فصلنامه بیهوشی و درد
سال یکم شماره 2 (زمستان 1389)

To compare intubating conditions and cardiovascular changes follow nduction of anesthesia and tracheal intubation in patients receiving either lidocaine-remifentanilpropofol or lidocaine-remifentanil-sevoflurane prior to induction. Methods and materials: In a randomized، double-blind study 75 healthy children patients were assigned to one of two groups: lidocaine 1. 5 mg·kg-1، remifentanil 2 μg·kg-1 and propofol 2 mg·kg-1 (Group P) or lidocaine 1. 5 mg·kg-1، remifentanil 2 μg·kg-1 and sevoflurane (Group S). Then laryngoscopy and tracheal intubation were attempted at BIS 40-50. Intubating conditions were assessed as excellent، good or poor on the basis of ease of ventilation، position of the vocal cords، and patient''s response to intubation and slow inflation of the tracheal cuff. The mean arterial pressure (MAP) and heart rate (HR) were measured before anesthetic agent administration، immediately after tracheal intubation، and five minutes after intubation. Excellent intubating conditions were obtained in 76% of Group P patients and 84% of Group S patients and were not significantly different between the two groups (p<0. 356). Cardiovascular changes following induction of anesthesia and tracheal intubation were not significantly different between the two groups. Lidocaine-remifentanil-sevoflurane is similar and safe like lidocaine-mifentanilpropofolfor tracheal intubation without muscle relaxants in children.

Ketamine efficacy as an analgesic adjuvant has been studied in several clinical settings with conflicting results. Sore throat and pain after swallowing following tonsillectomy is significant. The aim of this study was to investigate the effect of low dose ketamine on sore throat (pain) after tonsillectomy. In this double blind clinical trial، fifty children were، divided into two equal groups of Ketamine and control. The subjects aged 4-14 years old and physical ASA class I-II were randomized to receive pemedication with either ketamine 0. lmg/kg I. V. or placebo، 5 minutes before induction of a standard general anesthesia. The ketamine group showed significantly lower pain scores with less total pethidine consumption (P<0. 005) during 6h after surgery. The mean pain score in ketamine group was 1. 32±1. 02 and in control group was 2. 4±1. 25. There were no differences in the incidence of vomiting between the groups. Premedication with a small dose of ketamine reduces pain after tonsillectomy in children who received an analgesic regimen combined with an opioid.

Plantar calcaneal spurs are common; however their pathophysiology is poorly understood. This study aimed to evaluate the outcome of corticosteroid injection and ultrasound usage. Methods and materials: We chose124 subjects، divided into two groups. One treated by corton and the other received ultrasound waves. Pain levels after treatment were compared between these two groups. We had no significant differences between pain level of these two group but detected major differences among before and after position. BMI more than 30 also could increase pain level. Both of the methods could be used as non surgical treatments. But more study needed to evaluate more about these methods.

Percutaneus nephrolithotrips is commonly used for the removal of stones. This procedure can be performed under general or spinal anesthesia. In this study we evaluated amount of Bleeding and transfusion needs between two mentioned anesthesia routes. Methods and materials: A total of 80 ASA I-II patients undergoing PCNL were randomly llocated to receive spinal anesthesia (3 ml bupivacain % 0. 5) or general anesthesia which was induced with Thiopentone and maintained with propofol. Estimated blood loss and transfusion rates، postoperative pain (scored from 0 to 10 on a visual analog scale)، in two groups were recorded separately then collected data were analyzed by SPSS13 software. Mean blood loss was 262±113. 8 ml & 148. 1±55. 8 ml in general & spinal group، respectively. There is meaningful difference between two groups (p<0. 001). Rate of transfusion was 7. 5 % in general group & no one in spinal group. The spinal group had better patient satisfaction and lower pain scores (p<0. 001). Post operative pain after 1 hr (VAS) was 4. 2± 1. 0. 1 & 2. 3± 0. 9 in general group & in spinal group respectively. Spinal anesthesia decreased blood loss versus general anesthesia up to 50%، and had less postoperative pain score and is an attractive alternative to general anesthesia in these patients

Spinal anesthesia induced hypotension is common and it could be serious and life threatening. Occasionally many types of solutions use for prevention. We compared ringer lacatated (RL) vs Hetastarch (HS) about cardiac output reductions. Methods and materials: This is a randomized clinical trial which has done on 60 lower extremity orthopedic patients who went under surgery whereas spinal anesthesia has done for them. We used from electrovelosimetery for our evaluations. Base line heart rate، systolic and diastolic blood pressure and cardiac output were similar in both groups. whereas they were apparently reduced in ringer lactated group. This study showed effectiveness of hetastarch 6% in preventing of hemodynamic parameters changes in patients undergoing spinal anesthesia in comparison with ringer lactated solutions.

In recent years spinal anesthesia using a local anesthetic in combination with an opioid has gained popularity for lower limb operations due to the high success rate and patient satisfaction، and the decreased resource utilization compared with general anesthesia. In experimental studies، intrathecal administration of magnesium sulphate (MgSO4) significantly potentiated antinociception during spinal anesthesia; however available data are scarce. This study aimed at evaluating the effect of adding MgSO4 to bupivacaine and fentanyl for spinal anesthesia in lower limb orthopaedic surgeries. Methods & materials: In this double-blind randomized clinical trial، 100 candidates of spinal anesthesia for lower limp orthopaedic surgeries (ASA class I-II) were recruited in Hazrat Rasoul Akram Medical Complrx in a 10-month period. They randomized in two equal age- and sex-matched groups receiving 1. 0 ml of preservative-free 0. 9% sodium chloride (group S) or 50 mg of MgSO4 5% (1. 0 ml) (group M) following 12. 5 mg of bupivacaine 0. 5% plus 25 μg of fentanyl intrathecally. Date were collected regarding the time to reach the highest level of sensory blockade، time to L2 regression، times to reach the highest level of motor blockade and its full regression، time to consumption the first dose of postoperative analgesic and complications. Median time to reach the highest level of sensory blockade was significantly higher in the S group (16 vs. 14. 5 min; p=0. 02). Median time to L2 regression (243 vs. 207 min; p<0. 001)، as well as the median time to consumption the first dose of postoperative analgesic (345 vs. 232 min; p<0. 001) were significantly higher in the M group. Median times to reach the highest level of motor blockade and its full regression were comparable between the two groups. Hypotension and bradycardia were recorded in 20% and 10% of the patients in group M and 30% and 14% of patients n group S، respectively (p=0. 35). Intrathecal MgSO4 along with the spinal anesthesia with bupivacaine and fentanyl in lower limb orthopaedic surgeries hasten the sensory blockade and prolongs the period of anesthesia without additional side effects or influence on the motor blockade.

The patients with fractures of femoral shafts have severe and vigorous pain which limit their lateral positioning to perform spinal anesthesia. To detect an appropriate resolve for decreasing their pain، we decided to compare facia iliaca block and iv fentanyl injection. This study was performed as a randomized single blind sequential clinical trial. Prior to spinal anesthesia، pain score evaluated through visual analogue scale (VAS) [from 0 to 10] after that، patients randomly divided in to two groups، 10 members in each group. In the first group patients received 1. 5 mg/kg fentanyl intravenously. Once their condition was suitable to achieve the position، VAS again assessed. In second group after facia iliaca block (20ml lidocaine 2%) VAS evaluated، and then the patients positioned laterally to perform spinal anesthesia. This study showed that the time for painless lateral positioning in group fascia iliaca block was shorter than group iv fentanyl. VAS score for fascia iliaca block group was lower than iv fentanyl group. The entire information mentioned earlier was analytically significant (P<0. 05) and showed satisfactory consequences. In respect to this study، fascia iliaca block is reliable and safe and it is feasible to perform in all stages of accidents.

Although pregabalin is primarily an anticonvulsive drug and is also ffective on chronic neuropathic pain، there are limited data regarding its effect on acute pain. In this study we assessed the analgesic effect of pregabalin on acute post operative pain used as preemptive analgesia in comparison to placebo and compared pain intensity and opium requirements among placebo and pregabalin group. Methods and materials: 60 females who scheduled for TAH in Rasoul -Akram hospital were chosen، aged between 30-70، and weighted between 60 - 80 kg. Thirty had taken oral pregabalin (300) mg one hour pre surgical procedure، the others received placebo. Pain level and doses of opioid substance were compared between two groups at 4، 8، 12، 16، 20 and 24 hours after surgery. Agitation status، nausea، vomiting and dizziness were also recorded and compared. Pain level at 12، 20، 24 hours were significantly lower in the pregabalin group. Meperidin needed dosage and agitation level was reduced in the pregabalin group (p < 0. 0001). Nausea and vomiting had no difference between two groups. Dizziness was higher in pregabalin group (p = 0. 03). Pregabalin as a preemptive drug before surgery can reduce postoperative pain and agitation. However can increase some complications like dizziness.