Epidural dexamethasone for postoperative analgesia in patients undergoing unilateral inguinal herniorrhaphy: A comparative study

Background. This study was designed to evaluate the effect of adding dexamethasone to epidural bupivacaine on postoperative analgesia in unilateral inguinal herniorrhaphy. Methods. Forty-four patients were enrolled in this double-blind, clinical trial study. Patients were randomly allocated into dexamethasone or control group. In the dexamethasone group, patients received 18ml of bupivacaine 0.5% and 2ml (8mg) of dexamethasone; in the control group, patients received 18ml of bupivacaine 0.5% and 2ml of normal saline. The onset of sensory block and its duration and incidence of nausea and vomiting were recorded. Results. The onset of epidural anesthesia was significantly more rapid in the dexamethasone group than in the control group (P < 0.001). Duration of analgesia was markedly prolonged in the dexamethasone group than in the control group (P < 0.001). Five patients (22.7%) in the control group had nausea in the first hour after the procedure (P = 0.048). None of the patients in the dexamethasone group had nausea. None of our patients had vomiting in the two groups. Conclusions. This study showed that adding dexamethasone to bupivacaine significantly prolongs the duration of postoperative analgesia

The relationship between patients anthropometric characteristics and depth of spinal needle insertion

Background: Many surgeries are performed under spinal anesthesia. Inexperienced practitioners may find it difficult to obtain subarachnoid access. Objectives: This study aimed to examine the relationship between patients� anthropometric characteristics and depth of spinal needle insertion to the subarachnoid cavity. Patients and Methods: 385 patients with ASA class I � II, aged 18 - 65 years and undergoing elective surgery of the lower abdomen and extremities under spinal anesthesia, were selected for this cross-sectional study. The patients� demographic characteristics, body mass index (BMI), and anthropometric characteristics (height, weight, waist circumference, and arm circumference) were recorded. Linear regression and t-student tests were used to study the relationship between anthropometric characteristics and BMI, and depth of needle insertion. Results: Of the 385 patients studied, 88 were female and 297 were male. There was a strong correlation between the depth of needle insertion and BMI (24.9 ± 3.9), and between depth and weight/height ratio (r = 0.95 and r = 0.92, respectively). There was no significant correlation between depth of needle insertion and weight, height, gender, or arm circumference, when considered separately. The statistical predicting models showed that the following relationship was observed between the needle depth and the weight/height ratio: A: needle depth = 0.69 + (10.1 � weight/height); B: needle depth = 0.56 + (0.18 � BMI). Conclusions: The results of this study show that there is a strong relationship between depth of needle insertion and BMI, and between depth and the weight/height ratio; appropriate depths can be determined according to the equations obtained. © 2016, Iranian Society of Regional Anesthesia and Pain Medicine (ISRAPM)

Effect of artemisia sieberi extract on Leishmania major ulcers in BALB/c mice

Background: Considering the prevalence of leishmaniasis in different regions of the world including Iran and many side effects of pentavalent antimony compounds used in its treatment, and controversies about herbal drugs, the effects of Artemisia sieberi extract on the experimental ulcers of cutaneous leishmaniasis (CL) on BALB/c mice was studied at Kashan University of Medical Sciences. Materials and Methods: In this experimental study the effect of 1, 3 and 5 percent concentrations of Artemisia sieberi hydroalcohol lotions in mouse previously infected with alive and active Leishmania major promastogote was evaluated. The 50 selected BALB/c Mice were divided into 5 groups: 3 groups (n= 30) in experimental and 2 in control groups (n= 20). Three groups (cases) received drug one group received ethanol 80 and one group received none (controls). The drug was administered topically, three times daily for maximum of 30 days. Ulcer diameters were measured in all groups every 10 days and were tested for amastigote. Ulcer diameter change was analyzed by Paired t-test, ANOVA and Tukey. Results: Whole recovery wasn't observed in any treated mouse by Artemisia concentrates at the end of 30-day treatment period and mice direct smears in microscopic studies were positive. Conclusion: 1, 3 and 5 percent Artemisia extracts were ineffective in the treatment of Leishmania major ulcer. Artemisia emulsions had no effect on the reduction of ulcers diameter and leishman bodies at the end of treatment course

Prediction of mortality in hip fracture patients: Role of routine blood tests

Background: To assess the mortality predictive value of routine blood tests in patients with hip fracture. Methods: In a retrospective descriptive study, medical records of 204 hip fractured patients with the age of 60 or older who were admitted to the Department of Orthopedics was considered regarding routine laboratory tests. Predictive values of these tests were assessed using receiver operating characteristic curve (ROC). Results: The incidence of death due to hip fracture was 24. The mortality rate was significantly increased with age > 65 (OR= 15). There was no significant difference between mortality in regards to gender. High plasma BUN (more than 20 mg/dl) and creatinine (more than 1.3 mg/dl) significantly increased the chance of mortality. OR= 3.0 and OR=2.5 for BUN and creatinine, respectively. Patients' mortality did not show any correlation with sodium and potassium plasma levels and blood hemoglobin. Conclusions: There is direct correlation between plasma levels of BUN and creatinine and 3-month mortality after hip fractures. Patients with high plasma levels of BUN were three times more likely to die than those with normal BUN. Also, patients with high plasma creatinine levels were 2.5 times more likely to die than those who had normal values. Mortality was also associated with increasing age but did not vary with gender. Patients aging more than 65 were 15 times more likely to die following a hip fracture than those with younger age. © 2015 BY THE ARCHIVES OF BONE AND JOINT SURGERY