[Comparison between intrathecal midazolam and tramadol with conventional method for postoperative pain and shivering control after elective cesarean section]

Adding new supplements when performing spinal anesthesia can increase the duration of analgesia. The aim of the present study has been to compare intrathecal midazolam and tramadol with the conventional method for postoperative pain and shivering control after elective caesarean section. In this double-blind clinical trial, 210 ASA class I, II women, aged 20-35 years, candidate for elective caesarean section were randomly allocated to three groups. All patients received hyperbaric intrathecal lidocaine and additionally group I received 2 mg subarachnoid midazolam, group II received 25 mg subarachnoid tramadol and the control group received 5cc normal saline. Postoperative pain score, the painless duration and postoperative shivering were assessed in the three groups. The mean painless duration in tramadol, midazolam and the control group were 192.5 +/- 12.2, 111.3 +/- 16.6 and 86.1 +/- 9.9 minutes, respectively [p<0.001]. The mean painless duration in the midazolam group was significantly more than two other groups and this duration in the tramadol group was also more than the control one. The mean postoperative pain score, shivering occurrence and the frequency of requested painkiller in the first 24 hours, were also compared. In the midazolam group, they were all significantly less than the two other groups. In the meanwhile, these indexes in the tramadol group were less than the control one [p<0.001]. Adding intrathecal midazolam and tramadol to lidocaine 5% in elective caesarean section can increase the painless duration and lead to a reduction in postoperative shivering. Midazolam demonstrates a stronger effect

[ effect of aminophylline on hemodynamic parameters and recovery time after propofol infusion]

This study is aimed to assess the effect of aminophylline [1mg/kg] on reversal of the sedative effects of propofol and the recovery time in patients under propofol anesthesia. Due to the known effects of aminophylline on myocardial contractility and the increase in cardiac output, its effects on hemodynamic changes of propofol are also assessed. In a double blinded randomized clinical trial on 154 patients, intubation was done after induction of anesthesia with sufentanil [0.2 mcg/kg], propofol [2.5 mg/kg] and atracurium [0.5 mg/kg]. Anesthesia was maintained with 200 mcg/kg/min of propofol infusion. After discontinuing propofol at the end of the surgery patients were randomly allocated to receive either aminophylline 1 mg/kg or normal. Heart rate, blood pressure and oxygen saturation were recorded before and after injection, and every 2 minutes until extubation was performed, and thereafter every 5 minutes till the patients' discharge from recovery. The time interval between injection and extubation plus the duration of recovery stay were also recorded. The mean arterial pressure 2,6, and 8 minutes post-extubation ; the heart rate 2,4,6, and 8 minutes just after extubation; and oxygen saturation 2,4,5, and 10 minutes post-extubation; were higher in the aminophylline group. The discharge time was on the contrary, shorter in this group. Aminophylline [1mg/kg] will result in a shorter recovery time following propofol anesthesia and can control propofol-induced blood pressure decrease and bradycardia

[Comparing the efficacy of low dose ketamine versus pethidine in controlling shivering after tonsillectomy surgery]

Postoperative shivering is one of the most common problems after general and local anesthesia. We compared the efficacy of low dose ketamine versus pethidine in controlling shivering after surgery. In a double-blind randomized Clinical trial, 132 ASA I,II patients candidate for tonsillectomy were randomized to receive either pethidine and ketamine. At the time of arrival to the recovery and after 30 minutes, the occurrence of chills and possible complications were evaluated and compared between the two groups. Two patients in the ketamin group [3%] experienced shivering while none of the patients in the pethidine group reported shivering [p>0.05]. Other complications were more in the ketamin group [p<0.05]. Ketamin and pethidine are equally effective in controlling postoperative shivering, but regarding the lower incidence of other complications, pethidine is still the first choice of treatment

[ analgesic efficacy of low power laser in osteoarthritis patients under treatment with periarticular steroid injection]

Knee osteoarthritis [OA] is a prevalent and disabling disease. Periarticular corticosteroid injection has been traditionally used for the pain control in these patients. Recently low power laser has been introduced as a therapeutic option. This study was conducted to evaluate the efficacy of Low power laser added to periarticular steroid injection for long-term treatment of OA patients. In a clinical trial, 100 patients with knee OA were randomly allocated to receive either NSAIDS tablets, periarticular methylprednisolone injection and placebo laser [placebo group] or low power laser added to NSAID and periarticular injection [laser group]. The laser treatment was applied for 2 minutes in12 sessions. Patients were assessed 48 hours, 1 month, 3 months and 6 months after treatment regarding their pain, joint stiffness and difficulty doing daily activities. Placebo group showed lower pain scores only in the first 48 hours in all the conditions but in the first, third and sixth months follow-ups pain scores were significantly lower in the laser group rather than the placebo group [p<0.05]. Steroid injection controlled the pain in the early stages but was ineffective in longterm treatment. Combined treatment with steroid and low power laser can manage the pain up to 6 month

[Effect of preoperative gabapentin in reducing pain after laparoscopic cholecystectomy]

Background and aims: Although laparoscopy itself is a new step to improve the quality of different types of surgery, reducing their complications; postoperative pain remains a major problem. This study compares the effects of low dose oral gabapentin with placebo to control postoperative pain in patients undergoing laparoscopic cholecystectomy. In this double-blind randomized clinical trial, 70 patients aged 20-65 years old with ASA classes I and II, have been selected and divided into two groups. One hour before surgery, an oral capsule of 300 mg gabapentin and placebo have been given to the two groups, separately. All Patients underwent general anesthesia in a similar way. Pain plus nausea and vomiting were evaluated based on the visual pain scale and frequency, respectively. The interval for these assessments was every 2 to 6 hours after surgery and every 4 to 12 hours thereafter. The difference in Average pain intensity between placebo and gabapentin groups is statistically significant [P=0.01] .This significant difference has also been shown in the reduced need for additional drug in the gabapentin group. The average severity of nausea and the frequency of vomiting were at the same time lower in the gabapentin group [P=0.01]. Gabapentin can be effective in reducing pain after surgery and in various studies; no major side effect has been reported. As a result, this drug can be used in various surgeries as an analgesic