BackgroundPrevious studies have been conducted to evaluate the effect of different adjuvants on brachial plexus block.ObjectivesThis study investigated the effect of adding magnesium sulfate to lidocaine on postoperative pain in upper limb surgeries by supraclavicular brachial plexus block under ultrasound guidance.MethodsThis study was carried out on patients who were candidate for upper limb surgeries. This was a controlled double-blind study conducted on a number of 52 patients aged 18 - 75 years with ASA class I or II. The first group (M) received lidocaine 1% (4 mg/kg) plus fentanyl 50 micg and magnesium sulfate 20% (5 mL) while the second group (N) received lidocaine 1% (4 mg/kg) plus fentanyl 50 micg and normal saline (5 mL) to supraclavicular brachial plexus block under ultrasound guidance. Postoperative pain was evaluated by visual analog scale (VAS) until 24 hours. Sensory and motor blocks onset and duration, rescue analgesics, hemodynamic variables, and side effects were recorded for all the patients.ResultsPostoperative VAS values at 24 hours were significantly lower in group M than group N (P < 0.0001). Sensory and Motor blocks onset and duration were statistically longer in group M than group N (P < 0.0001).ConclusionsThe addition of magnesium sulfate to lidocaine decreased the postoperative pain and increased the onset and duration of sensory and motor blocks in supraclavicular brachial plexus block under ultrasound guidance in upper limb surgeries.

BackgroundSpinal anesthesia is an appropriate alternative for general anesthesia in many operations, particularly in cesarean section. However, the induced hypotension is the main drawback of this method. Therefore, the current study aimed at comparing the effects of crystalloid and colloid solutions used as the preload on the post-spinal hypotension and its complications in females who are candidate for elective cesarean section.MethodsThe current randomized, controlled, double-blind study was conducted on the female candidate of elective cesarean section (n = 96; age range: 20 to 40 years). The patients were in their 37 to 42 weeks of gestational age during the experiments. The systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR) variation, amount of injected ephedrine during surgery, Apgar score at birth, total solution infused after spinal anesthesia, urine output, nausea, and vomiting were comparatively assessed between the two groups.ResultsThe percentages of reduction in SBP and DBP variables in the crystalloid solution were higher than those of the colloid group and the differences were statistically significant (P = 0.042 and P = 0.008, respectively). Average percentage of HR changes was more significant in the crystalloid than the colloid group (P = 0.032). In contrary, administration of the two types of solutions did not result in significant differences in the Apgar scores. The prevalence of nausea and vomiting in the colloid group subjects was lower than those of the crystalloid solution group; however, the differences were not significant.ConclusionsThe current study findings recommend colloid solution to prevent hemodynamic instability after spinal anesthesia. However, the costs and availability of the solution and recommendation of anesthesiologist should be considered. Conduction of further clinical trials with larger sample sizes is recommended.

Objective: One of the critical components in the postoperative care is pain. Given that little research has been done regarding the analgesic effects of intra-articular injection of ketamine, this study was aimed to compare the analgesic effect of intra-articular and extra-articular injection of morphine and ketamine compound in arthrotomy surgery under spinal anesthesia. Methods: A total of 50 patients were candidate for arthrotomy surgery, aged 18-60 years were divided randomly into two groups. At the end of surgery, the first group was treated with combination of intra-articular morphine and ketamine compound and the second group was treated with combination of extra-articular morphine and ketamine compound. The amount of postoperative pain was recorded in the hours of 2,4,6,12,24 respectively. Also 24 hours consumption of rescue analgesic was recorded. Results: The pain severity (VAS) in the hours of 2, 4, 6, 12 and 24 after surgery in the intra-articular injection group was significantly lower than the extra-articular injection group (P<0.05). Postoperative morphine consumption in intra-articular injection group (3.2±3.78) was significantly less than the extra-articular injection group (6.36±5.22) (p = 0.018). Conclusion: Postoperative pain severity of intra-articular injection of ketamine and morphine in knee surgery is less than extra-articular injection.

Background and Objective: Hemodynamic changes following laryngoscopic tracheal intubation can trigger catecholamine release which consequently increases blood pressure and intraocular pressure (IOP) resulting in the disc rupture and ultimately blindness. Endotracheal intubation (endotracheal tube [ETT]) is a common technique for stress response management. The present study aims to comparatively investigate the hemodynamic changes and IOP after three intubation approaches of ETT, laryngeal mask airway (LMA) Classic™, and I-gel in patients undergoing elective cataract surgery. Materials and Methods: This clinical trial was conducted on 75 patients with ASA classes I and II (age range: 50-65 years old) who were the candidate for elective cataract surgery admitted in Ahvaz Imam Hospital, Iran, during 2013-2014. The hemodynamic changes and IOP values were measured in the patients before and after intubation with ETT, LMA Classic™, and I-gel. The pulse rate, systolic and diastolic blood pressures, and IOP were measured at four intervals at 1 minute before and at 1, 2, and 5 min after the insertion of the airway devices. The IOP was measured with Tonopen. Results: Immediately, before inserting ETT, LMA, and I-gel, the heart rate, systolic and diastolic blood pressures significantly increased in all groups. The results showed that the hemodynamic changes and IOP following I-gel were more stable than the LMA Classic™ and ETT devices. In addition, the LMA Classic™ intubation showed more stable hemodynamic response than the ETT. Conclusions: The findings showed that I-gel intubation results in more stable hemodynamic responses in elective cataract surgery.