فصلنامه بیهوشی و درد
سال یکم شماره 3 (بهار 1390)

During induction of anesthesia، when we are waiting to initiate the effect of neuromuscular blocking drugs، the patients suffer risk of aspiration. If the onset of neuromuscular action was more rapid، the risk would decrease. In order to reach this goal، we can do different things، such as use a priming dose of neuromuscular blocking drugs before major dose. Till now، in previous researchers، this has never done. A randomized double blind study was designed on 88 ASA 1 & 2 patients who were candidate for obstetrics & general surgeries. Patients were randomly assigned to three groups. Different groups received normal saline، 25mg/kg magnesium sulfate and 50mg/kg magnesium sulfate slowly & via a micro set during ten10 minutes. Blood pressure and heart rate were measured. Then، iv midazolam and fentanyl were administered as premedication. We calculated total dose of cisatracurium and 10% of this dose was administered as priming dose. After 3 minutes، thiopental sodium and remaining dose of cisatracurium were given. Neuromuscular monitoring with a nerve stimulator and single twitch test was done until the twitches were disappeared. The times were measured in all groups with a chronometer. Then، the patients were intubated and anesthesia was maintained with prpopfol. Heart rate and blood pressure were measured again. 2،5، 10، 15، 20، 25 and 30 minutes after intubation، intensity of blockade by PTC test، heart rate and blood pressures were measured. The onset of neuromuscular blockade in group 3 was faster than the normal saline group. The mean time of muscle relaxation in group 1،2 and 3 were 209، 226 and 188 seconds respectively. Intensity of neuromuscular blocking by PTC test in group 3 was more than group 2 & in latter was more than normal saline group. Arrhythmia were seen in 6 patients from all cases & both belonged to group 3. Side effects incidence of magnesium sulfate injection were more common in group 3. Using magnesium sulfate before cisatracurium during induction of anesthesia withpriming method leads to increase onset and intensity of neuromuscular blockade of cisatracurium. Alterations of blood pressure and heart rate were constant after injection of magnesium.

Postoperative pain is a common problem in perioperative period. There are several methods for pain controlling that including infiltration of bupivacain. The aim of this study is comparing intratubal and subcutaneous injection of bupivacain %0. 5 with placebo on ostoperative pain relief، analgesic consumption and patient satisfaction. In a double blind randomized clinical trial 50 candidates for tubal ligation were divided two groups. After spinal anesthesia with lidocain%5 tubal ligation were performed by Parkland method then 5ml bupivacaine %0. 25injected into the mesosalpinx and subcutaneous tissue in every side. Vital signs، nausea and vomiting، analgesic requirements VAS of pain in recovery time2، 8، 16، 24 hours and 7 days after surgery were recorded. Pain and analgesic requirements in recovery time، 2،16، 24 hours and 7 days after rgerywere significantly decreased in bupivcaine group. Pain and analgesic consumption in 8 hours after surgery were similar in two groups (p=0. 51). Tissue infiltration of bupivacaine %0. 25 in postpartum tubal ligation reduced pain،analgesic consumption and patients'' satisfaction.

This study was performed to evaluate the analgesic effect and adverse effects of nitroglycerine added to lidocaine in intravenous regional anesthesia. Methods and materials: In this Randomized Clinical Trial، 60 patients under intravenous regional anesthesia in Hazrate Fatemeh were evaluated that were randomly assigned to receive either 200 microgram nitroglycerine plus lidocaine or only lidocaine (each group 30 subjects).

Initial pain score (VAS) was alike between groups; but there was a statistically significant difference between second VAS in two groups. But the third VAS was not differed between two groups (P > 0. 05).

Totally، according to the obtained results، it may be concluded that use of nitroglycerine added to lidocaine would result in an increase in effect of anesthetic without additionaladverse effects.

Maintaining low back pain after spinal surgeries is one of the pretty challenging problems in treating patients. Various modalities have been introduced for treatment and one of the most effective ways between them، is steroid and other drugs injection into epidural space. In a double blind RCT study، 25 patient from pain clinic with low backpain due to failed back surgery syndrome were candidate for epidural transforaminal block and divided into case and control groups randomly. The selected drug regimens were as follow: in case group bupivacaine %0. 5، triamcinolone 40mg، hypertonic saline5%، hyaluronidase 1500IU، and in control group stilled water instead of hyaluronidase was used per each nerve root. Pain score، analgesic consumption، neurological examinations and satisfaction were evaluated in recovery and 1، 2، and 4 weeks later. There was no difference in demographic data between 2 groups. Pain score and total analgesic consumption in case group was meaningfully higher 2 and 4 weeks after blockade (p<0. 01). Patient satisfaction was higher in case group. Adding hyaluronidase to transforaminal injectate should be an effective for managingchronic low back pain in failed back surgery syndrome.

There are many methods to provide pain relief after operation، that includes: IV or IM opioids injections، patient controledl analgesia، uses NSAIDs useing (IM، IV or rectal). All of these methods have advantages and disadvantages. Another techniques for post operative analgesia is epidural catheter insertion and administration of opioids or local anesthetic continously. The goal of this study is to compare intrathecal administration of combination of sufentanil and morphine for postoperative pain relief after laparatomy. 40 ASA I-III patients who were candidates for laparatomic surgeries enrolled in two groups in this clinical trial study after written inform consent (randomly assigned). One group (N=20) before general anesthesia received a spinal injection of Sufentanil (5μ) and morphine (0. 3mg) (S-M groups) and another group (control group) didn''t receive intrathecal opioids. Post-operative pain was rated on a visual analogue scale (VAS) at rest in 6 and 12 hours after operation and also total dose of injected morphine for 24 hours after operation calculated. The data were analyzed by SPSS16، T-test، Chi-Square and paired T-test. Intrathecal injection of sufentanil and morphine caused VAS scores at rest were ignificantly higher in the control group in 6 and 12 hours after operation and total dose of morphine consumption was significantly lower in the SM group. Combination of intrathecal sufentanil and morphine produce good analgesic effect after laparatomic surgery at 12 hours after operation.

Prescribing high doses of analgesics for pain relief after major abdominal surgeries are accompany with side effects. Thus، introducing adjunct drugs to be able to reduce the required dose of opioids would have great clinical relevance. The aim of this study was to determine the effect of adding ketamine to pethidine in reducing post-operative pain in patients undergoing major abdominal operations. In this study، 100 patients aged 15-60 years who were candidate for elective major abdominal surgery allocated into two groups of pethidine + ketamine group (5 mg pethidine and 0. 25 mg/kg ketamine) or pethidine and placebo group (10 mg pethidine and NS) according to the regimen prescribed in postanesthesia care unit. Severity of pain (using visual analogue scale)، prescribed dose of pethidine، and side effects were recorded until 24 hours after operation. regarding post-operative pain، pethidine + ketamine group showed significant lower scores in all the times except 0 min، 2 h، 6 h، and 16 h. Nausea was significantly less frequent amongst pethidine + placebo group at times of 0، 15، 30، and 45 min (P<0. 05). Comparison of two groups did not show significant differences in prescribed pethedine dose in 0، 9 h، 12 h، 16 h، 20 h، and 24 h (P>0. 05). Yet، the mean dose of administered pethidine as rescue analgesic was significant lower in pethidine + ketamine group compared to pethidine + placebo group (112±31. 5 mg vs. 133. 5±24. 5 mg، P<0. 001). This study showed that co-administration of ketamine and pethidine will improve postoperative pain and reduce narcotic consumption. It may، however، increase rate of postoperative nausea in the first hour after operation.

At the first 48 hours after orthopedic surgery opioids are used for analgesia.Continuous popliteal nerve block has been performed with increasing frequency for postoperative analgesia after foot surgery and provide better analgesia than traditional systemic opioid-based analgesia.Several additives have been combined with local anesthetics for peripheral nerve blocks. Magnesium is well known as an antagonist of N-methyl-d-aspartate receptors and has some analgesic property.The aim of this study was addition of magnesium to lidocaine in patient- controlled regional analgesia (PCRA) through the popliteal catheter. Forty four patients scheduled for hospital admission after foot surgery entered into this study and divided two group,control(I) and magnesium(II).In control group lidocaine %1(5ml/h) and group II lidocaine %1(5ml/h) + magnesium (5mg/h) infused with (PCRA) pump. Patient characteristics, pain scores (VAS), use of analgesic medications (iv morphine), and side effects of analgesic therapy were recorded for 48 hours after surgery. Pain score (VAS) was more in control group than group II (P=0.001).there was no ignificant difference between two groups in morphin consumption and nausea and vomiting (P=0.12). There were significant difference between two groups in Sedation score(P=0.007) and motion (P=0.001). This study showed addition of magnesium to lidocaine %1 in patient-controlled egional analgesia (PCRA) through the popliteal nerve block catheter have advantages for post operative pain, sedation, motion, reductionof morphin consumption and nausea and vomitig after the foot surgery.

Postoperative pain is one of the most common problems after surgery،especially orthopedic surgery which if not prevent the onset or inadequate treatment، especially in older irreparable adverse reactions to be followed. Analgesic use of continuous epidural infusion in lower limb surgery with simultaneous use of local anesthetic drugs and narcotics is one of the most effective and safest methods of analgesic than the other methods is systemic. This study as double blind clinical trial was conducted، 82 patients undergoing lower limb orthopedic surgery in two groups randomly divided into 41 equal and after insertion of the epidural catheter before surgery، after surgery in all stages Patients pump analgesia epidural continuous infusion with two diet drug F (bupivacaine 0. 125 % + fentanyl 5 micr/ ml) and S (bupivacaine 0. 125 % + sufentanil 0. 5 micr/ ml) with a speed of 5ml/ h Connected. The pain intensity based on (VAS) and side of motor block، nausea and vomiting، itching، urinary retention،hypotension and respiratory depression during 1، 3، 8، 16، 24، 48 hours after surgery in both groups measured and recorded. The demographic in both groups، similar to one another. The mean pain scores (VAS) during activity than resting there، but the total in both S and F mean pain scores during activity and rest less than 3 was And a significant difference does not show the different hours. Hypotension in the first hour in group F than the S group had significantly increased، but at other hours is not a significant difference. Motor block and nausea and vomiting، although in Group S than Group F، but the difference was not significant. Difference in other complications (pruritus، sedation،respiratory depression) between the two groups is not significant. This study shows that both fentanyl and sufentanil regimen with bupivacaine in epidural analgesia with continuous infusion led to similar analgesia and acceptable side effects except the first hour of hypotension after surgery.