Peripheral Nerve Blocks Research Articles

Suggestions to Improve Peripheral Nerve Block Practices in Hospitals in Sri Lanka – Medical Administrators Perspectives.

Suggestions to Improve Peripheral Nerve Block Practices in Hospitals in Sri Lanka – Medical Administrators Perspectives.

Effects of combined dexamethasone and dexmedetomidine as adjuncts to peripheral nerve blocks: a systematic review with meta-analysis and trial sequential analysis.

The effects of combining dexamethasone and dexmedetomidine on block duration are unclear. To investigate the effects of combining dexamethasone and dexmedetomidine on block duration. Systematic review of randomized controlled trials (RCTs) from Medline, Embase, CENTRAL, CINAHL, the Web of Science, and BIOSIS until June 8, 2023. RCTs with adults undergoing surgery with a peripheral nerve block randomized to combined dexamethasone and dexmedetomidine versus placebo or other adjuncts were eligible. Primary outcome was duration of analgesia. We performed meta-analysis, trial sequential analysis, risk of bias-2, and Grading Recommendations Assessment, Development, and Evaluation assessment. We included 9 RCTs with 14 eligible comparisons. The combination of dexamethasone and dexmedetomidine was compared with placebo in three RCTs (173 participants), dexamethasone in seven (569 participants), and dexmedetomidine in four (281 participants). The duration of analgesia was likely increased with the combination versus placebo (mean difference 460 min, 95% CI 249 to 671) and versus dexmedetomidine (mean difference 388 min, 95% CI 211 to 565). The duration was likely similar with the combination versus dexamethasone (mean difference 50 min, 95% CI -140 to 239). The certainty of the evidence was moderate because most trials were at high risk of bias. Combined dexamethasone and dexmedetomidine likely increased the duration of analgesia when compared with placebo and dexmedetomidine. The combination likely provided a similar duration of analgesia as dexamethasone. Based on this systematic review, it seems reasonable to use dexamethasone as the sole adjunct if the goal is to increase the duration of analgesia.

Chronic post-surgical pain after knee arthroplasty: a role of peripheral nerve blocks.

Peripheral nerve blocks are an efficient method of pain control after total knee arthroplasty (TKA), but there is no report of their impact on chronic post-surgical pain (CPSP). This prospective observational study aimed to assess adductor canal block (ACB) and IPACK block (blocks vs. no blocks) on opioid consumption, postoperative pain score, chronic post-surgical pain 2 years after TKA. 166 patients (82 vs. 84) were analyzed. Opioid consumption was less in the group with blocks (9.74 ± 3.87 mg vs. 30.63 ± 11.52 mg) (p < 0.001). CPSP was present in 20.24% of patients in the group without blocks and 6.1% of patients with blocks (p = 0.011). Predictor variables of CPSP included pain before surgery (cut-off of 5.5), pain at rest (cut-off of 2.35), pain during active movement (cut-off: 2.5), and opioid consumption (cut-off: 8 mg). Peripheral nerve blocks provide adequate analgesia, significantly decrease opioid consumption, improve functional outcomes, and reduce CPSP 2 years after surgery.

Pericapsular Nerve Group (PENG) Block Results in Significant Opioid Reduction in Total Hip Arthroplasty: A Retrospective Analysis

PurposeThe purpose of this retrospective study was to determine the effectiveness of pericapsular nerve group (PENG) block for pain control intraoperatively in patients undergoing total hip arthroplasty (primary-27130) (THA), compared to opioid based analgesia. The PENG block is an emerging regional anesthesia technique that aims to provide hip analgesia with preservation of motor function offering benefit over existing regional techniques while reducing overall opioid requirements. DesignA retrospective cohort chart review and analysis. MethodsA single-site, retrospective chart review was performed for individuals undergoing THAs at a community hospital from 2019 to 2022 (N = 123). Anesthesia records were collected and observed for multiple data points including peripheral nerve block provided, micrograms of fentanyl administered before and during the case, additional medications given, and additional nerve blocks performed. The demographic data included birth date, sex, and procedure date. FindingsFor statistical analysis only, patients receiving PENG (59) were compared to those receiving only intravenous analgesia (No Block-57). Statistically and clinically significant reductions in fentanyl administration and morphine equivalents were found in the population receiving PENG blocks. The mean intraoperative fentanyl given to the No Block group was 292.98 mcg versus 50.42 mcg in the PENG group (P < .05). Mean morphine equivalents given in the No Block group was 23.51 mg versus 11.21 mg in the PENG group (P < .05). ConclusionsReceiving a PENG block preoperatively resulted in clinically and statistically significant opioid reduction during the perioperative period when compared with patients who did not receive a regional block.

Outcomes of Peripheral Nerve Blocks in Elderly Patients with Fragility Hip Fractures in the Philippine General Hospital: A 6-month Prospective Study.

Hip fractures among the elderly continue to be a serious public health concern. Hip fractures result in extremely painful injuries and given the higher risk of the elderly for complications, managing pain in this population can be challenging. This study aimed to describe the outcomes of peripheral nerve blocks on elderly patients with fragility hip fractures who will undergo elective or emergency hip surgery. A single-center prospective cohort study was conducted at the Philippine General Hospital from May 2022 to November 2022. Patients included were aged 60 years old and above with fragility hip fracture, for elective or emergency hip surgery, and with American Society of Anesthesiologists (ASA) Physical Status Score 1-3. Patients' baseline profile, intraoperative characteristics, and postoperative outcomes were collected using a standard data collection form. The data collector was blinded to the type of block performed. A total of 29 patients who underwent hip surgery were included in the study. Most (65.5%) had Subarachnoid block + Peripheral Nerve Block (SAB+PNB) while 24.1% had General Anesthesia + Peripheral Nerve Block (GA+PNB) and 10.3% had no Peripheral Nerve Block (PNB). The median Numerical Rating Scale (NRS) 30 minutes post block was similar (p=0.977) in those who had PNB blocks (GA+PNB = 0, SAB+PNB = 0). The median NRS at rest during Postoperative day 1 (POD1) was significantly highest (p=0.023) in the No PNB group (3) than in both GA+PNB (0) and SAB+PNB (0). In contrast, the median NRS at rest during POD2 was similar (p=0.713) in the three groups (GA+PNB = 0, SAB+PNB = 0, No PNB = 0). The median NRS at motion during POD1 was significantly highest (p=0.008) in the No PNB group (6) than in both GA+PNB (0) and SAB+PNB (1). Also, the median NRS at motion during POD2 was significantly highest (p=0.009) in No PNB group (4) than in both GA+PNB (0) and SAB+PNB (1). Median Morphine Milligram Equivalent (MME) of postoperative opioid was significantly higher in the No PNB group among the three groups (p=0.047). The median satisfaction score (p=0.210), median delirium score at POD2 (p=0.993), and median length of hospitalization (p=0.173) were all similar in the three groups. Peripheral nerve block is effective in elderly patients undergoing surgery for fragility hip fractures. It results in lower pain scores and can be administered with equal effectiveness either with general anesthesia or with subarachnoid block. Mortality rate, incidence of delirium, and hospital length of stay did not vary between those with and without peripheral nerve block.

Reduction of Postoperative Delirium and Opioid Use in Hip Fracture Patients Through Utilization of Emergency Department Physician Administered Regional Nerve Blocks.

The complication of delirium for hip fracture patients is a predictor of mortality. Use of opioid medication increases the incidence of delirium in the pre- and postoperative periods. Regional nerve blocks are effective in managing acute pain for acute hip fractures. This study aims to evaluate the utilization of ED physicians to perform fascia iliaca nerve blocks on hip fracture patients to decrease the incidence of delirium by decreasing usage of opioid medication. A quality improvement project for performing regional nerve blocks on patients with femoral neck fractures was implemented during fiscal year 2019. Data was collected retrospectively for frequency of ED nerve block procedures, amount of opioid medication use, and incidence of delirium in patients diagnosed with hip fracture. This data was compared to baseline data to determine success of the intervention. Utilization of regional nerve blocks in the ED increased from 2% in 2018 to 96% in 2021 and 89% in 2022. Preoperative opioid usage decreased from 38 MMEs to 16.9 and 18 MMEs respectively. Daily average MMEs decreased from 34 to 12.1 and 14 respectively. Postoperative delirium decreased from 6% in 2018 to 0% from 2020 to 2022. ED provider administration of fascia iliaca blocks and follow-up is a novel practice in our region to decrease the adverse effects of opiate use and decrease delirium rates. There was a reduction in length of stay and increased discharge home rate despite the Covid-19 pandemic. Administration of regional nerve blocks by ED physicians to hip fracture patients presenting to the ED results in a decrease in opioid medication usage. This also results in a decreased delirium rates in the hip fracture patient population.

The effect on the incidence of rebound pain of the application of anterior suprascapular nerve block added to interscalene brachial plexus block for shoulder surgery: A randomized controlled study

This study aimed to compare the incidence of rebound pain applied with anterior suprascapular nerve block (ASSB) added to interscalene brachial plexus block (ISB) as postoperative analgesia in shoulder surgery. This prospective, observer-blinded, randomized study involved 60 patients who were to undergo shoulder surgery. The patients were divided into two groups: group ISB (n=30) received ISB block, while group ISB+ASSB (n=30) received ASSB in addition to ISB. The primary outcome was to determine the occurrence of rebound pain. Secondary outcomes were numerical rating scale (NRS) values of postoperative pain at 6, 8, 12, 16, 18, 24, and 48 hours, 48-hour opioid consumption, sleep scale for the postoperative night and subsequent 6 nights, and the quality of recovery (QoR) scale evaluated on postoperative days 1 and 7. No statistically significant difference was found between the ISB group (56.7%) and the ISB+ASSB group (40%) in the incidence of rebound pain following the resolution of peripheral nerve block (PNB) (p=0.196). The ISB+ASSB group had a significantly longer time to PNB wear off (14.77±2.07 ) compared to the ISB group (12.87±1.94) (p=0.001). The postoperative day 1 QoR-15 values were significantly better in the ISB+ASSB group (122.60±10.79) than in the ISB group (116.33±11.48) (p=0.031). Sleep evaluation on the postoperative night showed a significant difference between the groups; ISB+ASSB (3[2-3])–ISB (2[1-3]). The addition of ASSB to ISB did not have a sufficient effect with respect to the incidence of postoperative rebound pain following shoulder surgery. However, there was seen to be a positive effect on prolonging the PNB and on the QoR day 1 values.

A Case of Upper Limb Amputation Managed with USG-guided Continuous Infraclavicular Nerve Block for Improved Postoperative Analgesia

Phantom Limb Pain (PLP) is defined as any perceived painful sensation localised to the region of the amputated body part, while phantom limb sensations are non painful sensations emanating from the phantom limb, including proprioceptive awareness, kinetic, exteroceptive, and superadded sensations. The mode of anaesthesia administered during amputation is an important factor in determining the emergence of PLP or phantom sensations. The majority of patients requiring emergency care are victims of traumatic injuries to the upper limbs, which are most often treated conservatively. The authors present the case of a 67-yearold male patient who sustained a fall on his arm while carrying a metal container, resulting in a laceration to his left arm that led to disruption of brachial artery blood flow, necessitating amputation. Although upper limb injuries are relatively common, concurrent vascular injuries are rare. However, when a major vessel such as the brachial artery is injured, amputation may be required. This loss of a limb can result in PLP. To prevent this, the authors used a unique and rare protocol of Continuous Peripheral Nerve Block (CPNB) in the present case. It not only underscored the importance of intraoperative analgesia in preventing PLP but also proved to be a crucial anaesthetic tool in facilitating the surgery and providing the patient with a more comfortable postoperative recovery.

The Role of Regional Anesthesia in Neonatal Care: A Review

Effective pain management in neonates is critical, as inadequate treatment can result in both immediate complications and long-term cognitive and behavioral issues. Neonates, particularly preterm infants, have heightened sensitivity to pain, which necessitates the use of specialized pain management techniques. Regional anesthesia (RA) offers significant benefits in this patient population, including reducing the need for opioids and their associated risks, minimizing the stress response, and improving postoperative outcomes. Despite its proven efficacy in pediatric and adult populations, there is limited published evidence regarding RA's use in neonates. This article reviews the fundamental science, clinical applications, and safety considerations of regional anesthesia in neonates, focusing on four modalities: neuraxial blocks, peripheral nerve blocks, fascial plane blocks, and analgesic catheters. While RA has been shown to provide superior pain control and reduce opioid consumption, safety is paramount, especially considering the unique physiological characteristics of neonates.

The Use of Peripheral Nerve Block and Intra-articular Steroid Injection for Pain Management in an Adolescent with Hutchinson-Gilford Progeria Syndrome: A Case Report.

Hutchinson-Gilford Progeria Syndrome (HGPS) is a rare genetic disorder causing accelerated aging and age-related pathologies. Weighing benefits and risks on doing surgical versus conservative pain management require multidisciplinary planning and consideration in HGPS patients. This presents a case of a 15-year-old patient with HGPS with severe pain from bilateral hip dislocation managed with peripheral nerve block and steroid injection. This afforded her immediate pain relief allowing her to undergo physical rehabilitation comfortably.

Anesthetic approach to trauma patients in the city hospital after the 2023 Maraş earthquake.

The February 6, 2023, Kahramanmaraş earthquake caused significant destruction across our country. More than 50,000 people lost their lives, thousands were injured, and health facilities were damaged. Victims were transferred to hospitals in other provinces for treatment. This study evaluates the anesthesia approach applied to the injured who were transferred to our tertiary hospital. We retrospectively reviewed the data of patients who underwent surgery between February 6 and February 20, 2023. The study included earthquake victims who underwent emergency trauma surgery, aged 10 years and above. We recorded the date of admission to the hospital, demographic information, type of surgery, surgical site, anesthesia technique, preference for peripheral block, laboratory values, dialysis and intensive care needs, and survival rates. Data analysis was performed using the IBM® Statistical Package for the Social Sciences (SPSS®) Version 26.0. A total of 375 cases were included in the study. Of these, 323 patients underwent surgery for extremity injuries, and 35 for vertebral injuries. Among the extremity injuries, 61.6% were to the lower extremities, and 17.1% to the upper extremities. Debridement was performed on 147 patients, fasciotomy on 49 patients, and amputation on 33 patients. General anesthesia was applied to 352 patients, spinal anesthesia to 19 patients, and sedoanalgesia to four patients. Peripheral nerve block was performed on 33 patients. Dialysis treatment was administered to 105 patients. Twenty-six patients were lost during the treatment process. There were no intraoperative patient deaths. The predominance of extremity injuries among earthquake victims increases the inclination towards regional anesthesia. Incorporating Plan A blocks into basic anesthesia skills could enhance the preference for regional anesthesia in disaster situations. Furthermore, transferring the injured to advanced centers may reduce morbidity.

Comparison of Post Operative Analgesic Efficacy of Dexamethasone as an Adjuvant with Ropivacaine 0.25% and Plain Ropivacaine 0.25%, Using Ultrasound Guided Tap Block after Total Abdominal Hysterectomy: A Randomized Controlled Trial

Introduction: Following abdominal surgery, transversus abdominis plane (TAP) block, a peripheral nerve block, can be a useful supplement to multimodal postoperative analgesia. The aim was assessment of postoperative analgesic effectiveness of 0.25% ropivacaine with 4 mg of dexamethasone on each side and 0.25% ropivacaine alone in the management of postoperative pain following total abdominal hysterectomy (TAH). Materials and Methods: Sixty adult patients planned for elective TAH with ASA Grades I–II under general anesthesia participated in this prospective, randomized, double-blinded study. Patients of Group A were given 20 mL of 0.25% ropivacaine on both the sides and Group B patients were given 20 mL of 0.25% ropivacaine with dexamethasone 4 mg on each side. The primary objective of this study was a comparison of Visual Analog Scale (VAS) scores between the groups and comparison of mean time of first rescue analgesia. The secondary objectives of this study were a comparison of hemodynamic parameters, postoperative analgesic requirement, patient satisfaction, and incidence of side effects. Results: VAS shows no discernible variation in 1 and 4 h after administration of block in Groups A and B. However, a significant difference appeared in VAS 8 h (P = 0.007), VAS 12 h (P = 0.000), and VAS 24 h (P = 0.000) after the administration of block between Groups A and B. The median time for first rescue analgesia was 2.75 h (interquartile range [IQR] = 1 h) and 5.8 h (IQR = 1.6 h) in Groups A and B, respectively, which was highly significant. Conclusion: We concluded that, after abdominal hysterectomy, dexamethasone added to ropivacaine TAP block tends to prolong postoperative analgesia and decrease the need for analgesics.

Supraklavikularni blok sa perineuralnim kateterom kod deteta sa dvostrukim prelomom lakta i podlaktice - prikaz slučaja

Introduction: Ultrasound-guided supraclavicular block with perineural catheter placement has enabled a significant reduction in block-related complications, as well as far better perioperative pain management. Case report: A 9-year-old boy was admitted for a combined forearm/elbow fracture, with a history of laryngitis. As a result, we opted to perform an ultrasound-guided supraclavicular brachial plexus block under procedural sedation, with the placement of a perineural catheter. We used 25 mL of 0,5% Levobupivacaine. Orthopedic repositioning and internal fixation were performed under procedural sedation and the supraclavicular block with monitoring of basic vital parameters. Throughout the procedure, the patient maintained hemodynamic and respiratory stability, and the pain was postoperatively managed with a continuous Levobupivacaine infusion at 0,2-0,5 mg/kg/h. The patient was discharged on the fifth postoperative day. Discussion: Although information is limited regarding peripheral nerve block in the pediatric population their use in adults is well established, as is a higher degree of skill necessary for their administration in children due to clear anatomic nuance. The utilization of peripheral nerve blocks reduces the incidence of postoperative nausea and vomiting, as well as the use of opioid or nonopioid rescue analgesia. Their benefit is additionally underlined by the fact that adequate postoperative analgesia can reduce exaggerated responses to pain later in life. Conclusion: Ultrasound-guided supraclavicular brachial plexus block with placement of a perineural catheter provides safe and effective perioperative analgesia in children with fractures at or below the level of the humerus.

Peripheral Nerve Block with Infraclavicular Block in Patient with Prior History of Cerebrovascular Accident: A Case Report

Peripheral Nerve Block with Infraclavicular Block in Patient with Prior History of Cerebrovascular Accident: A Case Report

Efficacy of Magnesium Sulfate and Dexmedetomidine as Adjuvants to Ropivacaine in Supraclavicular Brachial Plexus Block: A Randomised Clinical Study

Introduction: Peripheral nerve blocks have recently proven to be extremely promising in terms of patient satisfaction. In upper limb procedures, rapid and deep anaesthesia can be achieved with supraclavicular ultrasound-guided access to the brachial plexus. To improve the quality of local anaesthesia, adjuvants such as magnesium sulfate and dexmedetomidine have been added to the local anaesthetic. Aim: To evaluate the efficacy of magnesium sulfate and dexmedetomidine as adjuvants to ropivacaine in supraclavicular Brachial Plexus Blockade (BPB). Materials and Methods: A prospective randomised doubleblind study was conducted in the Department of Anaesthesiology from June 2016 to November 2017 ( 1 year and 6 months) at King George's Medical University, Lucknow, Uttar Pradesh, India. A total of 60 patients were divided into two groups using a computer-generated random number for upper limb surgeries (below the mid-humerus) under supraclavicular brachial plexus block. Group A (n=30) received ropivacaine 0.5% (30 mL) plus dexmedetomidine 50 µg for the supraclavicular block, and Group B received ropivacaine 0.5% (30 mL) plus magnesium sulfate 150 mg in 1 mL Normal Saline (NS) 0.9% for the same block. A comparison of these two groups was conducted for the time of onset, duration of sensory and motor block, haemodynamic stability, postoperative analgesia, and complications. Statistical analyses such as Student’s t-test, Chi-square test, and MannWhitney U-test were used. Results: The mean age of Group A was 28.03±5.86 years and Group B was 31.07±7.06 years. The sensory block and motor block onset were significantly faster among patients of Group A (6.47±1.43 min and 8.50±1.46 min) compared to Group B (9.57±1.22 min and 11.77±1.19 min). The mean duration of analgesia was significantly longer (p&lt;0.001) in Group A (1034.10±61.07 min) compared to Group B (460.00±35.82 min). The duration of sensory block and motor block was also significantly higher (p&lt;0.001) in Group A compared to Group B. Both groups were haemodynamically stable, but sedation was significantly higher in Group A. Conclusion: Dexmedetomidine 50 µg is a superior adjuvant compared to magnesium sulfate 150 mg with ropivacaine 0.5% in supraclavicular brachial plexus block as it significantly hastens onset time and prolongs the duration of sensory and motor blocks and the duration of analgesia.

Cure of Fingertip Necrosis after Median Nerve Block Application in Two Cases of Definite and Probable Systemic Sclerosis.

One patient with systemic sclerosis with index fingertip necrosis and another with probable systemic sclerosis with index and middle fingertip impending necrosis were successfully treated with ultrasound-guided median nerve block application on the affected side. The nailfold temperatures of the affected fingers measured using thermography were below 25°C. Immediately after application, the temperature increased substantially. After repeated applications, the mean basal temperature on the affected side increased by 3.6°C in Case 1 and by 5.9°C in Case 2. Peripheral nerve block can be a basic treatment for fingertip necrosis. The thermographical observation of the extent and region in which the temperature increased is novel.

Comparison of a hand-held high-end resolution infrared thermography (FLIR P640) and a smartphone infrared thermographic device (FLIR One) for the assessment of skin surface temperature after anaesthetising the median nerve in Healthy horses.

Accuracy of a median nerve block is normally assessed by testing skin sensitivity on the medial and dorsal aspects of fetlock and pastern. The present study evaluated subjective and objective analysis of skin surface temperature obtained with two different infrared (IR) thermography cameras (a high-end [FLIR P640] and a smartphone IR thermography device [FLIR One®]) before and after anaesthesia of the median nerve. Thermographic images were obtained at 0, 30, 60 and 90 minutes after performing a median nerve block with 2% mepivacaine hydrochloride. The subjective analysis of thermographic images using the FLIR P640 camera found assessors had >50% agreement for the presence of a nerve block (p<0.01) based on assessment of skin temperature within the expected dermatome of the median nerve. The objective analysis found skin temperature increases in the treated leg using the FLIR One® in the dorsal fetlock, dorsal pastern and medial pastern at 60 minutes, and the lateral pastern at 90 minutes (p<0.05). The treated leg, imaged using the FLIR P640 camera, had increases in skin temperature at the medial aspect of the fetlock at 60 minutes and lateral pastern at 90 minutes (p<0.05). Images obtained with the P640 camera had higher resolution and finer thermal detail. The images obtained with the FLIR One® camera had a wider temperature range with overall higher temperature measurements than the images obtained using the P640 camera (p<0.001). Skin temperatures in horses should be interpreted with caution when using the FLIR One® camera. Furthermore, the FLIR One® device detected an increase in skin surface temperature in both treated and non-treated legs and should not be used for assessment of a median nerve block. Infrared thermography appears to be useful for determining the presence of a high regional nerve block such as the median nerve block by observing increased temperatures of the skin surface after perineural anaesthesia. Further studies with a larger sample size as well as investigating the use of thermography for assessment of other regional nerve blocks are warranted.

A Comparative Study of the Tolerance to Stress Response Under Spinal Anaesthesia in Diabetic Versus Non-Diabetic Patients

INTRODUCTION: Activation of sympathetic nervous system, increase of catabolic hormone release and pituitary gland suppression are responses to surgical stress. Neural blockade via epidural or spinal anesthesia, intravenous administration of high-dose of strong opioid analgesics, and infusion of anabolic hormones such as insulin are three main methods for balancing stress responses to surgery. However, there are conflicting reports about the extent of autonomic disturbances occurring after inducing spinal anesthesia in diabetic patients due to underlying autonomic neuropathy. METHODOLOGY: An observational cohort study was conducted in an operative room of a tertiary health care center involving 25 diabetic patients and 25 non-diabetic patients to evaluate the tolerance to stress. The diabetic patients undergone an exercise tolerance test to evaluate for postural hypotension which would indicate presence of autonomic neuropathy. Stress parameters such as heart rate, mean blood pressure, blood glucose level, and temperature were measured at regular intervals pre, peri- and post-operatively. RESULTS: Intraoperative heart rate, mean blood pressure, and blood glucose level were high in diabetic patients with autonomic neuropathy (p≤0.05). Temperature was higher in diabetic patients with autonomic neuropathy initially (p≤0.05) and had a higher fall peri-and post-operatively (T=15 minutes, T=20 minutes, and T=after surgery). A significant differences in the parameters of stress response were observed in diabetic patients with autonomic neuropathy. CONCLUSION: By understanding the correlation between stress-response in diabetic patients with autonomic neuropathy peri-operatively will help the anesthetist to provide customized services to every patient

Construction and evaluation of acquired weakness nomogram model in patients with mechanical ventilation in intensive care unit.

The incidence of intensive care unit acquired weakness (ICU-AW) has shown an increasing trend with still a lack of effective treatment options. The early assessment of the risk of developing ICU-AW can provide patients with targeted interventions. This study aimed to determine the independent risk factors of ICU-AW in patients receiving mechanical ventilation (MV) and develop a nomogram and verify its predictive efficacy. This observational study included patients receiving MV therapy in the ICU of our hospital between January 2020 and January 2023. They were divided into the ICU-AW and non-ICU-AW groups. The training cohort (n = 264) and the validation cohort (n = 143) were constructed. Multivariate logistic regression analyses were used to select the risk factors, and a nomogram model was established. Calibration, receiver operating characteristic (ROC), and decision curves were used to evaluate the effectiveness of the model. The MV duration (OR = 1.24, 95%CI[1.11, 1.38]), APACHE II score (OR = 1.34, 95%CI[1.20, 1.50]), SOFA score (OR = 1.36, 95%CI[1.21, 1.53]), age (OR = 1.05, 95%CI[1.00, 1.10]), nerve blockers (OR = 3.26, 95%CI[1.34, 7.92]), and diabetes mellitus (OR = 3.12, 95%CI[1.10, 8.87]) were independent risk factors for ICU-AW. The nomogram had good predictive efficacy for both the training (area under the curve (AUC) = 0.950, 95%CI [0.93, 0.97]) and validation cohorts (AUC = 0.823, 95%CI [0.75, 0.89]). The MV duration, APACHE II, SOFA, age, use of nerve blockers, and diabetes mellitus are independent risk factors for ICU-AW. The nomogram model based on them had good predictive efficacy and may be clinically useful.

Lumbar epidural analgesia and sciatic and femoral peripheral nerve blocks attenuate the stress-induced response in patients during the early postoperative period following total knee replacement

Invasive surgical procedures cause immune system downregulation by inducing a profound proinflammatory response. Establishing the most effective type of postoperative analgesia is crucial to maintain the equilibrium of the immune system. The purpose of this research was to evaluate the influence of epidural analgesia, peripheral nerve blockade as well as systemic analgesia on stress response in patients during the early postoperative period following total knee replacement. In total, 60 patients undergoing total knee replacement were allocated into three groups (n = 20, per group) in this prospective randomized study. Group 1, Group 2 and Group 3 received epidural analgesia, sciatic and femoral peripheral nerve blocks and systemic analgesia, respectively. Intensity of pain was measured at rest and upon movement. Blood samples were collected at baseline (T0), immediately before (T1) and after (T2) surgery, and 24 (T3) and 72 (T4) h postoperatively. The absolute number of leukocytes, concentrations of catecholamine, cortisol and C-reactive protein were determined. Patients in Group 1 and Group 2 exhibited lower pain scores than Group 3. Concentrations of cortisol and norepinephrine, but not epinephrine, were significantly lower in Group 1 and Group 2 at T2 than in Group 3. Significantly lower interleukin-1β concentrations were observed in Group 1 and Group 2 at T3 and T4 than in Group 3. Interleukin-6 concentrations were minor in Group 1 and Group 2 at T2 than in Group 3. Lumbar epidural analgesia and sciatic and femoral peripheral nerve blocks are effective analgesic techniques that reduce the acute inflammatory stress response in patients during the early postoperative period following total knee replacement.