18 research outputs found
Preventive Effect of Paracetamol and Dexamethasone on Nausea, Vomiting, and Pain after Laparoscopic Cholecystectomy
Background: The currently used antiemetic drugs are not effective in all post-operative patients due to multifactorial origin of nausea and vomiting. Therefore, the present study was designed to evaluate the preventive effect of paracetamol on postoperative nausea and vomiting (PONV) in comparison with dexamethasone in patients undergoing elective laparoscopic cholecystectomy.Materials and Methods: in this double-blinded clinical trial 105 patients were selected using a random sampling method; they were American standards association (ASA) class I and II, 18-75 years and candidate for laparoscopic cholecystectomy; randomly assigned into three groups: Paracetamol, Dexamethasone, and control. They were anesthetized using the same method, using sodium thiopental, Fentanyl, Atracurium, and Lidocaine. Anesthesia was maintained with oxygen, Isoflurane and Morphine. They also received 6 mL/kg/h ringer lactate. Patients data were recorded and analyzed.Results: The mean severity of nausea and vomiting in the recovery room at minutes 30, 45, and 60 had a significant difference between the groups (p<0.05). The satisfaction score at minutes 45 and 60 had a significant difference between the groups (p<0.05). However, the mean scores of satisfaction of patients at 15 and 30 minutes were almost the same and no significant difference between the three groups was reported (p>0.05).Conclusion: The severity of nausea and vomiting was low in the Paracetamol group and Paracetamol was more effective than Dexamethasone in terms of reducing the rate of nausea and vomiting.Keywords: Paracetamol, Dexamethasone, laparoscopic cholecystectom
Effect of Intravenous Infusion of Lidocaine on Pain Reduction after Cesarean Section under General Anesthesia
Background: The present study was conducted to evaluate the effect of Lidocaine on pain reduction during and ileus and the need for opioids after caesarean section.Methods: For this randomized double-blind controlled clinical trial, 40 ASA I, II pregnant women who were candidates for caesarean section with general anesthesia, were randomly allocated into two groups of Lidocaine receivers and placebo using randomized block design; the Lidocaine group received 1.5 mg/kg of Lidocaine right before the surgery and then its infusion with a dose of 2 mg/kg.h until the end of the surgery and the placebo group received normal saline with the same volume and application. Patients’ pain intensity was measured using numerical rating scale (NRS), 0 (entering the recovery), 0.5, 1, 4, 12 and 24 hours after the surgery.Results: Lidocaine decreased the systolic and diastolic pressures of the patients only during the first minute after intubation, decreased the mean of arterial blood pressure at the 10th minute after intubation and 40th minute after surgery, and also decreased the mean of patients’ pain intensity, Diclofenac and Pethidine consumption, side effects (nausea and vomiting) and reduced the time interval before the first time of tolerating oral liquids; but it had effect on infants’ Apgar score 1 and 5 minutes after delivery.Conclusions: Lidocaine was definitely effective on reducing the intensity of pain, opioid and non-steroidal anti-inflammatory drugs consumption and ileus after surgery with the least occurrence of side effects for mothers and infants
The effect of ischioanal fossa block with bupivacain on decreasing post hemorrhoidectomy pain
چکیده: زمینه و هدف: عمل جراحی هموروئیدکتومی معمولاً با درد شدید در 24 تا 48 ساعت اول بعد از عمل همراه است. اقدامات مختلفی مانند مصرف مخدرها، بلوک های موضعی و غیره برای کاهش این درد صورت گرفته است ولی یک روش مطمئن در کاهش درد پس از این عمل ارائه نشده است. لذا هدف از این مطالعه بررسی اثرات بلوک حفره ایسکیوآنال با استفاده از بوپی واکائین در کاهش درد پس از عمل مذکور بوده است. روش بررسی: در این مطالعه کارآزمایی بالینی تعداد 80 بیمار کاندید عمل جراحی الکتیو هموروئیدکتومی در بیمارستان الزهراء(س) اصفهان تحت بیهوشی عمومی به صورت تصادفی در دو گروه بلوک حفره ایسکیوآنال با استفاده از تزریق cc4 محلول بی حسی (بوپی واکائین 25/0) (گروه مورد) و عدم بلوک حفره ایسکیوآنال (گروه شاهد) قرار گرفتند. نوع بیهوشی و عمل جراحی در هر دو گروه مشابه بود. پس از عمل در صورت نیاز و درخواست بیمار داروی پتدین با دوز معین تزریق شد. میزان درد بیماران با استفاده از معیار VAS (Visual Analogue Scale) در زمانهای 0 (بلافاصله پس از هوشیاری)، 4، 12 و 24 ساعت پس از عمل اندازه گیری شد و زمان درخواست پتدین و میزان کلی پتدین مصرفی در مدت 24 ساعت ثبت گردید. اطلاعات ثبت شده با استفاده از آزمون های t، کای دو و فیشر تجزیه و تحلیل شدند. یافته ها: اختلاف آماری معنی داری بین دو گروه از نظر سن، جنس، وزن و طول مدت عمل جراحی وجود نداشت. بر اساس نتایج میانگین نمره کل درد در گروه مورد و شاهد به ترتیب 92/0±65/2 و 09/1±93/4 بود (05/0
Preemptive effect of low dose of ketamine for cholecystectomy
چکیده: زمینه و هدف: یکی از روشهای تسکین درد، تکنیک preemptive analgesia است که مبنای آن بلوکه کردن رسپتورهای عصبی درد قبل از تحریک دردناک است. یکی از این رسپتورها، رسپتور ان متیل د اسپارتات (NMDA) است. داروی کتامین دارای خاصیت آنتاگونیستی این رسپتور است که جهت کاهش حساسیت بکار می رود. هدف از این بررسی، ارزیابی اثرات کتامین در تسکین درد، قبل از ایجاد برش در بیماران، پس از کله سیستکتومی بوده است. روش بررسی: در یک مطالعه کارآزمایی بالینی 65 بیمار بین سنین 30 تا 60 سال، با ASA I&II و کاندید عمل کله سیستکتومی الکتیو بطور تصادفی و دوسویه کور در دو گروه قرار گرفتند. نوع برش جراحی و نوع بیهوشی (عمومی) در هر دو گروه یکسان بود. به گروه اول 20 دقیقه قبل از ایجاد برش پوستی، کتامین و 20 دقیقه پس از برش پوستی نرمال سالین وریدی تزریق شد. در گروه دوم 20 دقیقه قبل از برش پوستی از mg/kg 5/0نرمال سالین و 20 دقیقه پس از برش پوستی از mg/kg 5/0 کتامین به صورت وریدی استفاده شد. پس از عمل از داروی پتیدین با دوز معین در صورت نیاز به عنوان مسکن فرعی استفاده شد. میزان درد بیماران با استفاده از پرسشنامه VSA در زمان های 0 (بلافاصله پس از هوشیاری)، 6، 12 و 24 ساعت پس از عمل اندازه گیری شد. زمان درخواست پتیدین و میزان کل مصرف پتیدین در طول مدت 24 ساعت ثبت گردید. اطلاعات ثبت شده با استفاده آزمون های t و مجذور کا تجزیه و تحلیل گردید.. یافته ها: میانگین نمره درد در زمان های 0، 6 ،12، 24 ساعت پس از عمل در بیماران بطور معنی داری در گروه اول کمتر از گروه دوم بود. میانگین کل درد در گروه اول 97/0±24/3 و در گروه دوم 09/1±18/4 بود (05/0
Distribution of Bupivacaine in Epidural Space
Background: There is no consensus regarding the spread of local anesthesia in thoracic epidural space to obtain regional analgesia or anesthesia. We aimed to determine the distribution of Bupivacaine injected into the thoracic epidural space to evaluate its cranial or caudal spread in patients undergoing epidural anesthesia.Materials and Methods: In a prospective clinical trial, thirty adults patients (12 males and 18 females) with ASA class I and II, scheduled for elective cholecystectomy under thoracic epidural anesthesia with 0.5% Isobaric Bupivacaine were studied. Clinical and radiological outcomes were evaluated to assess the correlation between the volume of the local anesthetic injected to the thoracic epidural space and the extension of its spread within the epidural space. Immediately after insertion and fixation of epidural catheter, patients were transferred to MRI unit to receive 8 mL of 5% Bupivacaine plus 1 mL Magnevist through the epidural catheter. Then, the patterns of spread were evaluated. Data were obtained prospectively during the procedure.Results: Mean distribution of bupivacaine in thoracic epidural space was 0.64 level/ml of local anesthetics and the average of spread was 5.21 levels. The mean spread of bupivacaine was more in females (5.5 ± 1.1) than males (4.8 ± 1.1); but the difference was not significant. Unlike Patients’ age and weight, the height and body mass index had a significant negative correlation with the distribution of Bupivacaine.Conclusion: Distribution of Bupivacaine in epidural space in female patients is more than male ones and the tendency of spread is more toward the cephalad direction than caudal.Keywords: Bupivacaine distribution, Epidural anesthesia, Local Anesthesia, Bupivacaine, Magnevis
Comparative evaluation of different values of bispectral index in determination of the appropriate level of anesthesia for tracheal intubation during inhalational induction of anesthesia in pediatrics
Background: Induction of anesthesia is the most crucial period of general anesthesia. Inhalational induction is the most commonly used technique in pediatric anesthesia. Tracheal intubation can be done after reaching the deep levels of anesthesia. The depth of anesthesia is often difficult to be judged. Bispectral index is a measure of the effects of anesthesia on brain. This study was designed to evaluate the efficacy of bispectral index (BIS) in clarifying suitable depth of anesthesia for tracheal intubation during inhalational induction of anesthesia.
Methods: In a clinical trial, ninety patients, ASA I & II, 1 to 6 years old, scheduled for elective surgery were enrolled into the study. After starting BIS monitoring, patients randomly were divided into three groups. Then, anesthesia was induced by gradual increase of halothane in 50% mixture of oxygen (O2 ) and N2O and continued until target BIS (60 ± 2, 50 ± 2 and 40 ± 2) achieved. After tracheal intubation, the duration of laryngoscopy and the presence of laryngospasm, bronchospasm, laryngoscopy failure, the movement of extremities and the changes in SpO2 and BIS were recorded. The data were analyzed by chi-square and ANOVA at 0.05 level of significance.
Results: BIS could not determine the appropriate level of anesthesia for tracheal intubation in this setting. There were no differences in laryngoscopy duration and the occurrence of laryngospasm, bronchospasm, laryngoscopy failure, extremity movement and awakening time among three groups.
Conclusions: These results confirmed that there was no significant difference in the incidence of complications related to intubation at different BIS values (from 60 to 40) during inhalation induction, and probably to achieve an adequate or more reliable depth of anesthesia, the lower values of BIS is required
The effect of early ambulation on the incidence of neurological complication after spinal anesthesia with lidocaine
Background: Transient neurological symptoms (TNS), was described in patients recovering from spinal anesthesia with lidocaine but its etiology remains unknown this study was evaluated the influence of ambulation time on the occurrence of TNSs after spinal anesthesia with lidocaine 5%. Materials and Methods: This randomized clinical trial was conducted on 60 patients with American Society of Anesthesiologists Grades I and II, who were candidates for lower abdominal surgery in supine or lithotomy positions. Patients were randomly divided into early ambulation group (Group A) who were asked to start walking as soon as the anesthesia was diminished or to the late ambulation group (Group B) who walked after at least 12 h bedridden. Participants were contacted 2 days after spinal anesthesia to assess any type of pain at surgical or anesthesia injection site, muscle weakness, fatigue, vertigo, nausea, vomiting, headache, and difficult urination or defecation. Results: Four subjects (13.3%) in Group A and two patients (6.7%) in Group B had pain at anesthesia injection site (P = 0.019). Fourteen patients in Group A (46.7%) and six patients in Group B (20%) had post-dural puncture headache (P = 0.014). Participants in Group B reported difficult urination more than Group A (P = 0.002). there were not statistically significant differences between two groups regarding frequency of fatigue, muscle weakness, vertigo, nausea, vomiting, difficult defecation, paresthesia, and the mean of visual analogue scale at the surgical site. Conclusion: Early ambulation after spinal anesthesia with lidocaine did not increase the risk of neurologic complication
A randomized controlled trial comparing the effect of intravenous, subcutaneous, and intranasal fentanyl for pain management in patients undergoing cesarean section
Background: The objective of this study was to evaluate and compare the effects of three methods of using intravenous (IV), subcutaneous and intranasal (IN) fentanyl for pain management following general anesthesia in patients undergoing cesarean section.
Materials and Methods: A prospective, randomized, single-blind clinical trial was done on 75 patients aged 20–40 years, American Society of Anesthesiology-1, who had a normal singleton pregnancy beyond 36 weeks of gestational age. Patients were randomized to receive 50 μg fentanyl intravenously (Group 1), subcutaneously (Group 2) or intranasally (Group 3) after closure of incision. The pain intensity, nausea, the systolic, and diastolic blood pressures were assessed.
Results: All groups were equivalent for baseline characteristics. The average pain visual analog scale (VAS) score was less in the second group who received fentanyl subcutaneously at the time of recovery admission (6.8 ± 1.5) (P = 0.037) and after 3 h (6.36 ± 1.5) (P = 0.033) postoperatively. The mean VAS score of nausea and the mean systolic and diastolic blood pressures were not significantly different between three groups throughout the study (P > 0.05).
Conclusion: subcutaneous fentanyl is an effective alternative to IV and IN route of administration for pain management