A retrospective review of efficacy of combination therapy with pregabalin and carbamazepine versus pregabalin and amitriptyline in treatment of trigeminal neuralgia

Aims: Trigeminal neuralgia is a rare cause of neuropathic pain and carbamazepine [CBZ] is its main treatment. However, its adverse effects sometimes compel the physicians to substitute or use it concurrently with other drugs. This study aimed to retrospectively compare the effects of combination therapy with pregabalin and carbamazepine versus pregabalin and amitriptyline, in the treatment of patients with refractory trigeminal neuralgia. Methodology: Hospital records of 37 patients with refractory trigeminal neuralgiaandno favorable response to the primary treatment without pregabalin, were retrospectively reviewed. Demographic information, drug doses and response to the treatment were recorded in a proforma. Visual Analogue Scale [VAS] was used as the tool for measuring pain intensity. Pain reduction equal or less than 50% based on VAS score after eight weeks of treatment was defined as no response to therapy, and pain reduction of more than 50% was considered as positive response. Results: Twenty eight patients received pregabalin and carbamazepine, three patients received combination of pregabalin and amitriptyline and six received pregabalin, carbamazepine and amitriptyline combination. The mean dose of pregabalin and carbamazepine was 125.68 +/- 63.87 and 283.78 +/- 193.66 mg/day, respectively. After 8 weeks of treatment, 18 patients [64.3%] in pregabalin and carbamazepine group, six patients [100%] in triple therapy group and two cases [66.7%] in pregabalin and amitriptyline group had responded to treatment. Conclusion: The effect of combination therapy with pregabalin and carbamazepine was comparable with pregabalin and amitriptyline. Using these combinations may be beneficial in patients with severe trigeminal neuralgia unresponsive to primary treatment

Patient controlled analgesia versus conventional analgesia for postoperative pain

Patients may control postoperative pain by self-administration of intravenous opioids using devices designed for this purpose [patient controlled analgesia or PCA]. This study set out to determine whether any of the two opioid administrations [i.e. PCA or conventional analgesia] would provide superior pain relief among patients undergoing laparoscopic cholecystectomy or not. In a clinical trial the PCA group received self-administered intermittent intravenous morphine via PCA and the conventional group received intravenous Pethidine every 6 hours per day. The patients were assessed on an hourly basis for the first 4 hours after surgery, every 2 hours for the next 8 hours and every 4 hours for next 12 hours. Two methods were used in order to evaluate the degree of pain relief in patients: [1] facial pain scale; pain assessment based on the patient's appearance and [2] numerical rating scale; based on patient ratings of their pain. Forty eight patients [79.1% female, 20.1% male] with a mean age of 45.7 +/- 10.7 years old were enrolled into the study. During the first 24 hours after laparoscopic cholecystectomy, pain intensity based on facial pain scale was lower in the PCA group. However, the difference was significant only in the second hour [mean pain score in PCA group: 2.9, mean pain score in conventional group: 3.7, P = .007]. Also, the mean pain scores based on numerical rating scale were significantly lower in PCA group except for the first hour. Although it was not significantly lower than conventional group [mean pain score in PCA group: 4.2, mean pain score in conventional group: 4.6, P = .45]. Intravenous PCA resulted in better postoperative pain reduction compared to intermittent bolus opioid delivery in laparoscopic cholecystectomy.

Nonsurgical treatment of stylohyoid (Eagle) syndrome: a case report

Eagle syndrome is a rare condition caused by elongation of the styloid process or calcification of the stylohyoid ligament. Patients with Eagle syndrome typically present with dysphagia, dysphonia, cough, voice changes, otalgia, sore throat, facial pain, foreign body sensation, headache, vertigo, and neck pain. Here we report a case in which the patient initially presented with sore throat, left-sided facial pain, and cough. This case report provides a brief review of the diagnosis and nonsurgical management of this rare syndrome.

Thyroid autoantibodies in euthyroid women with recurrent abortions and infertility

Evidences suggest an association between the prevalence of thyroid peroxidase [anti-TPO] and anti thyroglobulin [anti-Tg] with recurrent abortions and infertility. Iodine deficiency was once endemic in Iran and little data is available about the prevalence of these antibodies in different groups of fertile or infertile individuals. This case control study was designed to compare the presence of anti-TPO and anti-Tg in four groups of women to reveal their role in the etiology of recurrent abortion and infertility. Four groups of euthyroid women referring to Avicenna Infertility Clinic in Tehran were selected; 95 cases as fertile controls and 70, 78 and 137 cases with male and female factor infertility and recurrent abortion respectively. TSH, anti-TPO and anti-Tg were evaluated by chemiluminescent immunoassay. The prevalence of the above mentioned autoantibodies in euthyroid controls was about 25% and the percentage of people with an anti-Tg >500 was two times bigger in the abortion group compared to the control group [p<0.05] and the proportion of people with an anti-Tg>500 in younger cases in the abortion group was significantly higher than the rest of the cases [p<0.05]. Anti-TPO distribution had no significant differences. There were no statistically significant differences among four groups. It seems that more comprehensive studies are needed to reach a common conclusion about thyroid autoantibodies in women with recurrent abortions in different groups and different parts of Iran. In addition, dividing the recurrent abortion and infertility groups on the basis of their etiologies could be effective

effect of oral clonidine premedication on nausea and vomiting after ear surgery

Postoperative nausea and vomiting [PONV] is a most distressing adverse event for surgical patients with a considerable economic impact .The aim of the present study was to evaluate the effect of clonidine given orally for PONV in patients undergoing anesthesia for outpatient ear surgery. Sixty patients 30.2 +/- 9.9 years, scheduled for ear surgery, were randomly assigned to one of two groups [clonidine or placebo] in a double-blinded manner. Anesthesia was standardized laryngeal mask airway, fentanyl, propofol, halothane, nitrous oxide. A complete response, defined as no PONV and no need for rescue antiemetic medication, during the first 24h after anesthesia was 33% with placebo and 67% with clonidine, respectively [P. 0.01]. No clinically adverse event was observed in any of the groups. Oral premedication with clonidine reduced the rate of PONV in patients undergoing outpatient ear surgery

Obstruction of endotracheal tube; a manufacturing error

Manufacturing defects in endotracheal tubes [ETT] are known to occur, and may cause ETT obstruction in various ways[-1] We report an ETT manufacturing error resulting in partial airway obstruction with a 7.0 mm cuffed tube due to partial perforation of the distal orifice of the ET tube