Journal of Anesthesiology and Pain

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Background: Propofol is one of the most common drugs used in anesthesia induction and the pain during its intravenous injection is the most important and another side effect of it. Therefore a lot of methods and drugs are examined to reduce or eliminate this side effect. In this study the effects of Alfentanil, Magnesium sulfate and Ketamin drugs on reducing of pain during intravenous injection of propofol are investigated. 
Methods: This study was performed on 220 patients who were under orthopedic surgery in Poursina hospital in 2010. The intensity of propofol intravenous injection pain is measured after using premedication by VAS, result is analyzed by SPSS v16 software under Chi square and PostHoc exams.
Results: According to data and variance analysis statistic exam ANOVA it is definded that after propofol injection there is a meaningful difference in quantity of VAS among studied groups (Chi square = 49.78 and df = 3 and P<0.0001). The VAS score in Magnesium sulfate group has a meaningful difference in comparison of other groups according to PostHoc exams and there is no meaningful difference among other groups (P>0.05).
Conclusion: Despite reduction the propofol intravenous injection pain in three studies drugs in this thesis, there is no preference among them.

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The case report that will be presented is an inherited methemoglobinemia , during general anesthesia of 36year old patient and was suspected by some clinical xamination such a decrease oxygen saturation in pulse oximetry and a normal finding in ABG sample that have been prepared at the preparation of patient for anesthesia .So we are going to write about this problem in the perioperative period and how to manage it.

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Aim and Background: One of the most common surgical procedures is hemorrhoidectomy and pain is a common problem in patients after this surgery. Therefore postoperative pain control could have a significant impact on reducing complications and increasing patients' satisfaction. In this study, the effect of perianal block with bupivacaine on declining pain after hemorrhoidectomy has been studied. Methods and Materials: This study is a double-blind clinical trial in which, patients undergoing hemorrhoidectomy were randomly divided into two groups. The study group received perianal block with bupivacaine 0/25% after surgery and the control group did not recieve any block. In order to assess postoperative pain and nausea-vomiting , VAS and VDS scales were used, respectively. In the meanwhile, the duration of postoperative analgesia and patient satisfaction were evaluated. Findings: The two groups were sigificantly different considering the mean change in pain score (based on VAS ), the average amount of pethidine recieved, the rate of post-operative nausea and vomiting (VDS) and the percentage of patient satisfaction after the surgery. (P=0.0001). Conclusions: Perianal block with bupivacaine in elective surgical hemorrhoidectomy effectively reduces postoperative pain.

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Aim and Background : Postoperative acute pain management is necessary to prevent chronic pain. Pregabalin as a GABA analogue has been shown to have analgesic effects on postoperative pain. It has minimal side effects and is absorbed rapidly from the alimentary tract. The aim of this study was to evaluate the analgesic efficacy of single dose oral pregabalin on postoperative pain control after orthopedic surgeries performed under spinal anesthesia.

Materials and Methods : Sixty patients, candidate for orthopedic surgery under spinal anesthesia, were randomly allocated into two groups. For the intervention group 150 mg oral Pregabalin and for the control group placebo were prescribed one hour before surgery. Visual Analogue Scale (VAS) for pain assessment and opioid consumption were evaluated in a 12 hour period after surgery. If pain score (VAS) was more than four, intravenous pethidine (0/5 mg/kg) was administered.

Findings : No significant difference was found between the two groups, regarding demographic data. VAS in the post anesthesia care unit, 6, and 12 hours postoperatively in the pregabalin group was significantly less than the placebo group(p <0.05). Also pethidine consumption in the pregabalin group was significantly less than the placebo group (p=0.001 . )

Conclusions: Administration of a single dose pregabalin orally (150 mg), one hour before orthopedic surgery reduced post operative pain and opioid consumption.

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The patient was a 69 year-old man suffering from benign prostatic hypertrophy (BPH), who was candidate for transurethral resection of prostate (TURP) surgery with 980nm diode laser. At the end of the operation, the surgical team noticed abdominal distention. So with suspicion to an acute abdominal problem he underwent an exploratory laparotomy. During the surgery it was found that patient had extra -peritoneal bladder perforation, and after repairing the bladder perforation our patient was transferred to the intensive care unit (ICU) .In the meanwhile and after 48 hours, he was at last successfully discharged from ICU.

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Aims and background: Due to the nature of the orthopaedic surgery, affecting bone and joint, it is associated with a high rate of postoperative pain. Using intravenous, intramuscular, intrathecal and epidural opioids are methods for postoperative pain control for which the side effects are numerous. However, Intrathecal administration of magnesium with blocking NMDA receptors reduces postoperative pain without increasing side effects .The aim of this study was to investigate the effect of adding magnesium sulfate to Intrathecal lidocaine- epinephrine mixture on duration of postoperative analgesia in lower limb orthopaedic surgeries.

Materials and Methods: This double blind study was performed on patients who were candidate for lower extremity orthopaedic surgeries. For this purpose, 156 patients were randomly divided into two groups. One group received magnesium sulfate with lidocaine – epinephrine mixture and other group received the same drugs with distilled water as placebo. The duration of postoperative pain was determined according to patients' request for analgesics. Patients' pain degree was evaluated according to visual analogue score (VAS), and Pethedine consumption was also calculated. Data were analyzed by SPSS software.

Findings: Mean age of our patients in magnesium and control groups were 34.5 ±7.5 and 31.9±8.1 years old, respectively. The Mean (±SD) of postoperative analgesia duration in the magnesium group was 143.7±29.7min and it was 100.9±18.1 min in the control group, which shows a significant difference between two groups (p <0. 000). Patients’ pain score according to VAS in magnesium group was 3.9±o.36 and it was 5.65±0.35 in the control one. This was also significantly different between the two groups (p=0.000). Also mean Pethedine consumption was 15±6.24 mg and 33±6.27mg in the magnesium and control groups, which was again statistically significant (p=0.000).

Conclusions: Magnesium sulfate combined with lidocaine produces a reduction in postoperative pain in comparison with lidocaine alone.

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Aims and background:  Nowadays, multimodal approach is used to control post-operative pain. Pregabalin has been shown to have analgesic effects on postoperative pain as a Gaba-Amino-Buteric (GABA) analogue. This prospective, randomized, double-blind, controlled study has evaluated the beneficial effect of Pregabalin pretreatment on postoperative pain and opioid consumption in patints undergoing orthopedic elective surgery.

Materials and Methods: Sixty ASA 1-2 patients, scheduled for orthopedic elective surgery under spinal anesthesia, were randomly divided into two groups. Group 1 received 300 mg Pregabalin one hour before the operation and Group 2 was given Placebo capsule. Patient-controlled intravenous analgesia (PCIA) device, prepared with Sufentanil, was connected to both groups for postoperative analgesia. Postoperative pain scores according to visual analogue scale (VAS), opioid consumption, and side-effects like nausea were recorded for 12 hours after surgery. P value<0.05 was considered significant.

Findings: According to visual analogue scale (VAS), pain scores were significantly lower in Pregabalin group at post anesthesia care unit (PACU), 6 hours and 12 hours post-operatively(p<0.05). Also pethidine consumption was significantly less than the placebo group in Pregabalin group (p<0.05).

Conclusion: Administering a single dose of 300 mg Pregabalin orally, and 1 hour before elective orthopedic  surgery under spinal anesthesia, significantly reduces postoperative pain and opioid consumption.

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Abstract: Aims and Background: Esophageal foreign body can be harmful. Esophagoscopy is the most common method of foreign body extraction. But in many cases during laryngoscopy the foreign body is visible in hypopharynx region and anesthesiologist can remove it with a Magill forceps. In these cases laryngoscopy should give an appropriate and sufficient view from hypopharynx. The aim of this study was to compare two common laryngoscopy blades including Miller and Macintosh in producing direct view of hypopharynx and the possibility of foreign body removal, in order to present the preferred method. Methods and Materials: After performing lateral and anteroposterior neck radiography for confirming foreign body existence above the 7th cervical spine, patients over 10 years old with history of swallowed foreign body and candidate for esophagoscopy, were included in this study. Randomly one of the Miller and Macintosh blades was chosen and after induction of anesthesia and laryngoscopy the grade of hypopharynx view was recorded. In this grading system created by author, increasing grade of hypopharynx was associated with better view of hypopharyngeal inlet and more possibility of visualizing and removing foreign body. After laryngoscopy and in case of visualizing, attempt to remove the foreign body by Magill forceps was done. Findings: In 60 patients, with similar BMI and Demographic data , the Grade 4 of hypopharyngeal view ,creating a better view for the removing foreign bodies, was approximately 3 times more common in Macintosh group than Miller one (56.% vs. 20%).In grade 4 of hypophangeal view the success rate of Macintosh blade was (94.1%) and for Miller it was(50%)(P value:0.04).Overall, the success rate of Macintosh blade in all grades was 4.3 times more than Miller blade . Conclusions: Comparing laryngeal view and success rate of two laryngoscopes (Macintosh and Miller) showed that grade 4 of laryngoscopy, which seems to be more appropriate for removing foreign body, is more common in Macintosh group than the other one. Regarding the success rate, we observed that Macintosh blade had a higher chance of removing foreign body. In general, the success rate of the Macintosh laryngoscope was more than Miller. Key words: esophagoscopy , foreign body, laryngoscopy

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Abstract: Aims and Background: Tranexamic acid has been used to reduce blood loss and the need for blood transfusion in many surgeries. Traumatic mandibular surgeries can be associated with significant bleeding which affects the field of operation and creates difficulties for the surgeon. Therefore we decided to evaluate the effect of tranexamic acid on the amount of bleeding during traumatic mandibular surgeries. Methods and Materials: In this randomized double blinded clinical trail, 90 patients, scheduled for traumatic mandibular surgeries with ASA class I-II and aged between 18 to 40 years, were included. They were randomly assigned to each group (n=45). After induction of general anesthesia with the same plan they received tranexamic acid (10mg/kg) or equal volume of normal saline, intravenously. Intra operative bleeding, pre-op hemoglobin (Hb), hematocrit (Hct) concentration, post-op (after 6 hours) Hb and Hct concentration, rate of blood transfusion and the quality of surgical field were recorded for each patient. Then data analyisis was performed with (SPSS software version 16). Findings: Mean intraoperative bleeding in the tranexamic acid and placebo group were 80.44± 49.43ml and 183.0 ± 69.53ml, respectively (P=0.0001). Post-op decreasing rate of Hb and Hct were less in the tranexamic acid group vs. the control one(P=0.0001 for Hb , P=0.001 for Hct). The Quality of surgical field leading to the surgeon’s satisfaction was better in the tranexamic group than the control group. (P=0.0001). None of the patients needed blood transfusion. Adverse effects were not seen in any of the groups. Conclusions: Administration of IV tranexamic acid decreases the amount of bleeding during mandibular surgeries. Keywords: Tranexamic acid, Bleeding, Mandibular surgery, Hemoglobin, Hematocrit

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ABSTRACT:

Aims and background: Osteogenesis imperfecta is an authosomal dominant disease that almost always involve the   connective tissues .The major problem in these patients is inability to synthesize collagen type -1, that leads to multiple long bone fractures. This case report is going to describe management of anesthesia in a  patient with Osteogenesis imperfecta, who was scheduled for tibia plate insertion. Following failure of spinal anesthesia, the method was changed to general anesthesia by LMA insertion.

Case report: A  45 years old man , with 35 kg  weight and 132 cm height as a known case of osteogenesis  imperfecta ,was  candidate for tibia plate insertion surgery. He could not walk  due to the severity of his disease. The bad anatomy of the mandible and its protrusion that was combined by severe congenital scoliosis, made the supine position impossible, so the patient was candidate for regional and spinal anesthesia, actually .After failure of spinal anesthesia the method was changed to general anesthesia with total intravenous anesthesia(TIVA ) and laryngeal mask(LMA ) insertion for airway management. Management of anesthesia was good and patient was discharged from hospital healthy, after 3 days.

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Abstract

Aims and Background: Knee OA is the most common joint disease. Hip abductor muscle weaknesses has been reported in people with knee osteoarthritis. The aim of this study was to compare the effect of  two therapeutic methods namely  hip abductor-quadriceps strengthening and quadriceps strengthening alone in women with knee OA.

Materials and methods: 34 subjects were randomly assigned to the hip group or to the quadriceps group. The hip group performed hip abductor and quadriceps strengthening exercises, whereas the quadriceps group performed quadriceps strengthening exercises (3 times per week for 8wk). Pain with NRS , knee function with WOMAC, single leg balance test and timed up and go test (TUG) were all assessed before and after intervention. Repeated measure ANOVA, and Paired t-test were used to compare outcome measures between groups over time.

Findings: The results showed that there were significantly differences between the mean scores of pain, function, balance in both groups and TUG test in hip group before and after training (P<0.05). There was no significant difference in TUG test in quadriceps group (P>0.05).  Repeated Measure results indicated that the mean scores of pain, balance and TUG test in hip group were significantly better than quadriceps group (P<0.05) while they were not significantly different  in the physical function.

Conclusion: Hip abductor- quadriceps strengthening exercises were more effective than quadriceps strengthening alone in reducing pain, improving function, single leg balance and in TUG test in women with knee OA.

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Aims and background: The infraclavicular nerve block as a method for anesthesia or analgesia in upper
extremities that can be performed under guide of nerve stimulation or ultrasound. One of the adverse reaction
to this method is the local anesthetic systemic toxicity that has been decreased when using the ultrasound to
avoid intravascular injection.
Case report: This case report explains an infraclavicular block under guide of ultrasound in a 52-year-old
patient who was experienced local anesthetic systemic toxicity with lidocaine due to anomalous vasculature
that normally cannot be visualized in ultrasound guide. The epilepsy was controlled by barbiturate and after
one day, he was discharged.

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Aims and background: Tuberous sclerosis is an autosomal dominant disease characterized by hamartomas lesions in multiple organs. This article reports the case with tuberous sclerosis candidate femur surgery that was performed under general anesthesia without any  problem. case report: The patient was a 44 years old man with a weight of 48 kg and  height of 162 cm, known case tuberous sclerosis with mental retardation and recurrent seizure under treatment and urology complication lived in disabled sanitarium. After pre operative visite and  necessary implementation , patient was underwent  general anesthesia with endotracheal intubation  and  surgery was performed successfully without complications. After surgery the patient was fully conscious and transferred to recovery room with good general appearance  and  was discharged after three days 

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 Aims and Background: Despite the rapid growth and prevalence of obesity, the impact of obesity on outcome of exercise therapy in patients with chronic non-specific low back pain is still uncertain. The aim of this study was to investigate whether obesity can affect the efficacy of exercise therapy on pain and disability of patients with chronic non-specific low back pain. Materials and Methods: Study subjects include 32 male and female (21 men and 11 women) patients with chronic non-specific low back pain.They were classified Based on body mass index (BMI) and waist-to-hip ratio (WHR) into two groups of obese subjects (6 men , 4 women; mean age: 52.3±5.85 and BMI 32.45±2.15) and non-obese (15 men and 7 women; mean age, 51.81±7.10 and BMI 24.5±1.91). To assess pain visual analogue scale (VAS)was used and Roland Disability Questionnaire - Morris (RMQ) was used to assess back pain disability. Exercise program consisted of seven exercises which was carried out for 10 weeks, three times a week for 30 to 60 minutes. Data wasanalyzed by independent t test, ANOVA and Pearson correlation tests with the significant level of less than 0.05. Findings: The results showed a significant difference between pain intensity (F=-2.88, P=0.007) and disability (F=-2.16, P=0.04) of obese and non-obese subjects with chronic non-specific low back pain in pretest.A statistically significant relationship between body mass index and pain severity (r =0.43, p=0.02) and disability (P=0.49, p=0.017)was observed in patients with chronic non-specific low back pain. After the intervention, pain (F=14.27, p=0.001) and disability (F=5.42, p=0.03) improvement was significantly more for non-obese than obese chronic non-specific low back pain subjects. Conclusion: The results showed that obesity has a negative impact on efficacy of exercise therapy in patients with chronic non-specific low back pain. Accordingly, it seems that therapeutic approaches which target both body weight and back pain in obese patients with chronic non-specific low back pain,have more significant economic effect and even better long-term outcomes not only for pain but also for other complications associated with obesity.

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 Aim and Background: This    study    was    performed    with    the    purpose    to    determine    the    role    of    alexithymia    and    emotion    dysregulation    in    quality    of    life    in    patients    with    chronic    pain. Materials and methods:    This    research    is    descriptive    and    correlational.    The    research    sample    consisted    of    150    patients(90female    and    60male)    with    chronic    pain    who    referred    to    Gilan    pain    clinic    in    march-June    2017. They    were    selected    by    available    sampling    method.    Toronto’s    Alexithymia    scale,    Gratz    and    Roemer    emotion    dysregulation    Scale    and    Quality    of    Life    Scale    were    used    for    their    evaluation.    Data    was    analyzed    by    using    Pearson    correlation    coefficient    and    stepwise    regression. Findings: The    results    showed    a    negative    significant    relationship    between    Alexithymia    and    emotion    dysregulation    with    quality    of    life    (p    <0.01),    and    the    difficulty    in    identifying    emotions    and    emotion    dysregulation    predict    about    32%    of    the    quality    of    life    changes    in    patients    with    chronic    pain    (P    <0.01). Conclusion: Alexithymia    and    emotion    dysregulation    are    involved    in    the    quality    of    life    in    chronic    pain    patients    and    the    need    to    pay    attention    to    emotional    responses    can    improve    the    quality    of    life    in    patients.

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 Aims and background: The pain experience in people with chronic pain can effect on psychological and social aspects, also influenced. The purpose of this research was to investigate the efficacy of Acceptance and Commitment Therapy on Feeling Hope and pain management of Women with Chronic pain. Materials and methods: The present research was of applied research type. The research method was semiempirical with a pretest-posttest with control group design. Populations were all women with chronic pain were referred to Gilan pain clinic and were selected through voluntary sampling method. Sample numbers were 20 Woman that gained lowest scores on Feeling Hope And pain management randomly assigned to control and experiment groups (each group included 10 Woman). The experiment group exposed to 8 instruction sessions of Acceptance and Commitment Therapy. But the control group did not receive any intervention. The data were analyzed through descriptive statistics method and Ancova in SPSS v.20. Findings: The multivariate covariance analysis results for Feeling Hope (F=1.14) and pain management (F=1.11) suggested that there was a significant difference between the Women of experiment and control groups (P< 0.01). According to the posttest scores of the experiment control groups for these two variables, it was recognized that the Acceptance and Commitment Therapy has led to increase in Feeling Hope and pain management among the Women of the experiment group in comparison to the control group in the posttest stage. Conclusion: The results of this study showed that participating in Acceptance and Commitment Therapy meeting can affect promotion of Feeling Hope and pain management of Women with Chronic pain. Therefore it is possible to raise the level of Acceptance and Commitment by increasing the Feeling Hope and Upgrade pain management.

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 Aims and background: The use of mindfulness through the psychological components associated with the fearavoidance
model could be useful in treatment of chronic pain. The purpose of the present study was to evaluate the
effectiveness of adding mindfulness to exercise therapy in runners with patellofemoral pain.
Materials and Methods: This quasi-experimental study was performed in Kermanshah in 1398 Midyear. Thirty
women aged 18-40 years with patellofemoral pain syndrome were randomly allocated to Mindfulness-Based (n=15)
and control groups (n=15). The mindfulness group received an 8-session mindfulness program in addition to the
exercises received by the control group. Daily pain, pain during running, and pain during climbing up and downstairs
were assessed by NPRS before, 12 weeks, and 18 weeks after the intervention.
Results: The results showed that daily pain, pain during running, and pain during climbing up and downstairs in
Mindfulness-Based group is lower compared to control at 12th and 18th week post-intervention; however, there was
no significant difference between groups at week 6 (p˃0.05).
Conclusions: Adding an eight-session mindfulness program to an exercise therapy program was an effective treatment
to decrease pain in athletes with patellofemoral pain syndrome.