We compared the ability of metoclopramide with IV lidocaine pretreatment to abolish pain from a diazepam injection. In a randomized, prospective, double-blinded, placebo-controlled clinical trial, 159 patients (ASA physical status I and II), aged 20–70 yr old, were allocated to one of three groups. Placebo and study drugs were injected IV immediately before 0.1 mg/kg of diazepam into a dorsal hand vein. Patients in Groups 1, 2, and 3 received 2 mL of placebo, 2 mL of lidocaine 1%, and 2 mL of metoclopramide (10 mg), respectively. The patient's response was graded using a 4-point scale. Any score other than 0 represented pain on injection. We observed that the incidence of pain on diazepam injection was 83% in the placebo group, which was decreased to 70% and 39% in patients pretreated with metoclopramide and lidocaine, respectively. Although there was no significant difference in the incidence of pain in Groups 1 and 3 (P > 0.05), Group 3 showed significantly less patients with severe pain scores than Group 1 as diazepam was injected (P < 0.000). Group 2 showed a significantly less frequent incidence of pain than the saline (P < 0.000) and the metoclopramide (P < 0.002) groups as diazepam was injected. The intensity of pain in Group 2 was significantly less than Group 3 (P = 0.012). The intensity of diazepam injection pain was intense with placebo as compared with other groups (P < 0.000). Metoclopramide, rather than lidocaine pretreatment, may be a reasonable analgesic alternative for painful injections.
Background and Purpose: The best access for hemodialysis is an autologous arteriovenous fistula (AVF). The most helpful way for vasodilation in the upper limb is stellate ganglion block. We aim to evaluate the effect of stellate ganglion block on outcome of vascular access for dialysis. Materials and Methods: Some 105 hemodialysis patients were randomly allocated to three groups: In group 1, stellate ganglion block was performed before fistula surgery. Group 2 had stellate ganglion block after surgery and group 3 was control group without any block. Primary outcome for all groups was functional dialysis, which is defined as successful hemodialysis for 1 month. Results: The three groups were similar in age, gender, and underlying diseases. Stellate ganglion block before operation had a meaningful increase in successful hemodialysis rate, when compared with the other groups (p = 0.02). Conclusion: Stellate ganglion block before arteriovenous fistula surgery in the upper limbs improves hemodialysis success rate.
Abstract Objective Accurate needle placement to the target point is critical for ultrasound interventions like biopsies and epidural injections. However, aligning the needle to the thin plane of the transducer is a challenging issue as it leads to the decay of visibility by the naked eye. Therefore, we have developed a CNN-based framework to track the needle using the spatiotemporal features of speckle dynamics. Methods There are three key techniques to optimize the network for our application. First, we proposed a motion field estimation network (RMF) to extract spatiotemporal features from the stack of consecutive frames. We also designed an efficient network based on the state-of-the-art Yolo framework (nYolo). Lastly, the Assisted Excitation (AE) module was added at the neck of the network to handle imbalance problem. Results Ten freehand ultrasound sequences are collected by inserting an injection needle steeply into the Ultrasound Compatible Lumbar Epidural Simulator and Femoral Vascular Access Ezono test phantoms. We divided the dataset into two sub-categories. In the second category, in which the situation is more challenging and the needle is totally invisible statically, the angle and tip localization error were 2.43±1.14° and 2.3±1.76 mm using Yolov3+RMF+AE and 2.08±1.18° and 2.12±1.43 mm using nYolo+RMF+AE. Conclusion and significance The proposed method has the potential to track the needle in a more reliable operation compared to other state-of-the-art methods and can accurately localize it in 2D B-mode US images in real-time, allowing it to be used in in current ultrasound intervention procedures.
Introduction: Ultrasound-guided nerve blocks have enhanced our abilities to selectively and effectively suppress certain nerves to accomplish specific goals, including blockade a localized seizure muscle movement without affecting the seizure threshold or level of the consciousness. Case Presentation: This is a case report of the blockade of the movement of a chewing muscle by the continuous (catheter-based) mandibular nerve block in a 27 years old man with high-frequency partial seizures in facial muscles who was a candidate for seizure focus ablation. An out-of-plane approach was used to insert a catheter near the mandibular nerve to provide intermittent or continuous peripheral nerve block. This report demonstrated that a continuous block of the mandibular nerve could effectively facilitate the seizure focus mapping and ablation. Conclusions: We can selectively suppress the contractures of a certain muscle in partial seizures by a continuous block of the responsible nerve. This blockade can facilitate seizure focus mapping and ablation.
Background: Hyperalgesia is a major complication of continuous or intermittent opioid administration. The evidence suggests that concomitant administration of low-dose naloxone could prevent the development of acute opioid-induced hyperalgesia, with no effect on pain control. Objectives: The current study aimed to assess the effects of intraoperative low-dose naloxone, adding to remifentanil infusion on preventing acute postoperative hyperalgesia in patients undergoing general anesthesia for laparotomy. Methods: In this randomized clinical trial, patients undergoing general anesthesia for laparotomic hysterectomy in a tertiary referral teaching hospital from February to December 2019 were randomly assigned to one of three groups of remifentanil-naloxone (remifentanil 0.3 μg/ kg/min with low-dose naloxone 0.25μg/kg /h prepared in 50 mL of normal saline), remifentanil (0.3 μg/kg/min), and control (receiving 50 mL saline infusion), intraoperatively. Patients and researchers were blinded to the type of intervention. The severity of hyperalgesia, as the main outcome, was evaluated by the static Tactile test. The severity of pain was assessed by visual analogous scale 0.5, 2, 6, 12, and 24 hours after surgery. Results: In total, 75 patients were evaluated. The results showed no difference concerning the independent variables (age, body mass index, hypertension, surgery duration, anesthesia duration, and American Society of Anesthesiologists (ASA) class) between the three groups. Heart rate was significantly different in all study time points between the three groups (P < 0.001), but mean arterial pressure and systolic and diastolic blood pressure showed no significant difference (P > 0.05) throughout the study. Assessment of hyperalgesia using the tactile test revealed a higher incidence of hyperalgesia in the remifentanil group in 0.5, 2, 6, 12, and 24 hours after surgery compared to the other two groups, which was statistically significant between the groups at 0.5, 2, and 6 hours after surgery (P < 0.05). Shivering incidence, Morphine dose in 24 hours post-surgery, morphine dose in the recovery room, and VAS for pain were significantly different during the study between the three groups (P < 0.05). Conclusions: This study demonstrated the efficacy of intraoperative low-dose naloxone (0.25 μg/kg/h) added to remifentanil infusion on reducing the frequency and severity of acute postoperative hyperalgesia in patients undergoing general anesthesia for laparotomy hysterectomy.
Background: Taxane-induced pain is a disabling condition. This trial was conducted to assess the effects of melatonin on preventing paclitaxel-associated acute and chronic pain or decreasing its severity in patients with breast cancer. Methods: This randomized, double-blind, placebo-controlled clinical trial was conducted on breast cancer women who received weekly paclitaxel (80 mg/m2) with or without trastuzumab after using doxorubicin + cyclophosphamide. The intervention group randomly received oral melatonin (10 mg/day) or placebo, which started from the first night of chemotherapy and continued through the planned 12 weeks of chemotherapy. The level of arthralgia-myalgia as acute pain was assessed every day in both groups using the Brief Pain Inventory (BPI). The Douleur Neuropathique 4 questionnaire (DN4) and National Cancer Institute Common Terminology Criteria for Adverse Events (NCI-CTCAE) version 5.0 were used to measure chemotherapy-induced peripheral neuropathy as chronic pain. Results: Seventeen patients were enrolled in each group randomly. The incidence of neuropathy according to a DN4 score ≥ 4 was significantly lower in the melatonin group versus the placebo group at week 12 compared to baseline (5 vs 11, P-value= 0.039). In addition, the mean neuropathy severity was significantly lower in the melatonin group over time (β= -0.051, P-value= 0.01). However, there were no significant differences in the mean worst and least pain scores over the twelve cycles of treatment between arms (P-value= 0.633, 0.341 respectively). Conclusion: Co-administration of melatonin in women with breast cancer decreased the incidence of severe paclitaxel-associated neuropathy but melatonin was not effective against acute pain.
Introduction
Pregabalin is a co-analgesia to improve the pain control after colorectal cancer surgeries. But, the effect of Pregabalin on the sleep and ability to change position of patients in postoperative period is less well known. This study aimed to assess the effect of Pregabalin on postoperative morphine consumption, and effect of pain on sleep, mood and ability to change position after colorectal cancer surgery.
Methods
This double-blind, randomized, controlled, single-center clinical trial was conducted in Imam Khomeini hospital, Tehran, Iran from June 2017 to June 2018. Seventy patients were included for colorectal cancer surgery randomly divided into two groups. Group A received two doses of 150 mg Pregabalin preoperatively and postoperatively and group B placebo was administered at the same scheme. The two groups had same analgesia and anesthesia regimens otherwise. The pain score by a numerical rating scale (NRS); disturbance in sleep, mood and daily activity scores based on a scoring system like the BPI questionnaires; and, nausea- vomiting, fatigue headache, and morphine consumption were assessed 48 hours post-operatively.
Results
Morphine consumption was lower in the Pregabalin group 24 h postoperatively (P=0.01). The two groups were similar in terms of sleep interference scores and side effects (P>0.05). But, Mood and actions interference scores in the Pregabalin group showed a significant improvement in 48 h postoperative (P<0.05) (Table 3).
Conclusion
The results showed that Pregabalin could reduce postoperative morphine consumption and improve mood and actions interference scores after colorectal cancer surgery. However, there was no difference between Pregabalin and placebo in postoperative pain management and sleep interference scores after colorectal cancer surgery.
Inadequate pain management is highly prevalent and is associated with significant costs and socioeconomic problems, which can lead to disparities in patient care. Specific groups are at higher risk of this problem. A few studies have evaluated the predictive risk factors of inadequate pain management.This study evaluated the prevalence and predictive risk factors of inadequate pain management at the primary and secondary care centers with large sample size.Patients who had been managed in primary and secondary care clinics were asked to report their personal characteristics, pain intensity, pain duration, and analgesics they were receiving in their first visit at our pain clinic. Zelman pain management index was calculated for each patient by analgesic potency minus mean pain intensity. The negative index showed incongruence between pain intensity and analgesic potency score (pain stronger than medication), indicating inadequate pain management.A negative pain management index was reported in 77% of the 511 recruited patients. Patients with more severe pain were more likely to experience inadequate pain management. A logistic model demonstrated women, people aged 45 - 65 years, illiterates, and obese patients were at higher risks of inadequate pain management. The pain management index was affected by sex and education (via higher pain intensities) and by age and BMI (via lower analgesic potency).Age, sex, education, and BMI are predictive risk factors of inadequate pain management as a prevalent problem in chronic pain patients.
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