فهرست مطالب علی موافق

Stress and stressful situations can be a prelude to fatal diseases such as cardiovascular diseases and hypertension. The aim of this study was to investigate the relationship between perceived stress with five major characteristics of the heart disease in patients with myocardial infarction. In this cross sectional descriptive-analytical study that was conducted from May 2005 till October 2009, a total of 3,200 patients with myocardial infarction, from cardiovascular care unit of Ghaem and Imam Reza hospital, Mashhad, were randomly selected. A demographic questionnaire, an instrument for recording laboratory and electrocardiograph finding, and the Perceived Stress Scale were used for data collection. The results of this study show that while 35% of all cases suffer from moderate stress, 65% percent of them suffer from high level of stress. The level of perceived stress in different categories of variables such as gender, educational level, hypertension, history of hypertension, depression, cigarette smoking, exercising, job, level of incoming, location of living, and family history of cardiovascular disease was significantly different from each other. Considering the high levels of stress among patients with myocardial infarction, design and implementation of interventions for identifying stressors, as well as their management seem to be crucial.

Background and Use of intrathecal opioids causes an increase in the block depth of anesthetics and duration of analgesia. Intrathecal opioids are associated with side effects such as itching, nausea and vomiting. However, the use of NSAIDs reduces itching induced by intrathecal opioids. Therefore, the present study intends to determine and compare the effects of nanogram celecoxib on reducing the incidence and intensity of intrathecal meperidine-induced pruritus. Methods and Materials: This double-blind clinical trial was conducted on 90 patients undergoing caesarean section. Patients were randomly assigned into experimental and control groups. The experimental group received 25ng/kg or 100ng/kg celecoxib and the control group received oral placebo. Patients under spinal anesthesia received meperidine 10mg with intrathecal Bupivacaine 0.5%. Then, pruritus was assessed 0, 2, 6, 12 and 24 hours after surgery, and were recorded by scoring criteria. The obtained data were analyzed in SPSS using one-way ANOVA, chi-square and Fisher’s exact test. Values below 5% were considered significant. The difference of the two groups in their age, weight and oral intake was not significant (confidence interval 95%). The incidence of itching in the experimental groups of 25ng/kg (p=0.049) or 100ng/kg celecoxib (p=0.001) in 0 and 2 hours after surgery were significantly lower than the control group; also, the intensity of itching 2 hours after surgery was significantly lower then the control group (p=0.001). Nanogram doses of Celecoxib can be used for reducing the incidence and intensity of meperidine induced pruritus.

We designed a prospective, randomized, double-blind study to evaluate the effect of ultra-low dose of naloxone added to lidocaine and fentanyl mixture on the onset and duration of axillary brachial plexus block. Fifty four patients scheduled for elective hand and forearm surgery under axillary brachial plexus block were randomly allocated to receive either 34 mL lidocaine 1.5% with 2 mL 100 μg) of fentanyl and 1 mL of isotonic saline chloride (control group, n= 27) or 34 mL lidocaine 1.5% with 2 mL(100 μg) of fentanyl and 100 ng(1 mL) naloxone(naloxone group, n= 27). After performance of the block, sensory and motor blockade of radial, median, musculocutaneous, and ulnar nerves were recorded. The duration of surgery and the patient's characteristics were similar in the two groups. There was significant difference in the onset time of the sensory and motor block between groups. The duration of sensory and motor blockade were significantly longer in the naloxone than in the control group. The addition of ultra-low dose of naloxone to lidocaine 1.5% and fentanyl solution in axillary brachial plexus block prolongs the duration of sensory and motor blockade.

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.

Considering undesirable postoperative pain in recovery phase and many side effects of narcotics, the preemptive analgesic effect of oral dextromethorphane on cholecystectomized patients was studied in this study. In this double blind, randomized, clinical trial on 44 patients in Shari’ati Hospital, Tehran University of Medical Sciences, 22 patients received placebo and 22 received 45 mg oral dextromethorphane 2 hours pre-operation. The anesthesia method was the same in both groups. Visual analog scale (VAS) for pain was recorded for each group in 1, 6 and 24 hours. Used morphine amount was recorded. As dextromethorphane causes drowsiness the patient's alertness was also recorded with Ramsey scores post- operation. Data were analyzed using t-test, Chi-square, and Mann-Whitney-U-tests. Mean postoperative pain intensity was 9.55 in case and 8.33 in control group respectively. This was statistically significant but limited only in the first postoperative hour. No difference was observed in 6th, 24th hour pain, sedation, and alertness between the groups. Premedication with 45 mg oral dextromethorphane decreases post operative pain in first hour, so it can be used as an alternative analgesic drug along with narcotics.

Pain is one of the most common postoperative complaints in any type of surgery and has negative effects on all aspects of patient's functions, including psychiatric and somatic functions. Post-thoracotomy pain is commonly very severe and induces complications such as atelectasia. It affects pulmonary function. Different ways of pain control have been studied before and mutually compared. In the present study we compare four methods of post-thoracotomy pain control with emphasis on pulmonary function tests. 100 ASA physical status I & II patients scheduled for posterolateral thoracotomy were included in this study. The patients were randomized into one of the four groups (25 patients in each group): every 6 hours group A received fentanyl via epidural catheter every, group B received 0.25% bupiavacain via epidural catheter, group C were administered 0.25% bupivacain via inter-costal catheter, and group D received intravenous meperidine. Pain was assessed every 6 hours (15 minutes before medication injection) using visual analogue five-grade scale. Pulmonary function indexes were measured before and 72 hours after surgery. The mean of pain were different among the four groups (p≈ 0.00). In group C mean of pain was less than group A by 0.77(p= 0.001) & in group D was less than group A by 0.54 score (p= 0.04). There were no significant differences in pain score among other groups. In group D the petedine requsted were less than A, B & C groups by 61.9mg, 46.6mg & 46.6mg (p≈ 0.00). There was less FEV1/ FVC reduction in group B, but this reduction is not statistically significant. Also FEV1/ FVC ratio are significantly different among groups (p= 0.001) The study shows that intercostal injection of 0.5 ml/kg 0.25% Bupivacain or intravenous injection of 0.5 mg/kg Meperidine every 6 hours has better efficacy for post-thoracotomy pain relief in comparison with the other studied methods.

One of the disturbing complications of propofol is pain on injection and the incidence ranges from 28% to 90%. Metoclopromide is commonly used as an anti emetic drug. Some investigators reported that this drug could reduce the pain on injection of propofol. The aim of this study was to assess and comparison of the efficacy of propofol pretreatment with metoclopromide in incidence and severity of its pain on injection. In a randomized, prospective, double-blinded, placebo-controlled trail, 150 patients 18 to 40 yr old were randomly allocated in one three groups. C group (2ml of normal saline), L group (40mg lidocaine in 2ml), M group (l0mg metoclopromide in 2ml). Immediately after injection of study or placebo drugs, 10 mg of propofol with injection rate of 0.5 ml/s (In 4 Seconds) were injected in to the same vein that was inserted to the most prominent dorsal hand vein. Pain severity was measured using Visual Analogue Pain Scale that were educated to the patients before the trail (0 for no pain and 100 for the most aggressive pain in life) and values other than zero was encountered pain appearance. Patients with signs of sedation were excluded. There was no statistically significant difference between patients in three groups in number of men and women (P = 0.66), age (P = 0.29) and weight (P = 0.49). Furthermore severity (P = differences (C = 41.18, L - 25.4 and M = 13.1, P < 0.001) and patients in metoclopromide group experiences lower pain than other two groups (P < 0.001). Pain incidence in Control group was 77.1% and it was significantly reduced in lidocaine and metoclopromide group (P = 0.002), but there were no significant difference between them (P = 0.051). The 0.69) and incidence (P ~ 0.29) of pain has no significant difference between men and women. Pain severity between three groups has significant results showed that metoclopromide could significantly reduce the seventy of pain on injection of propofol more than lidocaine (opposite to diazepam), but they had no difference in pain incidence. It might lie on the different mechanisms that they produce pain. Pain on injection of diazepam is primarily attributed to propylene glycol, as a vehicle, but the pain mechanism in propofol is remaining unknown. Finally as regards to other useful effects of metoclopromide including postoperative nausea and vomiting and propofol induction dose reduction, especially when there is a medical condition where lidocaine is contraindicated, it may be a reasonable alternative before injection of propofol.