Effects of adding dexmedetomidine, fentanyl, and verapamil to 0.5% ropivacaine on onset and duration of sensory and motor block in forearm surgeries: a randomized controlled trial.

This study was aimed to compare the onset and duration of axillary block with ropivacaine 0.5% plus either dexmedetomidine, fentanyl, or verapamil in forearm surgeries. This double-blind clinical trial enrolled three equal-sized block-randomized groups of patients (n = 105) scheduled for hand and forearm surgery at Arak, Iran in 2019, who received: (i) ropivacaine (40 mL/0.5%) + dexmedetomidine (1 µg/kg), (ii) ropivacaine (40 mL/0.5%) + fentanyl (1 µg/kg), and (iii) ropivacaine (40 mL/0.5%) + verapamil (2.5 mg), respectively. We recorded some vital signs such as mean arterial pressure, heart rate and oxygen saturation, onset of complete sensory and motor block, duration of the block, opioid use, as well as pain score at recovery and certain time points (2, 4, 6, 12, and 24 hours post-operation). Adding dexmedetomidine to ropivacaine (40 mL/0.5%) prolonged the duration of sensory (P = 0.001) and motor block (P = 0.001) in compared to adding fentanyl and verapamil and it also shortens the time to onset of sensory (P = 0.001) and motor block (P = 0.001). There is a significant difference between three groups in terms of visual analog scale mean and the lowest pain score was obtained in the dexmedetomidine group (P = 0.001), significant time trend (P = 0.001), as well as the time and groups interaction (P = 0.001). Dexmedetomidine was concluded to be associated with alleviated pain; reduced opioid use; short onset of sensory block; and prolonged duration of sensory and motor block. It hence is recommended to lengthen the duration of axillary block and to help relieve postoperative pain and ultimately to move to cut down the postoperative opioid use in forearm surgery. The study was approved by the Ethical Committee of Arak University of Medical Sciences (approval No. IR.ARAKMU.REC.1397.266), and registered on Iranian Registry of Clinical Trials (registration No. IRCT20141209020258N111) on May 9, 2019.

Examining oral hygiene status and care needs of deaf and blind 6-12 years old exceptional school children in Kermanshah in 2015.

INTRODUCTION: Controlling and preventing oral diseases of patients with mental and physical disabilities had become one of the most important topics within the realm of dentistry researches. The main objective of this study was to examine oral hygiene and care needs of deaf and blind 6-12 years old exceptional school children in Kermanshah in 2015. MATERIALS AND METHODS: Oral hygiene of 51 deaf and blind 6-12 years old exceptional school children in Kermanshah in 2015 was examined in this study; indicators which underwent assessment included DMFT/decay, missing, falling, teeth (dmft), Gingival Index (GI), Plaque Index (PI), brushing, and flossing; the amount of used Unmet Treatment Need (UTN) was measured using DMFT/dmft index, and collected data were analyzed using SPSS, version 18. FINDINGS: The mean and standard deviation of GI and PI of the 51 deaf and blind students examined turned out to be 1.39 ± 0.30 and 0.86 ± 0.15, respectively; DMFT, dmft, and UTN of the blind students were 1.31 ± 1.20, 2.81 ± 2.81, and 0.76 ± 0.34, respectively; these values turned out to be 1.81 ± 2.16, 2.08 ± 3.48, and 0.85 ± 0.31, respectively, in case of deaf students. According to the results of this study, 18.7% of blind students and 27% of deaf students brushed their teeth once on a daily basis. CONCLUSION: Based on the results of this study, the incidence and severity of dental caries, particularly in primary teeth, were high among these children (mean: 2.06) and a large number of their teeth needed treatment (UTN: 1.18). In comparison to their peers, these group of children had lower state of oral health; therefore, a systematic, long-term is definitely required for the improvement of oral hygiene of studied patients.

Trans-4 Portal as a New Portal for Accessing the Lunate in Wrist Arthroscopy: a Cadaveric Study.

BACKGROUND: Evolving wrist arthroscopy requires creating new portals, and creating portals reciprocally leads to increased indications for arthroscopic wrist procedures. To facilitate access to the lunate bone and fossa for new arthroscopic procedures, a new portal was used. This is a cadaveric study of this portal. OBJECTIVES: In this cadaveric study, we evaluated a portal in wrist arthroscopy for procedures involving the lunate bone and lunate fossa. MATERIALS AND METHODS: Seventeen wrists from 10 fresh cadavers were included in this study. After diagnostic arthroscopy, a portal (Trans-4) was made through the fourth extensor compartment, exactly along the lunate's long axis under direct visualization from the 3-4 portal. Strand retractors were used to protect the extensor tendons and posterior capsule. Lunate bone core decompression and osteoscopy were done through the portal. At the end of the procedure, the position of the decompression hole in the lunate and any possible injury to the extensor tendons, distal radius cartilage, lunate cartilage, and perilunate ligaments were investigated. RESULTS: Lunate bone decompression was performed successfully in all cases using the trans-4 portal. In 15 wrists, the lunate hole was located in the middle third. In the other two wrists, it was located slightly radial in one case and slightly on the ulnar side in the other case. There was no cortical penetration during decompression, and no extensor tendon, superficial nerve branches, or peri-lunate ligament injuries were observed. CONCLUSIONS: The trans-4 portal could be a safe working portal in wrist arthroscopy that enables access to the lunate bone and lunate fossa.