Bilateral Optic Neuropathy Associated with Acute Inhaled Marijuana Use: Case Report and Review of the Literature

Marijuana is the most commonly used federally illegal drug in the United States. Acute marijuana use is associated with several cardiovascular and neuropsychological adverse effects. Ocular complications of marijuana abuse are very rare. Herein, we present the first report of bilateral optic neuropathy following smoking marijuana. A 28-year-old man presented to the emergency room with sudden onset of bilateral blurring of the inferior visual field 8 h after smoking marijuana. His best-corrected visual acuity was 20/30 in the right eye and 20/20 in the left eye. Fundus examination revealed blurring of the optic disc margins in both eyes and a splinter haemorrhage in the right eye. Bilateral inferior visual field defects were detected with greater severity on the right side. Optical coherence tomography confirmed the diagnosis of bilateral optic neuropathy. A urine drug screen test was positive for tetrahydrocannabinol, which is the primary active ingredient in cannabinoids. The rest of the neurological examination and imaging were normal. The patient was treated with intravenous corticosteroids and an anti-platelet drug. His vision recovered to 20/20 in both eyes, with complete resolution of the field defect over a follow-up of 6 months. Optic neuropathy following marijuana abuse is unusual. The results of our report emphasise the need for awareness of marijuana-associated optic neuropathy as part of ocular adverse effects of marijuana intoxication.

Uric acid and glaucoma: a systematic review and meta-analysis

Background

Glaucoma, the leading cause of irreversible blindness, is a common disorder that contributes to gradual optic nerve degeneration. The beneficial impacts of uric acid (UA) have been reported in some neurodegenerative conditions such as Parkinson's disease, Alzheimer's disease, and amyotrophic lateral sclerosis. But the results of current studies about the association between serum UA level and glaucoma are conflicting. The present meta-analysis was conducted to provide a better understanding of the association between serum UA level and glaucoma.

Methods

We searched the databases of PubMed, Scopus, Web of Science, and Google Scholar systematically until November 20, 2022 to identify case-control studies, comparing the serum UA concentrations of the patients with glaucoma and controls. The mean ± standard division difference was used to assess the difference in serum UA concentrations between the glaucoma patients and controls.

Results

Six studies involving 1,221 glaucoma patients and 1,342 control group were included in the present meta-analysis. This meta-analysis using a random effect model indicated that the mean UA level in glaucoma patients was 0.13 (I2 = 91.92%, 95% CI = -0.42 to 0.68) higher than the controls; however, it was not statistically significant.

Conclusions

Our findings provide evidence that glaucoma patients have a higher serum UA level compared to the controls, but this difference is not statistically significant. Prospective studies are needed to determine the possible association between increased UA and glaucoma pathogenesis.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022364055, identifier: CRD42022364055.

Comparison of visual outcomes, keratometric parameters and biomechanical profiles between deep anterior lamellar keratoplasty with big-bubble technique vs. Melles technique for keratoconus: a retrospective study

OBJECTIVE

Comparing results of two different DALK surgery techniques (big bubble vs. Melles) in patients with advanced keratoconus.

DESIGN

a retrospective comparative clinical study.

PARTICIPANTS

This study conducted on 72 eyes of 72 participants.

INTRODUCTION

This study designed to compare the results of two different DALK surgery techniques (big bubble vs. Melles) in patients with advanced keratoconus.

METHOD

Thirty-seven eyes were treated using the big bubble DALK method, while 35 eyes were treated using the Melles approach. Uncorrected visual acuity (UCVA), best corrected spectacle visual acuity (BCSVA), manifest refraction, keratometric characteristics, contrast sensitivity, corneal aberrations, corneal biomechanical characteristics, and endothelial cell profile are the outcome measurements.

RESULTS

Mean UCVA in big bubble group was 0.61 ± 25 LogMAR and in Melles group was 0.89 ± 0.41 LogMAR (p-value 0.043). Mean BCSVA in big bubble group (0.18 ± 0.12 Log MAR) was significantly better than Melles group (0.35 ± 0.16 Log MAR). Mean of sphere and cylinder refraction showed no significant difference between two groups. Comparing the endothelial cell profile, corneal aberrations, corneal biomechanical properties and keratometry had no significantdifferences. Contrast sensitivity reported as modulation transfer function (MTF) showed higher values in big bubble group and differences with Melles group weresignificant. Results of point spread function (PSF) in big bubble group had superiority to Melles group with considerable statistical P value of 0.023.

CONCLUSION

When opposed to the Melles approach, the big bubble technique generates a smooth interface with less stromal residue, which results in higher visual quality and contrast sensitivity.

The relationship between personality dimensions with resiliency and sense of coherence with respect to the role of spiritual health in the patients' candidate for eye surgery

Introduction

This research aimed to determine the relationship between personality dimensions with the rate of resiliency and internal cohesion regarding the intermediary role of spiritual health in candidate patients for eye surgery.

Methods

The method used in this is of correlation type, and statistical population in this project included all eye patients chosen for eye surgery who were examined at technical eye clinics in Tehran. The statistical sample included 200 patients from the statistical population who were chosen through a targeted sampling method. The data collection tools were Conner and Davidson's tolerance questionnaire (2003), Maccary and Costa's personality questionnaire (1985), Antonowski's internal cohesion scale (1970), and Politzin and Elison's spiritual health questionnaire (1982). The research hypotheses were examined through regression analysis, Pearson's correlation, and path analysis.

Results

The results showed that the calculated fit indices of the structural model of the research were correlated with the five dimensions of personality and internal cohesion of patients undergoing eye surgery with respect to the mediator role of spiritual health with 88% confidence. Investigation of path analysis coefficients showed a significant relationship between exogenous and intermediary variables on resiliency and internal cohesion (P value = 0.00).

Conclusion

According to the results of the research, the spiritual health variable plays a significant mediating role for exogenous and endogenous variables in this model. Therefore, personality traits not only directly influence resilience and internal cohesion but also indirectly influence spiritual well-being.

Optic Neuropathy following Botulinum Toxin Injection into the Medial Rectus Muscle for Diplopia

Purpose

To report a case of optic neuropathy (ON) following botulinum toxin A (BTA) injection into the medial rectus muscle.

Case Report

We describe a 37-year-old man with unilateral ON after a BTA injection into the left medial rectus for treatment of traumatic sixth nerve palsy. Oral prednisolone was prescribed for 14 days. After two weeks, his visual acuity returned to 20/20.

Conclusion

Botulinum toxin-induced neuropathy is a rare and vision-threatening complication of BTA. In patients with recent injection of BTA who present with visual complaints, botulinum toxin-induced neuropathy should be considered.

Serosurvey of parvovirus B19 and cytomegalovirus infections among female university students in Shiraz, Southern Iran

Infection with parvovirus B19 and cytomegalovirus (CMV) during pregnancy might lead to fetal infection, resulting in congenital abnormalities. This study aimed to investigate the frequency of IgM and IgG antibodies against parvovirus B19 and CMV in female university students in Shiraz, in Fars province, Southern Iran. In this cross-sectional study, 370 female university students were included. Blood samples were collected from each participant and tested for anti-parvovirus B19 and CMV IgG and IgM antibodies, using commercial ELISA kits. The mean age of the participants was 24 (±7)years. Out of 370 participants, 327 (88.4%) and 9 (2.4%) were positive for IgG and IgM antibodies against CMV. Moreover, 211 (57.0%) and 4 (1.1%) of the participants were respectively positive for IgG and IgM antibodies against parvovirus B19. The difference in CMV or parvovirus B19 seropositivity between different age groups was not statistically significant (P>0.05). The findings of our study showed that more than 50% of the female university students are seropositive to CMV and parvovirus B19 infections. It highlights the importance of health education and also the laboratory screening of females at childbearing age to reduce the risk of congenital infections resulting from these viral infections.

Comparison of the Effectiveness of Onion Extract, Topical Steroid, and Petrolatum Emollient in Cosmetic Appearance of Upper Blepharoplasty Scar

Purpose

To compare the effectiveness of onion extract, topical steroid, and petrolatum emollient in the prevention of scars in cases who underwent bilateral upper eyelid blepharoplasty.

Methods

A prospective, interventional, comparative, double-blinded case series was designed on cases who underwent upper lid blepharoplasty. After suture removal (1 week following the surgery), the eyelids of participants were randomly allocated into the three groups: The first group used onion extract on the right eyelids (n = 18), and the second group used topical steroid on the right eyelids (n = 19). In the third group, the control group, petrolatum emollient was used on the left eyelids (n = 37) of the first and second group's cases. They used drugs for 2 months and were evaluated by the Manchester Scar Scale (MSS) objectively by two graders who were blinded to the type of medication. MSS evaluates five different characteristics of the scar in addition to the Visual Analog Scale (VAS). These characteristics include color, distortion, contour, texture, and transparency. VAS scores the overall scar appearance which ranged among 0-10. The sum of the scores for the five different parameters, and VAS was calculated, analyzed, and compared among the groups.

Results

A total of 37 cases (74 eyelids) who underwent bilateral upper blepharoplasty were included. The mean ± standard deviation (SD) of age was 51.94 ± 9.26 years, 49.40 ± 9.37 years, and 47.00 ± 9.06 years in the onion extract, topical steroid, and petrolatum emollient groups, respectively (P = 0.275). There were no statistically significant differences in the mean ± SD of the sum of the MSS scores among the three groups (P = 0.924) or between the onion extract and topical steroid groups (P = 0.951). Furthermore, the color, distortion, contour, texture, transparency, and VAS scores were not statistically significantly different among the three groups or between the onion extract and topical steroid groups (P > 0.05).

Conclusion

There were no significant differences among these three groups of drugs regarding the appearance of the upper blepharoplasty scar.

Endocapsular hematoma as an uncommon early postoperative complication of phacoemulsification with intraocular lens implantation surgery

Herein we describe a 55-year-old woman presented with a chief complaint of visual loss in the right eye of 3 days duration. The patient underwent uncomplicated phacoemulsification cataract surgery on the right eye 1 week ago. Slit lamp examination revealed accumulation of blood in the capsular bag behind the intraocular lens with blood level. The patient was diagnosed as endocapsular hematoma. Neodymium-doped: yttrium-aluminum-garnet laser posterior capsulotomy was performed. The patient's vision improved completely.

Non-medial infectious orbital cellulitis: etiology, causative organisms, radiologic findings, management and complications

BACKGROUND

Orbital cellulitis is an ophthalmic emergency, which is associated with vision-threatening adverse effects. The purpose of this study is investigating etiology, radiologic findings, management and complications of patients with non-medial orbital cellulitis.

METHOD

A retrospective medical record and radiologic file review of patients with infectious orbital cellulitis was performed to detect all patients with non-medial orbital cellulitis who referred to Khalili hospital from 2016 to 2019. Age, sex, origin of infection, size of collection or abscess, medical or surgical management, microbiology, first and final best-corrected visual acuity, duration of admission, and complications was recorded. Patients divided into two groups; medical management and surgical management groups and all of data compared between in this groups.

RESULTS

Of ninety-six patients with infectious orbital cellulitis, 23 cases (14 male, 9 female) were included. Five patients (21.7%) were managed medically and 18 patients (78.3%) were managed surgically. Patients' age range was 5-70 years old. Most common location for non-medial cellulitis was superior space (66.7% in surgical and 40% in medical group; p = 0.511). In 13 cases of surgical group (72.3%) were detected microorganisms. The mean ± SD of collection volume in medical group were 476.5 ± 290.93 mm³ and 2572.94 ± 1075.75 mm³ in surgical group (p < 0.001). Ten patients in surgical group had compressive optic neuropathy. The mean ± SD of collection volume was 3204.97 ± 879.88 mm³ in patient with compressive optic neuropathy and 1280.43 ± 880.68 mm³ in patient without compressive optic neuropathy (P < 0.001). One case complicated by subdural empyema and another case progressed to necrotizing fasciitis.

CONCLUSION

Non-medial orbital cellulitis is an uncommon but sight-threatening and life-threatening condition. Timely diagnosis and accurate management reduce morbidity and mortality. Combined surgery for patients with superior or supra-temporal and large non-medial abscess is recommended.

Corneal Collagen Cross-Linking Using Epithelium Disruptor Instrument in Progressive Keratoconus

Purpose:

To compare the effects of accelerated corneal collagen cross-linking (CXL) in progressive keratoconus (KCN) patients via epithelium removal and transepithelial techniques, using Daya Disruptor (Duckworth and Kent, Hertfordshire, UK).

Methods:

This study is a double-blinded, randomized clinical trial. Patients with documented bilateral progressive KCN were randomized into two groups: one eye underwent epithelium removal (Group 1), and the fellow eye underwent epithelium disruption (Group 2). The primary outcomes were best corrected visual acuity (BCVA) and uncorrected visual acuity (UCVA), Scheimpflug-extracted keratometric indices, and anterior segment-optical coherence tomography-derived epithelial thickness profiles. These parameters were evaluated before and 12 months after CXL.

Results:

Sixty-four eyes from 34 patients with progressive KCN (34 eyes in the epithelium-removal group and 30 eyes in the epithelium-disruption group) were included. The mean ± standard deviation (SD) of age was 23.4 ± 3.8 years in the epithelium-removal group and 23.2 ± 3.5 years in the epithelium-disruption group. The mean ± SD of the preoperative spherical equivalent (SE), front maximum keratometry (K-max), back K-max, thickness of thinnest point, and corneal apex thickness were − 2.9 ± 3.0 diopter (D) and − 3.7 ± 3.1 D (P = 0.183), 53.8 ± 5.15 D and 54.4 ± 5.53 D (P = 0.653), −6.63 ± 2.40 D and − 6.68 ± 2.48 D (P = 0.131), 459.2 ± 37.4 μm and 460.8 ± 32.7 μm (P = 0.708), 470.5 ± 37.7 μm and 469.7 ± 33.1 μm (P = 0.679), and 55.4 ± 4.97 μm and 54.6 ± 7.16 μm (P = 0.767) in the epithelium-removal and epithelium-disruption groups, respectively. The mean ± SD changes of the UCVA and BCVA 12 months after CXL were − 0.1 ± 0.11 and − 0.02 ± 0.18 and − 0.04 ± 0.12 and − 0.02 ± 0.14 in the epithelium-removal and epithelium-disruption groups, respectively. No statistically significant improvement was observed in the UCVA and BCVA between the two groups (P = 0.868 and P = 0.937, respectively). The mean ± SD changes of the SE, superior epithelial thickness, corneal apex thickness, and thickness of thinnest point 12 months after CXL were − 0.21 ± 1.1 D and + 0.32 ± 1.6 D (P = 0.0001), −0.08 ± 0.26 μm and + 0.03 ± 0.33 μm (P = 0.028), −23 ± 11 μm and − 2 ± 6 μm (P = 0.0001), and − 25 ± 8 μm and − 3 ± 7 μm (P = 0.0001) in the epithelium-removal and epithelium-disruption groups, respectively.

Conclusions:

This study showed that the epithelium-disruption CXL using Daya has a similar potential for halting KCN progression as the epithelium-removal CXL. However, regarding the 12-month changes, the epithelium-disruption CXL is superior to the epithelium-removal CXL in the SE and corneal pachymetry.

Fourier Analysis of Keratometric Data in Epithelium Removal versus Epithelial Disruption Corneal Cross-linking

Purpose

To compare epithelium-removal and epithelium-disruption corneal crosslinking (CXL) methods in Fourier analysis of keratometric data and clinical outcomes.

Methods

In this double masked randomized clinical trial, each eye of 34 patients with bilateral keratoconus was randomly allocated to either the epithelium-removal or epithelium-disruption CXL treatment groups. Ocular examination, refraction, uncorrected and best spectacle-corrected visual acuity (UCVA and BSCVA, respectively) measurements, and Pentacam imaging (keratometry, pachymetry, and Fourier analysis) were performed at baseline and at six-month follow-up period.

Results

Patients' mean age was 23.3 ± 3.6 years. The preoperative thickness of the thinnest point was 459.20 ± 37.40 µm and 455.80 ± 32.70 µm in the epithelium-removal and epithelial-disruption CXL groups, respectively (P > 0.05). The corresponding figures were 433.50 ± 33.50 µm and 451.90 ± 39.70 µm, respectively, six months after the treatment (P = 0.0001). Irregularity component of the fourier analysis was 0.030 ± 0.016 µm in the epithelium-removal group and 0.028 ± 0.011 µm in the epithelium-disruption group preoperatively (P > 0.05). This measurement was 0.031 ± 0.016 µm and 0.024 ± 0.009 µm, respectively at month 6 (P = 0.04). The epithelium-disruption CXL group had better results in terms of the thickness of the thinnest point and the irregularity component as compared to the epithelium-removal group. The two study groups were comparable in spherical equivalent, mean keratometry, UCVA, BSCVA, or other Fourier analysis components (spherical R min, spherical eccentricity, central, peripheral regular astigmatism, and maximum decentration) (P > 0.05).

Conclusion

This study shows that epithelium-disruption CXL is superior to epithelium-removal CXL regarding the short-term changes in pachymetry and corneal irregularity. Other evaluated parameters were comparable between the two techniques.

Endogenous Candida Endophthalmitis as a Rare Complication of Trans-Urethral Lithotripsy in a Healthy Woman: A Case Report

Endogenous endophthalmitis is a serious sight-threatening ocular emergency that usually occurs in patients with serious underlying risk factors. In this report, we describe a case of endogenous Candida endophthalmitis following trans-urethral lithotripsy in an immunocompetent woman. In our case, the retinal lesion regressed completely and vision was restored. We discuss diagnostic procedures and management strategies in this article.

Unilateral endogenous Candida endophthalmitis after extracorporeal shock wave lithotripsy for a renal stone in an immunocompetent woman: a case report

Purpose

To report a case of endogenous Candida endophthalmitis that may cause catastrophic sight-threatening outcomes, after extracorporeal shock wave lithotripsy (ESWL) in a healthy woman.

Case presentation

A 32-year-old woman presented to the ophthalmology clinic with the symptom of blurred vision and floater in her right eye. She underwent ESWL for renal stone 1 week prior to her presentation. Fundus examination showed an elevated white lesion in para-fovea with fluffy border. Smear of diagnostic vitreous sampling showed pseudo-hypha and budding yeast. Systemic and immunologic and infectious workups were unremarkable. In our case, response to intravitreal and intravenous injection of amphotericin-B and oral fluconazole was dramatic. Six weeks after starting the treatment, infiltrative lesion completely disappeared. The authors review previous MEDLINE literature about this topic.

Conclusion

Endogenous Candida endophthalmitis following renal stone lithotripsy is a serious and rare intraocular infection that may happen in healthy individuals without any risk factors.

Corneal wasp sting: A case report and review of literature

Purpose

To report severe immunologic and toxic reaction due to corneal wasp sting that may cause catastrophic sight-threatening outcomes.

Methods

A 45-year-old man referred to the emergency room with corneal wasp sting of Vespa Orientalis. The authors review previous Medline literature about this topic.

Results

In our case, the response to frequent topical corticosteroid was dramatic, and at the seventh day after injury, all inflammatory responses in the anterior segment of the eye had been resolved.

Conclusion

Corneal wasp injury with Vespa Orientalis can cause severe inflammation of the cornea and the anterior segment. Topical corticosteroids are the mainstay of treatment.

Hold-up and flooding characteristics in a perforated rotating disc contactor (PRDC)

Dispersed phase hold-up and flooding behavior were investigated in a pilot plant scale perforated rotating disc contactor (PRDC) using three different liquid–liquid systems.

Efficacy of influenza vaccination in patients with cirrhosis and inactive carriers of hepatitis B virus infection

BACKGROUND

Influenza can causes morbidity and mortality that are greatly enhanced in patients with underlying chronic diseases such as Cirrhotic patients. This study was performed to assess the immunogenicity of Influenza vaccination in patients with cirrhosis and inactive carriers of Hepatitis B virus infection.

METHODS

In this clinical study 93 enrolled subjects divided into 3 groups: Cirrhotic (N=28), Inactive carriers of Hepatitis B (N=31) and subjects (N=34). All the participants were vaccinated by Influenza vaccine (Influvac®). Serum samples were taken before and 4 weeks after vaccination and the Humoral Immunogenicity was assessed by the Hemagglutination Inhibition (HI) test.

RESULTS

Four weeks after vaccination, seroconversion rates of vaccine strains ranged between 71.4% and 100% in Group 1, 70.6% and 94.1% in Group 2, and 58.1% and 80.7% in Group 3. No significant differences were seen in the rates of Seroconversion and antibody Geometric Mean Titers (GMTs) against Influenza A (H1N1 and H3N2) vaccine components in the three groups (P>0.05).The rates of Seroconversion and antibody GMTs against Influenza B vaccine component were significantly higher in Cirrhotic and inactive carriers of Hepatitis B than healthy subjects (P<0.005). No significant (P>0.05) differences in the rates of Seroprotection were observed within the three groups. Antibody GMTs against all three strains of Influenza vaccine increased significantly (P<0.001) after vaccination in three groups.

CONCLUSION

Influenza vaccination is effective in Cirrhotic patients and inactive carriers of Hepatitis B as well as healthy individuals. It means that vaccination should be considered in such patients in order to reduce the morbidity and mortality of Influenza.

Correlation of Hepatitis B surface antigen mutations with clinical status of the chronically infected patients from Kermanshah, West of Iran

AIM

Hepatitis B virus (HBV) genetic and protein variations have been found in chronic HBV infected patients who did not receive any treatment and active or passive immunizations. The aims of this study were to determine the genotypes as well as the patterns of variations distribution in chronically infected patients from the west part of Iran.

METHODS

Forty-six people with chronic HBV infection were enrolled in the study. The surface genes were amplified, sequenced and subsequently aligned using international and national Iranian database.

RESULTS

All strains belonged to genotype D, subgenotype D1 and subtype ayw2. Of all 116 "mutations" that occurred at 59 nucleotide positions, 49 (42.2 %) were missense (amino acid altering) and 67 (57.7%) were silent (no amino acid changing), respectively. At the amino acid level, 38 (79.1%) out of 48 amino acid mutations occurred in different immune epitopes within the surface proteins, of which 2 (5.2%) occurred in B cell; 12 (31.5%) in T helper and 24 (63.1%) inside CTL epitopes. There were significant associations between amino acid mutations (especially within immune epitopes) and anti-HBe positivity and increased ALT levels (P values: 0.014 and 0.04, respectively).

CONCLUSION

The distribution of amino acid mutations as well as the ratio between silent and missense nucleotide mutations showed that a narrowly focused immune pressure had already been on the surface protein T cell epitopes (94.9% of mutations), particularly CTL epitopes which led to the emergence of escape mutants in these patients.

Effect of Silicon Nutrition on Oxidative Stress Induced by Phytophthora melonis Infection in Cucumber

The effect of silicon nutrition on root rot of cucumber caused by Phytophthora melonis was studied in a greenhouse experiment. Two cucumber cultivars (Cucumis sativus 'Dominus' and 'Super Dominus') fertilized with three concentrations of Si (0.0, 1.0, and 1.7 mM Si in the form of sodium silicate) were not inoculated or were inoculated with P. melonis. The P. melonis isolate significantly decreased root dry weights, although the magnitude of growth reduction varied with cultivar and Si concentration. Silicon nutrition at either concentration significantly reduced disease severity relative to the treatment that received no silicon. There was a significant negative correlation between the extent of root rot caused by P. melonis and the extent of electrolyte leakage of roots. Roots infected with P. melonis had greater root catalase (CAT) and ascorbate peroxidase (APX) activities. There was a positive correlation between silicon concentrations and CAT and APX activities in plants inoculated with P. melonis. Silicon improved activity of antioxidant enzymes, resulting in enhanced crop resistance to oxidative stress induced by P. melonis infection and improved cucumber growth.

The effect of nitroglycerin as an adjuvant to lidocaine in intravenous regional anesthesia

PURPOSE

The disadvantages of intravenous regional anesthesia (IVRA) include slow onset, poor muscle relaxation, tourniquet pain, and rapid onset of pain after tourniquet deflation. In this randomized, double-blind study, we evaluated the effect of nitroglycerin (NTG) in quality improvement when added to lidocaine in IVRA.

METHODS

Forty-six patients (20-50 yrs), were randomly allocated in two equal groups. Under identical condition, the control group received a total dose of 3 mg/kg of lidocaine 1% diluted with saline, and the study group received an additional 200 microg NTG. Vital signs and tourniquet pain, based on visual analog scale (VAS) score were measured and recorded before and 5, 10, 15, 20, and 30 min after anesthetic solution administration. The onset times of sensory and motor block were measured and recorded in all patients. After the tourniquet deflation, at 30 min and 2, 4, 6, 12 and 24 h, VAS score, time to first analgesic requirement, total analgesic consumption in the first 24 h after operation, and side effects were noted.

RESULTS

The sensory and motor block onset time were shortened in study group (2.61 vs. 5.09 and 4.22 vs. 7.04 min, respectively) (p < 0.05). The recovery time of sensory and motor block and onset of tourniquet pain were also prolonged (7.26 vs. 3.43, 9.70 vs. 3.74 and 25 vs. 16.65 min., respectively) (p < 0.05). Analgesia time after tourniquet deflation was prolonged and tourniquet pain intensity was lowered in study group (p < 0.05). Intraoperative fentanyl and meperedine requirement during first postoperative day and pain intensity at 4, 6, 12 and 24 hr postoperatively were lower in the study group (p < 0.05). There were no significant side effects.

CONCLUSION

The NTG adding to lidocaine in intravenous regional anesthesia shortens onset times of sensory and motor block and decreases the tourniquet and postoperative pain, without any side effect.