RESUMEN
Background: Intravenous regional anesthesia [IVRA] is a easy and reliable method for extremity injuries. To improve block quality, decrease tourniquet pain and postoperative analgesia different drugs has been used as an adjuvant in IVRA. In this study, we evaluated the effect of nitroglycerin [NTG] in quality improvement when added to lidocaine and Meperidine as an adjuvant in IVRA
Material and Methods: Fifthly patient with upper extremity injury under IVRA were randomly and blindly to two groups. Under identical condition, control group received total dose of 200 mg lidocaine and 20 mg Meperidine diluted with saline [40cc] and study group received 200 mg lidocaine and 20 mg Meperidine plus 200?g Nitroglycerine. Onset time, anesthesia quality, tourniquet pain and analgesic use were assessed during surgery. After tourniquet deflation, the time to first analgesic requirement and side effect were noted
Results: The sensory block onset time were shortened in study groups [3.7 +/- 1.1 vs 5.1 +/- 1.3] [P=0.004].Intraoperative pain score and quality of analgesic were not different between two groups and fentanyl requirement was similar. The onset of postoperative pain were similar in study and control groups.[78.79 [61.28-92.23] vs 52.28 [35.07-73.448]].[P=0.29]
Conclusion: Addition of Nitroglycerine to lidocaine and Meperidine in intravenous regional anesthesia shortens onset times of sensory block but is not improved the quality of intraoperative analgesia and postoperative pain in patients undergoing hand surgery
RESUMEN
Background: among the most common complaints in elderly age group is constipation. Appropriate dietary regimes and administration of dietary fibers are effective in alleviating this symptom. When the mentioned problem continues, it is the time that some of patients use unusual methods for treating constipation! Till now, several reports have mentioned using different types of foreign bodies in return for relieving constipation. We have reported five patients with severe constipation, after self-enema with high pressure water in home, leading to colorectal perforations
Materials and Methods: five patients with peritonitis due to perforation of colon due to improper self-enema, characteristics and outcome of them after operation have been reported through a descriptive study
Results: the average age was 69.6 year, four of them were male and one was female. All of them had used self-enema because of constipation. One of patients had permanent colostomy because of severe anal sphincter injury and did self-enema through colostomy site. Clinical presentations of patients were sudden onset severe abdominal pain, peritonitis. Two of them died during 24 hours after operation [mean age: 76.5]. Average time needed since onset of symptoms till operation for dead and alive patient was 12.6, 4.6 hours respectively. Average age of patients that were alive was 65 years. In dead patients operation finding was rectal perforation in upper third segment and in *alive* patient was sigmoid colon perforation. The cause of death of two patients was severe sepsis and myocardial infarction. The average hospital stay of other three patients was 11.6 day four of five patients had chronic diseases such as DM, HTN and CRF. Early post up complication in one patient was facial dehiscence and in another was wound infection. One of patients after two years, with clinical diagnosis of colonic obstruction due to cancer of colon was operated
Conclusion: we recommend emergency laparotomy with least time consuming for pre-operation work up. With regards to advanced age, high incidence of constipation in this age group appropriate and correct ways should be educated to families and discourage them from self-enema with high pressure water! Other clinical trails with more cases are needed to determine relationships between concomitant intra luminal pathology and colorectal perforation following self-enema