Effect Of Nerve Block Research Articles

The effect of bilateral infraorbital nerve block on hemodynamic changes during sinus endoscopic surgery

The effect of bilateral infraorbital nerve block on hemodynamic changes during sinus endoscopic surgery

Ultrasound-guided single thoracic paravertebral nerve block and erector spinae plane block for perioperative analgesia in thoracoscopic pulmonary lobectomy: a randomized controlled trial

ObjectiveTo explore the effect of a single preoperative ultrasound-guided thoracic paravertebral nerve block (TPVB) and erector spinae plane block (ESPB) for perioperative analgesia in thoracoscopic pulmonary lobectomy.MethodsSeventy-two patients aged 40–70 years who underwent thoracoscopic pulmonary lobectomy under general anesthesia were enrolled and randomly divided into the control group (Group C), the TPVB group (Group T) and the ESPB group (Group E). The primary observation indicators included the visual analogue scale (VAS) at 1, 6, 12, 24, and 48 h postoperatively at rest and with a cough. The secondary observation indicators included the intraoperative sufentanil consumption, anesthesia awakening time and extubation time, the sufentanil consumption in the analgesic pump, and flurbiprofen ester consumption for remedial analgesia within 48 h after surgery and the incidence of postoperative adverse events.ResultsThe intraoperative sufentanil consumption, anesthesia awakening time, and extubation time were lower in groups T and E than those in group C (p < 0.05). Patients in group T had lower VAS scores at rest and with a cough at 1, 6, and 12 h postoperatively than in group C at the same time points (p < 0.05). The VAS scores at rest at 1 and 6 h postoperatively and coughing status at 1, 6, and 12 h postoperatively were lower in group E than in group C at the same time points (p < 0.05).ConclusionThe ultrasound-guided preoperative single TPVB and ESPB for thoracoscopic pulmonary lobectomy could both reduce the postoperative pain VAS score and reduce the dose of perioperative sufentanil and postoperative remedial analgesics.

Ultrasound Image-Guided Nerve Block Combined with General Anesthesia under an Artificial Intelligence Algorithm on Patients Undergoing Radical Gastrectomy for Gastric Cancer during and after Operation.

This study was aimed at investigating the location of gastric cancer by using a gastroscope image based on an artificial intelligence algorithm for gastric cancer and the effect of ultrasonic-guided nerve block combined with general anesthesia on patients undergoing gastric cancer surgery. A total of 160 patients who were undergoing gastric cancer surgery from March 2019 to March 2021 were collected as the research objects, and the convolutional neural network (CNN) algorithm was used to segment the gastroscope image of gastric cancer. The patients were randomly divided into a simple general anesthesia group of 80 cases and a transversus abdominis plane block combined with rectus abdominis sheath block combined with the general anesthesia group of 80 cases. Then, compare the systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR) at the four time points T0, T1, T2, and T3. The times of analgesic drug use within 48 hours after operation and postoperative adverse reactions were recorded. The visual analog scale (VAS) scores were also recorded at 4 h, 12 h, 24 h, and 48 h. The results show that the image quality after segmentation is good: the accuracy of tumor location is 75.67%, which is similar to that of professional endoscopists. Compared with the general anesthesia group, the transversus abdominis plane block combined with the rectus sheath block combined with the general anesthesia group had fewer anesthetics, and the difference was statistically significant (P < 0.05). Compared with the general anesthesia group, SBP, DBP, and HR were significantly reduced at T1, T2, and T3 in the transverse abdominis plane block combined with rectus sheath block and general anesthesia group (P < 0.05). Compared with the simple general anesthesia group, the VAS scores of the transversus abdominis plane block combined with rectus sheath block combined with the general anesthesia group decreased at 4 h, 12 h, and 24 h after surgery, and the difference was statistically significant (P < 0.05). The number of analgesics used in transversus abdominis plane block combined with the rectus sheath block combined with the general anesthesia group within 48 hours after operation was significantly less than that in the general anesthesia group, and the difference was statistically significant (P < 0.05). The average incidence of adverse reactions in the nerve block combined with the general anesthesia group was 2.5%, which was lower than the average incidence of 3.75% in the general anesthesia group. In summary, the CNN algorithm can accurately segment the lesions in the ultrasonic images of gastric cancer, which was convenient for doctors to make a more accurate judgment on the lesions, and provided a basis for the preoperative examination of radical gastrectomy for gastric cancer. Ultrasonic-guided nerve block combined with general anesthesia can effectively improve the analgesic effect of radical gastrectomy for gastric cancer, reduced intraoperative and postoperative adverse reactions and analgesic drug dosage, and had a good effect on postoperative recovery of patients. The combined application of these two methods can further improve the precision treatment of gastric cancer patients and accelerate postoperative recovery.

Suprascapular Nerve Block (SSNB) improves the outcome in exercise based management of Primary Adhesive Capsulitis (PAC): A prospective randomized comparative study.

Increased pain and associated stiffness hinders the advantages of exercise and process of recovery in primary adhesive capsulitis. We hypothesized that suprascapular nerve block may positively affect the outcome due to its role in pain relief of acute or chronic shoulder pain. We compared the effect of suprascapular nerve block and exercise with only exercise on the recovery of primary adhesive capsulitis. A total of 96 patients of both sexes presenting with primary adhesive capsulitis were divided by computer randomization in two equal groups (n = 48). Group A received exercise only and Group B received suprascapular nerve block followed by exercise. Oral paracetamol was given for analgesia as desired. Patients were followed up at 4, 8, 16, and 24 weeks. Pain was assessed by visual analog scale; functional outcome by Shoulder Pain and Disability Index and range of movement by goniometer. The pain scores and Shoulder Pain and Disability Index scores were significantly lower at all observation points of 4, 8,16, and 24 weeks in Group B than Group A (P < 0.05). The range of movement in all the ranges of forward flexion, extension, internal and external rotation, and abduction at all observation points was significantly higher in Group-B (P < 0.05) compared to Group A. The consumption of analgesics was significantly more in Group A than Group B at 4 and 8 weeks (P = 0.020 and P = 0.044) but comparable at 12 and 24 weeks (P = 0.145 and P = 0.237 respectively). Combining SSNB with exercise is more effective in treatment of primary adhesive capsulitis than exercise alone and reduces the use of analgesics. SSNB it is effective and safe to use in primary adhesive capsulitis.

Effect of Preoperative Continuous Femoral Nerve Block in Ease of Administration of Spinal Anaesthesia for Fracture Neck of Femur Stabilisation: A Case-control Study

Introduction: Subarachnoid block remains the anaesthesia modality of choice for surgical fixation of femur. Extreme fracture pain makes ideal positioning for spinal anaesthesia difficult. Preoperative continuous femoral block can provide analgesia for such patients. Aim: To evaluate the effect of continuous femoral nerve block in ease of administration of spinal anaesthesia for fracture neck of femur stabilisation. Materials and Methods: This was a prospective case-control study conducted at the Government Medical College, Kozhikode, Kerala, India from September 2020 to September 2021. Total of 86 adult patients posted for fracture femur neck stabilisation were selected and divided into two groups- group 1 and group 2. Patients in group 1, were administered ultrasound guided continuous femoral nerve block with 0.2% ropivacaine (15 mL) followed by subarachnoid block and group 2 patients were administered subarachnoid block without prior femoral nerve block. Parameters observed included were VAS score while positioning for spinal anaesthesia, ease of palpating interspinous space, time required to perform spinal anaesthesia, number of attempts required to achieve dural puncture, patient satisfaction score as well as haemodynamic and respiratory changes while positioning for subarachnoid block. Results: Group 1 patients had significantly lower VAS scores while positioning for spinal anaesthesia (4.2±1.8 in group 1 as compared to 6.3±1.2 in group 2, p-value=0.001). There was a significant difference in the number of attempts required for dural puncture (1.3±0.4 in group 1 as compared to 1.8±0.6 in group 2, p-value=0.04) and total performance time for spinal anaesthesia (2.2±0.4 min in group 1 as compared to 3.3±0.9 in group 2, p-value=0.02) between 2 groups. Patient satisfaction scores were significantly higher in group 1 compared to group 2 (9.3±0.6 in group 1 as compared to 6.5±0.5, p-value &lt;0.001). Both groups were comparable in terms of ease of palpating inter spinous space, haemodynamic and respiratory changes during positioning for subarachnoid block. Conclusion: Preoperative administration of continuous femoral nerve block provides better conditions for performing subarachnoid block in fracture neck of femur surgeries by reducing the pain while positioning.

Effects of ultrasound-guided lumbar-sciatic nerve block and epidural anesthesia on the levels of IL-6, IL-8, TNF-α and coagulation factors in peripheral blood of elderly patients after hip arthroplasty.

To investigate the effects of ultrasound-guided lumbar-sciatic nerve block and epidural anesthesia on the levels of inflammatory factors such as Interleukin-6 (IL6), Interleukin-8 (IL-8), Tumor necrosis factor-a (TNF-α) and coagulation factors in peripheral blood of elderly patients after hip arthroplasty to provides reference value for the choice of intraoperative anesthesia. 96 elderly patients underwent hip arthroplasty in our hospital from March 2018 to December 2019 were selected and divided into ultrasound-guided lumbar-sciatic nerve block group (group A) and epidural anesthesia group (group B) randomly , there were 48 cases in each group. The onset time of intraoperative anesthesia, postoperative hemodynamic indexes, pain score, inflammatory factors and blood coagulation factor levels were compared between group A and group B. It was proved that: (1) The onset time of sensory block and motor block in group B were shorter compared with group A, and the maintenance time of anesthesia was prolonged (P<0.05); (2) Compared with group A, visual analogue scale (VAS) score of group B patients after operation was lower (P<0.05); (3) The systolic blood pressure (SBP) and diastolic blood pressure (DBP) of group B were higher than group A (P<0.05) ) at T1 and T2, while the comparison of SBP and DBP between groups was not statistical difference at T3 and T4 (P>0.05); (3) Compared with group A, the levels of TNF, IL-8and IL-6 in peripheral blood of group B decreased after T2, T3 and T4 (P<0.05); (4) Statistical difference in plasma factor V activity (FV:C), coagulation factor VIII activity (FVIII:C) and fibrinogen (FIB) levels were showed between groups A and B at T2, T3 and T4 (P<0.05) with significantly lower values in group B compared to group A(P<0.05). (5) The half-year mortality rates of patients in two group were 5.56% and 8.33% respectively. There was no significant difference between group A and group B (P>0.05). Compared with epidural anesthesia, lumbarsciatic nerve block is showed significantly lower values in concentration of peripheral blood coagulation factors and inflammatory factors after surgery, thereby alleviating postoperative hypercoagulability and inflammation.

The effect of low concentration femoral and sciatic nerve block with dexamethason for post operative pain management in lower limb surgery

The effect of low concentration femoral and sciatic nerve block with dexamethason for post operative pain management in lower limb surgery

Effectiveness of Femoral Nerve Block Versus Intravenous Nalbuphine in Positioning of Patients with Intertrochanteric Fractures for Spinal Anaesthesia: A Randomised Clinical Study

Introduction: Femoral fracture is a common entity in all age groups. It is more common in elderly, and is a painful condition. Various modalities like peripheral nerve blocks, intravenous opioids can mitigate the pain associated with it which is deterrent to ideal patient positioning for spinal anaesthesia. Aim: To compare the effectiveness of Femoral Nerve Block (FNB) versus Intravenous Nalbuphine (IVN) in positioning of patients with intertrochanteric fracture for spinal anaesthesia. Materials and Methods: A randomised clinical study was conducted in 70 patients of American Society of Anesthesiologists (ASA) physical status I and II, with intertrochanteric fractures posted for surgery under Subarachnoid block. Group IVN received intravenous Nalbuphine at dose of 0.1 mg/kg, and Group FNB received femoral nerve block with 20 mL of 0.2% Ropivacaine 15 minutes, prior to positioning of patients for Subarachnoid block. The ease of patient positioning was assessed by the pain relief observed during positioning for spinal anaesthesia, and by means of anesthesiologist satisfaction score. Time taken to position the patients during spinal anesthesia, and patient satisfaction scores were also measured. Independent ‘t’ test and Mann-Whitney U tests were used for the analysis. Results: The Visual Analogue Scale (VAS) score achieved during positioning of patients for subarachnoid block was significantly better in FNB (3.87±0.99), as compared to IVN (5.09 ±1.23). No significant differences were observed between both the groups regarding anesthesiologist’s satisfaction score, (p=0.11). Time taken for positioning of patients for spinal anaesthesia in seconds (p=0.69), and patient satisfaction score (p=0.08) were also comparable between both groups of patients. Conclusion: FNB is more effective for positioning of patients of intertrochanteric fractures for spinal anaesthesia. Although either of the techniques can be adopted for improving patient care, FNB may have an edge over IVN.

Programmed-release intraosseus anesthesia as an alternative to lower alveolar nerve block in lower third molar extraction: a randomized clinical trial.

BackgroundIntraosseous anesthesia is the process by which an anesthetic solution, after penetration of the cortical bone, is directly injected into the spongiosa of the alveolar bone supporting the tooth. This study aimed to compare the effectiveness of the traditional inferior alveolar nerve block (IANB) and computerized intraosseous anesthesia in the surgical extraction of impacted lower third molars, compare their side effects systemically by monitoring heart rate, and assess patients’ a posteriori preference of one technique over the other.MethodsThirty-nine patients with bilaterally impacted third molars participated in this study. Each patient in the sample was both a case and control, where the conventional technique was randomly assigned to one side (group 1) and the alternative method to the contralateral side (group 2).ResultsThe traditional technique was faster in execution than anesthesia delivered via electronic syringe, which took 3 min to be administered. However, it was necessary to wait for an average of 6 ± 4 min from the execution to achieve the onset of IANB, while the latency of intraosseous anesthesia was zero. Vincent's sign and lingual nerve anesthesia occurred in 100% of cases in group 1. In group 2, Vincent’s sign was recorded in 13% of cases and lingual anesthesia in four cases. The average duration of the perceived anesthetic effect was 192 ± 68 min in group 1 and 127 ± 75 min in group 2 (P < 0.001). The difference between the heart rate of group 1 and group 2 was statistically significant. During infiltration in group 1, heartbeat frequency increased by 5 ± 13 beats per minute, while in group 2, it increased by 22 ± 10 beats per minute (P < 0.001). No postoperative complications were reported for either technique. Patients showed a preference of 67% for the alternative technique and 20% for the traditional, and 13% of patients were indifferent.ConclusionThe results identified intraosseous anesthesia as a valid alternative to conventional anesthesia in impacted lower third molar extraction.

The effects of different analgesic methods on chronic pain in patients undergoing video-assisted thoracoscopic surgery.

Thoracic epidural block, paravertebral block, and intercostal nerve block have been confirmed to alleviate acute pain after video-assisted thoracoscopic surgery (VATS). In contrast, little is known about the effects of these methods on chronic post-surgical pain (CPSP). To investigate the effects of epidural block, paravertebral block, and intercostal nerve block on postoperative chronic pain in patients undergoing VATS. A total of 240 patients undergoing VATS were randomly divided into 4 groups: an epidural group, paravertebral group, intercostal group, and a control group. All patients were interviewed after 1, 3, 6, and 12 months to investigate the incidence and severity of CPSP. The epidural group had lower incidence of chronic pain within 6 months and it was less severe within 3 months compared with the control group. The incidence and intensity of chronic pain within 3 months were lower in the intercostal group than in the control group. The incidence and intensity of pain within 1 month of surgery were lower in the paravertebral group than in the control group. Of the 122 patients who developed pain after 1 month, 93 (76.2%) reported chronic pain after 12 months, and only 9 (11.7%) had chronic pain after 12 months despite reporting no pain at 1 month. The prevalence of CPSP after VATS is high. Epidural block, paravertebral block, and intercostal nerve block can all reduce the incidence and severity of CPSP, with epidural block showing the best effect. In addition to acute pain, 1-month postoperative pain also exerts a warning effect on CPSP.

A randomized control trial to study the effect of bilateral Gow-gates block on visibility of surgical field and hemodynamic response in patients with carcinoma tongue

Background and AimsRegional anesthesia in oncosurgery is a current research topic. The use of nerve blocks near the surgical site gives good analgesia, surgical field visibility and hemodynamic profile. Our aim was to evaluate the effect of the Gow gate mandibular nerve block in tongue surgeries. MethodsASA 1 & 2 patients posted for surgery for carcinoma of tongue were included in the study. After randomization Bilateral Gowgates block was given to Group G. Group M received IV Morphine only. The investigator B who was blinded to which group the patient belonged conducted the anesthesia and did the outcome assessment. The hemodynamic response to surgical manipulation was noted. The visibility of the surgical field was assessed by the surgeon using Surgical visibility scale. Postoperative pain was assessed by assessing dose requirement of opioids and paracetamol. The mean difference between the two groups were tested using student's t-test for normally distributed variables and Mann-Whitney U test for non-normal variables. ResultsHemodynamic stress response during surgical stimulation was significantly lower in group G. Surgical field visibility score was better in the group G (p0.002). The use of morphine intraoperatively in group G was less (p= 0.001) ConclusionBilateral Gow gates block improves visibility of surgical field and hemodynamic response in patients undergoing surgery for carcinoma tongue.

The role of suprascapular nerve block in hydrodilatation for frozen shoulder.

Introduction: Frozen shoulder is a debilitating problem that requires comprehensive diagnosis and management. Patients usually recover, but the possibility of not reobtaining a full range of motion exists. Thus, early shoulder exercises are necessary to achieve their full range of motion. This study aims to understand the effects of suprascapular nerve block (SSNB) augmentation at the spinoglenoid notch in hydrodilatation to treat frozen shoulder to facilitate early shoulder exercises. Methods: The current study retrospectively observed 31 patients, including 40–60-year-old patients diagnosed and treated with primary frozen shoulder. The participants were divided into groups A (hydrodilatation) and B (hydrodilatation and the augmentation of an SSNB). Shoulder function and pain scores were assessed before, during, and after the intervention (at months 1 and 6). Results: The result of this study shows that suprascapular nerve block plays a role in decreasing pain in intraintervention (0.69 vs. 5.73; p < 0.05), month 1 of follow-up (3.44 vs. 6.40; p < 0.05), but not significant on month 6 of group A and B after intervention (5.88 vs. 7.20; p > 0.05). Better delta functional scores were noted in the therapy group during month 1 of the follow-up (delta American shoulder and elbow surgeons [ASES]: 19.29 vs. 34.40, p < 0.05; delta disabilities of the arm, shoulder, and hand [DASH]: 17.88 vs. 38.15, p < 0.05). The difference in functional score on month 6 between both groups was not significantly different (delta ASES: 31.97 vs. 30.31, p > 0.05; delta DASH: 36.63 vs. 38.92, p > 0.05). Discussion: One rationale for using an SSNB augmentation at spinoglenoid notch in hydrodilatation for treating frozen shoulder was to obtain pain relief immediately to facilitate early manual exercise. SSNB has positive effects on short-term evaluation of shoulder pain and function after glenohumeral hydrodilatation, but not in the long term.

The effects of ilioinguinal nerve block on acute and chronic neuropathic pain in patients following inguinal hernia repair with spinal anesthesia: A prospective cohort study

Background/Aim: Post-surgical pain is a major factor affecting the quality of life of patients. This study aims to investigate the effectiveness of ilioinguinal block on acute and chronic neuropathic pain after inguinal hernia surgery with spinal anesthesia. Methods: This prospective cohort study included sixty ASA I-III patients aged 18-65 years, who underwent a unilateral inguinal hernia operation. The patients were divided into two groups: Those who received spinal block only (Group 1, n=30), and those who received spinal and ultrasound-guided ilioinguinal nerve block (Group 2, n=30). The perioperative and postoperative complications, Visual Analogue Scale (VAS) scores on rest and Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) scores at the postoperative 2nd, 6th, 12th, and 24th hours, and in the 3rd and 6th months were noted. Results: No significant difference was observed in the time of first analgesic administration among the groups, but tramadol use significantly reduced in Group 2 (P=0.019). Time until mobilization and discharge was significantly shorter among the Group 2 patients (P

Clinical and Antinociceptive Effects of Distal Inferior Alveolar Nerve Block in Ponies with Tramadol 5% or Lidocaine 2%

Clinical and Antinociceptive Effects of Distal Inferior Alveolar Nerve Block in Ponies with Tramadol 5% or Lidocaine 2%

Comparative Evaluation of Morphometry of Mental Foramen using Orthopantomogram and Dry Bones in North Indian Population

Introduction: Mental Foramen (MF) holds strategic importance in clinical dentistry and oral surgery. Its accurate identification determines the effectiveness of nerve blocks and prevention of postoperative neurovascular complications. Aim: To compare mental foramen on dry bones with their orthopantomogram and to find out if any difference and correlation exist between both modalities . Materials and Methods: This descriptive, cross-sectional study was conducted at Anatomy Department of Government Medical college Amritsar, Punjab, India, from January 2018 to December 2021. It comprised of 200 dry human mandibles belonging to either sex, ranging from dentulous to partial dentulous. Orthopantomagram (OPG) of same mandibles were taken. Study was conducted in two phases. Phase I was dry bone phase and Phase II was radiographic phase. Distance of mental foramen from symphysis menti, posterior border of ramus, alveolar crest, lower border of body of mandible and distance between depth of the socket and mental foramen were evaluated. Student’s t-test for comparison and Pearson’s correlation coefficient were applied to find any correlation between two modalities . Results: Distance of mental foramen from symphysis menti, posterior border of ramus of mandible, alveolar crest and depth of socket showed statistically significant difference (p-value &lt;0.001) in between dry bone and orthopantomogram on both right and left sides. Actual bone length from mental foramen to symphysis menti,to posterior border of ramus and inferior border of body of mandible was more than it appeared on OPG. Distances obtained with OPG from MF to alveolar crest (dry bone: Right= 13.49±3.46 mm; Left= 13.42±3.49 mm and on OPG: Right= 16±4.15 mm; Left= 15.42±3.84 mm) and to depth of socket (dry bone: Right= 2.48±1.58 mm; Left= 2.70±1.68 mm and on OPG: Right= 3.69±2.08 mm; Left= 4.26±1.99 mm) were magnified. Conclusion: The results of the present study depicted that structures were not equally magnified. Knowledge about magnification at particular region is important before proceeding any surgery in that region.

Randomized control study comparing the functional outcome of suprascapular nerve block and hydrodistension in the treatment of frozen shoulder

Background: Frozen shoulder or adhesive capsulitis (AC) is a common musculoskeletal disease which imposes significant morbidity and affects the quality of life. The present study was done to compare the effectiveness of the suprascapular nerve block (SSNB) under ultrasound guidance and hydrodistension in the management of AC. Materials and Methods: This prospective randomized control study was conducted in 60 patients visiting the Department of Orthopaedic Surgery, BARC Hospital, Mumbai, with AC not improving with physiotherapy. Patients were divided into Group A (n = 30) who received SSNB under ultrasound guidance in addition to physiotherapy and Group B (n = 30) who underwent hydrodistension of shoulder in addition to physiotherapy. Values for the ROM, Quick DASH score, and visual analog scale (VAS) score were obtained for each patient at the baseline and at 4, 8, and 12 weeks. Results: Female preponderance was observed in both the groups and overall 22% werediabetics. The difference in improvement in flexion, abduction, external rotation, and internal rotation from baseline to 12 weeks, 4 to 8 weeks, 4 to 12 weeks, and 8 to 12 weeks was higher in hydrodistension group as compared to SSNB group (p &lt; 0.05). The decrease in the VAS and Quick DASH scores from baseline to 12 weeks was higher in hydrodistension group as compared to SSNB group (p &lt; 0.05). Conclusion: Both SSNB and hydrodistension are useful in the management of AC. However, hydrodistension displayed better outcome as compared to SSNB in improving the functional outcome of patients.

Efficacy of greater occipital nerve block for pain relief in patients with postdural puncture headache: A meta-analysis.

Background:This study aimed at assessing the therapeutic effectiveness of greater occipital nerve block (GONB) against postdural puncture headache (PDPH).Methods:Studies investigating analgesic effects of GONB against PDPH in adults were retrieved from the MEDLINE, EMBASE, Google scholar, and Cochrane central databases from their inception dates to May, 2021. Pain score at postprocedural 24 hours was the primary endpoint, while secondary endpoints were pain score at postprocedural 1 hour and 12 hours as well as the risk of intervention failure.Results:Of the 7 studies (randomized controlled trials [RCTs], n = 4; non-RCTs, n = 3) that recruited 275 patients, 2 investigated female patients undergoing cesarean section and the other 5 were conducted in both obstetric and nonobstetric settings. Pooled results showed a lower mean pain score at 24 hours (i.e., primary outcome) (mean difference [MD] = –2.66, 95%: CI: –3.98 to –1.33, P < .001; I2 = 97%, 6 studies), 1 hour (MD = –4.23, 95% confidence interval [CI]: –5.08 to –3.37, P < .00001; I2 = 86%, 5 studies), and 6 hours (MD = –2.78, 95% CI: –4.99 to –0.57, P = .01; I2 = 98%, 4 studies) in patients with GONB compared to those without. Trial sequential analysis supported the robustness of evidence at postprocedural 24 hours. The use of GONB also decreased the risk of intervention failure (relative ratio [RR] = 0.4, 95% CI: 0.19 to 0.82, P = .01; I2 = 96%, 6 studies, 277 patients).Conclusion:Our results suggested a therapeutic effect of greater occipital nerve block against postdural puncture headache up to postprocedural 24 hours. Further large-scale studies are warranted to evaluate its therapeutic benefit beyond the acute stage.

Clinical effects of suprascapular nerve block in addition to intra-articular corticosteroid injection in the early stages of adhesive capsulitis: A singleblind, randomized controlled trial.

The aim of this study was to evaluate the short and long-term effects of the combination of suprascapular nerve block (SSNB) and intra-articular corticosteroid injection (IAI) on pain, shoulder range of motion (ROM), disability, and quality of life in the management of patients with adhesive capsulitis (AC). Forty patients (ages 30-70 years) who were diagnosed with AC stages 1 and 2 were randomlyassigned to one of two groups: Group-1 received IAI and SSNB combination, while group-2 only-IAI. Both groups started a three-week rehabilitation program after the intervention. The Shoulder Pain and Disability Index (SPADI), Numeric Rating Scale (NRS), active and passive shoulder ROMs, and the Short Form 36(SF-36) were assessed by a physiatrist who was blinded to the allocation at baseline and three weeks, three months, and twelve months. The NRS and shoulder ROMs were also examined in the first hour. Nineteen patients from each group with mean ages of 55.84±2.19 (15 females, 4 males) and51.79 ± 1.58 (14 females, 5 males) were included. Within the groups, SPADI and NRS scores were decreased, while active and passive ROMs and the physical function, physical role, and bodily pain domains of SF-36 were increased by time (P < 0.05). Between the groups, the change in NRS value and active flexion in the first hour was more remarkable in group 1 (P < 0.05). No significant difference between outcome measurements was found at the 3rd week, 3rd month, and 12th month (P > 0.05). SSNB as an adjunct to IAI in AC positively affected the immediate pain relief and functional improvement after the intervention; however, it did not yield any additional benefit in the short and long-terms. Level I, Therapeutic Study.

Unilateral spinal anesthesia and the sciatic nerve block in foot surgery

Purpose of the study. To evaluate the effectiveness of unilateral spinal anesthesia as a method of pain relief during foot surgery. Analyze the effectiveness of unilateral spinal anesthesia versus sciatic nerve block. To develop an algorithm for performing unilateral spinal anesthesia during foot surgery.&#x0D; Materials and methods. We examined 64 patients who were treated in the department of purulent surgery of the 3rd city hospital in Zaporozhye with a diagnosis of diabetic foot syndrome in the period from 2017 to 2019.&#x0D; Research methods. Assessment of the level of pain intensity using the standard visual analogue scale and the concentration of glucose in the blood serum. Monitoring of the parameters of the cardiovascular system, the temperature of the skin of the lower leg during anesthesia, Doppler scanning of the peripheral circulation in the foot.&#x0D; Results. 4 hours after performing anesthesia, the intensity of pain during movement of the lower limb, according to the visual analogue scale in the group with unilateral spinal anesthesia was 2,3 times less than in the group with sciatic nerve block (p &lt; 0,05). After 10 hours – in the sciatic nerve block group there was a 9,4% increase in comparison with the unilateral spinal anesthesia group (p &lt; 0,05). Compared with the unilateral spinal anesthesia group, in the sciatic nerve block group 20 minutes after anesthesia, the heart rate decreased by 7,2% (p &lt; 0,05). After unilateral spinal anesthesia, the level of systolic blood pressure on 1 toe of the foot increased by 18,3% 20 minutes after anesthesia, and 20 minutes after sciatic nerve block – by 13,7% (p &lt; 0,05). In patients with the unilateral spinal anesthesia group, the temperature on the operated lower limb after anesthesia increased by 3,8%, in the sciatic nerve block group – by 2,8% (p &lt; 0,05).&#x0D; Conclusions. Regional anesthesia is the main method of choice for foot surgery compared to general anesthesia. sciatic nerve block does not in all cases lead to 100% surgical anesthesia and requires additional medical analgosedation. For foot surgery, unilateral spinal anesthesia is preferred.

Airway nerve block versus nebulization by lignocaine during diagnostic flexible bronchoscopy under moderate sedation: A randomized controlled trial

ABSTRACT Background Flexible bronchoscopy is an important procedure for the diagnosis and management of patients with respiratory diseases. This study aimed to assess safety and effectiveness of local anesthetic nebulization versus airway nerve block for upper airway anesthesia during diagnostic fiberoptic bronchoscopy under moderate sedation. Methods This randomized, controlled trial enrolled 120 patients scheduled for diagnostic fiberoptic procedures. The patients received 5 ml of 10% lignocaine by air-driven jet nebulizer for 20 minutes (Group A, n = 60) or bilateral superior laryngeal nerve block and trans-tracheal instillation of 4 ml of 2% lignocaine along with viscous lignocaine gargles twice (Group B, n = 60). In the postoperative period, the patient tolerance was assessed. Results Both groups were comparable in all baseline characteristics. The pain score was significantly lower in the nerve block group. Cough and requiring lignocaine were significantly more frequent in the nebulization group. No significant differences between the studied groups regarding intraoperative and postoperative PaO2, PaCO2, heart rate and mean blood pressure except heart rate; were significantly higher in the nebulized group. PaO2 reductions at intraoperative and postoperative (compared with induction) were non-significantly higher in the nebulized group. PaCO2, heart rate and mean blood pressure elevations in intraoperative and postoperative (compared with induction) were higher in the nebulized group, and the differences were non-significant in heart rate only. Conclusion Airway nerve block was associated with reduced consumption of lignocaine and less cough episodes during the procedure compared to nebulized lignocaine.