Anesthetic Technique Research Articles

Comparitive Study between the Analgesic Effect of Erector Spinae Plane Block and Transversus Abdominis Plane Block After inguinal hernia repair

Abstract Background Multimodal analgesia is used to control postoperative pain in inguinal hernia repair. Transversus Abdominis plane block is an effective regional anesthesia technique for postoperative analgesia in inguinal hernia repairs. The Erector Spinae plane block applied to the low thoracic region was also reported to provide effective analgesia in these surgeries. Aim and Objectives To assess and compare the analgesic efficacy of Erector Spinae plane block with that of Transversus Abdominis plane block after inguinal hernia surgeries. Subjects and Methods A prospective randomized clinical study, conducted at Ain Shams University hospitals, Cairo, Egypt on 56 patients divided into 2 groups: (Group 1) (ESP group); 28 patients received unilateral ultrasound guided ESP block, (Group2) (TAP group); 28 patients received unilateral ultrasound guided TAP block during a period of 6 months. Result There was high statistically significant difference between the studied groups as regard first analgesic request and total analgesic consumption. Conclusion ESPB is a more effective regional block technique for postoperative pain relief in patients undergoing inguinal hernia repair than TAPB. In which The ESP block has a longer duration of analgesia, delays the time to first requirement for analgesia, and reduces analgesic consumption when compared with the TAP block and can be used in multimodal analgesia and opioid-sparing regimens

Peri-Operative Use of Ketamine Infusion versus Dexmedetomidine Infusion for Analgesia in Obese Patients Undergoing Bariatric Surgery: A Double-Blinded Three-Armed Randomized Controlled Trial

Abstract Background The development of different techniques in bariatric surgeries has required the development of novel anesthetic techniques to reduce the incidence of complications and improve post-operative patient outcomes. Ketamine and dexmedetomidine have been used for their peri-operative analgesic profiles in different studies. Methods Ninety patients were studied and randomized equally into three groups. The Ketamine group received a bolus dose (0.3 mg/kg) of ketamine over 10 min followed by an infusion (0.3 mg/kg/h). The Dexmedetomidine group received a bolus dose (0.5 mcg/kg) of dexmedetomidine over 10 min followed by an infusion (0.5 mcg/kg/h). The control group received normal saline infusion. The total morphine dose was the primary outcome, and intra-operative fentanyl requirements, time to extubation, post-operative nausea and vomiting (PONV), Numerical Rating Scale (NRS) scores, and Modified Observer’s Agitation/Sedation Scale (MOASS) scores were secondary outcomes of the study. Results The Dexmedetomidine group showed decreased intra-operative fentanyl requirements (160.000 ± 42.345 µcg), less time to extubation (3.700 ± 0.925 min), and better scores on MOASS than the other groups. Post-operative NRS scores and the morphine requirement in the Ketamine group (1.867 ± 2.921 mg) were lower than in the other groups. The Dexmedetomidine group showed the lowest scores for PONV. Conclusions The Dexmedetomidine group showed lower total fentanyl doses, a significantly shorter time to extubation, better MOASS scores, and lower PONV. The Ketamine group showed significantly lower NRS scores and morphine doses than the other two groups. Dexmedetomidine was effective on the reduction of intraoperative fentanyl requirement with early extubation, and ketamine was effective on the reduction of postoperative pain. Trial Registration This trial has been registered on clinicaltrials.gov registry (NCT04576975) since 06/10/2020.

Wide-Awake Local Anesthesia No Tourniquet (WALANT) versus Regional Anesthesia with Tourniquet for Hand Flexor Tendon Repair Surgeries in Adults

Abstract Background Flexor tendon injuries represent a significant percentage of admissions in emergency departments in Egypt. A bloodless surgical field is important to perform a hand surgery. Traditionally, a tourniquet is used for hemostasis, and the standered anesthetic techniques utilized in hand surgery were general anesthesia, intravenous regional anesthesia, or brachial plexus block. Recently the evolving Wide-Awake Local Anesthesia No Tourniquet (WALANT) technique where patient is operated on under local anesthesia and hemostasis is achieved via adrenaline could be a better choice. Aim of this work is to compare the intraoperative pain scores, induction time, operating time, blood loss, postoperative pain scores, and patient satisfaction with WALANT versus supraclavicular brachial plexus block (SC-BPB ) with tourniquet, in patients undergoing flexor tendon repair. Patients and Methods In the current study 52 patients who underwent flexor tendon intervention were divided randomly into two groups, each group consisting of 26 patients. Group A: Patients in this group received WALANT. Group B: Patients in this group received SC-BPB with a tourniquet applied to the arm. Results Intraoperative Wong-Baker Faces scale revealed no statistically significant difference in intraoperative pain scores in both groups, except during injection (p = 0.04). Tourniquet-related pain was reported in 23% of patients of SC-BPB group (p = 0.001). Induction time was significantly shorter in WALANT (p < 0.01) but time needed to obtain sufficient hemostasis is significantly more in WALANT than SC-BPB (p < 0.01) while surgical time was similar in both groups (p = 0.538). Blood loss in spite of being minimal it was statistically significant higher in WALANT (p < 0.01). Conclusion WALANT anesthesia was found to be better alternative to SC-BPB in flexor tendon repair surgeries in adults being more simple technique and no need for special skills or ultrasound device, less time consumed in induction and less injection pain also no tourniquet-related pain, intraoperative active motion of the hand is preserved facilitating surgical technique, better effect on postoperative analgesia and more patient and surgeon satisfaction.

A Comparative Study between Continuous Epidural Analgesia versus Ultrasound Guided Continuous Femoral Nerve Block (CFNB) versus Ultrasound Guided Continuous Adductor Canal Block (ACB) for Post-Operative Pain Management after Total Knee Replacement (TKR)

Abstract Background Total knee replacement (TKR) is considered a prevailing cause of severe postoperative pain and discomfort among orthopedic surgeries, limiting postoperative ambulation that is important for regaining joint function. Despite being the gold standard, epidural analgesia can be accompanied by diverse complications delaying postoperative ambulation and discharge from hospital. Continuous femoral nerve block (CFNB) and continuous adductor canal block (ACB) are reliable and efficacious regional anaesthesia techniques allowing better control of postoperative pain. This study purposed to compare epidural analgesia, continuous femoral nerve block & continuous adductor canal block regarding postoperative analgesia & incidence of postoperative complications. The aim of this study is to estimate the efficacy of epidural analgesia, continuous femoral nerve block & continuous adductor canal block regarding postoperative pain control following total knee replacement and the rate of incidence of associated postoperative complications. This is a prospective randomized controlled study where sixty patients were randomized into three equal groups, patients in group A received epidural analgesia, patients in group B received continuous femoral nerve block while patients in group C received continuous adductor canal block with postoperative continuous infusion of 0.125% bupivacaine with fentanyl 2μg/ml in the three groups at a rate of 5 ml/hr. VAS score was assessed for 48 hours post-operatively and complications were recorded. Results Epidural analgesia was superior to CFNB and ACB regarding postoperative pain control using visual analogue scale and postoperative pain control. CFNB and ACB are superior to epidural analgesia regarding postoperative ambulation and postoperative complications. Conclusions Continuous epidural analgesia provides superior analgesia following total knee replacement than femoral nerve block and adductor canal block, with relatively more adverse effects like pruritus, post operative nausea, and vomiting (PONV). Both CFNB and ADB are good alternatives with fewer systemic side effects.

A Comparative Study between Ultrasound Guided Pectoral Nerve Block Type II versus Intravenous Patient Controlled Analgesia for Intra-Operative and Post-Operative Analgesia in Patients Undergoing Modified Radical Mastectomy

Abstract Background Breast surgery is becoming more and more common. Patients are often middle-aged women and with high public awareness around issues of breast cancer. The numbers are increasing. Breast surgery is an exceedingly common procedure and associated with an increased incidence of acute and chronic pain. Regional anaesthesia techniques may improve post-operative analgesia for patients undergoing breast surgery. Aim of the Work The primary aim of this study is to compare the efficacy of PECS block versus PCA with iv morphine to provide prolonged post-operative analgesia. The secondary objective is to identify the side effects of both techniques as post-operative analgesic techniques. Patients and Methods This study is a randomized clinical trial study conducted in Ain-shams University Hospitals, Cairo, Egypt for 6 months after medical ethical committee approval. The participants were allocated randomly into two groups of 25 patients each: group A: Patients received general anaesthesia followed by PECS block at the end of the operation before extubation, group B: Patients received general anaesthesia followed by the PCA at the end of surgery after extubation. Results The VAS score in the PECS group was statistically significantly lower at the 1st, 2nd and 4th hours. In this case, the use of PECS for postoperative analgesia is as effective as intravenous Morphine PCA in pain treatment, but with less systemic side effect as the nausea and vomiting is significantly higher in the PCA group than the PECS group at the 6th hour, however, the need of intra operative opioids in PCA group is significant. Conclusion In modified radical mastectomy, PECS block is as effective as intravenous Morphine PCA in pain treatment. Compared with intravenous PCA, PECS block can be considered as a more preferable method because it can avoid the systemic actions of morphine used for PCA, and can decrease the need of analgesia intra-operative, however PCA analgesic effect last longer, less invasive technique and easier to be used while PECS block require hand skills and limited to 24 hours analgesia only.

Safety and Efficacy of Combined Dexmedetomidine and Bupivacaine versus Bupivacaine Alone in Caudal Block in Pediatric Patients Undergoing Lower Abdominal Surgery

Abstract Background Lower abdominal surgeries are one of the most frequently performed surgical procedures in the pediatric population. Using optimal analgesic regimen provide safe and effective analgesia, reduce postoperative stress response and accelerate recovery from surgery. Regional anesthetic techniques are commonly used to facilitate pain control in pediatric surgical procedures. The most commonly used techniques in pediatrics is caudal block. Objective To evaluate the analgesic effect of dexmedetomidine when given caudally as an adjuvant to caudal block vs bupivacaine alone in caudal block for children undergoing lower abdominal surgeries. Methods The study was conducted on 88 randomly chosen patients in Ain Shams University Hospitals after approval of the medical ethical committee. Patients were divided randomly into two groups; each group consisted of 44 patients. After preoperative assessment and obtaining baseline vital data, all patients received general anesthesia. Group BD who would receive caudal dexmedetomidine and Group B who would receive caudal block with Bupivacaine. Results There was a highly statically significance between groups according to time to first analgesic requirement (hrs). This table show statically significance difference between groups according to number of paracetamol doses in first 24h. While a statically significant difference between the two groups according to PACERO score. The sedation score was higher in group BD compared to group B. Also a statically significance difference between two groups according to FLACC scale at 8h and 12h. The duration of adequate analgesia (FLACC pain score 4 or less) was significantly higher in group BD compare to group B. Conclusion Dexmedetomidine 1 mcg/kg, when used as an adjuvant to caudal anesthesia, can significantly prolong the duration of postoperative analgesia. It is better than bupivacaine alone in caudal block at similar doses in controlling postoperative pain.

Ultrasound Guided Pectoralis Nerve Block as a Novel Approach in Pacemaker Implantation

Abstract Background The use of implantable cardiac electronic devices (CEDs), including pacemakers, implantable cardioverter-defibrillators, and cardiac resynchronized therapy (CRT), is increasing worldwide for the treatment of cardiac arrhythmias. The aim of this work was to evaluate the effectiveness of PECS I, PECS II blocks as the primary anesthesia technique in patients undergoing subcutaneous pacemaker in comparison to local infiltration anesthesia. Methods This prospective cohort randomized study was carried out on 40 patients between the ages of 21 to 80 years old undergoing pacemaker implantation in Aswan heart center. Patients were randomly allocated into two equal groups: Group (1): received Pecs block and group (2): control group, received standard local infiltration anesthesia with lidocaine 0.2 (10-15ml).All patients were subjected tolaboratory examinations) Hemoglobin, platelet count international normalized ratio, prothrombin time, partial thromboplastin time), Echocardiography (ECG), VAS, PCIA and preoperative medications. Results Number of patients required postoperative analgesia was significantly lower in group 1 compared to the group 2 (P value <0.001). Time to first require analgesia was significantly delayed in PECS blocks group compared to the control group and postoperative analgesia was significantly lower in group 1 compared to the group 2 (P value <0.001). The hospital stay was significantly lower in PECS blocks group compared to control group (<0.001). Conclusions Ultrasound guided PECs provided adequate analgesia as shown by reducing the times of start procedure and technique, postoperative pain scores and total opioid usage, delayed the time to first require analgesia and better operator and patient satisfaction in pacemaker implantation as compared to infiltration anesthesia.

Ultrasound Guided Subscapularis and Subomohyoid Plane Blocks versus Interscalene Block with Levobupivacaine for Analgesia in Shoulder Surgery

Abstract Background Now Shoulder surgery is a common procedure, particularly as it is associated with reduced hospitalization times, even though the technique may lead to moderate and severe postoperative pain. In recent years, various studies have been carried out that demonstrated the need for valid anaesthetic techniques that allow adequate control of postoperative pain and also favour early mobilization and rehabilitation. Subscabularis and subomohyoid plane blocks allow pain control after shoulder surgery while decreasing the need of opioids and pain medication after surgery. In contrast to interscalene brachial plexus block, subscabularis and subomohyoid plane blocks carry minor risks of intrathecal injection or post operative respiratory distress. Aim of the Work to compare analgesic efficacy of ultrasound guided subomohyoid and subscapularis plane blocks versus interscalene block using levobupivacaine in both techniques for pain control after shoulder surgery. Patients and Methods This exploratory randomized clinical trial study was conducted in Ain Shams University hospital after approval of the anesthesia department and the local ethics and research committee over 6 months and after obtaining a written informed consent. Sixty patients underwent shoulder surgery under general anesthesia were included in the study their ages range between 21 and 65 years old and classified as ASA I and II. The patients were randomly divided using computer generated randomization and opaque sealed envelopes into two groups 30 patients in each (n = 30). Results In this study we find that combined subscapularis plane and sub-omohyoid injections may serve as an alternative to interscalene block for shoulder analgesia, with less complications. The present study shows no difference in the demographic data between the two groups (p-value >0.05). Also there was no statistically significant difference in the surgery duration between the two groups. But the duration of subomohyoid and subscapularis plane block was longer than the duration of interscalene block, the Mean± SD is (10.80±2.64 minutes) for subomohyoid and subscapularis plane blocks while interscalene block duration is (5.33±1.56 minutes) so there was astatically significant difference P-value <0.001. Conclusion Subscapularis plane and subomohyoid plane blocks can be used as an alternative shoulder analgesia with minor risks.

Comparative clinical study of attenuation of hemodynamic response to laryngoscopy and endotracheal intubation using clinical assessment guidance versus neuromuscular block monitoring guidance

Background: The hemodynamic response to the stress of laryngoscopy and endotracheal intubation does not present a problem for most patients, except in cardiovascular or cerebral disease. Various anesthetic techniques and drugs are available to control the hemodynamic response to laryngoscopy and intubation. However administration of an additional drug may adversely affect hemodynamics of the patient or unnecessarily increase the depth of anesthesia. Hence a non pharmacological measure to reduce response is preferred. The purpose of this study was to compare the hemodynamic response during laryngoscopy and intubation when choice of the moment of intubation is directed by either clinical assessment and neuromuscular monitoring with train of four. Methods: A total of 60 patients were randomised into two groups. In Group M endotracheal intubation was done after train of four count became zero in adductor pollicis muscle. In Group C timing of intubation was determined clinically by assessment of jaw muscle relaxation. Changes in heart rate (HR), systolic BP (SBP), diasolic BP (DBP), mean arterial pressure (MAP), time between the administration of neuromuscular blocking agent and endotracheal intubation was recorded. Results were analysed by the analysis of variance and chi square test. Results: Heart rate, SBP, DBP and mean arterial pressure were significantly higher in Group C as compared to Group M after laryngoscopy and endotracheal intubation (P<0.05). The mean time required for onset of intubation was significantly shorter in Group C compared to Group M. Conclusion: The objective assessment of neuromuscular relaxation prior to endotracheal intubation provides better attenuation of hemodynamic responses. Keywords: hemodynamic response; laryngoscopy; endotracheal intubation; neuromuscular block

Total intravenous anesthesia using remimazolam for primary lateral sclerosis

Primary lateral sclerosis (PLS) is an extremely rare neurodegenerative muscle disease of unknown cause. The choice of anesthesia for surgery in patients with neurodegenerative muscle disease is extremely important, as it may affect the patient’s prognosis. In this case report, we describe a 74-year-old man with PLS who underwent surgical closure of the larynx owing to repeated aspiration pneumonia. The surgery was performed without muscle relaxants and with total intravenous anesthesia using remimazolam, a relatively new, ultra-short-acting benzodiazepine sedative. The patient underwent surgery safely with no complications and had stable intraoperative hemodynamics. General anesthesia using remimazolam and remifentanil without muscle relaxants may be an appropriate anesthesia technique in patients with PLS who require surgery.

Sedation with Ketamine-Propofol in Patients Undergoing Transcatheter Aortic Valve Implantation: A Comparative Retrospective Study on General Anesthesia.

Transcatheter aortic valve implantation (TAVI) is used for patients with severe aortic stenosis who are at high risk for surgery. Since these patients are elderly and have comorbidities, their management is of great importance. This retrospective study compares two anesthesia techniques during TAVI: sedation (ketamine and propofol) and general anesthesia. Patients with severe aortic stenosis undergoing TAVI during 2021 in our hospital were retrospectively screened. Demographic data, comorbidities, anesthesia management, complications, and mortality of the patients were obtained from the records. There were 137 patients treated with TAVI; 74 (54%) patients had sedation and 63 (46%) had general anesthesia. When the anesthesia management was evaluated, no significant difference in mortality was observed between the patients who received general anesthesia and sedation. After univariate and multivariate logistic regression analyses were performed to investigate factors having an impact on mortality, anemia (only in univariate analysis) in the whole study population was a statistically significant risk factor for mortality in patients undergoing TAVI (p<0.014). There was no significant difference in mortality in terms of anesthesia management. Anemia was a risk factor for mortality (only in univariate analysis) in the whole study population. We concluded that conscious sedation with ketamine and propofol is effective and safe for TAVI procedures compared to general anesthesia.

The Safety and Feasibility of Segmental Thoracic Spinal Anesthesia above Umbilicus and Breast Surgery

This study was conducted on 30 patients aged 16 to 70 years with American Society of Anesthesiology (ASA) physical status I, II, and III. Though general anesthesia (GA) is a universally accepted technique for most abdominal surgeries but not free from drawbacks including poly medicine side effects, prolonged recovery time, and unnoticed inadequate pain control, as well as risk to elderly patients with cardiopulmonary conditions, and safety issue limits the usefulness of general anesthesia. Thus, the new technique adopted attracts the attention of anesthesiologists, as thoracic segmental spinal anesthesia (TSSA) for several common surgeries where local anesthetic agents injected intrathecally above the termination of the spinal cord show value in patients with high risk for general anesthesia who need deep analgesia. The types of surgery were periumbilical hernia 7 (23.33%) in both age groups followed by epigastric hernia 8 (26.66%), neoplastic diseases of breast 6 (20%), laparoscopy cholecystectomy 4 (13.33%), open cholecystectomy 5 (16.66%). The analysis of intraoperative and postoperative mean systolic and diastolic arterial pressures (MAP) of patients up to 24 hours was found insignificant (P&gt;0.05). Regarding the intraoperative hemodynamic changes, hypotension occurred in 3 patients and resolved with a single bolus of ephedrine, no tachycardia occurred, while bradycardia in 3 patients (15%). No patients need to be converted to general anesthesia due to inadequate block. On analysis complications, peri-operative or post-operative period showed that shoulder pain was experienced by 2 patients (6.66%) in the younger age group whereas in the older age group, two patients (6.66%) have hypotension and bradycardia was seen in 3 patients (13.33%). No respiratory complications, such as postoperative pneumonia or atelectasis were noted during the hospital stay with TSSA as well and no nausea/vomiting was noted. This study provides only preliminary evidence to support the feasibility and efficacy of segmental thoracic spinal anesthesia to be used effectively for safe anesthetic technique during routine laparoscopic surgery in normal patients as well as co-morbidity patients with stable intraoperative and post-operative hemodynamic and also avoidance of complications of general anesthesia with these benefits, decrease in length of stay in hospital, reduction of postoperative pain, and increased patients satisfaction. Thus, in future the segmental spinal anesthesia may become a good alternative to general anesthesia in normal patients as well as comorbid patients.

Improving safety: Neuraxial blockade guided by thromboelastography for patients with uncertain coagulation profile.

Neuraxial blockade procedures are essential for anesthesia and pain management but pose risks in patients with uncertain coagulation profiles. Traditional coagulation tests often fail to predict bleeding risks associated with neuraxial blockade. Thromboelastography (TEG) offers real-time insights into coagulation status, potentially improving safety outcomes. In this case series, six patients underwent neuraxial blockade guided by TEG analysis. An individualized anesthetic plan was formulated based on TEG findings to mitigate bleeding risks while ensuring pain management. Tailoring anesthetic techniques to real-time TEG data improved safety outcomes with minimized bleeding complications and satisfactory pain control. In conclusion, neuraxial blockade guided by TEG enhances safety in patients with uncertain coagulation profiles. Further studies are needed to validate benefits in broader clinical settings.

Comparison of Opioid Versus Non-opioid-based Anesthesia Techniques for Hemodynamic and Neuro-endocrine Responses in Laparoscopic Surgeries

Comparison of Opioid Versus Non-opioid-based Anesthesia Techniques for Hemodynamic and Neuro-endocrine Responses in Laparoscopic Surgeries

Effects of intraoperative fluid management on hemodynamics and tissue oxygenation according to the Pleth Variability Index in thoracic surgery.

The aim of this study was to compare the total fluid volume performed by noninvasive Pleth Variability Index in thoracic surgery patients in comparison to conventional fluid management. In this prospective randomized controlled study conducted between May 2019 and May 2020, 80 patients (68 males, 12 females; mean age: 58.5±6.7 years; range, 18 to 65 years) were divided into two groups: control (Group C) and the Pleth Variability Index (Group P). After performing routine anesthesia and Pleth Variability Index monitoring for all patients, fluids were given at a rate of 2 mL/kg/h with the standard anesthesia technique. Additional fluid supplementation was provided based on hemodynamic data in Group C. In Group P, 250 mL bolus crystalloid fluid was provided when Pleth Variability Index was >14%. Mean arterial pressure, heart rate, oxygen saturation, arterial blood gas, and blood biochemistry were recorded. Total fluid volumes and urinary output were also recorded. There was no significant difference between the groups in terms of total fluid volumes or urinary output. In the postoperative period, the oxygen saturation and mean arterial pressure of Group P were found to be higher than those of Group C. The postoperative creatinine and lactate values of Group P were lower than those of Group C. Although there was no significant difference in the total fluid given to the patients, fluid management by Pleth Variability Index monitoring had a positive effect on mean arterial pressure, oxygen saturation, lactate, and creatinine levels.

Pericapsular Nerve Group Block Did Not Reduce Postoperative Pain or Opioid Use After Total Hip Arthroplasty

BackgroundThe pericapsular nerve group (PENG) block is a newly developed regional anesthesia technique designed to manage postoperative hip pain following a fracture or surgery while also maintaining quadriceps strength and mobility. The goal of our study was to compare postoperative pain scores and opioid usage during the postoperative period before discharge following total hip arthroplasty (THA) using the posterior approach between patients who received a PENG block and those who did not. MethodsWe conducted a retrospective study on patients undergoing elective, posterior approach THA at a single tertiary-care academic center. The 2 groups included a study group (THA with PENG block in 2021; n = 66) and a control group (THA before PENG block implementation in 2019; n = 70). ResultsThere were no significant differences in pain scores during postoperative minutes 0 to 59 (study group 6.8; control group 6.6; P = .81) or during postoperative minutes 60 to 119 (study group 6.2; control group 5.6; P = .40). There were no significant differences in total postoperative in-hospital morphine milliequivalent opioid consumption (study group 55.8 morphine milligram equivalents; control group 75.0 morphine milligram equivalents; P = .14). The study group was found to have a shorter length of stay (study group 17.0 hours; control group 32.6 hours; P < .0001) and faster mobilization (study group 3.0 hours; control group 4.9 hours; P < .0001) than the control group. ConclusionsOur results show that use of the PENG block did not result in lower postoperative pain scores or opioid consumption after THA using the posterior surgical approach. The study group had a shorter length of stay and time to mobilization than the control group, though this was likely due to standard hospital procedure shifting to same-day discharge for THA between 2019 and 2021 due to COVID-19.

Comparison of the effects of single injection and continuous infusion popliteal nerve block on pain and hemodynamics in diabetic foot surgery; prospective randomized clinical trial

ObjectivesIn patients undergoing surgery due to diabetic foot complications from uncontrolled diabetes may lead to neuraxial or general anesthesia-related issues. Regional anesthesia techniques can be preferred to prevent these complications. This study aimed to compare the hemodynamic effects and outcomes in terms of pain of continuous infusion and single injection methods of popliteal nerve block in patients undergoing surgery due to diabetic foot. Materials and methodsSixty-three patients in ASA II-IV risk group scheduled for diabetic foot surgery were randomized into two groups for popliteal nerve block as the anesthesia method. Group 1 (n:32), 30 mL of local anesthetic was administered around the popliteal nerve under ultrasound guidance and nerve stimulator. Group 2 (n:31) had a catheter placed beyond the needle tip by 4–5 cm. An elastomeric pump was prepared for the infusion of 2 mL/h of 0.25 % bupivacaine through the catheter. Hemodynamic parameters before and after the block, onset, block duration times, postoperative pain scores, time to analgesic requirement, patient satisfaction, and discharge time were recorded. ResultsPain scores were higher in Group 1 after 12 h postoperatively and in Group 2 after 60 h postoperatively (p = 0.006, p < 0.01, respectively). The time to the first analgesic requirement was not statistically different between Group 1 (mean 804.64 ± 1020.8 min) and Group 2 (mean 2012.78 ± 1424 min) (p = 0.072). There was no significant difference in systolic, diastolic, mean arterial blood pressure, and heart rate between groups before and after successful blockade (p > 0.05). ConclusionsContinuous infusion method of popliteal nerve block provides a longer pain-free period. Both methods showed similar hemodynamic data and low pain scores. Although continuous infusion method provides better analgesia, its procedural cost, technical difficulties, and adverse effects on patient comfort should also be considered.

Regional Anaesthesia, Contemporary Techniques, and Associated Advancements: A Narrative Review.

In particular, the application of regional anaesthesia techniques in existing medicine can be characterized as experiencing regular changes in recent decades. It is useful for obtaining accurate and efficient pain management solutions, from the basic spinal and epidural blocks to the novel ultrasound nerve blocks and constant catheter procedures. These advancements do enhance not only the value of the perioperative period but also the patient's rated optimization as enhancing satisfaction, better precision, and the safety of nerve block placement. The use of ultrasound technology makes it even easier to determine the proper positioning of the needle and to monitor nerve block placement. Moreover, the duration and efficiency of regional anaesthesia are being enhanced by state-of-the-art approaches, which come in the form of liposomal bupivacaine, and better recovery plans and protocols, which shorten recovery time and decrease the number of hospital days. As these methods develop further, more improvements in the safety, efficacy, and applicability of regional anaesthesia in contemporary medicine are anticipated through continued research and innovation.

Anesthetic Choice for Percutaneous Transcatheter Closure of the Left Atrial Appendage: A National Anesthesia Clinical Outcomes Registry Analysis.

Left atrial appendage closure (LAAC) was developed as a novel stroke prevention alternative for patients with atrial fibrillation, particularly for those not suitable for long-term oral anticoagulant therapy. Traditionally, general anesthesia (GA) has been more commonly used primarily due to the necessity of transesophageal echocardiography. Compare trends of monitored anesthesia care (MAC) versus GA for percutaneous transcatheter LAAC with endocardial implant and assess for independent variables associated with primary anesthetic choice. Multi-institutional data collected from across the United States using the National Anesthesia Clinical Outcomes Registry. Retrospective data analysis from 2017-2021. Independent-sample t tests or Mann-Whitney U tests were used for continuous variables and Chi-square tests or Fisher's exact test for categorical variables. Multivariate logistic regression was used to assess patient and hospital characteristics. A total of 19,395 patients underwent the procedure, and 352 patients (1.8%) received MAC. MAC usage trended upward from 2017-2021 (P < 0.0001). MAC patients were more likely to have an American Society of Anesthesiologists (ASA) physical status of≥ 4 (33.6% vs 22.89%) and to have been treated at centers in the South (67.7% vs 44.2%), in rural locations (71% vs 39.5%), and with lower median annual percutaneous transcatheter LAAC volume (102 vs 153 procedures) (all P < 0.0001). In multivariate analysis, patients treated in the West had 85% lower odds of receiving MAC compared to those in the Northeast (AOR: 0.15; 95% CI 0.03-0.80, P = 0.0261). While GA is the most common anesthetic technique for percutaneous transcatheter closure of the left atrial appendage, a small, statistically significant increase in MAC occurred from 2017-2021. Anesthetic management for LAAC varies with geographic location.

Challenges of the Regional Anesthetic Techniques in Intensive Care Units - A Narrative Review.

Effective pain management is vital for critically ill patients, particularly post-surgery or trauma, as it can mitigate the stress response and positively influence morbidity and mortality rates. The suboptimal treatment of pain in Intensive Care Unit (ICU) patients is often due to a lack of education, apprehensions about side effects, and improper use of medications. Hence, the engagement of pain management and anesthesiology experts is often necessary. While opioids have been traditionally used in pain management, their side effects make them less appealing. Local anesthetics, typically used for anesthesia and analgesia in surgical procedures, have carved out a unique and crucial role in managing pain and other conditions in critically ill patients. This work aims to offer a comprehensive overview of the role, advantages, challenges, and evolving practices related to the use of local anesthetics in ICUs. The ability to administer local anesthetics continuously makes them a suitable choice for controlling pain in the upper and lower extremities, with fewer side effects. Epidural analgesia is likely the most used regional analgesic technique in the ICU setting. It is primarily indicated for major abdominal and thoracic surgeries, trauma, and oncology patients. However, it has contraindications and complications, so its use must be carefully weighed. Numerous challenges exist regarding critically ill patients, including renal and hepatic failure, sepsis, uremia, and the use of anticoagulation therapy, which affect the use of regional anesthesia for pain management. Appropriate timing and indication are crucial to maximizing the benefits of these methods. The advent of new technologies, such as ultrasonography, has improved the safety and effectiveness of neuraxial and peripheral nerve blocks, making them feasible options even for heavily sedated patients in ICUs.