Showing 8 results for Orthopedic
H.r Amiri, J Makarem, S Beiranvand,
Volume 66, Issue 5 (8-2008)
Abstract
Background: post operative pain is an essential problem. Epidural infusion of two different doses of bupivacaine in pain management of post orthopedic surgeries was studied.
Methods: In this double blinded randomized clinical trial we studied two groups of 42 patients undergone knee surgery. Based on block randomization, patients received two different concentration of bupivacaine (0.1% or 0.125%) in combination with fentanyl (1.7µg/ml). The beginning infusion rate was 5ml/h. Pain scores were documented by a blinded researcher 6, 12, 18, 24 and 48 hours after completion of surgery according to VAS tool. Patient satisfaction, complications and treatment failure (when increased volume of epidural infusion or other analgesics were required) were evaluated.
Results: In higher bupivacaine dose group, post operative pain scores were not significantly lower in different hours and during the follow up (both p values less than 0.001). After 48 hours, patients satisfaction were more in the higher bupivacaine group. There were no significant differences in complications. Treatment failure was more significant in lower bupivacaine dose (33.3% versus 11.9%, p=0.03).
Conclusion: continuous epidural infusion of both bupivacaine and fentanyl provide acceptable post operative pain control in orthopedic patients. Although higher concentrations of bupivacaine during first hours are more effective, lower concentrations are as effective as the higher one, during subsequent hours.
Kamran Aghakhani , Ebrahim Ameri , Maryam Ameri , Seyed Ali Mohtarami ,
Volume 73, Issue 1 (4-2015)
Abstract
Background: Orthopedic trauma is a common type of injury in children and may cause deep and permanent psychological and physical damage both for the patient and the parents. This study aimed to analyze the epidemiology age, gender distribution and the mechanism of injury in patients presenting to a level I trauma center in urban population of Tehran. Methods: In this prospective descriptive study, the patients under 19 years old with orthopedic trauma who were hospitalized in Tehran Shafa University Hospital were entered. This hospital is the main orthopedic referral center in Iran. The patients were prospectively evaluated from April 2013 to March 2014. The data were collected and analyzed. Results: The study included 1081 patients under 19 years old. There was a male predominance (76.8% n= 830). The boys had a higher mean age 11.04±5.06 year, versus girls with mean age 8.67±4.63 year (P< 0.05). The peak age of boys was 18 and the girls had two peaks at three and nine. The fractures occurred in upper limb in 70.8% (n= 621) and 29.2% (n= 256) in lower limb of patients. There were 27 cases with joint dislocation, 5 cases with knee ligamentous injuries, 128 cases with soft tissue injuries and 44 cases with spine injuries. The most frequent mechanism in both gender were falls from standing position (48.5%). The most common fractures were foreman both bone fractures (n: 146 16.7%), elbow supracondylar fractures (n: 134, 15.3%) and distal radius fractures (n: 84, 9.6%). The most fractures occurred in summer (30.1%) and the least in winter (18.1%). Conclusion: Evaluation of epidemiologic factors can lead to the best prediction and treatment planning of trauma. Early recognition of injury, even minor, and expected care using specialized teams will help to improve outcomes for these patients. This study determines the most at risk children for trauma and fractures and may help the parents to prevent damage.
Naeemeh Kalali, Sogand Mirshah, Mohammad Hossein Ebrahimzadeh , Bibi Fatemeh Kalalinia, Ali Moradi, Azar Gharib, Nafiseh Jirofti ,
Volume 81, Issue 12 (3-2024)
Abstract
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For over 50 years, bone cement has been used to strengthen artificial joints like hip, knee, shoulder, and elbow joints. The main purpose of bone cement is to fill the space between the prosthesis and the bone. This absorbs the forces on the joint by creating an elastic area. Besides ensuring the long-term stability of the artificial implant, it also improves the damaged bone. Polymeric bone cement consists of a polymer matrix known as polymethyl methacrylate (PMMA) and a liquid monomer called methyl methacrylate (MMA). When these two components are mixed, a free radical polymerization reaction occurs, leading to the cement's hardening at the place of use. The properties of bone cement, such as mechanical strength, biocompatibility, and handling characteristics, can be adjusted by combining the effective polymerization parameters. However, there are some challenges, such as heat generation during polymerization.
Ceramic bone cement is a composite material of ceramic particles dispersed in a polymer matrix, including calcium phosphate and calcium sulfate. The ceramic particles provide strength and bioactivity, while the polymer matrix enhances the transport properties of the cement. This combination results in a mechanically stable, bone-conductive, and biocompatible cement. Moreover, ceramic bone cement can be engineered to release therapeutic agents, such as antibiotics or growth factors, to prevent infection and foster bone regeneration. Ceramic bone cement is a promising alternative material for bone cement in joint replacement. However, more research and development are required to optimize the properties of bone cement and overcome the challenges associated with its use. With continued advancements in biomaterials, ceramic and polymer bone cement could revolutionize the field of orthopedic surgery and improve patient outcomes. Recent research has focused on developing new bone cement with improved properties like bioactivity, antibacterial activity, and drug delivery capabilities. These developments aim to enhance the performance of bone cement and remove the current limitations in orthopedic applications. In this review study, we will focus on the types of bone cement, their mechanical, biological, and structural properties, and how to optimize them.
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Seyedeh Roya Mousavi , Parvaneh Ebrahimzadeh, Sepideh Yazdanpanah , Nasim Alsadat Mousavi, Mansour Deylami ,
Volume 82, Issue 4 (7-2024)
Abstract
Background: Today, addiction is a major problem in modern society, which affects the management of patients during anesthesia. In patients with long-term use of opioids, higher doses of opioids are needed to create analgesia and control pain during and after surgery. Also, addicted patients have more resistance to local anesthetic drugs when they are used to perform peripheral and central nerve blocks. Therefore, many drugs are added to local anesthetics to enhance their analgesic properties, one of the most common of which is narcotic compounds. Itching caused by opium may be generalized and often occurs shortly after injection. Therefore, this study aims to investigate the amount of itching caused by intrathecal injection of fentanyl in opium addicts who undergo elective orthopedic surgeries of the lower limbs with spinal anesthesia. have been taken, designed and established.
Methods: This study was a double-blind clinical trial conducted on 68 patients who were candidates for elective lower limb orthopedic surgeries under spinal anesthesia and referred to 5 Azar Hospital in Gorgan in 2023. Patients were divided into two groups using random numbers table, Intervention (a group of addicted patients who received intrathecal marcaine together with fentanyl for spinal anesthesia) and control (a group of addicted patients who received only intrathecal marcaine for spinal anesthesia). Pruritus, nausea and vomiting were measured in both groups. Data analysis was done using descriptive statistics and inferential statistical tests.
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Results: In terms of age, gender, and BMI, there was no statistically significant difference between the intervention and control groups. There was no statistically significant difference in the incidence of nausea and vomiting between the two groups. The incidence of itching was zero in the bupivacaine group and 17.6% in the fentanyl and bupivacaine group, of which 3% required anti-itch medication for treatment.
Conclusion: The results of this study showed that due to the low incidence of pruritus in the group using fentanyl along with bupivacaine, its use is beneficial in people with drug addiction.
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Navid Kalani , Hasan Zabetian, Shahram Shafa, Erfaneh Alirezai, Fatemeh Eftekharian, Reza Sahraei ,
Volume 82, Issue 4 (7-2024)
Abstract
Background: Recently, epinephrine is used to increase the depth and duration of local anesthetic pain, and it is widely used topically to reduce local anesthetic release and reduce bleeding caused by surgery.
Methods: This study was a randomized, double-blind clinical trial on 30 patients aged 18 to 85 years undergoing lower limb orthopedic surgery referred to Peymaniyeh Hospital in Jahrom from September to December 2022. Patients were randomly assigned to two groups, A (epinephrine+fentanyl+bupivacaine) and B (bupivacaine+fentanyl). Systolic blood pressure, diastolic pressure, mean arterial pressure, arterial blood oxygen saturation percentage, and pulse rate were measured and recorded before drug administration, before spinal anesthesia, after anesthesia, and then every half hour until the end of surgery (15, 45, 30, 60, 75, 90, 120) and during recovery. Data analysis was performed using SPSS version 21 software and descriptive (mean, standard deviation) and inferential statistics (t-test, chi-square, Mann-Whitney, Friedman) at a significance level of P<0.05.
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Results: Thirty patients aged 18 to 85 years (in two groups of 15) with anesthesia class I and II undergoing lower limb orthopedic surgery were evaluated. The study groups are matched in terms of age and gender variables. There was no significant difference in mean systolic, diastolic, mean arterial blood pressure, and heart rate before and after anesthesia, 15, 45, 30, 60, 75, 90, and 120 minutes after drug injection, and at entry and exit from recovery between the Epinephrine+Fentanyl+Bupivacaine and Fentanyl+Bupivacaine groups. There was a significant difference in mean O2SAT before anesthesia, 15, 30, and 75 minutes after drug injection between the epinephrine+fentanyl+bupivacaine and fentanyl+ bupivacaine groups (P<0.05).
Conclusion: The use of the combination of epinephrine+fentanyl+intrathecal bupivacaine compared to the combination of fentanyl+bupivacaine did not have a significant difference in the studied variables of patients' vital signs.
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Kazem Kazemnejad, Parvaneh Ebrahimzadeh, Seyedeh Roya Mosavi, Mansour Deylami ,
Volume 82, Issue 6 (9-2024)
Abstract
Background: Shivering is one of the side effects of anesthesia that occurs both in general anesthesia and regional anesthesia. Ketamine, as an N-methyldiaspartate receptor antagonist, may prevent shivering after spinal anesthesia by reducing central heat distribution to the environment. Therefore, the purpose of this study is to investigate the effect of ketamine in preventing tremors after spinal anesthesia in lower limb orthopedic surgeries.
Methods: This randomized, single-blind clinical trial study was conducted on 60 patients who were candidates for orthopedic surgery of the lower limb referred to 5 Azar Hospital in Gorgan. Patients were randomly divided into two equal groups of ketamine (0.25 mg/kg) and control (placebo). The data collection tool includes a checklist containing information; Age, gender, mean arterial pressure, percentage of arterial oxygen saturation, heart rate, tremors and hallucinations. Data analysis was performed using descriptive statistics and inferential statistical tests at a significance level of P<0.05.
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Results: There was no statistically significant difference in gender between the control and intervention groups. The mean age of the study subjects in the control group was 36.13±12.53 and in the intervention group was 40.30±11.96. There was no statistically significant difference in age between the control and intervention groups. There is no statistically significant difference in mean arterial pressure (MAP) between the control and intervention groups. The incidence of shivering after spinal anesthesia was 13.33% in patients receiving prophylactic ketamine and 40% in patients receiving placebo. The incidence of hallucinations in the ketamine group was 26.67%. The rate of nausea and vomiting was similar in both groups. According to this study, between the two groups in terms of hemodynamic parameters, including mean arterial pressure, heart rate, percentage of arterial oxygen saturation; There was no significant difference.
Conclusion: The incidence of shivering in spinal anesthesia in the preventive use of ketamine has been more effective than placebo. Considering the effectiveness of ketamine in reducing the incidence of shivering, its use as a prevention is suggested to reduce the incidence of shivering.
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Shahram Shafa, Mehrdad Sayadinia, Bibi Mona Razavi, Tayyebeh Zarei , Maryam Ziyaei , Mansour Deylami,
Volume 83, Issue 2 (5-2025)
Abstract
Background: Controlling patients' anxiety before surgery reduces the possibility of postoperative problems and increases the possibility of patient participation and cooperation in the postoperative care and treatment plan.
Methods: This study uses a review approach to investigate non-pharmacological methods of anxiety management in patients undergoing orthopedic surgery. The systematic search involves several key steps. Literature search: A thorough search was conducted in PubMed, Sciences Direct, Scopus, Magiran, Sid, and Google Scholar databases. The search was refined using keywords such as “aromatherapy,” “music therapy,” “massage,” “educational intervention,” “educational film,” and “sound of the Quran” and their English equivalents to identify relevant studies published in the past ten years. Inclusion criteria included studies on orthopedic surgery, Persian and English articles, and original articles. Exclusion criteria included studies outside the specified time frame or studies that deviated from the defined focus. In this review, we conclude by summarizing key aspects of the review process, emphasizing the rigorous approach applied in study selection, data extraction, and synthesis.
Results: The results of the present study showed that the non-pharmacological methods used to control or reduce anxiety in orthopedic surgery include methods; Music therapy, the sound of the Quran, relaxation techniques, back massage, educational intervention, educational video, awareness and training before surgery and aromatherapy (chamomile, lemon, rose, valerian, cardamom, cinnamon, calendula, lavender, lemon sour).
Conclusion: The results of numerous and reputable research findings clearly show that the use of non-pharmacological methods plays an effective role in reducing the level of anxiety of patients before, during and after orthopedic surgery. These methods, which are generally low-cost, low-complication, and applicable in various clinical settings, include techniques such as preoperative education, music therapy, breathing and relaxation techniques, mindfulness-based interventions, psychological support, and the creation of a calm and reassuring environment. Since anxiety is a known factor in weakening the immune system, increasing postoperative pain, prolonging the recovery period, and reducing overall patient satisfaction, its management is of great importance. Therefore, by integrating and utilizing such non-invasive methods into nursing care protocols and holistic patient care programs, the detrimental and undesirable effects of anxiety after orthopedic surgery can be significantly reduced and faster recovery, a better patient experience, and more favorable clinical outcomes can be achieved.
Masoome Pourmokhtari , Shahram Shafa, Nasim Nabizadeh, Reza Sahraei, Hasan Zabetian, Mansour Deylami, Navid Kalani,
Volume 83, Issue 3 (6-2025)
Abstract
Background: Spinal anesthesia is an effective method for providing analgesia in surgery and a safe alternative to general analgesia; But despite its benefits, in many cases it is not free of side effects, including unwanted cardiovascular events such as hypotension and bradycardia. Ondansetron effectively reduces the incidence of nausea, vomiting, and bradycardia associated with spinal anesthesia Thus, the present study aimed to assess intravenous ondansetron's efficacy in preventing post-spinal hypotension among patients scheduled for lower extremity orthopedic surgery at Peymanieh Hospital in Jahrom, Iran.
Methods: This randomized double-blind clinical trial included 60 patients undergoing lower limb orthopedic surgery at Peymanieh Hospital, Jahrom, Iran, from March 2021 to February 2022. Patients were randomly allocated into two groups: the intervention group (receiving 8 mg intravenous ondansetron) and the control group (receiving distilled water). Systolic and diastolic blood pressure (SBP, DBP) and heart rate (HR) were measured before pre-spinal anesthesia, after spinal anesthesia and then every two minutes for the first ten minutes and at 15, 30, 45, 60 and 90 minutes after surgery. After spinal anesthesia, the patient was asked about pruritus every 10 minutes. Nausea and vomiting during surgery in case of incidence, recording and nausea after spinal anesthesia, the patient was asked every 10 minutes.
Results: The chi-square test indicated no significant differences between the study groups regarding age and sex distribution(P>0.05). Time before anesthesia, immediately after anesthesia, 10 minutes, 15 minutes, 30 minutes, 45 minutes, 60 minutes, 75 minutes, and 90 minutes after anesthesia, significant difference between ondansetron and placebo groups from There was no mean SBP and DBP and HR (P <0.05). No significant difference between ondansetron and placebo groups in the incidence of pruritus and nausea and vomiting at different times (p <0.05).
Conclusion: Dose of 8 mg of ondansetron in lower limb orthopedic surgery has no significant effect on hemodynamic symptoms as well as the prevention of postoperative nausea, vomiting and pruritus in these patients. Therefore, to achieve more results regarding the transient effect of this drug, it can be compared with other drugs in the class of HT3-5 receptor antagonists.
