فهرست مطالب

  • Volume:9 Issue: 6, 2019
  • تاریخ انتشار: 1398/10/08
  • تعداد عناوین: 15
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  • Farnad Imani *, Giustino Varrassi Page 1
  • Jefferson Zhi Jie Tang *, Laurence Weinberg Page 2
    Context

    The optimal analgesic method for patients undergoing major open hepato-pancreatic-biliary surgery remains controversial. Continuous epidural infusion at the thoracic level remains the standard choice, however concerns have been raised due to associated complications. Single shot intrathecal morphine has emerged as a promising alternative offering similar analgesia with an enhanced safety profile.

    Evidence Acquisition

     This review aimed to evaluate the literature comparing intrathecal morphine analgesia to other analgesic modalities following major open hepato-pancreatic-biliary surgery. The primary outcome was pain scores at rest and on movement 24 h after surgery. Secondary outcomes were postoperative opioid consumption within 72 postoperative hours, length of stay (LOS), intra-operative fluid administration and post-operative fluid administration within 72 postoperative hours, and overall systemic complication rate within 30 postoperative days.

    Results

    Eleven trials matching the inclusion criteria were analysed. Intrathecal morphine resulted in equivalent or lower pain scores when contrasted to alternative techniques, but required higher amounts of postoperative opioid. Intrathecal morphine also offered reduced LOS and reduced fluid administration requirements to epidural analgesia, and there was no difference observed in major complication rate between analgesic modalities.

    Conclusions

    In summary the evidence suggests that intrathecal morphine may be a better first-line analgesic modality than epidural analgesia in the context of major open hepato-pancreatic-biliary surgery, but high-quality evidence supporting this is limited.

    Keywords: Liver, Surgery, Analgesia, Epidural, Intrathecal
  • Reza Akhondzadeh, Mahboobe Rashidi *, Mohammadreza Gousheh, Alireza Olapour, Bahrammohamad Tasbihi Page 3
    Background

    Regional anesthesia provides safe anesthesia for upper extremity surgery. Axillary plexus block approach for hand and forearm surgery is commonly used. The use of adjuvants in combination with local anesthetics for peripheral nerve blocks enhances the quality and duration of anesthesia and postoperative analgesia.

    Methods

    This double-blind clinical trial was performed on 60 patients who were candidates for the surgery of upper extremity fractures with ASA I and II classes. The patients were randomly divided into two equal groups (n = 30). The intervention group 1 received 4 mg/kg lidocaine 1% and 50 µg fentanyl and the intervention group 2 received 4 mg/kg lidocaine 1% and 30 mg ketamine during the axillary block. After the necessary monitoring, a pinprick test was performed to evaluate sensory block, and a three-point scale test for the motor block was performed for median, ulnar, radial and musculocutaneous nerves. The duration of postoperative analgesia, the time of the first request for a painkiller, and the amount of opioid received were compared in the two groups.

    Results

    Onset of sensory and motor block was shorter in the fentanyl group but did not differ significantly. The sensory and motor block length was slightly higher in the fentanyl group, but no significant difference was observed. The severity of pain (VAS) and the mean of received opioid (pethidine) were significantly lower in the fentanyl group 24 hours after the surgery (P < 0.0001). The duration of postoperative analgesia and the time of the first request for painkiller were longer in the fentanyl group, but there was no significant difference.

    Conclusions

    The severity of pain and analgesic intake in the fentanyl group decreased significantly. Therefore, fentanyl is a better drug than ketamine for using as an adjuvant in the axillary block

    Keywords: Upper Extremity Fractures, Axillary Block, Fentanyl, Ketamine, Postoperative Analgesia
  • Behzad Nazemroaya *, Sayedeh Maryam Mousavi Page 4
    Background

    A variety of anesthetics including methohexital, thiopental sodium, propofol, ketamine, and etomidate are used for electroconvulsive therapy (ECT), each accompanied by adverse effects that can cause unpleasant experiences for patients. Etomidate-induced myoclonus is among the adverse effects. We attempted to assess the effect of premedication with low-dose midazolam compared to etomidate on the reduction of this complication.

    Objectives

    This study was designed to compare the effectiveness of low-dose etomidate and low- dose midazolam to suppress etomidate-induced myoclonus in ECT.

    Methods

    This randomized double-blinded clinical trial was conducted on 132 patients who were candidates for ECT. They were divided into three groups of 44 patients to receive 0.015 mg/kg midazolam, 0.03 mg/kg etomidate, or placebo. Independent t-test and chi-square test were used for comparison of variables.

    Results

    The frequency of myoclonic movements during anesthesia was different between the three groups (P value < 0.001). Myoclonic movements were significantly lower in the midazolam group than in the placebo (P value < 0.001) and etomidate (P value = 0.002) groups. In addition, the intensity of myoclonic movements was significantly higher in the midazolam group than in the placebo and etomidate groups (P value < 0.001).

    Conclusions

    Low-dose midazolam (0.015 mg/kg) before anesthesia induction with etomidate was accompanied with significantly lower incidence and intensity of myoclonus than low-dose etomidate (0.03 mg/kg).

    Keywords: Electroconvulsive Therapy, Low-Dose Midazolam, Low-Dose Etomidate, Myoclonus
  • Behrooz Zaman, Samad Noorizad, Seydalireza Seyed Siamdoust, Mahzad Alimian*, Sara Parak Page 5
    Background

    Pain on injection with propofol is still a major problem associated with anesthesia. Several factors involved in this event have been studied with respect to their pain attenuating effects.

    Objectives

    The purpose of this study was to evaluate the effect of propofol infusion before administration of its bolus dose of propofol on the resulted pain at its induction dose and on serum complement C3 levels.

    Methods

    This clinical trial was performed on patients undergoing surgery under general anesthesia divided into three groups, including A (without intervention), B (propofol infusion at a dose of 50 µg/kg/min before anesthesia induction), and C (propofol infusion at a dose of 100 µg/kg/min 100 before anesthesia induction). During anesthesia induction by propofol, the presence, absence or severity of pain was determined using the Numerical Rating Pain Scale. Serum complement C3 levels were measured and their relationships with pain scores were compared between three groups. The data were analyzed using SPSS V. 22 software.

    Results

    There were significant differences in the mean pain scores between three groups (P < 0.05). However, no significant difference in the mean pain scores was observed between the groups B and C (P > 0.05). The mean and standard deviation of the differences in complement C3 values in the three groups before and after injection were 72.15 ± 14.9, 27.65 ± 9.82, and 18.95 ± 4.68, respectively, which demonstrated a significant difference between three groups (P < 0.05). However, the difference in complement C3 values between the groups B and C was not significant (P > 0.05).

    Conclusions

    According to the obtained results, the low doses of infused propofol, 2 minutes before administration of its bolus dose, seems to have a considerable attenuating effect on its pain score.

    Keywords: Complement C3, Infusion, Propofol Injection Pain
  • Wael Fathy *, Mona Hussein, Hossam Khalil Page 6
    Background

    Multiple clinical trials targeted the assessment of cognitive function following local versus general anesthesia in patients undergoing ophthalmic surgery, but no previous clinical trials have focused on the effect of topical anesthesia on cognitive function.

    Objectives

    This study aimed to compare the effect of local anesthesia with lidocaine 2% versus topical anesthesia with Oxybuprocaine (benoxinate hydrochloride 0.4%) on cognitive function in patients undergoing elective cataract surgery.

    Methods

    This is a prospective randomized clinical trial carried out on 60 patients undergoing elective cataract surgery by phacoemulsification. Thirty patients received local anesthesia with lidocaine 2% and thirty patients received topical anesthesia with Oxybuprocaine (benoxinate hydrochloride 0.4%). Patients’ satisfaction was assessed postoperatively using the Iowa satisfaction with anesthesia scale (ISAS). Cognitive assessment for all patients was done preoperatively and 1 week postoperatively using paired-associate learning test (PALT) and category verbal fluency (VF) test (animal category).

    Results

    There was no statistically significant difference between local and topical anesthesia groups in the mean of responses to the 11 statements of ISAS (P = 0.071). Regarding cognitive assessment, there was a statistically significant postoperative decline in the local anesthesia group in both PALT scores (P = 0.005) and VF scores (P = 0.01). In the topical anesthesia group, there was no statistically significant difference between pre- and postoperative PALT scores (P = 0.326) or VF scores (P = 0.199).

    Conclusions

    Postoperative cognitive dysfunction following elective cataract surgeries under local anesthesia can be attributed to the effect of local anesthesia rather than the effect of surgery.

    Keywords: Cognitive Function, ISAS, Lidocaine, Oxybuprocaine (Benoxinate), PALT, VF
  • Mohammad Hajijafari *, Leila Mehrzad, Fatemah Sadat Asgarian, Hossein Akbari, Mohammad Hossein Ziloochi Page 7
    Background

    Anesthetic drugs may directly or indirectly affect respiratory function. We investigated the effects of intravenous propofol and inhaled sevoflurane anesthesia on postoperative spirometric indices in patients undergoing inguinal herniorrhaphy surgery.

    Methods

    We randomly assigned 111 patients, aged 18 - 65 years, undergoing inguinal herniorrhaphy surgery, to receive either intravenous propofol or inhaled sevoflurane. Forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), and FEV1/FVC were measured before and after anesthesia. Comparisons between the two groups were made using the t-test and ANOVA.

    Results

    There were no significant differences between the two groups in terms of age, sex, height, body weight, BMI, pain score, ASA class, operation duration, and received analgesics. The FEV1 and FVC values significantly decreased after the operation in the sevoflurane group.

    Conclusions

    Both intravenous propofol and inhaled sevoflurane can decrease postoperative spirometry parameters. However, it seems that patients receiving propofol have less decreased spirometric indices.

    Keywords: Propofol, Sevoflurane, Respiratory Function Tests, Spirometry
  • Hossein Majedi*, S. Sharareh Dehghani, Saeed Soleyman Jahi, Abbas Tafakhori, S. Ali Emami, Mohammad Mireskandari, S. Maryam Hosseini Page 8
    Background

    Inadequate pain management is highly prevalent and is associated with significant costs and socioeconomic problems, which can lead to disparities in patient care. Specific groups are at higher risk of this problem. A few studies have evaluated the predictive risk factors of inadequate pain management.

    Objectives

    This study evaluated the prevalence and predictive risk factors of inadequate pain management at the primary and secondary care centers with large sample size.

    Methods

    Patients who had been managed in primary and secondary care clinics were asked to report their personal characteristics, pain intensity, pain duration, and analgesics they were receiving in their first visit at our pain clinic. Zelman pain management index was calculated for each patient by analgesic potency minus mean pain intensity. The negative index showed incongruence between pain intensity and analgesic potency score (pain stronger than medication), indicating inadequate pain management.

    Results

    A negative pain management index was reported in 77% of the 511 recruited patients. Patients with more severe pain were more likely to experience inadequate pain management. A logistic model demonstrated women, people aged 45 - 65 years, illiterates, and obese patients were at higher risks of inadequate pain management. The pain management index was affected by sex and education (via higher pain intensities) and by age and BMI (via lower analgesic potency).

    Conclusions

    Age, sex, education, and BMI are predictive risk factors of inadequate pain management as a prevalent problem in chronic pain patients.

    Keywords: Inadequate Pain Management, Pain Management Index, Chronic Pain, Pain Intensity, Personal Factors, BMI, Obesity, Age, Sex, Education
  • Amirsadra Zangouei, Seyed Ali Hossein Zahraei, Amir Sabertanha, Ali Nademi, Zahra Golafshan, Malihe Zangoue* Page 9
    Background

    Spinal anesthesia is the most commonly used method for elective cesarean section, which is a popular technique due to its simplicity, reliability, and speed to achieve adequate anesthesia. Headache following dura perforation is the most important delayed complication following spinal and epidural anesthesia.

    Objectives

    To evaluate the impact of low-dose intravenous ketamine in patients undergoing cesarean section under spinal anesthesia on the prevention of dura perforation headache (PDPH).

    Methods

    This clinical trial study was performed on 64 pregnant women undergoing cesarean section at Vali-e-Asr Hospital. The patients were divided into two groups. In the case group, 0.15 mg/kg body weight ketamine was injected intravenously and in the control group, normal saline was used as the placebo. The incidence of headache and its severity at one, 4, 12, and 24 hours postoperatively, nausea and its severity were also measured and compared. Independent t-test, Mann-Whitney U and chi-square tests were used. A P value < 0.05 was considered statistically significant.

    Results

    The data revealed that low dose intravenous ketamine significantly decreased patients’ headaches (P = 0.001), the sensation of pruritus (P = 0.009), and the need for analgesic (P = 0.001). Furthermore, the sensation of postoperative nausea was less in the case group. The patients in the case and control groups had no significant difference in terms of hypertension or bradycardia (P = 0.717 and 0.939, respectively).

    Conclusions

    The injection of ketamine as a premedication in the cesarean section can reduce the severity of postoperative headache in mothers. Therefore, it is recommended to use ketamine as an anti-headache drug in pregnant women.

    Keywords: Spinal Anesthesia, Headache, Cesarean Section, Ketamine
  • Reza Derafshi, Fahimeh Rezazadeh, Janan Ghapanchi *, Delaram Basandeh Sharif, Mitra Farzin Page 10
    Background

    Orofacial pain is presented mainly as a pain in the front part of the head, including the oral cavity. Adult and elderly patients are important target groups affected by this chronic pain, which may cause several problems.

    Methods

    In this cross-sectional study, the characteristics of patients who suffered from orofacial pain were evaluated. The data such as patients’ gender, age, pain diagnoses, treatments, responses to treatments, duration and severity of pain, and disability were collected from their records. The diagnoses were provided based on the characteristics of pain, X-ray findings, physiological findings, lab tests, nerve block injection, and a drug challenge test.

    Results

    Among all the 5,221 patients referred to Oral and Maxillofacial Medicine and Prosthodontics Department, 583 (11.16%) reported orofacial pain as the chief complaint. The frequency of orofacial pain was more prevalent among women than men. Burning mouth syndrome was the most prevalent cause of orofacial pain in the elderly, followed by temporomandibular disorder and trigeminal neuralgia.

    Conclusions

    Most cases of orofacial pain in elderly patients were burning mouth syndrome, temporomandibular disorder, and neuralgia. It was more observed in females than males with the mean age of 55.3 ± 10.7 years old.

    Keywords: Orofacial Pain, Elderly Patient, Chronic Pain, Prevalence
  • Amir Sabertanha, Bibifatemeh Shakhsemampour *, Mina Ekrami, Elahe Allahyari Page 11
    Background

    Some studies have reported the effects of anesthesia induction using a single propofol dose and low ketamine doses in short-term outpatient operations.

    Objectives

    In this study, we aimed to evaluate the intra and post-operative hemodynamic effects of ketamine-propofol mixture (Ketofol) infusion in comparison with propofol infusion.

    Methods

    This study was performed on 54 class I and II of the American Society of Anesthesia patients aged 15 to 45 years who were candidates for leg fracture surgery. The patients were randomly assigned to propofol and ketofol groups. In the propofol and ketofol groups, propofol infusion (100 µg/kg/min) and propofol-ketamine infusion (50 µg/kg/min propofol + 25 µg/kg/min ketamine) were used for the maintenance of anesthesia, respectively. Heart rate and systolic, diastolic and mean blood pressure before, immediately after the induction of anesthesia and at 10-minute intervals were measured and recorded. Pain, nausea, and vomiting were recorded immediately after surgery and each 2 hours until 6 hours.

    Results

    Systolic, diastolic and mean blood pressure were significantly higher in the ketofol group than in the propofol group at 10 - 60 min intervals (P < 0.05). There was no significant difference, however, between the two groups in terms of the severity of nausea and pain and vomiting frequency.

    Conclusions

    Infusion of hypnotic doses of ketofol leads to increase in diastolic and systolic blood pressure and improves blood pressure stability in addition to inducing more as compared with propofol infusion, but it leads to higher risk of nausea and vomiting.

    Keywords: Anesthetic Maintenance Regimen, Propofol Ketamine, Pain, Nausea Vomiting, Hemodynamics
  • Reyhaneh Shahrokhirad, Soudabeh Haddadi, Malek Moien Ansar* Page 12