Background:Supraclavicular brachial plexus provides complete and reliable anesthesia for upper limb surgeries. Adjuvants are added to local anesthetists to improve various block characteristics. There are limited studies comparing the efficacy of dexmedetomidine and fentanyl as an adjuvant to levobupivacaine.Aims:The aim of the study was to evaluate and compare the effect of dexmedetomidine versus fentanyl as an adjuvant with levobupivacaine in ultrasound-guided supraclavicular brachial plexus block.Settings and Design:This study design was a prospective, randomized, double-blind controlled study.Subjects and Methods:A total of 120 patients in the age group of 30–55 years with physical status American Society of Anesthesiologists Classes I and II undergoing elective upper limb surgeries under ultrasound-guided supraclavicular brachial plexus block were randomly divided into three groups of forty each after taking informed consent and approval from Hospital Ethics Committee: Group A received 25 ml of 0.5% levobupivacaine with 5 ml normal saline (NS). Group B received 25 ml of 0.5% levobupivacaine with 1 μg/kg dexmedetomidine diluted to the volume of 5 ml NS. Group C received 25 ml of 0.5% levobupivacaine with 1 μg/kg fentanyl diluted to the volume of 5 ml NS. Onset and duration of sensory and motor block and duration of analgesia were noted and any side effects were observed.Statistical Analysis:The distribution of variables tested with Shapiro–Wilk test. Group comparison of values was made by Kruskal–Wallis test followed by Mann–Whitney test.Results:There was fastest onset time as well as longer duration of sensory and motor block in dexmedetomidine group, intermediate in fentanyl group as compared to levobupivacaine group.Conclusion:This study concludes that addition of dexmedetomidine to levobupivacaine for supraclavicular brachial plexus block shortens the onset time and prolongs the duration of sensory and motor blockade as compared to the addition of fentanyl.
Purpose The purpose of this study was to compare the analgesic efficacy of a single-dose of preoperative intravenous tramadol versus diclofenac in preventing pain after third molar surgery. Materials and Methods Fifty patients undergoing elective third molar surgery were randomly assigned into one of the two groups (25 in each group): Group 1 received diclofenac 75 mg, and Group 2 received tramadol 50 mg intravenously preoperatively before the surgery. After injection of the study drugs, the impacted third molars were removed under local anesthetic agent. Results The difference in postoperative pain was assessed by four primary end-points: pain intensity as measured by a 100 mm visual analogue scale hourly for 12 h, median time to rescue analgesic, postoperative acetaminophen consumption, and patient's global assessment. Throughout the 12 h investigation period, patients reported significantly lower pain intensity scores in the diclofenac versus tramadol group (P = 0.0001, Mann-Whitney U-test). Patients also reported significantly longer median time to rescue analgesic (10 vs. 8 h, P \ 0.05, Student t test), lesser postoperative acetaminophen consumption (P \ 0.05, Student t test) for the diclofenac versus tramadol group.
ConclusionPreoperative intravenous diclofenac 75 mg is more effective than tramadol 50 mg in the prevention of postoperative dental pain.
Purpose To evaluate the incidence and recovery of persistent sensory disturbances of the infraorbital (IO) nerve after isolated zygomatic complex fractures with various treatment methods.
Methods and ResultsThe study was inclusive of isolated unilateral zygomatic complex fractures and fractures of IO rim .Tests performed were Pin prick and Electrical detection threshold test. The evaluation was done preoperatively, after 1 month and after 6 months of surgery. The results suggested that neurosensory disturbance was present in all the patients with zygomatic complex fractures. At 1 month post-operatively some sensory deficit was present in all the patients on the affected side. After 6 months all the patients showed near to normal improvement comparable to normal side. Conclusion Study shows that earlier the surgical intervention, more the recovery of the nerve injury is appreciable during the 1 and 6 months follow up period.
In this urban pediatric ED population, there is limited awareness of community-based resources but high rates of interest in participating once informed. Whereas the self-reported prevalence of home smoke detectors is high in our study population, other fire safety practices are suboptimal.
BackgroundOutpatient parenteral antibiotic therapy (OPAT) is a safe and effective care delivery system that allows patients to receive intravenous (IV) antibiotic therapy outside of the hospital. OPAT patients require frequent follow-up appointments for clinical and laboratory monitoring of common adverse outcomes of any IV antibiotic administration such as line infections, adverse drug events, and reinfection. Despite the known importance of clinical monitoring, patient factors that influence adherence to OPAT appointments are unknown. The objective of this study was to identify factors that influence adherence to OPAT appointments, in order to improve the OPAT program and make adherence easier for patients if possible.Methods80 patients undergoing OPAT between December 2014 and January 2016 were interviewed via telephone regarding the following: reasons for not showing up to appointments, when the first follow up appointment was scheduled, whether they received appointment reminders, transit time, and whether they had to make special arrangements to attend their appointments.ResultsAdherence to follow-up appointments was high (83.8%). 52.5% of initial follow-up appointments were made while patients were still in the hospital. 92% of patients received at least one reminder in the form of a letter (32%), call to cell phone (21%), call to landline (22%), email (17%), or other (1%). Participants mostly cited either transportation (23.4%) or other (30.4%), specifically not feeling well, and work as the reason for missing an appointment.ConclusionThe majority of patients attended all appointments, and of those, almost all received an appointment reminder, suggesting this is an important factor contributing to appointment adherence. These data reveal some of the barriers some patients face. Future studies can examine whether decreased appointment adherence leads to worse clinical outcomes.Figure 1Transportation and other were the most cited reasons for missing appointments.Figure 2The majority of participants received a reminder for an upcoming appointment in the form of a letter.Figure 3The majority of initial follow-up appointments were scheduled while patients were in the hospital.Disclosures
G. Allison, Merck: Grant Investigator and Speaker’s Bureau, Grant recipient and Salary
The need for reduction among children with forearm fractures is significantly associated with male sex and major mechanisms of trauma but not with high weight status. Strategies to reduce severe forearm fractures should focus on preventing major mechanisms of trauma.
It is relatively common to observe a solitary well defined periapical cystic change associated with decayed primary tooth displacing the underlying developing permanent tooth bud. Marsupialisation of such cysts is indicated so as to allow for eruption of the underlying tooth bud. A similar solitary well defined periapical cystic lesion involving the mixed dentition in a child was planned for enucleation. Surprisingly, during the surgical intervention two distinct separate cystic pathological changes were observed. Marsupialisation of the cystic defect with extraction of the primary tooth would have left the enlarged follicle with the developing tooth bud unaddressed. The pathological process associated with the dilated follicle would continue to progress further and may require an additional surgical intervention. The distinction between enlarged follicle and dentigerous cyst clinically is also important. Considering the size, extent and presence of the large bony cavity during the surgical intervention enucleation of both the pathological changes was performed.
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