Outcome of continuous intrathecal opioid therapy for management of chronic pain in Iranian veterans of the imposed Iraq-Iran war

Among patients with chronic unrelieved pain, war veterans of eight years long Iraq-Iran war deserve especial attention. They not only suffer from severe intractable pain but also should bear some intangible consequences of unrelieved pain and severe disability. This perspective study reviews the outcome of implantation of intrathecal opioid pumps in these patients. Ten war veterans [mean age 43.36] with chronic nonmalignant pain included in this perspective study. Medical records reviewed to identify pain diagnosis, medication intake prior to implantation, details of the intrathecal opioid trial and date of implantation, surgical and technical complications. Outcome measures were global pain relief, physical activity levels, intrathecal opioid side effects, medication consumption and patient satisfaction. Overall pain relief at the time of study was 60%. Mean pain relief was 53%. A majority of patients reported improvements in physical activity levels and were satisfied with this type of therapy. Impotence and constipation were two most common pharmacological side effects. No surgical complication reported. The study showed that this type of therapy in Iranian war veterans improved analgesia, increased self-report physical activity levels and in spite of high incidence of pharmacological side effects, most of the patients were satisfied with this type of therapy. These results are comparable to those of previous studies in this field

effect of nitroglycerin as an adjuvant to lidocaine in intravenous regional anesthesia

The disadvantages of intravenous regional anesthesia [IVRA] include slow onset, poor muscle relaxation, tourniquet pain, and rapid onset of pain after tourniquet deflation. In this randomized, double-blind study, we evaluated the effect of nitroglycerin [NTG] in quality improvement when added to lidocaine in IVRA. Forty-six patients [20?50 yrs], were randomly allocated in two equal groups. Under identical condition, the control group received a total dose of 3mg/kg of lidocaine 1% diluted with saline, and the study group received an additional 200 microg NTG. Vital signs and tourniquet pain, based on visual analog scale [VAS] score were measured and recorded before and 5, 10, 15, 20, and 30 min after anesthetic solution administration. The onset times of sensory and motor block were measured and recorded in all patients. After the tourniquet deflation, at 30 min and 2, 4, 6, 12 and 24h, VAS score, time to first analgesic requirement, total analgesic consumption in the first 24 h after operation, and side effects were noted. The sensory and motor block onset time were shortened in study group [2.61 vs. 5.09 and 4.22 vs. 7.04 min, respectively] [p <0.05]. The recovery time of sensory and motor block and onset of tourniquet pain were also prolonged [7.26 vs. 3.43, 9.70 vs. 3.74 and 25 vs. 16.65min., respectively] [p <0.05]. Analgesia time after tourniquet deflation was prolonged and tourniquet pain intensity was lowered in study group [p <0.05]. Intraoperative fentanyl and meperedine requirement during first postoperative day and pain intensity at 4, 6, 12 and 24 hr postoperatively were lower in the study group [p <0.05]. There were no significant side effects...The NTG adding to lidocaine in intravenous regional anesthesia shortens onset times of sensory and motor block and decreases the tourniquet and postoperative pain, without any side effect