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Background:Metoclopromide have local anesthetic properties. The main object of performing the present study was to evaluate the analgesic effect of metoclopromide 10 mg when added to lidocaine for intravenous regional anesthesia (IVRA) of upper extremities in trauma patients.Materials and Methods:Ninety patients undergoing upper limb producer were randomly allocated to the three groups to receive 3 mg/kg 2% lidocaine diluted with saline to a total dose of 40 ml (Group L, n = 30) or 10 mg metoclopromide plus 3 mg/kg 2% lidocaine diluted with saline to a total dose of 40 ml (group LM, n = 30) or 3 mg/kg 2% lidocaine diluted with saline to a total dose of 40 ml plus 10 mg metoclopromide intravenously (Group IM, n = 30).Results:Our study showed that the onset times for sensory and motor block were significantly shorter in Group LM compared with Group L and Group IM (4.5 ± 0.7 vs. 5.0 ± 0.7 and 5.0 ± 0.6, respectively, P = 0.006 for sensory block; 6.3 ± 0.7 vs. 5.1 ± 0.9 and 5.9 ± 0.6 respectively, P = 0.000 for motor block). The postoperative VAS scores were significantly less at 1, 5, 10, 15, and 30 minutes after tourniquet release in Group LM compared with Group L and Group IM (P < 0.05).Conclusion:The results of our study showed that adding 10 mg metoclopromide to lidocaine for IVRG in trauma patients reduced intraoperative and postoperative analgesic use till 24 hours and improve quality of anesthesia.

Lagrange multiplier selection that is widely used in mode decision has a significant effect on the quality performance of video encoding. It has been shown in the literature that the Lagrange multiplier is closely related to the quantization factor. However, changing the Lagrange multiplier based on quantization, as it has been the case in several researches, may not be totally accurate. In this paper, it has been discussed from both analytical and experimental points of view that there is always a constant Lagrange multiplier which provides a better PSNR quality compared to the conventional adaptive Lagrange multiplier. This finding is very useful in applications such as constant bitrate coding or video coding with region of interest. When coding a video with constant bitrate, there is always a constant Lambda value that provides a PSNR quality better than a video encoded at the same bitrate but with an adaptive Lagrange multiplier. The proposed method has also been tested for very low bitrate applications where region of interest coding is used. Simulation results indicate that this approach improves quality by 0.67 dB in average.