Résumé
To evaluate the effects of intravenous ketorolac on early postoperative pain in patients with mandibular fractures, who underwent surgical repair
Methods: This prospective, randomized, placebo-controlled clinical trial was conducted in Shahid Rajaei Hospital, affiliated with Shiraz University of Medical Sciences during a 1-year period from 2015 to 2016. We included a total number of 50 patients with traumatic mandibular fractures who underwent surgical repair. Patients with obvious contraindications to ketorolac such as asthma, renal dysfunction, peptic ulceration, bleeding disorders, cardiovascular disease, mental retardation, or allergy to ketorolac or NSAIDS, were excluded. The patients were randomly assigned to receive intravenous ketorolac [30 mg] at the end of operation in post anesthesia care unit immediately upon the onset of pain [n=25], or intravenous distilled water as placebo [n=25]. Postoperative monitoring included non-invasive arterial blood pressure, ECG, and peripheral oxygen saturation. The postoperative pain was evaluated by a nurse using visual analog scale [VAS] [0-100 mm] pain score 4 hours after surgery and was compared between the two study groups
Results: Overall we included 50 patients [25 per group] in the current study. The baseline characteristics including age, gender, weight, operation duration, anesthesia duration and type of surgical procedure were comparable between two study groups. Those who received placebo had significantly higher requirements for analgesic use compared to ketorolac group [72% vs. 28%; p=0.002]. Ketorolac significantly reduced the pain intensity 30-min after the operation [p<0.001]. There were no significant side effects associated with ketorolac
Conclusion: Intravenous single-dose ketorolac is a safe and effective analgesic agent for the short-term management of mild to moderate acute postoperative pain in mandibular fracture surgery and can be used as an alternative to opioids
Résumé
Statement of the Problem: The preoperative or intraoperative administration of intravenous magnesium sulfate has been approved as an accepted medication for stabilizing hemodynamic indices during surgeries
Purpose: Intraoperative blood loss during orthognathic surgery is frequently abundant and sometimes requires blood transfusion. The present trial addressed the efficacy of intravenous magnesium sulfate on deliberating hypotension and bleeding reduction in patients undergoing bimaxillary orthognathic surgery
Materials and Method: This randomized double-blinded placebo controlled trial was conducted on 52 consecutive patients who underwent orthognathic surgery. The participants were randomly assigned to two groups receiving intravenous magnesium sulfate 30 mg/kg body weight bolus for 15 minutes immediately before anesthesia induction, followed by 10 mg/kg/hr dissolved in saline via pump infusion [n=26] and the second group received placebo as same bolus volume of normal saline in a 15-minute intravenous infusion which was continued until the end of operation [n=26]. Both systolic and diastolic blood pressures were measured before anesthesia induction at baseline, during surgery, and at the end of the surgery. Intraoperative blood loss was also determined
Results: Systolic and diastolic blood pressures did not differ between the two groups at baseline. Although a downward trend of both systolic and diastolic blood pressures was seen during the operation in both groups, the decrease in blood pressures occurred with greater gradient in the group administered magnesium sulfate. Assessing difference in the trend of the changes in systolic and diastolic blood pressures between the two study groups [adjusted for gender, age, mean body mass index, and time of surgery] showed different trends in the changes of blood pressures. No differences were observed in blood loss or blood product requirement between the two groups
Conclusion: The administration of intravenous magnesium sulfate can attenuate both systolic and diastolic blood pressures during orthognathic surgery with no significant effect on the volume of blood loss or need for blood transfusion
Résumé
Hemodynamic variations are inevitable during induction of anesthetic drugs. The present study, investigates the hemodynamic variations of two different drugs used for induction; Thiopental vs. Propofol. In a prospective randomized double-blind study, from June 2003 to November 2004, 120 [ASA I and II] patients scheduled for elective surgery, were randomly divided into two equal groups. Patients were premedicated with midazolam [0.05 mg/kg] and fentanyl [1 micro g/kg]. Anesthesia was induced with either thiopental 5 mg/kg [group T] or propofol 2 mg/kg [group P]. Neuromuscular blockade was achieved with atracurium [0.5 mg/kg] and anesthesia was maintained with halothane 1%, nitrous oxide [67%] in O[2]. Hemodynamic variable [systolic and diastolic blood pressure, mean arterial pressure and heart rate] were measured non-invasively in three periods: before drug administration, immediately after injection, prior to intubation, and finally immediately after intubation. The incidence of hemodynamic changes in systolic, diastolic, mean arterial blood pressures and heart rate were significantly higher in group T compared to group P. We conclude that Propofol causes less hemodynamic changes compared to Thiopental. Therefore, we recommend Propofol especially when dealing with hemodynamically compromised patients