Search

Objective: To investigate the effect of intravenous regional anesthesia with single-cuff forearm tourniquet and hematoma block on intraoperative and postoperative pain intensity of patients with distal radial bone fracture., Methods: In this randomized clinical trial, a total number of 52 patients with distal radius fractures were randomly assigned to receive either a traditional Bier block with 3 mg.kg -1 lidocaine (D group) or a single-cuff forearm tourniquet intravenous regional anesthesia with 1.5 mg.kg -1 lidocaine and a hematoma block with 10 mL 0.5% bupivacaine (S group). Pain intensity score of numerical rating scale (NRS) was measured hourly for 6 hours, then every two hours till 12 th hour and every 4 hours until 24 th postoperative hour. Total morphine consumption in the first 24 hours after surgery, its side effects and the patients' global satisfaction were assessed in each group., Results: Mean total morphine consumption during the first 24 hours after surgery was 11.68±7.88 mg in group D and 7.12±4.42 mg in group S ( p =0.13). Pain intensity score of NRS both during recovery room and surgical ward stay was less in S group compared to D group (0.016 and 0.02, respectively)., Conclusion: Intravenous regional anesthesia with single cuff forearm tourniquet and hematoma block compared to the traditional Bier block reduced intraoperative and postoperative pain intensity more effectively in patients with distal fracture of the radius bone and also reduced morphine consumption during the first 24 hours after surgery., (© 2020 Trauma Research Center, Shiraz University of Medical Sciences.)

Objective: To identify the human factors contributing to traffic accidents with a special focus on psychosocial factors amongst young girls of Tehran, Iran., Methods: In a descriptive study conducted in Tehran, Iran in 2013, 108 girls aged 18-24 were enrolled by using a stratified cluster sampling method. Participants filled a wide range of validated questionnaires about traffic psychology., Results: The developed psychological model about behaviors of drivers' factors as well as agreeable and aggressive personality trait with B coefficient of 0.25% and 0.37% were able to predict violation, driving style, perception of police laws, and off hook scheme and the mistrust with B coefficient of 0.33%, 0.23% and 0.28% in the level of 0.1 were able to predict violations and lapses of sample group, respectively. Extroversion with B coefficient of 0.27% also predicted unintentional violations of girls. B coefficient for perception of police laws was 0.22%. This was 0.25% for openness to experiences. Concerning driving accidents, the perception of police rules has the highest predictability., Conclusion: According to the results of the current research amongst girls in Tehran, a gender-sensitive interventional model can be designed for reduction of traffic accidents for this population group.

Objective: To determine the effects of intravenous Acetaminophen (Apotel®)  on pain severity and clinical findings of peritonitis in patients with acute appendicitis., Methods: This randomized  cross-over clinical trial was carried out duringa 6-month  period from August 2012 to February 2013 and comprised 107 patients diagnosed with acute appendicitis. Patients were randomly assigned to received placebo (n=54) or Apotel® (n=53). Patients were evaluated before, 30 minutes, 1 hour and 4 hours after administration  of Apotel®  or placebo,and were told to fill in two forms. The first form required patientsto measure their painintensityaccording to visual analogue scale (VAS). The second form was filled by a surgeon who examined the patients and recorded his or her findings using Alvarado score criteria for diagnosis of acute appendicitis at foregoing time points., Results: Of 72 patients, 37 (51.4%) were men and 35 (48.6%) were women. The mean age of the patients was 34.1±13.5 years. The mean pain score in 107 patients included in this study was 7.96±2.3. Those who received Apotel®  had significantly lower pain scores when compared to placebo at 30 minutes (p<0.001), 1 hour (p<0.001) and 4 hours of administration. There was no significant difference between two study groups regarding the frequency of Alvarado score; however the frequency of fever was significantly lower in those who received Apotel® (p<0.001). We found that Apotel® was not associated with resolved physical findings of acute appendicitis in different time intervals., Conclusion: Apotel® does not affect the clinical findings of acute appendicitis and dos not interfere with the accurate diagnosis. Therefore, it could safely be used as a reliable pain relieving agent, in patients with acute appendicitis.

Objectives: To compare the results of early versus late tracheostomy in trauma patients admitted to intensive care unit (ICU)., Methods:  This was case control study being performed at a major trauma centre in Shiraz, Iran including 120 trauma patients admitted to ICU during a 2-year period and underwent tracheostomy during their ICU stay. The patients were categorized into two groups of the early tracheostomy who underwent tracheostomy within the first 7 days of initiation of mechanical ventilation (n=60), and the late tracheostomy group, in which tracheostomy was performed after 7 days (n=60). The duration of mechanical ventilation, ICU stay and hospital stay as well as mortality rates in ICU and hospital were recorded and compared between two study groups., Results: The baseline characteristics such as age (p=0.325), sex (p=0.071), Glasgow coma scale (GCS) (p=0.431) and the mechanism of injury (p=0.822) were comparable between two study groups. Early tracheostomy was associated with a significantly shorter duration  of mechanical ventilation (p=0.008) and shorter ICU stay (p=0.003). Hospital stay (p=0.165), ICU mortality (p=0.243), and hospital mortality (p=0.311) were not different between the two study groups., Conclusion:  Early tracheostomy is associated with reduced ICU stay and shorter duration  of mechanical ventilation. Adopting a standardized strategy may improve resource utilization.

Objective: To evaluate the efficacy of modified perihepatic packing (MPHP) in reducing the rate of re-bleeding rate after packing removal., Methods: This was an experimental study being performed in Shiraz animal laboratory. High grade liver parenchymal injury was induced in 30 transgenic Australian rabbits which were then divided into two groups. Group A (control) included 14 and group B (experimental) comprised 16 rabbits. The animals in group A underwent standard perihepatic packing (SPHP) and those in group B were subjected to MPHP. Re-bleeding was assessed and compared between the two groups, after removal of perihepatic packings., Results: There was no significant difference between two study groups regarding baseline and perioperative characteristics. Rabbits in group A had significantly lower rate of postoperative re-bleeding compared to those in group A (57.1% vs. 12.5%; p=0.019). The mean bleeding volume was also significantly lower in group B compared to group A (76.88 ± 22.12 vs. 98.93 ± 33.8 mL; p<001). Although the survival rate was higher in group A compared to group B (93.8% vs. 78.6%) but the difference was not statistically significant (p=0.315)., Conclusion: MPHP is a simple and safe procedure for surgical management of high grade liver parenchymal injury concomitant with severe loss of glisson's capsule. This procedure significantly decreases re-bleeding after packing removal in comparison with SPHP.