Background:Tonsillectomy is one of the most common surgeries in children and posttonsillectomy pain and agitation management is a great challenge for anesthesiologists.Objectives:The aim of this study was to compare the efficacy of a single dose of ketamine combined with paracetamol with paracetamol alone in the management of postoperative pain in tonsillectomy.Materials and Methods:In this study, the subjects were randomly allocated into the two groups: the ketamine and control. Intravenous paracetamol infusion (15 mg/kg) was started 15 minutes before the end of surgery in both groups, continued with the IV injection of ketamine (0.25 mg/kg) in the ketamine group and an equal volume of saline in the control group. Using the children’s hospital of eastern Ontario (CHEOPS) pain scale, pain and agitation score and also the incidence of nausea and vomiting after the surgery were recorded in 0.5, 6 and 12 hours after the operation. Data were analyzed using SPSS software version 16 and P value less than 0.05 was considered as statistically significant in all cases.Results:There was no significant difference between the two groups considering demographic data (age, sex distribution, weight and height). The CHEOPS pain scales were significantly lower in the ketamine group compared to the control group at 0.5 and 6 hours after the surgery (P = 0.003 and P = 0.023, respectively). There was no significant difference in the CHEOPS scale at 12 hours after the surgery, dose of adjuvant analgesic and the incidence of nausea and vomiting after the surgery between the two groups.Conclusions:According to the results of the current study, postoperative analgesia in children was improved in the ketamine group. Therefore, for better management of posttonsillectomy pain, low-dose ketamine administration with paracetamol is recommended.

PURPOSE:To evaluate the effect of nitroglycerine (NTG) on sensory and motor block onset and recovery time as well as the quality of tourniquet pain relief, when added to lidocaine (LID) for intravenous regional anesthesia in elective forearm and hand surgery. METHODS:A randomized double-blinded clinical trial was performed on 40 patients that were randomly allocated into two groups received lidocaine 3 mg/kg with NTG 200 µg or received only lidocaine 3 mg/kg as the control. RESULTS:There was no difference between the two study groups in hemodynamic parameters before tourniquet inflation, at any time after inflation and after its deflation. There was no difference in the mean of pain score over time between the two groups. The onset time of sensory and motor blockades was shorter in the group received both LID and NTG. The mean recovery time of sensory blockade was longer in the former group. The frequency of opioid injections was significantly lower in those who administered LID and NTG. CONCLUSION:The adjuvant drug of NTG when added to LID is effective in improving the overall quality of anesthesia, shortening onset time of both sensory and motor blockades, and stabling homodynamic parameters in hand and forearm surgery.

Sudden cardiac arrest following spinal anesthesia is a relatively common and often fatal complication. Careful patient selection, appropriate dosing of the local anesthetic, volume loading, close monitoring and prompt intervention at the first sign of cardiovascular instability should improve outcomes.

Objectives: Relieving a very painful procedure such as impacted lower third molar surgery by combining analgesics into a single product using their synergistic effects is favorable. We designed a prospective, randomized, double-blind clinical trial to study the beneficial effect of the combination of acetaminophen, ibuprofen, and caffeine on reducing the severity of postoperative pain after impacted lower third molars surgery. Methods:This was a double-blinded clinical trial on 108 patients scheduled for impacted third molar surgery. The patients were randomly assigned into 2 groups. Two hours before the procedure the intervention group received combination therapy of acetaminophen (600 mg), ibuprofen (400 mg), and caffeine (15 mg) as pre-emptive analgesia, and the control group received placebo. All patients received gelofen capsules (400 mg) uniformly after the intervention as PRN. Postoperative assessment of pain severity [using a 10-point visual analog scale (VAS)] and analgesic consumption was performed at 2, 4, 6, and 8 hours after the operation. All statistical analyses were performed using SPSS software (version 19.0, SPSS Inc., Chicago, Illinois), with chi-square test or Fisher's and Mann-Whitney U test. Results:The severity of preoperative pain did not differ before receiving the first dose of study drugs. However, at any time points after the surgery, the mean pain score was significantly lower in the group who received combination regimen than the control group (P < 0.001). In a general linear model, using a repeated-measures analysis, concerning the analgesic dose administered after the surgery, the mean number of doses in 8 hours was 0.96 for the combination therapy group and 1.8 for the control group, with a significant difference (P = 0.022). Conclusions:The pre-emptive combination therapy including acetaminophen, ibuprofen, and caffeine can be used efficiently to control postoperative pain after impacted third molar surgery.

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