Medicine
Mohammad Reza Moharrami; Mahdi Nazari
Abstract
Introduction: This systematic review aims to compare the efficacy and safety of low-dose intravenous ketamine-midazolam with intravenous morphine for pain control in patients with hand fractures. By synthesizing the available evidence, we seek to provide clinicians with valuable insights into the potential ...
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Introduction: This systematic review aims to compare the efficacy and safety of low-dose intravenous ketamine-midazolam with intravenous morphine for pain control in patients with hand fractures. By synthesizing the available evidence, we seek to provide clinicians with valuable insights into the potential benefits and limitations of these analgesic strategies, aiding in informed decision-making for optimal pain management in this patient population. Material and Methods: This systematic review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to ensure transparency and methodological rigor in the review process. Results: The primary outcome of pain control was assessed using various pain scales, including the Visual Analog Scale (VAS) and Numeric Rating Scale (NRS). The majority of studies reported comparable pain control between low-dose ketamine-midazolam and intravenous morphine. Both analgesic regimens resulted in significant pain reduction. A subset of studies demonstrated that low-dose ketamine-midazolam provided superior pain control compared to intravenous morphine, particularly in the immediate post-intervention period. However, the overall evidence regarding the superiority of one regimen over the other was inconclusive due to variations in study designs, sample sizes, and outcome measures. Conclusion: Low-dose intravenous ketamine-midazolam and intravenous morphine are both effective analgesic regimens for pain control in patients with hand fractures. While the evidence regarding the superiority of one regimen over the other remains inconclusive, low-dose ketamine-midazolam appears to offer comparable pain control with reduced opioid consumption anda favorable safety profile.
Medicine
Sanaz Yasrebinia; Mansour Rezaei
Abstract
Introduction: This study aiming to provide vital insights into the potential impacts of these treatment modalities (morphine or methadone) on the neurodevelopmental trajectories of Neonatal Abstinence Syndrome (NAS) -affected infants. By investigating the potential disparities in neurodevelopmental outcomes ...
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Introduction: This study aiming to provide vital insights into the potential impacts of these treatment modalities (morphine or methadone) on the neurodevelopmental trajectories of Neonatal Abstinence Syndrome (NAS) -affected infants. By investigating the potential disparities in neurodevelopmental outcomes associated with morphine and methadone, we aspire to inform evidence-based treatment decisions and refine the standard of care for NAS.Material and Methods: Eight participating locations included 116 full-term newborns diagnosed with NAS, born to mothers under methadone or buprenorphine maintenance, who were enrolled in a randomized trial comparing morphine to methadone. Upon hospital discharge, 99 of these infants (representing 85% of the cohort) underwent assessment using the NICU Network Neurobehavioral Scale (NNNS). At the 18-month mark, 83 out of the 99 infants (approximately 83.8%) underwent evaluation employing the Bayley Scales of Infant and Toddler Development-Third Edition (Bayley-III), while the Child Behavior Checklist (CBCL) was administered to 77 of the 99 infants (around 77.7%).Results: Our adjusted analyses further revealed that internalizing and total behavior problems were linked to the utilization of phenobarbital (p=0.03 and p=0.04, respectively), elevated levels of maternal psychological distress (as measured by the Brief Symptom Inventory) (both p<0.01), and the presence of infant medical issues (both p=0.02). Additionally, externalizing problems were associated with maternal psychological distress (p<0.01) and continued maternal substance use (p<0.01).Conclusion: Neonates administered either morphine or methadone exhibited comparable neurobehavioral outcomes in both the short and long term. The neurodevelopmental progress of these infants may be associated with factors such as the requirement for phenobarbital, the general health of the infant, and the quality of postnatal caregiving.
Medicine
Mirmohammadtaghi Mortazavi; Sina GHasemi
Abstract
Introduction: This systematic review will contribute to the existing body of knowledge by synthesizing the available evidence regarding the effects of morphine injection during anesthesia on hemodynamic status and acute pain intensity after tibia plate implantation surgeries in the elderly. The findings ...
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Introduction: This systematic review will contribute to the existing body of knowledge by synthesizing the available evidence regarding the effects of morphine injection during anesthesia on hemodynamic status and acute pain intensity after tibia plate implantation surgeries in the elderly. The findings may have implications for perioperative pain management strategies, ultimately leading to improved patient outcomes and enhanced quality of care for this vulnerable patient population.Material and Methods: Data extraction will be performed independently by two reviewers using a standardized data extraction form. The extracted data will include study characteristics (author, publication year, country), study design, sample size, patient demographics (age, gender), intervention details (morphine dosage, timing of administration), comparison groups, outcome measures assessed, follow-up duration, and relevant statistical analyses.Results: The results of this analysis revealed that higher doses of morphine were associated with more pronounced effects on hemodynamic parameters, including a greater decrease in MAP and heart rate.Conclusion: this systematic review suggests that morphine injection during anesthesia may have favorable effects on hemodynamic stability and acute pain intensity in elderly patients undergoing tibia plate implantation surgeries. The administration of morphine during anesthesia appears to reduce blood pressure and heart rate fluctuations and provide effective analgesia in the immediate postoperative period.
