Anesthetic Technique Research Articles

A Comparative Study between Ultrasound-guided Concomitant Infraclavicular Plus Distal Median, Radial, and Ulnar Nerve Blockade Versus Infraclavicular Block Alone

Abstract Background: Peripheral nerve blocks can be used alone as the sole “surgical” anesthetic technique as the initial step in providing prolonged postoperative analgesia. There are studies, where accurate deposition of local anesthetic perineurally has the potential to improve the success rate and reduce the incidence of complications of the infraclavicular block. We hypothesized whether a combined block of the infraclavicular brachial plexus and distal median, radial, and ulnar nerves would accelerate upper extremity anesthesia compared with an infraclavicular block alone. Materials and Methods: This study was a prospective randomized control study conducted among 60 patients undergoing elective and emergency wrist and hand surgeries. A group of 30 patients received an infraclavicular block with 30 mL of a local anesthetic mixture containing 1% lignocaine with adrenaline and 0.25% bupivacaine from Group A. Group B received an infraclavicular block with 15 mL of local anesthetic mixture containing 1% lignocaine with adrenaline and 0.25% bupivacaine along with distal median, radial, and ulnar nerve blockade with 5 mL each of local anesthetic mixture containing 1% lignocaine with adrenaline and 0.25% bupivacaine. Pain score, assessment of sensory and motor functions, block performance time, and surgical anesthesia were observed. Results: The mean block performance time of Group A was 10.9 ± 1.1 min and Group B was 14.7 ± 0.5 min. The difference between the two groups’ block performance minutes was statistically significant (P < 0.001). The difference in the onset of the sensory block between the two groups was statistically significant (P < 0.001). The mean onset of motor blockade between the two groups was statistically very highly significant (P < 0.001). The mean of Group A was 5.0 ± 0.2 and Group B was 2.1 ± 0.4. Conclusion: From this study, we conclude that using an approximately equivalent dose of local anesthetics, combining ultrasound-guided infraclavicular block with distal median, radial, and ulnar nerve blockade shortens the onset time of sensory and motor block with improved block consistency compared to infraclavicular block alone.

Safety of anaesthesia techniques in patients undergoing carotid endarterectomy: a systematic review with meta-analysis of randomised clinical trials.

Safety of anaesthesia techniques in patients undergoing carotid endarterectomy: a systematic review with meta-analysis of randomised clinical trials.

Thoracic Continuous Spinal Anesthesia in Patients With Destroyed Lung Resulted in Favorable Perioperative Outcome.

Among patients needing open abdominal surgery, those with high-risk medical conditions impose significant challenges from an anesthesia point of view. Thoracic continuous spinal anesthesia (TCSA) is an evolving technique that may be beneficial for a subset of patients with underlying high-risk medical conditions where general anesthesia (GA) becomes a relative contraindication. TCSA, as a primary anesthesia technique, is gaining favor for its advantages over GA in open abdominal surgery as it avoids airway intervention and mechanical ventilation. The current article focuses on TCSA in 2 patients at high risk for GA, which resulted in favorable perioperative outcomes.

Effect of Anesthesia Type on Pain and Hemodynamic Parameters in Cesarean Section Surgery: Randomized Controlled Trial

Background: General and spinal anesthesia are commonly used for cesarean sections, each with implications for both the mother and the fetus. The choice of anesthesia technique depends on various factors. While spinal anesthesia is often preferred for cesarean surgeries due to its well-known benefits, general anesthesia may be chosen in emergency situations. The decision is ultimately based on the safety profile and benefits for both the mother and the fetus. Methods: This clinical trial was conducted at Fatemieh Hospital in Hamadan and involved 60 patients undergoing elective cesarean section. The patients were randomly divided into two groups of 30: One group received spinal anesthesia, and the other group received general anesthesia. Variables such as intraoperative bleeding, the Apgar score of the newborn, postoperative pain, and postoperative systolic and diastolic blood pressure were analyzed and compared between the two groups using SPSS software version 16. Results: The mean age of participants in the spinal and general anesthesia groups was 32 ± 3.5 years and 34 ± 3.4 years, respectively. The results showed that the amount of intraoperative bleeding in the general anesthesia group was higher than in the spinal anesthesia group, but this difference was not statistically significant (P = 0.85, P < 0.05). The Apgar scores at the first and fifth minutes in the spinal anesthesia group were higher than those in the general anesthesia group, but this difference was also not statistically significant (P = 0.32, P < 0.05). Postoperative pain in the spinal anesthesia group was significantly lower than in the general anesthesia group (P = 0.001, P < 0.05). Regarding hemodynamic parameters, systolic blood pressure after the operation was higher in the spinal anesthesia group compared to the general anesthesia group (P < 0.05). Conversely, diastolic blood pressure in the general anesthesia group was higher than in the spinal anesthesia group at all measurement stages, though not statistically significant in some measurements (P > 0.05). Conclusions: The results of our study indicate that spinal anesthesia is a preferable and safer method compared to general anesthesia, based on the parameters examined, particularly in emergency cesarean sections.

Case report: A Unique Case of Brainstem Anesthesia and Contralateral Amaurosis Following a Sub-Tenon Block.

To report and discuss a case of brainstem anesthesia and contralateral amaurosis following a sub-Tenon block. Single surgical case report of a patient who underwent an uncomplicated pars plana vitrectomy for an epiretinal membrane peel in the left eye following a sub-Tenon anesthesia technique. Post-operatively, the patient experienced symptoms of brainstem anesthesia as well as akinesia, a non-reactive pupil, and reduced visual acuity in the contralateral eye which gradually resolved within 24 hours. Imaging was within normal limits and did not reveal any anatomic abnormalities. Despite the use of a blunt-ended cannula in a sub-Tenon block, there is a non-negligible risk of it penetrating surrounding structures such as the optic nerve sheath. This case emphasizes the importance of monitoring for brainstem anesthesia and contralateral eye affections in patients both intra- and post-operatively.

Ultrasound-Guided Deep Serratus Plane Block in Cat Cadavers (Felis catus): A Description of Dye and Contrast Media Distribution.

The serratus plane block is an ultrasound-guided anaesthetic technique that aims to provide analgesia to the lateral thoracic wall cranial to the 8th rib. This block can be performed in a superficial (between the latissimus dorsi and the serratus ventralis thoracis (SVT) muscles) or deep plane (between the intercostales externi and the SVT muscles). This study aimed to assess the distribution and nerve staining of a mixture of 0.4 mL kg-1 of methylene blue and iopromide 50:50 performing a deep serratus plane (DSP) block at the level of the 5th rib. We hypothesise that this technique would be feasible and could stain the rami cutanei laterales (RCL) of the intercostales nerves cranial to the 8th rib in cat cadavers. This study was divided into two phases. Phase 1 consisted of an anatomical study of the thoracic wall (2 cadavers). Phase 2 consisted of the ultrasound-guided injection of the aforementioned mixture and the assessment of its distribution by computed tomography and anatomical dissection (12 cadavers). Contrast media spread a median of 5.5 (2.5-7.5) intercostal spaces. The dye stained a median of 3 (0-5) RCL, affecting RCL 2 (17.39%), RCL 3 (57.17%), RCL 4 (78.26%), RCL 5 (91.30%), RCL 6 (78.26%), and RCL 7 (8.70%) within the DSP. Occasionally, the rami dorsales laterales and the thoracicus longus nerve were stained. Based on these findings, the DSP block performed with a volume of 0.4 mL kg-1 of an anaesthetic could provide analgesia in the area innervated from T4 to T6.

The Impact of Tranexamic Acid Administration on Bleeding in Total Knee Arthroplasty: A Comparative Analysis Based on Anesthetic Techniques

Purpose: This retrospective study focused on examining the effect of local tranexamic use on postoperative bleeding in TKA surgery with general or spinal anaesthesia. Materials and methods: This study analysed the postoperative bleeding amounts in 95 knees with primary osteoarthritis that underwent TKA between January 2017 and 2023. Patients undergoing TKA under general or spinal anaesthesia were separated into four groups based on whether or not local tranexamic acid was given perioperatively. The postoperative hemogram alterations, drainage volume, and transfusion needs of these patients were assessed. Results: Group 4 saw a significantly higher decline in haemoglobin levels within the first twenty-four hours following surgery distinct from groups 1, 2, and 3 (p1:0.001; p2:0.000; p3:0.001, p0.05). Postoperative hemoglobin values in Group 3 were statistically importantly higher than Groups 1,2 and 4 (p1:0.019; p2:0.003; p

Pain Management in Labor: A Literature Review Comparing Anesthetic and Non-Pharmacological Techniques

Pain Management in Labor: A Literature Review Comparing Anesthetic and Non-Pharmacological Techniques

Erector spinae plane block versus intravenous opioid for analgesia in pediatric cardiac surgery: A systematic review and meta-analysis.

The erector spinae plane block (ESPB) has recently emerged as a regional anesthesia technique for perioperative pain management in pediatric cardiac surgery. However, evidence comparing its effectiveness with intravenous (IV) opioid-based analgesia is limited. We aimed to evaluate and compare the analgesic efficacy of ESPB versus IV opioids in this setting. We systematically reviewed and meta-analyzed studies comparing ESPB with IV opioid analgesia in pediatric cardiac surgeries with midline sternotomy. Primary outcomes were intraoperative fentanyl consumption and intensive care unit (ICU) length of stay (LOS). Secondary outcomes included postoperative opioid consumption, time to first rescue analgesia, pain scores, postoperative vomiting and other complications, extubation time, and hospital LOS. Statistical analyses were performed using RStudio version 4.2.3. Five studies with 384 patients were included, with 178 receiving ESPB. ESPB significantly reduced intraoperative fentanyl use (MD -1.90 μg.kg-1; 95% CI -3.15 to -0.66 μg.kg-1; p = .003; I2 = 58%) and ICU LOS (MD -3.50 h; 95% CI -4.32 to -2.69 h; p < .0001; I2 = 0%). No significant differences were found in the remaining outcomes. Our findings suggest the ESPB might be an important adjunct to enhancing analgesia for midline sternotomies in pediatric cardiac surgery, potentially reducing intraoperative opioid requirements and ICU LOS. CRD 42024526961.

Photobiomodulation therapy on puncture-associated pain: A controlled randomized double-blind clinical trial.

Dental fear and phobia are prevalent worldwide, with local anesthesia being the most feared procedure. This study aimed to determine whether photobiomodulation therapy (PBMT), used as a pre-anesthetic, could modulate puncture pain and enhance the effectiveness of local anesthesia. In this controlled, randomized, double-blind study, 49 participants were divided into an experimental group (n = 24), which received infrared laser therapy (100 mW, at 808 nm, 8 J, 80 s at a single point) immediately before standard anesthesia; and control group (n = 25), which received the standard anesthetic technique and sham laser. Pain levels were measured using the visual analog scale, and anesthetic efficacy was assessed through electrical tests (latency), percentage of failures, and cartridge usage. Anxiety levels were evaluated using the Beck Anxiety Inventory. Cardiovascular parameters were evaluated through blood pressure, oxygen levels, and heart rate. This randomized, double-blind study found no difference between groups in these experimental conditions. The bias toward a positive PBMT result was sufficiently removed. Autonomic responses of the PBMT group were maintained stable during the procedure.

Differences in the Time to Achieve Bromage Score (2) in Post-Spinal Anesthesia Caesarean Section Patients between the Use of Conventional Methods and Eracs

Pregnancy, labor, and delivery lead to significant physiological changes, and having accurate knowledge of these changes is crucial for an effective spinal anesthetic technique during a caesarean section. Optimizing the mother's health before, during, and after a caesarean section is the goal of the ERACS care method, which is a specialized approach to surgical procedures. Issues with lower limb mobility, anxiety, and dependence on others are some mental health problems that may arise from prolonged recovery periods. Spinal anesthesia patients are evaluated using the Bromage scale to determine if they are ready to be released from the post-anesthesia room. Researchers at Panglima Sebaya Hospital aimed to compare the time taken by standard operating room procedures and ERACS to reach a Bromage Score (2) after spinal anesthesia in caesarean section patients. This study employed a cross-sectional design based on observational analytical research, which is a non-experimental quantitative technique. Out of 84 patients, 47 were treated with standard SC techniques, and 47 were treated with ERACS SC. The findings indicated that the conventional method took 181–240 minutes (3–4 hours) to achieve a Bromage score (2), while the ERACS method only took 60–120 minutes (1–2 hours). A significance value of 0.000 (2-tailed) was determined based on the independent t-test results. The results showed that the ERACS method required less time than the conventional method to achieve Bromage Score (2) in CS patients post-spinal anesthesia.

Electrocardiogram assessment in long-eared hedgehogs (Hemiechinus auritus) following administration of anesthetics

Anesthesia in animals is a crucial requirement for conducting surgery, diagnostic imaging, and other procedures when the animal cannot be safely managed in a conscious state. The present study aimed to compare the impact of different anesthetic techniques on the electrocardiogram of hedgehogs. The animals were given three different anesthetic combinations: ketamine + xylazine, ketamine + diazepam, and ketamine + midazolam. The study measured the heart rate, duration, and amplitude of the P wave, QRS complex, and T wave through bipolar II derivations. Normal sinus rhythm was observed following induction by all anaesthetic combinations; however, the combination of ketamine and xylazine resulted in a significant decrease in heart rate. The P wave was positive with different combinations of anesthetics. The mean amplitude of the P wave in hedgehogs anesthetized using ketamine+xylazine was significantly lower than when using ketamine+diazepam and ketamine+midazolam. The QRS polarity was positive in leads I, II, and aVF after anesthesia induced by all combinations. The duration and amplitude of the QRS complexes did not differ significantly between all combinations. Hedgehogs anesthetized with ketamine+midazolam revealed the highest amplitude of the QRS (0.23 mv), while in the ketamine+diazepam anesthetized group, lowest amplitude (0.18 mv) was observed. The T wave was positive in all leads except leads III and aVR. Animals anesthetized with ketamine + xylazine had the lowest amplitude (0.117 mv) and the longest duration (0.08 s) of the T waves. The findings suggest that ketamine+midazolam is the choice combination based on ECG evaluation in hedgehogs.

Pioneer of epidemiology and anesthesiology – John Snow (1813–1858)

IntroductionJohn Snow, a British physician of the 19th century, played a pivotal role in challenging prevailing medical beliefs during his time. His groundbreaking studies on the cholera epidemic led to the rejection of the miasma theory and the establishment of the link between contaminated water and the spread of the disease.AimThis study aims to explore the contributions of John Snow to the fields of anaesthesiology and epidemiology, focusing on his significant findings and methodologies.Material and methodsThis study utilizes a literature review approach to examine John Snow's contributions to anaesthesiology and epidemiology. Searches were conducted in databases using relevant keywords, focusing on peer-reviewed articles and authoritative sources. The data was qualitatively synthesized to extract key insights into Snow's methodologies and findings, aiming to provide a brief overview of his impact on medical science.Results and discussion:John Snow (1813-1858) is celebrated as a pioneer in epidemiology and anaesthesiology. He identified contaminated water as the source of the 1854 cholera outbreak in London, establishing the basis for modern epidemiology. Snow's innovative mapping of cholera cases was crucial in controlling the epidemic. He also advanced anaesthetic techniques, notably using chloroform on Queen Victoria during childbirth, improving the safety of anaesthesia. His work remains influential in both fields.Conclusions:John Snow's pioneering work significantly impacted the development of anaesthesiology and epidemiology. His insights into cholera transmission and anaesthetic agents, along with his seminal publication On Chloroform and Other Anaesthetic, continue to inspire advancements in medical science. Snow's legacy underscores the importance of evidence-based medicine and the pursuit of knowledge in addressing public health challenges.

The Crucial Triad: Endothelial Glycocalyx, Oxidative Stress, and Inflammation in Cardiac Surgery-Exploring the Molecular Connections.

Since its introduction, the number of heart surgeries has risen continuously. It is a high-risk procedure, usually involving cardiopulmonary bypass, which is associated with an inflammatory reaction that can lead to perioperative and postoperative organ dysfunction. The extent of complications following cardiac surgery has been the focus of interest for several years because of their impact on patient outcomes. Recently, numerous scientific efforts have been made to uncover the complex mechanisms of interaction between inflammation, oxidative stress, and endothelial dysfunction that occur after cardiac surgery. Numerous factors, such as surgical and anesthetic techniques, hypervolemia and hypovolemia, hypothermia, and various drugs used during cardiac surgery trigger the development of systemic inflammatory response and the release of oxidative species. They affect the endothelium, especially endothelial glycocalyx (EG), a thin surface endothelial layer responsible for vascular hemostasis, its permeability and the interaction between leukocytes and endothelium. This review highlights the current knowledge of the molecular mechanisms involved in endothelial dysfunction, particularly in the degradation of EG. In addition, the major inflammatory events and oxidative stress responses that occur in cardiac surgery, their interaction with EG, and the clinical implications of these events have been summarized and discussed in detail. A better understanding of the complex molecular mechanisms underlying cardiac surgery, leading to endothelial dysfunction, is needed to improve patient management during and after surgery and to develop effective strategies to prevent adverse outcomes that complicate recovery.

Effect of anesthetic technique on antitumor immunity in patients undergoing surgery for gall bladder cancer: A prospective randomized comparative study.

There is a paucity of literature regarding the effect of anesthetic techniques on antitumor immunity, especially in gall bladder malignancies. We designed a study to compare the effect of propofol-based total intravenous anesthesia and sevoflurane-based general anesthesia-on antitumor immunity, including tumor growth factor-β (TGF-β), T-helper cell profile, and inflammatory markers. A pilot prospective randomized trial was conducted in 64 patients undergoing surgery for gall bladder malignancy under general anesthesia in a tertiary specialty cancer hospital. Adult cancer patients of ASA physical status I-III fulfilling the inclusion criteria were randomized to either group S (sevoflurane-based general anesthesia) or group T (propofol-based total intravenous anesthesia). Preoperative (morning of surgery) and postoperative (24 h and 1 month after surgery) blood samples were obtained. Demographic profile and preoperative parameters were comparable between both groups. There was a statistically significant difference in the postoperative value of TGF-β (higher in group T). There was a statistically significant difference in postoperative interleukin-17A value (indicative of TH17 cells), and it was found to be higher in group S. Propofol-based TIVA increases serum TGF-β levels. At the same time, Sevoflurane modulates T-helper cells-based immunity to increase TH17 cells in patients with gall bladder cancer. Multiple larger studies will be required to validate the results and provide useful recommendations.

Patient's Perspective on Miniscrews During Orthodontic Treatment-A Systematic Review With Meta-Analysis.

During orthodontic treatment, undesirable reciprocal forces are generated during tooth movement, which explains the use of anchorage strategies to minimise their harmful effects through intra and/or extraoral appliances. Miniscrews are intraoral devices used for temporary skeletal anchorage. Miniscrews are small-sized intraoral devices used for temporary skeletal anchorage and are easy to place and remove. However, some studies refer to adverse effects such as inflammation, pain, and discomfort. This systematic review aims to synthesise the available evidence on the use of miniscrews during orthodontic treatment from the patient's perspective. The literature search was conducted using various databases MedLine through PubMed, Cochrane Library, Web of Science Core Collection, and EMBASE. A search was also carried out in the grey literature. The search terms used were "Orthodontic Anchorage Procedures," "mini-implant," "Mini Dental Implant," "Miniscrew," and "microimplant." Cochrane risk of bias tools was used to assess the quality of included studies. Patients tend to overestimate the pain inherent in this procedure. The insertion of micro implants is more accepted than the tooth extraction procedure, with less postoperative pain reported. The location, surgical technique, and type of anaesthesia used in the placement of miniscrews influence levels of discomfort. Additionally, the execution of a good surgical technique and the clinician's communication skills are factors that influence patient satisfaction and positive perception. The most frequent outcome reported is pain and discomfort, which varies depending on its location (less with mini interradicular screws than with extra-alveolar screws). Most patients are satisfied or very satisfied with this application.

The Effectiveness and Safety of Rhomboid Intercostal Block for Postoperative Pain Management in Thoracic and Breast Surgical Procedures: A Meta-analysis

Background: The rhomboid intercostal block (RIB) is an emerging regional anesthesia (RA) technique used for pain control following thoracic and breast surgery. However, comprehensive documentation on its effectiveness and safety profile remains limited. This study aims to assess the effectiveness and safety of RIB in thoracic and breast surgical procedures. Methods: A study search was conducted following PRISMA 2020 guidelines in PubMed, Cochrane Library, Embase, Scopus, and ProQuest from 2016 to 2023 to identify randomized controlled trials (RCTs) evaluating the effectiveness and safety of RIB in thoracic and breast surgeries. The primary outcome was patient pain scores at rest, recorded at one, six, 12, and 24 hours post-surgery. Secondary outcomes included 24-hour opioid consumption and rates of postoperative nausea and vomiting (PONV). Results: This meta-analysis included five RCTs with a total of 368 patients. Rhomboid intercostal block led to a significant reduction in NRS scores one hour post-surgery (SMD = -1.33; 95% CI = -1.74 to -0.91; P &lt; 0.00001, I² = 18%, P = 0.27), 12 hours post-surgery (SMD = -0.74; 95% CI = -0.99 to -0.48; P &lt; 0.00001, I² = 36%, P = 0.21), and 24 hours post-surgery (SMD = -1.62; 95% CI = -2.56 to -0.69; P = 0.00006, I² = 91%, P &lt; 0.00001). Regarding secondary outcomes, the RIB group showed a significant reduction in 24-hour opioid consumption (SMD = -4.49; 95% CI = -6.09 to -2.90; P &lt; 0.00001, I² = 95%, P &lt; 0.00001) and PONV rates (RR = -0.29; 95% CI = 0.18 to 0.47; P &lt; 0.00001, I² = 0%, P = 0.88). Conclusions: Rhomboid intercostal block provides effective pain reduction and lowers opioid consumption within 24 hours post-surgery, while also minimizing PONV rates.

Impact of Operating Table Height on the Difficulty of Mask Ventilation and Laryngoscopic View.

Background/Objectives: Airway management techniques, including mask ventilation and tracheal intubation, are vital across medical settings. However, these procedures can be challenging, especially when environmental conditions are less than ideal. This study explores how the height of the operating table affects the difficulty of anesthesia techniques involving mask ventilation and tracheal intubation. Methods: Twenty anesthesiologists participated in this study. We assessed the difficulty of procedures such as mask ventilation, Macintosh laryngoscopy, and video laryngoscopy using McGRATH and AWS, on a four-level scale. The operating table's height was adjusted at four points: the operator's umbilicus, the inferior margin of the 12th rib, the xiphoid process, and the nipple. Results: Mask ventilation was easiest at the operating table's height aligned with the inferior margin of the 12th rib. Conversely, direct laryngoscopic exposure was perceived as easier at higher table heights, with nipple height being optimal. The McGRATH laryngoscopy showed consistent difficulty across table heights, whereas the AWS tended to be somewhat more difficult at greater heights. Conclusions: The optimal bed height for video laryngoscopy coincided with that for mask ventilation. Video laryngoscopy offers enhanced flexibility in optimal patient positioning compared to Macintosh laryngoscopy, contributing to its advantages in tracheal intubation procedures.

Clavipectoral fascial plane block versus superficial cervical plexus block for fracture clavicle surgery: a randomized clinical trial

Background &amp; objective: Both, the clavipectoral fascial plane block as well as superficial cervical plane block have been utilized as a regional anesthesia technique for clavicular fracture surgery. We compared the efficacy and safety of clavipectoral plane block with superficial cervical plexus block for intraoperative and postoperative pain relief in clavicular fracture surgery under general anesthesia (GA). Methodology: This double-blinded randomized controlled trial included 84 patients, aged between 21 and 60 y, ASA classification I and II, with fracture clavicle, either isolated or part of other trauma, undergoing fracture clavicle fixation. The patients were divided into two groups. The first group received a clavipectoral fascial plane block and the other received a superficial cervical plane block. The visual analogue scale (VAS) scores were recorded as primary outcome, while the patients’ hemodynamics, time to first rescue analgesic, and total morphine consumption were the secondary outcomes at post-anesthesia care unit (PACU) then every 2 h in the ward till 8 h. Results: Compared to the superficial cervical plexus block the clavipectoral plane block was superior in analgesia and more effective during surgical dissection and intraoperative manipulations with a clinically and statistically significant difference all the time from PACU to 8 h postoperatively. The heart rate and arterial blood pressure were much more stable in the clavipectoral group. Also, time to first rescue analgesic was more in the clavipectoral group than in the superficial cervical block. Total morphine consumption was significantly less in the clavipectoral group than in the superficial cervical group. Conclusion: Clavipectoral plane bock is superior to superficial cervical block in fracture clavicle surgeries regarding efficacy and safety. Postoperative pain, measured by VAS, was less with clavipectoral plane block, with more hemodynamic stability and less opioid consumption postoperatively. Abbreviations: PACU - post-anesthesia care unit; CFP - Clavipectoral fascial plane; SCP - Superficial cervical plexus Keywords: Clavipectoral Plane Bock; Fracture Clavicle; Pain, Postoperative; Superficial Cervical Plexus Block Citation: Sayed AG, Abdelmoez WA, Ali OM, Elshafeey AE. Clavipectoral fascial plane block versus superficial cervical plexus block for fracture clavicle surgery: a randomized clinical trial. Anaesth. pain intensive care 2024;28(5):945−950; DOI: 10.35975/apic.v28i5.2573 Received: April 03, 2024; Reviewed: May 13, 2024; Accepted: July 02, 2024

Comparison of ultrasound guided erector spinae plane block and fascia iliaca block for postoperative analgesia in hemiarthroplasty: a double-blind randomized trial

Background &amp; Objective: Peripheral nerve blocks are one of the peri-operative analgesic options that abolish surgical stress response, reduce the use of opioids, and control postoperative pain. During the previous few decades regional anesthesia and analgesia techniques have been widely used, especially with the enhanced safety and precision in these procedures with the use of ultrasound. We compared the efficacy of Erector Spinae Plane Block (ESPB) with Fascia Iliaca Block (FIB) for postoperative pain in hemiarthroplasty surgery. Methodology: This randomized double-blind trial included sixty-eight cases scheduled for hemiarthroplasty under spinal anesthesia. Patients were randomly divided into two equal groups: Group ES received ESPB, and Group FI received FIB. Blocks were performed preoperatively using 15 mL bupivacaine 0.25%- and 15 mL lidocaine 2%. Postoperatively, pain was assessed with Visual Analogue Scale (VAS) at 1 h, 2 h, 6 h, 12 h and 24 h. Results: The mean time to first dose and the amount of morphine used in the first 24 hours were comparable between Group ES and Group FI. Visual analogue scale measurements at rest and movement showed insignificant differences between both groups at 1 h, 2 h, 6 h, 12 h and 24 h. Quadriceps motor impairment revealed significant reduction in Group ES compared to Group FI (11.76 vs 44.12%, P = 0.006). Conclusions: In hemiarthroplasty, the analgesic profile of erector spinae plane block was comparable with fascia iliaca block with superiority of the former in preserving the quadriceps motor power. Keywords: Ultrasound, Erector Spinae Plane Block, Fascia Iliaca Block, Analgesia, Hemiarthroplasty Citation: Ahmed MB, Mohammed MM, Amin SMM, Belata MM. Comparison of ultrasound guided erector spinae plane block and fascia iliaca block for postoperative analgesia in hemiarthroplasty: a double-blind randomized trial. Anaesth. pain intensive care 2024;28(5):791−797; DOI: 10.35975/apic.v28i5.2562 Received: April 29, 2024; Reviewed: August 19, 2024; Accepted: August 25, 2024