Usporedba poslijeoperacijskog analgezijskog učinka potkožne primjene tramadola i bupivakaina u bolesnica podvrgnutih carskom rezu

Cesarean section is associated with significant postoperative pain. The aim of this study was to evaluate the effects of tramadol versus bupivacaine administration at wound closure on postoperative pain relief in patients undergoing cesarean section. Sixty women undergoing cesarean deliveries were randomly assigned to receive either 10 mL of bupivacaine 0.5% (n=30) or 50 mg of tramadol in 10 mL of normal saline (n=30), both as local wound infiltration prior to skin closure at the end of operation. Postoperative pain was evaluated with a visual analogue scale (VAS: 0-10) at 1, 2 and 6 hours after operation. Time to first analgesic administration and analgesic consumption in 24 hours after operation were recorded and compared between the two groups. Dana were analyzed by SPSS software version 15 and p0.05; Fisher exact test). No side effects were reported in either group. This study showed that subcutaneous administration of tramadol provided analgesic effect equal to bupivacaine with longer pain relief after cesarean section.Carski rez je udružen sa značajnom poslijeoperacijskom boli. Cilj ove studije bio je procijeniti učinak primjene tramadola u usporedbi s bupivakainom pri zatvaranju rane na olakšanje poslijeoperacijske boli u bolesnica podvrgnutih carskom rezu. Po 30 od ukupno 60 žena podvrgnutih carskom rezu i uključenih u studiju nasumce je primilo 10 mL bupivakaina 0,5% ili 50 mg tramadola u normalnoj fiziološkoj otopini ukapljeno u operacijsku ranu prije zatvaranja rane na kraju zahvata. Poslijeoperacijska bol procjenjivala se pomoću vizualne analogne ljestvice (VAS: 0-10) 1, 2 i 6 sati nakon operacije. U obje skupine bilježilo se i usporedilo vrijeme do prvog davanja analgetika i potrošnja analgetika kroz 24 sata od operacije. Podaci su analizirani pomoću programa SPSS ver. 15, a razina statističke značajnosti utvrđena je kao P0.05; Fisherov egzaktni test). Ni u jednoj skupini nisu zabilježene nikakve nuspojave. Ova studija je pokazala da potkožna primjena tramadola ima jednak analgezijski učinak kao bupivakain, ali s dužim olakšanjem boli nakon carskog reza

Comparison of peritonsillar infiltration effects of ketamine and tramadol on post tonsillectomy pain: a double-blinded randomized placebo-controlled clinical trial

Aim To assess the effect of peritonsillar infiltration of ketamine and tramadol on post tonsillectomy pain and compare the side effects. Methods The double-blind randomized clinical trial was performed on 126 patients aged 5-12 years who had been scheduled for elective tonsillectomy. The patients were randomly divided into 3 groups to receive either ketamine, tramadol, or placebo. They had American Society of Anesthesiologists physical status class I and II. All patients underwent the same method of anesthesia and surgical procedure. The three groups did not differ according to their age, sex, and duration of anesthesia and surgery. Post operative pain was evaluated using CHEOPS score. Other parameters such as the time to the first request for analgesic, hemodynamic elements, sedation score, nausea, vomiting, and hallucination were also assessed during 12 hours after surgery. Results Tramadol group had significantly lower pain scores (P = 0.005), significantly longer time to the first request for analgesic (P = 0.001), significantly shorter time to the beginning of liquid regimen (P = 0.001), and lower hemodynamic parameters such as blood pressure (P = 0.001) and heart rate (P = 0.001) than other two groups. Ketamine group had significantly greater presence of hallucinations and negative behavior than tramadol and placebo groups. The groups did not differ significantly in the presence of nausea and vomiting. Conclusion Preoperative peritonsillar infiltration of tramadol can decrease post-tonsillectomy pain, analgesic consumption, and the time to recovery without significant side effects

Two different concentrations of propofol and ketamine combinations in pediatric patients under intrathecal injection of chemotherapy drugs

Background: Intrathecal injection of chemotherapy drugs in leukemic children is a painful procedure that needs sedation and analgesia. Different combinations of ketamine and propofol (ketofol) are used for this purpose. In this study we compared two different concentrations of ketofol    (combination of 1/3 and 1/5 of ketamine and propofol). Methods: In this randomized double blinded controlled clinical trial, 80 Children were studied in two groups. Group 1 received a combination of 1/3 of ketamine and propofol and group 2 received a combination of 1/5 for procedure of Intrathecal injection of chemotherapy drugs. Hemodynamic parameters, recovery time, and drug side effects were compared between two groups.Results: In this study 80 children age 4-12 years old underwent Intrathecal injection of chemotherapy drugs were studied. There were no significant differences in age, weight between groups.  Recovery time was significantly shorter in group 2 (p = 0.001). Also heart rate was lower in group 2 significantly (p = 0.001), but mean arterial pressure was not different between two groups (p = 0.287). SPO2 was > 95% in all the children during the procedure (p = 0.74).Conclusions: Combination of 1/5 of ketamine and propofol (ketofol) for sedation in the children undergoing intrathecal injection of chemotherapy drugs is better than a combination of 1/3 because of shorter recovery time and lower heart rate.

Usporedba poslijeoperacijskog analgezijskog učinka potkožne primjene tramadola i bupivakaina u bolesnica podvrgnutih carskom rezu

Cesarean section is associated with significant postoperative pain. The aim of this study was to evaluate the effects of tramadol versus bupivacaine administration at wound closure on postoperative pain relief in patients undergoing cesarean section. Sixty women undergoing cesarean deliveries were randomly assigned to receive either 10 mL of bupivacaine 0.5% (n=30) or 50 mg of tramadol in 10 mL of normal saline (n=30), both as local wound infiltration prior to skin closure at the end of operation. Postoperative pain was evaluated with a visual analogue scale (VAS: 0-10) at 1, 2 and 6 hours after operation. Time to first analgesic administration and analgesic consumption in 24 hours after operation were recorded and compared between the two groups. Dana were analyzed by SPSS software version 15 and p0.05; Fisher exact test). No side effects were reported in either group. This study showed that subcutaneous administration of tramadol provided analgesic effect equal to bupivacaine with longer pain relief after cesarean section.Carski rez je udružen sa značajnom poslijeoperacijskom boli. Cilj ove studije bio je procijeniti učinak primjene tramadola u usporedbi s bupivakainom pri zatvaranju rane na olakšanje poslijeoperacijske boli u bolesnica podvrgnutih carskom rezu. Po 30 od ukupno 60 žena podvrgnutih carskom rezu i uključenih u studiju nasumce je primilo 10 mL bupivakaina 0,5% ili 50 mg tramadola u normalnoj fiziološkoj otopini ukapljeno u operacijsku ranu prije zatvaranja rane na kraju zahvata. Poslijeoperacijska bol procjenjivala se pomoću vizualne analogne ljestvice (VAS: 0-10) 1, 2 i 6 sati nakon operacije. U obje skupine bilježilo se i usporedilo vrijeme do prvog davanja analgetika i potrošnja analgetika kroz 24 sata od operacije. Podaci su analizirani pomoću programa SPSS ver. 15, a razina statističke značajnosti utvrđena je kao P0.05; Fisherov egzaktni test). Ni u jednoj skupini nisu zabilježene nikakve nuspojave. Ova studija je pokazala da potkožna primjena tramadola ima jednak analgezijski učinak kao bupivakain, ali s dužim olakšanjem boli nakon carskog reza

Efficacy of prophylactic dexamethasone in prevention of postoperative nausea and vomiting

Objective: Many trials have been conducted with regard to the relative benefits of prophylactic anti-emetic interventions given alone or in combination, yet the results remain unknown. This study reviewed the efficacy of a single prophylactic dose of dexamethasone on postoperative nausea or vomiting (PONV) after abdominal hysterectomy. Methods: In a prospective study of 100 women undergoing total abdominal hysterectomy (TAH) under general anesthesia, the dexamethasone group (n = 50) received a single dose (8 mg) immediately after the operation, and the saline group (n = 50) received a dose of saline as a placebo, in addition to conventional management. The incidence of nausea, vomiting, the need for an anti-emetic and patient satisfaction with the management of PONV were evaluated during the first 24 postoperative hours. Results: The overall frequency of nausea during the initial postoperative 24 in the dexamethasone and saline groups were 12% and 18%, respectively, and vomiting was 10% and 16%, respectively (P = 0.001). However, there was a lower need for a rescue anti-emetic drugs in the dexamethasone group (18% vs 24%), but it was not statistically significant (P = 0.06). Conclusion: The results of this study indicate that a single prophylactic dose of dexamethasone after an operation can reduce postoperative nausea and vomiting

Effect of oral gabapentin on haemodynamic variables during microlaryngoscopic surgery

Background: Manipulation of the larynx, such as laryngoscopy and tracheal intubation, is associated with haemodynamic and cardiovascular responses. In microlaryngoscopic procedures, these responses are more severe than laryngoscopy for endotracheal intubation because in microlaryngoscopic surgeries laryngoscope fixes for a longer time (15–20 minutes compared to 15–30 seconds in tracheal intubation). This study was performed to evaluate the effect of 800 mg oral gabapentin on the haemodynamic variables during microlaryngoscopic surgery.Methods: 30 patients aged 30–70 years, ASA physical status I or II, who underwent microlaryngeal surgery were included to the study. The night before surgery, 15 patients (group G) received 100 mg gabapentin and 15 patients (group P) received a placebo. Ninety minutes before the operation, they either received 800 mg gabapentin (group G), or received a placebo (group P).Results: Heart rate, systolic, diastolic and mean arterial blood pressure were measured on the night before the procedure, the morning before the procedure, at arrival to the operating room as baseline, before and after induction, 1, 3 min after tracheal intubation, 1, 5, 15, 25 min after fixing laryngoscope, before laryngoscope removal, and 1 min after that. Analyses revealed that the systolic blood pressure was lower in group G after induction, 1 and 5 min after fixing laryngoscope and before removing the laryngoscope. Diastolic blood pressure in group G was lower at the time of arriving in the operating room, after induction, 1 min after fixing surgical laryngoscope and before removing the laryngoscope. Mean arterial pressure behaved similarly, and additionally it was lower at 5 min after fixing the laryngoscope. Heart rate was reduced at the time after induction, 1, 3 min after intubation, 5 min after fixing the laryngoscope and before laryngoscope removal in group G. Overall, in the group G, diastolic blood pressure and mean arterial pressure were lower in the first 15 min after microlaryngoscopy compared to group P but there was no difference in mean systolic blood pressure and mean heart rate.Conclusion: 800 mg oral gabapentin given 90 min before a procedure attenuates the rise of diastolic blood pressure and mean arterial blood pressure in the first 15 min after microlaryngoscopy surgery, but has no effect on systolic blood pressure or heart rate.Background: Manipulation of the larynx, such as laryngoscopy and tracheal intubation, is associated with haemodynamic and cardiovascular responses. In microlaryngoscopic procedures, these responses are more severe than laryngoscopy for endotracheal intubation because in microlaryngoscopic surgeries laryngoscope fixes for a longer time (15–20 minutes compared to 15–30 seconds in tracheal intubation). This study was performed to evaluate the effect of 800 mg oral gabapentin on the haemodynamic variables during microlaryngoscopic surgery.Methods: 30 patients aged 30–70 years, ASA physical status I or II, who underwent microlaryngeal surgery were included to the study. The night before surgery, 15 patients (group G) received 100 mg gabapentin and 15 patients (group P) received a placebo. Ninety minutes before the operation, they either received 800 mg gabapentin (group G), or received a placebo (group P).Results: Heart rate, systolic, diastolic and mean arterial blood pressure were measured on the night before the procedure, the morning before the procedure, at arrival to the operating room as baseline, before and after induction, 1, 3 min after tracheal intubation, 1, 5, 15, 25 min after fixing laryngoscope, before laryngoscope removal, and 1 min after that. Analyses revealed that the systolic blood pressure was lower in group G after induction, 1 and 5 min after fixing laryngoscope and before removing the laryngoscope. Diastolic blood pressure in group G was lower at the time of arriving in the operating room, after induction, 1 min after fixing surgical laryngoscope and before removing the laryngoscope. Mean arterial pressure behaved similarly, and additionally it was lower at 5 min after fixing the laryngoscope. Heart rate was reduced at the time after induction, 1, 3 min after intubation, 5 min after fixing the laryngoscope and before laryngoscope removal in group G. Overall, in the group G, diastolic blood pressure and mean arterial pressure were lower in the first 15 min after microlaryngoscopy compared to group P but there was no difference in mean systolic blood pressure and mean heart rate.Conclusion: 800 mg oral gabapentin given 90 min before a procedure attenuates the rise of diastolic blood pressure and mean arterial blood pressure in the first 15 min after microlaryngoscopy surgery, but has no effect on systolic blood pressure or heart rate

The Effects of Propofol and Isoflurane on Blood Glucose during Abdominal Hysterectomy in Diabetic Patients

BackgroundAcute hyperglycemia in the perioperative period is associated with significantly increased complications. In few human studies the effects of propofol and inhalational anesthetic on the glucose metabolism were compared. In this study we evaluated the effect of propofol and isoflurane on blood glucose during abdominal hysterectomy in diabetic patients.MethodsAfter approval by the Ethical Committee and written informed consent, thirty 35 to 65 years old diabetic women underwent for elective abdominal hysterectomy under general anesthesia were studied in this randomized single blind clinical trial study. The plasma glucose was maintained at 100 to 180 mg/dL during the operation. Anesthesia protocol was similar in two groups except maintenance of anesthesia that was with infusion of propofol in the propofol group and with isoflurane in the isoflurane group. Blood glucose level and the rate of insulin intake during surgery compared between two groups.ResultsMean blood glucose before induction of anesthesia did not have significant difference between two groups, but 60 and 90 minutes after starting the operation blood glucose in the propofol group was significantly lower than isoflurane group. Also with using Repeated Measure test, two groups was significantly different according to blood glucose (P=0.045). Mean of administration of insulin during the surgery did not have significant difference between two groups by using repeated measure test and P=0.271. Also mean of bispectral index in different times during the surgery between two groups didn't have significant difference (P=0.35 repeated measure test).ConclusionBlood glucose increased during maintenance of anesthesia with isoflurane compared to propofol during the surgery

Comparison of prophylactic use of meperidine and two low doses of ketamine for prevention of post-anesthetic shivering: A randomized double-blind placebo controlled trial*

Abstract BACKGROUND: Postanesthetic shivering is one of the most common complications of anesthesia. We compared the efficacy of meperidine and two low doses of ketamine with placebo to prevent postanesthetic shivering after general anesthesia

Comparison of prophylactic use of meperidine and two low doses of ketamine for prevention of post-anesthetic shivering: A randomized double-blind placebo controlled trial

Background: Postanesthetic shivering is one of the most common complications of anesthesia. We compared the efficacy of meperidine and two low doses of ketamine with placebo to prevent postanesthetic shivering after general anesthesia. Methods: This was a prospective, randomized double-blind placebo controlled clinical trial involving 120 ASA I-II patients aging 20-50 years, undergoing endoscopic sinus surgery with general anesthesia. Patients were randomly allocated to receive meperidine 0.4 mg/kg (Group M, n = 30), ketamine 0.3 mg/kg (Group K 1 , n = 30), ketamine 0.5 mg/kg (Group K 2 , n = 30), or normal saline (Group N, n = 30) 20 minutes before completion of the surgery. Tympanic temperature, blood pressure, and heart rate were measured before and immediately after induction of anesthesia, 30 minutes after induction, and before administration of the study drugs. The drugs were prepared and diluted to a volume of 2 ml and presented as coded syringes. An investigator, blinded to the groups, graded postanesthetic shivering using a four-point scale. Statistical analyses were performed using Statistical Package for Social Sciences (SPSS) Windows version 16. A p-value < 0.05 was considered statistically significant. Results: Patient characteristics of the four groups were similar. The number of patients with observed shivering in groups was 0, 3, 1, and 9 in Groups M, K 1 , K 2 and N, respectively. The difference between groups M, K 1 , and K 2 with Group N was statistically significant. However, differences between groups M and K 1 , M and K 2 , and K 1 and K 2 were not significant. The number of patients with a shivering score of 2 or 3 was higher in Group N compared with other groups. Conclusions: Prophylactic use of low doses of intravenous ketamine (0.3 or 0.5 mg/kg) was found to be effective to prevent postanesthetic shivering. However, administration of 0.3 mg/kg ketamine lowered the rate of hallucination as compared with 0.5 mg/kg