Anesthesiology and pain medicine
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Intentional lowering of blood pressure helps to produce a desirably clean surgical field. Many drugs can be used to induce a hypotensive state, but due to their high potency and rapid effect, drugs that more easily and safely control the induction of hypotension are desirable. ⋯ Premedication with oral clonidine can improve the hemodynamic management of cesarean cases.
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Addicted patients present difficulties for pain management because they have another problem besides their pain. Adding adjuvants to opioid pumps to intensify quality, control other problems, lengthen analgesia, and reduce side effects has been considered in the field. ⋯ This study showed that, compared to simply increasing the dose of morphine, adding chloropromazine, promethazine, midazolam, and clinidine to morphine significantly controlled pain scores and increased treatment satisfaction in addicted patients without notable side effects.
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Post-dural puncture headache (PDPH) is an iatrogenic complication of spinal anesthesia. Reported risk factors for PDPH include sex, age, pregnancy, needle tip shape and size, bevel orientation, approach and others. Little is known regarding the effect of different approaches on the incidence of PDPH. ⋯ There is no difference between median and paramedian approaches with respect to PDPH incidence; the paramedian approach is therefore recommended, especially for older patients with degenerative changes in the spine and intervertebral spaces and those who cannot take the proper position. Moreover, the rate of PDPH was found to be significantly higher in females than in males.
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Low back pain is a major cause of disability and can result in substantial morbidity and high healthcare costs. Botulinum toxin has been used successfully to alleviate pain for a number of conditions caused by muscle contractions or spasms. ⋯ BoNT-A improves CLBP with a low incidence of side effects and can be used as a therapeutic tool in the management of these patients.