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)

Incidence and complications of acute kidney injury following coronary artery bypass graft: A retrospective cohort study

Introduction. Acute kidney injury (AKI) is a common complication of coronary artery bypass graft with several serious complications. This study aimed to find the incidence of AKI after coronary artery bypass graft and its complications based on the Acute Kidney Injury Network (AKIN) criteria. Materials and Methods. This study was done on 3470 patients who had undergone isolated coronary artery bypass graft. Acute kidney injury�s incidence was based on the AKIN criteria (only based on serum creatinine irrespective of urine output). Patients� demographic data, in-hospital complications, and out-hospital mortality were collected from hospital databases and compared between the patients with and without AKI. Results. Based on serum creatinine, the incidence of AKI was 27.7 (958 patients) on the 1st postoperative day. Nine patients (0.3) needed hemodialysis during their hospital stay, and 31 patients (0.7) developed persistent kidney failure until the discharge day. The number of patients undergoing hemodialysis was not significantly difference but persistent kidney failure was significantly more frequent in patients with AKI (P < .001). Those with AKI also experienced longer length of stay (P = .04) and longer length of stay in intensive care unit (P < .001), and their mortality rate was higher in hospital (P < .001) and during the 3-year follow-up period (P < .001). Conclusions. Although AKI is associated with great patients� morbidity and in-hospital and long-term mortality, most of AKI episodes after coronary artery bypass graft are mild with no need for hemodialysis, and they mostly improve spontaneously. © 2015, Iranian Society of Nephrology. All rights reserved