Tehran University Medical Journal

Background: Cardiovascular diseases are the leading cause of human mortality worldwide. Myocardial ischemia is a type of cardiovascular disease that increases with age spread. Therefore, the purpose of this study was to compare non-invasive myocardial ischemia in patients with heart problems in different age groups.
Methods: This study is a causal-comparative study was conducted from July to October 2016 in the University of Mazandaran. One hundred and seventy-five (age=45-59 years) and 124 (age=60-77 years) men with heart problem participated in this study. The questionnaires of Rose angina pectoris (for assessing the risk of ischemic myocardium), lifestyle and physical activity level were completed by the participants. In addition, the anthropometric characteristics, blood pressure and peak oxygen uptake (VO2peak) of the participants were measured.
Results: The risk of myocardial ischemia in men aged 60-77 years was significantly higher than men aged 45-59 years (P=0.049). Men aged 60-77 years were significantly lower in good indices (physical activity level, VO2peak and more lifestyle indices) and higher in bad indicators (waist/hip ratio, body shape index, ankle systolic blood pressure, brachial systolic and diastolic blood pressure) than men aged 45-59 years (P<0.031, for all variables). Also, there was no significant difference in the risk of ischemia between groups, when they were similar in physical activity level.
Conclusion: It seems that the higher risk of myocardial ischemia in men aged 60-77 years, as compared to men aged 45-59 years, might be related to aging process and imbalance in the risk factors. Promoting physical activity can favorably affect the risk of myocardial ischemia in the middle-aged or elderly men. It is concluded that physical activity effectively decreased the risk of myocardial ischemia.

Background: Tenderness, pain, muscle weakness, and limited range of motion (ROM) are symptoms of myofascial pain syndrome, which leads to restrictions on physical, occupational and social activities and ultimately reduction of productivity and quality of life. Different methods of rehabilitation are used to improve the symptoms of these patients. One of the new methods is the use of kinesio tape. The aim of this study was to evaluate the effect of kinesio tape on neck pain and disability and also muscle strength in myofascial pain syndrome.
Methods: In this single-blind randomized clinical trial, from June to November 2017 in Imam Hossein Hospital of Mashhad, Iran, thirty individuals (male and female) with Myofascial pain syndrome were divided into two groups (treatment and control), randomly by lottery. In treatment group, the kinesio tape with appropriate tension was applied directly over pain place and on upper trapezius muscle; and control group received placebo kinesio tape (kinesio taping without tension). In this study, before and three days after application of kinesio taping, numerical pain rating scale (NPRS), neck disability index (NDI) and manual muscle testing (MMT) were used to assess pain, disability and strength, respectively.
Results: To compare the effect of treatment, the mean of variables were compared with independent sample t-test before and after treatment. Pain and strength of upper trapezius were significantly different in both groups (P< 0.05), but in neck disability there was not significantly difference (P< 0.05). Then, for a closer examination, the paired t-test were used to compare the mean of disability before and after the treatment and result showed a significantly different in the treatment group and was not significantly different in the control group.
Conclusion: According to the results of this study, kinesio tape can reduce neck pain, increase the strength of upper trapezius, and ultimately reduce the disability of neck in myofascial pain syndrome. Therefore, this method can be used in rehabilitation clinics to improve the symptoms of patients with myofascial pain syndrome.

Background: It is important to use reliable, valid, and responsive instruments to assess the treatment outcomes. The functional rating index (FRI) is a patient reported outcome measure to assess the pain and function in patients with neck and low back pain. The FRI has been translated and culturally adapted into Persian language. The purpose of this study was to investigate the responsiveness of Persian functional rating index in patients with chronic non-specific neck pain (CNSNP).
Methods: The adult patients with CNSNP recruited from Shariati Hospital in Tehran and filled the Persian functional rating index (PFRI), Persian neck disability index (PNDI), and pain numerical rating scale (NRS) before and after 10 physiotherapy sessions, from March to July 2017. The patients completed the global rating change scale after treatment. For statistical analyses, the effect size (ES), standardized response mean (SRM), Guyatt response index (GRI) were used. The Spearman or Pearson test was used for correlation analyses. The area under the receiver operating curve (ROC) and minimal clinically important difference (MCID) were calculated.
Results: In this study, 30 patients (female 17) with a mean of age 45.6 years [standard deviation (SD) 13.8] participated. The mean duration of neck pain was 14.7 months (SD 12.8). Significant strong and moderate correlations were identified between PFRI with PNDI and GRC scores (r= 0.78 and r= 0.69). The respective ES and SRM values were 0.73 and 0.78 for PFRI. The GRI was 5.58. The AUC was 0.89 (P= 0.001). MCID was 11.7%.
Conclusion: This study confirms that the Persian functional rating index is responsive for assessing disability in Persian speaking patients with chronic non-specific neck pain.

Background: Ovarian fibroma is the most common benign solid tumor of the ovary. The most common symptoms are abdominal discomfort and pain. Ovarian fibroids are associated with Meigs syndrome in 1% to 10% of cases. The aim of study is report of a case of Meigs syndrome
Case presentation: A 65-year-old menopausal woman who complained of abdominal pain was referred to our academic hospital of Mashhad, Iran, in April 2018. In abdominal examination, a soft mass with size of 200×100 mm, was detected. Also leukocytosis and increase in CRP was observed. Marker CA125 was higher than 200. In CT scan in right adnexa heterogeneous mass 170×100 mm with enhancement was reveled. pleural effusion was reported in the both lungs and collapse of underlying lung tissue in Chest X-ray. Explorative laparotomy was performed. Ascites and inflamed omentum covered the surface of right ovary was detected. The huge solid-cystic hemorrhagic, irregular mass with a specific pedicle that enclosed in the capsule in right adnexa was seen. Right salpingo-oophorectomy was performed. The result of final pathologic was benign proliferative lesions of mitotic fibroblasts were reported according to ovarian fibroma.
Conclusion: In case of accompanying ovarian mass with ascites and pleural effusion, after the exclude of ovarian malignancies, Meigs syndrome should be considered in differential diagnosis.

Background: Animals have an internal biological clock with melatonin hormone that helps them to adapt to light/dark circles. Since melatonin is associated with an alteration in the expression and production of opioid receptors, this study aimed to evaluate the effect of changes in the light/dark circles on pain sensation in rats.
Methods: This research study in order to investigate the thermal and chemical pain sensation using tail flick and formalin tests, 35 Wistar rats were randomly divided into five groups of seven animals, including 24 hours of light (24L), 16 hours of light / 8 hours of darkness (16L/8D), 12 hours of light / 12 hours of darkness (control), 8 hours of light / 16 hours of darkness (8L/16D) and 24 hours of darkness (24D) were tested. The study was conducted at the Department of Biology of Ferdowsi University of Mashhad, Iran, from April to September 2015. Also besides the Rotarod test was performed to determine the general motor activity of animals.
Results: In the tail flick test, an increase in the time of darkness elevated the threshold of thermal pain and subsequently resulted in analgesic effect in the 24 hours of darkness (24D) group (P=0.03), while reducing the dark period in the group of 16 hours of brightness / 8 hours of darkness caused a reduction in the threshold of thermal pain, resulting in hyperalgesia (P=0.002). In the formalin test, the chemical pain score at the end of the chronic phase was significantly increased in the experimental group of 16 hours of brightness / 8 hours of darkness compared to control, indicating hyperalgesia (P=0.03).
Conclusion: Perhaps, alterations in light duration may change the production of melatonin and opioids and their receptors. Therefore, it is expected that reduction of the duration of darkness and thus shortening the period of increased production of melatonin and the subsequent lower expression of opioid receptors, in this group, resulting in a lower thermal pain threshold and analgesic response.

Background: A major problem in surgical procedures is postoperative pain. The effectiveness of prescribing preoperative tizanidine in reducing postoperative pain is not clear. The aim of this study was to determine the efficacy of tizanidine as a premedication in reducing pain after septoplasty.
Methods: This double blind clinical trial study was performed in 71 patients aged from 18 to 50 years, undergoing septoplastic surgery for the first time, who were classified in ASA (American Society of Anesthesiologists) classes 1 and 2 in the Ear, Nose, and Throat (ENT) Department of Shafa Hospital, in Kerman, Iran from April 2014  to March 2015. Patients were randomly assigned into two groups using numbers from a randomization table. A dosage of 4 mg of tizanidine was administered orally to the patients two hours before the surgery (septoplasty) in the intervention group. In the control group, placebo pills which were 100 mg vitamin B1 were prescribed. The severity of pain was measured and recorded after 4 and 8 hours, and the morning after the surgery.
Results: 62 patients (87.32%) were male and 9 (12.68%) were female. The mean age of the subjects was 24.6±7.5 years. The two groups were similar in regard to age (P=0.54), but the duration of surgery was different in the two groups (P=0.038) and was longer in the group that received tizanidine. The mean of pain was different between the two groups, after 4 hours and was significantly higher in the group that received tizanidine (P=0.043). The mean of pain was not significantly different between the two groups after 8 hours (P=0.95) or one day after surgery (P=0.79).
Conclusion: Although some researchers have reported that taking tizanidine before some surgeries may reduce postoperative pain, in this study the administration of tizanidine before surgery was not effective in reducing pain after septoplasty. 

Background: Oxford Shoulder Score (OSS) is a specific questionnaire for the assessment of pain and function in subjects with shoulder pain. The reliability and validity of the Persian version of this questionnaire have been shown previously. But its responsiveness has not been investigated yet. This study aimed to determine the Persian OSS responsiveness in subjects with shoulder pain.
Methods: This was a prospective cohort study design conducted in the Physiotherapy Clinic, School of Rehabilitation, Tehran University of Medical Sciences in 2018.  Thirty-one subjects with shoulder pain (20 females and 11 males) with a mean age of 50±15.3 participated in this study. They completed the Persian OSS, Disability of Arm, Shoulder & Hand (DASH) questionnaire, and Visual Analog Scale (VAS) before and after 10 physiotherapy sessions. After the 10th session, the Global Rating of Change (GRC) was also completed. The statistical analysis included the Effect Size (ES), Standardized Response Mean (SRM), and the Spearman or Pearson correlation coefficients.

Background: The endocannabinoid system interacts with the vanilloid and opioid systems. The current study aims to investigate the effects of the extract obtained from the heated Cannabis Sativa female flower base either with capsaicin at the spinal cord level or naloxone at the systemic level on the intensity of chemical and thermal pain sensation.
Methods: This experimental study was performed in the Department of Biology at Ferdowsi University of Mashhad from April 2014 to March 2015 using adult male Wistar rats (200-250 g) categorized into groups of 7 animals. In addition to the control and sham (solvent of chemicals) groups, groups with intraperitoneal administration of 50 mg/kg of the hydroalcoholic extract, 2 mg/kg of naloxone alone and naloxone together with extract were investigated. Moreover, intrathecal administration groups including the concentration of 0.01 mg/ 10 μl of extract, the concentration of           0.002 mg/10 μl of capsaicin alone and the extract together with capsaicin were evaluated. To measure the thermal pain threshold, a tail-flick test was used and to measure the chemical pain intensity, the formalin test was utilized. The obtained data were analyzed statically.

Results: Intrathecal administration of the extract together with capsaicin led to a significant reduction of thermal hyperalgesia (P<0.001) and chemical hyperalgesia (P<0.001) induced by intrathecal administration of capsaicin. On the other hand, intraperitoneal administration of naloxone together with the extract did not effect on the thermal pain threshold. While the administration of naloxone increased the severity of chemical pain during the acute phase compared to the group treated with the extract alone (P<0.01). Conclusion: The phytocannabinoids of the flower extract may have inhibited capsaicin-induced hyperalgesia via cannabinoid receptors activation and the TRPV1 receptor desensitization. Naloxone administration has also been able to attenuate the analgesic effect of hydroalcoholic flower extract during the acute phase of chemical pain. Probably the extract is thought to exert part of its effect on pain through opioid receptors.

Classifying patients with low back pain into homogeneous and distinct categories by organizing similar manifestations among individuals can be helpful to attain better results for treatments. Providing homogenous categories of patients with low back pain would improve benefits produced by treatments. To gain a greater understanding of the proposed multi-stage process and validate diagnostic categories, the current research was designed to conduct a review about this process. We aimed to validate movement system impairment (MSI) based categories of people with chronic low back pain. MSI-based classification uses a standardized approach for classifying people with low back pain into 1 of 5 subgroups. For the present narrative review, computerized databases of EMBASE, Google Scholar, MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed and Science Direct were searched for articles published between January 1990 and December 2018. For electronic searches, keywords and terms used were: “Reliability”, “Validity”, “Classification”, “low back pain" and “Human Movement System”. Fourteen full-text research reports that have been undertaken to add clinical, laboratory and outcome validity to MSI-based classification of low back pain were included in the review. Five studies were categorized as clinical validity studies which investigated the accuracy of examinations for patients with low back pain, 5 studies categorized as laboratory validity studies and 4 studies categorized as outcome validity studies which included randomized control trials. The results of this review revealed that novice users can learn the diagnosis algorithm of MSI-based categories of low back pain and by practicing, their inter-tester reliability and precision in applying the classification algorithm would be comparable to that of described for experienced expert raters. The laboratory-based tests, including 3D motion analysis, indicated that there are differences in movement patterns of the lumbar spine between low back pain subgroups. Also, for people with low back pain, classification-specific treatments based on the MSI model resulted in better outcomes. In conclusion, this review indicated the validity of the MSI classification system in people with chronic low back pain.

Background: Bier block is a reliable technique used in extremity surgeries. Typically, angiocatheters are palced in the distal portion of the extremity that is going to be operated. Although, it is not the case in every operation. Therefore, determining the effectiveness of the local anesthetic injection site on the quality of the upper-extremity block can be helpful.
Methods: In this double-blinded randomized clinical trial that took place in Kowsar Hospital (Sanandaj, Iran) at 2020, 60 patients after complete monitoring and sedation were assigned randomly into proximal bier block (32 in experimental) and distal bier block (28 in control) groups. 10ml/kg Ringer serum was prescribed for patients in both groups on the non-surgical hand. Depending on the patients’ placement in either group, an angiocatheter (22 or 24) was attached to the ante-cubital area (proximal bier block group) or on the back of the patient's hand (distal bier block group). Respectively, after blood was drained by a Smarch band from the extremity that was to be operated, the tourniquet was inflated up to 150mmHg above the patient’s systolic pressure and the smarch band is untied from the hand. For every patient regarding the group they were assigned, 3mg/kg lidocaine 0.5% was administered through an angiocatheter. After 5 minutes, the depth of patient's anesthesia and pain intensity were measured. Sensory and motor recovery was assessed every 10 minutes after surgery. Patient satisfaction with anesthesia was measured after the surgery and characterized by excellent, good, moderate (pain relief), and unsuccessful (need for pain medications) indicators. In case insufficient depth was reached, intravenous Remifentanil was injected.

Background: Spinal anesthesia is a type of neuraxial anesthesia that brings ample benefits. However, due to the fear of this type of anesthesia, many pregnant people refuse to experience it. In this study, we aimed to investigate the levels and causes of fear of spinal anesthesia in candidates for cesarean section.
Methods: The current study is a cross-sctional study performed on 67 patients undergoing cesarean section who were referred to the operation room of Shariati Hospital, in Tehran from September 2018 to September 2019. Matthey questionnaire, which consisted of three sections (demographic information, history of spinal anesthesia and fear of anesthesia), was filled out by candidates and after collecting information, the data were analyzed by SPSS software.

Today surgery is supposed as the cure for many diseases and the fear of post-operation pain burdens stress over the patients. Postoperative pain can, especially if severe, complicate the patient's condition and may lead to chronic postoperative pain. post-operation pain control is effective in the recovery process, hospitalization period and patients’ satisfaction. Insufficient post-operation pain control increases complications and care costs. Local analgesia is one of the components of multimodal postoperative. analgesic protocol to control pain. Local analgesia technique is a simple, accessible and feasible method for various surgeries. The opioid analgesics to control post-operation pain are associated with some complications such as opium addiction, nausea and vomiting, late return of bowel function and social costs. This review study aims. to review previous studies on the effect of injection of analgesic agents in the surgical incision in post-operation pain control. This is a Narrative review study. to related scientific documentaries a search was conducted in Persian and English using the keywords of local injection of the incision site, wound infiltration with analgesic agents and post-operation pain control in Google scholar, PubMed and Scopus database during the years 2000 to 2020. The obtained articles included systematic reviews, Meta-analyses and randomized clinical trials (RCT). We reviewed studies that had utilized single-dose injection of analgesic agents in surgical incisions at the end of surgery to control post-operation pain. A total of ten studies were reviewed. There were 4 studies in the field of laparoscopic gynecological and non-gynecological surgeries, three studies in the field of laparotomy and three review studies. injection of analgesic agents in the surgical incision to control post-operation pain is easily available and does not necessitate any special skill. On the other hand, it is a safe method without further complications and does not increase the duration of surgery. Regardless of the differences in various studies and the kind of analgesic agents, a general reduction in pain severity and consumption of opioid and non-opioid analgesic agents were observed using the injection of analgesic agents in surgical site incision.

Background: One of the most important issues for patients with osteoarthritis is reducing pain and returning them to normal life. In addition to losing weight and improving daily activities, pain management treatments may be needed. One of these treatments is the injection of hyaluronic acid gel into the knee joint, which has been studied in this study.

Background: Cataracts are the leading diseases that cause blindness. Cataracts can be treated with surgery. Pain, itching, burning, and a foreign body sensation in the eye are common ocular complaints of patients in recovery. In this study, we compared the effect of Ketorolac eye drops and naphazoline antazoline eye drops on reducing complaints of surgery.
Methods: This randomized clinical trial study was performed from February 2016 to March 2017 on patients who were candidates for cataract surgery at Feyz University Hospital in Isfahan, Iran.  In this study, 54 patients were enrolled in two groups receiving Ketorolac eye drops and naphazoline antazoline (NA) eye drops. After the operation, patients' ocular complaints such as burning, itching, pain, and severity were evaluated every 15 minutes in recovery and every half hour in the ward until discharge from the hospital.
Results: In this study, 54 patients in two groups of 27 were studied. In the post-anesthesia care unit, the burning sensation in the naphazoline-antazoline group was significantly lower than in the ketorolac group (P=0.02). Patients in the NA group had less foreign body sensation in the eye in recovery (P=0.97) and the ward (P<0.001) than in the ketorolac group. Mean Pain intensity in the recovery unit (P=0.39) and ward unit in the ketorolac group were less than NA (P<0.001). In the recovery unit in the NA group, the eye-burning sensation was significantly lower than in the ketorolac group. The foreign body sensation in the NA group was less than the ketorolac group but there was no significant difference between the two groups. In the NA group, itching of the eyes was less than in the ketorolac group.
Conclusion: It can be concluded that ketorolac drops have been more effective in reducing post-operative eye pain than NA and NA drops have been more effective in reducing burning, itching and foreign body sensation in the eyes than Ketorolac.

Background: There are many conservative interventions to reduce the symptoms of coccydynia, but it is not clear which treatment can be more effective. The aim of this review study was to evaluate the types of conservative interventions and the effectiveness of each of them in reducing coccydynia symptoms.
Methods: This systematic review was carried out based on PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) instruction. A search for research studies published up to October 2021 was conducted in Neuromusculoskeletal Research Center, Firoozgar General Hospital, Iran University of Medical Sciences, Tehran, Iran, using Scopus, Science Direct, Web of Knowledge and Cochrane without data constraints. The search was carried out in October 2021 and continued for seven months. The quality of the articles was evaluated using the Physiotherapy Evidence Database scale (PEDro). All prospective randomized clinical trial studies in which participants suffered from coccydynia  and were treated with nonsurgical treatments  were included.

Results: 945 articles were found in the primary search of the databases. After eliminating 493 repetitive papers, 452 studies remained which were screened by the two researchers of this study in terms of the title and abstract. 40 studies were selected for full-text evaluation. Finally, 12 articles were included in the review study. Two papers used extracorporeal shockwave, two papers used impar ganglion block, three papers manual therapy, and four studies injection. The remaining four studies used iontophoresis with ketoprofen, biofeedback therapy, acupuncture, and physiotherapy with Kinesio taping. Conclusion: Treatment with extracorporeal shock wave and impar ganglion block significantly improve tailbone pain and show more permanent effects on patients' symptoms. Manual therapies are mostly used in cases where the tailbone is stable. It seems that achieving the desired response requires more than six sessions, which is not pleasant for patients. Injections, especially those performed under fluoroscopic guidance, require high skill in addition to being unpleasant and painful. However, this procedure is done in one session, so there is no need for the next visit.

Background: Fine needle aspiration biopsy (FNAB) is usually used to distinguish the malignant and benign nodules. Applying a biopsy needle evokes a sense of fear and pain in the patients. Although some studies refute the usefulness of local anesthesia (LA) prior to fine needle aspiration biopsy, it is still debatable. This prospective cross-sectional study intended to evaluate the effect of LA prior to fine needle aspiration biopsy on pain and anxiety considering nodule size.
Methods: Amongst the patients who were referred to Shiraz Shahid Fagihi Hospital for Thyroid fine needle aspiration biopsy from August 2017 to January 2018, 114 patients participated in this study. LA was performed for 41 patients, and 73 underwent the thyroid nodule fine needle aspiration biopsy without LA. Patients' pain and anxiety were scored using the visual-analog-score and Spielberger anxiety scale. The nodules were categorized into five groups. Pain and anxiety of patients were compared considering their nodule sizes to assess the effects of LA in the reduction of pain and anxiety considering the nodule size.

Results: The patients undergoing LA had a mean age of 44.69 years old and average body mass index (BMI) of 26.7, the patients who performed thyroid nodule fine needle aspiration biopsy without LA had a mean age of 48.17 years old with an average BMI of 26.0. The patients with the maximum nodule size of<10 mm, experienced more pain during the fine needle aspiration biopsy without LA, but there was no significant difference between the S/T-anxiety of these patients. There was no significant difference between the pain and anxiety scores of the patients with larger nodules. Conclusion: The more pain experienced by the patients with the smallest nodules can be attributed to the need for more needle manipulation due to the small nodule size and less precision while piercing the needle into the nodule. Thus, it can be suggested that in patients with a small nodule size, less than 10mm, usage of LA prior to fine needle aspiration biopsy can reduce the pain significantly.

Background: Chronic low back pain (CLBP) is one of the most common spine disorders, which is seen in 65-80% of people. Knowing the normal patterns of spine and pelvic parameters is very helpful in determining the susceptible subjects for CLBP.
Methods: This study was conducted in healthy people during April 2017 until April 2018 in Golestan hospital of Ahvaz. Inclusion criteria include; Age group 20-65 years, no history of surgery, spine disorders, and having normal radiographs were performed. People who have complained of back pain in the last three months, neuromuscular disease, lumbosacral anomalies, kyphosis and obvious scoliosis, history of spine surgery and vertebral fracture, were excluded. A 36-inch radiology stereotype was prepared in the standing position. Pelvic and spine parameters that were investigated in this research included the following, Pelvic incidence, Pelvic tilt, Sagittal Vertical Axis, T9 Sagittal Angle, Thoracic Kyphosis, Lumbar Lordosis, and Sacral Slope. All data were analyzed with SPSS software, version 24 (SPSS Inc., Chicago, IL, USA).

Results: 50 participants including 27(54%) men and 23(46%) women with an average age of 33±12.5 years and BMI of 25±5.5 kg/m2 were examined. After examining the vertebral and pelvic parameters, it was found that PI is significantly higher in women than in men (P=0.02). It was also found that with increasing age, the amount of Pelvic incidence also increases (P=0.043), so that in people over 60 years of age, the amount of pelvic incidence is significantly higher than other people (P<0.05). Further analyzes showed that BMI has a direct effect on the amount of Thoracic Kyphosis (P=0.03) and Lumbar Lordosis (P=0.04). Thus, the highest amount of Lumbar Lordosis and Thoracic Kyphosis was seen in people with BMI 30-34.9 Kg/m2. Conclusion: The findings of the present study showed that spine and pelvis indices have an important effect on the occurrence of CLBP. Hence, it is highly recommended to check these parameters in asymptomatic people, especially in older people.

Background: In this study, the effect of intravenous dexamethasone on pain, nausea and vomiting after laparoscopic ovarian surgery was investigated.
Methods: This randomized clinical trial was conducted from June 2019 to March 2019 on patients undergoing laparoscopic ovarian cystectomy in Beheshti Hospital, Isfahan. In this study, 88 patients aged 18 to 45 years were included in the study. Patients were randomly divided into two groups receiving dexamethasone (D) and normal saline (S). Two minutes before induction of anesthesia, the first group received 8 mg (2 ml) of dexamethasone and the second group received normal saline (2 ml). The duration of surgery and stay in recovery, the frequency of pain and nausea and vomiting, the need for analgesic and anti-nausea drugs, and the cardiovascular response during the study were evaluated and recorded.

Results:  No significant difference was seen in terms of demographic characteristics between the two groups (P>0.05). The frequency of pain during recovery (P=0.4) was not significantly different between the two groups, but at 2 hours (P=0.005), 12 hours (P<0.001) and 24 hours after the operation (P=0.005) (P=0) was significantly lower than S group. The frequency of nausea in group D during recovery (P=0.003), 2 hours later (P<0.001), and 12 hours (P=0.002) was significantly lower than group S, but 24 hours after the surgery, there was no significant difference between the two groups (P=0.15). During recovery, there was no vomiting in both groups (P=1), the frequency of vomiting in 2 hours (P=0.003), 12 hours (P<0.002) and 24 hours after the operation (P=0.48) in group D was lower than S. At the time of the study, the dose of diclofenac and metoclopramide received in group D patients was lower than group S. There was no significant difference in cardiovascular response between the two groups during the study (P>0.05). Conclusion: Dexamethasone with a dose of 8 mg before induction of anesthesia can be effective in reducing pain, nausea and vomiting after laparoscopic ovarian surgery and reducing the need for analgesics and anti-nausea drugs.

Background: Due to the prevalence of laparoscopic cholecystectomy, controlling common problems after this surgery is essential. This study aimed to determine the factors affecting pain after laparoscopic cholecystectomy.
Methods: In this cross-sectional study, 222 patients over 18 years old with symptomatic gallstones who underwent laparoscopic cholecystectomy from March 2021 to February 2022 in Mashhad Medical Sciences of Islamic Azad University Hospitals, were included. The amount of analgesic received after surgery was the same for all patients (Acetaminophen 1 gram intravenously every 8 hours and diclofenac 100 mg rectal every 8 hours). Demographic information of patients, body mass index, history of abdominal surgery, duration of surgery, carbon dioxide pressure, type of surgery (elective or emergency), number of surgical incisions, and pain intensity six and 24 hours after surgery (using a visual analog scale) were collected, and finally, the findings were statistically analyzed by SPSS version 26.

Results: Out of 222 patients, 179 cases were women (80.6%), and their average age and body mass index were 44.68±12.27 years and 27.08±4.7 kg/m2, respectively. In our study, 110 people (49.5%) had a history of abdominal surgery, of which cesarean section was the most common delete. Pain six and 24 hours after the operation was more common in women than in men, and surgery with three incisions was more painful than surgery with four incisions (P<0.05). In patients with a history of surgery, the pain was greater in six hours after surgery (P<0.05). Pain 24 hours after the operation in patients with gas pressure less than or equal to 14mmHg was greater than in patients with gas pressure greater than 14 mmHg (P<0.05). Pain six and 24 hours after surgery according to age, body mass index, type of surgery (emergency or elective), and duration of surgery had no statistically significant difference (P>0.05). Conclusion: In our study, female gender, use of three incisions for surgery, and history of previous surgery were associated with more pain after laparoscopic cholecystectomy.