Effects of adding dexmedetomidine to local infiltration of bupivacaine on postoperative pain in pediatric herniorrhaphy: a randomized clinical trial.

BACKGROUND: Postoperative pain is a major problem, especially in children, as their tolerance level is lower and several drugs are contraindicated in childhood. This study aimed to compare the effect of dexmedetomidine added to local infiltration of bupivacaine for postoperative pain relief in children undergoing inguinal herniorrhaphy. METHODS: This double-blind, randomized clinical trial included 60 children aged 6-72 months undergoing unilateral herniorrhaphy at selected hospitals in Shiraz, Iran, randomly allocated into two groups, 30 in each group. One group received 1 µg/kg dexmedetomidine plus local infiltration of 0.2 ml/kg bupivacaine 0.5% at the incision site before surgery (BD), and the other group received bupivacaine and normal saline (BO). Analgesic requirements, emergence time, and nausea/vomiting, postoperative pain and sedation scores were assessed for 4 h after the operation. Heart rate (HR), systolic blood pressure (SBP), and oxygen saturation (SaO2) were recorded at baseline, and at 10 and 20 min after injection. RESULTS: Eighty percent were boy in each group; mean age was 22.75 ± 18.63 months. SaO2 and SBP were not different between the groups, while HR was significantly lower in the BD group at 10 and 20 min after injection (P <0.05). BD group had a lower pain score at 1 and 2 h after the operation, a higher sedation score at the first three time intervals, and longer emergence time than BO group (all P <0.001). BD group had a lower pain score at 1 and 2 h after the operation (P < 0.001, P < 0.047 respectively). CONCLUSIONS: Addition of dexmedetomidine to local infiltration of bupivacaine in children undergoing herniorrhaphy significantly reduced postoperative pain and increased sedation.

The association of diameter and depth of internal jugular and subclavian veins with hand dominancy.

BACKGROUND: The central veins' catheterization, required in critically ill patients, is more successful in larger veins. Some researchers hypothesized that hand preference might be associated with larger ipsi/contra central veins. OBJECTIVE: To determine the diameter and depth of internal jugular and subclavian veins on both sides and its association with left- or right-handedness. METHODS: This cross-sectional study, was conducted on patients referring for elective breast or thyroid check-up to Shahid Faghihi Hospital ultrasound unit, Shiraz, Iran, from September 2014 to May 2015. Inclusion criteria consisted of adult normotensive patients with American Society of Anesthesiology (ASA) class I without underlying diseases. The patients' demographics were recorded and the diameter and depth of the internal jugular and subclavian veins were measured by ultrasound. The results of measurements were compared between patients' hand preference by SPSS version 19, using paired-samples t-test and independent-samples t-test. RESULTS: Of 65 patients, 86% were women and 19 were left-handed (29%) with the only significant difference between the right and left subclavian diameter in right-handed individuals (p=0.007) and no significant difference between the left and right internal jugular vein diameter and depth and subclavian vein depth between the left- and right-handed patients. The subclavian diameter of the right and left side was also not different in left-handed patients. CONCLUSION: The right or left central veins are not superior to each other with respect to diameter and depth in right- or left-handed patients.