ABSTRACT
Background and aim: The postoperative pain control is performed with different methods [regional anesthesia, acupuncture, music therapy,] or drugs such as opioids, NSAIDs and Ketamine. In many researches, Metoclopramide is used for decreasing postoperative pain. The aim of this study was to compare the effect of Metoclopramide [M] and Ketamine [K] as a preemptive analgesia on postoperative pain
Methods: In a double blinded clinical trial study 86 ASA 1 and 2 patients enrolled in this study and divided into two groups of Metoclopramide [M] and Ketamine [K]. Half an hour before the operation patients in group M and group K received 10 and 0.3 mg/kg, i.v. Metochlopramide and Ketamine, respectively. The pain scores and the amounts of opioid consumption in recovery room and first 24 hours and the postoperative complications such as nausea, vomiting, irritability and psychological problems were recorded. Data were analyzed using student-t test, ANOVA and Chi-square statistical analysis
Results: There was no significant difference in demographic data including weight, age, sex, duration of surgery and basic hemodynamic parameters between two groups [P>0.05]. The pain score was lower in Metoclopramide group [3.98+/-3.04] compared to the Ketamine group [5.93+/-3.32] in recovery room and first 24 hours after surgery. In addition, there was a statistical difference in the frequency of drug's side effects in group M [30.02%] and the group K [95.3%] [P<0.001]. The extubation time was significantly longer in Ketamine group [5.3+/-0.8] than Metoclopramide group [7.4+/-0.7] [P<0.05]
Conclusion: The results of this research showed that administration of Metochlopramide before induction of anesthesia was more effective than Ketamine for reducing postoperative pain, which suggests analgesic effects of Metoclopramide
ABSTRACT
Tissue trauma, pain and surgical stress can increase coagulability in perioperative period. Tourniquet application can increase DVT by blood stasis and releasing tromboxane, but some studies concluded that tourniquet will increase fibrinolysis. In this study, the changes in coagulability and fibrinolysis due to tourniquet application were evaluated by thrombelastograph during knee arthroscopy. In this clinical trial, 30 patients without known risk factors of coagulopathies were studied. Blood sampling were done immediately before tourniquet inflation [TI] as well as 2 and 30 minutes after tourniquet deflation [TD]. Thrombelasthographic parameters including R-time, K-time, alpha angle, MA, LY30 and LY60 were measured and analyzed by t-paired test and ANOVA in SPSS software. The mean of R-time at 2 and 30 minutes after TD decreased and the mean of alpha increased in comparison with before TI [p<0.0001]. The mean of MA at 2 and 30 minutes after TD increased first and then decreased and LY30 decreased first and then increased in comparison to before TI [p, 0.001]. Tourniquet application initially can increase coagulability and the probability of thrombus formation after TD, but after a short time, compensatory clot lysis occurs by increasing fibrinolytic activities
Subject(s)
Blood Coagulation , Fibrinolysis , Thrombelastography , Arthroscopy , Knee Joint/surgery , Knee/surgeryABSTRACT
Many different methods have been used in an effort to provide adequate analgesia after knee arthroscopic surgery. In this study analgesic effect of intra-articular fentanyl, pethidine and dexamethasone was compared. In a double blind randomized study 48 male patients undergoing knee arthroscopic meniscectomy were allocated to groups receiving intra-articular fentanyl 50 ig or pethidine 20 mg or dexamethasone 8 mg at the end of arthroscopy during general aesthesia. Postoperative pain scores using visual analogue scale were measured and also analgesic requirements and the time of ability to walk were recorded. Pain scores at one, two, six and 24 h after intra-articular injection were not significantly different for fentanyl and pethidine but were higher significantly for dexamethasone at all four mentioned times. The mean average time of ability to walk was significantly longer for dexamethasone. The analgesic requirements during the first 24 h after intraarticular injection were significantly greater only for dexamethasone too. Better postoperative analgesia, less pain score and shorter time to walk were achieved by fentanyl and pethidine in comparison to dexamethasone but the results were not significantly different between fentanyl group and pethidine