جستجوی مقالات مرتبط با کلیدواژه « درد پس از عمل جراحی » در نشریات گروه « پزشکی »

Considering the importance of pain management using effective medicines, the present study aimed to compare the analgesic effect of magnesium sulfate and gabapentin on postoperative pain in patients undergoing laparoscopic cholecystectomy.

The present randomized clinical trial study was conducted on patients undergoing laparoscopic cholecystectomy in the operating room of Ayatollah Mousavi Hospital in Zanjan in 2019. The patients were assigned to three groups of 30 using the block randomization method. One group received 50 mg/kg of magnesium sulfate in 100 ml of normal saline within 1 h during the operation, the second group received 600 mg of gabapentin capsule 1 h before the operation, and the third group did not receive any additional medicines. The overall opioid dose, the time of the first analgesic request, and the Visual Analogue Scale (VAS ), 6, 12, 18, and 24 h postoperatively were compared in the three groups using repeated measures of ANOVA.

Based on the results, there was not a significant difference among the three groups in terms of gender and age (P>0.05). Moreover, the three groups t significantly differ in pain and drug dose received (P<0.001). The results of the Tukey post hoc test demonstrated that the pain and drug dose received in the control group was significantly higher than those in both intervention groups (P<0.001). Nonetheless, this difference between the two groups of magnesium sulfate and gabapentin was not statistically significant (P>0.05).

As evidenced by the obtained results, in patients undergoing laparoscopic cholecystectomy, gabapentin and magnesium sulfate significantly reduced pain intensity and the need to use drugs; however, there was no significant difference between the two drugs.

Adenotonsillectomy is one of the most commonly performed surgical procedures in children. Although this surgery is technically easy, it can run a high risk of serious complications, such as laryngeal spasm, laryngitis, bleeding, pain, and nausea. The present study  aimed to assess the effect of preemptive dexamethasone on pediatric post tonsillectomy pain.

This triple-blinded clinical trial study involved a total number of  70 children within the age range of  3-15 years. They were candidates for adenotonsillectomy and were randomly assigned to two groups. One hour before the surgery, one group received intravenous dexamethasone (0.1 mg/kg) and the other group received distilled water intravenously. Patients' pain at 1, 4, 10, and 24 hours after the surgery, initiation of soft-diet feeding and the prevalence of nausea and vomiting were evaluated in both groups. Data were analyzed in SPSS software (version 16).

The total number of patients was 70 (35 in each group). Both groups were homogenous in terms of age and gender. In the intervention group, the mean score of pain in the first and fourth hours and the mean initiation time of soft- diet feeding were significantly lower, as compared to those of the control group (P <0.05). The mean score of the pain in the intervention group at hours 1,4,10, and 24 after tonsillectomy were obtained at 8.40, 5.74, 4.28, and 2.28, respectively. On the other hand, in the control group, the above mentioned mean scores were measured at 9.40, 6.80, 4.51, and 2.7 respectively (P<0.05). Nonetheless, it is noteworthy that no significant difference was observed between the two groups regarding the incidence of nausea and vomiting.

As evidenced by the obtained results, preemptive dexamethasone reduces the post tonsillectomy pain in the first four hours after pediatric adenotonsillectomy. Moreover, it was revealed that it accelerates the initiation of soft-diet feeding without exerting any effect on nausea and vomiting.

In this study, we compared the effects combinations of ketamine and paracetamol with ketamine and metoclopramide on postoperative pain and their effects on surgical complications. Then, better method for reducing pain and complications was referenced.
In a clinical trial study, 102 candidates for laparoscopic surgery under general anesthesia divided into three equal groups of ketamine and metoclopramide, ketamine and paracetamol, and control. In the first group, 0.5 mg/kg ketamine and 0.1 mg/kg metoclopramide, in the second group, 0.5 mg/kg ketamine and 1 g paracetamol, and in the third group, normal saline were injected. Patients’ systolic and diastolic blood pressures and heart rates in all three groups were measured and recorded every 15 minutes. Then, the effects of these two drug combinations on postoperative pain and some other complications were studied and compared between the three groups.
Findings: Average pain intensity was significantly different among the three treated groups (P Combination of ketamine and paracetamol is more favorable because of significant decrease in postoperative pain.

Tonsillectomy is one of the most common procedures performed by otolaryngologists. Intraoperative bleeding is a significant problem, which requires hemostasis and causes prolonged operative time. Several different techniques are used to perform this operation. The Ligasure Vessel Sealing System (LVSST) has been widely used in head and neck surgery because of its effectiveness and safety.
This project was conducted at the department of otolaryngology of Besat Hospital, Hamadan, Iran. In this double-blinded clinical trial, 82 subjects, who were candidates for tonsillectomy and qualified in eligible criteria, were randomly assigned to 2 group of 41 subjects. Surgery was performed using Lvsst for one group and cold knife dissection for the other group. Measured outcomes for efficacy and adverse effect were intraoperative blood loss, operation time, post-operative pain in visual analogue scale, and post-operative bleeding for28 days after surgery. The SPSS 16 software was used for data analysis.
Method of LVSST was significantly better than CKT in operation time and bleeding on the first day after surgery, yet, postoperative blood loss in the first week after surgery in LVSST group was significantly higher than the CKT group. Severity of sore throat after surgery with Ligasure was higher than CKT the group, however the difference was not significant. Intraoperative bleeding in the LVSST group was significantly lower than that of the CKT group (P = 0.000).
The results of this study showed that the prevalence of respiratory symptoms LVSST was better than CKT in intraoperative (not post-operative) blood loss and operation time, yet there was no difference regarding postoperative pain. For workers with a history of allergies, this ratio is higher.

Acute postoperative pain in children increases by activation of physiological and biochemical stressresponses and leads to several complications. Caudal block and infiltration of local anesthetic are two effective modalities for postoperative pain management in children. The aim of this study was to compare the effects of these two methods on postoperative pain control in children. In this double blind clinical trial, 110 children who underwent herniorhaphy and orchidopexy, were allocated to two groups of caudal block and wound infiltration using randomized fixed quadripartite blocks.The drug dosage in caudal block group was 1mg/kg of bupivacaine 0.125 % and it was 0.5mg/kg of bupivacaine 0.25% in wound infiltration group. Pain score , time to start of micturition and gas passing, parents’ satisfaction, time for the first dose of acetaminophen , number and total acetaminophen dosage in 24 hours, were noted at 1-6- 12 -24 hours after operation. Pain score significantly diminished in caudal (0.0001) and infiltration (<0.0001) groups. There was no significant difference between the two groups in terms of pain score changes(0.8),time for the first dose of acetaminophen (p=0.77) , number of need for analgesia (p=0.81), total analgesic doses(p=0.9), the onset of intestinal activity(p=0.44) and micturation (p=0.66) during 24 hours after surgery. However, parents’ satisfaction was significantly more in infiltration group (p=0.002) It seems that both methods are effective for this purpose. However, considering the less time needed for the procedure, and more satisfaction of wound infiltration, it might be suggested as the preferred method.

Poor control of postoperative acute pain will result in various acute and chronic complications. Nowadays, a multimodal approach is used to control post-operative pain. Pregabalin and gabapentin have been shown to have analgesic effects on postoperative pain as a Gaba-Amino-Buteric Acid (GABA) analogue with minimal side effects. The aim of this study was to compare the analgesic effects of pregabalin with that of gabapentin in the prevention of postoperative pain in patients undergoing tibia fixation surgery. Sixty patients, candidate for tibia fixation surgery under spinal anesthesia, were randomly assigned into two groups. For the intervention group(P), 150 mg oral pregabalin one hour before surgery and for the intervention group(G)300 mg oral gabapentin were prescribed two hours before surgery .Visual Analogue Scale (VAS) for pain assessment, opioid consumption, nausea, vomiting and vertigo were evaluated in a 12 hour period after surgery. If pain score (VAS) was more than three, intravenous morphin (0.1 mg/kg) was administered .Chi-Square and repeated measurement and t- tests were used for statistical analysis. The results of the study showed that there was no significant difference between the two groups, regarding pain, nausea, vomiting and vertigo in measurement point times (p>0.05). However, it was found that VAS score in the two groups decreased during 12 hours postoperatively but there was no statistically significant difference between the groups (p=0.22, F=1.5). Administration of a single dose of pregabalin orally (150 mg) or gabapentin (300 mg) before orthopedic surgery reduced post operative pain, opioid consumption and consequently the rate of nausea and vomiting.

Pain is one of the most common postoperative complications that can be reduced via different methods like combination of two or more drugs to make synergistic effect. This research aimed to comparing the preventive effect of using combination of ketamine and fentanyl or ketamine and metoclopramide on the postoperative pain after laparoscopic cholecystectomy.

In a double-blinded clinical trial study, 90 patients in class I and II of ASA (American Society of Anesthesiologists) classification who were candidates for laparoscopic cholecystectomy were divided into two groups. Half an hour before completion of the operation, patients in the first group received intravenous metoclopramide (0.1 mg/kg) and ketamine (0.5 mg/kg) slowly; while the patients in the second group received intravenous ketamine (0.5 mg/kg) and fentanyl (0.5 µg/kg) slowly. After completion of operation, the pain severity was evaluated based on the visual analogue score (VAS) and the data were compared between the two groups.

The main pain score in ketamine and metoclopramide group at the end of recovery, also at the 2nd, 6th, 12th, 24th postoperative hours, was significantly lower than ketamine and fentanyl group (P < 0.001).

Preventive administration of ketamine and metoclopramide causes more reduction in postoperative pain than ketamine and fentanyl and is not associated with any severe postoperative complication.

Diclofenac is one of common non-steroidal anti-inflammatory drug that is used for postoperative pain relief. There are some limitations to diclofenac usage. Finding alternative methods that are safe and effective is very important. Gabapantin is one of cheap, available, and low side effects in low dose drug that is considered as postoperative pain relief supplement. This study aimed to comparison of effect of low dose gabapentin and diclofenac for postoperative pain reduction after abdominal hysterectomy. A double blinded randomized trial conducted on 100 undergoing hysterectomy patients in Al-zahra hospital from 2013 to 2014. Patients were randomly assigned in two equal number groups. Patients in one of group received 300 mg gabapentin orally and placebo rectally patients in other group received placebo orally and 100 mg diclofenac rectally in 8 and 16 hours after hysterectomy. Pain was assessed using numeric rating scale (NRS) in 12 and 24 hours after surgery. Pethedine consumption and adverse effects over 24 hours after surgery were recorded. Mean of pain score in 12 hours after surgery were 4.10 ± 0.84 in gabapentin group and 3.94 ± 0.68 in declofenac group that this difference between two group was not significant (P = 0.228). Mean of pain score in 24 hours after surgery were 3.50 ± 0.86 and 3.44 ± 0.79 in gabapentin and declofenac groups, respectively, that this difference was not significant (P = 0.593). Only one patient in diclofenac group requested pethedine after intervention (P = 1.0). Over 24 hours after surgery there were no significant difference between two groups in term of incidence of nausea (P=0.241), vomiting (P = 1.0) and dizziness (P = 0.487). Based on result of this study gabapentin is as effective as declofenac on pain reduction after hysterectomy that can be a suitable replacement for diclofenac. Trial registration Number: IRCT2012111710089N2 Conflict of interest: non declared

Despite applying new drugs and techniques, many patients experience moderate to severe pain after surgery. Our goal in this study was to determine the effect of intravenous (IV) lidocaine infusion on postoperative pain in laparoscopic cholecystectomy surgery. In this double-blind clinical trial a total of 70 candidates for laparoscopic cholecystectomy surgery were randomly selected and divided into two groups. With the same condition, in the case group before surgery, 1.5 mg/kg lidocaein 2% and then infusion of 2 mg/kg/h lidocaein 2% and the same volume of normal saline for control group was injected. Systolic and diastolic blood pressures, heart rate, analgesic score according to Visual Analog scale (VAS) were recorded and the data analyzed by mann-whitney and chi-square tests. Pain intensity according to VAS after postoperation was significantly lower in case group(1.25±2.88) by comparison with control (6.00±3.84), (p= 0.001). Analgesics consumption in suppository from and IV was significantly lower than the case group (p<0.05). Results wereshown lidocaine infusion can decrease pain intensity and analgesics consumption after laparoscopic cholecystectomy surgery.

After caesarean, mothers need to take care of their babies as soon as possible, and pain relief in them leads to more comfort and faster recovery and it reduces hospitalization time and complications such as pulmonary thromboembolism as well as treatment costs. Determining the effect of TAP block by injection of Bupivacaine 0.25% after caesarean section on post operative pain. This study was performed on seventy six women that underwent elective caesarean section. Then, the women were randomly divided into two groups. Six women were excluded from the study which was a double-blind clinical trial. In the case group: 20cc of Bupivacaine 0.25% was injected between transverse abdominal muscle fascia and internal oblique muscle fascia, and in control group the same amount of normal saline was used. Pain intensity was measured by VAS score at 2,4,6,12,24,48 hours after surgery. In both groups, if the patient needed pain relief, diclofenac suppository was used and its dose was recorded. Some complications such as nausea, vomiting and dizziness were recorded too, data were analyzed by SPSS (21) software, P value less than 0.05 was considered statistically significant. VAS score at 2, 4, 6 hours after surgery in case group was significantly lower than that in the control group. (P=0.0001, P=0.0001, P=0.039), respectively. The mean number of administered diclofenac in bupivacaine group was lower than that in placebo group (P=0.0001). The mean and standard deviation of pain free period in bupivacaine group was 13.77±2.41 and in placebo group was 5.94± 1.27. Survival rate of analgesia was 14.3% in bupivacaine group and 2.9% in placebo group. This difference was statistically significant (P= 0.001). Transverse abdominal plane block with Bupivacaine 0.25% can reduce post caesarean pain without any side effects, such as dizziness, nausea and vomiting, and any effect on the time of ambulation. It can also reduce use of analgesics Conflict of interest: non declared

The training is a one of important duties pediatric nurse and can empower parents to proper management the child''s tonsillectomy pain. This study with the aim of determines the effect of parents training on pain controlling in pediatric tonsillectomy in children admitted to Hamadan hospitals in 2013 was performed. In this randomized clinical trial study، 68 children 6 to 12 years admitted for tonsillectomy with a parent selected and randomly divided to control and case groups. For case group individual training، booklet and after discharge telephone follow-up were performed. Data collecting tools were the check list of self- reporting of pain and home dairy. Data were analyzed by SPSS 16 software، descriptive statistics and repeated measures ANOVA، independent t test and Chi-square test. In Three days after discharge، there was statistically significant differences between mean pain intensity scores (p=0. 006)، pain after swallowing (p=0. 008) and the sedative effect of analgesics (p=0. 04) in the experimental and control groups. Differences in pain intensity scores on the first day (p=0. 004) and second (p=0. 04)، pain after swallowing on the first day (p=0. 02) and second (p=0. 006) and the sedative effects of analgesic on the second day (p=0. 01) after discharge were significant. Pain intensity and pain after swallowing particular in the first two days after discharge lower and sedative effect of analgesic was higher in case group’s children. Therefore، training before tonsillectomy، with increases of knowledge and the skills of parents to manage pediatric pain at home was effective.

Postoperative pain relief in addicted patients compared with non-addicted patients is often more challenging and they usually suffer from inadequate postoperative pain relief. The purpose of this study was to compare satisfaction with postoperative pain management in addicted and non-addicted patients and level of pain interference with their functions. In this analytic cross sectional study, 105 addicted and 105 non addicted patients admitted to the surgical ward of Saveh Modares hospital in 2012 were selected. Two study groups were compared as regard to intensity of pain, satisfaction with postoperative pain management and level of pain interference with functions. Data collection instrument included a 4 section questionnaire that the first part covered patient's demographics, second part contained universal pain assessment tool, the third part included items on level of pain interference with their functions (usual functions, walking, emotions, sleep and relations with others) and fourth part was related to assessment of satisfaction with post-operative pain. Questionnaire was used after determining its validity and reliability. The data were statistically analyzed utilizing descriptive statistics and Pearson corelational T test and chi square test analytic. The majority of subjects (57.14%) in addicted group were dissatisfied from pain control after surgery, while 14.28 percent of non-addicted patients were dissatisfied with pain control post-operatively and this difference was significant (P=0.001). The results showed that postoperative pain interfered with functions in the areas of mood, sleep and relationships with others which was significantly different between two groups (P=0.01). The results indicated that special attention should be paid to concept of pain relief in addicted patients, especially acute pain such as pain after surgery and their rights as patients must be considered and respected.

Aims and T he present study has been performed to design a guideline for acute pain management after orthopedic surgeries, and also this study has a role in improving patient satisfaction and quality of life, and at the same time aiding hospital to reach a higher level of available pain control service. In this study which is a developmental research, first of all the databases such as Google Scholar, PubMed, Cochrane, Scopus, Elsevier, and Springer were searched on the key words such as Orthopedic Surgery, Acute Post-Operative Pain, Acute Pain Management, and Post-Operative Pain Management in the last five years. Articles in the form of Clinical trial, systematic review and meta-analysis about acute pain control after orthopedic surgery, with high quality were entered into the study. The evaluation of quality of articles was done by Jadad Score questionnaire, which is one of the most reliable questionnaires in the world for evaluating the quality of articles. Articles receiving a score less than 4 were excluded from the study. The clinical care guideline was designed based on Stetler model in evidence-based approaches. Seventy seven articles in the field of analgesia after orthopedic surgery were selected. Within these articles, 51 with a score> 4 according to Jadad questionnaire were assessed in the expert panel sessions. Three sessions were organized and finally the guideline was approved by the members attending the sessions. Multi-modal approach to pain management after orthopedic surgery, is one of the most valid protocols based on recent evidence. The Preemptive dosing of analgesic drugs, particularly non steroidal anti-inflammatory drugs such as Celecoxib, was especially effective in the articles.

Lumbar discectomy is a common elective surgical procedure. Many patientsexperience postoperative back pain which may delayhospital discharge. α2-agonist، inhibit pain sensation by inhibiting norepinephrine release from dorsal horn neuron in accordance with prolongation of analgesia and decreasing analgesic morphine requirements. The aim of this study was to assess the effect of tizanidine on the intensity of pain and equirement for analgesics for relief of postoperative pain after lumbar disc surgery. Eighty patients with single-level unilateral herniated disc that wererefractory to conservative management، and undergoing lumbar disc surgery under standard general anesthesia were enrolled. Forty patients received pre-operative oral Tizanidine and forty patients received placebo. Besides، all patients received patient controlled morphine pump for postoperation analgesia. Pain was measured usingnumerical rating scale (NRS) at 1، 3، 6، 12 and 24 hours post-operation. Total morphine requirement was also measured. Post-operative pain score (NRS) wassignificantly lower at 6 hour (p= 0. 01)، 12 (p= 0. 027) and 24 hours (p= 0. 015). Total 24 hours morphine requirement (rescue analgesic) was also significantly lower in Tizanidine than in control (p= 0. 02). Pre-operative use of tizanidine prior to lumbar disc herniation surgery maintains effective post-operative analgesia and decreases morphinerequirement without major or minor complications.

Introduction & Many surgical patients still experience moderate to severe pain after surgery despite efforts to administer new drugs and techniques. Postoperative analgesia clearly enhances patient’s satisfaction and facilitates earlier mobilization and rehabilitation. lidocaein has been introduced as part of post operative pain management and clinical studies revealed analgesic actions in patients with chronic neuropathic pain. Our goal in this study was to determine the effect of intravenous lidocaein on post operative pain of women under-going cesarean section under spinal anesthesia. In this double blinded clinical trial study, 72 patients candidate for Ce-sarean section under spinal anesthesia were randomly selected and divided in two groups. In the case group, infusion of1.5 mg/kg lidocaein and in the control group infusion of the same volume normal saline started 15 minutes before the beginning of operation. After spinal anes-thesia with definite technique in both groups, infusion of 1.5 mg/kg/h lidocaein in case group and the same volume normal saline in the control group was administered and continued till 0.5 hour after finishing the operation. Data including systolic and diastolic blood pressure, heart rate, analgesic score according VAS and using of analgesic drugs were recorded during 24 hours after the operation. Pain intensity according to VAS score in the time 2,6,12 hours post operation were significantly lower in the case group (P2= 0.05, P6 = 0.01, P12= 0.05). Analgesic consumption in form of suppository & IV,24 hours after surgery, was significantly lower in the case group.(P=0.001). Lidocaein infusion can decrease pain intensity & analgesic consumption after ce-sarean section under spinal anesthesia.

Controlling postoperative pain and its complications is a major issue in postoperative care and plays an important role in accelerating the recovery of patients. The present research compared the effects of ketamine alone and in combination with metoclopramide on postoperative pain.

This double-blind clinical trial was conducted on patients undergoing septorhinoplasty at Alzahra Hospital (Isfahan، Iran) in 2012. Patients were divided into two groups to intravenously receive either 10 mg metoclopramide combined with 0. 3 mg/kg ketamine or only 0. 3 mg/kg ketamine five minutes before the incision. Pain (based on a visual analogue scale)، vomiting، the required amount of morphine، and the side effects were evaluated in the two groups.

The two groups had a significant difference in pain intensity (P = 0. 028) and mean morphine consumption (P < 0. 001) 30 minutes-24 hours after the operation. There were also significant differences between the two groups in the incidence of nausea and vomiting during the 6th-12th postoperative hours (P = 0. 048 and 0. 035، respectively).

Combination of ketamine and metoclopramide was more effective than ketamine alone in reducing pain after septorhinoplasty. Therefore، the use of this combination is recommended in the absence of contraindications.

Introduction & Magnesium is a NMDA receptor antagonist and a calcium channel blocker. The aim of the study is to evaluate the analgesic efficiency of preoperative magne-sium sulfate infusion in patients undergoing elective cesarean surgery. In a randomized double blind trial study approved by local ethics com-mittee، 68 parturient who were admitted for elective cesarean section through spinal anesthe-sia were divided into two equal groups. Magnesium group (M) received IV magnesium sul-fate 50 mg/kg as a bolus and then 10 mg/kg/h IV as continuous infusion at the time of sur-gery. The control group (S) received the same amount of isotonic saline. Both groups were completely monitored and the data about blood pressure، heart rate، side effects and severity of pain (VAS) was recorded for 24 hours in the obstetric ward. The patients who had VAS = 4–6 received supp. Diclofenac Na (100 mg) and the patients who had VAS=7–10 received Diclofenac Na (75 mg) by intramuscular injection. The rate of diclofenac Na consumption was recorded for each patient. The pain scores in the magnesium group were significantly lower than the control group at 2 and 24 hours post operatively (P<0. 05). Diclofenac dose consumption was also significantly lower in the magnesium group (137 ± 54 rather than 231± 67) and (P<0. 005). IV magnesium sulfate administration during cesarean section in the parturients anesthetized intrathecally، decreases analgesic consumption after surgery and improves post-operative analgesia.

Pain control is one of the most important issues of post operation. Uncontrolled pain can be due to the complications such as rise of myocardial oxygen consumption، hypercoagulative state and suppression of respiratory system. There are several methods to control post operative pain، among which peripheral methods، due to fewer associated complications than others، (such as opioids and noroagsial methods) is more fruitful. The aim of this study was to compare efficacy of marcaine 0. 25% with that of lidocaine 2% for controlling the pain after cesarean section. In a double blind clinical trial، we selected 90 women with gravid one and term pregnancy. They were randomized into three groups. Patients underwent spinal anaesthesia. Following the surgery، we injected marcaine 0. 25% in dose of 0. 5 mg/kg with 20 cc distilled water، in 3 layers of abdomen (peritoneum، muscle، sub derm) in group 1، lidocaie 2%، 4mg/kg with 20 cc distilled water in group 2 and 30cc normal saline in group 3. The severity of pain was measured by VAS in 1، 2،3،4،8 and 12 hours after surgery. Also، the first dose administration time and mean consumption of diclofenac were assessed and compared among the three groups. We used SPSS، One Way ANOVA and Repeated Measure for analysis. (P. value less than 0. 05 was considered significant) The mean values of VAS in hours of 1،2،3،4 in group of marcaine were (3. 33،3. 6،3. 46،3. 33)، respectively، in lidocaine group were (3. 56،4. 16،4. 8،4. 43) and in normal saline group were (4. 06،5. 3،5. 66،5. 43). The mean time of the first dose administration of diclofenac in marcaine group was 2. 56، in lidocaine group was 2. 53 and in normal saline group was 1. 53. The local infiltration of marcaine 0. 25 % in puncture of cesarean seems to be more effective than lidocaine 2% for pain control and decreases analgesic consumption in early hours after cesarean section.

Pain is a common phenomenon after all surgical operation. Although using analgesia is usual to relieve pain, its complication, unavailability, necessity of taking less drug, especially analgesia, and also ineffectiveness of using analgesia alone, to relieve pain has focused therapeutic system on complementary treatments such as foot reflexology. Therefore, this study was performed to investigate the effects of foot reflexology on pain in patients who underwent cesarean section. This clinical trial study was carried out on 62 women referring to cesarean section in Alzahra Hospital (Rasht city). They were randomly divided into two groups of case and control. The reflexology group was received a 30-minute foot massage in two sessions, with 24-hours interval. Data gathering tool included a demographic form, step-visual analogue scale and pain score form. In the case group, severity of pain after first stage (day one) was significantly lower than before reflexology session and the control group (p<0.001, p<0.0001, repectively). The severity of pain after second stage was significantly reduced in the case group in comparison with the control group (P<0.001). In the case group, physiologic parameters (systolic and diastolic blood pressure, pulse rate and respiration rate) showed no significant differences assumed with the control group. In general, foot reflexology appears to be a useful method to reduce postoperative pain, but no effect on physiological parameters

Considering the side-effects of opiums and NSIADS drugs such as respiratory depression, apnea and GI effects, today it has been paid more attention to intra abdominal wall infiltration of local anesthetics for this purpose. The aim of this study is to determine the effect of intra abdominal wall infiltration with bupivacaine to reduce post operative diclofenac need in elective cesarean sections. In this double- blind, placebo-controlled trial, 60 healthy women with single term pregnancy underwent spinal anesthesia were randomized into two groups. Patients, then received a combination of 30cc of bupivacaine with 1.5cc of epinephrine as intra abdominal wall infiltration or equal volume of saline in cesarean section at the time of abdominal closure. Pain was assessed using a visual analogue scale 1, 2, 3, 4, 8 and 12 h after the operation.Also mean diclofenac consumption was assessed during 12 h after the operation. The final analysis was done with statistical tests by SPSS (P<0.05 was considered significant). Mean pain scores at 1 and 2 h after the operation was significantly lower in bupivacaine group than placebo(p<0.05). Mean diclofenac consumption was lesser in bupivacaine group than placebo (p<0.05). Also the time we prescribed diclofenac in bupivacaine group was later (p<0.05). Intra abdominal wall infiltration with 30cc of 0.25% bupivacaine leads to less pain and less diclofenac consumption at the first hours after cesarean section.