[Comparison of neurolysis and nerve resection in treatment refractory of meralgia paresthetica]

Meralgia paresthetica [MP] is due to lateral femoral cutaneous nerve [LFCN] involvement; if it is left either unattended miss treated it can be followed by significant disabilities. This study was done to compare the neurolysis and nerve resection in treatment refractory of Meralgia paresthetica. This descriptive - comparative study was carried out on 14 patients [7 males and 7 females] afflicted with Meralgia paresthetica and resisted to therapeutical regiment in Poorsina hospital in Rasht, North of Iran during 2001-08. The patients were selected non-randomly and neurolysis were gone under either neurolysis or nerve resection surgery with 18-month follow-up. All 5 patients with neurolysis operation were found to have the recurrent symptoms. None of the patient operated with nerve resection demonstrated the clinical manifestation of the recurrent symptoms, following 18 month follow-up. The success rate of neurolysis and nerve resection were determined to be 3% and 98.8% respectively. Six women and three men are LFCN-resected; a woman and four men treated with neurolysis. The mean age and the disease onset length were 64.6% +/- 9.8 year and 18 +/- 11 months, respectively. Nerve resection method is suggested in patients with Meralgia paresthetica resisted to therapeutical treatment

[Functional outcomes of radial nerve palsy associated with humeral fractures using microscopic nerve repair procedures]

Radial Nerve Palsy [RNP] is the most common nerve lesion complicating humeral shaft fractures in 2%-17% of cases. Exploration timing [early or delayed] and various nerve repair procedures are still matter of dispute. The objective of this study is to determine the functional treatment outcome of microsurgeric repair of RNP associated with humeral fractures. In this retrospective study of 20 patients [15 males and 5 females with a mean age of 35 +/- 12.5] with humeral fractures, 15 cases had primary RNP and t he other 5 cases experienced nerve palsy after their orthopedic manipulations [secondary or iatrogenic RNP]. Of the first 15 patients, 7 cases had open humeral fractures which were treated using ORIF and early exploration procedures and 8 cases with closed humeral fractures treated conservatively with closed reductioncasting and delayed exploration after 3months because of no recovery. Iatrogenic RNP were observed for 3 months and explored after no sign of recovery. Nerve repair procedures were performed based on nerve injury and patients were followed up for a mean of 24.4 +/- 2.5 months [19-20 months]. Exploration findings, kind of nerve repair and functional recovery rate [based on Alnot criteria] were recorded and analyzed using SPSS-19 software. Of the 7 cases who suffered from total radial nerve transection [repaired by interfasicular grafting] 3 cases had good outcome, 2 cases had fair outcome and 2 cases were failed. Exploration of 3 cases revealed partial nerve tearing [repaired by neurorrhaph y] with good results. Eight cases with perineural fibrosis and 2 cases of nerve entrapment in callus were treated by interfasicular neurolysis and the results were good. Overall recovery rate of these three procedures was 90%. In patients with RNP associated with humeral fractures, choosing proper microsurgeric nerve repair and determining proper exploration timing [early or delayed] could result in desirable functional outcomes

Comparing the effect of intramuscular injection of pethidine and diclofenac suppository in relief of pain following laminectomy surgery

Pain, particularly after surgery, can create a variety of side effects including delay in wound healing. Different drugs such as pethidine and non-steroidal anti-inflammatory drugs are used for relieving patient's pain after surgery. The purpose of this research was to compare effect of pethidine vs. diclofenac suppository in relief of pain after laminectomy. A total of 100 patients who underwent laminectomy entered this study. They were divided into pethidine and diclofenac groups. The patients' pain score was measured with visual analog scale [VAS] method. The mean pain score 24 hours after surgery was 2.8 +/- 2.0 in pethidine group and 4.46 +/- 2.30 in diclofenac group. There was a significant statistical difference between pain score after surgery in two groups [P < 0.05]. Nausea was the most common side effect observed in pethidine group [20%] and epigastric pain was the most common one in diclofenac group [18%]. There wasn't any statistical significant difference between side effects in these two groups. It seems that pethidine injection is more effective than diclofenac suppository in relieving pain after laminectomy