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Recently, epinephrine is used to increase the depth and duration of local anesthetic pain, and it is widely used topically to reduce local anesthetic release and reduce bleeding caused by surgery.

This study was a randomized, double-blind clinical trial on 30 patients aged 18 to 85 years undergoing lower limb orthopedic surgery referred to Peymaniyeh Hospital in Jahrom from September to December 2022. Patients were randomly assigned to two groups, A (epinephrine+fentanyl+bupivacaine) and B (bupivacaine+fentanyl). Systolic blood pressure, diastolic pressure, mean arterial pressure, arterial blood oxygen saturation percentage, and pulse rate were measured and recorded before drug administration, before spinal anesthesia, after anesthesia, and then every half hour until the end of surgery (15, 45, 30, 60, 75, 90, 120) and during recovery. Data analysis was performed using SPSS version 21 software and descriptive (mean, standard deviation) and inferential statistics (t-test, chi-square, Mann-Whitney, Friedman) at a significance level of P<0.05.

Thirty patients aged 18 to 85 years (in two groups of 15) with anesthesia class I and II undergoing lower limb orthopedic surgery were evaluated. The study groups are matched in terms of age and gender variables. There was no significant difference in mean systolic, diastolic, mean arterial blood pressure, and heart rate before and after anesthesia, 15, 45, 30, 60, 75, 90, and 120 minutes after drug injection, and at entry and exit from recovery between the Epinephrine+Fentanyl+Bupivacaine and Fentanyl+Bupivacaine groups. There was a significant difference in mean O2SAT before anesthesia, 15, 30, and 75 minutes after drug injection between the epinephrine+fentanyl+bupivacaine and fentanyl+ bupivacaine groups (P<0.05).

The use of the combination of epinephrine+fentanyl+intrathecal bupivacaine compared to the combination of fentanyl+bupivacaine did not have a significant difference in the studied variables of patients' vital signs.

Tonsillectomy is one of the most common surgeries in children, which is associated with pain and bleeding after the operation. This study was conducted to investigate the effect of lidocaine-epinephrine administration in controlling complications after tonsillectomy.

This clinical trial was conducted on 109 patients aged 5 to 18, who had referred to Kowsar Hospital in Sanandaj for tonsillectomy. After dividing the patients randomly, 40 mg of 1% lidocaine and 5 μg of epinephrine (a volume of 5 ml) were injected into the tonsillar bed in the intervention group before the surgery, but in the patients of the control group, surgery was started without lidocaine-epinephrine administration. Blood pressure and heart rate of the patients before, during and after surgery, and pain intensity based on Wong-Baker Faces Pain Scale at minutes 30 and 60 and 6, 12 and 24 hours after surgery, and the amount of bleeding during and after surgery were recorded and compared by calculating the volume of suction and blood pads as well as the length of stay in recovery.

The mean amount of bleeding in the intervention group was 65.5±47.1 ml and in the control group was 113.7±45.7 ml (p=0.0001). The mean pain intensity and hemodynamic changes at minutes 30 and 60, and 6, 12 and 24 hours after surgery in the intervention group were lower than the control group and showed statistically significant differences (p=0.0001). The mean time of discharge from recovery in the intervention group was 0.35±23.2 minutes and in the control group was 50.4±17.5 minutes (p=0.0001).

Based on the results of this study, it seems that the administration of lidocaine-epinephrine in the tonsil bed before tonsillectomy can reduce the amount of pain, bleeding, and hemodynamic changes during and after surgery, and the patient can recover sooner.

Traffic noise, as one of the noise types, is a widespread feature of the urban environments. Traffic noise exposure can lead to hearing loss, hypertension, obesity and ischemic heart diseases. Stress also has many physiological effects on the hormonal and neural function. Therefore, this study was designed to evaluate different periods of traffic noise effects on the levels of adrenal stress hormones in male rats.

48 male wistar rats were used in this study. They divided randomly into 6 groups; the control, short term (1 day) and long term (7, 14, 21 and 28 days) groups. Traffic sound was recorded, adjusted and played (86 dB) for animals. At the end of experiment, the animals were anesthetized and blood sample was drawn. Levels of epinephrine, norepinephrine and corticosterone were measured. Statistical analysis was done by one-way analysis of variances and Tukey’s post hoc test.

Findings showed that in the 1 day group, epinephrine level decreased and in the 21 days group significantly increased. Levels of norepinephrine showed significant increase in the 14, 21 and 28 groups. In the same way, concentration of corticosterone significantly increased with increase of traffic noise time.

It seems that traffic noise exposure led to decrease of epinephrine plasma concentration in the short term while it increased all of 3 hormones in the long term. It may be due to hormonal structure, half time and stress period.

Many patients experience anxiety when they visit a dentist and anxiety causes an increase in the patient's blood pressure, as well as an injection of epinephrine, is also effective in increasing the blood pressure of the patients. The aim of this study was to investigate changes in blood pressure following injection of lower jaw blocking with lidocaine containing 1:80000 epinephrine and its association with anxiety level in patients.

In this cross sectional study, 129 patients referred to the dental school of Islamic Azad University of Khorasgan were selected and their blood pressure was measured before injection of anesthetic drug and ten minutes later. The anxiety level of the patients was determined using a dental anxiety inventory and the relationship between the level of anxiety and blood pressure in the patients before and after injection was measured. Data were analyzed by T-paired statistical test, regression and Pearson test.

There is a positive correlation between the patient's systolic and diastolic blood pressure before the injection and the anxiety score is significant (p value < 0.001).There was also a significant association between the degree of correlation between mean pressure and anxiety score(p value < 0.001). There was a positive and significant correlation between injection pressure and anxiety scores. (p value < 0.001).

Lidocaine injection containing epinephrine 1: 80,000 in patients undergoing mandibular block is associated with a significant increase in patients' systolic blood pressure. There was also a significant relationship between patients 'levels of anxiety and blood pressure, which had a greater effect on patients' blood pressure than epinephrine injections.

Pain is the most common post-tonsillectomy complaint in children, whose insufficient relief can result in a number of complications. The present study aimed to determine and compare the effects of the local injection of bupivacaine and lidocaine-epinephrine mixture on post-tonsillectomy pain.

In this double-blind randomized clinical trial, 87 candidate children for tonsillectomy aged 4-10 years were selected through non-probability convenience sampling. The subjects were randomly assigned to 3 groups. All patients in the three groups underwent identical general anesthesia and cold knife dissection procedures. Five minutes before incision, children in the intervention groups received 2 mL of bupivacaine 0.125% and 2 mL of a mixture of lidocaine 1% and epinephrine (1:200,000), respectively, through tonsillar and peritonsillar local injection. Pain intensity was assessed 2, 4, 6, and 8 hours after surgery using the Wong-Baker Faces Pain Rating Scale. Data were analyzed in SPSS 21 using descriptive and inferential statistics at a 95% confidence interval and 0.05 significance level.

The postoperative pain intensity ranged from 4 to 8 in the bupivacaine-receiving group, from 5 to 8 in the lidocaine-epinephrine mixture-receiving group, and from 6 to 10 in the control group. A statistically significant difference was observed in the median pain intensity among the three groups of children participating in the study (p=0.001). Although the pain intensity in the bupivacaine-receiving children was lower than lidocaine-epinephrine mixture-receiving children 2, 4, 6, and 8 hours after surgery, the difference was only statistically significant 2 and 4 hours postoperatively (p=0.001) and no statistically significant difference was observed in other times (p>0.05). There was a significant difference in the pain intensity between the two intervention groups and the control group at all times (2, 4, 6, and 8 hours after surgery) (p=0.001).

Although local injection of bupivacaine and lidocaine-epinephrine mixture reduced post-tonsillectomy pain in children, there was no difference in their effect on pain reduction except 2 and 4 hours postoperatively.

The pain after the surgery is an important clinical problem. Until now a lot of methods for reducing pain after surgery have been evaluated. Because of the high prevalence of cesarean section and this point that pain after cesarean section can influence the healthy state of mothers and infants, this study with purpose of comparing of outcome of incisional infiltration with Lidocaine and Epinephrine versus Lidocaine in the end of cesarean section has been planned.

This study has been performed on 100 pregnant women with term pregnancy that were candidate for elective cesarean with spinal anesthesia. Patients were randomly divided to two groups including, group of 20 ml 2% Lidocaine or 20 ml solution of 1/4 of 1 mg/ml Epinephrine in 50cc of 2% Lidocaine (1/200000 dilution) that has been infiltrated in the subcutaneous after cesarean and before closing the skin. The measure of pain and narcotic use after surgery, the time of first lactating, to get out of bed , and discharge time of patients from hospital were compared between two groups with statistical tests, independent t, fisher exact test , and chi-square .

The results of this study showed that patients who have received Lidocaine and Epinephrine in the incisional site after cesarean versus patients who have received Lidocaine alone meaningfully started lactating sooner (P=0.018) and discharged sooner from hospital (P=0.010). Also, these individuals experienced less pain intensity from the 4 hours postoperatively until the end of the first day after the operation, compared to the lidocaine group (P<0.001), and the use of pethidine on the first day was less than that of the opposite group (P<0.001).

It seems adding Epinephrine to the local anesthetics like Lidocaine can prolong the effect of anesthetics and can reduce the doses of narcotic use after surgery and also can reduce the time of first lactating and discharge from hospital.

Anaphylaxis is a potential life threatening condition which may control by proper diagnosis and efficacious management. The aim of this study was to determine the level of knowledge of anaphylaxis diagnosis and management in pediatric residents.
Subjects & This study was conducted in teaching hospitals of Tehran University of Medical Sciences. A total of 192 pediatrician and general and subspecialty pediatric residents during Sep. 2013 to Feb 2014 were included. They were asked to complete a 19 item questionnaire. Collected data analyzed using SPSS (version19) software. p Almost all respondents knew anaphylaxis as a life threathening event, however 23.4% didn’t answer correctly to the questions about signs and symptoms of anaphylaxis. None could determine therapeutic steps of anaphylaxis correctly, however, 94.7% agreed to administer epinephrine as the drug of choice for treatment (P=0.014). Only 78.1% correctly identified intramuscular route of epinephrine administration as the route of choice (0.000) and 71.4% used the proper dose. About half of participants knew about in-hospital observation time.
the present study indicated that, pediatricians and pediatric residentsoften are not very familiarwith the proper dosage of epinephrine, administration route and the optimaltime for hospitaldischarge in anaphylaxis. herefore, it seems that theoretical education about anaphylaxis is not sufficient to provide pediatric residents for clinical practice.

Hypertension is one of the most common diseases in recent century with several complications. The purpose of this study was to evaluate the effect of hydroalcoholic extract of Juglans regia L. leaves (Walnut tree) on blood pressure and its interaction with the adrenergic system in male rats.
In this experimental study that established in the physiology lab, School of scinse in Shiraz University from September to October 2013, in order to determine some of hydroalcoholic extract of Juglans regia L. leaves effect on blood pressure, the present study was performed by following procedure: 10 adult male wistar rats weighing between 180-250g were used. They were divided into two groups (Each group contained 5 rats) randomly: Juglans regia L. leaf extract group and Juglans regia L. leaf extract and adrenaline group. Then each rat was anesthetized by IP injection of 1.2 g/kg urethane. After tracheostomy the femoral vine and artery were cannulated for drug injection and blood pressure recording respectively. Arterial cannula for recording arterial blood pressure connected to a pressure transducer (PowerLab, ADInstruments, Sydney, Australia). Blood pressure parameters were recorded before and after IV administration of hydroalcoholic extract of Juglans regia L. leaf, solvent, adrenalin and extract with adrenaline.
The result showed a significant decrease of mean arterial pressure, systolic and diastolic pressure in response to extract with compare to control and sham group (P It can be concluded that hydroalcoholic extract of Juglans regia L. leaf suggested as a hypotensive agent. It seems that this effect is probably due to inhibitory effect on adrenergic system.

Introduction & The most persistent rhythm in the treatment of cardiac arrest is asys-tole. In this situation، the survival is rare. The choice is epinephrine، and vasopressin is as an alternative drug. The study purpose is to compare the effects of vasopressin and epinephrine on the outcome of asystole rhythm. This clinical trial was performed on 210 patients with asystole rhythm. 105 patients received epinephrine (group1) and 105 patients'' vasopressin (group 2) as the first drug. American heart association guideline (2010) was performed on both groups. Then data collection (age، sex، return of spontaneous circulation، survival of first hour، first day and first month، heart rate after 10 minutes resuscitation and survival to discharge) were evaluated. These data were analyzed by SPSS 18 software. There were no significant difference in sex، age، return of spontaneous circulation، survival of first hour، first day and first month after resuscitation between the two groups. But there was a significant difference in post resuscitation heart rate after 10 minutes in group 2 compared to group 1، which was lower in group 2. As tachycardia due to receiving vasopressin is less than that of epinephrine، it may be more effective on survival in some conditions such as its combination with other drugs، administration of multiple doses of vasopressin or acidosis. Although، further studies are needed.

Postoperative nausea and vomiting (PONV) is one of the most common complaints of the patients. The prevention of postoperative nausea and vomiting leads to improving the patients'' satisfaction، prevention of delayed discharge from the recovery، the unexpected prolonged hospitalization and reducing the cost of health care. This study was performed with aim to provide better prevention of postoperative nausea and vomiting after elective cesarean section (C/S). This clinical trial study was performed on 100 term pregnant women with ASA class I-II scheduled for elective C/S with intrathecal anesthesia. the subjects were divided into two groups based on random number table. For control، Intrathecal lidocaine-Fentanyl and for intervention group، a combination of Intrathecal lidocaine-Fentanyl-Epinephrine were administered. Recording of vital signs، nausea and vomiting was continued until recovery of sensorimotor block level under T10. Data was analyzed using SPSS statistical software (version 11) by Kolmogrov - Smirnov test، independent t test، Chi-square، and Mann-Whitney tests. There was no statistically significant difference between two groups in terms of nausea (P=0. 80) and vomiting (P=0. 21)، age (0. 69)، parity (P=0. 94)، Ephedrine injection time (P=0. 29)، need to atropine injection (P=0. 50)، need to metoclopramide injection (P=0. 085). Mean decrease of blood pressure in control group was significantly higher than intervention group (P=0. 004). Newborns in two groups had an Apgar score of 8-9. Adding 0. 2 mg Epinephrine to a combination of Intrathecal lidocaine-Fentanyl does not cause significant difference in the incidence of postoperative nausea and vomiting.

Recently, circulating hematopoietic stem cells (HSC) have been used for the treatment of most types of leukemia. However, the G-CSF mechanism has not been known yet but it is believed that G-CSF is mostly effective by its indirect functions. The suppression of the nervous system affects G-CSF induced mobilization of HSC. The main gene involved in mobilization is CXCR4 that ligand to SDF-1. So, this study investigates the effect of the main catecholamine of nervous system-Epinephrin- on CXCR4 expression. In this experimental study, isolated cord blood CD34+ cell of 20 healthy newborn with MACs columns treated with 10 μM Epinephrine and 1 μM Proporanolol. Expression of CXCR4 has been investigated at 1, 3 and 5 hours with qRT-PCR. Receptors of beta adrenergic expression have been studied with RT-PCR. Beta adrenergic receptors are expressed on CD34+ cells. Epinephrine led to significantly increased CXCR4 in hours 1 (3.2 ± 0.5), 3 (2.4 ± 0.4) and 5 (2.2 ± 0.4). Cells treated with propranolol, return increased CXCR4 induced by epinephrine. It can be concluded that G-CSF affects the expression of CXCR4 through increasing secretion of epinephrine in bone marrow with on beta adrenergic receptors. Cells with increased CXCR4 mobilized to release SDF-1 in peripheral blood.

Aims and One of the most common surgeries in women is cesarean section. Hence, it is important to choose an anesthetic technique which is safe, appropriate and affordable for mom and baby. Spinal anesthesia is one of such techniques for which drugs with the least possible damage and most efficacy should be chosen. Among the additives to local anesthetics, "epinephrine" is an appropriate choice. Epinephrine is commonly used together with local anesthetic to induce tense block and it seems that adding epinephrine to lidocaine would improve sensory block during spinal anesthesia. This study is a randomized double blind clinical trial. 60 female patients were referred to the operating room of Mostafa Khomeini hospital in Ilam. The patients were divided into two groups receiving lidocaine alone and lidocaine plus epinephrine. The first group received 60mg lidocaine 5% and the second group received 60mg of lidocaine 5% and 0.2 mg epinephrine. Afterward, variables such as systolic blood pressure, diastolic blood pressure, heart rate, respiratory rate, and arterial oxygen saturation by pulse oximetry, level of sensory, motor and sympathetic block, and Apgar score of neonate at 1 and 5 minutes plus possible complications of anesthetic drugs were recorded. Finally the findings were analyzed by multivariate statistical methods. We measured different kinds of variables and the results are as follows. Average Pulse Rate after 5 minutes in the first and second groups were, 101/8 ± 31/51 and 107/4 ± 25/04, respectively. This was statistically significant among the groups. A higher level block was more common (with exception in one dermatome) in group one (lidocaine alone) which was confirmed to be statistically different (P <0/04). Regarding blood pressure decrease, no significant difference was shown between the two groups. According to this study, we can conclude that there has been a longer continuation of the sensory, motor and sympathetic block in the group receiving lidocaine plus epinephrine in comparison with the group who received lidocaine alone. In this study the use of additional anesthetic agents was also dramatically reduced. This in fact expresses the efficacy of epinephrine in prolonging local anesthetic effect.

Anxiety disorders are the most common psychiatric diseases in need of allocating high levels of health care services. This study aims to compare the effectiveness of drug therapy and relaxation on anxiety reduction and epinephrine and norepinephrine levels in patients with generalized anxiety disorder. This study was conducted on 30 patients with generalized anxiety disorder. Participants were divided into three groups consisting of 10 patients and categorized as relaxation، drug therapy and combination therapy groups. Furthermore، another group involving 10 healthy individuals was formed as the control group. Instruments included Beck Anxiety and Depression Inventory and Hamilton’s Rating Scale. To measure the levels of epinephrine and norepinephrine in the body، a 24-hour urine test was performed. Data were analyzed through Pearson correlation test، paired t-test، one-way-ANOVA and Tukey test. The results showed that relaxation therapy، drug therapy and combination therapy are significantly effective in reducing anxiety levels. But there were not significant differences between the three methods. In addition، there was a significant relationship between levels of epinephrine and norepinephrine and anxiety، and between treatment methods and reduction in the amount of epinephrine and norepinephrine. The results indicated that methods of relaxation and drug therapy and combination of them are effective on reduction of anxiety and epinephrine and norepinephrine levels in the body. So، relaxation can be used instead of anti-anxiety drugs having side effects on the body.

Considering the side-effects of opiums and NSIADS drugs such as respiratory depression, apnea and GI effects, today it has been paid more attention to intra abdominal wall infiltration of local anesthetics for this purpose. The aim of this study is to determine the effect of intra abdominal wall infiltration with bupivacaine to reduce post operative diclofenac need in elective cesarean sections. In this double- blind, placebo-controlled trial, 60 healthy women with single term pregnancy underwent spinal anesthesia were randomized into two groups. Patients, then received a combination of 30cc of bupivacaine with 1.5cc of epinephrine as intra abdominal wall infiltration or equal volume of saline in cesarean section at the time of abdominal closure. Pain was assessed using a visual analogue scale 1, 2, 3, 4, 8 and 12 h after the operation.Also mean diclofenac consumption was assessed during 12 h after the operation. The final analysis was done with statistical tests by SPSS (P<0.05 was considered significant). Mean pain scores at 1 and 2 h after the operation was significantly lower in bupivacaine group than placebo(p<0.05). Mean diclofenac consumption was lesser in bupivacaine group than placebo (p<0.05). Also the time we prescribed diclofenac in bupivacaine group was later (p<0.05). Intra abdominal wall infiltration with 30cc of 0.25% bupivacaine leads to less pain and less diclofenac consumption at the first hours after cesarean section.

Catecholamines play an important role in many vital body functions such as the metabolism of carbohydrates and lipids. This research was designed to examine the changes in catecholamines during an intense and exhausting aerobic exercise. In this study, fourteen healthy young men were taken a Bruce treadmill test with a mean time of 16.05 minutes and were totally exhausted. The blood samples of the participants were taken in four stages: before and after performing Bruce test and at third and fourth stages, one and two days immediately following the completion of test, respectively. The serum epinephrine and norepinephrine levels were analyzed using repeated measures ANOVA. Results showed that an intense and exhausting aerobic exercise significantly increased epinephrine (P>0.001) and norepinephrine (P>0.01) levels. Moreover, the norepinephrine level continued to increase two days after the aerobic exercise. It seems that catecholamines respond differently to the same exercise. The changes observed probably depend on the pre-exercise athlete condition as well as the intensity and duration of activity. Moreover, a mean time of 16.05 minutes for the performance of an intense physical activity with maximum oxygen consumption (54.83 ml/kg/min) can cause considerable changes in research variables.

The role of morphine in blood glucose changes has been documented. The aim of the present study was to investigate the hormonal mechanisms involved in changes caused by morphine on blood glucose in diabetic and non-diabetic mice. Animals were divided into two, the diabetic and non-diabetic, groups. Each group was further divided into subgroups: 1. Saline+saline 2. Naloxone+morphine and 3. Control (saline+saline). Blood samples were used for determining the blood glucose as well as for hormonal (insulin, cortisol and epinephrine) analyses. In non-diabetic and diabetic mice, blood glucose was significantly decreased in the saline+morphine group, compared to controls at 3h and 1h respectively, a decrease which compensated in the naloxone+morphine group, compared to saline+morphine group. After 3h, the level of insulin in non-diabetic mice was significantly decreased compared to the controls and was compensated in the naloxone+morphine group. At this time, the level of insulin showed no changes in diabetic animals. The level of cortisol remained constant both in diabetic and non-diabetic animals at 3h. The level of epinephrine displayed a significant decrease in diabetic and non-diabetic mice at 3h when compared to the controls and was compensated in the naloxone+morphine compared to the saline+morphine group. The administration of subcutaneous morphine caused hypoglycemia in diabetic and non-diabetic mice. The hypoglycemia and the decrease of insulin level in non-diabetic mice as well as the unchanged level of this hormone in diabetic animals may suggest an insulin-independent hypoglycemia induced by morphine.

Acute Bronchiolitis is a common seasonal lower respiratory disease in infants. Syncytial respiratory virus is responsible for more than 50 percent of bronchiolitis events. The treatment is usually supportive. This study was done to examine the efficacy of nebulizer magnesium sulfate in the treatment of acute bronchiolitis. This study was a double blind clinical trial in which 60 patients admitted with acute bronchiolitis in Alzahra, Amin and Shariati hospitals in Isfahan, Iran during 2010 and 2011 were studied. Patients were randomly divided into two groups, A and B. Group A were treated by magnesium sulfate, epinephrine and normal saline and group B were treated only by epinephrine and normal saline. Severity of symptoms was investigated by measuring the temperature, SPO2, pulse rate (PR), respiratory rate (RR) and respiratory distress assessment instrument (RDAI) index, at the beginning of stuy to 3 days after treatment by follow-up questionnaires. Data were analyzed by Student t-test and repeated measure ANOVA. The mean of temperature, SPO2, PR, RR and RDAI at admission and during hospital stay was not significantly different between two groups. After removing the confounding effect of different arrival, RDAI in second and third days in group A was significantly less than group B (P < 0.01). According to this study, treatment with magnesium sulfate has no effect on symptoms of acute bronchiolitis. Magnesium sulfate can reduce RDAI only in the second and third days of hospitalization.

Spinal analgesia is one of the effective and rapid methods for labor. It is not commonly used because of short duration of analgesia and motor block, which limits mother's force in labor progression. We attempted to prolong duration and quality of analgesia by adding Epinephrine. In this quasi-experimental study 90 pregnant women gravid II and III who referred to Motazedi and Imam Reza Educational & Medical Centers were recruited and divided into two groups of case and control (45 subjects in each group). The case group received spinal analgesia using Sufentanil and Bupivacaine, and Epinephrine while the control group received Sufentanil and Bupivacaine. Data including feeling of pain, motor block, duration of analgesia, fetal heart rate, nausea and vomiting, blood pressure was collected and analyzed using chi-square and t test. duration of analgesia and vomiting were significantly increased in the case group. (p=0.001, p=0.01 respectively). Hemodynamic status in mothers and Apgar score of neonates were not significantly different between two groups. It seems that adding Epinephrine to Sufentanil and Bupivacaine could increase analgesia duration without altering in sensory level although could increase nausea and vomiting its recommended in labor analgesia.

Axillary block is used for inducing anesthesia in outpatient hand and forearm surgeries. Few researches have studied hemodynamic and blockade effects of low doses of Epinephrine. The aim of the present study was to compare the duration of analgesia and hemodynamic changes following the injection of high/low epinephrine doses in such surgeries. The present randomized clinical trial study was conducted on healthy individuals (ASA I-II) who were candidates for hand and forearm surgeries.