Comparison of Spinal Versus Epidural Analgesia for Vaginal Delivery: A Randomized Double Blinded Clinical Trial.

BACKGROUND: Recently, one of the problems in developing countries is pregnant women who insist on cesarean section for fear of painful vaginal delivery. There are various methods to reduce labor pain, including medical and non-medical methods. Neuraxial analgesia is classified as one of the best ways to reduce labor pain. Epidural analgesia is a classic and popular procedure to decrease labor pain. Nevertheless, other methods, such as spinal or combined spinal-epidural analgesia, is more effective compared with the epidural. OBJECTIVES: In this study, we investigated a single intrathecal versus epidural injection in pregnant women during childbirth. METHODS: In our research, after obtaining informed consent, the patients were randomly assigned to two equal groups: epidural and spinal. Each group contained 50 parturient women in advanced labor. In the epidural group, 2.5 mL isobaric bupivacaine 0.5%, sufentanil (0.2 mcg/mL), and 7 mL saline 0.9% were injected by an 18-gauge Tuohy needle at the L4-5 or L5-S1 intervertebral space, and in the spinal group, 0.5 mL isobaric bupivacaine 0.5%, 2.5 mcg sufentanil, and 0.5 mL saline 0.9% were injected by a 25-gauge pencil-point Quincke needle at the L4-5 or L5-S1 intervertebral spaces. For pain intensity, the visual analog scale (VAS) was used at serial intervals, and other variables, such as the onset and duration of analgesia, hypotension, neonatal APGAR score, fetal heart rate (FHR) changes, and other variables were examined. RESULTS: The mean time to onset analgesic effect was 4.6 min in the spinal group compared with 12.5 minutes in the epidural (P < 0.001). Duration of analgesia was 121 minutes in the spinal group compared with 104 min in the epidural group (P < 0.001). The time to reach the maximum block was 8.4 min in the spinal group vs. 22.2 min in the epidural group (P < 0.001). The duration of the second and third gestation stages was the same in both groups. CONCLUSIONS: Spinal analgesia is short and easy to perform and does not require advanced equipment and technical experience. Spinal analgesia can be a good option for labor analgesia and leads to achieving a lower pain score than epidural analgesia.

Effect of Transcutaneous Electrical Nerve Stimulation on the Pain Intensity During Insertion of Needle in Patients Undergoing Spinal Anesthesia: A Randomized Controlled Study.

BACKGROUND AND OBJECTIVES: Needle insertion pain during spinal anesthesia is an unpleasant experience for patients. This study aimed to investigate the effects of Transcutaneous Electrical Nerve Stimulation (TENS) on the pain intensity during the insertion of spinal needles in patients undergoing spinal anesthesia. MATERIALS AND METHODS: In a double-blind clinical trial, 60 candidates for elective Trans Ureteral Lithotripsy surgery under spinal anesthesia were randomly divided into intervention and control groups. The electrodes of the TENS device were placed in the space between L3-L4 and L5-S1 vertebrae. The intensity of pain during insertion of the spinal needle by Visual Analog Scale and the frequency of attempts were recorded. RESULTS: The mean age of the study samples was 34.26 ± 5.07 and 32.8 ± 5.28 in the control and intervention group, respectively. The pain intensity during insertion of spinal needles was less significant in the intervention group compared to the control group (p = 0.001). The number of attempts to insert the spinal needle between the two groups was not statistically significant (p = 0.51). The duration of spinal anesthesia implementation procedure by physician in the intervention group was significantly shorter than that of the control group (p = 0.001). CONCLUSION: The use of TENS effectively reduced the pain of spinal needle insertion. Considering these beneficial effects, it is suggested that this procedure be used to relive pain in patients with spinal anesthesia.

Effect of Nebulized Eucalyptus for Preventing Ventilator-associated Pneumonia in Patients Under Mechanical Ventilation: A Randomized Double Blind Clinical Trial.

BACKGROUND: Pneumonia caused by the ventilator is the most common acquired infection in the intensive care unit (ICU), which increases the morbidity and mortality of the patients. Eucalyptus plant has antiseptic properties that may mollify such morbidity and mortality. OBJECTIVE: To assess the effect of Eucalyptus incense on prevention of pneumonia in patients with endotracheal tube in the ICU. RESEARCH DESIGN: A randomized controlled clinical trial with parallel groups of 100 patients undergoing mechanical ventilation. SETTING: An ICU in a teaching hospital. INTERVENTIONS: Randomization to received Eucalyptus solution 5% (intervention group = 50) and received 10 cc distilled water as an inhaler 3 times/d (every 8 h/d for 20 min) (control group = 50). PRIMARY OUTCOME MEASURES: The incidence of early and delay pneumonia and pulmonary infections based on clinical pulmonary infection criteria were assessed. RESULTS: The incidence of late pneumonia was significantly lower in the intervention group compared with control groups (P < .01). The prevalence of Klebsiella, Candida albicans, and Staphylococcus aureus was significantly decreased in the intervention group (P < .01). CONCLUSION: The results present study showed that Eucalyptus inhalation is effective in reducing the incidence of pulmonary infection in patients under ventilation.

Bupivacaine vs. Pethidine in Spinal Anesthesia of Old Patients: Haemodynamic Changes and Complications.

OBJECTIVE: Organ changes during the aging are one of the signifi cant events in old patients. rthopedic surgeries are common operations in these patients that accompany with hemodynamic changes as blood pressure decrease, heart rate, and respiratory rate change. On the other hand, pain management of the ancient patients due to negative consequences as tachycardia, blood pressure increase, and myocardial ischemia is vital. Various types of opioid analgesics have been used in order to pain control in these patients. We decided to conduct the present study in order to compare the hemodynamic changes of the old patients who undergo lower limbs orthopedic surgeries by applying subarachnoid bupivacaine and meperidine (pethidine). METHODS: Sixty-six patients older than 60 years included according to inclusion and exclusion criteria and randomly allocated into two same groups, Then in the fi rst group in the sitting posture by Quincke spinal needle 24 gauge, 12.5 mg of bupivacaine 0.5% (2.5 mL) injected in the subarachnoid space between L2-L3 or L3-L4. In the second group, in a same posture by applying the same spinal needle 24 gauge, 1 mg/kg of preservative-free pethidine injected in the subarachnoid space between L2-L3 or L3-L4. The patients evaluated for duration of anesthesia and analgesia, hemodynamic changes and complications such as headache, pruritus, shivering, urinary retention, and respiratory depression.. RESULTS: Thirty-two patients were males (48.5%) and 34 females (51.5%). There was no statistically signifi cant difference between groups in surgery types (p = 0.063). The duration of anesthesia was not different (p = 0.268) but the duration of analgesia was signifi cantly longer in pethidine group (p = 0.000). No statistically significant difference observed in any time of first 15 min up to 180 min following intervention in heart rate (p = 0.867). No statistical significant difference observed in blood pressure change between two groups (p = 0.605). The experience of headache was more common in the group of bupivacaine during and after the operation (p = 0.004 and 0.000, respectively). The need for pruritus treatment was more in the pethidine group (p = 0.016). However, the frequency of shivering during the operation was not signifi cant (p = 0.202), but after surgery was signifi cantly commoner in bupivacaine group (p = 0.001), but urinary retention and respiratory depression occurrence were not signifi cant (p = 0.228 and 0.720, respectively). CONCLUSION: By regarding different aspects of opioids use, it seems pethidine is more efficient due to longer analgesic time, similar hemodynamic changes, fewer headache, and shivering occurrence in comparison to bupivacaine in old patients.

General health of students of medical sciences and its relation to sleep quality, cell phone overuse, social networks and internet addiction.

BACKGROUND: In recent years, the phenomena of access to the cell phone and addiction to the Internet have been developed among students due to their many applications and attractiveness. Therefore, the present study was conducted with the aim of evaluating general health status and also determining the predictive role of variables such as cell phone usage, sleep quality, internet addiction and social networks addiction in students. METHODS: This cross-sectional study was conducted on 321 students of Kermanshah University of Medical Sciences in an analytical approach. Data collection tools were: Goldberg's General Health Questionnaire, Pittburgh Sleep Quality Index, Young Internet Addiction Test, Social Network Addiction Questionnaire, and Cell Phone Overuse Scale. Data analysis was done using SPSS version 21 and general linear model. RESULTS: Based on the results, the mean (SD) score of the general health was 21.27 (9.49). Variables of gender, sleep quality, and levels of cell phone usage were independent predictors of student's health. Male students (ß (95% CI) = - 0.28 (- 0.49 to - 0.01) and students with favorable sleep quality (ß (95% CI) = - 0.22 (- 0.44 to - 0.02) had lower total health score than the reference category (female students and students with unfavorable sleep quality, respectively). In addition, students with cell phone overuse (ß (95% CI) = 0.39 (0.08 to 0.69) had a higher general health score than the reference category (students with cell phone little use).In general, this group of students had lower general health status (Low or high scores of general health indicate a higher and lower general health status for subjects, respectively). CONCLUSION: Variables of gender, sleep quality and cell phone use were the most important variables associating the general health of medical students.

Transcutaneous Electrical Nerve Stimulation at the Acupuncture Points to Relieve Pain of Patients Under Mechanical Ventilation: A Randomized Controlled Study.

BACKGROUND AND OBJECTIVE: Electrical stimulation and acupuncture points as nonpharmacological methods have been the focus of pain reduction in different patients. This study is aimed at determining the effects of transcutaneous electrical nerve stimulation (TENS) on the acupuncture points of pain in patients under mechanical ventilators. MATERIALS AND METHODS: This randomized double-blind clinical trial study was conducted on 50 patients undergoing mechanical ventilation in intensive care units of Imam Reza hospital in Kermanshah, Iran, in 2017. The patients were randomly allocated into intervention and placebo groups. In the intervention group, TENS electrodes were placed on points Hegu and Zusanli. Pain severity was measured using the Care Pain Observation Tool scale, and the dosages of narcotics and sedation intake were recorded. Data were analyzed using the Statistical Package for the Social Sciences (SPSS) software, version 19. RESULTS: The level of pain in patients decreased in the intervention group in comparison with the sham group, and this decline was significant during certain hours (p < 0.05). The amount of analgesic and sedation drugs used was less significant in the intervention group than in the sham group (p = 0.01; p = 0.04). CONCLUSION: The results showed that the use of TENS on acupuncture points can decrease the level of pain and opioid consumption in intubated patients under a mechanical ventilator.