محمد رادمهر

 In arthroplasty, spinal anesthesia was preferred to general anesthesia for a variety of reasons due to the use of cement. the side effects of cement on the cardiovascular system of patients, which can be catastrophic, it,s necessary to find appropriate treatment methods to reduce side effects of cement.

In this clinical trial, 90 patients were arthroplasty candidates divided into three groups. The first group 25 mg intravenous promethazine, the second 10 mg intravenous ephedrine and the control group the equivalent volume of distilled intravenous water 10 minutes before cement injection received. Hemodynamic symptoms of patients entering the operating room, after spinal, immediately before injection. The drug was recorded after injection, five and ten minutes after cement injection. Data analysis by descriptive and inferential levels.

  promethazine and ephedrine and control groups in systolic blood pressure at the time after drug injection and five and ten minutes after cement and diastolic blood pressure at 10 minutes after cement were significant(p<0.05). There was a significant difference between the study groups in heart rate at five minutes after cementing (p = 0.041) and also in terms of O2 SAT at time of arrival (p = 0.001).

 According to the results of the study, in patients with arthroplasty by injection of cement due to hemodynamic changes, the use of ephedrine and promethazine can affect the hemodynamic stability of patients and help stabilize systolic blood pressure (ephedrine) and diastolic blood pressure and heart rate (promethazine) To minimize the complications of these surgeries

Nurses spend more time with patients than other medical personnel and this requires proper decision making by nurses regarding proper and effective pain control in patients. Therefore, this study was conducted to determine the knowledge and attitude of nurses in Jahrom University of Medical Sciences towards pain management.

This descriptive-analytical study was performed on 142 nurses working in hospitals of Jahrom University of Medical Sciences in 2021. Data collection tools in this study are demographic information questionnaire and nurseschr('39') knowledge and attitude questionnaire about pain. Data analysis was performed using SPSS software version 21 and descriptive statistical tests and inferential tests.

The Mean score of nurses chr('39')knowledge about pain management was 10.8±3.3 and the mean score of nurseschr('39') attitude towards pain management was 63.1±7.9. The level of knowledge of the majority of nurses was 130 (91.5%) and the level of attitude of the majority of nurses towards pain management was 112 (78.9%). Only 24 (16.9%) nurses had a positive attitude towards pain management. Pearson correlation coefficient showed a positive and significant relationship between knowledge score and nurseschr('39')attitude score (r=0.248, P=0.003).

The results of the present study showed that most nurses do not have sufficient knowledge and attitude towards pain management. Therefore, training and holding retraining classes are recommended for all nurses in modern jobs.

Various drugs are used as adjuvants for various purposes such as increasing analgesia, reducing analgesic complications and generally improving the quality of anesthesia with topical anesthetics. The use of alpha-2 agonists has recently been considered. One of these drugs is dexmedetomidine, which has been studied recently. The aim of this study was to evaluate the effect of dexmedetomidine as an adjunct to bupivacaine in spinal anesthesia in femoral fracture orthopedic surgery.

This double-blind randomized clinical trial study was performed on 60 patients 18-50 years old with Class I and II anesthesia who were candidates for tibia and femur orthopedic fracture surgery. Patients were randomly divided into two groups of intervention: 12.5 mg bupivacaine (2.5 cc) and 5 µg dexmedomidine (0.5 ml) and control group: 12.5 mg bupivacaine and 0.5 ml normal saline. Systolic, diastolic, and mean arterial blood pressure and pulse counts were recorded before spinal anesthesia, after anesthesia and then every 15 minutes until surgery and at recovery time. At 2, 8, 4, 12, and 24 hours postoperatively, patients were evaluated for pain, opioid administration during the first 24 hours, and the time of first analgesic administration.

There was a significant difference between the bupivacaine-normal saline and bupivacaine- dexmedetomidine groups in terms of systolic and diastolic blood pressure at 15, 30, 45 and 60 minutes during surgery (P<0.05). There was a significant difference in the frequency of pain between the Bupivacaine-Normal Saline and Bupivacaine- dexmedetomidine groups at 4, 8 and 24 hours postoperatively (P<0.05).

The results of this study showed that addition of 5 μg dexmedetomidine to bupivacaine in spinal anesthesia method prolonged analgesia time, decreased pain intensity, decreased postoperative opiate requirement. Conspicoiusly, there was no risk of respiratory suppression even at higher doses than other medicines used. Conclusively, dexamethasone seems to be an appropriate supplement to be added to bupivacaine to reduce postoperative pain.

Post-anesthesia shivering causes discomfort in the patient. Many drugs have tried to prevent or reduce shivering, but the ideal drug has not been finalized yet. The purpose of this study was todetermine the effect of dexodomodinewith bupivacaine in spinal anesthesia to prevent shivering in orthopedic fracture surgeryof femur and tibia.

This randomized clinical trial study was performed on 60 patients 18-50 years old with ASA class 1 and 2 who were candidates for tibia and femur orthopedic fracture surgeryin 2018. Patients were randomly divided into two groups; Intervention group: 12.5 mg bupivacaine (2.5 cc) and 5 μgdexmedetomidine (0.5 ml) and control group: 12.5 mg bupivacaine and 0.5 ml normal. Systolic, diastolic, and mean arterial blood pressure and blood O2% saturationwere recorded before spinal anesthesia, after anesthesia and then every 15 minutes until surgery and recovery time. At 2, 4, 8, 12 and 24 hours postoperatively shivering was evaluated. Data were analyzed using descriptive statistics indices (mean, percentage and standard deviation) and inferential statistical tests (chi-square, t-test, and Mann-Whitneyu) using SPSS 21 software.

The mean age of patients in the control group was 36.6 ±14.7 years and the intervention group was 32.7± 8.6 years. There was no significant difference in the frequency of shivering between the control and intervention groups at 2(4.3% vs. 7.1%) and 4(4.5% vs. 24.1%).Although, intervention subjects had no any shivering state at hours of 8, 12 and 24, but there was no significantly different compared to control group (7.1%, 3.6% and 3.6%, respectively).
 

The results of study showed that addition of 5 μgdexmedetomidine to bupivacaine in spinal anesthesia reduces the incidence of postoperative shivering, but this difference was not statistically significant. Thus, in this subject seems bee need to studies with whole and large sample of participants.

Paracetamol is a pre-acetaminophen drug that has been administered for analgesic and anti-inflammatory effects. In addition to having analgesic properties, it is associated with fewer complications. The aim of this study is to evaluate the analgesic effect of paracetamol for pain relief during and after surgery of the upper limb. The present study, double-blind and trial Randomized controlled, was performed on 44 patients from 15 to 55 years old, all with ASA1 and candidates of the upper extremity orthopedic surgery. The method of anesthesia was the same in all patients, and 22 patients were divided randomly into two equal 22-member groups. The first group received 15 mg kg paracetamol and the second group was the control group that did not receive any medication. According to Kolmogorov-Smirnov test on the distribution data, the pain before surgery was normal (p-value <0.05,), while was not normal after surgery (p-value <0.05). The results of Mann-Whitney test (Mann-Whitney Test) showed that the average drug consumption between the two groups during the whole study had no significant difference (P-value> 0.05). Paracetamol is not enough to reduce severe pain after orthopedic surgery of the upper limb. However, its analgesic effect brings out a 40 percent drop in drug use 1 hour after the end of surgery; so, paracetamol can be used as an aid to reduce pain.

Postoperative analgesia is one of the most concerns of anesthesiologist and patients. Systemic opioids administration is the gold standard in reducing the severe pain after surgery but some side effects prevent the use of adequate doses of opioids. The aim of this study was evaluation of adding acetaminophen on fentanyl in patient-controlled iv analgesia (PCIA). In this randomized clinical trial, 120 patients candidate for lower limb orthopedic surgery (ASA I-II) were recruited in Rasoul-Akram Medical Center in a 12- month period. They randomly allocated in two groups for postoperative pain, group F (Fentanyl) ((n=60) and group AF (Acetaminophen/ Fentanyl) (n=60) by patient-controledl intravenous analgesia (PCIA) groups. The pump has a continuous infusion of 5 ml per hour, bolus dose 2 ml and the lock out time 30 minutes was left. Each ml of solution in group F containing 10 mcg of fentanyl and in the group AF containing 5 mcg fentanyl and 20 mg acetaminophen. Pain score, sedation score, satisfaction, nausea and vomiting was evaluated for 48 hours after surgery. The demographic characteristics of the two groups did not differ significantly. Pain scores befor pump in F and AF groups were 6.8±1.6 and 6.5±1.4, respectively. After 24 and 48 hours pain scores (2.4± 0.8, 1.7± 0.7) and (1.9± 0.6, 1.2± 0.5) decreased (P<0.001). Changes in pain scores were similar in both groups. Level of sedation, nausea and vomiting in the F group and satisfaction in the AF group was higher. This study showed adding iv acetaminophen to fentanyl through an PCIA is effective in controlling pain in patients undergoing lower limb orthopedic surgery. Moreover, acetaminophen and fentanyl combination and has fewer side effects such as nausea, vomiting and sedation and more satisfaction than fentanyl alone.

Line S-80-18 (Deberia) a spring bread wheat line with pedigree of HD160/5/Tob/Cno/23854/3/Nai60//Tit/Son64/4/LR/Son64 was selected from the High Temperature Wheat Yield Trial, received from CIMMYT and evaluated at Zabol research station in 1994-95 cropping season. As a superior line, it was advanced to the Preliminary Yield Trial at Zabol station in 1995-96 cropping season. Due to high grain yield and desirable agronomic characteristics, it was further evaluated in a replicated yield trial at Zabol during 1998-99 cropping season and later in the Preliminary Regional Wheat Yield Trial of the southern warm and dry agro-climatic zone of Iran in five research stations of Ahvaz, Darab, Zabol, Iranshahr and Dezful in 1999-2000, where this line out-yielded Chamran (improved check) by more than 7%. The new line was advanced to the Advanced Regional Wheat Yield Trial for further evaluation in Ahvaz, Darab, Zabol and Dezful in 2001-01, and again yielded 5.2% more than Chamran. The adaptability and grain yield stability of this line was evaluated for two years in Elite Regional Wheat Yield Trial in six stations of Ahvaz, Darab, Zabol, Iranshahr, Dezful and Khorramabad during 2001-2003 cropping seasons. The results confirmed the wide adaptability and grain yield stability of the new line, therefore, it was finally evaluated in on-farm trials in different locations across the southern dry and warm areas of Iran in 2003-04 cropping season. Considering high grain yield, high resistance to stripe and leaf rust, exhibited in different hot spots locations, good grain quality (protein contents of 11-13.2%) as well as good agronomic performance including earliness, resistance to terminal heat stress and shattering, this line was officially introduced in Iran with the name of Aflak in 2010.

At the first 48 hours after orthopedic surgery opioids are used for analgesia.Continuous popliteal nerve block has been performed with increasing frequency for postoperative analgesia after foot surgery and provide better analgesia than traditional systemic opioid-based analgesia.Several additives have been combined with local anesthetics for peripheral nerve blocks. Magnesium is well known as an antagonist of N-methyl-d-aspartate receptors and has some analgesic property.The aim of this study was addition of magnesium to lidocaine in patient- controlled regional analgesia (PCRA) through the popliteal catheter. Forty four patients scheduled for hospital admission after foot surgery entered into this study and divided two group,control(I) and magnesium(II).In control group lidocaine %1(5ml/h) and group II lidocaine %1(5ml/h) + magnesium (5mg/h) infused with (PCRA) pump. Patient characteristics, pain scores (VAS), use of analgesic medications (iv morphine), and side effects of analgesic therapy were recorded for 48 hours after surgery. Pain score (VAS) was more in control group than group II (P=0.001).there was no ignificant difference between two groups in morphin consumption and nausea and vomiting (P=0.12). There were significant difference between two groups in Sedation score(P=0.007) and motion (P=0.001). This study showed addition of magnesium to lidocaine %1 in patient-controlled egional analgesia (PCRA) through the popliteal nerve block catheter have advantages for post operative pain, sedation, motion, reductionof morphin consumption and nausea and vomitig after the foot surgery.

Postoperative pain is one of the most common problems after surgery،especially orthopedic surgery which if not prevent the onset or inadequate treatment، especially in older irreparable adverse reactions to be followed. Analgesic use of continuous epidural infusion in lower limb surgery with simultaneous use of local anesthetic drugs and narcotics is one of the most effective and safest methods of analgesic than the other methods is systemic. This study as double blind clinical trial was conducted، 82 patients undergoing lower limb orthopedic surgery in two groups randomly divided into 41 equal and after insertion of the epidural catheter before surgery، after surgery in all stages Patients pump analgesia epidural continuous infusion with two diet drug F (bupivacaine 0. 125 % + fentanyl 5 micr/ ml) and S (bupivacaine 0. 125 % + sufentanil 0. 5 micr/ ml) with a speed of 5ml/ h Connected. The pain intensity based on (VAS) and side of motor block، nausea and vomiting، itching، urinary retention،hypotension and respiratory depression during 1، 3، 8، 16، 24، 48 hours after surgery in both groups measured and recorded. The demographic in both groups، similar to one another. The mean pain scores (VAS) during activity than resting there، but the total in both S and F mean pain scores during activity and rest less than 3 was And a significant difference does not show the different hours. Hypotension in the first hour in group F than the S group had significantly increased، but at other hours is not a significant difference. Motor block and nausea and vomiting، although in Group S than Group F، but the difference was not significant. Difference in other complications (pruritus، sedation،respiratory depression) between the two groups is not significant. This study shows that both fentanyl and sufentanil regimen with bupivacaine in epidural analgesia with continuous infusion led to similar analgesia and acceptable side effects except the first hour of hypotension after surgery.

The objective of our study was so to show the efficacy of PCIA with morphine or lornoxicam on the attenuation of postoperative pain after laparoscopic gastric bypass surgery. In this randomized clinical trial، 60 patients who were candidates for laparoscopic gastric bypass surgery were included. Patients were randomly receiving morphine (n=30) or lornoxicam (n=30) through PCIA for postoperative pain relief، at the end of the procedure. Visual analogue scale (VAS)، sedation score، and nausea and vomiting score (N&V score) were used up to 24 hours after laparoscopy. A physician، who was not aware of the therapy undertaken، evaluated the patients. There were no statistically significant differences between two groups according to age، gender، and body mass index. Before intervention، the means of pain intensity (VAS) in the morphine and lornoxicam groups were 6. 3±1. 7 and 6. 6±1. 5، respectively. After 24 hours، the means reduced to 1. 6±0. 8 and 1. 7±0. 5، respectively (p<0. 001). The changes of pain score were the same in two groups. During 24 hours follow-up، the means of sedation and N&V scores in patients receiving morphine were higher than the patients receiving lornoxicam significantly. Our finding suggests that administration of lornoxicam through PCIA is as effective as administration of morphine through PCIA with in management of post-operative pain in patients undergone laparoscopic surgery. In addition، lornoxicam has less side-effect such as sedation، nausea and vomiting than morphine.

Background and ObjectivesBlood reservation is done in many surgical operations because of the risk of bleeding. However, reservation should be based on a standard protocol so as to prevent blood loss. In this study, we deal with the ratio and causes of unused blood ordered from blood bank in elective surgeries in Rasoul-e-Akram hospital in Tehran. Materials and MethodsIn this descriptive study, a questionnaire was added to file records of patients who were candidates for elective surgery in Rasoul-e Akram Hospital during 2005. Questionnaires were filled out by the physicians who had ordered blood after patient's discharge; these questionnaires were ultimately sent to blood transfusion committee. The collected data were then analyzed using descriptive statistic methods and SPSS version11.5. ResultsThe total number of reserved blood bags for elective surgeries was 8385 in one year out of which 1460 (17/4%) were transfused. The ratio of transfused cross-matched blood was 3.12; the major reason for ordered blood not to be used was incorrect surgical team estimation (44.6%). ConclusionsThis study revealed that blood reservation is not performed based on any definite protocol and it is necessary to control the reservation and use of blood both qualitatively and quantitatively in medical centers.

Although shivering is one of the consequences of perioperative hypothermia and is rarely considered as the most serious complication, it occurs frequently and remains poorly understood. While cold-induced shivering has an obvious etiology, post-general anesthetic shivering is attributed to numerous causes. Until now, dexamethasone has been used for the treatment of post-general anesthetic shivering. The objective of the present study is to evaluate the effects of intravenous dexamethasone on the prevention of post-general anesthetic shivering. Patients and 80 patients who were candidates for elective knee arthroscopic surgery were selected and randomly divided into case and control groups. Immediately after the induction stage of anesthesia, which was the same for both groups, 0.15 mg/kg of intravenous dexamethasone was administered to the case group. The same amount of distilled water was intravenously administered as placebo to the control group. The temperature of the operating room was kept between 20 and 25 degrees centigrade. When the operation ended, shivering score was measured and recorded by a trained nurse in the recovery room. The patients and the nurse were blind to case and control allocation of the patients. The mean age of the patients, the temperature difference between operating room and patient's body, and shivering score were 27.34 years, 9.52 degrees centigrade and 1.76 respectively. Both groups were matched for age, weight, operating room and patient's body temperature difference, surgery time, recovery time, and the amount of administered fluids. There were statistically significant differences in score and incidence of shivering between the two groups. A statistically significant correlation was also found between administered fluid volume and shivering score in both groups. The obtained results revealed that intravenous dexamethasone is effective in the prevention of post-general anesthetic shivering. This confirms previous studies and it seems that this study supports central mechanism of post-general anesthetic shivering rather than peripheral one.

In order to determine, source of grain yield limitation under different enviromental conditions, as well as indentifying the rate of restrication caused by terminal heat stress on development and growth of wheat, this research was conducted with twenty wheat genotypes using Randomized Complete Block Design (RCBD) with three replications, in two separate experiments in two years(1998-2000). The experiments were sown in late of december and january to stimulate favoarable and unfavourable conditions, respectively. Five to seven days after anthesis flag leaf and spikelets from one side of spike were removed to stimulate, sink and source limitation respectively. Aftert harvest, source and sink restrication percentage were calculated according to the mean of remaining grains in treated spike and control (without removal of flag leaf and spikelets). Results indicated that all genotypes had not sink restrication and the contribution of flag leaf to grain dry weight was 12%. However, some genotypes showed source restrication. This restrication was estimated from 0 to 34% (mean: 12.6%) and 5.7 – 41.2% (mean:17.2%) for favourable and unfavourable conditions, respectively. Therfore, source restrication caused by exposure to terminal heat stress was greater by 6%. Likewise, results indicated that source restrication was higher in genotypes with large grain size. Grain weight had not significant effect in the determination of final yield. Reduction in grain yield must be sought in other yield components, such as grain number per spike and spikes number per sqaure meter.