Comparing transcervical intrauterine lidocaine instillation with rectal diclofenac for pain relief during outpatient hysteroscopy: a randomized controlled trial

There are a number of potential advantages to performing hysteroscopy in an outpatient setting. However, the ideal approach, using local uterine anesthesia or rectal non-steroidal anti-inflammatory drugs, has not been determined. Our objective was to compare the efficacy of intrauterine lidocaine instillation with rectal diclofenac for pain relief during diagnostic hysteroscopy. We conducted a double-blind randomized controlled trial on 70 nulliparous women with primary infertility undergoing diagnostic hysteroscopy. Subjects were assigned into one of two groups to receive either 100mg of rectal diclofenac or 5mL of 2% intrauterine lidocaine. The intensity of pain was measured by a numeric rating scale 0-10. Pain scoring was performed during insertion of the hysteroscope, during visualization of the intrauterine cavity, and during extrusion of the hysteroscope. There were no statistically significant differences between the groups with regard to the mean pain score during intrauterine visualization [p=0.500]. The mean pain score was significantly lower during insertion and extrusion of the hysteroscope in the diclofenac group [p=0.001 and p=0.030, respectively]. Nine patients in the lidocaine group and five patients in diclofenac group needed supplementary intravenous propofol injection for sedation [p=0.060]. Rectal diclofenac appears to be more effective than intrauterine lidocaine in reducing pain during insertion and extrusion of hysteroscope, but there are no significant statistical and clinical differences between the two methods with regard to the mean pain score during intrauterine inspection

new method for extubation: comparison between conventional and new methods

Extubation is associated with the risk of complications such as accumulated secretion above the endotracheal tube cuff, eventual atelectasia following a reduction in pulmonary volumes because of a lack of physiological positive end expiratory pressure, and intra-tracheal suction. In order to reduce these complications, and, based on basic physiological principles, a new practical extubation method is presented in this article. The study was designed as a six-month prospective cross-sectional clinical trial. Two hundred fifty-seven patients undergoing coronary artery bypass grafting [CABG] were divided into two groups based on their scheduled surgery time. The first group underwent the conventional extubation method, while the other group was extubated according to a new described method. Arterial blood gas [ABG] analysis results before and after extubation were compared between the two groups to find the effect of the extubation method on the ABG parameters and the oxygenation profile. In all time intervals, the partial pressure of oxygen in arterial blood / fraction of inspired oxygen [PaO[2] / FiO[2]] ratio in the new method group patients was improved compared to that in the conventional method; some differences, like PaO[2] / FiO[2] four hours after extubation, were statistically significant, however [p value = 0.0063]. The new extubation method improved some respiratory parameters and thus attenuated oxygenation complications and amplified oxygenation after extubation.

Comparison of the effect of fentanyl, sufentanil, alfentanil and remifentanil on cardiovascular response to tracheal intubation in children

Laryngoscopy and tracheal intubation may cause significant cerebral and systemic hemodynamic responses. Many drugs have been shown to be effective in modifying these hemodynamic responses, including fentanyl, sufentanil, alfentanil and remifentanil. The purpose of the current study was to compare the efficacy of fentanyl, sufentanil, alfentanil and remifentanil on blunting cardiovascular changes during laryngoscopy and intubation in children. Eighty children, 1-6 years old, classified as American Society of Anesthesiologists physical status I and II who were scheduled for elective surgery with general anesthesia and orotracheal intubation, were enrolled in this randomized and double-blinded study. Patients were randomly assigned into four groups of 20 patients. Group F received fentanyl 1 micro g/kg[-1], group S received sufentanil 0.1 micro g/kg[-1], group A received alfentanil 10 micro g/kg[-1] and group Rreceived remifentanil 1 micro g/kg[-1] intravenously. After establishment of neuromuscular blockade confirmed with a nerve stimulator, laryngoscopy and orotracheal intubation were performed 3 min after induction. Hemodynamic variables including systolic and diastolic blood pressure [SAP, DAP] and heart rate [HR] were recorded at base line [before opioid administration], before laryngoscopy and one minute after orotracheal intubation. The patients' characteristics and laryngoscopy grade were similar in all groups. There was no significant difference in the mean values of SAP, DAP and HR at each measured time between the four groups. There was significant difference in the mean values of SAP, DAP and HR measured over time in each group. The intravenous fentanyl attenuated laryngoscopy-induced SAP, DAP and HR increases better than sufentanil, alfentanil or remifentanil and hemodynamic stability is better preserved with fentanyl

Preoperative oral dextromethorphan does not reduce pain or morphine consumption after open cholesyctectomy

Dextromethorphan [DM], the D-isomer of the codeine analogue levorphanol, is a weak, noncompetitive N-Methyl-D-Aspartate [NMDA] receptor antagonist. It has been suggested that NMDA receptor antagonists induce preemptive analgesia when administrated before tissue injury occurs, thus decreasing the subsequent sensation of pain. The study was conducted in the Dr Ali Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran. In this seventy two patients scheduled for elective cholesyctectomy between February 2005 and December 2006 were randomized into three equal groups to receive as premedication either oral dextromethorphan 45 mg [Group D45 = 24], dextromethorphan 90 mg [Group D 90 = 24] or placebo [Group C, n = 24], 120 min before surgery. A visual analogue scale [VAS] for pain of each patient measured at arrival in the ward and 6 and 24 hours after surgery, was recorded. The demographic characteristics of patients, ASA physical status class, duration of surgery, and the basal VAS pain score were similar in the two groups. There was no significant difference in the mean of the VAS pain scores measured over time or morphine consumption between three groups. Dextromethorphan, 45 and 90 mg orally administrated 2 h before surgery had no effect on postoperative morphine requirement and pain intensity

Effect of incisional site infiltration of Bupivacaine on postoperative pain and meperidine consumption after midline laparotomy

The purpose of the current study was to determine whether infiltration of bupivacaine in the incision site of midline laparotomy reduces postoperative pain and opioid consumption. Fifty-six, 30-60 year-old patients who were undergoing midline laparotomy were enrolled in the present study. The patients were randomly assigned into two groups of control [group C, n = 28] or bupivacaine [group B, n= 28]. Just before suturing, the incision sites were infiltrated by 20 ml epineprinated bupivacaine 0.25% [group B] or 20 ml normal saline as placebo [group C]. The patients were asked to score their pain at 6, 24, and 48 hours after surgery. Demographic characteristics of the patients were similar in the two groups. There was no significant difference in the mean of visual analogue scale pain scores measured over time between the two groups. There was a significant difference in post operative meperidine consumption between the two groups, and in the bupivacaine group, meperidine request was less [90.53 +/- 13.36 mg in bupivacaine group v127.5 +/- 23.14 mg in the control group, P < 0.05]. After midline laparotomy, incisional site infiltration with 20 ml epineprinated bupivacaine 0.25% causes a significant decrease in postoperative meperidine consumption

Pulmonary function parameters changes at different altitudes in healthy athletes

Hypoxia and hypocapnia can cause broncho-constriction in human subjects, and this could have a bearing on performance at high altitude. The object of this study was to examine how pulmonary ventilatory functions during high-altitude trekking. This study is a cohort study on spirometric parameters at different altitudes. Fifty six healthy male volunteers from a university student population were enrolled in the study [ages 22.9 +/- 5.3 years]. Pulmonary function was assessed with a Spirolab II in all participants before ascending at baseline [1150 meter], after ascending at different altitudes [2850, 4150 meter], and after descending at sea level during a 3-day trek in Sialan Mount. This study indicates that in an actual trek, ascending results in significant decrease in forced vital capacity [FVC]. FVC significantly decreased with increasing altitude from baseline level and at the sea level it was significantly less than baseline level. Peak flow increased with increasing altitude from baseline [1150 m] to 2850 m and decreased with decreasing altitude [p < 0.01]. Maximal midexpiratory flow rate [FEF 25-75%] and forced expiratory volume in 1 second to forced expiratory volume ratio [FEV1.0%] significantly increased with increasing and decreasing altitude from baseline level [p < 0.001]. There was no significant change in FEV1. It could be concluded that changes in some pulmonary ventilatory parameters were proportional to the magnitude of change in altitude during a high-altitude trek. These changes are significant at the beginning of ascending

Post-thoracotomy pain and pulmonary function - comparison of intermittent intercostal- bupivacaine vs intravenous pethidine

In a prospective, observer-blind study, 50 patients scheduled for posterolateral thoracotomy were investigated to compare the effects of intermittent intercostal extrapleural bupivacaine [n= 25] and intravenous pethidine [n = 25] on post-thoracotomy pain and pulmonary function. The severity of chest pain [objectified by the use 5- point scale of Prince Henry] and changes in spirometric values [forced vital capacity [FVC], forced expired volume in 1 s [FEV1] and FEV1/FVC] were monitored during the first three postoperative days. Because intravenous pethidine was used to supplement pain relief in the patients who received intercostal analgesia, total pethidine used was compared to that administered to patients in the intravenous pethidine group. There were no statistical significant differences regarding patient demographics in both groups. No complications occurred. There was no significant difference between mean pain scores in the first postoperative day, but in the second and third postoperative days and also in the whole first 72 post-operative hours, pain scores were significantly higher in the intravenous group than the intercostal group. The postoperative decrease in FVC and FEVI was significantly less with intercostal bupivacaine compared with the intravenous pethidine. There was no significant intergroup difference in the post-to pre-operative FEVI/FVC ratio. The total amount of the pethidine received by the patients was significantly higher in the intravenous group than the intercostal group. Intermittent intercostal nerve block with bupivacaine appears to be a promising, safe and reliable technique in the management of post-thoracotomy pain. Use of intercostal bupivacaine could significantly reduce or even eliminate the postoperative need for systemic narcotics

Post-thoracotomy analgesia comparison epidural fentanyl to intravenous pethidine

To evaluate the efficacy of post-thoracotomy analgesia with intermittent epidural fentanyl. 50 patients were allocated randomly into 2 groups. The first group received intermittent epidural fentanyl and the second group received intermittent intravenous analgesia using pethidine. The variables studied were: pain score; total amount of additional intravenous opioid analgesia, and ventilatory function parameters [forced vital capacity [FVC], forced expiratory volume in the first second [FEV[1]] and FEV[1]/FVC ratio]. In the first postoperative day, pain scores were higher in the epidural group [P = 0.034], but there was no significant difference between mean pain scores in the second and third days [P = 0.61, P = 0.15, respectively]. On all three days, significantly more additional analgesics were required in the epidural group. A difference was found between both groups in the post- to pre-operative FEV[1], FVC and FEV[1]/FVC ratios, with the better preservation of the ventilatory function in the epidural group [P= 0.001, 0.013, O.0001, respectively]. The analgesic effect of intermittent epidural fentanyl is not adequate, and postoperative pain relief has not any significant advantage over the more easily-applied intravenous analgesia. However, better preservation of ventilatory function makes epidural fentanyl a useful adjunct analgesia in reduction of post-thoracotomy pulmonary complications