Comparison of impact of adjuvant treatment of midazolam, fentanyl, and magnesium sulfate with intrathecal bupivacaine on block characteristics and postoperative analgesia in knee arthroplasty: A randomized clinical trial

Objective:To compare the efficacy of midazolam,fentanyl,and magnesium sulfate as adjuvants to intrathecal bupivacaine on both block characteristics and postoperative analgesia in knee arthroplasty.Methods:This randomized double-blind clinical trial recruited spinal anesthesia patients of the American Society of Anesthesiologists classⅠorⅡ,who needed knee arthroplasty.Patients were stratified into three intervention groups,including the midazolam group,the fentanyl group,and the magnesium sulfate group,and the patients were administered with midazolam,fentanyl,and magnesium sulfate,respectively.Hemodynamic parameters,sensory and motor block,and pain score(Visual Analogue Scale)were measured and compared among the three groups.Results:A total of 105 patients were included in this study with 35 patients in each group.There was no statistically significant difference in terms of oxygen saturation,mean blood pressure,duration of surgery,and postoperative complications,including nausea,vomiting,bradycardia,dizziness,and hypotension,as well as the time of opioid administration among the three groups(P>0.05).Statistically significant differences were found in terms of heart rate at 15,30,45,60,75,and 105 min after beginning of operation among the three groups,which was lower in the midazolam group(P<0.05).The midazolam group showed a shorter time to achieve sensory block after spinal anesthesia,sensory block to T8 or higher and sensory block to T12 and L1(P<0.05).Besides,the three groups showed significantly differences in terms of onset of motor block after spinal anesthesia and time to achieve motor block to T8 or higher or Bromage score 3(P=0.001).No significant difference was noted in pain scores among the three groups(P>0.05).Conclusion:Midazolam resulted in a shorter time to achieve sensory and motor block to T8 or higher,the onset of motor block and sensory block after spinal anesthesia,and time to achieve sensory block to T12 and L1,and the pain scores were not significantly different among the groups.Thus,midazolam can be highly underlined,if a shorter onset of sensory and motor blocks is targeted.[Funded by the research deputy of Arak University of Medical Sciences(No.99258);fa.irct.ir number,IRCT20141209020258N164].

Zircon U-Pb age and geochemical characteristics of granodiorites from the western Qilian block

1 Introduction Qilian Block is located in between the South China Craton and the North China Craton and the Tarim Craton(Fig.1a),which is one of the key area to study the tectonic evolution of China.The Phanerozoic tectonic framework

Geological Characteristics of Potassium-Bearing Salt Layers in the Well Block Quele of the Kuqa Depression and their Significance

Potash is one of the long-term scare deposits in China,and potash prospecting has long been listed as a key brainstorm project for our nation and geological prospecting units.There have been considerable studies in search for potash deposits in the Kuqa depression of the Tarim basin(Jackson et al.,1991;Gemmer et al.,2004;Vendeville,2005;Vendeville and Jackson,1992a,1992b),

A catastrophic debris flow in the Wenchuan Earthquake area,July 2013：characteristics,formation,and risk reduction

In the Wenchuan Earthquake area,many co-seismic landslides formed blocking-dams in debris flow channels. This blocking and bursting of landslide dams amplifies the debris flow scale and results in severe catastrophes. The catastrophic debris flow that occurred in Qipan gully(Wenchuan,Southwest China) on July 11,2013 was caused by intense rainfall and upstream cascading bursting of landslide dams. To gain an understanding of the processes of dam bursting and subsequent debris flow scale amplification effect,we attempted to estimate the bursting debris flow peak discharges along the main gully and analyzed the scale amplification process. The results showed that the antecedent and triggering rainfalls for 11 July debris flow event were 88.0 mm and 21.6 mm,respectively. The event highlights the fact that lower rainfall intensity can trigger debris flows after the earthquake. Calculations of the debris flow peak discharge showed that the peak discharges after the dams-bursting were 1.17–1.69 times greater than the upstream peak discharge. The peak discharge at the gully outlet reached 2553 m^3/s which was amplified by 4.76 times in comparison with the initial peak discharge in the upstream. To mitigate debris flow disasters,a new drainage channel with a trapezoidal V-shaped cross section was proposed. The characteristic lengths(h1 and h2) under optimal hydraulic conditions were calculated as 4.50 m and 0.90 m,respectively.