Palpation Technique Research Articles

PENGARUH PENERAPAN PERMAINAN KECIL DALAM PEMANASAN TERHADAP KESIAPAN SISWA DALAM PEMBELAJARAN PJOK di SMPN 1 TUBAN

In the PJOK learning process there are various aspects that need attention, especially in the introduction of learning, namely ensuring students' readiness during warm-up. PJOK learning requires students' body conditions to be in good condition and ready to be used to move actively. A good choice is to use small games because they contain various movements and can also prepare students' concentration and also have playing activities in them. The aim of the study was to determine the effect of applying mini games in warming up on students' readiness for PJOK learning at SMPN 1 Tuban. The research used a quasi-experimental approach and the approach used was quantitative and used a one-group pre-test-post-test design. The population of this study were students of class VIII SMPN 1 Tuban with a total of 6 classes and a sample of class VII B students consisting of 32 students through the selection of cluster random sampling technique. Retrieval of data by calculating the number of HR using palpation techniques or feeling parts of the body precisely at the wrist. Use a stopwatch to count the number of beats for 30 seconds and multiply the result by two to get the number of beats per minute. Looking at the analysis of the results of the data using statistics, there is an effect of small games on the readiness of students at SMPN 1 Tuban with a significant increase. The conclusion is that there is an effect of implementing small games in warming up on students' readiness in PJOK learning at SMPN 1 Tuban.

Efficacy of the three-point cuff palpation technique in preventing endobronchial tube migration during positioning in robotic pelvic surgeries.

During robotic pelvic surgeries, the shortening of endotracheal tube (ETT) tip-to-carina distance (DTC) during pneumoperitoneum with 45° Trendelenburg position can result in endobronchial tube migration. In the three-point ETT cuff palpation (TPP) technique, maximal ETT cuff distension is felt over the tracheal segment located between the cricoid-thyroid membrane and suprasternal notch, which is likely to provide optimal placement. However, the reproducibility and reliability of the TPP technique in preventing endobronchial tube migration are yet to be evaluated. Hence, we compared three ETT placement techniques: TPP technique, intubation guide mark (IGM) technique and Varshney's formula (VF) for the prevention of endobronchial tube migration during robotic pelvic surgeries. ETT placement by TPP was compared with IGM and VF techniques in 100 American Society of Anesthesiologists physical class II-III patients, by assessing the serial changes in DTC and incidence of endobronchial tube migration throughout the different phases of pneumoperitoneum and Trendelenburg position using t-test and Chi-square test. Changes in the DTC during various phases were also measured. DTC (mean ± standard deviation) at baseline and during pneumoperitoneum was significantly better in TPP technique (2.80 ± 0.62 cm and 1.96 ± 0.66 cm) as compared to both IGM (2.50 ± 1.27 cm and 1.41 ± 1.29 cm) and VF techniques (1.83 ± 1.13 cm and 0.98 ± 1.18 cm), P < 0.001. During pneumoperitoneum, the mean shortening of DTC was 0.84 ± 0.20 cm, and no endobronchial tube migration was found in TPP technique compared to 20% in IGM and 25% in VF techniques, P < 0.001. TPP is a simple and reliable technique, which provides optimal ETT placement and prevents endobronchial tube migration throughout the different phases of robotic pelvic surgeries.

Comparison of ultrasonography, progesterone assay, ballottement, and non-return-to-heat with digital rectal palpation technique for early pregnancy diagnosis in Red Sokoto goat.

The objective of the study was to evaluate the effectiveness of the digital rectal palpation (DRP) technique for early pregnancy diagnosis and to compare the results of experiments I and II in the Red Sokoto goat. Experiment I had 68 goats with 52 does and 16 bucks. Does were divided into prostaglandin F2 -alpha (PGF2 α; n= 18), progesterone pessaries (P4 P; n= 18), and Control (n= 16) groups as oestrus synchronizaton methods. Bucks were used for oestrus detection (n= 6) and breeding (n= 10). Comparative pregnancy diagnosis was carried out on day 21 post-breeding using ultrasonography (US), DRP, progesterone assay (PA), ballottement (BL), and non-return-to-heat (NRH). Experiment II was a repeat but had 51 animals with 42 does and nine bucks; three bucks for oestrus detection and six for breeding. Does were divided into recto-vaginal artificial insemination (AI) by DRP (n= 14), vaginal speculum AI (n= 14), and Control-natural service (n= 14) groups, indicating breeding methods. Oestrus was synchronized with PGF2 α and pregnancy diagnosis was carried out on day 21 using US, DRP, PA, and NRH. The results for both experiments were similar. Pregnancy rates for PGF2 α group were 66.2%, 66.7%, 64.8%, 62.1%, and 63.0% for US, DRP, PA, BL, and NRH, respectively; P4 P had 81.5%, 81.5%, 42.6%, 20.3%, and 42.6% for US, DRP, PA, BL, and NRH, respectively; while Control was 73.6%, 79.2%, 70.9%, 73.6%, and 73.6% for US, DRP, PA, BL, and NRH, respectively. Proportions are significantly (p< .000) different in the P4 P group. It was concluded that the DRP technique was effective and consistent in early pregnancy diagnosis on day 21 and comparable to US, PA, BL, and non-return-to-oestrus in both experiments in Red Sokoto goat does.

A comparison of the success rate of radial artery cannulation between the ultrasound-guided and conventional palpation techniques in elderly patients undergoing cardiothoracic surgery.

Ultrasound-guided (USG) radial artery cannulation against the standard palpation technique increases the first attempt rate in both pediatric and adult patients. The objective of this study was to evaluate the benefits of USG versus the palpation technique in improving the first attempt rate in elderly patients. The patients over 65 years of age were randomized to the USG or Palpation group. The radial artery identification in the USG group was performed with the aid of the Sonimage HS 1. In the Palpation group, the radial artery was identified by manual palpation. The operators were cardiothoracic anesthesiologists. Overall success was defined as cannulation completed within 10 min. Eighty patients (40 in each group) were recruited. The respective first attempt and overall success rate for the USG group were similar to the Palpation group (P &gt; 0.999 and P = 0.732). The time to the first attempt and overall success were also similar (P = 0.075 and P = 0.636). The number of attempts, number of catheters used, and failure rates were similar between the groups (P = 0.935, P = 0.938, and P = 0.723). The number of successful cannulations within 10 min was similar for both the groups as categorized by the radial artery diameter (P = 0.169). The USG did not increase the first attempt or overall success rate of radial artery cannulation in the elderly patients undergoing cardiothoracic surgery. The time to first attempt and overall success were similar between both the groups. The number of attempts and number of catheters used were similar between both groups.

Comparison of the Success Rate of Radial Arterial Cannulation with Palpation Techniques and Ultrasound Guidance in Patients Undergoing Major Surgery with General Anesthesia

Background: Ultrasound-guided arterial cannulation has the potential to increase the total success rate and first attempt and reduce complications compared to conventional landmark palpation methods. This study aims to compare the success rate of radial artery cannula with palpation techniques and ultrasound guidance in patients undergoing major surgery under general anesthesia.&#x0D; Methods: This study is a randomized controlled trial singly. The inclusion criteria for this study were patients who underwent both emergency and elective surgery under general anesthesia, aged &gt;18 years, with ASA I and II physical status. The study sample (60 people) was randomized by computer and divided into two groups (ultrasound guidance and palpation technique). The study will assess the success of the first insertion of the radial artery cannula in both groups. Data analysis was performed with SPSS 25 univariate and bivariate.&#x0D; Results: There is a significant relationship with the success of the first attempt at an ultrasound-guided cannula trial with a p-value of 0.045 with an odds ratio of 3.33 with a 95% confidence interval (0.998 – 11.139).&#x0D; Conclusion: Ultrasound-guided arterial cannulation has a better success rate and fewer complications than conventional palpation techniques.

Accuracy of Cricothyroid Membrane Identification Using Ultrasound and Palpation Techniques in Obese Obstetric Patients: An Observational Study

(Int J Obstet Anesth. 2021;48:103205) Emergency front of neck access (e-FONA) is a potentially life-saving intervention but requires the accurate identification of the cricothyroid membrane (CTM). CTM identification failure is most common in obese females, who also have an increased risk of emergency and elective cesarean delivery. This study aimed to compare accuracy of CTM identification using ultrasound (US) compared with palpation in obese obstetric patients.

Estimation of diaphragm depth based on waist circumference in the Thai population.

There is a potential risk of causing a pneumothorax during needle electromyography of the diaphragm. The diaphragm depth can be estimated from body mass index (BMI), but this may not be practical in bedbound patients. The objectives of this study were to formulate correlation equations to estimate diaphragm depth based on waist circumference (WC) and determine their validity. Personal data, weight, height, and WC were collected from healthy volunteers, and the diaphragm depth from the skin and diaphragm thickness of the participants were measured by ultrasonography. These data were used to formulate the equations for estimation of diaphragm depth based on WC, and the equations were validated by comparing the estimated diaphragm depths between BMI-based equations and WC-based equations. A total of 100 volunteers (48 men and 52 women) were recruited. The median age of the participants was 27 y (interquartile range, 26). The mean WC was 83.3cm (SD, 7.8cm). The diaphragm depth ranged between 1.0 and 2.7cm. Equations for estimation of the diaphragm depth were created for each hemidiaphragm using data from 80 participants: left hemidiaphragm depth=(0.03 × WC) - 0.89 (r2 =0.56); right hemidiaphragm depth=(0.03 × WC) - 0.94 (r2 =0.55) with 10%-20% errors in 20 tested participants. The estimated diaphragm depths calculated from BMI and WC were comparable. The WC-based equation can be used in addition to palpation techniques for guiding needle EMG insertion when ultrasound guidance is not available.

Recto-vaginal artificial insemination using digital rectal palpation technique in Red Sokoto goat

Artificial insemination was carried out to evaluate the effectiveness of digital rectal palpation as a new technique of artificial insemination (AI) in Red Sokoto goat. Forty two Red Sokoto goat does were randomly divided into group A (Recto-vaginal DRPAI; n = 14), group B (Vaginal speculum AI; n = 14) and group C (Natural service; n = 14). Semen was collected from two Red Sokoto breeding bucks using artificial vagina, processed and stored at 4ºC. Oestrus was synchronised with prostaglandin F2-alpha, and oestrus detected by apronised bucks and visual observation. Breeding was by artificial insemination for groups A and B while group C bred by natural service. Pregnancy diagnosis was carried out using ultrasonography on day 126. Conception rates were 61.5%, 58.3% and 100%, while pregnancy rates were 57.1%, 50.0% and 100% for groups A, B and C, respectively. There was no significant difference (P > 0.05) between groups A and B. It was concluded that digital rectal palpation technique effectively carried out recto-vaginal artificial insemination with similar and acceptable conception (61.5%) and pregnancy (57.1%) rates to vaginal speculum artificial insemination but lower to natural service in Red Sokoto goat does. However, it is recommended that further studies be carried out with more animal number to verify findings.

Arterial Cannulation Simulation Training in Novice Ultrasound Users.

Arterial cannulation is an important procedure for hemodynamic monitoring and blood sampling. Traditional radial artery cannulation is performed by using anatomical knowledge and pulse palpation as a guide. Arterial cannulation using ultrasound (US) requires specific training, especially for new US users. We hypothesized that even for new US users, US guidance would facilitate the successful puncture by lower attempts before successful intraluminal cannulation of a simulation model of the radial artery. A prospective randomized controlled crossover study was conducted with new US users on a gelatin phantom wrist. Three sessions of training were proposed: US-guided technique with low blood pressure (BP), palpation-guided technique with high BP, and one secondary comparison with low BP. For the 2 first sessions, all volunteers performed each technique but not in the same order. The main criterion was the number of attempts before successful catheterization of the model artery. A secondary criterion was the number of needle movements (the number of attempts plus the number of needle directional changes). Twenty new US users participated in the study. Numbers of attempts before successful catheterization were significantly lower when using the US technique: 1.1 (± 0.4) for US versus 1.6 (± 0.8) for palpation high BP (P = .02) versus 2.5 (± 1.4) for the secondary comparison, palpation low BP (P < .001). All of the participants achieved success after the 12th needle movement for US technique, after the 19th needle movement for palpation high BP, and after the 25th needle movement for the secondary comparison, palpation low BP. The total time before success was not significantly different between the 2 first sequences (US vs palpation high BP). US technique was more successful than traditional palpation technique for novice US users performing arterial cannulations for the first time. A study in the clinical practice is needed to confirm these results.

Prepartum and Postpartum Evaluation of Internal Genitalia of Red Sokoto Goat Does Using Digital Rectal Palpation Technique

Study was aimed at determining prepartum and postpartum transrectal palpability of segments of internal genitalia of Red Sokoto Goat (RSG) does using digital rectal palpation technique. Weekly transrectal palpation of 50 does was performed prepartum for nine weeks using digital rectal palpation (DRP) technique with index finger to determine prepartum transrectal palpability. Transrectal measurement of width and length of genital segments was carried out on 26 does using DRP technique with index finger that had predetermined width and length. Twenty eight does that were cycling and with normal reproductive tract were selected and divided into artificial insemination (n = 14) and natural service (n = 14) groups indicating the method of breeding used. Body condition score (BCS) was measured. Determination of postpartum transrectal palpability and measurement of width and length of genital segments was performed on 26 does that kidded using DRP technique with index finger that had predetermined width and length. Evaluation was carried out on day 7, 14, 21 and 28 postpartum to palpate, measure genital segments and assess uterine involution. Length of index finger was 9.0 cm. Prepartum palpability of vagina, cervix, uterus, oviduct and ovary was 449 (100%), 433 (96.4%), 401 (89.3%), 0 (0.0%) and 207 (46.2%), respectively. Detection of uterus and ovary decreased with increasing BCS with P &lt; 0.05 association. Mean values for width and length of uterus was 2.67 ± 0.25 cm and 5.22 ± 0.49 cm, respectively. Postpartum palpability of vagina, cervix and uterus was 104 (100%) day 7, 14, 21 and 28. Width and length of uterus on day 28 postpartum was 2.70 ± 0.08 cm and 6.21 ± 0.60 cm, respectively. Conclusion: vagina, cervix, uterus and ovary were transrectally palpable prepartum and postpartum using DRP technique with index finger; postpartum width and length of uterus on day 28 indicate completion of postpartum uterine involution in RSG does.

Comparison of V Technique and Femoral Arterial Palpation Techniques Accuracy in Identifying the Femoral Vein’s Cannulation Site

BACKGROUND: The femoral vein cannulation is essential for vascular access and finding it by just relying on the femoral artery pulsation can be challenging in a certain condition. V technique is a new technique to identify the femoral vein’s cannulation site based on topographic anatomy without relying on femoral artery pulsation. AIM: This study was aimed to compare V technique and arterial palpation technique accuracies in identifying the femoral vein’s cannulation site. METHODS: This study was a cross-sectional study on 115 adult patients aged 18–65 years old with body mass index 18–25 kg/m2 who underwent elective surgery in Cipto Mangunkusumo National General Hospital on February-March 2020. After ethical approval and informed consent, the distance of the femoral vein’s cannulation site identified by both techniques with the skin projection of the femoral vein diameter identified by ultrasonography (USG) were compared in all subjects. Accuracy was defined when the femoral vein’s cannulation sites identified by both techniques were within the skin projection of femoral vein diameter identified by USG. Data were collected and analyzed using SPSS ver 20. RESULTS: The accuracy of the V technique in determining the femoral vein’s cannulation site was 93.9%, while the accuration of the femoral artery pulsation technique was 96.5%. Mcnemar analysis showed no difference in both techniques’ accuracy (p = 0.549). There was a statistically significant positive correlation between the distance of the femoral vein cannulation site predicted by both techniques with the skin projection of the femoral vein midpoint (r = 0.548; p &lt; 0.001). CONCLUSION: V technique’s accuracy was not significantly different from the femoral artery pulsation palpation technique’s accuracy in identifying the femoral vein cannulation site.

Inter-rater Accuracy and Reliability of a Palpation Protocol of the C7 Spinous Process Comprising a Combination of 3 Traditional Palpation Techniques

ObjectiveThe purpose of this study was to determine the accuracy and intrarater reliability of a palpatory protocol based on a combination of 3 palpatory methods to identify both the C7 spinous process (C7 SP) and the factors that affect the errors and inaccuracy of palpation. MethodsTwenty-five women between the ages of 18 and 60 years were submitted to a palpation protocol of the C7 SP, and a radiopaque marker was fixed on the skin at the possible location of the vertebrae. A radiograph and a photograph of the cervical spine were obtained in the same posture by a first rater. A second rater performed the same palpation protocol and took a second photograph. The accuracy and measurement error of the palpation protocol of C7 SP were assessed through radiographic images. The inter-rater reliability was estimated by the interclass correlation coefficient and assessed using photographs of each rater. The Pearson's correlation coefficients (r), the Fisher exact test, and the χ2 test were used to identify the factors associated with the error and inaccuracy of palpation. ResultsAccuracy of the C7 palpation was 76% with excellent reliability (interclass correlation coefficient = 0.99). There was a moderate correlation between weight and the measurement of palpation error (r = –0.6; P = .003). One hundred percent of inaccuracy palpation was related to the increased soft-tissue thickness (P = .005) in the cervical region. ConclusionThe palpation protocol described in this study was accurate and presented excellent reliability in identifying the C7 SP. Increased weight and dorsocervical fat pad were associated to error and palpation inaccuracy, respectively.

The influence of subtalar axis orientation on the foot posture of older adults in a closed kinetic chain

Objectives: This study compared the influence of subtalar axis position on foot behavior in a closed kinetic chain in older and younger adults. Methods: The sample included 50 older adults and a control group of 50 younger adults. The variables were initially analyzed for both feet together, and were later analyzed separately, comparing each foot (right and left) between groups. Range of motion was assessed by validated goniometric procedures: the position of subtalar axis was evaluated by the palpation technique, while the Foot Posture Index was used to assess behavior in a closed kinetic chain. Student’s t-test / Mann-Whitney test compared the main variables according to sample distribution, while Student’s t-test / Wilcoxon test was used for paired samples. A standardized Haberman residuals test was also used to determine the connection between the position of subtalar joint axis and the Foot Posture Index. Results: Data from the right and left feet were similar for all variables. The older group had reduced mobility in the ankle and first metatarsophalangeal joint (5.42º [SD (Standard Deviation), 4.49] and 76.12º [SD, 19.24], respectively) with statistically significant values, (p &lt; 0.001). The difference in subtalar axis position was not significant (p = 0.788), with more internal deviations in both groups. There was a significant difference in Foot Posture Index (p = 0.006, by applying the chi-square test), with the normal position more prevalent in the older group and the prone position more prevalent in the younger group. Conclusions: Regarding internal deviations in the subtalar joint axis, the older group had a higher frequency of feet in the normal position, while the younger group had a higher frequency of feet in the prone position which, in this case, agrees with the rotational balance theory. For the normal axis position, a higher frequency of normal position was found in both groups. Regarding external deviations of the subtalar joint axis, neither group followed the pattern expected in rotational balance theory. The most consistent connection in the older group was between external axis position and supine foot position, whereas in the younger group it was between normal axis position and normal foot position.

Ultrasound-Guided Radial Artery Cannulation Technique in Elderly Patients Undergoing Non-cardiac Surgery: A Randomized Controlled Trial

In elderly patients, radial arterial cannulation is challenging and time-consuming. With ultrasound guidance, the success rate of this procedure can be increased, the associated complications can be reduced, and the procedure can be completed more quickly. A comparison was made between ultrasound-guided radial artery cannulation and traditional palpation techniques in elderly patients. In this randomized controlled trial, ninety elderly patients undergoing non-cardiac surgery were randomly divided into ultrasound-guided and palpation groups and then had arterial cannulation using either method by anesthesia residents. In this study, the primary outcomes were the success rate of cannulation at the first attempt, the overall success rate, and the time necessary to perform cannulation, and the secondary outcome was the incidence of cannulation-related complications. Also, eighty-nine elderly patients were analyzed in the present study. It was found that the ultrasound-guided group (84.09%) had a significantly higher first-attempt success rate than the palpation group (55.5%, P = 0.003). The ultrasound-guided group (45.7 ± 11.0s) had a considerably shorter cannulation time than the palpation group (54.2 ± 16.2s, P = 0.000). Furthermore, in the ultrasound-guided group, fewer attempts were made than in the palpation group. However, there was no significant difference between the two groups when it came to overall success rates and cannulation-related complications. Ultrasound- guided arterial cannulation is preferred for elderly patients compared to traditional palpation, as it achieves a higher success rate of cannulation and has fewer complications.

201 Genital Examination Education and Instruction: Lowering Anxiety and Raising Competence

Gynaecologic Teaching Associate (GTA) and Male Urogenital Teaching Associate (MUTA) methodology have been utilized for decades in effective breast, pelvic and urogenital examination clinical skill instruction. This methodology is recognized as the gold standard of instruction when educating learners on the sensitive, invasive clinical skills techniques associated with a genital examination. While research shows it is the most effective way to learn these procedures, outside of the USA and Canada, there are few GTA/MUTA programmes at medical learning institutions.This methodology aims to provide hands-on, standardized instruction in an anxiety-free environment where learners safely practice the clinical skills techniques of breast, pelvic and urogenital examinations and have the unique experience of learning these techniques from the patient’s perspective.The GTA/MUTA is both instructor and live simulated patient, using their own bodies as teaching tools, guiding learners through examination techniques and providing instant feedback. With this unique opportunity for skills acquisition, learners receive step-by-step instruction on an actual person in a quality-controlled environment. In addition to correct palpation techniques, this patient-centred form of instruction addresses the emotional reaction patients may have to these examinations. GTA/MUTA instruction also includes patient education and communication and relaxation techniques. The GTA/MUTA patient empowerment methodology is designed to provide an anxiety-free atmosphere for the learner so that the sensitive nature of the genital examination and the embarrassment often accompanying the examination do not become an obstacle to acquiring safe, effective clinical technique.Decades of research prove that this method lowers learner anxiety and provides exceptional outcomes for learners in a multiplicity of learning criteria, including higher overall scores; superior communication skills; better ability to identify pathology; ‘better interpersonal skills than physician trained with lasting effects that can be demonstrated after clinical exposure’ The methodology has far-reaching implications. The specialized skills of these individuals mean that the teaching method can be brought outside of the well-patient experience; sexual assault providers can practice the trauma examination on live simulated patients; remediation can be provided to practitioners who must relearn techniques to maintain licensure; learners are more empathetic to their patients and more inclined to include their patients in the examination process thus improving patient care. This methodology can be utilized in any setting where invasive examination procedures, patient education and communication must be mastered.

Femoral Positioning of the Anterolateral Ligament Graft With and Without Ultrasound Location of the Lateral Epicondyle

Background: In anterior cruciate ligament (ACL) reconstruction with anterolateral ligament (ALL) reconstruction, precise positioning of the ALL graft on the femur and tibia is key to achieve rotational control. The lateral femoral epicondyle is often used as a reference point for positioning of the ALL graft and can be located by palpation or with ultrasound guidance. Purpose: To compare the ALL graft positioning on the femoral side between an ultrasound-guided technique and a palpation technique for the location of the lateral epicondyle. Study Design: Cohort study; Level of evidence, 2. Methods: A total of 120 patients receiving a primary combined ACL and ALL reconstruction between June and December 2019 were included. The location of the lateral epicondyle was determined by palpation in the palpation group (n = 60) and with preoperative ultrasound guidance in the ultrasound group (n = 60). Groups were comparable in age, sex, body mass index (BMI), and operated side. The planned positioning of the femoral ALL graft was proximal and posterior to the lateral epicondyle. The effective positioning of the femoral ALL graft was evaluated on postoperative lateral radiographs. The primary outcome was location of the graft in a 10-mm quadrant posterior and proximal to the lateral epicondyle. Results were analyzed in 2 subgroups according to BMI. Results: All 60 anterolateral grafts (100%) in the ultrasound group were positioned in a 10-mm quadrant posterior and proximal to the lateral epicondyle, as opposed to 52 (87%) in the palpation group (P = .006). Errors in graft positioning with palpation occurred in overweight patients (BMI >25) as well as nonoverweight patients (P = .3). Conclusion: Femoral positioning of the ALL graft posterior and proximal to the lateral epicondyle is more reproducible with ultrasound guidance when compared with palpation alone, regardless of BMI.

A randomized trial to investigate needle redirections/re-insertions using a handheld ultrasound device versus traditional palpation for spinal anesthesia in obese women undergoing cesarean delivery

BackgroundUltrasound may be useful to identify the spinal anesthesia insertion point, particularly when landmarks are not palpable. We tested the hypothesis that the number of needle redirections/re-insertions is lower when using a handheld ultrasound device compared with palpation in obese women undergoing spinal anesthesia for cesarean delivery. MethodsStudy recruits were obese (body mass index (BMI) >30 kg/m2) women with impalpable bony landmarks who were undergoing spinal anesthesia for elective cesarean delivery. Women were randomized to ultrasound or palpation. The primary study outcome was a composite between-group comparison of total number of needle redirections (any withdrawal and re-advancement of the needle and/or introducer within the intervertebral space) or re-insertions (any new skin puncture in the same or different intervertebral space) per patient. Secondary outcomes included insertion site identification time and patient verbal numerical pain score (0–10) for comfort during surgical skin incision. ResultsForty women completed the study. The mean BMI (standard deviation) for the ultrasound group was 39.8 (5.5) kg/m2 and for the palpation group 37.3 (5.2) kg/m2. There was no difference in the composite primary outcome (median (interquartile range) [range]) between the ultrasound group (4 (2–13) [2–22]) and the palpation group (6 (4–10) [1–17]) (P=0.22), with the 95% confidence interval of the difference 2 (−1.7 to 5.7). There were no differences in the secondary outcomes. ConclusionsHandheld ultrasound did not demonstrate any advantages over traditional palpation techniques for spinal anesthesia in an obese population undergoing cesarean delivery, although the study was underpowered to show a difference.

EVALUATION OF PREDICTORS FOR DIFFICULT LUMBAR NEUROAXIAL BLOCK BY USING ULTRASONOGRAPHY

Introduction: The neuraxial block, whether spinal or epidural, is commonly used as an anesthetic technique for the performance of surgeries or the treatment of chronic pain. In studies carried out, described by authors such as Kallidaikurichi et al and Grau et al, it has been shown that even experienced anesthesiologists are able to find the adequate intervertebral space in only 29% of patients who undergo this type of anesthetic procedure. Objectives: To determine the association of ultrasonographic parameters with the technical difficulty of lumbar neuraxial block, in patients undergoing elective surgery. Take ultrasound measurements that include the distance between the skin and the spinous process of L1, L2, L3, L4 and L5. To determine whether the presence of the yellow ligament and / or the posterior longitudinal ligament could be visualized by ultrasound. Assess whether there was concordance between the level determined by the palpation technique of anatomical landmarks and the ultrasound examination. Classify the level of difficulty of the neuraxial block based on the number of punctures, as well as the number of redirections of the needle during blocking. Method: This study included 45 electronic records of patients who underwent elective surgery at the Naval Medical Center in a period from May 2019 to May 2020 and whose anesthesia technique included Lumbar Neuroaxial Block and who also underwent a ultrasonographic tracking for the collection of anatomical data. Results: The results obtained in the analysis of these were not significant for the general objective of our study, however they helped us to conclude that the space referred by anesthesiologists and the one actually approached agrees only in 68.9%. Conclusions: Performing ultrasonography prior to performing BNA can improve its performance.

Preprocedure ultrasound imaging combined with palpation technique in epidural labor analgesia.

BACKGROUNDFor parturients with paroxysmal uterine contraction pain, rapid analgesia is needed. We used preprocedure ultrasound imaging combined with the palpation technique in epidural analgesia for labor, and evaluated the usefulness of this technique in epidural labor analgesia.AIMTo evaluate the usefulness of preprocedure ultrasound imaging in epidural analgesia for labor.METHODSIn this prospective randomized observational study, 72 parturients were assigned to two groups (combined or palpation group). The target interspace of all parturients was first identified by the palpation technique. Then in the combined group, preprocedure ultrasound imaging was used before epidural puncture. In the palpation group, only the traditional anatomical landmarks technique (palpation technique) was performed. The primary outcome was total duration of the epidural procedure (for the ultrasound group, the duration of the preprocedure ultrasound imaging was included). The secondary outcomes were the number of skin punctures, the success rate at first needle pass, the number of needle passes, the depth from the skin to epidural space, and the complications of the procedure.RESULTSTotal duration of the epidural procedure was similar between the two groups (406.5 ± 92.15 s in the combined group and 380.03 ± 128.2 s in the palpation group; P = 0.318). A significant improvement was demonstrated for epidural puncture and catheterization in the combined group. The number of needle passes was 1.14 in the combined group and 1.72 in the palpation group (P = 0.001). The number of skin puncture sites was 1.20 in the combined group and 1.25 in the palpation group (P = 0.398). The success rate at first needle pass was 88.89% in the combined group and 66.67% in the palpation group (P = 0.045).CONCLUSIONThis study demonstrated that the total duration of epidural procedures with preprocedure ultrasound imaging combined with the palpation technique was not longer than the traditional anatomical landmarks technique, which were performed by six experienced anesthesiologists in parturients with normal weights undergoing labor analgesia.

Temporomandibular Myofascial Pain Syndrome-Aetiology and Biopsychosocial Modulation. A Narrative Review.

This review elaborates on the aetiology, diagnosis, and treatment of temporomandibular (TMD) myofascial pain syndrome (MPS) regulated by psychosocial factors. MPS impairs functioning in society due to the accompanying pain. Directed and self-directed biopsychosocial profile modulation may be beneficial in the treatment of MPS. Moreover, nutrition is also a considerable part of musculoskeletal system health. A fruit and vegetable diet contributes to a reduction in chronic pain intensity because of its anti-inflammatory influence. Cannabidiol (CBD) oils may also be used in the treatment as they reduce stress and anxiety. A promising alternative treatment may be craniosacral therapy which uses gentle fascia palpation techniques to decrease sympathetic arousal by regulating body rhythms and release fascial restrictions between the cranium and sacrum. MPS is affected by the combined action of the limbic, autonomic, endocrine, somatic, nociceptive, and immune systems. Therefore, the treatment of MPS should be deliberated holistically as it is a complex disorder.