Intrathecal injection of magnesium sulfate: shivering prevention during cesarean section: a randomized, double-blinded, controlled study / 대한마취과학회지

BACKGROUND: Regional anesthesia is known to significantly impair thermoregulation and predispose patients to hypothermia. We hypothesized that the addition of an intrathecal injection of magnesium sulfate (MgSO4) to bupivacaine would improve perioperative shivering in female patients undergoing elective caesarean section. METHODS: In a block-randomized, double-blinded, controlled trial 72 patients scheduled for elective caesarean section with spinal anesthesia were separated into two groups. In the treatment group, 2 ml of 0.5% bupivacaine plus 25 mg MgSO4 (0.5 ml) were injected intrathecally, and in the control group 2 ml of 0.5% bupivacaine plus 0.5 ml normal saline were injected intrathecally. Core temperature was measured before and after drug injection at predetermined intervals. Sedation was graded using the Ramsay sedation scale. RESULTS: No significant intergroup differences in appearance of shivering were seen immediately or at 5, 30, 40, 50, 60, and 90 min after block administration. However, at 10, 15, and 20 min post block, there was a significant difference in shivering. The group administered MgSO4 showed lower shivering grades compared with the control group. Core temperature was significantly reduced in the MgSO4 group compared to the normal saline group 30 min after blocking. CONCLUSIONS: Intrathecal injection of MgSO4 improved perioperative shivering in female patients undergoing elective caesarean section.

Sonoanatomic Variation of Pes Anserine Bursa

BACKGROUND: The pes anserine bursa lies beneath the pes anserine tendon, which is the insertional tendon of the sartorius, gracilis, and semitendinosus muscles on the medial side of the tibia, but it can lie in different sites in the medial knee. Accurate diagnosis of the position of the bursa is critical for diagnostic and therapeutic goals. The aim of this study was to evaluate sonoanatomic variations of the pes anserine bursa in the medial knee. METHODS: One hundred seventy asymptomatic volunteers were enrolled in this study. Using ultrasound imaging (transverse approach, 7-13 MHz linear array probe) the sonoanatomic position of the pes anserine bursa and its relation to the pes anserine tendon were evaluated. Additionally, we evaluated the sonoanatomic variation of the saphenous nerve. RESULTS: The position of the pes anserine bursa was between the medial collateral ligament and the pes anserine tendons in 21.2%/18.8% (males/females) of subjects; between the pes anserine tendons and the tibia in 67.1%/64.7% (m/f); and among the pes anserine tendons in 8.2%/12.9% (m/f). No significant differences in the position of the bursa existed between males and females. The saphenous nerve was found within the pes anserine tendons in 77.6%/74.1% (m/f) of subjects, but outside the pes anserine tendons in 18.8%/15.3% (m/f). Visibility of sonoanatomic structures was not related to either gender or BMI. CONCLUSIONS: Ultrasound provides very accurate information about variations in the pes anserine bursa and the saphenous nerve. This suggests that our proposed ultrasound method can be a reliable guide to facilitate approaches to the medial knee for diagnostic and therapeutic objectives.

[Pain control and ACTH changes in postoperative intravenous analgesia versus epidural analgesia in limb orthopedic surgery patients]

The aim of this study is comparing ACTH changes in epidural and intravenous analgesia technique after lower limb orthopedic surgery. In a randomized clinical trial in Hazrat Rasool Akram Hospital during 1387-88, 60 patients candidate for surgery on the lower extremities were randomly allocated to receive either postoperative analgesia with epidural analgesia [PCEA] or IV analgesia [PCIA]. Measurement of ACTH levels and Visual analogue scale [VAS] was performed in four relief phases including at the time of arrival to the operating room, immediately after surgery and 12 hours after intravenous pump functionary and 24 hours after surgery were recorded. The mean level of ACTH and VAS, 24 hours and 12 hours after surgery in the PCEA group were less than PCIA. Ramsey Sedation Score [RSS] in PCEA group at these intervals was more than PCIA cases. It seems that PCEA relieves pain more effectively than PCIA method. However, the proper method of anesthesia for each patient as well as patients' preferences should be considered in selecting the method of postoperative analgesia

[Sonoanatomy survey of the distance between the suface of the skin and sixth cervical transverse process]

One of interventional procedure in pain specialty is Stellate Ganglion Block. In this study we tried to show more on the sonoanatomy of the area, including the diameter of longus coli muscle and the distance between sixth cervical transverse process and the surface of skin. Obviously, understanding different anatomical locations can help to more successful block and avoid possible complications. This descriptive study was performed on 145 patients who were candidated for elective orthopedic surgery. After patients consented, neck sonography was performed. Demographic data were recorded. Neck circumference, diameter of longus coli muscle and the distance between sixth cervical transverse process and the surface of skin were measured. The average distance from the skin to the transverse process was 2.84 cm and a maximum of 3.7 cm was recorded. Anteroposterior diameter of Longus coli muscle was 0.76 cm, on average. The distance from skin to the transverse process was significantly correlated with body mass index and neck circumference in both sexes. Since the average distance from the skin to the transverse process was 2.84 cm therefore, without any pressure on the skin, inserting the needle more than 2.84 cm has to be with coution, and when it is inserted more than 3.7 cm, it is possibly going off the main path

[ effect of transdermal TNG on the level of spinal anesthesia in knee arthroscopic surgery]

One of the problems with the implementation of spinal anesthesia is not to achieve an appropriate sensory level and sensory level decline before the end of operation that can cause pain and stress for the patient and surgeon dissatisfaction. In this study, the effects of transdermal TNG on the level of spinal anesthesia in knee arthroscopy patients were investigated. In a randomized clinical trial 46 patients randomly allocated in two groups of TNG or placebo. All of patients were premedicated with 10 mg diazepam before operation and then spinal anesthesia was performed with 1.5cc lidocaine 5%. After 20 minutes, one group received a transdermal placebo and the second group received transdermal TNG. The level of sensory block was measured by a blunt needle and alcohol swab. After 20 minutes a two level increase of sensory level in 82.6% of patients in the TNG group was observed but only 4.3%of the placebo group showed this raise. [p<0.05]. In spinal anesthesia, transdermal TNG can increase the sensory level via some theoretical mechanisms