effect of different doses of intra-articular ketamine on postoperative analgesia in diagnostic arthroscopic knee surgery

Arthroscopic knee surgery is a painful operation and control of its pain causes earlier recovery of the patients. Therefore, the reduction of the post-operative pain is very important. The aim of this study was to evaluate the analgesic effect of intra-articular ketamine injection after knee arthroscopy. In a double blind randomized study, 75 patients with age ranging of 18-60 years who were candidate for elective arthroscopy were chosen and the same anesthetic method was used for all of them. Based on the injected anesthetic drug, they were divided into five equal groups, A-E. Group A received both intra-articular ketamine [0.5 mg/kg] and intravenous placebo. Group B received intra-articular ketamine [0.75 mg/kg] and intravenous placebo. Group C received intravenous ketamine [0.5 mg/kg] and intra-articular placebo. Group D received intravenous ketamine [0.75 mg/kg] and intra-articular placebo. Group E received intravenous and intra-articular placebo. After the operation, if necessary, intra-veouns morphine [0.05 mg/kg] was given for pain relief. Using visual analogue scale [VAS 1 to 10], the pain was evaluated at 4, 8 and 24 hours after the operation. The time of first rescue analgesic request, and the total dose of morphine used was recorded. Statistical analysis was carried out by using SPSS software. The results of this study showed that there was no significant difference in the cases of age, sex, weight and duration of operation among 5 groups studied. Also, the total amount of opioid or the time beginning of analgesic request was not statistically different among the groups during 24 hours observation. Based on our results, intra-articular ketamine injection did not reduce postoperative pain after diagnostic knee arthroscopy and had no sparing effect on total opioid consumption and first postoperative analgesic request

effect of different concentrations of oxygen on postoperative nausea and vomiting after spinal anesthesia

Postoperative nausea and vomiting [PONV] are common complications after both general and regional anesthesia. A number of different drugs are used for prevention and treatment of PONV. However, the complications are still common. Some of the recent investigations showed that using high concentration of oxygen decreased nausea and vomiting after general anesthesia but there is no study about effects of oxygen on PONV after regional anesthesia. Therefore, in this study the effect of different doses of oxygen is studied on the nausea and vomiting of after spinal anesthesia. In this double-blinded clinical trial, 132 patients with ASA I and II [American Society of Anesthesiologyists] criteria and 15-70 years old who were scheduled to undergo elective surgery for reduction and fixation of tibia open fracture were randomly divided into three equal groups, Spinal anesthesia was performed with 0.5% bupivacaine solution and oxygen with concentrations of 30% [group 1], 50% [group 2] and 70% [group 3] has been administered during operation. The frequency of vomiting and the severity of nausea with regard to VAS [visual analogue scale] were determined. Data was analyzed by ANOVA and x2 tests with SPSS software and a P value< 0.05 is considered significant. The mean of vomiting frequency, nausea intensity and dose of metoclopramid consumption in the patients of the 3 groups were not significantly different. The result of this study revealed that the higher concentrations of oxygen didn't reduce PONV or metochlopramide consumption during and after the operation

Analgesic effects of intra-articular fentanyl, pethidine and dexamethasone after knee arthroscopic surgery

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

Evaluation of preemptive use of analgesia of the skin, before and after lower Abdominal surgery: a prospective, double-blind, randomized clinical trial

Perioperative pain is prevalent and poorly treated. Apart from that it makes the recovery from surgery unpleasent, pain often remains as a residual side effect of surgery, even though the tissue healing is complete. An essential observation is that tissue injury and the resulting nociceptor barrage initiates a cascade of events that can indelibly alter pain perception. Preemptive analgesia is the concept of initiating analgesic therapy before the onset of the noxious stimulus so as to prevent the nociceptor barrage and its consequences. However, anticipated clinical potency of preemptive analgesia, though has firmly grounded in the neurobiology of pain, has not been yet realized. As data accumulates, it has become clear that clinical studies emulating those from the laboratory and designed around a relatively narrow definition of preemptive analgesia have been largely unsupportive of its use. Nevertheless, preemptive analgesic interventions that recognize the intensity, duration, and somatotopic extent of major surgery can help reduce perioperative pain and its longer-term sequelae. surgeons spend a lot of time treating the pain of lower abdominal surgery. A total number of 48 consecutive patients who were going to undergo elective lower abdominal surgery. Were randomly assigned in two groups of 24 each. In one group the patients received an injection of 0.5% bupivacaine in the planned skin for incision just before lower abdominal surgery, and in the other group, they received an equal amount of 0.5% bupivacaine after the surgery had been done. Pain was objectified by a numerical visual pain score, in the 24 hours following the lower abdominal surgery. There were no differences in postoperative pain scores on the visual analog scale [VAS]: In groups 1and 2, VAS at hour 4 were 6.37 +/- 1.13 versus 6.29 +/- 1.19; At hour 8 were 5.54 +/- 1.17 versus 5.37 +/- 1.09; and at hour 12 were 4.5 +/- 1.31 versus 4.45 +/- 1.1 respectively [P-value was not significant]. There was not any difference between the main of morphine consumption between the two groups: at 12 hours, they were 11 +/- 3.5 versus 11.5 +/- 3.63; and at 24 hours, they were 17.87 +/- 5.88 versus 18.29 +/- 5.85 [P-value was not significant]. Conclusions: The administration of local anesthesia prior to starting surgery does not appear to have any advantage over its postoperative administration in patients undergoing lower abdominal surgery

Preemptive analgesia with ibuprofen and acetaminophen in pediatric lower abdominal surgery

Postoperative pain is a significant problem in pediatrics. Preemptive administration of analgesics has recently emerged as a method to enhance pain management associated with surgery. The objective of this study was to compare the analgesic efficacy of a single-dose of preoperative oral ibuprofen versus acetaminophen in preventing pain after lower abdominal surgery in pediatrics. In this randomized, double-blind study, following lower abdominal surgery, 75 children, aging 3 to 12 years, were assigned to receive either ibuprofen 20 mg/kg [n=25] or acetaminophen 35 mg/kg [n=25] or placebo [n=25] 2 hours before surgery. Agitation in recovery was measured and postoperative pain was quantified 3 and 24 hours after surgery by Oucher's scale. The amount of postoperative analgesic needed in the ward was also assessed. It was found that preoperative administration of ibuprofen and acetaminophen can reduce agitation in recovery but there was no difference in the agitation score between ibuprofen and acetaminophen groups [P=0.145]. Agitation score was significantly lower in ibuprofen group compared to placebo [P>0.005]. Similarly, patients in the acetaminophen group were considerably less agitated than those in the placebo group [P=0.002]. No significant difference was observed in pain intensity 3 and 24 hours after operation between the three groups [[P=0.495] and [P=0.582] respectively]. The amount of postoperative analgesic needed during ward hospitalization was not significantly different among the three groups [P>0.005].These results provide evidence that preemptive acetaminophen and ibuprofen may reduce agitation during recovery but they neither improve the postoperative pain nor reduce analgesics consumption in ward