Comparing the use of Memantine with Dextromethorphan and Placebo to Reduce Pain before Orthopedic Surgery

Introduction: To compare the use of Memantine with Dextromethorphan and placebo to reduce pain after orthopedic surgery.Materials and Methods: The present study was a double-blind clinical trial including180 patients undergoing elective orthopedic surgery of the lower limbs. Patients were divided randomly into three groups of 60 patients each. The first group (Group M) received 30 mg Memantine orally, the second group (Group D) received 45 mg of Dextromethorphan and the third group (Group P) received only placebo, two and a half hours before the operation. The intensity of pain (VAS score), sedation score, and nausea and vomiting were recorded postoperatively.Results: In this study, 60 patients were enrolled in each group. The total VAS (Visual Analogue Scale) score was significantly lower among patients receiving Memantine and the satisfaction was significantly higher compared to the Dextromethorphan and placebo groups (P-value <0.001).Conclusion: The present study results indicate that Memantine has a relatively better outcome compared to Dextromethorphan or placebo in reducing the post surgical pain among patients undergoing orthopedic surgeries. It also reduced the need for post surgical opioid use and improved the patients’ satisfaction. 

Comparison Postoperative Shoulder Pain, Nausea, and Vomiting Between Low and Normal Pressure Pneumoperitoneum in Laparoscopic Cholecystectomy

Background: Low-pressure pneumoperitoneum during laparoscopic surgeries decreases some side effects related to inflate gas into abdominal cavity. The current study aimed at comparing the effects of standard- and low-pressure pneumoperitoneum on shoulder pain, nausea, and  vomiting after laparoscopic cholecystectomy. Methods: In a randomized clinical trial, 202 ASA classes I and II patients, candidates for elective laparoscopic cholecystectomy, were randomly divided into the groups of standard- (12 to 14mmHg)and low- (6 to 7mmHg)pressure pneumoperitoneum. Postoperative shoulder pain, nausea, and vomiting were assessed between the 2 groups. Results: Post-operative shoulder pain was statistically lower in low-pressure group in comparison with standard-pressure group (P = 0.001). Nausea and vomiting were not statistically different between the 2 groups (P = 0.54). Conclusions: Low-pressure pneumoperitoneum during laparoscopic cholecystectomy was an efficient method to decrease postoperative shoulder pai

Effects of Low Pressure of Laparoscopic Cholecystectomy on Arterial Pressure of Carbon Dioxide and Mean Blood Pressure

Background: The effect of low pressure pneumoperitoneum in laparoscopic cholecystectomy on partial pressure of carbon dioxide in the arterial blood (PaCO2) is an important subject which has not been completely defined.Methods: In a double-blind clinical trial, we randomly studied 202 ASA (The ASA physical status classification system) class 1, 2 patients aged between 20 and 85 years who were candidates for elective laparoscopic cholecystectomy. They were randomly divided into two groups of low pressure pneumoperitoneum (6-8 mm Hg) and standard pressure pneumoperitoneum (12-14 mm Hg). By the same general anesthesia protocol in the two groups, PaCO2 was assessed before CO2 insufflation and desufflation. Mean Arterial blood Pressure (MAP) was measured in the two groups.Results: PaCO2 was not significantly different between the 2 groups before CO2 insufflation. But, PaCO2 was statistically lower in low pressure pneumoperitoneum group before CO2 desufflation (P= 0.001). Mean Arterial Pressure (MAP) in standard pressure pneumoperitoneum group was lower than the low pressure pneumoperitoneum group at 5 and 10 minutes after CO2 insufflation and before the time of CO2 desufflation (P=0.001, P=0.006 and P=0.001, respectively). While, MAP was not statistically different between the two groups before CO2 insufflation (P=0.55).Conclusion: Low pressure pneumoperitoneum during laparoscopic cholecystectomy can be an effective protocol to prevent the rise of PaCO2 by preserving the hemodynamic status in such cases.

Nerve Stimulator Guided Axillary Block in Painless Reduction of Distal Radius Fractures; a Randomized Clinical Trial

Introduction: Given the high prevalence of upper extremity fractures and increasing need to perform painless reduction in the emergency departments, the use of analgesic methods with fewer complications and more satisfaction appears to be essential. The aim of this study is comparison the nerve stimulator guided axillary block (NSAB) with intravenous sedation in induction of analgesia for painless reduction of distal radius fractures. Methods: In the present randomized clinical trial, 60 patients (18-70 years of age) suffered from distal radius fractures, were divided into two equal groups. One group received axillary nerve block by nerve stimulator guidance and the other procedural sedation and analgesia (PSA) using midazolam/fentanyl. Onset of analgesia, duration of analgesic effect, total procedure time and pain scores were recorded using visual analogue scale (VAS) and the outcomes were compared. Chi-squared and student t test were performed to evaluate differences between two groups. Results: Sixty patients were randomly divided into two groups (83.3% male). The mean age of patients was 31 ±0.7 years. While the onset of analgesia was significantly longer in the NSAB group, the mean total time of procedure was shorter than PSA (p<0.001). The NSAB group needed a shorter post-operative observation time (P<0.001). Both groups experienced equal pain relief before, during and after procedure (p>0.05). Conclusion: It seems that shorter post-operative monitoring time and consequently lesser total time of procedure, make nerve stimulator guided axillary block as an appropriate alternative for procedural sedation and analgesia in painless reduction of distal radius fractures in emergency department.

Treacher Collins Syndrome; Anesthetic considerations and Molecular Findings

Treacher Collins Syndrome (TCS) is a rare disease with mandibulofacial dysostosis. The deformities accompanied by this syndrome could cause especial challenges for anesthesiologist. On the other hand Treacher protein is well recognized in the pathogenesis of this syndrome. In this report we want to present a successful management of a patient with Treacher Collins syndrome and also describe new advances in the molecular aspect of this disease

Assessing the percent of necrosis after neoadjuvant chemotherapy with 24hr infusional cisplatin/3 days doxorubicin intermittent with ifosfamide-doxorubicin for osteosarcoma

Introduction: osteosarcoma is the most common primary bone tumor in children and young adults and appropriate chemotherapy can increase limb sparing and overall survival. Yet, the toxicity of chemotherapy regimens including MTX can be life threatening. Therefore; we tried another chemotherapy regimen for these patients. Method and materials: we investigated 15 patients aged 15 to 40 years old and used continuous infusion of cisplatin, doxorubicin intermittently with ifosfamide, doxorubicin as neoadjuvant chemotherapy. Percent of necrosis and toxicities was recorded for each patient. Results: Out of 15 patients investigated, 13 were males and 2 females. Tumor necrosis≥ 90% (defined as good necrosis) was observed in 60% of patients. 26.7% of the patients showed leucopenia grade three or four, 26.7% had anemia grade three or four, and 20% showed thrombocytopenia grade three or four. Conclusion: The above chemotherapy regimen can cause as good necrosis as the chemotherapy regimens including high dose of MTX with reduced toxicity and less nursing cares and laboratory tests. Of course small sample size limits extension of our result to all patients but trying this regimen is recommended in more patients to see more reliable results

Supplemental Oxygen therapy and Non-Invasive Ventilation in Corona Virus Disease (COVID-19)

The world has experienced a pandemic due to novel Severe Acute Respiratory Disease Corona Virus-2 (SARS-CoV2) since December 2019. The clinical spectrum of the disease known as Coronavirus Disease 2019 (COVID-19) is so much wide, starting from an asymptomatic state to paucisymptomatic clinical presentation, pneumonia, respiratory failure to even death. Supplemental oxygen therapy is essential in managing COVID-19. Also, there is sparse evidence regarding use of non-invasive ventilation (NIV) in pandemics like SARS-CoV-2. This study reviews the currently available methods for respiratory support in COVID-19 with a discussion about using these modalieties in the COVID-19 pandemic

Comparison of Propofol and Isoflurane Effects on Intraocular Pressure among Patients Undergoing Lumbar Disc Surgery

Purpose: Blindness is a catastrophic complication of surgeries performed in prone position which occurs mainly due to hemodynamic alterations and the relevant effects on optic nerve perfusion. In this study, we compared the effects of Propofol and Isoflurane on intraocular pressure among patients undergoing lumbar disk surgery.Patients and Methods: In this randomized clinical trial, 60 patients who were candidates for lumbar disk surgery were randomly assigned into two groups: Propofol and Isoflurane groups. Intraocular Pressure was measured before and after induction of anesthesia in supine position, immediately after prone positioning of the patient and at the end of operation in prone position and also after turning the patients back to supine position. Mean arterial pressure, systolic and diastolic blood pressure and heart rates were also assessed.Result: The baseline Mean Intraocular Pressure among awake patients in supine position in Isoflurane and Propofol groups were 15.8 ± 3.1 and 18.2 ± 5.4 mmHg respectively. At the end of operation intraocular pressure in prone position in these two groups of patients changed to 18 ± 5.8 and 17.2 ± 4.9 mmHg respectively (P = 0.024) indicating a statistically significant difference in change. According to mixed analysis, mean arterial pressure, systolic blood pressure, diastolic blood pressure, end tidal Co2 and heart rate did not show statistically significant difference between the two groups (P < 0.05).Conclusion: Propofol better controls the intraocular pressure compared to Isoflurane in prone position among patients undergoing lumbar disk surgery with no significant difference in hemodynamic responses. Keywords: Intraocular pressure; prone; position; surgery; Propofol; Isoflurane

Effect of magnesium sulphate added to lidocaine on inferior alveolar nerve block success in patients with symptoms of irreversible pulpitis: a prospective, randomized clinical trial

AIM: To investigate the effect of magnesium sulphate used as an adjuvant to lidocaine with epinephrine local anaesthetic on the success of inferior alveolar nerve blocks (IANB) in patients with irreversible pulpitis undergoing root canal treatment. METHODOLOGY: In a double-blind clinical trial, following power calculation, 124 patients with symptoms of irreversible pulpitis in mandibular molar teeth were selected and initial pain data was collected using a Heft-Parker (Heft & Parker 1984) visual analogue scale. The first group (control) received IANB with 1.8 mL of a local anaesthetic solution containing 1.8% lidocaine with 1:88,000 epinephrine whist the second group (test) received IANB with 1.8 mL of an anaesthetic solution containing 1% magnesium sulphate, and 1.8% lidocaine with 1:88,000 epinephrine. Pain data was collected after access cavity and penetration of files in the canals using a Heft-Parker visual analog scale. Two patients were not included in the study as they did not consent and a further 54 patients were excluded as they did not report lip numbness within 15 minutes after IANB administration, thus the data presented in this study is related to 68 patients. The data were analyzed using chi-square and t- test (α=0.05). RESULTS: The success of pulpal anaesthesia with IANB was 82% for the magnesium sulphate group and 53% for the control group. There was a significant difference in the effectiveness of the IANB between the 2 groups (P < 0.001). There was no significant difference between the magnesium sulphate and control groups regarding gender (P =0.598) or age (P = 0.208) or initial pain scores (P = 0.431). CONCLUSIONS: The addition of 1% magnesium sulphate to 1.8% lidocaine with 1:88,000 epinephrine resulted in a positive impact for the success of IANB in patients with a diagnosis of irreversible pulpitis related to mandibular molar teeth undergoing root canal treatment. Thus magnesium sulphate may be used as adjuvant for achieving profound pulpal anaesthesia in challenging cases. However, more studies with larger sample size and different concentration doses must be carried out to establish an appropriate conclusion before its routine clinical use