Journal of Research in Pharmacy Practice

Abstract Objective: The purpose of the present study was to evaluate the efficacy of 
midazolam‑ondansetron combination in prevention of postoperative nausea and 
vomiting (PONV) after middle ear surgery and its comparison with using midazolam 
or ondansetron alone.
Methods: One hundred and forty patients were enrolled in four groups to receive 
midazolam 0.75 mg/kg in group M, ondansetron 4 mg in group O, midazolam 0.75 mg/
kg and ondansetron 4 mg in group MO, and saline 0.9% in group S intravenously just 
before anesthesia. Assessment of nausea, vomiting, rescue antiemetic, and side effects 
of study drugs such as headache and dizziness was carried out postoperatively for 24 h.
Findings: The incidence of PONV was significantly smaller in groupMO than groupM and 
groupO, while there was no significant difference between group M and groupO during 
the first 24 h postoperatively. Requirement to the additional antiemetic was significantly 
more in group S (71.4%) compared to other groups, while in group MO (11.4%) was 
lower than group M (31.4%) and group O (34.3%).
Conclusion: Our study showed that prophylactic administration of midazolam 
0.75 mg/kg combined with ondansetron 4 mg was more effective than using midazolam 
or ondansetron alone in prevention of PONV after middle ear surgery.

Abstract Objective: This study was designed to evaluate the effect of different doses of midazolam 
on anesthesia and analgesia quality when added to lidocaine during the intravenous regional 
anesthesia (IVRA).
Methods: One hundred and forty patients underwent hand surgery were randomly allocated 
into four groups to receive 3 mg/kg lidocaine 2% diluted with saline to a total volume of 
40 mL in the control Group L‑C (n = 35), 30 µg/kg midazolam plus 3 mg/kg lidocaine 2% 
diluted with saline to a total volume of 40 mL in the midazolam Group L‑M1 (n = 35), 40 µg/kg 
midazolam plus 3 mg/kg 2% lidocaine diluted with saline to a total volume of 40 mL in the 
midazolam Group L‑M2 (n = 35), and 50 µg/kg midazolam plus 3 mg/kg lidocaine 2% diluted 
with saline to a total volume of 40 mL in the midazolam Group L‑M3 (n = 35). Sensory and 
motor block and recovery times, tourniquet pain, intra‑operative analgesic requirement, and 
visual analog scale (VAS) scores were recorded.
Findings: Onset time of sensory and motor block in L‑M3
 Group was shorter than the 
L‑M2
 and L‑M1
 and L‑C Groups (P < 0.001). Furthermore, prolonged sensory (P = 0.005) and 
motor recovery time (P = 0.001) in L‑M3
 were longer than the other groups. Intra‑operative 
VAS score and intra‑operative fentanyl consumption in L‑M3
 were lower than the other 
groups (P < 0.001). The numbers of patients needed to pethidine in Group L‑M3
 were 
significantly less compared with the other groups (P = 0.035). VAS scores were significantly 
lower in Group L‑M3
 in different time intervals in the postoperative period compared with 
the other groups (P < 0.001).
Conclusion: Addition of 50 µg/kg midazolam for IVRA (Group L‑M3
) enhanced 
intra‑operative analgesia and improved anesthesia quality better than other groups receiving 
lower midazolam doses as well as a control group.

Abstract Objective: Pruritus is a common and disturbing side effect of neuraxial opioids after 
cesarean section. The purpose of this study was to compare the efficacy of intravenous 
ondansetron and sub-hypnotic dose of propofol in control and treatment of intrathecal 
sufentanil induced pruritus in cesarean surgery.
Methods: Totally, 90 parturient with American Society of Anesthesiology physical status 
grade I-II, undergoing spinal anesthesia with 2.5 µg sufentanil and 10 mg bupivacaine 0.5% were 
enrolled to this randomized, prospective, double-blind study. The women were randomly 
assigned to two groups who received 8 mg ondansetron or 10 mg propofol to treat pruritus 
grade ≥3. The patient was evaluated after 5 min and in the lack of successful treatment, 
the doses of two drugs repeated and if the pruritus is on-going, the exact treatment with 
naloxone was done.
Findings: The incidence of pruritus was 69.3%. Both groups were well-matched. The 
peak time pruritus was 30–75 min after injection. The percentage of individuals consumed 
naloxone were 6.8% and 15.9% in ondansetron and propofol groups, respectively (P = 0.18). 
The mean score of satisfaction (according to visual analog scale criteria) was 9.09 ± 1.1 in 
ondansetron group and 9.3 ± 1.07 in the propofol group (P = 0.39).
Conclusion: Ondansetrone and sub-hypnotic dose of propofol are both safe and 
well‑tolerated. Due to their same efficacy in the treatment of intrathecal sufentanil‑induced 
pruritus, they can be widely used in clinical practice.

Abstract Objective: Laryngoscopy and intratracheal intubation may cause acute hemodynamic 
instabilities due to catecholamine release. Magnesium sulfate (MgSO4
) prevents catecholamine 
release and results in bradycardia and vasodilatation, so can be used to diminish complications 
of laryngoscopy and intubation in doses > 50 mg/kg. The aim of this study was to compare 
the different doses of MgSO4
 used to improve cardiovascular instabilities due to laryngoscopy 
and intratracheal intubation.
Methods: In this double-blind randomized controlled trial, 120 patients undergoing elective 
surgery were divided equally into four groups (n = 30) and received different doses of 
MgSO4
 as case groups (Group I: 30 mg/kg, Group II: 40 mg/kg, Group III: 50 mg/kg) or the 
equal volume of normal saline as a control group. The patients’ hemodynamic status was 
recorded at baseline, before laryngoscopy and in 1, 3, 5, and 10 minutes after laryngoscopy. 
Bradycardia, tachycardia, hypertension, hypotension, ST-T changes, arrhythmias, and duration 
of extubation and laryngoscopy were also recorded.
Findings: There was no significant difference in heart rate between four groups(Pbaseline = 0.46, 
Ppreoperation = 0.55, P1 min = 0.86, P3 min = 0.30, P5 min = 0.63, P10 min = 0.74). Systolic, diastolic and 
mean arterial pressures were statistically significant less at 1, 3, and 5 minutes after intubation 
in comparison with other times of following-up in the three groups received MgSO4
 than 
the control group.
Conclusion: The use of MgSO4
 in doses less than 50 mg/kg can be effective to reduce 
cardiovascular instability related to laryngoscopy and tracheal intubation.

Abstract Objective: Etomidate is an imidazole derivative and formulated in 35% propylene 
glycol. When given without a rapid lidocaine injection, etomidate is associated with 
pain after injection. Magnesium (Mg) is a calcium channel blocker and influences the 
N‑methyl‑D‑aspartate receptor ion channel. The aim of the study is to evaluate the efficiency 
of preemptive injection of magnesium sulfate and lidocaine on pain alleviation on etomidate 
intravenous injection.
Methods: In a randomized, double‑blinded trial study, 135 adult patients scheduled for 
elective outpatient or inpatient surgery were divided into three groups. Group M received 
620 mg magnesium sulfate, Group L received 3 ml lidocaine 1% and Group S received normal 
saline, all in a volume of 5 mL followed by a maximal dose of 0.3 mg/kg of 1% etomidate. 
Pain was assessed on a four‑point scale: 0 = no pain, 1 = mild pain, 2 = moderate pain and 
3 = severe pain at the time of pretreatment and etomidate injection.
Findings: About 60% of patients in the control group had pain during etomidate 
injection as compared to 22.2% and 40% in the lidocaine and magnesium sulfate groups, 
respectively. There was difference in induction pain score between three treatment groups, 
significantly (P = 0.01) and observed differences in pain scores between “normal saline 
and lidocaine group” (P < 0.001) and “normal saline and magnesium sulfate groups” were 
statistically meaningful (P = 0.044).
Conclusion: Intravenous magnesium sulfate and lidocaine injection are comparably effective 
in reducing etomidate‑induced pain.

Abstract Objective: Shivering is an unpleasant sensation for patients who undergoing spinal 
anesthesia. This randomized double‑blind clinical trial study was designed to compare the 
effect of intrathecal fentanyl with intrathecal meperidine for prevention of shivering in lower 
limb orthopedic surgeries under spinal anesthesia.
Methods: Ninety patients were randomly recruited to receive either 3 ml of 0.5% hyperbaric 
bupivacaine plus 20 μg of fentanyl (Group F), or 3 ml of 0.5% hyperbaric bupivacaine plus 
0.2 mg/kg of meperidine (Group M), or 3 ml of 0.5% hyperbaric bupivacaine plus normal saline 
(Group S). The incidence and intensity of shivering were compared in three groups. Data 
were analyzed by analysis of variances, Mann–Whitney U‑test followed by Chi‑square test.
Findings: There were not statistically differences in complications and side‑effects between 
three groups. Total incidence of shivering was similar between Groups F and M (16.7% 
vs. 13.3% respectively, P = 0.72) whereas it was significantly different to Group S (43.3%) 
(P = 0.025 for Group F vs. S, and P = 0.011 for Group M vs. S). Also the intensity of 
shivering between Groups F and M was similar (P = 0.66), while it was significantly less in 
these groups compared to Group S (P = 0.013 and P = 0.004, respectively).
Conclusion: Addition of fentanyl 20 µg or meperidine 0.2 mg/kg to 0.5% bupivacaine 
intrathecally significantly decreased the incidence of shivering in lower limb orthopedic 
surgeries. There was no significant difference between two drugs with this respect.

Abstract Objective: Intraoperative hypothermia is a common problem with anesthesia. Spinal 
anesthesia, the same as general anesthesia, affects the process of temperature regulation. The 
aim of this study was to compare the prophylactic effect of intravenous(IV) ondansetron with 
intrathecal (IT) meperidine on prevention of shivering during spinal anesthesia in patients 
underwent orthopedic surgery of the lower limb.
Methods: In this study, 120 patients with American Society of Anesthesiologists physical 
status I to II, between the ages 16 and 65 were randomized into three groups. Group O 
and Group M were given IV ondansetron 8 mg and IT meperidine 0.2 mg/kg, before spinal 
anesthesia, respectively. Group C received IV saline 0.9%. The core and ambient temperatures, 
the incidence and intensity of shivering, blood pressure, heart rate, and maximum level of 
sensory block were recorded.
Findings: Shivering was observed in 15%, 2.5%, and 37.5% of patients in Groups O, M, and 
C, respectively. There was a significant difference between Group O and M compared to 
Group C (P = 0.023 for Group O vs. Group C, P < 0.001 for Group M vs. Group C, P = 0.049 
for Group M vs. Group O). Shivering incidence and intensity in Group M was significantly 
lower than Group O (P = 0.049 and P = 0.047, respectively). Twenty‑two patients required 
additional IV meperidine among which 15 patients were from Group C (37.5%), six patients 
from Group O (15%) and one patient from Group M (2.5%).
Conclusion: We concluded that IT meperidine and IV ondansetron comparably can 
decrease intensity and incidence of shivering compared to control group as well as decreasing 
the requirement to additional doses of meperidine for shivering the control without any 
hemodynamic side effect.