Comparing Apotel and Remifentanil for Multimodal Patient-Controlled Analgesia in Postoperative Pain Management Following Total Knee Arthroplasty Surgery: A Randomized Controlled Trial.

Background: Total knee arthroplasty (TKA) is a standard surgical procedure for individuals with debilitating knee arthritis. Effective postoperative pain management is essential for successful recovery, although traditional opioid-based methods have limitations. Objectives: This study aimed to compare the efficacy of Apotel and remifentanil patient-controlled analgesia in managing postoperative pain after TKA. Methods: This double-blind, randomized, controlled clinical trial took place at Amir-al-Momenin and Qods Hospitals in Arak, Iran, spanning from June 2022 to September 2023. Sixty-two eligible patients scheduled for knee joint replacement were randomly assigned to receive either Apotel (Group A) or remifentanil (Group R) as part of multimodal analgesia administered via a pain pump for postoperative pain relief in TKA. The study assessed hemodynamic parameters, pain levels (measured using the Visual Analog Scale), analgesic duration, and narcotic consumption. Statistical analyses were performed using SPSS v.27 and Plotly. Results: Subjects exhibited no statistically significant differences in age, gender distribution, duration of surgery, or anesthesia. The hemodynamic status assessment in the recovery room showed no significant differences in SPO2, PR, or MAP between the groups. However, remifentanil demonstrated superior effectiveness in reducing pain over 24 hours post TKA surgery compared to Apotel, as evidenced by lower average Visual Analog Scale (VAS) scores (P < 0.001), longer duration without the need for narcotic painkillers (P < 0.001), and lower cumulative opioid analgesic consumption in Group R (P < 0.001). Conclusions: Remifentanil demonstrates superior pain control in a multimodal pain management approach compared to Apotel, providing sustained pain reduction over 24 hours post-surgery. Moreover, remifentanil offers longer-lasting pain relief and results in lower cumulative narcotic painkiller consumption compared to Apotel.

The effect of dexmedetomidine, remifentanil and metoral in reducing patient bleeding during rhinoplasty surgery.

INTRODUCTION: Rhinoplasty is one of the most common surgeries in the ENT department. Rhinoplasty hemorrhage is one of the complications that different strategies have been used to reduce it. Reduction of bleeding reduces the risk of complications such as hemolytic and non-hemolytic reactions, acute lung damage, viral and bacterial infections, hypothermia and coagulation disorders. Therefore, the aim of this study was to compare the effect of dexmedetomidine, remifentanil and metoral in reducing patient bleeding during rhinoplasty surgery. MATERIALS AND METHODS: This randomized, double-blind trial was performed on rhinoplasty patients. Rhinoplasty candidates who had the inclusion and exclusion criteria were divided into three groups of remifentanil, metoral and dexmedetomidine according to the random number table. Then 0.5 mg/kg/h of dexmedetomidine in the first group was administered, followed by 100-150 kg/h remifentanil in the second group and 50 mg metoral in the third group. Mean blood pressure, heart rate, mean bleeding and surgeon satisfaction were recorded in designed form. Data were analyzed by Spss-22 software. RESULTS: The mean blood pressure of patients in remifentanil group was lower than the other two groups (P = 0.03). In all three times during surgery, recovery and overall time, the amount of bleeding in the remifentanil group was found to be less than the other two groups. Furthermore, the rate of bleeding in the dexmedetomidine group was found to be less than the metoral group (P = 0.03, P = 0.02). The surgeon's satisfaction score in the remifentanil group was higher than the other two groups. Satisfaction score was higher in dexmedetomidine group than metoral group (P = 0.03). The recovery time in the metoral group was shorter than the other two groups (P = 0.02). CONCLUSION: Remifentanil caused a good and appropriate reduction of blood pressure in rhinoplasty surgery, causing less bleeding and higher satisfaction.

Effects of ketamine, granisetron and dexmedetomidine on postoperative shivering and hemodynamic changes after general anesthesia: a double-blind randomized clinical trial.

Postoperative shivering is one of the most common complications of surgeries. The current research compared the effects of ketamine, granisetron, and dexmedetomidine on reducing postoperative shivering after general anesthesia. This double-blind clinical trial enrolled 148 patients (39.08 ± 5.99 years old) who had been admitted to Vali-Asr Hospital of Arak, Iran in 2019-2021. The study drugs, including dexmedetomidine, ketamine, granisetron and normal saline, were administered in corresponding groups 30 minutes before the end of surgery. The results showed that dexmedetomidine reduced mean arterial pressure and heart rate in patients. The lowest incidence of shivering was observed in the dexmedetomidine group and it increased the duration of recovery. Overall, dexmedetomidine is recommended to reduce postoperative shivering after general anesthesia, but the increase in duration of recovery should be considered.

Effect of dexmedetomidine and fentanyl on hemodynamic changes and block profile following spinal anesthesia with ropivacaine among patients with femoral fractures undergoing lower limb surgery.

The aim of this study was to compare the effect of dexmedetomidine and fentanyl on hemodynamic changes and block characteristics following spinal anesthesia with ropivacaine among patients with femoral fractures undergoing lower limb surgery. In this double-blind clinical trial, 64 patients who were candidates for lower limb surgery. Patients were divided into two groups based on the block pattern. In the first group, dexmedetomidine was prescribed. In the second group, fentanyl with ropivacaine was prescribed. Sensory and motor blocks at or above the T8 dermatome in each group were measured. Furthermore, the sensory block was evaluated every 1 minute after anesthesia with a needle (pin prick method) and also the motor block was evaluated every 5 minutes by the bromage scale. There was a statistically significant difference between the two groups in terms of the time for achieving sensory block to T8 or higher dermatome (p = 0.0001). The time elapsed until the onset of motor block was shorter in the dexmedetomidine group, and dexmedetomidine had a shorter time for achieving sensory block to T8 or higher dermatome than fentanyl. A statistically significant difference was found in terms of the time elapsed until the motor block and the time for achieving sensory block to the T8 dermatome or higher (p <0.05). The time elapsed until the onset of motor block was shorter in the dexmedetomidine group, and dexmedetomidine had a shorter time for achieving sensory block to T8 or higher dermatome than fentanyl. Our findings revealed a statistically significant difference in terms of the duration of sensory block for reaching the T12 to L1 dermatome and the duration of obtaining bromide scores 0 and 1 (p = 0.0001). The time for achieving sensory block to dermatome T12 to L1 and the time of obtaining bromage scales of 0 and 1 were longer in dexmedetomidine group (p = 0.0001). Pain in dexmedetomidine group was less than fentanyl group in 2 to 8 hours after surgery (p <0.05). The duration of analgesia was longer in the dexmedetomidine group (p = 0.001). In summary, it can be suggested that adding dexmedetomidine to the anesthetic ropivacaine may be beneficial.

Efficacy of intraoperative epidural dexamethasone and bupivacaine in reduction of pain and disability following lumbar discectomy.

Background: In lumbar disc herniation, although surgery can provide relief from pain in the low back and lower extremities, many drugs can provide more relief; thus, the aim was the evaluation of epidural dexamethasone and bupivacaine efficacy in lumbar disc herniation surgery. Methods: A total of 42 cases were evaluated in a triple-blind randomized clinical trial study. Patients were divided into intervention and control groups based on permuted block randomization. The patient's condition was assessed based on the Visual Analogue Scale (VAS) at 3, 6, 12, and 24 h and 1, 3, and 6 months after surgery. In addition, the patient's disability was assessed by Oswestry disability index (ODI) at 1 and 6 months after surgery. Results: Of the 42 evaluated cases, age (44.0 ± 12.4, P = 0.4) and hospitalization duration (1.9 ± 0.3 days, P = 0.02) had statistically significant difference between two groups. The severity of low back pain before surgery was 2.9 ± 1.9 (P = 0.74), and 3 hours after surgery was 4.9 ± 1.9 in the control group and 2.8 ± 1.3 in the intervention group (P = 0.03), and there was a statistically significant difference between the two groups. In addition, based on the repeated measure test, there was no significant difference between the two groups. ODI value was before surgery 31.7 ± 8.3 (P = 0.77), 5.2 ± 2.4 (P = 0.9) at 1 month after surgery, and 4.5 ± 1.8 (P = 0.6) at 6 months after surgery, and there was no statistically significant difference between the two groups. Conclusion: Dexamethasone and bupivacaine can be effective in post-operation pain control, although this difference between the two groups was not statistically significant.

Effect of combined paracetamol and dexamethasone vs. paracetamol on postoperative nausea vomiting after cesarean section.

OBJECTIVES: Postoperative nausea and vomiting (PONV) are common symptoms after cesarean delivery (CD) that affect patients outcomes and satisfaction. The treatment of choice is still evolving, therefore, we aimed to evaluate PONV of combined paracetamol-dexamethasone vs. paracetamol alone. METHODS: This study is a double-blind randomized controlled trial on 100 patients undergoing cesarean delivery. Participants were randomly assigned into two groups of paracetamol or combined paracetamol-dexamethasone. Nausea and vomiting score, VAS score of pain, and chill were compared between the two groups. RESULTS: The result of this study found that mild nausea 2nd h after surgery in the combined group was lesser than paracetamol group (0.03). However, there was no statistically significant difference in nausea and vomiting score in other periods of time between the two groups. VAS score of pain decreased 12th and 6th h after the surgery in the combined and paracetamol group, respectively. Chilling occurred in two patients of combined group and four patients of paracetamol group (p=0.432). CONCLUSIONS: Dexamethasone added to paracetamol might not improve pain and vomiting after cesarean delivery comparison with just paracetamol. But it can be effective for reducing the score of nausea after the surgery.

Comparative analgesic, hemodynamic, pain and duration of sensory and motor block effects of dexmedetomidine, granisetron, and nitroglycerin added to ropivacaine in intravenous anesthesia for forearm surgeries: a randomized clinical study.

This trial-based paper strives to address the comparative efficacy of some ropivacaine adjuvant options, comprising dexmedetomidine, granisetron, and nitroglycerin, on pain and hemodynamic changes in intravenous anesthesia for forearm surgeries. This double-blind, placebo-controlled study enrolled four block-randomized eligible groups with patients (overall, n=128) undergoing orthopedic forearm surgeries in the dexmedetomidine, nitroglycerin, granisetron, and placebo groups. Intra- and post-operative vital signs (mean arterial pressure/heart rate/ oxygen saturation) were monitored at baseline and captured every 10 minutes until the end of the surgery, as well as the onset of sensory and motor block and length and duration of the block and mean opioid use within 24 hours. Lastly, pain was noted after tourniquet inflation (at 15, 30, and 45 minutes every 15 minutes until the end of surgery) and after deflation (every 30 minutes to 2 hours at 30, 60, 90, and 120 minutes), as well as 6, 12, and 24 hours after the tourniquet was deflated. The dexmedetomidine-sedated subjects appeared to demonstrate quicker onset and longer length and duration of sensory and motor block, plus less pain and opioid use at all scheduled times (both P = 0.0001). Dexmedetomidine is recommended as an adjuvant to regional anesthesia (Bier's block), while being coupled with the rapid onset and prolonged length and duration of sensory and motor blocks, in addition to soothed pain and diminished opioid use within postoperative 24 hours. The study was approved by Ethics Committee of Arak University of Medical Sciences (approval No. IR.ARAKMU.REC.1398.112) on July 21, 2019, and registered at Iranian Registry of Clinical Trials (registration number IRCT20141209020258N123) on November 2, 2019.

Prophylactic effect of Amiodarone and in combination with vitamin C in reducing atrial fibrillation after coronary artery bypass.

Atrial fibrillation (AF) is the most common arrhythmia following cardiac surgery, leading to hemodynamic impairment and increased mortality and morbidity after coronary artery bypass grafting (CABG) and increases hospitalization. Due to the antioxidant and anti-inflammatory effects of vitamin C as well as the antiarrhythmic effect of amiodarone in reducing the incidence of atrial fibrillation after coronary artery bypass grafting, we decided to compare and evaluate the prophylactic effect of amiodarone alone and in combination with vitamin C in controlling this complication. In this double-blind clinical trial, patients were divided into two equal groups of amiodarone (300 mg amiodarone bolus during 20-30 minutes) and amiodarone + vitamin C (150 mg amiodarone and 2g vitamin C combination). Each group included 42 patients. All data were analyzed by SPSS 19 software and statistical tests of ANOVA, Chi-square and Repeated Measure. There was a significant difference between the two groups of amiodarone and amiodarone+vitamin C (p-value = 0.01) and the mean incidence of AF in the amiodarone +vitamin C group was significantly lower than that of amiodarone alone. Other arrhythmias were also lower in the amiodarone +vitamin C group than in the amiodarone group alone. The use offibrillation after CABG compared with prophylactic amiodarone alone, but did not have a significant effect on decreasing ICU stay(discharge) and duration of hospitalization.

Comparison of the prophylactic effect of dexamethasone and dexmedetomidine and their combination in reducing postoperative nausea and vomiting in patients undergoing laparoscopic cholecystectomy.

Nausea and vomiting are some of the most common complaints of patients after any anesthesia, which is often associated with postoperative pain. The double-blind clinical trial study aimed to compare the prophylactic effect of dexamethasone and dexmedetomidine and their combination in reducing postoperative nausea and vomiting in patients undergoing laparoscopic cholecystectomy. One hundred sixty-two patients undergoing laparoscopic cholecystectomy were enrolled in the study. In the first group of patients, 25 mg of dexmedetomidine were administered slowly. In comparison, the patients in the second group received dexamethasone (4 ml/2 mg) with 0.1 mg/kg of normal saline solution. The third group received a combination of dexmedetomidine and dexamethasone. Hemodynamic changes were recorded during surgery and after surgery, and the patients were admitted to recovery. Nausea and vomiting scores were recorded 2 and 4 hours after surgery. Blood pressure and heart rate were lower in the dexmedetomidine group at all times (P<0.05). Two hours after surgery, the dexamethasone and dexmedetomidine combination group had less vomiting (P=0.012). The incidence of nausea 2 and 4 hours after surgery was lower in the dexamethasone and dexmedetomidine combination group (P<0.05). Blood pressure and heart rate were lower in the dexmedetomidine group at all times. The dexmedetomidine and dexamethasone combination decreased postoperative nausea and vomiting in patients. Therefore, we recommend using a dexmedetomidine and dexamethasone combination for reducing postoperative nausea and vomiting.

Efficacy of dexmedetomidine and ketamine addition to bupivacaine 0.25% by epidural method in reducing postoperative pain in patients undergoing femur fracture surgery.

BACKGROUND AND AIM: One of the most complex medical problems is pain, that due to inappropriate management of patients after surgery could cause various side effects on the psychological, physiological, and metabolic state of the patients. The natural duration of analgesia can be increased by adding new efficient adjuvant. The present study is mainly aimed to investigate the differences between the epidural dexmedetomidine and ketamine effectiveness when administered as an adjuvant to epidural 0.25% bupivacaine for improving the postoperative analgesia duration. METHODS: In the present double-blind clinical study, 105 patients of the age range of 40-85 years were selected for elective femoral surgery and then was divided into three of ketamine, dexmedetomidine, and control randomly. The scores of postoperative pain were evaluated in accordance with the visual Analogue Scale (VAS) criteria and the duration of analgesia and the amount of analgesics consumption were recorded. RESULTS: The mean pain VAS score during the first day after the surgery and recovery of patients in the dexmedetomidine group was significantly lower in comparison with two other groups (p = 0.01). However, no significant difference was found in the mean VAS score of Paine during 12 and 24 hours after the operation (P ≥ 0.05). Comparisons among these groups demonstrated that the mean on opioid administration during the operation and 24 hours after that was significantly higher in both groups of ketamine and control in comparison with the dexmedetomidine group (P = 0.001 and P = 0.01). Besides, analgesia duration among patients belonged to the dexmedetomidine group was notably lower in comparison with two other groups (P = 0.001). CONCLUSION: In epidural anesthesia cases adding ketamine and dexmedetomidine as adjuvants to the solution of bupivacaine 0.25%, could increase the duration of analgesia and reduce the consumption of analgesics, which is more in the dexmedetomidine group when compared with ketamine.

Comparison of the Effect of Dexmedetomidine and Remifentanil on Controlled Hypotension During Rhinoplasty: A Clinical Trial Study.

INTRODUCTION: One of the most important problems during cosmetic nose surgery is excessive bleeding. Controlled hypotension is an appropriate technique for reducing intraoperative bleeding as well as satisfactory and non-bloody surgical field. Different drugs, such as dexmedetomidine and remifentanil, are used to control hypotension. The aim of this study was to compare the effect of dexmedetomidine and remifentanil on the creation of control hypotension during rhinoplasty. MATERIAL AND METHOD: This study is a randomized, double-blind clinical trial which was performed on 60 patients randomly divided into two groups D (Dexmedetomidine) and R (Remifentanil). In group D (0.5 mg / kg / h) Dexmedetomidine infusion and in group R (50-100 µg / kg / h) Remifentanil infusion. The study groups were compared in terms of hemodynamics and intraoperative bleeding. The data obtained from completed questionnaires were analyzed using SPSS software, T-test and ANOVA statistical tests and were presented in tables and statistical charts. RESULTS: The results of this study showed that the mean MAP (Mean Arterial Pressure) was significantly lower in remifentanil group patients than in dexmedetomidine group, while the intraoperative bradycardia rate was different at various time. CONCLUSION: During rhinoplasty surgery, both dexmedetomidine and remifentanil were effective in controlling hypotension and reducing intraoperative bleeding, but the effect of remifentanil was more pronounced than dexmedetomidine.

Change in saturation oxygen and hemodynamic responses by adding intrathecal dexmedetomidine vs. sufentanil to bupivacaine in patients undergoing dynamic hip screw operation: a randomized clinical trial.

Sufentanil (SUF) and dexmedetomidine (DEX) are used as bupivacaine in the spinal technique that providing stable hemodynamic conditions with least side effects. This study aimed to compare the change in saturation oxygen and hemodynamic responses after intrathecal DEX and SUF as adjuvants to bupivacaine in patients undergoing dynamic hip screw. This clinical trial was conducted with 80 patients referring to Valiasr Hospital, Arak, Iran, who were randomly assigned to two groups (n = 40): DEX group (8 mg bupivacaine with 5 µg DEX) and SUF group (8 mg bupivacaine with 2.5 µg SUF). The pain severity was lower in DEX group at different hours and the systolic pressure and diastolic blood pressure were lower in DEX group than in SUF group after surgery. Saturation oxygen was generally lower and more stable in DEX group but there was no significant difference between two groups. The incidence of sensory and motor block was lower in DEX group than in SUF group, but the duration of assessment of sensory block was lower in SUF group than in DEX group. DEX relieves pain up to 24 hours postoperatively. Nevertheless, Care should be taken to avoid the DEX induced shivering in patients. The study was approved by Ethical Committee of Arak University of Medical Sciences by IR.ARAKMU.REC.1395.32 code on April 25, 2016 and was registered in Iranian Registry of Clinical Trials by code number: IRCT2017050220258N45 on August 4, 2017.

Comparison of the Effects of Haloperidol, Metoclopramide, Dexmedetomidine and Ginger on Postoperative Nausea and Vomiting After Laparoscopic Cholecystectomy.

Nausea is a mental sensation of unease and discomfort before vomiting. Vomiting refers to the return of the contents of the upper gastrointestinal tract to the mouth caused by contractions of chest and abdomen muscles. Postoperative nausea and vomiting is an unpleasant experience with high treatment costs. Therefore, this study aimed to compare the effects of haloperidol, metoclopramide, dexmedetomidine, and ginger on postoperative nausea and vomiting after laparoscopy. This double-blind clinical trial was performed on all laparoscopy candidates at Valiasr hospital, Arak, Iran. The patients were randomly divided into four groups (haloperidol, metoclopramide, dexmedetomidine and ginger), and all patients underwent general anesthesia using fentanyl, midazolam, atracurium, and propofol. After intubation, tube fixation, and stable hemodynamic conditions, the patients received four ginger capsules with a hint of lemon. A group of patients received 25 µg of dexmedetomidine. In the Plasil group, 10 mg of metoclopramide was given 30 minutes before the completion of surgery. In addition, 0.5 cc of haloperidol (5 mg) was administered to a group of patients. Heart rate, blood pressure, and oxygen saturation were recorded from the beginning of surgery, every 15 minutes until the end of the surgery. Furthermore, the occurrence of nausea and vomiting was recorded during recovery, 2 and 4 hours after surgery. Data were then analyzed using the SPSS software v.23. Eighty-eight patients were enrolled in the study. The youngest and the oldest were 30 years and 70 years old, respectively, and the mean age was 48.02 ± 9.31 years. Moreover, the number of women in the four groups was higher than that of men. Blood pressure in the dexmedetomidine group was lower than the other four groups (P <0.05). The lowest heart rate was observed in the haloperidol group, while the highest heart rate was seen in the plasil group (P <0.05). The occurrence of vomiting and nausea was not significantly different between the four groups (P <0.05). Our results showed no significant difference in postoperative nausea and vomiting between the four drugs. Due to the hemodynamic changes induced by each drug, it is best to use these drugs based on the patient's condition. Ginger is also a herbal remedy that has fewer side effects, and this drug can be a good option for patients when there is no contraindication.

Clinical Comparison of Adding Sulfate Magnesium and Dexmedetomidine in Axillary Plexus Block for Prolonging the Duration of Sensory and Motor Block: Study Protocol for a Double-blind Randomized Clinical Trial.

BACKGROUND: The purpose of this study was to compare the effect of magnesium sulfate adjunct to dexmedetomidine on increasing the duration of sensory and motor block in axillary block. MATERIALS AND METHODS: This study is a double-blind clinical trial. Ninety-nine patients were included in the study. They were undergoing forearm and hand surgery and were referred to Vali-e-Asr Hospital in Arak. The patients were divided into three groups. The first group received lidocaine (1.5%) and dexmedetomidine (0.5 µg/kg). The second group patients were given lidocaine (1.5%) plus magnesium. In the control group, lidocaine (1.5%) was adjusted to 35 cc with normal saline. The final volume was 35 cc in the three groups. Sensory and motor block and pain were measured and data were analyzed using SPSS v. 20. The final volume was 35 cc in the three groups. RESULTS: The sensory and motor block onset time and the stabilization time of the sensory and motor block in the magnesium sulfate group were lower (p<0/001). Pain in recovery, 2, 4, 6, 12, and 24 hours after surgery was lower in the magnesium sulfate group when compared with the dexmedetomidine group (p<0.001). The lowest dose of opioid was used in the dexmedetomidine group 24 hours after surgery (p<0.001). CONCLUSION: The results showed that dexmedetomidine decreases pain. Magnesium sulfate increased the sensory and motor block onset time, and the sensory and motor block stabilization time, but dexmedetomidine increases the motor block duration.

Comparing intravenous dexmedetomidine and clonidine in hemodynamic changes and block following spinal anesthesia with ropivacaine in lower limb orthopedic surgery: a randomized clinical trial.

Dexmedetomidine (DEX) can prolong duration of anesthesia and shorten onset of sensory and motor block relative to clonidine. This study attempted to compare the efficacy of intravenous DEX and clonidine for hemodynamic changes and block after spinal anesthesia with ropivacaine in lower limb orthopedic surgery. In a double-blind randomized clinical trial, 120 patients undergoing spinal anesthesia in lower limb orthopedic surgery were recruited and divided into three groups using balanced block randomization: DEX group (n = 40; intravenous DEX 0.2 µg/kg), clonidine group (n = 40; intravenous clonidine 0.4 µg/kg), and placebo group (n = 40; intravenous normal saline 10 mL) in which pain scores were assessed using visual analogue scales (at recovery, and 2, 4, 6, and 12 hours after surgery) and time to achieve and onset of sensory and motor block. Statistically significant differences were found in mean arterial pressure among the groups at all times except baseline (P = 0.001), with a less mean arterial pressure and a prolonged duration of sensory and motor block (P = 0.001) in the DEX group where pain relieved in patients immediately after surgery and at above mentioned time points (P = 0.001). Simultaneous administration of intravenous DEX with ropivacaine for spinal anesthesia prolongs the duration of sensory and motor block and relieves postoperative pain, and however, can decrease blood pressure. Although intravenous DEX as an adjuvant can be helpful during spinal anesthesia with ropivacaine, it should be taken with caution owing to a lowering of mean arterial pressure in patients especially in the older adults. This study was approved by Ethical Committee of Arak University of Medical Sciences (No. IR.Arakmu.Rec.1395.450) in March, 2017, and the trial was registered and approved by the Iranian Registry of Clinical Trials (IRCT No. IRCT2017092020258N60) in 2017.

Comparison the Oral Premedication of Midazolam, Dexmedetomidine, and Melatonin for Children's Sedation and Ease of Separation from Parents before Anesthesia.

BACKGROUND: Children's fear of surgery and preoperative separation from parents can contribute to anxiety and distress in children undergoing surgery. The study addressed the comparable efficacy of oral premedication of midazolam, dexmedetomidine, and melatonin to alleviate preoperative anxiety and easing the children's separation from parents. MATERIALS AND METHODS: A double-blinded trial enrolled three equal-sized groups of children (n = 153, aged 2-10 years) undergoing elective surgery who received oral midazolam, melatonin, and dexmedetomidine 30 min before induction. The observation sedation score, and ease of separation, acceptance of drug both preceding and following premedication administration were assessed and recorded every 5min till anesthesia induction. RESULTS: A significant difference was observed in the mean scores of sedation before premedication and after separation from parents, as well as in the degree of the separation when comparing between the midazolam and melatonin groups and the dexmedetomidine and melatonin groups (P < 0.001). The scores were significantly lower in the melatonin group than the other two groups, whereas no significant difference was found in those between the midazolam and dexmedetomidine groups, as well as in the acceptance of anesthesia induction between the midazolam and melatonin groups (P = 0.250). The differences were significant between the midazolam and dexmedetomidine groups (P = 0.002) and melatonin and dexmedetomidine groups (P < 0.001) and anesthesia induction was effective in the dexmedetomidine group than that in the other two groups. CONCLUSION: Dexmedetomidine is more effective in acceptance of anesthesia induction. Furthermore, the midazolam and dexmedetomidine groups indicated better ease of separation and sedation scores than melatonin.

The effect of tranexamic acid in reducing postoperative hemorrhage in patients undergoing coronary artery bypass graft.

INTRODUCTION: Nowadays, cardiovascular diseases such as coronary heart disease are one of the most important causes of human mortality worldwide. Coronary artery bypass graft (CABG) surgery is a standard therapy approach for those suffering from coronary artery disease. Tranexamic acid (TXA), an antifibrinolytic drug, which, in turn, inhibits fibrinolysis, leading to the prevention of bleeding, thus, the present study aimed to evaluate the effect of topical TXA on bleeding reduction after coronary artery CABG. MATERIALS AND METHODS: In this study 62 patients were randomly divided into two groups of TXA and control. After surgery and removal from the cardiopulmonary pump, TXA (2 g) was injected locally into the mediastinum by the surgeon. In the second group (control) the same amount of normal saline (100 cc) was given. Data were analyzed by SPSS 19 software via the t-test and Fisher's test. RESULTS: A significant difference was found between the 2 groups in terms of postoperative hemorrhage, packed cell volume, platelet transfusion, duration of surgery, and received FFP (P = 0.0001; P = 0.01; P = 0.0001; P = 0.0001; P = 0.0001), where were found to be lower in the TXA group than in the placebo group. There was no significant difference in age, sex, return to the operating room, and discharge. CONCLUSION: The use of topical TXA in GABC significantly reduced postoperative hemorrhage, packed cell volume, platelet transfusion, and FFP after surgery. Besides, it had no significant effect on the return to the operating room and mortality.

The Efficacy Of Ginger And Doxedetomidine In Reducing Postoperative Nausea And Vomiting In Patients Undergoing Abdominal Hysterectomy.

BACKGROUND: Nausea and vomiting are the most common complaints of patients after any general anesthesia, which are often accompanied by postoperative pain. Previous studies showed that ginger and dexmedmoidine can reduce postoperative nausea and vomiting. Therefore, the effectiveness of ginger was compared with dexmedmoidine for prevention of postoperative nausea and vomiting. METHODS: This randomized clinical trial study was performed on 92 patients who had abdominal hysterectomy in a double-blind evaluation. In this study, 92 patients were randomly divided into two equal groups of dexmedmotidine and ginger. In the ginger group, 1 gr of ginger was given orally before and after the anesthesia and in the second group, 25 mg of dexmedmotidine was slowly injected before surgery. Finally, after the operation, the questionnaire was completed for patients and the data obtained from the questionnaires were analyzed by SPSS19 software. RESULTS: There was a significant difference between the two groups of dexmodetomidine and ginger in terms of scorpion vomiting in recovery and 2 hours after operation. Vomiting scores were significantly lower in the ginger group than dexmodetomidine group (P = .02 and P = .03). However, no significant difference was defined between the two groups 4 hours after operation, and the scoring was reported to be zero in both groups. Moreover, a decreased level of nausea was observed in the ginger group as compared to the of dexmedetomidine group. CONCLUSION: Both dexmedmotidine and ginger are effective in reducing postoperative nausea and vomiting. But the effect of ginger is greater than that of dexmodetomidine.

Addition of dexmedetomidine, tramadol and neostigmine to lidocaine 1.5% increasing the duration of postoperative analgesia in the lower abdominal pain surgery among children: A double-blinded randomized clinical study.

Pain is a common complication after surgery. Insufficient control of postoperative pain has adverse effects on the physiological, metabolic and psychological state of the child. The use of local analgesics and anesthetics alone cannot produce complete anesthesia and intraoperative comfort. The addition of adjuvant drugs is commonly used to improve the quality of the block. Therefore, adding new supplements may increase the duration of analgesia. The aim of this study was to compare the addition of dexmedetomidine, tramadol and neostigmine to lidocaine 1.5% in increasing the duration of postoperative analgesia in the lower abdominal pain surgery in children aged 2-8 years. This double-blind randomized clinical trial was conducted on children candidate for lower abdominal surgery. The 96 patients were randomly divided into 3 groups including dexmedetomidine, neostigmine, and tramadol. For all children, 3 mg of midazolam was administered orally before entering the operating room. The patients underwent general anesthesia with 2 µg/kg fentanyl, 0.03 mg/kg midazolam, 0.5 mg/kg atracurium and 5-6 mg/kg thiopental. After determining the hiatus membrane, 2 mL syringes containing air and distilled water (each of which 1 mL) slowly entered the space. After eliminating caudal resistance, 1.5% lidocaine was injected at dose of 0.5 mL/kg. A total of 96 patients were enrolled in this study. The results revealed that pain scores in the dexmedetomidine group in recovery, 2, 6 and 12 hours after surgery were less than the other two groups. Furthermore, the tramadol group showed a lower score in comparison with the neostigmine group and the duration of analgesia in the dexmedetomidine group was more than the other two groups. In addition, the mean of analgesic at 24 hours after operation in the dexmedetomidine group was lower as compared to the other two groups, indicating the effect of dexmedetomidine as an adjuvant in increasing the duration of analgesia and reducing postoperative pain in patients along with lidocaine 1.5%. All three drugs (neostigmine, tramadol and dexmedetomidine drugs), along with other local anesthetic, increased the duration of analgesia and decreased postoperative pain in children. The effect of dexmedetomidine was greater than the other two drugs. The study was approved by the Ethics Committee of Arak University of Medical Sciences, Iran (approved No. IR.ARAKMU.REC.1396.112) on October 28, 2017, and registered at Iranian Registry of Clinical Trials (registration No. IRCT20141209020258N83) on August 29, 2018.

Comparison of hemodynamic changes of magnesium sulfate and dexmedetomidine for an axillary brachial plexus block.

INTRODUCTION: Axillary brachial plexus block is used for anesthesia in hands and forearm surgery. The aim of this study was to compare the hemodynamic changes of magnesium sulfate and dexmedetomidine in axillary block. MATERIALS AND METHODS: This randomized, double-blind clinical trial was conducted on 99 patients undergoing a forearm and hand surgery at the Vali-Asr Hospital. Patients were divided into three groups. Dexmedetomidine group consisted of lidocaine 1.5% plus 0.5 µg/kg dexmedetomidine, magnesium sulfate group included lidocaine 1.5% plus 100 mg magnesium sulfate, and the control group received lidocaine 1.5% with normal saline. The final volume was divided into 35 groups in three groups. Blood pressure, heart rate, and oxygen saturation were measured every 5 minutes during surgery, and data were analyzed by SPSS 23. RESULTS: There was a statistically significant difference between the three groups in terms of the mean blood pressure during surgery (P < 0.05). At all times, blood pressure in the dexmedetomidine group was lower as compared to the other two groups. But in the 20th and 25th minutes, there was a relative increase in blood pressure. There was a significant difference between the three groups in terms of heart rate during surgery in minutes 20, 25, 65-100, and 110-120 (P < 0.05). CONCLUSION: The final result showed that the blood pressure and heart rate of the dexmedetomidine group patients at different times were less than the other two groups.