Journal of Surgery and Trauma
Volume:1 Issue: 1, Winter 2013

The aim of this study is to compare the efficacy of epidural versus entonox methods for labor analgesia in nulliparous women. This randomized controlled trial was performed on 84 nulliparous women with - pregnancy admitted to Imam Reza Hospital in 10May 2010- 10May 2011. They were randomly divided into two groups; 42 women inhaled entonox in ac ve phase at the beginning of each contrac on, and for 42 cases, epidural catheter was inserted and analgesic substance was injected and it was increased adjusted with contraction progressing by bupivacaine combined with fentanyl. The rate of pain was measured with pain scores (minimum pain 0 and maximum pain 10). In epidural analgesia, pain score was lower in all stages of labor than entonox analgesia; 42% of cases had no pain, while as in entonox group, pain has been decreased 4 scores in 7% of cases and there was no complete analgesia. Dura􀆟on of different stages of labor was not sta􀆟s􀆟cally different between two groups (P=0.89). Cesarean rate was similar in two groups. First and five minute Apgar were not sta􀆟s􀆟cally different between two groups (P=0.87, P=0.75, respectively). Epidural analgesia with more relief in labor pain is the desired method. This method doesn’t cause more cesarean rate or prolonged labor duration. Although Entonox decreases labor pain in first stage, but doesn’t affect on second stage and fetus Apgar.

Several mehods have been proposed to alleviate pain after hysterectomy. Pre-emptive analgesia has been used to relieve pain following abdominal hysterectomy with conflicting results. This study was performed to evaluate the efficacy of pre-incision skin infiltration of Lidocaine in relieving postoperative pain in patients undergoing abdominal hysterectomy. 60 pa ents with ASA class of I or II scheduled for abdominal hysterectomy were recruited for the study. The patients were randomly assigned to receive pre-incision skin infiltration of either lidocaine or normal saline. The patients were evaluated with respect to postoperative pain scores and analgesic requirements in the first two postoperative days. They were also asked for satisfaction regarding the pain relief intervention. The patients were similar with respect to demographic characteristics. Patients in the saline group complained of more pain than the lidocaine group in the recovery room(p<0.001). However, the pa ents were similar with respect to postoperative pain scores and analgesic requirements. They were also similar regarding satisfaction rates during the first 24 hours postopera vely. We conclude that pre-incision skin infiltration of lidocaine is not effective in reducing postoperative pain following abdominal hysterectomy and does not affect the patients’ satisfaction.

Hemodialysis through creation of arteriovenous fistula (AVF) is an established surgical procedure for patients with End Stage Renal Disease (ESRD). Anesthetic methods management for this surgery should deal with different risk factors such as hypertension, ischemic heart disease and diabetes. Intravenous Regional Anesthesia (IVRA) or Bier block anesthesia as an option for AVF creation has reportedly been attributed to some advantages over other techniques in AVF creation. The present study aims to evaluate the efficacy of Bier block in AVF creation and compare its efficacy with local anesthesia. The subjects of the study were the pa ents (n=60, aged 20-65 years), who had been admi ed for an AVF creation. The patients were divided into two randomly assigned matched groups: Local Anesthesia (LA) group and Intravenous Regional Anesthesia (IVRA) group. The patients’ satisfaction levels, simplicity and feasibility of the procedure in the IVRA group were higher, compared to the LA group (94.1%, 66.7%, and 4.85% vs. 82.8%, 51.7% and 3.5%, respec􀆟vely). However, these differences were not statistically significant. The two main advantages of Bier block technique are the simplicity of operation and provision of a bloodless field for surgeon. It provides maximum dilatation in veins through the injection of the anesthetic drug and placing a tourniquet on it.

Although patients do not experience sever pain after laparoscopic surgery, most of them experience acute or chronic pain afterward. While conventional pain killers including NSAID and narcotics in laparoscopic surgery have specific side effects, their application is inevitable. This study compares the efficacy of local anesthetic drugs and conventional pain killers in post-operative pain control. This prospec ve clinical trial was conducted in two groups of pa ents (n=93). Group 1, as control group, was given conventional pain killers such as narcotics and NSAIDs. In another group as treatment group, at the end of laparoscopic surgeries, prior to port withdrawal, a local anesthe c mixture, a short ac ng (Lidocaine 2%) plus a long ac ng (Bupivacaine 0.5%) is ins lled through the port lumen between the abdominal wall layers. The efficacy of both types of medications was compared with regards to their effectiveness and side effects. 85% of the control group, received 5 to 20ml Morphine for pain control while the others were controlled with trans-rectal NSAIDs. In the treatment group, the pain of 65% of the pa ents was controlled only by local anesthe c drugs,30% required NSAIDs and the other 5% required narco cs administra on for pain control. The administration of local anesthetic drugs after laparoscopic surgery is an effective method for pain control with a low complication rate and side effects of narcotics.

Deep sternal wound infection is a rare but serious complication after cardiac surgery that can increase mortality and morbidity. The aim of this study was to investigate the incidence and causative germs of deep sternal wound infection following cardiac surgery. Data were collected retrospectively from patients who underwent different cardiac surgeries including coronary artery bypass gra ing and valvular heart surgeries between July 2010 and October 2012 at a teaching hospital in the north east of Iran. Patients with a deep sternal wound infection (DSWI) were defined based on clinical findings and culture results of the wound. The patients were tracked for the development of DSWI and causative germs and sensitivity were identified according to the microbiological studies. 4621 pa􀆟ents underwent different cardiac surgeries during the study period. There were 82 cases (1.77%) of DSWI with mean age of 53.93 years and male to female ra o of 47:35 with mortality rate of 10.9%. The most common germs in order of decreasing frequency included Klebsiella, Pseudomonas, Staphylococus Coagulase Negative, Acinetobacter, Staphylocciaureus, Escherichia coli, methicillin resistant Staphylocciaureus, Providenciarettgeri, and Obligatory anaerobe Streptococus. We conclude that DSWI remains a rare but devastating complication and is associated with significant comorbidity, increased hospital mortality, and reduced long-term survival with gram negative rods as the most common pathogens.

Appendicitis remains the most common condition in the pediatric population requiring emergency abdominal operation. Management of acute simple appendicitis is well described but controversy remains as to the optimal treatment of complicated appendicitis. Common complications of acute appendicitis include: localized peritonitis and abscess formation, flegmon and general peritonitis. In this prospective study we have evaluated the results of aggressive therapy in management of complicated appendicitis in children in Sarvar pediatric hospital of Mashhad, Iran. Among 60 children with acute complicated appendici s male to female ra o was 4:1 and mean age was 7.18±2.17 years. 60% were operated via low mid line incision and 40% by Rocky Davis incision. The most common nal diagnosis fi was appendicular abscess that was observed in 34 pa ents. Primary wound closure was performed in 96.7% and placement of drain in peritoneal cavity in right lower quadrant was done only in 13.3%. Safe appendectomy was performed in all 60 cases and post opera ve complica ons included two cases with wound infection and 4 cases with Chronic abdominal pain that were managed conserva vely. Only one pa ent was re admi ed and underwent re-laparotomy because of bowel obstruction. according to our findings the current non operative approach to complicated appendicitis in children needs a revision.

To present our experience about the safety of conservative management in asymptomatic and non-complicated hepatic hydatid cyst in pregnancy. Seven pregnant patients with hepatic hydatid cysts as an incidental finding in routine obstetrical ultrasonography were referred to our center during 2001 to 2008. Three pa ents were visited in the second and the rest in the third trimester of their pregnancy. It was found that all of them had asymptomatic and non-complicated cysts. They were suggested to participate in our close conservative plan as their treating method. Monthly ultrasonography and clinical examination was performed to find out any changes in size or clinical course of the cysts. Cesarean section and simultaneous surgical treatment of the cyst were performed in three patients while for the rest went through a natural vaginal delivery and surgical treatment of the cysts were postponed until six weeks after delivery. No complication was seen in these two groups. Conservative management of asymptomatic and non-complicated hepatic hydatid cysts until delivery may be a safe method in management of hepatic hydatid cysts in pregnancy which prevents preterm labor and other cyst related procedures complications.

Torsion of the gallbladder is a relatively rare surgical disease which mimics acute cholecystitis'' symptoms that usually would not be respondable to medical therapies. The torsion would mostly be diagnosed intra operatively. Cholecystectomy is the treatment of choice. In general in our centre, General Surgery department, Imam Reza hospital, Mashhad, Iran, since 1986 over 14000 cholecystectomies have been performed and 3 cases with an underlying cause of gallbladder torsion are documented. The relative literatures reviewed so then the presentation, paraclinical findings, and the treatment of gallbladder volvulus are discussed. Gallbladder volvulus: Review of the literature and report of three cases.