Evaluating memory dysfunction after spinal anesthesia among patients undergoing elective surgery: Descriptive-analytical study

Effects on ondansetron of postdural puncture headache after cesarean section under spinal anesthesia

Background

Spinal anesthesia is commonly performed for cesarean section, however, postdural puncture headache (PDPH) is one of its most common adverse effects. Ondansetron is an antiemetic for cancer treatment and analgesia-induced nausea and vomiting. In this study, the authors aim to evaluate the effect of postoperative ondansetron on PDPH.

Methods

In this randomized controlled clinical trial study, 120 pregnant patients are ASA ll, undergoing elective cesarean section, were randomized into two groups (placebo or study). The patients in the study group, immediately after the birth of a baby and 24 h after the operation, received ondansetron 4 mg IV while the placebo group received a placebo. The severity and incidence of headache, postoperative nausea and vomiting, dizziness, neck and lower back pain, and the use of analgesia was assessed in the two groups.

Results

The significant meaning of the time effect (P<0.001) indicated that regardless of the group, for each unit increase in time, the chance of developing a headache increased by 23%, which was statistically significant. Also, the significant meaning of the group effect indicated that regardless of time, patients who did not take indomethacin had ~4.11 times higher chances of developing a headache compared to those who received the medication, which was statistically significant (P=0.004).

Conclusion

The administration of ondansetron significantly reduces the occurrence of postspinal anesthesia headaches and neck pain. There was no significant difference in headache severity between the two study groups.

A retrospective study on the cardiac assessment of isolated sternal fracture patients based on radiographic and clinical outcomes

OBJECTIVE

Sternal fracture may be associated with major and serious injuries. In this study, the complications associated with isolated sternal fracture in trauma patients are evaluated based on radiographic and cardiac findings.

METHODS

This retrospective study was performed on patients with isolated sternal fractures admitted to the emergency department of (XXX) Madani Educational-Medical. Data regarding demographic information, mechanism of trauma, length of hospitalization, electrocardiography (ECG), cardiac enzyme, and chest radiography were recorded in the questionnaire for each patient.

RESULTS

The mean age of patients 41.2 + 11.04 years and 63.9% were male. The most common cause of the trauma was car accidents in 41% (25 cases). The mean duration of hospitalization was 1.54 ± 0.90 days. The mechanism of trauma was not associated with x-ray and computed tomography findings, p = 0.53 and p = 0.86, respectively. ECG findings were significantly related to x-ray and computed tomography outcomes, p < 0.001, respectively.

CONCLUSION

Patients with isolated sternal fracture with displacement >0.5 cm and hematoma are likely to require cardiac consultation.

Effect of caffeine on postoperative bowel movement and defecation after cesarean section

INTRODUCTION

and Importance: Inadequate bowel movement after cesarean section (C-section) can delay the intake of solid diet. Coffee is reported to have beneficial effects on bowel motility after the surgery. This study is designed to evaluate the effects of coffee on bowel movement and defecation following C-section.

METHODS

In this randomized clinical trial study, women undergoing elective C-section at the hospital of (XXX) during 2019-2020 were included. Following the surgery, the patients were divided in case (coffee) and control (water) group. At three different interval after the surgery, 111 ml of coffee or water was given to these patients. After the intervention, time of bowel movement, first defecation, body mass index (BMI), age, gestational age, parity and gravidity were recorded and evaluated between the two groups.

RESULTS

Of total 36 patients (18 in study and control group, respectively), the mean age, gravidity, parity, BMI and gestational age was not significantly different, p-value<0.05. The mean onset of bowel movements in case group was 14.56 h and control group was 16.83 h and the first defecation after cesarean section in case and control group was 27.78 and 31.67 h, respectively. The two groups were significantly different in both the terms, p-value = 0.042 and p-value = 0.002, respectively.

CONCLUSION

The postoperative bowel movement and defecation time is shorter with the intake of coffee among patients undergoing C-section.

Effects of preoperative melatonin on postoperative pain following cesarean section: A randomized clinical trial

BACKGROUND

Data regarding the analgesic effects of melatonin after the surgery is scare. So far, only one study has investigated the analgesic effect of melatonin during cesarean section. Objective: The present study was performed to investigate the effect of preoperative oral melatonin on pain intensity after cesarean section during spinal anesthesia.

METHODS

In a double-blind randomized controlled clinical trial study, 204 patients undergoing elective cesarean section with class 1 and 2 anesthesia (ASA) were enrolled. Patients were randomly divided into 3 groups of 68 patients. Patients in group A were given 5 mg melatonin tablets, patients in group B were given 10 mg melatonin tablets, and group C was given placebo. All patients underwent spinal anesthesia with the same anesthesia protocol. Pain intensity, nausea, vomiting, pruritus and headache were assessed and recorded 2, 6, 12 and 24 h after surgery. The time of first dose of analgesia, the amount of opioid consumed within 24 h, and the time to resume physical activity was also recorded. Statistical analysis of data was performed using SPSS 20 software.

RESULTS

Repeated measurements of pain intensity during the study showed that in all 3 groups pain intensity was significantly reduced during the study, p < 0.001, respectively. The intensity of pain was significantly different in groups B and C, groups B and A and groups A and C, P < 0.001, respectively. The pain reduction was greatest in group B, followed by group A and group C, respectively. The time interval between the end of surgery and the patient's need for analgesia was significant in group B compared to group A (P = 0.035) and C (P < 0.001) and also in group A compared to group C (P = 0.011). The mean dose of opioid was significantly least in group B, p < 0.001. The mean time to resume physical activity was also shortest in group B, p < 0.001 Headache and nausea/vomiting were observed in 7 patients (10.7%) group A and 7 patients (10.7%) in group C. None of the patients in group B developed complications.

CONCLUSION

The results of the present study showed that the use of 10 mg of melatonin before cesarean section with spinal anesthesia is not only safe, but also reduces the severity of patients' pain, increases the duration of postoperative analgesia, reduces the need for analgesics after surgery and resumption of physical activity.

The effect of preoperative sublingual buprenorphine on postoperative pain after lumbar discectomy: A randomized controlled trial

Background

Lumbar discectomy is one of the most common surgical procedures performed to manage pain caused by the protrusion of an intervertebral disc. Postoperative pain management can be challenging and might lead to increased intake of opioids. Objective: The aim of this study was to determine the effect of preoperative sublingual buprenorphine on severity of pain after lumbar disc surgery and postoperative intake of morphine.

Methods

This Randomized clinical trial study was performed on 78 patients who were selected for lumbar discectomy surgery. Patients were randomly divided into two groups of 39 patients, each. Patients in the buprenorphine and placebo group received 2 mg buprenorphine sublingual, and placebo 1 h before surgery. Severity of pain, nausea, vomiting and pruritus and intake of opioids in the two groups were evaluated and recorded 1, 6, 12 and 24 h after surgery. Data were analyzed using SPSSv21.

Results

There was a significant difference in pain score in buprenorphine group at 1, 6, 12, and compared with placebo (P < 0.005). In the control group, the use of analgesics was more than the buprenorphine group. In the first hours after surgery (1–6 h), the incidence of nausea in the buprenorphine group was significantly lower than of the control group (P < 0.05). However, at 12 and 24 h, this difference was not observed, p > 0.05. There was no significant difference in incidence of side effects (nausea, vomiting, pruritus) in the two groups (P > 0.05).

Conclusion

Sublingual buprenorphine in postoperative pain management is an effective and low dose drug. Due to its simpler administration, it is recommended to relief postoperative pain after lumbar disc surgery.

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Lumbar discectomy is one of the most common surgical procedures performed to manage pain.

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Postoperative pain management can be challenging and might lead to increased intake of opioids.

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Sublingual buprenorphine in postoperative pain management is an effective and low dose drug.

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It is recommended to relief postoperative pain after lumbar disc surgery.