Hematoma Formation Research Articles

Effect of medial stabilizer chest position on pectus bar dislocation

PurposeThe current standard method for pectus excavatum (PE) repair is the Nuss procedure. One major postoperative complication is the displacement of the implanted metal bar, which is used to remodel the chest wall. Blocking the possible ways that the bar can be displaced with the use of stabilizers and peri/intracostal sutures has reduced the incidence of bar displacement. Despite the modifications, bar dislocation is often reported. We adopted the medial position stabilizer placement method and imposed no postoperative restrictions. In this study, we analyzed the bar dislocation rate with this modification and concurrent postoperative full activity.MethodsNuss procedure modification where stabilizers are placed bilaterally in the medial location was done on patients irrespective of age and Haller index greater than 3.25. A single bar was used for all patients. Cryoanalgesia was performed on every patient. No postoperative restrictions were imposed on the patients. Full immediate activities, including sports, were allowed.Results114 patients (103 male, 11 female) were analyzed from 2016 to 2023. The median age was 15 years old. There was zero incidence of bar displacement. The combined incidence of other postoperative complications was 4%: 2 wound infections and 2 hematoma formations, both needing incision and drainage.ConclusionBilateral medial stabilizer placement resulted in no incidence of bar dislocation. Return to immediate full activities after the Nuss procedure did not appear to increase the incidence of bar displacement if stabilizers were placed medially.

Piezoelectric Biomedical Material, Poly-L-Lactic Acid (PLLA), in the Treatment of Spinal Epidural Compression: Diagnosis, Monitoring, and Postoperative Support

This study aims to design an intelligent biomedical piezoelectric material for monitoring the pressure in the spinal epidural space caused by postoperative hematoma compression (spinal epidural hematoma). Hematoma compression in the spinal epidural space is a clinically challenging condition that is difficult to diagnose, and failure to address it within forty-eight hours may lead to severe consequences. Given its urgency, prompt and accurate diagnosis and intervention are crucial. Due to its elusive diagnostic nature, patients often miss the opportune time for treatment. Therefore, this study utilizes poly L-lactic acid (PLLA), an FDA-approved highly biocompatible biomaterial. After undergoing high-pressure polarization, PLLA exhibits excellent piezoelectric properties, making it an ideal material for monitoring intracavitary pressure. Additionally, since postoperative hematoma formation is a primary cause of spinal epidural membrane compression, this study integrates urokinase, a potent thrombolytic protein, with PLLA electrospun fibers, enabling preliminary treatment upon pressure detection.This intelligent organic biomedical material not only enables real-time monitoring of postoperative spinal epidural space pressure but also passively utilizes ultrasound to release urokinase from PLLA fibers for initial treatment when pressure is detected. Furthermore, the application of electrospun PLLA biomedical material makes the material more easily moldable and simplifies the manufacturing process, expanding its potential applications. In summary, this technology combines expertise in organic materials science, electrochemistry, and clinical medicine, offering an innovative approach to addressing the crisis posed by hematoma compression in the spinal epidural space. In future clinical applications, this technology holds the promise of providing earlier and more effective treatment for patients, potentially becoming a significant breakthrough in the fields of medical electronics and biomedical engineering. Keywords: Piezoelectric Biomaterial, Pressure Monitoring Sensor, Drug Control Release, Postoperative Support, Diagnostic Innovation

Comparative Efficacy of Wound Drainage and Non-Drainage in Posterior Spinal Surgery

Background: The recent trend has been toward recommendation of nondrainage in spinal surgery. However, the use of drains following posterior spinal surgery is still controversial. It has been claimed that wound drainage confers no significant advantages, increases the risk of infection and the need for blood transfusion with the attendant risks of this therapy. Suction drainage is used to minimize infection, prevention of wound swelling, improvement of the local wound environment, prevent hematoma and /or seroma formation. The aim of this study was to determine the incidence of post-operative complications after posterior lumbar instrumentation with and without a subfascial drain. Methods: This is prospective analysis of 32 adult (≥18 years old) spine patients that underwent elective and emergency posterior lumbar instrumentation at Kathmandu Medical College Teaching Hospital, from January to December 2023. There were randomly assigned 16 (50%) patients who had a post-operative drain and 16 (50%) patients who did not have a postoperative drain (No-Drain: n=16; Drain-Use: n=16). Patient demographics, comorbidities, intra- and post-operative complication rates were collected for each patient. The primary outcome investigated in this study was pain, the need for post-operative transfusion, dressing changes, surgery – discharge interval, the rate of post-operative complications, specifically surgical site infections (SSI) and hematoma formation. Data was analyzed using SPSS statistics version 29 (IBM Corp., New York). Results: Our study revealed that no significant differences regarding wound infection (P = 1), hematoma, neurological injury, estimated blood loss (P = 0.3), or dry and moderate dressing drainage between the groups. There were no 30-day hospital readmission or incidence of 30-day wound dehiscence, draining wound or bleeding between both patient groups. Conclusions: There is no obvious advantage of the application of suction drains for spinal surgery. There was no significant difference in the rate of infection or wound healing and no patient developed a postoperative neurologic deficit. However, a decision of wound drainage or wound non-drainage should be individualized for each patient because many factors affect the outcomes.

Ultrasonic Doppler as a guide for feline peripheral arterial catheterization.

The study aimed to determine if an ultrasonic Doppler-guided technique (UDGT) leads to improved placement efficacy (time, success) of feline dorsal pedal arterial catheters vs the traditional palpation-guided technique (TPT). A total of 26 adult, client-owned cats requiring sedation or general anesthesia for any reason, aged >12 months and weighing >3.0 kg, and with Doppler blood pressure measurements of at least 80 mmHg were enrolled. Each hindlimb was randomly assigned for dorsal pedal arterial catheterization using either the UDGT or TPT. With the UDGT, the location of the artery was identified by an audible sound using the Doppler. Successful catheter placement was confirmed by visualization of an arterial pressure waveform using a transducer and monitor system attached to the catheter. The Kaplan-Meier method and log-rank test were used to compare the two techniques. The overall proportion of successful arterial catheterization was 17% (9/52): 19% (5/26) via UDGT and 15% (4/26) via TPT. Among successful arterial catheterizations (n = 9), the mean time to catheterization was 339 ± 198 s: 328 ± 237 s (n = 5) with UDGT and 353 ± 171 s (n = 4) with TPT. The log-rank test showed the two techniques were not significantly different in likelihood of successful arterial catheter placement or time to successful catheterization (P = 0.698). An arterial flash occurred in 62% (32/52) of the limbs, 58% (15/26) with the UDGT and 65% (17/26) with the TPT. Complications (self-limiting bruising, hematoma formation) were observed equally between UDGT (3/26 limbs) and TPT (3/26 limbs) in six cats. The UDGT did not improve the efficacy of catheter placement compared with the TPT. Few complications were associated with arterial catheterization.

A Case Report of a 44-Year-Old Middle-Aged Woman with Acute Chest Pain

<p>胸痛是臨床常見的主訴，鑑別診斷必須配合心電圖，並優先考量會猝死的心血管疾病。本篇個案是一位44歲的中年女性，因急性胸痛至急診就醫，經連續追蹤心電圖與抽血檢驗，診斷為非ST節段上升之急性冠心症(non ST-elevation acute coronary syndrome, NSTE-ACS)，心導管冠狀動脈攝影檢查結果合乎自發性冠狀動脈剝離(spontaneous coronary artery dissection, SCAD)的變化。本文之目的在強調無冠狀動脈疾病危險因子的中年女性發生急性冠心症，須考慮SCAD的可能性。SCAD的病因為冠狀動脈內膜撕裂，血流進入血管內壁產生血腫，當假腔壓迫冠狀動脈血流會使心肌缺血而導致胸痛的症狀，與冠狀動脈阻塞型心肌梗塞成因不同，故治療與處理的方式有不同之處，必須視臨床病人情況做謹慎的評估，以降低侵入性治療的風險。照顧個案期間藉由最少的侵入性檢查給予正確診斷，並配合適當的藥物治療，達成緩解病人症狀、預防合併症與復發的治療目的。藉由這篇病例報告，希望醫護人員對照顧自發性冠狀動脈剝離的病人有更多的認知。</p> <p> </p><p>Chest pain is a common clinical complaint. Electrocardiograms must be included in diagnosis, and the priority should be given to cardiovascular diseases that may lead to sudden death. The case described here is a 44-year-old middle-aged woman who presented to the emergency room with unendurable chest pain. After continuous follow-up ECG and blood tests, she was diagnosed with non-ST-elevation acute coronary syndrome (NSTE-ACS). The result of coronary angiography correspond to sponta-neous coronary artery dissection (SCAD). The purpose of this article is to emphasize the possibility of SCAD in acute coronary syndrome in middle-aged women without coronary artery disease risk fac-tors. SCAD is characterized by intimal tear, intramural hematoma, and false lumen formation, which can obstruct coronary blood flow and cause myocardial ischemia with chest pain. Since the etiology of SCAD is different from obstructive coronary artery myocardial infarction, their medical treatments must be carefully evaluated through clinical patient conditions to reduce the risks of invasive proce-dure. In this case, early and correct diagnosis was made to reduce invasive procedure, and appropriate medication therapy were applyed to achieve the purpose of relieving the patient’s symptoms, prevent-ing complications and recurrence. Through this case report, it is hoped that healthcare professionals will improve awareness of caring for patients with spontaneous coronary artery dissection.</p> <p> </p>

Simultaneous resolution of arachnoid cyst and chronic subdural hematoma after middle meningeal artery embolization: illustrative case.

Arachnoid cysts are cerebrospinal fluid-filled spaces that are typically congenital and treated conservatively or with fenestration when symptomatic. Chronic subdural hematomas (cSDHs) can arise in the presence of arachnoid cysts due to fragile leptomeningeal vessels or veins within the cyst wall or cyst lumen, leading to bleeding and subsequent hematoma formation. Middle meningeal artery (MMA) embolization is regularly used for the treatment of cSDH as an alternative to craniotomy and evacuation. Here, the authors present the first known report of the simultaneous resolution of an arachnoid cyst and cSDH following MMA embolization in an adult. A 24-year-old male presented to the emergency department with 1 month of worsening headaches. Imaging revealed the presence of a cSDH and ipsilateral arachnoid cyst. The cSDH was treated with MMA embolization using coils exclusively. Follow-up imaging 4 months after embolization demonstrated simultaneous resolution of both the hematoma and the arachnoid cyst. MMA embolization has been used for the treatment of cSDH. In cases in which the hematoma is related to an arachnoid cyst, MMA embolization can also lead to the concurrent resolution of both pathologies. https://thejns.org/doi/10.3171/CASE24192.

Mechanism research progress of acupuncture for regulating axon regeneration after stroke.

Stroke brings the pathological changes of brain tissues such as hematoma formation or ischemia and hypoxia, which leads to neuronal death and axon degeneration. Axon regeneration after its injury is mainly dependent on the surrounding microenvironment and the related proteins, including glial scar, myelin associated inhibitory factors, axon guidance molecules, and neurotrophic factors. All of them affect axon growth by regulating the morphology and orientation of growth cones, the synaptic stability, and the proliferation and differentiation of neural stem cells. This article summarizes the mechanism of acupuncture in regulating axon regeneration after stroke. Acupuncture inhibits glial scar formation, alleviates the inhibitory effects of its physical and chemical barriers on axon growth, reverses the inhibitory effects of myelin-related inhibitory factors on axon growth, and adjusts the level of axon guidance molecules to promote the proliferation and differentiation of neural stem cells and the regeneration of injured axons, and up-regulates neurotrophic factors. Eventually, post-stroke nerve injury can be ameliorated.

Immediate vs delayed venous thromboembolism prophylaxis following spine surgery: increased rate of unplanned reoperation for postoperative hematoma with immediate prophylaxis

BACKGROUND CONTEXTThere is significant variability in postoperative chemoprophylaxis protocols amongst spine providers due to perceived risks and benefits, but limited data on the topic. At our institution, both orthopaedic spine and neurosurgery departments utilize unfractionated subcutaneous heparin in identical dosages and frequency, with the only difference being time to initiation postoperatively. PURPOSETo evaluate the rate of symptomatic venous thromboembolism (VTEs) and unplanned reoperation for hematoma based on timing of chemoprophylaxis initiation. STUDY DESIGN/SETTINGSingle institution retrospective cohort study. PATIENT SAMPLEPatients undergoing elective spine surgery, excluding patients undergoing surgery in the setting of trauma, malignancy, or infection. OUTCOME MEASURESOutcome measures included the diagnosis of a venous thromboembolism within 90 days of surgery and unplanned reoperation for a hematoma. METHODSPatients undergoing elective spine surgery from 2017 to 2021 were grouped based on chemoprophylaxis protocol. In the “immediate” group, patients received subcutaneous heparin 5000 units every 8 hours starting immediately after surgery, and in the “delayed” group, patients received chemoprophylaxis starting postoperative day (POD)-2 for any decompressions and/or fusions involving a spinal cord level (ie, L2 and above) and POD-1 for those involving only levels below the spinal cord (ie, L3 to pelvis). A cox proportional hazards model was created to assess independent predictors of venous thromboembolic events, while a logistic regression was utilized for unplanned reoperations for hematoma. RESULTSOf 8,704 patients, a total of 98 (1.13%) VTE events occurred, of which 43 (0.49%) were pulmonary embolism. Fifty-four patients (0.62%) had unplanned reoperations for postoperative hematomas. On cox proportional hazards model analysis, immediate chemoprophylaxis was not protective of a venous thromboembolism (Hazard Ratio: 1.18, p=.436), but, it was a significant independent predictor for unplanned reoperation for hematoma on multivariable logistic regression modeling (Odds Ratio: 3.29, p<.001). CONCLUSIONSBoth chemoprophylaxis protocols in our study resulted in low rates of VTE and postoperative hematoma. However, our findings suggest that the delayed chemoprophylaxis protocol may mitigate postoperative hematoma formation without increasing the risk for a thrombotic event.

Sonological predictors of complications of percutaneous renal biopsy—a prospective observational study

Percutaneous renal biopsy, although essential for renal disease diagnosis, is associated with a number of post-biopsy complications ranging from gross haematuria to AV fistula to death. In this study, we carried out an active haematoma surveillance and attempted to correlate renal sonological parameters—kidney length, renal parenchymal changes, renal cortical and parenchymal thickness for their potential use in prediction of post-renal biopsy complications.MethodsThis was a prospective study done from April 2022 to April 2023 on all adult patients undergoing native or transplant kidney biopsy. Baseline clinical, laboratory and renal sonological parameters were noted prior to biopsy. USG-guided renal biopsy was done and any haematoma at 0 h, 12 h and 24 h post-biopsy noted. Biopsy complications including need for any interventions were noted.ResultsOut of the 240 patients enrolled in the study, 58.3% experienced post-biopsy complications. Among these, 5% of patients encountered major complications, with 3.33% necessitating medical intervention following renal biopsy procedures. A high percentage, 98.89%, exhibited hematoma formation within 12 h post-biopsy. Furthermore, our analysis revealed that a hematoma size exceeding 1.2 cm at the 12-h mark exhibited a sensitivity of 100% and specificity of 71% in predicting the need for blood transfusion. Renal parenchymal changes were the most reliable sonological parameters for predicting post-biopsy complication on multivariate analysis.ConclusionThe incidence of major complications requiring interventions following renal biopsy is notably low. Our study highlights the significance of renal sonological characteristics, including parenchymal thickness, cortical thickness and parenchymal changes, in predicting these complications. Furthermore, we emphasize the utility of hematoma surveillance immediately post-biopsy and at the 12 h, as a valuable tool for predicting the necessity of post-biopsy interventions. This approach can aid in efficiently triaging patients and determining the need for further observation post-renal biopsy.

Cubital vein access provides a practical alternative to internal jugular vein access for coronary sinus catheter placement.

Insertion of electrode catheters into the coronary sinus (CS) through the right internal jugular vein (RIJV) carries risks of pneumothorax and severe hematoma formation. This study was performed to compare the safety and feasibility of catheterization through the left cubital superficial vein versus the RIJV. This prospective nonrandomized study involved consecutive patients who underwent catheter ablation from September 2021 to February 2023. Blind puncture techniques were used in the left cubital vein group; ultrasound-guided insertion was performed in the RIJV group. The success rates of sheath insertion and CS catheterization, the procedure and fluoroscopy times of CS cannulation, and complications were compared between groups. The left cubital vein group comprised 152 patients, and the RIJV group comprised 58 patients. The sheath insertion success rate was significantly lower in the cubital vein group than in the RIJV group (84.9% vs 100%, respectively; p = .0008). In the cubital vein group, blind puncture attempts failed in 20 patients; three patients developed guidewire-induced venous injury. One arterial puncture occurred in the RIJV group. After successful sheath insertion, no significant differences were observed in the CS cannulation success rate (97% vs 100%, p = .55), procedure time (median [range], 93 [51-174] vs 74 [44-129] s; p = .19), or fluoroscopy time (median [range], 66 [36-134] vs 48 [30-92] s; p = .17). No serious complications requiring procedural discontinuation occurred. The left cubital vein approach is practical, offering a viable alternative to the RIJV approach.

Ultrasound Guided Bilateral Erector Spinae Plane Block vs Intravenous Patient-Controlled Analgesia for Pain after Total Laparoscopic Hysterectomy

Abstract Background Pain is an everyday challenge during all surgeries and it is a chief postoperative complication, so pain management is a corner stone in anesthetic practice. Total Laparoscopic Hysterectomy (TLH) is a minimally invasive procedure, it has certain advantages over an open abdominal hysterectomy, such as reduced pain, less incidences of wound infection, a rapid recovery, a shorter hospital stay and lower complication Aim of the Work The present study was designed to assess the analgesic efficacy and safety of ultrasound guided ESPB done at lower thoracic transverse process level in patients undergoing TLH for postoperative analgesia versus intravenous patient-controlled analgesia. Patients and Methods This study is as Prospective double blinded cohort study, it was performed on Patients undergoing elective Total laparoscopic hysterectomy (TLH) in the hospital of gynecology of Ain Shams university hospitals over a period of six months. Patients who fulfilled the inclusion criteria and agreed to participate in the study were randomly divided into two groups using computer-generated randomized list such that group A for ESPB and group B for PCA. Results The main finding in this study was that ultrasound guided ESPB at level of thoracic process provided a good analgesic effect in patients undergoing TLH also reduced the need for rescue analgesia and the total amount of postoperative opioid consumption in comparison to PCA group, Prolonged the time to first request of analgesia (duration of analgesia), Provided early mobilization, Increase patient satisfaction in 1st 24 hour and Decrease incidence of nausea and vomiting due to decrease opioids intake. Conclusion Ultrasound-guided erector spinae plane block was found statistically efficient in reducing postoperative opioid consumption, alleviating postoperative pain scores and improving patients’ satisfaction in the first 24 hours after TLH, without associated adverse effects or complications like nausea and vomiting, nerve injury, respiratory depression and hematoma formation.

Effect of Intra-Operative Erector Spinae Plane Block on Post-Operative Consumption of Opioids after Video-Assisted Thoracoscopic Surgeries (VATS)

Abstract Background Pain is an everyday challenge during all surgeries and it is a chief postoperative complication, so pain management is a corner stone in anesthetic practice. Although VATS is less painful than an open thoracotomy, patients may still feel severe pain and restricted mobility during the first few postoperative hours. Ultrasound guided nerve block is considered a recent technique for pain management. It provides better visualization of the nerves and reduces the risk for complications e.g. unintended injury to adjacent structures. Objective to assess the analgesic efficacy and safety of ultrasound guided ESPB done at lumbar transverse process level in patients undergoing VATS for postoperative analgesia. Patients and Methods The study was conducted in Ain Shams university Hospitals after approval of the ethics committee and written patients’ consent. It included a total of 30 adult patients aged 21-50 years, Scheduled for lumbar spine surgeries. Patients were randomly divided into two equal groups, 15 each, according to the inclusion and exclusion criteria. Group A (n = 15): Received fentanyl 1-2 mcg/kg during induction of anesthesia and maintained by additional boluses of fentanyl.5 mcg/kg, also received ketrolac 30mg and perfelgan 1gm before extubation in addition 40 ml bupivacaine 0.25% (20ml on each side) as a single level bilateral injection for ESPB. Group B (n = 15) (the controlled group): Received only fentanyl 1- 2 mcg/kg during induction of anesthesia and maintained by additional boluses of fentanyl.5 mcg/kg, also received ketrolac 30mg and perfelgan 1gm before extubation. Results The main finding in this study was that ultrasound guided ESPB at level of thoracic process provides a good analgesic effect in patients undergoing VATS also reduced the total amount of postoperative morphine consumption in comparison to controlled group, Prolonged the time to first request of analgesia (duration of analgesia), Provided early mobilization, Increase patient satisfaction in 1st 24 hour and Decrease incidence of nausea and vomiting due to decrease opioids intake. Conclusion Ultrasound-guided bilateral erector spinae plane block reduced postoperative morphine consumption, alleviated postoperative pain scores and improved patients’ satisfaction in the first 24 hours after VATS, without associated any adverse effects or complications like nausea and vomiting, nerve injury, respiratory depression and hematoma formation. The ESPB slightly decreased the rate of PONV. This might be because the use of ESP might have decreased the use of intraoperative opioids.

Erector Spinae Plane Block versus Patient Controlled Analgesia for Postoperative Analgesia in Patient Undergoing Urologic Surgeries with Lumbar Incision

Abstract Background Pain is an everyday challenge during all surgeries and it is a chief postoperative complication, so pain management is a corner stone in anesthetic practice. Urologic surgeries with lumbar incision are usually associated with acute postoperative pain and restricted mobility. Ultrasound guided nerve block is considered a recent technique for pain management. It provides better visualization of the nerves and reduces the risk for complications e.g. unintended injury to adjacent structures. Aim of the Work The present study was designed to detect the effectiveness of ESPB for post-operative analgesia in urologic surgeries with lumbar incision and its effectiveness to decrease the use of analgesic drugs requirements compared to PCA. Patietns and Methods The study was conducted in Ain Shams university Hospitals after approval of the ethics committee and written patients‟ consent. It included a total of 60 adult patients aged 21-60 years, Scheduled for urologic surgeries with lumbar incision e.g: open nephrectomy. Patients were randomly divided into two equal groups, 30 each, according to the inclusion and exclusion criteria. Group A (n = 30): will receive fentanyl 1-2 mcg/kg during induction of anesthesia and will be maintained by additional boluses of fentanyl 0.5 mcg/kg, also will receive ketrolac 30mg and paracetamol 1gm before extubation in addition 40 ml bupivacaine 0.25% as a single level unilateral injection for ESPB after induction of anesthesia and before skin incision. Group B (n = 30): will receive only fentanyl 1- 2 mcg/kg during induction of anesthesia and will be maintained by additional boluses of fentanyl 0.5 mcg/kg, also will receive ketrolac 30mg and paracetamol 1gm before extubation and PCA will be started after the end of the surgery. Results The main finding in this study was that ultrasound guided ESPB at level of thoracic process provides a good analgesic effect in patients undergoing urologic surgeries with lumbar incision also reduced the total amount of postoperative morphine consumption in comparison to the PCA group, Prolonged the time to first request of analgesia (duration of analgesia), Provided early mobilization, Increase patient satisfaction in first 24 hour and Decrease incidence of nausea, vomiting and constipation due to decrease opioids intake. Conclusion Ultrasound-guided unilateral ESPB reduced postoperative morphine consumption, alleviated postoperative pain scores and improved patients‟ satisfaction in the first 24 hours after urologic Surgeries with Lumbar Incision, without associated any adverse effects or complications like nausea and vomiting, nerve injury, respiratory depression and hematoma formation. The ESPB markably decreased the rate of PONV. This might be because the use of ESPB might have decreased the use of intraoperative opioids.

Erector Spinae Plane Block for Postoperative Analgesia after Video-Assisted Thoracoscopic Surgery (VATS)

Abstract Background Pain is an everyday challenge during all surgeries and it is a chief postoperative complication, so pain management is a corner stone in anesthetic practice. Ultrasound guided nerve block is considered a recent technique for pain management. It provides better visualization of the nerves and reduces the risk for complications. Aim of the Work The present study was designed to assess the analgesic efficacy of ultrasound guided Erector Spinae Plane Block done at the fifth thoracic transverse process level in patients undergoing VATS surgeries for postoperative analgesia. Patients and Methods This prospective randomized clinical study was conducted in Ain Shams University Hospitals. It included a total of 60 adult patients aged 21-60 years, Scheduled for VATS surgeries. Patients were randomly divided into two equal groups 30 patients each. The ESPB group (n = 30): received ESPB after induction of anaethesia, while the Control group (n = 30): received only fentanyl 1- 2 mcg/kg during induction of anesthesia and additional boluses of fentanyl.5 mcg/kg were given according to the patient’s vital data. Results The main finding in this study was that ultrasound guided ESPB provided a good analgesic effect in patients undergoing VATS surgery, it also reduced the need for rescue analgesia and the total amount of postoperative opioid consumption in comparison to controlled group, Prolonged the time to first request of analgesia, allowed early mobilization, Increase patient satisfaction in 1st 24 hour and Decrease incidence of nausea and vomiting. Conclusion Ultrasound-guided erector spinae plane block was found statistically significantly in reducing postoperative opioid consumption, alleviating postoperative pain scores and improving patients’ satisfaction in the first 24 hours after VATS surgeries, without associated adverse effects as postoperative nausea and vomiting, nerve injury, respiratory depression and hematoma formation.

Use of Drains in Spine Surgery Systematic Review &amp; Meta-Analysis

Abstract Background Wound suction drains have been used to decrease the rate of postoperative hematoma formation and thus wound infections for many years throughout all surgical subspecialties. Although the use of surgical drains dates back to the years of Hippocrates, in the orthopedic literature these drains have not been shown to be beneficial in decreasing the rates of these complications, especially in orthopedic procedures including fracture fixation or arthroplasty surgeries. However, these drains are still commonly used throughout the orthopedic community, including spine surgery. Aim of the Work This study aims to review the use of closed suction drains in spine surgery. It aims to perform a systematic review and meta-analysis of the outcome of use of drains, their method and provide intervention recommendation by the best available evidence. Material and Methods We followed the PRISMA statement guideline during this systematic review and meta-analysis preparation and performed all steps according to the Cochrane handbook of systematic reviews of intervention. We searched PubMed, Scopus, Cochrane Central Register of Controlled Trials, Web of Science, Embase, and Science Direct till September 2021 relevant keywords. We used the following search strategy for searching different databases. “Wound drain” OR “Suction drainage” OR “Drain” OR “Spine Surgery” OR “Spine” OR “SSI” OR “Surgical Site Infection” OR “Hematoma”) AND (“Vertebral Column” OR “Column, Vertebral” OR “Columns, Vertebral” OR “Vertebral Columns” OR “Spinal Column” OR “Column, Spinal” OR “Columns, Spinal” OR “Spinal Columns” OR Vertebra OR Vertebrae). All the references of the included studies were searched for relevant studies. Results In contrast to other spine procedures, posterior spinal fusion as a surgical treatment for adolescent idiopathic scoliosis necessitates big skin incisions, a lengthy operating duration, and a higher rate of blood transfusion. This meta-analysis comprised four studies. Surprisingly, drains had no effect on total blood loss, the rate of post-surgical infection, the rate of post-operation hematoma, or hospital stay. The drain group required greater blood transfusion than the non-drain group, according to. A drain could also result in a post-durotomy fistula. Drain use is not required after intra-dural spinal cord tumor surgery. Regarding the difference in hemoglobin between preoperative and day 3 postoperative 3 studies, no difference was found between the drain group and the no drain group in all spine surgeries. Conclusion The routine use of a drain in post-operative spine surgery appears to have no effect on the likelihood of post-operative surgical site infections or post-operative epidural hematoma, according to this study. It does, however, increase total estimated blood loss without lowering hemoglobin levels, and has no effect on hospital stay length. To further strengthen any meta- analysis in the future, high-quality studies addressing their use in the spine are require.

Comparison of Different Genioplasty Techniques in Terms of Neurosensory Deficit and Haematoma Formation.

To compare different types of genioplasty techniques (chin advancement, rotation and advancement, setback, and reduction) in terms of neurosensory deficit and haematoma formation. Comparative analytical study. Place and Duration of the Study: Department of Oral and Maxillofacial Surgery, Armed Forces Institute of Dentistry, Rawalpindi, Pakistan, from January 2022 to April 2023. Patients requiring genioplasty and fulfilling the inclusion criteria i.e. both genders aged 16-60 years were included and divided into 4 groups according to the type of genioplasty performed. Genioplasty was planned as per the ortho treatment plan and performed under general anaesthesia. Setback genioplasty was performed on 8 patients, advancement genioplasty on 11 patients, reduction genioplasty on 3, and advancement with rotation genioplasty on 16 patients. Postoperatively neurosensory deficit was recorded on follow-up after 1 month by subjective and objective assessments, and haematoma formation was assessed clinically on the 7th day after the procedure. Advancement with rotation genioplasty showed the highest frequency of neurosensory deficit (almost 50%) and reduction type genioplasty showed the least frequency of neurosensory deficit (<1%, p = 0.49). The frequency of haematoma formation was maximum in the advancement with rotation genioplasty (62.5%) and minimum in equal setback genioplasty (25%, p = 0.61). Advancement with rotation genioplasty had the highest rate of postoperative neurosensory deficit and haematoma formation when compared with other techniques of genioplasty. Genioplasty, Neurosensory deficit, Haematoma, Advancement with rotation genioplasty, Setback genioplasty.

Acoustic Shadowing to Facilitate Ultrasound Guided Arterial Cannulation: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

Ultrasound-guided arterial catheterization is a frequently performed procedure. Additional techniques such as acoustic shadowing-assisted ultrasound may be useful in improving success rate. This systematic review aimed to assess the efficacy of acoustic shadowing assisted ultrasound for arterial catheterization. PubMed, Medline, EMBASE, Cochrane Library, EMCARE, and MedNar were searched in January 2024. Randomized controlled trials comparing the first attempt success rate of arterial catheterization using acoustic shadowing ultrasound vs unassisted ultrasound were included. Data were pooled for risk ratios (RRs) using the random-effects model. Subgroup analysis was conducted based on a single or double acoustic line. Sensitivity analysis was undertaken after excluding pediatric data. The certainty of evidence (COE) was assessed using the GRADE framework. Six randomized controlled trials (n = 777) were included. A meta-analysis found the first attempt success rate is significantly higher in the acoustic ultrasound group (n = 6, RR: 0.47, 95% CI: 0.34-0.66, p ≤ 0.00001). Hematoma formation was significantly less in the acoustic ultrasound group (n = 6, RR: 0.52, 95% CI: 0.34-0.80, p = 0.003). First attempt success was significantly higher in the single acoustic line ultrasound (USG) group compared to the unassisted ultrasound group (n = 3, RR: 0.41, 95% CI: 0.28-0.59, p ≤ 0.00001). Sensitivity analysis after excluding pediatric data was similar to the primary analysis (n = 5, RR: 0.50, 95% CI: 0.33-0.70, p ≤ 0.00001). Certainty of evidence was "Moderate" for the first attempt cannulation. Acoustic shadowing-assisted ultrasound improved first-attempt arterial catheterization success rate and was associated with reduced hematoma formation. Mishra L, Rath C, Wibrow B, Anstey M, Ho K. Acoustic Shadowing to Facilitate Ultrasound Guided Arterial Cannulation: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Indian J Crit Care Med 2024;28(7):677-685.

Modifications and Optimization of an Autologous Intracerebral Hemorrhage Rat Model

Objective: To date, no novel drug therapies have proven effective in improving outcomes after intracerebral hemorrhage (ICH). This has been slowed, in part, by a lack of reliable preclinical models that recapitulate the pathophysiological consequences of ICH. Limited descriptions of the methodology of preclinical models may play a role in this failed translation. The current study aimed to improve the autologous blood injection model of ICH and provide a comprehensive methodology to facilitate a reliable preclinical model that bridges the translational research gap. Methods: A modified single-injection protocol for an autologous-blood ICH model was developed and tested. This rodent ICH model produces injury in the basal ganglia of adult rats via a stereotaxically-assisted right-sided single-injection of fresh autologous whole blood. A comprehensive step-wise description of the methodology is presented and documented in a written and visual format with supporting pictorialmaterial, to prevent common mistakes that result in failed hematoma formation.Rates of successful hematoma formation using the single-injection protocol, outlined here, were compared to those using the traditional double-injection protocol.

From Routine to Exceptional: Exploration of a Unique Case of Bilateral Renal Parenchymal Perforation and Unilateral Hematoma Formation after Double J Ureteral Stent Insertion

From Routine to Exceptional: Exploration of a Unique Case of Bilateral Renal Parenchymal Perforation and Unilateral Hematoma Formation after Double J Ureteral Stent Insertion

Application of negative wound pressure therapy to skin grafts after coverage of uncertain granular sites: a case series

The split thickness skin graft (STSG) is one of the most popular tools used in reconstructive surgery. Developed for the first time by Olier in 1872, with perpetually improving techniques, this graft has since facilitated the reconstruction of skin defects. Negative wound pressure therapy (NPWT) is a therapeutic procedure that has been widely used for decades; it stabilizes the wound environment, improves tissue perfusion by stimulating granulation and angiogenesis, and reduces bacterial load and, consequently, wound edema. This case series of 3 patients aimed to show the advantages of applying NPWT over STSGs after the coverage of uncertain granular sites. The intake rate was 95% on average, with rapid wound healing, no hematoma formation, no need for regrafting, and no pain or signs of infection.