significantly different (P>0. 05). Although a higher sensory block level was attained in the paramedian group compared with the median group (P=0. 007)، unexpectedly the incidence of nausea and vomiting was higher in the median group (P=0. 002) for which the difference was significant. The two groups were similar regarding many different variables، however due to a lower incidence of nausea and vomiting، and a higher block level; the paramedian approach may be a favorable choice for neuraxial block in cesarean section operations especially in the cases with difficult spinal anatomy.

Aim and Today the effect of Electroconvulsive therapy (ECT) in cure of Major depressive disease (MDD)، and psychiatric patients is well accepted and usage of this method is developed every day. In this regard، selecting the most effective hypnotic drugs in ECT and their therapeutic and hemodynamic effects seem very important and critical. In this study we selected 26 patients (gender was not important) with MDD who were candidate for ECT therapy with ASA<3. 13 patients received induction with ketamine and succinylcholine in first session and for second session received thiopental and succinylcholine; the second group of 13 patients unlike the first group، received thiopental and succinylcholine in first session and in second they received ketamine and succinylcholine. In all patients we measured blood pressure، heart rate، and O2 saturation before induction، immediately after induction، 1st minute، 2nd minute، 4th minute، 10th minute post-induction، and after the patients were awake. Also we measured seizure and recovery duration and any possible complication. Considering heart rate، systolic blood pressure، diastolic blood pressure، O2 saturation and recovery time we found no significant differences nor between the groups and neither in whole patients. However regarding seizure duration، we found significant difference between two groups and in all 26 patients. It was totally shown that seizure duration was longer with ketamine than thiopental. About complications we found only significant differences in myalgia which was seen in 12 cases of thiopental but 1 case of ketamine induction. Our findings show that ketamine prolongs seizure duration and it leads to no significant difference in hemodynamic parameters and less complications in comparison with thiopental. So it seems that ketamine is a better choice for anesthesia in ECT than thiopental.

Aim and There is little doubt that patients with low back pain (LBP) use their body differently in comparison with healthy individuals. The purpose of this review was to investigate changes in biomechanical perspective which may be present in athletes with LBP. Methods and Materials: TThe search strategy for this review consisted of an electronic database search of full text in PUBMED database. From 461 records that were initially identified through the PUBMED database، 28 studies met the eligibility criteria، most of which were cross-sectional in nature. The studies demonstrate that athletes with LBP exhibit a range of biomechanical perspective changes in the trunk، lumbar spine، pelvis and lower extremities. However، inconsistencies were apparent between the results. Athletes with LBP demonstrate some biomechanical perspective changes during sport specific and non-sport specific functions. More studies، especially large prospective studies which control for non-mechanical factors are required to determine the relationship between LBP and biomechanical perspective changes in athletes.

Aims and The purpose of this study was to investigate the short-term effects of massage، stability and combination exercise on dynamic stability in patients with chronic non-specific low back pain during the sitting to standing task. In this study، 30 patients with chronic low back pain with an average age of 33. 44±9. 02 years participated. Patients were randomly divided into three groups of ten: massage، stability and combination exercises. Patients received protocols of massage، stability، and combination exercises for 12 sessions (4 weeks، on every other day) under supervision of therapists. The results of this study showed that after stabilization and combination exercises، there was significant difference between pre and post test in Rising Index and COG Sway Velocity variables. The results showed that combination of massage with stability exercise is more effective than using either one alone.

Aims and Pain is an inevitable part of the childbirth process. Nowadays non-pharmacological methods such as acupuncture are considered for labor pain relief، due to their lower side effects. So this study was conducted to evaluate the effect of Auriculotherapy on pain intensity during the active phase of labor. This was a clinical trial on 80 nulliparous-women who were admitted to Sina Hospital. 40 women were assigned to the Auriculotherapy group and 40 women were assigned to the control group. The technique of Auriculotherapy was applied by the researcher at dilatations of 4، 6 and 8 cm in the intervention group. Pain intensity was measured by Visual Analogue Scale in two groups. Data analysis was done by descriptive statistics، independent t-test، Mann-Whitney and Chi-square test، using the SPSS version 21. The results showed that mean pain intensity at different stages of dilatation was significantly decreased in the group receiving Auriculotherapy compared with the control group (P<0/05). The results of this study showed that Auriculotherapy is a simple، safe and cost-effective method to reduce pain in the active phase of labor. Using this method is recommended in low-risk and physiologic deliveries.

Aims and the aim of this investigate was to compare two aquatic exercise therapy protocol on pain and disability in the middle – aged men with chronic low back pain. in this semi – experimental study، 36 middle-aged men who suffer from chronic back herniated disc are chosen and divided into 3 equal groups: experimental group1 (walking in water; n=12)، experimental group2 (laying backward on the water; n=12) and control group (n=12). Experimental groups did the aquatic exercise therapy program that included of 24 sessions in 6 weeks and 4 sessions per week for 45-60 minutes. The mean score of pain and disability of these individuals respectively registered by VAS index and questionnaire of “oswestry disability” before and after the intervention were measured. Data were analyzed by paired- samples t-test and one-way analysis of variance at a significant level of P<0. 05. The results showed after 6 weeks of aquatic exercise therapy the amount of pain and disability significantly changed in both experimental groups (P<0. 001). The results of this investigate showed aquatic exercise therapy by patients who suffer from chronic sciatic low back pain، could decrease pain and disability in them and we could prescribe this protocol as a useful method for these patients.

Aims and Opiate addiction، is one of the most prominent health problem in diverse communities which may lead to anxiety during treatment and relapse. This study investigates the efficacy of transcranial direct current stimulation (TDCS) on anxiety during treatment of opiate addiction via the ultra rapid opioid detoxification approach (UROD). Methods and materials: It is a randomized، double blind controlled survey which was conducted on forty scheduled subjects for UROD. TDCS was applied at 24 hour intervals for two sessions by the researcher. The anxiety scores were recorded before the intervention، immediately before UROD، and 24 hours afterwards using Beck questionnaire. Data were analyzed via repeated measure ANOVA using SPSS software. All the participants were male with mean drug abuse duration of 8. 37 ±2. 4 and 7. 37 ± 2. 4 years in intervention and control groups، respectively. According to statistical analysis، anxiety was less in the intervention group and the difference was significant at all time intervals (P-value≤0. 008). We observed about 90% decline for anxiety in intervention group one hour after UROD (p-value≤ 0. 01) while it was about 25%for control group (P-value=0. 163) and it increased in the control group within 24 hours. Generally speaking، TDCS is an effective approach to alleviate anxiety due to pre-anesthesia and withdrawal syndromes during UROD.

Case report: Severe burn injuries are associated with significant pathologic changes in nearly all of organ systems، among them are facial and airway injuries. Thus، one of the important points is airway management in head and facial burn injuries which lead to difficult or impossible tracheal intubation in these patients. In this study we introduce a 37 year-old man، who was burned with electricity and had contracture injuries in his face، hands، and circumorally. He was candidate for reconstructive lid surgery 84 days post-burn. Because of severe restriction in the mouth opening we intubated him Trans nasally with preservation of spontaneous breathing. In circumoral post burn injuries with restriction in mouth opening، it seems reasonable to intubate trachea with preservation of spontaneous breathing and extreme caution when using drugs; especially when flexible fiberoptic bronchoscope is not available. In these situations، nasal tracheal intubation with head and neck movement by Glidescope could be useful as an alternative.