Comparison of the Effect of Inhalational Isoflurane-Nitrous Oxide Anesthesia and Intravenous Propofol-Remifentanil Anesthesia on Postoperative Pain

Background: The severity of postoperative pain varies widely in the different types of anesthesia. The aim of the present study was to compare the effect of isoflurane-nitrous oxide anesthesia and propofol-remifentanil anesthesia on postoperative pain after foot and ankle surgery. Methods: In this double-blind clinical trial, 60 eligible patients were divided into two equal intervention and control groups; the first group inhaled anesthesia with isoflurane-nitrous oxide and the control group were given intravenous anesthesia with propofol-remifentanil using the quadruple random block model and postoperative pain intensity was measured and compared in the two groups. Data on pain severity were collected at different times and analyzed using SPSS statistical software and related tests. The significant level was set at 0.05.   Results: Of the 60 participants, 38 (52.4%) were male and 22 (47.6%) were female. The mean age of the participants was 33.9±15.1 years. The intensity of pain in the recovery room and up to 4 hours after surgery was significantly (Pvalue<0.001) lower in the intervention group but after 4 hours there was no significant difference between the two groups. So, it can be seen in the present study that there was a significant decrease (Pvalue<0.036) in the number of cases requiring analgesics prescribed in the recovery room and up to 4 hours after surgery in the intervention group. Conclusions: According to the results, evaporation anesthetic isoflurane-nitrous oxide can be used in the stage of induction of anesthesia in orthopedic surgeries, and has achieved good results in reducing pain, especially during the first 4 hours, postoperative. Key Words: Isoflurane, Propofol, Inhaler Anesthesia, IV Anesthesia, Postoperative Pai

Comparing the Diagnostic Precision of Clinical Examination and MRI with Findings from Arthroscopy in Traumatic Knee Injuries with Femur or Tibia Shaft Fracture

Background: Diagnosis of knee injuries following trauma to the lower extremity is very important and needs to be carefully examined. This study aimed at comparing the diagnostic precision of clinical examination (CE) and MRI with findings from arthroscopy in traumatic knee injuries with femur or tibia shaft fracture.Methods: A cross-sectional study was conducted on 164 patients with traumatic knee injuries with femur or tibia shaft fracture who had been referred to Imam Hossein Hospital, Shahroud, between March 2014 and February 2015. We compared CE and MRI with arthroscopic findings (gold standard) to determine the concordance, accuracy, sensitivity, and specificity of injuries to the meniscus and knee ligaments.Results: The results showed that internal mucus rupture was the most common trauma, noted in 83 cases (50.6%), followed by anterior corrosion rupture, noted in 65 cases (39.6%). CE sensitivity was 68.4% and specificity was 96.2% for medial meniscal (MM) injuries, while sensitivity was 53.6% and specificity was 96.4% for lateral meniscal (LM) injuries. For anterior cruciate ligament (ACL) injuries, CE showed sensitivity of 77.2% and specificity of 91.8%. For posterior cruciate ligament (PCL) injuries, CE showed sensitivity of 52.6% and specificity of 98.6%. For MM injuries, MRI showed sensitivity of 92.5% and specificity of 86.5%, while for LM injuries, it showed sensitivity of 85.00% and specificity of 98.6%. For ACL injuries, MRI showed sensitivity of 86.7% and specificity of 93.8%, and for PCL injuries, MRI showed sensitivity of 84.5% and specificity of 98.8. For ACL injuries, the best concordance was with CE, while for MM and LM injuries, it was with MRI (P<0.001).Conclusions: Meniscal and ligament injuries in traumatic knee injury can be diagnosed through careful clinical examination, while requests for MRI can be reserved for complex or doubtful cases. CE and MRI used together have high sensitivity for ACL, PCL, and MM lesions, while for LM lesions, the specificity is higher

Comparing the Diagnostic Precision of Clinical Examination and MRI with Findings from Arthroscopy in Traumatic Knee Injuries with Femur or Tibia Shaft Fracture

Background: Diagnosis of knee injuries following trauma to the lower extremity is very important and needs to be carefully examined. This study aimed at comparing the diagnostic precision of clinical examination (CE) and MRI with findings from arthroscopy in traumatic knee injuries with femur or tibia shaft fracture.Methods: A cross-sectional study was conducted on 164 patients with traumatic knee injuries with femur or tibia shaft fracture who had been referred to Imam Hossein Hospital, Shahroud, between March 2014 and February 2015. We compared CE and MRI with arthroscopic findings (gold standard) to determine the concordance, accuracy, sensitivity, and specificity of injuries to the meniscus and knee ligaments.Results: The results showed that internal mucus rupture was the most common trauma, noted in 83 cases (50.6%), followed by anterior corrosion rupture, noted in 65 cases (39.6%). CE sensitivity was 68.4% and specificity was 96.2% for medial meniscal (MM) injuries, while sensitivity was 53.6% and specificity was 96.4% for lateral meniscal (LM) injuries. For anterior cruciate ligament (ACL) injuries, CE showed sensitivity of 77.2% and specificity of 91.8%. For posterior cruciate ligament (PCL) injuries, CE showed sensitivity of 52.6% and specificity of 98.6%. For MM injuries, MRI showed sensitivity of 92.5% and specificity of 86.5%, while for LM injuries, it showed sensitivity of 85.00% and specificity of 98.6%. For ACL injuries, MRI showed sensitivity of 86.7% and specificity of 93.8%, and for PCL injuries, MRI showed sensitivity of 84.5% and specificity of 98.8. For ACL injuries, the best concordance was with CE, while for MM and LM injuries, it was with MRI (P<0.001).Conclusions: Meniscal and ligament injuries in traumatic knee injury can be diagnosed through careful clinical examination, while requests for MRI can be reserved for complex or doubtful cases. CE and MRI used together have high sensitivity for ACL, PCL, and MM lesions, while for LM lesions, the specificity is higher

Comparison of Diagnostic Value of ESR, CRP and Leukocytosis with Pathologic Findings among Patients with Acute Appendicitis

Background: Acute appendicitis is a serious condition that is occasionally falsely diagnosed. The correct diagnosis of this condition helps reduce unnecessary surgeries or complications due to the lack of diagnosis. Laboratory tests are used to diagnose this condition. The present study was conducted to compare the diagnostic value of the ESR, the CRP level and leukocytosis with pathological findings in patients with acute appendicitis.Methods: This descriptive study examined 125 cases with a primary diagnosis of appendicitis from August 2015 to October 2016 at Imam Hossein Hospital in Shahroud, Iran. The patients’ blood samples were collected for ESR, CRP and leukocyte testing and were then sent to the laboratory. After the appendectomies, samples of their appendices were sent to the pathology laboratory for further examination. The blood test results were compared with the pathological findings and analyzed in terms of sensitivity, specificity and positive and negative predictive values.Results: In this study, 59.2% of the cases were male and the rest were female. Acute appendicitis and other pathological appendices were confirmed in 91 patients (72.8%) based on their pathological evaluation and 34 cases (27.2%) were reported as normal. The sensitivity and specificity were obtained as 57.1% and 79.4% for ESR. These indices were 78.0% and 83.5% for CRP and 74.4% and 50% for leukocytosis.Conclusions: The results of this study showed that, in addition to basic laboratory findings, ESR, CRP and leukocytosis testing can also be helpful in the correct diagnosis of acute appendicitis; however, the predictive value of CRP was the highest

Comparison of Diagnostic Value of ESR, CRP and Leukocytosis with Pathologic Findings among Patients with Acute Appendicitis

Background: Acute appendicitis is a serious condition that is occasionally falsely diagnosed. The correct diagnosis of this condition helps reduce unnecessary surgeries or complications due to the lack of diagnosis. Laboratory tests are used to diagnose this condition. The present study was conducted to compare the diagnostic value of the ESR, the CRP level and leukocytosis with pathological findings in patients with acute appendicitis.Methods: This descriptive study examined 125 cases with a primary diagnosis of appendicitis from August 2015 to October 2016 at Imam Hossein Hospital in Shahroud, Iran. The patients’ blood samples were collected for ESR, CRP and leukocyte testing and were then sent to the laboratory. After the appendectomies, samples of their appendices were sent to the pathology laboratory for further examination. The blood test results were compared with the pathological findings and analyzed in terms of sensitivity, specificity and positive and negative predictive values.Results: In this study, 59.2% of the cases were male and the rest were female. Acute appendicitis and other pathological appendices were confirmed in 91 patients (72.8%) based on their pathological evaluation and 34 cases (27.2%) were reported as normal. The sensitivity and specificity were obtained as 57.1% and 79.4% for ESR. These indices were 78.0% and 83.5% for CRP and 74.4% and 50% for leukocytosis.Conclusions: The results of this study showed that, in addition to basic laboratory findings, ESR, CRP and leukocytosis testing can also be helpful in the correct diagnosis of acute appendicitis; however, the predictive value of CRP was the highest

The Comparison of the Effect of Inhalational Isoflurane-Nitrous Oxide Anesthesia and Intravenous Propofol-Remifentanil Anesthesia on Postoperative Pain

Background: The severity of postoperative pain varies widely in the different types of anesthesia. The aim of the present study was to compare the effect of isoflurane-nitrous oxide anesthesia and propofol-remifentanil anesthesia on postoperative pain after foot and ankle surgery. Methods: In this double-blind clinical trial, 60 eligible patients were divided into two equal intervention and control groups; the first group inhaled anesthesia with isoflurane-nitrous oxide and the control group were given intravenous anesthesia with propofol-remifentanil using the quadruple random block model and postoperative pain intensity was measured and compared in the two groups. Data on pain severity were collected at different times and analyzed using SPSS statistical software and related tests. The significant level was set at 0.05.   Results: Of the 60 participants, 38 (52.4%) were male and 22 (47.6%) were female. The mean age of the participants was 33.9±15.1 years. The intensity of pain in the recovery room and up to 4 hours after surgery was significantly (Pvalue<0.001) lower in the intervention group but after 4 hours there was no significant difference between the two groups. So, it can be seen in the present study that there was a significant decrease (Pvalue<0.036) in the number of cases requiring analgesics prescribed in the recovery room and up to 4 hours after surgery in the intervention group. Conclusions: According to the results, evaporation anesthetic isoflurane-nitrous oxide can be used in the stage of induction of anesthesia in orthopedic surgeries, and has achieved good results in reducing pain, especially during the first 4 hours, postoperative. Key Words: Isoflurane, Propofol, Inhaler Anesthesia, IV Anesthesia, Postoperative Pai