امید نبویان

Anesthesiologists and surgeons strive as a team to minimize postoperative patient reported pain scores by using modern multimodal pain management protocols. This study was designed to examine the effects of adding different doses of adjuvant tramadol to bupivacaine solution in interscalene block (ISB) in patients undergoing shoulder arthroscopic surgery.

In this prospective controlled randomized double-blinded trial, 60 consecutive eligible subjects candidate for arthroscopic shoulder surgery were assigned randomly into 3 groups. The patients were assigned to receive one of the specific doses of tramadol in bupivacaine mixture in their preoperative ultrasound-guided ISB. In the control group (T0), the ISB was performed with 30 ml solution of perineural 0.25% bupivacaine and epinephrine. The block was performed with the same solution mixed with 100 or 200 mg of adjuvant tramadol with a total volume of 30 ml in patient in T100 and T200 groups, respectively. The required postoperative duration of analgesia, 24 hours postoperative analgesic consumption, observational and patient-reported pain scores, and side effects were recorded in the recovery room and up to 24 hours.

Mean postoperative analgesia duration was significantly longer in group T200 (681 ± 270 min) than in Group T100 (501 ± 298 min) and Group T0 (402 +/- 223 min) (P =0.006). A statistically significant difference was found in the first 24 hour postoperative cumulative opioid consumption among groups T200 (5.5 +/- 3.2 mg), T100 (9.0 +/- 4.5 mg) and T0 (9.30+/- 4.78 mg) (P=0.009).  There was no intergroup difference in intraoperative analgesic consumption, postoperative sedation score, and complications due to ISB or tramadol adverse effects.

There is a dose-dependent prolongation of ISB with adjuvant tramadol for arthroscopic shoulder surgeries.

The present study is an overview of the causes of patient complaints against physicians and the medical staff in Imam Khomeini Hospital Complex، and strategies to reduce the complaints. For this purpose، complaints that had been filed with the clinical governance office of Imam Khomeini Hospital Complex in 2012 and 2013 were investigated. The information in the forms included age and sex of the plaintiffs، their level of education، type of complaint and similar details. Of the 309 complaints، 174 had been recorded in 2012 and 135 in 2013. The plaintiffs were males with a mean age of 50. 5، and 69. 6% of them had high school diplomas or lower. Most (16. 2%) of the complaints pertained to the emergency department، while 48. 5% and 22. 7% of the complaints were related to doctors and nurses respectively. In 62. 5% of the cases، the accused had been acquitted and 34% had been convicted. The main cause of complaint involved treatment and care at 40. 1% and 36. 6% respectively. In general، the most common causes of complaints were treatment and care for doctors، and lack of respect for nurses and others. Thus، more attention should be paid to the continuous education of medical students and residents during training years in order to increase the knowledge and skills of physicians. Other measures that can reduce complaints are: providing sufficient information to patients before diagnostic or therapeutic procedures; improving the equipment in health centers; educating the society and raising public awareness of the treatment process; offering the necessary information during medical procedures; obtaining informed consent; careful choice of the medical team and assigning them to the right position; and holding communication skills workshops.

Background and Opioids are frequently added to local anesthetics in order to improve analgesia in neuraxial blocks which may lead to – sometimes intolerable - pruritus in the patients. In this study the effect of meperidine on pruritus following the preh1ion of opioids (in the scale and dose of mg) in regional anesthesia was investigated. Methods and Materials: This clinical trial was conducted on 54 patients in two groups of 27. The patients included those hospitalized fro cesarean section in the midwifery ward as well as those in the surgical-orthopedic ward. Both groups received anesthetic and opioids (meperidine in mg doses). The first group i.e. the control group received a certain volume of physiologic serum and the second group i.e. the experimental group received the same volume of physiologic serum plus IV meperidine (nanogram dose). Pruritus was measured in the conventional scale at hours 0 6 12 and 24 after surgery. In the statistical analysis Mann Whitney U Fisher's exact test and chi-square were used. in the experimental group incidence and intensity of pruritus (in case of occurring) were significantly lower than the control group (intensity score being one). Using nano-doses of opioids (meperidine) is effective in preventing pruritus.