Hooman Esfahani; Zahra Khazaeipour; Arash Safaie; Seyed Mojtaba Aghili
Volume 9, Issue 2 , April 2021, , Pages 73-79
Abstract
Objective: To compare the ketamine efficacy at a sub-dissociative morphine dose to reduce pain in isolated limb traumatic injuries. Methods: A double-blind randomized clinical trial study was carried out on patients referred to emergency departments (EDs) due to isolated limb traumatic injuries. Eligible ...
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Objective: To compare the ketamine efficacy at a sub-dissociative morphine dose to reduce pain in isolated limb traumatic injuries. Methods: A double-blind randomized clinical trial study was carried out on patients referred to emergency departments (EDs) due to isolated limb traumatic injuries. Eligible patients were divided into two groups which one group received 0.1 mg/kg ketamine and the other group received 0.05 mg/kg morphine, intravenously. An observed side effect includes pain scores and vital signs were recorded at baseline of every 5 minutes for 30 minutes. Results: Totally, 73 patients with the mean age of 32.9±10.4 were enrolled of whom 59 (80.8%) individuals were men. The baseline characteristics difference of the two study groups was not statistically significant. The results showed that the change of mean pain score was -6.2 (95% CI: -5.72 to -6.69) points in the group receiving ketamine compared to -5.8 (95%CI: -5.15 to – 6.48) in the group who were administered morphine. At all assessed checkpoints, the pain mean score was lower in the ketamine group than in the morphine group (p <0.05); the mean of total pain reduction was greater in the ketamine group during the observation period compared with patients who received morphine (p=0.002). Conclusion: The study findings suggest that the sub-dissociative ketamine efficacy in controlling of the acute pain is not lower than morphine sulfate in patients with isolated limb trauma in ED’s. Thus, it can be considered as a safe and effective alternative approach.
Khodayar Oshvandi; Zahra Veladati; Marzieh Mahmoodi; Farshid Rahimi Bashar; Azim azizi
Volume 8, Issue 3 , July 2020, , Pages 156-162
Abstract
Objective: To determine the effects of foot massage on pain severity during in unconscious trauma patients admitted to the intensive care unit (ICU). Methods: In this randomized clinical trial (RCT), 80 unconscious trauma patients admitted in the ICU of a hospital in an urban area of Iran were ...
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Objective: To determine the effects of foot massage on pain severity during in unconscious trauma patients admitted to the intensive care unit (ICU). Methods: In this randomized clinical trial (RCT), 80 unconscious trauma patients admitted in the ICU of a hospital in an urban area of Iran were included using the convenience sampling method. They were randomly assigned to the intervention and control groups (n=40 in each group). In both groups, the intensity of pain was measured immediately, 10 minutes after the first change position and without any intervention before the change of position using the Critical Care Pain Observation Tool (CCPOT). In the intervention group, before the second position change, classic foot massage was performed for 20 minutes, but the control group received routine care. Pain was re-evaluated after the change position at desired times. The pain intensity was compared between the two study groups. Results: The baseline characteristics were comparable between the two study groups and no difference was found. There was no statistically significant difference between the mean scores of pain after the change of position (immediately and ten minutes later) before the intervention in the groups (p=0.915 and 0.660, respectively). However, after the intervention, the pain intensity was significantly lower in the intervention groups compared to the control group (p<0.001). Conclusion: Foot massage decreases the pain intensity related to the change of position in unconscious trauma patients admitted in the ICU. Due to its simplicity and low cost, this method can be used along with analgesic drugs to reduce pain in patients. Clinical trial registry: IRCT2016121031327N1
Masoud Hashemi; Payman Dadkhah; Mehrdad Taheri; Kasra Dehghan; Rohollah Valizadeh
Volume 7, Issue 2 , April 2019, , Pages 137-143
Abstract
Objective: To compare parasagittal interlaminar cervical epidural steroid injection (PSIL-CESI) and the classic midline interlaminar cervical epidural steroid injection (MIL-CESI) in terms of pain relief and functional improvement in patients with unilateral upper extremity radicular pain.Methods: This ...
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Objective: To compare parasagittal interlaminar cervical epidural steroid injection (PSIL-CESI) and the classic midline interlaminar cervical epidural steroid injection (MIL-CESI) in terms of pain relief and functional improvement in patients with unilateral upper extremity radicular pain.Methods: This was a randomized clinical trial being conducted in a single pain center in Tehran. Twenty-six patients were allocated into two groups of 13, undergoing either PSIL-CESI or MIL-CESI. After confirmation of radiocontrast spread in the epidural space by fluoroscopic guidance, dexamethasone 8 mg and bupivacaine 0.125% in a volume of 5 ml were delivered to the epidural space. Evaluation of functional state and pain intensity before and 1 month after the procedure was accomplished using the neck disability index (NDI) and the numeric rating scale (NRS) respectively.Results: Demographic and baseline characteristics of the cases showed no significant statistical difference. Improvements in the NDI and the NRS were observed in both groups; meanwhile, improvements were more pronounced in the PSIL-CESI group as compared to the MIL-CESI group (P<0.001). With the PSIL approach the ventral spread of radiocontrast was significantly higher (38%) than with the MIL approach (0.7%) (P<0.001). All patients in PSIL group showed radiocontrast spread ipsilateral to the painful side and all patients in the MIL group showed a midline distribution of radiocontrast.Conclusion: PSIL-CESI provides superior pain relief and improvement of functional disability in patients with unilateral upper extremity radicular pain in comparison to the classic MIL-CESI.Clinical trial registry: IRCT20180524039816N1
Masoud Hashemi; Payman Dadkhah; Mehrdad Taheri; Mahshid Ghasemi; Ali Hosseinpour
Volume 7, Issue 2 , April 2019, , Pages 144-149
Abstract
Objective: To evaluate the effectiveness of transforaminal lumbar epidural steroid injections (TFESI) in patients with unilateral radiculopathy due to lumbar intervertebral disc protrusion regarding pain intensity, functional disability, current opioid intake and patients’ satisfaction.Methods: ...
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Objective: To evaluate the effectiveness of transforaminal lumbar epidural steroid injections (TFESI) in patients with unilateral radiculopathy due to lumbar intervertebral disc protrusion regarding pain intensity, functional disability, current opioid intake and patients’ satisfaction.Methods: The study is conducted in a pain management center (Tehran, Iran), during 2018. Inclusion criteria were age ≥18 years, radiculopathy for more than 6 months due to imagine-proved lumbar intervertebral disc protrusion and no response to conservative treatments. Exclusion criteria were spinal canal stenosis, lumbar surgery, and inability to communicate in Persian language. During a phone call interview, cases were instructed to rate their pain intensity according to the visual analogue scale (VAS), functional ability, satisfaction according to the patient satisfaction score (PSQ) and report current opioid use and additional injection and/or surgery.Results: Forty-three (89.5%) of the 48 subjects were reachable for study with mean age of 59.14 years and 16 subjects were men (37.2 %). Mean VAS after intervention was 4.67 and before the intervention was 6.91 (p=0.002). Mean functional disability before intervention was 47.23 and after intervention was 37 (p<0.001). Mean patient satisfaction score was 3.07 while 18 cases reported a PSQ level ≥4. 10 cases reported using opioid for analgesia, 23 cases reported receiving additional TFESIs and 11 reported having undergone lumbar surgery.Conclusion: Lumbar Epidural steroid injection is an effective non-surgical treatment option with regard to pain relief and improvement in functional ability with an average patients’ satisfaction during 2 years follow up although nearly 25% of patients may need additional injections and half of the patients may finally proceed to surgery.
Fatemeh Jahanian; Seyed Mohammad Hosseininejad; Hamed Amini Ahidashti; Farzad Bozorgi; Iraj Goli Khatir; Seyyed Hosein Montazar; Vahideh Azarfar
Volume 6, Issue 1 , January 2018, , Pages 31-36
Abstract
Objective: To compare the effects of intravenous morphine and a low dose of ketamine on pain intensity of patients with traumatic fractures of the long bones.Methods: This randomized, controlled, double-blinded, clinical trial was conducted in the adult emergency department (ED) of Emam Khomeini hospital, ...
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Objective: To compare the effects of intravenous morphine and a low dose of ketamine on pain intensity of patients with traumatic fractures of the long bones.Methods: This randomized, controlled, double-blinded, clinical trial was conducted in the adult emergency department (ED) of Emam Khomeini hospital, a tertiary general hospital affiliated with Mazandaran University of Medical Sciences, in Northern Iran, during a 6-month period. Patients were randomly assigned to receive intravenous morphine (0.1 mg/kg) or low dose ketamine (0.5 mg/kg) for control of the pain in the emergency room. The pain intensity was checked by a nurse using the visual analogue scale (VAS) at 30, 60, 90, 120, 180 and 240, minutes after the intervention.Results: Overall we included a total number of 156 patients with mean age of 35.87±3.38 years. There were 111 (71.2%) men and 4 (28.8%) women among the patients. Patients were randomly assigned to receive intravenous morphine (n=78) or low dose ketamine (n=78). The pain intensity decreased significantly in both study groups after 240 minutes of intervention. However, there was no significant difference between the two study groups regarding the pain intensity at 30 (p=0.378), 60 (p=0.927), 90 (p=0.434), 120 (p=0.557), 180 (p=0.991) and 240 (p=0.829) minutes. The side effects were comparable while low dose ketamine was associated with higher need for rescue analgesic (p=0.036). Conclusion: The results of the current study demonstrates that the intravenous low dose ketamine leads to successful pain control in patients with long bone fractures and the effects are comparable with intravenous morphine.The study is registered with the Iranian Registry for Clinical trials (www.irct.ir; IRCT2017041221480N6)
Ashley K Losing; Justin M Jones; Adis Keric; Steven E Briggs; David D Leedahl
Volume 4, Issue 3 , July 2016, , Pages 165-169
Abstract
Ketamine is a promising alternative agent for pain control that offers benefit to traditional strategies, particularly in the setting of rib fracture. Current pharmacologic therapies have clear adverse effects, and other options may be invasive, cost prohibitive, or marginally effective. We describe ...
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Ketamine is a promising alternative agent for pain control that offers benefit to traditional strategies, particularly in the setting of rib fracture. Current pharmacologic therapies have clear adverse effects, and other options may be invasive, cost prohibitive, or marginally effective. We describe three consecutive patients with traumatic injuries including rib fracture for which a ketamine infusion was utilized as part of their pain control strategy. For each patient, use of a ketamine infusion trended toward reduced opioid requirements with stable pain scores. One patient experienced a dissociative adverse effect prompting decrease and discontinuation of ketamine. No pulmonary complications in the form of emergent intubation or new diagnosis of pneumonia were observed. We believe the addition of ketamine infusion to be a valid alternative strategy for managing pain associated with rib fracture.
Vahid Hattami; Sajjad Hatami; Khairolah Asadolahi; Mahtab Anvari
Volume 1, Issue 4 , October 2013, , Pages 152-157
Abstract
Objectives: To determine the effects of Meperidine (Pethedine®) on pain intensity, clinical findings, final diagnosis and management of patients with acute abdominal pain.Methods: This was a randomized clinical trial including 100 patients, with lower abdominal pain lasting for less than 48 hours ...
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Objectives: To determine the effects of Meperidine (Pethedine®) on pain intensity, clinical findings, final diagnosis and management of patients with acute abdominal pain.Methods: This was a randomized clinical trial including 100 patients, with lower abdominal pain lasting for less than 48 hours who were referred to the emergency department of Imam Khomeini hospital affiliated with Ilam University of Medical Sciences, over a period of 11 months. Hemodynamically unstable patients were not included in the study. The baseline pain severity was measured using a visual analogue scale (VAS). Patients were randomly assigned to receive 25 mg of intramuscular Meperidine (Pethedine®) (n=50) or 5 mL of intravenous normal saline as placebo intravenously (n=50). After 1-hour the patients were then re-examined and the pain severity was re-assessed and the clinical diagnosis was recorded.Results: There was no significant difference between two study groups regarding the baseline characteristics. The mean pain score on arrival was comparable between groups (6.80 ± 1.6 vs. 6.81 ± 1.2; p=0.956). The abdominal tenderness was not affected in Meperidine group. Rebound tenderness disappeared in 4% of the Meperidine group and in 2% of the placebo group. Nausea was decreased in 14% of the Meperidine group and 32% of the placebo group. Changes in the clinical pattern and diagnostic peritoneal signs in patients were negligible and did not significantly interfere with the diagnosis (p=0.133). Diagnostic accuracy was 96% in the Meperidine group and 98% in placebo group, which was not significantly different (p=0.554).Conclusion: Administration of Meperidine reduces pain intensity in patients with acute abdominal pain without interference with the clinical diagnosis. Thus analgesics could be safely administered to the patients with acute abdominal pain for increasing the patients comfort.
