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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. 相似文献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.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.
MethodsBetween 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.
ResultsTwenty-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.
ConclusionA 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.
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