Effect of fentanyl and epinephrine, alone or together with and without lidocaine on the sensory and motor block duration and hemodynamic variations in spinal anesthesia

Spinal anesthesia due to its simplicity, rapid onset of its effect and low dose of drug administration, is a desirable procedure to anesthetics particularly for lower extremity and lower abdomen operations. Lidocaine is widely used in this method of anesthesia for prolongation of the sensory block. In the method, different drugs are used to prolong the duration of sensory block. Fentanyl and epinephrine are being used widely for this purpose and so far, the effects of these drugs were not compared. Therefore, in this study, the effect of the two drugs, alone or together, with and without lidocaine, on the duration and intensity of sensory and motor block has been investigated. In this double-blinded clinical trial, 60 c and idates for elective surgery of lower abdomen were randomly divided into three equal groups. For spinal anesthesia, the first group was subjected to 50 mg lidocaine plus 0.2 mg epinephrine, the second one to 50 mg lidocaine plus 0.2 mg epinephrine and 20-micro g fentanyl and the third group to 50 mg lidocaine plus 20-micro g fentanyl. Subsequently, the patients in the 3 groups were evaluated and compared for the duration of sensory and motor block and their hemodynamic variations. The data was analyzed using ANOVA and Chi-square tests. Age and sex distribution among the three groups was not significantly different. The mean of sensory block duration in the first, second and third groups were 130.25 +/- 9.05, 133 +/- 32.7 and 116 +/- 14.58 min, respectively with no significant difference. The mean of motor block duration in the first, second and third groups were 120.95 +/- 14.63, 118.75 +/- 25.74 and 107 +/- 18.23 min, respectively. ANOVA test showed no significant difference among the three groups as well. Also, with respect to hemodynamic variation, there was no significant difference among the three groups. Our findings showed that addition of epinephrine and fentanyl and combination of them to the lidocaine had no effect on the duration of sensory and motor block and hemodynamic variations. Therefore, combined use of these drugs is not necessary

effect of different doses of intra-articular ketamine on postoperative analgesia in diagnostic arthroscopic knee surgery

Arthroscopic knee surgery is a painful operation and control of its pain causes earlier recovery of the patients. Therefore, the reduction of the post-operative pain is very important. The aim of this study was to evaluate the analgesic effect of intra-articular ketamine injection after knee arthroscopy. In a double blind randomized study, 75 patients with age ranging of 18-60 years who were candidate for elective arthroscopy were chosen and the same anesthetic method was used for all of them. Based on the injected anesthetic drug, they were divided into five equal groups, A-E. Group A received both intra-articular ketamine [0.5 mg/kg] and intravenous placebo. Group B received intra-articular ketamine [0.75 mg/kg] and intravenous placebo. Group C received intravenous ketamine [0.5 mg/kg] and intra-articular placebo. Group D received intravenous ketamine [0.75 mg/kg] and intra-articular placebo. Group E received intravenous and intra-articular placebo. After the operation, if necessary, intra-veouns morphine [0.05 mg/kg] was given for pain relief. Using visual analogue scale [VAS 1 to 10], the pain was evaluated at 4, 8 and 24 hours after the operation. The time of first rescue analgesic request, and the total dose of morphine used was recorded. Statistical analysis was carried out by using SPSS software. The results of this study showed that there was no significant difference in the cases of age, sex, weight and duration of operation among 5 groups studied. Also, the total amount of opioid or the time beginning of analgesic request was not statistically different among the groups during 24 hours observation. Based on our results, intra-articular ketamine injection did not reduce postoperative pain after diagnostic knee arthroscopy and had no sparing effect on total opioid consumption and first postoperative analgesic request

dose-response study of magnesium sulfate in suppressing cardiovascular responses to laryngoscopy and endotracheal intubation

The effects of pretreatment with magnesium on cardiovascular responses associated with intubation have been studied previously. In this study we wanted to find optimal dose of magnesium that causes decreased cardiovascular responses after laryngoscopy and endotracheal intubation. In a double-blind, randomized, clinical trial,120 ASA-1 patients with ages between 15-50 years old, who were candidates for elective surgery, were selected and classified in 6 groups [20 patients in each]. The pulse rate and arterial blood pressure were measured and recorded at 5 minutes before taking any drug then, according to different groups, patients took magnesium sulfate [10, 20, 30, 40, 50mg/kg] and lidocaine [1.5 mg/kg]. The induction of anesthesia was same in all groups and the pulse rate and arterial blood pressure were measured and recorded just before intubation and also at 1, 3, and 5 minutes after intubation [before surgical incision]. Statistical analysis was performed by use of ANOVA, Post Hoc test [Duncan], Pearson correlation, and Chi square test. There were no statistically significant differences in blood pressure, pulse rate, Train Of Four [TOF], and complications between groups who received magnesium but the significant differences in these parameters were seen between magnesium and lidocaine groups. We concluded that pretreatment with different doses of magnesium sulfate have a safe decreasing effect on cardiovascular responses that is more effective than pretreatment with lidocaine