Anesthesiology and Pain Medicine
Volume:14 Issue: 2, Apr 2024

 Post-spinal anesthesia back pain often initiates with needle insertion and may persist for months, particularly among young women following cesarean section. Mechanical vibration has been proposed as an effective method to alleviate this pain.

 The study aimed to evaluate the impact of vibration on reducing pain experienced during needle insertion, as well as its effects one week and one-month post-puncture.

 This randomized clinical trial enrolled patients undergoing spinal anesthesia for various surgical procedures. Patients were randomly assigned to either receive routine spinal anesthesia or spinal anesthesia combined with vibration. Demographic data were collected, and pain levels during needle insertion and back pain were assessed using a visual analog scale (VAS).

 A total of 64 patients were included in the study. There were no significant differences between the two groups in terms of the number of attempts required for needle insertion (P = 0.341), the predominant anatomical level, or the needle approach (midline or paramedian). Ultimately, pain experienced during needle insertion, back pain after one week, and back pain after one month did not differ significantly between the two groups (P = 0.562, P = 0.14, and P = 0.267, respectively)

 The results of the present study showed that vibration at the site of needle insertion during spinal anesthesia had no effect on acute and chronic back pain on subsequent follow-up due to spinal anesthesia.

 Laryngoscopy and tracheal intubation lead to an increased sympathetic reflex response, which is associated with increased heart rate and blood pressure. This response can be detrimental in patients with myocardial ischemia. This study aimed to investigate the effects of etomidate in comparison to a combination of midazolam and sodium thiopental in reducing the sympathetic response to laryngoscopy and tracheal intubation.

 This double-blind, randomized clinical trial study was conducted on two groups of 39 candidates for elective surgery under general anesthesia. Anesthesia was induced by etomidate (E) 0.3 mg/kg in the first group and sodium thiopental 2.5 mg/kg and midazolam 0.075 mg/kg in the second group (TM); then, the patients were intubated. Laryngoscopy findings and cardiovascular response were evaluated during the study. Finally, the data were analyzed using SPSS version 23 (IBM SPSS, Armonk, NY, USA).

 There was no significant difference between the two groups in terms of age (P = 0.82), weight (P = 0.42), height (P = 0.201), body mass index (P = 0.78), gender (P = 0.65), American Society of Anesthesiologists (ASA) physical status (P = 0.36), and laryngoscopy view grading (P = 0.83). The average laryngoscopy time in the E group was less than the TM group (P = 0.019). In the TM group, at 10 minutes after intubation, mean diastolic blood pressure (P = 0.029) and mean arterial blood pressure (P = 0.023) were significantly lower; however, at other times, there was no significant difference between the two groups (P > 0.05). There was no significant difference between the two groups in terms of adverse responses to laryngoscopy and intubation (P = 0.19).

 The results of the present study showed that etomidate (E) and a combination of midazolam-sodium thiopental (TM) acted similarly in attenuating the cardiovascular response to laryngoscopy and tracheal intubation, and it seems that TM can be used instead of E if needed.

 Proper perioperative pain management remains a cornerstone of well-conducted functional endoscopic sinus surgery (FESS). In such a context, proper pain management entails the adequate provision of prolonged postoperative analgesia, the avoidance of overusing opioids, and consequently limiting their unwanted side effects.

 We aimed to evaluate the effect of bilateral ultrasound-guided suprazygomatic maxillary nerve block (MNB) on postoperative pain in patients undergoing FESS.

 Patients eligible for FESS were randomized into two groups: the MNB group (n = 30), who underwent bilateral ultrasound-guided suprazygomatic maxillary nerve block after induction of anesthesia, and a control group (n = 30), who received multimodal analgesia, including opioids. Postoperatively, patients were observed for 48 hours. Pain scores were evaluated upon arrival to the sPACU and at 2, 6, 12, 24, 36, and 48 hours postoperatively, particularly at the time of removal of the hemostatic agent after 36 hours postoperatively. Total rescue analgesia, postoperative complications (including nausea and vomiting [PONV], hypotension, bradycardia, headache), and patient satisfaction were also diligently recorded.

 Sixty patients who were candidates and underwent FESS surgery were enrolled randomly in both groups. The NRS pain score in the MNB group was significantly lower than that of the control group (P < 0.001), especially the NRS during the removal of the hemostatic agent at T10 was significantly lower in the MNB group (P < 0.001). However, at the 24 - hour point post-surgery, there were no significant differences between both groups (P = 0.568). Total rescue analgesia required was significantly lower in the MNB group compared with the control group (P < 0.001) throughout the first 48 hours postoperatively. The percentage of patients with no postoperative complications (nausea, vomiting, and headache) was higher in the MNB group (76.7 %) compared with the control group (40 %). Patient satisfaction was statistically significantly higher in the MNB group (P < 0.001).

 Bilateral ultrasound-guided suprazygomatic MNB appeared to be safe and advantageous, as its use was associated with a decrease in total analgesic consumption, a reduction in postoperative morbidities such as pain, nausea, and vomiting, and greater patient satisfaction.

 Total knee arthroplasty (TKA) is a standard surgical procedure for individuals with debilitating knee arthritis. Effective postoperative pain management is essential for successful recovery, although traditional opioid-based methods have limitations.

 This study aimed to compare the efficacy of Apotel and Remifentanil patient-controlled analgesia in managing postoperative pain after TKA.

 This double-blind, randomized, controlled clinical trial took place at Amir-al-Momenin and Qods Hospitals in Arak, Iran, spanning from June 2022 to September 2023. Sixty-two eligible patients scheduled for knee joint replacement were randomly assigned to receive either Apotel (Group A) or Remifentanil (Group R) as part of multimodal analgesia administered via a pain pump for postoperative pain relief in TKA. The study assessed hemodynamic parameters, pain levels (measured using the Visual Analog Scale), analgesic duration, and narcotic consumption. Statistical analyses were performed using SPSS v.27 and Plotly.

 Subjects exhibited no statistically significant differences in age, gender distribution, duration of surgery, or anesthesia. The hemodynamic status assessment in the recovery room showed no significant differences in SPO2, PR, or MAP between the groups. However, Remifentanil demonstrated superior effectiveness in reducing pain over 24 hours post TKA surgery compared to Apotel, as evidenced by lower average Visual Analog Scale (VAS) scores (P < 0.001), longer duration without the need for narcotic painkillers (P < 0.001), and lower cumulative opioid analgesic consumption in Group R (P < 0.001).

 Remifentanil demonstrates superior pain control in a multimodal pain management approach compared to Apotel, providing sustained pain reduction over 24 hours post-surgery. Moreover, Remifentanil offers longer-lasting pain relief and results in lower cumulative narcotic painkiller consumption compared to Apotel.

 The ganglion impar block is a minimally invasive technique used for alleviating pain associated with coccydynia.

 This research evaluates the effectiveness of the ganglion impar block in treating patients with coccydynia who have not benefited from conservative treatments.

 This cross-sectional analysis reviewed the clinical records of coccydynia patients who received ganglion impar block injections at Urmia Imam Khomeini Hospital, Urmia, Iran, between 2020 and 2022. Data regarding age, gender, body mass index (BMI), onset of pain, and levels of patient satisfaction post-treatment were gathered from the medical records.

 The study comprised 26 patients, with 4 (15.4%) being male and 22 (84.6%) female. The average age and BMI were 39.15 ± 14.24 years and 28.91 ± 2.14 kg/m2, respectively, which did not show significant variation (P = 0.19). The average Visual Analogue Scale (VAS) score before the ganglion impar block was 6.23 ± 2.35, which reduced to 4.47 ± 2.41 immediately after the procedure. At the 1-month follow-up, the average VAS score had further decreased to 3.47 ± 0.79. The decrease in VAS scores, both immediately after the procedure and at the 1-month follow-up, was statistically significant. The success rate of the block (defined as a reduction in pain of at least 20% from the baseline) was significantly high immediately and one-month post-procedure (P < 0.001). Out of the 26 patients treated with the impar block, satisfaction rates were 42.3% excellent, 27% good, 19.2% fair, and 11.5% poor.

 The study endorses the trans-sacro-coccygeal “needle inside needle” method for providing relief to patients suffering from coccydynia. The findings revealed significant patient satisfaction, with the majority describing their experience as excellent.

Spinal decompression is a common procedure in spinal, neurosurgery, and orthopedic surgery. While there are a number of known complications associated with it, pneumocephalus (air in the brain) is generally not a recognized complication postoperatively. However, in rare cases, it can occur as a result of spinal decompression surgery. We describe a case of a 54-year-old female patient who developed pneumocephalus following percutaneous lumbar disc decompression surgery of the lumbar spine. The patient presented to the emergency department 3 hours after discharge with severe restlessness, cognitive impairment, nausea, vomiting, and lack of balance. During symptomatic treatment in the emergency department and 1 hour after taking oxygen, the patient’s vital signs improved. Before discharge, a computed tomography (CT) scan was taken again, which showed the disappearance of radiological symptoms. The patient was discharged 12 hours after hospitalization with suitable clinical conditions. Obtaining urgent imaging tests (magnetic resonance imaging [MRI] or CT) at the cranial and spinal levels, along with an electroencephalogram, allows us to diagnose the problem and determine the appropriate course of treatment, whether pharmacological or surgical.