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Background: There are various protocols for pain management after anterior cruciate ligament (ACL) reconstruction surgery. Objective: This study aimed to compare two blocking protocols, including femoral nerve block (FNB) and infrapatellar nerve block (IPNB) in terms of pain severity, patient satisfaction, and muscle force preservation. Materials and Methods: This single-blind clinical trial study investigated the patients who underwent elective knee arthroscopic ACL surgery randomly either by ultrasound-guided FNB or IPNB. Subsequently, the patients were evaluated 1, 3, 6, 12, and 24 h following NB for pain severity, patient satisfaction level, and muscle force. Results: The pain score (both at rest and in flexion) was significantly lower in the first three h after the intervention in the FNB group. Moreover, the mean score of the patients’ satisfaction in the first hours was significantly higher in the FNB group after the procedure. Additionally, the IPNB group obtained a significantly faster mean time required for the first dose of opioid request. The mean dose of used opioids over 24 h was significantly lower in the FNB group. There was a significant difference between the groups in terms of the muscle strength score within 24 h; moreover, the FNB group obtained a significantly greater delay in muscle recovery. Conclusion: The FNB is associated with greater pain relief and satisfaction in patients who underwent arthroscopic ACL reconstruction surgery, compared to the IFNB technique. However, a further delay in the recovery of quadriceps muscle force is evident in the FNB group.

Background: Postoperative pain is a major complication in patients undergoing eye surgery. N-methyl-D-aspartate (NMDA) receptor antagonists are widely used to manage postoperative pains. Dextromethorphan, as an NMDA antagonist, is commonly used as an oral drug. Objectives: This study was conducted to evaluate the effect of Dextromethorphan on post-operation pain and sedative effect in comparison to placebo. Methods: A double-blinded, placebo-controlled, randomized clinical trial, upon 60 patients undergoing vitrectomy surgery was done. Thirty patients received 30 mg oral Dextromethorphan before the operation, and 30 patients received a placebo. Post-operation pain and sedation were evaluated after zero, one, two, and six hours. Results: Post-operation pain was significantly lower in patients who received Dextromethorphan at zero, one, and two hours after operation (P < 0.001); however, not at six hours after operation (P = 0.11). Sedative effect was higher in the Dextromethorphan group at zero (P = 0.03) and one hour (P = 0.01) after operation. Conclusions: Prescribing oral Dextromethorphan before a vitrectomy surgery could reduce postoperative pain. It also has postoperative sedation effects.

Background: Postoperative pain is a common complication after Cesarean Section (CS) and its management is essential to prevent adverse effects of pain. Various methods are used to control pain after CS. Regional anesthesia using Transversalis Fascia Plane (TFP) and Transversus Abdominis Plane (TAP) block is shown to reduce pain after abdominal surgery. Objectives: This study aimed at evaluating the efficacy of these two methods in controlling pain after CS. Methods: In this randomized clinical trial, 56 patients undergoing elective CS under spinal anesthesia were randomly allocated to receive TFP or TAP block after surgery with ultrasound guidance. The pain severity using Visual Analogue Scale (VAS) at rest and during coughing at 0, 2, 4, 6, 12, 24, and 36 hours after surgery, time to first analgesic request, and dosage of analgesic use and complications were compared between groups. Results: There were no significant differences between groups in pain severity at rest or coughing at0, 2, 4, 6, 12, 24 and 36 hours, postoperatively. There was no considerable nausea and vomiting between groups (14.3% vs. 10.7%, P = 0.68), and time to the first analgesia (100.00 ± 69.28 versus 123.12 ± 50.19 minutes, P = 0.47) and total analgesic use (33.33 ± 14.43 vs. 25.00 ± 15.81 mg, P = 0.57) were comparable between groups. There were no complications in any of the groups. Patients in both groups were mostly satisfied for pain control after surgery (good to perfect, 89.3% versus 82.1%, P = 0.7). Conclusions: Ultrasound-guided TFP provided pain control the same as TAP block after CS with a comparable decreased need of analgesics.

Background A few studies are available actually comparing the clinical efficacy of intravenous acetaminophen with other medications such as dexamethasone to inhibit postoperative adverse events in children. Objectives This randomized blinded controlled trial was designed to compare controlling status of postoperative events in children after tonsillectomy randomized to receive either intravenous acetaminophen or dexamethasone. Patients and Methods Eighty four children aged between 4 to 13 undergoing tonsillectomy were randomized using a computer-generated schedule to double-blind treatment with intravenous acetaminophen (15 mg/kg) or intravenous dexamethasone (0.1 mg/kg). Children were post-operatively assessed for swallowing pain, pain while opening mouth, ear pain, and postoperative sore throat in recovery room (within one hour after surgery), at the time of admission to the ward, as well as at 12 and 24 hours after surgery, assessed by the objective pain scoring system (OPS; minimum score: 0 = no pain, maximum score: 10 = extreme pain). Results There were no significant differences between the two groups with regard to the severity of postoperative pain due to swallowing or opening mouth measured at the different study time points from postoperative recovery to 24 hours after the surgery. There was no difference in ear pain severity at the time of postoperative recovery, at the admission time to ward and also at 12 hours after surgery; however mean score of ear pain severity was significantly higher in those who administered acetaminophen 24 hours after operation. Also, the mean score severity of sore throat was significantly higher in the acetaminophen compared with the dexamethasone group within 12 hours of surgery. Postoperative vomiting and bleeding were similarly observed between the two study groups. The severity of swallowing pain, pain while opening mouth, ear pain, as well as postoperative sore throat as gradually assuaged within 24 hours of tonsillectomy in both groups, however no between-group differences were observed in the trend of the severity of these events. Conclusions The dexamethasone-based regimen may have more advantage over the intravenous acetaminophen regimen for inhibiting pain and PONV following tonsillectomy in children.