The effect of melatonin on prevention of postoperative delirium after lower limb fracture surgery in elderly patients: a randomized double blind clinical trial.

BACKGROUND: Postoperative delirium is a common complication with a high morbidity rate. This study was designed to consider the effectiveness of melatonin in prevention and treatment of postoperative delirium. METHODS: Seventy-two patients aged >60 years old with Abbreviated Mental Test (AMT) >8 scheduled for orthopedic surgery under spinal anesthesia, were randomly distributed equally to melatonin or placebo groups. In the melatonin group, the patients were given 5 mg melatonin capsules orally the night before surgery, the night of the operation, and two nights after the surgical operation at 9 pm. Likewise, in the placebo group, the patients received placebo in the same times. For diagnosis of postoperative delirium, the AMT test was used before the operation and three days after that. The Generalized estimating equations model (GEE) with logit link to Multivariate analysis was used in the study and P<0.05 was considered statistically significant. RESULTS: In total, 72 patients completed the study. Thirty-three patients (45.8%) were male with a mean (SD) age 71.4 (3.6) years. On the first day after the surgery, the incidence of delirium was significantly lower in the melatonin group compared to the placebo group (22.2% vs. 44.4%, P=0.046). On the second and third days after the surgery, the level of delirium in the melatonin group was also significantly lower than that in the placebo one. The GEE model showed a significant interaction between time and treatment groups. CONCLUSION: The findings of the study showed that melatonin prevented delirium after the orthopedic surgeries in the elderly patients and could be useful for the patients as such.

Effect of intraoperative dexmedetomidine infusion during functional endoscopic sinus surgery: a prospective cohort study.

BACKGROUND: Dexmedetomidine, an α2 agonist, has well-known anesthetic and analgesic-sparing effects. We designed this study to evaluate the effect of intraoperative dexmedetomidine infusion on intra operative blood loss and postoperative pain in functional endoscopic sinus surgery. METHODS: This prospective cohort study included 90 patients planning to undergo endoscopic sinus surgery, who were randomly divided into three groups. 2 to 2.5 mg/kg of propofol was used in all groups to induce anesthesia. One group received dexmedetomidine 0.2 µg/kg per hour infusion whereas the other group received dexmedetomidine 0.5 µg/kg per hour infusion. The control group received normal saline infusion. RESULTS: The mean age of patients was 41.02 ± 11.93. 33 patients in the dexmedetomidine 0.2 µg/kg/h group, 30 patients in the dexmedetomidine 0.5 µg/kg/h group and 27 patients in the placebo group. The lowest amount of bleeding was related to the dexmedetomidine 0.5 µg/kg/h group. The volume of bleeding between the three groups was significantly different (p = 0.012). The satisfaction of the surgeon in the dexmedetomidine 0.5 µg/kg/h group was more than other groups. There was a significant relationship between the satisfaction of the surgeon and the treatment groups (p < 0.001). The lowest duration of surgery was related to the dexmedetomidine 0.2 µg/kg/h group. The most Trinitroglycerin (TNG) consumption was in the placebo group and the highest dose of labetalol was in the dexmedetomidine 0.5 µg/kg/h group. There was no significant difference in the TNG and labetalol consumption between three groups. The lowest consumption of morphine and pethidine in the dexmedetomidine 0.5 µg/kg/h group. CONCLUSIONS: Infusion of dexmedetomidine 0.5 µg/kg/h decreased blood loss and consumption of morphine and pethidine in patients who underwent endoscopic sinus surgery.

The data set development for the National Spinal Cord Injury Registry of Iran (NSCIR-IR): progress toward improving the quality of care.

STUDY DESIGN: Descriptive study. OBJECTIVES: The aim of this manuscript is to describe the development process of the data set for the National Spinal Cord Injury Registry of Iran (NSCIR-IR). SETTING: SCI community in Iran. METHODS: The NSCIR-IR data set was developed in 8 months, from March 2015 to October 2015. An expert panel of 14 members was formed. After a review of data sets of similar registries in developed countries, the selection and modification of the basic framework were performed over 16 meetings, based on the objectives and feasibility of the registry. RESULTS: The final version of the data set was composed of 376 data elements including sociodemographic, hospital admission, injury incidence, prehospital procedures, emergency department visit, medical history, vertebral injury, spinal cord injury details, interventions, complications, and discharge data. It also includes 163 components of the International Standards for the Neurologic Classification of Spinal Cord Injury (ISNCSCI) and 65 data elements related to quality of life, pressure ulcers, pain, and spasticity. CONCLUSION: The NSCIR-IR data set was developed in order to meet the quality improvement objectives of the registry. The process was centered around choosing the data elements assessing care provided to individuals in the acute and chronic phases of SCI in hospital settings. The International Spinal Cord Injury Data Set was selected as a basic framework, helped by comparison with data from other countries. Expert panel modifications facilitated the implementation of the registry process with the current clinical workflow in hospitals.

Road traffic deaths in Kashan region, Iran: An eight-year study (2006-2013).

PURPOSE: The aim of this study was to analyze the trend of road traffic fatalities in Kashan Region, Iran, in a period of eight years. METHODS: Through a cross-sectional study, all road traffic deaths classified under the V01V99 codes according to ICD-10 in Kashan region, central Iran, from March 2006 to March 2013 and population data were collected from the registration system of Kashan University of Medical Sciences. Years of lost life (YLL) and mortality rates were calculated regarding age, gender and year of the accident. Generalized linear model (GLM) with Poisson log-linear link was used to evaluate the effects of the mentioned variables on mortality rate. RESULTS: During the period of the study (8 years), 928 people (767 men) died due to road traffic injuries (RTIs). The total YLL was 20,818. The mortality rate due to RTIs has been declined constantly from 43.1 in March 2006 to 21.1 per 100,000 in March 2013. The highest mortality rate was found in the age group of over 60 years old and the lowest in the age group of 0-14 years old. Both mortality rate and YLL was greater in men than in women. Poisson regression showed that age, gender and year of the accidents had a significant effect on mortality rate (p < 0.001). CONCLUSION: Although there has been a constant decline of mortality rate in Kashan area within the study period, the value remains higher than the mean level of Eastern Mediterranean region and the global average, which is a notable fact for policymakers and authorities.

Effects of pregabalin and gabapentin on postoperative pain and opioid consumption after laparoscopic cholecystectomy.

BACKGROUND: Gabapentin and pregabalin are antiepileptic drugs that are also used for chronic pain treatment. This study evaluated the effects of pregabalin and gabapentin on postoperative pain in patients undergoing laparoscopic cholecystectomy. METHODS: A total of 108 candidates for elective laparoscopic cholecystectomy were randomly assigned to gabapentin (n = 36), pregabalin (n = 36), and placebo (n = 36) groups. Patients received 800 mg of gabapentin or 150 mg of pregabalin orally one hour before surgery. Postoperative analgesia was administered by pethidine via patient-controlled analgesia. The amount of opioid consumed, number of nausea events, vomiting, and pain scores at 2, 6, 12, and 24 hours after surgery were recorded. RESULTS: The gabapentin and pregabalin groups had significantly lower pain intensity than the placebo group, and pain intensity in the pregabalin group decreased more compared to the gabapentin group. The mean amount of pethidine consumption in the placebo group was significantly higher than in the gabapentin and pregabalin groups. CONCLUSIONS: A single dose of gabapentin or pregabalin decreased postoperative pain and nausea, as well as vomiting and opioid consumption after laparoscopic cholecystectomy. Moreover, the findings revealed that pregabalin was superior to gabapentin for reducing postoperative pain.

Spinal injury resulting from car accident: Focus to prevention.

AIM: To determine and compare the patterns of spinal injury in car occupants. MATERIALS AND METHODS: Retrospective cross-sectional study enrolling all patients with spinal fracture after car accidents, who were admitted to hospital more than 24 h during 2004-2009. RESULTS: The lumbosacral spine was the most commonly involved region (64.8). Six patients had spinal cord injury (6.6%). The majority of the victims were drivers of the vehicle (86.8%) and remaining were passengers. There was a significant difference in lumbar anatomic region (P = 0.05) and place of accident (P = 0.05) in car occupants' position (P = 0.05). Car rollover was the most common mechanism of spinal fractures. There was a significant difference in lumbar anatomic region (P = 0.05), and two or more associated organ injuries (P ≤ 0.05) in car accident mechanism (P = 0.05). CONCLUSION: The chance of sustaining serious spine and associated multiple injuries in car accidents is quite high in our today's society. This may be due to the low level of standards for car manufacturing, absence or inadequacy of appropriate safety measures in cars, and poorly designed roads and problems in quality of driving to mention some reasons. Therefore, these victims are prone to significant morbidity and even mortality and need more specific prehospital supportive interventions.

The Relationship Between Patients' Anthropometric Characteristics and Depth of Spinal Needle Insertion.

BACKGROUND: Many surgeries are performed under spinal anesthesia. Inexperienced practitioners may find it difficult to obtain subarachnoid access. OBJECTIVES: This study aimed to examine the relationship between patients' anthropometric characteristics and depth of spinal needle insertion to the subarachnoid cavity. PATIENTS AND METHODS: 385 patients with ASA class I - II, aged 18 - 65 years and undergoing elective surgery of the lower abdomen and extremities under spinal anesthesia, were selected for this cross-sectional study. The patients' demographic characteristics, body mass index (BMI), and anthropometric characteristics (height, weight, waist circumference, and arm circumference) were recorded. Linear regression and t-student tests were used to study the relationship between anthropometric characteristics and BMI, and depth of needle insertion. RESULTS: Of the 385 patients studied, 88 were female and 297 were male. There was a strong correlation between the depth of needle insertion and BMI (24.9 ± 3.9), and between depth and weight/height ratio (r = 0.95 and r = 0.92, respectively). There was no significant correlation between depth of needle insertion and weight, height, gender, or arm circumference, when considered separately. The statistical predicting models showed that the following relationship was observed between the needle depth and the weight/height ratio: A: needle depth = 0.69 + (10.1 × weight/height); B: needle depth = 0.56 + (0.18 × BMI). CONCLUSIONS: The results of this study show that there is a strong relationship between depth of needle insertion and BMI, and between depth and the weight/height ratio; appropriate depths can be determined according to the equations obtained.

Preemptive Analgesic Effects of Transcutaneous Electrical Nerve Stimulation (TENS) on Postoperative Pain: A Randomized, Double-Blind, Placebo-Controlled Trial.

BACKGROUND: Transcutaneous electrical nerve stimulation (TENS) is a non-pharmacological analgesic method used to control different types of pain. OBJECTIVES: The aim of this study was to evaluate the effects of preoperative TENS on post inguinal hernia repair pain. PATIENTS AND METHODS: This randomized, double-blind, placebo-controlled clinical trial was performed on 66 male patients with unilateral inguinal hernias who were admitted to the Shahid Beheshti hospital in Kashan, Iran, from April to October 2014. Participants were selected using a convenience sampling method and were assigned to intervention (n = 33) and control (n = 33) groups using permuted-block randomization. Patients in the intervention group were treated with TENS 1 hour before surgery, while the placebo was administered to patients in the control group. All of the patients underwent inguinal hernia repair by the Lichtenstein method, and pain intensity was evaluated at 2, 4, 6, and 12 hours after surgery using a visual analogue scale. Additionally, the amounts of analgesic administered by pump were calculated and compared between the two groups. RESULTS: The mean estimated postoperative pain intensity was 6.21 ± 1.63 in the intervention group and 5.45 ± 1.82 in the control group (P = 0.08). In the intervention group pain intensity at 2 and 4 hours after surgery were 3.54 ± 1.48 and 5.12 ± 1.41 (P < 0.001), respectively. In the control group these values were 4.0±1.5 and 4.76 ± 1.39 (P = 0.04), respectively. No significant differences were observed in mean pain intensities at 6 and 12 hours. CONCLUSIONS: TENS can reduce postoperative pain in the early hours after inguinal hernia repair surgery.

Status of ocular trauma in hospitalized patients in Kashan, 2011: As a sample of industrial city.

PURPOSE: Ocular trauma is the third leading cause of hospitalization in ophthalmology patients, imposing direct and indirect physical and psychological costs on society. This study aims to investigate the status of ocular trauma in hospitalized patients in the industrialized city of Kashan in 2011. METHODS: This cross-sectional descriptive applied study was conducted in 2012 on patients hospitalized for ocular trauma. Data, including age, gender, occupation, education, timing of admission following accident, location of accident, type of injury, damaging instrument, and type of trauma, were collected using a questionnaire designed by a trained nurse, and analyzed using SPSS-16 software by means of means ± standard deviation, frequency, and percentage for descriptive data and t-test, one-way analysis of variance, Chi-square and Fisher exact test for analysis at significance level of p < 0.05. RESULTS: In total, 82 patients were hospitalized due to ocular traumas. The majority of patients were male (65 patients, 79.3%). Their mean age was (25.4 ± 21.4) years, with an age range of 20-40 years (30 patients, 36.6%). Hyphema was the most common injury (26 patients, 25.5%), home was the most frequent incident location (32 patients, 39%), and knife or other cutting tools were mostly responsible for injuries (18 patients, 21.9%). Patients were hospitalized for 1e6 days, and the average length of stay in hospital was 2.63 days. Frequency distribution of injuries based on whether or not ruptures differed significantly among different age groups. CONCLUSION: The majority of ocular trauma occurred in young males. Knife was the principle culprit for eye injuries, followed by vehicles. To reduce such incidents, it is recommended that people be trained to avoid high-risk behaviors when using knives and to better heed driving rules and regulations.

Epidemiology of Urban Traffic Accident Victims Hospitalized More Than 24 Hours in a Level III Trauma Center, Kashan County, Iran, During 2012-2013.

BACKGROUND: Urban traffic accidents are an extensively significant problem in small and busy towns in Iran. This study tried to explore the epidemiological pattern of urban traffic accidents in Kashan and Aran-Bidgol cities, Iran. OBJECTIVES: This study aimed to assess various epidemiological factors affecting victims of trauma admitted to a main trauma center in Iran. PATIENTS AND METHODS: During a retrospective study, data including age, sex, injury type and pattern, outcome, hospital stay and treatment expenditures regarding urban Road Traffic Accidents (RTAs) for one year (March 2012-March 2013) were obtained from the registry of trauma research center, emergency medical services and deputy of health of Kashan University of Medical Sciences. One-way ANOVA and chi-square tests were used to analyze data using SPSS version 16.0. P value < 0.05 was considered significant. RESULTS: A total of 1723 victims (82.6% male, sex ratio of almost 5:1) were considered in this study. Mortality rate in trauma cases hospitalized more than 24 hours during our study was 0.8%. Young motorcyclist men with the rate of more than 103 per 10000 were the most vulnerable group. The most common injury was head injury (73.6%) followed by lower limb injury (33.2%). A significant association was found between mechanism of injury and head, lower limb, multiple injuries and high risk age group. CONCLUSIONS: Urban RTAs are one of the most important problems in Kashan and Aran-Bidgol cities, which impose a great economic burden on health system. Motorcyclists are the most vulnerable victims and multiple trauma and head injury are seen among them extensively.

Inhalation anesthesia in a patient with xeroderma pigmentosum: a case report.

INTRODUCTION: Xeroderma Pigmentosum (XP) is a rare autosomal recessive disease, which is defined by extreme sensitivity to sunlight and UV radiation and characterized by skin lesions and neuromuscular abnormalities. It is caused by a molecular defect in nucleotide excision repair genes. It has been reported that volatile anesthetics may cause genotoxic side effects or aggravation of the neurological signs. We report an XP patient with difficult intubation whose airway was controlled with Laryngeal Mask Airway (LMA) and was anesthetized with sevoflurane. CASE PRESENTATION: A 23-year-old woman, who had been a known case of XP since her childhood, was admitted to our hospital for excision of face mass (SCC) and skin graft surgery. Her airway examination revealed some anatomical and pathological abnormalities, including limitation of mouth opening, jaw protrusion, head extension, and class 4 of mallampati, all predicting difficult intubation. We chose general anesthesia with inhalation induction, LMA insertion and maintenance with sevoflurane without muscle relaxant. The surgery was completed uneventfully and the patient left the hospital the day after the surgery without any new complaint. CONCLUSIONS: We suggest that for XP patients with compromised air-way, sevoflurane (not all volatiles) may be preferred.

Cerebral state index versus Glasgow coma scale as a predictor for in-hospital mortality in brain-injured patients.

OBJECTIVE: To compare the value of Glasgow coma scale (GCS) and cerebral state index (CSI) on predicting hospital discharge status of acute brain-injured patients. METHODS: In 60 brain-injured patients who did not receive sedatives, GCS and CSI were measured daily during the first 10 days of hospitalization. The outcome of prognostic cut-off points was calculated by GCS and CSI using receiver operating characteristic (ROC) curve regarding the time of admission and third day of hospitalization. Sensitivity, specificity and other predictive values for both indices were calculated. RESULTS: Of the 60 assessed patients, 14 patients had mild, 13 patients had moderate and 33 patients had severe injuries. During the course of the study, 17 patients (28.3%) deteriorated in their situation and died. The mean GCS and CSI in patients who deceased during hospitalization was significantly lower than those who were discharged from the hospital. GCS<4.5 and CSI<64.5 at the time of admission was associated with higher mortality risk in traumatic brain injury patients and GCS was more sensitive than CSI to predict in-hospital death in these patients. For the first day of hospitalization, the area under ROC curve was 0.947 for GCS and 0.732 for CSI. CONCLUSION: GCS score at ICU admission is a good predictor of in-hospital mortality. GCS<4.5 and CSI<64.5 at the time of admission is associated with higher mortality risk in traumatic brain injury patients and GCS is more sensitive than CSI in predicting death in these patients.

Agreement of cerebral state index and glasgow coma scale in brain-injured patients.

BACKGROUND: Variables derived from electroencephalogram like cerebral state index (CSI) have been used to monitor the anesthesia depth during general anesthesia. Observed evidences show such variables have also been used as a detector of brain death or outcome predictor in traumatic brain-injured (TBI) patients. OBJECTIVES: The current study was designed to determine the correlation between Glasgow coma score (GCS) and CSI among TBI patients. PATIENTS AND METHODS: In 60 brain-injured patients who did not need and receive sedatives, GCS and CSI were daily measured during the first ten days of their hospital stay. Correlation between GCS and CSI was studied using the Pearson's correlation test. The Gamma agreement coefficient was also calculated between the two variables for the first day of hospitalization. RESULTS: A significant correlation coefficient of 0.611-0.796 was observed between CSI and GCS in a ten-day period of the study (P < 0.001). Gamma agreement coefficient was 0.79 (P < 0.001) for CSI and GCS for the first day of hospitalization. An increased daily correlation was observed in both CSI and GCS values. However, this increase was less significant in CSI compared with the GCS. CONCLUSIONS: A statistically significant correlation and agreement was found between GCS and CSI in the brain-injured patients and GCS was also found to be more consistent and reliable compared with CSI.

The effect of pre-warmed intravenous fluids on prevention of intraoperative hypothermia in cesarean section.

BACKGROUND: Hypothermia is one of the problems occurring during surgery, which can happen due to thermoregulation mechanism disorders and intake of low temperature IV fluids, and may cause increase in blood pressure, heart rate, intracranial pressure, oxygen consumption, pain, and discomfort to the patient. The rate of cesarean section in our country is three times more than the global standard. As one of the responsibilities of the nurse is patient's advocacy, s/he should support them. This study aimed to investigate the effect of pre-warmed intravenous fluids on prevention of hypothermia during general anesthesia in cesarean section. MATERIALS AND METHODS: Sixty-two women undergoing elective cesarean section by general anesthesia were randomly allocated in two groups of intervention and control. Women in the intervention group received pre-warmed serum (37°C) while those in the control group received serum at room temperature (25.5°C). The core body temperature and some hemodynamic parameters of the participants were assessed during the operation. RESULTS: The mean of pulse rate, systolic blood pressure, diastolic blood pressure, and arterial O2 saturation in the two groups were not statistically significant (P > 0.05). But the mean of mothers' core body temperature at the end of anesthesia in the intervention and control groups were 36 ± 0.5°C and 35.34 ± 0.6°C, respectively (P < 0.05). CONCLUSION: Infusion of pre-warmed serum (37°C) would prevent intraoperative hypothermia and improve the nursing care for women who undergo cesarean section by general anesthesia.

Comparing remifentanil versus propofol effect on pain and homodynamic change of patients undergoing phacoemulsification with topical anesthesia.

INTRODUCTION: The purpose of this study was to compare remifentanil versus propofol effect on pain and homodynamic in patients undergoing phacoemulsification with topical anesthesia. MATERIALS AND METHODS: A double blind clinical trial was conducted to research following the approval of the ethical committee research of the university. One hundred volunteer subjects were randomly assigned into two equal groups (n = 50). The subjects in the propofol group received 3mg/kg/hr while the patients in the remifentanil drug received 3 µg/kg/hr of this medication. Phaco time, blood pressure and heart rate before and after surgery, respiratory depression (O2 sat < 90%) and vomiting, pain scores, ophthalmologist satisfaction and demographic data were recorded. RESULTS: The results of analysis showed that there were no significant differences between the age, sex, and duration of operation of the two treatment groups. Systolic, diastolic blood pressure and heart rate were significantly lower in the propofol group .The propofol group complained of pain than the remifentanil group (P = 0.001) while the surgeon satisfaction was higher for the remifentanil condition (P = 0.01). No significant differences were found between the two groups with respect to respiratory depression .No patient suffered from nausea and vomiting. CONCLUSIONS: The results of this study indicated that using appropriate dose of remifentanil instead of propofol results in less pain, more stable homodynamic condition, and satisfaction of surgeon without no respiratory depression or perioperative nausea and vomiting.

Pattern of ocular trauma among the elderly in Kashan, Iran.

OBJECTIVE: Ocular trauma is a common cause of visual impairment and accounts for 38% to 52% of all patients presenting as ophthalmic accident and emergency cases to the hospital. The purpose of this study is to describe the pattern of ocular injuries that leads to hospitalization in the elderly in Kashan, Iran. METHODS: In the retrospective consecutive case series, a total of 94 geriatric patients (larger than or equal to 65 years) who admitted and underwent management for ocular trauma from April 2001 to March 2011 at Matini Hospital of Kashan, the only center of eye surgery in the region of Kashan, were reviewed. The items include age, sex, injury mechanism, site and extent of damage, presenting and final best corrected visual acuity at least 3 months after trauma, which were reviewed and analyzed with SPSS software. RESULTS: During the 10 years, 94 eyes of 94 patients with ocular trauma were included. Mean age of patients was (77.5+/-5.1) years (range 65 to 102 years). Male to female ratio was 2.76. The mechanism of ocular injury included sharp trauma in 56 patients (59.6%) and blunt in 38 patients (40.4%). Trauma occurred mostly in males (69 patients, 73.4%) and at the work place (38 patients, 40.4%). On admission the visual acuity in 50 patients (53.2%) with damaged eyes was light perception to hand motion. While the final best corrected visual acuity in 36 patients (38.3%) was better than hand motion. CONCLUSION: Ocular trauma is a serious cause of visual impairment in the elderly. Appropriate and timely management may improve their visual prognosis.

A comparison of rectal misoprostol and intravenous oxytocin on hemorrhage and homeostatic changes during cesarean section.

BACKGROUND: Post partum bleeding is a major cause of mortality and morbidity in pregnant women. In this study the effects of rectal misoprostol and oxytocin on post-cesarean bleeding are compared. METHODS: In this clinical trial 100 pregnant women candidate of elective cesarean section (CS) were randomly allocated in one of two groups of patients receiving either 400 micro g of misoprostol, rectally, after spinal anesthesia, or intravenous oxytocin, after delivery of the baby. Intra-operative bleeding, hemoglobin level before and 24 hour after operation, mean arterial blood pressure, heart rate before and after the administration of the drugs, and adverse drug effects. RESULTS: There was no difference between the groups in age, duration and number of pregnancy, and surgery. The amount of the blood lost in misoprostol group was 578+/-185 cc, and in oxytocin group 620+/-213 cc (p=0.39). Decrease in hemoglobin level in the two groups was not statistically significant (p=0.55). Changes in mean arterial pressure and heart rate were only significant in oxytocin group. Shivering was significantly more common in the misoprostol group and respiratory distress in the oxytocin group. Other adverse effects were equally seen in both groups. CONCLUSION: Misoprostol is an appropriate alternative for intravenous oxytocin in patients undergoing cesarean section, with lesser side effects and longer duration of action.

Effects of gabapentin on pain and opioid consumption after abdominal hysterectomy.

BACKGROUND: Postoperative pain is an important factor affecting anesthesia and surgery. OBJECTIVES: The present study assessed the effects of 1200 mg gabapentin, an anticonvulsant drug that acts through voltage-dependent calcium channels, for the control of postoperative pain in patients undergoing abdominal hysterectomy. METHODS: Fifty patients undergoing hysterectomy were enrolled in the present study. Subjects received either 1200 mg gabapentin or placebo 2 h before surgery. The amount of morphine consumption and level of postoperative pain at 2 h, 6 h, 12 h and 24 h after surgery were measured. RESULTS: There were no significant differences in age, duration of surgery and anesthesia, or body mass index between the two groups. The mean intensity of pain in the gabapentin group was significantly lower than in the placebo group. The mean amount of morphine used in the placebo group (5.2 ± 2.8 mg) was significantly higher than in gabapentin group (1.2 ± 0.29 mg; P=0.001). Nausea and vomiting in the placebo group was more common than in the gabapentin group (P=0.001). The time interval for initial ambulation after surgery was significantly shorter in the gabapentin group (12.24 ± 2.18 h) compared with the placebo group (15 ± 3.61 h; P=0.002). CONCLUSION: 1200 mg gabapentin reduced postoperative pain and the need for opioids, and enabled earlier ambulation of the patient. Significant side effects were not observed.

Demographic Profiles of Adult Trauma During a 5 Year Period (2007-2011) in Kashan, IR Iran.

BACKGROUND: Trauma, in addition to mortality and disability experienced by an individual, imposes direct and indirect economic and social costs on a community. Traditionally, trauma is a disease of young and middle age adults, an age group which is known to be the most dynamic and economically productive of the community. Increasing our knowledge concerning the etiology and patterns of trauma seems to be the most profitable and accessible way to prevent injuries of this nature. OBJECTIVES: This study was designed to evaluate the epidemiology of adult trauma in Kashan, Iran. PATIENTS AND METHODS: The current study used a retrospective cross-sectional approach, enrolling all trauma adults (20 - 60 y) admitted to the Shahid Beheshti Hospital, Kashan, between 2007 and 2011. Age, gender, place of residence, work status, educational level, urban/rural location of the accident, method of transportation to hospital, injured body areas of the victims and therapeutic interventions, were extracted from the data registry and analyzed through descriptive statistics using SPSS software. RESULTS: A total of 22 564 patients were included in this study. Mean age of the victims was 33.18 ± 10.90 years and the male/female ratio was 4:1. Most of the victims were manual workers (61%), and they had completed primary and junior high school level education (49.4%), they were also more likely to be residents of urban areas (88.6%). Regarding the place of injury, most accidents occurred on city streets (43.8%). Approximately 40% of the total victims were transferred to the hospital by emergency medical services (EMS). During the study period, 260 deaths were recorded and among these, 76% were related to traffic accidents. CONCLUSIONS: Regarding the high prevalence of trauma found in manual workers with low educational levels and motorbike users, the establishment of an integrated program aimed at improving public knowledge on the use of safety and protective measures in work environments should be implemented. The use of safety protective equipment by cyclists, motorbikers and car passengers should also be enforced.