Background and Objective: With consideration the daily increased development of outpatient surgeries and high rate of these surgeries in elderly patients, rapid and safe recovery of patients is necessary. In this clinical trial study, recovery time and nausea and vomiting after the use of two rapid-onset narcotics, Alfentanil and Remifentanil, in elderly patients were evaluated. Methods: In this double-blind prospective clinical trial, 40 elderly patients (age above 65 years) candidate to cataract surgery with general anesthesia were studied. The patients were divided randomly into two groups and for first group, 10 μg/kg of Alfentanil was injected and for second group Remifentanil 0.5 μg/kg was injected intravenously during 30 seconds one minute before induction. Both two groups were under general anesthesia with same method and during the anesthesia, first group took infusion of Alfentanil 1 μg/kg/min and second group took Remifentanil 0.1 μg/kg/min. In the end of surgery, the time intervals between end of anesthesia drug administration and spontaneous respiration, eyes opening with stimulation, verbal response and discharge of recovery room, also the incidence of complications related to narcotic drugs, especially nausea and vomiting, was recorded. The data were analyzed in SPSS software using descriptive and analytical statistics such as T-test and chi square test. Results: The time of spontaneous respiration in Alfentanil group was 2 minutes and in Remifentanil group was 3.3 minutes, the difference was not statistically significant (P=0.08). The time of eyes opening with stimulation, verbal response, and discharge of recovery room were not significantly different. During recovery, incidence of nausea and vomiting in Remifentanil group (30% of patients) was significantly more than Alfentanil group (5% of patients) (P=0.045). Conclusions: Recovery time between Alfentanil and Remifentanil group was not significantly different, but incidence of nausea and vomiting in Remifentanil group was higher than Alfentanil group significantly. It seems that using Alfentanil in the anesthesia for surgical treatment of the elderly people can be preferred.
A new treatment for pain is becoming popular among orthopedic and pain specialists: the injection of platelet rich plasma (PRP). Most everyone thinks of blood platelets as being responsible for blood clotting after injury which is true. What many people do not know is that blood platelets serve two other important functions. Blood platelets are responsible for bringing white blood cells to the injured area to clean up the remains of dead and injured cells. Most importantly to this discussion, blood platelets release growth factors that are directly responsible for tissue regeneration. These substances are called cytokins and include platelet derived growth factor, epithelial growth factor, and other important growth factors. PRP has been used for years in surgical centers around the US and abroad to improve the success of bone grafting (especially in dental surgery) and also by cosmetic surgeons for speeding healing time and decreasing the risk of infection after surgery. Only in the last few years have doctors and surgeons been experimenting with injecting PRP for the treatment of chronic pain. Tennis elbow, Plantar Fasciitis, Achilles tendonitis/tendonosis, Rotator Cuff Tears, meniscal tears, Osteoarthritis and chronic low back and neck pain are all being treated with the injection of PRP with the goal of regenerating degenerated connective tissue with reports of success. A PRP treatment looks like this: a patient’s blood is drawn and placed into a special collection kit. Using the person’s own blood eliminates the risk of transmission of any blood-borne disease. This kit is placed in a centrifuge for 15 minutes and the platelets and plasma are separated the red and white blood cells. Two thirds of the plasma is removed and discarded and the remaining plasma is mixed with the platelets. This higher than normal concentration of platelets is what gives us platelet rich plasma. The PRP is drawn into a syringe. The area to be treated is injected with a local anesthetic and after waiting five minutes for the anesthetic to take effect, the PRP is injected. The injection technique is identical to Prolotherapy/regenerative injection therapy, only the solution injected is different. Same instrument, different sheet music. Patient generally report two days of being sore and then usually pain relief occurs within the first week and continues to improve over a period of months. To date, one PRP treatment is the therapeutic equivalent of three or four prolotherapy/regenerative injection therapy treatments using dextrose.
محدوده تاریخ انجام: 1395
سابقه و هدف: لرز بعد عمل جراحی یکی از عوارض شایع به دنبال بیهوشی عمومی است و می تواند منجر به عوارض متعددی شود. مطالعه حاضر جهت ارزیابی اثر تجویز پروفیلاکتیک کتورولاک وریدی بر لرز در مقایسه با پتیدین، طی دقایق اولیه بعد از جراحی در ریکاوری، طراحی شد. مواد و روش ها: در یک کارآزمایی بالینی تصادفی شده دوسو کور، شصت بیمار مطابق با شرایط فیزیکی 1 و 2 انجمن متخصصین بیهوشی آمریکا، در محدوده سنی 20 تا 60 سال که جهت انجام جراحی شکمی (کوله سیستکتومی و لاپاراتومی) تحت بیهوشی عمومی برنامه ریزی شده بودند، به صورت تصادفی به دو گروه تقسیم شدند، که 30 میلی گرم کتورولاک (یک مهار کننده سیکلواکسیژناز غیر انتخابی) وریدی یا mg/kg 5/0 پتیدین (مپریدین)، 20 تا 30 دقیقه قبل از اتمام عمل جراحی دریافت کردند. بعد از اتمام جراحی در ریکاوری بروز و درجه لرز بعد از عمل و نمره درد به ثبت رسید. یافته ها: اطلاعات دموگرافیک، مدت زمان عمل جراحی و نمره درد بعد عمل در دو گروه تفاوت معناداری نداشت. لرز بعد عمل جراحی در 4 نفر از گروه پتیدین مشاهده شد (13/33%) و این تعداد 7 نفر در گروه کتورولاک بود (23/33%) (36/0 = p). تهوع واستفراغ بعد عمل در ریکاوری در گروه پتیدین نسبت به گروه کتورولاک شایع تر بود (016/0 = p). نتیجه گیری: کتورولاک با دوز 30 میلی گرم وریدی، 20-30 دقیقه قبل از اتمام عمل جراحی به اندازه پتیدین با دوز mg/kg 5/0 وریدی به عنوان یک ضد لرز مؤثر است و با تهوع واستفراغ بعد از عمل کمتری همراه است.