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Spinal

در نشریات گروه پزشکی
  • Seyed Babak Mojaver Aghili, Solmaz Halakou*, Fatemeh Talebi, Zahra Mehrbakhsh
    Background

    Spinal anesthesia in orthopedic surgeries presents challenges, especially concerning the choice of anesthetic agents and their adjuncts, which affect analgesia quality and potential side effects. This study was conducted with the aim of determining the effects of intrathecal bupivacaine, meperidine and magnesium sulfate on hemodynamic parameters, onset and duration of sensory/motor block in spinal anesthesia in patients with lower limb fractures.

    Methods

    This double-blind, randomized clinical trial included 130 patients who were candidates for planned lower limb orthopaedic surgery. They were divided into four groups: 1: bupivacaine 10 mg, 2: meperidine (1 mg/kg), 3: bupivacaine 10 mg + magnesium sulfate of 100 mg, and 4: meperidine (1 mg/kg) + magnesium sulfate with (100 mg). Parameters measured included hemodynamic status and sensory and motor block onset and duration. The level of sensory block was assessed via the pinprick sensation method, while the Bromage scale was used to evaluate motor block.

    Results

    No clinically significant differences in hemodynamic parameters were observed across the groups. The onset of sensory block (P value= 0.235), onset of motor block (P value= 0.097), and duration of motor block (P value= 0.135) were statistically similar across the groups. However, significant differences were found in the duration of the sensory block (P value= 0.035). Magnesium sulfate increased the duration of motor block in the meperidine group (80.93 ± 30.28 minutes). However, it reduced the duration in the bupivacaine group (75.23 ± 38.56 minutes) Motor block onset was prolonged in groups receiving magnesium sulfate, with a significant difference between the meperidine and meperidine with magnesium sulfate groups (CI = 1.10 to 12.52, P value = 0.04).

    Conclusion

    The intrathecal drugs used did not produce significant side effects, suggesting that they can be used interchangeably... However, magnesium sulfate, as an adjuvant, did not enhance the length or quality of the block in spinal anesthesia when used with meperidine and bupivacaine.

    Keywords: Spinal, Anesthesia, Magnesium Sulfate, Meperidine, Bupivacaine
  • Seyed Mohammadreza Hadavi, Ashkan Panah *, Sona Shamohammadi, Fatemeh Kanaani Nejad, Mohammadali Sahmeddini, Naeimehos Sadat Asmarian
    Background

    Post-dural puncture headache (PDPH) is the most common complication following spinal anesthesia among parturients undergoing cesarean section surgery. The purpose of this study was to evaluate the effectiveness of acetaminophen and caffeine in preventing PDPH.

    Methods

    This double-blind, randomized clinical trial was conducted on 96 obstetric women, who were candidates for elective cesarean section. Following the randomization of participants into two groups, participants in the intervention group received tablets of acetaminophen (500 mg)+caffeine (65 mg), and participants in the control group received placebo tablets orally 2 hours before spinal anesthesia induction and then every 6 hours after surgery up to 24 hours. All parturients were evaluated for frequency and intensity of PDPH every 6 hours until 24 hours after surgery and then 48 and 72 hours after surgery. Overall satisfaction during the first 72 hours of postpartum was evaluated. The data were analyzed using SPSS software. P<0.05 was considered statistically significant.

    Results

    Participants in the intervention group were 70% less likely to experience PDPH after spinal anesthesia (OR=0.31 P=0.01, 95% CI [0.12-0.77]). They also experienced significantly milder headaches 18 hours, 48 hours, and 72 hours later. Participants in the intervention group reported higher levels of satisfaction at the end of the study (P=0.01). No side effects related to the intervention were reported.

    Conclusion

    Prophylactic administration of acetaminophen+caffeine decreases 70% the risk of PDPH and significantly attenuates pain intensity in obstetric patients who underwent spinal anesthesia for cesarean section.

    Keywords: Acetaminophen, Caffeine, Post-Dural Puncture Headache, Anesthesia, Spinal
  • Fatemeh Rahimi-Sharbaf, Fatemeh Golshahi, Hosseinali Atai, Mahbobeh Shirazi, Behrokh Sahebdel, Maryam Yousefi, Majid Kaheh, Parestesh Makhzani, Akhtar Momen, Elham Feizabad, Maryam Gerayeli
    Background

    Prolonged predelivery time in cesarean-section (C-section) may be associated with worse neonatal outcomes such as lower umbilical cord acid-base profile. This study investigated the association between surgical and anesthetic predelivery time intervals and neonatal acidosis in pregnant women delivering via C-section under spinal anesthesia.

    Methods

    This cross-sectional study was conducted on 70 pregnant women candidates for elective cesarean C-section, referred to Yas Hospital.

    Results

    Umbilical artery pH<7.3 was observed in 27 (38.6%) out of 70 included participants. The study variables including maternal age, hypertension, and gestational diabetes were not associated with umbilical pH level. 1-minute Apgar scores were linearly associated with pH (β: 0.170, 0.100 to 0.239, p-value<0.001). Among all evaluated surgical and anesthetic intervals, induction of spinal anesthesia to delivery (β: -0.008, -0.012 to -0.004, p-value<0.001), and skin incision to uterine incision interval (β: -0.006, -0.009 to -0.002, p-value=0.002) interval time had a significant linear association with PH.

    Conclusion

    The duration of induction of spinal anesthesia to delivery and skin incision to the uterine incision in non-emergent C-sections is linked to lower neonatal umbilical pH which shows the importance of optimizing the timing of elective C-section surgeries and reducing the risk of neonatal acidosis for obstetricians and anesthesiologists.

    Keywords: Cesarean Section, Anesthesia, Spinal, Infant, Newborn, Fatal Outcome
  • Morteza Hashemian *, Mohsen Barouni, Zahra Honarvar, Katayoun Alidousti, Seyed Amir Mohajerani, Leila Rezaeizadeh
    Background

     Spinal anesthesia is considered to be the safest method of anesthesia for cesarean sections in patients with preeclampsia. Patients with preeclampsia are at an increased risk of experiencing severe hypotension following spinal anesthesia, which could have more profound and deleterious effects on both the fetus and the mother. However, bupivacaine, the most commonly used drug, can induce severe hypotension even at low doses. The purpose of this study is to minimize post-spinal hypotension in both the mother and the fetus.

    Objectives

     To determine and compare the reduction in hypotension following spinal anesthesia in patients with preeclampsia between the ropivacaine and bupivacaine groups.

    Methods

     In a randomized clinical trial, a total of 90 parturients with preeclampsia undergoing spinal anesthesia were enrolled and randomly divided into 2 groups: One receiving ropivacaine and the other receiving bupivacaine. The dose of spinal ropivacaine was 15 mg of a 0.5% solution, and the dose of bupivacaine was also 15 mg of a 0.5 % solution. Hemodynamic parameters, including systolic and diastolic blood pressure and heart rate, were recorded following the administration of spinal anesthesia. Pain scores and the time until the return of motor movement were also documented.

    Results

     For statistical analysis, the t-test, Chi-square, and ANOVA tests were utilized to compare the groups. Demographic variables, including maternal age, gestational age, parity, and gravidity, were not significantly different between the 2 groups. The trend of mean systolic blood pressure (SBP) was significantly lower in the bupivacaine group compared to the ropivacaine group at all measured time points in the study (P < 0.05). The amount of ephedrine used after spinal anesthesia was significantly different at 2 and 4 minutes in the ropivacaine group compared to the bupivacaine group (P = 0.012, P = 0.025). Post-operative pain scores at 1 hour in recovery were not significantly different between the ropivacaine and bupivacaine groups (P = 0.015). The time to knee movement was also significantly shorter in the ropivacaine group compared to the bupivacaine group (P < 0.001).

    Conclusions

     Ropivacaine reduces the incidence of hypotension in spinal anesthesia compared to bupivacaine for cesarean section in patients with preeclampsia. This is attributed to a lower occurrence of spinal-induced hypotension, improved hemodynamic control, reduced ephedrine usage, and faster patient ambulation. A future study could focus on investigating different dosages of both drugs with a larger number of participants.

    Keywords: Block, Bupivacaine, Hypotension, Preeclampsia, Ropivacaine, Spinal
  • Behrouz Karkhanei *, Ahmad Moradi, Ali Moradi, Fatemeh Ghasemi
    Background

    Spinal anesthesia is one of the most common and safest methods of anesthesia. However, a challenge for patients who are candidates for spinal anesthesia is the pain caused by inserting the spinal needle. It seems possible to reduce needle pain with local pressure, based on the gate control theory in spinal anesthesia.

    Objectives

    This clinical trial aims to evaluate the effect of applying local pressure on the intensity of pain caused by needles during spinal anesthesia.

    Methods

    In this study, 120 adult patients aged 18 - 50 who were scheduled for elective surgery under spinal anesthesia and had an American Society of Anesthesiologists (ASA) I-III were randomly assigned to the control and intervention groups. In the intervention group, just before inserting the spinal needle, a local pressure of about 5 kg using the thumb was applied to the skin at the needle insertion point for 15 seconds. The control group received routine anesthesia. The severity of needle pain was compared between the two groups using the verbal rating scale (VRS) tool.

    Results

    The incidence of mild pain in the intervention and control groups was 78.7% and 60%, respectively. Also, the control group experienced higher levels of moderate and severe pain compared to the intervention group. In addition, patients in the control group had a higher chance (odds ratio (OR): 3.4, 95% confidence interval (CI): 1.5 - 7.8, P = 0.039) of experiencing moderate to severe pain compared to the intervention group. Pain intensity was significantly lower in patients with a spinal anesthesia history (P = 0.028).

    Conclusions

    Our findings showed that applying local pressure on the skin before inserting a spinal needle can effectively reduce pain during spinal anesthesia. However, further studies with a larger sample size are necessary to confirm the effects of applying local pressure to reduce needle pain during spinal anesthesia.

    Keywords: Needle, Gate Control Theory, Pressure, Pain Management, Anesthesia, Spinal
  • Mohammadtaghi Khodadadi, Fatemeh Pouladkhay, Alireza Talaie, Maryam Taghavi, Mousa Sajjadi *, Reza Mehmandoust
    Background

    Post-dural puncture headache (PDPH) is a common side effect after spinal anesthesia.

    Objectives

    This study aimed to compare the sedative dose of propofol and midazolam in reducing headaches after spinal anesthesia.

    Methods

    In order to conduct this study, 80 candidates for spinal anesthesia were divided into two groups, A and B. Both groups received spinal anesthesia with marcaine. In group A, propofol was infused slowly at a dose of 30 g per minute, and in group B, 1 mg midazolam was injected intravenously. In the two groups, the incidence and intensity of headaches were measured using the VAS pain scale. Data were analyzed using Mann-Whitney and t-tests at a significance level of 0.05.

    Results

    In this study, 65% (52) were male and 35% (28) were female. There was no significant difference between the two groups in terms of demographic information (P > 0.05). In the propofol group, the incidence and severity of headaches were significantly lower than in the midazolam group (P < 0.01).

    Conclusions

    This study’s results indicated that administering low-dose propofol as a sedative during spinal anesthesia may be more effective in reducing PDPH than midazolam.

    Keywords: Midazolam, Propofol, Spinal, Headache, PDPH
  • Amir Sabertanha, Samaneh Kouzegaran, Ramin Honarmand, Sajjad Jahangiri *

    Spinal anesthesia is gaining popularity and more frequent use due to its efficacy, patient satisfaction, lower complication rates, and good durability. Nerve blocks reduce the complications and risks associated with general anesthesia and lessen the patient’s need for postoperative care compared to general anesthesia, leading to earlier patient discharge. One spinal procedure involves administering low doses for anesthesia induction. This review article explored this approach by incorporating studies reporting the administration of lower doses of the local anesthetic bupivacaine. Findings indicate that lower and conventional doses of bupivacaine have comparable sensory and motor block impacts and induction times. However, the recovery time at lower doses is faster, and patients are discharged sooner from the postanaesthetic care unit. Complications associated with spinal anesthesia are significantly decreased at lower doses of bupivacaine administration. Thus, lower doses can be used to induce spinal anesthesia successfully with minimal adverse effects.

    Keywords: Anesthesia, Spinal, local anesthetics administration, local anesthetics dosage, bupivacaine administration, bupivacaine dosage
  • Zeinabsadat Fattahi-Saravi, Vida Naderi-Boldaji, Azadeh Azizollahi, Simin Azemati, Naeimehossadat Asmarian, Mohammad-Bagher Khosravi *
    Background
    Several adjuvants, added to local anesthetics, were suggested to induce an ideal regional block with high-quality analgesia. The purpose of this study was to evaluate the particular blocking properties of low-dose bupivacaine in combination with meperidine and fentanyl in spinal anesthesia during Cesarean sections.
    Methods
    A randomized, double-blind clinical trial was conducted at Hafez Hospital affiliated with Shiraz University of Medical Sciences (Shiraz, Iran) from February 2015 to February 2016. A total of 120 pregnant women, who underwent spinal anesthesia during elective Cesarean section were enrolled in the study. Based on block-wise randomization, the patients were randomly assigned to three groups, namely “B” group received 2 mL bupivacaine 0.5% (10 mg), “BM” group received 8 mg bupivacaine and 10 mg meperidine, and “BF” group received 8 mg bupivacaine and 15 µg fentanyl intrathecally. The block onset, the duration of analgesia, and the time of discharge from the post-anesthesia care unit (PACU) were all assessed. Data were analyzed using SPSS software version 21, and P<0.05 were considered statistically significant.
    Results
    The mean duration of motor blocks in the B group (150 min) were significantly higher than the BM (102 min) and BF (105 min) groups (P<0.0001). In both the BM and BF groups, the duration of sensory and motor blocks was the same. The length of stay in the PACU was significantly longer in the B group (P<0.001) than the BM and BF groups. When meperidine or fentanyl was added to bupivacaine, the duration of the analgesia lengthened (P<0.001). 
    Conclusion
    Intrathecal low-dose spinal anesthesia induced by bupivacaine (8 mg) in combination with meperidine and/or fentanyl for Cesarean section increased maternal hemodynamic stability, while ensuring effective anesthetic conditions, extending effective analgesia, and reducing the length of stay in PACU.Trial Registration Number: IRCT2015013119470N14.
    Keywords: Bupivacaine, Anesthesia, spinal, Local anesthesia, Meperidine, Fentanyl, Cesarean Section
  • Yernar Dauletovich Mamyrov *, Daulet Urazovich Mamyrov, Gulzhanat Ertaevna Jakova, Yoshihiro Noso, Marat Kelisovich Syzdykbayev
    Background

     Unilateral spinal anesthesia is often accompanied by technical difficulties in implementation, multiple puncture attempts, unsuccessful punctures, and, as a result, insufficient anesthesia, along with various complications associated with a dural puncture.

    Objectives

     This work compares the efficacy and safety of conventional Unilateral Spinal Anesthesia (USpA) and unilateral spinal anesthesia with electrical nerve stimulation (USpA+ENS).

    Methods

     A total of 134 patients with an upcoming vascular surgery on one lower extremity were randomly assigned to two groups. All the patients were positioned with the operated limb below and used 7.5 mg of Bupivacaine-Spinal®. In the UsPA group, anesthesia was performed according to the standard technique. In the USpA+ENS group, electrical nerve stimulation was additionally used. Primary outcomes were the presence or absence of post-dural puncture headache (PDPH), number of puncture attempts, lateralization, and anesthesia adequacy. Secondary outcomes were intraoperative pain scores, the presence or absence of nausea and vomiting, and the need for hemodynamics correction.

    Results

     The frequency of puncture complications was sufficiently lower in the USpA+ENS group than in the UsPA group. The local anesthetic solution distribution, pain score indicators, and secondary outcomes were comparable in both groups with a slight difference.

    Conclusions

     We showed that USpA+ENS reduces the incidence of puncture complications and improves the quality of anesthesia and adherence of both patients and anesthesiologists to the unilateral spinal anesthesia technique.

    Keywords: Anesthesia, Spinal, Post-Dural Puncture Headache, Spinal Puncture, Cerebrospinal Fluid, Varicose Veins, Electric Stimulation
  • فاطمه افتخاریان، احمد رستگاریان، رضا اینالو، رضا صحرایی*
    مقدمه

    در بی حسی نخاعی بی دردی پس از عمل و همچنین بی دردی و بی حرکتی حین اعمال جراحی یکی از مسایلی بسیار مهم می باشد که بر نتیجه جراحی و رضایتمندی جراح تاثیر بسزایی دارد. لذا، هدف از انجام این مطالعه مقایسه تاثیر روپیواکایین و بوپیواکایین بر میزان تغییرات همودینامیک در بیماران تحت عمل جراحی نفرولیتوتریپسی با بی حسی اسپاینال، می باشد.

    روش

    این مطالعه از نوع کارآزمایی بالینی تصادفی شده دو سویه کور می باشد. در این مطالعه 93 نفر از بیماران تحت عمل جراحی نفرولیتوتریپسی با کلاس بیهوشی I و II وارد مطالعه شدند. بیماران به صورت تصادفی به دو گروه بوپیواکایین و روپیواکایین تقسیم شدند. ابزار جمع آوری اطلاعات در این مطالعه شامل چک لیست حاوی اطلاعات: سن، جنسیت، فشار خون سیستول، دیاستول، ضربان قلب و میزان درصد اشباع اکسیژن خون شریانی می باشد. تجزیه و تحلیل اطلاعات با استفاده از نرم افزار SPSS نسخه 21 و آمارهای توصیفی و آزمون های آماری استنباطی در سطح معنی داری P<0.05 صورت گرفت.

    یافته‎ ها:

     نتایج مطالعه حاضر نشان داد که گروه های بوپیواکایین و روپیواکایین از لحاظ جنسیت همسان بودند. نتایج آزمون آماری تی تست نشان داد که بین گروه های بوپیواکایین و روپیواکایین از لحاظ فشارخون سیستول و دیاستول، تنگی نفس تفاوت آماری معنی داری وجودنداشت. بین گروه های بوپیواکایین و روپیواکایین از لحاظ ضربان قلب در زمان ده دقیقه تفاوت معنی دار وجودداشت (P=0.038)، ولی در زمان های دیگر بین دو گروه تفاوت معنی دار وجودنداشت. میانگین ضربان قلب در زمان ده دقیقه، در گروه روپیواکایین بالاتر از گروه بوپیواکایین مشاهده شد.

    نتیجه‎ گیری:

     نتایج مطالعه حاضر بیانگر آن بود که بین دو گروه روپیواکایین و بوپیواکایین بر میزان تغییرات همودینامیک در بیماران تحت عمل جراحی نفرولیتوتریپسی با بی حسی اسپاینال تفاوت آماری معنی داری وجودندارد. پیشنهاد می شود مطالعات آتی با حجم نمونه بالاتر و با دوزهای بالاتر انجام شود.

    کلید واژگان: بوپیواکایین، روپیواکایین، نفرولیتوتریپسی، همودینامیک، اسپاینال
    Fatemeh Eftekharian, Ahmad Rastgarian, Reza Inaloo, Reza Sahraei*
    Introduction

    Postoperativeanalgesia and immobility are among the most important issues that significantly impact surgical outcomes and surgeon satisfaction. Therefore, the purpose of this study was to compare the effects of ropivacaine and bupivacaine on the extent of hemodynamic changes in patients undergoing nephrolithotripsy surgery with spinal anesthesia.

    Methods

    This study is a double-blind randomized clinical trial. In total, 93 patients who underwent nephrolithotripsy surgery with anesthesia classes 1 and 2 were included in the study. Patients were randomly divided into two groups: bupivacaine and ropivacaine. The data collection tool in this study included a checklist containing information; Age, gender, systolic, and diastolic blood pressure, heart rate and arterial blood oxygen saturation percentage.

    Results

    The results of the present study showed that the bupivacaine and ropivacaine groups were similar in terms of gender. The results of Ozone's t-test showed that there was no statistically significant difference between the bupivacaine and ropivacaine groups in terms of systolic and diastolic blood pressure, shortness of breath. There was a significant difference between bupivacaine and ropivacaine groups in the heart rate in ten minutes (P=0.038). However, no significant difference was observed between the two groups at other time points. The average heart rate in 10 min was higherin the ropivacaine group than in the bupivacaine group.

    Conclusion

    The results of the present study indicated no statistically significant difference between the ropivacaine and bupivacaine groups regarding the number of hemodynamic changes in patients undergoing nephrolithotripsy surgery with spinal anesthesia. Further studies with higher sample sizes and higher doses.

    Keywords: Bupivacaine, Ropivacaine, Nephrolithotripsy, Hemodynamic, Spinal
  • Poonam Arora, Niyati Arora*

    Spinal anesthesia is traditionally performed using landmark technique to identify the level and point of needle insertion. However use of ultrasonography (USG) has emerged among anaesthesiologists to guide neuraxial blockade. The views that are of utmost importance are “transverse spinous view”, “transverse interspinous view” and “longitudinal parasagittal oblique view”. For in-plane technique and real time imaging longitudinal parasagittal oblique view is used while transverse views are used for visualizing spinous level, epidural and subarachnoid space, posterior complex (PC), anterior complex (AC) and depth of canal. In patients with deformed spine like kyphoscoliosis or morbid obesity obtaining optimum views is not possible. We discuss a morbidly obese patient with very poor ultrasonographic views of spine. We describe a novel technique to estimate depth of spinal canal using only bony shadows in a single transverse view.

    Keywords: Spinal, Anesthesia, Obesity, Ultrasonography, Theorem, Spine
  • Majid Dejbakht, Zohreh Montaseri, Jalal Saem, Mehrdad Rezaei, Marzieh Akbarzadeh*
    Background

    Pain control methods after cesarean section may interfere with infant breast-feeding. The aim of this study was to evaluate the effect of pethidine on breast feeding of infants born via cesarean section with spinal anesthesia.

    Methods

    In this randomized double-blind clinical trial, we evaluated 116 infants born via cesarean section in Gerash Amiralmomenin hospital (Southern Iran) in 2017. The subjects were selected through purposive sampling and randomly by permuted block randomization and assigned to intervention and control groups. The test group received 100 mg of pethidine as intravenous infusion and the control group received only routine cares. Infants’ breast feeding behavior in both groups was recorded within 48 hours of hospitalization, using the standard tool for rapid assessment of infant feeding behavior, which consists of 4 main components of breastfeeding, including readiness to feed, rooting, latching, and sucking with a score range of 0 to 3 for each component evaluated at 1, 6, 12, 24, 36, and 48 hours postnatally. Data were analyzed using independent t tests and chi-square test.

    Results

    The highest score of breast-feeding behavior pertained to sucking reflexes in the control group and the lowest score to breast feeding readiness in the pethidine group. Readiness for feeding in the control group (2.09±0.53) was significantly higher than the pethidine group (1.81±0.61) (95% CI: 0.0552, 0.5092 and P=0.015). Sucking reflex (95% CI: -0.1461, 0.2208 and P=0.687), latching (95% CI: -0.3012, 0.0345 and P=0.118) and rooting reflexes (95% CI: -0.1685, 0.2342 and P=0.747) were almost equal in the control group (2.54±0.49, 2.52±0.38, 2.5±0.48, respectively) and pethidine groups (2.51±0.43, 2.65±0.45, 2.46±0.53, respectively). The total score of feeding behavior in the control group (9.66±1.04) was higher than that of the pethidine group (9.44 ±.69) (95% CI: -0.2032, 0.6412 and P=0.306). There was no significant difference between the infants’ feeding frequency (95% CI: -0.269, 1.930 and P=0.137) and duration of feeding (95% CI: -3.2067, 0.4597 and P=0.14).

    Conclusion

    Evaluation of infants in the first 48 hours after birth showed that those babies whose mothers received pethidine were less willing to start breast-feeding. However, other components of breast-feeding behaviors were similar.

    Keywords: Breast feeding, Behavior, Cesarean section, Pethidine, Spinal
  • بهزاد ناظمرعایا*، مهرداد مسعودی فر، مطهره رجبی مقدم
    زمینه و هدف

    کنترل همودینامیک در عمل های جراحی به ویژه عمل های جراحی ستون فقرات از اهمیت خاصی برخوردار است. یکی از شیوه های پیش گیری از تغییرات همودینامیک حین جراحی استفاده از داروهایی نظیر میدازولام (Midazolam) و دکسمدتومیدین (Dexmedetomidine) است. اثر این داروها در بیهوشی اسپاینال بیماران در مطالعات مختلف به اثبات رسیده است اما میزان اثر این دو دارو بر روی همودینامیک، مقدار خونریزی، رضایتمندی جراح و بیمار تاکنون مطالعه نشده است.

    روش بررسی

    مطالعه حاضر یک پژوهش کارآزمایی بالینی دوسوکور است که پس از تصویب آن در کمیته اخلاق دانشگاه علوم پزشکی اصفهان، در مرکز بین المللی ثبت کارآزمایی های بالینی ایران ثبت گردید. این مطالعه از اردیبهشت 1398 تا شهریور سال1398 در بیمارستان الزهرا (س) انجام شد. از بین بیماران کاندید عمل جراحی لامینکتومی تحت بیهوشی اسپاینال، 105 نفر به صورت تصادفی انتخاب شدند و به سه گروه میدازولام، دکسمدتومیدین و کنترل تقسیم شدند.

    یافته ها: 

    آزمون Analysis of Variance با تکرار مشاهدات نشان داد که هم اثر زمان (001/0>P) و هم اثر گروه (001/0>P) برای فشارخون سیتول، دیاستول و متوسط شریانی در سه گروه معنادار بود، اما اثر گروه (12/0=P) بر تعداد ضربان قلب و Spo2 معنادار نبود و همچنین با مقایسه میانگین مقدار خونریزی و مدت زمان اقامت در ریکاوری مشخص گردید بین سه گروه مورد مطالعه اختلاف معناداری وجود داشت.

    نتیجه گیری:

     حین عمل فراوانی عوارض در گروه دکسمدتومیدین کمتر از گروه میدازولام بود و فراوانی عوارض در ریکاوری ریکاوری نیز در گروه دکسمدتومیدین کمتر از گروه میدازولام بود.

    کلید واژگان: دکسمدتومیدین، لامینکتومی، میدازولام، اسپاینال
    Behzad Nazemroaya*, Mehrdad Masoudifar, Motahare Rajabi Moghadam
    Background

    One of the most empirical subjects particularly in substantial operations for example in surgeries involving the vertebral column, are the implication of sedatives in a manner which would create the least complications such as changes in the hemodynamic parameters. Two such drugs that are widely used in this capacity in clinical settings are midazolam and dexmedetomidine. Hemodynamic stability is particularly important in surgical operations, especially during spinal surgery. One of the ways to prevent hemodynamic changes during surgery is the use of drugs such as midazolam and dexmedetomidine.

    Methods

    This double-blind randomized clinical trial recruited 105 patients undergoing laminectomy spinal surgery under spinal anesthesia at Al-Zahra Hospital, Isfahan between 21 April 2019 till 1 September 2019. Patients were randomly divided into 3 groups: First was the midazolam group, second the dexmedetomidine group and the third was the control group. Data were presented as mean±standard deviation and percentages. In order for the evaluation of differences to be performed between all groups, an evaluation using the one-way analysis of variance was utilized. Statistical analysis was done by means of the SPSS software version 23 (IBM Corporation, Armonk, New York, USA). The P-value which was accepted as significant was P less than 0.05. (P<0.05)

    Results

    There differences in age and gender were not statistically significant among the studied groups (p>0.05). Results from the ANOVA test showed that the effects when taking into consideration time (P<0.001) and group (P<0.001) were statistically significant on Mean of Arterial Pressure, Systole Blood Pressure and Diastole Blood Pressure. However, Heart Rate and oxygen saturation (SPO2) were not significantly different inter-group as well as intra-group over time (before, during, and after the operation) (P=0.12).  Furthermore, the mean of the hemorrhage amount and duration of recovery stay had significant differences over time between all three groups (P<0.05).

    Conclusion

    The incidence of complications during surgery in the dexmedetomidine group was less than the midazolam group. Additionally, the frequency of complications in the subjects given midazolam was higher than the dexmedetomidine group during recovery.

    Keywords: dexmedetomidine, laminectomy, midazolam, spinal
  • سارا آدرویشی، مریم دستورپور، حمید یزدانی نژاد*، پریسا محمدی، مائده کردنژاد، راضیه رنجبرها، زهرا اخلاقی
    زمینه و هدف

    انتخاب نوع بیهوشی برای سزارین به عواملی همچون علت عمل، درجه اورژانسی بودن عمل و تمایل خود بیمار بستگی دارد. در پی انتخاب هر یک از روش های بیهوشی عمومی و بیحسی نخاعی برای مادر و نوزاد پیامدهایی را به دنبال خواهد. این مطالعه با هدف مقایسه پیامدهای مادری و نوزادی پس از عمل جراحی سزارین با دو روش بیهوشی عمومی و بیحسی نخاعی در بیمارستان  های آموزشی شهر اهواز در سال 1398 انجام شد.

    مواد و روش ها

    این مطالعه تحلیلی در سال 1398 بر روی 110 نفر از زنان باردار 35-20 ساله که جهت ختم حاملگی، کاندید سزارین الکتیو تکراری در بیمارستان های آموزشی شهر اهواز باشند، انجام شد. ابزار پژوهش شامل پرسش نامه ای سه قسمتی مربوط به مشخصات دموگرافیک و اطلاعات قبل از سزارین و اطلاعات بعد از سزارین بود. برای توصیف و تحلیل داده ها از نرم افزار SPSS  نسخه 22 و آزمون های تی زوجی و مستقل و مجذور کای استفاده شد.

    یافته ها

    استفاده از روش بیحسی نخاعی جهت انجام عمل سزارین در مقایسه با بیهوشی عمومی با درد کمتر، مصرف مسکن کمتر، نمره آپگار بالاتر، میانگین هماتوکریت و هموگلوبین بالاتر، عدم گلودرد، رضایت مندی بیشتر  همراه بود. ولی عوارض تهوع، استفراغ و سردرد بعد از عمل در گروه با بیحسی نخاعی بیشتر دیده می شود.

    نتیجه گیری

    لذا با توجه به نتایج مطالعه انجام شده توصیه می شود تا در زایمان به روش سزارین تا جایی که ممکن است از روش بی حسی نخاعی استفاده شود.

    کلید واژگان: سزارین، بیهوشی عمومی، بیحسی نخاعی، نوزادی-مادری
    Sara Adarvishi, Maryam Dastoorpur, Hamid Yazdani Nejad*, Parisa Mohammadi, Maedeh Kurd Nejad, Razieh Ranjbarha, Zahra Akhlaghi
    Aims and background

    The choice of anesthesia for cesarean section depends on factors such as the cause of the operation, the degree of urgency of the operation and the patient’s desire. Following the choice of any of the methods either general anesthesia or spinal anesthesia for mother and baby will have consequences. The aim of this study was to compare maternal and neonatal outcomes after cesarean section with general and spinal anesthesia in teaching hospitals in Ahvaz in 1398.

    Materials & Methods

    This analytical study was performed in 1398 on 110 pregnant women aged 20-35 years who are candidates for repeat elective cesarean section in Ahvaz educational hospitals for termination of pregnancy. The research instruments included a three-part questionnaire related to demographic characteristics and pre-cesarean section information and post-cesarean section information. SPSS software version 22 and paired t-test and independent t-test and chi-square were used to describe and analyze the data.

    Results

    The use of spinal anesthesia for cesarean section was associated with less pain, less analgesia, higher Apgar score, higher hematocrit and hemoglobin, no sore throat, and more satisfaction compared to general anesthesia. But the complications of nausea, vomiting and postoperative headache are more common in the group with spinal anesthesia.

    Conclusion

    Therefore, according to the results of the study, it is recommended to use spinal anesthesia as much as possible in cesarean delivery.

    Keywords: Cesarean section, general, anesthesia, spinal, Fetal-Maternal
  • Farnad Imani, Sarah Lotfi, Javad Aminisaman, Afshar Shahmohamadi, Abbas Ahmadi
    Background

     Recently, one of the problems in developing countries is pregnant women who insist on cesarean section for fear of painful vaginal delivery. There are various methods to reduce labor pain, including medical and non-medical methods. Neuraxial analgesia is classified as one of the best ways to reduce labor pain. Epidural analgesia is a classic and popular procedure to decrease labor pain. Nevertheless, other methods, such as spinal or combined spinal-epidural analgesia, is more effective compared with the epidural.

    Objectives

     In this study, we investigated a single intrathecal versus epidural injection in pregnant women during childbirth.

    Methods

     In our research, after obtaining informed consent, the patients were randomly assigned to two equal groups: epidural and spinal. Each group contained 50 parturient women in advanced labor. In the epidural group, 2.5 mL isobaric bupivacaine 0.5%, sufentanil (0.2 mcg/mL), and 7 mL saline 0.9% were injected by an 18-gauge Tuohy needle (PAJUNK GmbH) at the L4-5 or L5-S1 intervertebral space, and in the spinal group, 0.5 mL isobaric bupivacaine 0.5%, 2.5 mcg sufentanil, and 0.5 mL saline 0/9% were injected by a 25-gauge pencil-point Quincke needle (Dr. Japan Co, Ltd) at the L4-5 or L5-S1 intervertebral spaces. For pain intensity, the visual analog scale (VAS) was used at serial intervals, and other variables, such as the onset and duration of analgesia, hypotension, neonatal APGAR score, fetal heart rate (FHR) changes, and other variables were examined.

    Results

     The mean time to onset analgesic effect was 4.6 min in the spinal group compared with 12.5 minutes in the epidural (P < 0.001). Duration of analgesia was 121 minutes in the spinal group compared with 104 min in the epidural group (P < 0.001). The time to reach the maximum block was 8.4 min in the spinal group vs. 22.2 min in the epidural group (P < 0.001). The duration of the second and third gestation stages was the same in both groups.

    Conclusions

     Spinal analgesia is short and easy to perform and does not require advanced equipment and technical experience. Spinal analgesia can be a good option for labor analgesia and leads to achieving a lower pain score than epidural analgesia.

    Keywords: Visual Analog Scale, Spinal, Epidural Analgesia, Maximum Block Time, Labor Analgesia
  • Maryam Vosoughian, Shideh Dabir*, Mastaneh Dahi, Mohammadreza Moshari, Soudeh Tabashi, Firoozeh Madadi

    Spinal muscular atrophy is a rare genetic neuromuscular disease characterized by loss of anterior horn cells of spinal cord and brain stem nuclei, resulting in progressive muscle weakness. Anesthesia for these patients is risky because of the risk of worsening of muscle weakness and consequent postoperative respiratory complications. We report anesthesia management in a nulliparous parturient with type 3 disease who underwent urgent cesarean delivery due to progressive decline of amniotic fluid index.

    Keywords: Spinal muscular atrophy, Pregnancy, Anesthesia, Spinal
  • محمد فتحی، نیلوفر مسعودی*، علی دباغ

    مقدمه یکی از مهم ترین چالش های متخصص بیهوشی قبل از انجام پروسیجر های دردناک مثل اسپاینال آنستزی که با آن روبرو می باشد اضطراب و ترس بیماران به علت درد ناشی از ورود سوزن به پوست و در نتیجه عدم همکاری بیمار می باشد. این مطالعه با هدف بررسی تاثیر اسپری لیدوکایین 10 درصد بر روی رضایتمندی بیمار در بیهوشی اسپاینال انجام شد.

    مواد و روش ها

    در این کار آزمایی بالینی دوسو کور بیماران برای بی حسی نخاعی به بخش جراحی عمومی ارجاع شدند. بیماران به طور تصادفی به دو گروه تقسیم شدند. بیماران گروه اول (گروه لیدوکایین) به عنوان بی حسی لیدوکایین 10 درصد دریافت کردند و بیماران گروه دوم حجم مساوی از نرمال سالین دریافت کردند. سپس بر اساس مقیاس VAS (Visual Analogue Scale)  از بیماران در مورد میزان درد حین ورود سوزن به درم سوال شد و میزان رضایتمندی بیمار مشخص شد.

    یافته ها

    داده ها کاهش معنی داری را بین درد و بهبود ترس در بیمارانی که به صورت موضعی لیدوکایین دریافت کردند را نشان داد.

    نتیجه گیری

    رابطه معنی داری بین بی دردی، رضایتمندی، عدم همکاری و اضطراب در زمان ورود سوزن وجود داشت.

    کلید واژگان: بیماران، بی حسی نخاعی، رضایتمندی شخصی
    Mohammad Fathi, Nilofar Massoudi*, Ali Dabbagh
    Introduction

    One of the most important challenges facing the anesthesiologist before performing painful procedures, such as spinal anesthesia, is the anxiety and fear of patients due to the pain of needle entry into the skin and the consequent lack of cooperation. This study aimed to evaluate the effect of 10% lidocaine spray on patient satisfaction in spinal anesthesia.

    Material and methods

    In this double-blind clinical trial, patients were referred to a general surgery ward for spinal anesthesia. Patients were randomly divided into two groups. Patients in the first group (lidocaine group) received 10% lidocaine as anesthesia and patients in the second group received an equal volume of normal saline. Then, based on the Visual Analogue Scale, patients were asked about the extent of pain during needle insertion into the skin and the degree of patient satisfaction was noted.

    Results

    Our data revealed a significant reduction of pain and improvement of fear in patients who received the local application of lidocaine.

    Conclusion

    There was a significant relationship between analgesia, satisfaction, lack of cooperation, and anxiety at the time of needle insertion.

    Keywords: Patients, Anesthesia, Spinal, Personal Satisfaction
  • Pooya Derakhshan *, Farnad Imani, Seyed Alireza Seyed Siamdoust, Sorour Garousi, Nasrin Nouri
    Background

    Studies have reported lower pain threshold, spinal anesthesia duration, and level of sensoryblock in addicts compared to non-addict patients undergoing spinal anesthesia for surgery. Moreover, bloodgas and cerebrospinal fluid (CSF) were likely to be affected as well. The aim in the present study is to evaluateCSF and spinal parameters in addict versus non-addict patients during lower limb surgery.

    Methods

    In this case-control study, 22 opium addicts and 22 sex- and age- matched non-addicts undergoinglower limb surgery under spinal anesthesia were included. The CSF parameters, venous blood gas (VBG), andsensory and motor block findings were compared between the groups.

    Findings

    The addict and non-addict patients were similar regarding CSF and blood gas parameters excepthigher pH in VBG (7.39 ± 0.06 vs. 7.33 ± 0.11, P = 0.030) and CSF (7.39 ± 0.06 vs. 7.33 ± 0.11, P = 0.030) foraddict patients. The addict patients had significantly later onset of sensory block (5.72 ± 1.57 vs. 3.16 ± 0.93minutes, P < 0.001) and shorter motor block duration (137.72 ± 11.51 vs. 149.09 ± 14.44 minutes, P = 0.006),with no significant difference in the sensory block duration and motor block onset.

    Conclusion

    Addict patients have delayed onset of sensory block with shorter duration of motor block and lowersensory block level. Among the blood gas and CSF markers, only pH was significantly higher in addict patients,needing further evaluations; however, it seems that addiction has no significant effect on these parameters.

    Keywords: Opioid-related disorders, Anesthesia, Spinal, Opium, Bupivacaine, cerebrospinal fluid
  • Molouk Jaafarpour, Ziba Taghizadeh, Elham Shafiei *, Aminolah Vasigh, Kourosh Sayehmiri
    Context

    Spinal anesthesia is the most preferred method for cesarean section. This meta-analysis was performed to determine the effect of minimum and maximum intrathecal doses of meperidine (pethidine) [5 to 40 mg] on the maternal and newborn outcomes after cesarean section. Evidence Acquisition: The data were collected through the systematic search in the ISI, PubMed, Scopus, Google Scholar, Barakat, MagIran, SID, Irandoc, and EMBASE medical databases. Eighteen clinical trial studies with 1,494 patients were included.

    Results

    Patients who had received intrathecal meperidine had experienced lower shivering, relative risk [RR] = 0.34 (95% CI = 0.23, 0.48) and longer analgesia, [standard mean difference (SMD)] = 7.67 (95% CI = 1.85, 13.49) after the surgery. Moreover, RR of nausea = 1.37 (95% CI = 1.13, 1.66), vomiting RR = 2.02 (95% CI = 1.28, 3.20), and pruritus RR = 9.26 (95% CI = 4.17, 20.58) was higher in the pethidine group than in the control group. There was no statistically significant difference in the Apgar score at one-minute RR = 0.99 (95% CI = 0.9, 1.09), at five-minute RR = 0.93 (95% CI = 0.87, 1.08), maternal hypotension RR = 1.00 (95% CI = 0.87, 1.15), and maternal sensory and motor blockade durations, SMD = -1.72 (95% CI = -3.78.0.34) and SMD = -4.38 (95% CI = -9.19, 0.44), respectively in the two pethidine and control groups.

    Conclusions

    Intrathecal meperidine can reduce shivering and increase the duration of postoperative analgesia, though it increases the relative risk of nausea, vomiting, and pruritus. No significant difference was found both in the Apgar score, maternal hypotension, and duration of the motor and sensory block.

    Keywords: Spinal, Cesarean Section, Mothers, Injections, Meperidine
  • محمدرضا صفوی، عظیم هنرمند*، آناهیتا شبانیان، سمیرا اسدی
    مقدمه

    هدف از انجام این مطالعه، مقایسه ی اثرات ضد لرز دزهای 100 و 200 میلی گرم Celecoxib خوراکی در مقایسه با گروه شاهد در جراحی ارتوپدی اندام تحتانی تحت بی حسی نخاعی در بیماران جراحی بود.

    روش ها:

    در این کارآزمایی بالینی دو سو کور تصادفی که در بیمارستان آیت الله کاشانی اصفهان انجام شد، بیماران کاندیدای اعمال جراحی انتخابی ارتوپدی اندام تحتانی، تحت بی حسی نخاعی با درجه ی بیهوشی I بر اساس معیارهای بیهوشی American Society of Anesthesiologists (ASA) مورد مطالعه قرار گرفتند. 3 ساعت قبل از بی حسی نخاعی، گروه شاهد، قرص دارونما دریافت کردند؛ در حالی که گروه دوم 100 میلی گرم و گروه سوم 200 میلی گرم Celecoxib خوراکی دریافت کردند. بروز و شدت لرز در سه گروه، در زمان های 10 دقیقه بعد از بی حسی و هر 15 دقیقه یک بار تا پایان عمل ارزیابی و مقایسه شد.

    یافته ها:

    بین سه گروه در تمام زمان ها (10 دقیقه بعد از بی حسی و هر 15 دقیقه یک بار تا پایان عمل)، تفاوت معنی داری در شدت لرز وجود داشت (050/0 > P)؛ به طوری که بیماران دریافت کننده ی دز 200 میلی گرم Celecoxib، لرز کمتری را تجربه کردند.

    نتیجه گیری:

    دز 200 میلی گرم Celecoxib خوراکی بر لرز حین و بعد از عمل جراحی اندام تحتانی ارتوپدی تحت بی حسی نخاعی بیماران در مقایسه با دز 100 میلی گرم وگروه شاهد، موثرتر بود.

    کلید واژگان: ارز، Celecoxib، جراحی، ارتوپدی، اندام تحتانی، بیحسی نخاعی
    Mohammadreza Safavi, Azim Honarmand*, Anahita Shabanian, Samira Asadi
    Background

    This study aimed to compare the anti-shivering effects of 100 mg and 200 mg oral celecoxib with control group undergoing orthopedic lower extremity surgeries under spinal anesthesia.

    Methods

    In a randomized double-blinded clinical trial study that was conducted at Ayatollah Kashani hospital in Isfahan, Iran, the patients undergoing elective orthopedic surgery of the lower extremity under spinal anesthesia with class 1 stage based on the American Society of Anesthesiologists (ASA) scale, were evaluated. The first group received placebo tablets, the second group received 100 mg oral celecoxib, and the third group received 200 mg oral celecoxib 3 hours prior to spinal anesthesia. Incidence and intensity of shivering was compared 10 minutes after the anesthesia, and every 15 minutes until the end of surgery in all three groups.

    Findings

    A significant difference was observed between the three groups at all periods of time (P < 0.05). The group receiving 200 mg celecoxib experienced the less shivering.

    Conclusion

    A dose of 200 mg oral celecoxib was reported to be more effective on shivering during and after the orthopedic lower extremity surgery in patients under spinal anesthesia as compared to 100 mg oral celecoxib and the control group.

    Keywords: Shivering, Celecoxib, Orthopedics, Surgery, Anesthesia, spinal
نکته
  • نتایج بر اساس تاریخ انتشار مرتب شده‌اند.
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