Fentanyl supplement expedites the onset time of sensory and motor blocking in interscalene lidocaine anesthesia

Background and the purpose of the study

Opioids are usually used in regional anesthesia, with or without local anesthetics to improve the regional block or postoperative pain control. Since no data are available on fentanyl''s effect on the onset time of lidocaine interscalene anesthesia, the purpose of this study was to examine its effect on the onset time of sensory and motor blockade during interscalene anesthesia.

Methods

In a prospective, randomized, double-blind study, ninety patients scheduled for elective shoulder, arm and forearm surgeries under an interscalene brachial plexus block.They were randomly allocated to receive either 30 ml of 1.5% lidocaine with 1.5 ml of isotonic saline (control group, n=39) or 30 ml of 1.5% lidocaine with 1.5 ml (75 µg) of fentanyl (fentanyl group, n=41). Then the onset time of sensory and motor blockades of the shoulder, arm and forearm were evaluated every 60 sec. The onset time of the sensory and motor blockades was defined as the time between the last injection and the total abolition of the pinprick response and complete paralysis. The duration of sensory blocks were considered as the time interval between the administration of the local anesthetic and the first postoperative pain sensation.

Results

Ten patients were excluded because of unsuccessful blockade or unbearable pain during the surgery. The onset time of the sensory block was significantly faster in the fentanyl group (186.54±62.71sec) compared with the control group (289.51±81.22, P<0.01). The onset times of the motor block up to complete paralysis in forearm flexion was significantly faster in the fentanyl group (260.61±119.91sec) than the control group (367.08±162.43sec, P<0.01). There was no difference in the duration of the sensory block between two groups.

Conclusion

Results of the study showed that the combination of 75 µg fentanyl and 1.5% lidocaine solution accelerated the onset of sensory and motor blockade during interscalene anesthesia.     

Hepatitis C virus in patients with squamous cell carcinoma of the head and neck in Iran: is there any relation?

Recently, some studies have noticed a large number of patients with squamous cell carcinoma of the head and neck (SCCHN), who are infected with hepatitis C virus (HCV). The aim of this study is to determine the prevalence of HCV in these patients in our population. Patients with SCCHN in four tertiary centers in different regions of Iran were checked for HCV. The prevalence of HCV in 107 patients diagnosed with head and neck squamous cell carcinoma was 0.9%, which has no significant difference with its prevalence in normal population. It seems that HCV at least in Iran could not be considered as a risk factor for SCCHN.     

Impact of subcutaneous infiltration of 0.5% bupivacaine on post-operative C-reactive protein serum titer after craniotomy surgery

Background

Tissue injuries may provoke neuro-hormonal response which in turn may lead to release of inflammatory cytokines. We hypothesize that block of afferent sensory pathways by infiltration of 0.5% bupivacaine in the scalp may decrease neuro-hormonal response in the neurosurgical patient.

Methods

After obtaining informed consent, forty ASA physical statuses I, II, or III patients between the ages of 18 and 65 years were enrolled randomly into two equal groups to receive either 20 ml of 0.5% bupivacaine (group A) or 20 ml of 0.9% normal saline as a placebo (group B) in the site of pin insertion and scalp incision. As the primary outcome we checked serum C-reactive protein (CRP) levels before implementation of noxious stimulus, 24h, and 48h after the end of surgery to compare these values between groups. In addition, mean arterial pressure (MAP) and heart rate (HR) were checked at baseline (after the induction of anesthesia), one minute after pin fixation and 5, 10, and 15 minute after skin incision and the recorded values were compared between groups.

Results

No significant difference was found between serum CRP levels of the two groups. Comparison of mean HR between groups shows no significant difference. The mean of MAP was significantly lower in the group A in comparison with the group B (p< 0.001).

Conclusion

The results of this study confirm that 0.5% bupivacaine scalp infiltration before skull-pin holder fixation and skin incision could not decrease post-operative C-reactive protein level.     

Single-position circumferential lumbar spinal fusion: an overview of terminology,concepts, rationale and the current evidence base

European Spine Journal - To provide definitions and a conceptual framework for single position surgery (SPS) applied to circumferential fusion of the lumbar spine. Narrative literature review and...     

Intractable epilepsy and mild brain injury: incidence,pathology and surgical outcome

Objective : To study the role of mild brain injury in intractable epilepsy. Methods : The medical charts of 86 patients who underwent surgery for intractable epilepsy were reviewed in regard to the history of mild brain injury, pathology and surgical outcome. Results : Nine of 86 patients had a previous history of mild brain injury (10.4%) compared to 2.5% of 80 age and sex matched controls. Six of nine patients had non-neoplastic and three had neoplastic lesions. Post-surgical outcome was excellent in eight of nine patients (Engel class IA). Conclusions : The incidence of mild brain injury was 4-times higher in patients with intractable epilepsy compared to asymptomatic controls. The pathology was variable but in four of nine patients it was compatible with the described pathology in traumatic brain injury. Both groups, with or without brain injury, had good surgical outcome (88% versus 70%).     

Mapping of the gene for a novel spinocerebellar ataxia with pure cerebellar signs and epilepsy

We investigated a family with a new type of autosomal dominant cerebellar ataxia (ADCA) in which pure cerebellar ataxia is often accompanied with epilepsy. No CAG repeat expansions were detected at the spinocerebellar ataxia (SCA) type 1, 2, 3, 6, or 7 locus, and SCAs 4 and 5 were excluded by linkage analysis. We found linkage between the disease locus and D22S274 (Zmax = 3.86 at theta = 0.00) and two other makers in 22q13-qter. Haplotype analysis of the crossover events and the multipoint linkage mapping localized the disease locus to an 8.8-cM region between D22S1177 and D22S1160.     

Impact of rural family physician program on child mortality rates in Iran: a time-series study

Background

The rural family physician program and social protection scheme were started in Iran about 10 years ago, and no comprehensive study has been carried out to investigate the effects of this program on mortality-related health indicators yet. The present study aims to examine the impacts of implementation of the family physician program and rural insurance program, which was launched in June 2005, on neonatal (NMR), infant (IMR), and under-5-year (U5MR) mortality rates in rural areas of Iran between 1995 and 2011, using a time-series analysis.

Methods

Three segmented regression models were built to evaluate the effects of the program on NMR, IMR, and U5MR, and several independent variables were entered into the models, including annual incremental effect of the program (variable of interest), time effect, behvarz density, effect of the family physician and rural insurance programs, as well as socioeconomic variables including years of schooling, wealth index, sex ratio, and logarithmic scales of rural population size in each area. Data were gathered from secondary sources and other studies. Data pertaining to the year 2007 were excluded from the final analysis due to their inaccuracy.

Results

Our results show that the incremental effect of implementing the rural family physician program is associated with significant reductions in NMR (β?=???0.341. p???value?=?0.003) and IMR (β?=???0.016. p???value?=?0.009). Although the association between this effect and reductions in U5MR were evident, they were not statistically significant (β?=???0.003. p???value?=?0.542). Moreover, wealth status of inhabitants was associated with reductions in NMR (β?=???0.889. p???value?=?0.001), IMR (β?=???0.052. p???value?<?0.001), and U5MR (β?=???0.055. p???value?<?0.001) in the time period of the study.

Conclusions

In this nationally representative study, we showed that implementation of the second health system reform in Iran, known as the family physician program and social protection scheme for rural inhabitants, is associated with significant reductions in NMR and IMR. However, reported reductions in U5MR were not found to be statistically associated with the launch of the program.The advantage of this study was the ability to depict a more precise picture of the outcomes of a national-level intervention.

     

Setting for single position surgery: survey from expert spinal surgeons

Purpose

To describe a comprehensive setting of the different alternatives for performing a single position fusion surgery based on the opinion of leading surgeons in the field.

Methods

Between April and May of 2021, a specifically designed two round survey was distributed by mail to a group of leaders in the field of Single Position Surgery (SPS). The questionnaire included a variety of domains which were focused on highlighting tips and recommendations regarding improving the efficiency of the performance of SPS. This includes operation room setting, positioning, use of technology, approach, retractors specific details, intraoperative neuromonitoring and tips for inserting percutaneous pedicle screws in the lateral position. It asked questions focused on Lateral Single Position Surgery (LSPS), Lateral ALIF (LA) and Prone Lateral Surgery (PLS). Strong agreement was defined as an agreement of more than 80% of surgeons for each specific question. The number of surgeries performed in SPS by each surgeon was used as an indirect element to aid in exhibiting the expertise of the surgeons being surveyed.

Results

Twenty-four surgeons completed both rounds of the questionnaire. Moderate or strong agreement was found for more than 50% of the items. A definition for Single Position Surgery and a step-by-step recommendation workflow was built to create a better understanding of surgeons who are starting the learning curve in this technique.

Conclusion

A recommendation of the setting for performing single position fusion surgery procedure (LSPS, LA and PLS) was developed based on a survey of leaders in the field.

     

Estimation of LV End-Diastolic Pressure Using Color-TDI and Its Application to Noninvasive Quantification of Myocardial Wall Stress

Background: This study was undertaken to evaluate early-diastolic annular velocity (Ea) by color-TDI, combined with the early transmitral filling velocity (E) by pulsed Doppler echocardiography for estimation of left ventricular end diastolic pressure (LVEDP). We applied LVEDP to noninvasive quantification of myocardial wall stress in end-diastole. Forty-one coronary artery disease (CAD) patients with sinus rhythm underwent echocardiography and cardiac catheterization evaluated in the study. Methods: First linear regression analysis was performed to assess the relationships between E/Ea and LVEDP. Second LVEDP estimation with these two methods was tested prospectively in 59 additional CAD patients, and average end-diastolic wall stress was calculated at rest by measuring the principal radii, the thickness of the LV segments, and the estimated LVEDP. The results were compared to the wall stress that was calculated using catheter-measured LVEDP. Linear regression analysis was performed to assess the relationships between calculated wall stress using Doppler-estimated LVEDP (WSEP) and calculated wall stress using catheter-measured LVEDP (WSMP). Results: The results showed that LVEDP had a strong correlation to the lateral E/Ea (r = 0.85; P < 0.001) and medial E/Ea ratios (r = 0.73; P < 0.001). No significant differences were found between the WSEP and WSMP. There were highly significant correlations (at least r = 0.85, P < 0.001) between the WSMP and WSEP at all the myocardial sites. Conclusions: The current data demonstrate that the lateral E/Ea ratio obtained by Doppler echocardiography and color-TDI is a powerful estimator of LVEDP in CAD patients and provides pressure information required for noninvasive quantification of LV myocardial wall stress with reasonable accuracy in diastole.