فصلنامه بیهوشی و درد
سال یازدهم شماره 2 (تابستان 1399)

Intraoperative nausea and vomiting causes anxiety for the patient , gynecologist and anesthesiologist, and can increase the risk of visceral injury during surgery due to unintentional abdominal movements. The purpose of this study was to compare the efficacy of low-dose Ketamine and dexamethasone in controlling nausea and vomiting in patients undergoing cesarean section with spinal anesthesia.

A total of 135 patients underwent cesarean section by spinal anesthesia in the operating room. All patients were 18-40 years old and ASAI-II. Patients were randomly divided into three groups using blocking method as Ketamine intake group (including 45 subjects diluted 20mg ketamine diluted in normal saline 5ml total volume), dexamethasone group (including 45 patients diluted 8mg dexamethasone normal saline 5ml total volume) and control group (including 45 patients who received 5 ml of saline) and the incidence of nausea and vomiting were recorded during anesthesia, nausea by an anesthesia technician under the supervision of an anesthetic resident who was unaware of the patient`s group. Finally, all data were analyzed by statistical analysis (spss21) program.

In this study, 135 patients were divided into three groups of 45 (dexamethasone, ketamine and placebo). In this study, low dose of dexamethasone and ketamine before cesarean section did not significantly reduce the incidence of nausea and vomiting (P=0.02) and shivering (P=0.550). However, the intensity of nausea and vomiting was significantly decreased in the low dose ketamine group compared to the dexamethasone group. There was no significant change in the blood pressure and heart rate of the patients, and blood pressure falctuations were consistent at different times. Also, there was no significant difference in the incidence of hypotension (P=0.885), Ephedrine intake for hypertension (P=0.623), and the incidence of bradycardia (P=0.146) in the study groups. On the other hand, it was observed that the incidence of bradycardia was significantly lower in the ketamine recipients than in the dexamethasone group.

This study showed significant reduction in nausea and vomiting in the Ketamine group compared to Dexamethasone and no significant difference between two groups regarding the hypotension and shivering. It also showed that there was no statistically significant difference between groups receiving Dexamethasone and low dose Ketamine compared to control group during the operation period regarding the decrease in rate of nausea and vomiting, hypotension and shivering.

Inappropriate kinetic and kinematic are considered as effective factors in knee injuries especially patellofemoral pain. The aim of this study was to investigate the immediate effect of Mulligan taping on knee dynamic valgus, maximum knee flexion angle, the maximum ground reaction force, time to stabilization and pain in physically active female with patellofemoral pain and dynamic knee valgus.

Fifteen physically active female with patellofemoral pain and dynamic knee valgus was selected purposefully. Before and after Mulligan taping, dynamic knee valgus and flexion in single leg landing and squatting were measured using a two-dimensional video-based method, pain with visual analogue scale and maximum ground reaction force and time to stabiliz during the single leg landing on the force plate were assessed. Dependent t-test was used to statistical analysis (α≤0.05).

The results of dependent t-test showed that the pain (p=0.041, 24.4% reduction), dynamic knee valgus was significantly decreased during single-leg squatting (p=0.001, 58.2% reduction), and landing (p=0.001, 42.9% reduction), and time to stabilization (p=0.033, 64.7% reduction) after taping. However, the maximum knee flexion angle (p=0.518), and the maximum ground reaction force(p=0.267) did not show a significant difference. 

The results of this study revealed that Mulligan corrective taping can reduce knee dynamic valgus angle, time to stabilization and pain. Therefore, this method of taping recommended due to modify the related and exacerbating factors of patellofemoral pain and pain reduction in active female with this disorder and dynamic valgus.

The aim of the present study was to compare the effectiveness of cognitive- behavior therapy (CBT) and schema therapy (ST) on the reduction of cognitive error of pain catastrophizing and increase of pain self- efficacy of Tehranian patients with chronic back pain.

The present study was aquasi-experimental design that conducted in the form of pretest, post-test and 2 months follow-up with control group. In this study, 35 patients with chronic low back pain who were referred to pain specific clinic of Akhtar and Imam Hussein hospitals (AS) and neurosurgery clinic of Imam Hussein hospitals (AS) in Tehran, were selected with purposive sampling method (non-probabilistic). All patients completed Chronic Pain Questionnaire, Catastrophizing subscale of Coping Strategies Questionnaire, Pain Self Efficacy Questionnaire in the pre-test, post-test and 2months follow-up. In addition, the schema therapy group completed the 90-Item Short Form of Young Schema Questionnaire (YSQ-SF) apart from the mentioned questionnaires. Mixed effect regression model using SPSS software was used to analyzing the data.

The results showed that cognitive-behavior therapy significantly reduced catastrophizing cognitive error whereas schema therapy did not have significant impact on the scores of catastrophizing cognitive error. Also cognitive-behavior therapy significantly increased pain self- efficacy and schema therapy noticeably increased pain self- efficacy and there was no significant difference between two methods in terms of impact on pain self- efficacy.

According to the result᾿s of present study, cognitive-behavior therapy decrease negative automatic thoughts such as catastrophizing and increase pain self-efficacyin chronic pain patients and schema therapy has acceptable influence on increase pain self- efficacy in chronic pain patients. Therefore probably both two treatment methods can be used as appropriate treatment methods in chronic pain patients.

Due to the importance of pain control in the postoperative period, the use of pain killers reduces postoperative complications by improving the patients’ pain intensity. This study was performed to compare the efficacy of oral Meloxicam with pain pump containing Paracetamol and Sufentanil in post-cesarean analgesia.

In this clinical trial study, 59 pregnant women undergoing spinal cesarean section in Ali ebn-e Abi taleb Hospital of Zahedan in 2017 were studied. Patients were randomly divided into two groups receiving oral Meloxicam and Paracetamol and Sufentanil pain pump. The severity of pain, satisfaction, sedation and need for analgesics were assessed in both groups.

Mean age of patients was 26.9 ± 4.9 years. In the present study, mean pain intensity in patients receiving Meloxicam and pump at zero moment were 3.9 ± 1.5 and 4.2 ± 1.4 (P = 0.426), at 6 hours post-surgery, respectively  3.3±0.9 and 2.6 ± 0.8 (P = 0.006) ,at 12 h post-surgery  were 2.1 ± 0.9 and 1.7 ± 0.7 (P = 0.059) and at 24 h, respectively were 1.0 ± 7.8 and 1.1 ± 0.7, respectively (P = 0.001) .The need for analgesic in Meloxicam  group was 18.1 ± 11.4 mg and in pain pump group was 10.8 ±12.6 mg. (P = 0.024).

The results of this study showed that pain intensity in patients receiving pain pump was significantly lower than those taken oral Meloxicam. Also, the demand for analgesic was lower in this group.

Experience of pain and emotion control in people with cancer would have various psychological and social impacts. The purpose of this study was to evaluate the efficacy of commitment and acceptance on acceptance of pain and control of emotions in patients with cancer.

The present study was applied in terms of purpose, quasi-experimental and in terms of pre-test and post-test with control group. The statistical population of this study was men with cancer in Kohgiluyeh Countyin 2018. The statistical sample consisted of 26 men with cancer who were selected by purposive sampling and were randomly assigned to two experimental (13 subjects) and a control group (13 subjects). Data were collected using the McKracken & Woles (2004) pain acceptance questionnaires and Williams & Chambers (1997) emotion control questionnaires. The experimental group received acceptance and commitment based treatment during 8 sessions within 90 minutes, but the control group did not receive any intervention. Data were analyzed using multivariate analysis of covariance (MANCOVA) and analysis of covariance (ANCOVA) in SPSS software.

The results showed that acceptance and commitment-based therapy were effective on pain tendency, active participation, and overall acceptance of pain, anger, depressed mood, anxiety, positive affect, and overall emotional control score at the post-test stage, but the effect did not stand permanently. (p<.05)

Psychologists may use the results of this study for therapeutic interventions based on acceptance therapy and the commitment to increase pain acceptance and control emotions in cancer patients. .

Fibromyalgia syndrome is a chronic condition associated with widespread musculoskeletal pain that primarily affects women and has negative impact on psychosocial aspects of one’s life. The aim of this study was to evaluate the effectiveness of group acceptance and commitment therapy on perceived stress and pain perception in women with fibromyalgia.

This was an experimental single-blind clinical trial study with pretest – posttest design on control group. The statistical population included all women with fibromyalgia who referred to rheumatology specialists in Ardabil in 2019. The subjects were 36 patients with fibromyalgia who were selected based on convenience sampling and were randomly divided into one experimental (N=18) and one control (N=18) group. Patients were evaluated by two questionnaires including Cohen’s perceived Stress Scale and MC Gill Pain Questionnaire. Data were analyzed by MANCOVA.

Result showed that there was a significant difference in perceived stress and pain perception between acceptance and commitment group and control group after treatment.

Group acceptance and commitment therapy might be effective in reducing psychological problems in women with fibromyalgia.

Pain is one of the most common clinical symptoms faced by nurses, so its control and taxis are considered as nursing priorities and In this regard, knowledge, nursing skills and attitude are needed. Heading to this field, this study aimed to investigate the effect of teaching the principles of pain management on knowledge of nurses in the neonatal and pediatric intensive care unit.

This clinical trial study was carried out on nurses working in Neonatal and pediatric intensive care units of Motahari Hospital in Jahrom within year 1396. The nurses working in these parts were selected by census method and then divided into two intervention and control groups for the workshop randomly. This study was carried out in two stages. At first, the researcher had a questionnaire about pain management knowledge for all personnel. In the second stage, nurses were randomly divided into two groups: control and intervention; participating in a workshop on pain assessment and control methods, a questionnaire was completed by the personnel one month later. Data were analyzed using SPSS 21 software.

The results of the research showed that the mean score of knowledge in the test group was significantly higher than the pre-test group (P <0.001). Also, in the stage of postoperative and post-test, the two groups showed significant differences in knowledge (P <0.001).

Results indicated that pain management training workshop was effective on increasing each of the knowledge and practice factors of nurses in the pediatric and neonatal intensive care unit after intervention.

Chronic low back pain (LBP) is one of the most common and costly musculoskeletal disorders in societies that have been suggested for many therapies. Exercise therapy is one of the most widely used methods in control and treatment of chronic low back pain. The purpose of the present study is to systematically review English-language studies that have investigated the effect of different exercise methods on some of the negative factors associated with non-specific chronic low back pain.

Searches were conducted from 2008 to 2019 years from databases of google scholar, Since Direct, PubMed, PsycINFO, using keywords including Exercise therapy, Corrective Exercise, Chronic Low Back Pain. Studies investigating the effect of different methods of exercise therapy on pain relief and disability in patients with chronic low back pain were included. PEDro scale was used to check the quality of articles.

Out of 48 articles, 10 articles with 668 subjects met the inclusion criteria. These studies have mainly focused on the effect of core stability, and Pilates exercises on variables of pain, functional disability in patients with non-specific chronic low back pain. In this study, the positive effect of stability exercises and Pilates was documented.

It seems that core stability and Pilates training methods are effective interventions in the rehabilitation of non-specific chronic low back pain.