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The subject of pain is one of the topics of interest in various scientific disciplines. Various disciplines such as anthropology, sociology, philosophy, literature, art, etc. along with medical disciplines have discussed and considered pain with different approaches.Among universities and study centers active in the field of treatment, Shahid Beheshti University of Medical Sciences is one of the most important centers for the development of pain fellowships and the development of advanced interventions in the treatment of chronic pain. The aim of this study was to obtain the necessary information about how the field was formed and the process of its creation by talking to its founders and in the form of written articles to related centers and institutions, such as the University and the Pain Association and other related fields

The present study was a mixed-method study. The data were collected in two qualitative and quantitative stages. In the quantitative stage, available litratures were reviewed using systematic search, after that expert were interviewed individually in qualitative stage. Finally, the results of the quantitative and qualitative sections are combined and reported .

Among the shortcomings in all anesthesia and intensive care units in the country was the lack of training in the treatment of acute and chronic pain by anesthesia assistants.

Based on this, the proposal of the first multidisciplinary pain fellowship course based on the executive curricula of prestigious American and European universities, in 2006.This proposal was approved by Shahid Beheshti University and the Secretariat of the Specialized Council and approved during the legal process. In 2007, the first pain fellowship course involving 4 anesthesiologists began.

Controversy exists over the preferred surgical method for inguinal hernia repair between the open and laparoscopic methods. This clinical trial was performed to compare the rate of early complications and recurrence rates of inguinal hernia between laparoscopic (TAPP) and open methods (Lichtenstein).

In this clinical trial, 84 patients who were candidates for elective inguinal hernia repair at Imam Hossain Hospital were randomly divided into two groups: TAPP and Lichtenstein groups. Spinal anesthesia was used for both groups. Patients were followed for short-term complications (e.g. infection, seroma, hematoma, postoperative pain), hospitalization stays, and recurrence within the first year. Data were analyzed using SPSS software (version 16).

There were no significant differences between the two groups in terms of age and gender. Unfortunately, in the TAPP group, 23 patients (54.8%) received general anesthesia due to lack of co-operation, excessive abdominal wall stiffness, and failure of spinal anesthesia. We found shorter hospitalization stay (P <0.001), less postoperative pain in the first 24 hours (P <0.001), and longer operative time (P <0.001) in the TAPP group compared with those in the Lichtenstein group. There were no significant differences between the two groups in terms of infection and recurrence rates in the first year. Seroma was seen only in 16.7% of the patients in the Lichtenstein group (P <0.012). Pain intensity measured in the first 24 hours at three-time points (1, 8, and 24 hours) was lower in the TAPP group with spinal anesthesia than in the TAPP with GA and Lichtenstein groups (P <0.001).

The results of this study showed that TAPP with spinal anesthesia is associated with reduced postoperative pain in the first 24h, and irrespective of the  type of anesthesia TAPP is associated with lower risk of seroma formation

The aim of the present study was to evaluate the efficiency and success rate in training air duct piping using laryngoscope video, considering the importance of air duct piping and claiming more success of direct laryngoscope video method with direct laryngoscope.

In the current interventional study, we enrolled 157 medical interns without any intubation experience in the Emergency Department of Imam Hussein Hospital during 2016. Individuals were divided into two groups: the first group, worked with the direct laryngoscopy, and the second group learned to work with the video laryngoscope. To evaluate and to compare the data in two training modalities, the performance of the individuals including seeing vocal cord, proper positioning, correct posture to the moulage, handling and correct insertion of the laryngoscope, and the successful intubation were recorded. All analyses were performed using SPSS, version 19.

Time of intubation and observing vocal cord in the group trained with video laryngoscope was lower than those in the direct laryngoscopy group (23.3±6.8 vs. 28.8±6.4 and 21.9±5.2 vs. 26.9±5.6 sec, respectively; P-value for both=0.001). Furthermore, failure in observing the vocal cords in the direct laryngoscopy group was higher than those in the video laryngoscope group (23.5 vs. 14.5%, P-value=0.217). The percentages of standing in the correct position in the video laryngoscope and direct laryngoscopy group were 85.5 and 66.7%, respectively (P=0.014).

It seems that given the time spent on intubation and the time of observing vocal cord in the group trained with video laryngoscope in comparison with the group who was prepared with a direct laryngoscope, applying video laryngoscope may have better effects in educating medical interns.

Sever shivering is the most common adverse effect of spinal anesthesia during and after operation that causes physiologic complication. One of the drugs that could decrease operative shivering is ketamine.
The aim of this study is the effect of ketamine to reduce shivering, during spinal anesthesia.
This prospective randomized, and double-blind clinical trial was conducted on 355 patients of candida different surgeries with spinal anesthesia in Bu-Ali and Velayat Hospitals in Qazvin (2017). Patients were randomly divided into experimental (n=175) and control (n=180) groups. For the experimental and control groups, ketamine (0.2 ml/kg) or an equal volume of distilled water were administered with intravenous infusion pumps immediately after initiating spinal anesthesia, respectively. Then degree of shivering checked by anesthesiologist with visual scale during surgery.
Findings: The rate and intensity of shivering at ketamine group significantly decreased compared to the control group. Shivering during surgery was less than in men, urological surgery and age (20-40 years) in both groups.
Adding ketamine to drug’s pump in patients undergoing spinal anesthesia could be effective method to control shivering during operation.

Intravenous lidocaine has anti-inflammatory role and analgesic properties, and is able to reduce the need for opioids during and after surgery. This study was conducted with the aim of evaluating the effect of intravenous (IV) lidocaine infusion during general anesthesia on levels of inflammatory factors according to Glasgow prognostic score in breast cancer surgery candidates.
The present study is a randomized clinical trial. 63 patients with breast cancer, who were candidates of mastectomy elective surgery, were included. The patients were allocated to 2 groups using a random numbers table. After inducing anesthesia similarly for all the patients using midazolam 0.02 mg/kg, fentanyl 2-4 µg/kg, propofol 1-2 mg/kg and atracurium 0.5 mg/kg, the first group received 1.5 mg/kg/hr IV lidocaine and in the second group, the same volume of normal saline was infused intravenously. Glasgow prognostic score was calculated before surgery and also 6, 24, and 48 hours and 14 days after surgery. Required data were gathered via a checklist. To statistically analyze the data, SPSS software version 20 was used. To compare qualitative variables, Fisher’s exact test, and to compare means of quantitative data, independent t-test was applied. In addition, for comparing C reactive protein, albumin, and Glasgow prognostic score measures between the 2 groups; generalized mixed model regression analysis was used. Significance level was considered to be p A total of 63 women with breast cancer, with the mean age of 49.25 ± 9.32 years, were included. 28 of them were allocated to lidocaine group and 35 were in the control group. Mean age was 48.61 ± 9.26 years in lidocaine group and 49.89 ± 9.38 years in control group (p=0.591). Additionally, there was no statistically significant difference between the 2 groups regarding incision size (p=1.000) and duration of surgery (p=0.752). Using mixed model regression analysis and after adjusting the effect of baseline measures of variables, a significant difference was not detected between the groups regarding their Glasgow prognostic score during the follow-up time (p=0.122).
Based on the results of this study, IV infusion of lidocaine during general anesthesia did not have a significant effect on the level of inflammatory factors according to Glasgow prognostic score in patients who were candidates of breast cancer surgery.

Nausea and vomiting are common in patients after minor gynecological surgeries. This study was performed to assess prophylactic effects of Deroperidol, Dexamethasone and metoclopramide on nausea and vomiting after hysteroscopy surgery.
120 patients ASA 1, 2 undergoing diagnostic hysteroscopy were randomly allocated in 4 groups: group 1 received deroperidol 1.25 mg / IV, group 2 received dexamethasone 8 mg /IV, group 3 received metoclopramide 10mg/IV and group 4 received normal saline immediately after induction of Anesthesia. Frequency of nausea and vomiting and rescue treatments were recorded in PACU and 24 hours after surgery. Recovery Steward scores were assessed at 15 and 30 minutes in PACU.
Demographic parameters of patients in trial groups were similar. Frequency of nausea and vomiting in deroperidol was significantly lower than the other groups (p= 0.000) However, incidence of nausea was the same among groups. The number of patients who required rescue treatment at PACU was less in deroperidol group than other groups. (p = 0.03). The mean number of nausea and vomiting per patient in 24 hours was 1.2, 1.46, 1.66 and 1.71 for group 1,2,3 and 4. The steward recovery scores of groups were similar in 30 minutes at PACU. However, in 15 minutes in group 1 was lower than group 3,4 but not different from group 2.
Over all, prophylactic administration of deroperidol, dexamethasone and metoclopramide decrease PONV but deroperidol is the most effective agent.

This study was performed with the aim of comparing the dosage of opioid consumption for induction and maintenance of anesthesia in people with and without sleep disorder.
In this cohort study for patients who candidate for cataract surgery, Pittsburgh sleep quality questionnaire was completed and based on the results, patients were divided into 2 groups of normal, and sleep disorder. The same protocol was used for induction and maintenance of anesthesia in all patients. Total dose of fentanyl consumption was calculated and recorded.
70 patients with the mean age of 63.8 ± 10.7 years were entered (67.1% female). Demographic and baseline characteristics of the patients were not significantly different between normal and sleep disorder groups. Fentanyl consumption for induction and maintenance of anesthesia were lower in the sleep disorder group compared to the normal group, but the difference was not statistically significant (p Based on the findings of this study, it seems that although patients with sleep disorders need a lower dose of opioids for induction and maintenance of anesthesia during surgery, compared to those who are normal in this regard, the difference is not statistically significant.

The present study was designed and carried out aiming to evaluate the effects of local Dexmedetomidine on propofol consumption in candidate patients for fiberoptic nasotracheal awake intubation.
Candidate patients were randomly divided into two groups including local Dexmedetomidine group and control group. Local anesthesia using lidocaine was performed in all patients followed by injection of Dexmedetomidine in local Dexmedetomidine group. After performing the intubation, propofol infusion was used to keep the patients on considered cerebral state index (CSI). Hemodynamic parameters and arterial blood O2 saturation (SpO2) were monitored. Propofol consumption for assessing CSI about 65-75 was measured.
A total of 64 patients with the mean age of 44.9±13.9 were evaluated (54.7% female). Baseline hemodynamic parameters and SpO2 were not significantly different between two groups. There is significant statistical difference in propofol consumption between local Dexmedetomidine group in compare with control (p It is likely that local Dexmedetomidine can be useful with the aim of propofol dose saving during awake intubation via fiberoptic.

Dexmedetomidine is a selective αR2 R adrenoceptor agonist by anxiolytic and analgesic properties which in perineural administration as an adjuvant to local anesthetic can prolong analgesia and decrease opioid side effects. As there is any study performed on the effect of dexmedetomidine as sole anesthetic agent on intraoperative hemodynamic parameters, in the present study perineural Dexmedetomine effects on hemodynamic alterations during femoral shaft fracture has been assessed.
As a double blinded clinical trial on 64 ASA class I, II patients by femoral shaft fracture under general anesthesia, the patients were divided into two groups according to block permuted randomization: group (D) who had ultrasound guided perineural block by 100 microgram Dexmedetomidine and group (c) who did not have any block. Hemodynamic parameters in both groups were recorded.
Mean Systolic, Diastolic blood pressure and heart rate during three hours after operation were significantly less than the first hour in (D) group. (P Dexmedetomidine as a sole local agent reduced mean heart rate, systolic and diastolic blood pressure during the 3 hours of operation in comparison with the control group.

Neurologic dysfunction is a common complication after coronary artery bypass graft surgeries. Magnesium sulphate is a non competitive NMDA receptor antagonist which is associated with improved neurological function, especially in shortterm memory. The aim of this study was to examine the effects of magnesium sulphate on neurocognitive dysfunction after coronary artery bypass graft surgery.

In a double blind clinical trial study 80 patients were randomly entered to two different groups: The first group consisted of patients who got 800 mg of magnesium sulphate 50% during induction of anesthesia in 15 minutes and the following 3200 mg of magnesium sulphate during 24 hours. The second group received normal saline as placebo exactly in the same manner and the same amount. All patients were assessed by Mini Mental Status Exam (MMSE) before and 5 to 7 days after operation.

Demographic data were the same between two groups. Post-operative cognitive status scores decreased in comparison with pre-operative state but there was less decrease in magnesium sulphate than the normal saline group (p= 0.02).

According to MMSE scores, magnesium sulphate can decrease cognitive complications after CABG surgeries.

Lack of adequate pain control after laparoscopic cholecystectomy is of displeasure and delays post-operative discharge. Considering the systemic side effects of opioids, several techniques including thoracic epidural or intraperitoneal analgesia are used as an alternative to control postop pain. In this study we compare the analgesic effects of single dose intraperitoneal bupivacaine plus fentanyl to single dose of thoracic epidural as two different analgesic techniques in laparoscopic cholecystectomy.

In a randomized clinical trial, 52 ASA class I, II patients between 18 to 68 candidate for laparoscopic cholecystectomy were divided into intraperitoneal (I) and thoracic epidural (T) groups. In (I) group, before Trocar removal, 80 ml of 0.125% Bupivacaine plus 50 microgram fentanyl and 1/200000 epinephrine were injected intraperitoneally via infra umbilical incision site. In (T) group 15 ml of 0.125% bupivacaine plus 50 microgram fentanyl and 1/200000 epinephrine wereinjected through epidural thoracic space. Pain at thetime of discharge from recovery room and within 6,12 and 24 hours after surgery, using visual analog scale (VAS) were evaluated and the first time of analgesic need with VAS>3 were recorded and compared. Total morphine consumption in recovery room and within 24 hours post-operative were recorded and compared. Moreover, hemodynamic parameters and postop nausea and vomiting were assessed.

Effects of postop analgesia and time to first analgesic requirement in intraperitoneal and thoracic epidural groups were not statistically different (p values> 0.05).

Both intraperitoneal and thoracic epidural analgesia are effective techniques in post laparoscopic cholecystectomy pain control, which are applicable according to patient’s condition.

Menstrual cycle has considerable effects on physiologic parameters. Premenstrual syndrome (PMS) is a nearly common syndrome by related effects on hemodynamic alterations. The effects of PMS on anesthesia parameters are a concern which has not been studied before. In a cohort study 80 women between 18-48 years, ASA class 1 candidate for laparotomy surgeries (cystectomy, myomectomy) according to American college of Obstetrics & Gynecologic (ACOG) criteria divided into two 40 different groups: Premenstrual syndrome (PMS) positive and negative.All operations were performed in follicular phase of menstruation. Heart rates mean arterial blood pressure (MAP), cerebral state Index (CSI), total dose of fentanyl and propofol during anesthesia have all been recorded and assessed. Total dose of fentanyl consumption during anesthesia in PMS+ was 209±67μg and in PMSgroups was 135±33μg (p<0.001). Total dose of intraoperative propofol in PMS+ was 893±244 mg and in PMS- was 721±177 mg (p<0.001). Mean changes of HR and MAP in PMS + group were more considerable than PMS - patients. Fentanyl and propofol consumption in PMS+ patients during anesthesia are significantly more than PMS- group that necessitate more consideration in anesthesia management of such a group of patients.

Blindness is a catastrophic complication of surgeries performed in prone position. It occurs mainly due to hemodynamic alterations and the relevant effects on optic nerve perfusion. In this study, we compared the effects of propofol and isoflurane on intra ocular pressure of patients by having Lumbar disk surgeries. In our randomized clinical trial, 60 patients were candidates for lumbar disk surgery accidentally assigned into two groups of propofol (P) and isoflurane (I). IOP measured before and after induction of anesthesia in supine position, immediately after prone and at the end of operation in prone and after turning the patients back to supine position. Mean arterial pressure (MAP), systolic (SBP) and bDiastolic blood pressure (DBP) and heart rate (HR) all assessed. Finally, all data are evaluated by using T-test, Chi-square test and Generalized Estimating Equations. Mean IOP of awake patients in supine position in I and P groups were 15.8±3.1 and 18.2±5.4 mmHg, and at the end of operation, in prone position IOPs were changed to 18±5.8 and 17.2±4.9 mmHg that these alterations were significant (p=0.024). According to mixed analysis, MAP, SBP, DBP, ET CO2 and HR had no significant changes in two groups. (p<0.05) In comparison with isoflurone, propofol can control IOP during lumbar disk surgeries in prone position despite of no significant alterations in hemodynamic responses.

Intravenous regional anesthesia (IVRA) is an efficient method for short-term procedures of the upper extremities. Some defects are associated with IVRA including tourniquet-related pain and insufficient duration of the anesthesia. The main purpose of the current study was to compare the effects of adding paracetamol or magnesium sulfate to lidocaine in IVRA on pain، venous blood gasses (VBG) and sensory and motor block. There were 90 patients contributed in the current study. Patients were divided into paracetamol (P)، magnesium sulfate (Mg) and control (C) groups، randomly. Severity of the pain، time interval between the injection and onset of the sensory and motor block، duration of the sensory and motor block and the changes of VBG were measured. The onset of the sensory and motor block was reduced significantly in Mg group (p<0. 05). There was a meaningful increase in the motor block duration in Mg group in relation to C group (p<0. 05)، but no statistically significant difference between Mg and P groups. Also، there was no meaningful difference between C and P groups in the means of onset of block and block duration. Neither MgSO4 nor paracetamol decreased the tourniquet-related pain. The changes of VBG were significantly lesser in the P group. Adding MgSO4 to lidocaine improves the sensory and motor block in the IVRA. In other hand، paracetamol prevents ischemic changes to occur. None of these drugs are helpful to relief the tourniquet-related pain.