Evaluating resident physicians' knowledge, attitude, and practice regarding the pain control in cancer patients

Pain has been one of the most debilitating symptoms of cancer. The aim of this study was to evaluate residents' knowledge, attitude, and practice regarding pain control in cancer patients. In a descriptive study, 69 randomly selected third-year various residents practicing in teaching hospitals of Shahid Beheshti School of medicine participated in this study. They have provided their demographic characteristics and completed a questionnaire, based on their "knowledge", "attitude" and "practice" regarding cancer pain and its management. Data analysis has performed using SPSS v.19. A p value of less than 0.05 has considered as significant. Obtained Data from 69 participants including 32 anesthesiology residents has included to our study. The average scores were 35.8 +/- 6.1 [ranging from 20 to 49] for the residents' attitude, 25.1 +/- 9.1 [ranging from 0 to 53] for their knowledge and 11.2 +/- 4.1 [ranging from 0 to 17] for their practice. The overall scores of the questions have related to attitude and knowledge were higher for residents of anesthesiology but the difference was not statistically significant [A: 37.1 +/- 4.9 vs. 34.7 +/- 6.8, p=0.106, K: 27.2 +/- 11.8 vs. 23.3 +/- 5.6, p=0.076]. The average score for questions on physician' practice was significantly higher in residents of anesthesiology [P: 12.8 +/- 3.2 vs. 9.7 +/- 4.2, p=0.001]. In order to provide patients with adequate pain relief, it has seemed advisable for medical schools to focus on improving the educational curriculum and integrating it into clinical practice

Intravenous regional block with phentolamine in the treatment of complex regional pain syndrome

Complex regional pain syndrome [CRPS] is a variety of painful conditions following injury which appears regionally having a distal predominance of abnormal findings. This study, evaluate the use of phentolamine for sympathetic block and regional anesthesia in treatment of CRPS related pain. In this study, 68 patients with CRPS who were referred to pain clinics of Imam Hossein and Akhtar Hospitals and Gandy Center of Surgery between 2003-2008 were evaluated. Forty three of 87 patients finally undertaken intravenous regional sympatholytic block according to therapeutic protocol. 37 patients [86%] received one block, 2 of them [4.75%] received 2 repetitions of blocks and finally repeated block for three times occurred in 4 patients [9.3%]. A week after block pain relief outcomes was recorded as following; excellent in 7 patients [16.3%], good in the 32 patients [74.4%] and moderate in the 4 patients [9.3%]. After a month, 8 patients [18.5%] showed excellent relief and it was good and moderate in 32 [78%] and one case [2.4%], respectively. Pain relief after three months was excellent, good and moderate in the 13 patients [31.7%], 25 patients [61%] and 3 patients [7.3%], respectively. In this study level of pain relief was significant in various intervals and it showed significant difference in relief three months after block [P=0.04]. CRPS due to SMP[sympathetically maintained pain] is thought to be alleviated by phentolamine. Intravenous phentolamine infusion is potentially a new significant option for the therapy of CRPS

[Evaluating the effects of local injections of bupivacaine and triamcinolone acetate on shoulder joint pain and restricted range of motion following cerebrovascular accidents]

Shoulder pain is a common complication of cerebrovascular accidents. This study was conducted to assess the effects of local injections of bupivacaine and triamcinolone acetate on shoulder joint pain and on restricted range of motion following brain events. This single-blind clinical trial study included 35 patients with chronic shoulder pain [the controls] and 35 patients with chronic shoulder pain due to brain events [the case group]. The study was done at Imam Hossein Hospital and Gandhi Day Clinic during the year 2008-2010. The patients in the two groups received bupivacaine and triamcinolone acetate for subacromial bursa injection and suprascapular nerve block by following the protocol described by Dangoisse et al. The patients were followed up for 12 weeks and they were evaluated for pain and range of motion 1, 6, and 12 weeks after the injections. The mean age of the patients was 60.9 +/- 9.07 years. Statistically significant improvements in pain score [P=0.001] and shoulder joint range of motion [P=0.001] were observed in patients with chronic shoulder pain versus patients with brain events 12 weeks after suprascapulare nerve block and subacromial bours injections by bupivacaine and triamcinolone acetate. Suprascapular nerve block and subacromial bursa injections of bupivacaine and triamcinolone acetate is a safe and efficacious treatment for the treatment of chronic shoulder pain and restricted range of motion but it is not efficacious or of significant value for the treatment of shoulder pain in patients with brain events

[Comparison of intraoperative hemodynamic parameters and post operative analgesia of gabapentin and tizanidine in patients with tibial fractures]

Preoperative consumption of some drugs can control intra operative and post operative pain. Gabapentin and Tizanidine analgesic effects have been studied but a comparison between analgesic effects of these two drugs has not been studied before. We studied 60 patients with tibial fractures between 15 to 80 years. They were divided into two groups: 30 patients were given 300 mg Gabapentin orally 1 hour before operation [Group G], and 30 patients were given 8 mg Tizanidine by oral route 1 hour before operation [Group T]. Pain was assessed 1 hour before until 12 hours post operation using Visual Analogue Scale [VAS]. All patients had general anesthesia. Vital signs and fentanyl consumption during Surgery, the first time morphine was needed and the total dose of Morphine after operation were assessed. Systolic, diastolic blood pressure and heart rates during operation between two groups were not statistically significant. intra operative fentanyl dose in group G was significantly less than group T[P = 0.001]. The first time morphine was needed in group G was significantly longer than group T [P = 0.001] and total dose of Morphine Consumption during 12 hours after operation in group G was significantly less than group t [P = 0.003]. VAS was only different between two groups 12[th] hours. After operation. Preoperative oral consumption of Gabapentin compared to Tizanidine might facilitate better analgesia and more opioid saving during and after operation