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Jiang H, Quan S, Su Y, Li J, Zhang X. Analysis of clinical application effects of Esketamine combining Sufentanil in labor analgesia and their impacts on postpartum depression. Pak J Med Sci 2024; 40:1914-1918. [PMID: 39416617 PMCID: PMC11476173 DOI: 10.12669/pjms.40.9.8689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 08/31/2023] [Accepted: 06/30/2024] [Indexed: 10/19/2024] Open
Abstract
Objective To evaluate the clinical effects of Esketamine combining Sufentanil in labor analgesia and their impacts on postpartum depression. Methods This was a retrospective study. One hundred and fifty primiparae with spontaneous labor were selected at SSL Central Hospital of Dongguan City from July 10, 2021 to May 10, 2022 as the research objects and randomly divided into two groups (each n=75). While the control group underwent epidural infusion of Sufentanil for analgesia, the study group was administered Esketamine combining Sufentanil. Compared analgesic effects, time of birth course, adverse reactions, pain intensity, scores assigned to depression and anxiety before analgesia and after delivery were made for pregnant women in both groups. Results The response rates of the study and control groups reached 100% and 93%, respectively, with statistically significant differences (p=0.02). The time of the first, second, and third stages of labor in the study group were all significantly lower than that of the control group; showing statistical significance (p=0.00). Regarding adverse reactions showed no statistically significant differences (p=0.44). Moreover, the study group showed noticeably lower pain intensity than those of the control group during delivery, 20 minutes and one hour after delivery; and their differences were statistically significant (p=0.00). After delivery, both the SAS and SDS of the study group were respectively lower than those of the control group, with statistically significant differences as well (p=0.00). Conclusions Applying Esketamine combining Sufentanil in epidural painless delivery produces rather favorable analgesic effects, shortens the time of the birth process, and improves postpartum anxiety and depression without leading to more adverse reactions.
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Affiliation(s)
- Haoyu Jiang
- Haoyu Jiang, Department of Anesthesiology, The Affiliated Dongguan Songshan Lake Central Hospital, Guangdong Medical University, Dongguan 441000, Guangdong, China
| | - Shoubo Quan
- Shoubo Quan, Department of Anesthesiology, SSL Central Hospital of Dongguan City, Affiliated Shilong People’s Hospital of Southern Medical University, Dongguan 523326, Guangdong, China
| | - Yahai Su
- Yahai Su, Department of Anesthesiology, SSL Central Hospital of Dongguan City, Affiliated Shilong People’s Hospital of Southern Medical University, Dongguan 523326, Guangdong, China
| | - Jingyi Li
- Jingyi Li, Department of Pain, SSL Central Hospital of Dongguan City, Affiliated Shilong People’s Hospital of Southern Medical University, Dongguan 523326, Guangdong, China
| | - Xuefeng Zhang
- Xuefeng Zhang, Department of Pain, SSL Central Hospital of Dongguan City, Affiliated Shilong People’s Hospital of Southern Medical University, Dongguan 523326, Guangdong, China
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Cheng J, Wan M, Yu X, Yan R, Lin Z, Liu H, Chen L. Pharmacologic Analgesia for Cesarean Section: An Update in 2024. Curr Pain Headache Rep 2024; 28:985-998. [PMID: 38951467 DOI: 10.1007/s11916-024-01278-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2024] [Indexed: 07/03/2024]
Abstract
PURPOSE OF THE REVIEW With the increasing prevalence of cesarean section globally, the importance of perioperative analgesia for cesarean section is becoming increasingly evident. This article provides an overview and update on the current status of cesarean section worldwide and associated analgesic regimens. RECENT FINDINGS Some recent studies unveiled potential association of neuraxial analgesia might be associated with children's autism, pharmacologic analgesia in obstetric will potentially gain some more attention. Various commonly used techniques and medications for analgesia in cesarean section are highlighted. While neuraxial administration of opioid remains the most classic method, the use of multimodal analgesia, particularly integration of nonsteroidal anti-inflammatory drugs, acetaminophen, peripheral nerve blocks has provided additional and better options for patients who are not suitable for intrathecal and neuraxial techniques and those experiencing severe pain postoperatively. Optimal pain management is crucial for achieving better clinical outcomes and optimal recovery, and with the continuous development of medications, more and better pharmacologic regimen will be available in the future.
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Affiliation(s)
- Jing Cheng
- Department of Anesthesiology, Maternal and Child Health Hospital of Hubei Province, NO.745 Wuluo Road, Hongshan District, Wuhan, Hubei, China, 430070
| | - Mengjiao Wan
- Department of Anesthesiology, Maternal and Child Health Hospital of Hubei Province, NO.745 Wuluo Road, Hongshan District, Wuhan, Hubei, China, 430070
| | - Xiaoyan Yu
- Department of Anesthesiology, Maternal and Child Health Hospital of Hubei Province, NO.745 Wuluo Road, Hongshan District, Wuhan, Hubei, China, 430070
| | - Rongrong Yan
- Department of Anesthesiology, Maternal and Child Health Hospital of Hubei Province, NO.745 Wuluo Road, Hongshan District, Wuhan, Hubei, China, 430070
| | - Zirui Lin
- Department of Anesthesiology, Maternal and Child Health Hospital of Hubei Province, NO.745 Wuluo Road, Hongshan District, Wuhan, Hubei, China, 430070
| | - Henry Liu
- Department of Anesthesiology & Critical Care, The University of Pennsylvania Perelman School of Medicine, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - Lin Chen
- Department of Anesthesiology, Maternal and Child Health Hospital of Hubei Province, NO.745 Wuluo Road, Hongshan District, Wuhan, Hubei, China, 430070.
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JN S, BC P, Savitha LM, Kalaburgi RA. Comparison of Epidural Bupivacaine and Buprenorphine to Bupivacaine and Butorphanol for Postoperative Analgesia in Lower Limb Orthopedic Surgery. Anesth Pain Med 2023; 13:e132686. [PMID: 37645004 PMCID: PMC10461383 DOI: 10.5812/aapm-132686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 02/06/2023] [Accepted: 02/24/2023] [Indexed: 08/31/2023] Open
Abstract
Background Postoperative analgesia is of utmost importance in the treatment of patients undergoing surgery. Good postoperative pain management reduces hospital stay and improves early ambulation. This study compared the efficacy of epidural bupivacaine with buprenorphine to butorphanol in lower limb orthopedic surgery. Objectives This study was carried out to investigate the onset of analgesia, the extent of analgesia, sedation score, and side effects of butorphanol with bupivacaine versus buprenorphine with bupivacaine. Methods In a clinical trial study, 100 patients who underwent elective orthopedic lower limb surgery were randomly allocated to two groups. A total of 100 patients with American Society of anesthesiologists grades I and II posted for lower limb orthopedic surgery were enrolled in this randomized, double-blind study. The patients were divided into groups A and B. Subarachnoid block was achieved with 3.4 mL of 0.5% bupivacaine. The pain was monitored by the visual analog scale postoperatively. The patients in group A received bupivacaine with buprenorphine, and group B received bupivacaine with butorphanol when they complained of pain in the postoperative period. The onset of analgesia, duration of analgesia, sedation score, and side effects were compared between the two groups. Results The onset of analgesia was observed earlier in group A than in group B (7.7 ± 1.6 vs. 12.6 ± 1.7 minutes, P < 0.001). The duration of analgesia was longer in group A than in group B (590 ± 40 vs. 480 ± 54 minutes, P < 0.001). Pulse rates and mean arterial pressures were significantly different (P < 0.001). Side effects were common in both groups. Conclusions Buprenorphine added to bupivacaine provides earlier onset and longer postoperative epidural analgesia than epidural butorphanol with bupivacaine.
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Affiliation(s)
- Sujay JN
- Department of Anesthesiology, Sri Siddhartha Medical College, Tumkur, India
| | - Prakash BC
- Department of Anesthesiology, Sri Siddhartha Medical College, Tumkur, India
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Nie Z, Cui X, Zhang R, Li Z, Lu B, Li S, Cao T, Zhuang P. Effectiveness of Patient-Controlled Intravenous Analgesia (PCIA) with Sufentanil Background Infusion for Post-Cesarean Analgesia: A Randomized Controlled Trial. J Pain Res 2022; 15:1355-1364. [PMID: 35573842 PMCID: PMC9091317 DOI: 10.2147/jpr.s363743] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 04/29/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose To investigate the effectiveness of sufentanil patient-controlled intravenous analgesia pump (PCIA) and background infusion in patients of post-cesarean analgesia. Patients and Methods This trial compared two groups of women undergoing cesarean section and receiving PCIA: no background infusion group (n=30), 6-min lockout time, and background infusion group (n=30), 2 mL/h infusion, 10-min lockout time. Both groups with 2 μg/kg sufentanil was diluted to 100 mL with normal saline. VAS scores at rest at 36 h was the primary endpoint. The secondary endpoints were the VAS scores at rest at 6, 12, and 24 h, the total amount of sufentanil consumed, the Ramsay sedation score (RSS) assessed at the same time points, postpartum bleeding within 24 h, the injection/attempt (I/A) ratio, BP and HR, PONV, side effects of sufentanil. Results Compared with the no background infusion group, the background infusion group showed lower VAS pain scores at 6, 12, and 24 h (P<0.01), but no differences at 36 h (95% CI = -0.5-0.8. P>0.05). Attempts, injections, and total sufentanil consumption were significantly different between the two groups (P<0.001), but without difference in I/A. Bleeding was less in the background infusion group at 1 h (P=0.03). The minimal respiration rates were not significantly different between groups. Conclusion Background infusion increased the total consumption of sufentanil within 36 h after cesarean section. Although it did not reduce uterine contraction pain and wound pain at 36 h, it significantly reduced the pain at 6, 12, and 24 h after cesarean section. It improved patient satisfaction and reduced the amount of bleeding after 1 h. Importantly, it did not increase the incidence of hypertension, PONV and respiratory depression.
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Affiliation(s)
- Zhongbiao Nie
- Pharmaceutical Department, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, 030012, People’s Republic of China
| | - Xianmei Cui
- Obstetrics Department, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, 030012, People’s Republic of China
| | - Ran Zhang
- Nephrology Department, Affiliated Hospital of Shanxi University of Traditional Chinese Medicine, Taiyuan, 030036, People’s Republic of China
| | - Zhihong Li
- Pharmaceutical Department, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, 030012, People’s Republic of China
| | - Bin Lu
- Anesthesiology Department, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, 030012, People’s Republic of China
| | - Suxian Li
- Pharmaceutical Department, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, 030012, People’s Republic of China
| | - Tao Cao
- Obstetrics Department, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, 030012, People’s Republic of China
| | - Ping Zhuang
- Anesthesiology Department, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, 030012, People’s Republic of China
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The efficacy of ultrasound-guided stellate ganglion block in alleviating postoperative pain and ventricular arrhythmias and its application prospects. Neurol Sci 2021; 42:3121-3133. [PMID: 34008041 DOI: 10.1007/s10072-021-05300-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 04/29/2021] [Indexed: 02/05/2023]
Abstract
Stellate ganglion block (SGB) has been applied in clinic for almost a century as a therapeutic procedure to alleviate pain-related syndromes and vascular deficits in the upper extremities. A great number of causative side effects and complications due to technological insufficiency and anatomical variations called for the popularity of ultrasound-guided SGB which has made tremendous contribution for clinical diagnosis and therapy, primarily in postoperative pain and cardiac and vascular disorders. This work was aimed at systematically summarizing the current clinical application of ultrasound-guided SGB and putting forward the potential prospective application in future. By searching ultrasound-guided SGB-related works on PubMed database, we mainly elucidated the analgesic effect of preoperative SGB in patients undergoing surgical procedures and substantial reduction in patients with ventricular arrhythmias. The volume of local anesthetics used in ultrasound-guided SGB has been diminished in the recent few years' investigations and successful operation of ultrasound-guided SGB could be achieved with minimal safe volume of local anesthetics. This invasive and safe procedure shows vast potential for future development in clinical treatment for autonomic nervous system and autoimmune disorders. We also put forward hypothesis that ultrasound-guided SGB could be applied combined with controlled hypotension to reduce the intraoperative complications in orthopedic surgery such as insufficiency of cerebral blood flow and reflexive tachycardia. Thus, it is of vital essence to improve the professional skills of physicians for the high rate of success and explore more effective measures which could enhance therapeutic effects when combined with ultrasound-guided SGB in alleviating misery of patients.
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Zhao W, Ma L, Wang J, Shi X. Retrospective Comparison of the Safety and Effectiveness of Dexmedetomidine Versus Standard of Care Before and During Cesarean Delivery in a Maternity Unit in Zhengzhou, China. Med Sci Monit 2020; 26:e925709. [PMID: 33097682 PMCID: PMC7592428 DOI: 10.12659/msm.925709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background The objective of the present study was to test the hypothesis that intravenous dexmedetomidine is safe and effective when administered to women before and during cesarean section. Material/Methods The analysis included 392 women who received spinal anesthesia and no analgesia prior to undergoing elective cesarean delivery. Of them, 115 women received dexmedetomidine before anesthesia and during delivery (DX cohort), 109 received normal saline before anesthesia and during delivery and dexmedetomidine after delivery (SC cohort), and 168 received normal saline only before anesthesia and during delivery (CN cohort). Data about the women’s consumption of sufentanil and ondansetron during hospitalization, onset of lactation, and hospital stays were retrospectively collected and analyzed. Results Most of the women in the study were primiparous (362/392). The women in the DX cohort received less sufentanil during their hospital stays than those in either of the other 2 cohorts (SC comparison: 151.45±11.15 μg vs. 175.12±25.15 μg, P<0.0001, q=8.776; CN comparison: 151.45±11.15 μg vs. 185.42±37.45 μg, P<0.0001, q=13.911). Also, the women in the DX cohort received less ondansetron before discharge and had shorter times to first lactation and hospital stays than those in the SC and CN cohorts. Conclusions Administering dexmedetomidine before spinal anesthesia appears to be safe and effective for women undergoing elective cesarean delivery.
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Affiliation(s)
- Wei Zhao
- Clinical Psychiatric Nursing, School of Nursing and Health, Zhengzhou University, Zhengzhou, Henan, China (mainland)
| | - Ling Ma
- Clinical Psychiatric Nursing, School of Nursing and Health, Zhengzhou University, Zhengzhou, Henan, China (mainland)
| | - Jingjing Wang
- Clinical Psychiatric Nursing, School of nursing and health, Zhengzhou University, Zhengzhou, China (mainland)
| | - Xiaoyan Shi
- Clinical Surgical Nursing, The General Surgery Ward of The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China (mainland)
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Hatefi M, Parvizi R, Borji M, Tarjoman A. Effect of Self-Management Program on Pain and Disability Index in Elderly Men with Osteoarthritis. Anesth Pain Med 2019; 9:e92672. [PMID: 31750095 PMCID: PMC6820295 DOI: 10.5812/aapm.92672] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 05/29/2019] [Accepted: 06/09/2019] [Indexed: 12/23/2022] Open
Abstract
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.
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Affiliation(s)
- Masoud Hatefi
- School of Medicine, Ilam University of Medical Sciences, Ilam, Iran
| | - Reza Parvizi
- Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Milad Borji
- Department of Nursing, Faculty of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Asma Tarjoman
- Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Corresponding Author: Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran. Tel: +98-9183404704,
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Effects of ultrasound guided ganglion stellate blockade on intraoperative and postoperative hemodynamic responses in laparoscopic gynecologic surgery. Wideochir Inne Tech Maloinwazyjne 2019; 15:351-357. [PMID: 32489497 PMCID: PMC7233162 DOI: 10.5114/wiitm.2019.89653] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 10/03/2019] [Indexed: 11/17/2022] Open
Abstract
Introduction Laparoscopic gynecologic surgery is one of the most well-known procedures. Pneumoperitoneum with carbon dioxide insufflation can cause unfavorable hemodynamic effects due to catecholamine and vasopressin release. Aim To examine the effects of stellate ganglion block on hemodynamic response and postoperative pain. Material and methods In a prospective double blinded randomized parallel study we included 40 patients with ASA physical status I and II, aged between 18 and 50 years with a gynecologic problem candidate for laparoscopic surgery under general anesthesia. The patients were randomly divided into two groups. Fifteen minutes before anesthesia induction, the patients underwent ultrasound guided stellate ganglion block with 10 ml of lidocaine 1% and the control group underwent stellate ganglion block using 10 ml of distilled water as placebo. After induction of general anesthesia, systolic and diastolic blood pressure and heart rate were recorded, especially after blowing of CO2 gas, the position change, depletion of CO2, and tracheal extubation in recovery. The postoperative pain was calculated using the visual analogue scale (VAS) at three times (0, 30, and 24 h after surgery). Results Our results showed that mean systolic and diastolic blood pressure and heart rate did not show any significant difference at the measurement times (p > 0.05), and mean VAS of patients in the two groups was significantly different for the three measurement times except 24 h after surgery (p < 0.05). Conclusions Stellate ganglion block before laparoscopic gynecologic surgery has no significant effect on intraoperative and postoperative hemodynamic responses; however, it can decrease VAS in the early postoperative period.
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Rahimzadeh P, Faiz SHR, Imani F, Soltani A, Derakhshan P. The Effect of Nitroglycerine Infusion on Postoperative Pain in Lower Limb Surgery: A Clinical Double-Blind Study. Anesth Pain Med 2019; 9:e93848. [PMID: 31754611 PMCID: PMC6825369 DOI: 10.5812/aapm.93848] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 07/07/2019] [Accepted: 08/13/2019] [Indexed: 01/19/2023] Open
Abstract
Background Acute postoperative pain causes severe discomfort in patients accompanied by hemodynamic and metabolic instability. Objectives The aim of this study was to evaluate the effects of nitroglycerin addition on the infusion of intravenous analgesia pump in patients with lower limb orthopedic surgery. Methods This study was a double-blind clinical trial conducted on 75 patients with lower limb fracture. Patients were randomly assigned to receive three regimens for postoperative pain control via intravenous analgesia pump, including group A (fentanyl 10mc/kg + 10 mL distilled water), B (fentanyl 10 mc/kg + nitroglycerin 500 mc), and C (fentanyl 10 mc/kg + nitroglycerin 1000 mc). The patients at the beginning of recovery and prior to putting the pain pump at the time of 4, 8, 12, 24, and 48 hours, were assessed with visual analogue scale (VAS) to measure pain and Ramsay scale to measure sedation. Results The results showed that weight, height, and gender distribution were not significantly different in the three groups. The HR, MAP, and VAS mean scores showed a significant difference for intragroup and intergroup differences in the three groups at many times. Conclusions Low dose nitroglycerine, as an adjuvant drug, can be added to intravenous patient-controlled analgesia pump in patients undergoing surgery for better analgesic purposes in patients without underlining disease.
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Affiliation(s)
- Poupak Rahimzadeh
- Pain Research Center, Iran University of Medical Sciences, Tehran, Iran
| | | | - Farnad Imani
- Pain Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Atoosa Soltani
- Pain Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Pooya Derakhshan
- Pain Research Center, Iran University of Medical Sciences, Tehran, Iran
- Corresponding Author: Assistant Professor of Anesthesiology, Pain Research Center, Iran University of Medical Sciences, Tehran, Iran.
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Rahimzadeh P, Faiz SHR, Hoseini M, Mousavie SH, Imani F, Negah AR. Comparison of intraperitoneal bupivacaine, acetazolamide, and placebo on pain relief after laparoscopic cholecystectomy surgery: A clinical trial. Med J Islam Repub Iran 2018; 32:112. [PMID: 30815407 PMCID: PMC6387819 DOI: 10.14196/mjiri.32.112] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2017] [Indexed: 01/04/2023] Open
Abstract
Background: Given the importance of patients' pain after laparoscopic surgeries, this study was conducted to compare the effectiveness of intraperitoneal bupivacaine, acetazolamide, and placebo on pain relief after laparoscopic cholecystectomy surgery. Methods: Patients admitted to Rasool Akram hospital with physical status I or II, based on the American Society of Anesthesiologists (ASA) system, who were candidates for laparoscopic cholecystectomy surgery due to gallstones, were included in this study. Patients were divided into 3 groups (each group containing 20 patients) using block randomization with foursome blocks. Group 1 received bupivacaine, group 2 acetazolamide, and group 3 intravenous saline as placebo. After surgery, pain score was assessed by visual analogue scale, and shoulder pain and analgesic doses were also measured. The mentioned parameters were assessed at 1, 4, 8, 12, and 24 hours after surgery. Results: In this study, 60 patients were included in 3 groups. The mean pain recorded (VAS) at 1, 4, and 8 hours after surgery was not significantly different between acetazolamide and bupivacaine groups, but their score was significantly lower than the placebo group (p<0.05). However, the score recorded at 12 and 24 hours after surgery was not significantly different between the 3 groups (p>0.05). Mean of pain reliever (acetaminophen) injected to the patients when needed was not significantly different among the 3 intervention groups (p<0.05). The highest prevalence of shoulder pain (70%) belonged to the placebo group and the lowest (25%) to acetazolamide (p<0.05). Mean heart rate, systolic blood pressure, diastolic blood pressure, and the respiratory rate were not significantly different among intervention groups in 1, 4, 8, 12, and 24 hours after surgery (p>0.05). Conclusion: According to the results, acetazolamide and bupivacaine injection reduced pain in early hours after laparoscopy. However, pain intensity was not different between intervention groups and the control group after 12 hours, so re-prescription seems to be appropriate at this time. Acetazolamide injection significantly reduces shoulder pains after surgery.
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Affiliation(s)
- Poupak Rahimzadeh
- Pain Research Center, Iran University of Medical Sciences, Tehran, Iran
| | | | - Mostafa Hoseini
- Rasool Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | | | - Farnad Imani
- Pain Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Reza Negah
- Rasool Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
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Comparison Between Ultrasound Guided Transversalis Fascia Plane and Transversus Abdominis Plane Block on Postoperative Pain in Patients Undergoing Elective Cesarean Section. IRANIAN RED CRESCENT MEDICAL JOURNAL 2018. [DOI: 10.5812/ircmj.67844] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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12
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Nie Y, Tu W, Shen X, Yu W, Yu Y, Song X, Wang S, Luo A, Cao M, Wu X, Huang S. Dexmedetomidine Added to Sufentanil Patient-Controlled Intravenous Analgesia Relieves the Postoperative Pain after Cesarean Delivery: A Prospective Randomized Controlled Multicenter Study. Sci Rep 2018; 8:9952. [PMID: 29967332 PMCID: PMC6028483 DOI: 10.1038/s41598-018-27619-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 06/06/2018] [Indexed: 11/09/2022] Open
Abstract
This study evaluated the efficacy and safety of dexmedetomidine in intravenous patient-controlled analgesia (PCA) after cesarean delivery. This multicenter study enrolled 208 subjects who were scheduled for selective cesarean delivery from 9 research centers. Patients received 0.5 ug/kg dexmedetomidine (study group) or normal saline (control group) after delivery and an intravenous PCA pump after surgery (100 μg sufentanil +300 μg dexmedetomidine for the study group, 100 μg sufentanil for the control group, background infusion: 1 ml/h, bolus dose: 2 ml and lock time: 8 min). The sufentanil consumption, pain scores, rescue analgesia, sedation scores, analgesic satisfaction, the incidence of postoperative nausea and vomiting (PONV) and the first passage of flatus were recorded within 24 h after surgery. The sufentanil consumption in the study group was significantly lower than that in the control group (p = 0.004). Compared with the control group, the study group had lower pain scores (p < 0.01), higher analgesic satisfaction degree [p < 0.001, odd ratio 4.28 and 95% CI (2.46, 7.46)], less requirement of rescue analgesia (p = 0.003), lower incidence of PONV (p = 0.005 and p < 0.001, respectively), and shorter time to first passage of flatus (p = 0.007). Dexmedetomidine added to sufentanil intravenous PCA significantly enhanced the analgesic effects, improved analgesic satisfaction, and had the potential benefits of reducing PONV and the recovery of intestinal functions after cesarean section.
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Affiliation(s)
- Yuyan Nie
- Department of Anaesthesiology, the Obstetrics and Gynecology Hospital of Fudan University, Shanghai, 200090, China
| | - Weifeng Tu
- Department of Anaesthesiology, General Hospital of Guangzhou Military Command of PLA, Guangzhou, 510010, China
| | - Xiaofeng Shen
- Department of Anaesthesiology, Nanjing Maternity and Child Care Hospital, Nanjing, 210000, China
| | - Weifeng Yu
- Department of Anaesthesiology, Renji Hospital Shanghai Jiaotong University School of Medicine, Shanghai, 200127, China
| | - Yonghao Yu
- Department of Anaesthesiology, Tianjin Medical University General Hospital, Tianjin, 300052, China
| | - Xingrong Song
- Department of Anaesthesiology, Guangzhou Women And Children's Medical Center, Guangzhou, 510623, China
| | - Shiduan Wang
- Department of Anaesthesiology, The Affiliated Hospital of Qingdao University, Qingdao, 266071, China
| | - Ailin Luo
- Department of Anaesthesiology, Tongji Medical College Huazhong University of Science & Technology, Wuhan, 430030, China
| | - Minghui Cao
- Department of Anaesthesiology, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, 510120, China
| | - Xinmin Wu
- Department of Anaesthesiology, Peking University First Hospital, Peking, 100034, China
| | - Shaoqiang Huang
- Department of Anaesthesiology, the Obstetrics and Gynecology Hospital of Fudan University, Shanghai, 200090, China.
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Haghighi M, Mardani-Kivi M, Mirbolook A, Tehran SG, Saheli NA, Hashemi-Motlagh K, Sahbe-Ekhtiari K. A Comparison between Single and Double Tourniquet Technique in Distal Upper Limb Orthopedic Surgeries with Intravenous Regional Anesthesia. THE ARCHIVES OF BONE AND JOINT SURGERY 2018; 6:63-70. [PMID: 29430498 PMCID: PMC5799603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 11/05/2017] [Indexed: 06/08/2023]
Abstract
BACKGROUND Several studies have put an effort to minimize the tourniquet pain and complications after conventional double tourniquet intravenous regional anesthesia (IVRA). We expressed in our hypothesis that an upper arm single wide tourniquet (ST) may serve a better clinical efficacy rather than the conventional upper arm double tourniquet (DT) in distal upper extremity surgeries. METHODS In this randomized controlled trial, 80 patients undergoing upper limb orthopedic surgeries were randomized into two groups. IVRA was administered using lidocaine in both groups. Tourniquet pain was recorded based on visual analogue scale (VAS). In case of pain (VAS>3) in the DT group, the proximal tourniquet was replaced with a distal tourniquet while fentanyl 50µg was injected in the ST group. The onset time of tourniquet pain, time to reach to maximum tourniquet pain and the amount of fentanyl consumption were compared between the two groups. RESULTS No significant difference was seen in demographic characteristics. The onset time of tourniquet pain (VAS=1) in the ST group (26.9±13.2 min) was longer than that of the DT group (13.8±4.8 min) (P<0.0001). The median of time to reach to maximum tourniquet pain (VAS>3) in DT and ST groups were 25 and 40 minutes, respectively; indicating that the patients in ST group reached to pain level at a significantly later time (P<0.0001). The total opioid consumption in the DT group (61 µg) was significantly lower than the ST group (102 µg) (P<0.0001); however, both groups were similar regarding fentanyl consumption before 40 minutes of surgeries. CONCLUSION It seems that in upper limb orthopedic surgeries with less than 40-minute duration, a single tourniquet may serve as a proper alternative opposed to the conventional double tourniquet technique.Level of evidence: II.
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Affiliation(s)
- Mohammad Haghighi
- Anesthesiology Research Center, Guilan University of Medical Sciences, Rasht, Iran Orthopedic Department, Guilan Road Trauma Research Center, Guilan University of Medical Sciences, Rasht, Iran Orthopedic Research Center, Guilan University of Medical Sciences, Rasht, Iran Anesthesiology Department, Anesthesiology Research Center, Guilan University of Medical Sciences, Rasht, Iran Guilan Road Trauma Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Mohsen Mardani-Kivi
- Anesthesiology Research Center, Guilan University of Medical Sciences, Rasht, Iran Orthopedic Department, Guilan Road Trauma Research Center, Guilan University of Medical Sciences, Rasht, Iran Orthopedic Research Center, Guilan University of Medical Sciences, Rasht, Iran Anesthesiology Department, Anesthesiology Research Center, Guilan University of Medical Sciences, Rasht, Iran Guilan Road Trauma Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Ahmadreza Mirbolook
- Anesthesiology Research Center, Guilan University of Medical Sciences, Rasht, Iran Orthopedic Department, Guilan Road Trauma Research Center, Guilan University of Medical Sciences, Rasht, Iran Orthopedic Research Center, Guilan University of Medical Sciences, Rasht, Iran Anesthesiology Department, Anesthesiology Research Center, Guilan University of Medical Sciences, Rasht, Iran Guilan Road Trauma Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Samaneh Ghazanfar Tehran
- Anesthesiology Research Center, Guilan University of Medical Sciences, Rasht, Iran Orthopedic Department, Guilan Road Trauma Research Center, Guilan University of Medical Sciences, Rasht, Iran Orthopedic Research Center, Guilan University of Medical Sciences, Rasht, Iran Anesthesiology Department, Anesthesiology Research Center, Guilan University of Medical Sciences, Rasht, Iran Guilan Road Trauma Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Nasim Ashouri Saheli
- Anesthesiology Research Center, Guilan University of Medical Sciences, Rasht, Iran Orthopedic Department, Guilan Road Trauma Research Center, Guilan University of Medical Sciences, Rasht, Iran Orthopedic Research Center, Guilan University of Medical Sciences, Rasht, Iran Anesthesiology Department, Anesthesiology Research Center, Guilan University of Medical Sciences, Rasht, Iran Guilan Road Trauma Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Keyvan Hashemi-Motlagh
- Anesthesiology Research Center, Guilan University of Medical Sciences, Rasht, Iran Orthopedic Department, Guilan Road Trauma Research Center, Guilan University of Medical Sciences, Rasht, Iran Orthopedic Research Center, Guilan University of Medical Sciences, Rasht, Iran Anesthesiology Department, Anesthesiology Research Center, Guilan University of Medical Sciences, Rasht, Iran Guilan Road Trauma Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Khashayar Sahbe-Ekhtiari
- Anesthesiology Research Center, Guilan University of Medical Sciences, Rasht, Iran Orthopedic Department, Guilan Road Trauma Research Center, Guilan University of Medical Sciences, Rasht, Iran Orthopedic Research Center, Guilan University of Medical Sciences, Rasht, Iran Anesthesiology Department, Anesthesiology Research Center, Guilan University of Medical Sciences, Rasht, Iran Guilan Road Trauma Research Center, Guilan University of Medical Sciences, Rasht, Iran
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Imantalab V, Mirmansouri A, Mohammadzadeh Jouryabi A, Naderi Nabi B, Kanani G, Nassiri Sheikhani N, Atrkarroushan Z, Ghazanfar Tehran S, Samadpour N. Comparing the Effectiveness of Patient Control Analgesia Pump and Bolus Morphine in Controlling Pain After Cardiopulmonary Bypass Graft Surgery. Anesth Pain Med 2017; 7:e12756. [PMID: 29696108 PMCID: PMC5903217 DOI: 10.5812/aapm.12756] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 05/07/2017] [Accepted: 08/19/2017] [Indexed: 12/27/2022] Open
Abstract
Background Postoperative pain is a complex process commonly caused by surgical trauma. It is one of the major concerns of patients undergoing heart surgery. Despite new techniques and modern analgesic treatments, postoperative pain is still one of the most important controversial issues. Methods 68 patients scheduled for elective CABG with CPB were included in a prospective, double-blind clinical trial. They were randomly divided into two groups. One group received PCA pump including morphine (group P) with underlying infusion of 0.02 mg/kg/Qh, bolus dose of 1 mg, lockout time of 15 minutes, and a maximum of 4 bolus of 0.02 mg/kg for one hour and the other group received morphine bolus (group B). Three patients were excluded from the study, and 33 and 32 patients participated in the groups P and B, respectively. Variables including age, gender, pump time, aortic clamp time, duration of surgery, complications (nausea and vomiting, GI Bleeding, and hypoxia), level of pain based on VAS, opioid consumption, hemodynamic, and sedation status were measured in both groups. Results There was no significant difference between the groups regarding age, gender, pump time, clamp time, duration of surgery, complication, sedation score, and hemodynamic status in most of the assessment periods. By assessing the pain severity in the groups at different periods, results showed a significant difference between the groups except at enrollment, and a lower severity of pain was noted in the group P compared to the group B. The consumed opioid was significantly higher in the group P than in the group B. However, higher doses of diclofenac and paracetamol were administered in the group B compared to the group P. Conclusions Results showed that higher morphine would be used in patients with PCA pump after extubation following heart surgery, and this increased dose of opioid was associated with better pain control and lack of complication. Therefore, PCA pump with underlying infusion could be effectively used in patients undergoing CABG that are directly assessed in intensive care unite.
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Affiliation(s)
- Vali Imantalab
- Associate Professor of Anesthesiology, Fellowship of Anesthesia in Cardiac Surgery, Anesthesiology Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Ali Mirmansouri
- Associate Professor of Anesthesiology, Fellowship of Anesthesia in Cardiac Surgery, Anesthesiology Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Ali Mohammadzadeh Jouryabi
- Associate Professor of Anesthesiology, Fellowship of Anesthesia in Cardiac Surgery, Anesthesiology Research Center, Guilan University of Medical Sciences, Rasht, Iran
- Corresponding author: Ali Mohammadzadeh Jouryabi, Anesthesiology Research Center, Guilan University of Medical Sciences, Rasht, Iran. Tel: +98-9111311510, E-mail:
| | - Bahram Naderi Nabi
- Associate Professor of Anesthesiology, Fellowship of Anesthesia and Pain (FIPP), Anesthesiology Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Gholamreza Kanani
- Assistant Professor of Cardiac Surgery, Department of Cardiac Surgery, Guilan University of Medical Sciences, Rasht, Iran
| | - Nassir Nassiri Sheikhani
- Assistant Professor of Cardiac Surgery, Department of Cardiac Surgery, Guilan University of Medical Sciences, Rasht, Iran
| | - Zahra Atrkarroushan
- Assistant Professor of Biostatistics, Guilan University of Medical Sciences, Rasht, Iran
| | - Samaneh Ghazanfar Tehran
- Assistant Professor of Anesthesiology, Anesthesiology Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Nastaran Samadpour
- Resident of Anesthesia, Anesthesiology and Critical Care Research Center, Guilan University of Medical Sciences (GUMS), Rasht, Iran
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Olapour AR, Mohtadi AR, Soltanzadeh M, Ghomeishi A, Akhondzadeh R, Jafari M. The Effect of Intravenous Magnesium Sulfate Versus Intravenous Sufentanil on the Duration of Analgesia and Postoperative Pain in Patients with Tibia Fracture. Anesth Pain Med 2017; 7:e44035. [PMID: 28920052 PMCID: PMC5594416 DOI: 10.5812/aapm.44035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 01/11/2017] [Accepted: 01/31/2017] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND In the recent decades controlling postoperative pain has become a popular topic as it leads to the patients' wellbeing and improved life quality, while it reduces the costs for both patients and medical facilities. OBJECTIVES This study aimed at comparing intravenous magnesium sulfate versus intravenous sufentanil on the duration of analgesia and postoperative pain in patients undergoing tibia fracture surgery. METHODS This double blind clinical trial study was performed on 70 candidates of tibia fractures between the ages of 18 and 55 years with American society of anesthesiologists (ASA) class I and II. The patients were randomly divided to 2 groups, 1 receiving magnesium sulfate (M) and another receiving sufentanil (S). Both of the groups underwent spinal anesthesia with 10 mg bupivacaine 0.5%. One hour after ensuring the sensorimotor blockade, in the S group 0.1 µg/kg/hour and in the M group 8 mg/kg/hour was diluted in 1 liter of Ringer's solution and infused. In this study, full weakness of the lower limb was considered as the sign of sensorimotor blockade initiation. The postoperative pain intensity was measured using the Visual Analog Scale (VAS), 0, 1, 4, 8, 16, and 24 hours after the end of anesthesia duration. In case of VAS ≥ 3, the patients received 0.3 mg/kg pethidine, intravenously. At last, the time of requesting the first narcotic drug and the total usage of pethidine were recorded. RESULTS AND CONCLUSIONS Sufentanil was found to be more effective than magnesium sulfate in reducing postoperative pain and the time of first narcotics request was later in patients receiving sufentanil (P < 0.05).
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Affiliation(s)
- Ali Reza Olapour
- Assistant Professor, Department of Anesthesiology, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Ahmad Reza Mohtadi
- Assistant Professor, Department of Anesthesiology, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mansour Soltanzadeh
- Full Professor, Department of Anesthesiology, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Ali Ghomeishi
- Assistant Professor, Department of Anesthesiology, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Reza Akhondzadeh
- Associate Professor, Department of Anesthesiology, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Corresponding author: Reza Akhondzadeh, Department of Anesthesiology, Pain Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. Tel/Fax: +98-6112220168, E-mail: ;
| | - Maryam Jafari
- Anesthesiologist, Department of Anesthesiology, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Farzi F, Mirmansouri A, Naderi Nabi B, Atrkar Roushan Z, Ghazanfar Tehran S, Nematollahi Sani M, Makhlooghi Azad S, Nemati M. Comparing the Effect of Adding Fentanyl, Sufentanil, and Placebo with Intrathecal Bupivacaine on Duration of Analgesia and Complications of Spinal Anesthesia in Patients Undergoing Cesarean Section. Anesth Pain Med 2017; 7:e12738. [PMID: 29696107 PMCID: PMC5903220 DOI: 10.5812/aapm.12738] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 05/07/2017] [Accepted: 08/07/2017] [Indexed: 01/21/2023] Open
Abstract
Background Spinal anesthesia is the method of choice for most elective and emergency Cesarean sections. To increase the duration of anesthesia and improve the quality of analgesia during and after surgery, intrathecal opioids, as adjuvant drugs, are used in combination with local anesthetics. Methods This was a double-blind clinical trial performed on 99 patients. Women were divided into 3 groups of fentanyl, sufentanil, and placebo. For fentanyl group, 12.5 mg of bupivacaine and 25 micrograms of fentanyl; for sufentanil group, 12.5 mg of bupivacaine and 2.5 micrograms of sufentanil; and for placebo group, 12.5 mg of bupivacaine and a half mL of normal saline were injected in subarachnoid space. The sensory and motor block, hemodynamic status (mean blood pressure and heart rate), and probable complications were assessed. Results There was no significant difference between the groups in demographic characteristics. Durations of analgesia were, respectively, 314 ± 42.95, 312.5 ± 34.44, and 116.1 ± 42.24 minutes in the fentanyl, sufentanil, and placebo groups (P = 0.0001). Duration of sensory and motor block was higher in fentanyl and sufentanil groups compared with the placebo group. The highest duration of sensory and motor block was noted in sufentanil group (P = 0.0001). No significant difference was found between the groups in the hemodynamic parameters (P > 0.05). The frequency of itching in the fentanyl group was higher than sufentanil and placebo groups (P = 0.003). Also, shivering was higher in the placebo group compared with other groups (P = 0.036). Conclusions According to the results, adding 25 microgram fentanyl or 2.5 microgram sufentanil to intrathecal bupivacaine increased the duration of analgesia and provided hemodynamic stability with no major complication. As administering intrathecal fentanyl had a similar duration of analgesia like sufentanil with faster return of motor block and ambulation, it seems that it is a preferred additive for Cesarean section surgery.
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Affiliation(s)
- Farnoush Farzi
- Associate Professor of Anesthesiology, Anesthesiology Research Center, Department of Anesthesiology, Alzahra Hospital, Guilan University of Medical Sciences (GUMS), Rasht, Iran
| | - Ali Mirmansouri
- Associate Professor of Anesthesiology, Anesthesiology Research Center, Department of Anesthesiology, Heshmat Hospital, Guilan University of Medical Sciences (GUMS), Rasht, Iran
- Corresponding author: Ali Mirmansouri, MD, Anesthesiology Research Center, Guilan University of Medical Sciences, Rasht, Iran. Tel: +98-9111315314, E-mail:
| | - Bahram Naderi Nabi
- Associate Professor of Anesthesiology, Anesthesiology Research Center, Department of Anesthesiology, Poursina Hospital, Guilan University of Medical Sciences (GUMS), Rasht, Iran
| | - Zahra Atrkar Roushan
- Assistant Professor of Statistics, Department of Statistics, Guilan University of Medical Sciences (GUMS), Rasht, Iran
| | - Samaneh Ghazanfar Tehran
- Assistant Professor of Anesthesiology, Anesthesiology Research Center, Department of Anesthesiology, Alzahra Hospital, Guilan University of Medical Sciences (GUMS), Rasht, Iran
| | - Mona Nematollahi Sani
- Resident of Anesthesia, Anesthesiology Research Center, Guilan University of Medical Sciences (GUMS), Rasht, Iran
| | - Soodabe Makhlooghi Azad
- Resident of Anesthesia, Anesthesiology Research Center, Guilan University of Medical Sciences (GUMS), Rasht, Iran
| | - Maryam Nemati
- Resident of Anesthesia, Anesthesiology Research Center, Guilan University of Medical Sciences (GUMS), Rasht, Iran
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Kızılcık N, Özler T, Menda F, Uluçay Ç, Köner Ö, Altıntaş F. The effects of intra-articular levobupivacain versus levobupivacain plus magnesium sulfate on postoperative analgesia in patients undergoing arthroscopic meniscectomy: A prospective randomized controlled study. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2017; 51:104-109. [PMID: 28314555 PMCID: PMC6197358 DOI: 10.1016/j.aott.2017.02.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 06/14/2016] [Accepted: 09/15/2016] [Indexed: 01/31/2023]
Abstract
Objective The aim of this study was to compared the effectiveness of intraarticular levobupivacain with levobupivacain and magnesium sulfate. Methods In this prospective randomized double blinded study, 96 patients (67 male, 29 female; age range: 18–65 years) with ASA (American Society of Anesthesiologist) score I and II, who had undergone arthroscopic meniscectomy operation, were divided to 3 groups that had postoperative analgesia with intra-articular saline injection (control group), levobupivacain injection (L group) or levobupivacain and magnesium sulfate injection (LM group). Patients were compared with postoperative VAS (Visual Analog Score) score during rest and activity, opioid analgesic need, non-opioid analgesic need and other medication needs. Results Postoperative VAS scores during rest and activation at early postoperative period were significantly lower at LM group when compared with L group and lower than control group at all time periods. Opioid analgesic need, non-opioid analgesic need and other medication needs for non-pain symptoms were lower at LM group when compared with L and control groups at all time periods. Conclusion Intraarticular magnesium sulfate plus Levobupivacain injection is a safe and effective method for post operative pain management after arthroscopic meniscectomy. Keywords: Intra-articular injection, Magnesium sulfate, Levobupivacain, Postoperative analgesia, Chondrocyte apoptosis, Pain management, Arthroscopic menisectomy Level of Evidence Level I, Therapeutic study
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Affiliation(s)
| | - Turhan Özler
- Yeditepe University Faculty of Medicine, Turkey.
| | - Ferdi Menda
- Yeditepe University Faculty of Medicine, Turkey
| | | | - Özge Köner
- Yeditepe University Faculty of Medicine, Turkey
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Sedighinejad A, Imantalab V, Mirmansouri A, Naderi Nabi B, Tarbiat M, Sadeghi AM, Nassiri Sheikhani N, Haghighi M, Sayahe Varag Z. Comparing the Effects of Isoflurane-Sufentanil Anesthesia and Propofol-Sufentanil Anesthesia on Serum Cortisol Levels in Open Heart Surgery with Cardiopulmonary Bypass. Anesth Pain Med 2016; 6:e42066. [PMID: 28975079 PMCID: PMC5560634 DOI: 10.5812/aapm.42066] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Revised: 10/13/2016] [Accepted: 11/05/2016] [Indexed: 12/19/2022] Open
Abstract
Background Major surgeries such as open-heart surgery with cardiopulmonary bypass are associated with a complexity of stress response leading to post-operative complications. Studies have confirmed that anesthesia can mitigate the surgically induced stress response. Objectives The aim of this study was to compare the effects of propofol and isoflurane, both supplemented with Sufentanil, on the stress response in coronary artery bypass graft surgery with cardiopulmonary bypass, using cortisol as a biochemical marker. Methods This double-blind randomized clinical trial was conducted on 72 patients who underwent coronary artery bypass grafting (CABG) with cardiopulmonary bypass meeting the inclusion criteria. The subjects were randomly divided into two groups of isoflurane (n = 36) and propofol (n = 36) both supplemented with sufentanil. Serum cortisol levels were measured and compared between the groups; 30 minutes before the surgery (T0), at the end of the cardiopulmonary bypass (T1), and 24 hours after the surgery (T2). Results Compared to the baseline (T0), at the end of cardiopulmonary bypass (T1), both groups demonstrated a decrease in plasma cortisol levels with no statistical significant difference (P = 0.4). At T2 measuring time point, the level of plasma cortisol significantly increased in both groups (P = 0.02), however this increase was less in the Isoflurane group. Conclusions In CABG with cardiopulmonary bypass, using plasma cortisol level as a measure, Isoflurane-Sufentanil significantly reduces the stress response to the surgery, when compared to propofol-Sufentanil.
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Affiliation(s)
- Abbas Sedighinejad
- Associate Professor of Anesthesiology, Fellowship of Anesthesia in Cardiac Surgery, Anesthesiology Research Center, Guilan University of Medical Sciences (GUMS), Rasht, Iran
| | - Vali Imantalab
- Associate Professor of Anesthesiology, Fellowship of Anesthesia in Cardiac Surgery, Anesthesiology Research Center, Guilan University of Medical Sciences (GUMS), Rasht, Iran
- Corresponding author: Vali Imantalab, MD, Anesthesiology Research Center, Guilan University of Medical Sciences, Rasht, Guilan, Iran. Tel: +98-9111316138, E-mail:
| | - Ali Mirmansouri
- Associate Professor of Anesthesiology, Fellowship of Anesthesia in Cardiac Surgery, Anesthesiology Research Center, Guilan University of Medical Sciences (GUMS), Rasht, Iran
| | - Bahram Naderi Nabi
- MD, Associate Professor of Anesthesiology, Fellowship of Anesthesia and Pain (FIPP), Anesthesiology Department, Anesthesiology Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Masoud Tarbiat
- Associate Professor of Anesthesiology, Fellowship of Anesthesia in Cardiac Surgery, Anesthesiology Research Center, Guilan University of Medical Sciences (GUMS), Rasht, Iran
| | - Ali Mohammad Sadeghi
- Department of Cardiology, Assistant Professor of Cardiac Surgery, Guilan University of Medical Sciences, Rasht, Iran
| | - Nassir Nassiri Sheikhani
- Department of Cardiology, Assistant Professor of Cardiac Surgery, Guilan University of Medical Sciences, Rasht, Iran
| | - Mohammad Haghighi
- Associate Professor of Anesthesiology, Anesthesiology Research Center, Guilan University of Medical Sciences (GUMS), Rasht, Iran
| | - Zahra Sayahe Varag
- Department of Anesthesiology, Anesthesiology Research Center, Guilan University of Medical Sciences, Rasht, Iran
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Etezadi F, Aklamli M, Najafi A, Khajavi M, Shariat Moharari R, Mirrahimi B, Mortazavi SA, Mojtahedzadeh M. Evaluation of the anti-inflammatory effects of peri-operative infusion of magnesium sulfate on the microsurgical procedures for intracranial tumors. Anesth Pain Med 2015; 4:e22379. [PMID: 25798379 PMCID: PMC4358335 DOI: 10.5812/aapm.22379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Revised: 08/20/2014] [Accepted: 08/27/2014] [Indexed: 11/16/2022] Open
Abstract
Background: The anti-inflammatory properties of magnesium sulfate have never been discussed in brain tumor surgeries. Objectives: This study is aimed to find anti-inflammatory aspects of high dose magnesium sulfate infusion during perioperative period of neurosurgical patients through checking the serial C-reactive protein (CRP) blood levels as a biomarker of inflammation. Patients and Methods: Sixty patients who were candidate for elective craniotomy were enrolled randomly into two equal groups to receive either magnesium sulfate or normal saline during their perioperative period. Infusion of magnesium was performed three times during the study and a summation of 15 grams was administered: 1- two days before surgery, 2- one day before surgery, 3- from the beginning of surgery (five grams was infused within six hours in each session). Serum level of CRP was checked just before commencement of magnesium infusion and on the first and second day after surgery as primary outcome. Hemodynamic parameters, total propofol requirement and total blood loss were recorded as well. Results: No significant difference was found between groups in terms of serum CRP levels. The mean arterial blood pressure, heart rate, blood loss and total anesthetic requirement were significantly lower in magnesium group in comparison to the control group. Conclusions: We did not find conclusive evidence for anti-inflammatory effects of magnesium in craniotomy for microsurgery of intracranial tumors using CRP level changes. However, high dose magnesium might be suggested as a safe anesthetic adjuvant in neurosurgery.
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Affiliation(s)
- Farhad Etezadi
- Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Majid Aklamli
- Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Atabak Najafi
- Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Khajavi
- Sina Trauma and Surgery Research Center, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Corresponding author: Mohammadreza Khajavi, Sina Trauma and Surgery Research Center, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. Tel: +98-9123837096, Fax: +98-2166348551, E-mail:
| | | | - Bahador Mirrahimi
- Pharmaceutical Sciences Research Centre, Faculty of Pharmacy, Tehran University of Medical Sciences, Teheran, Iran
| | | | - Mojtaba Mojtahedzadeh
- Pharmaceutical Sciences Research Centre, Faculty of Pharmacy, Tehran University of Medical Sciences, Teheran, Iran
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