poupak rahimzadeh

This study compares the effects of transforaminal magnesium sulfate injection versus other methods for managing radicular back pain, highlighting its potential for improved pain relief and functional outcomes.

This randomized, double-blind clinical trial involved 30 patients with radicular back pain who were randomly assigned to receive either transforaminal magnesium sulfate or triamcinolone injection. Primary outcomes were pain intensity and functional disability, assessed using the Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI), respectively. These were evaluated at five time points: Before the injection, 2 weeks, 1 month, 3 months, and 6 months after the injection. Secondary outcomes included drug-related adverse events within the six-month follow-up period.

Baseline characteristics were not significantly different between the two study groups. Compared to pre-injection measures, post-injection pain intensity and functional disability were significantly reduced in both groups at all time points (P < 0.001). At all postoperative evaluations, pain intensity and functional disability were lower in the magnesium sulfate group compared to the steroid group (P < 0.001). No drug-related side effects were recorded in either group.

For patients with radicular back pain, transforaminal magnesium sulfate injection appears to be an effective and safe alternative to transforaminal steroid injection.

 Lumbar spinal stenosis (LSS) is the most common indication for lumbar surgery in elderly patients. Epidural injections of calcitonin are effective in managing LSS.

 This study aimed to compare the efficacy of transforaminal and caudal injections of calcitonin in patients with LSS.

 In this double-blind randomized clinical trial, LSS patients were divided into two equal groups (N = 20). The first group received 50 IU (international units) of calcitonin via caudal epidural injection (CEI), and the second group received 50 IU of calcitonin via transforaminal epidural injection (TEI). The Visual Analogue Scale (VAS) and Oswestry Low Back Pain Disability Questionnaire (ODI) were used to assess the patient's pain and ability to stand, respectively. Visual Analogue Scale and ODI scores were recorded and analyzed.

 The results showed that caudal and TEIs of calcitonin significantly improved pain and ability to stand during follow-up compared to before intervention (P < 0.05). Additionally, CEI of calcitonin after 6 months significantly reduced pain in LSS patients compared to TEI of calcitonin (P < 0.05). However, no significant difference was observed between the two epidural injection techniques in improving the patient's ability to stand (P > 0.05).

 The results of the study indicate that epidural injection of calcitonin in long-term follow-up (6 months) had a significant effect on improving pain intensity and mobility in patients with LSS, and its effect on pain in the TEI method was significantly greater than that in the CEI method.

Patient anesthesia using continuous epidural infusion (CEI) has been an optimal and acceptable technique for inducing epidural anesthesia for many years. This study aimed to compare two methods of programmed intermittent epidural bolus (PIEB) with continuous epidural injection (CEI) in labor analgesia among patients receiving epidural dexmedetomidine.

This study was a randomized clinical trial. The target population was term women candidates for epidural anesthesia. After selection of sample size based on inclusion criteria and a total of 3 cc of Dexmedetomidine (0.5 µg/ml) and Ropivacaine 0.1% was injected. Furthermore, 5 ml was injected as a loading dose of Dexmedetomidine 0.5 µg /ml and Ropivacaine 0.1%. Then recorded the pain score by Patient Control Epidural Analgesia tool. What were considered as the outcomes of the study included demographic information. SPSS software Version 23 was used for statistical analysis of data.

First, the neonatal Apgar score in PIEB method was more improved, and secondly, the use of assisted delivery tools such as vacuum in PIEB method was reduced. Moreover, the duration of the first phase of labor in this method was more reduced than CEI. This was while the hemodynamic conditions of the       patients in the two groups, including vital signs and arterial gar analysis, were maintained in a stable state. As a result, patients in the group undergoing epidural anesthesia by PIEB method were associated with a higher level of satisfaction with the delivery process (p < 0.05) and induction of epidural anesthesia than patients undergoing CEI protocol.

The PIEB method is associated with further improvement in neonatal (Apgar score) and maternal outcomes (reduction in the duration of the first phase of labor and no need to use assisted delivery methods) compared to the CEI protocol, but has little effect on hemodynamic conditions or drug dosage.

Chronic pain is a significant clinical problem in the world. There is not quite effective treatment for chronic pain due to its complex nature. However, timely retrieval of accurate and comprehensive information through organized clinical and epidemiological studies is an essential prerequisite for providing high-quality clinical care and more accurate health care planning. This can be achieved by the creation of an electronic registry system as a strong source of information. The purpose of this study was to develop and evaluate a chronic pain registry for patients with chronic pain syndromes.

In this study, Onion architecture with the MVC design pattern was selected in design phase. Using onion architecture leads to more flexible and reusable codes and results in easier development and maintenance. In the development phase, MYSQL DBMS and the PHP programming language, which are suitable for developing the web-based system, were used.

The minimum data set was determined in the previous study. This dataset covered six areas: demographic information, initial pain assessment, medical history, mental health and well-being, diagnostic measures, and diagnosis and treatment plan. A web-based pain registry system was developed based on the minimum data set.

There are many studies for development of web- based pain registries in the world but there is a few information about technical architecture and structure in design phase. In this study, we focused on the technical architecture design of system. Using onion architecture leads to more flexible and reusable codes and results in easier development and maintenance. In the current study, it was chosen to use MYSQL and the PHP programming language, which is suitable for developing the web-based system. Finally, a web-based registry system was developed to store and report on the information of patients suffering from chronic pain. It can manage and control chronic pain and facilitate future research.

The erector spinae plane (ESP) block is a regional anesthetic technique that involves injecting a local anesthetic below the erector spinae muscle in an interfascial plane.

We report a case of a 66-year-oldmanwith cervicothoracic junction pain caused byanadvanced Pancoasttumor. The administration of ESP block at the T2-T3 level led to pain relief of more than 50% in this patient after two sessions.

Therefore, the application of this method of regional analgesia is both convenient and safe and reduces opioid consumption. Further studies are needed to evaluate the safety and effectiveness of continuous blocks in outpatient settings.

 Electrical storms and ventricular tachycardia are two life-threatening arrhythmias that are becoming more common. In developing ventricular arrhythmias, the sympathetic nervous system plays a vital role. Stellate ganglion (SG) block can be used in many situations as an important therapeutic target, like treating tachyarryhthmias and ventricular tachyarrhythmias.

 The patient was a 53 years old woman with a history of implantable cardioverter defibrillator (ICD) insertion due to ventricular tachycardia. The patient complained of an awkward and unpleasant sensation when the ICD sensed the tachyarrhythmia and shocked her. Regarding the positive response to the previous SG block, with the goal of a longer duration of this effect, stellate ganglion radiofrequency was performed.

 Stellate ganglion radiofrequency shows a safe and long-term effect for patients with tachyarrhythmias and ICD who cannot tolerate episodes of ICD activation.

 Post-laparoscopic cholecystectomy (LC) pain control is still an issue postoperatively.

 We investigated the effectiveness of the unilateral right-side ultrasound-guided erector spinae plane block (ESPB) on post-LC pain intensity and opioid consumption.

 This is a parallel-arm randomized control trial on 62 adult patients with an American Society of Anesthesiologists (ASA) physical status ≤ 2 who underwent LC. The patients were randomized into 2 groups (the block group [BG] and the control group [CG]; n = 31 per group). BG received a single-shot right-sided T7 ESPB with 20 mL of 0.2% ropivacaine at arrival time in the post-anesthesia care unit (PACU). CG) received no regional anesthesia. Both groups received patient-controlled intravenous fentanyl and rescue meperidine for analgesia. The primary outcome was the pain intensity determined using a Numerical Rating Scale (NRS) in the first 24 hours after surgery. Secondary outcomes included total fentanyl and meperidine consumption within 24 hours.

 Median pain scores were significantly higher in CG at rest and with coughing up to 12 hours after surgery compared with BG. Pain scores were higher in CG with a cough at 24 hours compared with BG (median 1 [interquartile range (IQR) 1, 2] vs. 1 [1, 0]; P = 0.0005). Total fentanyl consumption and meperidine consumption within 24 hours were significantly lower in BG compared with CG (median 60 µg [IQR 60, 90] vs 250 µg [90, 300]; P < 0.0001 and median 20 µg [IQR 10, 20] vs 25 [20, 25]; P = 0.002, respectively).

 A single-shot, right-sided, unilateral ESPB decreases post-LC opioid consumption and pain.

Context:

 This systematic review and meta-analysis evaluated the effect of the intra-articular injection of platelet-rich plasma (PRP) and oxygen-ozone therapy and provided an evidence-based methodology to treat KOA.

 Databases, including Cochrane Library, PubMed, and EMBASE, were searched. The retrieval period was before 2021. Two reviewers performed the process of screening and data extraction. Mean differences were calculated [95% confidence interval (CI)] with an inverse-variance method and fixed effect model. Meta-analysis was performed using the latest version of STATA version 16.

 A total of 12 studies out of 769 articles were evaluated. The mean difference of visual analog scale score between ozone and control groups in the first month after injection was -0.02 (MD, -0.02; 95% CI: -0.32, 0.28; P < 0.05). Mean differences of WOMAC pain, stiffness, and physical function score between baseline and after PRP were -3.53 (MD: -3.53; 95% CI: -4.04, -3.02; P = 0.00), -0.60 (MD: -0.60; 95% CI: -4.0 - 0.864, -0.34; P = 0.00), and -5.96 (MD: -5.96; 95% CI: -7.83, -4.09; P = 0.00).

 Our results showed that to treat knee osteoarthritis, using PRP for a longer period of 6-12 months after the intervention shows better clinical results, while oxygen-ozone therapy has short-term results.

The target-controlled infusion (TCI) system controls the plasma concentration of administered drugs, improves hemodynamic stability, prevents the cumulative effect of drugs, provides faster recovery, and perhaps reduces renal complications. We sought to investigate the effects of the TCI method on blood urea nitrogen (BUN) and creatinine (Cr) levels in patients with renal impairment undergoing open-heart surgeries.

This double-blind clinical trial was performed on 66 patients undergoing cardiac surgeries with preoperative Cr levels of greater than 1.5 mg/dL. The patients were randomly divided into 3 groups. The first group received propofol and remifentanil via the TCI system. The second group received these 3 drugs via the usual dosing (mg/kg) method. The third group received midazolam and fentanyl conventionally (based on the mg/kg method). Postoperative Cr and BUN levels, urine volume, the need for dialysis, and hemodynamic parameters were recorded up to 3 postoperative days. After the exclusion of 10 patients from the study, 56 patients were analyzed.

Postoperative BUN and Cr values were significantly lower in the TCI group than in the other groups (P<0.05) There were no significant differences between the 3 groups concerning hemodynamic status. The total dose of anesthetics was significantly lower in the TCI group than in the propofol-remifentanil group (P<0.05). The incidence of postoperative arrhythmias in the TCI group was significantly lower than that in the other 2 groups (P<0.05).

In our patients with renal dysfunction, the TCI method reduced post-cardiac surgery BUN and Cr levels, the dose of the anesthetics administered, and the incidence of arrhythmias. 

Previous studies have suggested the use of ultrasonography for more success in spinal anesthesia. The purpose of this study was to compare the effect of ultrasonography and traditional method on the success rate of spinal anesthesia by an anesthesia resident. In this clinical trial study, patients who were candidate for leg or lower abdominal surgery under spinal anesthesia and referred to Firoozgar and Rasoul-e-Akram hospitals in 2019 were randomly assigned to techniques: 1) common surface marking techniques and 2) the use of ultrasonography to find the spinal canal. The dural puncture success rate at the first needle entry attempt, time required for determining the needle entry site, time required for needle entry until CSF exit, number of needle redirection without complete skin exit, and needle entry after complete needle withdrawal in each group were measured and recorded. The success rate of dural puncture at the first attempt of entry and the time required to determine the needle entry site in the ultrasonography group (55.2%) was significantly higher than that in Landmark group (21.4%) (P<0.05). The time required for needle entrance to CSF exit, the total procedure time for patients, the number of needles redirection without complete removal of the skin, and the number of needle entry after complete removal of the skin in the ultrasonography group was significantly lower than that in Landmark group (P<0.05). The use of ultrasonography in comparison with the traditional method has been effective on the success rate of spinal anesthesia by an anesthesia resident.

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.

Paravertebral blocks are one of the possible postoperative pain management modalities after laparotomy. Adjuvants to local anesthetics, including alpha agonists, have been shown to lead to better pain relief and increased duration of analgesia.

The aim of this study is to examine the effect of adding dexmedetomidine to bupivacaine for ultrasound-guided paravertebral blocks in laparotomy.

In this double-blind, randomized controlled trial (RCT), we enrolled 42 patients scheduled for T6 to T8 thoracic paravertebral block (TPVB) for analgesia after laparotomy. The patients were randomly assigned into two groups of BD (bupivacaine 2.5 mg/mL 20 mL plus dexmedetomidine 100 µg) and B (bupivacaine 20 mL alone). Following surgery, intravenous fentanyl patient-controlled analgesia was initiated. The numerical rating scale (NRS) for pain, sedation score, total analgesic consumption, time to first analgesic requirement, side effects (such as nausea and vomiting), respiratory depression, and patients’ satisfaction during the first 48 hours of evaluation were compared in the two groups.

Pain scores and mean total analgesic consumption at the first 48 hours in the BD group were significantly lower than Group B (P = 0.03 and P < 0.001, respectively). The time of first analgesic request was significantly longer in BD group (P < 0.001). Sedation scores and side effects did not differ significantly between the two groups.

Adding dexmedetomidine to bupivacaine for TPVB after laparotomy yielded better postoperative pain management without significant complications.

Mastectomy is sometimes performed in transgender patients, which may damage the regional nerves such as the pectoral and intercostobrachial nerves, leading to postoperative pain. An ultrasound-guided nerve block can be used to track and block the nerves properly.

This study aimed to compare the ultrasound-guided type-II pectoral nerve block with the blind (conventional) intercostal nerve block (ICNB) for pain control after breast tissue reconstruction surgery in transgender patients.

In the present single-blind randomized clinical trial, 47 patients were randomly divided into two groups: (A) Ultrasound-guided type-II pectoral nerve block (n = 23) and (B) blind intercostal nerve block (n = 24). After nerve block in both groups, pain intensity at 3, 6, 12, and 24 hours after surgery, upper limb paresthesia, frequency of nausea and vomiting, shortness of breath, hematoma, and the length of hospital stay were assessed.

Patients who received the ultrasound-guided type-II pectoral nerve block had a greater reduction in pain intensity (24 h after surgery), opioid use (24 h after surgery), nausea, vomiting, and hospital stay than those who received ICNB, whereas the recovery time did not differ between the study groups.

The pectoral nerve block under ultrasound guidance, compared to the intercostal nerve block, in transgender patients can reduce the required dosage of opioids within 24 hours, pain intensity within 24 hours after surgery, the incidence of postoperative nausea, and vomiting, and the hospital stay of patients.

Perioperative glycemic control is an important factor in the clinical management of a patient with diabetes mellitus under surgery. Poorly controlled long-term hyperglycemia not only predisposes individuals to systemic complications of diabetes mellitus and cardiovascular morbidity but also increases the risk of anesthesia and weakens the outcome of the surgery. Given the importance of the issue and the limited studies on glucose control using insulin glargine during surgery, we aimed to investigate the effects of glargine on glucose control in patients with diabetes mellitus during vitrectomy surgery.

This randomized, double-blind trial was conducted in two groups of 35 patients with diabetes mellitus under treatment with insulin. In the control group, the patients received regular insulin based on the blood glucose and the sliding scale, and in the intervention group, they received insulin glargine (0.3 unit/kg) before surgery. From the start of the operation up to 3 hours of the surgery blood glucose of the patients was measured every 45 minutes and once 6 hours after the operation, and if needed, the regular insulin was injected. Data were analyzed using SPSS 16. Frequency, percentage, mean, and standard deviation (SD) were used to describe the data. To compare the quantitative variables, the independent t-test or U-Mann-Whitney test was used. For comparison of the qualitative variables, Chi-square test or Fischerchr('39')s exact test and repeated measure ANOVA was employed. The significance level (P-value) was considered as p<0.05.

Use of insulin glargine was associated with significantly lower blood glucose levels compared to regular insulin at 90-minutes (p=0.004), 135 minutes (p=0.001), and 6 hours after the operation (p=0.005).

Glycemic control using glargine compared to regular insulin has a better performance with less need for surplus insulin dose administration during surgery.

Various studies have shown the benefits of using glucocorticoids following surgery. However, side effects associated with drug administration have been investigated sufficiently. We aimed to evaluate the effects of different doses of dexamethasone on blood glucose concentration in patients undergoing elective abdominal surgery.

This double-blind clinical trial design study was conducted among 90 candidates of elective abdominal surgery referred to RasoolAkram Medical Complex in Tehran ,Iran, 2017-218. Patients included two groups of intervention: group I, received 4 mg dexamethasone; group II, received 8-10 mg dexamethasone; and group III (control group), received ondansetron after induction of general anesthesia. Data were analyzed using ANOVA, Kruskal-Wallis test, and repeated measures. α=0.05 was considered as a statistically significant level.

The highest increase in blood glucose concentrations in all three groups occurred in the first 6 hours after the surgery. The lowest intensity of pain in all the groups occurred in the first 24 hours after the surgery. All the groups showed statistically significant changes in blood glucose concentration and pain intensity. Comparing among the mean blood glucose concentrations over time, there were statistically significant changes in time and group/time (p<0.001). Comparing the mean intensity of pain over time, statistically, significant changes were observed in time and group / time (p<0.001).

In general, change trends in blood glucose concentration and pain intensity could be dependent on the medication used and its dose, as well as the time of drug administration. Changes in blood glucose levels in the control group can be attributed to metabolic changes caused by surgical trauma.

 Post-arthroscopic shoulder surgery pain is severe enough to interfere with initial recovery and rehabilitation.

 We aimed to evaluate the analgesic effects of postoperative ultrasound-guided suprascapular plus axillary nerve blocks superficial subepidermal axon bundles (SSAB) with interscalene block (ISB) in arthroscopic shoulder surgery.

 In this single-blind randomized, open-label clinical trial, 80 candidates of elective arthroscopic shoulder surgery were randomly allocated to receive either SSAB or ISB at a postoperative care unit. The severity of resting and changing position pain was measured using visual analogue scale (VAS) score at 4h, 8h, 12h, 16h, and 24h, postoperatively. Timing of first opioid request, 24h dose requirement, patients' satisfaction rate, and side effects were also recorded. All registered data were analyzed using SPSS software version 23 for Windows (SPSS, Chicago, IL).

 Resting and changing position pain scores were comparable between SSAB and ISB groups in the most time intervals. At 12h, moving and resting pain was significantly lower in ISB than SSAB group, while moving pain was more severe in ISB group at 24h assessment. Patient satisfaction scores were comparable between the two groups except for 12h assessment. Time to first analgesic requirement and total dose of 24h opioid requirement were not significantly different between the two groups.

 Suprascapular plus axillary nerve block could be an effective and safe alternative for interscalene block for pain management after arthroscopic shoulder surgery.

There are various protocols for pain management after anterior cruciate ligament (ACL) reconstruction surgery.

This study aimed to compare two blocking protocols, including femoral nerve block (FNB) and infrapatellar nerve block (IPNB) in terms of pain severity, patient satisfaction, and muscle force preservation.

This single-blind clinical trial study investigated the patients who underwent elective knee arthroscopic ACL surgery randomly either by ultrasound-guided FNB or IPNB. Subsequently, the patients were evaluated 1, 3, 6, 12, and 24 h following NB for pain severity, patient satisfaction level, and muscle force.

The pain score (both at rest and in flexion) was significantly lower in the first three h after the intervention in the FNB group. Moreover, the mean score of the patients’ satisfaction in the first hours was significantly higher in the FNB group after theprocedure. Additionally, the IPNB group obtained a significantly faster mean time required for the first dose ofopioid request. The mean dose of used opioids over 24 h was significantly lower in the FNB group. There was a significant difference between the groups in terms ofthe muscle strength score within 24 h; moreover, the FNB group obtained a significantly greater delay in muscle recovery.

The FNB is associated with greater pain relief and satisfaction in patients who underwent arthroscopic ACL reconstruction surgery, compared to the IFNB technique. However, a further delay in the recovery of quadriceps muscle force is evident in the FNB group.

 World Health Organization (WHO) declared that the outbreak of COVID-19 constituted a public health emergency of global concern.

 Owing to limited data on critically ill patients admitted to ICU, we aimed to describe the clinical characteristics and prognosis of these patients based on ventilatory variables and clinical features.

 In this retrospective study, 45 critically ill patients with laboratory-confirmed COVID-19 who were admitted to Intensive Care Unit (ICU) wards of the hospital from April 8 to May 9, 2020, were enrolled. Medical files of the patients were reviewed, and demographic and clinical characteristics, laboratory data, lung CT scan findings, causes of intubation, and outcomes of the patients were all collected.

 The median age of the patients was 67 years (range 22 to 91), 64% were men, and hypertension was the most common comorbidity. History of close contact with previously confirmed patients was positive in 62.2% of the patients. The mean time from symptom onset to hospital admission was 5.98 ± 2.93 days. The most common symptoms at the onset of illness were dyspnea (95.6%), and gastrointestinal symptoms (22.2%) were rare. The average length of the intubation was 4.84 ± 3.28 days. The distribution of intubation causes in the deceased patients was significantly more than the recovered patients (P = 0.031). The mean score of lung CT involvement in deaths (370.26 ± 207.50) was significantly higher than the recovered patients (235.71 ± 81.21) (P = 0.042). Length of the intubation had a statistically direct correlation with respiratory rate (P = 0.03).

 Most of the critically ill patients admitted to ICU were older men and had poor outcomes with a high mortality rate. Furthermore, the score of chest CT involvement and respiratory rate are important prognostic factors in determining the severity of the illness, requiring ventilatory support, and outcome.
 

Knowledge about clinical features of critically ill patients with COVID-19 still lacks adequate information up to now.

We aimed to describe and compare the epidemiological and clinical characteristics of critically ill patients with COVID-19 in Rasoul Akram Hospital.

In this case series, 70 critically ill patients with COVID-19 admitted in ICU wards of Rasoul Akram Hospital, Tehran, Iran, from 29 February to 25 April 2020 were enrolled. Demographic and clinical characteristics, laboratory data, and outcomes of the patients were all collected and compared between deceased and recovered patients.

Fifty-six cases had died of COVID-19, and 14 patients had fully recovered and discharged. The median age of the patients was 68 years old, ranging from 22 to 91 years, 66% were men, 80% had one or more comorbidities, and hypertension was the most common comorbidities (45% of deceased cases). The most common signs and symptoms at the onset of illness were SPO2 depression (92%) and dyspnea (90%). Dyspnea was significantly more common in deceased patients (95%) than recovered patients (70%) (P = 0.048). Most patients had lymphopenia (80%). The number of patients who needed mechanical ventilation in the deceased patients was 53 (95%), which was significantly more than the recovered patients (10 [70%]) (P = 0.048).

The mortality rate of critically ill patients with COVID-19 is very high, and the patients with dyspnea and required mechanical ventilation are at higher risk for death.

In previous clinical trials and a small number of studies, the fractional injection of anesthetics led to reduced physiological complications and hemodynamic stability and increased duration of anesthesia.

The present study intended to compare the effect of fractionated and bolus dose injection of bupivacaine and fentanyl on spinal anesthesia for lower limb fracture surgeries.

In this randomized, double-blind clinical trial, 70 patients with lower limb fractures were divided into groups of bolus spinal anesthesia (Group A) and fractional spinal anesthesia (Group B). Group A received a bolus dose of 25 μg fentanyl plus 15 mg bupivacaine 0.5% intrathecally at a rate of 0.2 mL/sec and were laid down in supine position after 45 seconds. In Group B, a half dose of the mixture, i.e., 25 μg fentanyl plus 15 mg bupivacaine 0.5% mixture, was injected intrathecally, and then, the other half was injected after 45 seconds while the needle was still in place. Afterward, the patients were immediately laid down in the supine position. Hemodynamic changes in the sensory and motor blockage parameters were recorded in both groups.

The motor blockage onset time was shorter in Group B compared to Group A (P = 0.026). Moreover, the sensory blockage duration was longer (P = 0.035), and the highest level of sensory blockage was lower (P = 0.008) in Group B compared to Group A.

Fractional spinal anesthesia led to a longer duration and more favorable levels of sensory blockage compared to the bolus method. In addition, hemodynamic changes and complications occurred less frequently following this procedure.

Postoperative pain has many adverse effects and if not properly controlled, it can cause a wide range of problems.

The purpose of this study is to compare the results of using ketamine and apotel infusion pumps to control pain after posterior fusion surgery.

In this clinical trial study, 72 patients hospitalized for posterior spine fusion surgery were randomly assigned into two groups, including ketamine infusion pumps (ketamin group) and apotel infusion pumps (apotel group). In the ketamin group, 0.2 mg/kg/h of ketamine was infused to by a pain pump with normal saline to 100 cc. In the apotel group, apotel was used instead of ketamine. The rate of pain was evaluated in recovery, and at 6, 12, 18, 24, and 48 hours after the surgery, based on VAS criteria. The rate of sedation was recorded based on Ramsy score.

There was no significant difference between age, sex, BMI, underlying diseases, and smoking in patients with posterior spinal fusion surgery between the groups. Postoperative pain score was significantly lower in the patients with posterior fusion surgery at 6, 12, 18, 24, and 48 hours in the ketamin group compared to the apotel group (P < 0.001). Patients’ satisfaction with the analgesia was significantly higher in the patients at 24 hours (P = 0.001) and 48 hours (P = 0.04) in the ketamine group compared to the apotel. With regards to the Ramsy scores of the patients with posterior fusion surgery, there was no significant difference between the groups (P = 0.16).

The use of a ketamine infusion pump can be more effective than an apotel infusion pump to control pain after posterior fusion surgery.

The labor pain is one of the factors encouraging pregnant women for cesarean section delivery. Recently, intradermal and subdermal injection of distilled water has shown to be effective in improving this pain.

The present study aimed to determine which method has a greater impact on labor pain reduction.

In this double-blind, randomized clinical trial, 121 nulliparous women with a gestational age of ≥ 37 weeks were randomly divided into three groups: (1) 0.5 cc sterile water injection subdermally at four sacral points with insulin needles (n = 40); (2) 0.5 cc sterile water injection intradermally (n = 39); and (3) needle contact with the mentioned points as the placebo (n = 42). Before the intervention, the VAS score was measured for labor pain, and it was repeated 10, 30, 60, and 90 min after the intervention. The results were compared between the three groups.

Before the intervention, the mean VAS pain score had no significant difference between the three groups. However, 30, 60, and 90 min after the intervention, the mean pain score was significantly lower in the intradermal and subdermal injection groups than in the control group (P = 0.001); however, the difference between the intradermal and subdermal injection groups was not significant.

The injection of distilled water by either intradermal or subdermal method was associated with a significant reduction in the pain score during labor, but there was no difference between these two methods in terms of decreasing labor pain. As sterile water injection is a safe, effective, and low-cost method, it is proposed to increase the knowledge of midwives and obstetricians about this method.

Administration of steroids in the lumbar transforaminal block for lumbar radicular pain is considered one of the preferred treatment methods though it is associated with some complications.

The effects and side effects of triamcinolone and dexmedetomidine in the lumbar transforaminal block were investigated in the present study.

In this study, 30 patients, aged 40 - 70 years, suffering from lumbar radicular pain arising from the lumbar disc protrusion were equally divided into two groups of triamcinolone (T) and dexmedetomidine (D). They all underwent lumbar transforaminal blocks. An injection solution of triamcinolone (20 mg) plus ropivacaine (0.2%) and another one containing dexmedetomidine (50 g) plus ropivacaine (0.2%) were administered in the triamcinolone and dexmedetomidine groups, respectively. Visual Analog Scale (VAS), Oswestry Disability Index (ODI), Straight Leg Raise (SLR or lasègue’s test), and Fasting Blood Sugar (FBS) were measured at 0, 2 weeks, 1, 3, and 6 months post-procedure. The levels of calcium, magnesium, and vitamin D, as well as potential complications, were also evaluated.

Significant differences were found in the VAS and ODI during the measurement times within each group. The VAS and ODI were remarkably different between the dexmedetomidine group and the triamcinolone group. In addition, there were considerable differences in the increased FBS and reduced calcium and vitamin D levels in the triamcinolone group from changes in the dexmedetomidine group.

The lumbar transforaminal block with triamcinolone or dexmedetomidine attenuates the lumbar radicular pain. Further, dexmedetomidine exerts a more potent pain relief effect than triamcinolone.