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Moradi Farsani D, Mortazavi SAA, Masjedi S, Heidari SM, Nazemroaya B. Comparison between the Effects of Acetaminophen, Dexmedetomidine, and Normal Saline Infusion on Pain Severity after Cataract Surgery. Adv Biomed Res 2022; 11:71. [PMID: 36325174 PMCID: PMC9621349 DOI: 10.4103/abr.abr_254_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 04/14/2021] [Accepted: 10/20/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Cataract surgery is one of the most common eye surgeries, which is currently performed under topical anesthesia using sedative medications. Dexmedetomidine and acetaminophen are good candidates for analgesia in other circumstances, however, this study aimed to evaluate the effect of dexmedetomidine or acetaminophen infusion and normal saline (NS) alone compared with the control group on the severity of pain in cataract surgery. MATERIALS AND METHODS In this parallel randomized controlled clinical trial, the effect of dexmedetomidine or acetaminophen infusion and NS on level of pain, vital signs, recovery status, and surgeon satisfaction during cataract surgery were assessed. One hundred and thirty-five patients between the age of 50-80 years undergoing cataract surgery were recruited on a consecutive basis and randomized into three groups receiving acetaminophen (15 mg/kg), dexmedetomidine (0.5 μgr/kg), and NS. Baseline vital signs, blood pressure, arterial oxygen saturation, respiratory and heart rate at certain time-points including the start of surgery, 5, 10, and 15 min after surgery, after arrival to the recovery room, 20, 40, 60 min after recovery were measured. Pain intensity and drugs side effects were also recorded after surgery. RESULTS Level of respiratory depression was higher in patients receiving dexmedetomidine. Heart rate and oxygen saturation percentage had no significant differences in the three groups as well as pain intensity. CONCLUSIONS Acetaminophen was as effective as dexmedetomidine with lower side effects and higher surgeons' satisfaction, without any interference with cardiovascular and respiratory parameters. Acetaminophen infusion should be considered as an acceptable analgesic drug for cataract surgery.
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Affiliation(s)
- Dariush Moradi Farsani
- Department of Anesthesiology, Al-Zahra Medical Center, Isfahan University of Medical Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Seyed Ali-Akbar Mortazavi
- Department of Ophthalmology, Isfahan Eye Research Center, Isfahan University of Medical Sciences, Isfahan, Iran,Address for correspondence: Dr. Seyed Ali-Akbar Mortazavi, Department of Ophthalmology, Isfahan Eye Research Center, Isfahan University of Medical Sciences, Isfahan, Iran. E-mail:
| | - Sanaz Masjedi
- Department of Anesthesiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Sayed Morteza Heidari
- Department of Anesthesiology, Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Behzad Nazemroaya
- Department of Anesthesiology, Al-Zahra Medical Center, Isfahan University of Medical Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
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Hashemi M, Dadkhah P, Taheri M, Momenzadeh S, Parsa T, Hosseini B, Abbasian M. Unilateral Epidural Blockade for Lower Limb Fracture Surgery: Parasagittal Epidural Versus Midline Epidural Anesthesia. Bull Emerg Trauma 2019; 7:150-155. [PMID: 31198804 PMCID: PMC6555211 DOI: 10.29252/beat-070210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Objective: To compare the efficacy of parasagittal interlaminar (PIL) and midline interlaminar (MIL) approaches for epidural block in patients with lower limb orthopedic surgery. Methods: This double-blind randomized clinical trial was performed on 40 patients undergoing tibial shaft fracture surgery. In PIL group, an 18-gauge, 3.5 inch, Tuohy needle was placed at the level of L2-3 or L3-4 intervertebral spaces and pushed forward in a posteroanterior (PA) direction vertical to the body surface. After determining the most lateral place for needle arrival in an anteroposterior (AP) view, needle was pushed forward into the epidural space. For the MIL group, needle was pushed forward from the midline interspinous space with the same method. After confirmation of needle position, 1 mL of contrast was injected to confirm the epidural space distribution and then 15 ml lidocaine 2% was injected. The sensory and motor block level, onset, duration, heart rate (HR), mean arterial pressure (MAP), and arterial oxygen saturation (SPO2), and success rate were recorded. Results: Mean patients’ baseline characteristics showed no statistically significant difference between the two groups.p>0.05). Outcome measures were statistically different and significantly higher in PIL group (p-values for sensory block level <0.001, motor block level <0.001, duration of sensory block: <0.001 and duration of motor block <0.001 and success rate: <0.001). Hemodynamic variables didn’t show statistically significant difference between the two groups (p-values for Systolic pressure: 0.997, diastolic pressure:0.579, MAP:0.585, HR:0.710). Conclusion: Epidural anesthesia with parasagittal interlaminar approach provide deep motor block, high sensory level block, and hemodynamic stability. Clinical trial registry: IRCT2017041615515N2
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Affiliation(s)
- Masoud Hashemi
- Department of Anesthesiology and Pain, Akhtar Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Payman Dadkhah
- Department of Anesthesiology and Pain, Labbafi Nejad Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehrdad Taheri
- Department of Anesthesiology and Pain, Imam-Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sirous Momenzadeh
- Department of Anesthesiology and Pain, Akhtar Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Tahereh Parsa
- Department of Anesthesiology and Pain, Masih-Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Behnam Hosseini
- Department of Anesthesiology and Pain, Akhtar Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Abbasian
- Department of Orthopedic Surgery, Akhtar Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Banerjee U, Hagan K, Bhavsar S, Grasu R, Dang A, McCutcheon IE, Suarez M, Gottumukkala V, Cata JP. Association between intravenous acetaminophen and reduction in intraoperative opioid consumption during transsphenoidal surgery for pituitary tumors. J Anaesthesiol Clin Pharmacol 2018; 34:465-471. [PMID: 30787509 PMCID: PMC6360881 DOI: 10.4103/joacp.joacp_276_17] [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] [Indexed: 11/04/2022] Open
Abstract
Background and Aims Pain during and after transsphenoidal surgeries originates from stimulation of branches of the trigeminal cranial nerve that supply the inner aspect of the nose cavity and dura mater. Thereby, patients undergoing transsphenoidal surgery may require moderate-to-large amounts of analgesics including opioids. Intravenous acetaminophen provides analgesia and reduces opioid consumption for a wide variety of surgeries. We hypothesized that the use of intravenous acetaminophen is associated with a reduction in intraoperative opioid consumption and provides significant analgesia during and after transsphenoidal surgery. Material and Methods This retrospective study included 413 patients who underwent transsphenoidal surgery for pituitary adenomas. The primary outcome of this study was intraoperative opioid consumption. Secondary outcomes included pain intensity, Richmond Agitation Sedation Scale scores, and nausea and vomiting upon arrival to postoperative anesthesia care unit. Patients were divided into two groups based on the intraoperative acetaminophen use. A prospensity score matching analysis was used to balance for important variables between the two groups of treatment. Regression models were fitted after matching the covariates. A P < 0.05 was considered statistically significant. Results After matching, 126 patients were included in each group of treatment. Patients in the acetaminophen group required significantly less amount (a decrease by 14.9%) of opioids during surgery than those in the non-acetaminophen group. Postoperative pain, postoperative nausea and vomiting, and sedation scores were not significantly different between patients who received intravenous acetaminophen and those who did not. Conclusion Intravenous acetaminophen is associated with a reduction in intraoperative opioids during transsphenoidal pituitary surgery.
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Affiliation(s)
- Upasana Banerjee
- Anesthesiology and Surgical Oncology Research Group, Houston, Texas, USA.,School of Biomedical Informatics, The University of Texas Health Science Center, Houston, Texas, USA
| | - Katherine Hagan
- Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Shreyas Bhavsar
- Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Roxana Grasu
- Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Anh Dang
- Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ian E McCutcheon
- Anesthesiology and Surgical Oncology Research Group, Houston, Texas, USA.,Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Miguel Suarez
- Anesthesiology and Surgical Oncology Research Group, Houston, Texas, USA.,Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Vijaya Gottumukkala
- Anesthesiology and Surgical Oncology Research Group, Houston, Texas, USA.,Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Juan P Cata
- Anesthesiology and Surgical Oncology Research Group, Houston, Texas, USA.,Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Colburn JL, Mohanty S, Burton JR. Surgical Guidelines for Perioperative Management of Older Adults: What Geriatricians Need to Know. J Am Geriatr Soc 2017; 65:1339-1346. [PMID: 28323335 DOI: 10.1111/jgs.14877] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
A multidisciplinary panel of experts representing surgery, anesthesia, and geriatrics recently published guidelines for surgeons on the optimal perioperative management of older adults, including recommendations on postoperative recovery and posthospital transitions of care. Geriatricians have an important role in the care for older adults in the preoperative period as older adults consider surgical options and prepare for surgical procedures, during the perioperative period as inpatient consultants, and in the postoperative period as older adults transition to rehabilitation facilities or to home. This article outlines the perioperative surgical guidelines and describes how they apply to the role of the geriatrician in the care of older adults during the perioperative period.
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Affiliation(s)
- Jessica L Colburn
- Division of Geriatric Medicine and Gerontology, School of Medicine, The Johns Hopkins University, Baltimore, Maryland
| | - Sanjay Mohanty
- Department of Surgery, Henry Ford Hospital, Detroit, Michigin
| | - John R Burton
- Division of Geriatric Medicine and Gerontology, School of Medicine, The Johns Hopkins University, Baltimore, Maryland
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