Multimodal preincisional premedication to prevent acute pain after cholecystectomy

Postoperative pain as an important medical concern is usually treated by opioids which also are of various inevitable side effects. The aim of this study was to assess the efficacy of multimodal preincisional premedication on preventing post-cholecystectomy acute pain. In a randomized clinical trial, sixty patients undergoing open cholecystectomy were randomized into two groups. Before anesthesia induction, Diclofenac suppository [100 mg] and oral Clonidine [0.2 mg] were administered in the first group. Immediately before operation, patients received Ketamine [1 mg/kg IV] while the control group received placebo. The site of incision was infiltrated by the surgeon with 20 mL Bupivacaine 0.25% in both groups. Anesthesia induction and maintenance were similar in both groups. The severity of pain was recorded 2, 4, 6, 12, 24 and 48 hours after operation according to Visual Analogue Scale. The severity of pain at two defined stages [6 and 12 hours later] was significantly less in the intervention group than the control group [P<0.005]. The average pain severity score was less than the control group [P<0.005]. In our study, the administration of Clonidine, Diclofenac and Ketamine and bupivacaine infiltration to the site of incision, altogether was associated with a significant decrease in pain score and opioid requirement after cholecystectomy in comparison to bupivacaine infiltration to the site of incision.

Comparison of cardiac stress index with rate pressure product in trans - abdominal prostatectomy

The current study is to evaluate cardiovascular effects of anesthetic medications and volatile anesthetics on cardiac stress using cardiac stress index [CSI] and rate pressure product [RPP] and to determine which of them in useful in evaluating cardiac stress after comparing results obtained from each method. Forty patients, 60-80 years old, who were all performed Trans abdominal prostatectomy, were studied. Patients were divided into tm groups; half of patients were placed in group A and the other half in group B. The study was carried out as a blinded study. CCSI was measured and evaluated in group A and RPP changes were studied in group B. The mean CSI were 60.25 +/- 5.57, 63.05 +/- .54, 55.75 +/- 4.78 and 67.65 +/- 4.88 before anesthesia induction, after induction, before surgical incision and in recovery respectively. There was no meaningful difference among these four stages measurements. RPP mean in four above mentioned stages was 10.15 +/- 0.44, 9.9 +/- 0.69, 6.8 +/- 0.36 and 9.2 +/- 0.61 respectively. There was a significant difference between RPP in stages before anesthesia induction and before surgical incision [P< 0.0001]. Considering the obtained results from this study, it can be seen that even in non-cardiac surgery, the stress level is high in patients in preoperative period. This condition was not clear in RPP index case and was not in accordance with CSI, which means CSI has been able to illustrate existing stress level better and efficiently

Incidence of back pain following spinal anesthesia and its relationship to various factors in 176 patients

After neuraxial anesthesia, back pain is the most common complaint. The back pain may be related to needle trauma or surgical positioning or transient neurotoxicity of concentrated local anesthetics. The goal of this study was to compare the incidence of back pain following spinal anesthesia with hyperbaric lidocaine 5% and bupivacaine 0.5% and spinal needle insertion spaces. In this clinical trial after approving ethics committee and obtaining patients consent, we included 176 adult patients with physical status of I- II ASA from May 2006 to May 2008 undergoing various elective urologic surgeries under spinal anesthesia in Imam Hospital in Tabriz, Iran. Patients were allocated randomly in two equal groups. Group lidocaine, a nesthetized with hyperbaric 5% lidocaine and group bupivacaine. All patients were interviewed 6, 24, 48 hours after surgery for back pain. This study indicated no statistically significance difference in the incidence of back pain following spinal anesthesia considering age and frequency of needle puncture during spinal anesthesia. Incidence of back pain was higher in lidocaine group than bupivacaine group [31.82% vs. 18.18%; respectively; P<0.001].Incidence of back pain was higher in L3-4 interspace of needle insertion than L4-5 [23.7% vs. 12.8%, respectively; P<0.001]. The intensity of back pain was slight and tolerable in 77% of the cases, and the back pain in all the patients lasted not more than 48 hours. This study implies that the area of needle insertion and type of anesthetics have effects on the back pain following spinal anesthesia

Giant cell tumor of the frontal bone and the frontal sinus

We describe a 7-year-old girl with Giant Cell Tumor involving the frontal bone and the frontal sinus. She presented with headache and a large swelling at the forehead. On skull x-ray a large nonspecific lytic lesion was seen. Total resection of the tumor and cranioplasty of the skull defect was performed and there was no relapse after 4 - year follow-up