RESUMO
Background: Postoperative pain control after thoracotomy is very important, and if not controlled, it can cause severe complications. Objectives: This study aimed to compare dexmedetomidine and ketamine in serratus anterior plane block (SAPB) in pain control after thoracotomy. Methods: This randomized clinical trial was conducted on 74 patients aged 18 to 60 years old with American Society of Anesthesiologists (ASA) class I or II who were referred to Imam Khomeini hospital in Ahvaz, Iran, for thoracotomy and randomly divided into two groups. After surgery, the SAPB with ultrasound-guided was performed. In the ropivacaine-ketamine (RK) group, ketamine 0.5 mg/kg and 0.4 cc/kg ropivacaine solution 0.25% and in the ropivacaine-dexmedetomidine (RD) group, in addition to 0.4 cc/kg ropivacaine 0.25%, dexmedetomidine 0.5 µg/kg was added. Verbal Numeric Scale (VNS), systolic blood pressure (SBP), diastolic blood pressure (DBP), respiratory rate (RR), heart rate (HR), and mean arterial blood pressure (MAP) were recorded. Results: There was no significant difference in both groups in terms of demographic information (P < 0.05). The average VNS was lower in the ketamine group than in the dexmedetomidine group; however, there was a significant difference only at 1, 12, and 24 hours after surgery (P < 0.05). There was no statistically significant difference between the two groups in terms of SBP and DBP, HR, and MAP. There was a significant difference in the RR in the two groups at 12 and 24 hours after the operation (P < 0.05). Conclusions: Dexmedetomidine and ketamine, which were used as supplements to ropivacaine for SAPB in patients undergoing elective thoracotomy, reduced the pain intensity after thoracotomy; nevertheless, the intensity of pain reduction was more and more effective in the group receiving ketamine.
RESUMO
BACKGROUND: Managing the amount of use of sedatives due to their high side effects in the intensive care unit is essential. Sedation-agitation protocols may play an important role in this regard. However, they have not been practically applied in Iran. AIMS: This study aimed to evaluate the effect of using the Richmond agitation and sedation scale on hospital stay duration and dependency rate on the intensive care unit ventilator system in Ahwaz City, Iran, in 2016-2017. METHODS: This randomised clinical trial was conducted on 74 patients. The subjects were selected by a stratified sampling method and divided into the experimental (n = 32) and control (n = 32) groups. Sedation and agitation levels were managed by the Richmond agitation and sedation scale as soon as the samples were anxious and agitated, and every 6 hours in the intervention group. However, the control group received routine care. The data obtained were analysed by the Statistical Package for the Social Sciences (SPSS). RESULTS: There was no significant difference between the two groups in terms of demographic variables, such as age, gender, admission diagnosis and Glasgow coma scale scores on admission. However, they differed in terms of hospital stay duration and ventilator connection (P < 0.001), Glasgow coma scale score at the separation time from the device (P < 0.001), Glasgow coma scale score at the discharge time from the intensive care unit (P < 0.02) and intensive care unit death rate (P < 0.001). In all cases mentioned previously, the intervention group's condition was better. CONCLUSIONS: Based on the results of this study, as well as the approval of validation and reliability of the Richmond agitation and sedation scale in different studies, this protocol can be very effective in optimising the use of sedatives in the intensive care unit.
