The Effect of Intravenous Paracetamol on Postoperative Pain after Lumbar Discectomy

Study DesignA randomized, double-blinded controlled trial.PurposePostoperative pain relief especially using analgesic drugs with minimal side effects has considerable clinical importance. This study aimed to examine the effect of intravenous paracetamol on pain relief after lumbar discectomy as a major surgery.Overview of LiteraturePatients undergoing lumbar discectomy experience a high degree of lumbar pain. Some authors emphasize the use of intravenous paracetamol to improve postoperative pain and increase patients' satisfaction following this surgery.MethodsFifty-two patients scheduled for lumbar discectomy were randomly allocated into two groups: a group that received intravenous paracetamol (1 g/100 mL normal saline) within the last 20 minutes of surgery as the case group (n=24) and a group that received sodium chloride 0.9% 100 mL as the control group (n=28). Postoperative pain was assessed at 1, 6, 12, 18, and 24 hours after surgery by a visual analogue scale (VAS). The dosage of the administered opioid (morphine), as well as drug-related side effects within the first 24 hours after surgery were also recorded.ResultsThe mean VAS score was significantly lower in the paracetamol group than the controls for all of the assessed time points. Although the dose of the administered morphine was numerically lower in the paracetamol group, this difference was not statistically significant (5.53±4.49 mL vs. 7.85±4.17 mL).ConclusionsIntravenous paracetamol as a non-opioid analgesic can relieve postoperative pain in patients undergoing lumbar discectomy; however, its use alone may not represent the best regimen for reducing the needed dose of opioids after operation

Comparison of Epidural Methylprednisolone, Bupivacaine and Normal Saline Injection in Chronic Low Back Pain Due to Discal Hernia

Objective: Low back pain is the most common skeletal-muscular complaints, requiring medical care, causing many complications and social and economic damages to society as the fifth most common reason for a physician visit especially among men. The purpose of this study was to compare epidural injection of methylprednisolone, bupivacaine, normal saline in chronic low back pain due to discal hernia. Material and Methods: In a randomized, single-blind, clinical trial conducted on patients with chronic low back pain, the impact of epidural injection of methylprednisolone, bupivacaine, normal saline in chronic low back pain due to disc herniation in three groups was randomly studied. Method of epidural injection in all groups was similar. In the first group, 80 mg of methylprednisolone in 10 cc volume, in the second group, local anesthesia drug, 10 mL of bupivacaine 0.5 %, and in the third group, 10 mL of normal saline solution (equal injected volumes) were prepared. During the injection, the patient was monitored in terms of pain, hemodynamics, consciousness, arterial oxygen saturation. Results: Three months after treatment, the severity of pain in methylprednisolone group was less, the rate of disability in normal saline group was significantly high (P < 0.001) and also disability reduction rate in methylprednisolone group was significantly high (P < 0.001). In our study, the average time to return to daily activities in normal saline patients was significantly more (P = 0.005). Conclusion: Epidural methylprednisolone and bupivacaine injection were more effective than placebo (normal saline) injection in these patients

Operating Room World: One Day Challenges and Interactions

When sun rises, the hyperactive day begins in operation room (OR). Management of OR needs regular programs for human and material resources. For deciding about OR programs, there should be requirement to obtaining information of multidisciplinary stakeholders (1). It appears that we go to OR, we enter to new world in new time zone and time will stand here (2). It is well known that trained staff are required for coordination between OR and several departments and providing advanced patient care. The major duties of these personnel, especially surgery and anesthesia nursing included to keep patient safety and navigation of various type of surgery throughout their course. OR staff work in closed, relatively isolated environment and spent several hours of their life here! (3). I think that OR environment looks like fish aquarium, we swim in it and everyone has her or his responsibilities, move toward our unit. It seems crowd but substantially beautiful picture. Stress is a main challenge in OR, that is, the personnel must communicate with each other and patients (4), Raji et al concluded in their study that in academic areas is even more in personnel communication, practice, feelings and humiliating experience fields and they must determine priority in few times and coping with their stress (5). Surgeons and anesthesiologists complete this scenario. However, what are the final goal of these precise efforts? It is clear that improving of efficiency plays key role in OR, it can be achieved by increasing work or lowering costs. Parish et al suggested that to prevent delays in post-anesthesia care unit (PACU) and discharge time, it is important to select proper anesthetic techniques, especially because of growing number of outpatient surgery and anesthesia (6- 8). Costs for maintenance of OR environment, numbered staff and different instruments. Start time is a cornerstone of OR (9). On the other hand, nurses of OR interpret efficiency as improvement of knowledge and training for patient care whereas OR manager understands efficiency as production per minute or completing programs (10). Although usage of simpler devices and dressing can help to save time, it means to compromise of any unnecessary parameters which do not affect results. "Eliminate and streamline" are OR mention (11). Oh, I forgot writing about cancellation and its consequences. Cancellation of planned operations is main and long- standing occurrence in OR. It has significant financial, psychological and social implication on patients and their families. The reasons for cancellation vary among between different countries such as lack of medically fitting for operation, lack of bed, unnecessary interventions and occasionally, patient turning up for surgery. Some of them are avoidable but remainder are not (12). So, we have very little knowledge about sound levels in OR environment (13). Now, this time is afternoon, all surgeries were terminated, patients were transported to their departments. You can sit and drink a cup of tea in your pavilion because emergency cases can arrive at any time

The Effect of Omega-3 Fatty Acids on ARDS: A Randomized Double-Blind Study

Purpose: The aim of this study was to evaluate the effect of an enteral nutrition diet, enriched with omega-3 fatty acids because of its anti-inflammatory effects on treatment of patients with mild to moderate ARDS. Methods: this randomized clinical trial was performed in two ICUs of Tabriz University of Medical Sciences from Jun 2011 until Sep 2013 in north west of Iran. Fifty-eight patients with mild to moderate ARDS were enroled in this clinical trial. All patients received standard treatment for ARDS based on ARDS network trial. In intervention group, patients received 6 soft-gels of omega-3/day in addition to the standard treatment. Results: Tidal volume, PEEP, pH, PaO2/FiO2 , SaO2, P platue and PaCO2 on the 7th and 14th days didn’t have significant difference between two groups. Indices of lung mechanics (Resistance, Compliance) had significant difference between the groups on the 14th day. Pao2 had significant difference between two groups on both 7th and 14th days. Trend of PaO2 changes during the study period in two groups were significant. We showed that adjusted mortality rate did not have significant difference between two groups. Conclusion: It seems that adding omega-3 fatty acids to enteral diet of patients with ARDS has positive results in term of ventilator free days, oxygenation, lung mechanic indices; however, we need more multi center trials with large sample size and different doses of omega-3 fatty acids for their routine usage as an adjuant for ARDS treatment