Spinal Anesthesia Research Articles

Evaluating the safety and efficacy of repeated spinal anesthesia in multiple lower extremity surgeries: a case series of four patients.

Evaluating the safety and efficacy of repeated spinal anesthesia in multiple lower extremity surgeries: a case series of four patients.

Comparative Study between Colloid versus Crystalloid Solutions during Spinal Anesthesia for Elective Cesarean Section

Comparative Study between Colloid versus Crystalloid Solutions during Spinal Anesthesia for Elective Cesarean Section

Comparison of nerve block and spinal anesthesia in second toe pulp free flap surgery for fingertip reconstruction.

Toe pulp flap surgery is a viable option for soft tissue defects of the fingertips, effectively addressing patient needs and fingertip characteristics. The preferred anesthesia for lower-extremity surgery includes spinal and regional anesthesia. However, the choice between these methods depends on patient safety and surgical efficacy. In this retrospective study, we aimed to ascertain the optimal anesthetic technique by examining the efficacy, safety, pain control, and potential side effects of spinal and peripheral nerve block anesthetics. We included 40 patients aged 18-60 years who underwent partial second toe pulp free flap surgery for fingertip reconstruction. Twenty patients received spinal anesthesia (SA), while the remaining 20 received peripheral nerve block anesthesia. We conducted a comparative analysis of postoperative pain scores, adverse effects, analgesic usage, and patient satisfaction scores associated with each anesthesia method. Independent t-test, Mann-Whitney U test, and chi-squared test were performed. The SA group exhibited hypotension, bradycardia, urinary retention, and postdural puncture headache rates of 10%, 10%, 5%, and 5%, respectively. A significant difference in the timing of first analgesic use was observed (spinal, 3.7 ± 0.8 vs. peripheral nerve block, 13.2 ± 6.6; P = 0.006). Visual analog scale (VAS) scores of the patients at the 2nd, 4th, and 6th h were significantly lower in the peripheral nerve block group (P < 0.001, P < 0.001, P < 0.001, respectively). VAS scores at 12 and 24 h were similar between the groups (P = 0.07, P = 0.135, respectively). Peripheral nerve block anesthesia is superior to SA for partial second toe pulp free flap surgery, offering lower complication rates, reduced postoperative pain, and improved patient comfort.

Efficiency of dexamethasone in reducing the incidence of headaches after spinal anesthesia during caesarean section

Background. A caesarean section is the delivery of a fetus through an abdominal incision (laparotomy) and a uterine incision (hysterectomy). The anesthesia method most often used for caesarean birth is spinal anesthesia, the prevailing complication of spinal anesthesia (SA) is post-dural puncture headache. Aims of the study. To investigate the effects of dexamethasone in reducing the incidence of headache and pain in spinal anesthesia in caesarean section. Subjects and methods. Clinical trial was conducted at Basra Maternity and Children Hospital from January 1, 2022 to July 1, 2023. The studied population was divided into two groups: Group I included 98 patients who received intravenous dexamethasone 0.2 mg/kg (maximum 16 mg) just after the spinal anesthesia, and Group II, the control group, which included 100 patients who received IV normal saline prior to spinal anesthesia. The average severity of headache was evaluated using the visual analogue scale (VAS) after recovery within the first hour, 24 hours, 48 hours, and 1 week. Results. Dexamethasone usage significantly reduced postoperative pain (no pain: 89.7% vs. 68.0%), with a p-value equal to 0.001. No notable differences were found in sociodemographic characteristics, PDPH incidence (recovery time: 8.1% vs. 9.0%, 24 hours: 10.2% vs. 9.0%, 48 hours: 4.08% vs. 5.0%, one week: 0.0% vs. 0.0%). Conclusion. Dexamethasone given intravenously had no discernible effect on headaches following a spinal puncture. It dramatically lowers pain after surgery, but it has no discernible impact on bradycardia, nausea or vomiting, shivering, or postoperative hypotension.

Palliative Radiation Treatment in Patients Managed With Advanced/Interventional Pain Therapy such as Pump-delivered Continuous Opioids.

The study aim was to analyze the feasibility and efficacy of palliative radiotherapy in patients receiving advanced/interventional pain therapy, such as epidural or spinal anesthesia or subcutaneous pump delivery of opioids. Endpoints such as pain relief, treatment in the last month of life and survival were evaluated. Different baseline parameters including but not limited to age and Eastern Cooperative Oncology Group performance status (ECOG PS) were assessed. Outcomes were abstracted from electronic health records. The Edmonton Symptom Assessment System (ESAS) was utilized to score pain intensity. The study included 48 patients, 44 of whom completed radiotherapy as prescribed. Device malfunction was not observed. Overall, 31 patients (65%) had journal notes available allowing for evaluation of pain relief. Twenty-six of 31 experienced pain relief (54% in the intention-to-treat population of 48 study patients). Twelve patients (25%) stopped interventional pain therapy and were converted to transdermal or oral drugs. Median survival was 1.6 months. Forty-four percent had received radiotherapy during the last month of life. Sixty-four percent of patients with ECOG PS 3-4 had received radiotherapy during the last month of life, compared to 22% of those with ECOG PS <3, p=0.004. Palliative radiotherapy was feasible in this setting, but given the short median survival and high likelihood of treatment during the last month of life, patient selection and choice of fractionation regimen should be optimized. The record review identified several patients who experienced worthwhile pain relief, sometimes leading to conversion of pain therapy back to non-invasive oral or transdermal application.

LIMBERG FLAP FOR SACROCOCCYGEAL PILONIDAL SINUS: A SAFE AND PROMISING SURGERY

Introduction:Sacrococcygeal pilonidal sinus is a common disease of the adult age group, especially male population, causing significant morbidity from both disease and surgery done for the same. It is essentially a cleavage between the buttocks (i.e., natal cleft), and diagnosis is made by identifying the epithelialized follicle opening (i.e., sinus). The name PILONIDAL is taken from Latin meaning nest of hairs. The estimated incidence is 26 per 1,00,000 people1. It generally presents as a cyst, abscess, or sinus tract with or without discharge2. Men affected more often than women1, rare both before puberty and after the age of 40 years3. The etiology of the pilonidal sinus is a matter of controversy. Aims &amp; Objectives:Literature study showed that Limberg flap reconstruction following rhomboid excision of the sinus area was superior to primary closure and other flap procedures and a safe and reliable method in sacrococcygeal pilonidal sinus disease with low complication and recurrence rates. Hence, this study was performed in our setup to evaluate the usefulness of Limberg flap procedure in sacrococcygeal pilonidal sinus, patient compliance, complications and long-term recurrence rates following the procedure. Materials &amp; Methods:The study involves 22 patients, from May 2022 to September 2023. Most of the patients were males of those 4 were females. Average age was 24 years—the oldest was 29 years and the youngest was 15 years. Results:In this study 22 patients were included. Among them 18 were males and 4 were females. Mean age was 24 years (range 15–29 years). Of the 22 patients, 14 had primary disease, 6 had recurrent disease, and 2 came up after having previous incision and drainage for abscess. All patients came with pilonidal sinus, from May 2022, were assessed for its severity and investigated, and then they underwent Limberg flap surgery under spinal anesthesia. Discussion:Sacrococcygeal pilonidal sinus is blind epithelial tract situated in the skin of the natal cleft, close to anal verge, generally containing hair. The etiology is matter of debate initially congenital origin was thought of which is now given up. Main causes for the formation of this sinus are hirsutism, sweating in the area, repeated maceration due to trauma, leading to breakage of the skin barrier, attracting hair inside which initiates a foreign body reaction leading to infection with abscess or sinus formation. Conclusion:Sacrococcygeal pilonidal sinus is headache to both the patient and the treating surgeon because of its repeated infection, persistent pain with discharge, and high recurrence rates with regular procedures.

Feasibility, Safety, and Efficacy of Segmental Spinal Anesthesia with Predominantly Isobaric Levobupivacaine: A Tertiary Care Hospital Study

Objective: To assess feasibility, safety, and efficacy of segmental spinal anesthesia with isobaric levobupivacaine in patients undergoing various abdominal and lower limb surgeries. Methods: This was a prospective cohort study conducted at the department of anesthesiology and critical care of Kota heart institute and group of hospitals in India. The study involved 100 patients undergoing various abdominal and lower limb surgeries under segmental spinal anesthesia (SSA). Isobaric levobupivacaine 0.5% with fentanyl 20-25 μg or dexmedetomidine 5-10 as adjuvant or hypobaric levobupivacaine 0.167% was injected in intervertebral space depending on the surgery. Hemodynamic parameters, postoperative pain level, and adverse effects were analyzed with a p-value less than 0.05 was considered statistically significant.Results: An overall male predominance was observed with a 1:0.515 male-to-female ratio. The most affected age group was 41-50 years (37%), with a mean age of 44.51 ± 11.72 years. ASA classification indicated 34% of patients in ASA I, 40% in ASA II, 24% ASA III and 2% in ASA IV . The primary surgery was laparoscopic cholecystectomy (26%) in normal risk group and orthopedic in high-risk group(20%). Postoperative pain assessment showed mean VAS scores ranging from 1.92 to 3.42 at different time intervals. Common adverse effects were hemodynamic instability (13%), shoulder tip pain (33%), PONV (3%), headache (6%), pruritis (2%) and urinary retention (1%). The hemodynamic instability showed less incidence in ASA III/IV category.Conclusion: Segmental spinal anesthesia can be used successfully for abdominal and lower limb orthopedic surgeries in patients of ASA I to ASA IV.

Regional anaesthetic techniques in 14 Slovenian obstetric units between 2013 and 2021: where are we and where are we going?

Background: The use of regional anaesthetic techniques for caesarean section and labour analgesia is necessary for quality-driven obstetric anaesthesia as required by European minimum standards for obstetric analgesia and anaesthesia departments, which were issued by the European Society of Anaesthesiology and Intensive Therapy in 2020. The aim of this article is to evaluate the rate of caesarean sections performed using regional anaesthetic techniques and the rates of epidural, remifentanil-PCA, and meperidine analgesia for managing labour pain across the 14 Slovenian obstetric units, respectively. Methods: Data from the Slovenian National Perinatal Information System (NPIS) from 2013 to 2021 were analysed. Results: Spinal anaesthesia was used as a primary anaesthetic method (&gt; 50% of elective caesarean sections) in a half of Slovenian obstetric units. For emergency caesarean sections, regional anaesthetic methods (spinal and epidural) were used in &gt; 50% parturients in 3 obstetric units. Eight obstetric units had an epidural rate of &gt;10%. The use of epidural analgesia has progressively increased in 9 of 14 obstetric units. Remifentanil has been routinely used in 6 obstetric units. Accordingly, the consumption of meperidine has dropped in all but one obstetric unit in Slovenia. Conclusion: In the past decade, considerable progress has been observed in obstetric anaesthesia practice in Slovenia. This is evident from the increased use of regional anaesthesia for caesarean section and labour analgesia. However, there are considerable discrepancies in anaesthetic practices between different obstetric units in Slovenia, a situation the parturients should be informed of well in advance to be able to choose the obstetric unit according to their labour and delivery preferences. In order to avoid the differences in the quality and accessibility of anaesthetic practice between units, it is necessary to increase the number of anaesthesiologists involved in obstetric anaesthesia to ensure 24/7 service of labour analgesia to be able to fulfill minimum European standards for obstetric analgesia and anaesthesia departments.

Comparison of Fractionated Dose Versus Bolus Dose of Bupivacaine Hyperbaric (0.5%) with Buprenorphine in Spinal Anaesthesia for Lower Limb Surgeries

Comparison of Fractionated Dose Versus Bolus Dose of Bupivacaine Hyperbaric (0.5%) with Buprenorphine in Spinal Anaesthesia for Lower Limb Surgeries

A Comparative Study of Infusion of Ephedrine and Phenylephrine on Hemodynamic Stability After Spinal Anesthesia in Elderly Patients Undergoing Lower Limb Orthopedic Surgeries.

Background Hypotension during spinal anesthesia occurs due to sympathetic nervous system blockade, resulting in decreased systemic vascular resistance and reduced cardiac output. Due to reduced sympathetic tone, peripheral arterial vasodilatation and blood pooling in lower limbs due to venodilatation occur, reducing preload to the heart and stroke volume. The elderly patients have reduced cardiovascular compensatory mechanisms, increasing the frequency and severity of hypotension due to sympathetic blockade after spinal anesthesia significantly. Vasopressors correct hypotension during the intraoperative period to maintain organ perfusion. Fluids can be administered, and if given excessively, can cause fluid overload and urinary retention. This study aimed to compare the effectiveness of vasopressors, phenylephrine, and ephedrine in maintaining hemodynamic stability intraoperatively through prophylactic infusion after spinal anesthesia in elderly patients for lower limb orthopedic surgeries. Methodology A total of 174 elderly patients aged 60 years and above with American Society of Anesthesiologists (ASA) Classification I and II, undergoing lower limb orthopedic surgeries, enrolled in a randomized comparative study, were allocated into three groups: Group P (phenylephrine, n=58) received 250 mcg phenylephrine in 30 ml normal saline using infusion syringe pump, Group E (ephedrine, n=58) received 30 mg ephedrine in 30 ml normal saline using infusion syringe pump, and Group C (control group, n=58) received mephentermine I/V (6 mg bolus) when the fall in blood pressure was below 30% of baseline without any placebo infusion. Hemodynamic parameters (systolic and diastolic blood pressure, mean arterial pressure (MAP), heart rate) at 15, 10, and 5-minute intervals before spinal anesthesia, and at 3, 6, 9, 12, 15, 20, 25, and 30-minute intervals after spinal anesthesia. The need for rescue doses to treat hypotension after spinal anesthesia was recorded. Result At all time intervals following spinal anesthesia, Group E reported heart rate and systolic blood pressure better than Groups P and C, significantly. At 3, 6, 9, 12, 15, and 25-minute intervals following spinal anesthesia, the diastolic blood pressure in Group E was enhanced significantlythan Groups P and C. The MAP in Group E was substantially higher than in other groups at 3, 6, 15, and 20-minute intervals following spinal anesthesia, which was statistically significant. Compared to Groups P and C, Group E required lesser rescue doses to treat intraoperative fall in hypotension 30% below baseline and lesser events of bradycardia. Conclusion Following spinal anesthesia, the preload to the heart is to be maintained with intravenous (crystalloid or colloidal) solutions to maintain cardiac output adequately. Intraoperative use of phenylephrine and ephedrine as a low-dose prophylactic infusion can be used, as it increases both systemic vascular resistance and preload without cardiac stimulation along with intravenous solutions to maintain hemodynamic parameters such as systolic and diastolic blood pressure, MAP, heart rate effectively but preferably ephedrine in elderly patients.

Comparison of ultrasound-guided continuous erector spinae plane block versus continuous paravertebral block for postoperative analgesia in patients undergoing proximal femur surgeries.

Proximal femur fracture surgeries have become increasingly prevalent, presenting unique challenges for postoperative pain management due to patient demographics and comorbidities. Erector spinae plane block (ESPB) has emerged as a relatively safe alternative to paravertebral block (PVB). Our aim was to compare ultrasound-guided continuous ESPB with continuous PVB for postoperative analgesia in patients undergoing proximal femur surgeries under spinal anesthesia. A prospective randomized interventional study was conducted on 60 patients between 18 and 60 years of age undergoing proximal femur surgeries under spinal anesthesia with American Society of Anesthesiologists physical status I and II between January 2019 and April 2020. Patients were randomly assigned to receive either ultrasound-guided continuous ESPB (Group E, n = 30) or ultrasound-guided continuous PVB (Group P, n = 30) using a computer-generated randomization table. The mean maximum visual analog scale (VAS) score, VAS score in the first 24 h, the time of rescue analgesia, and total requirement of rescue analgesia were assessed. The maximum VAS score within the first 24 h was numerically higher in Group P but statistically insignificant (p-value 0.279). VAS scores at 0, 1, 2, 6, and 18 h postoperatively were comparable in both groups. However, at the 24-h mark, the VAS score between Group E and Group P was statistically significant (p-value 0.018) but not clinically relevant. The mean paracetamol and tramadol requirements were comparable between the two groups. Continuous ESPB is as effective as continuous PVB for postoperative analgesia in proximal femur surgeries. The enhanced safety profile of erector spinae block underscores its significance in postoperative pain management.

Comparison of Dexmedetomidine and Midazolam for Preoperative Sedation in Patient Under Going Surgeries Under Spinal Anaesthesia

Preoperative anxiety is a frequent condition. Generally, it starts two days before the operation and reaches its peak just prior to induction of anesthesia. Anxiety, stress, and fear that arise just before the operation and anesthesia may lead to psychological trauma and increase the levels of stress hormones, resulting in undesirable metabolic responses before anesthesia. In our study primary objective was to compare the effectiveness of dexmedetomidine and midazolam with control group in preoperative sedation prior to surgical procedures. Considering the sample size and methodology of the seed article a sample size of 207 was obtained This prospective, hospital based, comparative study was conducted in Department of Anesthesia, Mahatma Gandhi Medical College &amp; Hospital, Jaipur over a period from March 2023 to august 2024. Group C was control, Group D was dexmedetomidine, and Group M was the midazolam group. Patients of Group C were given 100 ml of physiological saline over 10 min. patients of Group D were given 0.25 µg/kg dexmedetomidine in 100 ml physiological saline over 10 min. Group M were given 0.03 mg/kg midazolam in 100 ml physiological saline over 10 min. Group D (dexmedetomidine group) has significantly lower bromage score, Anxiety, and VAS scores, demonstrating better overall recovery, reduced anxiety, and less pain as compare to other two group. Also group D patient show better stabilization of vital parameter.

Left ventricular end-diastolic pressure response to spinal anaesthesia in euvolaemic vascular surgery patients

Left ventricular end-diastolic pressure response to spinal anaesthesia in euvolaemic vascular surgery patients

Low-Dose Opioid Spinal Analgesia during Cesarean Section at the Commune 1 Reference Health Center of Bamako

The need to provide maternal comfort and facilitate rapid recovery during caesarean section requires pain management. The aim of our study of low-dose morphine spinal analgesia during caesarean section was to evaluate its effectiveness during and after the operation. Methodology: We conducted a prospective, descriptive, cross-sectional study lasting 6 months from 1 July to 31 December 2023. It involved 101 Caesarean women undergoing spinal analgesia, selected by random sampling at the reference health centre in Commune I of the Bamako district. Results: The mean age of the patients was 27 ±1.51 years, with ASA I classification in 63.4%. The combination of bupivacaine 10 mg and morphine 0.1 mg was used in 68.3% of cases. The mean duration of motor block release was 2.78 ± 0.7 hours. The manifestation of pain (VAS=0) was 100% at H1 (first hour), with peaks of VAS [1,3] in 42.57% and VAS [4,6] in 6.97% at H4 (fourth hour). Arterial hypotension was found in 57% of cases. From H12 onwards, all the women were very satisfied. Conclusion: The efficacy of morphine spinal analgesia during caesarean section has been proven in all our parturients from H12 (twelfth hour). However, pain management in the first few hours must be started with a well-adapted protocol.

Evaluation of perfusion index to predict hypotension in lower segment caesarean section under spinal anaesthesia

Background: Spinal Anaesthesia is the most popular choice for elective caesarean section. Both general anaesthesia and regional anaesthesia are acceptable techniques for anaesthesia for elective and emergency caesarean sections. Objectives: The study aimed to investigate the role of the perfusion index in predicting the incidence of hypotension following spinal anaesthesia in parturients undergoing elective lower segment caesarean sections. Methods: A prospective, observational study was carried out among sixty parturients posted for elective caesarean section. The study was conducted in the operation theatres of Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi. About 60 participants were interviewed for the study. Data were entered and analysed with the help of the Statistical Package for Social Science (SPSS) version.16. Results: Sixty eligible ASAI (American society of anaesthesiologist’s physical status classification) parturients scheduled for elective caesarean section were divided into two groups pre-operatively after determining their baseline Perfusion Index (PI) as those with PI ≤ 3.5 and those with PI &gt; 3.5 using a Masimo® pulse oximeter probe. When comparing the heart rate at time intervals among the two groups, it became increasingly clear that those with baseline PI &gt; 3.5 had generally higher heart rate especially immediately after the block and at 2nd, 4th, 6th,8th, 10th, 12th, 14th and 20th minutes. Conclusion: The study concludes that a Perfusion Index &gt; 3.5 is associated with a higher incidence of hypotension in lower segment caesarean section under spinal anaesthesia. The hemodynamic parameters such as increased heart rate and significantly lower systolic, diastolic and mean arterial pressures in parturients with baseline PI &gt; 3.5 suggest that these patients have lower baseline SVR and depleted autonomic resilience to hypotension compared to those with baseline PI ≤ 3.5. High BMI seems to be significantly associated with high baseline PI.

Comparison of Duration of Action in Spinal Anesthesia of 0.5% Bupivacaine and 0.5% Bupivacaine with Dexmedetomidine

Background: Spinal anesthesia is a common technique for surgeries below the navel, utilizing bupivacaine, a local anesthetic. Adding adjuncts like dexmedetomidine may enhance the efficacy and duration of the block.Objective: To compare the duration of action of 0.5% bupivacaine versus 0.5% bupivacaine with dexmedetomidine in spinal anesthesia.Methods: This quasi-experimental trial included 60 patients aged 20-60 years, ASA grade 1 or 2, undergoing general, plastic, orthopedic, or urological surgery at CMH Karachi. Patients were non-randomly assigned to Group B (0.5% bupivacaine, n=30) or Group BD (0.5% bupivacaine plus 5 mcg dexmedetomidine, n=30). Onset and duration of sensory and motor blocks, duration of analgesia, and adverse effects were recorded. Data were analyzed using SPSS version 25, with a p-value ≤ 0.05 considered significant.Results: Group BD showed faster onset of sensory block (7.08 ± 0.54 mins vs. 13.48 ± 0.73 mins, p &lt; 0.001) and motor block (10.32 ± 0.91 mins vs. 17.55 ± 0.69 mins, p &lt; 0.001). Duration of motor block was longer in Group BD (284.06 ± 5.64 mins vs. 133.93 ± 5.72 mins, p &lt; 0.001), as was duration of analgesia (218.07 ± 4.86 mins vs. 125.36 ± 5.42 mins, p &lt; 0.001).Conclusion: The addition of dexmedetomidine to 0.5% bupivacaine significantly enhances the onset and duration of spinal anesthesia with a comparable safety profile.

Surgical abortion service reorganization in response to the COVID-19 pandemic: a unique experience of attending second trimester D&E procedures under spinal anesthesia as emergency procedures.

The COVID-19 pandemic created a massive shift in how health care systems interact with COVID testing for patients. To avoid delay in accessing second trimester surgical abortion at our hospital (St. Paul's Hospital Millennium Medical College) during this pandemic, dilation and evacuation (D&E) procedures were attended as emergency cases, instead of as elective surgical procedures, which then required adherence to the universal preoperative COVID-19 testing protocol. This study aimed at documenting the experience of this unique abortion service adjustment in response to the COVID-19 pandemic. This was a retrospective descriptive study conducted at St. Paul's Hospital Millennium Medical College (SPHMMC) in Addis Ababa, Ethiopia, from April 1, 2021 to July 31, 2021. We reviewed second trimester surgical abortion cases managed with D& E procedures, performed under spinal anesthesia using the emergency COVID-19 pre-operative testing protocol. Data were analyzed using SPSS version 23 and simple descriptive statistics were applied. Percentages and proportions were used to present the results. Nineteen cases of second trimester D&E cases were reviewed. The median gestational age of the abortion clients was 21.57 weeks. Eight of 19 cases had cervical preparation with overnight intra-cervical Foley catheter placement while the rest 11 (57.9%) cases had their cervical preparation with Laminaria. The median time interval from initial evaluation of the abortion client to time of doing D& E procedure was 21.83 h. Surgical abortion service reorganization enabled abortion clients to access dilation and evacuation procedures within 24 h of their initial presentation. This prevented significant delays in accessing abortion care that could otherwise have occurred as a result of adhering to the preoperative COVID-19 testing protocols applied to elective surgeries.

Effect of anexiolytic dose of medazolam on Incidence of intraoperative nausea and vomiting during spinal cesarean section

Opioids have sedative properties and can lessen intraoperative nausea and vomiting (IONV), even if they may cause nausea and vomiting. The current work was aimed to evaluate the effect of anxiolytic dose of midazolam on Incidence of intraoperative nausea and vomiting during spinal cesarean section. The study was conducted from October 2023 to April 2024 with approval from the research and ethics committees of the university. once an informed consent form has been signed, full-term (90) pregnant participants were included, and scheduled for cesarean section (CS) under spinal anesthesia at Al-Shifa Private Hospital in Baqubah, Diyala. Data from all participants were analyzed. demographic data was non-significant (P≤0.05) variance in the experimental group compared with the control group. The mean blood pressure in both groups, as it was measured every 10 minutes, starting from 0 to 40 minutes of the operation, and there were no significant (P≤0.05) variance between the two groups. The findings showed that the 27 (60%) cases of Nausea and vomiting in the control group, which revealed a significant (P≤0.05) variance compared with the medazolam group, if the number of cases was 8 (17.8%). We conclude that the incidence of intraoperative nausea and vomiting during cesarean sections performed under spinal anesthesia is significantly influenced by the dosage of anxiolytic drugs.

Validation of a novel medical device (Chloe SED®) for the administration of analgesia during manual vacuum aspiration: a randomized controlled non-inferiority pilot study.

Millions of women worldwide annually undergo manual vacuum aspiration (MVA) with no pain medication, which is a violation of their basic human dignity. We designed a novel device (Chloe SED®) to administer paracervical block (PCB) during MVA in countries where pain medication is not typically given due to the high cost of the necessary tools. We conducted a single-blinded, randomized controlled non-inferiority trial including 61 patients at two hospitals in Kisumu, Kenya, to validate Chloe SED® for administration of PCB during MVA. PCB administered with Chloe SED® was compared to PCB administered with a standard spinal needle. Patients requiring MVA were block randomized in blocks of six, each provider completing six PCBs-three with the Chloe SED® and three with the standard spinal needle. The trial was registered with the Kenya Pharmacy and Poisons Board, ECCT/19/03/01 (https://ctr.pharmacyboardkenya.org/applications/index/protocol_no:RUNDVC8xOS8wMy8wMQ__/filter:/investigator:/sites:/pages:5/start_date:/end_date:/disease_condition:/users:/ercs:/stages). An intention-to-treat analysis was completed. The primary outcome was the non-inferiority of the pain score during uterine evacuation with a non-inferiority margin of 2 points on an 11-point numerical rating scale. Secondary outcomes included the non-inferiority of the pain score at four other time points and patient satisfaction. Chloe SED® showed non-inferiority of the primary outcome with a mean pain score during evacuation of 3.8 [90% confidence interval (CI): 3.1-4.6] compared with the spinal needle at 4.1 (90% CI: 3.5-4.7). Non-inferiority of the pain score was shown at all time points. Most patients expressed a desire for the continued use of the device to administer PCB for MVA. No adverse events were noted. In summary, the Chloe SED® appears non-inferior to the spinal needle and desirable for the administration of PCB during MVA.

Clinical application of ultrasound in thoracic medial branch block and thoracic cooled-radiofrequency ablation: Case report and literature review

Introduction: Radiofrequency ablation is a procedure used to alleviate pain by destroying nerves with by radiofrequency-generated heat. Traditionally, radiofrequency ablation is preceded by diagnostic medial branch block injections, both guided by fluoroscopy. Fluoroscopic visualization of the superolateral aspect of the thoracic transverse process, where thoracic medial branch nerves occur, can be challenging due to anatomical complexities, especially in obese patients. We present a novel technique in which ultrasound was utilized in conjunction with fluoroscopy to perform medial branch block and radiofrequency ablation of the thoracic medial branch nerves. Case Report: First, two diagnostic thoracic medial branch nerve blocks were performed under ultrasound guidance. For the subsequent radiofrequency ablation, spinal needles were first advanced under ultrasound guidance to the target thoracic medial branch nerves. The position of those spinal needles was then used to guide the placement of cooled radiofrequency ablation probes using fluoroscopy. The patient reported 100% pain relief following the procedures. Discussion: We found that the addition of ultrasound allowed us to overcome the challenge of visualizing the superolateral aspect of thoracic transverse process under fluoroscopy alone. Direct ultrasound visualization allowed us to accurately and safely perform a thoracic medial branch block and radiofrequency ablation in a patient with poor fluoroscopic anatomy, as demonstrated by the patient’s complete pain relief after both medial branch block and radiofrequency ablation. We also theorize that our novel technique allows the provider to directly visualize the pleura, which could reduce the risk of severe pneumothorax associated with thoracic medial branch block and cooled radiofrequency ablation.