The effect of needle type (25 G Sprotte vs. Quincke) in spinal anesthesia on the incidence of transient neurologic syndrome: A randomized clinical trial.

Background and Aims: Transient neurologic syndrome (TNS) is a postoperative pain in the back and buttock that can occur after spinal anesthesia. The spinal needle design may have an impact on the occurrence of TNS. We decided to compare the incidence of TNS and related factors between two spinal needle types. Methods: In this randomized clinical trial, 150 patients aged 18-60 years and American Society of Anesthesiologists (ASA) physical status I who underwent lower abdomen or lower extremity surgeries with spinal anesthesia and supine position were enrolled. They were randomly divided into two groups (25 G Quincke or Sprotte needle) with 0.5% bupivacaine (12.5 mg). After the operation, the patients were asked to report any pain in the lower back, buttock, and thigh areas. A Visual Analog Scale (VAS) was also used to record the severity of the pain. Results: Overall, 45 patients developed TNS. Twenty-nine patients in the Sprotte group (38.7%) and 16 patients in the Quincke group (21.3%) developed TNS (p = 0.75). More patients in the Sprotte group (25.3%) had severe pain (VAS score of 8-10) when compared with the Quincke group (6.7%). There was no significant difference in TNS symptoms duration between the two groups. In about half of patients (51.9%) in the Sprotte group and 57.3% of patients in the Quincke group, the symptoms resolved after 2-3 h. Conclusion: Although the incidence of TNS did not differ significantly, patients for whom a Sprotte spinal needle had been used had more severe pain. This suggests that the Quincke needle caused less severe pain.

Target-controlled infusion anesthesia with propofol and remifentanil compared with manually controlled infusion anesthesia in mastoidectomy surgeries.

Target-controlled infusion (TCI) system is increasingly used in anesthesia to control the concentration of selected drugs in the plasma or at the site of drug effect (effect-site). The performance of propofol TCI delivery when combined with remifentanil in patients undergoing elective surgeries has been investigated. Our aim in this study was to assess the anesthesia profile of the propofol and remifentanil target controlled infusion (TCI) anesthesia as compared to the manually controlled infusion (MCI), in mastoidectomy surgery, where a bloodless field is of utmost importance to the surgeon. Sixty patients, aged 18-60 years ASA I-II enrolled in the study, were divided into two equal groups. Group MCI received propofol and remifentanil by conventional-dose-weight infusion method, and Group TCI received propofol 4 microg/ml and remifentanil 4 ng/ml as effect-site target concentration. The hemodynamic variability, recovery profile, postoperative nausea and vomiting (PONV), surgeons satisfaction were assessed. Results were analyzed by SPSS version 11.5. The two groups were comparable with respect to age, ASA class, sex, weight, basal vital signs, operation time. The blood pressure and pulse were above desired levels in some data points in the MCI Group (P < or = 0.05). The PACU stay time to reach Aldret score of 10 was longer in the MCI Group (42.54 +/- 8 vs 59.01 +/- 6 min) (P < or = 0.05). The PONV was more common in the MCI Group (P < or = 0.05). Surgeon's satisfaction of the surgical field showed no significant differences except when described as "good", more common in the TCI Group. TCI is capable to induce and maintain anesthesia as well as MCI. In some stages of anesthesia, the TCI control of vital signs are better than the MCI. In some stages of anesthesia, the TCI control of vital signs are beter than the MCI. Recovery profile and complication rate and surgeon's satisfactions are more acceptable in the TCI than in the MCI Group.

Intraperitoneal bupivacaine effect on postoperative nausea and vomiting following laparoscopic cholecystectomy.

BACKGROUND: Postoperative nausea and vomiting (PONV) after laparoscopic cholecystectomy (LC) has multifactorial etiology. Pain and use of opioids are among the important factors. OBJECTIVES: The present study aimed to evaluate the efficacy of intrapritoneal (IP) injection of bupivacaine on PONV. PATIENTS AND METHODS: This was a double-blind randomized clinical trial, conducted on 66 patients aged 20-60, ASA I or II, candidates for LC. Patients were randomly assigned to two groups. Bupivacaine group received 20 mL bupivacaine 0.25% in the gallbladder bed, before and after cholecystectomy and the control group did not. The incidence of nausea and postoperative pain intensity was measured with Visual analogue scale (VAS) at 1, 2, 3 and 4 hours after operation, at rest and when coughing and changing positions. Nausea and vomiting occurrence were assessed at the same times. RESULTS: There were no demographic data differences between groups. No differences were found between the two groups, in terms of incidence of nausea and vomiting. Furthermore, both groups were similar with respect to opioid consumption, during four hours post-operation. CONCLUSIONS: Intraperitoneal bupivacaine administration at the beginning and end of laparoscopic cholecystectomy reduced only visceral and shoulder pains at the 4th postoperative hour, but had no effect on reducing neither PONV, nor opioid demand, during the first four postoperative hours.

Minimum appropriate dose of lidocaine with a fixed dose of sufentanil epinephrine used for spinal anesthesia in caesarian section.

BACKGROUND: Caesarian section is a commonplace surgery in females for which spinal anesthesia is the preferred method. The local anesthetic medications used in the surgery are often associated with complications such as nausea, vomiting, dyspnea, hypotension, and bradycardia. In the present study, we decreased the dose of the anesthetic drug and added an opioid instead. OBJECTIVES: We tried to find an appropriate combination of medications required for optimal anesthesia with minimum complications. PATIENTS AND METHODS: One hundred twenty six candidates for C/S with first and second class ASA aged 18-35 years were randomly divided into three groups. All patients received sufentanil (2.5 µg) and epinephrine (100 µg) doses but the lidocaine doses were respectively 50 mg, 60 mg and 75 mg in the groups 1, 2 and 3. Complications including hypotension, bradycardia, dyspnea, nausea, vomiting, and anesthesia quality were recorded and statistically analyzed. RESULTS: The level of anesthesia was significantly different between groups. By reducing the lidocaine dose, patients with anesthesia level under the nipple increased but the surgeon and the patient were satisfied with the results. Nausea, vomiting, and dyspnea was degraded by decreasing the lidocaine dose especially in the 50 mg group. The need to use ephedrine was directly associated with the lidocaine. However, the need to use atropine was not significantly different between groups. Pruritus was not significantly different as well. CONCLUSIONS: It seems that reducing the lidocaine dose, when combined with sufentanil, decreases most complications of spinal anesthesia such as hypotension, dyspnea, nausea, and vomiting while preserving anesthesia quality.

Analgesic efficacy of intra-articular morphine after arthroscopic knee surgery in sport injury patients.

BACKGROUND: Anterior cruciate ligament (ACL) tearing is a common injury among football players. The present study aims to determine the best single-dose of intra-articular morphine for pain relief after arthroscopic knee surgery that, in addition to adequate and long-term analgesia, leads to fewer systemic side effects. METHODS: This clinical trial was conducted on 40 ASA-I athletes. After surgery, all participants received an injection of 20 cc of 0.5% intra-articular bupivacaine. In addition, the first control group received a saline injection and 5, 10 and 15 mg of morphine were respectively injected into the joints of the second, third and fourth groups by use of Arthroscopic equipment before the Arthroscopic removal. The amount of pain based on VAS at 1, 2, 4, 6 and 24 hours after surgery, duration of analgesia and the consumption of narcotic drugs were recorded. RESULTS: The VAS scores in the fourth, sixth and twenty-fourth hours after surgery showed a significant difference between the study groups. The average time to the first analgesic request from the bupivacaine plus 15 mg morphine group was significantly longer than other groups and total analgesic requests were significantly lower than other groups. No drowsiness complications were observed in any of the groups in the first 24 hours after injection. CONCLUSIONS: Application of 15 mg intra-articular morphine after Arthroscopic knee surgery increases the analgesia level as well as its duration (IRCT138902172946N3).

Granisetron versus dexamethasone in prophylaxis of nausea and vomiting after laparoscopic cholecystectomy.

BACKGROUND: Post-operative nausea and vomiting (PONV) is one of the common problems after laparoscopic cholecystectomy. OBJECTIVES: The current study aimed to compare Dexamethasone effect with that of Granisetron in prevention of PONV. PATIENTS AND METHODS: In the current study 104 patients aged 20-60 with ASA class I or II who were candidates for laparoscopic cholecystectomy were included in the study. Patients were randomly divided into two groups of A and B. 15 minutes before anesthesia induction, in group a patient's 3 mg Granisetron and in group B patients 8 mg Dexamethasone was intravenously injected. Then both groups underwent general anesthesia with similar medications. After operation the prevalence of nausea and vomiting was assessed at three time intervals (0-6 hours, 6-12 hours and 12-24 hours after consciousness). SPSS software version 16 was employed to analyze data. T test, chi-square test and Fischer exact test were performed level of significance was P < 0.05. RESULTS: There was no significant difference between age, gender proportion, weight, height, and body mass index (BMI) of patients in the two groups. In Dexamethasone group, seven patients experienced nausea and three patients had vomiting, and in Granisetron group, five patients experienced nausea and three patients had vomiting after consciousness. Statistical analysis indicated no significant difference between the two groups in this regard. CONCLUSIONS: Intravenous injection of 8 mg Dexamethasone or 3 mg Granisetron before anesthesia induction had similar effects in prophylaxis of nausea and vomiting after laparoscopic cholecystectomy.

Profile of acute carbon monoxide poisoning in the west province of Iran.

OBJECTIVE: To document the epidemiology and risk factors of acute carbon monoxide (CO) poisoning in the west of Iran and specify potentially presentable characteristics. STUDY DESIGN: Observational study. PLACE AND DURATION OF STUDY: Imam Khomeini Hospital of Kermanshah, Iran, from July 2006 to March 2008. METHODOLOGY: This study was conducted using the records of 143 cases of CO poisoning referred to the only centre for the reference of poisoning cases. Intent, age groups, source of poisoning and clinical presentation were noted and described as frequency. RESULTS: One-hundred forty two cases (99.3%), were accidental and only one case (0.7%) was suicidal. Mortality was (21.7%, n=31). The highest mortality was found in the age groups of 20-30 years and below 10 years. The greatest frequency happened in autumn and winter. The clinical symptoms and manifestations of CO poisoning included headache (35.3%), nausea (25.4%), vomiting (21%), dyspnea (10.3%), and decrease in level of consciousness (8%). Gas water heaters (35%), room heaters (32%), stoves (24%) and other items (9%) were the principal sources of the individuals' exposure to CO. CONCLUSION: CO poisoning is a serious public health problem in west of Iran (Kermanshah). The number of CO poisoning cases was highest in the colder seasons of the year, whereas the majority of the poisoning cases could be prevented.