Abstract:Background:Anterior Cruciate Ligament (ACL) tearing is a common injury among football players. The present study aims to determine the best single-dose of intra-articular morphine for pain relief after arthroscopic knee surgery that, in addition to adequate and long-term analgesia, leads to fewer systemic side effects. Methods:This clinical trial was conducted on 40 ASA-I athletes. After surgery, all participants received an injection of 20cc of 0.5% intra-articular bupivacaine. In addition, the first control group received a saline injection and 5, 10 and 15 mg of morphine were respectively injected into the joints of the second, third and fourth groups by use of Arthroscopic equipment before the Arthroscopic removal. The amount of pain based on VAS at 1, 2, 4, 6 and 24 hours after surgery, duration of analgesia and the consumption of narcotic drugs were recorded. Results:The VAS scores in the fourth, sixth and twenty-fourth hours after surgery showed a significant difference between the study groups. The average time to the first analgesic request from the bupivacaine plus 15 mg morphine group was significantly longer than other groups and total analgesic requests were significantly lower than other groups. No drowsiness complications were observed in any of the groups in the first 24 hours after injection. Conclusions:Application of 15 mg intra-articular morphine after Arthroscopic knee surgery increases the analgesia level as well as its duration (IRCT138902172946N3).

It can be indicated that using 50 mg of lidocaine, instead of 75 mg, in combination with opioids and epinephrine in mothers that are candidates for C/S not only provides an acceptable anesthesia level but also offers a more stable hemodynamic state with fewer side effects and less of a need for drugs to control blood pressure and vomiting.Background: Caesarian section is a commonplace surgery in females for which spinal anesthesia is the preferred method. The local anesthetic medications used in the surgery are often associated with complications such as nausea, vomiting, dyspnea, hypotension, and bradycardia. In the present study, we decreased the dose of the anesthetic drug and added an opioid instead. Objectives: We tried to find an appropriate combination of medications required for optimal anesthesia with minimum complications. Patients and Methods: One hundred twenty six candidates for C/S with first and second class ASA aged 18-35 years were randomly divided into three groups. All patients received sufentanil (2.5 µg) and epinephrine (100 µg) doses but the lidocaine doses were respectively 50 mg, 60 mg and 75 mg in the groups 1, 2 and 3. Complications including hypotension, bradycardia, dyspnea, nausea, vomiting, and anesthesia quality were recorded and statistically analyzed. Results: The level of anesthesia was significantly different between groups. By reducing the lidocaine dose, patients with anesthesia level under the nipple increased but the surgeon and the patient were satisfied with the results. Nausea, vomiting, and dyspnea was degraded by decreasing the lidocaine dose especially in the 50 mg group. The need to use ephedrine was directly associated with the lidocaine. However, the need to use atropine was not significantly different between groups. Pruritus was not significantly different as well. Conclusions: It seems that reducing the lidocaine dose, when combined with sufentanil, decreases most complications of spinal anesthesia such as hypotension, dyspnea, nausea, and vomiting while preserving anesthesia quality.

Background:Medical sphincterotomy has gained popularity as a treatment for anal fissure. Calcium channel blockers in topical forms could also be appropriate with low adverse effects.Objectives:This was a prospective randomized controlled trial to compare topical and oral nifedipine in the treatment of chronic anal fissure.Patients and Methods:A prospective randomized controlled trial was conducted at two centers of Shahed University. One hundred and thirty patients with chronic anal fissure aged 18 to 60 years managed in our clinics were included in this study. The patients were randomly divided into two groups. Sixty-five patients received topical nifedipine (TN) and the same number received oral nifedipine (ON).Results:Ulcer healing occurred in 43 (73.33%) of topical nifedipine group compared to 29 (49.5%) patients in oral nifedipine, which was significantly different (P < 0.05). Side effects such as headache and flushing in oral nifedipine group were more prevalent than topical nifedipine, which was statistically different. Recurrence rates were the same after six months of follow-up.Conclusions:Although oral nifedipine can reduce symptom and signs of anal fissure, topical nifedipine has a superior role for anal fissure treatment with higher healing rate and lower side effects.

BackgroundColorectal cancer (CRC) is one of the most common cancers worldwide which is not extensively researched in Iran.ObjectivesThe present study aims to investigate the epidemiologic characteristics of CRC in patients referred to selected hospitals of Tehran University of Medical Sciences.Patients and MethodsIn this descriptive-analytic study 218 patients with colorectal cancer were investigated. Data were collected via reviewing recorded pathologic results of patients of these hospitals which then were analyzed by univariant methods.ResultsAmong 218 patients, 140 (64.2%) were male and 78 (35.8%) were female. Of all patients, 132 (60.0%) suffered from tumors in rectum; 38 (17.4%) in sigmoid; 12 (5.5%) in descending colon; 10 (4.6%) in transverse colon and 26 (11.9%) in ascending colon and cecum. Tumors were well differentiated in 134 patients (61.5%), moderately in 62 cases (28.4%) and poorly differentiated in 22 patients (10.1%). There was no significant difference between males and females regarding the location and degree of tumor differentiation.ConclusionsRegarding high prevalence of colorectal cancer in Iran and potential environmental and genetic factors, surveillance must be considered for this disease. Its risk factors such as diet, life style and low physical activity should be evaluated and screening should start at younger ages.

Background:Postoperative nausea and vomiting (PONV) after laparoscopic cholecystectomy (LC) has multifactorial etiology. Pain and use of opioids are among the important factors.Objectives:The present study aimed to evaluate the efficacy of intrapritoneal (IP) injection of bupivacaine on PONV.Patients and Methods:This was a double-blind randomized clinical trial, conducted on 66 patients aged 20-60, ASA I or II, candidates for LC. Patients were randomly assigned to two groups. Bupivacaine group received 20 mL bupivacaine 0.25% in the gallbladder bed, before and after cholecystectomy and the control group did not. The incidence of nausea and postoperative pain intensity was measured with Visual analogue scale (VAS) at 1, 2, 3 and 4 hours after operation, at rest and when coughing and changing positions. Nausea and vomiting occurrence were assessed at the same times.Results:There were no demographic data differences between groups. No differences were found between the two groups, in terms of incidence of nausea and vomiting. Furthermore, both groups were similar with respect to opioid consumption, during four hours post-operation.Conclusions:Intraperitoneal bupivacaine administration at the beginning and end of laparoscopic cholecystectomy reduced only visceral and shoulder pains at the 4th postoperative hour, but had no effect on reducing neither PONV, nor opioid demand, during the first four postoperative hours.