Journal of Anesthesiology and Pain

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Background and aim: In recent years spinal anesthesia using a local anesthetic in
combination with an opioid has gained popularity for lower limb operations due to the high
success rate and patient satisfaction, and the decreased resource utilization compared with
general anesthesia. In experimental studies, intrathecal administration of magnesium sulphate
(MgSO4) significantly potentiated antinociception during spinal anesthesia however available
data are scarce. This study aimed at evaluating the effect of adding MgSO4 to bupivacaine and
fentanyl for spinal anesthesia in lower limb orthopaedic surgeries.
Methods & materials: In this double-blind randomized clinical trial, 100 candidates of
spinal anesthesia for lower limp orthopaedic surgeries (ASA class I-II) were recruited in Hazrat
Rasoul Akram Medical Complrx in a 10-month period. They randomized in two equal age- and
sex-matched groups receiving 1.0 ml of preservative-free 0.9% sodium chloride (group S) or 50
mg of MgSO4 5% (1.0 ml) (group M) following 12.5 mg of bupivacaine 0.5% plus 25 μg of
fentanyl intrathecally. Date were collected regarding the time to reach the highest level of
sensory blockade, time to L2 regression, times to reach the highest level of motor blockade and
its full regression, time to consumption the first dose of postoperative analgesic and
complications.
Results: Median time to reach the highest level of sensory blockade was significantly higher
in the S group (16 vs. 14.5 min p=0.02). Median time to L2 regression (243 vs. 207 min
p<0.001), as well as the median time to consumption the first dose of postoperative analgesic
(345 vs. 232 min p<0.001) were significantly higher in the M group. Median times to reach the
highest level of motor blockade and its full regression were comparable between the two groups.
Hypotension and bradycardia were recorded in 20% and 10% of the patients in group M and 30%
and 14% of patients n group S, respectively (p=0. 35).
Conclusion: Intrathecal MgSO4 along with the spinal anesthesia with bupivacaine and
fentanyl in lower limb orthopaedic surgeries hasten the sensory blockade and prolongs the period
of anesthesia without additional side effects or influence on the motor blockade.

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Background and aims: The patients with fractures of femoral shafts have severe and
vigorous pain which limit their lateral positioning to perform spinal anesthesia. To detect an
appropriate resolve for decreasing their pain, we decided to compare facia iliaca block and iv
fentanyl injection.
Materials and Method: This study was performed as a randomized single blind sequential
clinical trial. Prior to spinal anesthesia, pain score evaluated through visual analogue scale (VAS)
[from 0 to 10] after that, patients randomly divided in to two groups, 10 members in each group.
In the first group patients received 1.5 mg/kg fentanyl intravenously. Once their condition was
suitable to achieve the position, VAS again assessed. In second group after facia iliaca block
(20ml lidocaine 2%) VAS evaluated, and then the patients positioned laterally to perform spinal
anesthesia.
Results: This study showed that the time for painless lateral positioning in group fascia iliaca
block was shorter than group iv fentanyl.
VAS score for fascia iliaca block group was lower than iv fentanyl group. The entire
information mentioned earlier was analytically significant (P<0.05) and showed satisfactory
consequences.
Conclusion: In respect to this study, fascia iliaca block is reliable and safe and it is feasible to
perform in all stages of accidents.

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Background &aim: Several reasons cause to pain in ICU patients. The pain brings some side effects in the patients so that different methods have been introduced for pain reduction. The aim of this study was comparison the effect of epidural fentanyl injection with intravenous fentanyl injection for analgesia and the effect of these two methods on ICU patients' continuousness level.
Material and methods: This investigation was a single-blind clinical trial in ICU patients of Shahid Bahonar Hospital in Kerman. These patients suffered from abdominal and chest trauma that were mechanically ventilated. Sixty patients were assessed in two groups. Patients in Group A received intravenous fentanyl for first 24 hrs, and then get epidural fentanyl from epidural catheter. Patients in B group were injected by epidural fentanyl in first 24 hrs, and then by intravenous fentanyl in second 24 hrs. Levels of fentanyl were 1.5 mcg.kg^-1 intravenous injection and 8 mcg.kg^-1 for epidural injection that were regulated with injection pump. Glascow Coma Scale and Visual Analogue Pain Score were assessed in 0, 2, 6, 24, 50, 54 and 72 hours.
Results: In both groups, pain score in 2 hours was significantly lower in intravenous injection than epidural way but after 6 hours, epidural way cause to relieve pain than intravenous way (P<0.05). In all items, fentanyl intravenous injection cause to decrease patients GCS than epidural way (P<0.05). There were no significant differences between patient's pain score and GCS with their age, sex, and trauma (abdomen, chest or both of them) (P>0.05).
Conclusion: The best way of pain control in mechanically ventilated patients with abdominal and chest trauma is intravenous injection of fentanyl in the first 2 hours and epidural injection of it in other hours. In addition, intravenous injection of fentanyl always decreases consciousness level more than epidural way.

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Background and aims:

 Postoperative analgesia is one of the most concerns of anesthesiologist and patients. Systemic opioids administration is the gold standard in reducing the severe pain after surgery but some side effects prevent the use of adequate doses of opioids. The aim of this study was evaluation of adding acetaminophen on fentanyl in patient-controlled iv analgesia (PCIA).
Materials and Methods:

 In this randomized clinical trial, 120 patients candidate for lower limb orthopedic surgery (ASA I-II) were recruited in Rasoul-Akram Medical Center in a 12- month period. They randomly allocated  in two groups for postoperative pain, group F (Fentanyl)  (n=60)  and group AF (Acetaminophen/ Fentanyl) (n=60) by patient-controledl  intravenous analgesia (PCIA) groups. The pump has a continuous infusion of 5 ml per hour, bolus dose 2 ml and the lock out time 30 minutes was left. Each ml of solution in group F containing 10 mcg of fentanyl and in the group AF containing 5 mcg fentanyl and 20 mg acetaminophen. Pain score, sedation score, satisfaction, nausea and vomiting was evaluated for 48 hours after surgery.
Results:

The demographic characteristics of the two groups did not differ significantly. Pain scores beforpump  in F and AF groups were  6.8±1.6 and6.5±1.4, respectively. After 24 and 48 hours pain scores (2.4± 0.8, 1.7± 0.7) and (1.9± 0.6, 1.2± 0.5) decreased (P<0.001). Changes in pain scores were similar in both groups. Level of sedation, nausea and vomiting in the F group  and satisfaction in the AF group was higher. 
Conclusion:

 This study showed adding iv acetaminophen to fentanyl through an PCIA is effective in controlling pain in patients undergoing lower limb orthopedic surgery. Moreover, acetaminophen and fentanyl combination and has fewer side effects such as nausea, vomiting and sedation and more satisfaction than fentanyl alone.

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Aims and Background : Shivering is one of the common unpleasant side effects after surgery. Shivering is associated with problems such as increased oxygen consumption, increased intracranial pressure and other complications. The aim of the present study has been to compare the effect of different doses of Pethidine and Fentanyl in preventing postoperative shivering after spinal anesthesia for orthopedic surgeries.

Materials and methods: In this randomized clinical trial, 60 orthopedic patients admitted to Ilam Imam Khomeini Hospital were selected from March 2013 to September 2013. All participants were randomly assigned into two groups : Pethidine and Fentanyl . The Severity of shivering after spinal anesthesia was compared between the groups. The analysis was done using the p aired t test , independent t-test , and Chi-squared test. P-value less than 0.05 was considered to be statistically significant.

Finding : The key variables known to affect surgery outcomes were statistically similar in both groups. 98.3% of all participants had mild shivering, and 1.7% had moderate shivering .There was no report of any cases with severe shivering. The mean severity of shivering was reduced significantly in both groups. However, this reduction in the severity of shivering was not statistically significant between the two groups (P=0.28).There was not any difference in shivering severity between the groups before (P=0.052) and after (P=0.47) the intervention .

Conclusion: Pethidine and Fentanyl have the same effect in preventing postoperative shivering . Therefore, assessment of other conditions in patients would be recommended for anesthesiologists in order to control shivering .

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Abstract:                                                                                                         

Aims and background : Cancer pain is a major problem for the health care providers. One of the most important aspects of cancer pain is palliative care management.  Recently, different research finding shows the efficacy of opioid analgesics such as fentanyl transdermal patch in chronic pain management.Transdermal Fentanyl patches may cause side effects such as drowsiness, dizziness, itching, life-threatening or serious breathing difficulties and diarrhea,  mainly during the first 72 hours of patient’s treatment initiation and any time when the drug’s dose is increased.

Case report:  We report three cases of severe diarrhea associated with Fentanyl patches during the first 72 hours of patient’s treatment, however no other common side effect of this drug was observed in these patients.

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Aim and Background: The correct management of delivery and anesthesia is important for the maternal and fetal health outcome during cesarean section. The aim of this study was to compare the effect of spinal anesthesia with plain bupivacaine, bupivacaine+25 µg fentanyl and bupivacaine+12.5 µg fentanyl on the newborn Apgar score during elective cesarean section.

Methods and Materials: This study was randomized double blind clinical trial on 120 women aged 20-40 years, ASA 1&2 who were admitted for elective cesarean section. Patients were allocated in the three equal groups (n=40). Spinal anesthesia was applied by a plain bupivacaine (group 1), bupivacaine+12.5 µg fentanyl group (group 2), bupivacaine+25 µg fentanyl group (group 3). The 1st and 5th minute Apgar scores, demographic variables and other variables were recorded during the operation. The statistical analysis was applied by ANOVA using SPSS 16.00 software.

Findings: The three groups were the similar regarding age, weight and height. Apgar scores at 1 and 5 minutes were not significantly different between the three groups. The incidences of side effects were not significantly different among the three groups.

Conclusion: The doses of 12.5 and 25 microgram fentanyl added to intrathecal bupivacaine did not have any significant effect on the neonates Apgar scores. Additionally it did not significantly increase spinal anesthesia side effects in the parturients.

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 Aims and background: One of the major challenges in women’s surgery, including cesarean section, is postoperative pain control. Postoperative pain as one of the most common problems in the postoperative phase and can lead to a significant reduction in the quality of surgical operations, along with other problems such as nausea and vomiting, hypotension and shivering. Therefore, the present study we aimed to study the efficacy of sublingual Buprenorphine in postoperative pain control following cesarean surgery and its effects among patients. Materials and Methods: The present study is a randomized, double-blind clinical trial. Patients aged 18_45years old and all candidates underwent cesarean section at Alavi Hospital in Ardabil in 2017. After obtaining consent from patients for inclusion in the study, 80 patients were selected using simple sampling method and divided into two groups of 40. In the first group,) control group) 40 patients received fentanyl and placebo tablets, and the pump was used to inject intravenous fentanyl and the drug lasted for up to 24 hours. the second group )40 patients) received normal saline pump and buprenorphine pills. In the second group (sublingual buprenorphine + placebo pump), it was repeated 6 and 12 hours after the first dose. Then, VRS pain scores, vomiting  nausea, sedation )from Ramsay sedation scale), and the amount of analgesic demand for pain control at 2, 6, 12, and 24 hours, and postoperative analgesia (time to first need analgesia) were recorded. Finally, all patient information entered into a pre-designed checklist and all the data entered into the SPSS v20 statistical analysis program and we analyzed the data. Findings: In this study, 80 patients were evaluated in two groups The results of VRS pain score in patients showed that, except within 24 hours after surgery, in other hours of study, the pain score in the two groups did not show any significant difference. In the control group, the demand for analgesics was higher than the buprenorphine group. In the early hours after surgery (hours 2 and 6), the incidence of nausea and vomiting was significantly lower in the buprenorphine group than in the control group, but the rest of  it, no difference was observed. The sedation score was also evaluated, but no significant difference was observed in the two groups. Also, the incidence of other side effects in the two groups did not differ significantly. Conclusion: The results of this study showed that buprenorphine is an effective drug in reducing postoperative pain in postoperative patients and, due to its very low side effects, can be routinely used in patients.

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Introduction: The prevalence of postoperative urinary retention is between 5% and 70%, depending on the type of surgery, the type and combination of anesthetics, and the patient's underlying conditions. Studies have shown that reducing the dose of local anesthetics in spinal anesthesia and the use of the drug combination reduces the incidence of urinary retention and the need for postoperative catheterization. This study was designed to evaluate the effect of adding fentanyl to spinal anesthesia on the incidence of postoperative urinary retention.
Patients and Methods: In a randomized clinical trial, patients who were candidates for lower limb orthopedic surgery or lower abdominal surgery under spinal anesthesia were enrolled. Patients with a history of urinary problems were not included. participants were excluded if a change in the method of anesthesia was intended, urinary catheterization required or urinary tract trauma occurred. Patients were randomly allocated to either spinal anesthesia with Bupivacaine 2-2.5 ml or spinal anesthesia with Bupivacaine 1.5-2 ml plus fentanyl 25 µg. Postoperative urinary retention was assessed based on the need for catheterization or a complaint of difficult or incomplete urination.
Results: There was a significant borderline association between the complaints of incomplete (20 vs. 12 patients) or difficult urination (16 vs. 8 patients) after surgery and the addition of fentanyl to the spinal anesthesia. (P=0.05) There was no statistically significant relationship between the need for postoperative catheterization and the addition of fentanyl to the spinal anesthesia (20 vs. 13 patients; p=0.11). Logistic regression analysis showed that age and amount of fluid intake during surgery were independent predictors of difficult urination.
Conclusion: Adding fentanyl 25µg to local anesthetics in spinal anesthesia will increase the incidence of postoperative urinary retention. The use of lower doses of fentanyl in combination with various local anesthetic drugs in spinal anesthesia is recommended in future studies.

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Introduction: two drugs, fentanyl and sufentanil, are drugs added to the anesthetic trial, which have been used more than other drugs, however, there is still no detailed information about the safety of adding these two drugs to the anesthetic drug in the event of urinary retention in Therefore, the present study was conducted with the aim of comparing the addition of fentanyl and sufentanil to the anesthetic drug and its effects on urinary retention after spinal anesthesia.
Methods: This study was conducted as a systematic review and meta-analysis based on the PRISMA statement. Searching MEDLINE, CENTRAL and EMBASE, Web of Science, Scopus, Mag Iran and SID databases using the keywords anesthesia, spinal anesthesia, phenethyl, sufentanil, bupivacaine, ropicaine, levobopiva, regional anesthesia, urinary retention and after Anesthesia was performed with the help of Boleyn operatives.
Results: There was no significant difference in urinary retention (RR=1.02 [0.70-1.49]; 95% CI) between the intervention and control groups; Also, there was no significant difference between fentanyl or sufentanil (Chi=0.13/I=0%).
Conclusion: Adding fentanyl or sufentanil to the anesthetic drug during spinal anesthesia has no effect on urinary retention after surgery