Comparison between epidural block vs. high intensity laser therapy for controlling chronic low back pain

Background: Chronic low back pain is among a wide spread musculoskeletal conditions that is related to disability with high economy cost. There are several treatment modalities for controlling chronic low back pain [CLBP], among them high intensity laser therapy [HILT] and epidural blocks [EB] use more commonly. This study aimed to evaluate the benefits and hazards of each of these two methods

Materials and Methods: We designed a randomized controlled double blind study during 24 months.101 patients divided in 2 groups [52 in EB and 49 in HILT group]. Pain intensity was assessed by using faces pain scales [FPS] and LINKERT questionaries' before procedure and during one, four, 12, and 24 weeks after beginning the procedures

Results: There were no differences between two groups in FPS lumber tenderness, straight leg rising test [SLRT], paresthesia, deep tendon reflex [DTR], and imaging changes. Motor problems seem was less in HILT group comparing EB

Conclusion: This study showed both EB and HILT approaches can control the pain intensity and motor activities in CLBP patients. Future studies will clarify the precise importance of each these methods

Familial dysautonomia, report of 3 cases from iran and a discussion about their general and anaesthesia care

Familial Dysautonomia [FD] is a rare hereditary syndrome which is an autosomal recessive trait that typically affects Jewish children. Important signs and symptoms of the disorder include; diminished pain perception, absence of overflow tears, hypotonia, fainting cardiac arrhythmias and autonomic crisis. In this article we reported 3 cases of FD syndrome which had presented for surgical operation followed by a discussion about general care of these patients as well as Anesthesia considerations

Whole lung lavage of nine children with pulmonary alveolar proteinosis: experience in a tertiary lung center

Pulmonary alveolar proteinosis [PAP] is a rare disease in children, characterized by intra-alveolar accumulation of large amounts of surfactant proteins, which severely reduce gas exchange. Whole lung lavage [WLL] is the preferred technique for the treatment of severe PAP. This report presents nine pediatric cases with advanced PAP who underwent WLL under general anesthesia during a 9 year period. One patient was treated with multiple unilateral WLL without employing cardiopulmonary bypass [CPB] and eight cases were treated by simultaneous lavage of both lungs using partial CPB. Our experience suggested that partial CPB was useful to support oxygenation during WLL in small children with severe PAP in whom lung separation and selective lavaging of each lung were impracticable

Acute respiratory failure as a rare complication of celiac plexus block in a patient with adenocarcinoma of the Ampulla of Vater

Celiac and splanchnic plexus blocks are considered as terminal approaches for pain control in end stage pancreatic cancer. It may be done temporarily [using local anesthetics] or as a permanent act [using alcohol and/or phenol]. Like every other interventional procedure, celiac plexus block has its own potential complications and hazards among them pneumothorax and ARDS are very rare. In this case report we present an end stage patient with adenocarcinoma of ampulla of Vater with involvement of both abdomen and thorax who presented with severe intractable abdominal pain. Bilateral celiac plexus block in this patient resulted in left side pneumothorax and subsequent development of ARDS. We discuss the rare complications of celiac plexus block as well

efficacy of a single dose of pethidine, fentanyl and morphine in treating postanesthesia shivering

Postanesthesia shivering is an undesirable event that may induce a variety of adverse consequences including patient discomfort, increased oxygen consumption and wound pain. Thus, its pharmacological treatment should be regarded. The purpose of this study was to compare the efficacy of morphine, fentanyl and pethidine for the treatment of postanesthesia shivering. Fifty patients who developed shivering were treated in a randomized double blinded manner with an intravenous bolus dose of 2 or 4 mg morphine, 25 or 50 mg pethidine, and 50 microg fentanyl. Then, they were monitored for 30 minutes and the shivering suppression grade, the time taken to stop shivering, the shivering cessation time, recurrence of shivering and opioid side effects were evaluated. Core body temperature was measured immediately before, and at 15 and 30 minute after administering the drug. The groups did not differ significantly regarding shivering suppression grade, shivering cessation time, and recurrence of shivering. There was a significant difference in the time taken to stop shivering between groups. Following injection of the drugs, the core temperatures increased in the five groups with statistical difference. All opioids were effective in treating postanesthesia shivering in a similar extent