Effects of intraneural and perineural injection and concentration of Ropivacaine on nerve injury during peripheral nerve block in Wistar rats

Introduction: Injury during peripheral nerve blocks is relatively uncommon, but potentially devastating complication. Recent studies emphasized that location of needle insertion in relationship to the fascicles may be the predominant factor that determines the risk for neurologic complications. However, it is wellestablished that concentration of local anesthetic is also associated with the risk for injury. In this study, we examined the effect of location of injection and concentration of Ropivacaine on risk for neurologic complications. Our hypothesis is that location of the injection is more prognostic for occurrence of nerve injury than the concentration of Ropivacaine.Methods: In experimental design of the study fi fty Wistar rats were used and sciatic nerves were randomized to receive: Ropivacaine or 0.9% NaCl, either intraneurally or perineurally. Pressure data during application was acquired by using a manometer and was analyzed using software package BioBench. Neurologic examination was performed thought the following seven days, there after the rats were sacrificed while sciatic nerves were extracted for histological examination.Results: Independently of tested solution intraneural injections in most of cases resulted with high injection pressure, followed by obvious neurologic defi cit and microscopic destruction of peripheral nerves. Also, low injection pressure, applied either in perineural or intraneural extrafascicular area, resulted with transitory neurologic defi cit and without destruction of the nerve normal histological structure.Conclusions: The main mechanism which leads to neurologic injury combined with peripheral nerve blockade is intrafascicular injection. Higher concentrations of Ropivacaine during intrafascicular applications magnify nerve injury

Analytical and morphometric study of nutrient foramina of femur and its clinical implications

Background: The femur is supplied princially by the diaphyseal nutrient artery which enters the bone throught the nutrient foramen. This supply is essential during the growing period, the early phases of ossification, and in different surgical procedures. The aim of present study was to examine the morphology and topography of the femur nutrient foramen to provide detalied data on such features.Methods: This was a cross-sectional-descriptive study in which we observed 50 femurs. We analysed the number and location of nutrient foramina, the length of the bone, the position of the nutrient foramen regarding to values of FI, correlation between number of nutrient foramen and length of femur, correlation between position of nutrient foramen and side of extremity to which femur belongs.Results: The double foramina were common in right (57.1%) and left (42.1%) femur, mostly located in medial lip of aspera line in right (64.3%) and on the lateral lip in left femur (68.4%), with statistically significant correlation, χ = 4.85; p = 0.03, p 0.05). There is positive correlation between length of right and left femur and number of foramina.Conclusions: The study provides data of the nutrient foramina on femur, which is helpful for clinicians to help preserve bone vascularization during surgery

Efficiency of dental health care in Federation of Bosnia and Herzegovina

Introduction: Despite the great improvements in the oral health status of the population across the world, oral diseases remains a major public health issue connected with a lost of numerous school days for children and absenteeism from work in adults. This effect is particularly evident in low and middle income countries as Bosnia and Herzegovina. This retrospective study presents the effi ciency of dental health care in Federation of Bosnia and Herzegovina measured by number of visits and performed dental treatments during the time period of six years, from 2005-2011. Methods: Data were collected by evaluation of the results obtained by forms which are mandatory to be completed by dentists. Results: The number of graduated dentists from 2007 to 2011 decreased from 108 in 2007 to 68 in 2011. In the same time, number of dentists employed in public sector slightly increased from 529 in 2005 to 587 in 2011. Number of extracted permanent teeth decreased from the 412 extracted permanent teeth per dentist in 2005 to 364 in 2011. Small number of fi lled primary teeth comparing to large number of extracted primary teeth showed negligence in their treatment. Conclusion: Having in mind that improving oral health in developing countries is a very challenging objective we can conclude that dental health care system in Federation of Bosnia and Herzegovina need to be reform in order to improve oral health in general, particularly in children population

Effects of intraneural and perineural injection and concentration of Ropivacaine on nerve injury during peripheral nerve block in Wistar rats

Introduction: Injury during peripheral nerve blocks is relatively uncommon, but potentially devastating complication. Recent studies emphasized that location of needle insertion in relationship to the fascicles may be the predominant factor that determines the risk for neurologic complications. However, it is wellestablished that concentration of local anesthetic is also associated with the risk for injury. In this study, we examined the effect of location of injection and concentration of Ropivacaine on risk for neurologic complications. Our hypothesis is that location of the injection is more prognostic for occurrence of nerve injury than the concentration of Ropivacaine. Methods: In experimental design of the study fi fty Wistar rats were used and sciatic nerves were randomized to receive: Ropivacaine or 0.9% NaCl, either intraneurally or perineurally. Pressure data during application was acquired by using a manometer and was analyzed using software package BioBench. Neurologic examination was performed thought the following seven days, there after the rats were sacrificed while sciatic nerves were extracted for histological examination. Results: Independently of tested solution intraneural injections in most of cases resulted with high injection pressure, followed by obvious neurologic defi cit and microscopic destruction of peripheral nerves. Also, low injection pressure, applied either in perineural or intraneural extrafascicular area, resulted with transitory neurologic defi cit and without destruction of the nerve normal histological structure. Conclusions: The main mechanism which leads to neurologic injury combined with peripheral nerve blockade is intrafascicular injection. Higher concentrations of Ropivacaine during intrafascicular applications magnify nerve injury

The impact of respiratory symptoms presence on quality of life of tobacco smokers

Introduction: Quality of life is a broad term that refers to the total well-being of the individual in terms of physical, psychological, emotional, mental, and social well-being, and which is in turn influenced by numerous factors including age, gender, socioeconomic status, risk factors in behavior, the environment, and the absence or presence of disease. Goal: The goal was to determine the presence of respiratory symptoms in smokers and to compare them with non-smokers as well as determine the relationship between quality of life with the frequency of respiratory symptoms from the aspect of gender, age, the environment in which they live, and the total monthly income of smokers compared to non-smokers. Material and Methods: The study was conducted on a sample of 600 subjects who were divided into two groups. The first group consisted of regular smokers (300 subjects) and the second group consisted of non-smokers. Former smokers were not included in the study. The survey questionnaire was designed on the basis of the following. A questionnaire to test the quality of life SF-36; Inventory of socioeconomic status EuroQoL; Basic respiratory symptoms were examined by MRC questionnaire (consisting of 9 questions).Results: The presence of respiratory symptoms was not associated with gender and the area of origin of the respondents, while the level of education, age, total monthly household income, and smoking status were directly related to the presence of respiratory symptoms, so that respondents with lower education levels, older ones, those with lower incomes, and smokers have more pronounced symptoms of respiratory problems. There is large negative impact of respiratory symptoms presence on respondent′s quality of life. Conclusion: Smoking status were directly related to the presence of respiratory symptoms. There is large negative impact of respiratory symptoms presence on respondent′s quality of life

Detection of nerve structures during peripheral nerve blockade in pigs model

Objective: In recent years regional anesthesia has gained great popularity. However, like any other medical procedure, the regional anesthesia carries certain risk of unintended intraneural injection and consequential neurological complications. Studies in animals have suggested that intraneural application of local anesthetics may cause mechanical injury. Previous studies, however, have used small animal models and clinically irrelevant injection speed or equipment. In this study we used equipment and injection methods in common clinical use to study the consequences and pressure dynamics of intraneural injection. Our hypothesis is that an intraneural injection is heralded by higher injection pressure and leads to neurologic impairment in pigs. Materials and Methods: Ten pigs of mixed breed (21-26 kg, 4-6 months old) were studied. After general anesthesia, the sciatic nerves (n = 20) were exposed bilaterally. Under direct vision, a 25-gauge insulated nerve block needle was placed either intraneurally (n = 10) or perineurally (n = 10), and 4 ml of preservative-free lidocaine 2% was injected using an automated infusion pump (15 ml/min). Injection pressure data were acquired using an in-line manometer coupled to a computer via an analog-to-digital conversion board. After injection, the animals were awakened and subjected to serial neurologic examinations during next 7 days. Results: All perineural injections resulted in injection pressures below 40 kPa. In contrast, intraneural injections resulted in significantly higher peak pressures (P < 0.01). In seven (70%) intraneural injections, the injections pressures were over 140 kPa (140-350 kPa). Neurologic function returned to baseline within 24 hours in all sciatic nerve receiving perineural injections. In contrast, residual neurologic impairment was present in seven sciatic nerves after intraneural injection and was associated with injection pressures >140 k Pa. Conclusion: High injection pressure (>140 kPa) predicts intraneural injection and consequential neurologic deficit. As long as the injection pressure is low, injection into poorly compliant tissue can be avoided and neurological complication can be prevented