Introduction: To compare the effects of oral clonidine and tramadol on shivering caused by spinal anesthesia in patients undergoing transurethral lithotripsy (TUL). Methods: The present study is a triple-blind clinical trial conducted on 80 elective urologic surgical candidates during 2016-2017 at Tehran Hasheminejad Hospital in Iran. Using the Balanced Block Randomization method, the patients were randomly assigned into two groups (40 patients per group) 90 minutes before performing spinal anesthesia. The first group (group C) received 150 µg of oral clonidine and the second group (group T) received 50 mg of oral tramadol. Body temperature, core body temperature, heart rate, diastolic blood pressure and shivering were recorded for the patients at different time periods, and entered in the SPSS22 software program. The above variables were then statistically analyzed using independent sample T-tests chi-squared tests and Repeated Measure ANOVA. Results: The results of this study indicated that there was a significant statistical difference (P<0.05) between the clonidine and tramadol treatment groups with regards to some variables, such as average body temperature and average core temperature, at different time periods. However, for other variables, such as heart rate, systolic blood pressure, diastolic blood pressure and shivering, there were no significant statistical differences between the two treatment groups (P>0.05). Conclusion: Clonidine and tramadol treatment groups were only significantly different in terms of body temperature and core temperature. Therefore, it is recommended that other precise randomized clinical trials be performed to ensure the accuracy of the results of this study.
: There is a lack of evidence to support the effectiveness of long-term opioid therapy in patients with chronic, noncancer pain. Despite these findings, opioids continue to be the most commonly prescribed drug to treat chronic back pain and many patients undergoing spinal surgery have trialed opioids before surgery for conservative pain management. Unfortunately, preoperative opioid use has been shown repeatedly in the literature to negatively affect spinal surgery outcomes. In this review article, we identify and summarize the main postoperative associations with preoperative opioid use that have been found in previously published studies by searching on PubMed, Google Scholar, Medline, and ScienceDirect; using keywords: Opioid dependency, postoperative, spinal surgery, specifically (1) increased postoperative chronic opioid use (24 studies); (2) decreased return to work (RTW) rates (8 studies); (3) increased length of hospital stay (LOS) (9 studies); and (4) increased healthcare costs (8 studies). The conclusions from these studies highlight the importance of recognizing patients on opioids preoperatively to effectively risk stratify and identify those who will benefit most from multidisciplinary counseling and guidance.
Introduction: Complex regional pain syndrome (CRPS) is characterized by extreme pain in a limb disproportional to the clinical history or physical findings accompanied by the signs of autonomic dysfunction. The pathophysiology of CRPS is obscure, making it challenging to treat. Treatment options include medications, physical therapy, and psychological support. In some cases, surgery or other minimally-invasive procedures such as nerve blocks may be recommended, while several novel treatments, such as ozone therapy, lack sufficient clinical evidence. Case Presentation: A 40-year-old man with CRPS was referred to our clinic with pain in his right arm and left lower leg. The patient had a history of trauma to the ulnar nerve and had undergone a sural to ulnar nerve autograft surgery. After the surgery, the patient’s symptoms began, primarily in the right arm. Despite receiving conventional drugs, multiple nerve blocks, and lidocaine patches, the patient’s symptoms persisted. In addition, we tried medical ozone for 14 sessions along with ketamine infusion, but these treatments were also ineffective. Conclusions: We emphasize the importance of studying and developing more effective treatments for CRPS and suggest that further randomized clinical trials are needed to determine whether ozone therapy is effective for patients with severe, intractable CRPS symptoms.
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