Steroid injection can palliate plantar heel pain rapidly but dry needling can provide more satisfactory results for patients with plantar fasciitis in the long term.

Level I.

Objective:Shivering is an unpleasant sensation for patients who undergoing spinal anesthesia. This randomized double-blind clinical trial study was designed to compare the effect of intrathecal fentanyl with intrathecal meperidine for prevention of shivering in lower limb orthopedic surgeries under spinal anesthesia.Methods:Ninety patients were randomly recruited to receive either 3 ml of 0.5% hyperbaric bupivacaine plus 20 μg of fentanyl (Group F), or 3 ml of 0.5% hyperbaric bupivacaine plus 0.2 mg/kg of meperidine (Group M), or 3 ml of 0.5% hyperbaric bupivacaine plus normal saline (Group S). The incidence and intensity of shivering were compared in three groups. Data were analyzed by analysis of variances, Mann–Whitney U-test followed by Chi-square test.Findings:There were not statistically differences in complications and side-effects between three groups. Total incidence of shivering was similar between Groups F and M (16.7% vs. 13.3% respectively, P = 0.72) whereas it was significantly different to Group S (43.3%) (P = 0.025 for Group F vs. S, and P = 0.011 for Group M vs. S). Also the intensity of shivering between Groups F and M was similar (P = 0.66), while it was significantly less in these groups compared to Group S (P = 0.013 and P = 0.004, respectively).Conclusion:Addition of fentanyl 20 μg or meperidine 0.2 mg/kg to 0.5% bupivacaine intrathecally significantly decreased the incidence of shivering in lower limb orthopedic surgeries. There was no significant difference between two drugs with this respect.

Objective:Laryngoscopy and intratracheal intubation may cause acute hemodynamic instabilities due to catecholamine release. Magnesium sulfate (MgSO4) prevents catecholamine release and results in bradycardia and vasodilatation, so can be used to diminish complications of laryngoscopy and intubation in doses > 50 mg/kg. The aim of this study was to compare the different doses of MgSO4 used to improve cardiovascular instabilities due to laryngoscopy and intratracheal intubation.Methods:In this double-blind randomized controlled trial, 120 patients undergoing elective surgery were divided equally into four groups (n = 30) and received different doses of MgSO4 as case groups (Group I: 30 mg/kg, Group II: 40 mg/kg, Group III: 50 mg/kg) or the equal volume of normal saline as a control group. The patients’ hemodynamic status was recorded at baseline, before laryngoscopy and in 1, 3, 5, and 10 minutes after laryngoscopy. Bradycardia, tachycardia, hypertension, hypotension, ST-T changes, arrhythmias, and duration of extubation and laryngoscopy were also recorded.Findings:There was no significant difference in heart rate between four groups (Pbaseline = 0.46, Ppreoperation = 0.55, P1 min = 0.86, P3 min = 0.30, P5 min = 0.63, P10 min = 0.74). Systolic, diastolic and mean arterial pressures were statistically significant less at 1, 3, and 5 minutes after intubation in comparison with other times of following-up in the three groups received MgSO4 than the control group.Conclusion:The use of MgSO4 in doses less than 50 mg/kg can be effective to reduce cardiovascular instability related to laryngoscopy and tracheal intubation.

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