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Background Data regarding the analgesic effects of melatonin after the surgery is scare. So far, only one study has investigated the analgesic effect of melatonin during cesarean section. Objective : The present study was performed to investigate the effect of preoperative oral melatonin on pain intensity after cesarean section during spinal anesthesia. Methods In a double-blind randomized controlled clinical trial study, 204 patients undergoing elective cesarean section with class 1 and 2 anesthesia (ASA) were enrolled. Patients were randomly divided into 3 groups of 68 patients. Patients in group A were given 5 mg melatonin tablets, patients in group B were given 10 mg melatonin tablets, and group C was given placebo. All patients underwent spinal anesthesia with the same anesthesia protocol. Pain intensity, nausea, vomiting, pruritus and headache were assessed and recorded 2, 6, 12 and 24 h after surgery. The time of first dose of analgesia, the amount of opioid consumed within 24 h, and the time to resume physical activity was also recorded. Statistical analysis of data was performed using SPSS 20 software. Results Repeated measurements of pain intensity during the study showed that in all 3 groups pain intensity was significantly reduced during the study, p < 0.001, respectively. The intensity of pain was significantly different in groups B and C, groups B and A and groups A and C, P < 0.001, respectively. The pain reduction was greatest in group B, followed by group A and group C, respectively. The time interval between the end of surgery and the patient's need for analgesia was significant in group B compared to group A (P = 0.035) and C (P < 0.001) and also in group A compared to group C (P = 0.011). The mean dose of opioid was significantly least in group B, p < 0.001. The mean time to resume physical activity was also shortest in group B, p < 0.001 Headache and nausea/vomiting were observed in 7 patients (10.7%) group A and 7 patients (10.7%) in group C. None of the patients in group B developed complications. Conclusion The results of the present study showed that the use of 10 mg of melatonin before cesarean section with spinal anesthesia is not only safe, but also reduces the severity of patients' pain, increases the duration of postoperative analgesia, reduces the need for analgesics after surgery and resumption of physical activity.

Background Lumbar discectomy is one of the most common surgical procedures performed to manage pain caused by the protrusion of an intervertebral disc. Postoperative pain management can be challenging and might lead to increased intake of opioids. Objective : The aim of this study was to determine the effect of preoperative sublingual buprenorphine on severity of pain after lumbar disc surgery and postoperative intake of morphine. Methods This Randomized clinical trial study was performed on 78 patients who were selected for lumbar discectomy surgery. Patients were randomly divided into two groups of 39 patients, each. Patients in the buprenorphine and placebo group received 2 mg buprenorphine sublingual, and placebo 1 h before surgery. Severity of pain, nausea, vomiting and pruritus and intake of opioids in the two groups were evaluated and recorded 1, 6, 12 and 24 h after surgery. Data were analyzed using SPSSv21. Results There was a significant difference in pain score in buprenorphine group at 1, 6, 12, and compared with placebo (P < 0.005). In the control group, the use of analgesics was more than the buprenorphine group. In the first hours after surgery (1–6 h), the incidence of nausea in the buprenorphine group was significantly lower than of the control group (P < 0.05). However, at 12 and 24 h, this difference was not observed, p > 0.05. There was no significant difference in incidence of side effects (nausea, vomiting, pruritus) in the two groups (P > 0.05). Conclusion Sublingual buprenorphine in postoperative pain management is an effective and low dose drug. Due to its simpler administration, it is recommended to relief postoperative pain after lumbar disc surgery.

Objective: During an elective cesarean section, the choice of method of anesthesia is critical for maternal and fetal outcomes. However, the anesthesiologist’s decision is dependent on the patient’s desire. This study aimed to determine the choice of general and spinal anesthesia among women undergoing elective cesarean sections and the factors affecting their choice. Methods: In this descriptive study, pregnant women who had the ability to undergo both spinal and general anesthesia were referred to public and private hospitals in (Sari Imam Khomeini Hospital, Mazandaran University of Medical Sciences). A questionnaire recorded the patient’s demographic data, education and occupation, history of anesthesia, choice of anesthetic method, and reason for selection. Results: A total of 384 women were included in the study, of whom 60% selected general anesthesia and 40% selected spinal anesthesia. Among the reasons for not choosing spinal anesthesia, most common were fear of injury to the spinal cord (64.3%) and fear of seeing and hearing during the surgery (53.3%), and among the reasons for not choosing general anesthesia, most common were fear of not waking (54.3%) and a desire to be alert at the time of infant birth (40.7%). Most of the women with a history of spinal anesthesia selected spinal anesthesia (53%), and 62% of those without a history of spinal anesthesia selected general anesthesia. Factors such as age, nonmedical staff advice, and being employed were significantly correlated with the choice of anesthesia (P<0.005). Conclusion: The rate of general anesthesia selection was higher than spinal anesthesia. More attention and efforts are required to educate patients regarding the method of anesthesia prior to the surgery.

Objective Admission to the intensive care unit is a forecaster of mortality and disability. The sequential organ failure assessment is used to predict patients’ outcomes and mortality in these cases. The aim of this study is to examine the relationship between patients’ mortality and standardized SOFA & modified SOFA scores among patients in the ICU. Methods This is a prospective descriptive study (cohort) that was conducted on patients with trauma in ICU. The patients were evaluated using SOFA standard and modified scoring systems. The obtained data were analyzed using SPSS version 22 software. Results Of 44 patients who completed the study, the mean age of patients was 36.84 ± 14.23, which was 16% female and 84%, male. The average age of women was 32.28 and the mean age of men was 37.70. The average SOFA score was 8 among patients who died whereas, modified SOFA was 6. In patients who were rescued, on the first day, the mean SOFA score was 1.95 and modified SOFA score was 1.51. The results showed that the average scoring of modified SOFA was lower than the average scoring of standard SOFA (P = 0.001) Conclusion Modified SOFA may be effective in predicting mortality similar to SOFA among the patients however, further studies are required in this domain. Highlights