000			09180namaa22004451i 4500
003			EG-GICUC
005			20260120124545.0
008			260110s2025 ua a|||frm||| 000 0 eng d
040			_aEG-GICUC _beng _cEG-GICUC _dEG-GICUC _erda
041	0		_aeng _beng _bara
049			_aDeposit
082	0	4	_a616.723
092			_a616.723 _221
097			_aM.Sc
099			_aCai01.11.25.M.Sc.2025.Ah.I
100	0		_aAhmed Naser Hanafi Mahmoud, _epreparation.
245	1	0	_aIs single-injection digital nerve block technique effective in finger surgeries done under local anaesthesia? / _cby Ahmed Naser Hanafi Mahmoud ; Supervision Prof. Dr. Yasser ElSafoury, Prof. Dr. Mostafa Ezzat, Dr. Mohamed Ahmed Mohamed Ibrahim.
246	1	5	_aهل تكون تقنية التخدير للعصب الإصبعى بحَقنة واحدة فعالة فى جراحات الأصابع التى تتم تحت التخدير الموضعى ؟
264		0	_c2025.
300			_a90 pages : _billustrations ; _c25 cm. + _eCD.
336			_atext _2rda content
337			_aUnmediated _2rdamedia
338			_avolume _2rdacarrier
502			_aThesis (M.Sc)-Cairo University, 2025.
504			_aBibliography: pages 84-90.
520		3	_aBack ground: The increasing rate of finger surgeries, necessitates the use of the wide-awake approach to cope with higher flow of patients, posing a challenge on hand surgeons to choose the most appropriate DNB with highest efficacy & least complication for different types of finger surgeries. Objective: to assess efficacy and pain associated with the subcutaneous DNB for different types of finger surgeries. Patients & Methods: A group of 51 participants age range (16-65 years), with finger lesions, recruited from the ER and outpatient setting. All had their operations done under a single injection SCB injected at midline of the proximal digital crease, with SC infiltration of 3-5 ml of o.5% bupivacaine. Testing for success was done by pinprick testing at 5 min intervals and NRS score was used for measuring injection and procedure pain scores, while surgeon satisfaction was measured on a 1 to 10 scale. Results: Among the 51 participants undergoing the SCB we had an 86.3% success rate. Mean injection pain of 3.17±1.7, mean procedure pain 0.84 1.5. The mean TTOA was 11.3±4.02 minutes, while mean DOP was 20.08±8.6 minutes. Location of the lesion had a significant impact on failure rate, PP, moderate SS and injection pain, the former 3 were highest among proximal dorsal regions, while the latter was highest among proximal volar ones. Ring fingers had higher injection pain while thumb and little finger had higher failure rate. Higher volume of anaesthetic was associated with lower procedure pain and shorter TTOA. Success rate was higher among chronic lesions but results were insignificant. Bony lesions although having a relatively low injection pain, they had high failure rate and PP level with low level of satisfaction whereas skin lesions had 100% success rate but the lowest level of surgeon satisfaction. Conclusion: The SCB is a safe, efficient DNB, that should be practically integrated into the everyday practice of hand surgeons, replacing traditional blocks. Surgeons should apply fine adjustments in block administration on a case-to-case basis according to modifiable risk factors identified to ensure maximal efficacy and least pain associated with the block
520		3	_aﻳﺘﻄﻠﺐ ﺗﺰﺍﻳﺪ ﻣﻌﺪﻝ ﺟﺮﺍﺣﺎﺕ ﺍﻷﺻﺎﺑﻊ ﺍﺳﺘﺨﺪﺍﻡ ﻧﻬﺞ ﺍﻟﻴﻘﻈﺔ ﺍﻟﺘﺎﻣﺔ ﻟﻠﺘﻌﺎﻣﻞ ﻣﻊ ﻋﺪﺩ ﺃﻛﺒﺮ ﻣﻦ ﺍﻟﻤﺮﺿﻰ، ﻣﻤﺎﻳُﺸﻜﻞ ﺗﺤﺪﻳًﺎ ﻟﺠﺮﺍﺣﻲ ﺍﻟﻴﺪ ﻓﻲ ﺍﺧﺘﻴﺎﺭ ﺃﻧﺴﺐ ﻁﺮﻳﻘﺔ ﻟﺘﺨﺪﻳﺮ ﺍﻟﻌﺼﺐ ﺍﻻﺻﺒﻌﻰ ﺫﺍﺕ ﺍﻟﻔﻌﺎﻟﻴﺔ ﺍﻟﻌﺎﻟﻴﺔ ﻭﺍﻷﻗﻞ ﻣﻀﺎﻋﻔﺎﺕ ﻟﻤﺨﺘﻠﻒ ﺃﻧﻮﺍﻉ ﺟﺮﺍﺣﺎﺕ ﺍﻷﺻﺎﺑﻊ. ﻣﺠﻤﻮﻋﺔ ﻣﻦ 51 ﻣﺸﺎ ﺎ ﺗﺘﺮﺍﻭﺡ ﺃﻋﻤﺎﺭﻫﻢ ﺑﻴﻦ ً ﺭﻛ 16 ﻭ65 ﺎ، ﻳﻌﺎﻧﻮﻥ ﻣﻦ ﺇﺻﺎﺑﺎﺕ ﻓﻲ ﺍﻷﺻﺎﺑﻊ، ً ﻋﺎﻣ ﺗﻢ ﺗﺠﻨﻴﺪﻫﻢ ﻣﻦ ﻗﺴﻢ ﺍﻟﻄﻮﺍﺭﺉ ﻭﺍﻟﻌﻴﺎﺩﺍﺕ ﺍﻟﺨﺎﺭﺟﻴﺔ.ﺃُﺟﺮﻳﺖ ﻋﻤﻠﻴﺎﺗﻬﻢ ﺟﻤﻴﻌًﺎ ﺑﺎﺳﺘﺨﺪﺍﻡ ﺣﻘﻨﺔ ﻭﺍﺣﺪﺓ ﻣﻦ ﺗﺨﺪﻳﺮ ﺍﻟﻌﺼﺐ ﺍﻻﺻﺒﻌﻰ ﻋﻦ ﻁﺮﻳﻖ ﺍﻟﺤﻘﻦ ﺗﺤﺖ ﺍﻟﺠﻠﺪ ﻓﻲ ﻣﻨﺘﺼﻒ ﺛﻨﻴﺔ ﺍﻹﺻﺒﻊ ﺍﻟﻘﺮﻳﺒﺔ، ﻣﻊ ﺣﻘﻦ 3-5 ﻣﻞ ﻣﻦ ﺑﻮﺑﻴﻔﺎﻛﻴﻦ ﺑﺘﺮﻛﻴﺰ 0.5%. ﺗﻢ ﺍﺧﺘﺒﺎﺭ ﺍﻟﻨﺠﺎﺡ ﻋﻦ ﻁﺮﻳﻖ ﺍﺧﺘﺒﺎﺭ ﻭﺧﺰ ﺍﻹﺑﺮﺓ ﻟﻘﻴﺎﺱ ﺩﺭﺟﺎﺕ ﺃﻟﻢ ﺍﻟﺤﻘﻦ ﻭﺍﻹﺟﺮﺍء NRSﺑﻔﺎﺻﻞ 5 ﺩﻗﺎﺋﻖ، ﻭﺍﺳﺘُﺨﺪﻡ ﺍﻟﻤﻘﻴﺎﺱ ﺍﻟﺮﻗﻤﻰ ﻟﻸﻟﻢ ﺍﻟﺠﺮﺍﺣﻰ، ﺑﻴﻨﻤﺎ ﺗﻢ ﻗﻴﺎﺱ ﺭﺿﺎ ﺍﻟﺠﺮﺍﺡ ﻋﻠﻰ ﻣﻘﻴﺎﺱ ﻣﻦ 1 ﺇﻟﻰ 10. ﻣﻦ ﺑﻴﻦ 51 ﻣﺸﺎﺭًﻛﺎ ﺧﻀﻌﻮﺍ ﻟﻌﻤﻠﻴﺔ ﺗﺨﺪﻳﺮ ﺍﻻﺻﺒﻊ ﺑﺤﻘﻨﺔ ﻭﺍﺣﺪﺓ ﺗﺤﺖ ﺍﻟﺠﻠﺪ، ﻛﺎﻥ ﻣﻌﺪﻝ ﺍﻟﻨﺠﺎﺡ . ﻛﺎﻥ ﻣﺘﻮﺳﻂ ﻭﻗﺖ 1.5±0.84، ﻣﺘﻮﺳﻂ ﺃﻟﻢ ﺍﻹﺟﺮﺍء1.7±86.33.17%. ﻣﺘﻮﺳﻂ ﺍﻟﻢ ﺍﻟﺤﻘﻦ ﺩﻗﻴﻘﺔ.8.6±20.08ﺩﻗﻴﻘﺔ، ﺑﻴﻨﻤﺎ ﻛﺎﻥ ﻣﺘﻮﺳﻂ ﻭﻗﺖ ﺍﻟﺤﻘﻦ 4.02±11.3ﺍﻟﺤﻘﻦ ﻛﺎﻥ ﻟﻤﻮﻗﻊ ﺍﻻﺻﺎﺑﺔ ﺗﺄﺛﻴﺮ ﻛﺒﻴﺮ ﻋﻠﻰ ﻣﻌﺪﻝ ﺍﻟﻔﺸﻞ، ﻭﺍﻻﻟﻢ ﺍﻟﺠﺮﺍﺣﻰ، ﻭ ﺭﺿﺎ ﺍﻟﺠﺮﺍﺡ ﺍﻟﻤﻌﺘﺪﻝ، ﻭﺃﻟﻢ ﺍﻟﺤﻘﻦ. ﻛﺎﻧﺖ ﺍﻟﺜﻼﺛﺔ ﺍﻷﻭﻟﻰ ﻫﻲ ﺍﻷﻋﻠﻰ ﺑﻴﻦ ﺍﻟﻤﻨﺎﻁﻖ ﺍﻟﻈﻬﺮﻳﺔ ﺍﻟﻘﺮﻳﺒﺔ، ﺑﻴﻨﻤﺎ ﻛﺎﻧﺖ ﺍﻷﺧﻴﺮﺓ ﺍﻷﻋﻠﻰ ﺑﻴﻦ ﺍﻟﻤﻨﺎﻁﻖ ﺍﻟﺮﺍﺣﻴﺔ ﺍﻟﻘﺮﻳﺒﺔ. ﻛﺎﻥ ﺃﻟﻢ ﺍﻟﺤﻘﻦ ﺃﻋﻠﻰ ﻓﻲ ﺍﻟﺒﻨﺼﺮ، ﺑﻴﻨﻤﺎ ﻛﺎﻥ ﻣﻌﺪﻝ ﺍﻟﻔﺸﻞ ﺃﻋﻠﻰ ﻓﻲ ﺍﻹﺑﻬﺎﻡ ﻭﺍﻟﺨﻨﺼﺮ. ﺍﺭﺗﺒﻂ ﺣﺠﻢ ﺍﻟﺘﺨﺪﻳﺮ ﺍﻷﻛﺒﺮ ﺑﺄﻟﻢ ﺃﻗﻞ ﻓﻲ ﺍﻹﺟﺮﺍء ﻭﻭﻗﺖ ﻟﺘﺤﻘﻴﻖ ﺍﻟﺘﺨﺪﻳﺮ ﺃﻗﺼﺮ. ﻛﺎﻥ ﻣﻌﺪﻝ ﺍﻟﻨﺠﺎﺡ ﺃﻋﻠﻰ ﺑﻴﻦ ﺍﻹﺻﺎﺑﺎﺕ ﺍﻟﻐﻴﺮ ﻁﺎﺭﺋﺔ، ﻟﻜﻦ ﺍﻟﻨﺘﺎﺋﺞ ﻛﺎﻧﺖ ﺿﺌﻴﻠﺔ. ﺎ ﻣﻨﺨﻔًﻀﺎ ﻧﺴﺒﻴًﺎ ﻋﻨﺪ ﺍﻟﺤﻘﻦ، ﺇﻻ ﺃﻥ ﻣﻌﺪﻝ ﻓﺸﻠﻬﺎ ﻋﻠﻰ ﺍﻟﺮﻏﻢ ﻣﻦ ﺃﻥ ﺍﻹﺻﺎﺑﺎﺕ ﺍﻟﻌﻈﻤﻴﺔﺗُﺴﺒﺐ ﺃﻟﻤ ﻭﻣﺴﺘﻮﻯ ﺍﻻﻟﻢ ﺍﻟﺠﺮﺍﺣﻰ ﻓﻴﻬﺎ ﻣﺮﺗﻔﻌﺎﻥ، ﻣﻊ ﺍﻧﺨﻔﺎﺽ ﻣﺴﺘﻮﻯ ﺍﻟﺮﺿﺎ، ﺑﻴﻨﻤﺎ ﺣﻘﻘﺖ ﺍﻹﺻﺎﺑﺎﺕ ﺍﻟﺠﻠﺪﻳﺔ ﻣﻌﺪﻝ ﻧﺠﺎﺡ 100%، ﻟﻜﻦ ﻣﺴﺘﻮﻯ ﺭﺿﺎ ﺍﻟﺠﺮﺍﺡ ﻛﺎﻥ ﺍﻷﻗﻞ. ﻳُﻌﺪّ ﺣﻘﻦ ﺍﻟﻤﺨﺪﺭ ﺍﻟﻤﻮﺿﻌﻰ ﻟﺘﺨﺪﻳﺮ ﺍﻟﻌﺼﺐ ﺍﻻﺻﺒﻌﻰ ﺗﺤﺖ ﺍﻟﺠﻠﺪ ﺣﻘﻨًﺎ ﺟﺮﺍﺣﻴًﺎ ﺁﻣﻨًﺎ ﻭﻓﻌﺎﻻ ﻭﻳﻨﺒﻐﻲ ﺩﻣﺠﻪ ﻋﻤﻠﻴًﺎ ﻓﻲ ﺍﻟﻤﻤﺎﺭﺳﺔ ﺍﻟﻌﻤﻠﻴﺔ ﻟﺠﺮﺍﺣﻲ ﺍﻟﻴﺪ، ﻟﻴﺤﻞ ﻣﺤﻞ ﺍﻟﺘﺨﺪﻳﺮ ﺍﻟﺘﻘﻠﻴﺪﻱ. ﻳﺠﺐ ﻋﻠﻰ ﺍﻟﺠﺮﺍﺣﻴﻦ ﺇﺟﺮﺍء ﺗﻌﺪﻳﻼﺕ ﺩﻗﻴﻘﺔ ﻓﻲ ﺇﻋﻄﺎء ﺍﻟﺘﺨﺪﻳﺮ ﻋﻠﻰ ﺃﺳﺎﺱ ﻛﻞ ﺣﺎﻟﺔ ﻋﻠﻰ ﺣﺪﺓ، ﻭﻓﻘًﺎ ﻟﻌﻮﺍﻣﻞ ﺍﻟﺨﻄﺮ ﺍﻟﻘﺎﺑﻠﺔ ﻟﻠﺘﻌﺪﻳﻞ ﺍﻟﺘﻲ ﺗﻢ ﺗﺤﺪﻳﺪﻫﺎ، ﻟﻀﻤﺎﻥ ﺃﻗﺼﻰ ﻗﺪﺭ ﻣﻦ ﺍﻟﻔﻌﺎﻟﻴﺔ ﻭﺃﻗﻞ ﻗﺪﺭ ﻣﻦ ﺍﻷﻟﻢ ﺍﻟﻤﺼﺎﺣﺐ ﻟﻠﺘﺨﺪﻳﺮ.
530			_aIssues also as CD.
546			_aText in English and abstract in Arabic & English.
650		0	_aOrthopedics
650		0	_aطب العظام
653		1	_aFinger _aDigital nerve block _aSingle injection _aSubcutaneous _aتقنية التخدير للعصب الإصبعى بحَقنة واحدة فعالة _aتحت التخدير الموضعى
700	0		_aYasser ElSafoury _ethesis advisor.
700	0		_aMostafa Ezzat _ethesis advisor.
700	0		_aMohamed Ahmed Mohamed Ibrahim _ethesis advisor.
900			_b01-01-2025 _cYasser ElSafoury _cMostafa Ezzat _cMohamed Ahmed Mohamed Ibrahim _UCairo University _FFaculty of Medicine _DDepartment of Orthopedic Surgery
905			_aShimaa _eEman Ghareb
942			_2ddc _cTH _e21 _n0
999			_c177558