فصلنامه بیهوشی و درد
سال پنجم شماره 4 (زمستان 1393)

Aims and Chronic radicular low back pain is usually temporarily relieved by transforaminal epidural(TFE) injection of steroids; our aim was to evaluate the effect of TFE dexmedetomidine injection in comparison with steroids in patients with chronic lumbar radicular pain. Patients with 3 months of low back and leg pain due to intervertebral disc herniation were randomized to receive transforaminal epidural (TFE) injection(s) of 0.2% bupivacaine and either dexmedetomidine (1 mcg/kg) or triamcinolone (20mg). Patients, investigators and study coordinators were blinded to treatment. Primary outcome was visual analogue score (VAS) after the procedure, and functional improvement according to Oswestry disability index(ODI) after 2 weeks, 1, and 6 months. Other outcomes included serum Vitamin D, fasting blood sugar, and bone densitometry which were checked before and after the treatment with an interval of 1 month,3 days, and 6 months, respectively. Twenty-two patients were screened and enrolled; 11 received dexmedetomidine and 11 triamcinolone. Both groups showed significant improvement in pain score after the injection compared to baseline (p< 0.05). The dexmedetomidine group showed additional functional improvement at 1 and 6 months relative to triamcinolonebased upon ODI (p=0.001). Fasting blood sugar was also significantly increased in triamcinolone group in comparison with dexmedetomidine group (p=0.007).However, as target enrollment was not reached in our study, we cannot say with confidence that dexmedetomidine would surely result in better outcome in patients. Regarding side-effects, there were no serious complications. Radicular pain due to disc herniation improved rapidly with TFE injection of either dexmedetomidine or triamcinolone. Dexmedetomidine resulted in greater functional improvement, with better side effect profile. Future studies however, would probably determine if dexmedetomidine is superior to placebo and of particular use in those at risk for corticosteroid complications.

General anesthesia with endotracheal intubation for smokers who are elected, being irritable airways due to the high risk of Broncho spasm‚hypoxia and coughing fallow post operation. The purpose of this study: comparison of three methods of preparation, heavy smokers with normal spirometry on pulmonary complications after coronary artery bypass surgery In this study, 225 patients were heavy smokers who smoked cigarettes at age 35-65age (20Pakt / year) with normal spirometry FEV1 / FVC≥70%, FEV1> 2 Lit and ASA (II III) without respiratory symptoms who underwent coronary artery bypass surgery were selected. Patients were divided into 3 groups 75 person. Group I: patients were smokers, who had not been treated before surgery had smoked a cigarette. Two groups of patients were smokers undergoing treatment for3 drug Salbutamol - Atrovent- Beclomethasone inhaler 2 puffs twice a day were 10 to 14 days before surgery. And had smoked before surgery. The third group of smokers who had quit smoking for 8 weeks. All patients underwent general anesthesia with endotracheal intubation were similar drugs. All patients underwent surgical procedures and all on cardio pulmonary pump‚ Time of surgery were similar. after surgery patients incubate‚ were transferred to the intensive care unit to obtain the appropriate condition were monitored. Then, on the first and second postoperative pulmonary complications such as cough - shortness of breath - Fever - rales -wheezing - tachypnea - radiographic changes CXR-time of mechanical ventilation in ICU and reoperation were recorded. in the first group of 75 people, 35 people and the second group 23 people and‚third group 31 people were experiencing one of the above effects of frequency of coughing – mechanical ventilation time- wheezing- and incidence reoperation due to the opening of the esternom because of recurrent cough in the group treated with Salbutamol – Atrovent – Beclometazon significant reduction and were statistically superior to the other two groups, the difference was significant.

One of the most common clinical symptoms is pain. Nurses as the key people who have the most communication with patients; pain assessment and control, comfort providing and discomfort preventing are their important responsibilities. This study aimed to determine the impact of the nurse-patient communication skills training on pain reducing of patients. Methods and Material: An experimental study was carried out by random selection of 30 nurses who have worked in the Medical and surgical ward of Ghaem and Imam Reza hospitals in Mashhad city. A two-day workshop based on Nurse-Patient communication training for 8hours was held for the nurses. The data collection tools were the demographic information, paying attention to communication and control of pain questionnaires which were filled out by the nurses and 3 patients per nurse before and 4 weeks after the intervention. The data were analyzed by SPSS software version 16 and using analytical statistics.

The nurse–patient communication scores were 21/6± 5/95 pre-training and 35/7 ± 4/11 post- training; the attention to pain mean scores were 13/8± 0/35 pre-training and 19/5±2/57 post-training which there were different significantly (p<0.001) from the nurses perspective. The mean score of nurse's communication to patients were 21/3± 5/78 post- training and 35/9±4/09 post- training; the paying attention to pain mean score was 15/4± 3/76 pre-training and 27/2±3/01 post- training that there were different significantly as well (p<0.001).

Communication skills training and establishing nurse–patient communication reduces the patient's pain therefore, it's essential that nursing managers and nursing education administrators consider to the nurse's communication skills improvement.

Aim and With respect to importance of chronic pain acceptance assessment in the elderly, accessing to a presice instrument for chronic pain acceptance assessment is essential. Hence, the current study aimed to development and psychometric evaluation of chronic pain acceptance instrument in the elderly. This study is a mixed method research, which implemented in three stages for development and psychometric evaluation of an instrument for chronic pain acceptance assessment in older people. The grounded theory approach was applied for chronic pain acceptance concept exploration in the first stage based on 30 elderly people with chronic pain, 3 relatives and 29 health care providers viewpoints participated with purposive and theoretical sampling methods. At the second stage, instrument sentences were extracted and developed by qualitative part results and review of the valid and related litherature respectively. Methodological approach was applied for psychometric evaluation of that in the third stage based on face, content, and constructs validities, internal consistency and stability reliabilities. Chronic pain acceptance concept was explored at the first stage. Based on participants viewpoints in the qualitative part of study, pain acceptance was means that pain beliving, pain related limitations and disabilitites beliefs which could helps one in pain controlling attempts.Elementary instrument with 38 sentencess was developed at the second stage. During the third phase of the study, face and content validities as quality and quantity methods (Content validity ratio average = 0/94, and content validity index average= 0/92) were performed respectively. More over, construct validity was assessed by exploratory factor analysis, and instrument sentences were decreased to 7 item, in which two factors were obtained, as in the first factor (awareness of pain) including two items and in the second factor (trying to decrease pain) with 5 items, situated respectively. Finaly, internal consistency (α =0/83) and stability reliability by test-retest (0/85) were determined for reliability evaluation. With respect to precise development process and suitable validity and reliability of chronic pain acceptance assessment instrument, its application for pain acceptance assessment and effective pain management in the elderly purposes for health care providers team and researchers.

Aim and Annually about 200-500 million amputations occurring around world because of disease, trauma and congenital defects which approximately 85% are in limbs. For those with amputation the phantom limb pain is a serious problem and causes the therapeutic challenges for who need therapy. Present study was conducted to identify 18 month follow up efficacy Eye Movement Desensitization and Reprocessing on phantom limb pain in patients with amputation. present study is semi-experimental in nature. A total of 40 patients which suffering from phantom limb pain and were under pharmacological therapy for long time selected by available sampling (2012-2014) and were divided by random assignment into experimental and control groups. EMDR method applied for each patient individually at consultation room during 12 sessions per one hour for one month. In order to collect data, demographic and Numeric Rating Scale (NRS) questionnaire were used. data were gathered on phantom limb pain at pretreatment, posttreatment and 18 month follow up and were analyzed using descriptive statistics, repeated measures Mean phantom limb pain in before, after and 18 month follow up intervention was 7.15(±1.08), 3.40(±1.23) and 1.75(±1.01) respectively, which using with repeated measures showed significant difference (p<0.001). these results suggest that 18 month follow up Emdr therapy was successful in the treatment phantom limb pain in patients suffering from amputation. Therefore, its use as a therapeutic and alleviative method could be suggested for patients suffering from phantom limb pain.

Aim and The purpose of this study was to compare the effects of massage therapy, stability exercise and combination exercise on improvement of chronic low back pain Methods and Materials: In this study, 30 patients with chronic low back pain with an average age of 33.44±9.02 years participated. Patients were randomly divided into three groups: massage, stability and combination. The protocol consisted of training for 8 weeks, three days a week and each session was about an hour.Patients for 12 sessions (4 weeks, or every other day), protocols massage, stability exercises and combination with supervision therapists received. The results of this study showed that the studied methods significantly (P<0.05) decreased the pain and improved function compared to the pre-test. Also significant difference was observed between groups (P<0.05). the results showed that stabilization training combined with massage therapy is more effective than using each alone.

Aim and pain is a complication after spinal surgery. Because of non.pharmacological methods are the preferred pharmacological agent therefore; the purpose of this study was assessment of effect of foot Reflexology on pain in scoliosis patients undergoing spinal surgery. Methods and Materials: this study was a randomized controlled trial, conducted on 56 scoliosis patients undergoing spinal surgery hospitalized in the shafa hospital in 2013. The reflexology group received massage the second day after surgery for 4 consecutive days. In the control group, patients foot applying any pressure and only for 1 mintues was fat. Variable pain in before and after the intervention was recorded by the use of short from mac gill pain questionnaire at the time mentioned. results showed that there is a significant differences in all components of mac gill pain questionnaire after the intervention between experimental and control group (P=0). According to the study Results foot Reflexology massage, as one of the branches of complementary alternative method can be recommended in patients after spinal surgery to reduce pain.

Aim and Hemodynamic monitoring of critical patients in intensive units is the cornstone of care. It constitutes an extensive part of care and is helpful in determination of the causes and the response to treatment of hemodynamic instability. Aim of this review articale is to investigate of the Non invasive hemodynamic monitoring in critical care units. 61 articales allocated for this study the time frame covered was 1890 to 2010. The references of this review article were obtained from pubmed,Elsevier, Google scholar, Elsevier mason, Science direct, JAMA. The authors have also used the keywords including: cardiac output, noninvasive, intensive care unit, oxygenation, upstream, Downstream Markers,Hemodynamic monitoring, minimum invasive methods, and Circulatory shock. the results of this study show that The desirable and premium monitoring of serious patients in the intensive care units have yet remained as a challenge. Awareness on the cardiac output which is the most important indicator of cardiac function is of vital importance for deciding on the method of clinical administration, selection of treatment method, clinical assessment, and prognosis of the patients suffering from cardiac problems. a lots of this study show that Non-invasive monitoring system is easier, safer, cheaper, and more effective than invasive monitoring system of cardiac output, if this method is used properly,it could reduce the mortality and morbidity rate.

Since electrocardiography (ECG) is essential for the diagnosis of pediatric asymptomatic Complete Heart Block (CHB) and it is not usually done in the preoperative evaluation of asymptomatic children, physicians might confront with asymptomatic cases of CHB at anesthesia induction. Case Report: In this study, we introduced a 31-month-old boy who faced CHB after anesthesia induction. The mentioned 15-kg-weighted child who had got involved in bradycardia after the induction of anesthesia for renal anti-reflex surgical procedure. Anesthesia was reversed after diagnosis of CHB and emergency cardiology consultation was performed and referred to pediatric cardiac ICU for further evaluation. In the primary ECG, atrial and ventricular beats were 150 and 70 rhythms, respectively, and ventricular complexes were also narrow. A temporary transcutaneous cardiac pacemaker was placed and a normal echocardiography was detected. After the preparation of Angiography Unit, he was provided with a temporary intravenous pacing. A 24-hour Holter Monitoring with the underlying heart rate of 40 bpm was implemented for the patient as an indication of his CHB with an average heart rate of 90 bpm. No other positive finding was obtained. Regarding lack of the patient's improvement after several days, his probable congenital CHB was posed. Subsequently, the patient with a intravenous temporary pacemaker was referred to the referral hospital for surgical procedure and then readmitted at ICU. Two days after the surgery, his pacemaker was removed and he was discharged and recommended for follow-up visits Since anesthetic drugs can intensify bradycardia, preparation of chemical pacemaker, temporary pacemaker, and a skilled physician for their utilization in case of confrontation with such undiagnosed problems is necessary. Moreover, for instances of diagnosed cases, pacemakers should be positioned before commencing anesthesia induction after confirmation of their proper performance.