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AIM: The aim of this study was to compare the sedative and analgesic effects of ketorolac and diclofenac eye drops among patients with cataract surgery (CS) who received tetracaine. METHODS: This double-blind randomized clinical trial was conducted in 2022. Participants were the candidates for CS consecutively selected from Amirkabir hospital, Arak, Iran, and were assigned to an artificial tear group, a ketorolac group, and a diclofenac group through block randomization. Pain, sedation status, heart rate, blood pressure, and arterial oxygen saturation were assessed during and after surgery. Complications prevalence and intraoperative propofol use were also documented. Data were analyzed using the SPSS software (v. 20.0) at a significance level of <0.05. RESULTS: There were no significant differences among the study groups respecting participants' age, gender, body mass index, blood pressure, heart rate, arterial oxygen saturation, CS duration, and Aldrete score (P > 0.05). From 5 min after CS onward, the mean score of pain in the ketorolac group was significantly less than the other groups (P < 0.05). The mean score of sedation from recovery to 1 h after surgery in the artificial tear group was significantly more than the other groups, whereas the mean score of sedation 2 and 4 h after CS in the ketorolac group was significantly more than the other groups (P < 0.05). Propofol use in the artificial tear group was significantly more than in other groups (P = 0.001) and patient and surgeon satisfaction in this group was significantly less than in other groups (P < 0.05). The ketorolac and the diclofenac groups did not significantly differ from each other respecting surgeon and patient satisfaction and the prevalence of complications (P > 0.05). CONCLUSION: Ketorolac eye drops are more effective than diclofenac eye drops in significantly reducing intraoperative pain among the candidates for CS with topical anesthesia. Therefore, ketorolac eye drops can be used with tetracaine eye drops in CS with topical anesthesia to produce greater perioperative analgesia and sedation. [ABSTRACT FROM AUTHOR]

Postoperative shivering is one of the most common complications of surgeries. The current research compared the effects of ketamine, granisetron, and dexmedetomidine on reducing postoperative shivering after general anesthesia. This double-blind clinical trial enrolled 148 patients (39.08 ± 5.99 years old) who had been admitted to Vali-Asr Hospital of Arak, Iran in 2019–2021. The study drugs, including dexmedetomidine, ketamine, granisetron and normal saline, were administered in corresponding groups 30 minutes before the end of surgery. The results showed that dexmedetomidine reduced mean arterial pressure and heart rate in patients. The lowest incidence of shivering was observed in the dexmedetomidine group and it increased the duration of recovery. Overall, dexmedetomidine is recommended to reduce postoperative shivering after general anesthesia, but the increase in duration of recovery should be considered. [ABSTRACT FROM AUTHOR]

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]

Background: Surgery is a well-known and effective method of treating lumbar intervertebral disc herniation. The present study aimed to compare the effects of administering tranexamic acid (TXA), nitroglycerin (NTG), and remifentanil (REF) on hemorrhage prevention during herniated lumbar intervertebral disc surgery. Methods: A double-blind clinical trial was conducted on 135 participants undergoing lumbar intervertebral disc surgery. A randomized block design was used for subject assignment to three groups including TXA, NTG, and REF. The hemodynamic parameters, bleeding rate, hemoglobin level, and the amount of infused propofol were measured and recorded after surgery. Data were then analyzed in SPSS software using Chi-square test and analysis of variance. Results: The mean age of participants in the study was 42.12 ± 7.93 years, and all three groups were equal in terms of demographic characteristics (P > 0.05). The mean arterial pressure (MAP) of the TXA and NTG groups was notably higher than the REF group (P < 0.008). The mean heart rate (HR) of the TXA and NTG groups was notably higher than the REF group (P < 0.05). The propofol dosage used in the TXA group was higher than the two groups of NTG and REF (P < 0.001). Conclusion: Among participants undergoing lumbar intervertebral disc surgery, the greatest MAP variability was observed in the NTG group. Higher mean HR and propofol consumption was observed in the NTG and TXA groups when compared to REF. No statistically significant differences were noted between groups in oxygen saturation or bleeding risk. Based on these findings, REF may be considered a preferred surgical adjunct over TXA and NTG during lumbar intervertebral disc surgery. [ABSTRACT FROM AUTHOR]

Background: Intravenous (IV) regional anesthesia is an easy, safe, reliable, and efficient option for inducing anesthesia during surgeries but with tourniquet-related pain. This study aimed to evaluate midazolam, paracetamol, tramadol, and magnesium sulfate administration as adjuvants with ropivacaine on pain relief and hemodynamic changes in IV regional anesthesia. Methods: A randomized, double-blind, placebo-controlled trial was conducted in subjects undergoing forearm surgery with IV regional anesthesia. The block randomization method was used to assign eligible participants to each of five study groups. Hemodynamic parameters were assessed before applying the tourniquet, at prespecified time points (5, 10, 15, and 20 min), then and every subsequent 10 min until surgery completion. A Visual Analog Scale was used to assess pain severity at baseline followed by every 15 min until completion of the surgery, and after tourniquet deflation every 30 min to 2 h, and at 6, 12, and 24 h postoperative. Data were analyzed using Chi-square and analysis of variance with repeated data testing. Results: The shortest onset and the longest duration of sensory block were observed in the tramadol group and the shortest onset of motor block in the midazolam group (P < 0.001). Pain score was estimated to be significantly lower in the tramadol group at the time of tourniquet application and release, and 15 min to 12 h after tourniquet release (P < 0.05). In addition, the lowest dose of pethidine consumption was observed in the tramadol group (P < 0.001). Conclusion: Tramadol appeared to be able to effectively relieve pain, shorten the onset of sensory block, prolong the duration of sensory block, and achieve the lowest consumption of pethidine. [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]

Objective: To compare effect of intrathecal meperidine, tramadol, magnesium sulfate, and dexmedetomidine on the prevention of postspinal anesthesia shivering and adverse events in hip fracture repair patients. Methods: In a randomized, double-blind trial, 132 patients with American Society of Anesthesiology (ASA) I and II spinal anesthesia who needed hip fracture surgery were enrolled. Patients were stratified into 4 intervention groups based on a randomized block pattern: meperidine, tramadol, magnesium sulfate, and dexmedetomidine. Hemodynamic parameters including blood pressure, heart rate, and oxygen saturation, as well as the severity of shivering, core body temperature, Ramsay sedation score, adverse events, meperidine consumption were recorded and compared. Results: There was no statistically significant difference in the normal hemodynamic parameters, temperature, duration of surgery, meperidine consumption, and adverse events such as dizziness, hypotension, nausea, and bradycardia among groups (P>0.05). Compared to other groups, severity of shivering was the lower in the dexmedetomidine group 6 and 8 h after surgery. The Ramsay sedation scores were higher in the dexmedetomidine and meperidine groups 4 h after surgery (P=0.020). Conclusion: Dexmedetomidine acts better than the other three adjuvants in reducing complications such as shivering. Overall, these four adjuvants are helpful to prevent postoperative shivering and could be put forward as promising local anesthetics in spinal anesthesia, based on anesthesiologists' discretion and patients' general conditions. Clinical registration: The study was approved by the Research and Ethics Committee at the Valiasr Hospital (Arak, Iran) with the clinical trial code of IRCT20141209020258N153. [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]

This trial-based paper strives to address the comparative efficacy of some ropivacaine adjuvant options, comprising dexmedetomidine, granisetron, and nitroglycerin, on pain and hemodynamic changes in intravenous anesthesia for forearm surgeries. This double-blind, placebo-controlled study enrolled four block-randomized eligible groups with patients (overall, n=128) undergoing orthopedic forearm surgeries in the dexmedetomidine, nitroglycerin, granisetron, and placebo groups. Intra- and post-operative vital signs (mean arterial pressure/heart rate/ oxygen saturation) were monitored at baseline and captured every 10 minutes until the end of the surgery, as well as the onset of sensory and motor block and length and duration of the block and mean opioid use within 24 hours. Lastly, pain was noted after tourniquet inflation (at 15, 30, and 45 minutes every 15 minutes until the end of surgery) and after deflation (every 30 minutes to 2 hours at 30, 60, 90, and 120 minutes), as well as 6, 12, and 24 hours after the tourniquet was deflated. The dexmedetomidine-sedated subjects appeared to demonstrate quicker onset and longer length and duration of sensory and motor block, plus less pain and opioid use at all scheduled times (both P = 0.0001). Dexmedetomidine is recommended as an adjuvant to regional anesthesia (Bier's block), while being coupled with the rapid onset and prolonged length and duration of sensory and motor blocks, in addition to soothed pain and diminished opioid use within postoperative 24 hours. The study was approved by Ethics Committee of Arak University of Medical Sciences (approval No. IR.ARAKMU.REC.1398.112) on July 21, 2019, and registered at Iranian Registry of Clinical Trials (registration number IRCT20141209020258N123) on November 2, 2019. [ABSTRACT FROM AUTHOR]

Objective: To compare the effect of ketamine, lidocaine, acetaminophen, and dexmedetomidine combined with morphine patient-controlled analgesia for opium addicts after tibial fracture surgery. Methods: This double-blind clinical trial included opium-addicted patients undergoing tibia fracture surgery. Patients were recruited and randomized to four different groups including the ketamine group, the lidocaine group, the acetaminophen group, and the dexmedetomidine group. The hemodynamic parameters such as heart rate (HR), mean arterial pressure, and arterial SaO2, alongside visual analog scale pain scores, sedation assessed by Ramsay score, nausea and vomiting, and opioid use were recorded and compared among the four groups. Results: This study included 140 patients, aged 37 (32, 41) years, with 92 males and 48 females, and each group had 35 patients. Dexmedetomidine-sedated subjects had the lowest blood pressure from 1 to 24 h after surgery, decreased HR at 12 and 24 h after surgery, and more satisfactory sedation (P<0.05). Notwithstanding no significant difference was noted in the pain scores, or nausea and vomiting among the groups (P>0.05). Conclusions: Dexmedetomidine has a better sedation effect compared to ketamine, lidocaine, and acetaminophen for pain control, but the final choice hinges on the patients' physical condition and the anesthesiologist's preference. [ABSTRACT FROM AUTHOR]

Abstract Depression is a major worldwide health problem. Indeed, by 2020, depressive disorders are estimated to represent the second largest disease burden worldwide. Although a variety of pharmaceutical agents are [...]

Objective: To compare the efficacy of midazolam, fentanyl, and magnesium sulfate as adjuvants to intrathecal bupivacaine on both block characteristics and postoperative analgesia in knee arthroplasty. Methods: This randomized double-blind clinical trial recruited spinal anesthesia patients of the American Society of Anesthesiologists class I or II, who needed knee arthroplasty. Patients were stratified into three intervention groups, including the midazolam group, the fentanyl group, and the magnesium sulfate group, and the patients were administered with midazolam, fentanyl, and magnesium sulfate, respectively. Hemodynamic parameters, sensory and motor block, and pain score (Visual Analogue Scale) were measured and compared among the three groups. Results: A total of 105 patients were included in this study with 35 patients in each group. There was no statistically significant difference in terms of oxygen saturation, mean blood pressure, duration of surgery, and postoperative complications, including nausea, vomiting, bradycardia, dizziness, and hypotension, as well as the time of opioid administration among the three groups (P>0.05). Statistically significant differences were found in terms of heart rate at 15, 30, 45, 60, 75, and 105 min after beginning of operation among the three groups, which was lower in the midazolam group (P<0.05). The midazolam group showed a shorter time to achieve sensory block after spinal anesthesia, sensory block to T8 or higher and sensory block to T12 and L1 (P<0.05). Besides, the three groups showed significantly differences in terms of onset of motor block after spinal anesthesia and time to achieve motor block to T8 or higher or Bromage score 3 (P=0.001). No significant difference was noted in pain scores among the three groups (P>0.05). Conclusion: Midazolam resulted in a shorter time to achieve sensory and motor block to T8 or higher, the onset of motor block and sensory block after spinal anesthesia, and time to achieve sensory block to T12 and L1, and the pain scores were not significantly different among the groups. Thus, midazolam can be highly underlined, if a shorter onset of sensory and motor blocks is targeted. [Funded by the research deputy of Arak University of Medical Sciences (No.99258); fa.irct.ir number, IRCT20141209020258N164]. [ABSTRACT FROM AUTHOR]

Aims: The current study aimed at comparing arm and forearm double tourniquet in terms of the onset and duration of analgesia, tourniquet pain, and the return of sensation and movement in distal upper extremity surgery. Methods: This double‑blind clinical trial was performed on 70 patients who were candidates for distal upper extremity orthopedic surgeries. The patients were randomized into two groups of arm and forearm double tourniquet. The onset time and duration of sensory and motor blocks were recorded. The pain level was recorded by visual Analog Scale (VAS) after inflating the tourniquet every 15 min till the end of operation at 15, 30, and 45 min as well as every 30 min for 2 h (at 30, 60, 90, and 120 min.) and at 6, 12, and 24 h after deflating the tourniquet. SPSS version 20 was used to analyze the data. Results: During 8–24 h after the surgery, the pain in arm double‑ tourniquet group was less than that in the other group (P < 0.05). There was no statistically significant difference in the time to onset of sensory– motor block between the two groups (P > 0.05). The duration of sensory block in arm double tourniquet was longer than that in forearm double tourniquet group (P = 0.002). In addition, the duration of motor block in arm double tourniquet was also longer than that in forearm double tourniquet group (P = 0.001). The pain level was equal in both the groups at all times except for the time interval of 8–24 h after the operation in arm double tourniquet group. Furthermore, there was no statistically significant difference in the pain level, and the time to onset of sensory–motor block was the same in both the groups as well. However, the duration of sensory–motor block was longer in the arm double tourniquet group, while no complication was found in either group. [ABSTRACT FROM AUTHOR]

This study was aimed to compare the onset and duration of axillary block with ropivacaine 0.5% plus either dexmedetomidine, fentanyl, or verapamil in forearm surgeries. This double-blind clinical trial enrolled three equal-sized block-randomized groups of patients (n = 105) scheduled for hand and forearm surgery at Arak, Iran in 2019, who received: (i) ropivacaine (40 mL/0.5%) + dexmedetomidine (1 μg/kg), (ii) ropivacaine (40 mL/0.5%) + fentanyl (1 μg/kg), and (iii) ropivacaine (40 mL/0.5%) + verapamil (2.5 mg), respectively. We recorded some vital signs such as mean arterial pressure, heart rate and oxygen saturation, onset of complete sensory and motor block, duration of the block, opioid use, as well as pain score at recovery and certain time points (2, 4, 6, 12, and 24 hours post-operation). Adding dexmedetomidine to ropivacaine (40 mL/0.5%) prolonged the duration of sensory (P = 0.001) and motor block (P = 0.001) in compared to adding fentanyl and verapamil and it also shortens the time to onset of sensory (P = 0.001) and motor block (P = 0.001). There is a significant difference between three groups in terms of visual analog scale mean and the lowest pain score was obtained in the dexmedetomidine group (P = 0.001), significant time trend (P = 0.001), as well as the time and groups interaction (P = 0.001). Dexmedetomidine was concluded to be associated with alleviated pain; reduced opioid use; short onset of sensory block; and prolonged duration of sensory and motor block. It hence is recommended to lengthen the duration of axillary block and to help relieve postoperative pain and ultimately to move to cut down the postoperative opioid use in forearm surgery. The study was approved by the Ethical Committee of Arak University of Medical Sciences (approval No. IR.ARAKMU.REC.1397.266), and registered on Iranian Registry of Clinical Trials (registration No. IRCT20141209020258N111) on May 9, 2019. [ABSTRACT FROM AUTHOR]

Physiological responses remain common during anesthesia emergence and endotracheal extubation, causing some complications. We aimed to address the effect of dexmedetomidine (DEX) on decrease of cough, hemodynamic parameters and Ramsay score in comparing to lidocaine (LID) during anesthesia. In this double-blinded randomized clinical trial 120 hospitalized patients undergoing general anesthesia were enrolled after obtaining written consent. Block random allocation was used to assign patients into three groups including DEX (intravenous injection; 0.5 μg/kg), LID (1.5 mg/kg), and PBO (10 mL normal saline) at 10 minutes before anesthesia. No statistical significance was uncovered among three groups in blood pressure, oxygen saturation, frequency of laryngospasm and duration of surgery amongst the groups (P > 0.05), but DEX having lower heart rate and cough frequency (P < 0.05). Moreover, the mean of Ramsay score was statistically higher in DEX and LID groups than PBO except at the 50th and 60th minutes after extubation (P < 0.05). Since the mean of Ramsay score was higher in DEX vs. LID groups and reduced heart rate and cough frequency demonstrates in DEX, it seems that DEX could be an appropriate drug on suppressing cough during anesthesia without side effects. The study protocol was approved by the Ethical Committee of Arak University of Medical Sciences by code IR.ARAKMU.REC.1397.140 on August 19, 2018, and the protocol was registered at Iranian Registry of Clinical Trials by code IRCT20141209020258N97 on February 22, 2019. [ABSTRACT FROM AUTHOR]

Background: Postdural puncture headache (PDPH) is a common complication after spinal anesthesia, mainly due to the loss of cerebrospinal fluid. This study was aimed to compare the preventive effect of oral caffeine (CAF) and melatonin (MEL) on headache after the spinal anesthesia for lower limb surgery (LLS). Methods: A double-blinded, randomized clinical trial enrolled on 150 patients undergoing LLS were randomly divided into three groups (n = 50 in each). CAF, MEL, and placebo (PBO) (control group) receiving a capsule containing 300 mg CAF, MEL 3 mg tablet, and a placebo 1 h before the spinal anesthesia. While recording the variables (SaO2, heart rate, mean blood pressure, and the dose of analgesic drug consumption), the pain score was measured using the visual analog scale at 12 and 24 h, as well as 2, 3, 5, and 7 days after surgery, afterward followed by SPSS-based data analysis. Results: Significant differences were found in headache pain score among the three groups (P < 0.001). The lowest pain score was seen with the CAF until 3 days after the surgery and in the MEL on day 5 and 7 days after the surgery. The incidence of PDPH in CAF, MEL, and PBO groups was 18%, 22%, and 36%, respectively (P = 0.006). Conclusion: CAF and MEL reduced the incidence of PDPH after spinal anesthesia for LLS with no hemodynamic changes. Based on the study results, the preventive effects of CAF on PDPH have been confirmed, and MEL can be suggested to be used for its prevention. However, further studies, with larger sample sizes, will be needed to completely prove these findings. [ABSTRACT FROM AUTHOR]