Method Of Anesthesia Research Articles

Novel sequential proximal iliopsoas compartment block: A four-in-one block as a primary anaesthetic technique for intramedullary femoral nailing surgery: A retrospective study

Background and Aims: The fragile elderly population suffering from hip fractures presents an anaesthetic challenge; therefore, widening the armamentarium for surgical treatment should be sought. This retrospective study presents a new primary anaesthetic method for intramedullary femoral nailing (IMFN) surgery in the context of hip fracture: the sequential proximal iliopsoas compartment (SPIC) block. Methods: This single-centre retrospective study involved 25 patients aged 80 or older submitted to IMFN surgery. The patients were given a single-shot SPIC block using a total of 25 ml of ropivacaine 0.5% plus dexamethasone 8 mg administered sequentially in the proximal iliopsoas space, divided equally as per two different sites as a primary anaesthetic technique associated with moderate sedation. The outcome measure was the adequacy of the anaesthetic approach. The one-tailed Wilcoxon signed-rank test compared the preoperative numerical pain rating scale (NPRS) with the NPRS at 24 h and the pre-incision with the maximum intraoperative mean arterial pressure. Results: The patients were successfully anaesthetised, had no vasopressor consumption, had good surgical conditions, and had no complaints recorded. No tachycardia or hypertensive events were noted. No additional opioids were given. No statistically different values were observed when the pre-incisional and intraoperative mean arterial pressure values were compared (P = 0.52), and the preoperative NPRS compared with the NPRS at 24 h showed a statistically significant difference (P < 0.001). Conclusion: The SPIC block combined only with moderate sedation permits adequate anaesthesia while avoiding the significant risk of neuraxial/sympathetic blockade.

Case Report: Innovative anesthetic approaches for whole lung lavage in an infant with pulmonary alveolar proteinosis

IntroductionPulmonary alveolar proteinosis (PAP) is a rare disease in infancy characterized by the accumulation of lipoprotein material within the alveoli, leading to impaired gas exchange, ventilation-perfusion mismatch, and, in severe cases, respiratory failure that may result in death. Treatment options include medical therapy and whole lung lavage (WLL), typically requiring lung isolation techniques or extracorporeal membrane oxygenation. Previous studies have reported the application of several lung isolation techniques in pediatric WLL. However, the use of a bronchial blocker (BB) in infant WLL has not been previously reported.Case descriptionThis study reports the anesthesia management of a 12-month-old infant diagnosed with secondary PAP, complicated by severe pneumonia and patent ductus arteriosus. The child presented with respiratory failure requiring WLL. The anesthesia method employed was intravenous general anesthesia, and airway management involved using a BB placed outside the endotracheal tube to facilitate one-lung ventilation (OLV). The procedure successfully maintained blood oxygen levels above 90%, and the WLL was completed without any anesthetic complications.ConclusionThis case demonstrates that using endotracheal intubation combined with extraluminal placement of a BB for lung isolation is a viable and effective approach for performing WLL in infants.

Dynamics of heart rate variability depending on the type of anesthesia during surgery for anterior abdominal wall hernias

Background. Heart rate variability (HRV) is a non-invasive method of analyzing the response of the entire body to surgical stress. The adequacy of the autonomic nervous system response during the perioperative period involves both the initial reserves of the body and the physiology of anesthesia method. HRV is used to predict perioperative complications, especially cardiac ones, mortality, and duration of inpatient treatment. The purpose of the study was to perform a comparative analysis of the dynamics of heart rhythm variability at the stages of elective surgery for anterior abdominal wall hernias depending on the type of anesthesia. Materials and methods. Ninety-one patients with anterior abdominal wall hernias were examined and treated. They were divided into 3 groups according to the method of anesthesia (general, neuraxial and regional blockades). Patients underwent 24-hour ECG monitoring with assessment of HRV. Changes in HRV were evaluated during the surgery: the dynamics of 30 intervals of 5 minutes, a total of 2 hours and 30 minutes were chosen. The monitoring was conditionally divided into 3 stages — the initial, the main one, and the end of the surgery. Results. Under general anesthesia, the median SDNN and pNN50 by the end of the operation were significantly lower than the baseline. Under regional and neuraxial anesthesia, they increased compared to the preoperative level or returned to the baseline. In patients with general anesthesia, LF/HF median decreased statistically significantly until the end of the surgery, and under regional and neuraxial anesthesia, it increased and exceeded the preoperative level. In all patients, along with a decrease in total HRV, there was a reduction in the influence of both sympathetic and parasympathetic parts of the autonomic nervous system on cardiac rhythm. But in general anesthesia, HRV reduction was maintained until the end of the follow-up period, in contrast to patients with epidural anesthesia and regional blockades who reported an increase in both sympathetic and parasympathetic activity until the end of the surgical intervention. Conclusions. The dynamics of HRV during neuraxial and regional analgesia reflects the most physiological response of the autonomic nervous system of a patient with comorbid cardiovascular pathology during elective surgery for anterior abdominal wall hernias.

Topical anesthetics methods used to reduce needle pain/discomfort prior to local anesthesia in children and adolescents: a scoping review.

The aim of this study was to review the most effective topical anesthetic methods for reducing pain/discomfort prior to dental local anesthetic needle puncture for dental procedures in children and adolescents. A scoping review was conducted. Individual search strategies were developed for each of the bibliographic databases (Cochrane, Embase, LILACS, LIVIVO, Pubmed, Scopus, PsyINFO, Web of Science), and in the gray literature (Google Scholar, Open Gray), comprehensively, without restrictions on language, publication data, or level of socioeconomic development of the country in which the study was conducted. The search was conducted on April 21, 2021 and the updates on May 24, 2024. Randomized controlled studies conducted in patients up to 18 years of age were included. Variables collected: characteristics of the included studies, topical anesthetics evaluated, time and the mode of application. Initially, 8579 studies were retrieved. Then 3127 were identified as eligible, of which (n = 3127), 52 studies were included in the narrative synthesis. The most commonly observed anesthetic methods with the most favorable outcomes were lidocaine, benzocaine, ice cooling, and EMLA. Spray, gel or patch were used, with application times ranging from 1 to 10 min. Mucosal cooling an ice stick was analyzed by eight studies. Only one showed a smaller reduction in pain perception scores than others. Cooling is a technique with numerous clinical advantages from the clinical point of view, for reduction of pain/discomfort prior to needle puncture of dental local anesthesia in children and adolescents. It is an accessible, inexpensive and pleasant method that does not resemble needles or unpleasant tastes, nor involves systemic toxicity and complications that may be associated with others anesthetics agents. Future randomized controlled studies in accordance with the Consort Statement are needed to further investigate the topic.

Anesthesia depth monitoring during opioid free anesthesia – a prospective observational study

BackgroundPatients undergoing general anesthesia are more frequently monitored for depth of anesthesia using processed electroencephalography. Opioid-free anesthesia is nowadays an accepted modality for general anesthesia, however it is unclear how to interpret data from processed electroencephalography when using a mixture of non-opioid anesthetic drugs. Our objective was to describe density spectral array patterns and compare processed encephalographic data indices between opioid-free and routine opioid based anesthesia.MethodsThis prospective observational cohort study was conducted on 30 adult patients undergoing laparoscopic surgery in a non-tertiary regional hospital. The patients underwent general anesthesia with three different methods and were monitored for anesthesia depth using processed encephalography and density spectral array. Primary outcome is a group-derived mean difference in patient state index and spectral edge frequency. As a secondary outcome a descriptive comparison of the spectral power, derived from the density spectral array, was done between groups.ResultsThe opioid-free anesthesia group had significantly higher patient state index and spectral edge frequency compared to routine anesthesia. Density spectral array patterns were also different, most notably lacking the high power in alpha frequency spectrum seen in the other routine anesthesia methods.ConclusionsProcessed electroencephalography monitoring can be used in opioid-free anesthesia, however clinicians should expect higher values in monitoring indices. The density spectral array pattern using a common protocol for opioid-free anesthesia, with mainly sevoflurane combined with low doses of dexmedetomidine and esketamine, differs from well described opioid and GABA-ergic anesthesia methods. These findings should be further validated using other protocols for opioid-free anesthesia in order to safely monitor anesthesia depth.Trial registrationClinicaltrials.gov registration number NCT06227143, registration date; 26th of January 2024.

Combining Transversus Abdominis Plane and Rectus Sheath Blocks in Open Inguinal Hernia Surgery Anesthesia: A Retrospective Cohort Analysis.

Lichtenstein hernia repair is a common surgical procedure. Previously, combined rectus sheath (RS) and transversus abdominis plane (TAP) blocks have been shown to be beneficial in laparoscopic inguinal hernia surgery. Our hypothesis is that combining the two blocks will also be beneficial in open Lichtenstein hernioplasty day-case procedures. This retrospective study analyzed data from 186 patients undergoing inguinal hernia surgery chosen using the propensity score matching. Primary endpoint was intraoperative and postoperative opioid consumption. Secondary endpoints were conversion of the anesthetic method, postoperative nausea and vomiting (PONV), unscheduled hospitalization or emergency room visits, perioperative duration, analysis of the patient flow, and surgical complications. Ninety-three patients treated with the blocks (study group) and 93 controls were analyzed. The study group had significantly lower opioid use in the operating room (2.5-7.5mg vs. 5.0-7.5mg and p<0.01) and in the recovery room (0.0-2.0mg vs. 1.0-10.6mg and p<0.0001). There was no difference in postoperative recovery room times nor in the patient flow. Postoperative hospitalization due to pain was 9.1% in the control group, whereas no patients in the study group were hospitalized (p<0.01). RS and TAP blocks reduce postoperative pain in inguinal hernia surgery, resulting in significantly lower postoperative opioid use and hospitalization rates. The blocks are technically easy and quick to perform and should be considered for pain management in inguinal hernia day-case surgery.

Impact of anesthetic methods on outcomes for patients with large core stroke undergoing endovascular treatment

BackgroundThe optimal anesthetic method for endovascular therapy in acute large core stroke remains unclear. This study aimed to evaluate the impact of anesthetic methods on outcomes in patients with large...

Anterior Cruciate Ligament Reconstruction: Analysis of Grafts, Associated Injuries, And Anesthetic Strategies

Objective: This study analyzed the clinical and surgical outcomes of patients undergoing anterior cruciate ligament (ACL) reconstruction, evaluating associated injuries, graft types, anesthetic strategies, and tourniquet time. Methods: Sixteen patients with ACL injuries were included, and their medical records were reviewed to collect data on the variables. Associated injuries were categorized, the types of grafts used were recorded, and anesthetic practices and tourniquet times were analyzed. Results: Associated injuries were identified in 60% of patients, with meniscal injuries being the most common (40% with sutures). The patellar tendon was the most used graft (80%), while anesthetic methods such as spinal anesthesia combined with continuous additional block (BCA) were applied in 40% of cases. The average tourniquet time was 68 minutes, remaining within safe limits according to the literature. Conclusion: ACL reconstruction requires meticulous surgical planning, considering clinical and technical variables. Graft selection and anesthetic strategies, combined with the preservation of joint structures, are essential for favorable functional outcomes and the prevention of complications.

Risk of Dementia After Uterus or Prostate Resection: 17-Year Follow-Up of a Population-Based Retrospective Cohort Study.

The purpose of this retrospective study was to determine the effect of surgical operation, age at surgery, sex hormones, and anesthesia modality on the risk of dementia in both sexes. Data of females aged between 30 and 70 years old who were diagnosed with dysmenorrhea and underwent hysterectomy/myomectomy or without surgery, and males with benign prostate hyperplasia (BPH) with or without transurethral resection of the prostate (TURP) were identified from the National Health Insurance Research Database 2000-2016. The effect of age at surgery, surgery type, and anesthesia modality on dementia risk was assessed using Cox regression analyses. Among the 855,893 subjects, 10,242 developed dementia. Surgery at older age increased dementia risk in both sexes. Among females, hysterectomy/myomectomy was not significantly associated with dementia risk, although myomectomy was associated with a lower risk for dementia than hysterectomy. In males, TURP significantly increased the risk of dementia. Men with BPH and women with dysmenorrhea who were older at surgery have a higher risk of dementia. Regardless of the anesthetic method, surgery increased the risk of dementia in men. Among the data of women, although the surgery factor was not significantly associated with dementia risk, women with myomectomy had a lower risk of dementia than the ones with hysterectomy. These findings together contributed to risk stratification for each sex in such surgical settings.

Effectiveness of vapocoolant spray compared toeutectic lidocaine/prilocaine cream to enhance tolerance during intravenous catheterisation: a randomised controlled trial.

To determine if tolerance of intravenous catheterisation differs following the application of vapocoolant spray compared to lidocaine/prilocaine cream in dogs and cats. A randomised controlled trial of client-owned dogs and cats requiring intravenous catheterisation was performed. They were randomly allocated to either have lidocaine/prilocaine cream applied to their skin 1 hour prior to intravenous catheterisation or a swab saturated with vapocoolant spray applied immediately prior to intravenous catheterisation. The procedure was video-recorded and a single blinded observer reviewed the recordings and assigned reaction scores (0 to 3) at 4 time points (initial restraint, limb handling, swab application and skin puncture). Between October 2020 and March 2022, a total of 101 animals (83 dogs and 18 cats) were enrolled, with 56 patients randomised to receive vapocoolant spray and 45 to receive lidocaine/prilocaine cream. There was no significant difference in the age, sex status, number of cross and pure breeds, and mentation detected between the groups. There was no significant difference in reaction scores between the treatments when comparing all patients at any time point except for a significantly increased swab application reaction score in patients receiving vapocoolant spray. Vapocoolant spray was significantly less effective in reducing adverse reaction to skin puncture than lidocaine/prilocaine cream in the small number of cats evaluated. When considering all patients together, no single method of anaesthesia appeared superior for improving tolerance of intravenous catheter placement. However, vapocoolant spray may be less effective than lidocaine/prilocaine cream in reducing adverse response to skin puncture during catheterisation in cats.

Heavy gravity combined with light gravity local anesthetic in subarachnoid anesthesia for cesarean section did not reduce the incidence of intraoperative hypotension in maternal women: a prospective cohort study

BackgroundSubarachnoid anesthesia is the primary anesthetic method for elective cesarean section surgery, characterized by rapidly taking effect and reliable analgesia. However, subarachnoid anesthesia is prone to cause a high block level, resulting in a high incidence of maternal hypotension. How to reduce the incidence of maternal hypotension under subarachnoid anesthesia is a practical problem that needs to be solved urgently in clinical practice.MethodsThis prospective cohort study was performed at Nantong Maternal and Child Health Care Hospital in China between January and July 2023. This study compared the incidence of hypotension in pregnant women undergoing subarachnoid anesthesia during elective cesarean section in four groups, including group A (control group) with 10 mg of 10% glucose solution; Group B with 5 mg 10% glucose solution group; Group C with 4 mg 10% glucose solution group; Group D with 2 mg 10% glucose solution group. Each group was given a dose of 10 mg Ropivacaine with a concentration of 0.5% and a volume of 2 ml. The primary outcome was the incidence of maternal hypotension. The secondary outcomes were the plane of anesthesia, abdominal wall muscle relaxation degree and the incidence of adverse events.ResultsData from 74 (18, A group; 26, B group; 15, C group; 15, D group) participants were analyzed. Hyperbaric combined with hypobaric local anesthetic in subarachnoid anesthesia for cesarean section did not reduce the incidence of intraoperative hypotension in pregnant women (P = 0.152). The plane of anesthesia gradually shifted from T4 to T10 as the specific gravity of ropivacaine decreased (P < 0.01). Satisfaction about abdominal wall muscle relaxation degree gradually decreased with the decrease of the specific gravity of ropivacaine (P = 0.04). And the incidence of adverse events gradually increased with the decrease of the specific gravity of ropivacaine (P = 0.027).ConclusionsHyperbaric combined with hypobaric local anesthetic in subarachnoid anesthesia for cesarean section did not reduce the incidence of intraoperative hypotension in pregnant women.

Retrospective evaluation of the effects of different anesthesia methods on emergence agitation in patients undergoing vitreoretinal surgery.

The agitation that can occur in patients undergoing vitreoretinal surgery on awakening from general anesthesia is a serious post-operative problem. In our study, we aimed to compare the effects of different anesthesia methods on emergence agitation in patients undergoing vitreoretinal surgery. Patients undergoing vitreoretinal surgery were divided into two groups: Total intravenous anesthesia (Group T) and inhalation anesthesia (Group D) according to the maintenance of anesthesia applied by consulting the records. Patients' heart rate, mean blood pressure, extubation quality scores, and Richmond Agitation and Sedation Scale values were examined. For the study, data were available from 100 patients undergoing vitrectomy surgery. It was observed that in the total intravenous anesthesia group the quality of extubation and the patients' additional analgesic requirements were better, and the patients' agitation levels at min 0 were lower. In our study, it was observed that the choice of total intravenous anesthesia as an anesthetic method in patients undergoing vitreoretinal surgery reduced agitation upon awakening compared to those receiving inhalational anesthesia.

The global research trends in perioperative cognitive function protection for preventing postoperative delirium: A bibliometric analysis.

This study aims to analyze the global trends and current status of perioperative cognitive function protection for preventing postoperative delirium(PCFP-POD), as well as to predict research hotspots. We conducted a literature search on the Web of Science Core Collection (WoSCC) and selected articles published between January 1, 2014, and December 31, 2023, related to PCFP-POD. The retrieved data were subjected to bibliometric analysis and visualization using CiteSpace 6.2.R4, VOSviewer 1.6.20 software, and the Bibliometrics website. A total of 355 articles published between 2014 and 2023 were retrieved from the online databases. The number of publications on perioperative cognitive function protection for preventing postoperative delirium sharply increased from 2018 onwards. Key themes included drug and non-drug interventions, postoperative cognitive dysfunction in cardiac and hip surgery, and the effects of anesthetic drugs. High-frequency keywords included postoperative delirium, intervention, postoperative cognitive impairment, and cognitive training. The number of research articles on PCFP-POD increased significantly from 2014 to 2023. Future research trends may focus on cognitive function protection related to surgical categories, anesthesia methods, electroencephalogram monitoring, and nursing care.

Comparing C3, 4, and 5 nerve root block and interscalene with intermediate cervical plexus block in diaphragmatic motion for clavicle surgery

Regional anesthesia is a popular method for surgical anesthesia in clavicular surgery. Selective blocking of the cervical 3, 4, and 5 nerve roots shows promise in clavicle surgery, with its fast onset, good anesthesia and less complications, necessitating evaluation of its impact on diaphragmatic function. The purpose of this study is to examine the safety of C3, 4, and 5 nerve root block for its application in clavicle surgery. We conducted a pragmatic, randomized trial to evaluate the effect of C3, 4, and 5 nerve root block as compared with interscalene with intermediate cervical plexus block in diaphragmatic motion. This study involved forty patients undergoing right clavicle surgery. Patients were assigned in a 1:1 ratio to either a C345 nerve root block (administered with 2, 3, and 5 ml of 0.5% ropivacaine) or an interscalene with intermediate cervical plexus block (ISB + ICPB, each receiving 10 ml of 0.5% ropivacaine). Diaphragmatic kinetics were quantitatively assessed using sonographic techniques. The primary outcome was the incidence of complete hemi-diaphragmatic paralysis, observed at 30 min post-blockade. Secondary outcomes included the rate of complete hemi-diaphragmatic paralysis at 15 min and the degree of diaphragmatic motion restoration at 2, 4, 6, and 8 h post-blockade, onset time of block, motor block score in upper extremity, and adverse events. Results showed that only one patient (5%) in the C345 group vs. fifteen (75%) in the ISB + ICPB group experienced complete hemi-diaphragmatic paralysis at 30 min during deep breathing (P = 0.001). No patients in the C345 group, compared to five (25%) in the ISB + ICPB group exhibited paradoxical movement at 30 min during voluntary sniffing (P = 0.0471). Additionally, the C345 group demonstrated significantly greater diaphragmatic motion and upper limb strength restoration at all measured intervals post-blockade. Moreover, faster onset time and less adverse events were observed in the C345 group vs. in the ISB + ICPB group. Benefit from low volume of local anesthetics, the C345 nerve root block not only significantly reduces the incidence of complete hemi-diaphragmatic paralysis but also facilitates better recovery from diaphragmatic paralysis compared to the ISB + ICPB. It can be inferred that C345 is a more beneficial anesthesia method for early recovery of clavicular patients.Trial registration number: ChiCTR2300078283 04/12/2023.

Does cytochrome 2D6 genotype affect the analgesic efficacy of codeine after ambulatory surgery? Prospective trial in 987 adults.

Paracetamol-codeine combination tablet is widely used in pain management after day surgery. For safety reasons, its use has decreased in recent years. Codeine is a prodrug metabolised in the liver by the cytochrome P450 2D6 (CYP2D6) enzyme to morphine that produces the analgesic effect of codeine. CYP2D6 is highly polymorphic, and based on genotypes, individuals can be divided into four categories: poor-, intermediate-, normal- and ultrarapid metabolisers. Differences in morphine and its metabolite concentrations have been described between different CYP2D6 genotypes following codeine administration. The aim of the study was to investigate the possible effect of CYP2D6 genotype on codeine efficacy and adverse effects in a large cohort of adult patients undergoing ambulatory surgery. A total of 987 patients scheduled for ambulatory surgery were included in the analyses. Operation types or anaesthesia methods were not limited in the study protocol. All study patients received a fixed dose of paracetamol (1000 mg) and codeine (60 mg) orally for premedication. A blood sample was drawn to identify the genotype of CYP2D6. At home, the first-line analgesic was paracetamol-codeine combination of 1-2 tablets at 1-3 times per day. Data on the efficacy and side effects of codeine were collected on the day of surgery and the following two postoperative days. Of the studied patients, 37 (3.7%) were poor CYP2D6 metabolisers, 264 (27%) were intermediate, 623 (63%) were normal and 63 (6.4%) were ultrarapid metabolisers. Activity scores ranged from 0 to 4. CYP2D6 genotype was not associated in a statistically significant manner with postoperative pain, opioid consumption or the adverse effects of codeine, except for constipation at home. Poor CYP2D6 metabolisers reported significantly less severe constipation compared with normal metabolisers (p = .009, OR 0.40, 95% Cl 0.20-0.80). CYP2D6 genotype appears to be of minor importance for the analgesic efficacy of oral paracetamol-codeine combination therapy after ambulatory surgery in adult patients undergoing similar types of surgery as in the present study but it may affect the risk of constipation.

A Clinical Comparative Study of Ultrasound-Guided Tumescent Local Anaesthesia versus Epidural Anaesthesia in Great Saphenous Vein Stripping.

To compare the effects of ultrasound-guided tumescent local anaesthesia (TLA) and epidural anaesthesia (EA) in great saphenous vein stripping and to explore the feasibility of using TLA in this procedure. This study included 144 patients diagnosed with varicose veins of the great saphenous vein who required surgical treatment and were admitted to the Second People's Hospital affiliated with Fujian University of Traditional Chinese Medicine from March 2020 to November 2023. Patients were divided into two groups based on the anaesthesia method used, including the observation group (TLA) and the control group (EA), with 72 patients in each group. Both groups underwent high ligation, internal stripping, and microvenectomy of the great saphenous vein. Perioperative data were collected, and pain was assessed using the visual analogue scale (VAS) immediately after anaesthesia, immediately after surgery, 24 hours postsurgery, and 48 hours postsurgery. Intraoperative conditions, postoperative recovery, complications, and economic benefits were compared between the two groups. Compared with the control group, the observation group had lower VAS scores immediately after anaesthesia (3.6±1.4 vs. 4.5±1.7) and immediately after surgery (2.1±1.4 vs. 3.3±1.5) (P<0.05). Blood pressure fluctuations (113.8±9.8 vs. 120±8.9 mmHg) and heart rates (77.3±7.8 vs. 97.3±5.7 beats/min) during stripping were significantly lower in the control group (P<0.05). The observation group had a significantly shorter postoperative bed rest duration (45.5±11.9 vs. 93.6±13.8 min), postoperative urinary retention (0 vs. 6 patients), postoperative deep vein thrombosis (1 vs. 7 patients), total postoperative hospital stay (1.7±0.5 vs. 3.3±0.5 days), and hospitalization costs (¥7311.7±117.5 vs. ¥9234.3±87.5) (P<0.05). No significant differences were noted between the groups in terms of the VAS score at 24 and 48 hours postsurgery, operation time, postoperative nausea and vomiting, or incidence of postoperative incision infections (P>0.05). Ultrasound-guided tumescent local anaesthesia for great saphenous vein stripping reduces intraoperative pain, allows for earlier ambulation, and effectively minimizes postanaesthesia complications and deep vein thrombosis. This method enables quicker recovery and reduces hospitalization costs.

Comparison of postoperative analgesic efficacy between erector spinae plane block and rhomboid intercostal block in breast-conserving surgery and sentinel lymph node biopsy: A randomized non-inferiority clinical trial.

Breast-conserving surgery is a common breast operation type in the world. Patients may feel severe postoperative pain after the surgery. Several regional anesthesia methods are used for postoperative pain control as a part of multimodal analgesia management after breast surgery. Erector spinae plane block (ESPB) and rhomboid intercostal plane block (RIB) are commonly used techniques for this purpose. The studies that compare these methods are limited. Therefore, we aimed to compare the efficacy of ESPB and RIB. This prospective, randomized study included sixty female patients with ASA class I-II physical status in the study. All patients underwent general anesthesia. We performed the blocks at the end of the surgery before extubation. Participants were randomized into two groups between the operation: the Group ESPB (n=30) and the Group RIB (n=30). We performed 30 ml volume of 0.25% bupivacaine for the blocks. 400 mg ibuprofen 3x1 was ordered postoperatively, and a fentanyl PCA device (2 ml bolus, 0 ml infusion, 20 min lock time, 4 hour limit) was attached intravenously to the participants. If the pain score was ≥4, meperidine (0.5 mg/kg) was performed. There were no differences in terms of demographical data. The postoperative opioid use, pain scores, adverse events, and the need for rescue analgesia were similar between groups. Both RIB and ESPB are effective regional anesthesia techniques following breast surgery. They are simple and safe methods. Anesthesiologists may prefer one or the other based on their clinical experience.

Comparison of perioperative analgesic effectiveness of ultrasound-guided erector spinae plane block and transversus abdominis plane block in patients undergoing laparoscopic nephrectomy.

In this study, we aimed to compare the efficacy of two regional anesthesia methods, transversus abdominis plane (TAP) block and erector spinae plane (ESP) block, for intraoperative and postoperative pain relief in patients undergoing laparoscopic nephrectomy. Fifty patients aged 18-80 years with American Society of Anesthesiologists (ASA) classification I-II scheduled for elective laparoscopic nephrectomy were included after ethical approval and informed consent. Patients were randomly assigned to either Group TAP (receiving TAP block) or Group ESP (receiving ESP block). Postoperatively, all patients received patient-controlled analgesia (PCA) with morphine. We evaluated intraoperative hemodynamics, additional opioid use, resting and coughing pain scores (Visual Analog Scales - VAS), time to first PCA dose, postoperative opioid consumption, rescue analgesic needs, opioid side effects, and patient and surgeon satisfaction. In Group ESP, postoperative VAS scores at 8 hours and during the first mobilization were significantly lower (p=0.019, p=0.004, respectively) compared to Group TAP. Patient satisfaction was notably higher in Group ESP (p=0.014). However, other postoperative parameters were similar between the groups (p>0.05). These findings held true when considering only radical nephrectomies, with no differences in the assessed parameters between simple and partial nephrectomies. In conclusion, both TAP and ESP blocks demonstrated comparable effectiveness in postoperative pain management for laparoscopic nephrectomies. Nevertheless, due to lower VAS scores during mobilization and higher patient satisfaction, the ESP block appears to be more effective for multimodal analgesia. Further research is required to comprehensively assess their efficacy in laparoscopic radical nephrectomies.

COMPARISON OF FASCIA ILIACA COMPARTMENT BLOCK AND INTRAVENOUS FENTANYL FOR ANALGESIA DURING POSITIONING FOR SPINAL ANESTHESIA IN HIP FRACTURE SURGERIES

Effective pain management in hip fracture surgeries is crucial for optimal recovery. Spinal anesthesia is commonly used but positioning patients can be challenging, especially in frail, elderly individuals. Two main approaches for managing pain during positioning are the fascia iliaca compartment block (FICB) and intravenous fentanyl. FICB, a regional anesthesia technique, targets the lumbar plexus, providing longer-lasting pain relief with fewer systemic side effects compared to opioids. It reduces the need for additional analgesics, improving patient comfort and reducing intraoperative complications. FICB is especially beneficial in elderly patients with comorbidities. Intravenous fentanyl offers rapid pain relief but has a shorter duration and carries risks such as respiratory depression, sedation, and nausea, particularly in the elderly. Frequent dosing may lead to inconsistent pain control. Studies show that FICB provides superior pain relief and fewer side effects than fentanyl, making it a preferable choice for hip fracture surgeries. This study aims to compare their efficacy. Objective: 1. To study the effect of analgesia for positioning during spinal anaesthesia using VAS score in fascia iliaca compartment block and intravenous fentanyl 2. To compare the effect of analgesia in fascia iliaca compartment block and intravenous fentanyl 3. The time taken for giving spinal anaesthesia Materials and method: This study is on patients undergoing hip fracture surgery under subarachnoid block and was done in basaweshwara teaching and general hospital,MR medical college gulbarga. It was a Prospective interventional study included 60consented patients of age group 30 to 60 years belonging to American society of anesthesiologists class I or II and posted for hip fracture surgery under subarachnoid block. Results: This study included 60 patients, 30 in each group. Group A-30 patients received preoperative USG fascia iliaca compartment block.Group B- 30 patients received 1mcg/kg IV fentanyl 5 minute before placing in sitting position for spinal blockade. The mean Visual Analog Scale (VAS) score during positioning was significantly lower in Group A (1.13 ± 1.25) compared to Group B (2.33 ± 1.58) with a highly significant difference (p&lt;0.001), while the mean time to perform spinal anesthesia was significantly shorter in Group A (4.79 ± 0.54 minutes) than in Group B (5.14 ± 0.57 minutes), with a p-value of 0.017 the age distribution between the two groups showed no significant difference, with 46.7% of Group A and 66.7% of Group B in the 51-60 age group (p=0.143). Conclusion: In conclusion, the Fascia Iliaca Compartment Block is a superior analgesic technique compared to intravenous fentanyl for providing pain relief during positioning for spinal anesthesia in patients undergoing hip fracture surgeries. The benefits of FICB, including effective pain relief, prolonged analgesia, and reduced side effects, make it a valuable tool in optimizing pain management in this patient population.

Anesthetic approaches and 2-year recurrence rates in non-muscle invasive bladder cancer: a randomized clinical trial

BackgroundThe effect of anesthesia methods on non-muscle invasive bladder cancer (NMIBC) recurrence post-resection remains uncertain. We aimed to compare the oncological outcomes of spinal anesthesia (SA) and general anesthesia (GA)...