Background:Postoperative pain relief is important in procedures of the lower extremity. Several previous studies have evaluated the efficacy of intra-articular (IA) pethidine as a compound, which has local anesthetic and opioid agonist properties, on postoperative pain relief in arthroscopic knee surgery (AKS). This study compared the postoperative analgesic effect of pre- and post-surgical IA pethidine administration in AKS.Materials and Methods:Seventy-five patients of American Society of Anesthesiologists (ASA) I and II undergoing AKS with general anesthesia were enrolled in this double-blind study. Patients were randomized in three equal groups to receive either 50 mg IA pethidine before surgical incision incision and saline after skin closure (PS), saline before surgical incision and pethedine after skin closure (SP), and only saline at two different times (SS). In each patient with operated knee joint, pain at rest and joint movement was evaluated at 1, 2, 6, 12, and 24 h after surgery completion using Visual Analog Scale (VAS). Data were analyzed using analysis of variance (ANOVA)-repeated measure, t-paired, and Chi-square tests.Results:Postoperative pain score at rest and joint movement in PS group was significantly lower than those in other groups. The time (Mean ± SD) between completion of operation and patient's request for morphine, total morphine consumption (Mean ± SD) in postoperative 24 h, and the numbers of patients requesting analgesic in PS, SP, SS, groups were: 5.2 ± 1.3, 3.3 ± 1.5, and 2 ± 1.3 h (P < 0.05); 4.4 ± 2.4, 8.7 ± 2, and 11.6 ± 4.4 mg (P < 0.05); 11, 18, and 21 persons (P < 0.05), respectively.Conclusion:The present study shows that preemptive intra-articular pethidine 50 mg injection is more effective than preventive injection for postoperative pain relief at rest and joint movement in arthroscopic knee surgery.

Background:Cognitive dysfunction after surgery is common in elderly patients. Many factors such as anesthetic drugs can cause complication in this surgery. Lidocaine is one of the drugs commonly used during anesthesia. So, we designed this study to find out cognitive effect of lidocaine in elderly patients undergoing non-cardiac surgeries.Materials and Methods:In this double-blinded clinical trial, we enrolled 70 patients older than 65 years age undergoing urologic or orthopedic surgeries, were divided in two groups. Patients randomly received intravenous lidocaine (1.5 mg/kg) or normal saline in the same volume immediately before extubation. Mini mental state examination (MMSE) test was used to evaluate cognitive state at discharge time, 6 and 24 h after surgery.Results:Mean MMSE scores at the time of discharge from recovery room in lidocaine and saline groups were 22.4 ± 4.5 vs. 22.1 ± 4.4, P = 0.755, respectively. It was significantly lower than MMSE before surgery, 6 and 24 h after the operation. The mean MMSE scores and frequency distribution of intensity of cognitive impairments were not significantly different between two groups at different times.Conclusion:Bolus intravenous lidocaine before extubation, did not affect cognitive states in elders undergoing non-cardiac surgery. Effect of lidocaine on cardiac surgeries is clear, but in non-cardiac surgeries, lidocaine has no clinical effects. So, more studies with different doses of lidocaine and different assessment methods are recommended.

Background:Postanesthetic shivering (PAS) is an accompanying part of general anesthesia with different unpleasant and stressful complications. Considering the importance of proper prevention of PAS in order to reduce its related adverse complications in patients undergoing surgery, in this study, we investigated the effect of orally administrated tramadol in the prevention of this common complication of general anesthesia.Materials and Methods:In this prospective randomized double-blind clinical trial, 80 ASA I and II patients aged 15-70 years, scheduled for elective surgery under general anesthesia, were randomized to intervention (oral tramadol 50 mg) and placebo groups. PAS was evaluated during surgery and in the recovery room, and compared in the two study groups.Results:PAS was seen in 5 patients (12.5%) in the intervention group and 10 patients (25%) in the placebo group (P = 0.12). The prevalence of grade III and IV shivering was 7.5% (3/40) and 25% (10/40) in tramadol and placebo groups, respectively (P = 0.03).Conclusion:The overall prevalence of PAS was not significantly different in the two study groups, but the higher grades of shivering which needed treatment were significantly lower in the tramadol group than in the placebo, and those patients who received tramadol experienced milder form of shivering. It is suggested that higher doses of tramadol would have better anti-shivering as well as analgesic effects. Studying different doses of tramadol would be helpful in this regard.

ntroduction: Preoperative volume loading (PVL) in addition to counteract the decreases in blood pressure during intraoperative period, also may decrease postoperative nausea and vomiting (PONV). This study was designed to investigate the effect of preoperative volume loading on the intraoperative blood pressure variability and postoperative nausea and vomiting. Methods: Thirty subjects scheduled for elective orthopedic procedures randomly divided into case and control groups. The patients in the case group received lactated Ringer 10 ml/kg before induction of general anesthesia. Mean arterial blood pressure (MAP) and heart rate were recorded in two groups every 3 minutes from induction of anesthesia until five minutes after extubation. Variability of mean arterial blood pressure and heart rate were defined as the standard deviation (SD) of the measured values for each patient. Means of these individual SD values were compared between two groups using Mann-Whitney U test. Results: The mean variability of mean arterial blood pressure and heart rate ware significantly lower in case group (8.3 ± 3 mmHg and 8.4 ± 2.5 bpm vs. 13 ± 6 mmHg and 11 ± 2.6 bpm in control group; p < 0.5). The severity of nausea (measured as a ten-point visual analog scale) was significantly lower in case group (1.2 ± 0.9 vs. 3.9 ± 1.8 in control group; p < 0.05). No patients in case group developed postoperative vomiting (compared to 5 patients in control group). Conclusions: The results of this study shows that preoperative volume loading is associated with lower variability of blood pressure and heart rate during operative period and also reduces the severity and incidence of postoperative nausea and vomiting.

Background:Nausea and vomiting are common postoperative complications with incidence of 20–80% depends on the surgery type, anesthetic drugs, age, sex, etc. This complication may lead to patient discomfort, intraocular, and intracerebral pressures increase, sutures rupture, esophageal injury, and rarely death. Many studies reported that midazolam and dexamethasone alone can decrease postoperative nausea and vomiting (PONV), but their combination has never been studied yet. The aim of this study was to compare the effect of midazolam and midazolam-dexamethasone on PONV after middle ear surgery.Materials and Methods:66 ASA I and II patients aged 15–65 year scheduled for elective middle ear surgery under general anesthesia randomly divided into two groups. Immediately after induction of the anesthesia group one (M) received midazolam 0.075 mg/kg and group two (M+D) received combination of midazolam (0.075 mg/kg) plus dexamethasone (0.05 mg/kg). Then the severity of nausea was measured by visual analog scales 0–10 (VAS) in recovery room at 6, 12, and 24 h after surgery. Metoclopramid (0.1 mg/kg) was administrated I.V. slowly if nausea score was above 3 or patient had vomiting. The postoperative need for antiemetics and the duration of stay in recovery room were recorded. Values of P<0.05 were considered statistically significant.Results:There were no significant differences in age, gender, and weight between the two groups. There was no significant difference in the mean nausea scores between two groups except after 12 h postoperatively (1.39 ± 3.19 in M group vs. 0.42 ± 1.71 in M+D group). The mean vomiting frequency was significantly less in midazolam-dexamethasone group in the recovery room (0.9 ± 0.29 vs. 0 ± 0) and at 6–12 h (1.09 ± 2.41 vs. 0.3 ± 0.8), and 12–24 h (0.42 ± 1.32 vs. 0.03 ± 0.17) postoperatively. During the first 24 h postoperatively, the metoclopramid consumption was significantly less in combination therapy (6.48 ± 9.54) than in the midazolam group (12.9 ± 23.44) (Value<0.5).Conclusion:The combination of midazolam-dexametazone is more effective than midazolam alone in prevention of postoperative vomiting after middle ear surgery. Therefore, we recommend combination therapy for patients who are prone to PONV.