Anesthesiology and Pain Medicine

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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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Comparison of the Effect of SAMPE and ALDERTE Checklists on the Incidence of Complications After Discharge of Radical Prostatectomy Patients from the Post-anesthesia Care Unit (PACU)
(Brieflands, 2025-02-28) Alireza Zareie; Parisa Moradimajd; Azam Saei; Jamileh Abolghasemi
Background: Among the available tools, the SAMPE and ALDERTE checklists have been specifically designed to facilitate timely patient discharge, minimize human error, and optimize resource utilization. Given the complexities associated with surgical care, a comparative analysis of these two checklists is essential to evaluate their efficacy in improving discharge outcomes and preventing complications. Methods: This descriptive-analytical cross-sectional study assessed the distribution of complications following radical prostatectomy surgery by utilizing the SAMPE and ALDERTE checklists for discharge from the post-anesthesia care unit (PACU). A total of 156 participants, divided into three groups of 52 individuals each, were monitored for post-discharge complications 12 hours after their discharge from the PACU across three training centers. This methodology enabled a thorough evaluation of the roles of both checklists in mitigating adverse events during the critical post-operative period. Results: No significant differences in complication rates were observed among the groups; however, bleeding and vomiting were slightly more common in the SAMPE group. Conclusions: This study concluded that neither the SAMPE nor the ALDERTE checklist provided a distinct advantage over the control group, which comprised patients routinely discharged from the same treatment center. Both checklists demonstrated similar functionalities, with each showing relative strengths in specific aspects; however, neither was found to be universally superior to the other.
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.
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.
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.
Mid-Term Patency in Radial Artery and Saphenous Vein After Coronary Artery Bypass Grafting in Asymptomatic Patients Using 128-Slice CT Coronary Angiography
(Brieflands, 2015-02-01) Ali Sadeghpour; Hamidreza Pouraliakbar; Rasoul Azarfarin; Alireza Alizadeh Ghavidel; Somayeh Zavareian; Ali Amirahmadi
Background: Patency of the revascularization conduit is an essential predictor of long-standing survival after coronary artery bypass grafting. Objectives: We have conducted this study to compare the mid-term patency rates of radial artery (RA), left internal thoracic artery (LITA) and also saphenous vein (SV) grafts in asymptomatic patients following coronary artery bypass graft surgery (CABG) undergoing total IV anesthesia. Patients and Methods: In this study, 30 three-vessel disease patients with 104 RA, LITA, and SV grafts used concomitantly for primary isolated non-emergent CABG surgery were assessed. The primary end point was CT angiographic graft patency rate. After 53.5 (24-97) months’ follow-up, graft patency was assessed using 128-slice CT coronary angiography. Logistic regression analysis was used to detect the independent predictors of graft failure. Results: A total of 104 grafts, including 30 LITA, 44 SV, and 30 RA grafts, were studied. Cumulative graft patency rates were 93.3% in LITA, 83.3% in RA, and 70.5% in SV grafts. Statistically significant difference was found between the LITA and the SV graft patency rates (P = 0.019), whereas the difference between the RA conduit patency and the LITA or SV graft patency rates did not have any statistical significance (P = 0.424 and P = 0.273, respectively). Independent predictors of RA grafts occlusion were native coronary stenosis < 70% and female gender. Conclusions: In our patients, the RA grafts had an acceptable patency rate in 2 to 5 years’ follow-up. Although the SV grafts had a relatively higher patency rate than RA grafts in our asymptomatic patients, the patency rates in RA and SV grafts were close to each other. The RA graft function was poor in the patients with a higher number of risk factors and in the females.
Comparison of Three Tracheal Intubation Procedures Using Personal Protective Equipment, Direct and Video Laryngoscopes: An Open, Randomized, Parallel Clinical Trial
(Brieflands, 2024-08-31) Dita Aditianingsih; Pryambodho Pryambodho; Jonathan Antonius Wibowo; El Nissi Leonard; Chrisella Annabelle
Background: During the COVID-19 pandemic, severe respiratory failure is a life-threatening condition, and life-saving tracheal intubation is a high-risk aerosol- and droplet-generating procedure. It is crucial to protect healthcare workers without compromising patient safety during intubation. The use of personal protective equipment (PPE) and different types of laryngoscopes are measures to reduce the risk of infectious transmission that might impact the intubation process. Objectives: This study aimed to evaluate the effects of different levels of PPE and types of laryngoscopes on the duration of the intubation process and its success rate. Methods: We conducted an open, randomized, parallel clinical trial on non-COVID-19 adult patients scheduled for elective and emergency surgeries under general anesthesia from November 2021 to May 2022. Patients were divided into three groups: Group 1 was intubated using a video-guided laryngoscope with operators wearing level three PPE; group 2 was intubated using a direct laryngoscope with operators wearing level three PPE; and group 3 was intubated using a direct laryngoscope with operators wearing level two PPE. Intubation was performed by 2nd- and 3rd-year anesthesia residents. Results: The duration of intubation varied significantly among the groups, with Group 1 taking the longest time (P = 0.046). Group 3 had a higher success rate for first-attempt intubation (P = 0.056). Conclusions: The use of PPE and video-guided laryngoscopy had varying effects on the intubation procedure, with the most notable impact being on the overall length of intubation. Further research with a larger sample size is needed to validate these findings.
Effect of Intravenous Acetaminophen on Postoperative Pain in Vitrectomy: A Randomized, Double-Blind, Clinical Trial
(Brieflands, 2017-06-30) Seyed Hossein Sadrolsadat; Fardin Yousefshahi; Abbas Ostadalipour; Fatemeh Zahra Mohammadi; Jalil Makarem
Background: Nowadays, pain, nausea, and vomiting are regarded as important complications of anesthesia and surgery. The current study aimed at assessing the effect of preemptive intravenous acetaminophen on control of pain, nausea, vomiting, shivering, and drowsiness following the general anesthesia for retina and/or vitrectomy surgeries. Methods: In a randomized, double-blind, clinical trial, 83 candidates for retina or vitrectomy eye surgery under general anesthesia were distributed into 3 groups: A) 41 patients in the control group who received 100 mL of normal saline just before the surgery and 100 mL of normal saline 20 minutes before the end of surgery; B) 21 patients in the preemptive group who received acetaminophen 15 mg/kg in 100 mL normal saline just before the surgery and 100 mL normal saline 20 minutes before the end of surgery; C) 21 patients in the preventive group who received 100 mL normal saline just before the surgery and acetaminophen 15 mg/kg in 100 mL normal saline 20 minutes before the end of surgery. Pain, nausea, vomiting, and shivering were assessed at the recovery and 2, 4, and 24 hours after the operation. Anesthesia emergence situation was assessed after arrival in the recovery room by the Richmond agitation-sedation scale (RASS) questionnaire. Blood pressure and heart rate were recorded before anesthesia induction, just after intubation, before extubation, and on discharge from the recovery room. Results: Total intraoperative fentanyl, duration of operation, and duration of anesthesia were not different among the studied groups. Vital signs were not statistically different among the groups at before anesthesia induction, just after intubation, before extubation, and on discharge from the recovery room. Thirty-three patients in the control group (87.8%), 11 in preemptive (52.4%), and 14 in preventive groups (66.7%) needed acetaminophen in the first 24 hours after the surgery (P value = 0.008). Pain scores measured by visual rating scale (VRS) was lower in the preemptive and preventive groups, compared with those of the control group, in the recovery (P value = 0.006), 2 hours after the surgery (P value = 0.008), and 4 hours after the surgery (P value = 0.012), but not in 24 hours after the operation (P value = 0.1). Conclusions: Intravenous acetaminophen administered as preemptive or preventive medication was effective and safe to control acute postoperative pain and analgesic request after the vitrectomy eye surgery.
The Lateral Position Improved Airway Patency in Anesthetized Patient With Burn-Induced Cervico-Mento-Sternal Scar Contracture
(Brieflands, 2016-04-01) Young-Chang P. Arai; Jun Kawanishi; Yoshikazu Sakakima; Koichi Ohmoto; Akihiro Ito; Yuki Maruyama; Tatsunori Ikemoto
A 78-year-old woman with burn-induced cervico-mento-sternal scar contracture was scheduled for laparoscopic cholecystectomy. During inhalational induction of sevoflurane, her airway patency deteriorated. The right lateral position and assist ventilation using a breathing bag dramatically improved her airway patency.
Effect of Preoperative Oral Amantadine on Acute and Chronic Postoperative Pain After Mandibular Fracture Surgery
(Brieflands, 2016-06-01) Javad Yazdani; Davood Aghamohamadi; Masoomeh Amani; Ali Hossein Mesgarzadeh; Davood Maghbooli Asl; Tannaz Pourlak
Background: Postoperative pain from open reduction and internal fixation of mandibular fracture is a serious issue. Amantadine is an N-methyl-D-aspartic acid or N-methyl-D-aspartate (NMDA) receptor antagonist that can be effective against postoperative pain. Objectives: The present study examined the efficacy of amantadine in alleviating the postoperative pain of mandibular fracture surgery. Patients and Methods: In this double-blind study, 60 patients (ASA physical status I–II) were randomly divided into two groups. The mean ages of the participants were 31.2 ± 13.1 years and 32.3 ± 18.1 years, respectively. The male/female ratios were 24/6 and 26/4, respectively, in the case and control groups. Randomization was based on a single sequence of random assignments using computer-generated random numbers. Group I was given oral amantadine 100 mg 1 hour before surgery, and group II received a placebo at the identical time. Through PCA pumps, patients received a bolus dose of morphine at 0.02 mg/kg body weight, to a maximum of 1.5 mg. PCA pumps were set at 6 minutes lockout intervals and a maximum dose of 0.15 mg/kg/h, to a maximum of 10 mg/h. Pain was assessed using a visual analog scale (VAS) at 0, 2, 4, 6, 12, and 24 hours and 1, 2, 3, 4, 5, and 6 months after surgery. The amounts of analgesic consumed were recorded for the first 24 hours, and for 6 months after surgery. Results: There were no significant differences between the two groups with respect to age, gender, nausea and vomiting, sleep quality, blood pressure, and heart rate. No significant differences were observed between the two groups in pain scores (P = 0.39) and analgesic consumption (P = 0.78). Conclusions: The results suggest that a single dose of preoperative oral amantadine did not reduce acute or chronic postoperative pain, nor analgesic consumption.
Effect of Self-Management Program on Pain and Disability Index in Elderly Men with Osteoarthritis
(Brieflands, 2019-08-07) Masoud Hatefi; Reza Parvizi; Milad Borji; Asma Tarjoman
Background: Osteoarthritis (OA) is a progressive disease of the joints, leading to decreased function and disability. Objectives: The study aimed to investigate the effect of self-management (SM) program on disability index and pain in aging men with knee OA. Methods: The study included an SM group and a control group. Given the sample size of the previous studies, 83 patients were recruited. The study tools included a demographic profile questionnaire, visual analogue scale (VAS), and HAQ 8-item DI. The intervention included 10 SM sessions for patients in the SM group (8 sessions of in-person intervention and 2 sessions of telephone intervention). Patients were placed in groups of 7, and the sessions were held weekly each for a period of 45 to 60 minutes. Data were analyzed using descriptive and analytical tests by SPSS V. 16 software. Results: The two groups(SM and control group) were homogeneous in terms of demographic characteristics (P > 0.05). The mean (SD) disability score was 19.12 (1.92) in the SM group before the intervention, which reduced to 14.70 (1.63) after the intervention (P = 0.000, T = 10.02). The mean (SD) pain score, was 9.19 (0.71) in the SM group before the intervention, which reduced to 6.48 (0.84) after the intervention (P = 0.000, T = 18.15). Conclusions: Training can help patients perform SM measures and improve their health status by enhancing the information needed for the disease.
Comparative Effects of Total Intravenous Anesthesia with Propofol and Remifentanil Versus Inhalational Sevoflurane with Dexmedetomidine on Emergence Delirium in Children Undergoing Strabismus Surgery
(Brieflands, 2021-02-28) Mohamed E Oriby; Ayman Elrashidy
Background: Emergence delirium (ED) is common after strabismus surgery due to postoperative visual disturbance, vomiting, and pain. Total intravenous anesthesia (TIVA) has many advantages like smooth emergence from anesthesia, decreased incidence of postoperative nausea and vomiting (PONV), and postoperative analgesia. Objectives: Our study aimed to compare the incidence of ED using inhalational sevoflurane with dexmedetomidine (DEX) versus TIVA with remifentanil. Methods: Eighty-four patients aged 3 - 11 years scheduled for strabismus surgery under general anesthesia were randomly allocated into two groups. Patients in group I received sevoflurane and DEX (group I, n = 42), while group II patients received TIVA with propofol and remifentanil infusion (group II, n = 42). Mean arterial pressure (MAP), heart rate (HR), and pulse oximetry (SpO2) were monitored before induction, at induction, and every 10 minutes during the surgery. In the postanesthetic care unit (PACU), pediatric anesthesia emergence delirium (PAED), face, legs, activity, cry, and consolability (FLACC), need for rescue analgesics, recovery time, level of parents’ satisfaction, and PONV were recorded. Results: Based on the results, HR and MAP significantly decreased 10 and 20 min after induction compared to baseline in group I after infusion of DEX. The incidence of PONV was significantly lower in group II than in group I, while the recovery time was significantly shorter in group I. The incidence of emergence delirium decreased in both groups. Conclusions: The use of either total intravenous anesthesia with propofol and remifentanil or sevoflurane inhalational anesthesia with dexmedetomidine resulted in a lower incidence of emergence delirium, although dexmedetomidine resulted in hypotension, bradycardia, and PONV.
Effect of Hydroalcoholic Leaves Extract of Rhus Coriaria on Pain in Male Rats
(Brieflands, 2016-02-01) Saeed Mohammadi; Mohammad Zarei; Mohammad Mahdi Zarei; Iraj Salehi
Background: The drive toward the use of medicinal plants has been increasing in recent years. They have few side effects and a large variety of efficient components. Objectives: This study was designed to investigate the analgesic effects of hydroalcoholic Rhus coriaria leaf extract (HRCLE) in a rat model. Materials and Methods: A total of 42 adult male rats were divided into seven groups: a control group (the animals did not receive any drug), three HRCLE groups, (receiving 80, 100, and 300 mg/kg, intraperitoneally [ip]), a morphine group (1 mg/kg, ip) an aspirin group (1 mg/kg, ip), and a group that received 300 mg/kg of HRCLE plus naloxone (1 mg/kg, ip). The analgesic effects of HRCLE were assessed via writhing, tail flick, and formalin tests, and the data obtained were compared with the control group using one-way analysis of variance and Tukey post hoc tests. Results: HRCLE signiﬁcantly inhibited the number of contractions induced by acetic acid in the writhing test at all doses, while anti-nociceptive activity was only shown at the 100 mg/kg dose (in the chronic phase) and at the 300 mg/kg dose (in the chronic-acute phase) in the formalin test. Interestingly, the greatest effect was observed at the 300 mg/kg HRCLE dose in the tail flick test. Simultaneous utilization of naloxone and HRCLE inhibited the anti-nociceptive effect of the extract in all tests. It is worth mentioning that aspirin and morphine revealed anti-nociceptive effects in all tests. Conclusions: Our findings suggest that the analgesic effect of HRCLE may be mediated via both peripheral and central mechanisms. The presence of flavonoids might be responsible for the anti-nociceptive activity of this plant.
Evaluating the Efficacy of the National Early Warning Score in Predicting the Mortality of Stroke Patients Admitted to Intensive Care Units
(Brieflands, 2022-04-30) Ali Mohammadian Erdi; Mahzad Yousefian; Khatereh Isazadehfar; Fatemeh Badamchi
Background: National Early Warning Score (NEWS) is a tool used to identify patients at risk. Scores are based on initial clinical observations, including heart rate, respiration rate, systolic blood pressure, oxygen saturation, level of consciousness, body temperature, and oxygen support. To date, few studies have been conducted on NEWS evaluation worldwide, and no study has been conducted in Iran. Objectives: This study aims to evaluate the efficacy of the NEWS in predicting the mortality of stroke patients admitted to intensive care units (ICU). Methods: The present cross-sectional study included 90 patients with a definitive diagnosis of cerebrovascular accident (CVA) based on symptoms and para-clinical evidence. At the beginning of admission to the ICU and up to first 24 hours of admission, all NEWS parameters were measured and evaluated. Results: There was a significant relationship between systolic blood pressure, respiratory support, heart rate, and level of consciousness with patients’ discharge status. Also, there was no significant relationship between age, sex, respiratory rate, SPO2, and fever with discharge status. In addition, there was a significant relationship between clinical risk based on NEWS scoring system and patients’ status. Conclusions: Our results showed a significant relationship between clinical risk based on NEWS scoring and patients’ discharge status so that there was a significant increase in mortality in patients with higher NEWS.
The Role of Caffeine in Pain Management: A Brief Literature Review
(Brieflands, 2016-06-01) Alireza Baratloo; Alaleh Rouhipour; Mohammad Mehdi Forouzanfar; Saeed Safari; Marzieh Amiri; Ahmed Negida
Context: Caffeine is the most commonly used psychoactive legal drug in the world. Caffeine’s role in controlling pain has received less attention in the past, yet is being increasingly considered. This article briefly reviewed the literature to clarify the role of caffeine as a drug for pain control and attract investigators to this topic. Evidence Acquisition: The data on Caffeine as an adjuvant therapy or as a main component for pain modulation has been narratively reviewed. Results: Caffeine plays an important role in pain modulation through their action on adenosine receptors which are involved in nociception. The use of caffeine as adjuvant treatment was well-established in the literature and caffeine is currently available in some over the counter medications. Studies showed controversial results about the interaction between caffeine and morphine for pain relief in patients with terminal stage cancer. As a main component for pain modulation, Caffeine can be used for hypnic headache and postdural puncture headache. Conclusions: Caffeine has a potential role for pain modulation. Current evidence on caffeine use for migraine and terminal stage cancer is not well-established. Future studies should address the use of caffeine alone for different types of pain with dose escalation and standardization of outcome measurement.
Differential Diagnosis of Churg-Strauss Syndrome with Tingling Sensation and Weakness of the Lower Extremities
(Brieflands, 2018-12-31) WooSeong Jeong; So Hui Yun; Jin Seok Kim
Introduction: Churg-Strauss syndrome (CSS; or eosinophilic granulomatosis with polyangiitis) is an extremely rare autoimmune condition characterized by hypereosinophilia and vasculitis of small or medium-sized blood vessels, occurring in patients with asthma and allergic rhinitis. Case Presentation: A 47-year-old man (height, 175.8 cm and weight, 74.8 kg) complained of a tingling sensation in his leg. He had a history of hypertension and asthma in the previous two years, and history of sinus surgery for sinusitis in the previous one year. He showed weight loss of 6 kg during the last month, and the signal intensity of the bone marrow on magnetic resonance imaging was diffusively reduced to be less than or equal to the disc. These findings indicated a hematologic disease and the possibility of malignancy. However, a nerve conduction study suggested multiple mononeuropathies. In addition, his laboratory findings showed peripheral eosinophilia and positivity for myeloperoxidase anti-neutrophil cytoplasmic autoantibody. Therefore, CSS was strongly suspected. Conclusions: Churg-Strauss syndrome is considered to be a condition with variable presentation and is difficult to diagnose because it has various clinical symptoms and disease progression. This study reports on a case with CSS, who underwent nerve biopsy and cholecystectomy for pathological confirmation because of various symptoms, and early diagnosis was difficult.
The Effects of Dexmedetomidine Administration on Postoperative Blood Glucose Levels in Diabetes Mellitus Patients Undergoing Spinal Anesthesia: A Pilot Study
(Brieflands, 2016-12-01) So Hui Yun; Yun Suk Choi
Background: Dexmedetomidine (DEX) is an α2-adrenergic receptor agonist with sedative and sympatholytic effects. It inhibits the stress response and insulin secretion. Therefore, postoperative changes to blood glucose levels were investigated when DEX was intraoperatively infused for sedation purposes in diabetic patients under spinal anesthesia. Methods: Twenty diabetic patients were randomly allocated to two groups (n = 10). Group A patients were infused with DEX at a dose of 0.4 - 0.8 μg/kg/hour and group B (control) patients were infused with the same volume of normal saline. The blood glucose levels were measured preoperatively and at 1, 3, 6, 12, and 24 hours postoperatively. Results: There was no statistically significant difference between the blood glucose levels in groups A and B up to 24 hours postoperatively (P = 0.088). A statistically significant difference in the blood glucose level was not demonstrated 24 hours after surgery in comparison with the baseline level in Group A. The blood glucose level significantly decreased at three hours in group B in comparison with the level at baseline (P = 0.007) and increased at 24 hours (P = 0.037). Conclusions: An intraoperative DEX infusion maintains blood glucose levels at a constant level relative to baseline in diabetic patients within 24 hours postoperatively. The frequency of hyperglycemia was low in group A in the perioperative period compared with that in the control group (group B).
The Efficacy of Sphenopalatine Ganglion Block and Radiofrequency Denervation in the Treatment of Cluster Headache: A Case Series
(Brieflands, 2020-11-22) Dorsa Amighi; Hossein Majedi; Abbas Tafakhori; Amirhossein Orandi
Background: Cluster headache is a variant of primary neurovascular headaches. some patients with cluster headache are not responsive to medical treatment and may benefit from interventional modalities, including sphenopalatine ganglion block and denervation. Objectives: Our purpose was to evaluate the efficacy of sphenopalatine ganglion block/denervation in the treatment of cluster headache. Methods: In this study, we performed the sphenopalatine ganglion block for patients with cluster headaches, intractable to medical therapy, who were referred to our pain clinic between 2014 and 2018. We registered the following information for all patients: demographic data, pain relief, and pain intensity. First, we conducted a prognostic C-arm-guided sphenopalatine ganglion block. If there was at least 50% pain relief within the first 5 h, then we denervated the ganglion by radiofrequency ablation. The main outcome of the study (dependent variable) was pain relief. We followed the patients for 6 months. Results: Among 23 enrolled patients, 19 consented to interventional treatment. Fifteen out of 19 patients (79%) had an acceptable response to the prognostic block. Ultimately, 11 patients underwent ganglion denervation, and 4 patients did not consent for ganglion ablation. Pain relief at intervals of 48 h, and 1, 3, and 6 months after ganglion denervation was 77, 59, 50, and 31 percent, respectively. Conclusions: Sphenopalatine ganglion conventional radiofrequency denervation can effectively decrease the pain intensity of the patients with cluster headache for at least several months.
Electromyographic Findings After Epidural Steroid Injections in Patients with Radicular Low Back Pain: A Prospective Open-Label Study
(Brieflands, 2017-12-30) Chrysanthi Batistaki; Athina Angelopoulou; Maria-Eleni Smyrnioti; Maria-Chrysanthi Kitsou; Georgia Kostopanagiotou
Epidural steroid injections (ESIs) are commonly used in the management of chronic lower back and leg pain. The aim of this study was to investigate the short- and long-term electromyographic and clinical outcome of patients with chronic radicular pain after ESIs. This prospective, open-label study, included patients with chronic radicular pain due to disc herniation or spinal stenosis, who underwent interlaminar, fluoroscopy-guided ESIs. Patients were assessed before ESIs, as well as after 6 and 12 months, clinically (VAS 0-10, BPI, DN4, Rolland Morris, DASS, STAI) and electromyographically for the improvement of spontaneous activity (SA) and of motor unit recruitment/interference pattern (IP/MUR). A total of 39 patients were studied, 20 (51.3%) who had a significant improvement in VAS, RM, DN4 and BPI were revealed, mainly during the first 6 months (P < 0.05). Statistically significant improvement was revealed in MUR/SA for almost all nerve roots studied. Patients with disc herniation showed a greater improvement in mean difference of MUR/SA (P < 0.05) (with a prognostic value of radicular LBP versus spinal stenosis in short- [VAS P = 0.042] and long-term improvement of pain [VAS P = 0.009]. The independent variables “MUR” and “SA” had a significant prognostic value for improvement of pain (VAS: R2 = 0.287, P = 0.032 and VAS: R2 = 0.277, P = 0.036 respectively). Electromyographic and clinical findings indicated a benefit from epidural steroid injections. Patients with disc herniation exhibited a better outcome, especially during the first 6 months post-treatment.
Four-Week Pain Profile and Patient Non-Adherence to Pharmacological Pain Therapy After Day Surgery
(Brieflands, 2020-06-09) Ina Callebaut; Steffe Jorissen; Caroline Pelckmans; Noor Berends; Martijn Droogmans; Maxime van Rossum; Marijke Nulens; Bjorn Stessel
Background: Nowadays, complicated and painful surgical procedures are encouraged to be carried out in an ambulatory setting. Objectives: The current study aimed to assess 4-week postoperative pain profiles of 4 painful ambulatory surgical procedures. We analyzed the prevalence of and reasons for non-adherence and partial adherence of patients to a predefined treatment schedule after the ambulant surgery. Methods: The current study analyzed data from a large randomized trial by evaluating the effect of postoperative pain medication on acute postoperative pain at home during the first 4 postoperative days (POD) in patients scheduled for ambulatory hemorrhoid surgery, shoulder or knee arthroscopy, and inguinal hernia repair. Postoperative pain intensity was assessed at POD 0, 1, 2, 3, 4, 7, 14, and 28 via the Numeric Rating Scale (NRS). Adherence was assessed on POD 1, 2, 3, and 4. Results: Median average pain scores were above an NRS of 3 during the first postoperative week after shoulder arthroscopy and even above 4 during the first postoperative week after hemorrhoid surgery. 26% of patients undergoing shoulder arthroscopy and hemorrhoid surgery still had moderate pain 1 week after surgery. Median average pain scores were below an NRS of 3 during the whole study period after inguinal hernia repair and knee arthroscopy. 24.61% of patients did not use the study medication as prescribed, 5.76% of whom were non-adherent, and 18.85% were partially adherent. Conclusions: Each type of ambulant surgery has its unique postoperative pain profile. New strategies should be developed for pain therapy at home, particularly after the ambulatory arthroscopic shoulder surgery and hemorrhoid surgery. Non-adherence is uncommon if they are provided with a multimodal analgesic home kit together with clear verbal, written instructions, and intensive follow-up.
The Effect of Premenstrual Syndrome and Menstrual Phase on Postoperative Pain
(Brieflands, 2015-04-03) Maliheh Arab; Alireza Mirkheshti; Giti Noghabaei; Adeleh Ashori; Tahereh Ghasemi; Seyed Mostafa Hosseini-Zijoud
Background: Premenstrual syndrome (PMS) is a common finding in luteal phase of menstrual cycle resulting in several changes in woman life including pain sensation. Objectives: This study evaluated the alterations of postoperative pain sensation in those with and without a history of PMS. Patients and Methods: A total of 140 women in in postoperative period were assigned to four groups regarding luteal or follicular phase of menstrual cycle and the history of PMS and were evaluated regarding scale of pain sensation and morphine demand in recovery room. To evaluate the difference among the groups, Mann Whitney U, Kruskal-Wallis, and Bonferroni tests were used. Results: Patients with PMS presented higher pain sensation and analgesia request (P = 0.003). Patients in luteal phase showed less pain and analgesia request in two out of five studied outcomes (P = 0.075). Conclusions: The most comfortable postoperative women were those in luteal phase without history of PMS group.

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