RESUMEN
Introduction Pain after orthopedic surgeries represents a special concern in patients with fractures. The use of multimodal analgesia significantly reduced the opioid need and reduced the risk of their side effects. Objectives This study compared the effectiveness and safety of methocarbamol and nefopam in the reduction of post-operative pain for patients undergoing orthopedic surgeries. Method This prospective, double-blind, randomized controlled trial took place at Al-Sader Teaching Hospital in Basrah, Iraq, from the first of February 2022 to the end of October 2023. The study aimed to assess the post-operative pain relief efficacy and safety of intramuscular nefopam (20 mg) and intravenous methocarbamol (1 g) in 110 adults (aged 18-65) undergoing elective orthopedic surgeries. Exclusions were made for allergies to the drugs, substance abuse history, and severe hepatic or renal impairment. Participants were randomized into two groups, with pain intensity measured at one hour, six hours, and 12 hours post-operation using the visual analog scale (VAS). Side effects were also evaluated. Statistical analysis was done using SPSS 27, with a significance level set at p<0.05 and a 95% confidence interval (CI). Results In this study, we conducted a rigorous comparison between two groups, methocarbamol and nefopam, to evaluate their efficacy and safety in post-operative pain management. We started by ensuring that the groups were well-matched in terms of age, gender distribution, and body mass index (BMI). The results showed remarkable similarities in mean age, gender distribution, and BMI, supported by robust p-values, affirming the effective matching of the two groups. Moving to pain management, we observed a significant advantage in favor of methocarbamol. At all-time intervals (one hour, six hours, and 12 hours post-operation), methocarbamol consistently demonstrated lower mean VAS scores compared to nefopam. These differences were highly statistically significant, underscoring the superior pain relief efficacy of methocarbamol. Exploring side effects, we found no statistically significant disparities in the occurrence of nausea and vomiting between the two groups. However, there was a noticeable trend toward higher tachycardia incidence in the nefopam group, though it did not reach statistical significance. Conclusion The present study showed a higher efficacy of methocarbamol in post-operative pain reduction in comparison to nefopam. No serious side effects were observed with both drugs.
RESUMEN
Mechanical trapping of fine particles in the pores of granular materials is an essential mechanism in a wide variety of natural and industrial filtration processes. The progress of invading particles is primarily limited by the network of pore throats and connected pathways encountered by the particles during their motion through the porous medium. Trapping of invading particles is limited to a depth defined by the size, shape, and distribution of the invading particles with respect to the size, shape, and distribution of the host porous matrix. Therefore, the trapping process, in principle, can be used to obtain information about geometrical properties, such as pore throat and particle size, of the underlying host matrix. A numerical framework is developed to simulate the mechanical trapping of fine particles in porous granular media with prescribed host particle size, shape, and distribution. The trapping of invading particles is systematically modeled in host packings with different host particle distributions: monodisperse, bidisperse, and polydisperse distributions of host particle sizes. Our simulation results show quantitatively and qualitatively to what extent trapping behavior is different in the generated monodisperse, bidisperse, and polydisperse packings of spherical particles. Depending on host particle size and distribution, the information about extreme estimates of minimal pore throat sizes of the connected pathways in the underlying host matrix can be inferred from trapping features, such as the fraction of trapped particles as a function of invading particle size. The presence of connected pathways with minimum and maximum of minimal pore throat diameters can be directly obtained from trapping features. This limited information about the extreme estimates of pore throat sizes of the connected pathways in the host granular media inferred from our numerical simulations is consistent with simple geometrical estimates of extreme value of pore and throat sizes of the densest structural arrangements of spherical particles and geometrical Delaunay tessellation analysis of the pore space of host granular media. Our results suggest simple relations between the host particle size and trapping features. These relationships can be potentially used to describe both the dynamics of the mechanical trapping process and the geometrical properties of the host granular media.
