Background: Pain relief after surgery is an essential component of postoperative care. Objectives: The purpose of this study was to compare the efficacy of intravenous acetaminophen and intravenous meperidine in pain relief after outpatient urological surgery. Patients and Methods: In a prospective, randomized, double-blind clinical trial, 100 outpatients of urological surgery were studied in two groups of acetaminophen (A) and meperidine (M). Patients in group A received 1g of acetaminophen in 100 mL saline within 15 minutes and patients in group M received a single intravenous injection of meperidine 0.5 mg/kg, 15 minutes prior to the end of operation. Postoperative pain was recorded using visual analog scale (VAS). Vital signs, nausea, vomiting, dizziness and respiratory depressions were compared between the two groups. Results: Pain severity in patients treated with intravenous acetaminophen six hours after the operation within one-hour interval was significantly lower than meperidine group (P < 0.0001). Ninety patients in the meperidine group and five patients in the acetaminophen group required additional doses of analgesics. Nausea was significantly lower in acetaminophen group than meperidine group. Conclusions: Intravenous acetaminophen reduced pain following outpatient urological surgery more significantly than meperidine.

Background:The use of laparoscopic surgeries is escalating thanks to their advantages over the open surgeries. However, several complications can be observed following laparoscopy operation. Postoperative pain is a major concern in cholecystectomy surgeries. Pain can be both experienced in operated areas and radiated to the right shoulder. Acetazolamide is used for glaucoma, acute mountain sickness prophylaxis, and epilepsy in few patients with recurrent epilepsy. It seems that patients’ pain can be reduced by preventing carbonic acid production in abdomen after operation.Objectives:We aimed at evaluating if administration of acetazolamide preoperatively could affect early or late postoperative pain following laparoscopic surgery.Patients and Methods:In a randomized-controlled clinical trial study, 70 subjects (30 - 60 years) scheduled for laparoscopic cholecystectomy were included after obtaining a written informed consent. Patients were divided into two groups randomly (intervention and control). The intervention group received 5 mg/kg oral acetazolamide one hour before the operation. The control group did not receive any further medication.Results:Administration of a single dose of acetazolamide did not have any statistically significant impact on sleep quality (P = 1.000). Moreover, there was no statistically significant difference between groups regarding nausea and vomiting on single dose administration of acetazolamide (P = 1.000). Single dose of acetazolamide was associated with statistically significant decrease in shoulder pain immediately after laparoscopy (P = 0.017). However, there was no statistically significant difference regarding shoulder pain between the studied groups 2, 4, 6, 8, 10, 12, and 24 hours after laparoscopy. Single dose of acetazolamide did not significantly affect analgesic administration in 2, 4, 6, 8, 10, 12, and 24 hours after laparoscopy.Conclusions:Single dose of acetazolamide was associated with statistically significant decrease in shoulder pain immediately after laparoscopy. However, this effect was limited to the first postoperative hours and it failed to reduce postoperative pain of right shoulder during 24 hours after the operation.

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Objectives: Prediction of nausea and vomiting can positively contribute to the management of this post-anesthesia adverse effect. Therefore, the present study aimed to design and implement a checklist for predicting anesthesia-induced nausea and vomiting in candidate patients for mastectomy. Materials and Methods: This methodological study was conducted on 300 candidate patients for mastectomy during 2018-2019 at Imam Reza hospital, Tabriz, Iran. The checklist items were designed and developed based on scientific articles, expert opinions, and patient interviews. The Pearson correlation coefficient, Cronbach’s alpha, Spearman-Brown coefficient, factor analysis, the KaiserMeyer-Olsen measure of sampling adequacy, and VARIMAX rotation were used to analyze the data. Eventually, the distribution of data with a normal distribution was compared through the Kolmogorov-Smirnov test. Results: In the first stage, 100 items were collected, which were reduced to 35 cases after modification by a team of experts. Twenty items were ultimately selected after observing the 80/20 response rate. The overall scale reliability was calculated as 0.953 based on Cronbach’s alpha. The correlation coefficient of the first and second implementations was 0.853. Finally, the four extracted factors accounted for 69.51 of the variance of the checklist based on factor analysis. Conclusions: The prediction checklist for post-anesthesia nausea and vomiting in candidate patients for mastectomy comprised adequate psychometric indicators that could be used with high reliability according to the extracted indices.

Objectives: The quality of recovery can affect the results of abdominal hysterectomy although this effect is unknown in different methods of anesthesia. Therefore, the present study was conducted to compare general anesthesia (GA) and spinal anesthesia (SA) methods on the quality of the recovery of patients with selective abdominal hysterectomy in patients visiting the largest women’s disease hospital in Northwestern Iran. Materials and Methods: This cross-sectional descriptive study was conducted with the participation of 350 patients with abdominal hysterectomy, who were selected by convenience sampling in Al-Zahra hospital, Tabriz, Iran in 2019. Demographic data, visual pain scale, hemodynamic status, and Aldrete-Kroulik index were recorded for each patient. Data were analyzed using Mann-Whitney, t-test, multivariate regression, and Kolmogorov-Simonov tests in SPSS 20, and P<0.05 was considered statistically significant. Results: In the hemodynamic status, it was found that the SA group was more stable than the GA group but this difference was not significant (P>0.05). Regarding the need for pethidine, the results revealed that the mean (± standard deviation) of the GA group was significantly higher (35.14 ± 10.14) than that of the SA group (20.15 ± 05.25, P=0.039) while there were no significant differences between the two groups in the use of the antiemetic drug (P=0.203). Finally, the evaluations of the quality of recovery showed that the mean±) SD) of the quality of recovery in SA patients was significantly higher compared to GA patients (P=0.015). Conclusions: In general, the quality of recovery was higher in the SA compared to the GA regarding abdominal hysterectomy.

Background: Sore throat is one of the major complications of tracheal intubation after general anesthesia. Pregabalin is an analgesic, the anti neuropathic pain and analgesic effects of which have been demonstrated in various studies. This study examined the effects of single dose pregabalin one hour before tracheal intubation, to prevent sore throat after extubation. Methods: In a double-blind, randomized clinical trial, 60 patients who had undergone general and urologic surgeries at Imam Reza hospital in Tabriz, Iran, since March to July 2015 that required tracheal intubation, were included in the study. The patients were randomly divided into two groups (group A, 30 patients and group B, 30 patients). In the group A, an hour before anesthesia, one pregabalin tablet (300mg) was given to the patients. For the patients of the group B, the placebo was given. After awareness of patients, the severity of sore throat was measured and recorded by VAS scale after 2, 6 and 24 hours of the surgery. Results: Severity and incidence of sore throat after tracheal intubation were not significantly different between two groups. Meanwhile, no side effects of pregabalin were observed in the group A. Conclusion: Administration of pregabalin as a single dose of 300 mg one hour prior to anesthesia and intubation decreased the incidence and severity of sore throat in the case group than the control group, although the amount of this reduction was not statistically significant between the two groups.

Objectives: Approximately one-third of women having breast surgery experience neuropathic pain although no study has so far identified its risk factors. It seems that the coronavirus infection increases the likelihood of neuropathic pain through influencing the neuropsychological system. Therefore, the current study aimed to investigate factors affecting the severity of neuropathic pain before and after coronavirus disease 19 (COVID-19) in patients who had breast cancer surgery. Materials and Methods: The current descriptive-analytical study was conducted six months before June 4, 2020. In total, 40 women having breast surgery participated in this study. Postoperative neuropathic pain and its influencing factors were evaluated using demographic tools, Spielberger anxiety, and a 36-item short-form health survey for measuring the quality of life (QoL). Finally, data were analyzed by multivariate regression. Results: Neuropathic pain significantly increased during the COVID-19 pandemic. Mastectomy (P=0.009), removal of lymph nodes (P=0.011), number of radiotherapy sessions (P=0.003), history of chemotherapy (P=0.009), disease stage (P=0.015), hidden anxiety (P=0.005), and explicit anxiety (P=0.001), and all domains of QoL (P<0.05) significantly predicted neuropathic pain. Conclusions: In general, adverse effects of coronavirus pandemic reduced the QoL while increasing anxiety (hidden and explicit), thus leading to an increase in the severity of postoperative neuropathic pain.

Bispectral index parameter is used to guide the titration of general anesthesia. This monitoring improves recovery times and hospital discharges, as well as minimizes adverse events. The objective of this study is the comparison of anesthesia depth monitoring by conventional and bispectral index on nausea and vomiting after urological surgery. 180 participants who were scheduled for abdominal urological surgery were studied. Patients before induction of anesthesia were randomize into two groups with and without bispectral index monitoring. Incidence and severity of nausea and vomiting were recorded every 30 minutes for 2 hours and every 6 hours to 24 hours after surgery. The incidence of postoperative nausea and vomiting in Bispectral index group is 14.4% and 8.9% and in control group 28.9% and 23.3%, respectively. The risk of nausea and vomiting after surgery was reduced by 14.5% and 14.4%, respectively in patients monitored with bispectral index.INTRODUCTIONNausea is the conscious perception of medulla stimulation that is associated with vomiting center and create vomiting response (1). General anesthesia with the use of inhalants can cause nausea and vomiting after surgery (Postoperative nausea and vomiting, PONV). The incidence of PONV is reported about 20-30 percent (2). It seems that multiple-factor can cause PONV and few items such as anesthetic drugs, kind of surgery and personal risk factors is effective on PONV. These factors make into two categories that includes factors out of control by anesthesiologists and factors can control by anesthesiologists.1. Factors out of control by anesthesiologists: some of these factors are age, gender, past history of PONV and motion sickness, smoking, kind of surgery, operating time and anesthesia time, anxiety of patients and parents. 2. Factors controlled by anesthesiologists: these factors are associated of anesthesia settings, including premedications, kind of anesthesia, anesthesia drugs during surPublishedby Australian