Comparison efficacy of topical piroxicam gel and lidocaine with intravenous pethidine in reducing pain during Eswl

ESWL is a non-invasive method of breaking stones, using acoustic shock waves. Shock waves cause temporary deep visceral pain and discomfort in entry; therefore, administration of sedatives is necessary. The purpose of this study was to compare the effect of topical lidocaine and piroxicam gel with intravenous pethidine in reducing pain during ESWL. This clinical trial study was performed on 159 patients who referred to Ayatollah Kashani Hospital in Shahrkord for ESWL in 2009. Patients were randomly divided into three-groups. For the first group, intravenous pethidine [0.5 mg/kg alone] was administered. The second group received topical piroxicam, and the third group received topical lidocaine in the area of flank for half an hour before ESWL. During the operation, those patients who had unbearable pain, received another 0.5 mg/kg of pethidine. Data was collected using MC Gill questionnaires and analyzed using the SPSS software, using parametric, nonparametric methods and Dunn's Multiple Comparisons tests. The mean of pain scores in the first group [pethidine] was 6.2 +/- 6.9 while these scores were 3.2 +/- 2 .7 and 3.9 +/- 3.1 for the second [piroxicam gel] and third group [lidocaine gel] respectively. The differences in the mean score of pain was significant in the pethidine group compared to the other groups [P <0.05]. The average pethidin consumption were 24 +/- 16 mg for the first group [pethidine], 10 +/- 13 mg for the second group [piroxicam gel], and 5 +/- 9 mg for the third group [lidocaine gel]. The mean difference was significant in pethidine treated group in comparison with other two groups [P < 0.05]. The use of topical piroxicam or lidocaine reduces pain in patients after ESWL It also reduces the need for sedative drugs

[Management of blunt hepatic trauma in patients referred to Isfahan Alzahra hospital during 1998-2008]

Liver is the most commonly injured organ in blunt abdominal trauma. Early diagnosis and appropriate treatment of blunt hepatic trauma would decrease morbidity and mortality rates. To achieve this goal, physicians should be aware of the prevalence, etiologies, signs and symptoms, diagnostic procedures and up-to-date management of blunt hepatic trauma. A descriptive retrospective study was conducted on all 130 patients admitted to the emergency department of Isfahan Alzahra Hospital during 1998- 2008. Data were collected from patients' medical records and analyzed using descriptive statistical methods. Out of 130 patients, 103 cases [79.2%] were male. Mean age of cases was 29.7 +/- 13.46. The most common traumatic mechanism was vehicle accidents in 100 cases [76.9%]. Sonography in association with CT scan as the most commonly used diagnostic method was obtained in 68 cases [52.3%]. Eighty-eight cases [67.7%] underwent surgery while conservative treatment was selected for the other 42 cases [32.3%]. Admission to ICU was more frequently needed in conservative treatment group [P=0.001]. The mean length of hospitalization was shorter for patients underwent surgery. Better clinical results and fewer complications in the group managed conservatively presents it as a safer and more efficient treatment method

[ efficacy of dexamethasone on post-cholecystectomy nausea and vomiting]

Nausea and vomiting are among the common complications of anesthesia and surgery with a higher incidence in laparoscopic cholecystectomy [LC]. The purpose of this study was to evaluate the efficacy of pre-operative dexamethasone on the relief of postoperative nausea and vomiting following LC. This is a randomized clinical trial study. In this prospective, placebo-controlled study, 90 patients requiring laparoscopic cholecystectomy [LC] were randomly divided into two groups: the dexamethasone group [n=45] received dexamethasone [8 mg, IV] and the control group [n=45] received saline [2cc, IV] 90 minutes before the anesthesia. Signs and symptoms of nausea and vomiting were recorded every 4h for 16h in the two groups. The data were analyzed using Fisher's, Chi-square and t test. A lower feeling of nausea was seen 4h and 12h post-surgery in the dexamethasone group [P=0.02, P=004], also a lower accurance of vomithng was observed 4h post-operative in the same group compared to the control group [P=0.013]. The results suggest that pre-operative dexamethasone [8 mg, IV] application significantly reduces the incidence of post-operative nausea and vomiting

[Assessment of oral acetazolamide on postoperative pain after laparoscopic cholecystectomy]

Carbon dioxide [Co2] is used during laparoscopy for producing pneumoperttoneum. Combination of this gas with irrigation fluid in the abdomen produces carbonic acid which creates two kinds of abdominal and referred pain to right shoulder. In the present research, we have studied the effect of oral acetazolamide in reducing postoperative pain after laparoscopic cholecystectomy. This clinical trial was performed in 88 patients with cholelithiasis without any complication that were candidate for laparoscopic cholecystectomy. The patients devided randomly and equally in two groups. The experimental group received Acetazolamide [250 mg orally, 24 hours before surgery. every 8 hours] and control group recieved placebo. Abdominal and shoulder pain measured using McGill pain score by a person who was blind for both groups. Pain measurement was performed in four different times, before and after the surgery, discharge from recovery and 24 hours after surgery. Data were analyzed by using SPSS software. We observed that mean pain scores was significantly higher in acetazolamide group compared to the placebo group, 24 hours after the operation [P<0.05]. However; no significant changes were observed between groups in other times [P>0.05]. Although acetazolamide can reduce abdominal pain referred to right shoulder by reducing acidity in peritoneal irrigation fluid, but this drug can increase abdominal pain in the site of surgery with damaged tissues by producing tissue acidosis [as a side effect of drug]