Motor Sparing Research Articles

"Shoulder Anterior Capsular Block: An Effective Strategy for Alleviating Pain During Shoulder Mobilisation in Adhesive Capsulitis Patients": A Case Series

Frozen shoulder is a condition of varying severity characterized by the gradual development of global limitation of active and passive shoulder motion where radiographic findings are limited and associated with severe shoulder pain. Frozen shoulder is also referred to as adhesive capsulitis, painful stiff shoulder, and periarthritis. Treatment typically focuses on reducing shoulder pain and restoring joint mobilisation. In the context of shoulder mobilization, the predominant nerve blocks encompass the interscalene, supraclavicular upper trunk block collectively referred to as the SCUT block, as well as the axillary nerve block. These nerve blocks demonstrate high efficacy in delivering targeted analgesia. However, a notable limitation of these interventions is the concomitant motor blockade and phrenic nerve block induced by them. This motor blockade poses a significant impediment to the initiation of early rehabilitation, thereby delaying the commencement of rehabilitative exercises and intervention. Shoulder Anterior Capsular Block is a motor sparing block which can be effectively used in shoulder mobilisation.

Triple injection peri-sartorius (TIPS) block for postoperative analgesia after total knee arthroplasty: Randomised controlled study.

Motor-sparing analgesia after total knee arthroplasty (TKA) is crucial. The primary endpoint was the postoperative visual analogue scale (VAS) score after triple injection peri-sartorius (TIPS) block after TKA. Secondary endpoints were postoperative morphine consumption, 24-h postoperative ambulation distances and the degrees of active knee extension. After general anaesthesia or spinal anaesthesia administration and before surgical incision, 80 patients undergoing TKA were randomised into group TIPS (received ultrasound-guided TIPS block where 40 ml 0.25% bupivacaine and 4 mg dexamethasone were injected: 10 ml at the distal femoral triangle, 10 ml above the sartorius and 20 ml at the distal adductor canal) and group FNB (femoral nerve block; received ultrasound-guided FNB with 20 ml 0.25% bupivacaine mixed with 4 mg dexamethasone). Postoperative pain score was noted and compared. Dynamic VAS scores were lower in the TIPS group than in FNB, while the resting VAS scores were not significantly different. Mean (standard deviation [SD]) postoperative morphine consumption was 5.82 (2.47) mg in the TIPS group (95% confidence interval [CI] 5.03,6.61) versus 9.87 (2.99) mg in the FNB group (95% CI 8.91,10.83). Ambulation distances and active postoperative knee extension in the TIPS group showed greater significance than in the FNB group (TIPS: 18.0 [7.37] m, 95% CI 15.64,20.35] vs. FNB: 8.95 [5.93] m, 95% CI 7.05,10.84) and (TIPS: 52.12 [16.39], 95% CI 46.88,57.33 vs. FNB: 26.05 [11.10], 95% CI 22.501,29.59). Nausea was more evident in FNB patients. TIPS block provides superior analgesia than FNB with motor sparing of the quadriceps after TKA.

Analgesic efficacy of anterior iliopsoas muscle space block combined with local infiltration analgesia after total hip arthroplasty: A prospective, double-blind, placebo-controlled study

BackgroundThe present study aimed to evaluate the efficacy of ultrasound-guided anterior iliopsoas muscle space block (AIMSB) combined with local infiltration analgesia (LIA) for pain management and recovery in patients who have undergone total hip arthroplasty (THA) via a posterolateral approach. MethodsIn this prospective, double-blind, placebo-controlled study, 80 patients undergoing primary THA under general anesthesia were included in the final analysis between March 22, 2022, and June 1, 2022. All patients were randomly assigned to receive AIMSB combined with LIA (AIMSB group, n = 40) or sham AIMSB and LIA (Sham group, n = 40). The primary outcome was cumulative morphine consumption (mg) within 24 h after surgery. Secondary outcomes were pain scores on a visual analog scale (VAS) at rest or during motion after surgery, time to first rescue analgesia, cumulative morphine consumption during hospitalization, intraoperative consumption of opioids, postoperative recovery, and postoperative adverse effects. ResultsPatients in the AIMSB group consumed significantly less morphine than the Sham group within the first 24 h and throughout hospitalization, as well as smaller amounts of intraoperative opioids. Also, significantly lower pain scores were recorded at rest or during motion within 24 h after surgery in AIMSB patients. Patients in the AIMSB group recovered more quickly than Sham patients. No significant difference was observed in quadriceps strength and postoperative complications between the two groups. ConclusionsCompared to treatment with LIA alone, ultrasound-guided AIMSB combined with LIA can provide better postoperative pain relief, decrease opioid consumption, promote motor sparing, and enhance the recovery of THA patients.

A COMPARATIVE STUDY BETWEEN EPIDURAL NALBUPHINE AND FENTANYL WITH BUPIVACAINE FOR POST OPERATIVE ANALGESIA IN LOWER LIMB SURGERIES

Background:The shorter duration of action of typical local anaesthetics used for spinal anaesthesia demands the early need for postoperative analgesia. Epidural analgesic administration reduces the stress reaction to pain and surgery, reduces the requirement for systemic analgesics, and promotes early rehab.1 It was discovered that using opioids as an adjuvant to local anaesthetics has synergistic effects. The advantages of this combination were improved pain alleviation, motor sparing, and less toxicity.2 Objective:To compare the efficacy of epidural analgesia by using fentanyl and nalbuphine as adjuvants along with bupivacaine following lower limb surgeries with respect to Onset, Duration, and side effects. Meterials and Methods:Prospective randomized doubled blind comparative study would be conducted on 60 adult patients of ASA grade I & II in the age group of 18 to 59 years of either sex, posted for lower limb surgeries after taking informed written consent. Patients were randomly divided on an alternative basis into 2 groups of 30 each. In study conducted in AL-AMEEN MEDICAL COLLEGE. VIJAYAPUR, KARNATAKA during the period of April 2021 to December 2022. If visual analogue score is more than one ,GROUP A: Patient received 50ug of fentanyl + 2.5 ml 0.5% bupivacaine diluted to 10ml with distilled water given epidurally (0.125%). GROUP B: Patient received 5mg of nalbuphine +2.5 ml 0.5% bupivacaine diluted to 10ml with distilled water given epidurally (0.125%). . Noting onset and duration analgesia also monitoring of patients SBP,DBP,SpO2,RR,VAS score till 15 min followed by 30 min,1hr ,2hr,4hr ,6hr,8hr is done and asked for any side effects like nausea ,vomiting, pruritis ,sedation and urinary retention. Conclusion: Epidural fentanyl has faster onset of action compared to nalbuphine and has longer duration of action compared to nalbuphine , for post operative epidural analgesia. There was no any statistically significant side effects in any of the two groups.

Overview about motor Sparing articular nerves Intervention in Chronic Shoulder Pain: Review Article

Overview about motor Sparing articular nerves Intervention in Chronic Shoulder Pain: Review Article

Combining Pericapsular Nerve Group (PENG) Block With the Supra-Inguinal Fascia Iliaca Block (SIFICB) for Perioperative Analgesia and Functional Recovery in Patients Undergoing Hip Surgeries: A Retrospective Case Series.

The complex innervation of the hip joint may require a combined peripheral nerve block technique for perioperative effective analgesia and early recovery. The pericapsular nerve group (PENG) and suprainguinal fascia iliaca compartment blocks (SIFICB) are interfascial plane blocks aiming to involve the femoral, obturator, accessory obturator, and lateral femoral cutaneous nerves. The data still lacks in providing the standard of care for patients undergoing hip surgery. In this case series, we studied the efficacy of ultrasound-guided combined PENG block and SIFICB for perioperative analgesia and functional recovery in patients posted for hip surgery. We studied 10 adults of either gender who underwent close reduction and internal fixation of hip fracture. Before receiving spinal anesthesia, all patients had PENG block and SIFICB with 10 ml and 20 ml of local anesthetics respectively. Patients were observed for ease of giving sitting position for spinal anesthesia (EOSP), visual analogue score (VAS) at rest and 15° leg elevation, duration of postoperative analgesia, the cumulative requirement of rescue analgesic at 48 hours and ability of patients to undergo weight-bearing trial postoperatively. The static and dynamic VAS before receiving spinal anesthesia and postoperatively, was reduced compared to pre-block. The optimal position for delivering spinal anesthesia was possible to achieve as the patients were able to sit comfortably after 10 minutes of receiving both blocks. Duration of postoperative analgesia also extended up to 18 hours with the cumulative requirement of injection tramadol restricted to two doses postoperatively. All were able to walk down a minimum of 55 steps after 48 hours of completion of surgery. Combining PENG block along with SIFICB is effective in the provision of perioperative analgesia with a considerable reduction in opioids and enhanced functional recovery due to motor sparing effect after surgical repair of the hip fracture.

A comparative randomized controlled study of modified 4 in 1 block versus IPACK plus adductor canal block for post-operative analgesia in total knee arthroplasty.

Postoperative analgesia for Total Knee Arthroplasty (TKA) is paramount for early mobilisation and rehabilitation. The newer motor sparing peripheral nerve blocks for analgesia for TKA are 4 in 1 block, modified 4 in 1 block, infiltration between popliteal artery and capsule of the knee (IPACK) block along with adductor canal block (ACB). We hypothesised that Modified 4 in 1 block is as efficient as the already proven technique of combined IPACK and ACB in providing post-operative analgesia to the patients of TKA. Seventy patients fulfilling the inclusion criteria posted for TKA surgery were randomised into two groups: Modified 4 in 1 block group (Group - M) and combined IPACK + ACB group (Group - I). After thorough preoperative evaluation and with mimimum standard monitoring the patients received sub-arachnoid block followed by the desired peripheral nerve block as per the group. After the surgery the visual analog scale (VAS) pain score was compared at 3, 6, 12, 24 hours postoperatively and tabulated. The mean pain scores between both the groups was comparable at 3 hours, 6 hours and 24 hours. But at 12 hours after the surgery, VAS was less in Group-M in comparison to Group-I, Haemodynamic parameters were comparable between both the groups. None of the patients in both the groups showed any complications like muscle weakness in the post-operative period. Modified 4 in 1 block is a new and novel technique for the TKA surgeries and is comparable with already established combined IPACK+ACB technique for providing adequate postoperative analgesia after TKA.

Anatomical and Radiological Assessments of Injectate Spread Stratified by the Volume of the Pericapsular Nerve Group Block.

The pericapsular nerve group (PENG) block was recently suggested as a regional technique for managing acute pain after hip surgery. However, few anatomical studies have confirmed the spread of injectate during the PENG block. This cadaver study aimed to analyze injectate spread to the target nerves during single-injection ultrasound-guided PENG block. Ultrasound-guided PENG block with 3 different injectate volumes (10, 20, or 30 mL) was performed in 18 cadavers. Injectate spread by the volume was first evaluated on computed tomography, followed by cadaver dissection. The spread of the dye over the pelvis and lower limb was evaluated. The articular branches of the femoral nerve were stained nearly sufficiently with 20- and 30-mL specimens. The femoral nerve itself was stained simultaneously in six of 12 (50%) 20-mL specimens and 12 of 12 (100%) 30-mL specimens. The accessory obturator nerve was observed only in three (9%) of 36 specimens. The articular branches of the obturator nerve were rarely affected, regardless of injectate volume (1/12, 10 mL specimens; 2/12, 20 mL specimens; 1/12, 30 mL specimens; P > .999). Rather, the obturator nerve was affected. However, the obturator nerve was not stained consistently even with 30 mL of injectate (50%). After combining the dissection and radiological findings, the single-injection ultrasound-guided PENG blocks with volumes of 10, 20, and 30 mL do not support motor sparing or selective anterior hip capsule innervation in a clinical setting. If early rehabilitation is needed, high-volume PENG block might not be the ideal option, and persisting pain after PENG block might be attributed in part to the lack of obturator nerve articular branches blockade.

Posterior Spinal Hemi- Anaesthesia for Tendon Transfer in Patient with Foot Drop- Case Report

In surgery for foot drop, regional anaesthesia, with selective sensory block and preserved motor function, can be of immense benefit to the surgeon. It allows patient to move foot on command, thus helping in identifying functional tendons, and determine the efficacy of transplanted tendon intraoperatively. We describe a simple and effective technique to achieve this, using hypobaric local anaesthetic drug for spinal anaesthesia and keeping the patient prone in jack-knife position for 15 minutes This allows only sensory posterior nerve roots to be blocked, sparing the motor anterior nerve-roots. Keywords: Levobupivacaine, Baricity, Anaesthetic local, Density, Motor sparing block, Tendon transfer, Spinal anaesthesia

Prospective Comparative Double-Blind Study on Ultrasound-Guided Pericapsular Nerve Group Block Versus Suprainguinal Fascia Iliaca Block for Perioperative Analgesia in Traumatic Hip Surgeries

Background: Severe pain in hip fractures limits ideal positioning for spinal anaesthesia. We evaluated the analgesic efficacy of ultrasound-guided pericapsular nerve group block (PENG) and suprainguinal fascia iliaca block (SIFI) for positioning and postoperative pain relief in hip surgeries. Methods: A prospective, randomized, double-blind study including 30 patients aged 30-90 years of either sex, American Society of Anesthesiologists’-physical status score I to II undergoing traumatic hip surgeries were divided into two groups. Each group was administered 20 ml bupivacaine 0.25% + 10 ml lignocaine 1%. Vitals and visual analogue scale (VAS) score pre-block, 10 mins post-block, after shifting to operation theatre and after positioning; at rest, and after straight leg raise (SLR) and quadriceps muscle strength were noted. The remaining aspects of perioperative care, including subarachnoid block and rescue analgesic techniques were standardized. Time to request first rescue analgesia, duration of block, and incidence of nausea was noted. Statistical analysis done using the Student t test, Chi-Square test. Results: VAS scores in both groups 10 mins post block at rest, after SLR, and after positioning were comparable. The drop in VAS score although statistically insignificant was more in the PENG group. The motor blockade in SIFI was significantly higher compared to the PENG group (p-0.002). Duration of analgesia with SIFI 551.9 (±56.2) min was longer than PENG block 400.4 (±62.8) min (p=0.0005%). No significant difference between the groups to demographics, hemodynamic parameters, rescue analgesia and incidence of nausea. Conclusion: PENG block provides superior and faster analgesia with potentially motor sparing effect compared to SIFI block whereas SIFI provides longer duration of analgesia. Keywords: Analgesia, Pain, Regional Anaesthesia, Ultrasonography

Evaluation of Analgesic Efficacy of Ultrasound-Guided Adductor Canal Block With 20 mL of 0.5% Ropivacaine in Patients Undergoing Knee Surgeries-A Randomized Control Trial.

Adductor canal block (ACB) is a motor sparing block providing analgesia for surgeries involving anterior part of the knee. The aim of our study was to evaluate the analgesic efficacy of ACB to reduce pain in arthroscopic knee surgeries done under spinal anesthesia. Our primary objective was to evaluate the 24 hours postoperative morphine consumption. The secondary objectives were to evaluate the visual analog scale (VAS) scores at rest and during knee flexion, hemodynamics and side effects of the block. In this prospective randomised controlled trial, 70 patients who underwent arthroscopic knee surgeries were randomly divided into two groups, A and C. Surgeries were done under spinal anesthesia. Group A patients received ACB with 20 mL of 0.5 % ropivacaine using ultrasound postoperatively. Block was not performed in group C. The amount of morphine consumption in PCA pump, duration of analgesia, mean VAS scores at rest and flexion, hemodynamics and adverse effects were monitored. The average morphine consumption was significantly lesser with a P-value ＜ 0.001 in group A (8.628 ± 2.001 mg) when compared to group C (21.914 ± 5.118 mg). The duration of analgesia was longer in group A (365.71 ± 53.648 min vs. 150.429 ± 22.537 min) with highly significant P-value of ＜ 0.001. Group A patients had significantly decreased VAS scores at rest and knee flexion and better haemodynamic stability. We conclude that ultrasound-guided ACB resulted in significantly lesser morphine consumption after arthroscopic knee surgeries. ACB prolonged the duration of analgesia with better hemodynamics, lesser VAS pain scores and with no complications.

Same Day Joint Replacement Surgery: Patient Selection and Perioperative Management.

Joint replacements are increasingly performed as outpatient surgeries. The push toward ambulatory joint arthroplasty is driven in part by the changing current health care economics and reimbursement models. Patients' selection and well-designed perioperative care pathways are critical for the success of these procedures. The rate of complications after outpatient joint arthroplasty is comparable to the rate of complications in the ambulatory setting. Patient education, adequate social support, multimodal analgesia, regional anesthesia are key ingredients to the ambulatory care pathway after joint arthroplasty. Motor sparing nerve blocks are often used in these settings. Implementation of the elements of fast protocols can result in overall improvement of outcome metrics for all patients undergoing joint arthroplasty, including reduced length of stay and increased rate of home discharge.

335 Motor Sparing Peripheral Nerve Block: A Modern Approach to Total Knee Arthroplasty

Abstract Aim To maximise postoperative analgesia, whilst minimising opioid use, motor sparing peripheral nerve blocks have been described as an alternative to local infiltration analgesia (LIA) with adductor canal block (ACB) in total knee arthroplasty (TKA). At The Robert Jones and Agnes Hunt Orthopaedic Hospital, we have developed a new technique, involving ten separate injections to the four genicular nerves, saphenous nerve, nerve to the vastus medialis, the popliteal plexus and to the medial, intermediate, and lateral cutaneous nerves of the thigh. The aim was to compare the analgesic effect of this type of motor sparing nerve block against LIA with ACB in TKA. Method Two groups were identified retrospectively. The test group included fifty patients who received 5ml each of 0.75% Levobupivacaine to the saphenous nerve and nerve to the vastus medialis, and 40ml of 0.25% Levobupivacaine to the four genicular nerves, the popliteal plexus, and to the cutaneous nerves. A matched control group received standard treatment with ACB and LIA. The primary outcome was the consumption of opioid analgesics, measured as a total morphine equivalent. Results For patients in the test group, the mean amount of IV morphine equivalent administered in the first 48-hours postoperatively was 34mg vs 108mg. This equates to a 68% reduction in opioid consumption compared to the control group. Conclusions Motor sparing nerve blocks provide a significant reduction in opioid consumption compared to LIA with ACB in TKA. The results have implications in terms of pain management, reduced opioid-induced side effects and overall, enhanced patient recovery.

Evaluation of Analgesic Efficacy of Ultrasound-Guided Adductor Canal Block With 20 mL of 0.5% Ropivacaine in Patients Undergoing Knee Surgeries-A Randomized Control Trial.

Adductor canal block (ACB) is a motor sparing block providing analgesia for surgeries involving anterior part of the knee. The aim of our study was to evaluate the analgesic efficacy of ACB to reduce pain in arthroscopic knee surgeries done under spinal anesthesia. Our primary objective was to evaluate the 24 hours postoperative morphine consumption. The secondary objectives were to evaluate the visual analog scale (VAS) scores at rest and during knee flexion, hemodynamics and side effects of the block. In this prospective randomised controlled trial, 70 patients who underwent arthroscopic knee surgeries were randomly divided into two groups, A and C. Surgeries were done under spinal anesthesia. Group A patients received ACB with 20 mL of 0.5 % ropivacaine using ultrasound postoperatively. Block was not performed in group C. The amount of morphine consumption in PCA pump, duration of analgesia, mean VAS scores at rest and flexion, hemodynamics and adverse effects were monitored. The average morphine consumption was significantly lesser with a P-value ＜ 0.001 in group A (8.628 ± 2.001 mg) when compared to group C (21.914 ± 5.118 mg). The duration of analgesia was longer in group A (365.71 ± 53.648 min vs. 150.429 ± 22.537 min) with highly significant P-value of ＜ 0.001. Group A patients had significantly decreased VAS scores at rest and knee flexion and better haemodynamic stability. We conclude that ultrasound-guided ACB resulted in significantly lesser morphine consumption after arthroscopic knee surgeries. ACB prolonged the duration of analgesia with better hemodynamics, lesser VAS pain scores and with no complications.

Ultrasound-Guided Motor-Sparing Knee Blocks for Postoperative Analgesia Following Total Knee Arthroplasty: A Cost Analysis.

BackgroundWe recently performed a clinical trial comparing motor sparing blocks (MSB) to periarticular infiltration (PAI) following total knee arthroplasty (TKA). We found that MSBs provided longer analgesia (8.8 hours) than PAI with retention of quadriceps strength, and with similar function, satisfaction, and length hospital stay. However, its potential increased cost could serve as a barrier to its adoption. Therefore, our aim was to compare the costs of MSBs to PAI following TKA.MethodsWe conducted a retrospective review of data from our previous RCT. There were 82 patients included in the RCT (n = 41 MSB group, n = 41 PAI group). We compared the mean total costs associated with each group until hospital discharge including intervention costs, health-care professional service fees, intraoperative medications, length of stay, and postoperative opioid use.ResultsSeventy patients were included (n = 35 MSB group, n = 35 PAI group). The mean total costs for the MSB group were significantly higher ($1959.46 ± 755.4) compared to the PAI group ($1616.25 ± 488.33), with a mean difference of $343.21 (95% CI = $73.28 to $664.11, p = 0.03). The total perioperative intervention costs for performing the MSB was also significantly higher; however, postoperative inpatient costs including length of stay and total opioid use did not differ significantly.ConclusionMotor sparing blocks had significantly higher mean total and perioperative costs compared to PAI with no significant difference in postoperative inpatient costs. However, its quadricep sparing nature and previously demonstrated prolonged postoperative analgesia can be used to facilitate an outpatient TKA pathway thereby offsetting its increased costs.

COMBINED PERICAPSULAR NERVE GROUP AND OBTURATOR NERVE BLOCKS (PARTHA’S COMBO BLOCK) FOR EMERGENCY REDUCTION OF DISLOCATED PROSTHETIC HIP: A CASE REPORT

The perioperative management of hip fractures and dislocation of hips with already fixed hardware are challenging in the elderly because of poor physiological reserve and multiple comorbidities. Previously, general anesthesia and a few regional anesthetic techniques were used to reduce dislocated hip. The pericapsular nerve group block (PENG) was first described in 2018, especially for total hip arthroplasties for a near-complete perioperative analgesia with motor sparing. In this case, a 75-year-old male with a history of hemiarthroplasty 15 days prior presents with a repeat fall and hip injury. We used a combined PENG and obturator nerve (ON) block to treat a dislocated prosthetic hip with a fractured pubic ramus. PENG was given with 20 ml of 0.375% bupivacaine and 6 ml each was administered for the anterior and posterior branches of ON. Following this Partha’s combo block (PENG block+obturator), pain score reduced to 1/10 in around 20 min and closed reduction was done successfully in 4 min. The reduction was successful, painless, and without any major side effects. This is the first such report of reduction of dislocation of prosthetic hip. We surmised that a good pain relief of pubic fracture and the relief of associated adductor spasm targeted by the ON block may be the key to our success.

Current Concepts in Postoperative Pain Management Surgeries of Hip Joint: A Narrative Review

Hip surgery is a common surgical procedure in the elderly and leads to significant pain postoperatively. The hip joint has a complex innervation which is unlikely to be covered with any single modality of pain relief. Multimodal analgesia has been critical in facilitating early recovery and rehabilitation in these patients. Regional analgesia is an important component of multimodal analgesia regimens and is instrumental in achieving optimal patient outcomes. Single shot or continuous central or peripheral nerve blocks provide effective and safe postoperative analgesia, lower opioid consumption, faster rehabilitation, and a high level of patient satisfaction. An ideal regional anaesthesia technique for hip surgery should be motor sparing while providing effective perioperative pain relief. Regional anaesthesia has seen enormous growth in the recent past due to advances in technology and research. These blocks have shown analgesic efficacy, have an opioid-sparing effect, and enable better patient positioning for central neuraxial blocks. Some of the novel interfascial plane blocks like Pericapsular Nerve Group (PENG) block are now being explored for hip analgesia. Within a few years of being described, these novel nerve blocks have seen tremendous favour in the literature and are being extensively used in the current practice of analgesia for hip surgery. In the present review, we aim to discuss the various modalities of analgesia which have been utilised in the past and would discuss few of the newer blocks for hip surgery. Keywords: Nerve blocks, Ultrasonography, Analgesics, Total hip arthroplasty, Fascia illiaca block, Multimodal analgesia, Transmuscular, Quadratus lumborum block

Evaluation of ultrasound-guided adductor canal block with two different concentration of bupivacaine in arthroscopic knee surgery: A feasibility study.

The application of regional anaesthesia techniques as a component of multimodal analgesia in knee arthroscopic surgeries increases the quality of postoperative analgesia. Adductor canal block (ACB) is an effective "motor sparing" analgesia technique used in knee surgeries. This study aimed to evaluate the efficacy of ACB using two different concentrations of local anaesthetic in terms of analgesic requirements and pain density in patients undergoing knee arthroscopy. Prospective, randomised, controlled. Tertiary hospital. A total of 60 patients (ASA I-II) were evaluated in three groups, with 20 patients in each group. Standardised postoperative analgesia was performed in all groups. In addition, ultrasound-guided ACB (same volume/two different concentrations of bupivacaine: 0.25% vs 0.16%) was applied to the experimental groups. Tramadol consumption, rescue analgesic requirement and Numeric Rating Scores (NRS). Tramadol requirement in the first 24hours was significantly higher in the control group (209.5±23.27mg) (P<.001), and there was no difference between the experimental groups (63±42.06mg vs 80.5±36.63mg). Although the mean NRS scores in the first three hours were higher in the control group when compared with both block groups, it was similar in all groups in the following measurements. In arthroscopic knee surgery, ACB interventions with 0.25% and 0.16% concentrations of bupivacaine were similar in terms of postoperative analgesic efficacy, and they increased the quality of multimodal analgesics when compared with the control group.

From emergency department to operating room: interventional analgesia techniques for hip fractures.

To provide an update on pain management options with regional anesthesia for patients with hip fractures at the emergency department (ED). Patients who sustain a hip fracture are typically admitted and diagnosed in the ED before being transferred to the operating room for surgery. Studies have clearly demonstrated the ability of the fascia iliaca compartment blocks (FICBs) and femoral nerve blocks (FNBs) to reduce pain and the risk of an acute confusional state. Their administration at an early stage of the patient's trajectory in the ED is beneficial. Recent anatomical studies contributed new knowledge of nociception in the hip joint, which allowed the development of more specific infiltration analgesia techniques without muscle weakness (e.g., pericapsular hip blocks). Further research on the timing of nerve blocks and an evaluation of new motor sparing techniques is indicated. FICB and FNB are established and recommended techniques in pain management for hip fracture patients. Their use early on in the ED may improve patient comfort and outcome. Pericapsular nerve hip blocks could provide a relevant alternative in future pain management in this group of patients.

An Observational Study between Intrathecal Fentanyl and Butorphanol with Low Dose Bupivacaine to Facilitate Early Ambulation in Perineal Surgeries

Background: Neuraxial opioids are widely used with local anaesthetics as they allow lower dose of local anaesthetics while providing adequate anaesthesia and faster recovery from spinal anaesthesia because of their sympathetic and motor nerve sparing activities. In the last few years the number of surgeries performed on an ambulatory basis has increased worldwide because of many advantages like short hospital stay, less chance of wound infection and less chances of deep vein thrombosis.Methods: 64 patients of ASA- I or II of either gender who underwent perineal surgeries were divided into two groups of 32 each:- Group BF patients received 1ml of 0.5% hyperbaric bupivacaine with 20µg fentanyl(0.4ml) and Group BB patients received 1ml of 0.5% hyperbaric bupivacaine with 200µg butorphanol(0.2ml) and normal saline(0.2ml).Patients were observed for onset of sensory and motor blockade, duration of sensory and motor blockade, duration of analgesia and time to unassisted ambulation. There was no difference in onset of sensory and motor blockade between the two groups(P&gt; 0.005).Patients receiving butorphanol had statistically significantly longer duration of sensory and motor blockade and duration of analgesia than fentanyl(p-0.001).Patients receiving fentanyl were observed to ambulate unassisted significantly early compared to butorphanol (p-0.001).Conclusion: Patients receiving intrathecal fentanyl 20µg can ambulate earlier compared to patients receiving butorphanol 200µg when used as an adjuvant with low dose hyperbaric bupivacaine 0.5% without any complication.