مستانه داهی

Introsuction:

 Itching is one of the main side effects of intrathecal opioids administration. In the present study, prevalence of itching following intrathecal fentanyl administration and its related factors have been investigated in adult patients who were candidates for lower extremity surgeries.

320 patients had participated in the study. Spinal anesthesia was done in a standard setting with a combination of bupivacaine and fentanyl. After confirming and stabilizing block height patients were provided sedation with 1-2mg intravenous midazolam. A nurse anesthetist then collected data regarding pruritis and its severity if applicable.

Itching was reported in 84 patients (27%) with a mean severity score of 4.94. Of the 84 patients who reported pruritus, 70 were in need of treatment. The severity of itching was significantly higher in men than in women (P=0.029). None of the indicators of severity and prevalence of itching had a significant relationship with the BMI of the patients (P>0.05). The average age of patients in whom itching was reported was significantly lower than the age of other patients (P=0.044).

Our results showed that the intensity of itching is significantly higher in men. Moreover, the incidence of itching was also higher in younger patients.

A better understanding of the mechanism and / or pathophysiology of shoulder pain syndrome after laparoscopic gynecological surgery leads to an increase in the number of clinical trials to prevent this complication. Therefore, the present study was conducted with aim to define the mechanism and prevention methods of shoulder pain syndrome after laparoscopic gynecology surgeries.

In this narrative review study, to find the articles related to shoulder pain syndrome after laparoscopic gynecology surgeries, the published articles from 2000 including observational and clinical trials, descriptive and correlational studies were searched in the electronic databases of PubMed, Scopus, EMBASE, PEDro, Google Scholar, CINAHL , SID and Magiran with the keywords of shoulder pain syndrome, shoulder pain, surgery, laparoscopy, gynecology, postoperative and gynecology laparoscopy.

The main searched mechanisms included the pain mechanism, pain due to surgical incision, causes of shoulder pain syndrome after laparoscopic surgery in women, use of an alternative blowing gas to reduce shoulder pain syndrome, use of low pressure pneumoperitoneum to reduce the shoulder pain syndrome, gas-free laparoscopy and active gas excretion to reduce shoulder pain syndrome, use of heated or heated and humidified CO2 to reduce shoulder pain syndrome, use of sub-diaphragmatic intraperitoneal anesthesia or localized intraperitoneal anesthesia to reduce tip shoulder pain and use of pulmonary recurrence maneuvers in reducing shoulder pain syndrome.

Shoulder pain syndrome in laparoscopic gynecological surgeries can be minimized with preventive measures such as the use of hot and humid gas, intraperitoneal administration of local analgesics and pulmonary recovery maneuver.

Most women who undergo first trimester medical abortion experience abdominal pain and cramps. The present study was performed aimed to evaluate the effect of Transcutaneous Electrical Nerve Stimulation (TENS) on reducing the pain of induction of abortion in the first trimester of pregnancy.

In this single-blind clinical trial which was performed in 2020-2021, for 40 women in the first trimester of pregnancy who were candidate for medical abortion with misoprostol in order to reduce pain, randomly administered Ibuprofen and inactive TENS or Ibuprofen and active TENS with a frequency of 80 Hertz and intensity of 0 to 80 milliampere to reduce pain. These two groups were compared in terms of pain intensity before and after the use of TENS, the amount of used Ibuprofen, satisfaction from the process of medical abortion and complications. Data were analyzed by SPSS (version 16) and Chi-square and Mann-Whitney statistical tests. P<0.05 was considered statistically significant.

In the active TENS group, the use of ibuprofen was significantly lower (P= 0.001) and pain reduction was significantly higher (P= 0.001) than the other group. Also in this group, satisfaction with the abortion process was higher (P=0.044).

In patients who are hospitalized for medical abortion in the first trimester of pregnancy, in addition to Ibuprofen, TENS can be used for further relief.

The maternal health is one of the priorities of the World Health Organization and countries around the world. In this regard, promoting physiological childbirth has always been important for health care policy makers. However, fear of pain is one of the main reasons for pregnant women to refuse a natural childbirth, while this pain can be reduced by various analgesic methods. This study is a report of our experiences in painless deliveryand the related problems and complications.

In this retrospective cross-sectional study,all cases of painless delivery performed over a period of seven years in Taleghani Hospital affiliated to the Shahid Beheshti University of Medical Sciences in Tehran were investigated. The data was collected from the maternity ward by a questionnaire.

Out of 3398 pregnant women referred to the maternity ward, 421 (11%) underwent various analgesic methods for painless delivery. Out of 421 pregnant mothers, neuraxial analgesia performed in 283 cases including 208 (73%) spinal, 33 (11%) epidural and 46 (16%) combined spinal and epidural methods. Thirteen patients (4%) had labor pain despite neuraxial analgesia.

Most cases underwent spinal anesthesia. The results showed that despite a well-equipped center and appropriate facilities, a significant number of pregnant mothers did not agree with neuraxial analgesia.