Publications by authors named "Seyed Hamid Reza Faiz"

38 Publications

Mental health care for hospitalized COVID-19 patients; an experience from Iran.

Med J Islam Repub Iran 2020 2;34:162. Epub 2020 Dec 2.

Antimicrobial Resistance Research Center, Iran University of Medical Sciences, Tehran, Iran.

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http://dx.doi.org/10.47176/mjiri.34.162DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8004565PMC
December 2020

Neuropsychiatric manifestations of COVID-19 can be clustered in three distinct symptom categories.

Sci Rep 2020 12 1;10(1):20957. Epub 2020 Dec 1.

Rasoul Akram Hospital Clinical Research Development Center (RCRDC), Iran University of Medical Sciences, Sattarkhan St, Tehran, Iran.

Several studies have reported clinical manifestations of the new coronavirus disease. However, few studies have systematically evaluated the neuropsychiatric complications of COVID-19. We reviewed the medical records of 201 patients with confirmed COVID-19 (52 outpatients and 149 inpatients) that were treated in a large referral center in Tehran, Iran from March 2019 to May 2020. We used clustering approach to categorize clinical symptoms. One hundred and fifty-one patients showed at least one neuropsychiatric symptom. Limb force reductions, headache followed by anosmia, hypogeusia were among the most common neuropsychiatric symptoms in COVID-19 patients. Hierarchical clustering analysis showed that neuropsychiatric symptoms group together in three distinct groups: anosmia and hypogeusia; dizziness, headache, and limb force reduction; photophobia, mental state change, hallucination, vision and speech problem, seizure, stroke, and balance disturbance. Three non-neuropsychiatric cluster of symptoms included diarrhea and nausea; cough and dyspnea; and fever and weakness. Neuropsychiatric presentations are very prevalent and heterogeneous in patients with coronavirus 2 infection and these heterogeneous presentations may be originating from different underlying mechanisms. Anosmia and hypogeusia seem to be distinct from more general constitutional-like and more specific neuropsychiatric symptoms. Skeletal muscular manifestations might be a constitutional or a neuropsychiatric symptom.
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http://dx.doi.org/10.1038/s41598-020-78050-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7708626PMC
December 2020

Commentary: Remote electronic consultation for COVID-19 patients in teaching hospitals in Tehran, Iran.

Med J Islam Repub Iran 2020 8;34:31. Epub 2020 Apr 8.

Rasoul Akram Hospital Clinical Research Development Center (RCRDC), Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.

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http://dx.doi.org/10.34171/mjiri.34.31DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7320982PMC
April 2020

Effects of ultrasound guided ganglion stellate blockade on intraoperative and postoperative hemodynamic responses in laparoscopic gynecologic surgery.

Wideochir Inne Tech Maloinwazyjne 2020 Jun 11;15(2):351-357. Epub 2019 Nov 11.

Endometriosis Research Center, Iran University of Medical Sciences, Tehran, Iran.

Introduction: Laparoscopic gynecologic surgery is one of the most well-known procedures. Pneumoperitoneum with carbon dioxide insufflation can cause unfavorable hemodynamic effects due to catecholamine and vasopressin release.

Aim: To examine the effects of stellate ganglion block on hemodynamic response and postoperative pain.

Material And Methods: In a prospective double blinded randomized parallel study we included 40 patients with ASA physical status I and II, aged between 18 and 50 years with a gynecologic problem candidate for laparoscopic surgery under general anesthesia. The patients were randomly divided into two groups. Fifteen minutes before anesthesia induction, the patients underwent ultrasound guided stellate ganglion block with 10 ml of lidocaine 1% and the control group underwent stellate ganglion block using 10 ml of distilled water as placebo. After induction of general anesthesia, systolic and diastolic blood pressure and heart rate were recorded, especially after blowing of CO gas, the position change, depletion of CO, and tracheal extubation in recovery. The postoperative pain was calculated using the visual analogue scale (VAS) at three times (0, 30, and 24 h after surgery).

Results: Our results showed that mean systolic and diastolic blood pressure and heart rate did not show any significant difference at the measurement times (p > 0.05), and mean VAS of patients in the two groups was significantly different for the three measurement times except 24 h after surgery (p < 0.05).

Conclusions: Stellate ganglion block before laparoscopic gynecologic surgery has no significant effect on intraoperative and postoperative hemodynamic responses; however, it can decrease VAS in the early postoperative period.
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http://dx.doi.org/10.5114/wiitm.2019.89653DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7233162PMC
June 2020

Comparison of Two Acupuncture Protocols (K1, DU25 or K1, DU26) Efficacy on Recovery Time of Patients After General Anesthesia, a Randomized Control Clinical Trial.

Anesth Pain Med 2019 Oct 28;9(5):e96172. Epub 2019 Oct 28.

Pain Research Center, Rasoul Akram Hospital, Iran University of Medical Sciences (IUMS), Tehran, Iran.

Background: Acupuncture has been used for more than two thousand years as part of traditional Chinese medicine.

Objectives: This randomized prospective clinical trial aimed to compare the effect of acupuncture on K1 (Yongquan) and DU26 (Renghong) with acupuncture on K1 (Yongquan) and DU25 (Suliao), with sham acupuncture on the recovery time of general anesthesia.

Methods: The patients (51) were randomly assigned to three groups: (A) acupuncture on K1 and DU26, (B) acupuncture on K1 and DU25, and (C) sham acupuncture. In each group, at the end of surgery acupuncture was performed accordingly for twenty minutes and the Bispectral Index (BIS) values at end of surgery, 5th minute, 10th minute, 15th minute and 20th minute as well as time of extubation and time of eye opening after the end of surgery were evaluated.

Results: BIS study at 5th minute, 10th minute and 15th minute after the end of surgery in the groups revealed a significant difference between sham acupuncture group and both A and B acupuncture groups, which was higher in groups A and B in comparison with sham acupuncture group. Time of opening eyes and time of extubation after the end of surgery between group A and sham acupuncture group differed significantly, which was earlier in group A. There was no significant difference between group B and sham acupuncture group in terms of eye opening and extubation time.

Conclusions: Acupuncture on K1 and DU26 accelerates restoring of consciousness and shortens of eye opening and extubation after general anesthesia, but on K1 and DU25 only speeds up retrieving of consciousness without significant effect on time of eye opening or extubation after general anesthesia.
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http://dx.doi.org/10.5812/aapm.96172DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6935292PMC
October 2019

The Effect of Nitroglycerine Infusion on Postoperative Pain in Lower Limb Surgery: A Clinical Double-Blind Study.

Anesth Pain Med 2019 Aug 27;9(4):e93848. Epub 2019 Aug 27.

Pain Research Center, Iran University of Medical Sciences, Tehran, Iran.

Background: Acute postoperative pain causes severe discomfort in patients accompanied by hemodynamic and metabolic instability.

Objectives: The aim of this study was to evaluate the effects of nitroglycerin addition on the infusion of intravenous analgesia pump in patients with lower limb orthopedic surgery.

Methods: This study was a double-blind clinical trial conducted on 75 patients with lower limb fracture. Patients were randomly assigned to receive three regimens for postoperative pain control via intravenous analgesia pump, including group A (fentanyl 10mc/kg + 10 mL distilled water), B (fentanyl 10 mc/kg + nitroglycerin 500 mc), and C (fentanyl 10 mc/kg + nitroglycerin 1000 mc). The patients at the beginning of recovery and prior to putting the pain pump at the time of 4, 8, 12, 24, and 48 hours, were assessed with visual analogue scale (VAS) to measure pain and Ramsay scale to measure sedation.

Results: The results showed that weight, height, and gender distribution were not significantly different in the three groups. The HR, MAP, and VAS mean scores showed a significant difference for intragroup and intergroup differences in the three groups at many times.

Conclusions: Low dose nitroglycerine, as an adjuvant drug, can be added to intravenous patient-controlled analgesia pump in patients undergoing surgery for better analgesic purposes in patients without underlining disease.
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http://dx.doi.org/10.5812/aapm.93848DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6825369PMC
August 2019

Comparison of intraperitoneal bupivacaine, acetazolamide, and placebo on pain relief after laparoscopic cholecystectomy surgery: A clinical trial.

Med J Islam Repub Iran 2018 13;32:112. Epub 2018 Nov 13.

Rasool Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.

Given the importance of patients' pain after laparoscopic surgeries, this study was conducted to compare the effectiveness of intraperitoneal bupivacaine, acetazolamide, and placebo on pain relief after laparoscopic cholecystectomy surgery. Patients admitted to Rasool Akram hospital with physical status I or II, based on the American Society of Anesthesiologists (ASA) system, who were candidates for laparoscopic cholecystectomy surgery due to gallstones, were included in this study. Patients were divided into 3 groups (each group containing 20 patients) using block randomization with foursome blocks. Group 1 received bupivacaine, group 2 acetazolamide, and group 3 intravenous saline as placebo. After surgery, pain score was assessed by visual analogue scale, and shoulder pain and analgesic doses were also measured. The mentioned parameters were assessed at 1, 4, 8, 12, and 24 hours after surgery. In this study, 60 patients were included in 3 groups. The mean pain recorded (VAS) at 1, 4, and 8 hours after surgery was not significantly different between acetazolamide and bupivacaine groups, but their score was significantly lower than the placebo group (p<0.05). However, the score recorded at 12 and 24 hours after surgery was not significantly different between the 3 groups (p>0.05). Mean of pain reliever (acetaminophen) injected to the patients when needed was not significantly different among the 3 intervention groups (p<0.05). The highest prevalence of shoulder pain (70%) belonged to the placebo group and the lowest (25%) to acetazolamide (p<0.05). Mean heart rate, systolic blood pressure, diastolic blood pressure, and the respiratory rate were not significantly different among intervention groups in 1, 4, 8, 12, and 24 hours after surgery (p>0.05). According to the results, acetazolamide and bupivacaine injection reduced pain in early hours after laparoscopy. However, pain intensity was not different between intervention groups and the control group after 12 hours, so re-prescription seems to be appropriate at this time. Acetazolamide injection significantly reduces shoulder pains after surgery.
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http://dx.doi.org/10.14196/mjiri.32.112DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6387819PMC
November 2018

A clinical trial comparing ultrasound-guided ilioinguinal/iliohypogastric nerve block to transversus abdominis plane block for analgesia following open inguinal hernia repair.

J Pain Res 2019 4;12:201-207. Epub 2019 Jan 4.

Pain Research Center, Iran University of Medical Sciences, Tehran, Iran,

Objective: To compare the efficacy of ilioinguinal/iliohypogastric (IINB) nerve block to transversus abdominis plane (TAP) block in controlling incisional pain after open inguinal hernia repair.

Patients And Methods: This was a prospective randomized clinical trial of 90 patients who received either IINB (N=45) or TAP block (N=45) using 0.2% bupivacaine 15 mL under ultrasound (US) guidance based on a random assignment in the postanesthesia care unit after having an open repair of inguinal hernia. Numeric Rating Scale (NRS) scores were recorded immediately following, 4, 8, 12, and 24 hours after completion of the block. NRS scores at rest and during movement were recorded 24, 36, and 48 hours after surgery. Analgesic satisfaction level was also evaluated by a Likert-based patient questionnaire.

Results: NRS scores were lower in the IINB group compared to the TAP block group both at rest and during movement. The difference in dynamic pain scores was statistically significant (=0.017). In addition, analgesic satisfaction was significantly greater in the IINB group than the TAP block group (mean score 2.43 vs 1.84, =0.001). Postoperative opioid requirements did not differ between the two groups.

Conclusion: This study demonstrated that compared to TAP block, local blockade of ilioinguinal and iliohypogastric nerves provides better pain control after open repair of inguinal hernia when both blocks were administered under US guidance. Greater satisfaction scores also reflected superior analgesia in patients receiving IINB.
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http://dx.doi.org/10.2147/JPR.S179506DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6324918PMC
January 2019

Comparison of the effects of stellate ganglion block and paroxetine on hot flashes and sleep disturbance in breast cancer survivors.

Cancer Manag Res 2018 26;10:4831-4837. Epub 2018 Oct 26.

Pain Research Center, Iran University of Medical Sciences, Tehran, Iran,

Background: The incidence of menopausal symptoms, including hot flashes and sleep disturbance, caused by drug treatment is a common problem in breast cancer survivors. Considering the limitations of hormone therapy in such patients, several studies have been conducted to find alternative methods. The aim of this study was to investigate and compare the effectiveness of stellate ganglion block (SGB) with that of paroxetine, which was approved by the US Food and Drug Administration (FDA) as a medicine for the treatment of hot flashes and ensuing sleep disturbance.

Patients And Methods: A total of 40 patients survived from breast cancer and complaining of these symptoms were equally assigned to two groups of 20 each. In the study group, SGB was performed successfully under sonography guidance using 10 mL of 0.5% bupivacaine, and in the control group (paroxetine), the daily administration of 7.5 mg of paroxetine was conducted for 6 weeks. The frequency and severity of hot flash attacks and sleep quality of patients were evaluated prior to the intervention and after 2, 4 and 6 weeks. The incidence of adverse events during treatment or follow-up was recorded.

Results: A significant decrease in hot flash score and sleep disturbance index (SDI) was observed in both groups. Comparison of the results showed no noticeable difference between the two groups. Two participants in the control group had discontinued medication due to gastrointestinal symptoms, and only one case of mild headache was reported in the study group.

Conclusion: SGB is as much effective as paroxetine in controlling hot flashes and sleep disturbances in breast cancer survivors and is associated with few complications.
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http://dx.doi.org/10.2147/CMAR.S173511DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6208490PMC
October 2018

Impact of the Ultrasound-Guided Serratus Anterior Plane Block on Post-Mastectomy Pain: A Randomised Clinical Study.

Turk J Anaesthesiol Reanim 2018 Sep 4;46(5):388-392. Epub 2018 Sep 4.

Pain Research Center, Iran University of Medical Sciences, Tehran, Iran.

Objective: A variety of methods, including neuraxial and regional blocks, have been used to manage post-mastectomy pain. This study evaluates the effect of serratus anterior plane block on acute pain after mastectomy.

Methods: A total of 60 patients who were candidates for mastectomy under general anaesthesia were divided in this trial into two groups. After entering the recovery room, the first-experimental-group (SAB) underwent the ultrasound-guided serratus anterior block, but the second-control-group (CTL) received no block intervention. An intravenous patient-controlled analgesia (PCA) device was used to deliver fentanyl in both groups. Using the Visual Analog Scale (VAS), the patients' pain was assessed at intervals of 1, 6, 12 and 24 hours after entering the recovery room. Intravenous acetaminophen was administered as a rescue analgesic if the pain exceeded 3 on the VAS. A total amount of fentanyl consumed, the time to first PCA request, a total amount of acetaminophen consumption and possible adverse effects were evaluated.

Results: The pain scores assessed at the time intervals were not significantly different between the two groups (p>0.5). The total consumption of fentanyl was significantly lower in the SAB group than in the CTL group (p=0.0001). Duration of the time to first PCA request was remarkably longer in the SAB group than in the CTL group (p=0.0001). The total amount of acetaminophen consumed was notably higher in the CTL group than in the SAB group (p=0.001). None of the patients experienced side effects.

Conclusion: Undertaking serratus anterior block following mastectomy can reduce pain scores and lower opioid usage.
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http://dx.doi.org/10.5152/TJAR.2018.86719DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6157977PMC
September 2018

Comparison of percutaneous intradiscal ozone injection with laser disc decompression in discogenic low back pain.

J Pain Res 2018 31;11:1405-1410. Epub 2018 Jul 31.

Anesthesiology Department, Iran University of Medical Sciences, Tehran, Iran.

Background: Intervertebral disc herniation with the pressure on the surrounding neural structures is one of the most important causes of chronic low back pain, which sometimes leads to open surgery. Reducing the pressure inside the disc with intradiscal intervention such as laser irradiation or ozone injection is a minimally invasive method and an alternative to surgery with satisfactory results. These two methods were compared with each other in this research.

Patients And Methods: In this clinical trial, 40 patients with back pain radiating to lower limb due to lumbar intervertebral disc herniation were selected. These patients were randomly divided into two equal groups for percutaneous intradiscal intervention. The Laser Disc Decompression Group (LDG) (n=20) was exposed to 1500 J of laser irradiation into the disc center. In the Ozone Injection Group (OZG) patients (n=20), 6 mL of ozone 30 µg/mL was injected into the center of the disc. Considering the level of neural root involvement, both groups received 20 mg of triamcinolone injection via transforaminal epidural. Patients were followed up for 12 months regarding score on visual analogue scale and life performance improvement based on Oswestry Disability Index (ODI) and satisfaction level.

Results: According to the results, no difference was found between the two groups for ODI variable before intervention, whereas OZG showed better ODI scores in the measured time intervals. In LDG, only a significant difference in terms of ODI score was found between the times of before surgery and the first month.

Conclusion: Intradiscal ozone injection could be an effective and cost-effective method for treatment of patients with discogenic back pain.
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http://dx.doi.org/10.2147/JPR.S164335DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6074825PMC
July 2018

Comparative addition of dexmedetomidine and fentanyl to intrathecal bupivacaine in orthopedic procedure in lower limbs.

BMC Anesthesiol 2018 06 6;18(1):62. Epub 2018 Jun 6.

Rasoul-e-Akram Medical Complex, Iran University of Medical Sciences, Tehran, Iran.

Background: Spinal block is a common procedure for lower limbs surgery. Fentanyl, a synthetic opioid and dexmedetomidine, a selective α2 agonist have been used as adjuvants in spinal anesthesia to prolong intraoperative and postoperative analgesia. The aim of current study is to compare the efficacy of dexmedetomidine and fentanyl added to intrathecal bupivacaine in orthopedic procedures in lower limbs.

Methods: In this randomized clinical trial, 90 patients undergoing elective lower limb surgeries were randomly allocated to three groups. Via intrathecal approach, the patients received 2.5 ml hyperbaric bupivacaine 0.5% plus 5 micrograms dexmedetomidine (BD group), 25 micrograms fentanyl (BF group) or 0.5 ml normal saline (BN group), respectively. Time to reach the complete motor block, the highest sensory level, regression from block, analgesic request and duration of the drug effect, hemodynamic changes and side effects were compared between the groups.

Results: There was no significant difference between the groups regrading time to reach complete motor block, but time to reach the highest sensory level was shorter in group BD than group BF (6.28 ± 1.75 vs. 7.17 ± 1.45, p = 0.03). Group BD had significantly lower mean of NRS 6 h after operation (1.90 ± 0.84 vs. 6.16 ± 1.44 vs. 6.30 ± 1.17, p < 0.001) and longer duration to regress to Bromage 0 (331.60 ± 73.96 vs. 185.56 ± 35.87 vs. 147.03 ± 33.05 min, p < 0.001), to analgesic request (496.63 ± 70.19 vs. 296.33 ± 44.83 vs. 221.83 ± 22.26 min, p < 0.001), to regress two sensory levels (149.00 ± 23.17 vs. 88.90 ± 12.85 vs. 69.33 ± 6.67 min, p < 0.001) and to regress to S1 (560.53 ± 81.86 vs. 329.83 ± 44.10 vs. 241.83 ± 22.26 min, p < 0.001). Serial changes in SBP (p = 0.006), DBP (p = 0.03) and HR (p = 0.002) in group BF were significantly higher than the other two groups. The three groups had comparable side effects.

Conclusions: Using dexmedetomidine as an adjuvant to bupivacaine for spinal anesthesia in lower limb surgeries has longer duration of sensory and motor block and longer postoperative analgesia.

Trial Registration: IRCT registration number: IRCT2017041010599N15 , 24 May 2017.
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http://dx.doi.org/10.1186/s12871-018-0531-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5991430PMC
June 2018

The Effect of Different Doses of Intrathecal Hyperbaric Bupivacaine Plus Sufentanil in Spinal Anesthesia for Cesarean Sections.

Anesth Pain Med 2017 Dec 31;7(6):e14426. Epub 2017 Dec 31.

Resident, Department of Anesthesiology, Iran University of Medical Sciences, Tehran, Iran.

Background: Decreasing side effects and improving the quality of block in caesarean sections by appropriate dosage of local anesthetics and adjuvants could play an important role in the safe management of cesarean section. The present study aimed at comparing the effects of 3 different doses of intrathecal hyperbaric bupivacaine injected with a fixed dose of sufentanil in cesarean sections.

Methods: In a double- blind randomized clinical trial, 105 candidates of elective cesarean section were randomly assigned into 3 groups of 8, 9, and 10 mg of intrathecal bupivacaine plus sufentanil 2.5 µg. The maximum level of sensory block, the intensity of motor block, and vital signs were measured at regular intervals. The incidence of hypotension and bradycardia were also recorded.

Results: No significant difference was found between the maximum level of sensory block and the intensity of motor block in 3 groups. The incidences of hypotension and bradycardia as well as administration of atropine and ephedrine were comparable among the 3 groups (P > 0.05).

Conclusions: According to similar effects of different doses of bupivacaine, administration of lower doses of bupivacaine (8mg) is more reasonable for spinal anesthesia for cesarean section.
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http://dx.doi.org/10.5812/aapm.14426DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5903377PMC
December 2017

Which Ultrasound-Guided Sciatic Nerve Block Strategy Works Faster? Prebifurcation or Separate Tibial-Peroneal Nerve Block? A Randomized Clinical Trial.

Anesth Pain Med 2017 Aug 24;7(4):e57804. Epub 2017 Jul 24.

Resident of Anesthesiology, Iran University of Medical Sciences, Iran.

Background: Peripheral nerve block is an accepted method in lower limb surgeries regarding its convenience and good tolerance by the patients. Quick performance and fast sensory and motor block are highly demanded in this method. The aim of the present study was to compare 2 different methods of sciatic and tibial-peroneal nerve block in lower limb surgeries in terms of block onset.

Methods: In this clinical trial, 52 candidates for elective lower limb surgery were randomly divided into 2 groups: sciatic nerve block before bifurcation (SG; n = 27) and separate tibial-peroneal nerve block (TPG; n = 25) under ultrasound plus nerve stimulator guidance. The mean duration of block performance, as well as complete sensory and motor block, was recorded and compared between the groups.

Results: The mean duration of complete sensory block in the SG and TPG groups was 35.4 ± 4.1 and 24.9 ± 4.2 minutes, respectively, which was significantly lower in the TPG group (P = 0.001). The mean duration of complete motor block in the SG and TPG groups was 63.3 ± 4.4 and 48.4 ± 4.6 minutes, respectively, which was significantly lower in the TPG group (P = 0.001). No nerve injuries, paresthesia, or other possible side effects were reported in patients.

Conclusions: According to the present study, it seems that TPG shows a faster sensory and motor block than SG.
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http://dx.doi.org/10.5812/aapm.57804DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5881004PMC
August 2017

The effects of injecting intra-articular platelet-rich plasma or prolotherapy on pain score and function in knee osteoarthritis.

Clin Interv Aging 2018 4;13:73-79. Epub 2018 Jan 4.

Anesthesia Department, Iran University of Medical Sciences, Tehran, Iran.

Introduction: Osteoarthritis (OA) is a chronic joint disease that usually occurs in older people and leads to pain and disabilities. OA treatment ranges from drug therapy to surgery. Drug and rehabilitation therapy are preferred over surgery, and, especially, there is a tendency toward compounds causing regenerative changes in the knee joint. In the present study, the effects of platelet-rich plasma (PRP) injection and prolotherapy (PRL) were examined on the level of pain and function of the knee joint in patients with OA.

Methodology: After fulfilling the inclusion criteria and signing the informed consent form, 42 patients with knee OA were scheduled for intra-articular injection in the present randomized, double-blind, clinical trial. Following admission to the operating pain room, the condition of the patient's knee was evaluated first via the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and, then, ultrasound-guided knee injection was done. Accordingly, patients in the PRP therapy group received 7 mL PRP solution and those in the PRL group received 7 mL 25% dextrose. Using the WOMAC, levels of pain and knee function were evaluated and recorded for each patient immediately prior to the first injection as well as at 1 month (immediately prior to the second injection), 2 months (a month after the second injection), and 6 months later. Data collected were analyzed using the SPSS v.20.

Results: During the first and second months, a rapid decrease in the overall WOMAC score was observed in both groups. The overall WOMAC score increased at the sixth month, but was lower than the overall WOMAC score in the first month. Statistical analysis indicated that the overall WOMAC score significantly decreased in both groups of patients over 6 months.

Conclusion: Results of the present study suggested a significant decrease in the overall WOMAC score of patients who undergo either PRP therapy or PRL. This positive change in the overall WOMAC score led to an improvement in the quality of life of patients with knee OA shortly after the first injection. PRP injection is more effective than PRL in the treatment of knee OA.
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http://dx.doi.org/10.2147/CIA.S147757DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5757490PMC
July 2018

Comparison of ultrasound-guided posterior transversus abdominis plane block and lateral transversus abdominis plane block for postoperative pain management in patients undergoing cesarean section: a randomized double-blind clinical trial study.

J Pain Res 2018 19;11:5-9. Epub 2017 Dec 19.

Anesthesia Department, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran.

Background: Due to the importance of pain control after abdominal surgery, several methods such as transversus abdominis plane (TAP) block are used to reduce the pain after surgery. TAP blocks can be performed using various ultrasound-guided approaches. Two important approaches to do this are ultrasound-guided lateral and posterior approaches. This study aimed to compare the two approaches of ultrasound-guided lateral and posterior TAP blocks to control pain after cesarean section.

Materials And Methods: In this double-blind clinical trial study, 76 patients scheduled for elective cesarean section were selected and randomly divided into two groups of 38 and underwent spinal anesthesia. For pain management after the surgery, one group underwent lateral TAP block and the other group underwent posterior TAP block using 20cc of ropivacaine 0.2% on both sides. Pain intensity was evaluated based on Numerical Analog Scale (NAS) at rest and when coughing, 2, 4, 6, 12, 24 and 36 hours after surgery.

Results: The pain at rest in the posterior group at all hours post surgery was lower than the lateral group, especially at 6, 12 and 24 hours after the surgery and the difference was statistically significant (=0.03, <0.004, =0.001).

Conclusion: The results of this study show that ultrasound-guided posterior TAP block compared with the lateral TAP block was more effective in pain control after cesarean section.
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http://dx.doi.org/10.2147/JPR.S146970DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5741073PMC
December 2017

An investigation into the effect of depth of anesthesia on postoperative pain in laparoscopic cholecystectomy surgery: a double-blind clinical trial.

J Pain Res 2017 28;10:2311-2317. Epub 2017 Sep 28.

Department of Anesthesiology, Iran University of Medical Sciences, Tehran, Iran.

Backgrounds And Objective: Some studies have shown that deeper anesthesia is more effective on postoperative analgesia and reduces the need for sedative drugs. This study sought to investigate the effect of depth of anesthesia on postoperative pain in laparoscopic cholecystectomy.

Materials And Methods: In this double-blind clinical trial, 60 patients undergoing laparoscopic cholecystectomy were randomly divided into two groups: low bispectral index (L-BIS=35-44) and high bispectral index (H-BIS=45-55). Anesthesia protocol was the same for both groups (propofol and remifentanil). The pain intensity (at rest and during cough) was evaluated based on the visual analog scale scores in recovery and at 8, 16 and 24 hours after surgery.

Results: The mean pain score was significantly lower in patients in the L-BIS group at all examined times at rest and during cough than that in the H-BIS group. The number of patients in need of additional sedative drug in the H-BIS group in recovery was significantly more than that in the L-BIS group (27 vs 18 patients, =0.007). The incidence of nausea in the recovery room 8 hours after the surgery was significantly less in the L-BIS group than that in the H-BIS group, while at 16 and 24 hours, no case of nausea was reported in the two groups.

Conclusion: Given the results of this study, it seems that general anesthesia with propofol and remifentanil with L-BIS causes less need for additional analgesic drug and less nausea and vomiting compared to anesthesia with H-BIS.
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http://dx.doi.org/10.2147/JPR.S142186DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5627759PMC
September 2017

Adding Intra-Articular Growth Hormone to Platelet Rich Plasma under Ultrasound Guidance in Knee Osteoarthritis: A Comparative Double-Blind Clinical Trial.

Anesth Pain Med 2016 Dec 19;6(6):e41719. Epub 2016 Oct 19.

Department of Anesthesiology and Pain Medicine, Pusan National University, Korea.

Introduction: Intra-articular injections of platelet rich plasma (PRP) for the treatment of knee osteoarthritis have been shown to reduce pain and improve joint function. The aim of this study is to examine the joint function by adding intra-articular growth hormone to platelet rich plasma. This study was performed on the individuals with knee osteoarthritis and under ultrasound guidance.

Methods: Fifty four patients who were scheduled for ultra-sound guided intra-articular injection were enrolled in the study. The patients were randomly allocated to groups P (platelet rich plasma) and PS (platelet rich plasma and Somatropin). Group P and PS were injected with 5 mL of platelet rich plasma, and 4 IU growth hormone (Somatropin) added to platelet rich plasma, respectively. Intra-articular injection was performed in two steps; the onset of study and one month after. Knee joint function based on Western Ontario and McMaster osteoarthritis index (WOMAC) score at the baseline, 1 and 2 month later, and complications were evaluated.

Results: WOMAC score in both groups has been significantly reduced after injections (P = 0.030). WOMAC score reduction in group PS in first month was significantly higher than group P, but in second month 2, the difference between two groups was not significant (P = 0.235). No complication was observed.

Conclusions: These results showed that adding growth hormone to platelet rich plasma for intra-articular injection improved function of the osteoarthritic knee joint in short period of time.
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http://dx.doi.org/10.5812/aapm.41719DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5560632PMC
December 2016

A Comparative Study on the Efficacy of Oral Memantine and Placebo for Acute Postoperative Pain in Patients Undergoing Dacryocystorhinostomy (DCR).

Anesth Pain Med 2017 Jun 26;7(3):e45297. Epub 2017 Apr 26.

Center for Academic and Health Policy, Tehran University of Medical Sciences, Tehran, Iran.

Background: Memantine is an N-methyl-D-Aspartate (NMDA) antagonist. By transferring acute postoperative pain, the NMDA channels may lead to active excess and neuropathic pain. Objectives: This study attempted to investigate the effect of preoperative use of single oral dose of memantine in controlling Dacryocystorhinostomy (DCR) postoperative pain.

Methods: A double-blind clinical trial was conducted on 60 patients undergoing DCR. On arrival at the operating room, the memantine group received 20 mg of oral memantine and the control group received placebo. The severities of pain by visual analogue scale (VAS) and sedation by Ramsy Scale were measured immediately 1, 2, and 6 hours after the operation. The drug's side effects were recorded.

Results: The pain scores of patients in the recovery in 1, 2, and 6 hours after operation were significantly lower in the memantine group than the placebo group (P < 0.001). The sedation score, 1 hour after the operation, was significantly greater in the memantine group than the placebo (P < 0.001). The sedation scores did not have any statistically significant difference in recovery and 2 hours after surgery between the two groups. Moreover, the sedation scores in 6 hours after the surgery were identical in the two groups.

Conclusions: The oral single-dose 20 mg of memantine administered before DCR can reduce postoperative pain compared with placebo.
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http://dx.doi.org/10.5812/aapm.45297DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5561447PMC
June 2017

Ultrasound-guided fascia iliaca compartment block in orthopedic fractures: Bupivacaine 0.2% or 0.3%?

Med J Islam Repub Iran 2016;30:433. Epub 2016 Oct 24.

Associate Professor of Anesthesiology, Endometriosis and gynecologic disorders Research Center, Iran University of Medical Sciences, Tehran, Iran.

Postoperative pain is one of the major problems in patients with femoral or hip fracture. Current study investigates the effect of 0.2% and 0.3% bupivacaine in ultrasound-guided fascia iliaca compartment block (FICB) on postoperative pain. This randomized clinical trial study was conducted in Rasoul Akram Hospital of Iran University of Medical Sciences. Forty-eight patients with femoral or hip fractures who were candidates for surgery underwent FICB, divided into two groups receiving bupivacaine in 0.2% and 0.3% concentrations. Pain was evaluated with Visual Analog Scale (VAS) at times 2, 6, 12, 24, and 48 hours after surgery. Need for opioids, nausea and vomiting after surgery, patients' satisfaction with pain control and motor block were also recorded. T-test or Mann- Whitney U test and Repeated measure ANOVA was used for analysis. Pain score after surgery was significantly lower in groups receiving 0.3% than the group receiving 0.2% concentration. Patients' satisfaction with pain control in 0.2% group was significantly higher (p=0.04). Time to analgesic onset in both groups had no significant differences (p=0.5). The incidence of nausea and vomiting (p=0.5) and opioid consumption (p=0.1) between the two groups showed no significant difference. In femoral or hip fracture, bupivacaine with 0.3% concentration in fascia iliaca compartment block can cause lower pain score compared to bupivacaine with 0.2% concentration, but patients' satisfaction with pain control and severity of motor block is higher in bupivacaine 0.2%.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5307510PMC
October 2016

Remifentanil versus dexmedtomidine for posterior spinal fusion surgery.

Med J Islam Repub Iran 2015 6;29:215. Epub 2015 Jun 6.

Associate Professor of Anesthesiology, Faculty of Medicine, Ardebil University of Medical Sciences, Ardebil, Iran.

Background: Controlling the hemodynamic situation of patients who have spinal operation is of prime importance, and maintaining the heart rate and blood pressure in normal or low- normal levels in these patients can reduce their bleeding loss. One of the commonly used drugs for this purpose is remifentanil. Another sedative-hypnotic-analgesic drug, with acceptable effects is dexmedetomidine. The aim of this study was to compare the effect of dexmedetomidine with remifentanil in spinal operation.

Methods: In a double blind randomized clinical trial, using random sampling method, 60 patients with the age range of 15-65 years who were candidates for posterior spinal fusion operation were included. Induction of anesthesia was performed, and both groups received isoflurane 1% during the surgery. Remifentanil was injected via infusion pump in one group. The patients in the trial group received dexmedetomidine. As trial outcomes, heart rate and blood pressure were measured before, after induction and during the operation. Pain score, sedation score and the need to analgesic therapy were recorded in the recovery room and the ward. Independent sample t-test and chi-square were used for statistical analysis.

Results: Dexmedetomidine had a significant lowering impact on intraoperative blood pressure and heart rate compared to remifentanil (p<0.001). The mean of sedation scores after extubation in patients who received dexmedetomidine was significantly higher than the sedation scores in patients who received remifentanil (p<0.001). The mean of post-extubation and recovery pain score in patients taking remifentanil was significantly higher than patients taking dexmedetomidine (p<0.05).

Conclusion: Dexmedetomidine in patients with spinal operation is associated with lower postoperative pain score and intraoperative bleeding. Hemodynamic effects are significantly better in patients received dexmedetomidine.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4606949PMC
October 2015

Which one is more efficient on propofol 2% injection pain? Magnesium sulfate or ondansetron: A randomized clinical trial.

Adv Biomed Res 2015 17;4:56. Epub 2015 Feb 17.

Department of Anesthesiology, Iran University of Medical Sciences, Tehran, Iran.

Background: Painful sensation has been reported after propofol injection in most of the patients but no definite mechanism for this painful sensation has been proposed yet. The present randomized clinical trial compares analgesic effect of ondansetron, magnesium sulphate (MS) and placebo on patients after propofol 2% injection.

Materials And Methods: The present randomized clinical trial with parallel design was performed on 90 patients American Society of Anesthesiologists I-II undergoing general anesthesia within vitrectomy operation with propofol induction. Subjects were randomly allocated into three groups with 30 patients each: (1) MS group (2) ondansetron group and (3) normal saline (NS) group as placebo group. Anesthesia induction and maintenance were the same between groups. Pain intensity of propofol injection in subjects was assessed by a four-point scale (none 0, mild 1, moderate 2 and severe 3) at four time intervals (5, 10, 20 and 25 s) after injection.

Results: MS and ondansetron had significant impacts on pain reduction after propofol 2% injection in comparison with NS as placebo. Comparing two trial groups did not have any significant priority for analgesic impact.

Conclusion: Using ondansetron or MS had no priority on each other on declining propofol injection induced pain.
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http://dx.doi.org/10.4103/2277-9175.151593DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4361955PMC
March 2015

Comparison of hydroxyethyl starch 6% and crystalloids for preloading in elective caesarean section under spinal anesthesia.

Med Arch 2014 Aug 31;68(4):279-81. Epub 2014 Jul 31.

Department of Anesthesiology and pain, Rasool Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.

Background: Although controversial, many studies have shown effectiveness of colloid loading as a substitute for crystalloids on reducing the incidence of hypotension in spinal anesthesia. This study was conducted to compare the effects of three intravenous fluid regimens on hemodynamic changes following spinal anesthesia in cesarean section. The regimens included 6% Hydroxyethylstarch 130/0.4 (HES) as a colloid and two crystalloids (lactated ringer's solution and sodium chloride 0.9%).

Material & Method: In a double-blind clinical trial, 90 otherwise healthy parturients candidate of elective caesarean section were randomly allocated to receive lactated ringer's solution (1000 ml), sodium chloride 0.9% (1000 ml) or HES (7.5 mL/Kg) as preloading before spinal anesthesia. Hemodynamic parameters including blood pressure and heart rate, umbilical cord blood pH and the neonatal Apgar score were compared among the three groups.

Results: There was no difference in the basic hemodynamic measurements among the three groups. The incidence of hypotension and required dose of ephedrine was lower in HES group (p=0.008). There was no significant difference in umbilical cord blood PH or Apgar scores among intervention groups.

Conclusion: Preloading with HES is more effective than crystalloids in prevention hypotension after spinal anesthesia without significant difference in Apgar score and umblical cord blood pH.
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http://dx.doi.org/10.5455/medarh.2014.68.279-281DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4240562PMC
August 2014

Investigation the efficacy of intra-articular prolotherapy with erythropoietin and dextrose and intra-articular pulsed radiofrequency on pain level reduction and range of motion improvement in primary osteoarthritis of knee.

J Res Med Sci 2014 Aug;19(8):696-702

Department of Anesthesiology and Pain Medicine, Shahid Rajaee Heart Center, Iran University of Medical Sciences, Tehran, Iran.

Background: Osteoarthritis is one of the most common diseases and the knee is the most commonly affected joint. Intra-articular prolotherapy is being utilized in acute and chronic pain management setting. This study was designed to compare the efficacy of three methods of intra-articular knee joint therapies with erythropoietin, dextrose, and pulsed radiofrequency.

Materials And Methods: After approval by the Ethics Committee and explaining the therapeutic method to volunteers, 70 patients who were suffering from primary knee osteoarthrosis went through one of the treatment methods (erythropoietin, dextrose, and pulsed radiofrequency). The study was double-blind randomized clinical trial performed from December 2012 to July 2013. Patients' pain level was assessed through the visual analog pain scale (VAS), and range of motion (ROM) was measured by goniometric method. Furthermore, patients' satisfaction was assessed before and after different treatment methods in weeks 2, 4, and 12. For analysis, Chi-square, one-way ANOVA, and repeated measured ANOVA were utilized.

Results: The demographic results among the three groups did not indicate any statistical difference. The mean VAS in erythropoietin group in the 2(nd), 4(th), and 12(th) weeks was 3.15 ± 1.08, 3.15 ± 1.08, and 3.5 ± 1.23, respectively (P ≤ 0.005). Knee joint ROM in the erythropoietin group in the 2(nd), 4(th), and 12(th) weeks was 124 ± 1.50, 124 ± 1.4, and 123 ± 1.53 respectively (P ≤ 0.005). Satisfaction score in the 12(th) week in erythropoietin group was extremely satisfied 15%, satisfied 55%, and moderately satisfied 30%, (P = 0.005). No specific side-effects were observed.

Conclusion: Intra-articular prolotherapy with erythropoietin was more effective in terms of pain level reduction and ROM improvement compared with dextrose and pulsed radiofrequency.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4235087PMC
August 2014

Comparing the effect of ketamine and benzydamine gargling with placebo on post-operative sore throat: A randomized controlled trial.

Adv Biomed Res 2014 21;3:216. Epub 2014 Oct 21.

Department of Anaesthesiology, Iran University of Medical Sciences, Tehran, Iran.

Background: Air way intubation for general anesthesia usually leads to sore throat after surgery. Ketamine plays an important role to block a number of receptors related to pain. Benzydamine hydrochloride is a non-steroidal anti-inflammatory drug that has been used to improve oropharyngeal disorders. In this study, it was intended to compare the effect of gargling different solutions before the surgery on post-operative sore throat (POST) in patients who underwent general anesthesia for hysterectomy.

Materials And Methods: A total of 60 patients who underwent the elective hysterectomy were entered to the randomized controlled trial regarding to the eligibility criteria. Patients were simply randomly allocated to three groups and received one code. Every code was representative for a specific drug: 20 cc normal saline (control group) or 1.5 mg benzydamine in 20 cc solution or 20 mg ketamine in 20 cc solutions. All the research teams were blinded to the received solutions. POST was evaluated with numerical rating scale. The data were entered to SPSS software and analysis of variance (ANOVA) and Kruskal-Wallis one-way analysis of variance test, were performed.

Results: The mean ages of ketamine, benzydamine, and normal saline recipients were not significantly different. The trend of the severity of sore throat during the first 24 h after the operation in ketamine recipients was significantly lower than the other two groups (P < 0.001).

Conclusion: The pain scale after surgery was reduced by using both ketamine and benzydamine, but the ketamine effect was more noticeable.
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http://dx.doi.org/10.4103/2277-9175.143292DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4219213PMC
November 2014

Appropriate anesthesia regimen to control sevoflurane-induced emergence agitation in children; propofol-lidocaine and thiopental sodium-lidocaine: a randomized controlled trial.

Iran Red Crescent Med J 2014 Jul 5;16(7):e16388. Epub 2014 Jul 5.

Preventive and Community Medicine specialist, Community Based Participatory Research Center, Iranian Institute for Reduction of High-Risk Behaviors, Tehran University of Medical Sciences, Tehran, IR Iran.

Background: Emergence Agitation (EA) is a common problem in pediatric anesthesia. The current study evaluated the effect of intravenous lidocaine combined with propofol or thiopental sodium to control EA by sevoflurane in children.

Objectives: The current study aimed to compare the effectiveness of two anesthesia regimen propofol-lidocaine and thiopental sodium lidocaine to control sevoflurane-induced emergence agitation in children.

Patients And Methods: The study enrolled 120 children aged 12 to 36 months with retinoblastoma who underwent induction of anesthesia with sevoflurane for Eye Examination Under Anesthesia (EUA). Sampling was done at Rasoul-Akram Hospital in Tehran, Iran. The subjects were randomly assigned into four groups including: group one (thiopental sodium-lidocaine [TL]), group two (thiopental sodium-saline [TS]), group three (propofol-lidocaine [PL]), and group four (propofol-saline [PS]). Emergence agitation was assessed by using a five-point scoring scale, every 10 minutes during the first 30 minutes after admission to the recovery room.

Results: EA occurred in 24 cases (20%) of children. Incidence of EA in the TS, TL, PS, and PL groups were 21 (70%), 2 (6.7%), 1 (3.3%), and 0 (0%), respectively (P < 0.001). Nausea and vomiting after anesthesia did not occur in any of the patients. After removal of the endotracheal tube, laryngospasm complication occurrence in the TS group (10 cases) was higher than the other groups and no statistically significant difference was observed (P = 0.1).

Conclusions: Propofol-lidocaine anesthesia regimen was more effective to control the pediatric emergence agitation than the other combinations.
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http://dx.doi.org/10.5812/ircmj.16388DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4166083PMC
July 2014

Anesthesia for patients with liver disease.

Hepat Mon 2014 Jul 1;14(7):e19881. Epub 2014 Jul 1.

Middle East Liver Disease Center (MELD), Tehran, IR Iran ; Baqiyatallah Research Center for Gastroenterology and Liver Diseases, Baqiyatallah University of Medical Sciences, Tehran, IR Iran.

Context: Liver plays an important role in metabolism and physiological homeostasis in the body. This organ is unique in its structure and physiology. So it is necessary for an anesthesiologist to be familiar with various hepatic pathophysiologic conditions and consequences of liver dysfunction.

Evidence Acquisition: WE SEARCHED MEDLINE (PUB MED, OVID, MD CONSULT), SCOPUS AND THE COCHRANE DATABASE FOR THE FOLLOWING KEYWORDS: liver disease, anesthesia and liver disease, regional anesthesia in liver disease, epidural anesthesia in liver disease and spinal anesthesia in liver disease, for the period of 1966 to 2013.

Results: Although different anesthetic regimens are available in modern anesthesia world, but anesthetizing the patients with liver disease is still really tough. Spinal or epidural anesthetic effects on hepatic blood flow and function is not clearly investigated, considering both the anesthetic drug-induced changes and outcomes. Regional anesthesia might be used in patients with advanced liver disease. In these cases lower drug dosages are used, considering the fact that locally administered drugs have less systemic effects. In case of general anesthesia it seems that using inhalation agents (Isoflurane, Desflurane or Sevoflurane), alone or in combination with small doses of fentanyl can be considered as a reasonable regimen. When administering drugs, anesthetist must realize and consider the substantially changed pharmacokinetics of some other anesthetic drugs.

Conclusions: Despite the fact that anesthesia in chronic liver disease is a scary and pretty challenging condition for every anesthesiologist, this hazard could be diminished by meticulous attention on optimizing the patient's condition preoperatively and choosing appropriate anesthetic regimen and drugs in this setting. Although there are paucity of statistics and investigations in this specific group of patients but these little data show that with careful monitoring and considering the above mentioned rules a safe anesthesia could be achievable in these patients.
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http://dx.doi.org/10.5812/hepatmon.19881DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4080095PMC
July 2014

Effect of intravenous methylprednisolone on pain after intertrochanteric femoral fracture surgery.

J Clin Diagn Res 2014 Apr 15;8(4):GC01-4. Epub 2014 Apr 15.

Assistant Professor, Preventive and Community Medicine Specialist, Community Based Participatory Research Center, Iranian Institute for Reduction of High-Risk Behaviors , Tehran University of Medical Sciences, Tehran, Iran .

Background: Pain after surgery is one of the major problems in patients with intertrochanteric fracture. This study investigates administration of single-dose Methylprednisolone prior to surgery with the goal of reducing Post-operative pain.

Materials And Methods: The study was a Double Blind Randomized Clinical Trial. Eighty two patients with stable intertrochanteric unilateral fracture were selected and divided into two groups: one received Methylprednisolone (MP) 125 mg and the other received placebo. Pain was evaluated at rest and 45° flexion of the hip in times 4, 6, 8, 12, 24, 36, and 48 hours and during walking in times 24, 36, and 48 hours after the surgery. Post-operative nausea, vomiting and fatigue and changes in C - reactive protein (CRP) levels before and after the surgery were also recorded.

Results: Pain at rest, 45° flexion of the hip and during walking after the surgery was significantly lower in the MP group compared to the control group (p < 0.001). Fatigue (p = 0.002) and changes in CRP (p=0.001) were significantly lower in MP group. Incidence of nausea, vomiting (p = 0.37) and opioid consumption (p = 0.49) were not significantly different between the two groups.

Conclusion: Single-dose methylprednisolone 125 mg (IV) can reduce Post-operative pain in patients with intertrochanteric fracture undergoing elective surgery.
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http://dx.doi.org/10.7860/JCDR/2014/8232.4305DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4064860PMC
April 2014

Comparing GlideScope Video Laryngoscope and Macintosh Laryngoscope Regarding Hemodynamic Responses During Orotracheal Intubation: A Randomized Controlled Trial.

Iran Red Crescent Med J 2014 Apr 5;16(4):e12334. Epub 2014 Apr 5.

Department of Anaesthesiology, Rasoul-Akram Medical Center, Iran University of Medical Sciences, Tehran, IR Iran.

Background: To determine if the GlideScope® videolaryngoscope (GVL) could attenuate the hemodynamic responses to orotracheal intubation compared with conventional Macintosh laryngoscope.

Objectives: The aim of this relatively large randomized trial was to compare the hemodynamic stress responses during laryngoscopy and tracheal intubation using GVL versus MCL amongst healthy adult individuals receiving general anesthesia for elective surgeries.

Patients And Methods: Ninety five healthy adult patients with American Society of Anesthesiologists physical status class I or II that were scheduled for elective surgery under general anesthesia were randomly allocated to either Macintosh or GlideScope arms. All patients received a standardized protocol of general anesthesia. Hemodynamic changes associated with intubation were recorded before and at 1, 3 and 5 minutes after the intubation. The time taken to perform endotracheal intubation was also noted in both groups.

Results: Immediately before laryngoscopy (pre-laryngoscopy), the values of all hemodynamic variables did not differ significantly between the two groups (All P values > 0.05). Blood pressures and HR values changed significantly over time within the groups. Time to intubation was significantly longer in the GlideScope (15.9 ± 6.7 seconds) than in the Macintosh group (7.8 ± 3.7 sec) (P< 0.001). However, there were no significant differences between the two groups in hemodynamic responses at all time points.

Conclusions: The longer intubation time using GVL suggests that the benefit of GVL could become apparent if the time taken for orotracheal intubation could be decreased in GlideScope group.
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http://dx.doi.org/10.5812/ircmj.12334DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4028761PMC
April 2014

Analgesic effects of adding lidocaine to morphine pumps after orthopedic surgeries.

J Res Med Sci 2014 Feb;19(2):122-7

College of Literature, Science and the Arts, University of Michigan, Ann Arbor, USA.

Background: Opiate is used in patient-controlled intravenous analgesia pumps (PCIA) for controlling pain in post-surgical patients. Other drugs are remarkably added to opioid pumps to enhance quality, lengthen analgesia, and reduce side effects. Lidocaine, a local anesthetic which inhibits sodium channels, has anesthetic and analgesic effects when injected locally or intravenously. The objective of this study is to evaluate the analgesic effects of adding lidocaine 1% to different doses of morphine via IV pump to patient-controlled analgesia (PCA) after orthopedic surgeries.

Materials And Methods: In a randomized clinical trial, 60 patients who had undergone orthopedic surgery of lower extremities were divided into three equal groups to control postoperative pain. Intravenous pump with 5 ml/h flow rate was used as the analgesic method. The solution consisted of lidocaine 1% plus 20 mg morphine for the first group, lidocaine 1% plus 10 mg morphine for the second group, and only 20 mg morphine for the third group (control group). Patients were checked every 12 h, and Visual Analog Scale (VAS), extra opioid doses, nausea/vomiting, and sedation scale were examined.

Results: Pain score was lower in the first group compared to the other two groups. Mean VAS was 2.15 ± 0.2, 2.75 ± 0.2, and 2 ± 0.25 on the first day and 1.88 ± 0.1, 2.74 ± 0.3, and 2.40 ± 0.3 on the second day, respectively, in the three groups and the difference was statistically significant (P < 0.01 and <0.05, respectively). Also, 10% of patients in the first group needed extra opioid doses, while this figure was 30% in the second group and 25% in the third group (P < 0.01). Nausea/vomiting and sedation scores were not statistically different among the three groups.

Conclusion: Compared to lidocaine 1% plus 10 mg morphine or 20 mg morphine alone in PCIA, adding lidocaine 1% to 20 mg morphine decreases the pain score and opioid dose after orthopedic surgeries without having side effects.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3999597PMC
February 2014