Background: A straightforward and efficient anesthetic approach for hand and forearm surgery is intravenous regional anesthesia (IVRA), often known as the Bier Block. Dr. August Bier developed this method in 1908, and it offers total anesthesia as well as a bloodless operating room. Historically, the local anesthetic has been contained and a bloodless surgical field has been created by using an upper arm tourniquet. Major issues following IVRA with an upper arm tourniquet are uncommon, although they typically arise from systemic toxicity of local anesthetics upon tourniquet relaxation. Convulsions, coma, respiratory depression and arrest, and cardiovascular depression are signs of significant systemic local anesthetic responses, which might be lethal. Because of this, some medical professionals favor general anesthesia or other loco-regional procedures for hand and forearm surgery. Objective: The aim of this review was to compare the effects of early vs late distal tourniquet deflation during hand and forearm surgery under intravenous regional anesthetic with or without ketorolac. Methods: A comprehensive search was conducted in PubMed, Google Scholar, and Science Direct, from August 2000 to July 2021, using the keywords "Deflation, Distal tourniquet, Intravenous Regional Anesthesia, Ketorolac, Hand and Forearm Surgery". The reviewers evaluated relevant literature references as well. Only the most recent or complete study was taken into account. Examples of articles that weren't regarded as significant scientific research include unpublished manuscripts, oral presentations, conference abstracts, and dissertations. The lack of resources for translation has led to the ignoring of documents written in languages other than English. Results: The reviewed literature showed that alternative adjustments in extremities surgery can improve IVRA. In shortterm hand procedures, the forearm tourniquet may be chosen since it is simple to administer, has a minimal risk of toxicity, and offers an early block to healing. Conclusion: Depending on the patient's preferences, a Bier block with a forearm tourniquet can be utilized with or without further sedation or analgesics.
Background: Multiple modalities are existing for pain management in knee osteoarthritis cases. This study was conducted to compare between the efficacy of genicular nerves radiofrequency ablation versus intraarticular steroid injection in pain management in knee osteoarthritis. Patients and methods: A total of 58 cases with knee osteoarthritis were included and they were divided into 2 equal groups; the RF group who underwent radiofrequency for the genicular nerves, and the IA group who underwent intraarticular steroid injection. Follow up visits were scheduled after 1week, 2 weeks, 1,2, 3, and 6 months. Both visual analog score and The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores were assessed in each visit. Furthermore, patient satisfaction was also recorded. Results: Patient characteristics did not differ significantly between the two groups (p > 0.05). Both VAS and total WOMAC scores were improved in both groups. However, the RF showed better scores at 2-, 3-, and 6-month visits. Satisfaction grades did not differ between the two groups. Conclusion: Both genicular nerve RF and intraarticular steroid injection are safe and efficacious in pain management in knee osteoarthritis cases. Nevertheless, the effect is more prolonged after RF.
Background: First described paravertebral block (PVB) to provide abdominal analgesia in 1905. This technique has been modified for rib fracturing, flail chest, hepatic-biliary operations, open cholecystectomy, inguinal hernia repair, breast tumors operations and thoracotomies. PVB was shown to be as successful as thoracic epidural analgesia with less minimal complications in recent systematic reviews and meta-analyses. Objective: To evaluate the effect of paravertebral block and Thoracotomy to the other technique in issues analgesia, complications. Conclusion:Paravertebral block is a very useful regional anaesthetic technique for surgeries, Paravertebral block was shown to be as successful as thoracic epidural analgesia with less minimal complications.
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