The effect of intra-articular meperidine and bupivacaine 0.5 on postoperative pain of arthroscopic knee surgery; a randomized double blind clinical trial

Background: Arthroscopic knee surgeries have a painful postoperative course, which often necessitates acute pain management. Among different analgesia techniques, Intra-articular injection is the technique of choice for many pain specialists, based on its confined effect to the surgical site (knee), lack of systemic effects and promotion of safe early ambulation. Objectives: The aim of this study was to compare analgesic effects of intra-articular meperidine, bupivacaine 0.5 or their combination after knee arthroscopic surgery. Patients and Methods: Sixty ASA class I-II patients� candidates for arthroscopy knee surgery enrolled in a randomized double blind study to receive either 20 mL of bupivacaine 0.5; 100 mg meperidine (diluted in normal saline) or bupivacaine 0.5 along with 100 mg meperidine. A written informed consent was obtained from all patients. Postoperative analgesia duration, VAS at 2, 6, 12 and 24 hours, the Results: The bupivacaine-meperidine group had better duration of postoperative analgesia (P = 0.001), latter first analgesic request (P � first analgesic request time, total fentanyl consumption in first 24 hours, patients� satisfaction and adverse effects were recorded. 0.001), lower total fentanyl consumption in first 24 hours after the operation (P = 0.001), less mean VAS at 2 hours (P = 0.001) and more patients� overall satisfaction (P = 0.01) compared with each medication alone. VAS at 6, 12 and 24 postoperative hours were not different between the groups of study. No adverse effects were observed. Conclusions: Although postoperative intra-articular meperidine is a better alternative for bupivacaine, their combination could improve their analgesic effects compared with each other alone. © 2015, Iranian Society of Regional Anesthesia and Pain Medicine (ISRAPM)

Clinical and radiographic alterations in bilateral avascular necrosis of the femoral head following laser acupuncture: A case report

Introduction: Avascular necrosis (AVN) of the femoral head is an increasingly common cause of musculoskeletal disability with unknown etiology. Traumatic and non-traumatic factors can be effective in its occurrence. About 50 of cases are bilateral. The underlying treatment is prosthetic replacement surgical procedure. Case Presentation: We report a case of bilateral AVN of femoral heads who was a candidate for prosthetic replacement surgery but improved significantly, using laser acupuncture. The patient was a 55-year-old woman with a diagnosis of bilateral osteonecrosis of the femoral head for five years. As the patient declined the surgical option, laser acupuncture was started for pain control. Regarding the signs of bilateral femoral head recovery (according to the MRI scan criteria), a total of 3 courses of laser acupuncture (each course was 20 sessions) with 2 months intervals was performed. Ten acupuncture points: Li4, Li11, St36, SP6, LIV3, GB4, GB5, GB6, GB13, GB14, GB20, GB30, GB31, GB34, were irradiated bilaterally using red 650 nm laser, 100 mW, 1505 Hz frequency, duty cycle 50 3 J/point and near infrared 810 nm laser, 100 mW, 1705 Hz frequency, duty cycle 50 3 J/point, for 2 minutes. The patient received 3 laser therapy courses. During the first-course, laser therapy was done every other day to reduce pain. For the second and third courses, according to pain decrease, therapy was done every week. Results: The results of the MRI scans and x-ray studies show progressive regeneration of the right femoral head from VI to B II and of the left from V to C II (based on the standard table of Pennsylvania). Conclusion: It seems that this procedure may be mentioned in future research projects, especially in cases with high risks of surgery. © 2018, Laser Application in Medical Sciences Research Center

Clinical and radiographic alterations in bilateral avascular necrosis of the femoral head following laser acupuncture: A case report

Introduction: Avascular necrosis (AVN) of the femoral head is an increasingly common cause of musculoskeletal disability with unknown etiology. Traumatic and non-traumatic factors can be effective in its occurrence. About 50 of cases are bilateral. The underlying treatment is prosthetic replacement surgical procedure. Case Presentation: We report a case of bilateral AVN of femoral heads who was a candidate for prosthetic replacement surgery but improved significantly, using laser acupuncture. The patient was a 55-year-old woman with a diagnosis of bilateral osteonecrosis of the femoral head for five years. As the patient declined the surgical option, laser acupuncture was started for pain control. Regarding the signs of bilateral femoral head recovery (according to the MRI scan criteria), a total of 3 courses of laser acupuncture (each course was 20 sessions) with 2 months intervals was performed. Ten acupuncture points: Li4, Li11, St36, SP6, LIV3, GB4, GB5, GB6, GB13, GB14, GB20, GB30, GB31, GB34, were irradiated bilaterally using red 650 nm laser, 100 mW, 1505 Hz frequency, duty cycle 50 3 J/point and near infrared 810 nm laser, 100 mW, 1705 Hz frequency, duty cycle 50 3 J/point, for 2 minutes. The patient received 3 laser therapy courses. During the first-course, laser therapy was done every other day to reduce pain. For the second and third courses, according to pain decrease, therapy was done every week. Results: The results of the MRI scans and x-ray studies show progressive regeneration of the right femoral head from VI to B II and of the left from V to C II (based on the standard table of Pennsylvania). Conclusion: It seems that this procedure may be mentioned in future research projects, especially in cases with high risks of surgery. © 2018, Laser Application in Medical Sciences Research Center

Electroconvulsive therapy for a patient with suicide by drinking bleach during treatment of COVID-19: A case report

Electroconvulsive therapy (ECT) was first experienced in 1938 and had been conducting without anesthesia for 30 years. In this study, the most common indication for ECT was mood disorder (major depressive disorder and bipolar I disorder). We introduce a patient with a history of COVID-19 and suicide who required emergency ECT. Electroconvulsive therapy can be life-saving in patients with suicide history or catatonic schizophrenia. Health workers are at the front line of the COVID-19 outbreak control and must follow health instructions. Aerosol-producing procedures such as suction in anesthesia for ECT may facilitate the transmission of infectious diseases such as COVID-19. When performing aerosol-producing procedures during the pandemic of novel coronavirus, every patient should be considered suspicious. © 2020, Author(s)

Simple arm tourniquet as an adjunct to double-cuff tourniquet in intravenous regional anesthesia

Background: Intravenous Regional Anesthesia (IVRA) is a well-known technique for producing analgesia during surgical procedures in the extremities. However, the rapid onset of pain following the deflation of a double-cuff tourniquet during IVRA is a serious disadvantage, leading patient suffering. Objectives: The aim of this study was to evaluate the clinical effectiveness of a pneumatic arm tourniquet applied 2 cm above the double-cuff tourniquet in controlling the pain that occurs after its deflation. Patients and Methods: Twenty patients undergoing outpatient hand surgery were operated on under IVRA, using 40 - 50 mL of a solution containing 3 mg/kg of lignocaine. A simple pneumatic tourniquet was applied proximal to the double-cuff tourniquet, 3 min before its deflation, while the procedure was being conducted. The severity of pain on the basis of the Numerical Rating Scale (NRS) was assessed throughout the operation, and continued until an hour after the double-cuff tourniquet was removed. Results: The mean operation time after the deflation of the double-cuff tourniquet was 20.12 ± 6.1 minutes. Moreover, the mean NRS for the post-deflation time was insignificant (NRS = 2), and only one patient during first 20 minutes received opioids. Conclusions: This study showed that a pneumatic arm tourniquet as an adjunct to IVRA provides acceptable analgesia following the deflation of the double- cuff tourniquet for relieving surgical pain. © 2016, Iranian Society of Regional Anesthesia and Pain Medicine (ISRAPM)

The effect of common hawthorn (Crataegus monogyna Jacq.) syrup on gastroesophageal reflux disease symptoms

Common Hawthorn has been known as a traditional remedy to relieve gastroesophageal reflux disease symptoms and to improve stomach function. This study aims to investigate the effectiveness and safety of common hawthorn fruit in patients who suffer from gastroesophageal reflux disease.Eighty male and female patients with clinically diagnosed gastroesophageal reflux disease were included in the study. The patients were randomly assigned into experimental (treatment) and control groups. Experimental group members took common hawthorn syrup and those in the control group received placebo syrup for 4 weeks (5 ml after each meal). Gastroesophageal reflux disease symptoms were assessed based on an available validated questionnaire, before and after the treatment in both groups. The side effects were monitored according to old and new medical resources. In order to assess the probable effect on hepatic or renal function, the levels of alanine transaminase, aspartate transaminase, blood urea nitrogen, and creatinine were measured before and after the treatment.After four weeks of taking the hawthorn and placebo syrups, a significant improvement was observed in two main symptoms of gastroesophageal reflux disease in the experimental group compared with the control one. Heartburn and regurgitation were alleviated by 93.5 and 94.2 respectively. The impact of the common hawthorn syrup on atypical symptoms of gastroesophageal reflux disease such as dyspnea, chest pain, cough and dysphagia was also evaluated and differences were not statically significant. Any adverse effects of the medicine on the functions of liver and kidney were not observed. Our findings suggest common hawthorn fruit as a natural source to control the main symptoms of gastroesophageal reflux disease. © 2016, Iranian Association of Pharmaceutical Scientists. All rights reserved