Complex regional pain syndrome (CRPS) is a variety of painful conditions following injury which appears regionally having a distal predominance of abnormal findings. This study, evaluate the use of phentolamine for sympathetic block and regional anesthesia in treatment of CRPS related pain. In this study, 68 patients with CRPS who were referred to pain clinics of Imam Hossein and Akhtar Hospitals and Gandy Center of Surgery between 2003-2008 were evaluated. Forty three of 87 patients finally undertaken intravenous regional sympatholytic block according to therapeutic protocol. 37 patients (86%) received one block, 2 of them (4.75%) received 2 repetitions of blocks and finally repeated block for three times occurred in 4 patients (9.3%). A week after block pain relief outcomes was recorded as following; excellent in 7 patients (16.3%), good in the 32 patients (74.4%) and moderate in the 4 patients (9.3%). After a month, 8 patients (18.5%) showed excellent relief and it was good and moderate in 32 (78%) and one case (2.4%), respectively. Pain relief after three months was excellent, good and moderate in the 13 patients (31.7%), 25 patients (61%) and 3 patients (7.3%), respectively. In this study level of pain relief was significant in various intervals and it showed significant difference in relief three months after block (P=0.04). CRPS due to SMP (sympathetically maintained pain) is thought to be alleviated by phentolamine. Intravenous phentolamine infusion is potentially a new significant option for the therapy of CRPS.

Infraclavicular plexus block has recently become a technique with increasing interest. However, no approach has provided easily identifiable landmarks and lack of complications (mainly pneumothorax). In this study we performed the infraclavicular block with modified approach of the Raj technique.The block was performed in 30 pateints (Mean age 22.64±0.96 years) based on the identification of the acromial process of the scapula, jugular notch, and emergence of the axillary artery within the axillary fossa, with the arm abducted to 90. and elevated by approximately 30° We performed this approach by injecting 40-50 ml mixture of lidocain 1% and bupivacain 0.25% with epinephrin 1.200000. Success was define as a sensory block of the 5 nerves of the forearm within 30 min after performeing the block.The success rate was 100% when a distal response (flexion or extension of the wrist or fingers) was elicited and 72.7% when a proximal (contraction of the triceps, biceps) was obtained using a nerve stimulator. Complications were rate. Aspiration of blood was seen in 3% of patients and 11% complained sever pain during the procedure; no pneumothorax or hematoma was occured.In Conclusion the modified approach of the Raj technique for infraclavicular block is very effective when a distal nerve stimulator response is obtained with a small complication rate.

In this study, weather conditions such as air humidity, temperature air, and wind speed were investigated in relation to wind turbine efficiency with the approach of an exergy study. In this study, the wind speed has been investigated in two different climatic regions of Iran with an approximate distance of 1200 km, in the names of Ardabil and Marvast. The amount of wind density of Ardabil is equal to 66 (kW/m2) and Marvast is equal to 123 (kW/m2). Power production using a 10 (Kw) wind turbine in the Ardabil region is 2.3 (MWh) and in the Marvast region is 3.2 (MWh) per year. The highest wind turbine exergy efficiency is 0.48 in the Ardabil region, and the highest exergy efficiency in the Marvast region is 0.18. The amount of reduction of CO2 gas production, using wind turbines in comparison to gas and diesel power plants in Ardabil, are 1.1 and 2.1 tons and in Marvast are 1.5 and 2.9 tons per year. This reduction in CO2 greenhouse gas per year is equal to using a forest region of 1000 (m2) to 3000 (m2). The use of wind turbines reduces the fuel consumption of diesel power plants in the Ardabil region for the amount of 797.4 liters and in the Marvast region for the amount of 1244 liters of diesel per year. According to this review, it can be concluded that in addition to wind speed, air humidity plays a significant role in the selection, installation, and commissioning of wind turbines in the region. According to this survey, it can be seen that in the Ardabil region, the wind speed of the wind turbine has a higher exergy efficiency than in the Marvast region, and it can be concluded that the wind turbine has performed better in the Ardabil region.

Introduction: Intravenous regional anesthesia is a simple and reliable method for surgeries of the lower extremities. The purpose of this study was to compare the effect of regional intravenous anesthesia with spinal anesthesia on foot surgeries. Materials and Methods: This study was conducted as a randomized clinical trial on 60 patients undergoing foot surgery in two similar groups. In this account, the intervention group received intravenous regional anesthesia with 40 mililitre of lidocaine (0. 5%) and the control group underwent spinal anesthesia with marcaine (0. 5%). Duration of analgesia, duration of postoperative analgesia after opening the tourniquet, recovery time, postoperative pain intensity based on Visual Analogue Scale (VAS), blood pressure, heart rate during the surgery and recovery period, and other complications such as nausea, vomiting and headache were assessed in both groups. Results: The two groups did not differ in age and sex. The mean duration of analgesia in the spinal group was 121. 13± 17. 30 minutes and in the intravenous anesthesia group was 49. 50± 5. 14 minutes (P<0. 001). The mean duration of analgesia after opening the tourniquet was 72. 17± 15. 29 minutes in the control group and 11. 17± 6. 22 minutes in the intervention group (P<0. 001). The mean recovery time in the control group was 26. 83± 4. 82 and in the intervention group was 13. 10± 3. 20 min (P<0. 001). One hour postoperative pain score was 2. 3 ± 0. 31 in the control group and 7. 1± 0. 20 in the intervention group (P<0. 001). Hypotension, bradycardia, nausea and vomiting, dizziness, and headache were more incidental in the spinal group than in the intravenous anesthesia group (P<0. 001). Conclusion: In short-term foot surgeries, intravenous regional anesthesia is more appropriate than intra-spinal.

Strength measurement of rock requires testing that must be carried out on test specimens with particular sizes in order to fulfill testing standards or suggested methods. Often, the coring process breaks up the weaker core pieces, and they are too small to be used in either index tests or conventional strength tests such as point load index (Is) and Brazilian tensile strength (BTS). One of the index tests to indirectly determine the rock strength is the block punch index (BPI) test, which requires flat disc specimens without special treatment. This study aimed to evaluate the applicability of the BPI test for predicting the uniaxial compressive strength (UCS), BTS and IS of the sandstones by empirical equations. Also, we have compared the performance of the BPI and IS for predicting the UCS and BTS. It was experimentally shown that BPI is a reliable method for predicting the UCS, BTS and Is of the sandstones under study. Moreover, the results indicate that BPI could be utilized with same importance as Is for predicting the UCS, while predicting the BTS by Is appears to be more reliable than BPI.

Bier block anesthesia is an intravenous regional anesthesia technique in which an extremity is made numb for surgery by injecting a local anesthetic solution into a vein after the blood has been squeezed out of the extremity and a tourniquet has been placed on it. The tourniquet prevents the local anesthetic from leaving the extremity and blood from entering it, giving the patient a numb (anesthetic) extremity and the surgeon a bloodless field to work in. The technique is named for August Bier.The advantages of the technique is that it is simple to perform, and provides a bloodless field that is easy to work in and minimizes blood loss. The disadvantages are that there is a practical time limit on its use of about 1 hour due to tolerance of the awake patient for the pain of the tourniquet and 2 hours due to the maximum time blood flow can be restricted to the extremity without anoxic tissue damage.In this case we performed bier block in a high risk diabetic patient for below knee amputation. We added mg sulfate as an adjuvant drug in order to improve block quality and to prolong patient analgesia.

Background: The most important side effect of venous (Bier) block is systemic toxicity induced by local anesthetics. This is occurred by accidental tourniquet release after drugs’ injection. Effects of sensory and motor block of lidocaine increase by use of sub anesthetic dose of ketamine with lidocaine simultaneously and its toxicity reduces. To evaluate the sensory and motor block via venous block in patients under upper extremity, surgeries induced by lidocaine compared to lidocaine and ketamine.Material and Methods: Forty ASA physical status I-II patients, undergoing elective surgery of the hand or the forearm, were studied in Shahid Rajaee University Hospital. Patients divided in two groups randomly (n=20). The affected extremity was exsanguinated by elevating it and wrapping it with an esmarsh bandage.The proximal double- cuffed tourniquet was inflated on the arm of affected extremity and local anesthetics administered (each patient in control group received with 40 ml of lidocaine 0.5% and each patient in intervention group received 40 ml of lidocaine 0.25% plus ketamine 0.1% (40 mg)). Sensory blocking was assessed by using a blunt pin every 1 minute after local anesthetic injection. Motor block also assessed based on patient’s ability to move the operative hand fingers. Data were analyzed using t- test.Results: the mean time of sensory and motor blocks were 4.25±0.63 and 7.65±0.24 minutes in control group and 4.35±0.62 and 8.35±0.67 minutes in intervention group respectively. Time of motor block was significantly longer in lidocaine and ketamine group compared to lidocaine group (p=0/003).Conclusion: Using lidocaine combined with ketamine is safe method for the intravenous regional anesthesia especially in surgeries on hand or forearm. In this method lidocaine doses for blocking is lessen and reach to nontoxic level.