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ABSTRACT Introduction & Objective : Elimination of local anesthetic from subarachnoid space is probably depends on rate of local diffusional surface of anesthetic and its vascular absorption. This study was designed to evaluate the relationship between the spread of hyperbaric spinal anesthesia and duration of spinal block. Materials & Methods: To determine the effects of hyperbaric local anesthetic extension on duration of spinal block we studied 40 ASA Class I, II patients whom were candidate for elective surgery (Inguinal hernia) . We randomly divided them into 2 equal groups . After performing spinal block with 2cc hyperbaric lidocaine 5% the first group was left in horizontal position and the second group in 30 torso elevated position. The patients was monitored for pulse oximetry, ECG and noninvasive BP. BP and HR were checked 5 minutes for 30 minutes and then every 15 minute until the end of study. Results: The decrease in MAP was significantly more obvious in horizontal group than 30 toros elevated group. Duration of block existing is less in horizontal group than 30 toros elevated group. Conclusion: Placing patients in 30 elevation of torso, after spinal injection, prolonged the duration of spinal block and lessen the hemodynamic changes of spinal anesthesia

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Introduction & Objective: Brachial plexus block is the most popular peripheral neural blockade that can take action in many anatomic locations. Surgical procedure can be performed on this block upon elbow, hand and forearm. Serveral studies noted that adding chemiclas such as epinephrine and narcotics to local anesthetics enhance the quality and duration of anesthesia. The aim of this study was to compare the effects of fentanyl added to lidocaine for axillary block on duration of anesthesia. Material & Methods: This is a duble-blinded clinical trail, wich performed on 60 patients with ASA class I and II that scheduled for elective hand and forearm surgery. This study was performed in Tabriz Shohada hospital in 2004. All patients received 400 mg of 1% lidocaine injected into the brachial plexus sheath. Patients were randomly assigned into two groups. The patients in control group were given lidocaine and patients in study group received lidocaine containing 1 ml fentanyl (50 μg). Sensory and motor blockade were evaluated by using apinpriek, pinch and by measuring pushing and pulling force, respectively. Date were collected by a questionnaire and analyzed with SPSS software using, chi-square test and independent sample analysis. Results: Differences in age and gender of patients in both group were not statistically significant. The duration of the sensory blockade increased in study group (176.20 ±13.63) compared with control group and these changes were statistically significant (121.17 ± 9.36, p<0.001). However, onset time of analgesia was prolonged by adding fentanyl to blachial plexus block (14.73 ± 2.50 in control group versus 21.24 ± 2.76 in study group, p<0.001). Conclusion: Addition of fentanyl to lidocaine significantly increases the duration of brachial plexus blockade, but delays the onset of analgesia.

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ABSTRACT: Introduction & Objective: Endotracheal intubation during general anesthesia is necessary to control the ventilation of patients during surgery. Nevertheless, the endotracheal tube as an external object can stimulate the patient’s airway during the emergence from general anesthesia and create different reactions and complications. To prevent these reactions, a wide variety of interventions have been examined. In this study, post-extubation endotracheal tube complications are investigated in 3 different states of lidocaine 4% for filling endotracheal tube cuffs. Materials & Methods: In this quasi-experimental clinical trial study executed in one of Shiraz hospitals during 2005-2006, 200 candidates of elective surgery being in class1 and 2 ASA were randomly divided into 4 groups (N=50). The endotracheal tube cuffs of each group members were filled with (5-10ml) distilled water, lidocaine 4%, alkalized lidocaine 4% and warmed alkalized lidocaine 4%, respectively. The patients were observed for complications such as cough (for 6 hrs), sore throat, hoarseness (for 24 hrs) and laryngospasm (immediately) after extubation. The data were analyzed by chi square and logistic regression using SPSS. Results: The findings revealed that the frequency of cough, sore throat and hoarseness was more in the control (distilled water) group as compared to the 2 groups of the study (alkalized lidocaine 4% and warmed alkalized lidocaine 4%). Distilled water and lidocaine 4% groups differed significantly in only the frequency of sore throat. The odds ratio of cough, sore throat and hoarseness was just significant for the distilled water group in comparison to warmed alkalized lidocaine 4 %. Furthermore the odds ratio of the above-mentioned complications was significant for the distilled water and lidocaine 4% groups in comparison to the warmed alkalized lidocaine 4% group. Among all the considered variables, the duration of tube existence in trachea was significantly effective in the frequency of complications. Conclusion: Filling endotracheal tube cuffs with alkalized lidocaine 4% and warmed alkalized lidocaine 4% decreases the frequency of the post-extubation complications (cough, sore throat and hoarseness). The odds ratio for the observed complications is less in the warmed alkalized lidocaine 4% group as compared to other groups.

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Introduction & Objective: Finger injuries are very common and majority of them can be treated under digital block anesthesia. Traditional digital block is one of the most commonly performed blocks performed by care providers in several medical fields. There are two other less known methods, transthecal (pulley) block, in which local anesthesia is injected into the flexor tendon sheat that needs less volume of anesthesia and hasnot neurovascular complications and subcutaneous block in which local anesthesia is injected subcutaneously at the level of A1 pulley. This study aimed to compare the results of the three methods of digital block. Materials & Methods: A prospective randomized clinical trial was performed at Kashani hospital to compare the less known transthecal (pulley) and subcutaneous methods with traditional digital block with regard to the length of anesthesia and need to another anesthetic method (due to insufficient anesthesia) as a supplement. We divided 150 patients that were admitted to kashani hospital operating room due to finger injury, randomly, into three groups. In each group the patients were anesthetized by one of the three different methods. All blocks were performed by the same investigator. Data were analyzed by SPSS software using T test. Results: Mean length of anesthesia was 34.2 min’s in the transthecal digital block method and 34 min’s in the subcutaneous method and 33.8 min’s in the traditional digital block method. A repeat injection or local infiltration as a supplement was necessary in 5 instances (7 blocks) in the traditional digital block method and 9 instances (11blocks) in the subcutaneous method (p<0.05). Conclusion: Regarding fewer injections and less amount of lidocaine and no risk of damaging the neurovascular bundles and comparable length of anesthesia and no need to supplemental anesthesia, transthecal digital block is an appropriate alternative to traditional digital block and subcutaneous injection.

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ABSTRACT: Introduction & Objective: A standard treatment option for carpal tunnel syndrome (CTS) is local injection of anesthetic-corticosteroid. This clinical trial was designed to compare the safety and efficacy of daily application of the EMLA cream with that of a single injection of methyl prednisolone acetate. Materials & Methods: This is a clinical trial which was performed in the clinics of Shiraz medical school in 1386. Sixty five participants with clinical and electrodiagnostic evidence of mild to moderate CTS were randomized to receive either the EMLA cream (group 1) or one injection (40 mg) of methylprednisolone acetate at wrist (group 2). Visual analog scale was used to assess the patients’ pain acuity. Collected data were statistically analyzed by SPSS software using Chi-Square test. Results: Pain intensity before and after treatment and also 4 weeks after treatment in group A was 5.8±0.98 , 0.7±0.82 and 2.1± 1.2 and 5.7 ±1, 2.4±1.5 and 1.6±1.4 in group B. The differences in pain intensity in both group were significant (p<0.001). Conclusion: EMLA cream was effective in reducing pain associated with CTS. It can be an effective, noninvasive symptomatic treatment for the patients with mild to moderate CTS.

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Introduction & Objective: ESWL is a non-invasive method of breaking stones, using acoustic shock waves. Shock waves cause temporary deep visceral pain and discomfort in entry therefore, administration of sedatives is necessary. The purpose of this study was to compare the effect of topical lidocaine and piroxicam gel with intravenous pethidine in reducing pain during ESWL. Materials & Methods: This clinical trial study was performed on 159 patients who referred to Ayatollah Kashani Hospital in Shahrkord for ESWL in 2009. Patients were randomly divided into three-groups. For the first group, intravenous pethidine (0.5 mg/kg alone) was administered. The second group received topical piroxicam, and the third group received topical lidocaine in the area of flank for half an hour before ESWL. During the operation, those patients who had unbearable pain, received another 0.5 mg/kg of pethidine. Data was collected using MC Gill questionnaires and analyzed using the SPSS software, using parametric, nonparametric methods and Dunn's Multiple Comparisons tests. Results: The mean of pain scores in the first group (pethidine) was 6.2 ± 6.9 while these scores were 3.2 ± 2 .7 and 3.9 ± 3.1 for the second (piroxicam gel) and third group (lidocaine gel) respectively. The differences in the mean score of pain was significant in the pethidine group compared to the other groups (P <0.05). The average pethidin consumption were 24 ± 16 mg for the first group (pethidine), 10 ± 13 mg for the second group (piroxicam gel), and 5 ± 9 mg for the third group (lidocaine gel). The mean difference was significant in pethidine treated group in comparison with other two groups (P < 0.05). Conclusion: The use of topical piroxicam or lidocaine reduces pain in patients after ESWL It also reduces the need for sedative drugs.

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Abstract Background & aim: The methods to increase duration of spinal anesthesia is always noticed.,the aim of this study was to investigate the effect of mexiletine on duration of sensory and motor block in spinal anesthesia. Methods: In a clinical trial study 60 patients with age 18-50, ASA 1,2 who were scheduled for lower limb elective surgery at Shahid Bahonar hospital were enrolled. They were randomally assigned in two groups of control and intervention. Intervention group received oral mexiletine 200 mg 2hours before operation and control group received placebo.Spinal anesthesia was carried out with lidocaine /5 (100mg) in L2-L3 or L3-L4 space by the same method in two groups. Pulse rate,Pulse oximetry and mean arterial blood pressure were recorded in two groups every 5-10 minutes.Also the duration of sensory and motor block was recorded. The results were analyzed with Student t-test,Chi square and Mann-Whitney. Results:The onset of sensory and motor block was significantly faster in intervention group.(P<0/01) The duration of sensory and motor block was significantly more in intervention group than control.(P<0/001) The pulse rate in intervention group were signifigantly less than control group in 0,5,10,60,75 minutes after spinal injection. (P<0/05) Conclusion: Mexiletine is effective in increasing duration of sensory and motor block in spinal anesthesia with lidocaine and also increases the onset of both sensory and motor block with lidocaine. Key Words: Mexiletine, Sensory and motor block, Spinal anesthesia, Lidocaine

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Abstract
 
Background & aim: Easy access, rapid recovery and high potency of monocyte cell therapy have led to special attention in cell therapy research. Monocytes are considered as sticky cells to the flask. Therefore, finding the appropriate isolation method that has the least damage to the cell and its function is of particular importance. The purpose of this study was to compare the functional capabilities of monocytes after isolation with three methods: lidocaine / EDTA, trypsin and cold PBS / EDTA.
 
Methods: In this experimental study, after extraction of peripheral blood mononuclear cells from Balb / c mice, cells (107 × 1 cells / ml) were incubated in RPMI culture medium in T25 culture flask for 4 hours. After incubation time, non-adherent cells (mainly lymphocytes) were separated by two rinsing and removed from the flask. Three different methods of trypsin, lidocaine and phosphate buffer saline were used for isolation of monocyte cells. After isolating the cells with each method, the functional capabilities of the monocytes were measured and compared with each other. The collected data were analyzed using one-way ANOVA.
 
Results: The amount of extraction, survival, metabolic activity, phagocytosis percentage, respiratory explosion, nitric oxide levels, and yeast potential in cells isolated by lidocaine were significantly higher than other groups. Although the use of trypsin, although it results in the removal of more cells, is cooled to the PBS method, but these cells exhibit significant physiological impairment in comparison with the Lidocaine / EDTA or PBS / EDTA method. Neutral red uptake was detected by trypsin isolated monocyte cells in comparison to the other two methods at lower levels. In comparison between cold PBS and lidocaine, it seems that there is no significant difference between the monocytes obtained from the two methods in terms of neutralization.
 
Conclusion: Compared to trypsin and PBS / EDTA, the Lidocaine / EDTA method is an appropriate method for isolating monocytes adherent to the flask, due to the extraction of more efficient and efficient cells.
 
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Background & aim: Pain is the most important complaint of children after tonsillectomy. Thus, poor relief will lead to complications. Therefore, the aim of the present study was to determine and compare the effect of topical injection of bupivacaine with lidocaine-epinephrine combination on pain after tonsillectomy.
 
Methods: The present paper was a double-blind controlled clinical trial study. The statistical population consisted of 87 children aged 4-10 years who were candidates for tonsillectomy. All patients in all 3 groups underwent general anesthesia in the same way and the knife surgery method was the same in all patients. 5 minutes before the incision, 2 cc in the first group and 2 cc in the second group in the children in the bed and around the tonsils were injected locally and no intervention was performed in the control group. Pain intensity in children 2, 4, 6 and 8 hours after surgery was assessed using the Wang Baker pain scale. The collected data were analyzed using descriptive and analytical statistical tests (95% confidence interval and significance level (p <0.05).The statistical population included 87 children aged 4-10 years who were candidates for tonsillectomy. All subjects which met the inclusion criteria were selected by non-probability and available sampling and randomly assigned to block in 3 groups.
 
Results: The range of postoperative pain intensity in children receiving bupivacaine was 4-8, in the group receiving lidocaine-epinephrine combination was 5-8 and in the control group was 6-10, respectively. There was a statistically significant difference between the pain intensity between the 3 groups of children participating in the study (p=0.001). Although the pain intensity of children in the bupivacaine group at 2, 4, 6, and 8 hours postoperatively was lower than that in children receiving the lidocaine-epinephrine combination, but this difference was statistically only at 2 and 4 hours postoperatively. Significant was reported (p=0.001) and no statistically significant difference was reported at other times (p>0.05). There was a statistically significant difference between the pain intensity range of children in the two intervention groups and children in the control group at all measurement times (2, 4, 6 and 8 hours after surgery) (p=0.001).
 
Conclusion: Topical injection of bupivacaine and lidocaine-epinephrine combination around the tonsils reduced the severity of pain in children after tonsillectomy, however no difference was seen in the effect of topical bupivacaine injection with lidocaine-epinephrine combination on postoperative pain relief after surgery not observed except at 2 and 4 hours after surgery. Topical injection of bupivacaine and lidocaine-epinephrine combination was safe at the injected concentration and no side effects were observed.