فصلنامه بیهوشی و درد
سال ششم شماره 4 (زمستان 1394)

Aims and The purpose of this study was to compare ultrasound-guided ilioinguinal/iliohypogastric nerve block and transversus abdominis plane block for postoperative pain control after open inguinal hernia repair. 88 patients undergoing open inguinal hernia surgery in Rasoul e Akram Hospital were randomly assigned into two groups. One group received ultrasound-guided ilioinguinal/iliohypogastric nerve block and the other received transversus abdominis plane (TAP) block. Patients were monitored for visual analogue scale (VAS) scores at rest, in recovery, at 4, 8, 12,and 24h postoperatively, and also during walking at 24, 36 and 48h after surgery. The data was then analyzed using SPSS 22 software VAS pain scores were lower in ilioinguinal group than TAP block group both at rest and during movement. The difference was statistically significant during movement (p=0.017). In addition, analgesic satisfaction was significantly greater in the ilioinguinal group than the TAP block group (Mean score 2.43 vs. 1.84, p=0.001). Postoperative narcotic requirements was not statistically different between the two groups. This study suggests that ultrasound-guided ilioinguinal/iliohypogastric nerve block provided better pain control than transversus abdominis plane block after open inguinal hernia repair.

Aims and Sore throat, cough and hoarseness of voice are common postoperative complications in patients who undergo tracheal intubation for surgical procedures and such complications can be distressing to the patients even more than postoperative pain. The aim of this study was to determine the efficacy of the endotracheal tube cuff lubrication with lubricant jell before intubation on postoperative sore throat and hoarseness. In a prospective, randomized, double blind, controlled clinical trial, eighty ASA class I and II patients undergoing elective surgeries under general orotracheal anesthesia were randomized into two groups: water soluble gel, and control groups. Visual analogue scale (VAS) for sore throat and the incidence of hoarseness in each group at the end of general anesthesia and at 1, 12, and 24 h after operation were evaluated.: Main VAS scores for sore throat 1 h after anesthesia were 3.30± 2.11 cm in the control group and 1.10 ± 1.48cm in the lubricated group.(p=0.0001) VAS scores 12 h after operation were 2.3 ± 2 cm in the control group and 0.55 ± 1.06 cm in the lubricated group.(p=0.001). VAS scores 24 h after operation were 1.05 ± 1.41 cm in the control group and 0.27 ± 0.64 cm in the lubricated group.(p=0.001) However, there was no hoarseness among the groups. Tracheal tube cuff lubrication with a water-soluble gel before anesthesia reduces severity of sore throat.

Aims and Electroconvulsive therapy (ECT) as a method of treatment in severe psychological disorders results in autonomic system stimulation and hemodynamic complications. To relieve these complications especially severe bradycardia and asystole, some authors usually premedicate patients with anticholinergic drugs. The aim of this study was to determine and compare the effects of premedication with hyoscine, atropine and placebo on hemodynamic stability and recovery time in patients treated with electroconvulsive therapy. Sixty patients scheduled for ECT were randomly allocated to 3 equal groups. Anesthesia method was the same among the three groups. Blood pressure and heart rate and any cardiac arrhythmias were recorded before, during and after ECT at predetermined intervals. Complications such as time interval to recovery, salivation volume, and any agitation upon recovery were recorded. These variables were compared between the three groups. Tachycardia was significantly more prevalent in two groups pre-medicated with anticholinergics especially at two intervals in patients receiving hyoscine: after premedication and immediately after the shock(p<0.05).Arterial blood pressure was not significantly different among the groups. Severe bradycardia or asystole were not seen in any groups. Salivary secretions were significantly decreased in both atropine and hyoscine groups compared to placebo (p<0.003). There was no difference between 3 groups in regards to agitation, arrhythmia and recovery time. Premedication with anticholinergics before ECT especially hyoscine butyl bromide potentiates tachycardia and decreases salivation but has no significant effect on agitation and recovery time. So we do not recommend routine anticholinergic administration before ECT to prevent any probable bradycardia or asystole.

Aims and New standards have been developed for pain management in the recent years, and many focused on perioperative pain management to reduce complications during and after the surgery. This study has been designed to determine the impact of ultrasonography on the onset and duration of the analgesia by femoral nerve block after isolated femoral fracture surgery. In this randomized clinical trial 48 patients with femoral fracture candidate for plate fixation surgery were randomly enrolled into two groups of 24(nerve stimulator and ultrasonography combined with nerve stimulator). The results were analyzed with SPSS 16 software. P value <0/05 was considered significant.Finings: The mean onset time of analgesia for nerve stimulator group was 6.375 minutes and for Nerve stimulator with ultrasonography it was 4.333 minutes. Considering the P _ value which was <0.001 for the onset of analgesia, commence of analgesia in ultrasonography group was significantly earlier. The mean duration of analgesia in nerve stimulator group was 299.16 minutes and for ultrasonography with nerve stimulator it was 377.5 minutes (p<0.001) so long-term analgesia was improved with adding ultrasonography to nerve stimulator. Ultrasonography improved femoral nerve block efficacy in different aspects such as successful block, time of onset and duration of analgesia.

Aims and The important goals of nursing are to provide safe care, prevention of injury and health promotion for patients. The patient's safety is disturbed in intensive care unit for various reasons including medication errors. This study aimed to identify medication errors, to report them and finally to provide preventive Strategies from the perspective of nurses in intensive care units. This Descriptive-Correlational study was conducted in 1394.The sampling was census consisting of 235 nurses working in intensive care units of educational hospitals affiliated to Isfahan University of Medical Sciences. Data collection was performed using a five-part questionnaire (Demographic features, nature of medication errors, its Contributing Factors, the Consequence, and errors preventive strategies). Participants were asked to identify factors involved in medication errors, consequence of medication errors and strategies to prevent it. 300 questionnaires were sent to the population study, and 235 questionnaires were returned (78/3%).80% of participants said that they have been experiencing medication errors over the past month. The most causes of medication errors in order were high workload (67/2%), illegible medication orders (56/2%) and preparing the medication without double checking (38/3%). Most medication errors were related to the PICU and ICU. In 47/1%, the error had a minimal adverse effect and in 5/3% error led to prolonging hospitalization of the patient. 28% of participants did not report the error and 58/5% of them said they were frightened of being known as troublemaker, and 27/1% were afraid of blame and criticism from the head nurse due to their fault. Male nurses were more among the reporting nurses.Most reporting was done in the morning shift. Participants mentioned the continuous monitoring of nurses adherence to the "5 Right" rule (87/7%) as the most important preventive strategy. Considering the most common causes of medication errors (high workload and illegible medication orders), the best recommendation for health care centers is to adjust the nurses work environment such as: affording the right ratio of nurses to patients, providing the necessary infrastructure for computerized prescription and establishment of appropriate reporting system in order to prevent and reduce medication errors and improve patient safety.

Aims and Knee OA is the most common joint disease. Hip abductor muscle weaknesses has been reported in people with knee osteoarthritis. The aim of this study was to compare the effect of two therapeutic methods namely hip abductor-quadriceps strengthening and quadriceps strengthening alone in women with knee OA. 34 subjects were randomly assigned to the hip group or to the quadriceps group. The hip group performed hip abductor and quadriceps strengthening exercises, whereas the quadriceps group performed quadriceps strengthening exercises (3 times per week for 8wk). Pain with NRS, knee function with WOMAC, single leg balance test and timed up and go test (TUG) were all assessed before and after intervention. Repeated measure ANOVA, and Paired t-test were used to compare outcome measures between groups over time. The results showed that there were significantly differences between the mean scores of pain, function, balance in both groups and TUG test in hip group before and after training (P<0.05). There was no significant difference in TUG test in quadriceps group (P>0.05). Repeated Measure results indicated that the mean scores of pain, balance and TUG test in hip group were significantly better than quadriceps group (P<0.05) while they were not significantly different in the physical function. Hip abductor- quadriceps strengthening exercises were more effective than quadriceps strengthening alone in reducing pain, improving function, single leg balance and in TUG test in women with knee OA.

Aims and The term of opiate refers to natural and synthetic materials that have morphine-like activity. Opiates have central nervous system depressant and analgesic effects. They can lead to pleasure and euphoric sensations. So subsequent to therapy, the probability of relapse is high. The aim of this study is to determine the effect of transcranial direct current stimulation on the recurrence of drug abuse following ultra rapid opioid detoxification (UROD). It is a randomized, double blind, sham controlled survey which has been conducted for forty scheduled subjects undergoing UROD. Transcranial direct current stimulation was applied at 24 hour intervals for three sessions. The relapse rate was assessed within two weeks, one and three months after detoxification using addiction strip test and psychiatric visit. The acquired data was analyzed via ordinal logistic regression model while selecting group therapy as a predictor variable, with other variables using SPSS software. All the participants were male with mean ages of 25 ±2.11 and 26 ± 1.71 years in intervention and control groups, respectively. Although the intervention was shown to be effective for a short time and the relapse rate within the first two weeks was decreased, no significant difference was shown between the groups finally(P-value=0.931). Considering other important factors influencing the relapse rate, only the marital status was effective (P-value<0.05). The findings showed no long-term effects of transcranial electrical stimulation on the relapse rate following UROD approach.

Aims and Nausea and vomiting after surgery is one of the undesirable complications which occurs in more than %30 of patients. In the meanwhile, Serotonin antagonists have an expanded function in prevention of postoperative nausea and vomiting. The aim of this research was to compare the effectiveness of Ondansetron and Palonosetron(Serotonin antagonist) in this regard. This research has been an organized review with Meta-analysis. Search process has been done in Data bases namely: Clinicaltrials.Gov, CRD Database, Cochrane Systematic Review, Clinical key, and Pub Med just RCT articles, which compared incidence of postoperative nausea and vomiting under general anesthesia, have been chosen. After search and evaluation, 8 articles entered Meta-analysis. Risk estimation integration, and risk ratio calculation were analyzed via STATA 13. Number of samples in articles were 739. The incidence of Postoperative nausea and vomiting was assessed until 24 hours after surgery in 389 persons. Data analysis during 0 to 24 hours showed that Palonosetron decreased the incidence of nausea by %50, and the incidence of vomiting by 79% in comparison with Ondansetron (p= 0.001) Evaluating the effect of 0.075 mg Palonosetron versus 4mg of Ondansetron in primary 24 hours past surgery demonstrated that Palonestron has more efficiency on incidence reduction of Nausea and Vomiting, compared to Ondansetron in patients.

Aims and Cancer pain is a major problem for the health care providers. One of the most important aspects of cancer pain is palliative care management. Recently, different research finding shows the efficacy of opioid analgesics such as fentanyl transdermal patch in chronic pain management.Transdermal Fentanyl patches may cause side effects such as drowsiness, dizziness, itching, life-threatening or serious breathing difficulties and diarrhea, mainly during the first 72 hours of patient’s treatment initiation and any time when the drug’s dose is increased.Casereport: We report three cases of severe diarrhea associated with Fentanyl patches during the first 72 hours of patient’s treatment, however no other common side effect of this drug was observed in these patients.

Aims and Osteogenesis imperfecta is an authosomal dominant disease that almost always involve the connective tissues. The major problem in these patients is inability to synthesize collagen type -1, that leads to multiple long bone fractures. This case report is going to describe management of anesthesia in a patient with Osteogenesis imperfecta, who was scheduled for tibia plate insertion. Following failure of spinal anesthesia, the method was changed to general anesthesia by LMA insertion.Caser eport: A 45 years old man, with 35 kg weight and 132 cm height as a known case of osteogenesis imperfecta, was candidate for tibia plate insertion surgery. He could not walk due to the severity of his disease. The bad anatomy of the mandible and its protrusion that was combined by severe congenital scoliosis, made the supine position impossible, so the patient was candidate for regional and spinal anesthesia, actually. After failure of spinal anesthesia the method was changed to general anesthesia with total intravenous anesthesia(TIVA) and laryngeal mask(LMA) insertion for airway management. Management of anesthesia was good and patient was discharged from hospital healthy, after 3 days.