Medicine
Mohammad Irajian; Vahid Fattahi
Abstract
Introduction: Regional anesthesia is considered an important tool in postoperative pain management while minimizing opioid use. However, post-operative recovery (characterized by peripheral nerve hyperalgesia) may reduce or completely block the effect of this change, since opioids may act better after ...
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Introduction: Regional anesthesia is considered an important tool in postoperative pain management while minimizing opioid use. However, post-operative recovery (characterized by peripheral nerve hyperalgesia) may reduce or completely block the effect of this change, since opioids may act better after the blockage is removed.Material and Methods: This study was a systematic Review. We reviewed the published literature describing the pathophysiology and development of complications after peripheral artery dissection in orthopedic surgery patients. Search for related articles using PubMed, EMBASE, and Web of Science.Results: We included 28 articles (n=28) in our review. Perioperative peripheral nerve considerations and other postoperative pain management for orthopedic surgery patients are discussed. Multimodal strategies such as preemptive analgesia, intra-articular or intravenous anti-inflammatory drugs, and adjuvants in vain block fluid before block failure will reduce the burden of rebound pain.Conclusion: Additionally, educating the patient about the possibility of back pain is important to ensure proper use of pain relievers and to reduce the need for pain relief opioids. Understanding the effects of relapse and prevention of relapse is important to reduce the side effects associated with the use of opioids for regional anesthesia.
Medicine
Vahid Fattahi; Mohammad Irajian
Abstract
The term arthroplasty refers to joint replacement through open surgery, which is used for cases where the joint has lost its function and the patient no longer has the ability to perform daily activities in the joint. In patients with knee osteoarthritis (arthrosis), the concentration of hyaluronic acid ...
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The term arthroplasty refers to joint replacement through open surgery, which is used for cases where the joint has lost its function and the patient no longer has the ability to perform daily activities in the joint. In patients with knee osteoarthritis (arthrosis), the concentration of hyaluronic acid in the synovial fluid is lower than the normal value. As a result, by injecting hyaluronic acid (viscosupplementation), the patient's knee pain is reduced and the patient can carry out his daily activities as before. The pain reduction effect of hyaluronic acid injection usually lasts for 3 to 9 months, and after this period, the injection can be repeated up to 2 times. At this time, the surgeon can replace the joint by considering the patient's physical conditions as well as his age and activities. Joint replacement or arthroplasty is one of the methods considered to treat patients with advanced arthritis. Complications after arthroplasty are things that can be reduced by specialized physiotherapy. Many patients will gain appropriate abilities after surgery and recovery in physiotherapy clinics in such a way that they will return to normal conditions in daily activities, but some of them may need to extend the sessions or at least reduce the pain after surgery in different ways. The useful life of the joints depends on their conditions and how their use is different in different people and mainly the joints that bear more weight or those joints that are used more are more exposed to joint damage and destruction such as arthritis. Also, diseases such as rheumatic diseases, metabolic disorders can lead to the destruction of joints and the need for joint replacement. Most of the involved joints include hip and knee, and the incidence of involvement of these two joints is much higher than other joints.
Medicine
Mohammad Irajian; Vahid Fattahi
Abstract
Introduction: Most patients experience moderate to severe pain after ankle surgery. Early and appropriate treatment of postoperative pain is essential for effective treatment that leads to preservation of lung function, normal breathing, rehabilitation and prevention of chronic pain. In this retrospective ...
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Introduction: Most patients experience moderate to severe pain after ankle surgery. Early and appropriate treatment of postoperative pain is essential for effective treatment that leads to preservation of lung function, normal breathing, rehabilitation and prevention of chronic pain. In this retrospective study, we aimed to identify potential predictors of moderate-to-severe postoperative pain in the post-anesthesia care unit (PACU) in patients undergoing gastric bypass surgery.Material and Methods: In this systematic review VAS/vNRS score of 4-6 is considered moderate, and 7-10 is considered severe. Additional factors investigated included time from ankle fracture to surgery, anesthesia procedure, preoperative anesthesia, medication use and postoperative medication use, classification radiation, bone complexity, surgical technique, and tourniquet operative time.Results: Data from 336 patients who underwent ankle arthroplasty between January 2009 and December 2022 were analyzed. None of the following variables had a significant effect on pain; age, weight, smoking, time from fracture to surgery, type of anesthesia, opioids to control dysfunction, complexity of the fracture, surgical procedure or tourniquet technique increase. Gender predicted moderate to severe pain after PACU by 2 differences.31 (1.39–3.86, P = 0.001). To our knowledge, this is the first study to report gender differences in pain reporting in the hours following joint surgery.Conclusion: Female patients who had surgery for ankle sprains reported higher pain scores in the PACU than men.
Medicine
Mohammad Irajian; Vahid Fattahi
Abstract
Knee arthroplasty is a type of surgery that replaces the joint surface of the femur and leg bones in the knee joint with an artificial surface. Tranexamic acid binds to the binding sites of lysine in plasmin and plasminogen and thereby displaces plasminogen from the surface of fibrin and thus inhibits ...
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Knee arthroplasty is a type of surgery that replaces the joint surface of the femur and leg bones in the knee joint with an artificial surface. Tranexamic acid binds to the binding sites of lysine in plasmin and plasminogen and thereby displaces plasminogen from the surface of fibrin and thus inhibits fibrinolysis. Local use of tranexamic acid can reduce bleeding in gynecological and obstetric surgeries, especially after delivery, urological surgery, oral surgery in hemophilia patients, and brain and spinal cord surgeries. Tranexamic acid is a plasminogen inhibitor and also inhibits urokinase activators. Tranexamic acid can be used orally and intravenously. Urokinase is a physiological thrombolytic agent that is produced in the kidney parenchymal cells and found in the urine. Urokinase binds directly to plasminogen and produces plasmin. Tranexamic acid is a synthetic derivative of the amino acid lysine and an antifibrinolytic agent that binds to plasminogen and prevents the interaction of plasminogen with fibrin and prevents fibrin clot dissolution. Urine and urothelium contain high concentrations of plasminogen activators. Tranexamic acid is used to reduce bleeding in heart surgeries, liver transplants, orthopedic surgeries, as well as in cases of arthroplasty and knee joint replacement, and to reduce bleeding after prostatectomy or tooth extraction. Also, this drug is used to treat idiopathic menorrhagia (20-23). Although prostate surgery is a very common surgery, little study was done on strategies to reduce the amount of transfusion, and there is still no universally accepted method.
