reza faiz

Paracetamol and non-steroidal anti-inflammatory drugs (e.g. ketorolac) can be considered for mild to moderate post-caesarean pain. As a selective α-2 agonist adrenergic receptor, dexmedetomidine has analgesic and sedative effects without causing respiratory depression. This study aimed to evaluate the effects of adding dexmedetomidine to paracetamol or ketorolac on post-caesarean pain and the associated complications thereof. Sixty pregnant women, who were candidates for caesarean section with spinal anesthesia, were randomly assigned to either of two groups of 30 patients. For post-operative pain management, an intravenous patient-controlled analgesia (PCA) device was used for 24 hours. Dexmedetomidine (3 µg kg-1) was added to paracetamol (35 mg kg-1) in the group DP and to ketorolac (1 mg kg-1) in the group DK. Visual analog scale (VAS), Ramsay sedation scale, hemodynamic changes, rescue analgesic (meperidine) consumption, patient satisfaction, and possible complications were recorded at 6, 12, and 24, hours after surgery, and compared afterward. The pain score was significantly lower in the DK group than in the DP group (P < 0.05). The hemodynamics and sedation scale were similar in both groups. The total meperidine consumption was higher in the DP group, but it was not significantly different. Maternal satisfaction was greater in the DK group (P < 0.05). Concerning complications, the two groups did not show statistically significant differences (P = 0.4). The addition of dexmedetomidine to ketorolac, compared with its addition to paracetamol, causes further reduction in the post-operative pain score and provides more satisfaction

Intra-articular injections of platelet rich plasma (PRP) for the treatment of knee osteoarthritis have been shown to reduce pain and improve joint function. The aim of this study is to examine the joint function by adding intra-articular growth hormone to platelet rich plasma. This study was performed on the individuals with knee osteoarthritis and under ultrasound guidance..
Fifty four patients who were scheduled for ultra-sound guided intra-articular injection were enrolled in the study. The patients were randomly allocated to groups P (platelet rich plasma) and PS (platelet rich plasma and Somatropin). Group P and PS were injected with 5 mL of platelet rich plasma, and 4 IU growth hormone (Somatropin) added to platelet rich plasma, respectively. Intra-articular injection was performed in two steps; the onset of study and one month after. Knee joint function based on Western Ontario and McMaster osteoarthritis index (WOMAC) score at the baseline, 1 and 2 month later, and complications were evaluated..
WOMAC score in both groups has been significantly reduced after injections (P = 0.030). WOMAC score reduction in group PS in first month was significantly higher than group P, but in second month 2, the difference between two groups was not significant (P = 0.235). No complication was observed..
These results showed that adding growth hormone to platelet rich plasma for intra-articular injection improved function of the osteoarthritic knee joint in short period of time..

Pain is one of the major concerns of patients underwent Total Knee Arthroplasty (TKA); appropriate pain management is a key factor in patient''s early physical fitness to move, physiotherapy, and most importantly, patient satisfaction.. In this study the analgesic effect of single injection femoral nerve block (SFNB) was compared with local infiltration analgesia (LIA)..Patients and Forty patients who underwent TKA under spinal anesthesia were randomized to receive single femoral nerve block (group F) or intra-periarticular infiltration (group I). Group F received single injection 20cc ropivacaine (10mg/cc) and in group I, a combination of 300mg ropivacaine, 30mg ketorolac and 0.5mg epinephrine diluted to a volume of 150cc and locally injected in and around the knee joint in 3 stages. Postoperative pain intensity measured by Visual Analog Scale (VAS). Morphine consumption, mobilization time and patients’ satisfaction evaluated as well.. Group I had significantly lower morphine consumption in the first postoperative day (10 vs. 12.5mg, P-value < 0.05). Within 6 hours postoperatively, VAS score was statistically lower in group I compared to group F (3 vs. 4, P-value < 0.05). However, within 12 hours it was statistically higher in group I than group F (6 vs. 5, P-value < 0.05). Other parameters were not statistically different in two groups.. Both methods LIA and SFNB provided excellent pain relief and lower morphine consumption following TKA. LIA is a surgeon-controlled analgesic technique, which can be used to enhance patients’ satisfaction and reduce the pain in the very early postoperative period by surgeon independently..

Post-operative pain and the administration of opioids to relieve it, is considered to be one of the important issues in surgery wards. This issue is even more significant in obese patients, because of the side effects of opioids. Pregabalin is an analog of gamma aminobutyric acid (GABA) which can be effective in dealing with post-operative pain. This study will consider the effect of oral pregabalin in relieving the pain of obese patients after gastric bypass surgery.Patients and In a double blind clinical trial, 60 candidates for laparoscopic gastric bypass surgery were enrolled in the study through convenience and non-random sequential sampling, into two groups; pregabalin group and control group. Inclusion criteria consisted of: morbid obesity with a body mass index (BMI) > 35, age 18-50, American Society of Anesthesiologists (ASA) status I or II, and willingness to take part in the study. Patients in the pregabalin group received 300 mg of oral pregabalin on the morning of the surgery. Post-operative pain was controlled by the patient-controlled intravenous analgesia (PCIA) method, an AutoMed infusion pump containing 20 mg of morphine and normal saline (total volume 100 cc) was administered to all patients after surgery. Patients’ level of pain were compared by considering their pain intensity on a visual analog scale (VAS), and the occurrence of nausea/vomiting from recovery, until 24 hours after surgery. A total of 60 patients were compared; 30 patients in each of the pregabalin and control groups. Both groups were similar in age and sex distribution. Mean pain intensity levels during the whole follow up were lower in the pregabalin group than in the control group, up to a maximum of 24 hours after the operation (P < 0.001). Incidence of nausea/vomiting was greater in the control group than in the pregabalin group (P < 0.001). The findings of this study indicate that oral pregabalin (300 mg dose) can alleviate patients’ pain and nausea/vomiting and notably reduce adverse effects.

Morquio''s syndrome is an autosomal recessive disease. It is from mucopolysacaridosis group disease and it''s obvious clinical signs are severe skeletal dysplasia and normal intelligence. Deposition of keratan sulfate in different tissues is seen and with progression of the disease، connective tissue of cornea، airways، lung and heart valves will be involved. In this article we present a case of Morquio''s rare syndrome that we terminated the pregnancy due to severe respiratory distress of mother and also we present the anesthesia management of this case.

Postoperative pain control is one of the problems for these patients. Opioid agents are the most important analgesics which commonly used for postoperative pain control. There are several trials for reducing the doses of opioids. It seems addition of ketamine to the opioids other than postoperative pain relief، reduces the total opioid consumption. The goal of this study was evaluation of postoperative analgesic effects of adding ketamine to morphine and tramadol after major abdominal surgery. Eighty patients candidate for major abdominal surgery under similar general anesthesia were enrolled in this study. Postoperative pain was managed by iv patient controlled analgesia (PCA) for aal patients. After the end of surgery، they were randomly allocated into the 1) morphine (M)، 2) tramadol (T)، 3) ketamine and morphine (KM)، and 4) ketamine and tramadol (KT) groups. Analgesic solution in PCA in M group was morphine (0. 2 mg/ml)، in T group was tramadol (2 mg/ml)، in KM group was ketamine (2 mg/ml) and morphine (0. 2 mg/ml)، and in KT group was ketamine (2 mg/ml) and tramadol (2 mg/ml). Visual analogue scale (VAS)، total opioid consumption، complications، and satisfaction were measured and recorded for during the first 24 hours after surgery. Demographic data was not differences between groups. Pain score in early period (1st and 6th hours) was significantly lower in KM group than the others. Furthermore، addition of ketamine significantly reduced total morphine and tramadol consumption. No side effects were observed in the all groups. Our finding showed that addition of ketamine to morphine could reduce pain score and total opioid consumption after major abdominal surgery.

Maintaining low back pain after spinal surgeries is one of the pretty challenging problems in treating patients. Various modalities have been introduced for treatment and one of the most effective ways between them، is steroid and other drugs injection into epidural space. In a double blind RCT study، 25 patient from pain clinic with low backpain due to failed back surgery syndrome were candidate for epidural transforaminal block and divided into case and control groups randomly. The selected drug regimens were as follow: in case group bupivacaine %0. 5، triamcinolone 40mg، hypertonic saline5%، hyaluronidase 1500IU، and in control group stilled water instead of hyaluronidase was used per each nerve root. Pain score، analgesic consumption، neurological examinations and satisfaction were evaluated in recovery and 1، 2، and 4 weeks later. There was no difference in demographic data between 2 groups. Pain score and total analgesic consumption in case group was meaningfully higher 2 and 4 weeks after blockade (p<0. 01). Patient satisfaction was higher in case group. Adding hyaluronidase to transforaminal injectate should be an effective for managingchronic low back pain in failed back surgery syndrome.

This study was performed to evaluate the analgesic effect and adverse effects of nitroglycerine added to lidocaine in intravenous regional anesthesia. Methods and materials: In this Randomized Clinical Trial، 60 patients under intravenous regional anesthesia in Hazrate Fatemeh were evaluated that were randomly assigned to receive either 200 microgram nitroglycerine plus lidocaine or only lidocaine (each group 30 subjects).

Initial pain score (VAS) was alike between groups; but there was a statistically significant difference between second VAS in two groups. But the third VAS was not differed between two groups (P > 0. 05).

Totally، according to the obtained results، it may be concluded that use of nitroglycerine added to lidocaine would result in an increase in effect of anesthetic without additionaladverse effects.

We have compared the effects of lidocaine، remifentanil and placebo on the hoemodynamic responses to tracheal extubation. This was a prospective، randomized clinical trial، double-blind study in 18 to 50 years old adults with ASA I - II، undergoing an orthopedic surgery. Anesthesia was induced with fentanyl 2 μg/kgIV and propofol 1. 5 mg/kg and atracurium 0. 6 mg/kg، and maintained with propofol 100μg/kg/min and repeated doses of atracurium 0. 2 mg/kg. Ten and 50 minutes before the end of surgery، propofol and fentanyl were discontinued respectively. At the end of surgery a bolus dose of Remifentanil 0. 25 μg/kg or Lidocaine 1. 5 mg/kg or 5 ml normal saline was given and tracheal extubation was performed after standard criteria acheivement. Arterial pressure and heart rate were recorded at the time of 1،5،10 intervals from the end of surgery. There were statistically significant differences between the lidocaine and remifentanil group with respect to hemodynamic parameters (heart rate، diastolic blood pressure) at 5، 10 min intervals from the end of surgery. Systolic blood pressure at three times was significantly different in three groups. Remifentanil is more effective than lidocaine on cardiovascular response control during emergence from anesthesia and extubation.