Effect Of Anesthetic Technique Research Articles

Modified thoracoabdominal nerves block through perichondrial approach is effective in reducing postoperative opioids requirements in patients undergoing laparoscopic cholecystectomy: a meta-analysis with trial sequential analysis.

The modified thoracoabdominal nerves block through perichondrial approach (M-TAPA) has been proposed as an effective regional anesthesia technique for reducing postoperative opioid consumption in patients undergoing laparoscopic cholecystectomy (LC). We conducted this systematic review and meta-analysis with trial sequential analysis to assess the analgesic efficacy of M-TAPA block in LC. We searched Pubmed Central, Scopus and Cochrane Central Register of Controlled Trials (from inception to until 1 July 2024). The effects of the M-TAPA were compared with those of sham block, placebo and no intervention. Randomized controlled trials, observational and retrospective studies were included. The primary outcome was postoperative opioid consumption at 24 hours, while secondary outcomes included pain scores at 12 and 24 hours, postoperative nausea and vomiting (PONV), and rescue analgesic requirements. This meta-analysis included six studies encompassing four randomized controlled trials, one retrospective study, and one prospective observational study, with a total of 350 patients. The analysis demonstrated a significant reduction in postoperative opioid consumption (MD -9.06; 95% CI -11.6 to -6.48, P=0.001) in the M-TAPA group. Additionally, patients receiving M-TAPA reported lower pain scores at 12 and 24 hours postoperatively. The risk of PONV was significantly reduced (OR 0.19; 95% CI 0.10 to 0.39, P=0.001), and fewer patients required rescue analgesics (OR 0.24; 95% CI 0.09 to 0.65, P=0.05). M-TAPA block provides superior analgesia when compared with control group in LC.

Comparison of Perioperative Analgesic Efficacy of Lidocaine Intratesticular Block and Spermatic Cord Instillation in Feline Castration

Intratesticular block is an effective local anesthetic technique for castration; however, its use may be limited in cases of testicular masses or infections. Instillation is a simple technique used in several procedures, though studies investigating its application in feline castration remain scarce. Therefore, this study aimed to compare the perioperative analgesic efficacy of lidocaine intratesticular block and spermatic cord instillation in feline castration. Forty-five male cats were randomly divided into three groups: the intratesticular block group (IT), the spermatic cord instillation group (S), and the control group (C). All cats were anesthetized using the same protocol and both techniques were performed based on group assignments. Lidocaine (2 mg/kg) was administrated according to the designated route, while 0.9% normal saline was used for the alternative route and in the C group. Intraoperative parameters were recorded, showing that noninvasive blood pressure in the IT and S groups was significantly lower than in the C group. Although both lidocaine intratesticular block and spermatic cord instillation effectively reduce surgical noxious stimulation, intratesticular block is recommended as it provides more stable intraoperative vital signs and less postoperative pain. Therefore, spermatic cord instillation can be considered as an optional technique for managing pain in feline castration.

Isolated Continuous Lumbar Plexus Block Infusion for Hip Fractures: Their Role as Sole Analgesic and Anaesthetic Modality—A Retrospective Observational Study

Background and Aims: India is one of the advancing ageing societies of the world; with this, the country’s demographic structure also changes. The incidence of lower limb fractures is high in this population, and it threatens their health both physically and mentally. Therefore, an effective anaesthesia and analgesia regimen is crucial for smooth and stable surgery and perioperative care. Methods: In this retrospective study, we aimed to describe the use of lumbar plexus block with an indwelling catheter as a sole anaesthetic technique intra-operatively and for providing peri-operative pain relief for 54 patients with intertrochanteric fracture posted for proximal femoral nailing or dynamic hip screw fixation from October 2020 to October 2023. Results: It was found that pain scores remained less than 1 for the majority of the study duration. Most patients underwent surgery within the first day of admission in our hospital and surgery lasted for one to two hours. All patients were discharged within five days of hospitalisation. There were no failures of the blocks before and during the surgical procedures. There were no records of any complications related to the technique. No supplement opioid was used during the procedure. Conclusion: With adequate monitoring, expertise, knowledge and familiarity with the procedure, lumbar plexus block with continuous infusion via a perineural catheter supplemented with periprocedural sedation can be used as a safe and effective anaesthetic technique for hip and proximal femur fracture reduction surgeries.

The use of a lateral ultrasound‐guided proximal radial, ulnar, median and musculocutaneous nerve block in a medium‐sized dog undergoing surgical repair of a humeral condylar fracture

AbstractNovel ultrasound‐guided local‐anaesthetic blocks have become increasingly popular due to improved visualisation of anatomical structures, needle and probe handling, reduced risk of neuronal or vascular damage, increased patient safety and enhanced block efficacy. The proximal‐RUMM block, targeting the radial (R), ulnar (U), median (M) and musculocutaneous (M) nerves, is well established for small animal forelimb surgeries distal to the mid‐humerus and is an effective regional anaesthetic technique in dogs. The classic medial approach to the proximal‐RUMM block can be challenging due to small muscle mass, superficial nerve locations and risk of inadvertent intrathoracic or intravascular injections. Therefore, a lateral approach to the proximal‐RUMM block has been suggested to be beneficial in small patients and has been previously documented in a small dog undergoing elbow surgery. This case report documents the use of a lateral approach for ultrasound‐guided proximal‐RUMM block in a 14.5 kg dog undergoing humeral condyle fracture repair.

Effect of Anaesthesia Technique on anti-tumor Immunity through TGF-β levels in Adult Patients Undergoing Surgery for Oral Cancer.

There is a paucity of literature regarding the effect of anesthetic techniques on anti-tumor immunity, especially in Oral cavity Malignancies. We designed a study to evaluate the effect of 3 anesthetic techniques - Opioid, Lignocaine infusion and Dexmeditomedine infusion-based on anti-tumor immunity, using TGF-β, T-helper cell profile and inflammatory markers such as IL-6 and IL-10. A pilot prospective randomized trial was conducted in 90 patients undergoing surgery for Oral cavity malignancy under general anesthesia in a tertiary specialty cancer hospital. Adult cancer patients of the American Society of Anaesthesiologists (ASA) physical status I-III fulfilling the inclusion criteria were randomized to either group A (Opioid general anesthesia), group B (lignocaine infusion-based general anesthesia), or group C (Dexmedetomidine infusion-based general anesthesia). Preoperative (morning of surgery) and postoperative (24 hours after surgery) blood samples were obtained. Statistical analysis was done, and the results were analyzed. Demographic profile and pre-operative parameters were comparable between both groups. We did not find any statistically significant difference in the Post-operative levels of TGF-β, neutrophil-lymphocyte ratio (NLR), Monocyte Lymphocyte Ratio (MLR), platelet lymphocyte ratio (PLR), IL-6, IL-10, and T-helper cell profile( IFN-γ, IL-17A, and IL-4 as surrogate markers) among the three study groups. However, it was noted that the overall Opioid consumption was markedly reduced in Group C without any major adverse effects being noted.

Postoperative analgesic effect of lumbar erector spinae plane block for developmental hip dysplasia surgery: a randomized controlled double-blind study.

Open surgery for developmental dysplasia of the hip (DDH) may cause severe pain due to tenotomies and pelvic-femoral osteotomies. This study aims to evaluate the analgesic effect of ultrasound-guided Lumbar Erector Spina Plane (L-ESP) Block in pediatric patients undergoing DDH surgery. Sixty children scheduled for DDH surgery were randomly assigned into two groups. Group I (n = 30) received L-ESP with 0.5 mL/kg of 0.25% bupivacaine before surgery. In contrast, Group II (n = 30), as the control group, received the same volume of saline injection. Identical postoperative analgesia protocol was adjusted for both groups. Parental satisfaction, pain levels, ibuprofen, and opioid consumption were recorded. Pain levels were evaluated with the FLACC (Face, Legs, Activity, Crying, Consolability) scale. FLACC scores at the first 24th hours were lower in the L-ESP group than the control group (p < 0.001). Rescue opioid utilization was higher in the control group (15/26) than in the L-ESP group (2/29) (p < 0.001). The consumption of ibuprofen was higher in the control group than in the L-ESP group in the ward (24/26 vs. 3/29, p < 0.001, respectively). Parental satisfaction was superior in the L-ESP group (p = 0.024). To provide postoperative analgesia for DDH surgery, ultrasound-guided L-ESP may be an effective and alternative regional anesthetic technique.

Comparison of the Analgesic Efficacy of Ultrasound-Guided Transperineal Approach Using Pudendal Nerve Block Versus Caudal Block in Children Undergoing Urological Surgeries: A Randomized Controlled Trial.

Caudal block is an effective regional anesthesia technique for perineal surgeries but is associated with various adverse effects. Recently, pudendal nerve block has emerged as a promising alternative for these procedures. This study assessed the effectiveness of a novel transperineal technique for ultrasound-guided pudendal nerve block and compares it with ultrasound-guided caudal block for perineal surgeries in pediatric patients. The study included 60 American Society of Anesthesiologists (ASA) Physical Status Classification Systemgrade I/II children aged 1-12 years and scheduled for elective perineal operations under general anesthesia. Patients were randomly allocated to two equal groups: Group C (ultrasound-guided caudal block) and Group P (ultrasound-guided pudendal nerve block). The groups were evaluated for time to first rescue analgesia (primary outcome), block performance time, total analgesic consumption, Face, Legs, Activity, Cry, and Consolability (FLACC) scores, time to achieve a Post-Anesthetic Discharge Scoring System (PADSS) score of 9, and any complications. The median interquartile range (IQR) first rescue analgesia time was significantly higher in the pudendal block (17.5 (17-18) hours vs 4.65 (4.5-4.77) hours; p<0.001). The median (IQR) dose of postoperative analgesia (diclofenac) required was similar in the pudendal block group and caudal group (10 (0-10) mg vs 10 (0-20) mg; p=0.290). The median (IQR) FLACC scores at "zero" hour post-surgery were 2 (2-2) and 2 (1-2) in the pudendal and caudal groups, respectively (p=0.052). The median (IQR) PADDS score was significantly higher in the pudendal group (10 (9.25-10) vs 9 (8-9); p<0.001). The time to reach a PADSS score of 9 was significantly longer in the pudendal group (21.4±3 vs 14.9±4.8 hours; p<0.0001). There were no complications in either group. The findings of this study suggest that pudendal nerve blockprovides longer-lasting analgesia, lower pain scores, andfaster readiness for discharge though with a similar analgesic consumption compared to caudal block. These resultsindicate the potential of ultrasound-guided pudendal nerve blocks as a beneficial and safe alternative to caudal block for perineal procedures in children.

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.

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.

Modified thoracoabdominal nerves block through perichondrial approach: a new strategy with a wide range of utilization in laparoscopic gynecological surgeries

Background Modified thoracoabdominal nerve block via the perichondrial approach (M-TAPA) was expressed lately as an effective regional anesthetic technique involving the anterolateral aspects of the thoracoabdominal wall via deposition of local anesthetics to the perichondrium’s underneath side. Even though the efficacy of M-TAPA has been registered, additional research is advocated. The rationale of the current study was to evaluate the analgesic effectiveness of M-TAPA blockade accomplished before surgery in subjects undergoing laparoscopic gynecological surgeries. Patients and methods 60 female patients (20–65 years) were categorized randomly into two groups. Group (M): received bilateral M-TAPA using bupivacaine (0.25%), whereas group (C): (control group) received conventional general anesthesia with multimodal analgesia. Postoperative pain assessment, time to first rescue analgesic requirement, total opioid consumption during the first 24 h postoperatively, and patients’ satisfaction were recorded. Also, the time to modify the Aldrete score greater than or equal to 9 was estimated. Results Pain scores were significantly lower in the M-TAPA group versus the control group at all times of measurement (P&lt;0.05 at each time point). Also, the total amount of opioid consumption was significantly less in the M-TAPA group versus the control group. Patients in the M-TAPA group were statistically more satisfied with their analgesia (P&lt;0.001) and attained a modified Aldrete score greater than or equal to 9 earlier than those in the control group. Conclusions Ultrasound-guided M-TAPA block achieved efficient analgesia to the anterolateral aspects of the anterior abdominal wall and reduced opioid consumption in patients who underwent laparoscopic gynecological surgeries.

Analgesic efficacy of ultrasound-guided bilateral sphenopalatine ganglion block as a sole analgesic in fess surgeries and reconstructive nasal surgeries

: Severe postoperative pain is the most common complaint following Functional endoscopic sinus surgeries (FESS) and reconstructive nasal surgeries. Sensory, autonomic nerves supplying paranasal sinuses, nasal cavity, and palate relay in sphenopalatine ganglion. Bilateral Sphenopalatine ganglion block can be an effective regional anaesthetic technique for post-operative analgesia. We conducted a study with ultrasound-guided bilateral sphenopalatine ganglion block as the sole analgesic compared to Fentanyl in patients undergoing FESS &amp; reconstructive nasal surgeries performed under general anaesthesia. The primary objective of our study was to assess the analgesic effect, quality, and duration of analgesia of ultrasound guided bilateral sphenopalatine ganglion block as a sole analgesic. In addition, the secondary aim was to further evaluate the adverse effects.With Institutional ethical committee approval and written informed consent, we conducted this study with two groups of 30 patients each. The surgical procedure was performed under general anaesthesia. At the end of the surgery and before the reversal of neuromuscular blockade, bilateral sphenopalatine plexus block was performed under ultrasound guidance in interventional Group (A) with a mixture of 0.25% Ropivacaine, Dexamethasone 4mg 7.5ml each side, whereas the control Group (B) received fentanyl 2ug/kg intraoperatively. Visual analogue scale (VAS) scores were evaluated soon after extubating (0hrs) and up to 48 hrs postoperatively in all patients.There was no significant difference in VAS scores at 0hrs, 2hrs between both groups. Interventional group(A) had statistically significant lower scores (P &amp;#60;0.00) 4hrs onwards till 48hrs than in control group(B). No adverse events were noted with minimal postoperative analgesic requirement in group(A) (P &amp;#60;0.000).: We conclude, that ultrasound-guided bilateral sphenopalatine block is a safe and effective procedure that provides sustained and superior quality of analgesia when compared to fentanyl

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

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

State of the Art of Anesthetic Practice for Endouterine Evacuation in the South-East of DR Congo

Objective: Evaluate the different anesthetic practices in the management of incomplete abortions. Materials and Methods: Our study is descriptive in a retrospective approach on; in six hospitals in South Kivu in DR Congo and data were collected then entered then encoded in Microsoft Excel software (preliminary analysis of the data or statistical description of the variables) then they were analyzed in Epi Info software. Results: The age group between 26 to 35 years was the most represented with an average of 30±7.5 years, the weight for the majority of them varied in the group from 60 to 69 or 60.4%, the majority came from the health zone and represented 94.6%, they were a priori housewives and Catholics and represented 55.4%. We noted narcosis or hyponosis (propofol + Fentanyl followed by Ketamine + Diazepam + Atropine) with a very high frequency at 97.5%. Many patients did not have any complications during their interventions and this would be estimated at a rate of 92.5%; all remaining complications represented 7.5%, i.e. respectively: Desaturation, hypotension and Vomiting. The factors correlated with morbidity and mortality were ASA class and complications with a significant difference because their P value is &lt; 0.001. Conclusion: The current recommendations in terms of ECP for incomplete abortions are respected in the hospital structures of South Kivu but as elsewhere, there is no predominant anesthetic technique hence the need to think about a more effective and more effective anesthetic technique. comfortable for patients and practitioners in terms of management of incomplete abortions than the techniques currently practiced.

Efficacy of Erector Spinae Plane (ESP) Block for Non-cardiac Thoracic and Upper Abdominal Surgery: A Single Institute Comparative Retrospective Case Series.

Introduction Erector spinae plane (ESP) block was first introduced for the management of thoracic pain but has become increasingly popular for the treatment of abdominal surgical pain. Previous studies have shown the ESP block can be easily adapted to abdominal procedures at the corresponding dermatome level and provide postoperative analgesia. Though the versatility, simplicity, and safety of the ESP block have been demonstrated, there is a gap in the literature regarding its comparison between thoracic and abdominal surgeries. This study aims to evaluate the efficacy of the ESP block in treating acute postoperative pain in patients undergoing thoracic and abdominal surgeries. Methods This retrospective study included 50 patients in the non-cardiac thoracic surgery group (bilateral breast mastectomy with reconstruction) and 50 patients in the abdominal surgery group (robotic or laparoscopic sleeve gastrectomy). Data was obtained via the acute pain service records at a tertiary care center from 2018 to 2022.All patients received bilateral ESP blocks, performed under ultrasound guidance. Various parameters were evaluated including oral morphine equivalents (OMEs) and visual analog scale (VAS) scores during post-anesthesia care unit (PACU), 6, 12, and 24 hours postop. The use of abortive antiemetic medications within 24 hours was also measured to evaluate the incidence of nausea and vomiting. The results were analyzed and compared. No control group is included, as all patients at our institution receive a peripheral nerve block as a part of the institution's enhanced recovery pathway (ERP). Results This retrospective study included 50 patients in the non-cardiac thoracic surgery group (bilateral breast mastectomy with reconstruction) and 50 patients in the abdominal surgery group (robotic or laparoscopic sleeve gastrectomy). Compared to the thoracic group, the abdominal group had a statistically higher VAS score in PACU with mean difference (MD)1.3 VAS, 95% confidence interval (CI) 0.03-2.56, p-value 0.0443, statistically higher OME consumption in the PACU (difference 13.35 OME, 95% CI 4.97-21.73, p-value 0.0003), and requiredsignificantly more antiemetic pharmacotherapy (mean 1.4 antiemeticsadministered, 95% CI 0.84-2.04, p-value <0.0001). Despite the abdominal group having more OME utilization in the PACU, there was no difference in cumulative OME use in the first 24hours (95% CI-9.745-24.10, p-value 0.4021). Conclusion In this study, we demonstrated that ESP blocks are an effective regional anesthesia technique to reduce postoperative pain and opioid consumption. The ESP block can serve as a useful and safe alternative to either thoracic epidural or paravertebral blocktechniques in thoracic and upper abdominal surgeries for perioperative pain management.

Segmental thoracic anesthesia for transabdominal colectomy with spontaneous ventilation through combined spinal-epidural block. Case report with video

Introduction: The combined spinal-epidural (CSE) technique offers advantages over the epidural or single injection spinal anesthesia alone. Assessing the distance between the dura mater and the spinal cord in the thoracic region with magnetic resonance imaging showed that there is a large space that allows the needle to enter without reaching the spinal cord. Segmental thoracic spinal anesthesia is being used in several types of surgery. Case report: A woman aged 73 years, 64 kg, 163 cm, physical status ASA II, type II diabetic, with systemic arterial hypertension, was scheduled for resection of a tumor in the right colon. The CSE was placed at the T9-T10 interspace and 10mg 0.5% hyperbaric bupivacaine was injected into the subarachnoid space. The epidural catheter (20G) was then inserted four centimeters. Sedation was obtained with 1mg of midazolam as needed (total 5mg). Two hours after 0.5% bupivacaine had to be administered in a bolus of 25 mg through the catheter. There was no necessity for the use of vasopressor drugs or atropine. Conclusion: This case has provided evidence that segmental spinal anesthesia can be an effective anesthetic technique for gastrointestinal surgery with spontaneous ventilation, and the infusion of 0.1% bupivacaine with an elastomeric pump provided 40 hours of analgesia.

Retrolaminar block for opioid-free anaesthesia and enhanced recovery after posterior lumbar discectomy: A randomised controlled study.

Intraoperative regional analgesia and enhanced recovery are standard care models aimed at reducing perioperative opioid use following spine surgeries. This study aimed to examine the analgesic effect of retrolaminar block in promoting recovery and pain relief after posterior lumbar discectomy. The patients undergoing elective posterior lumbar discectomy were randomised into the retrolaminar group (n = 36) (received an intra-operative bilateral retrolaminar block with 15 mL of bupivacaine 0.25%, 2 mL (8 mg) of dexamethasone, and 2 mL of magnesium sulphate 10% (200 mg) on each side) and control group (n = 36) (received standard general anaesthesia). Primary outcomes were recovery time (time from isoflurane discontinuation to the first response to verbal command) and time to discharge (time from admission to the post-anaesthesia care unit (PACU) to discharge from the PACU, when Aldrete score was ≥9). P values < 0.05 were considered statistically significant. The extubation, recovery, and discharge times were significantly shorter in the retrolaminar group compared to the control group (P < 0.001). Postoperative pain scores were significantly lower in the retrolaminar group for up to 8 h compared to only 2 h in the control group (P < 0.001). The time to first administration of ketorolac post-operatively was significantly longer in the retrolaminar group compared to the control group (P < 0.001). The total consumption of ketorolac post-operatively was significantly reduced in the retrolaminar group compared to the control group (P < 0.001). Intra-operative retrolaminar block is an easy and effective opioid-free regional anaesthesia technique that improves recovery after posterior lumbar discectomy.

Femoral-Obturator-Sciatic (FOS) Nerve Block as an Anesthetic Triad for Arthroscopic ACL Reconstruction: Is This the Magic Trick We Were Missing?

Arthroscopic anterior cruciate ligament (ACL) reconstruction with hamstring grafting is a common orthopedic procedure that is associated with moderate-to-severe pain. Peripheral nerve blockade as an anesthetic technique is an appealing option in the era of modern anesthesia. The aim of this narrative review is to document the efficacy and safety of the combination of femoral, obturator, and sciatic (FOS) nerve blocks as an exclusive method for anesthesia in patients undergoing ACL reconstruction. An electronic search of the literature published up to October 2023 was conducted in the Medline, Embase, Cochrane, Web of Science, and Google Scholar databases to find studies on ACL reconstruction and peripheral obturator nerve block. Overall, 8 prospective studies-with a total of 315 patients-published between 2007 and 2022 were included in this review. Ultrasound-guided peripheral FOS nerve blockade is an effective anesthetic technique for ACL reconstruction, offering good perioperative pain management, minimal opioid consumption, and an excellent safety profile. Further well-designed prospective studies are needed to determine the best approach for obturator nerve blockade and the appropriate type and dosage of local anesthetic.

Effectiveness of Peripheral Nerve Block in Terms of Search for a Standardized Treatment Protocol in Diabetic Foot Patients Using Anticoagulants: A Double-Center Study.

Lower-extremity amputation for a diabetic foot is mainly performed under general or central neuraxial anesthesia. Ultrasound-guided peripheral nerve block (PNB) can be a good alternative, especially for patients who require continuous anticoagulation treatment and patients with additional comorbidities. We evaluated bleeding due to PNB application in patients with diabetic foot receiving antiplatelet or anticoagulant therapy. Perioperative morbidity and mortality and the need for intensive care hospitalization were analyzed. This study included 105 patients with diabetic foot or debridement who underwent distal foot amputation or debridement between February and October 2020. Popliteal nerve block (17 mL of 5% bupivacaine and 3 mL of saline) and saphenous nerve block (5 mL of 2% lidocaine) were applied to the patients. Postoperative pain scores (at 4, 8, 12, and 24 hours) and complications due to PNB were evaluated. Intensive care admission and 1-month mortality were recorded. The most common diseases accompanying diabetes were hypertension and peripheral artery disease. No complications due to PNB were observed. Mean ± SD postoperative first analgesic need was determined to be 14.1 ± 4.1 hours. Except for one patient, this group was followed up without the need for postoperative intensive care. In 16 patients, bleeding occurred as leakage from the surgical area, and it was stopped with repeated pressure dressing. Mean ± SD patient satisfaction score was 8.36 ± 1.59. Perioperative mortality was not observed. Ultrasound-guided PNB can be an effective and safe anesthetic technique for diabetic patients undergoing distal foot amputation, especially those receiving antiplatelet or anticoagulant therapy and considered high risk.

A Five-Year Retrospective Closed Cohort Study to Find a Superior Anaesthetic Technique for Caesarean Section From a Haemodynamic Perspective.

Background A cesarean section (CS) is common and requires a safe and effective anesthetic technique for the safety of both the mother and the fetus. This study aims to compare the intraoperative hemodynamic safety profile with general anesthesia (GA) and regional anesthesia (RA) and propose a superior technique for cesarean from the hemodynamic perspective. Methods After obtaining ethical committee approval, a retrospective closed cohort study was conducted on patients who underwent cesarean with GA and RA. This study was conducted at a tertiary-level university hospital in Oman from January 2015 to December 2019. The investigators collected maternal and fetal data (hypotension, bradycardia, blood loss, APGAR score, fetal mortality, complications, and length of stay) from January 2015 to December 2019. The primaryoutcome was the incidence of intraoperative hypotension, and the secondaryoutcomes studied were significant blood loss and APGAR score in both anesthesia techniques. Results A total of 2500 cesarean patients were studied, of whom 1379 received RA and 1121 received GA. The overall hypotension (systolic BP<90 mm Hg) rate observed was 40.1%; it was significantly lower with GA as compared to RA (32.1% versus 46.5%, respectively, P<0.001, OR 0.545, 95% CI 0.462 to 0.643). Consequently, the requirement for vasopressors was low with GA compared to RA (1.6% versus 23.1%, P<0.001, OR 0.054, 95% CI 0.034 to 0.088). Blood loss (>1 L) was remarkably higher in GA as compared to the RA (15.5% versus 8.9%, respectively, P<0.001, OR 1.916, 95% CI 1.499 to 2.448). APGAR scores were lower with GA than RA (2.8% versus 0.9%, P<0.001). Bradycardia and fetal mortality were almost equal in both groups. Conclusion GA is associated with significantly better hemodynamic stability during the cesarean section.

Comparative Analysis of Local Anesthetic Techniques for Pain Management in Pediatric Dental Procedures: A Randomized Clinical Trial.

The present study aims to conduct a comparative analysis of different local anesthetic techniques for pain management in pediatric dental procedures. Goal is to evaluate and compare the efficacy and safety of various local anesthetic methods to identify the most effective approach in reducing pain and discomfort during dental treatments in children. A prospective, randomized clinical trial was conducted with 60 pediatric patients (aged 3 to 10 years) undergoing dental procedures in a single dental clinic. The participants were randomly assigned into three groups: Group A received conventional infiltration anesthesia (lidocaine 2% with epinephrine 1:100,000), Group B received topical anesthesia followed by the same infiltration anesthesia, and Group C received intraosseous anesthesia using articaine 4% with epinephrine 1:100,000. The patients' demographic data, treatment details, and pre-procedure anxiety levels were recorded. The study demonstrated that all three local anesthetic techniques effectively managed pain during pediatric dental procedures. However, Group C, which received intraosseous anesthesia, showed significantly lower pain scores (mean ± standard deviation) compared to Group A and Group B: 1.5 ± 0.6, 2.3 ± 0.8, and 2.1 ± 0.7, respectively (P < 0.05). Additionally, Group C exhibited a shorter onset of anesthesia compared to Group A and Group B, with mean onset times of 1.8 ± 0.4, 3.2 ± 0.6, and 2.9 ± 0.5 minutes, respectively (P < 0.001). No significant differences in adverse events or post-procedure complications among the groups. Intraosseous anesthesia (articaine 4% with epinephrine 1:100,000) was found most effective local anesthetic technique for pain management during pediatric dental procedures.