Liposomal bupivacaine (LB) provides prolonged analgesia, but it remains unclear whether it prevents rebound pain or merely delays its onset. This study investigated the effect of LB on rebound pain in a mouse model of peripheral nerve block to determine whether its resolution results in a pain response exceeding that of unblocked controls. Methylene blue staining was employed to compare the success rate of nerve stimulator-guided versus anatomical landmark-based techniques for combined sciatic and femoral nerve blockade.Postoperative rebound pain following liposomal bupivacaine administration under nerve stimulator guidance was assessed at multiple time points using von Frey and Hargreaves tests. Histological analyses of perineural inflammation and Wallerian degeneration were conducted on postoperative days 2 and 28. Nerve stimulator-guided blocks had high success rates (sciatic: 93.3%, P=0.035; femoral: 73.3%,P=0.030).LB extended thermal (24h,P<0.05) and mechanical (36h,P<0.05) analgesia. Transient thermal rebound pain occurred at 48h (P=0.003), but no mechanical rebound was observed. LB group showed significantly more severe Wallerian degeneration and Neural inflammation in both the sciatic and femoral nerves compared to the S group at day 2 (P<0.05). Liposomal bupivacaine did not prevent rebound pain but merely delayed its onset in a mouse model of combined sciatic and femoral nerve block.

Background: Hip fractures are among the most prevalent orthopedic complications in elderly individuals. Objectives: This study aimed to compare the effects of pericapsular nerve group (PENG) block and femoral nerve (FN) block on quadriceps muscle strength in patients with hip fractures. Methods: This study included 100 patients with hip fractures scheduled for hip surgery under spinal anesthesia. Patients were randomly assigned to either the PENG block group or the FN block group, with 50 subjects in each. The PENG block group received 20 mL of 0.25% bupivacaine via ultrasound-guided PENG block. The FN block group received the same medication and dosage using an ultrasound-guided FN block. The primary outcome was quadriceps muscle strength after the resolution of spinal anesthesia. Secondary outcomes included perioperative pain intensity [Visual Analog Scale (VAS) at rest and during movement], patient acceptance and quality of positioning for spinal anesthesia, 24-hour post-operative tramadol consumption, and the incidence of adverse events. Results: Quadriceps muscle strength after the effects of spinal anesthesia had worn off (intact/reduced/absent) was significantly higher in the PENG block group (32/14/4) compared to the FN block group (0/24/26). In addition, the PENG block group demonstrated superior quality of patient positioning during spinal anesthesia (2.24 ± 0.52) compared to the FN block group (2.00 ± 0.54). Conclusions: The PENG block demonstrated superior preservation of quadriceps muscle strength, a significantly longer duration of analgesia, and improved quality of patient positioning for spinal anesthesia compared to the FN block.

BackgroundHip fractures are a common injury among older adults, leading to higher morbidity and mortality. Effective treatment pathways are needed. We aimed to compare an orthogeriatric model of care (OMC) and routine care in older hip fracture patients regarding discharge disposition, adherence to clinical care standards and functional outcomes.MethodsWe performed a retrospective cohort study in patients aged ≥ 70 years with acute hip fracture consecutively admitted to a tertiary Swiss hospital between January 1, 2023 and December 31, 2023 (n = 100). Patients meeting eligibility criteria (≥ 3 geriatric syndromes, no severe dementia) received OMC (n = 46) including an intensive multiprofessional rehabilitation program (MRP) comprising 7 physical, 2 nutritional, and 1 occupational therapy sessions led by a geriatrician during the acute hospital stay. All other patients received routine care (n = 56) on the same acute ward led by an orthopedic surgeon. Discharge destination, adherence to nine pre-specified clinical care standards and functional outcomes (Barthel index [BI] and De Morton Mobility index [DEMMI]), were assessed.ResultsMean age was 83.6 years, 59% were female, and 66% frail (Clinical Frailty Scale ≥ 5). Overall, 30 patients (65.2%) in the OMC were discharged to inpatient geriatric rehabilitation compared to 15 patients (27.8%) in routine care. After post-acute rehabilitation, 23 patients (50%) in the OMC versus 16 patients (29.6%) in routine care were discharged home. Length of stay was similar in the OMC versus routine care (10.8 vs. 9.4 days). Mean adherence to nine clinical care standards was 87.9% in the OMC versus 58.7% in routine care. In OMC patients, adherence was lowest for pain management using a femoral nerve block (58.7%), and full-weight bearing (76.1%), while full adherence was observed for mobilization the first day after surgery. In the OMC, functional outcomes improved within 7 days (median increase BI 10 points, DEMMI 8 points).ConclusionsThe OMC including MRP resulted in higher numbers discharged to post-acute rehabilitation and to home afterwards, as well as improvement of adherence to clinical care standards and functional outcomes, suggesting that OMC is a promising care model. Refinement of OMC is needed to optimize adherence to full weight-bearing and femoral nerve block.Supplementary InformationThe online version contains supplementary material available at 10.1186/s13018-025-06335-5.

Background and Objectives: Ultrasound (US)-guided peripheral regional anesthesia (pRA) is gaining increasing importance in emergency medicine as an effective, low-ridsk alternative to general anesthesia (GA), procedural sedation (PS), or opioid therapy. By enabling rapid, direct pain management in the emergency department (ED), pRA can help preserve scarce surgical and anesthetic resources and, in some cases, avoid inpatient admissions. The aim of this study was to analyze the indications, techniques, and clinical impact of pRA in the orthopedic-focused ED of an affiliated hospital. Materials and Methods: All pRA and PS procedures performed over a six-year period were retrospectively reviewed among 35,443 orthopedic-trauma emergency patients. pRA was carried out under US guidance with standardized monitoring. Diagnoses, block techniques, effectiveness, and complications were analyzed descriptively. Results: A total of 1292 patients (3.7%) underwent either pRA (n = 1117; 3.2%) or PS (n = 175; 0.5%). pRA was performed in 22% of cases for interventions such as reductions or extensive wound management. In 78%, pRA was applied for analgesia, for example, in the diagnostic work-up and treatment of non-immediately operable fractures, lumbago, or arthralgia. The most common pRA techniques were brachial plexus blocks (54%) and femoral nerve blocks (25%). Fascial plane blocks (6.1%) and paravertebral blocks (1.5%) were rarely used. PS was performed in 175 of 1292 patients (13%), although pRA would have been feasible in 159 of these cases. No complications of pRA were observed, and GA could routinely be avoided. Conclusions: US-guided pRA proved to be an effective and safe alternative to PS, GA, or systemic analgesia for selected indications, allowing immediate treatment without the need for operative capacities. To ensure safe application, these techniques should be an integral part of the training curriculum for ED personnel.

Femoral nerve block vs IV fentanyl for hip fracture pain in the emergency department: A randomized double-blind clinical trial.

Background: Postoperative pain in knee surgeries hampers rehabilitation and increases morbidity. Continuous femoral nerve block (CFNB) and continuous epidural analgesia (CEA) are widely used, but their comparative efficacy remains uncertain.Objective: This study aimed to compare the analgesic efficacy, hemodynamic stability, and rescue analgesic requirements of CFNB and CEA in patients undergoing knee surgeries.Methods: In this double-blind randomized controlled trial, 70 American Society of Anesthesiologists (ASA) grades I and II patients (18-60 years) undergoing elective knee surgeries were randomized into two groups. Group A received CFNB with 0.2% ropivacaine at 6 ml/hr. Group B received CEA with 0.2% ropivacaine at 6 ml/hr. Visual Analogue Scale (VAS) pain scores were recorded at 0-48 hours postoperatively. Hemodynamic parameters and rescue analgesia were also assessed.Results: Both groups showed comparable VAS scores throughout 48 hours (p > 0.05). At six hours, VAS was 4.06 ± 1.19 in Group A vs. 4.29 ± 0.67 in Group B (p = 0.32). Hemodynamic parameters remained stable, and rescue analgesic requirements were not significantly different.Conclusion: CFNB and CEA provide equivalent postoperative analgesia and hemodynamic stability in knee surgeries. Either technique may be chosen based on patient profile and institutional preference.

Introduction: Postoperative pain after knee surgery affects the early postoperative joint mobility and rehabilitation of patients. Peripheral nerve block is an effective method to prolong the duration of postoperative analgesia and reduce need of systemic analgesic with less complications. We did the study of single-shot peripheral nerve stimulator (PNS)-guided FNB (femoral nerve block) and PNB (popliteal nerve block) with ropivacaine (0.25% and 0.375%) with an aim to compare the postoperative analgesic efficacy. Materials and Methods: Prospective, double blind, randomised comparative study of 50 patients of American Society of Anesthesiologists (ASA) Grade I–III aged 18–70 years posted for knee surgeries under spinal anaesthesia (SA) was done. Postoperatively both groups A and B received FNB (30 mL) and PNB (20 mL) with ropivacaine (0.25%) and (0.375%) respectively. Postoperative visual analogue scale (VAS) score at rest and on movement, total duration of analgesia and number of rescue analgesic required in 24 hours were noted. Results: Postoperative VAS score at rest at four hour was significant (5.0 + 1.4) in group A compared to group B (3.44 + 1.1) ( P &lt; .05), while VAS on movement at two and four hour was significant (2.16 ± 1.78 and 5.24 ± 1.10) in group A compared to (1.32 ± 1.00 and 4.56 ± 1.1) in group B ( P &lt; .05). Mean duration of analgesia was longer in group B ( P &lt; .05) and total analgesic consumption in 24 hours was higher in group A ( P &lt; .05). Conclusion: PNS-guided single-shot FNB and PNB improve quality of analgesia after knee surgery done under SA with ropivacaine 0.375% having longer duration of analgesia compared to 0.25% without much side effects.

BackgroundStandard prehospital pain management relies on opioids, which involved avoidable risks. Few studies have evaluated pre-hospital locoregional anesthesia (LRA), especially fascia iliaca compartment blocks (FICB) and femoral nerve blocks (FB). We aimed to analyze the safety and opioid sparing potential of LRA in a Swiss alpine Helicopter Emergency Medical Service (HEMS).MethodsRetrospective analysis over 36 months. Variables recorded included type of block, ultrasound guidance, provider training, injury mechanism, diagnosis, patient data, on site time, pain scores evolution, complementary medication before/after LRA and complications. Descriptive statistics and non-parametric test were used.ResultsTwenty-eight procedures were performed (0.26% of all missions): 25 FICB (89.3%) and 3 FB (10.7%). Ultrasound was used in 21.4% of cases (12% of FICBs, 100% of FBs). Ski accidents accounted for 64,3% and femoral diaphyseal fracture was suspected in 82,1%. Eight missions required hoisting, one terrestrial evacuation. Sixty percent 60.0% of blocs were performed by non-anesthesiologist. Only lidocaine 1% was used. Time on site was similar with or without ultrasound (p = 0.25). Pain score documentation (NRS) was incomplete in 50% but scores significantly decreased after LRA (p < 0.001). The need for complementary analgesic and or sedative was reduced (p = 0.025). Fentanyl use significantly decreased (p = 0.028), midazolam and ketamine did not (p = 0.16 and 0.56). No complications were documented.ConclusionsLRA appears effective and safe in prehospital (alpine) settings, providing substantial pain relief and reducing fentanyl use. Further studies are needed to investigate whether LRA protocols could reduce opioid-related morbidity and mortality.

Comparison between femoral nerve block and pericapsular nerve group block as preemptive analgesia in geriatric intertrochanteric fractures: A prospective randomised controlled clinical trial.

PENG, fascia-iliaca compartment block or femoral nerve block for pain management of patients with hip fractures.

Introduction: Hip fractures cause severe pain, especially in elderly patients, making effective pain management crucial in the emergency setting. Regional anesthesia techniques are increasingly used to reduce opioid requirements and improve analgesia. However, the comparative efficacy of supra-inguinal fascia iliaca compartment block (SFIB) versus femoral nerve block (FB) remains unclear. Materials and Methods: This prospective, randomized study included patients aged 18 years or older with radiologically confirmed proximal hip fractures. Patients were randomized to receive either ultrasound-guided SFIB or FB. Pain intensity was measured using the Numeric Rating Scale (NRS) at baseline and at 20 minutes, 2, 4, 6, and 8 hours after the block. Opioid consumption, additional analgesic use, and adverse events were recorded. Results: A total of 48 patients were included (SFIB: 27, FB: 21). Baseline NRS scores were similar between the groups. The onset time of the block was shorter in the SFIB group (p

Background: Femoral fractures are highly painful and commonly require surgical fixation, typically performed under SAB (Subarachnoid Block). However, severe pain can hinder proper positioning for SAB. PNB (Peripheral Nerve Blocks), such as FNB (Femoral Nerve Block) and FICB (Fascia Iliaca Compartment Block) offer effective analgesia in these cases. Methods: This prospective observational study included 70 patients undergoing femur fracture surgery, divided into two groups: Group 1 (n=35) received ultrasound-guided FNB (15 ml of 0.25% bupivacaine), and Group 2 (n=35) received FICB before SAB. Parameters assessed included VAS during positioning, ease of interspinous space palpation, number of dural puncture attempts, patient satisfaction, and haemodynamic/respiratory changes. Results: Both blocks effectively reduced pain during positioning, but Group 2 (FICB) showed significantly lower VAS scores (p &lt; 0.05), indicating superior analgesia. Both techniques had a similar onset of analgesia, achieving pain relief within 15 minutes (p &lt; 0.05). Patient satisfaction was higher in the FICB group (p &lt; 0.05). Quality of positioning, assessed by fewer spinal attempts, was also better in the FICB group (p &lt; 0.05). No significant differences were observed between groups regarding interspinous palpation, haemodynamic, or respiratory changes. Conclusion: Preoperative FICB provides superior analgesia compared to FNB for SAB positioning in femur fracture surgeries, evidenced by lower VAS scores, better positioning, and higher patient satisfaction. Both techniques were safe with no significant impact on haemodynamics or respiration during positioning.

Adverse events associated with the use of various diagnostic and therapeutic agents are becoming an increasingly urgent and social problem. Anaphylaxis during anesthesia is a rare but life-threatening complication. The incidence of anaphylaxis to cephalosporins according to US researchers was 8 cases per 487,630 cases of parenteral administration of drugs, while cefazolin was the most common cause of perioperative anaphylaxis. Antibiotic prophylaxis is widely used before surgery, but can lead to severe anaphylactic reactions, including anaphylactic shock. The aim of this article was to present a clinical case of anaphylaxis during anesthesia with a description of the symptoms, differential diagnosis and algorithm for providing emergency care, which will allow to deepen the awareness of practicing anesthesiologists about this rare but potentially fatal complication. We present a clinical case of a 32-year-old patient who was scheduled for arthroscopic knee surgery under spinal anesthesia. Upon admission to the operating room, the patient's condition was assessed as satisfactory. Antibiotic prophylaxis with 2 g of cefazolin was performed. After preloading with isotonic NaCl solution, the patient underwent unilateral spinal anesthesia, which was subsequently assessed as inadequate. As a result, it was necessary to supplement the anesthesia plan with an additional femoral nerve blockade. 5 minutes after the femoral nerve blockade, the patient developed a clinical picture of shock. Intensive therapy included the use of vasopressors (adrenaline) and infusion therapy. As a result of the therapy, the patient's condition was stabilized and he was discharged from the hospital after 24 hours of observation in the intensive care unit. During the case analysis, it was found that the patient had concealed an episode of a mild anaphylactic reaction to cefazolin in the past. Preventive measures should include the availability of detailed medical documentation of drug allergies, including anaphylaxis. Thus, anesthe­siologists should be familiar with the epidemiology, mechanisms of development, clinical cases and treatment of patients with anaphylaxis during anesthesia. The result of the study is a recommendation to practicing anesthesiologists to carefully approach the collection of allergic history, including the possible use of preoperative questionnaires for patients for this purpose, which contributes to a significant reduction in the risks of adverse events during anesthesia care.

Postoperative data indicate that 15-30% of patients undergoing unicompartmental knee arthroplasty (UKA) experience moderate-to-severe pain during the early recovery period, impeding rehabilitation. Due to the complex innervation in the knee, continuous femoral nerve block (FNB) is often administered but provides incomplete analgesia. Although the analgesic effects of nerve blocks are well studied, less is understood about their effects on postoperative rehabilitation and gait kinematics. Thus, in this study, we aimed to investigate the impact of ultrasound-guided obturator nerve block (ONB) combined with FNB on gait kinematics in patients undergoing UKA. This is the first study to quantify the biomechanical benefits of ONB combined with FNB in patients undergoing UKA by gait analysis. Patients undergoing UKA and admitted to the Department of Orthopedics, People's Hospital of Ningxia Hui Autonomous Region between March 2024 and December 2024 were retrospectively enrolled. The patients were allocated based on their postoperative nerve block procedure into the FNB or FNB + ONB group, with 30 cases in each group. The FNB group underwent ultrasound-guided, single-shot FNB with catheterization, whereas the FNB + ONB group underwent additional ipsilateral ONB. Patient demographics, preoperative and postoperative visual analog scale (VAS) scores (at rest and during 30° knee flexion), adverse events, kinematic gait parameters, Knee Society Score, and range of motion were recorded. No intergroup differences were observed in the preoperative VAS scores (P > 0.05). Both groups showed improved postoperative VAS scores (P < 0.05) with comparable resting VAS scores (P > 0.05). The FNB + ONB group demonstrated significantly lower activity-associated VAS scores than did the FNB group (P < 0.05). Analgesic rescue needs and adverse event rates showed no intergroup differences (P > 0.05). The FNB + ONB group exhibited superior postoperative Knee Society Scores, greater range of motion, and reduced kinematic gait abnormalities compared with the FNB group (all, P < 0.05). ONB combined with FNB provides superior postoperative analgesia compared with FNB alone in patients undergoing UKA, particularly during activity, thereby facilitating early rehabilitation and mitigating postoperative gait disturbances.

The aim of this study was to compare the analgesic efficacy of different strategies at various perioperative stages in patients with hip or femoral shaft fractures, and to identify the optimal prespinal anesthesia analgesic approach. A systematic search was conducted in PubMed, Cochrane, MEDLINE, Web of Science, and Embase for randomized controlled trials published up to July 2025. A network meta-analysis was performed using Stata 17.0 to assess the effectiveness of 4 analgesic methods - pericapsular nerve group (PENG) block, fascia iliaca compartment block (FICB), femoral nerve block, and intravenous analgesia - across 6 outcomes: Visual Analog Scale (VAS) score during positioning, quality of patient positioning, time to perform spinal anesthesia, VAS score during anesthesia, patient satisfaction, and postoperative morphine consumption. A total of 23 randomized controlled trials involving 1359 patients were included. The PENG block demonstrated the most favorable performance in most intraoperative-related outcomes, with surface under the cumulative ranking curve values of 96.6% for positioning VAS, 97.6% for positioning quality, 83.9% for anesthesia procedure time, 88.0% for VAS during anesthesia, and 91.7% for patient satisfaction. FICB ranked highest in minimizing postoperative morphine consumption (surface under the cumulative ranking curve: 92.5%). Different analgesic strategies showed varied efficacy across outcome measures. The PENG block offers significant advantages in intraoperative analgesia and patient cooperation, while FICB is more effective in sustaining postoperative pain control. These findings provide robust evidence to guide the individualized selection of perioperative analgesic strategies.

The femoral nerve typically arises as a single trunk from L2-L4 posterior divisions of ventral rami. Variations are rare but clinically significant. During routine dissection of a 80 years old female cadaver, the femoral nerve was found to originate as two distinct trunks - with one passing beneath the psoas major and the other coursing through it. The trunks unified distal to the inguinal ligament. No anomalous muscular slips were present. This configuration appears to be previously unreported. Surgeons and clinicians performing femoral nerve blocks or interpreting lumbar plexus imaging (e.g., MRI, CT, or ultrasound) should be aware of this variant, as it may influence both diagnostic interpretation and procedural outcomes.

Background:The lateral approach is commonly used in hip fracture surgery. Pericapsular nerve group (PENG) block cannot block the lateral femoral cutaneous nerve (LFCN), which is involved in sensing the skin incision during the lateral approach. Therefore, we compared the effect of adding the LFCN block to the PENG block on opioid consumption and pain scores in hip fracture operations under spinal anesthesiaMethods:In this prospective randomized-controlled study, patients undergoing hip fracture surgery under spinal anesthesia were randomized into 3 groups: PENG, PENG + LFCN, and CONTROL group. In the PENG group, 20 mL of 0.25% bupivacaine was injected under ultrasound guidance, while in the PENG + LFCN group, LFCN block, involving 5 mL of 0.25% bupivacaine, was performed in addition to the PENG block. Spinal anesthesia was the preferred method in all patients. Postoperative opioid consumption, numerical rating scale (NRS) pain scores at 0-, 2-, 6-, 12-, and 24-hours postoperatively and while giving spinal anesthesia position, time of first analgesic requirement, and the time of first mobilization were recorded.Results:A total of 20 patients from each group were included in the statistical analysis. Postoperative opioid consumption was lower in the PENG and PENG + LFCN groups as compared to the CONTROL group, while the PENG and PENG + LFCN groups did not differ significantly (PENG: 8.10 ± 6.72 mg, PENG + LFCN: 8.40 ± 4.38 mg, CONTROL: 15.30 ± 5.59 mg, P < .001). Postoperative NRS pain scores during activity (NRSA) were significantly lower at all-time points in the PENG + LFCN than in the CONTROL group, and were lower at 2, 6, and 24 hours in the PENG than in the CONTROL group. These scores did not differ significantly between the PENG and PENG + LFCN groups at any time point. The time to first postoperative analgesic requirement was significantly shorter in the CONTROL than in the PENG and PENG + LFCN groups.Conclusion:Addition of an LFCN block to the PENG block did not contribute to postoperative opioid consumption and pain scores in patients undergoing hip fracture surgery under spinal anesthesia. Preoperative PENG block plays an important role both during positioning for spinal anesthesia and in postoperative analgesia management.

Objectives:Pre- and Peri-Operative nerve blocks are traditionally administered by the anesthesia team as an adjunctive for operative pain management. Providing safe and effective peri-operative pain control helps to limit narcotic use by patient, postoperative nausea and improves post-operative patient flow through the PACU. Recently, there have been significant advancements in perioperative nerve blocks, local anesthesia, and multi-modal pain regimens to improve patient comfort and reduce reliance on opiate pain medications. Infiltration of 10 mL mixture of 30mL of 0.5% Marcaine, 20mL of 0.9% Normal Saline, 1mL of Morphine 10mg/1mL, and 1mL of Toradol 30mg/1mL between the popliteal artery and capsule of the knee or IPACK block has been described as a motor sparring nerve block which can provide effective analgesia following knee surgery and serve as an adjunct to commonly used adductor canal or femoral nerve blocks. We have recently reported on a posterior knee capsular block technique administered under direct arthroscopic visualization, intra-operatively by the orthopedic surgeon providing coverage identical to a traditional ultrasound guided Infiltration Between Popliteal Artery and Capsule of the Knee (IPACK Block). We have devised a simple, and reproducible technique for intraoperative, arthroscopic administration of local anesthetic in the space directly posterior to the knee capsule. This technique has been implemented by sports medicine orthopedic surgeons at our institution over the past couple of years. While the practice anecdotally seems to have improved post operative pain control in our patients, the safety and efficacy have not been formally studied. The purpose of this study is to investigate the effect of this practice on the post operative pain control as well as identify any adverse events over the period that this block was added to our standard practice.Methods:Electronic medical records of patients undergoing primary anterior cruciate ligament (ACL) reconstruction by three fellowship-trained sports medicine surgeons at our institution between March 2019 and February 2022 were retrospectively reviewed. Patients were included if they underwent primary arthroscopic assisted ACL reconstruction with or without concomitant meniscus procedure, chondroplasty, or microfracture. Patients who underwent revision ACL reconstruction, multi-ligament reconstruction, a concomitant realignment osteotomy, or a concomitant osteochondral allograft or meniscus allograft transplantation were excluded. Patients were divided into two groups according to the receival of arthroscopic IPACK block. All patients received a nerve block, but no patients received an IPACK done in the preoperative setting with anesthesia, any anesthesia IPACK block performed was in the PACU as a rescue block. The primary outcome was the need for a postoperative rescue nerve block. The secondary outcome was the incidence of complications related to the surgeon-directed IPACK blockResults:Three hundred and twenty-five patients were included. Among them, 117 received the IPACK block and 208 did not receive it. There was no statistically significant difference in patient’s age and gender between the groups. There was a trend towards more rescue blocks in patients who did not receive the IPACK block compared to those who receive it (10.5% vs 6.8% respectively, p=0.264), and this trend reached the statistical significance when we looked at a subgroup of patients who received concomitant meniscus repair (17.4% vs 4.7% respectively, p=0.017). Logistic regression analysis showed that IPACK block decreased the risk of receiving a rescue block by approximately 50%. No complications related to IPACK block were reported.Conclusions:Implementing the arthroscopic assisted IPACK block reduced the need for postoperative rescue block in patients undergoing primary ACL reconstruction, and more significantly in those who had concomitant meniscus repair. It is a safe procedure with no reported complications or adverse events in our cohort. Implementation of the block adds very little time or cost to the surgical procedure. It has the potential to improve postoperative pain control, decrease reliance on postoperative opiate medications, facilitate early rehabilitation, and contribute to overall patient satisfaction after surgery.

Sacral erector spinae plane block (S-ESP) combined with femoral nerve block: a promising surgical anesthesia approach for high-risk patients undergoing hip fracture surgery.

Ultrasound is a modern foundational tool used by anesthesiologists for peripheral nerve blocks. Clinicians performing hands-on ultrasound training on patients presents unique challenges, and the use of human anatomical donors has become a common substitute. With that, whereas ultrasound training sessions are common, they do not often include basic science anatomy reviews. This study explores an anatomist-led clinical anatomy review and physician-led ultrasound training session for first (n = 7) and second (n = 11) year anesthesiology residents. Residents attended a 2-hour anatomy review on prosected anatomical donors by anatomists prior to physicians facilitating an ultrasound-guided peripheral nerve block training session on undissected donors. The session covered the interscalene, supraclavicular, femoral, sciatic, and transversus abdominis plane ultrasound-guided peripheral nerve blocks. Data was collected using presurveys and postsurveys and assessments and analyzed. The session was found to be useful and significantly improved the residents' confidence across 14 domains related to the anatomy and approach to ultrasound for the given peripheral nerve blocks. All the participants (18, 100%) felt it was very useful having undissected anatomical donors side by side to dissected ones during the session. Knowledge acquisition also improved based on the significant increase in score on the 8-question assessment (p = .003). The residents found this activity valuable and useful, especially learning from both undissected and prosected donors. With this approach, residents could compare the ultrasound image to the physical anatomy, which led to an increase in the residents' knowledge and confidence.