Background In this study, we aimed to compare the efficacy of corticosteroid trigger point injection (TPI) versus extracorporeal shock wave therapy (ESWT) on inferior trigger points in the quadratus lumborum (QL) muscle. Methods In this single-blind randomized clinical trial, 54 low back pain patients with myofascial trigger points on QL muscle were investigated. Participants were randomly allocated into two groups with A and B pockets. Patients in group A underwent radial ESWT and received 5 treatment sessions (1 per week) and actually were not followed-up. However, patients in group B received corticosteroid TPI and received one session of corticosteroid treatment and followed-up for 4 weeks after injection. Oswestry Disability Index (ODI), visual analogue scale (VAS), pain pressure threshold (PPT) and short form (36) health survey (SF-36) were measured in both groups before, two weeks after and four weeks after intervention. Results The between group comparison indicated that corticosteroid TPI leaded to significant higher improvements of ODI (P-value< 0.01), VAS (P value< 0.001), and PPT (P-value = 0.001) scores compared to the ESWT group at two-week follow-up time-point. ESWT group recorded significant higher improvement of ODI (P-value< 0.01) and SF-36 (P-value< 0.001) compared to the corticosteroid TPI at 4th week post treatment evaluation. At four-week follow-up time-point, the patients in the ESWT group were 1.46 times more likely to achieve 30% reduction in VAS, 2.67 times more likely to achieve 30% reduction in ODI, and 2.30 times more likely to achieve 20% improvement in SF-36 compared to the participants in corticosteroid TPI group. These results refer to large effect size for all study outcomes in ESWT group (d = 4.72, d = 1.58, d = 5.48, and d = 7.47 for ODI, PPT, SF-36, and VAS, respectively). Conclusion Corticosteroid TPI was more effective compared to ESWT in short-term controlling of pain and disability caused by myofascial pain syndrome of QL muscle. However, after 4 weeks treatment, ESWT further improved the quality of life and disability and was related with more probability of achievement the minimal clinically important difference concerning pain, disability and quality of life and large effect size for all study outcomes in treated patients compared to corticosteroid TPI. Trial registration www.irct.ir, IRCT20100827004641N14, retrospectively registered 2019-01-19.

BackgroundPain control after surgery in children is very important. Despite having good analgesic effects, the use of opioids is, however, limited due to side effects.ObjectivesThis study was aimed to investigate the effect of transverse abdominis plane (TAP) block on the intensity and frequency of pain after appendectomy in children.MethodsIn a single-blinded clinical trial, 40 children aged from 4 to 16 years, candidates for the appendectomy, were divided randomly to intervention and control groups. The intervention group received ultrasound-guided TAP block using 0.25 mL/kg of 0.25% bupivacaine in the Petit triangle after general anesthesia. Postoperative pain was assessed within the first 24 hours after surgery based on the Wong-Baker FACES Pain Rating Scale (WBFP).ResultsThere was a reduction in WBFP scores at 2 hours after appendectomy in the intervention group compared with the control group (5.05 ± 2.83 vs 6.30 ± 2.2063). Also, the pain intensity within 24 hours after surgery in the intervention and control groups was 3.10 ± 1.33, and 3.60 ± 1.63 respectively according to WBFP scale (P > 0.05).ConclusionsThe TAP block was effective to reduce pain after appendectomy in children, however, there was no significant difference between intervention and control groups. Further studies with larger sample sizes are needed to be done in this area of research.

Background & Aims:Video-guided laryngoscopy, though unproven in achieving better success rates of laryngoscopy outcome and intubation, seems to provide better glottic visualization compared with direct laryngoscopy. The objective of this study was to compare the efficacy of video-guided laryngoscope (VGL) in the airway management skills of medical students.Materials and Methods:Medical students throughout their anesthesiology rotations were enrolled in this study. All students received standard training in the airway management during their course and were randomly allocated into two 20 person groups. In Group D, airway management was performed by direct laryngoscopy via Macintosh blade and in Group G intubation was performed via VGL. Time to intubation, number of laryngoscopy attempts and success rate were noted. Successful intubation was considered as the primary outcome.Statistical Analysis:All data were analyzed using SPSS 16 software. Chi-square and Fisher's exact test were used for analysis of categorical variables. For analyzing continuous variables independent t-test was used. P < 0.05 was considered as statistically significant.Results:Number of laryngoscopy attempts was less in Group G in comparison to Group D; this, however, was statistically insignificant (P: 0.18). Time to intubation was significantly less in Group G as compared to Group D (P: 0.02). Successful intubation in Group G was less frequently when compared to Group D (P: 0.66). Need for attending intervention, esophageal intubation and hypoxemic events during laryngoscopy were less in Group G; this, however, was statistically insignificant.Conclusions:The use of video-guided laryngoscopy improved the first attempt success rate, time to intubation, laryngoscopy attempts and airway management ability of medical students compared to direct laryngoscopy.

Background: The normal small difference (3–5 mmHg) between arterial (partial pressure of carbon dioxide [PaCO 2 ]) and end-tidal carbon dioxide pressure (ETPCO 2 ) increases in children with congenital heart disease. The present study was conducted to evaluate the effect of corrective or palliative cardiac surgery on this difference (known as DPCO2). Patients and Methods: In a prospective study, 200 children (aged <12 years old) candidate for corrective or palliative cardiac surgery were studied. Using arterial blood gas measurement and simultaneous capnography, DPCO 2 was calculated at various intra- and postoperative periods. DPCO 2 values were compared within and between corrective or palliative procedures. Results: Corrective and palliative procedures were carried out on 154 and 46 patients, respectively. Initial DPCO 2 was higher than normal values in corrective or palliative procedures (15.50 ± 13.1 and 10.75 ± 9.1 mmHg, respectively). DPCO 2 was higher in patients who underwent palliative procedure, except early after procedure. The procedure did not have any effect on the final DPCO 2 in palliative group. Although DPCO 2 decrease was significant in the corrective group, it did not return to normal values. Operation time was longer, and the need to inotropic support was higher in corrective procedures; however, longer periods of ventilatory support were needed in the palliative group. Complication rate and Intensive Care Unit stay time were the same in two operation types. Conclusions: DPCO 2 did not change after palliative cardiac procedures. DPCO 2 decreased after corrective procedures; however, it did not return to normal values at early postoperative period. Thus, DPCO 2 may not have any clinical value in monitoring the quality of corrective or palliative procedures.

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