The Effect of Clonidine Premedication on Hemodynamic Changes Following Tracheal Intubation and Co2 Gas Insufflation and Postoperative Shivering In Patients Undergoing Laparoscopic Cholecystectomy; a Randomized Clinical Trial

BACKGROUND

Laparoscopic cholecystectomy is a proper treatment for cholecystitis but the Carbon dioxide gas which is used in surgery stimulates the sympathetic system and causes hemodynamic changes and postoperative shivering in patients undergoing operations. This study was conducted to evaluate the effects of clonidine on reducing hemodynamic changes during tracheal intubation and Carbon dioxide gas insufflation and postoperative shivering in patients undergoing laparoscopic cholecystectomy.

MATERIAL AND METHODS

This prospective, randomized, triple-blind clinical trial was conducted on 60 patients between the 18-70 years-old age group, who were candidates of laparoscopic cholecystectomy surgery. The patients randomized into two groups (30 patients received 150 μg oral clonidine) and 30 patients received 100 mg oral Vitamin C). Heart rate and mean arterial pressure of patients were recorded before anesthesia, before and after laryngoscopy, before and after Carbon dioxide gas insufflation. Data were analyzed using Chi-2, student t-test, and analysis of variance by repeated measure considering at a significant level less than 0.05.

RESULTS

The findings of this study showed that both heart rate and mean arterial pressure in clonidine group after tracheal intubation and Carbon dioxide gas insufflation were lower than patients in the placebo group, but there was not any statistically significant difference between the two groups (p>0.05) and also postoperative shivering was not different in groups. There was no significant statistical difference in postoperative shivering between the two groups (p>0.05).

CONCLUSION

Using 150 μg oral clonidine as a cheap and affordable premedication in patients undergoing laparoscopic cholecystectomy improves hemodynamic stability during operation.

The Effect of Granisetron, Ondansetron, and Meperidine in Preventing Postoperative Shivering: Controlled Clinical Trial

BACKGROUND

Recently, use of HT35 receptor antagonists to prevent postoperative shivering has attracted a great deal of attention. This study was conducted with the aim of investigating the effectiveness of granisetron as an HT35 antagonist when compared with ondansetron and meperidine in preventing postoperative shivering.

MATERIAL AND METHODS

In this triple blind random clinical trial study, 90 patients 18-50 years of age with ASA Class I and II undergoing general anesthesia were randomly assigned into one of the three drug groups: O (4-mg ondansetron), G (40 μg/kg of granisetron), and P (25 mg meperidine), immediately before induction of anesthesia. After anesthesia induction, at the end of the surgery, after the entrance and after leaving the recovery state, central temperature, peripheral temperature, heart rate, systolic blood pressure, diastolic blood pressure, and shivering were measured and documented. Two-tailed P < 0.05 was considered significant.

RESULTS

In the meperidine, ondansetron, and granisetron groups, 4 (13.3%), 3 (10%), and 10 (33.3%) of patients experienced shivering during recovery, where the difference between the ondansetron and granisetron groups was significant (p-value=0.02). The variations in the mean arterial pressure during the investigation stages only in the ondansetron group were not significant (p>0.05). At the beginning of recovery, the reduction of peripheral temperature significantly was lower in the ondansetron group (p<0.05), while reduction of the central temperature was significantly (p<0.05) higher in the granisetron group. By the end of the recovery, the variations in the peripheral temperature across the three groups were consistent with the changes at the beginning of recovery, but variations of the central temperature across the three groups was not significantly diverse.

CONCLUSION

Granisetron was not found to be much effective in preventing postoperative shivering. Ondansetron and meperidine were equally effective in preventing postoperative shivering. Ondansetron also causes less hemodynamic changes compared to other drugs, while granisetron is more effective in terms of preventing nausea and vomiting.

Examining the efficacy of intravenous ibuprofen and meperidine for preventing post-operative shivering after laparoscopic cholecystectomy with general anesthesia

Postoperative shivering is a common complication that can lead to increased postoperative complications. This study aimed to compare the effectiveness of intravenous ibuprofen and meperidine in preventing shivering following laparoscopic cholecystectomy. A total of 120 patients, aged 20-70 and classified as ASA I-II, were enrolled in this triple-blind clinical trial. The participants were randomly assigned to one of three groups: ibuprofen (800mg IV), meperidine (30 mg), or placebo (normal saline 2 ml), administered 30 minutes before the end of surgery. The occurrence of postoperative shivering was assessed and recorded at regular intervals (0, 5, 10, 15, 30, and 60 minutes after surgery). Additionally, postoperative pain levels were measured using a visual analog scale (VAS), sedation levels were evaluated using the Ramsay Sedation Scale (RSS), and the incidence of postoperative nausea and vomiting was documented. The prevalence and severity of postoperative shivering were not statistically significant between groups. The VAS was significantly lower in the meperidine group than the ibuprofen group throughout the study (p <0.001). The VAS was significantly lower in the ibuprofen group than the placebo group at 0 and 15 minutes after surgery. Although the incidence of nausea was slightly higher in the meperidine group, the difference was not statistically significant (p=0.75). Sedation scores were consistently lower in the ibuprofen group and higher in the meperidine group compared to the other groups (p<0.0001) The meperidine group had a significantly higher sedation score indicative of deep sleepiness (score of 4) than the other groups. Intravenous ibuprofen demonstrated comparable efficacy to meperidine in controlling shivering. Additionally, the incidence of nausea, vomiting, and sleepiness was lower in the intravenous ibuprofen group, suggesting it is a potential alternative to meperidine.

The Effect of Nicotine Patch on Reducing Nausea, Vomiting, and Pain Following Laparoscopic Cholecystectomy: A Randomized Clinical Trial

BACKGROUND

The effect of nicotine on nausea, vomiting, and postoperative pain has been investigated in studies on animals and humans. This study aimed to evaluate the effect of nicotine patch on decreasing nausea, vomiting, and pain in laparoscopic cholecystectomy.

METHODS

The study sample consisted of 100 non-smoking patients undergoing laparoscopic cholecystectomy under general anesthesia in a triple-blind clinical trial. One hour after the start of surgery, patients were randomly assigned to receive 17.5-mg nicotine or placebo patches. The patches located on the right arm were left for 24 hours. The visual analogue scale (VAS) for pain and N/V score for the severity of nausea and vomiting were measured at intervals of 0, 6, 12, and 24 hours.

FINDINGS

The results showed there was no statistically significant difference between the groups in terms of pain intensity as well as nausea and vomiting at different time periods after surgery (P>0.05). A total of 36 patients in the nicotine group and 24 patients in the placebo group received meperidine. There was also no statistically significant difference between the two groups in terms of analgesics (P=0.096) and antiemetics (P=0.1). Moreover, the frequency of severe nausea and vomiting during the study in the nicotine group was higher than in the placebo group (4 vs. 1) but this difference was not statistically significant (P>0.05).

CONCLUSION

Receiving a 17.5-mg nicotine patch had a similar effect to receiving placebo in controlling postoperative pain, nausea, and vomiting in non-smokers. Nicotine use had no effect on reducing analgesia.

Evaluation the effects of adding ketamine to morphine in intravenous patient-controlled analgesia after orthopedic surgery

Background:

Intravenous patient-controlled analgesia (PCA) with morphine is commonly used for post-operative pain after major surgery. Ketamine has analgesic property at lower doses, and in combination with opioids it could have synergistic effect. The aim of this study is to determine effects of the addition of ketamine to morphine for PCA after orthopedic surgery.

Materials and Methods:

In this double-blind randomized clinical trial, 60 patients were randomly allocated to receive PCA consisting: Group 1 (morphine 0.2 mg/ml), Group 2 (morphine 0.2 mg/ml + ketamine 1 mg/ml), and Group 3 (morphine 0.1 mg/ml + ketamine 2 mg/ml). In this, anesthesiologists managed study, patients had orthopedic surgery. Assessments were made at 24 h and 48 h post-operatively. Visual analog scale (VAS) was used for recording pain score. PCA morphine use was recorded at 24 h and 48 h. VAS scores over 48 h were analyzed with analysis of variance for repeated measures. Significance level was taken as 0.05.

Results:

There is no significant difference between demographic information of the three groups (P > 0.05). Control of pain in Group 2 and Group 3 was better than in Group 1 (only morphine) (P = 0.001) but there was no significant difference between Group 2 and Group 3 (P > 0.05). Rate of narcotic consumption in groups 2 and 3 was significantly lower than Group 1 (P < 0.05).

Conclusion:

After orthopedic surgery, the addition of ketamine to morphine for intravenous PCA was superior to Intravenous PCA opioid alone. The combination induces a significant reduction in pain score and cumulative morphine consumption.

The effects of oral pregabalin on post-operative pain of lower limb orthopedic surgery: A double-blind, placebo-controlled trial

Background:

Post-operative pain is one of the problems, wherein lack of control on it has many side-effects such as tachycardia, hypertension, myocardial ischemia, decreased alveolar ventilation, and poor wound healing.

Aims:

In this study, we evaluated the pre-operative administration of pregabalin sufficiency and security in relieving post-operative pain after lower limb orthopedic surgery and reducing the need for opioids and their possible side-effects.

Materials and Methods:

This study is a randomized, double-blind clinical trial. It was performed on 60 patients under lower limb surgery by spinal anesthesia. Patients were randomly allocated to two groups, one group has received a 150 mg pregabalin capsule 2 h before surgery and the other group has received placebo as a control. In both groups at 2, 6, 12, and 24 h after surgery, the patients were evaluated and the pain score, the score of sedation, incidence of nausea and vomiting was recorded in the checklists. Then, the data were analyzed by SPSS v16.

Results:

Visual analog pain scores at all hours in pregabalin group significantly reduced compared to the placebo group (P < 0.0001). Also, in the pregabalin group nausea and vomiting scores at all hours, sedation levels at 2 h and 6 h post-operatively, and pethidine consumption in all hours have significantly been reduced.

Conclusion:

A single pre-operative oral dose of pregabalin 150 mg is an effective method for reducing post-operative pain and pethidine consumption in patients undergoing orthopedic surgery.

Comparison of the effects of remifentanil and alfentanil on intraocular pressure in cataract surgery

Background:

Anesthesia for ophthalmic surgery requires management of intraocular pressure (IOP) during perioperative period. In an open eye, in conditions such as after traumatic injury or during cataract surgery, IOP increase can lead to permanent vision loss. Administration of narcotics concomitant with anesthetics has the ability to reduce this increase of IOP. This clinical trial aims to compare the efficacy of remifentanil and alfentanil in preventing an increase in IOP after administration of succinylcholine, intubation and during anesthesia.

Methods:

This double-blind clinical trial was conducted on 50 patients undergoing elective general surgery for cataracts. Patients were randomly divided into two groups. Alfentanil (20 μg/kg in 30 s) for group 1 and remifentanil (1 μg/kg in 30 s) for group 2 were injected before induction of anesthesia, and 0.5 μg/kg/min alfentanil for group 1 and 0.1 μg/kg/min remifentanil for group 2 were infused during the anesthesia. Systolic and diastolic blood pressure, heart rate, and IOP from normal eye were measured before the induction, after administration of thiopental and succinylcholine, after tracheal intubation, and 2 min later, and were repeated in 2-min intervals until the end of operation.

Results:

IOP decreased after injection of anesthetics and remained lower all through the operation in both groups, but IOP decreased after injection of succinylcholine in remifentanil group while it increased in alfentanil group (P<0.05).

Conclusions:

Results of this study indicate benefits of both remifentanil and alfentanil in managing IOP after induction and during anesthesia. It seems that remifentanil is better than alfentanil in controlling the IOP after injection of succinylcholine.

The effects of indomethacin, diclofenac, and acetaminophen suppository on pain and opioids consumption after cesarean section

BACKGROUND

Cesarean section is one of the common surgeries of women. Acute post-operative pain is one of the recognized post-operative complications.

AIMS

This study was planned to compare the effects of suppositories, indomethacin, diclofenac and acetaminophen, on post-operative pain and opioid usage after cesarean section.

MATERIALS AND METHODS

In this double-blind clinical trial study, 120 candidates of cesarean with spinal anesthesia and American Society of Anesthesiologists (ASA) I-II were randomly divided into four groups. Acetaminophen, indomethacin, diclofenac, and placebo suppositories were used in groups, respectively, after operation and the dosage was repeated every 6 h and pain score and opioid usage were compared 24 h after the surgery. The severity of pain was recorded on the basis of Visual Analog Scale (VAS) and if severe pain (VAS > 5) was observed, 0.5 mg/kg intramuscular pethidine had been used.

STATISTICAL ANALYSIS USED

The data were analyzed in SPSS software version 15 and analytical statistics such as ANOVA, Chi-square, and Tukey's honestly significant difference (HSD) post-hoc.

RESULTS

Pain score was significantly higher in control group than other groups, and also pain score in acetaminophen group was higher than indomethacin and diclofenac. The three intervention groups received the first dose of pethidine far more than control group and the distance for diclofenac and indomethacin were significantly longer (P < 0.001). The use of indomethacin, diclofenac, and acetaminophen significantly reduces the amount of pethidine usage in 24 h after the surgery relation to control group.

CONCLUSIONS

Considering the significant decreasing pain score and opioid usage especially in indomethacin and diclofenac groups rather than control group, it is suggested using of indomethacin and diclofenac suppositories for post-cesarean section analgesia.

Dexamethasone for prevention of postoperative shivering: a randomized double-blind comparison with pethidine

BACKGROUND

Postoperative shivering is very common and followed by many problems such as increasing oxygen consumption, blood pressure, intracranial and intraocular pressure, and postoperative pain. Therefore, prevention of shivering is important, especially in elderly and ischemic heart disease patients. The goal of this study was to compare the effect of pethidine (meperidine), dexamethasone, and placebo on prevention of shivering.

METHODS

This double-blind clinical trial study was carried out on 120 patients who were candidates for surgery under general anesthesia. The patients were randomly divided into three groups. Induction and maintenance of anesthesia for all patients were similar. Temperature of patients was measured every 5 min interval. After induction, saline 0.9%, dexamethasone and pethidine were injected to groups a, b, and c, respectively. In recovery, patients were controlled for visible shivering. All data were statistically analyzed by analysis of variance (ANOVA) and Chi-square tests.

RESULTS

There were no significant differences among three mentioned groups regarding gender, age, duration of surgery and anesthesia, extubation time, duration of recovery, and basic clinical characteristics. Nineteen cases (47.5%) of placebo group had postoperative shivering, whereas in dexamethasone group only four cases (10%) had shivering and the difference between the two groups was significant. Also in pethidine group, 15 cases (37.5%) had shivering and the difference with placebo group was significant (P value = 0.001).

CONCLUSION

The present study showed that pethidine and dexamethasone are effective drugs for prevention of postoperative shivering in elective surgery and the effect of dexamethasone in preventing the postoperative shivering is better than pethidine.

The comparison of Alfentanil and Remifentanil infusion during anesthesia on post-anesthesia recovery

Background and Objective:

With consideration the daily increased development of outpatient surgeries and high rate of these surgeries in elderly patients, rapid and safe recovery of patients is necessary. In this clinical trial study, recovery time and nausea and vomiting after the use of two rapid-onset narcotics, Alfentanil and Remifentanil, in elderly patients were evaluated.

Methods:

In this double-blind prospective clinical trial, 40 elderly patients (age above 65 years) candidate to cataract surgery with general anesthesia were studied. The patients were divided randomly into two groups and for first group, 10 μg/kg of Alfentanil was injected and for second group Remifentanil 0.5 μg/kg was injected intravenously during 30 seconds one minute before induction. Both two groups were under general anesthesia with same method and during the anesthesia, first group took infusion of Alfentanil 1 μg/kg/min and second group took Remifentanil 0.1 μg/kg/min. In the end of surgery, the time intervals between end of anesthesia drug administration and spontaneous respiration, eyes opening with stimulation, verbal response and discharge of recovery room, also the incidence of complications related to narcotic drugs, especially nausea and vomiting, was recorded. The data were analyzed in SPSS software using descriptive and analytical statistics such as T-test and chi square test.

Results:

The time of spontaneous respiration in Alfentanil group was 2 minutes and in Remifentanil group was 3.3 minutes, the difference was not statistically significant (P=0.08). The time of eyes opening with stimulation, verbal response, and discharge of recovery room were not significantly different. During recovery, incidence of nausea and vomiting in Remifentanil group (30% of patients) was significantly more than Alfentanil group (5% of patients) (P=0.045).

Conclusions:

Recovery time between Alfentanil and Remifentanil group was not significantly different, but incidence of nausea and vomiting in Remifentanil group was higher than Alfentanil group significantly. It seems that using Alfentanil in the anesthesia for surgical treatment of the elderly people can be preferred.

The effect of ketamine on posttonsillectomy pain in children: a clinical trial

INTRODUCTION

Tonsillectomy is one of the most common surgical operations and has such complications as pain, hemorrhage and laryngospasm. Pain management is of vital importance in order to reduce the suffering and restlessness in children having undergone tonsillectomy. Different studies differ in their findings as to the use of ketamine for postoperative analgesia. The aim of this study was to investigate the effect of peritonsillar injection of ketamine preoperatively on postoperative pain relief.

MATERIALS AND METHODS

This was a randomized controlled trial (RCT) on sixty 3-12-year-old children. Children were randomly assigned to the intervention and control groups. Peritonsillar injection consisted of 1 mg/kg ketamine in the intervention group and of normal saline in the control group. An injection of 1 cc was administered on each side five minutes prior to tonsillectomy. Pain assessment was performed using the self-report Oucher Scale and CHEOPS (Children's Hospital of Eastern Ontario Pain Scale) and sedative state assessment was performed using the Wilson Sedation Scale. Pain, medication and complications were studied for 24 hours. Data analysis was performed using chi-squared test and t-test.

RESULTS

The ketamine group had a lower pain score compared with the control group (1.40±1.003 compared with 1.53±1.074). The average pain was less in the control group two hours after the surgery. The difference was statistically significant. There was no difference between the two groups in terms of nausea and vomiting incidence.

CONCLUSION

The peritonsillar injection of ketamine five minutes prior to the surgery reduces the post-tonsillectomy pain without causing any complications.

Efficacy of metoclopramide and dexamethasone for postoperative nausea and vomiting: a double-blind clinical trial

Postoperative nausea and vomiting are common complications of anaestnesia. This double-blind clinical trial assessed the incidence of nausea and vomiting after cataract surgery with intravenous anaesthesia in 100 patients randomly assigned to preinduction placebo (saline), metoclopramide (10 mg), dexamethasone (8 mg) or the 2 drugs combined. The incidence of nausea in the recovery room was 44% with placebo, 20% with metoclopramide, 16% with dexamethasone and 8% with the combination. The incidence of vomiting was 20%, 4%, 4% and 0% respectively in the 4 groups. Metoclopramide plus dexamethasone combination significantly decreased nausea and vomiting both in the recovery room and 24 hours afterwards and is recommended for high-risk groups, especially in outpatient surgeries.

Prevalence of gastrointestinal symptoms and signs in northwestern Tabriz, Iran

OBJECTIVE

To determine the prevalence of gastrointestinal (GI) signs and symptoms in the general population in the northwestern area of Tabriz, Iran.

METHODS

During May 2000, 4225 subjects were randomly chosen from a general population of approximately 230,000 individuals, and invited to a questionnaire interview and a clinical examination.

RESULTS

Of the subjects invited, 3983 (94.2%) participated in the study. Among them, 569 (14.3%) reported one or more GI symptoms in the last 2 weeks, and 96 (2.4%) had GI signs. Abdominal pain (5.1%), constipation (3.6%), heartburn (3.0%), dyspepsia (2.9%), a mass prolapsing from the anus (2.1%), bloating (1.5%), and hematochezia (l%) were the most common GI symptoms. Abdominal tenderness on deep palpation was the commonest clinical sign (1.2%).

CONCLUSION

The prevalence of GI symptoms in the population studied was lower than that reported from other populations.