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One of the most proven trajectories for analyzing the drug consumption patterns in the community is to assess the prescriptions. Using the antibiotics for prevention and treatment of infectious diseases not only leads to the loss of pathogens but also causes various complications, the most important of which is the drug resistance. The aim of current study was investigating the different antibiotics prescript by general practitioners (GPs) for outpatients in Ardabil city.
This study is designed based on the cross-sectional method. The number of 2,000 copies (according to Morgan) from total of 526000 copies sent to Ardabil health insurance during the 4 seasons of 2013 were randomly evaluated. The collected data were analyzed by descriptive statistics, ANOVA and T-Test using SPSS software. The P ≤0.05 was considered statistically significant.
In this study the average drug per prescription was 3.6 and 54.9% of the prescriptions included antibiotics so that the cefixime, azithromycin, Co-amoxiclave and penicillin 6.3.3 were the most frequently prescribed antibiotics, respectively. The highest prescriptions belonged to penicillins (39.4%) cephalosporins (27.7%) and macrolides (18.3%). The most expensive antibiotic was cefixime tablet (32% of the total cost). The most of the antibiotics were prescribed to be taken orally (tablets or capsules). The mean price of each prescription was 74539±71050 Rials. The highest rate of antibiotic prescription was related to the autumn and then winter and there was a significant relationship between the the number of antibiotics in different seasons of the year (p = 0.005).
The average drugs of each prescription are in accordance with local statistics, but much higher than the global figures. The frequency of antibiotics prescription was higher than the global, several Middle Eastern and even African countries’ indices but was lower than the average level of some regions in the country. The pattern of prescribing antibiotics among the Ardabil GPs shows the more drugs in number and expensive broad-spectrum. The average price of prescripts was higher than the national average. These findings suggest that prescription and using antibiotics is not desirable in Ardabil.

A routine method to control post-operative pain is patient-controlled intravenous analgesia (PCIA) using opioids. Regarding complications of opioids, it seems necessary to reduce their dosage and to improve the quality of analgesia using adjuvants. We aimed to assess the effect of adding ketamine to morphine in PCIA pumps for post-operative pain control in orthopedic patients. Sixty patients, being 20-60 years old (ASA class I-II) and undergoing orthopedic surgery in lower extremity, were enrolled They had no history of opioid addiction or epilepsy. Our patients were randomly allocated to three groups 20 mg morphine sulfate, 100 mg ketamine plus 20 mg morphine and 200 mg ketamine plus 10 mg morphine in their PCIA pump. The pain score was evaluated using VAS (0-10) and VRS (0-5); besides the sedation score and the degree of nausea-vomiting were assessed with Ramsay scale (0-5) and N&V score (1-4), respectively. All these measurements were performed 2, 4, 12, 24, and 48 hours postoperatively. The incidence of adverse drug reactions was not different among the three groups (p>0.05), but pain control was significantly better in the second and third group (ketamine plus morphine) in comparison with the first one (p<0.05). There was no difference in the quality of pain control between the second and the third groups. Also, the need for additional opioid was significantly reduced in the two latter groups compared with the first one (p<0.05). Adding ketamine to morphine in PCIA pumps would result in better pain control and less need for additional break-through analgesic.

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.

Although pregabalin shows efficacy against neuropathic pain, very limited evidence support postoperative analgesic efficacy. Our study objective to investigate analgesic efficacy of oral pregabalin in orthopedic surgery postoperative pain and opioid consumption. A randomized, double-blind, placebo-controlled was performed in. Patients received in first groupand in second group(30 patients) PCA morphine (10 mg/100ml) + oral pregabalin 300 mg daily for 48h after surgery. Pain score (VAS) and opioid consumption assessed in 48 hr after surgery. There was not significant difference between groups for demographic data. Pain score and opioid consumption in pregabaline group was significantly lower than morphine group without any significant complications. preoperative oral dose of 300 mg pregabalindailyfor 48h after surgery reduces post operative acute pain in orthopedic 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.