فهرست مطالب

Anesthesiology and Pain Medicine - Volume:9 Issue: 2, 2019
  • Volume:9 Issue: 2, 2019
  • تاریخ انتشار: 1398/02/15
  • تعداد عناوین: 12
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  • Khatereh Rostami, Farkhondeh Sharif*, Ladan Zarshenas, Abbas Ebadi, Arash Farbood Page 1
    Background
    Chronic back pain is a disease many people suffer from it and they have different problems and needs.
    Objectives
    Due to the vague nature of these needs and lack of information in this regard, the present research was aimed to identify the needs of the patients suffering from chronic back pain.
    Methods
    This qualitative study was conducted using content analysis method. Here, 29 participants entered the study using a purposive sampling; they were interviewed one by one, face to face, and in a semi-structural mode. Gathering the data, transcribing the interviews, and analyzing them were performed simultaneously using Graneheim and Lundman method. First, codification and meaning similarities were revised and the subthemes were identified; then, in the second revision, the related subthemes were put in one category. The data were analyzed using the max Q software version 2007.
    Results
    Analyzing the results led to deriving four main themes and nine categories. The main themes were related to the needs of the patients suffering from chronic back pain, including teaching and informing, religious-spiritual dimension, socio-economic dimension, and physical-psychological dimension.
    Conclusions
    This study provided a comprehensive understanding of the health-related needs of the patients suffering from chronic back pain in Iran. According to the obtained criteria from this study, identifying the needs, planning for them, and evaluating the measures taken for the patients suffering from chronic back pain will become possible.
    Keywords: Health, Back Pain, Iran, Needs
  • Sotiria Vrouva, Chrysanthi Batistaki*, Efterpi Paraskevaidou, Konstantinos Chanopoulos, Dimitrios Kostopoulos, Efthimios Stamoulis, Georgia Kostopanagiotou Page 2
    Background
    Pain induction is the primary characteristic of a rotator cuff tear while muscle weakness appears as a secondary feature, leading to further disability.
    Objectives
    The study aimed to determine the effectiveness of physiotherapeutic interventions through transcutaneous electrical nerve stimulation (TENS) or microcurrent electrical nerve stimulation (MENS) in conjunction with kinesiotherapy in patients with partial thickness rotator cuff tear.
    Methods
    This was a blinded randomized prospective study. The study recruited 42 outpatients with partial rotator cuff tear under conservative treatment selected from the 401 General Military Hospital of Athens and the University General Hospital ‘Attikon’ during 2015 - 2017. Patients were assessed for pain and disability using the SPADI (shoulder pain and disability index), a numerical rating scale (NRS) for pain, and the EuroQoL-5 questionnaire for the evaluation of the quality of life. The first group received TENS and kinesiotherapy while the second group received MENS and kinesiotherapy. Three measurements were recorded. The first assessment was performed during the initial patient visit; the second after completion of the physiotherapeutic sessions, and the third one three months after the initial assessment. A follow-up ultrasound scan was performed three months after the completion of the therapeutic sessions to assess the anatomical healing of the rotator cuff tear.
    Results
    Repeated measurements analysis indicated a significant improvement in pain scores, functionality, and patients’ quality of life (P value < 0.001). Comparison of the two treatment methods did not reveal any significant differences (P value > 0.05) despite the fact that the MENS was associated with a greater improvement in pain intensity and TENS with a greater improvement in functionality and quality of life.
    Conclusions
    Using MENS and TENS appears to be equally effective in terms of pain relief, functional improvement, and quality of life enhancement in patients.
    Keywords: Pain, Disability, Non-pharmacological Treatment, MENS, TENS, Rotator Cuff Tear
  • Eunsu Kang*, Ki Hwa Lee, Jae Hong Park Page 3
    Background
    Over the past few decades, interventional neuroradiology (INR) has been a rapidly growing and evolving area of neurosurgery. Sevoflurane and propofol are both suitable anesthetics for INR procedures. While the depth of anesthesia is widely monitored, few studies have examined the patient state index (PSI) during clinical neuroanesthesia.
    Objectives
    This study aimed to investigate the differences in PSI values and in hemodynamic variables between sevoflurane anesthetic and propofol anesthetic during INR procedures.
    Methods
    We reviewed the medical charts of the patients who underwent embolization of a non-ruptured intracranial aneurysm by a single operator at a single university hospital from May 2013 to December 2014. Sixty-five patients were included and divided into two groups: S group (sevoflurane anesthesia, n = 33) vs. P group (propofol anesthesia, n = 32). The PSI values, hemodynamic variables, and use of hemodynamic drugs between two groups were analyzed.
    Results
    There were significant differences between the PSI values obtained through different perioperative stages in the two groups (P < 0.0001). During the procedure, the PSI values were significantly lower in the P group than in the S group (P = 0.000). The P group patients had a more prolonged extubation time (P = 0.005) and more phenylephrine requirement than the S group patients (P = 0.007). More anti-hypertensive drugs were administered to the patients in the S group during extubation (P = 0.0197).
    Conclusions
    The PSI can be used to detect changes in anesthetics concentration and in the depth of anesthesia during INR procedures. Although the extubation was faster under sevoflurane anesthetic, propofol anesthetic showed rather smoother recovery.
    Keywords: Interventional Neuroradiology, Propofol, Sevoflurane
  • Masoud Tarbiat, Morteza Majidi, Nahid Manouchehrian* Page 4
    Introduction
    Spinal anesthesia is a commonly used anesthetic technique for lower extremity surgery. Despite its widespread use, the acceptable frequency of repeated spinal anesthesia for a patient is unclear. Therefore, herein, we report a patient who frequently received spinal anesthesia.
    Case Presentation
    A 21-year-old man with severe head and leg injury was admitted to the hospital after a motorcycle accident. On admission, he had a tracheal tube and GCS score of six. After emergency vascular and orthopedic surgeries under general anesthesia, he was transported to the ICU. Within 12 days of admission to the ICU, he was extubated with full awareness. After consultation with a neurosurgeon for spinal anesthesia, the patient received seven spinal anesthesia procedures for his lower extremity injury in a period of 15 days. Spinal anesthesia was performed at the L3 - L4 or L4 - L5 interspace with 24 or 25-gauge Quincke needles in the sitting position (12 - 15 mg of 0.5% hyperbaric bupivacaine) by four anesthesiologists. Despite performing several spinal anesthesia procedures, no neurologic sequelae were observed. Finally, he was discharged in a good overall condition. At a four-month follow-up, the patient was in a stable situation without any neurological complications.
    Conclusions
    This report emphasizes that spinal anesthesia with hypertonic bupivacaine could be used several times for a patient in some situation.
    Keywords: Anesthesia, Spinal, Bupivacaine, Lower Extremity
  • Zahra Mirbolook Jalali*, Azadeh Farghadani, Maryam Ejlali Vardoogh Page 5
    Background
    Correcting false cognitions and establishing preventive behaviors in patients with chronic low-back pain can improve self-efficacy and self-discovery of these patients against the physical and psychological consequences of chronic back pain through reinforcing thoughts and constructive behaviors.
    Objectives
    This study aimed to investigate the effectiveness of cognitive-behavioral training in self-efficacy, self-discovery, and pain perception of patients with chronic low-back pain.
    Methods
    Based on a quasi-experimental design, 40 patients with chronic low-back were selected through purposive sampling and assigned into two groups of intervention (n = 20) and control (n = 20). After administering the pain self-efficacy (PSE) scale, the self-discovery scale (SDS), and the pain perception questionnaire (MPQ) to both groups, the intervention group received the cognitive-behavioral training while the control group did not receive the intervention. The post-test was performed on both groups and the data were analyzed using SPSS.
    Results
    The scores of pain self-efficacy and self-discovery (self-awareness and acceptance, commitment and attraction, transcendence and development, and personal growth) were higher in the intervention group than in the control group (P < 0.01). The highest increase with an effect size of 0.514 was related to the self-awareness and acceptance subscale. In addition, the pain assessment perception was the only reduced subscale among the other dimensions of pain perception (P < 0.01).
    Conclusions
    Psychosocial complementary therapies can provide patients suffering from chronic pain with better physical and mental conditions to have a higher quality of life.
    Keywords: Cognitive-Behavioral Training, Pain Perception, Pain Self-Efficacy, Self-Discovery
  • Marcus Komann*, Claudia Weinmann, Matthias Schwenkglenks, Winfried Meissner Page 6
    Background
    Non-pharmacological methods (NPMs) like cold packs, acupuncture, meditation or distractions are supposed to ease acute post-surgical pain.
    Objectives
    This study assessed how frequently these methods are used in clinical routine and if their use is associated with pain relief or with the wish for more pain treatment.
    Methods
    Data from the world’s largest acute post-operative pain registry, PAIN OUT, was used for this study. In PAIN OUT, patients report their pain levels and side effects related to pain therapy after surgery. Overall, 15 different NPMs were tested for their association with pain relief and the wish for more pain treatment using Mann-Whitney U test, Kruskal-Wallis test, General Linear Model, and Logistic Regression. The researchers adjusted for age and gender, and specifically looked at the three most frequent surgeries: total knee replacement, total hip replacement, and laparoscopic cholecystectomy.
    Results
    Data of 14 767 patients from 12 European hospitals were analyzed. Overall, 6563 (44.4%) patients used at least one NPM; with distraction and cold packs being the most frequently used. The 8204 (55.6%) patients, who did not use NPMs had little yet significantly more pain relief than patients, who used them (means of 71.2% ± 27.9% versus 68.6% ± 25.7%, P < 0.001). Using NPMs does not affect the wish for more pain treatment. This is true for every single NPM. The only exceptional sub-group included total knee replacement patients, where a positive effect of NPMs was observed.
    Conclusions
    Some NPMs are widely used while others are rarely applied. Their association with pain relief is doubtful. These findings add to a rather contradictory literature. Advantages and disadvantages of applying NPMs solely for pain relief should thus be considered carefully.
    Keywords: Postoperative Pain, Pain Relief, Wish for More Pain Treatment, Non-Pharmacological Methods, Patient-Reported Outcome Measures
  • Susilo Chandra *, Alfan Mahdi Nugroho, Henry Agus, Astrid Pratidina Susilo Page 7
    Background
    Maternal hypotension in cesarean delivery related to spinal anesthesia results in increasing morbidity of both mothers and children. Studies show that low dose spinal anesthesia was able to prevent hypotension while providing adequate analgesia. However, the dose used in those studies varies and this leaves the debate of the dose scheme of spinal anesthesia open.
    Objectives
    This study aimed to compare the effectiveness of 5 mg hyperbaric bupivacaine 0.5% and 25 mcg of fentanyl with 7.5 mg hyperbaric bupivacaine 0.5% and 25 mcg of fentanyl to prevent hypotension in spinal anesthesia for cesarean delivery.
    Methods
    This study was a double-blinded randomized controlled trial of 112 mothers undergoing cesarean delivery with spinal anesthesia. The intervention group received 5 mg bupivacaine and 25 mcg fentanyl. The comparison group received of 7.5 mg bupivacaine and 25 mcg fentanyl. The primary outcome was the incidence of hypotension. The adequacy of anesthesia, duration of recovery from the motoric block, the quality of analgesia as perceived by patients and surgeons, and the side effects of anesthesia were also recorded.
    Results
    There was no difference of effectiveness to prevent hypotension in both groups. The 7.5 mg dose provided better adequacy of anesthesia as reflected in lower incidence of conversion into general anesthesia. More surgeons reported adequacy of relaxation in the 7.5 mg dose. The 5 mg dose offered faster motoric recovery and fewer side effects.
    Conclusions
    The dose of 7.5 mg hyperbaric bupivacaine 0.5% and 25 mcg of fentanyl can be used as a prevention measure against hypotension due to spinal anesthesia cesarean delivery.
    Keywords: Spinal Anesthesia, Low-Dose Bupivacaine, Cesarean Delivery
  • Rahendra Rahendra *, Pryambodho Pryambodho, Dita Aditianingsih, Raden Besthadi Sukmono, Aida Tantri, Annemarie Chrysantia Melati Page 8
    Background
    An adequate anesthesia technique generates appropriate postoperative analgesic properties and decreases the patient’s stress response. This will lead to decreased morbidity and mortality associated with immunology disturbances, such as infection, prolonged wound healing, and sepsis.
    Objectives
    The aim of this study was to compare interleukin-6 (IL-6) and C-reactive protein (CRP) concentrations, as the markers of the stress response, between continuous epidural and quadratus lumborum (QL) block as postoperative analgesia techniques among living kidney donors.
    Methods
    Sixty-two patients were randomly divided into two equal groups: continuous epidural and QL block. A group received bilateral QL block with 20 mL of bupivacaine 0.25% and the other received 6 mL/hour of bupivacaine 0.25% continuously via an epidural catheter. Prior to extubation, the QL block group received bilateral QL block with the same dose and the continuous epidural group was administered with 6 mL/hour of bupivacaine 0.125%. Blood samples were drawn to compare IL-6 and CRP concentrations after intubation (preoperatively), directly after surgery, 24 hours postoperatively, and 48 hours postoperatively. Postoperative pain was measured with the numerical rating scale (NRS). Morphine requirement and duration of catheter usage were also measured postoperatively. Side effects within 24 hours postoperatively were noted. Data were analyzed with independent t-test or Mann-Whitney test.
    Results
    No difference was observed between the groups in the plasma concentration of IL-6 either after surgery or 24 hours postoperatively (P = 0.785 and P = 0.361, respectively) although the mean IL-6 concentration 24 hours postoperatively was lower in the QL block group than in the continuous epidural group. CRP concentration was not significantly different between the groups either after surgery or 48 hours postoperatively (P = 0.805 and P = 0.636, respectively).
    Conclusions
    There was no significant difference in IL-6 and CRP concentrations between continuous epidural and QL block among living kidney donors. Both continuous epidural and QL block techniques showed comparable postoperative analgesic properties among living kidney donors undergoing laparoscopic nephrectomy.
    Keywords: Quadratus Lumborum Block, C-reactive Protein, Continuous Epidural, Interleukin-6, Laparoscopic Nephrectomy
  • Siamak Rimaz, Ali Ashraf, Shideh Marzban, Mohammad Haghighi, Seyyed Mahdi Zia Ziabari, Gelareh Biazar *, Sheyda Rimaz, Samad Omidi Page 9
    Background
    Myocardial dysfunction is frequently described as an underlying cause of mortality in traumatic brain injury (TBI) known as brain-cardiac link. However the impact on prognosis of a disease remains uncertain.
    Objectives
    The current study aimed at investigating the correlation between TBI and cardiac troponin I (cTnI) rise and in-hospital mortality rate among patients with TBI.
    Methods
    In the current prospective study TBI patients with abbreviated injury scale score (AIS) > 3 and Glasgow coma scale (GCS) score ≤ 8 with cTnI measurement within the first 24 hours of admission were evaluated. Chi-square, Kruskal-Wallis, Mann-Whitney U and Logistic Regression tests were used for data analysis.
    Results
    A total of 166 eligible patients were studied .The mean age of the cases was 37.64 ± 17.21 years, largely under 65 (93.4%) and male (86.7%).The most common injuries were cerebral contusion (35.1%), while motor vehicle crash (MVC) was the most common cause of injuries (83.73%); 59 % of the patients showed detectable cTnI concentrations within 24 hours of admission; 65.7% of the patients expired; they showed higher levels of cTnI compared to survivors that showed lower levels, 0.148 ± 0.074 vs 0.057 ± 0.055, respectively (P < 0.001). Moreover, a significant association was observed between mortality rate and lower admission GCS 3.49 ± 1.08 vs 6.79 ± 1.66, respectively (P < 0.001).
    Conclusions
    Increased cTnI levels could be a predictor of mortality among patients with TBI. Its measurement and investigation for therapeutic strategies could lead to better management of these cases.
    Keywords: Cardiac Troponin I, Traumatic Brain Injury, Mortality
  • Mehran Farzaneh, Ali Abbasijahromi *, Vahid Saadatmand, Nehleh Parandavar, Hamid Reza Dowlatkhah, Ayda Bahmanjahromi Page 10
    Background
    Non‐pharmacological treatment methods are being increasingly investigated for pain prevention and relief either alone or in combination with pharmacological treatment.
    Methods
    The present randomized placebo-controlled trial was conducted on 57 mothers undergoing elective cesarean section over 10 months from April 2015 to February 2016. The participants were randomly assigned to three groups: control, headphone, and nature-based sounds (N-BS). The investigator recorded pain severity every eight hours after the surgery. Mothers in the headphone group used headphones for 20 minutes (without playing sounds) and mothers in the N-BS group used headphones and listened to N-BS for 20 minutes. We played pleasant nature sounds for the N-BS group using media players and headphones. Mothers’ pain severity was measured immediately before the intervention and 15 and 60 minutes after the end of the intervention.
    Results
    The N-BS group had a significantly lower pain severity than the headphone and control groups. Statistically insignificant differences were observed between the control and headphone groups indicating that headphone only did not reduce the pain in the intervention group. These reductions were more evident progressively in 15 and 60 minutes after the end of the intervention.
    Conclusions
    The application of N-BS for mothers undergoing elective cesarean section promotes nursing autonomy and the notion that nurses can influence the patient’s environment.
    Keywords: Cesarean Section, Complementary Therapies, Headphone, Nature-Based Sounds, Postoperative Pain
  • Leili Adinehmehr, Hamidreza Shetabi *, Darioush Moradi Farsani, Ali Salehi, Mohadese Noorbakhsh Page 11
    Background
    According to the favorable effects of combination therapy to provide better sedation during phacoemulsification and lack of any studies investigating the sedative effect of etomidate, propofol, and midazolam in combination with fentanyl during the procedure.
    Objectives
    The current study aimed at comparing the sedative properties of the mentioned three combination therapies in this field.
    Methods
    The current double-blind, randomized, controlled clinical trial was conducted on patients referred for elective phacoemulsification surgery under sedation. They were randomly allocated to the three groups to receive fentanyl plus one of the following medications: Propofol, midazolam, and etomidate. Demographic characteristics, medical condition, and hemodynamic parameters before, during, and after surgery, sedation level, anesthetic complications, sedation-related adverse events, and patients’ and surgeons’ satisfaction were evaluated and recorded by the anesthesiologist and compared in the three studied groups.
    Results
    In the current study, out of 150 enrolled patients, 98 completed the study. Frequency of different levels of Ramsay scores was not significantly different between the groups (P = 0.41). Frequency of Ramsay scores 3 and 4 was 92%, 79.4%, and 88.2% in etomidate, midazolam and propofol groups, respectively (P = 0.32). The median recovery time was significantly higher in the midazolam group than the propofol group (P = 0.04); intergroup comparisons indicated that the patients’ mean score of satisfaction in the propofol group was significantly higher than that of the etomidate group (P = 0.006).
    Conclusions
    The current study findings indicated that though the quality of sedation during phacoemulsification cataract surgery was acceptable in the three agents and the results had no significantly differences among the groups, and considering other factors including recovery time, hemodynamic evaluation, sedation-related complications, and patients’ satisfication scores, it is suggested that propofol was superior to the other two agents.
    Keywords: Sedation, Etomidate, Propofol, Midazolam, Phacoemulsification
  • Sameh Abdelkhalik Ahmed*, Amany Faheem Omara Page 12
    Background
    Sensory fibers of the glossopharyngeal nerve supply the tonsillar and peritonsillar areas. Thus, bilateral glossopharyngeal nerve block may alleviate post-tonsillectomy pain and improve postoperative analgesia.
    Objectives
    The purpose of this clinical trial was to evaluate the effect of glossopharyngeal nerve block on postoperative analgesia in children undergoing adeno-tonsillectomy
    Methods
    Ninety ASA I-II pediatric patients presented for adeno-tonsillectomy were included in this trial. They were equally divided and randomly assigned to one of two groups: A control group, in which children did not receive a nerve block, and a glossopharyngeal nerve block group, in which children received bilateral glossopharyngeal nerve block after surgery. The postoperative pain score (FLACC score) during rest and swallowing, the time for the first request for rescue analgesia, the total dose consumption of pethidine rescue analgesia, and the incidence of postoperative complications were all assessed. Moreover, response to gag reflex, degree of difficulty in swallowing, and parents’ satisfaction were recorded.
    Results
    Bilateral glossopharyngeal nerve block in children presented for adeno-tonsillectomy significantly prolonged the time for the first request of rescue analgesia, compared to the control group, reaching 5.833 ± 2.667 hours (P < 0.0001). It also decreased postoperative pethidine consumption to 0.878 ± 0.387 mg/kg (P = 0.0009). Moreover, it significantly decreased the postoperative FLACC score assessed two, four, six, and twelve hours after surgery, during rest and swallowing (P < 0.05). The response to gag reflex and difficulty in swallowing were also significantly decreased (P ≤ 0.0001 and 0.006, respectively). In addition, glossopharyngeal nerve block significantly increased parents’ satisfaction (P = 0.0002), with no significant increase in the incidence of postoperative complications (P > 0.05).
    Conclusions
    Bilateral glossopharyngeal nerve block in children undergoing adeno-tonsillectomy improved the duration and the quality of postoperative analgesia, decreased swallowing difficulties, and improved parents’ satisfaction.
    Keywords: Glossopharyngeal Nerve, Tonsillectomy, Analgesia, Gag Reflex, Swallowing