Anesthesiology and Pain Medicine

BACKGROUND: Postoperative pain management is vital to improve patient care. Successful postoperative pain relief is currently achieved only through NSAIDs and narcotics. OBJECTIVES: We compared dexmedetomidine and clonidine as additives to hyperbaric levobupivicaine 0.5% for the sub-arachnoid block (spinal anesthesia) concerning the onset time, duration of the block, hemodynamic changes, level of sedation intraoperatively and postoperatively and time taken for the first postoperative analgesic request and frequency...

BACKGROUND: Percutaneous transforaminal endoscopic discectomy (PTED) has become popular over the years due to its safety and low invasiveness. This surgery can be performed with different anesthesia techniques; however, the extent to which the surgeon and patient are satisfied with the analgesia is debatable. OBJECTIVES: This study investigated the efficiency of the S1 transforaminal epidural block. METHODS: This retrospective study was conducted on 60 patients with L4 - L5 lumbar disc herniation who underwent PTED under the S1 transforaminal epidural block...

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BACKGROUND: Postoperative pain management using nonsteroidal anti-inflammatory drugs with no narcotic-attributed adverse effects, such as respiratory depression, nausea, and vomiting, is still the subject of extensive research. However, concerns about bleeding and nephrotoxicity have limited routine use. OBJECTIVES: The present trial aimed to compare the effects of ketorolac/apotel and meperidine on postoperative pain relief in patients undergoing thoracotomy. METHODS: This randomized controlled trial enrolled 122 patients who were candidates for right thoracotomy...

BACKGROUND: Opium has been used for thousands of years for medical and analgesic purposes, and its misuse has also increased in recent years. Methadone, a synthetic opioid, has been used as an analgesic and to help patients quit opium addiction. However, some evidence suggests that long-term use of opioids can affect the hypothalamic-pituitary-adrenal axis. OBJECTIVES: We aimed to evaluate the serum cortisol level and response to the cosyntropin stimulation test in opium addicts on methadone treatment...

BACKGROUND: Despite the high acceptability of the extracorporeal shock wave lithotripsy (ESWL) procedure in the treatment of urinary stones at all ages, it is necessary to use a variety of analgesic drugs during the procedure, especially among children. OBJECTIVES: We aimed to evaluate the effect of dexmedetomidine-ketamine (DK) and midazolam-ketamine (MK) compounds in the sedation of children (2-6 years old) undergoing ESWL. METHODS: This randomized, double-blind clinical trial was performed on children aged 2 to 6 years with renal stones undergoing ESWL...

BACKGROUND: Patients may experience anxiety, discomfort, and pain during endoscopy, which cannot be tolerated without sedative drugs. OBJECTIVES: This study aimed to compare the sedative effects of dexmedetomidine and midazolam on patients undergoing endosonography outside the operating room. METHODS: This randomized, double-blind clinical trial was conducted on 126 patients aged 18 - 65 years old with American Society of Anesthesiologists (ASA) physical status I - II undergoing elective endosonography...

CONTEXT: The type of anesthesia in cesarean section can affect the mother and baby. This study aimed to determine the comparative effect of intrathecal hyperbaric bupivacaine vs. hyperbaric ropivacaine on maternal and neonatal outcomes after cesarean section. EVIDENCE ACQUISITION: PubMed, Web of Science, Embase, Google Scholar, IranDoc, MagIran, and Scopus databases were searched from 1 September 2022 to 1 November 2022. Eighteen clinical trials with 1542 patients were included in the analysis...

CONTEXT: After the COVID-19 pandemic, multiple reviews have documented the success of veno-arterial extracorporeal membrane oxygenation (VA-ECMO). Patients who experience hypoxemia but have normal contractility may be switched to veno-venous-ECMO (VV-ECMO). PURPOSE: In this review, we present three protocols for anesthesiologists. Firstly, transesophageal echocardiography (TEE) aids in cannulation and weaning off inotropes and fluids. Our main objective is to assist in patient selection for the Avalon Elite single catheter, which is inserted into the right internal jugular vein and terminates in the right atrium...

BACKGROUND: The occurrence of lung ultrasound abnormalities in patients without lung disease remains uncertain, while patients with respiratory disease often exhibit such abnormalities. OBJECTIVES: The primary aim was to identify pathological ultrasonographic pulmonary findings and their correlation with baseline diseases and static lung compliance in patients without any pre-existing respiratory conditions. METHODS: This prospective observational study enrolled a series of surgical patients with no history of pulmonary pathology (n = 104)...

INTRODUCTION: Schwartz-Jampel syndrome (SJS) is a rare autosomal recessive disease characterized by muscle weakness and stiffness, abnormal bone development, short stature, joint contractures, and facial dysmorphisms. Myopathy, anatomical deformities, and malignant hyperthermia are challenging for anesthesiologists. CASE PRESENTATION: This case report describes one case of SJS. The female patient was scheduled for Blepharoplasty in Rasuol Akram General Hospital...

BACKGROUND: Intravenous cannulation is a prerequisite before any major or minor surgical procedures. OBJECTIVES: The rationale of the study was to compare the effectiveness of eutectic mixtures of local anesthetics (EMLA) cream and vapocoolant spray for pain reduction during intravenous (I.V.) cannulation. METHODS: This observational prospective cohort study was done on 140 patients requiring I.V. cannulation prior to elective procedure who were divided into two groups, including group E: EMLA (eutectic mixtures of local anesthetics) cream and group V: Vapocoolant spray (ethyl chloride)...

BACKGROUND: Direct laryngoscopy is the standard method for intubation in pediatric patients. The introduction of video laryngoscopy brought a paradigm shift in managing pediatric airways. OBJECTIVES: We compared the tracheal intubation technique between direct and video laryngoscopy with McIntosh Blade 2 in pediatric patients 2 - 8 years of age requiring airway management. The glottic view and the first pass success rate were compared and analyzed. METHODS: An observational cross-sectional study was conducted with 120 children between 2 - 8 years with normal airways...

Parkinson's disease (PD) is a chronic neurological degenerative disease affecting the central nervous system, which is responsible for progressive disorders such as slow movements, tremors, rigidity, and cognitive disorders. There are no specific recommendations and guidelines for anesthetic management of patients with PD undergoing ophthalmic procedures. This narrative review aims to summarise the anesthetic considerations in patients with PD presenting for cataract surgery.

Symptomatic patients with coronavirus disease 2019 (COVID-19) mostly have flu-like symptoms. However, neurologic manifestations are common and may be the early findings of COVID-19. Data for COVID-19 do not indicate an increased risk of infection in pregnant individuals, but the risk of disease severity and mortality is high in this patient population. We report a case of a pregnant woman in the 10th gestational week, who presented with neurological symptoms of sudden impairment in walking, balance, speech, and consciousness, started the night before, and a seven-day history of fever, chills, myalgia, and general weakness before admission...

CONTEXT: Hemiplegic shoulder pain (HSP) is one of the complications of a stroke. OBJECTIVES: This study aimed to determine shoulder pain prevalence in cerebrovascular accident (CVA) patients. METHODS: This meta-analysis study searched English and Persian descriptive or descriptive-analytical full-text studies on CVA patients. The search was carried out in all databases by two researchers using keywords such as stroke, pain, CVA, hemiplegic, and shoulder pain...

BACKGROUND: Stroke is prevalent in Iran, and its complications can decline patients' quality of life and psychological state. OBJECTIVES: This study aimed to investigate the relationship between pain following stroke (PFS) and disability in stroke patients. METHODS: The current case-control study was conducted on 184 stroke patients (92 cases and 92 controls). Data collection tools included a demographic questionnaire, the Visual Analog Scale (VAS), and the Disabilities of the Arm Shoulder and Hand (DASH) questionnaire...

INTRODUCTION: The erector spinae plane (ESP) block is a regional anesthetic technique that involves injecting a local anesthetic below the erector spinae muscle in an interfascial plane. CASE PRESENTATION: We report a case of a 66-year-old man with cervicothoracic junction pain caused by an advanced Pancoast tumor. The administration of ESP block at the T2-T3 level led to pain relief of more than 50% in this patient after two sessions. CONCLUSIONS: Therefore, the application of this method of regional analgesia is both convenient and safe and reduces opioid consumption...

BACKGROUND: Laryngoscopy is the most painful noxious stimulus during anesthesia and surgery. Dexmedetomidine is increasingly used as a sedative in surgeries involving microlaryngoscopy. OBJECTIVES: This study aimed to evaluate the effect of dexmedetomidine and a combination of fentanyl and midazolam on mitigating the stress response in patients scheduled for microlaryngoscopy. METHODS: This randomized, double-blind clinical trial enrolled 60 patients (28 males and 32 females) aged 18 - 65 years with the American Society of Anesthesiologists (ASA) physical status I - III...

BACKGROUND: Unilateral spinal anesthesia is often accompanied by technical difficulties in implementation, multiple puncture attempts, unsuccessful punctures, and, as a result, insufficient anesthesia, along with various complications associated with a dural puncture. OBJECTIVES: This work compares the efficacy and safety of conventional Unilateral Spinal Anesthesia (USpA) and unilateral spinal anesthesia with electrical nerve stimulation (USpA+ENS). METHODS: A total of 134 patients with an upcoming vascular surgery on one lower extremity were randomly assigned to two groups...