The Effects of Pre-Spinal Anesthesia Administration of Crystalloid and Colloid Solutions on Hypotension in Elective Cesarean Section.

BACKGROUND: Spinal anesthesia is an appropriate alternative for general anesthesia in many operations, particularly in cesarean section. However, the induced hypotension is the main drawback of this method. Therefore, the current study aimed at comparing the effects of crystalloid and colloid solutions used as the preload on the post-spinal hypotension and its complications in females who are candidate for elective cesarean section. METHODS: The current randomized, controlled, double-blind study was conducted on the female candidate of elective cesarean section (n = 96; age range: 20 to 40 years). The patients were in their 37 to 42 weeks of gestational age during the experiments. The systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR) variation, amount of injected ephedrine during surgery, Apgar score at birth, total solution infused after spinal anesthesia, urine output, nausea, and vomiting were comparatively assessed between the two groups. RESULTS: The percentages of reduction in SBP and DBP variables in the crystalloid solution were higher than those of the colloid group and the differences were statistically significant (P = 0.042 and P = 0.008, respectively). Average percentage of HR changes was more significant in the crystalloid than the colloid group (P = 0.032). In contrary, administration of the two types of solutions did not result in significant differences in the Apgar scores. The prevalence of nausea and vomiting in the colloid group subjects was lower than those of the crystalloid solution group; however, the differences were not significant. CONCLUSIONS: The current study findings recommend colloid solution to prevent hemodynamic instability after spinal anesthesia. However, the costs and availability of the solution and recommendation of anesthesiologist should be considered. Conduction of further clinical trials with larger sample sizes is recommended.

Nerve Stimulator versus Ultrasound-Guided Femoral Nerve Block; a Randomized Clinical Trial.

INTRODUCTION: Pain control is the most important issue in emergency department management of patients with femoral bone fractures. The present study aimed to compare the procedural features of ultrasonography and nerve stimulator guided femoral nerve block in this regard. METHOD: In this randomized clinical trial, patients with proximal femoral fractures presenting to emergency department were randomly divided into two groups of ultrasonography or nerve stimulator guided femoral block and compared regarding success rate, procedural time, block time, and need for rescue doses of morphine sulfate, using SPSS 20. RESULTS: 50 patients were randomly divided into two groups of 25 (60% male). The mean age of studied patients was 35.14 ± 12.95 years (19 - 69). The two groups were similar regarding age (p= 0.788), sex (p = 0.564), and initial pain severity (p = 0.513). In 2 cases of nerve stimulator guided block, loss of pinprick sensation did not happen within 30 minutes of injection (success rate: 92%; p = 0.490). Ultrasonography guided nerve block cases had significantly lower procedural time (8.06 ± 1.92 vs 13.60 ± 4.56 minutes; p < 0.001) and lower need for rescue doses of opioid (2.68 ± 0.74 vs 5.28 ± 1.88 minutes; p < 0.001). CONCLUSION: Ultrasonography and nerve stimulator guided femoral block had the same success rate and block duration. However, the ultrasonography guided group had lower procedure time and lower need for rescue doses of morphine sulfate. Therefore, ultrasonography guided femoral block could be considered as an available, safe, rapid, and efficient method for pain management of femoral fracture in emergency department.

Comparison of the analgesic effect of intra-articular and extra-articular injection of morphine and ketamine compound in arthrotomy lower limb surgery under spinal anesthesia.

OBJECTIVE: One of the critical components in the postoperative care is pain. Given that little research has been done regarding the analgesic effects of intra-articular injection of ketamine, this study was aimed to compare the analgesic effect of intra-articular and extra-articular injection of morphine and ketamine compound in arthrotomy surgery under spinal anesthesia. METHODS: A total of 50 patients were candidate for arthrotomy surgery, aged 18-60 years were divided randomly into two groups. At the end of surgery, the first group was treated with combination of intra-articular morphine and ketamine compound and the second group was treated with combination of extra-articular morphine and ketamine compound. The amount of postoperative pain was recorded in the hours of 2,4,6,12,24 respectively. Also 24 hours consumption of rescue analgesic was recorded. RESULTS: The pain severity (VAS) in the hours of 2, 4, 6, 12 and 24 after surgery in the intra-articular injection group was significantly lower than the extra-articular injection group (P<0.05). Postoperative morphine consumption in intra-articular injection group (3.2±3.78) was significantly less than the extra-articular injection group (6.36±5.22) (p = 0.018). CONCLUSION: Postoperative pain severity of intra-articular injection of ketamine and morphine in knee surgery is less than extra-articular injection.