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Introduction: The present study set out to compare the effects of midazolam, dexamethasone, ondansetron and propofol on the prevention and control of opioid-induced pruritus after spinal anaesthesia with bupivacaine and fentanyl as adjuvants in femoral fracture surgery. Materials and Methods: This double-blind clinical trial study was conducted on 136 patients who were scheduled for orthopaedic surgery in Valiasr Hospital of Arak. The patients were randomly divided into four groups (ondansetron, midazolam, dexamethasone and propofol) with a block randomisation pattern. Blood pressure, heart rate, oxygen saturation, the incidence of pruritus, nausea, vomiting and sedation level were monitored and recorded intraoperatively and postoperatively in recovery and every 2 h until 12 h postoperatively. Data were then analysed with SPSS 20. Results: From 10 min to 60 min, blood pressure was lower in the midazolam group, while it was lower in the propofol group from 60 min to 105 min. In general, blood pressure in the midazolam group was lower than that in the other groups (P = 0.001). Furthermore, pruritus was observed less in the midazolam group than in the other groups (P < 0.05). Sedation level was higher in the midazolam group than in the other groups (P < 0.05). Conclusion: Midazolam reduced pruritus and increased sedation in patients. On the other hand, a decrease in blood pressure was observed in the midazolam group, which did not require any special treatment. According to the results of the present study, after midazolam, propofol and dexamethasone, and finally ondansetron, respectively, were effective in controlling pruritus after spinal anaesthesia, but the efficacy and effectiveness of midazolam were higher than that in the other groups. As such, this drug is recommended to be used in such procedures. Of course, it should be mentioned that the final decision depends on the patients' physical conditions and the anaesthesiologist's discretion. [ABSTRACT FROM AUTHOR]

Introduction: Blood loss management in craniotomy is essential for a patient's haemodynamic stability and a significantly better view of the surgical site. The study aimed to address the comparative efficacy of labetalol (LAB), remifentanil (REM) and dexmedetomidine (DXM) on the bleeding control during the craniotomy procedure. Materials and Methods: In a double-blind trial, ninety patients eligible for undergoing craniotomy were recruited and assigned to DXM, LAB and REM groups by the block-randomised method. The vital signs, including heart rate (HR), mean arterial pressure, and oxygen saturation (SaO2) after induction and during the hypotension phase every 15 min until the end of surgery and at recovery and certain time points (2, 4 and 6 h post-operative), were recorded. The amount of bleeding, surgeon satisfaction and dose of propofol used, side effects and haemoglobin level before and 12 h after surgery were registered. Data analysis was conducted using the SPSS software by one-way analysis of variance, repeated measurement test and Chi-square test at a significance level of 0.05. Results: No significant difference was found in vital signs, including SaO2, blood pressure, HR, duration of surgery, extubation time and the amount of propofol consumed, side effects and haemoglobin level (P > 0.05). Nevertheless, the DXM group showed a prolonged recovery time (P = 0.018), less bleeding (P = 0.001) and the highest surgeon satisfaction (P = 0.001) when compared with other groups. Conclusion: Our results showed that DXM helps increase surgeon satisfaction and reduce bleeding while increasing the recovery time. Overall, it does, however, have improved performance without any side effects, based on which DXM can hence be recommended to be used to control bleeding during craniotomy. [ABSTRACT FROM AUTHOR]

Introduction: This study aimed to provide an evidence-based foundation for appraising the efficacy of magnesium sulphate, ketamine and neostigmine plus bupivacaine 0.5% on key supraclavicular block (SCB) characteristics made up of onset, duration and quality for forearm surgery. Materials and Methods: This double-blind trial enrolled ninety patients who were identified as having needed forearm surgery and been hospitalised in the Arak-based Valiasr Hospital, Iran, stratified participants into triad randomised groups receiving the aforementioned adjuvants. The basic requirements were met to incorporate the underneath groups' data to be recorded and analysed within SPSS release 20: (a) haemodynamic parameters (including mean arterial pressure/heart rate/oxygen saturation) documented at 5-min intervals until the end of surgery; (b) the onset and next to the duration of complete sensory and motor block, the time to administration of the patient's first post-operative analgesia and the overall dose of analgesic administered; (c) all block failures; (d) opioid consumption during post-operative 24 h and (e) pain score measured on a visual analogue scale throughout recovery time and scheduled post-operative times (2, 4, 8, 12 and 24 h). Results: Notwithstanding the shorter onset of sensory and motor block manifested in the magnesium sulphate group and longer duration of motor block in those receiving neostigmine regimen (P < 0.001), the findings endorsed strong support for the potential efficacy of ketamine in affording the longer duration of sensory block, better clinically meaningful pain relief at all scheduled times and diminished opioid consumption during 24 h (all P < 0.001). Conclusion: Bearing in mind the lack of complication needing to be thought of and the trial's clinical findings, which bespeak the shorter onset of the block (both sensory and motor) in the group receiving magnesium sulphate versus the longer duration of motor and sensory block in the neostigmine- and ketamine-treated groups, respectively, and diminished pain score and opioid consumption in the latter, all the adjuvants, thus, could be suggested to be contributed to achieving successful SCB in forearm fracture patients, depending on the patient's general condition and the anaesthesiologist's discretion. [ABSTRACT FROM AUTHOR]