Introduction Post-dural puncture headache (PDPH) is one of the most common problems of cesarean section. The present study aimed to evaluate the effect of pregabalin on PDPH among patients undergoing elective cesarean section. Materials and methods This double-blind clinical trial was performed on 136 patients undergoing elective cesarean section referred to Shahid Motahari Teaching Hospital in Urmia in northwestern Iran from February 1 to December 20, 2020. Patients were selected by convenience sampling method and randomly divided into two groups of intervention and control (N = 68 people each group). The presence of PDPH and its severity were recorded in the checklist based on the VAS, and conventional treatments were prescribed in the case of occurrence of the PDPH. The PDPH severity was also assessed by the patient using the 10-cm Visual Analog Scale (VAS). Results The mean age of participants was 27.82 years. A total of 29 people suffered from hypotension. Regarding pain severity, the mean pain score in the intervention group was significantly lower than the control group (p = 0.01). Results also showed that the frequency of PDPH in the intervention group was significantly lower than the placebo group (4.4% vs. 11.8%; p = 0.019). There was no significant difference between intervention and control groups in terms of demographic characteristics (p > 0.05). Conclusion Results of the present study showed the use of oral pregabalin at night before spinal anesthesia in patients undergoing elective cesarean(C-) section had a preventive effect on the severity and incidence of PDPH.

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Background: Caudal block is a common, safe, and effective anesthetic technique for lower abdominal, urological, and lower extremity surgeries in pediatrics. Objectives: This study aimed to evaluate the cardiovascular effects of adjuvant epinephrine in the caudal block on heart rate and blood pressure changes in children. Methods: This double-blind, randomized clinical trial was performed on 60 children who underwent elective infra-umbilical surgeries. They were under general anesthesia with midazolam, fentanyl, lidocaine, and propofol. The patients were ventilated through laryngeal mask airway (LMA), and anesthesia was maintained with sevoflurane in O2 and N2O mixture. The intervention group received a caudal block with 0.2% bupivacaine and 1/200000 epinephrine (1 mL/kg), while the control group received a caudal block without epinephrine. Heart rate, blood pressure, and ECG were monitored before the block and in the first, fifth, and 20th minutes after surgery. Results: The two groups showed no statistically significant differences in demographics and systolic and diastolic blood pressures. However, sinus arrhythmia was more prevalent in the study group in the first minute after the block (P < 0.001). No differences were observed in the incidence of arrhythmia in the fifth and 20th minutes after the block. Conclusions: It appears that epinephrine as an adjuvant to the caudal block does not have long-lasting effects after the block, except sinus tachycardia in the first minute. Considering that no changes in blood pressure and other hemodynamic parameters were observed, it seems that epinephrine can be used safely in the caudal block in pediatric patients.

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Background and objective: selecting the analgesia method in pediatrics is of most importance. In pediatrics required hypospadias repair, two methods of the caudal block and penile block are used increasingly. This study aimed to compare two methods of the caudal block and penile block using rectal acetaminophen in postoperative analgesia of hypospadias repair. Methods: This clinical trial was conducted on 50 children who underwent hypospadias referred to the educational hospital of Shahid Motahari in Urmia in west-north of Iran from July 1st, 2019 to March 1st, 2020. Patients were selected using a convenient sampling method and were allocated in two groups of the caudal block and penile block using rectal acetaminophen by random allocation software. To assess analgesia, the FLACC scale was used. Results: Mean age of participants was 27 months, the mean weight of participants was 13 kg, and their mean height was 82 cm. Regarding assessment changes in pain severity, the results showed in two groups that in group 1 (caudal block) in time intervals of recovery, 6 h, 12 h, and 24 h after the surgery, pain severity was reached to 1.16 and in group 2 (penile block) was reached to 3.44. The results showed that in group 1 (caudal block) patients suffer significantly less pain than patients in group 2 (penile block) (P = 0.001). Conclusions: According to results obtained from this study, hypospadias repair in pediatrics using caudal block can provide longer analgesia for the patient. Highlights

Introduction: Inguinal hernia is a more frequent problem in male infants with an increased incidence in twin ones. Prematurity is considered as a risk factor. During open surgery of hernia under general anesthesia, there is a high incidence of apnea especially in the preterm infants. Caudal anesthesia could been a more effective approach for induction of anesthesia and analgesia. Case presentation: Here, we presented three two-months-old infants (3.5-3.9 kg) for inguinal hernia repair, simultaneously who were born at 35 weeks’ gestation al age. They were undergone bilateral inguinal hernia repair with single shot awake caudal anaesthesia. Conclusion: Although herrniorraphy is a common procedure in preterm infants, the induction of simultaneous caudal anesthesia for this procedure is rare event. On the other hand, the complications of anestethic techniques such as apnea are important.Indeed, triple infants with based same genetic background didn’t show any undesirable events after anaesthesia.