Anesthesiology and Pain Medicine Anesthesiology and Pain Medicine Anesth Pain Med http://www.anesthpain.portal.tools 2228-7523 2228-7531 10.5812/aapm. en jalali 2019 4 26 gregorian 2019 4 26 6 5
en 27847693 10.5812/aapm.36607 Comparison of Spinal Needle Deflection in a Ballistic Gel Model Comparison of Spinal Needle Deflection in a Ballistic Gel Model research-article research-article Conclusions

There is clinical utility in knowing the relative deflection of various needle tips. When a procedure requires a needle to be steered around obstacles, or along non-collinear targets, the predictable and large amount of deflection obtained through use of a beveled spinal needle may prove beneficial.

Materials and Methods

Six needles commonly used in spinal procedures (Quincke, Short Bevel, Chiba, Tuohy, Hustead, Whitacre) were selected for use in this study. Ballistic gel samples were made in molds of two depths, 40mm and 80 mm. Each needle was mounted in a drill press to ensure an accurate needle trajectory. Distance of deflection was recorded for each needle.

Results

In comparing the mean deflection of 22 gauge needles of all types at 80 mm of depth, deflection was greatest among beveled needles [Short Bevel (9.96 ± 0.77 mm), Quincke (8.89 ± 0.17 mm), Chiba (7.71 ± 1.16 mm)], moderate among epidural needles [Tuohy (7.64 ± 0.16 mm) and least among the pencil-point needles [Whitacre (0.73 ± 0.34 mm)]. Increased gauge (25 g) led to a significant increase in deflection among beveled needles. The direction of deflection was away from the bevel with Quincke, Chiba and Short Beveled needles and toward the bevel of the Tuohy and Hustead needles. Deflection of the Whitacre pencil-point needle was minimal.

Background

Percutaneous diagnostic and therapeutic procedures are commonly used in the treatment of spinal pain. The success of these procedures depends on the accuracy of needle placement, which is influenced by needle size and shape.

Objectives

The purpose of this study is to examine and quantify the deviation of commonly used spinal needles based on needle tip design and gauge, using a ballistic gel tissue simulant.

Conclusions

There is clinical utility in knowing the relative deflection of various needle tips. When a procedure requires a needle to be steered around obstacles, or along non-collinear targets, the predictable and large amount of deflection obtained through use of a beveled spinal needle may prove beneficial.

Materials and Methods

Six needles commonly used in spinal procedures (Quincke, Short Bevel, Chiba, Tuohy, Hustead, Whitacre) were selected for use in this study. Ballistic gel samples were made in molds of two depths, 40mm and 80 mm. Each needle was mounted in a drill press to ensure an accurate needle trajectory. Distance of deflection was recorded for each needle.

Results

In comparing the mean deflection of 22 gauge needles of all types at 80 mm of depth, deflection was greatest among beveled needles [Short Bevel (9.96 ± 0.77 mm), Quincke (8.89 ± 0.17 mm), Chiba (7.71 ± 1.16 mm)], moderate among epidural needles [Tuohy (7.64 ± 0.16 mm) and least among the pencil-point needles [Whitacre (0.73 ± 0.34 mm)]. Increased gauge (25 g) led to a significant increase in deflection among beveled needles. The direction of deflection was away from the bevel with Quincke, Chiba and Short Beveled needles and toward the bevel of the Tuohy and Hustead needles. Deflection of the Whitacre pencil-point needle was minimal.

Background

Percutaneous diagnostic and therapeutic procedures are commonly used in the treatment of spinal pain. The success of these procedures depends on the accuracy of needle placement, which is influenced by needle size and shape.

Objectives

The purpose of this study is to examine and quantify the deviation of commonly used spinal needles based on needle tip design and gauge, using a ballistic gel tissue simulant.

Spinal Needle;Needle Deflection;Back Pain;Ballistic Gel;Interventional Pain Spinal Needle;Needle Deflection;Back Pain;Ballistic Gel;Interventional Pain http://www.anesthpain.portal.tools/index.php?page=article&article_id=36607 Ethan Rand Ethan Rand Department of Rehabilitation and Regenerative Medicine, Presbyterian Hospital, New York, The United States Department of Rehabilitation and Regenerative Medicine, Presbyterian Hospital, New York, The United States George Christolias George Christolias Department of Rehabilitation and Regenerative Medicine, Columbia University Medical Center, Presbyterian Hospital, New York, The United States Department of Rehabilitation and Regenerative Medicine, Columbia University Medical Center, Presbyterian Hospital, New York, The United States Christopher Visco Christopher Visco Department of Rehabilitation and Regenerative Medicine, Columbia University Medical Center, Presbyterian Hospital, New York, The United States Department of Rehabilitation and Regenerative Medicine, Columbia University Medical Center, Presbyterian Hospital, New York, The United States Jaspal R. Singh Jaspal R. Singh Department of Rehabilitation and Regenerative Medicine, Weill Cornell Medicine Spine Center, Presbyterian Hospital, New York, The United States; Department of Rehabilitation and Regenerative Medicine, Weill Cornell Medicine Spine Center, Presbyterian Hospital, 525 East 68th Street, Baker 16, New York, The United States. Tel: +01-2127461500, Fax: +01-2127468303 Department of Rehabilitation and Regenerative Medicine, Weill Cornell Medicine Spine Center, Presbyterian Hospital, New York, The United States; Department of Rehabilitation and Regenerative Medicine, Weill Cornell Medicine Spine Center, Presbyterian Hospital, 525 East 68th Street, Baker 16, New York, The United States. Tel: +01-2127461500, Fax: +01-2127468303
en 27847694 10.5812/aapm.37577 Contribution of Low-Dose Computerized Tomography With Digital Multiplanar Reconstructions in Thoracic Epidurography and Correlation With Sensory Block in Postoperative Analgesia Contribution of Low-Dose Computerized Tomography With Digital Multiplanar Reconstructions in Thoracic Epidurography and Correlation With Sensory Block in Postoperative Analgesia research-article research-article Conclusions

CT epidurography is not closely correlated with a clinical assessment of epidural block; thus, a clinical assessment of the sensory block is mandatory. The use of opioid analgesia in combination with local anesthetics may compensate for the lack of efficacy of local anesthetics alone.

Objectives

The primary objective of this study was to evaluate, by CT imaging and digital multiplanar reconstruction, the spread and distribution of contrast medium injected into the epidural space through a catheter inserted in a low thoracic position for postoperative analgesia.

Materials and Methods

Ten patients undergoing major abdominal cancer surgery with effective epidural analgesia were prospectively included at postoperative day three. Two consecutive boluses of 5 mL of a mixture of ropivacaine and contrast medium were injected at 15 minutes intervals into the epidural space. Multislice low-dose CT scan epidurography and an assessment of the sensory block were performed before and after injection of the second bolus. The primary objective was to assess the contribution of CT scan epidurography to predict a correlation between the level of sensory block and the spread of the contrast medium in the epidural space; the secondary objective was to determine the agreement between the two methods.

Results

The spread of contrast material and the clinical sensory block significantly increased after the second injection (32%; P < 0.05). However, no highly significant correlation was observed between the two methods. A gap of two spinal segments of CT opacification was observed in two patients and was confirmed by clinical assessment.

Background

The level of sensory block in postoperative epidural analgesia has been correlated with conventional contrast epidurography in only one study, while low-dose CT scan epidurography with multiplanar reconstruction may be a better tool for this purpose.

Conclusions

CT epidurography is not closely correlated with a clinical assessment of epidural block; thus, a clinical assessment of the sensory block is mandatory. The use of opioid analgesia in combination with local anesthetics may compensate for the lack of efficacy of local anesthetics alone.

Objectives

The primary objective of this study was to evaluate, by CT imaging and digital multiplanar reconstruction, the spread and distribution of contrast medium injected into the epidural space through a catheter inserted in a low thoracic position for postoperative analgesia.

Materials and Methods

Ten patients undergoing major abdominal cancer surgery with effective epidural analgesia were prospectively included at postoperative day three. Two consecutive boluses of 5 mL of a mixture of ropivacaine and contrast medium were injected at 15 minutes intervals into the epidural space. Multislice low-dose CT scan epidurography and an assessment of the sensory block were performed before and after injection of the second bolus. The primary objective was to assess the contribution of CT scan epidurography to predict a correlation between the level of sensory block and the spread of the contrast medium in the epidural space; the secondary objective was to determine the agreement between the two methods.

Results

The spread of contrast material and the clinical sensory block significantly increased after the second injection (32%; P < 0.05). However, no highly significant correlation was observed between the two methods. A gap of two spinal segments of CT opacification was observed in two patients and was confirmed by clinical assessment.

Background

The level of sensory block in postoperative epidural analgesia has been correlated with conventional contrast epidurography in only one study, while low-dose CT scan epidurography with multiplanar reconstruction may be a better tool for this purpose.

Epidural Analgesia;CT Epidurography;Sensory Blockade Epidural Analgesia;CT Epidurography;Sensory Blockade http://www.anesthpain.portal.tools/index.php?page=article&article_id=37577 Cyrus Motamed Cyrus Motamed Department od Anesthesiology and Interventional Radiology, Institut Gustave Roussy, Villejuif, France; Department od Anesthesiology and Interventional Radiology, Institut Gustave Roussy, Villejuif, France Department od Anesthesiology and Interventional Radiology, Institut Gustave Roussy, Villejuif, France; Department od Anesthesiology and Interventional Radiology, Institut Gustave Roussy, Villejuif, France Karin Chedevergne Karin Chedevergne Department od Anesthesiology and Interventional Radiology, Institut Gustave Roussy, Villejuif, France Department od Anesthesiology and Interventional Radiology, Institut Gustave Roussy, Villejuif, France Frederic Deschamps Frederic Deschamps Department od Anesthesiology and Interventional Radiology, Institut Gustave Roussy, Villejuif, France Department od Anesthesiology and Interventional Radiology, Institut Gustave Roussy, Villejuif, France Lambros Tselikas Lambros Tselikas Department od Anesthesiology and Interventional Radiology, Institut Gustave Roussy, Villejuif, France Department od Anesthesiology and Interventional Radiology, Institut Gustave Roussy, Villejuif, France Christian Jayr Christian Jayr Hôpital René Huguenin, Saint-Cloud, France Hôpital René Huguenin, Saint-Cloud, France
en 27847695 10.5812/aapm.37778 Combined Ketamine-Tramadol Subcutaneous Wound Infiltration for Multimodal Postoperative Analgesia: A Double-Blinded, Randomized Controlled Trial after Renal Surgery Combined Ketamine-Tramadol Subcutaneous Wound Infiltration for Multimodal Postoperative Analgesia: A Double-Blinded, Randomized Controlled Trial after Renal Surgery research-article research-article Background

Pain is an important consideration after renal surgery. A multimodal approach to postoperative pain management could enhance analgesia by risking fewer side effects after surgery.

Objectives

The aim of this study was to evaluate the clinical efficacy of the subcutaneous infiltration of ketamine and tramadol at the incision site to reduce postoperative pain.

Methods

Sixty-four patients between 18 and 80 years old who were scheduled for elective renal surgery were enrolled in a double-blind randomized controlled study. At the end of the surgery, patients were divided into four groups with 16 patients in each group: the saline group, who were treated with 10 mL of saline solution; the K group, who were treated with 1 mg/kg etamine in 10 mL of saline solution; the T group, who were treated with 1 mg/kg tramadol in 10 mL of saline solution; and the K/T group, who were treated with 0.5 mg/kg ketamine with 0.5 mg/kg tramadol in 10 mL of saline solution. In each group, the solution was infiltrated subcutaneously at the incision site. The postoperative pain scores and rescue analgesic consumption of the patients in each group were recorded for 24 hours and compared. The primary goal of the study was to compare the results of patients treated with a combined ketamine and tramadol subcutaneous wound infiltration, patients treated with a tramadol subcutaneous wound infiltration, and patients treated with a ketamine subcutaneous wound infiltration.

Results

Sixty-four patients were enrolled in the study. Pain intensity and cumulative meperidine consumption were significantly lower in the K/T group (27 mg; 95% confidence interval, 25.2 - 53.2) in comparison with the group that received a saline infusion during the first 24 hours after surgery (P < 0.001). The sedation score of the K, T, and K/T groups were significantly higher than the saline group (P < 0.001).

Conclusions

The combined subcutaneous infiltration of ketamine and tramadol at the incision site produces better analgesia and an opioid-sparing effect during the first 24 hours when compared with the control group and the groups that received a subcutaneous infiltration of only ketamine or tramadol.

Background

Pain is an important consideration after renal surgery. A multimodal approach to postoperative pain management could enhance analgesia by risking fewer side effects after surgery.

Objectives

The aim of this study was to evaluate the clinical efficacy of the subcutaneous infiltration of ketamine and tramadol at the incision site to reduce postoperative pain.

Methods

Sixty-four patients between 18 and 80 years old who were scheduled for elective renal surgery were enrolled in a double-blind randomized controlled study. At the end of the surgery, patients were divided into four groups with 16 patients in each group: the saline group, who were treated with 10 mL of saline solution; the K group, who were treated with 1 mg/kg etamine in 10 mL of saline solution; the T group, who were treated with 1 mg/kg tramadol in 10 mL of saline solution; and the K/T group, who were treated with 0.5 mg/kg ketamine with 0.5 mg/kg tramadol in 10 mL of saline solution. In each group, the solution was infiltrated subcutaneously at the incision site. The postoperative pain scores and rescue analgesic consumption of the patients in each group were recorded for 24 hours and compared. The primary goal of the study was to compare the results of patients treated with a combined ketamine and tramadol subcutaneous wound infiltration, patients treated with a tramadol subcutaneous wound infiltration, and patients treated with a ketamine subcutaneous wound infiltration.

Results

Sixty-four patients were enrolled in the study. Pain intensity and cumulative meperidine consumption were significantly lower in the K/T group (27 mg; 95% confidence interval, 25.2 - 53.2) in comparison with the group that received a saline infusion during the first 24 hours after surgery (P < 0.001). The sedation score of the K, T, and K/T groups were significantly higher than the saline group (P < 0.001).

Conclusions

The combined subcutaneous infiltration of ketamine and tramadol at the incision site produces better analgesia and an opioid-sparing effect during the first 24 hours when compared with the control group and the groups that received a subcutaneous infiltration of only ketamine or tramadol.

Analgesia;Anesthesia;Local;Ketamine;Pain;Tramadol Analgesia;Anesthesia;Local;Ketamine;Pain;Tramadol http://www.anesthpain.portal.tools/index.php?page=article&article_id=37778 Mohammad Reza Khajavi Mohammad Reza Khajavi Department of Anesthesiology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran Department of Anesthesiology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran Marzieh Navardi Marzieh Navardi Department of Anesthesiology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran Department of Anesthesiology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran Reza Shariat Moharari Reza Shariat Moharari Department of Anesthesiology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran Department of Anesthesiology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran Pejman Pourfakhr Pejman Pourfakhr Department of Anesthesiology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran Department of Anesthesiology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran Narjes Khalili Narjes Khalili Community and Preventive Medicine Specialist, Cancer Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran Community and Preventive Medicine Specialist, Cancer Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran Farhad Etezadi Farhad Etezadi Department of Anesthesiology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran Department of Anesthesiology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran Farsad Imani Farsad Imani Department of Anesthesiology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran; Department of Anesthesiology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. Tel: +98-9123088460, Fax: +98-2166348550 Department of Anesthesiology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran; Department of Anesthesiology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. Tel: +98-9123088460, Fax: +98-2166348550
en 27847696 10.5812/aapm.38293 Ice Reduces Needle-Stick Pain Associated With Local Anesthetic Injection Ice Reduces Needle-Stick Pain Associated With Local Anesthetic Injection research-article research-article Conclusions

Cooling the injection site prior to local anesthetic injection is an effective and inexpensive method to reduce the pain and discomfort caused by the injection.

Methods

Subjects who presented with superficial lacerations were randomly assigned to 2 groups, the first group received ice packing prior to injection and the second did not. The pain severity, length and depth of the laceration, and the other necessary information before and after the pain-reducing intervention were measured, documented, and compared at the end of the study. Pain scores were measured using a numerical rating scale before and after the procedure, and the differences were compared using a t-test.

Background

Local anesthetic injections are widely used in the emergency department for different purposes. Pain management for such injections is of great importance to both patients and the healthcare system.

Results

Ninety subjects were enrolled in the study, 45 in each group. There were no statistical differences between the 2 groups in terms of baseline preoperative and operative characteristics (P > 0.05). The pain scores in the cryotherapy group were significantly lower before and after the procedure (P < 0.001). There was no statistically significant difference between the 2 groups for wound infection (P = 0.783).

Objectives

Our study aimed to determine the effectiveness and safety of cryotherapy in patients receiving local anesthetic injections.

Conclusions

Cooling the injection site prior to local anesthetic injection is an effective and inexpensive method to reduce the pain and discomfort caused by the injection.

Methods

Subjects who presented with superficial lacerations were randomly assigned to 2 groups, the first group received ice packing prior to injection and the second did not. The pain severity, length and depth of the laceration, and the other necessary information before and after the pain-reducing intervention were measured, documented, and compared at the end of the study. Pain scores were measured using a numerical rating scale before and after the procedure, and the differences were compared using a t-test.

Background

Local anesthetic injections are widely used in the emergency department for different purposes. Pain management for such injections is of great importance to both patients and the healthcare system.

Results

Ninety subjects were enrolled in the study, 45 in each group. There were no statistical differences between the 2 groups in terms of baseline preoperative and operative characteristics (P > 0.05). The pain scores in the cryotherapy group were significantly lower before and after the procedure (P < 0.001). There was no statistically significant difference between the 2 groups for wound infection (P = 0.783).

Objectives

Our study aimed to determine the effectiveness and safety of cryotherapy in patients receiving local anesthetic injections.

Wound;Local Anesthetic Injection;Cryotherapy;Ice;Pain Management Wound;Local Anesthetic Injection;Cryotherapy;Ice;Pain Management http://www.anesthpain.portal.tools/index.php?page=article&article_id=38293 Babak Mahshidfar Babak Mahshidfar Emergency Medicine Management Research Center, Rasoul-e-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran Emergency Medicine Management Research Center, Rasoul-e-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran Salimeh Cheraghi Shevi Salimeh Cheraghi Shevi Emergency Medicine Management Research Center, Rasoul-e-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran Emergency Medicine Management Research Center, Rasoul-e-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran Mohsen Abbasi Mohsen Abbasi Emergency Medicine Management Research Center, Rasoul-e-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran Emergency Medicine Management Research Center, Rasoul-e-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran Mohammad Hosseini Kasnavieh Mohammad Hosseini Kasnavieh Emergency Medicine Management Research Center, Rasoul-e-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran Emergency Medicine Management Research Center, Rasoul-e-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran Mahdi Rezai Mahdi Rezai Emergency Department, Firoozgar Hospital, Emergency Medicine Management Research Center, Rasoul-e-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran Emergency Department, Firoozgar Hospital, Emergency Medicine Management Research Center, Rasoul-e-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran Mina Zavereh Mina Zavereh Emergency Medicine Management Research Center, Rasoul-e-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran Emergency Medicine Management Research Center, Rasoul-e-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran Reza Mosaddegh Reza Mosaddegh Emergency Department, Firoozgar Hospital, Emergency Medicine Management Research Center, Rasoul-e-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran; Emergency Department, Firoozgar Hospital, Emergency Medicine Management Research Center, Rasoul-e-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran. Tel: +98-9123496712 Emergency Department, Firoozgar Hospital, Emergency Medicine Management Research Center, Rasoul-e-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran; Emergency Department, Firoozgar Hospital, Emergency Medicine Management Research Center, Rasoul-e-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran. Tel: +98-9123496712
en 27847697 10.5812/aapm.38337 Comparison of the Effect of Open and Closed Endotracheal Suctioning Methods on Pain and Agitation in Medical ICU Patients: A Clinical Trial Comparison of the Effect of Open and Closed Endotracheal Suctioning Methods on Pain and Agitation in Medical ICU Patients: A Clinical Trial research-article research-article Background

Endotracheal suctioning is a necessary procedure practiced by nurses in intensive care units to remove lung secretions. This procedure leads to higher oxygenation levels and reduced breathing difficulties. It also prevents atelectasis, pulmonary infections, and the accumulation of secretions.

Objectives

The present study aims to compare the effectiveness of open and closed endotracheal suction tube systems on pain and agitation in patients under mechanical ventilation.

Methods

A randomized controlled clinical trial was conducted in the general intensive care units of Khatam-ol-Anbia hospital and Sina hospital, Tehran, Iran, in 2015. In total, 60 patients who were qualified to be included in the study were randomly assigned to either the intervention group or the control group. When necessary, suction was carried out for each patient using the standard technique. The patients’ level of pain and agitation was measured in both groups at five stages (before, during, immediately after, 5 minutes after, and 15 minutes after the intervention) using the behavioral pain scale and the Richmond agitation sedation scale.

Results

Significant statistical differences in the pain and agitation at different times within each of the two groups were observed for both open and closed suction (P > 0.001). However, these changes at different times between the two groups was not significant (P < 0.05).

Conclusions

Although statistical differences were observed in the levels of pain and agitation in the two groups, the type of suction system did not have any effect on the level of pain and agitation of patients under mechanical ventilation. The researchers recommend that other studies with larger sample sizes should be carried out.

Background

Endotracheal suctioning is a necessary procedure practiced by nurses in intensive care units to remove lung secretions. This procedure leads to higher oxygenation levels and reduced breathing difficulties. It also prevents atelectasis, pulmonary infections, and the accumulation of secretions.

Objectives

The present study aims to compare the effectiveness of open and closed endotracheal suction tube systems on pain and agitation in patients under mechanical ventilation.

Methods

A randomized controlled clinical trial was conducted in the general intensive care units of Khatam-ol-Anbia hospital and Sina hospital, Tehran, Iran, in 2015. In total, 60 patients who were qualified to be included in the study were randomly assigned to either the intervention group or the control group. When necessary, suction was carried out for each patient using the standard technique. The patients’ level of pain and agitation was measured in both groups at five stages (before, during, immediately after, 5 minutes after, and 15 minutes after the intervention) using the behavioral pain scale and the Richmond agitation sedation scale.

Results

Significant statistical differences in the pain and agitation at different times within each of the two groups were observed for both open and closed suction (P > 0.001). However, these changes at different times between the two groups was not significant (P < 0.05).

Conclusions

Although statistical differences were observed in the levels of pain and agitation in the two groups, the type of suction system did not have any effect on the level of pain and agitation of patients under mechanical ventilation. The researchers recommend that other studies with larger sample sizes should be carried out.

Endotracheal Suctioning;Open Suctioning;Closed Suctioning;Pain;Agitation;Mechanical Ventilation Endotracheal Suctioning;Open Suctioning;Closed Suctioning;Pain;Agitation;Mechanical Ventilation http://www.anesthpain.portal.tools/index.php?page=article&article_id=38337 Raziyeh Dastdadeh Raziyeh Dastdadeh Student of Master Degree in Nursing, Tehran Medical Branch, Islamic Azad University, Tehran, Iran Student of Master Degree in Nursing, Tehran Medical Branch, Islamic Azad University, Tehran, Iran Abbas Ebadi Abbas Ebadi Behavioral Sciences Research Center, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran; Behavioral Sciences Research Center, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran. Tel: +98-9122149019, Fax: +98-2126127237 Behavioral Sciences Research Center, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran; Behavioral Sciences Research Center, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran. Tel: +98-9122149019, Fax: +98-2126127237 Amir Vahedian-Azimi Amir Vahedian-Azimi Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
en 27847698 10.5812/aapm.38550 Intrathecal Midazolam as an Adjuvant in Pregnancy-Induced Hypertensive Patients Undergoing an Elective Caesarean Section: A Clinical Comparative Study Intrathecal Midazolam as an Adjuvant in Pregnancy-Induced Hypertensive Patients Undergoing an Elective Caesarean Section: A Clinical Comparative Study research-article research-article Conclusions

Intrathecal midazolam 2 mg provides significantly longer and effective postoperative analgesia with no side effects.

Results

Postoperative analgesia was significantly longer in the midazolam group compared to the control group (201.5 minutes vs. 357.6 minutes). The mean onset times of the sensory and motor blocks were significantly faster (P < 0.01) in the midazolam group compared to the control group. The mean times to attain the maximum sensory level and motor blocks were also significantly faster in the midazolam group compared to the control group (P < 0.05). The incidence of hypotension was 6.6% in the midazolam group and 36.6% in the control group, which was highly significant. In addition, the number of patients with side effects was significantly lower in the midazolam group compared to the control group.

Objectives

This prospective, randomized, double-blind study was designed to compare the analgesic efficacy and safety of intrathecal midazolam vs. plain bupivacaine as an adjunct to bupivacaine in pregnancy-induced hypertension patients scheduled for elective caesarean section.

Methods

Sixty patients diagnosed with pregnancy-induced hypertension on regular treatment who were scheduled for a caesarean section were randomly allocated into two groups: a control group (Group BC, n = 30) and a midazolam group (Group BM, n = 30). Both groups received 10 mg (2 mL) of 0.5% hyperbaric bupivacaine. Group BC received 0.4 mL of distilled water, while group BM received 0.4 mL (2 mg) of midazolam intrathecally. The duration of postoperative analgesia, analgesic requirements during the first 24 hours after surgery, onset times and durations of sensory and motor blocks, incidence of hypotension, vasopressor requirements, and side effects were recorded.

Background

A pain-free postoperative period is essential following a caesarean section so new mothers may care for and bond with their neonates. Intrathecal adjuvants are often administered during this procedure to provide significant analgesia, but they may also have bothersome side effects. Intrathecal midazolam produces effective postoperative analgesia with no significant side effects.

Conclusions

Intrathecal midazolam 2 mg provides significantly longer and effective postoperative analgesia with no side effects.

Results

Postoperative analgesia was significantly longer in the midazolam group compared to the control group (201.5 minutes vs. 357.6 minutes). The mean onset times of the sensory and motor blocks were significantly faster (P < 0.01) in the midazolam group compared to the control group. The mean times to attain the maximum sensory level and motor blocks were also significantly faster in the midazolam group compared to the control group (P < 0.05). The incidence of hypotension was 6.6% in the midazolam group and 36.6% in the control group, which was highly significant. In addition, the number of patients with side effects was significantly lower in the midazolam group compared to the control group.

Objectives

This prospective, randomized, double-blind study was designed to compare the analgesic efficacy and safety of intrathecal midazolam vs. plain bupivacaine as an adjunct to bupivacaine in pregnancy-induced hypertension patients scheduled for elective caesarean section.

Methods

Sixty patients diagnosed with pregnancy-induced hypertension on regular treatment who were scheduled for a caesarean section were randomly allocated into two groups: a control group (Group BC, n = 30) and a midazolam group (Group BM, n = 30). Both groups received 10 mg (2 mL) of 0.5% hyperbaric bupivacaine. Group BC received 0.4 mL of distilled water, while group BM received 0.4 mL (2 mg) of midazolam intrathecally. The duration of postoperative analgesia, analgesic requirements during the first 24 hours after surgery, onset times and durations of sensory and motor blocks, incidence of hypotension, vasopressor requirements, and side effects were recorded.

Background

A pain-free postoperative period is essential following a caesarean section so new mothers may care for and bond with their neonates. Intrathecal adjuvants are often administered during this procedure to provide significant analgesia, but they may also have bothersome side effects. Intrathecal midazolam produces effective postoperative analgesia with no significant side effects.

Midazolam;postoperative analgesia;PIH;hypotension Midazolam;postoperative analgesia;PIH;hypotension http://www.anesthpain.portal.tools/index.php?page=article&article_id=38550 Ravichandra Dodawad Ravichandra Dodawad ESIC Medical College, Gulbarga, India; ESIC Medical College, Gulbarga. India. Tel: +99-86514152 ESIC Medical College, Gulbarga, India; ESIC Medical College, Gulbarga. India. Tel: +99-86514152 Sumalatha G. B. Sumalatha G. B. ESIC Medical College, Gulbarga, India ESIC Medical College, Gulbarga, India Sandeep Pandarpurkar Sandeep Pandarpurkar ESIC Medical College, Gulbarga, India ESIC Medical College, Gulbarga, India Parashuram Jajee Parashuram Jajee ESIC Medical College, Gulbarga, India ESIC Medical College, Gulbarga, India
en 27847699 10.5812/aapm.38834 Ultrasound for Localization of Central Venous Catheter: A Good Alternative to Chest X-Ray? Ultrasound for Localization of Central Venous Catheter: A Good Alternative to Chest X-Ray? research-article research-article Conclusions

Despite close concordance between ultrasonography and chest radiography, CEUS is not a suitable alternative for standard chest radiography in detecting CVC location; however, considering its high sensitivity and acceptable specificity in our study, its usefulness as a triage method for detecting CVC location on a real-time basis in the operating room cannot be ignored.

Results

Chest radiography revealed 16 CVC misplacements: two cases of intravascular and 14 cases of right atrium (RA) misplacement. CEUS detected 11 true catheter malpositionings in the RA, while it could not recognize seven catheter placements correctly. CEUS showed two false RA misplacements and five falsely correct CVC positions. A sensitivity of 98% and specificity of 69% were achieved for CEUS in detecting CVC misplacements. Positive and negative predictive values were 95% and 85%, respectively. The interrater agreement (kappa) between CEUS and radiography was 0.72 (P < 0.001).

Background

Chest radiography after central venous catheter (CVC) insertion is the main method of verifying the catheter location. Despite the widespread use of radiography for detecting catheter position, x-ray may not always be readily available, especially in the operating room.

Objectives

We aimed to compare contrast-enhanced ultrasonography (CEUS) and chest radiography for detecting the correct location of CVCs.

Methods

One hundred sixteen consecutive patients with indications for CVC before cardiac surgery were enrolled in this observational study. After catheter insertion, CEUS was performed. Portable radiography was obtained postoperatively in the intensive care unit. Sensitivity, specificity, and predictive values were determined by comparing the ultrasonography results with radiographic findings as a reference standard.

Conclusions

Despite close concordance between ultrasonography and chest radiography, CEUS is not a suitable alternative for standard chest radiography in detecting CVC location; however, considering its high sensitivity and acceptable specificity in our study, its usefulness as a triage method for detecting CVC location on a real-time basis in the operating room cannot be ignored.

Results

Chest radiography revealed 16 CVC misplacements: two cases of intravascular and 14 cases of right atrium (RA) misplacement. CEUS detected 11 true catheter malpositionings in the RA, while it could not recognize seven catheter placements correctly. CEUS showed two false RA misplacements and five falsely correct CVC positions. A sensitivity of 98% and specificity of 69% were achieved for CEUS in detecting CVC misplacements. Positive and negative predictive values were 95% and 85%, respectively. The interrater agreement (kappa) between CEUS and radiography was 0.72 (P < 0.001).

Background

Chest radiography after central venous catheter (CVC) insertion is the main method of verifying the catheter location. Despite the widespread use of radiography for detecting catheter position, x-ray may not always be readily available, especially in the operating room.

Objectives

We aimed to compare contrast-enhanced ultrasonography (CEUS) and chest radiography for detecting the correct location of CVCs.

Methods

One hundred sixteen consecutive patients with indications for CVC before cardiac surgery were enrolled in this observational study. After catheter insertion, CEUS was performed. Portable radiography was obtained postoperatively in the intensive care unit. Sensitivity, specificity, and predictive values were determined by comparing the ultrasonography results with radiographic findings as a reference standard.

Catheterization;Central Venous;Ultrasonography;Interventional;Radiography;Thoracic Catheterization;Central Venous;Ultrasonography;Interventional;Radiography;Thoracic http://www.anesthpain.portal.tools/index.php?page=article&article_id=38834 Hamid Kamalipour Hamid Kamalipour Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran Sedigheh Ahmadi Sedigheh Ahmadi Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran; Department of Anesthesiology and Intensive Care, Namazi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran. Tel: +98-9173117608, Fax: +98-7138305661 Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran; Department of Anesthesiology and Intensive Care, Namazi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran. Tel: +98-9173117608, Fax: +98-7138305661 Karmella Kamali Karmella Kamali Medical Imaging Research Center, Shiraz University of Medical Sciences, Shiraz, Iran Medical Imaging Research Center, Shiraz University of Medical Sciences, Shiraz, Iran Alireza Moaref Alireza Moaref Department of Cardiology, Shiraz University of Medical Sciences, Shiraz, Iran Department of Cardiology, Shiraz University of Medical Sciences, Shiraz, Iran Masih Shafa Masih Shafa Department of Cardiac Surgery, Shiraz University of Medical Sciences, Shiraz, Iran Department of Cardiac Surgery, Shiraz University of Medical Sciences, Shiraz, Iran Parsa Kamalipour Parsa Kamalipour Shiraz University of Medical Sciences, Shiraz, Iran Shiraz University of Medical Sciences, Shiraz, Iran
en 27847700 10.5812/aapm.38943 The Effect of Ginger Extract on the Incidence and Severity of Nausea and Vomiting After Cesarean Section Under Spinal Anesthesia The Effect of Ginger Extract on the Incidence and Severity of Nausea and Vomiting After Cesarean Section Under Spinal Anesthesia research-article research-article Conclusions

The findings of this study showed that ginger extract can be used for the prevention of nausea and vomiting during cesarean section under spinal anesthesia.

Background

Nausea and vomiting are one of the most common complications of cesarean sections under spinal anesthesia. Recently, the use of drugs to treat nausea and vomiting has decreased, and nonpharmaceutical and alternative traditional medicine are often preferred.

Objectives

This study aimed to determine the effect of ginger extract on the incidence and severity of nausea and vomiting after cesarean section under spinal anesthesia.

Methods

In this double-blind randomized clinical trial, 92 pregnant women, each of whom underwent a cesarean section under spinal anesthesia, were divided in two groups: a control group and an intervention group. The intervention group received 25 drops of ginger extract in 30 cc of water, and the control group received 30 cc of water one hour before surgery. The incidence and severity of nausea and vomiting were assessed during the surgery and two and four hours after the surgery using a self-report scale. Data analysis was performed using SPSS software and statistical tests.

Results

There was no statistically significant difference between the two groups in terms of maternal age, duration of fasting, duration of surgery, and confounding factors (P > 0.05). According to an independent t-test, there was a significant relationship between the two groups in terms of the incidence and mean severity score of nausea and vomiting during the cesarean section (P < 0.05). However, no statistically significant relationship was found between the two groups in terms of the incidence and mean severity score of nausea and vomiting two and four hours after surgery (P > 0.05).

Conclusions

The findings of this study showed that ginger extract can be used for the prevention of nausea and vomiting during cesarean section under spinal anesthesia.

Background

Nausea and vomiting are one of the most common complications of cesarean sections under spinal anesthesia. Recently, the use of drugs to treat nausea and vomiting has decreased, and nonpharmaceutical and alternative traditional medicine are often preferred.

Objectives

This study aimed to determine the effect of ginger extract on the incidence and severity of nausea and vomiting after cesarean section under spinal anesthesia.

Methods

In this double-blind randomized clinical trial, 92 pregnant women, each of whom underwent a cesarean section under spinal anesthesia, were divided in two groups: a control group and an intervention group. The intervention group received 25 drops of ginger extract in 30 cc of water, and the control group received 30 cc of water one hour before surgery. The incidence and severity of nausea and vomiting were assessed during the surgery and two and four hours after the surgery using a self-report scale. Data analysis was performed using SPSS software and statistical tests.

Results

There was no statistically significant difference between the two groups in terms of maternal age, duration of fasting, duration of surgery, and confounding factors (P > 0.05). According to an independent t-test, there was a significant relationship between the two groups in terms of the incidence and mean severity score of nausea and vomiting during the cesarean section (P < 0.05). However, no statistically significant relationship was found between the two groups in terms of the incidence and mean severity score of nausea and vomiting two and four hours after surgery (P > 0.05).

Ginger;Nausea;Vomiting;Cesarean Section;Spinal Anesthesia Ginger;Nausea;Vomiting;Cesarean Section;Spinal Anesthesia http://www.anesthpain.portal.tools/index.php?page=article&article_id=38943 Hossein Zeraati Hossein Zeraati Anesthesiology Department, School of Nursing and Midwifery, North Khorasan University of Medical Sciences, Bojnurd, Iran Anesthesiology Department, School of Nursing and Midwifery, North Khorasan University of Medical Sciences, Bojnurd, Iran Javad Shahinfar Javad Shahinfar Anesthesiology Department, School of Nursing and Midwifery, North Khorasan University of Medical Sciences, Bojnurd, Iran; Anesthesiology Department, School of Nursing and Midwifery, North Khorasan University of Medical Sciences, Bojnurd, Iran. Tel: +98-9157870313, Fax: +98-5832297095 Anesthesiology Department, School of Nursing and Midwifery, North Khorasan University of Medical Sciences, Bojnurd, Iran; Anesthesiology Department, School of Nursing and Midwifery, North Khorasan University of Medical Sciences, Bojnurd, Iran. Tel: +98-9157870313, Fax: +98-5832297095 Shiva Imani Hesari Shiva Imani Hesari Anesthesiology Department, Emam Ali Hospital, North Khorasan University of Medical Sciences, Bojnurd, Iran Anesthesiology Department, Emam Ali Hospital, North Khorasan University of Medical Sciences, Bojnurd, Iran Mahnaz Masrorniya Mahnaz Masrorniya Health Department, North Khorasan University of Medical Sciences, Bojnurd, Iran Health Department, North Khorasan University of Medical Sciences, Bojnurd, Iran Fatemeh Nasimi Fatemeh Nasimi School of Nursing and Midwifery, Jahrom University of Medical Sciences, Jahrom, Iran School of Nursing and Midwifery, Jahrom University of Medical Sciences, Jahrom, Iran
en 27847701 10.5812/aapm.39226 The Effect of Desmopressin on the Amount of Bleeding in Patients Undergoing Coronary Artery Bypass Graft Surgery with a Cardiopulmonary Bypass Pump After Taking Anti-Platelet Medicine The Effect of Desmopressin on the Amount of Bleeding in Patients Undergoing Coronary Artery Bypass Graft Surgery with a Cardiopulmonary Bypass Pump After Taking Anti-Platelet Medicine research-article research-article Conclusions

Our study showed that desmopressin could not reduce the amount of blood loss after CABG. Also, desmopressin did not have a significant effect on coagulation status. Therefore, based on the results of our study, it seems that the use of this medication cannot be a helpful for patients with any indication for CABG.

Background

Coronary artery bypass grafting (CABG) is a common surgical intervention at the end-stages of coronary artery occlusion disease. Despite the effectiveness of CABG, it may have particular complications, such as bleeding during and after surgery. So far, there have been many drugs used to reduce bleeding.

Objectives

This study aimed at investigating the effects of desmopressin on the amount of bleeding in patients undergoing CABG with a cardiopulmonary bypass pump (CPBP) who were taking anti-platelet medicine.

Methods

One hundred patients scheduled for elective CABG with a CPBP were included in a prospective, placebo-controlled, double-blinded clinical trial study. They were randomly divided into two groups. One group received desmopressin (40 μg) and the other group received a placebo (isotonic saline). Seven patients were excluded from the study, and 47 and 46 patients participated in the desmopressin and control groups, respectively. The methods of monitoring and the anesthetic techniques were similar in both groups, and all surgeries were performed by one surgeon. Variables including age, gender, pump time, aortic clamp time, duration of surgery, complications (e.g., nausea and vomiting, blood pressure changes), the necessity to receive blood products, and coagulation tests (prothrombin time, partial thromboplastin time, international normalized ratio, and bleeding time) were assessed. Data were statistically analyzed with SPSS software version 17.

Results

There was no significant difference between the groups regarding age, gender, pump time, clamp time, duration of surgery, complications, and the changes in hemoglobin and coagulation test measurements (P > 0.05). No significant difference was noted between the groups regarding the rate of bleeding after surgery (359.3 ± 266.2 in group D vs. 406.3 ± 341.6 in group P (control group); P = 0.208). However, the platelet changes after surgery in both groups were significantly different. The analysis revealed that the rate of thrombocytopenia after surgery was higher in the control group (P = 0.012).

Conclusions

Our study showed that desmopressin could not reduce the amount of blood loss after CABG. Also, desmopressin did not have a significant effect on coagulation status. Therefore, based on the results of our study, it seems that the use of this medication cannot be a helpful for patients with any indication for CABG.

Background

Coronary artery bypass grafting (CABG) is a common surgical intervention at the end-stages of coronary artery occlusion disease. Despite the effectiveness of CABG, it may have particular complications, such as bleeding during and after surgery. So far, there have been many drugs used to reduce bleeding.

Objectives

This study aimed at investigating the effects of desmopressin on the amount of bleeding in patients undergoing CABG with a cardiopulmonary bypass pump (CPBP) who were taking anti-platelet medicine.

Methods

One hundred patients scheduled for elective CABG with a CPBP were included in a prospective, placebo-controlled, double-blinded clinical trial study. They were randomly divided into two groups. One group received desmopressin (40 μg) and the other group received a placebo (isotonic saline). Seven patients were excluded from the study, and 47 and 46 patients participated in the desmopressin and control groups, respectively. The methods of monitoring and the anesthetic techniques were similar in both groups, and all surgeries were performed by one surgeon. Variables including age, gender, pump time, aortic clamp time, duration of surgery, complications (e.g., nausea and vomiting, blood pressure changes), the necessity to receive blood products, and coagulation tests (prothrombin time, partial thromboplastin time, international normalized ratio, and bleeding time) were assessed. Data were statistically analyzed with SPSS software version 17.

Results

There was no significant difference between the groups regarding age, gender, pump time, clamp time, duration of surgery, complications, and the changes in hemoglobin and coagulation test measurements (P > 0.05). No significant difference was noted between the groups regarding the rate of bleeding after surgery (359.3 ± 266.2 in group D vs. 406.3 ± 341.6 in group P (control group); P = 0.208). However, the platelet changes after surgery in both groups were significantly different. The analysis revealed that the rate of thrombocytopenia after surgery was higher in the control group (P = 0.012).

Bleeding;Desmopressin;Coronary Artery Bypass graft Bleeding;Desmopressin;Coronary Artery Bypass graft http://www.anesthpain.portal.tools/index.php?page=article&article_id=39226 Ali Mirmansoori Ali Mirmansoori Anesthesiology Research Center, Guilan University of Medical Sciences, Rasht, Iran Anesthesiology Research Center, Guilan University of Medical Sciences, Rasht, Iran Farnoush Farzi Farnoush Farzi Anesthesiology Research Center, Guilan University of Medical Sciences, Rasht, Iran; Anesthesiology Research Center, Guilan University of Medical Sciences, Rasht, Iran. Tel: +98-9113311653, Fax: +98-1333369024 Anesthesiology Research Center, Guilan University of Medical Sciences, Rasht, Iran; Anesthesiology Research Center, Guilan University of Medical Sciences, Rasht, Iran. Tel: +98-9113311653, Fax: +98-1333369024 Abbas Sedighinejad Abbas Sedighinejad Anesthesiology Research Center, Guilan University of Medical Sciences, Rasht, Iran Anesthesiology Research Center, Guilan University of Medical Sciences, Rasht, Iran Vali Imantalab Vali Imantalab Anesthesiology Research Center, Guilan University of Medical Sciences, Rasht, Iran Anesthesiology Research Center, Guilan University of Medical Sciences, Rasht, Iran Ali mohammadzadeh Ali mohammadzadeh Anesthesiology Research Center, Guilan University of Medical Sciences, Rasht, Iran Anesthesiology Research Center, Guilan University of Medical Sciences, Rasht, Iran Zahra Atrkar Roushan Zahra Atrkar Roushan Department of Statistics, Guilan University of Medical Sciences, Rasht, Iran Department of Statistics, Guilan University of Medical Sciences, Rasht, Iran Samaneh Ghazanfar Tehran Samaneh Ghazanfar Tehran Anesthesiology Research Center, Guilan University of Medical Sciences, Rasht, Iran Anesthesiology Research Center, Guilan University of Medical Sciences, Rasht, Iran Maryam Nemati Maryam Nemati Anesthesiology Research Center, Guilan University of Medical Sciences, Rasht, Iran Anesthesiology Research Center, Guilan University of Medical Sciences, Rasht, Iran Afsaneh Dehghan Afsaneh Dehghan Anesthesiology Research Center, Guilan University of Medical Sciences, Rasht, Iran Anesthesiology Research Center, Guilan University of Medical Sciences, Rasht, Iran
en PMC5101420 10.5812/aapm.39476 Treatment of Post-Latissimus Dorsi Flap Breast Reconstruction Pain With Continuous Paravertebral Nerve Blocks: A Retrospective Review Treatment of Post-Latissimus Dorsi Flap Breast Reconstruction Pain With Continuous Paravertebral Nerve Blocks: A Retrospective Review research-article research-article Conclusions

Patients receiving a cPVB in addition to tPVB after LDF reconstruction experienced similar pain to those receiving tPVB alone. A larger, randomized clinical trial is warranted to fully determine the benefits of using cPVB in addition to tPVB for this procedure.

Results

A total of 22 patients were included in this study (11-cPVB and 11-tPVB). The mean NRS pain score of cPVB patients (3.5 (standard deviation (SD) 1.8) was lower than that of the single-injection tPVB patients (4.4 (SD 2.1), however this difference was not statistically significant (P = 0.31). The length of hospital stay and opioid use was not statistically different between groups.

Objectives

The addition of a perioperative continuous paravertebral nerve block (cPVB) to a single-injection thoracic paravertebral nerve block (tPVB) has demonstrated improved analgesia in breast surgery. However, its use following isolated post-mastectomy reconstruction using a latissimus dorsi flap (LDF) has not previously been examined.

Methods

We performed a retrospective review of patients who underwent salvage breast reconstruction with a unilateral LDF by a single surgeon. Preoperatively, all patients received a single-injection tPVB with 0.5% ropivacaine. Additionally, patients had the option for catheter placement to receive a continuous 0.2% ropivacaine infusion with intermittent boluses. Infusions commenced in the recovery room and the catheters were removed on the morning of discharge. The primary endpoint was the mean pain numeric rating scale (NRS) scores for the 24-hour period beginning at 7:00 on post-operative day 1.

Conclusions

Patients receiving a cPVB in addition to tPVB after LDF reconstruction experienced similar pain to those receiving tPVB alone. A larger, randomized clinical trial is warranted to fully determine the benefits of using cPVB in addition to tPVB for this procedure.

Results

A total of 22 patients were included in this study (11-cPVB and 11-tPVB). The mean NRS pain score of cPVB patients (3.5 (standard deviation (SD) 1.8) was lower than that of the single-injection tPVB patients (4.4 (SD 2.1), however this difference was not statistically significant (P = 0.31). The length of hospital stay and opioid use was not statistically different between groups.

Objectives

The addition of a perioperative continuous paravertebral nerve block (cPVB) to a single-injection thoracic paravertebral nerve block (tPVB) has demonstrated improved analgesia in breast surgery. However, its use following isolated post-mastectomy reconstruction using a latissimus dorsi flap (LDF) has not previously been examined.

Methods

We performed a retrospective review of patients who underwent salvage breast reconstruction with a unilateral LDF by a single surgeon. Preoperatively, all patients received a single-injection tPVB with 0.5% ropivacaine. Additionally, patients had the option for catheter placement to receive a continuous 0.2% ropivacaine infusion with intermittent boluses. Infusions commenced in the recovery room and the catheters were removed on the morning of discharge. The primary endpoint was the mean pain numeric rating scale (NRS) scores for the 24-hour period beginning at 7:00 on post-operative day 1.

Latissimus Dorsi Flap;Continuous Paravertebral Catheter;Breast Reconstruction Latissimus Dorsi Flap;Continuous Paravertebral Catheter;Breast Reconstruction http://www.anesthpain.portal.tools/index.php?page=article&article_id=39476 Jonathan T. Unkart Jonathan T. Unkart Department of Surgery, University of California, San Diego, USA; Department of Surgery, 200 West Arbor Drive, MC 0739, San Diego, California, USA. Tel: +1-4157069274, Fax: +1-8588226194 Department of Surgery, University of California, San Diego, USA; Department of Surgery, 200 West Arbor Drive, MC 0739, San Diego, California, USA. Tel: +1-4157069274, Fax: +1-8588226194 Jennifer A. Padwal Jennifer A. Padwal School of Medicine, University of California, San Diego, USA School of Medicine, University of California, San Diego, USA Brian M. Ilfeld Brian M. Ilfeld Department of Anesthesiology, University of California, California, USA Department of Anesthesiology, University of California, California, USA Anne M. Wallace Anne M. Wallace Department of Surgery, University of California, San Diego, USA Department of Surgery, University of California, San Diego, USA
en 27847704 10.5812/aapm.39495 Treatment of Postoperative Pain in Pediatric Operations: Comparing the Efficiency of Bupivacaine, Bupivacaine-Dexmedetomidine and Bupivacaine-Fentanyl for Caudal Block Treatment of Postoperative Pain in Pediatric Operations: Comparing the Efficiency of Bupivacaine, Bupivacaine-Dexmedetomidine and Bupivacaine-Fentanyl for Caudal Block research-article research-article Conclusions

The results show that the analgesic and sedative effects were better when dexmedetomidine was added to bupivacaine than when fentanyl was added or bupivacaine alone was administered in the pediatric population studied here that underwent elective inguinal hernia repair.

Results

A total of 61 patients were analyzed. The lowest pain scores were found in the BD group at all time points (P < 0.001). The sedation scores were higher in the BD group than in the other two groups at all time points (P < 0.001). No motor block was observed after the operation. Only three patients required analgesic administration 2 to 6 hours after the operation in group B. No side effects were observed in any of the groups, and there was no significant difference in the duration of surgery among the three groups.

Objectives

The aim of this study was to compare the additive effects of dexmedetomidine and fentanyl on bupivacaine-induced caudal analgesia in pediatric patients who had undergone elective inguinal hernia repair.

Methods

This randomized, double-blind clinical trial included children aged 1 - 5 years who were divided into three groups: the bupivacaine group (Group B) received 0.25% bupivacaine (1 ml/kg), the bupivacaine-dexmedetomidine group (Group BD) received 0.25% bupivacaine (1 mL/kg) plus 2 µg/kg dexmedetomidine, and the bupivacaine-fentanyl group (Group BF) received 0.25% bupivacaine (1 mL/kg) plus 2 µg/kg fentanyl. The hemodynamic variables (heart rate, systolic blood pressure, respiratory rate, and peripheral arterial oxygen saturation) were measured perioperatively. Pain, sedation and motor block scores and adverse events (nausea and vomiting, pruritis, hypotension, bradycardia, urinary retention and respiratory depression) were documented at 30 and 60 minutes, and the 1st, 2nd, 4th, 6th, 12th and 24th hours after the operation. The other recordings include the duration of surgery and analgesic requirement.

Background

Caudal analgesia is a common method for postoperative pain management in pediatric patients. Additive agents such as opioids and α2 agonists have been used to enhance the analgesic effects of local anesthetics for caudal block.

Conclusions

The results show that the analgesic and sedative effects were better when dexmedetomidine was added to bupivacaine than when fentanyl was added or bupivacaine alone was administered in the pediatric population studied here that underwent elective inguinal hernia repair.

Results

A total of 61 patients were analyzed. The lowest pain scores were found in the BD group at all time points (P < 0.001). The sedation scores were higher in the BD group than in the other two groups at all time points (P < 0.001). No motor block was observed after the operation. Only three patients required analgesic administration 2 to 6 hours after the operation in group B. No side effects were observed in any of the groups, and there was no significant difference in the duration of surgery among the three groups.

Objectives

The aim of this study was to compare the additive effects of dexmedetomidine and fentanyl on bupivacaine-induced caudal analgesia in pediatric patients who had undergone elective inguinal hernia repair.

Methods

This randomized, double-blind clinical trial included children aged 1 - 5 years who were divided into three groups: the bupivacaine group (Group B) received 0.25% bupivacaine (1 ml/kg), the bupivacaine-dexmedetomidine group (Group BD) received 0.25% bupivacaine (1 mL/kg) plus 2 µg/kg dexmedetomidine, and the bupivacaine-fentanyl group (Group BF) received 0.25% bupivacaine (1 mL/kg) plus 2 µg/kg fentanyl. The hemodynamic variables (heart rate, systolic blood pressure, respiratory rate, and peripheral arterial oxygen saturation) were measured perioperatively. Pain, sedation and motor block scores and adverse events (nausea and vomiting, pruritis, hypotension, bradycardia, urinary retention and respiratory depression) were documented at 30 and 60 minutes, and the 1st, 2nd, 4th, 6th, 12th and 24th hours after the operation. The other recordings include the duration of surgery and analgesic requirement.

Background

Caudal analgesia is a common method for postoperative pain management in pediatric patients. Additive agents such as opioids and α2 agonists have been used to enhance the analgesic effects of local anesthetics for caudal block.

Anesthesia;Caudal;Bupivacaine;Dexmedetomidine;Fentanyl;Postoperative Pain Anesthesia;Caudal;Bupivacaine;Dexmedetomidine;Fentanyl;Postoperative Pain http://www.anesthpain.portal.tools/index.php?page=article&article_id=39495 Hashem Jarineshin Hashem Jarineshin Anesthesiology, Critical Care and Pain Management Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran Anesthesiology, Critical Care and Pain Management Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran Fereydoon Fekrat Fereydoon Fekrat Anesthesiology, Critical Care and Pain Management Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran Anesthesiology, Critical Care and Pain Management Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran Aida Kargar Kermanshah Aida Kargar Kermanshah Anesthesiology, Critical Care and Pain Management Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran; Anesthesiology, Critical Care and Pain Management Research Center, Shahid Mohammadi Hospital, Hormozgan University of Medical Sciences, Bandar Abbas, Iran. Tel/Fax: +98-7633345009 Anesthesiology, Critical Care and Pain Management Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran; Anesthesiology, Critical Care and Pain Management Research Center, Shahid Mohammadi Hospital, Hormozgan University of Medical Sciences, Bandar Abbas, Iran. Tel/Fax: +98-7633345009
en 27853681 10.5812/aapm.39835 Sedative and Analgesic Effects of Propofol-Fentanyl Versus Propofol-Ketamine During Endoscopic Retrograde Cholangiopancreatography: A Double-Blind Randomized Clinical Trial Sedative and Analgesic Effects of Propofol-Fentanyl Versus Propofol-Ketamine During Endoscopic Retrograde Cholangiopancreatography: A Double-Blind Randomized Clinical Trial research-article research-article Results

The sedative effects were equal in the two groups (P > 0.05), but the analgesic effects were higher in the PF group than in the PK group (P < 0.05). The PK group had higher blood pressure levels in the eighth minute. Respiratory rate, heart rate, and arterial oxygen saturation showed no significant differences between the groups (P > 0.05). Endoscopist satisfaction, patient satisfaction, and recovery time showed no significant differences between the two groups (P > 0.05).

Conclusions

The results showed that the sedative effect of propofol-ketamine was equal to the propofol-fentanyl combination during ERCP. To prevent respiratory and hemodynamic complications during ERCP, the propofol-ketamine combination should be used in patients with underlying disease.

Background

Endoscopic retrograde cholangiopancreatography (ERCP) is a painful procedure that requires analgesia and sedation.

Objectives

In this study, we compared the analgesic and sedative effects of propofol-ketamine versus propofol-fentanyl in patients undergoing ERCP.

Methods

In this clinical trial, 72 patients, aged 30 - 70 years old, who were candidates for ERCP were randomly divided into two groups. Before the start of ERCP, both groups received midazolam 0.5 - 1 mg. The intervention group (PK) received ketamine 0.5 mg/kg, and the control group (PF) received fentanyl 50 - 100 micrograms. All patients received propofol 0.5 mg/kg in a loading dose followed by 75 mcg/kg/minute in an infusion. The patients, the anesthesiologist, and the endoscopist were unaware of the medication regimen. Sedation and analgesia quality (based on a VAS), blood pressure, respiratory rate, heart rate, arterial oxygen saturation, recovery time (based on Aldrete scores), and endoscopist and patient satisfation were recorded.

Results

The sedative effects were equal in the two groups (P > 0.05), but the analgesic effects were higher in the PF group than in the PK group (P < 0.05). The PK group had higher blood pressure levels in the eighth minute. Respiratory rate, heart rate, and arterial oxygen saturation showed no significant differences between the groups (P > 0.05). Endoscopist satisfaction, patient satisfaction, and recovery time showed no significant differences between the two groups (P > 0.05).

Conclusions

The results showed that the sedative effect of propofol-ketamine was equal to the propofol-fentanyl combination during ERCP. To prevent respiratory and hemodynamic complications during ERCP, the propofol-ketamine combination should be used in patients with underlying disease.

Background

Endoscopic retrograde cholangiopancreatography (ERCP) is a painful procedure that requires analgesia and sedation.

Objectives

In this study, we compared the analgesic and sedative effects of propofol-ketamine versus propofol-fentanyl in patients undergoing ERCP.

Methods

In this clinical trial, 72 patients, aged 30 - 70 years old, who were candidates for ERCP were randomly divided into two groups. Before the start of ERCP, both groups received midazolam 0.5 - 1 mg. The intervention group (PK) received ketamine 0.5 mg/kg, and the control group (PF) received fentanyl 50 - 100 micrograms. All patients received propofol 0.5 mg/kg in a loading dose followed by 75 mcg/kg/minute in an infusion. The patients, the anesthesiologist, and the endoscopist were unaware of the medication regimen. Sedation and analgesia quality (based on a VAS), blood pressure, respiratory rate, heart rate, arterial oxygen saturation, recovery time (based on Aldrete scores), and endoscopist and patient satisfation were recorded.

Propofol;Midazolam;Ketamine;Fentanyl;Sedation;Analgesia Propofol;Midazolam;Ketamine;Fentanyl;Sedation;Analgesia http://www.anesthpain.portal.tools/index.php?page=article&article_id=39835 Fakhroddin Bahrami Gorji Fakhroddin Bahrami Gorji Student Committee Research, The Clinical Research Development Unit of Roohani Hospital, Babol University of Medical Sciences, Babol, Iran Student Committee Research, The Clinical Research Development Unit of Roohani Hospital, Babol University of Medical Sciences, Babol, Iran Parviz Amri Parviz Amri Department of Intensive Care, Babol University of Medical Sciences, Babol, Iran; Department of Intensive Care, Babol University of Medical Sciences, Babol, Iran. Tel: +98-1112238301 Department of Intensive Care, Babol University of Medical Sciences, Babol, Iran; Department of Intensive Care, Babol University of Medical Sciences, Babol, Iran. Tel: +98-1112238301 Javad Shokri Javad Shokri Department of Gastroenterology, Babol University of Medical Sciences, Babol, Iran Department of Gastroenterology, Babol University of Medical Sciences, Babol, Iran Hakimeh Alereza Hakimeh Alereza Vice Chancellor, Babol University of Medical Sciences, Babol, Iran Vice Chancellor, Babol University of Medical Sciences, Babol, Iran Ali Bijani Ali Bijani Social Determinants of Health Research Center, Babol University of Medical Sciences, Babol, Iran Social Determinants of Health Research Center, Babol University of Medical Sciences, Babol, Iran
en 27843786 10.5812/aapm.33979 Diffuse Alveolar Hemorrhage in Patients Undergoing Neurointervention: A Case Report Diffuse Alveolar Hemorrhage in Patients Undergoing Neurointervention: A Case Report case-report case-report Conclusions

Small dose of clopidogrel (75 mg) may lead to rare, life-threatening DAH, so physicians should be aware of the possibility of DAH after neurointervention in patients who have respiratory distress, worsening alveolar infiltrates accompanied by hemoptysis.

Introduction

Diffuse alveolar hemorrhage (DAH) is a very rare complication but acute and life-threatening event. Clopidogrel has generally administered for neurointerventional surgery, but there were no reports of DAH related to clopidogrel in patients undergoing neurointervention.

Case Presentation

A 70-year-old male presented with DAH associated with clopidogrel after transfemoral cerebral angiography and coil embolization for cerebral aneurysm. The chest radiography showed bilateral symmetric peribronchial consolidation and bronchoscopy revealed diffuse hemorrhage on the bronchial wall at the bilateral lung. Clopidogrel was withdrawn and mechanical ventilation was applied for postoperative three days.

Conclusions

Small dose of clopidogrel (75 mg) may lead to rare, life-threatening DAH, so physicians should be aware of the possibility of DAH after neurointervention in patients who have respiratory distress, worsening alveolar infiltrates accompanied by hemoptysis.

Introduction

Diffuse alveolar hemorrhage (DAH) is a very rare complication but acute and life-threatening event. Clopidogrel has generally administered for neurointerventional surgery, but there were no reports of DAH related to clopidogrel in patients undergoing neurointervention.

Case Presentation

A 70-year-old male presented with DAH associated with clopidogrel after transfemoral cerebral angiography and coil embolization for cerebral aneurysm. The chest radiography showed bilateral symmetric peribronchial consolidation and bronchoscopy revealed diffuse hemorrhage on the bronchial wall at the bilateral lung. Clopidogrel was withdrawn and mechanical ventilation was applied for postoperative three days.

Clopidogrel;Pulmonary Hemorrhage;Endovascular Procedure Clopidogrel;Pulmonary Hemorrhage;Endovascular Procedure http://www.anesthpain.portal.tools/index.php?page=article&article_id=33979 Yun Suk Choe Yun Suk Choe Department of Anesthesiology and Pain Medicine, Jeju National University Hospital, Jeju National University, Jeju Special Self-Governing Province, South Korea Department of Anesthesiology and Pain Medicine, Jeju National University Hospital, Jeju National University, Jeju Special Self-Governing Province, South Korea Na Young Kim Na Young Kim Graduate School of Medicine, Jeju National University, Jeju Special Self-Governing Province, South Korea Graduate School of Medicine, Jeju National University, Jeju Special Self-Governing Province, South Korea Ae Ryoung Lee Ae Ryoung Lee Department of Anesthesiology and Pain Medicine, Jeju National University Hospital, Jeju National University, Jeju Special Self-Governing Province, South Korea; Department of Anesthesiology and Pain Medicine, Jeju National University Hospital, Jeju National University, Jeju Special Self-Governing Province, South Korea. Tel: +82-647171810, Fax: +82-647172042 Department of Anesthesiology and Pain Medicine, Jeju National University Hospital, Jeju National University, Jeju Special Self-Governing Province, South Korea; Department of Anesthesiology and Pain Medicine, Jeju National University Hospital, Jeju National University, Jeju Special Self-Governing Province, South Korea. Tel: +82-647171810, Fax: +82-647172042
en 27853682 10.5812/aapm.40067 Acute Cervical Spontaneous Spinal Epidural Hematoma Presenting with Minimal Neurological Deficits: A Case Report Acute Cervical Spontaneous Spinal Epidural Hematoma Presenting with Minimal Neurological Deficits: A Case Report case-report case-report Introduction

Spontaneous spinal epidural hematoma (SSEH) is an uncommon but potentially fatal condition. The increased bleeding tendency associated with anticoagulant medications has been proven to increase the risk of SSEH. The symptoms of SSEH usually begin with sudden severe neck or back pain and are followed by neurological deficits. However, some cases present with only axial pain or with radicular pain similar to herniated disc disorders.

Case Presentation

A 28-year-old healthy man developed a sudden onset of severe neck and right shoulder pain with mild arm weakness. The MRI revealed an SSEH that was compressing his spinal cord in the right posterolateral epidural space from C2-C6. On the second hospital day, his symptoms suddenly improved, and most of the hematoma had spontaneously resolved.

Conclusions

Currently, the incidence of SSEH is expected to increase. Pain physicians must include SSEH in their differential diagnosis for patients with axial pain or radicular symptoms alone, particularly when risk factors are present.

Introduction

Spontaneous spinal epidural hematoma (SSEH) is an uncommon but potentially fatal condition. The increased bleeding tendency associated with anticoagulant medications has been proven to increase the risk of SSEH. The symptoms of SSEH usually begin with sudden severe neck or back pain and are followed by neurological deficits. However, some cases present with only axial pain or with radicular pain similar to herniated disc disorders.

Case Presentation

A 28-year-old healthy man developed a sudden onset of severe neck and right shoulder pain with mild arm weakness. The MRI revealed an SSEH that was compressing his spinal cord in the right posterolateral epidural space from C2-C6. On the second hospital day, his symptoms suddenly improved, and most of the hematoma had spontaneously resolved.

Conclusions

Currently, the incidence of SSEH is expected to increase. Pain physicians must include SSEH in their differential diagnosis for patients with axial pain or radicular symptoms alone, particularly when risk factors are present.

Cervical;Epidural Hematoma;Spinal Cervical;Epidural Hematoma;Spinal http://www.anesthpain.portal.tools/index.php?page=article&article_id=40067 Jisoon Huh Jisoon Huh Department of Neurosurgery, Jeju National University Hospital, School of medicine, Jeju National University, Jeju, South Korea Department of Neurosurgery, Jeju National University Hospital, School of medicine, Jeju National University, Jeju, South Korea Ho-young Kwak Ho-young Kwak Department of Computer engineering, College of engineering, Jeju National University, Jeju, South Korea Department of Computer engineering, College of engineering, Jeju National University, Jeju, South Korea You-Nam Chung You-Nam Chung Department of Neurosurgery, Jeju National University Hospital, School of medicine, Jeju National University, Jeju, South Korea Department of Neurosurgery, Jeju National University Hospital, School of medicine, Jeju National University, Jeju, South Korea Sun Kyung Park Sun Kyung Park Department of Anesthesiology and Pain medicine, Jeju National University Hospital, School of medicine, Jeju National University, Jeju, South Korea Department of Anesthesiology and Pain medicine, Jeju National University Hospital, School of medicine, Jeju National University, Jeju, South Korea Yun Suk Choi Yun Suk Choi Department of Anesthesiology and Pain medicine, Jeju National University Hospital, School of medicine, Jeju National University, Jeju, South Korea; 3Department of Anesthesiology and Pain medicine, Jeju National University Hospital, School of medicine, Jeju National University, Jeju, South Korea. Tel: +82-647172026, Fax: +82-647172042 Department of Anesthesiology and Pain medicine, Jeju National University Hospital, School of medicine, Jeju National University, Jeju, South Korea; 3Department of Anesthesiology and Pain medicine, Jeju National University Hospital, School of medicine, Jeju National University, Jeju, South Korea. Tel: +82-647172026, Fax: +82-647172042
en 27847702 10.5812/aapm.39256 Central Venous Cannulation of the Internal Jugular Vein Both With and Without Ultrasound Guidance in Iran Central Venous Cannulation of the Internal Jugular Vein Both With and Without Ultrasound Guidance in Iran letter letter Central Venous Catheterization;Jugular Vein;Ultrasonography Central Venous Catheterization;Jugular Vein;Ultrasonography http://www.anesthpain.portal.tools/index.php?page=article&article_id=39256 Hamidreza Karimi-Sari Hamidreza Karimi-Sari Students’ Research Committee, Baqiyatallah University of Medical Sciences, Tehran, Iran; Students’ Research Committee, Baqiyatallah University of Medical Sciences, Tehran, Iran. Tel: +98-2181264354 Students’ Research Committee, Baqiyatallah University of Medical Sciences, Tehran, Iran; Students’ Research Committee, Baqiyatallah University of Medical Sciences, Tehran, Iran. Tel: +98-2181264354 Niloofar Nikjoo Niloofar Nikjoo Medical Student Research Committee (MSRC), Iran University of Medical Sciences, Tehran, Iran Medical Student Research Committee (MSRC), Iran University of Medical Sciences, Tehran, Iran