Role of suprascapular nerve block in idiopathic frozen shoulder treatment: a clinical trial survey.

BACKGROUND: Several therapeutic methods have been proposed for frozen shoulder syndrome. These include suprascapular nerve block, a simple and cost-effective technique that eliminates the need for nonsteroidal anti-inflammatory drug therapy. METHODS: This was a clinical trial that included patients with unilateral shoulder joint stiffness. Patients were divided into three groups: those treated with isolated physiotherapy for 12 weeks (PT group), those treated with a single dose intra-articular injection of corticosteroid together with physiotherapy (IACI group), and those treated with a suprascapular nerve block performed with a single indirect injection of 8-mL lidocaine HCL 1% and 2 mL (80 mg) methylprednisolone acetate together with physiotherapy (SSNB group). The variables assessed were age, sex, side of involvement, dominant limb, presence of diabetes, physical examination findings including erythema, swelling, and muscle wasting; palpation and movement findings; shoulder pain and disability index (SPADI) score; and the visual analog scale (VAS) score pre-intervention and at 2-, 4-, 6-, and 12-week post-intervention. RESULTS: Ninety-seven patients were included in this survey (34 cases in the PT group, 32 cases in the IACI group, and 31 cases in the SSNB group). Mean age was 48.55±11.06 years. Fifty-seven cases were female (58.8%) and 40 were male (41.2%). Sixty-eight patients had a history of diabetes (70.1%). VAS and SPADI scores and range of mototion degrees dramatically improved in all cases (p<0.001). Results were best in the SSNB group (p<0.001), and the IACI group showed better results than the PT group (p<0.001). CONCLUSIONS: Suprascapular nerve block is an effective therapy with long-term pain relief and increased mobility of the shoulder joint in patients with adhesive capsulitis.

Effects of Acupressure on Fatigue in Patients with Cancer Who Underwent Chemotherapy.

Fatigue is the commonest symptom in cancer patients; despite high levels of clinically significant persistent cancer-related fatigue, few treatments are currently available. The aim of this study was to evaluate the efficacy of acupressure on fatigue in patients with cancer who underwent chemotherapy. The study was designed as a randomized and controlled trial. Ninety samples were selected using the convenience sampling method, and random block sampling was used for allocation of groups (30 for each group). The three groups were similar by age and gender. The experimental group underwent acupressure at the Zusanli (ST-36), Hegu (LI-4), and Sanyingjiao (SP-6), whereas sham pressure was used in the placebo group and no intervention was applied in the control group; the level of fatigue of participants in three groups was calculated in three phases, before, during, and after chemotherapy. Data were analyzed using SPSS, version 22. The results showed that the mean of visual analog score of fatigue is significantly different in three groups at the end of chemotherapy (p = 0.021). The mean visual analog score of fatigue in the acupressure group was meaningfully lower than that in the control group after chemotherapy (p = 0.028). Results of this investigation showed that acupressure has short-term effectiveness on the cancer-related fatigue of patients undergoing chemotherapy.

Effectiveness of acupressure on anxiety of children undergoing anesthesia.

BACKGROUND AND OBJECTIVES: Tonsillectomy is one of the most commonly used pediatric surgeries with high stress levels for children and their parents. The present study was designed and implemented regarding the fact that limited studies have ever been carried out about the effects of complementary therapies such as acupressure on the preoperative anxiety levels in children throughout the world. MATERIALS AND METHODS: Present study was a randomized clinical trial that was done in three groups with 144 children aged 5-12 years undergoing tonsillectomy. In present study, the children were allocated in three groups: intervention, control and sham. In the intervention group, the acupressure was applied on the Yintang point and in the sham group, was applied at a sham acupoint. No intervention was performed in the control group. Before and after intervention, the pediatric anxiety levels were measured using instruments. The results were analyzed using descriptive and inferential statistics such as the Kruskal-Wallis and Wilcoxon tests, chi-square (χ2) and analysis of variance (ANOVA) test. The significance level was considered p < 0.05. RESULTS: The total anxiety score in children was (70.39 ± 20.93) in the control group, (67.83 ± 16.78) in the intervention group and (71.40 ± 21.82) in the sham group, not significant difference (p > 0.05). The different in the overall anxiety score among children before intervention compare to after intervention was as following: Control group (-3 ± 17.46), intervention group (8.42 ± 32.98) and sham group (-4.32 ± 24.47). CONCLUSION: Like other surgical procedures, the tonsillectomy has serious stress for children. Our study demonstrates that the acupressure has a significant effect on the level of preoperative anxiety in children undergoing surgery. Therefore, nurses can use this technique to reduce the pediatric anxiety.

Is Spinal Anesthesia with Low Dose Lidocaine Better than Sevoflorane Anesthesia in Patients Undergoing Hip Fracture Surgery.

BACKGROUND: To evaluate general anesthesia with sevoflurane vs spinal anesthesia with low dose lidocaine 5% on hemodynamics changes in patients undergoing hip fracture surgery. METHODS: In this randomized double blind trial 100 patients (50 patients in each group) older than 60 years under hip surgery were randomized in general anesthesia with sevoflurane and spinal anesthesia with lidocaine 5%. Hemodynamic changes including mean arterial pressure (MAP) and heart rate, blood loss, pain severity, nausea and vomiting and opioids consumption were compared in two groups. RESULTS: During surgery, difference between two groups regarding changes in mean arterial pressure was not significant, but the changes in heart rate were significantly different. Mean arterial pressure changes during recovery between two groups were significantly different. But there was no significant difference in heart rate changes. Bleeding in the sevoflurane group was significantly more than spinal group (513.ml vs. 365 ml). Moreover, AS Score, opioid consumption, and the nausea and vomiting in spinal anesthesia group was significantly lower than the sevoflurane group. CONCLUSION: We showed that general anesthesia with sevoflurane and spinal anesthesia with low dose lidocaine 5% have comparable effects on hemodynamics changes in patients undergoing hip fracture surgery. However postoperative pain score, vomiting and morphine consumption in patients with spinal anesthesia were lower than general anesthesia.

Does Tranexamic Acid Reduce Bleeding during Femoral Fracture Operation?

BACKGROUND: Proximal Femoral shaft fractures are commonly associated with marked blood loss which can lead to postoperative acute anemia and some other complications. Tranexamic acid (TA) is an antifibrinolytic medication that reduces intra-and postoperative blood loss and transfusion requirements during some elective surgeries. The aim of this study is to evaluate the effect of intravenous Tranexamic acid (TA) on intraoperative blood loss and a subsequent need for transfusion in patients who were undergoing surgery for femoral shaft fractures in trauma setting. METHODS: Thirty-eight ASA grade I-II patients undergoing proximal femoral shaft fracture surgery with intra medullary nailing were included in this double blind randomized controlled clinical trial. They were allocated into two groups. Group I, the intervention group with eighteen patients received 15 mg/kg (TA) via intravenous infusion before surgical incision. Patients in the placebo group received an identical volume of normal saline. Hemoglobin level was measured four hours before and after the surgeries. Postoperative blood loss and hemoglobin change as well as transfusion rates and volumes were compared between the two groups. RESULTS: Mean Percentage fall in hemoglobin after surgery were 1.75±0.84 and 2.04±1.9 in the study and placebo groups, respectively (P=0.570). Hemoglobin loss was higher in the placebo group. Transfusion rates was lower in TA group (5.6%) compared to the placebo group (30%) (P=0.06). No significant difference in The Allowable Blood Loss during the surgery was found between the two groups (P=0.894). CONCLUSION: Preoperative treatment with TA reduces postoperative blood loss and the need for blood transfusion during traumatic femoral fracture operation.

Electroconvulsive therapy-related cognitive impairment and choice of anesthesia: the tipping point.

INTRODUCTION: Electroconvulsive therapy (ECT) is among the most effective treatments of several life-threatening psychiatric disorder. Despite effective therapy, ECT-induced seizure could cause several adverse effects including cognitive disorders and memory impairment. Drugs such as thiopental, which have been prescribed for anesthesia required for ECT, are known as drugs with cognitive effects. This pilot randomized clinical trial tried to assess the feasibility of using a lower dose of thiopental in combination with remifentanil instead of a higher challenging dose of a single drug with cognitive side effects such as thiopental. We evaluated post-ECT cognitive impairment in patients who received remifentanil-thiopental compared with thiopental-placebo group. PATIENTS AND METHODS: One hundred twenty patients with psychiatric disorders between the ages of 18 and 60 years were enrolled. The patients were randomized into 2 groups who received either thiopental sodium (4 mg/kg) and remifentanil (1 µg/kg) or thiopental sodium (3 mg/kg, placebo). The psychiatric patients were examined using mini-mental state examination in terms of the cognitive deficits before ECT as well as 5 and 24 hours after ECT. Statistical analyses were done using Statistical Package for the Social Sciences version 16. Unpaired t test, χ2 test, and analysis of variance were used to determine the association of variables. RESULTS: All the patients completed the trial. There were no reports of adverse effects. In terms of depth of anesthesia measured by bispectral index, no significant difference was observed. Regarding mini-mental state examination scores, the difference was not statistically significant. CONCLUSIONS: Depth of anesthesia was similar between the groups.

Hemodynamic and Arterial Blood Gas Parameters during Cemented Hip Hemiarthroplasty in Elderly Patients.

BACKGROUND: Patients undergoing cemented hip hemiarthroplasty may develop bone cement implantation syndrome (BCIS) which is a leading cause of intraoperative complications. The purpose of this study was to evaluate cardiovascular changes during cemented hip hemiarthroplasty in elderly patients. METHODS: Cemented hip hemiarthroplasty was performed on 72 patients with femoral neck fracture. All patients were catheterized with a radial artery catheter to assess mean arterial pressure (MAP) and arterial blood gas (ABG) in these time points: just before cementation, just after cementation (0th), 5 min (5th) and 10 min (10th) after cementation, and at the end of surgery (END). Also, systolic and diastolic blood pressure (SBP & DBP), heart rate and any arrhythmia or cardiac arrest was evaluated. RESULTS: Seventy-two patients (33 females, 39 males; mean age: 66.8±7 years) were evaluated. All parameters changed during cementation with a significant drop in MAP, SBP, and DBP immediately after cementation and pH and base excess decreased significantly (P<0.001) with no changes in O2 saturation. Mean heart rate rose until the 5th and then decreased dramatically with no bradycardia presentation. During cementation, 12 patients showed arrhythmia, but no cardiac-arrest was observed. CONCLUSIONS: Under strict observation of a anesthesiology care team, hemiarthroplasty can be a safe method for femoral neck fracture in elderly osteoporotic patients without severe cardiopulmonary compromise.