[Evaluation of sub-fascial lidocaine infusion in post-operative pain management following laparotomy]

One of the important problems of major abdominal surgery is post-operative pain control. There are different modalities to control the pain after surgery, such as oral, local or intravenous analgesic drugs, regional nerve block, epidural catheters and pain killer pumps with their own benefits and complications. The aim of this study was to evaluate the effect of continuous peritoneal infusion of lidocaine by a pain killer pump for post-operative pain management following laparotomy. This double blind randomized clinical trial was performed on 76 patients [38 cases and 38 controls] who underwent laparotomy with midline incision, in Imam Hospital, Sari, Iran, in 2008. Two groups were matched in age and sex. After surgery a catheter infusion pump was prepared for all patients. In case group, 2% lidocaine [20mg/kg/day] and for control, normal saline infused for 24 hours. Pain score [Visual Analog Scale], blood pressure, heart rate, respiratory rate, temperature and analgesic requirement was evaluated in 4, 10, 16 and 24 hours after surgery. Results analyzed by means of SPSS [15] software and chi-square, t test and repeated measurement. The p value less than 0.05 was considered to be significant statistically. 76 patients, 39 [51.3%] females and 37 [48.7%] males, with mean age of 47.03 +/- 15.2 years were studied. There was no significant difference in age, sex and weight between two groups. The mean of admission days was 5.03 +/- 0.6 in case and 5.29 +/- 1.3 in control, with no significant difference between them. Mean of opiod consumption was 16.05 +/- 13.05 mg and 25.39 +/- 11.4 mg in case and control respectively [P= 0.002]. Mean of VAS score, blood pressure, heart rate, respiratory rate and temperature in case group was less than control group and the difference was significant statistically. Pain severity changes during 4, 10, 16 and 24 hours following surgery were significantly different in two groups, with linear correlation between time and pain reduction. Our study demonstrates that continuous infusion of 2% lidocaine by a pain killer pump can reduce pain and opioid requirements after abdominal surgeries

[ effect of metronidazole on hemorrhoidectomy pains]

Topical metronidazole [10 percent] has been previously demonstrated to decrease post operative pain after hemorrhoidectomy. The aim of this study was to evaluate the effect of topical metronidazole [10 percent] on postoperative and after defecation pains of hemorrhoidectomy. A double-blind randomized trial was conducted to compare post- hemorrhoidectomy pain using topical metronidazole [10 percent] to. placebo carrier applied to surgical site. Forty-seven patients were randomly selected to receive metronidazole [n=25] or placebo [n=22]. Pain was assessed using a visual analog scale [VAS] preoperatively as well as on postoperative hours 6 and 12, and on days 1, 2, 7, and 14. The use of narcotic, additional analgesics and complications were recorded. [Pain scores were calculated and compared with baseline values and control group [t-test, SPSS ver.10]. Patients in the topical metronidazole group had significantly less postoperative pain than those in the placebo group by the day 14 [P

[Comparison of polydioxanone [PDS] and polyamid [nylon] sutures complications in abdominal midline repair [laparotomy surgery]]

Despite progresss in the techniques of surgery, there is still a lot of controversy about selection of the best technique and suture material. Many post operation complications such as infection, wound dehiscence, pain and sinus formation are related to the type of the suture used. In this study we compared the complications due to the absorbent suture [PDS] with a non absorbent suture [nylon] in laparotomy operation. This clinical trial was performed on 120 patients referring to Imam Khomeini hospital, Sari, 2003-2005 for laparotomy. They were randomly divided in tow groups of equal number. The incision was repaired with PDS sutures in case and with nylon suture in control group. All patients under study were followed up for one year. Data about chronic pain,wound dehiscence, infection, hernia and sinus formation were recorded and analyzed using SPSS software and Chi- square test. In this study 120 patients [60 in case and 60 in control groups] were enrolled. After laparotomy, the incidence of chronic pain and sinus formation in case group was significantly less than the control group. There were no significant differences between the rate of infection, hernia and wound dehiscence in the two groups. No significant differences in the rate of infection, hernia and wound dehiscence between two types of suture materials were observed. However, application of PDS leads to less pain and sinus formation. Therefore, it can be a better choice in surgical incisions

[ role of laparoscopy in diagnosing metastasis of upper gastrointestinal tract malignancies]

Upper gastrointestinal tract cancers are important malignancies in the entire world. Many Diagnostic procedures are frequently used for staging gastrointestinal malignancies. Laparoscopy has emerged as a good staging modality for most gastrointestinal cancers than many other preoperative modalities. Patients with gastrointestinal tract malignancies were selected for evaluation from 2000 to 2001. After complete physical examination and paraclinical evaluations, all patients underwent laparoscopy with general anesthesia and biopsies prepared from metastasis followed by laparotomy. Data were analyzed by statistical tests. Fourty three patients, 41%female and 59% male with a mean age of 61.25 +/- 14 years were studied. Sensitivity and specifity of laparoscopy in diagnosing lymph node metastasis of upper gastrointestinal tract malignancies were 83.33%, 100% respectively. These indices were 75% and 100% in liver metastasis. Positive and negative predictive values of lymph node metastasis were 100% and 89.3% respectively and 100% and 20% in liver metastasis. Preoperative laparoscopy is an effective method for diagnosing metastasis in patients with gastrointestinal tract cancers and can prevent many unnecessary laparotomies

[Evaluation of topical L-arginine gel and comparison with lateral internal sphincterotomy in treatment of chronic anal fissure]

At present, surgery is the best method for chronic anal fissure, but by acquiring more knowledge about the pathogenesis and function of internal anal sphincter, non surgical treatment such as using of Glycerin trinitrate, Isosorbide, Bethancol, Diltiazem and Butilinum toxin has been suggested. There is controversy about using of L-Arginine. The aim of the present study was to compare the effect of L-Arginine [chemical Sphincterotomy] with lateral internal Sphincterotomy [surgical Sphincterotomy] in treatment of chronic anal fissure. This clinical trial study was performed on 60 patients referring to our hospital complaining for chronic anal fissure. They were randomly divided in tow groups of equal number: patients undergoing internal Sphinctrotomy [control], and using of topical L-Arginine gel [case]. All of the patients under study where followed for three months, data about pain, bleeding, and wound healing were recorded, and analyzed by SPSS 11 software, chi- square and t-test. The results observed in this study showed that in case group, rectal bleeding discontinued in 70% and pain controlled in 70%, while wound healing occurred in only 26.7%. in control group, 100% had no pain and no bleeding after treatment and wound healing occurred in 56.7% . Local application of L-Arginine can not replace internal sphinctrotomy, but can be used when patient is unwilling for surgery and in cases with underlying disease

Evaluation of clinical skills of final year nursing students in critical care units

Clinical education in critical care units is very important and promotion of quality of clinical education can lead to higher qualification and professionalism of nursing students in this area of practice. So, this study was conducted to evaluate the clinical skills of nursing students in ICU, CCU and dialysis Units. This research was a cross sectional descriptive one and the samples of this research were 72 final year nursing students of Yazd Shaheed Sadoughi Nursing School. The data was collected by a demographic and checklist questionnaire about clinical skills in ICU, CCU, and dialysis unit. Analysis and descriptive statistics were used for the research goals. Results showed that clinical skills of nursing students in critical care units is ideal, but these skills in CCU are lower than ICU and dialysis unit. Results indicated that the levels of the clinical skills of nursing students were directly related to their examination scores and interest in nursing. Our findings indicate that special attention should be paid to clinical education in critical care units and selection of students in this field should be given special attention