Anesthesiology and Pain Medicine

In Collaboration with Society of Regional Anesthesia and Pain Medicine (ISRAPM)

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The Anesthesiology and Pain Medicine journal, official publication of ISRAPM since 2011, offers comprehensive insights into pain management research, education, and clinical practice. It features a broad spectrum of content, including research, reviews, and debates relevant to anesthesiologists, neurosurgeons, and pain specialists.

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Now showing 1 - 20 of 1033
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    Comparing Analgesic Efficacy: Ropivacaine with Dexamethasone vs. Ropivacaine with Dexmedetomidine After Cesarean Section Using Transversus Abdominis Plane Block (2020 - 2021)
    (Brieflands, 2024-10-31) Mohammadreza Jamshidi; Mona Ghaderi; Mitra Hojatansari
    Background: There are several methods for managing postpartum pain. The combined use of drugs with anesthetics can lead to effective pain management. Objectives: The present study aimed to compare the analgesic effects of ropivacaine (RPV) + dexamethasone (DEXA) and RPV + dexmedetomidine (DEX) on pain after cesarean section (CS) using the transversus abdominis plane (TAP) block. Methods: This double-blind, randomized clinical trial employed a quadruple block randomization method and included 40 participants scheduled for CS at Ayatollah Mousavi Hospital in Zanjan, Iran, during 2020 - 2021. The participants were divided into two groups: The first group received 15 mL of RPV 2% combined with 100 µg of DEX via the bilateral TAP block method, while the second group received 15 ml of RPV 2% combined with 8 mg of DEXA. The analgesic effects of the two drug combinations were evaluated at 0, 3-, 6-, 12-, and 24-hours post-CS using the visual analog scale (VAS) to measure pain intensity. Data analysis was conducted using SPSS software, version 24. Results: In the RPV + DEX group, the onset of pain was delayed, resulting in a longer duration before the administration of painkillers (P = 0.041 and P < 0.001). However, pain intensity between 3- and 24-hours post-surgery was significantly higher in the RPV + DEX group compared to the RPV + DEXA group (P = 0.028, P < 0.001). The RPV + DEX group experienced longer durations before the onset of pain and the need for painkillers (P = 0.041, P < 0.001). Hypotension was more frequently observed in the RPV + DEXA group at 0 hours (P = 0.068) and 3 hours post-surgery (P = 0.003). Additionally, bradycardia and sedation incidences were higher in the RPV + DEXA group at 3 hours post-surgery (P = 0.005, P = 0.048). Conclusions: The use of RPV + DEXA, unlike RPV + DEX, demonstrated positive and significant effects on pain management in female CS candidates using the TAP block method, despite its side effects.
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    Enhanced Recovery After Surgery (ERAS) Protocol for Craniotomy Patients: A Systematic Review
    (Brieflands, 2024-10-31) Masood Zangi; Mahsa Asadi Anar; Mahdi Amirdosara; Majid Mokhtari; Reza Goharani; Sara Sanei Moghaddam; Omidvar Rezaei; Seyede Hamideh Hashemiyazdi; Mohammadreza Hajiesmaeili
    Context: The enhanced recovery after surgery (ERAS) protocol is a multidisciplinary approach aimed at improving surgical outcomes, reducing complications, minimizing hospital stays, and lowering healthcare costs. Objectives: This study assesses the impact of the ERAS protocol on elective craniotomies, a routine procedure in neurosurgery. Methods: A comprehensive search across PubMed, Embase, Scopus, and Web of Science identified 562 articles. Following strict screening criteria, 54 studies were reviewed, and ultimately 10 studies meeting the inclusion criteria were selected for detailed analysis. Results: The review encompassed ten studies [one prospective, one systematic review, and eight randomized controlled trials (RCTs)] published between 2016 and 2023. Key components of the ERAS protocol included preoperative counseling, high-protein intestinal nutrition, preoperative fasting while avoiding carbohydrate intake within 2 hours of surgery, standardized anesthetic and analgesic regimens, and early postoperative initiation of enteral feeding. Postoperative outcomes showed fewer complications, early mobilization, and notably shorter hospital stays, all of which contributed to improved patient recovery. Conclusions: This review demonstrates that the ERAS protocol, when applied to elective craniotomies, is effective in enhancing postoperative recovery, improving functional outcomes, and reducing hospitalization duration.
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    Transient Neuronal Injury Followed by Intravascular Injection During an Ultrasound Guided Stellate Ganglion Block
    (Brieflands, 2013-01-01) Hariharan Shankar; Swetha Simhan
    Ultrasound guidance for pain interventions is becoming increasing recognized as a useful imaging tool. One of the common interventions where it is gaining wider acceptance is during the performance of a stellate ganglion block. The following is a unique report where intravascular and neuronal injury occurred during the performance of an ultrasound guided stellate ganglion block followed by dysphagia. 41 year old male, with a diagnosis of complex regional pain syndrome, was referred to our clinic for further management. He underwent a diagnostic ultrasound guided stellate ganglion block after having tried conservative therapies. The stellate ganglion block provided him with complete pain relief for over five weeks. During a subsequent therapeutic stellate ganglion block, performed by an experienced pain medicine fellow with more than 50 ultrasound guided proceduresclinician, the patient developed a transient injury to the brachial plexus upon needle entry. Subsequent redirection and injection of an ml of injectate resulted in an intravascular injection producing tinnitus. After the tinnitus decreased, he underwent another stellate block using an out of plane approach without any further complications. Two days later, he reported chest and throat discomfort which resolved over the next few days possibly due to a retropharyngeal hematoma. He declined further interventions and was subsequently managed with 3 tablets of oxycodone a day. This report highlights the importance of vigilance and meticulous planning during the performance of ultrasound guided pain interventions.
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    Management of Critically Ill Patients with COVID-19: What We Learned and What We Do
    (Brieflands, 2020-06-10) Ata Mahmoodpoor; Kamran Shadvar; Ali Akbar Ghamari; Mojtaba Mohammadzadeh Lameh; Roghayeh Asghari Ardebili; Masood Hamidi; Hassan Soleimanpour
    There are many unknown questions and puzzle pieces that should describe the clinical course of COVID-19 and its complications, especially ARDS. We provide the initial immediate surge response to allow every patient in need of an ICU bed to receive one. Till our knowledge is improved, the most important intervention in the treatment of critically ill patients with COVID-19 seems to be the level of standard care and appropriate and early diagnosis and treatment. It seems that each center should have its protocol on the management of critically ill COVID-19 patients regarding prevention, diagnosis, and treatment. This treatment should now be performed regardless of the reason which lies behind the pathophysiology of this disease, which is yet unknown. In this report, we share our experience in the management of critically ill COVID-19 patients during the 2 months in our intensive care unit.
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    Comparison of the Effect of Two Different Doses of Labetalol to Induce Controlled Hypotension on Hemodynamic Changes During Spinal Fusion Surgery
    (Brieflands, 2021-10-31) Zahra Rahimi; Mehrdad Masoudifar; Behzad Nazemroaya; Haidar Almadi
    Background: Spinal fusion surgery is often associated with heavy bleeding. Labetalol is one of the most effective drugs used to control bleeding in surgery. Objectives: Here, we measured the effect of two therapeutic doses of labetalol on the amount of bleeding. Methods: This is a randomized clinical trial that was performed in 2020-2021 in Al-Zahra hospital in Isfahan, Iran, on patients that were candidates for posterior spinal fusion surgery under general anesthesia. A total number of 64 patients were entered and randomized into two groups, one receiving labetalol at the dose of 2 mg/min and another group at 4 mg/min during surgery. The amount of bleeding in patients, heart rate, blood pressure, blood oxygen saturation, hypotension or bradycardia, and the mean length of stay in the recovery room were measured and compared between the groups. Results: Extubation time (14 ± 4) and recovery time (76 ± 17) were significantly lower in patients that received labetalol (2 mg/min) compared to another group (21 ± 7 for intubation time and 116 ± 32 for recovery time (P < 0.001 for both items). Patients that received labetalol (4 mg/min) had significantly lower amounts of hemorrhage compared to other group (P = 0.001), and the surgeon's satisfaction was significantly higher in the second group (P = 0.001). The frequency of hypotension and bradycardia during the surgery were significantly higher among patients that received labetalol at the dose of 4 mg/min (P = 0.002 and P = 0.001, respectively). The patients in the group labetalol at 4 mg/min had also significantly lower systolic and diastolic blood pressure and lower mean arterial pressure (MAP) compared to the other group (P < 0.05). Conclusions: Administration of labetalol at the dose of 4 mg/min had significantly desirable effects on hemodynamics that resulted in reduced bleeding volume and blood pressures compared to labetalol at the dose of 2 mg/min.
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    Analgesic Effect of Quadratus Lumborum Block Type III and Type II Versus Lateral Transversus Abdominis Plane Block in Cesarean Section: A Randomized Controlled Multicenter Trial
    (Brieflands, 2024-02-29) Hesham Elsayed Elashry; Mohamed Abdelbadie; Abeer Ali Elshabacy; Omnia Ali Elmiseery
    Background: Appropriate pain management promotes immediate mobilization and allows the parturient to adequately care for her neonate after cesarean section (CS). Objectives: This trial objective was to compare the type III and type II quadratus lumborum block (QLB) to transversus abdominis plane block (TAPB) regarding postoperative analgesic effect in CS. Methods: This randomized, controlled, single-blind trial involved 60 women presenting for CS under spinal anesthesia. The patients were assigned randomly to either the QLB type III, QLB type II, or lateral TAPB group. All blocks were performed using 20 mL of bupivacaine 0.25% bilaterally at the end of the operation with ultrasound guidance. Pain was assessed using the numerical rating scale (NRS) score at the post-anesthesia care unit (PACU) at 2, 4, 6, 8, 12, 18, and 24 hours. The level of patient satisfaction was graded on a 5-point Likert scale. Results: Numerical rating scale measurements at 6, 8, and 12 hours and total consumed meperidine in the 1st 24 hours after the operation were reduced significantly in QLB III than in QLB II and TAPB groups (P < 0.05) with an insignificant difference between the QLB II and TAPB groups (P > 0.05). The onset of the first request for analgesia was delayed significantly in QLB III, compared to QLB II and TAPB groups (P < 0.05), without a significant difference between the QLB II and TAPB groups (P > 0.05). Patient satisfaction and adverse events (e.g., postoperative nausea and vomiting, bradycardia, and hypotension) exhibited insignificant differences among the three groups (P > 0.05). Conclusions: The QLB type III ensured better analgesia as evidenced by significantly lower pain measurements and amount of meperidine in the first 24 hours after the operation with delayed time of the first rescue analgesia in comparison to QLB II and TAPB; however, QLB II and TAPB were similar.
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    Comparison Between Erector Spinae Plane Block versus Serratus Anterior Plane Block Regarding Analgesia and Stress Response After Modified Radical Mastectomy: Randomized Controlled Trial
    (Brieflands, 2024-04-30) Ahmed Abd Elmohsen Bedewy; Maged Salah Mohamed; Hesham Mohamed Sultan; Moataz Salah Khalil
    Background: Modified radical mastectomy (MRM) is the primary surgical treatment for breast cancer, yet it leads to significant postoperative pain. Objectives: This randomized controlled trial evaluates the effects of an erector spinae plane block (ESPB) versus a serratus anterior plane block (SAPB) on post-MRM pain management and stress response reduction. Methods: Sixty individuals scheduled for unilateral MRM under general anesthesia from October 2021 to October 2022 were divided into three groups. Group A comprised 20 patients who received ultrasound-guided ESPB (20 mL of 0.25% bupivacaine). Group B included 20 patients who received ultrasound-guided SAPB (20 mL of 0.25% bupivacaine). Group C was treated with intravenous morphine based on pain scores. Anesthesia was induced using 2 μg/kg of fentanyl and 2 - 3 mg/kg of propofol. The study compared the three groups regarding pain scores using a numerical rating scale, serum cortisol levels, total fentanyl, and morphine consumption, changes in mean arterial blood pressure (MAP) and heart rate (HR) during surgery, and the occurrence of postoperative complications. Results: Statistically significant reductions in pain scores were observed in group A compared to groups B and C. Moreover, group A exhibited a significant decrease in postoperative morphine consumption, serum cortisol levels 1 hour post-surgery (P = 0.021), MAP, and postoperative vomiting and nausea compared to group B. Furthermore, groups A and B showed statistically significant improvements in all parameters compared to group C. Conclusions: The study demonstrates that ESPB provides superior analgesic effects compared to SAPB in patients undergoing MRM, with reduced morphine use and lower postoperative cortisol levels. Both blocks offer more effective pain control than intravenous morphine alone.
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    Compared the Effectiveness of Intraperitoneal Bupivacaine with Lung Recruitment Maneuver Versus Normal Saline with Lung Recruitment Maneuver in Reducing Shoulder Pain After Laparoscopic Surgery: A Double-Blind Randomized Controlled Trial
    (Brieflands, 2024-06-30) Javad Shahinfar; Hossein Zeraati; Mahdiyeh Dartoomi; Hosnieh Raoufian
    Background: Postoperative shoulder pain is one of the most common complications following laparoscopic surgery. Various interventions have been proposed to control this pain. Objectives: The main objective of this comparative study was to determine the effects of intraperitoneal bupivacaine and normal saline infusion, in combination with lung recruitment maneuver (LRM), on shoulder pain following laparoscopic surgery. Methods: The present randomized controlled trial was conducted on 105 candidates for laparoscopic cholecystectomy referred to Imam Ali Hospital in Bojnurd, Iran, from November 2021 to June 2022. The patients were assigned to three groups using block randomization: BR (receiving 50 cc of 0.25% diluted intraperitoneal bupivacaine + LRM), NR (receiving 50 cc of intraperitoneal normal saline + LRM), and N (receiving 50 cc of intraperitoneal normal saline). Postoperative shoulder pain and surgical incision site pain were assessed using the Visual Analogue Scale (VAS) at recovery intervals of 4, 12, 24, and 48 hours after surgery. Additionally, the prevalence of nausea and vomiting, the first time of need for sedation, and the incidence of sedation overdose in the first 24 hours after surgery were investigated. The data were analyzed using one-way analyzed by one-way analysis of variance (ANOVA) with SPSS software at a significance level of 0.05. Results: The findings showed no significant differences in demographic variables between the three groups. The range and mean score of shoulder pain based on VAS was 0 - 1 (0.3) in the BR group, 0 - 2 (1.4) in the NR group, and 1 - 3 (2.1) in the N group at 4 hours after surgery. The mean score of shoulder pain intensity in the BR group was lower compared to the NR and N groups during recovery time intervals at 4, 12, and 24 hours after surgery. This difference between groups was significant. There was also a statistically significant difference in the mean score of surgical incision site pain intensity and the first time of need for sedation between the three groups. The occurrence of side effects was not significant between the groups. Itching, bradycardia, and hypotension were not observed in any of the groups. Conclusions: The findings of this study showed that bupivacaine, along with LRM, is a safe method effective in relieving postoperative shoulder pain. It prolonged the first time of need for sedation and significantly reduced the incidence of shoulder pain.
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    A Continuous Transversus Abdominis Plane Block Decreases Hospital Length of Stay Compared to Thoracic Epidural Analgesia After Open Radical Cystectomy Surgery: A Retrospective Study
    (Brieflands, 2024-02-29) Sanaz Beig Zali; Rachel Steinhorn; Vivian Hu; Linda Hung; Francis McGovern; Farbod Alinezhad; Tammer Yamany; Thomas Anthony Anderson; A. Sassan Sabouri
    Background: Poorly managed postoperative pain can prolong hospital stays and increase the risk of complications in patients undergoing open radical cystectomy (ORC). Despite strong support from the clinical guidelines for using surgical site-specific peripheral regional anesthetic techniques and neuraxial analgesia, their effects on postoperative outcomes are unclear. Objectives: This study aims to fill the above knowledge gap by comparing thoracic epidural analgesia (TEA) and continuous transversus abdominis plane (CTAP) blocks in ORC patients. Methods: In this retrospective observational study, we conducted chart reviews at a quaternary care academic hospital in Boston, Massachusetts, between March 2015 and September 2017. Patients undergoing ORC and receiving either CTAP or TEA were included. The primary outcome was the hospital length of stay (HLOS), and secondary outcomes included time until ambulation, postoperative narcotic usage, and renal function as measured by the glomerular filtration rate (GFR). Results: We studied 146 patients, 124 of whom met our inclusion criteria. Patients receiving CTAP had a 17.4% reduction in HLOS (95% CI: 3.2, 29.4; P = 0.02) and a 13.9% reduction in time until ambulation (95% CI: 3.4, 23.3; P = 0.01) compared to those receiving TEA. This was equivalent to a relative decrease in HLOS of approximately 2.1 days in the CTAP group as compared to the TEA group. No significant differences were observed in narcotic usage or GFR between the two groups. Our sensitivity analyses using instrumental variables analysis yielded similar results. Conclusions: Continuous transversus abdominis plane was associated with a shorter HLOS and quicker time to ambulate compared to TEA, without affecting narcotic usage or renal function. These findings suggest that CTAP may be a viable alternative to TEA for perioperative analgesia in ORC patients. Further research is needed to confirm these findings.
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    Postoperative Management of Shivering: A Comparison of Pethidine vs. Ketamine
    (Brieflands, 2014-05-01) Mahmood Eydi; Samad EJ Golzari; Davood Aghamohammadi; Khosro Kolahdouzan; Saeid Safari; Zohreh Ostadi
    Background: One of the unpleasant side effects of general anesthesia is shivering in the process of recovery. It is an involuntary oscillatory mechanical movement that can be classified as clonic movements. These movements can affect one or several groups of skeletal muscles beginning from 5 to 30 minutes after the discontinuation of anesthesia. Objectives: We aimed to study ketamine’s effect on shivering after operation compared to pethidine as a way for treatment of postoperative shivering. Patients and Methods: In this study, 60 patients who underwent ENT surgery with general anesthesia and had shivering during recovery were randomly divided into two groups of 30 patients each receiving ketamine (0.2 mg/kg IV) and pethidine (0.5 mg/kg). Results: There was no statistically significant difference between the shivering intensity in both groups. Only regarding the shivering in the first minute after entering the recovery room, there was an obvious difference between ketamine and pethidine groups which was again not statistically significant (P = 0.07). Conclusions: The results of this study showed that ketamine and pethidine are both equally effective in the reduction of postoperative shivering.
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    Comparison of Transforaminal Triamcinolone and Dexmedetomidine in Radicular Low-Back Pain: A Randomized Double-Blind Clinical Trial
    (Brieflands, 2019-10-31) Farnad Imani; Poupak Rahimzadeh; Seyed-Hossein Khademi; Mahnaz Narimani Zamanabadi; Kambiz Sadegi; Abouzar Abolfazli-Karizi
    Background: Administration of steroids in the lumbar transforaminal block for lumbar radicular pain is considered one of the preferred treatment methods though it is associated with some complications. Objectives: The effects and side effects of triamcinolone and dexmedetomidine in the lumbar transforaminal block were investigated in the present study. Methods: In this study, 30 patients, aged 40 - 70 years, suffering from lumbar radicular pain arising from the lumbar disc protrusion were equally divided into two groups of triamcinolone (T) and dexmedetomidine (D). They all underwent lumbar transforaminal blocks. An injection solution of triamcinolone (20 mg) plus ropivacaine (0.2%) and another one containing dexmedetomidine (50 μg) plus ropivacaine (0.2%) were administered in the triamcinolone and dexmedetomidine groups, respectively. Visual Analog Scale (VAS), Oswestry Disability Index (ODI), Straight Leg Raise (SLR or lasègue’s test), and Fasting Blood Sugar (FBS) were measured at 0, 2 weeks, 1, 3, and 6 months post-procedure. The levels of calcium, magnesium, and vitamin D, as well as potential complications, were also evaluated. Results: Significant differences were found in the VAS and ODI during the measurement times within each group. The VAS and ODI were remarkably different between the dexmedetomidine group and the triamcinolone group. In addition, there were considerable differences in the increased FBS and reduced calcium and vitamin D levels in the triamcinolone group from changes in the dexmedetomidine group. Conclusions: The lumbar transforaminal block with triamcinolone or dexmedetomidine attenuates the lumbar radicular pain. Further, dexmedetomidine exerts a more potent pain relief effect than triamcinolone.
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    Ultrasound Guided Maxillary Nerve Block for Perioperative Pain Management for Patients Undergoing Endoscopic Sinus Surgery: Randomized Control Trial
    (Brieflands, 2024-04-30) Mahmoud Badry Ahmed; Ahmed Zaghloul; Ahmed Maarouf; Mohammed M Maarouf; Minatallah Elshafie
    Background: Proper perioperative pain management remains a cornerstone of well-conducted functional endoscopic sinus surgery (FESS). In such a context, proper pain management entails the adequate provision of prolonged postoperative analgesia, the avoidance of overusing opioids, and consequently limiting their unwanted side effects. Objectives: We aimed to evaluate the effect of bilateral ultrasound-guided suprazygomatic maxillary nerve block (MNB) on postoperative pain in patients undergoing FESS. Methods: Patients eligible for FESS were randomized into two groups: The MNB group (n = 30), who underwent bilateral ultrasound-guided suprazygomatic maxillary nerve block after induction of anesthesia, and a control group (n = 30), who received multimodal analgesia, including opioids. Postoperatively, patients were observed for 48 hours. Pain scores were evaluated upon arrival to the sPACU and at 2, 6, 12, 24, 36, and 48 hours postoperatively, particularly at the time of removal of the hemostatic agent after 36 hours postoperatively. Total rescue analgesia, postoperative complications (including nausea and vomiting [PONV], hypotension, bradycardia, headache), and patient satisfaction were also diligently recorded. Results: Sixty patients who were candidates and underwent FESS surgery were enrolled randomly in both groups. The NRS pain score in the MNB group was significantly lower than that of the control group (P < 0.001), especially the NRS during the removal of the hemostatic agent at T10 was significantly lower in the MNB group (P < 0.001). However, at the 24 - hour point post-surgery, there were no significant differences between both groups (P = 0.568). Total rescue analgesia required was significantly lower in the MNB group compared with the control group (P < 0.001) throughout the first 48 hours postoperatively. The percentage of patients with no postoperative complications (nausea, vomiting, and headache) was higher in the MNB group (76.7 %) compared with the control group (40 %). Patient satisfaction was statistically significantly higher in the MNB group (P < 0.001). Conclusions: Bilateral ultrasound-guided suprazygomatic MNB appeared to be safe and advantageous, as its use was associated with a decrease in total analgesic consumption, a reduction in postoperative morbidities such as pain, nausea, and vomiting, and greater patient satisfaction.
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    The Effect of Pulsed Radiofrequency on Radicular Pain in Lumbal Herniated Nucleus Pulposus: A Systematic Review and Meta-analysis
    (Brieflands, 2021-04-30) Anita Marliana; Ismail Setyopranoto; Indarwati Setyaningsih; Sholahuddin Rhatomy
    Context: Radiofrequency therapy is a medical procedure mainly used to reduce pain with a low complication rate (less than 1%), ease of application, and low cost. This review’s objective was to (1) evaluate the pulsed radiofrequency (PRF) effectiveness in treating radicular pain and (2) assess the PRF procedure’s safety in managing radicular pain in lumbar herniated nucleus pulposus (HNP). Methods: A systematic review and meta-analysis. A tertiary care center and an academic medical center. Six full articles with the following features were selected for this review: (1) Articles published in English; (2) studies on the PRF effect on radicular pain in lumbar HNP; and (3) randomized control trials. Results: The studies showed that the PRF group had a reduction in pain scores at each evaluation. In four of the studies, the PRF group showed a more significant reduction in pain scores than the control, and in two of the studies, the reduction in pain scores was not significant in the PRF group compared to the control. An adverse effect was reported in one patient experiencing increased radicular pain after PRF. Lack of data required for statistical analysis, and lack use of a uniform duration for the PRF procedure by all the studies. Conclusions: PRF can be used as a promising clinical recommendation for pain management with minimally invasive radicular pain techniques due to lumbar HNP.
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    Comparison of Modified Mallampati Classification in Supine and Sitting Positions to Predict Difficult Tracheal Intubation in Diabetic Patients
    (Brieflands, 2024-04-30) Diya Sarah Jacob; Sonal Bhat; Sunil Vasudev Rao
    Background: Airway management of patients with long-standing diabetes poses a major challenge for anaesthesiologists due to stiff joint syndrome affecting the atlanto-occipital joint. In certain cases requiring immobilization, the Mallampati test must often be performed in the supine position for obvious reasons. Objectives: Hence, we determined the diagnostic precision (sensitivity and specificity) of the modified Mallampati test in sitting and supine positions among the diabetic population in predicting difficult tracheal intubation. Methods: A single-center prospective observational study on adult diabetic patients undergoing general anesthesia and orotracheal intubation was carried out. An observer recorded the modified Mallampati in the sitting posture during the pre-anesthetic examination. The Mallampati in the supine position was determined while in the operating room, and the difficulty of intubation was noted, and diagnostic precision was calculated. The main objective was to predict a difficult airway by calculating the sensitivity, specificity, positive predictive value, and negative predictive value. Results: Out of the 150 participants, Mallampati grading in a sitting position was correctly able to identify 42.5% of difficult intubation cases, whereas it was 97.5% with Mallampati in the supine position. Mallampati grading in the sitting position was able to correctly identify 89.1% of easy intubation cases, which was 63.6% with Mallampati in the supine position. The correlation of Mallampati in the supine position with CL grading was statistically significant (P < 0.001). Conclusions: Among diabetic patients, the modified Mallampati test in the supine position can be considered a more accurate and sensitive predictor of difficult intubation than the sitting posture.
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    Pain Management and Sociology Implications: The Sociomedical Problem of Pain Clinic Staff Harassment Caused by Chronic Pain Patients
    (Brieflands, 2024-04-30) Olumuyiwa Akinwumi Bamgbade; Monisola Temidayo Sonaike; Leili Adineh-Mehr; Daniel Olutosin Bamgbade; Zaina Samir Aloul; Cherith Boatametse Thanke; Thakgalo Thibela; Grace Gaceri Gitonga; Genet Tadesse Yimam; Aria Genaelle Mwizero; Fidelia Batombari Alawa; Lahja Omagano Kamati; Nolubabalo Patience Ralasi; Mwewa Chansa
    Background: Patients with chronic pain often experience psychological issues. They may also exhibit harassing behaviors toward healthcare staff. This complex sociomedical issue necessitates increased attention. Objectives: This study analyzed incidents of staff harassment caused by chronic pain patients. It examined the characteristics of chronic pain patients who harassed clinic staff, as well as the causative or associated factors. The study also explored the management and outcomes of these harassment incidents. Methods: This prospective observational study involved 1102 chronic pain patients who received treatment at a pain clinic. Data were prospectively collected on patients' gender, age, ethnicity, occupation, injury insurance claims, and incidents of staff harassment caused by patients. Results: Pain clinic staff were harassed by 121 patients (11%). Among the harassers, females constituted 70.2% and males 29.8%. Additionally, 50.4% of the harassers were unemployed, with unemployed patients causing more staff harassments (P = 0.001). A significant portion, 86 %, of the harassers had injury insurance claims and were associated with a higher incidence of staff harassments (P = 0.002). Patients making disability insurance claims also caused more staff harassments (P = 0.001). Among the harassers, 50.4 % demanded higher drug doses, and 50% did not have regular primary healthcare providers. The types of harassment included insults (34.7%), threats (19.8%), retaliations (3.3%), and sexual harassment (42.2%). All cases of sexual harassment were addressed; the patients involved were counseled. Most harassment incidents were resolved through tactful communication. Of the harassers, 9.9 % were discharged from the clinic. Conclusions: Harassment of pain clinic staff by chronic pain patients is significant. This sociomedical issue may be worsening due to factors such as opioid misuse, racism, the pandemic, and socioeconomic challenges. While most chronic pain patients are reasonable, some can be challenging. This study confirmed that the majority of patients who harassed staff were female, unemployed, had made injury insurance claims, and demanded higher drug doses. Abusive patients should receive anxiolytic therapy, behavioral boundaries, counseling, distraction therapy, and empathy. Pain clinics should implement staff training and support programs to protect staff from harassment. Additionally, pain clinicians should establish peer support networks to mitigate the psychological impacts of patient aggression and maintain professional well-being.
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    Short-Term Efficacy of Epidural Injection of Triamcinolone Through Translaminar Approach for the Treatment of Lumbar Canal Stenosis
    (Brieflands, 2020-02-29) Saeed Sabbaghan; Elham Mirzamohammadi; Maryam Ameri Mahabadi; Farshad Nikouei; Farhad Rahbarian; Susan Ahmadichaboki; Samira Eftekhari; Maryam Zamankhani; Amir Aghaie Aghdam
    Background: Epidural steroid injection is a non-operative minimally invasive procedure for pain relief in spinal canal stenosis. However, there is no significant consensus regarding its efficacy. Objectives: In this study, we aimed to evaluate the effectiveness of translaminar injection of triamcinolone in lumbar canal stenosis. Methods: In a retrospective study, we included 111 patients with MRI-confirmed spinal canal stenosis who were irresponsive to 12 weeks of conservative treatment and underwent epidural injection of triamcinolone through the translaminar approach. Outcome measures were routinely checked before the intervention and four weeks after the intervention, which included the Visual Analog scale (VAS) for low back pain, VAS for lower-limb pain, and Oswestry Disability index (ODI). Results: The study population included 32 (28.8%) males and 79 (71.2%) females with the mean age of 61 ± 13.4 years. The mean ODI, VAS for low back pain, and VAS for lower-limb pain significantly improved at the final evaluation session (P < 0.001, P = 0.001, and P < 0.001, respectively). The levels of improvement in ODI, VAS for low back pain, and VAS for lower-limb pain were considerably more in patients with single-level involvement (P < 0.001, P = 0.04, and P < 0.001, respectively). Improvement of lower-limb VAS was negatively correlated with age (r = -0.400, P < 0.001) and BMI (r = -0.525, P < 0.001). The ODI improvement was also negatively correlated with BMI (r = -0.569, P < 0.001). Conclusions: Epidural injection of triamcinolone through the translaminar approach could be regarded as an efficacious method for the alleviation of pain and disability in patients with spinal canal stenosis.
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    Comparison Between the Effects of Ringer`s Lactate and Hydroxyethyl Starch on Hemodynamic Parameters After Spinal Anesthesia: A Randomized Clinical Trial
    (Brieflands, 2013-01-01) Mehdi Fathi; Farnad Imani; Marjan Joudi; Vahid Goodarzi
    Background: Hypotension during spinal anesthesia is common and can lead to severe injuries and even death. Administration of crystalloid fluids is advised to prevent occurrence of hypotension; however its effectiveness is still the matter of arguments. Objectives: This study was designed to compare the effects of Ringer`s lactate and hydroxyethyl starch 6% on hemodynamic parameters after spinal anesthesia in patients undergoing orthopedic surgeries on lower limbs. Patients and Methods: This randomized clinical trial was performed in Rasoul Akram Hospital, Tehran, Iran. 60 patients undergoing elective femoral fracture surgeries with spinal anesthesia were included in this study. Fitted patients were randomly divided into two equal groups. After entrance to the operation room and before spinal anesthesia, patients\' hemodynamic parameters including systolic blood pressure (SBP), cardiac output (CO), and cardiac index (CI) were evaluated using monitoring electro-velocimetry set. In both groups, spinal anesthesia was performed using needle no. 25 and 3 mL of marcaine 0.5% in the sterile situation. None of the treatment group was aware of investigated group during the study. Results: The baseline values of mentioned variables did not show a significant difference between two groups using t-test (P > 0.05). Also SBP, CI, and CO after intervention was not significantly different between two groups using t-test (P > 0.05). Conclusions: The result of present study on patients undergoing femoral fracture surgeries who received Hetastarch or Ringer`s lactate solutions showed that Hetastarch was not significantly more effective in compensation of hypotension induced by spinal anesthesia.
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    Comparing the Effectiveness of Patient Control Analgesia Pump and Bolus Morphine in Controlling Pain After Cardiopulmonary Bypass Graft Surgery
    (Brieflands, 2017-10-30) Vali Imantalab; Ali Mirmansouri; Ali Mohammadzadeh Jouryabi; Bahram Naderi Nabi; Gholamreza Kanani; Nassir Nassiri Sheikhani; Zahra Atrkarroushan; Samaneh Ghazanfar Tehran; Nastaran Samadpour
    Background: Postoperative pain is a complex process commonly caused by surgical trauma. It is one of the major concerns of patients undergoing heart surgery. Despite new techniques and modern analgesic treatments, postoperative pain is still one of the most important controversial issues. Methods: 68 patients scheduled for elective CABG with CPB were included in a prospective, double-blind clinical trial. They were randomly divided into two groups. One group received PCA pump including morphine (group P) with underlying infusion of 0.02 mg/kg/Qh, bolus dose of 1 mg, lockout time of 15 minutes, and a maximum of 4 bolus of 0.02 mg/kg for one hour and the other group received morphine bolus (group B). Three patients were excluded from the study, and 33 and 32 patients participated in the groups P and B, respectively. Variables including age, gender, pump time, aortic clamp time, duration of surgery, complications (nausea and vomiting, GI Bleeding, and hypoxia), level of pain based on VAS, opioid consumption, hemodynamic, and sedation status were measured in both groups. Results: There was no significant difference between the groups regarding age, gender, pump time, clamp time, duration of surgery, complication, sedation score, and hemodynamic status in most of the assessment periods. By assessing the pain severity in the groups at different periods, results showed a significant difference between the groups except at enrollment, and a lower severity of pain was noted in the group P compared to the group B. The consumed opioid was significantly higher in the group P than in the group B. However, higher doses of diclofenac and paracetamol were administered in the group B compared to the group P. Conclusions: Results showed that higher morphine would be used in patients with PCA pump after extubation following heart surgery, and this increased dose of opioid was associated with better pain control and lack of complication. Therefore, PCA pump with underlying infusion could be effectively used in patients undergoing CABG that are directly assessed in intensive care unite.
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    Effects of Angiotensin Converting Enzyme Inhibitors Before, During and After Coronary Artery Bypass Graft Surgery on Hemodynamic Responses and Vasoactive Drugs Requirement
    (Brieflands, 2014-08-01) Ahmad Ebadi; Mansour Soltanzadeh; Sholeh Nesioonpour; Reza Akhondzadeh; Mehdi Dehghani Firoozabadi; Mansoureh Attariyan
    Background: According to the previous studies, antihypertensive drugs should be withdrawn before surgery. Nowadays it is accepted that some drugs effectively control systemic blood pressure (BP) to assure its desirable therapeutic control. Objectives: In this study, the effects of captopril, an angiotensin converting enzyme inhibitor (ACEI), on hemodynamic changes before, during and after the coronary artery bypass graft (CABG) surgery was studied. Patients and Methods: In this study, 54 patients were randomly selected in the cardiac surgery ward of Ahvaz Golestan Hospital. Amongst them, 27 patients (control group) did not consume any ACEI for controlling BP but the remained 27 patients (experimental group) used the drugs. In these groups, the effects of captopril on hemodynamic changes before, during and after surgery were studies. Results: Two groups did not have any significant differences in oxygen saturation (P value: before, 0.15; during, 0.08; and after CABG, 0.53) and pulse rate (P value: before, 0.09; during, 0.25; and after CABG, 0.15). Nevertheless, they had significant differences in changes in systolic and diastolic BP in different time points (P Value of systolic BP: before, 0.001; during, < 0.001; and after CABG, 0.007; and P Value of diastolic BP: before, < 0.001; during, 0.001; and after CABG, 0.009). Conclusions: Using ACEI can effectively reduce the systolic and diastolic BP before, during, and after CABG surgery without any effects on oxygen saturation and pulse rate.