فهرست مطالب محمود رضا آل بویه

Continuous epidural analgesia (CEA) is the most common local anesthesia technique used to control pain after Total knee arthroplasty (TKA). CEA has many side effects. Continuous paravertebral block is an effective method with fewer side effects in controlling TKA pain. The aim of this study was to compare the effect of this two methods on post-TKA pain.TKA patients were randomly divided into two groups (N = 19): A) CEB: Bupivacaine 0.25% was injected epiduraly by pump at 4 ml / hr during 24 hours after surgery. B) Continuous Lumbar Paravertebral Block (CLPB): all interventions were similar to group A, but by paravertebral catheter. Basic Mobility Scale (BMS) and the Visual Analogue Scale (VAS) ( static and dynamic) four times (4, 8, 16 and 24 hours after surgery) were measured and recorded. Use of opioids and their complications were measured.Patients in the CLPB group experienced significantly less dynamic and static pain 4 and 8 hours after TKA than patients in the CEA group (p< 0.05). There was no side effects in patients in the CLPB group but,  patients in the CEA group experienced Nausea and Vomiting. No significant difference was observed for BMS and Muscular Strength in any of the follow-up stages between the two groups (P> 0.05).Continuous paravertebral block has equal efficacy in controlling pain in patients undergoing TKA surgery compared to continuous epidural block. Due to, lack of complications it can be considered as a suitable alternative in TKA patients.

The purpose of this study was to compare of the effectiveness of acceptance and commitment therapy and positive cognitive-behavioral therapy on the psychological disquietudes of patients with chronic pain.

The present study was semi-experimental with pretest, posttest, and follow-up design with a three-month with control-group. The sample of thise study included of 45 people of patients with chronic pain referring to Rasool Akram Hospital of Tehran sity. selected by available sampling method and were assigned randomly into two experimental groups and one control group. three groups completed Depression, Anxiety, Stress Scall (DASS-21) in pre-test, post-test and follow-up. 2 group received intervention duration in 8 sessions of 90 minutes a week for 1 session, acceptance and commitment therapy and positive cognitive behavioral therapy. and did not received the control group any intervention. at the end was performed post-test of all three groups. Data were analyzed by SPSS- 25 and using descriptive statistics indices and repeated measure.

There was significant difference between acceptance and commitment-based therapy and positive cognitive-behavioral therapy with control group on the psychological disquietudes of patients with chronic pain (p<0/001). But there was no significant difference between acceptance and commitment-based therapy and positive cognitive-behavioral therapy on the psychological disquietudes of patients with chronic pain (p> 0/05).

acceptance and commitment-based therapy and positive cognitive-behavioral therapy can be used as a useful intervention method for decreasing on the psychological disquietudes of patients with chronic pain.

Several studies have been conducted on the impact of acceptance-based and cognitive-behavioral therapy. But research comparing the efficacy of acceptance-based and commitment-based therapy and positive cognitive-behavioral therapy on pain self-efficacy in patients with chronic pain remains neglected.

To compare the efficacy of acceptance and commitment based therapy and positive cognitive-behavioral therapy on pain self-efficacy in patients with chronic pain.

This study was a quasi-experimental study with a 3-month-old instructor with 3 witnesses. The statistical population consisted of all patients with chronic pain referred to Hazrat Rasool Akram Hospital in Tehran in summer of 2019. 45 patients were selected as the sample and randomly assigned to one of the two groups. Research tools are: Nicholas Pain Self-efficacy Questionnaire (2007), Acceptance and Commitment Therapy Intervention (Hayes et al., 2013) and Positive Cognitive-Behavioral Therapy (Ben Nink, 2014). Descriptive statistics and repeated measures analysis were used.

There was a significant difference between acceptance and commitment based therapy and positive cognitive-behavioral therapy with the control group in pain self-efficacy in patients with chronic pain (P< 0/001). But there was no significant difference between acceptance and commitment based therapy and positive cognitive-behavioral therapy in pain self-efficacy in patients with chronic pain (P< 0/05).

Acceptance and commitment based therapy and positive cognitive-behavioral therapies are important in increasing my pain self-efficacy.

Postoperative pain management would result in increased patient’s satisfaction and decreases their problems. This survey was performed to determine the efficacy of premedication with dextromethorphan and gabapentin alone or in combination, for postoperative pain management in anterior cruciate ligament and posterior cruciate ligament knee arthroscopy with general anesthesia.

In a randomized clinical trial, 114 patients under anterior cruciate ligament and posterior cruciate ligament knee arthroscopy with general anesthesia were randomly assigned to receive either dextromethorphan or gabapentin alone or in combination. The intensity of pain was assessed by numeric rating scale (NRS). Analgesic use and Ramsay score were compared among the three groups.

In this study, the pain (P=0.0001) and analgesic use (P=0.004) were significantly lower in patients who had received the combination of dextromethorphan and gabapentin.

According to current study, premedication with combination of dextromethorphan and gabapentin is superior to each one alone for postoperative pain management in anterior cruciate ligament and posterior cruciate ligament knee arthroscopy with general anesthesia.

The present study aimed to investigate the effectiveness of Mindfulness-Based Stress Reduction (MBSR) on the severity of depression, anxiety, stress, and the perception of low back pain after childbirth. 

 This was a quasi-experimental research with a pre-test, post-test and a control group and one-month follow-up design. The statistical population included all females with chronic postpartum low back pain in Tehran City, Iran. Forty of them were selected by convenience sampling method and were assigned into the experimental (20) and control (20) groups. The study instruments included Depression Anxiety Stress Scale (DASS-21) and Ossouri's low back pain scale. The samples were followed-up one month after conducting the intervention. A mindfulness training program based on stress reduction was carried out in 8 120-minute sessions once a week for the experimental group. The collected data were analyzed using SPSS. 

 The study findings suggested a significant difference between the mean post-test scores of the experimental and control groups. Thus, mindfulness training on chronic low back pain perception had a significant effect at P<0.01. Additionally, mindfulness training had a significant effect on reducing depression, anxiety, and stress. 

 Mindfulness exercises are associated with increasing the awareness of the thoughts, feelings, and senses of the patients and their admission. Moreover, these techniques reduced their level of depression, anxiety, stress, and lower chronic back pain perception. Therefore, they can help in designing better healthcare programs for therapists, counselors, and psychologists.

Residents spend much of their time at the hospitals to earn their required educational skills and although they act as a kind of human resource in the hospital, they increase hospital costs. The present study was designed to calculate the share of educational costs of different medical residents in hospitals.

In this descriptive and applied study performed in one of the hospitals affiliated to Iran University of Medical Sciences, the hospital cost items of education of residents in different medical fields during the academic year of 2017-2018 were identified by use of two scenarios.

In short, mean educational cost of one resident in the studied academic year was about 5357$ based on the first scenario and about 5404 $ according to the second scenario. Based on both scenarios, salaries paid to residents accounted for more than 50% of the costs followed by the cost of consumed materials by residents. Forensic Medicine and Anesthesiology residency programs had respectively the lowest and highest share of costs in both scenarios.

The cost of training in the hospital is different among residency fields based on the required tests and errors in each field. But, in order to save hospital costs, the culture of optimal use of materials as well as medical equipment should be taught to residents.

Knee osteoarthritis (OA) is a major public health issue because it causes chronic pain, reduces physical function and diminishes quality of life. Knee osteoarthritis is a chronic disease and is one of the most common causes of disability in the elderly. Population ageing and increased global prevalence of obesity are anticipated to dramatically increase the prevalence of knee OA and its associated impairments. Because of direct and indirect costs, it is costly for patients and community. No definitive treatment for knee osteoarthritis is known, but prolotherapy is a complementary injecting drug for chronic muscular pain, including knee osteoarthritis, which is used to stimulate repair of soft tissue and decrease the pain associated with chronic soft tissue damage. Therefore, the present study was conducted to evaluate various prolotherapy methods for the treatment of patients with knee osteoarthritis. A systematic literature search was conducted in five medical electronic databases, PubMed, Scopus, Medline, Cochrane Collaboration and Google Scholar, up until April 2018. We included randomized controlled trials and quasi-randomized controlled trials (where the allocation is not strictly random (comparing dextrose with erythropoietin, platelet-rich plasma and radiofrequency for osteoarthritis of the knee in adults. Risk of bias analysis and best evidence synthesis were performed. The main aspects related to treatment were analyzed: decrease in pain level, stiffness, physical function and range of motion. Two clinical trials including 112 patients were included in this study. The results analysis showed that, the level of pain reduction in the erythropoietin group was 52.5% higher than the rest of the treatment methods in first month after treatment. In comparison to dextrose group and in the 6th month after treatment, the rate of knee stiffness, functional limitations, and overall WOMAC score in patients treated with PRP were decreased 53.7%, 52.3% and 53.7%, respectively. In the third month after treatment, the knee range in patients treated with erythropoietin showed a 25.4% improvement, which was more effective than other procedures. According to study result, the effectiveness of intra-articular injection methods for knee osteoarthritis treatment and in order to reduce the pain level, respectively, were: erythropoietin, radiofrequency pulse, platelet-rich plasma, and dextrose. It should be noted that more research is needed to estimate the effectiveness of these methods in the long run.

Aims and Maigne''s or thoracolumbar syndrome is an almost common disease with simple diagnosis based on symptoms and corrects physical examination; besides there are very effective therapeutic methods available for this syndrome. However as there is no special radiologic sign and para-clinic data is normal in these patients¡ the diagnosis is usually challenging. Sometimes the patient''s symptoms are very severe despite normal radiography and EMG-NCV findings; therefore early treatment prevents later complications.
Case report: A 47 year-old woman complaining of low Back pain¡ buttock pain¡ and anterolateral leg pain from a year ago was referred to pain clinic. After Maigne syndrome was diagnosed¡ Dorsal and Lateral rami block of 11th and 12th thoracic nerves was performed for her and she had pain relief.
Maigne''s syndrome is among illnesses which does not have any specific radiologic or labarotory sign despite specific pain symptoms in the areas mentioned¡ so pain physicians may become confused encountering such patients.

Aim and Femoral nerve block is the common method for controlling pain after knee surgery, but it is not the only knee nerve and so always does not provide successful block. Another innervation of the knee is from obturator nerve.
In this double-blind study, 60 patients whom have undergone elective arthroscopic knee surgery randomly divided into 2 groups of equal number; The femoral nerve block group and obturator nerve block group that. Then after the block patients were evaluated for pain with VAS. Also satisfaction scale was inquired [based on the excellent (1), good (2) moderate (3) and dissatisfied (4)]. Data was analyzed with SPSS 20 software.
Findings: Pain was measured at rest in the femoral block, which at all hours showed less scores than obturator block except for measuring at 24 hours. And at 0, 3 and 6 hours after block this difference was statistically significant (at time 0 P value = 0.048 and at 3 and 6 The study showed that patients undergoing femoral nerve block have less pain and greater satisfaction scores compared with patients that were under obturator block. Although, VAS in both groups was in an acceptable level of analgesia after surgery.

Aims and Pain after surgery is a major problem for patients with fractures of the femur or hip. We studied the effect of Bupivacaine at a concentration of 0.2% and 0.3% in fascia iliac block on postoperative pain. The study was a Randomized double-blinded clinical trial. A total of 48 patients who had femur or hip fracture underwent fasia iliac block. Patients were randomly assigned to two groups receiving Bupivacaine at a concentration of 0.2% and 0.3%, respectively. Then the two groups were compared in terms of pain and satisfaction with pain control and intensity of motor block. Postoperative pain score in 0.3% group was significantly lower than 0.2%(p< 0.001) while the patient satisfaction of pain control and intensity of motor block were significantly higher in Group 0.2% (p=0.04). Onset of analgesia had no significant difference between the two groups. Bupivacaine with concentration of 0.3% in fascia iliac block could further decrease the pain score after hip or femoral fracture surgery; however patient satisfaction with pain control and intensity of motor block were higher with 0.2. % concentration of Bupivacaine.

Teaching experience in operating room is the core of learning for residents of anesthesiology. Therefore, the present study was carried out to evaluate the learning environment of operating rooms from viewpoints of anesthesiology residents in teaching hospitals of Tehran, Iran, and Shahid Beheshti Universities of Medical Sciences based on ATEEM questionnaire.In this descriptive cross-sectional study, views of 156 anesthesiology residents regarding the learning environment of operating rooms in hospitals associated with Tehran, Iran and Shahid Beheshti Universities of Medical Sciences were collected by means of census method using ATEEM (Anesthetic Trainee Theatre Educational Environment Measure) questionnaire in 2014-2015. Data were analyzed using independent t-test and one-way ANOVA. Final mean score of the questionnaire was 114. 03±23. 59 (out of 160) and at a desired level. Total mean scores of all domains were 113. 59±25. 12 and 114. 85±21. 78 for female and male residents respectively and were not significantly different (p=0. 742). Comparison of mean scores in terms of academic year showed significant difference (p=0. 032, F=3. 025) regarding the domain of residents’ perception of faculty members and teaching; however, no significant difference was found in other domains. Results showed that residents’ perspective of the learning environment in operating rooms was favorable. It seems that high workload and interference with training programs and lack of learning opportunity during practice are weaknesses of this learning environment that needs to be further investigated and handled by the competent authorities.

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.

Aims and Patients undergoing abdominal surgery usually receive an epidural block for postoperative analgesia. However, when epidural analgesia is contraindicated or unwanted, various regional analgesia techniques are used in conjunction with systemic analgesia. The objective of this trial was to assess the effectiveness of paravertebral block in patients undergoing laparotomy. We analyzed 40 patients scheduled for laparotomy. The patients were randomized to receive either an ultrasound-guided bilateral paravertebral block with bupivacaine (Group 1) (n=20) or to be part of the control group (n=20) (Group 2). Post-operatively, intravenous patient-controlled analgesia (PCIA) was used for all patients for pain control, which contained Fentanyl and Paracetamol. Visual analogue pain scores (VAS) at 1, 6, and 24 hours postoperatively, Additional analgesic request, the total amount of received analgesics and the complications were all evaluated. Visual analogue pain score (VAS) in the first hour after the Paravertebral block was significantly lower (P<0/05),but it was not significantly different among the two groups at 6, 24 hours and immediately (zero time) after the block (P>0/05). The total amount of drugs and the delivered Bolus dose by PCIA in 24hr was significantly lower in the paravertebral group (P<0/05). The first request time was significantly longer in Paravertebral group (P<0/05). Paravertebral block could serve as effective analgesia adjunct in patients undergoing laparotomy and we recommend using this technique in postoperative period, according to our results.

Aim and Nerve stimulator and Sonography are both used for nerve localization and block, either alone or in combination. This study compares these methods regarding the speed of onset and quality of brachial pleuxus block in Supraclavicular area. Methods and Materials: In this double blind clinical trial, 30 patients with upper extremity fracture were recruited. They were divided into two groups. In the nerve stimulation group, block was performed with the plumb-bob approach, using nerve stimulator only. In the second group, block was done using nerve stimulatoin plus Sonography. After the procedure, the quality and onset of motor plus sensory block were recorded and analyzed. The patients had a mean age of 33/66±11/05 years. Regarding quality of motor block, the difference between the two groups was statistically significant (p=0/04), while no difference was found in sensory block quality. There was a significant statistical difference in the onset of motor block between the two groups (18/26±0/96 using Sonography and stimulatoin, and 22/4±/0/98 in the nerve stimulation group). Using nerve stimulation and ultrasonography together for Supraclavicular block, increases the quality and reduces the onset of block for upper extremity.

Aim and Acetaminophen, in both oral and intravenous forms (Apotel), is a safe drug in controlling mild to moderate pain. However, Opioids are still a part of routine plan. We compared the effectiveness of Apotel with oral acetaminophen codeine and oxycodone for postoperative pain control. Methods and Materials: In this single blind clinical control trial, 75 patients, being candidate for elective septorhinoplasty, were enrolled and divided into 3 groups. All groups received 1000 mg Apotel in the recovery room; then the first group received 900/30 mg oral acetaminophen codeine after 6 hours QID, the second group received 10 mg oxycodone after 8 hours TDS and the third group received 1000 mg Apotel after 8 hours TDS. All three regimens resulted in a significant pain reduction and there was no significant difference in the pain score at different intervals; however Systolic blood pressure and Diastolic Blood pressure showed significant reduction in the aceminophen codeine and oxycodone group. Considering the significant pain reduction in all the three groups, selection between the 3 regimens should be based on other factors.

The aim of this study is comparing ACTH changes in epidural and intravenous analgesia technique after lower limb orthopedic surgery. In a randomized clinical trial in Hazrat Rasool Akram Hospital during 1387-88، 60 patients candidate for surgery on the lower extremities were randomly allocated to receive either postoperative analgesia with epidural analgesia (PCEA) or IV analgesia (PCIA). Measurement of ACTH levels and Visual analogue scale (VAS) was performed in four relief phases including at the time of arrival to the operating room، immediately after surgery and 12 hours after intravenous pump functionary and 24 hours after surgery were recorded. The mean level of ACTH and VAS، 24 hours and 12 hours after surgery in the PCEA group were less than PCIA. Ramsey Sedation Score (RSS) in PCEA group at these intervals was more than PCIA cases. It seems that PCEA relieves pain more effectively than PCIA method. However، the proper method of anesthesia for each patient as well as patients'' preferences should be considered in selecting the method of postoperative analgesia.

Use of drugs with short apnea duration and less hemodynamic changes for intubation of trachea in intensive care units is necessary. This study compares the effects of propofol and sodium thiopental on hemodynamic changes and apnea duration after tracheal intubation in patients admitted to intensive care units. In this double blind clinical trial، 25 ICU-admitted patients were evaluated. They were intubated two times with 72 hours interval، once received 1. 5mg/kg sodium thiopental، and the other time 0. 75 mg/kg propofol، while the drug used for intubation in the first time was randomly selected. Hemodynamic variables include systolic and diastolic BP، heart rate، MAP، RPP، MAP/HR and apnea duration in two times، during pre intubation، intubation and after intubation were measured. Data were analysed with statistical tests of independent''s t and ANOVA repeated test. In comparison with pre-intubation، hemodynamic variables such as systolic and diastolic BP، MAP and MAP/HR were decresed during tracheal intubation in both groups، but range of changes in propofol group is less than those of thiopental group and the difference is statistically significant (P<0. 0001). In comparison with thiopental، Propofol has fewer changes in hemodynamics in patients who needed tracheal intubation، and also has short er apnea period. Accordingly use of propofol over thiopental is recommended for tracheal intubation in ICU patients.

In recent years spinal anesthesia using a local anesthetic in combination with an opioid has gained popularity for lower limb operations due to the high success rate and patient satisfaction، and the decreased resource utilization compared with general anesthesia. In experimental studies، intrathecal administration of magnesium sulphate (MgSO4) significantly potentiated antinociception during spinal anesthesia; however available data are scarce. This study aimed at evaluating the effect of adding MgSO4 to bupivacaine and fentanyl for spinal anesthesia in lower limb orthopaedic surgeries. Methods & materials: In this double-blind randomized clinical trial، 100 candidates of spinal anesthesia for lower limp orthopaedic surgeries (ASA class I-II) were recruited in Hazrat Rasoul Akram Medical Complrx in a 10-month period. They randomized in two equal age- and sex-matched groups receiving 1. 0 ml of preservative-free 0. 9% sodium chloride (group S) or 50 mg of MgSO4 5% (1. 0 ml) (group M) following 12. 5 mg of bupivacaine 0. 5% plus 25 μg of fentanyl intrathecally. Date were collected regarding the time to reach the highest level of sensory blockade، time to L2 regression، times to reach the highest level of motor blockade and its full regression، time to consumption the first dose of postoperative analgesic and complications. Median time to reach the highest level of sensory blockade was significantly higher in the S group (16 vs. 14. 5 min; p=0. 02). Median time to L2 regression (243 vs. 207 min; p<0. 001)، as well as the median time to consumption the first dose of postoperative analgesic (345 vs. 232 min; p<0. 001) were significantly higher in the M group. Median times to reach the highest level of motor blockade and its full regression were comparable between the two groups. Hypotension and bradycardia were recorded in 20% and 10% of the patients in group M and 30% and 14% of patients n group S، respectively (p=0. 35). Intrathecal MgSO4 along with the spinal anesthesia with bupivacaine and fentanyl in lower limb orthopaedic surgeries hasten the sensory blockade and prolongs the period of anesthesia without additional side effects or influence on the motor blockade.

Although calcium channel blockers such az verpamile are added to local anesthetics for regional anesthesia،rarely they may cause undesirable hemodynamic side effects This study compared the hemodynamic and blockade effects of verapamile and sufentanile during axillary brachial plexus blockade with lidocaine 1. 5%. Forty five patients were divided randomly into 3 groups. Patients in group 1 received 1. 5% lidocaine; patients group 2 received 105% lidocaine mixed with 5 mg verapamile; patients in group 3 received 1. 5% lidocaine mixed with 5 mg verapa،ile and 5 μg sufentanile. Hemodynamic data were measured four times. The duration time of anesthesia and sensory block was recorded. The beginning time of anesthesia was similar in 3 groups، but analgesia duration was significantly longer in groups 3 and 2 than in group 1 (p<0. 05). There were no significant differences in Hemodynamic data between 3 groups. Verapamile offers more stable hemodynamics and similar blockade، and thus may be beneficial for ASA I patients undergoing forearm and hand surgery.

Nowadays tricyclic antidepressants (TCAs) are commonly used orally for treating chronic pain states، such as neuropathic pain. TCAs produce analgesia by various mechanisms involving Sodium channels، N-methyl-d-aspartate receptors، biogenic amines، opioids، inflammatory mediators، and substance P. Studies have shown that intrathecal tricyclic administration effectively attenuates pain and thermal hyperalgesia in inflammatory and neuropathic pain in rats. In a double blind RCT study in animal lab intathecal injection of drugs performed in 30 Wistar male rats. They devided in 3 groupes. In G1، 90 μl Doxepine (50 mM)، G2، 90 μl amitriptyline (60mM) and in G3، 90 μl bupivacaine (23 mM) was injected. Then sensory، motor and proprioceptive changes was measured in these hours: 1، 2، 3، 4، 6 and 12 by one examiner Three rats died in G1 and G2. After adjusting the influences from different concentrations، amitriptyline had a similar potency but a longer duration of spinal blockade of motor، propioception، and nociception than did bupivacaine (p value<0. 05). Whereas doxepine had a reasonable but lower efficacy and shorter duration of spinal blockade than did bupivacaine (P value<0. 05). The full recovery times for G2 were significantly longer. Conclussion: It seems that tertiary amine drugs such as amitriptyline and doxepin، had reasonable potencies of spinal blockade when compared to bupivacaine. But amitriptyline has a more potent and long-acting spinal anesthetic effect. It may turn to be a clinical valuable local anesthetic.

Studies showed that Verapamil as a calcium channel blocker, potentiates the analgesic effects of local anesthesia; however there is controversy regarding the dosage of Verapamil in this regard. In this study, we evaluated the effect of two doses of Verapamil (5 and 10 mg) in combination with Lidocaine, on quality of local axillary blockage in comparison with placebo. The present study was a double blind placebo –controlled clinical trial. Ninety two patients candidate for upper limb orthopedic and plastic surgery with axillary block were enrolled and divided in three groups randomly. In group A, the patients received only lidocaine 1.5%; in group B, the patients received Verapamil 5 mg plus lidocaine 1.5%; and in group C, the patients received Verapamil 10 mg plus lidocaine 1.5%. Time of onset and duration of analgesia, sympathetic, sensory and motor blocks as well as hemodynamic changes (heart rate, blood pressure and mean arterial pressure) before, during and after surgery were evaluated and compared in the three groups. SPSS V.13, Chi2 and One way ANOVA tests were used for data analysis. P= 0.05 was considered as statistically significant. Systolic, diastolic and mid arterial blood pressures significantly decreased during 15-60 min in both groups receiving Verapamil (5 and 10 mg); after which the blood pressure remained similar in the three groups. Mean onset of sympathetic, sensory and motor block was shorter in patients who received Verapamil (5 and 10 mg) than those who received Lidocaine alone (p<0.001). There was no difference in regard to the onset of sympathetic block in the groups receiving Verapamil (p=0.18). Meanwhile duration of motor and sensory block in Verapamil groups was greater than Lidocaine group. Patients who received Verapamil experienced less post-operative (6 hours) pain than those in placebo group, which was statistically significant. Our finding showed that Verapamil 10 mg could amplify quality of axillary blockage (prolonged duration of analgesia, sensory and motor block and reduced post operation pain) without significant changes in hemodynamic situations in comparison with patient who received Verapamil 5 mg.