Unilateral Block Research Articles

Combined psoas compartment block and sciatic nerve block versus unilateral subarachnoid block as a sole anaesthetic technique for lower limb orthopaedic surgery – A prospective randomised controlled study

: Nerve block as a part on regional anaesthesia extends analgesia time and gives better haemodynamic stability, so comparison of nerve block like psoas compartment block and sciatic nerve block with spinal anaesthesia is our main aim of study. Total 96 patients of tibial surgeries with any gender of ASA grade I, II and III were assigned and randomly divided into two groups:- group P- psoas compartment block plus sciatic nerve block and group S-unilateral subarachnoid block. Parameters compared were onset, peak effect and duration of sensory and motor blockage, haemodynamic parameters, postoperative duration of analgesia and requirement of rescue analgesics post-operatively. Onset of motor and sensory block were faster in group S than group P. There was no significant difference in haemodynamic parameters in both the group. Duration of analgesia in group P was 16.79 ±2.3 hours as compared to group S was 5.57 ±0.49 hours, which was highly significant. Number of rescue analgesic required was significantly less in group P(1.10 ± 0.30) as compared to group S (3.04 ± 0.20) without significant complications in both the groups.Combined psoas compartment block with sciatic nerve block provides prolonged duration of analgesia over subarachnoid block and less numbers of rescue analgesics required postoperatively with good haemodynamic stability.

Ultrasound-Guided Quadratus Lumborum Block Versus Caudal Block for Pain Relief in Children Undergoing Lower Abdominal Surgeries: A Randomized, Double-Blind Comparative Study.

The quadratus lumborum (QL) block, also known as the abdominal truncal block, was developed to provide visceral and somatic analgesia during abdominal procedures. This study aimed to assess pain alleviation, the incidence of complications in lower abdominal procedures, and hemodynamic stability between the caudal block and ultrasound-guided QL block. Fifty-two patients aged 1 to 7 years old from both genders scheduled for unilateral lower abdominal surgery were randomly assigned to 2 study groups: group QL, unilateral QL block (n = 26), and group C, caudal block (n = 26). In group C, children received caudal block. In group QL, an ultrasound-guided QL block was performed. The time to first rescue analgesia was evaluated as a primary outcome. The quality of analgesia was determined using the face, legs, activity, cry, consolability scale (FLACC scale), hemodynamic parameters, and incidence of complications because hemodynamic instability was recorded under ultrasound guidance. Signs of local anesthetics toxicity and the parents' satisfaction were secondary outcomes. The time until the first demand for analgesia postoperatively was statistically longer in group QL compared to group C. A non-significant difference was observed between the 2 groups (P > 0.05) regarding age, weight, gender, duration of surgery, type of surgery, FLACC scale, and hemodynamics (SBP, systolic blood pressure), except at 30 minutes, which was significant in QL block. Also, a non-significant difference was observed in the severity of postoperative pain up to 1 day postoperatively. Group QL showed more satisfaction than group C. No intraoperative complications were detected. Compared to caudal block, QL block produced sustained and adequate analgesia time postoperatively, with higher satisfaction.

Can ultrasound-guided erector spinae plane block replace thoracic epidural analgesia for postoperative analgesia in pediatric patients undergoing thoracotomy? A prospective randomized controlled trial.

Many analgesic modalities have been investigated in pediatrics for thoracotomy. We studied the analgesic efficacy of unilateral continuous ultrasound-guided erector spinae plane block (ESPB) compared to a thoracic epidural in pediatric patients undergoing thoracotomy. A prospective, randomized, observer-blinded, controlled study. Pediatric patients (2-7 years) scheduled for right or left thoracotomy under general anesthesia (GA) were enrolled in the study. We randomly assigned patients into two groups: The thoracic epidural analgesia (TEA) group received GA with an epidural catheter. The ESPB group received GA with a unilateral ultrasound-guided erector spinae plane catheter. The primary outcome was postoperative cumulative opioid consumption for 24 h. The total intraoperative fentanyl requirement was 35.4 ± 11.44 μg in the TEA group and 30.4 ± 9.08 μg in the ESPB group (t-value - 1.53013, P value: 0.134). The total postoperative fentanyl requirement was comparable in both the groups and clinically nonsignificant (44 ± 2.82 in the TEA group vs. 44.25 ± 13.72 in the ESPB group, t-value = -0.02412, P = 0.981). The median (IQR) Face, Legs, Activity, Cry, and Consolability (FLACC) score at 0, 2, 4, 8, 12, and 24 h time points in the ESPB was equivalent to the TEA group. At 6 h time point, the TEA group had a significantly lower FLACC score than the ESPB group (1[1.75, 1] in the TEA group and 2 [2, 1] in the ESPB group, P value = .02, U = 117.5, z-score = -2.218). The complications were higher in the TEA group (urine retention 20% and hypotension 40%) than in the ESPB group (0 and 0%). This study shows that the ESPB provides similar postoperative analgesia to the TEA in pediatric patients undergoing thoracotomy. The ESPB is simpler, faster, and has a lower complication rate.

Effects of Unilateral Intermediate Cervical Plexus Block on the Diaphragmatic Function in Patients Undergoing Unilateral Thyroidectomy: A Randomized Controlled Study.

Background and PurposeAlthough unilateral intermediate cervical plexus block (ICPB) can be used for perioperative analgesia in neck surgery, its effect on diaphragm function remains controversial. This prospective study aimed to examine whether unilateral ICPB with different concentrations of ropivacaine resulted in the diaphragmatic dysfunction in unilateral thyroidectomy.MethodsA total of 54 patients scheduled to undergo unilateral thyroidectomy under general anesthesia were randomly allocated to receive either 10 mL of 0.3% (Group L) or 0.5% (Group H) ropivacaine for ICPB. General anesthesia was then administered for surgery. The diaphragm thickness and diaphragmatic excursion were measured at three different times: before the ICPB, at 40 min and 4 h after the block. The primary outcome was the incidence of diaphragmatic dysfunction of the block side at 40 min and 4 h after ICPB. Secondary outcomes included the maximum pain score within 24 h after the surgery, rescue analgesics within 24 h after the surgery, and time to first ambulation.ResultsThe incidence of diaphragmatic dysfunction on the block side of Group H was higher than that of Group L at 40 min after block (58% vs 29%, P = 0.01). However, the incidence of diaphragmatic dysfunction was comparable between Group H and Group L (65% vs 46%) at 4 h after block placement. Within 24 h after the operation, the maximum VAS pain score of Group H was significantly lower than Group L (P = 0.04), and fewer patients in Group H required rescue analgesics (P < 0.01).ConclusionThe ICPB with different concentrations of ropivacaine can induce the ipsilateral diaphragmatic dysfunction. The high concentration of ropivacaine results in higher incidence of diaphragmatic dysfunction at 40 min, but comparable incidence at 4 h after block compared with lower concentration of ropivacaine.Chinese Clinical Trial RegistryChiCTR2000029348.

Posterior quadratus lumborum block versus posterior transversus abdominis plane block for unilateral inguinal hernia surgery.

Ultrasound-guided truncal nerve blocks are increasingly used for postoperative pain relief after abdominal surgery. The aim of this prospective and randomized study was to compare posterior transversus abdominis plane block (pTAPB) with posterior quadratus lumborum block (pQLB) for postoperative analgesic efficacy in patients undergoing unilateral inguinal hernia surgery under general anesthesia (GA). A total of 90 adult patients were randomized into 3 groups: group pTAPB (n = 30), group pQLB (n = 30), and group Control (n = 30). The patients in groups pQLB and pTAPB received a unilateral block using 20 ml of 0.25% bupivacaine after the induction of GA. Intravenous (IV) tramadol patient control group analgesia (PCA) and paracetamol were used in the postoperative period as a part of the multimodal analgesic regimen in both groups. Postoperative pain was assessed using a visual analog scale (VAS) during postoperative 24 h. Dexketoprofene was used as a rescue analgesic when VAS is >3. The primary outcome measure was mean pain scores. Secondary outcome measures were consumption of rescue analgesics and the amount of tramadol delivered by PCA. P <0.05 was considered statistically significant. Mean VAS scores were significantly lower in the group pQLB than group pTAPB and group Control at all-time points (pQLB < pTAPB < Control; P < 0.001). Rescue analgesic was not required in group QLB. Rescue analgesic consumption, the number of bolus demand on PCA, and total PCA dose were highest in group Control and lowest in the pQLB group (Control > pTAPB > pQLB; P < 0.001). It is concluded that both pQLB and pTAPB provided effective pain relief after unilateral inguinal hernia surgery. pQLB was superior to pTAPB due to lower pain scores and analgesic consumption.

Unilateral erector spinae plane block for procedural sedation- A case report

MRI of the spine requires the patient to stay still in lying down position. With patient on severe excruciating pain, lying down supine is not always feasible during MRI and any intervention with least possible adverse effect on the patient is preferred. Sedation in MRI suite requires MRI compatible monitors which is not readily available in all centers. The erector spinae plane block provides analgesia via its action on the ventral rami of spinal nerves. ESP block is a safe and easy procedure and it aids to overcome the side effects of administering intravenous agents for procedural sedation.

Thoracolumbar retrolaminar block in seven dogs undergoing spinal surgery

BackgroundThoracolumbar intervertebral disc extrusion is a common neurologic complaint in dogs and is associated with debilitating pain that requires careful analgesic management to avoid the transition to a chronic pain state. Recently, there has been an increased effort to incorporate regional anaesthetic techniques whenever possible, both for perioperative analgesia management and for prevention of chronic pain. A novel regional anaesthetic technique named retrolaminar block is a fascial plane block where the local anaesthetic is injected directly on top of the dorsal aspect of the vertebral lamina, in the fascial plane between the lamina and the epaxial muscles. The technique was recently described in humans and it is claimed to provide analgesia in patients undergoing thoracic and lumbar procedures. To the authors’ knowledge, the retrolaminar block has not been previously reported in live dogs.Case presentationSeven dogs presented to our hospital for suspected thoracolumbar intervertebral disc extrusion were anaesthetised using an anaesthetic premedication and induction protocol tailored for each individual animal. Once the suspected diagnosis was confirmed, all seven dogs were placed in sternal recumbency, and the target thoracolumbar vertebral spinous process was identified with palpation. A unilateral retrolaminar block was performed in all dogs with 2 mg/kg of 0.25% bupivacaine. Physiologic parameters, as well as responses to nociceptive stimuli, were monitored throughout the anaesthetic event.Intraoperatively, one dog required a bolus of fentanyl to control nociceptive stimulation while the epaxial muscles were retracted. No further intraoperative rescue analgesia was required in any of the cases. The postoperative pain was assessed using the Short Form of Glasgow Composite Measure Pain Scale for dogs every four hours for the duration of the dogs’ hospitalization. The retrolaminar block reduced the intraoperative requirement for systemic opioids and other adjunct analgesic agents and all dogs were comfortable throughout their hospitalization and up until the time of their discharge.ConclusionsThis case report presents the performance of the retrolaminar block technique as part of multimodal analgesia management in seven dogs undergoing thoracolumbar spinal surgery.

Analgesic Effects of a Novel Combination of Regional Anesthesia After Pediatric Cardiac Surgery: A Retrospective Cohort Study

The objective of this study was to determine whether the use of regional anesthesia in children undergoing congenital heart surgery was associated with differences in outcomes when compared to surgeon-delivered local anesthetic wound infiltration. A retrospective cohort study. At a single pediatric tertiary care center. Pediatric patients who underwent primary repair of septal defects between January 1, 2018, and March 31, 2022. The patients were grouped by whether they received surgeon-delivered local anesthetic wound infiltration or bilateral pectointercostal fascial blocks (PIFBs) and a unilateral rectus sheath block (RSB) on the side ipsilateral to the chest tube. Using overlap propensity score-weighted models, the authors examined postoperative opioid requirements (morphine milliequivalents per kilogram), pain scores, length of stay, and time under general anesthesia (GA). Eighty-nine patients were eligible for inclusion and underwent analysis. In the first 12 hours postoperatively, the block group used fewer morphine equivalents per kilogram versus the infiltration group, 0.27 ± 0.2 v 0.64 ± 0.42, with a weighted estimated decrease of 0.39 morphine equivalents per kilogram (95% CI -0.52 to -0.25; p < 0.001), and had lower pain scores, 3.2 v 1.6, with a weighted estimated decrease of 1.7 (95% CI -2.3 to -1.1; p < 0.001). The length of stay and time under GA also were shorter in the block group with weighted estimated decreases of 22 hours (95% CI -33 to -11; p=0.001) and 18 minutes (95% CI -34 to -2; p=0.03), respectively. Bilateral PIFBs and a unilateral RSB on the side ipsilateral to the chest tube is a novel analgesic technique for sternotomy in pediatric patients. In this retrospective study, these interventions were associated with decreases in postoperative opioid use, pain scores, and hospital length of stay without prolonging time under GA.

The reversing effect of ondansetron on bupivacaine-induced sciatic nerve block.

This experimental study was designed to test the hypothesis that ondansetron, a selective 5-HT3 receptor antagonist, would decrease the duration of motor, sensory, and proprioception blockade in a dose-dependent fashion in a bupivacaine-induced sciatic nerve blockade. Forty-nine male Wistar Albino rats who underwent unilateral sciatic nerve block were divided into seven groups with an equal number in each group. Group B: only perineural block (PB), Group BO200: PB and perineural 200 μg ondansetron, Group BO400: PB and perineural 400 μg ondansetron, Group BO800: PB and perineural 800 μg ondansetron, Group BO800IP: PB and intraperitoneal 800 μg ondansetron, Group O800: only perineural 800 μg ondansetron, Group S: sham-operated. The rats' motor, sensory, and proprioception functions were evaluated by a blinded investigator every 10 min until they returned to normal function. The recovery times of the motor, sensory, and proprioception functions were recorded and compared. All sciatic nerves were removed and examined by electron microscopy for neurotoxic signs. In which sciatic nerve block was formed with bupivacaine, the duration of the motor, sensory, and proprioception functions blockade was decreased, and the duration to return to normal functions was significantly shortened at Group BO800 (p < 0.05). According to electron microscopy results, perineural 200 μg, 400 μg, and 800 μg ondansetron were not neurotoxic. This is the first study showing that perineural ondansetron administration (800 μg dose) reverses the effect of the local anesthetics and shortens the duration of the motor, sensory, and proprioception functions blockade.

The usefulness of homoeopathic medicines for infertility – A case series

Introduction: Infertility is the inability to achieve a successful pregnancy within 2 years of regular unprotected sexual intercourse. About 8–12% of couples of reproductive age experience infertility worldwide. Infertility may result from any underlying pathology or unexplained causes and can cause severe emotional disturbances in both partners. The complexity and cost of conventional treatment may not be affordable for a majority of people. Case Summary: Three cases of infertility with an underlying pathology successfully treated with standalone homoeopathic treatment are reported. These cases presented with a structural deformity as a cause of infertility. The patients partners were also given homoeopathic medicines in all the cases. The first case showed a long liquefaction time on semen analysis and the female partner had a unilateral tubal block. The second case investigation reported ipsilateral varicocele and small-sized testes with oligospermia. In the third case, the female had polycystic ovarian syndrome with a sub-septate uterus and multinodular goitre. All three cases were treated with individualised homoeopathic medicine. All these cases were followed up regularly and they conceived within 6 months of treatment.

ID:15744 Atypical Complex Regional Pain Syndrome or Functional Neurologic Disorder: A Case Report

A 41 year-old, male was referred by neurology to the outpatient pain clinic with an initial tentative diagnosis of a functional neurologic disorder. Upon interview the patient endorsed an approx. 3 year history of progressive, ascending numbness and neuropathic pain in bilateral lower extremities that was precipitated following a ligamentous injury involving the right ankle. He also reported temperature sensitivity and noted delayed healing of on an ulcer on his 5th digit. On physical examination the patient was neurologically intact and did not display allodynia. EMG/NCS revealed no evidence of a pathologic process. Given the post traumatic onset of his pain and possible trophic symptoms it was hypothesized that his neurologic symptoms could be related to a sympathetically mediated process. He subsequently underwent a fluoroscopic guided unilateral lumbar sympathetic block using local anaesthetic and dexamethasone. Pre-procedurally he rated his pain as 8/10. Within two days the patient reported complete resolution of his pain with lasting benefit at 2 weeks’ follow up.

Unilateral erector spinae plane block versus intravenous morphine for postoperative analgesia after Percutaneous nephrolithotomy. A randomized controlled trial

Pain is an everyday challenge during all surgeries and it is a chief postoperative complication, so pain management is a corner stone in anesthetic practice. Percutaneous nephrolithotomy PCNL surgeries are usually associated with acute postoperative pain. Ultrasound guided nerve block is considered a recent technique for pain management. it provides better visualization of the nerves and reduces the risk for complications e.g. unintended injury to adjacent structures. Erector spinae plane (ESP) block is a novel method of delivering postoperative analgesia after PCNL surgery, technique involves injecting local anaesthetic into the interfascial plane between the erector spinae muscle and the transverse processes.and is therefore devoid of major adverse effects like pneumothorax, spinal cord trauma, and hypotension that can occur with other types of blocks like thoracic paravertebral block (TPVB). The goal of this research was to determine the analgesic efficacy and safety of ultrasound-guided ESP. block done at T8 transverse process level in patients undergoing PCNL surgeries for intraoperative and postoperative analgesia.

Continuous Unilateral Erector Spinae Plane Block versus Intravenous Analgesia in Minimally Invasive Cardiac Surgery: A Randomized Controlled Trial

Objectives: the study was conducted to assess the safety and efficacy of anesthesia under the erector spinae plane block (ESPB) in minimally invasive cardiac surgery (MICS). Methods: a prospective, randomized controlled trial was carried out in 56 adult patients who underwent MICS via a right thoracic incision at Vietnam National Heart Institute, Bach Mai hospital, Vietnam. Patients were randomly allocated into two groups: ESPB and conventional analgesia (intravenousmorphine patient-controlled analgesia, PCA). Patients in ESPB group received ultrasound-guided unilateral ESPB at the T4/T5 transverse process level, and the tip of the catheter was advanced 5cm beyond the tip of the needle; injected with 20 ml ropivacaine 0.5%. At the cardiac ICU, patients received paracetamol (1g every 6 hours), continuous infusion ropivacaine 0.1% 0.2ml/kg/hour. Patients in the PCA group received paracetamol (1g every 6 hours) and intravenous morphine PCA. All patients were followed for 72 hours after being extubated. Results: the resting VAS score was significantly lower in ESPB group at the time H4, H8, H12, H16, H36, H42, H48, H54, H60, H66 after extubated compared to that of the PCA group (p&lt; 0.05). The dynamic VAS score at was also significantly lower in the ESPB group at all measured time points (p&lt;0.05). Only 4 patients in the ESPB group required intravenous morphine PCA with the mean amount morphine were statistically lower in the ESPB group compared to the PCA group at 24 hours, 48 ​​hours, 72 hours postoperative. No serious adverse events such as neurological complications, bleeding or infection were observed in both groups. Conclusion: ESPB is an effective analgesic for MICS via thoracic incision in reducing the VAS score and the morphine required. It is also a safe method with no severe ESPB-related complications.

Is Right Unilateral Transversus Abdominis Plane (TAP) Block Successful in Postoperative Analgesia in Laparoscopic Cholecystectomy?

Background Transversus abdominis plane (TAP) block is used for postoperative analgesia in laparoscopic cholecystectomy. In laparoscopic cholecystectomy, the incisions are located mainly on the upper right side of the abdomen. Aims We aim to determine the efficacy of less-invasive ultrasound-guided right unilateral oblique subcostal TAP block in laparoscopic cholecystectomy on postoperative analgesia by comparing patients undergoing bilateral TAP block and a control group. Methods Ninety patients were equally divided into control, unilateral, and bilateral TAP block groups. TAP blocks were conducted before anesthesia. No block was applied to the control group. Patients' demographics and postoperative pain, satisfaction, and nausea-vomiting scores and tramadol/ondansetron doses were evaluated. Results There was no significant difference in the verbal numerical rating scale for pain scores at rest and during coughing (VNRS-R and VNRS-C) between unilateral and bilateral TAP block groups at postoperative 1 hour, 2 hour, 4 hour, 8 hour, 12 hour, and 24 hours. In addition, VNRS-R and VNRS-C scores were significantly higher in the control group than in the other two groups. Tramadol consumption in the control group was significantly higher than in the unilateral and bilateral TAP block groups (p ≤ 0.01), while no significant difference was identified between unilateral and bilateral TAP block groups (p=0.303). Nausea-vomiting scores and ondansetron consumption did not differ significantly between all the groups. Patient satisfaction was significantly higher in unilateral and bilateral groups (p < 0.01, p < 0.01) than in the control group, while there was no significant difference between unilateral and bilateral TAP block groups (p=0.793). Conclusions Right unilateral TAP block provides postoperative analgesia as effective as bilateral TAP block in laparoscopic cholecystectomy.

Refractory otitis media with effusion due to eustachian tube sialolipoma inform consistent with eustachian tube inflammatory polyp: rare case presentation and literature review

BackgroundUnilateral otitis media with effusion in adult patient is considered alarming finding needing a detailed examination of the nasopharynx. The lesions in this area ranged from benign to more destructive malignant pathologies. Lipoma as a cause of obstruction is an extremely rare entity. We are reporting a case of eustachian tube lipoma presented with refractory otitis media with effusion. This is an extremely rare location of such entity and to the best of our knowledge, this is the third case reported in the world literature of eustachian tube lipoma after 2 cases published in 2011 and 2016 respectively. However, this is the first case reported in the literature of eustachian tube sialolipoma.Case presentationWe are reporting a 27-year-old male who presented to our outpatient department with a complain of unilateral ear block, hearing loss, and intermittent tinnitus. Clinical evaluation revealed unilateral otitis media with effusion that was confirmed by pure tone audiogram and tympanometry. Computed tomography and magnetic resonance imaging were obtained showed a lesion originating in the eustachian tube area protruding in the nasopharynx. Surgical removal was successful with complete recovery.ConclusionsUnilateral otitis media with effusion necessitate nasal endoscopic examination to rule-out lesions at the nasopharynx. This is the first case of sialolipoma in eustachian tube in the literature. Endoscopic removal is usually successful with uneventful short recovery period.

The Khuvsgul Earthquake of January 12, 2021 (MW = 6.7, ML = 6.9) and Early Aftershocks

—The MW = 6.7, ML = 6.9 Khuvsgul (Khubsugul, Khövsgöl) earthquake occurred on January 12, 2021 in the Northern Mongolia close to the border of Russia. The earthquake caused ground shaking which reached intensity IX at the epicenter and was perceptible in the cities and villages of the Eastern and Western Siberia. The earthquake occurred in the region of the same-name fault and caused intense aftershock process on a segment between two fault’s bends. The fault segment encompassed by the aftershocks goes from the lake to the northwest. Seismic activation has involved a segment of the boundary of the ancient Tuva–Mongolian microcontinent hosting the parallel Khuvsugul and Darkhat rift depressions and the Busingol rift depression consisting of three linearly elongated troughs. Until the present, the region of the Busingol depression was distinguished by high seismicity, whereas the regions of the Darkhat and Khuvsgul depressions were characterized by moderate and low seismicity, respectively. The earthquake of 2021 is the largest earthquake that occurred on the Khuvsgul fault over the entire history. In less than two months, the level of the frequency–magnitude graph for the aftershocks has exceeded the level of the annual frequency–magnitude graph of the earthquakes for the Altai–Sayan mountain region. The aftershock density is nonuniformly distributed along the fault; the structure of the distribution is correlated to the unilateral block structure of the Earth’s crust east of the activated fault segment. The seismic potential of the Khuvsgul fault was estimated at Mmax = 7–7.5, and this earthquake, as suggested by the geological data, is not the maximum possible event. Given that seismic activation after the 1991 Busingol earthquake has not yet ceased, we have two strong activations in the Tuva–Mongolian block which can significantly affect evolution of its seismicity.

Kümmell’s Disease: An Interventional Pain Approach

BACKGROUND: Kümmell’s disease is a rare diagnosis that involves avascular necrosis of the vertebral body after minor injury. Presentation is subtle and there are pathognomonic findings on imaging. Treatment ranges from symptom management to vertebral augmentation to open surgery depending on patient preference. CASE REPORT: We evaluated the case of an 88-year-old woman with a past medical history of scoliosis who presented to clinic complaining severe low back pain with associated neurologic symptoms 2 weeks after a fall at home. Imaging showed avascular necrosis of T12. CONCLUSIONS: After discussion with the patient, she elected to proceed with a unilateral lumbar medial branch block over vertebral augmentation. Pain scores greatly improved and opioid usage decreased. KEY WORDS: Case report, Kümmell’s disease, avascular necrosis, medial branch block

Comparison of block characteristics in continuous spinal anesthesia and continuous epidural anesthesia for lower limb orthopedic surgeries: An interventional study

Background: Continuous epidural anesthesia (CEA) is commonly used in routine practice even though it needs a higher dose of local anesthetics (LA) and is sometimes associated with a patchy or unilateral block. Despite advantages, continuous spinal anesthesia (CSA) is underutilized because of concern related to infection and postdural puncture headache. Our aim was to compare the block characteristics and hemodynamic changes following CSA and CEA in lower limb orthopedic surgeries. Materials and Methods: After approval from the Institutional Scientific and Ethics Committee and Registration with (Clinical Trials Registry of India/2021/02/031575), a prospective, double-blind, randomized study was conducted in 144 patients, American Society of Anesthesiologists I-II, aged 18–65 years, scheduled for lower limb orthopedic surgeries. Patients were randomly divided into two groups according to anesthesia technique used (n = 72), i.e., Group CSA and Group CEA. Block characteristics, hemodynamic variables, intraoperative LA requirement, and complications were recorded. Results: Demographic and surgical data, grade of sensory and motor blockade, and incidence of complications were comparable in both the groups. Induction time was significantly shorter in CSA (8.14 ± 0.88 min vs. 15.75 ± 3.29 min, P < 0.0001). Performance time (5.31 ± 0.92 min vs. 4.92 ± 1 min; P = 0.008), duration of blockade (68.3 ± 4.23 min vs. 65.54 ± 4 min; P < 0.0001), and analgesia (230.48 ± 40.76 min vs. 222.86 ± 39.79 min; P = 0.024) were significantly longer in CSA. A significant fall in diastolic blood pressure and mean arterial pressure occurred in CEA. LA requirement was significantly lower in CSA (11.62 ± 2.5 mg vs. 65.35 ± 7.71 mg; P < 0.00001). Conclusions: Considering shorter induction time, prolonged sensory blockade, and analgesia with greater hemodynamic stability, CSA could be preferred over CEA for lower limb orthopedic surgeries.

Role of diagnostic hysterolaparoscopy in the evaluation of infertility among the patients attending one of the tertiary care centers of Ahmedabad, Gujarat

Background: Reproduction is the basic expectation of human life. There is worldwide increase in incidence of infertility due to many factors such as delaying child-bearing, increase in lifestyle disorders, and stress to achieve personal and professional goals. The incidence varies between 5 and 15%. Aims and Objectives: The aims of this study were to evaluate the factors responsible for infertility using diagnostic hysterolaparoscopy among the patients attending tertiary care hospital. Materials and Methods: It was a prospective study conducted from December 2018 to May 2022 in Obstetrics and Gynecology Department of GCS Medical College, Ahmedabad. Around 150 patients were included in study. All patients of primary and secondary infertility whose hormonal profile was normal were included in the study. Results: In the present study, primary infertility was present in 73% of cases where as 27% were having secondary. Majority (43%) of patients of the primary infertility belonged to age 26–30 years and 29% of secondary infertility cases were in the age group 31–35 years. Tubal factors were highest (32%), followed by ovarian factors (29%), peritoneal factors (11%), and uterine factors (9%). Among tubal factors, bilateral block was present in 19% and unilateral tubal block in 11%; among ovarian factors, polycystic ovary syndrome was highest (18%) and in peritoneal factor, endometriosis was seen in 6%. In uterine factors, fibroid was present in about 8% of cases. Conclusion: Diagnostic hysterolaparoscopy provides reliable information in evaluation of infertility and determining various causes such as tubal, ovarian, peritoneal, and uterine.

The Use of Peripheral Nerve Blockade in Laparoscopic and Robotic Surgery: Is There a Benefit?

The purpose of this review is to synthesize recent literature investigating the use of regional anesthesia for minimally invasive surgery. Recent studies investigating the use of newer peripheral nerve blocks such as erector spinae plane (ESP) and quadratus lumborum (QL) block are very limited. Evidence supporting the use of peripheral nerve blockade in laparoscopic or robotic surgery is very limited and of low-moderate quality. While transverse abdominal plane (TAP) block may decrease opioid and pain scores after laparoscopic cholecystectomy, bariatric surgery, and colorectal surgery, the benefit of the block in the presence of multimodal analgesia remains to be clarified. Unilateral paravertebral block may be beneficial for percutaneous nephrolithotomy. ESP and rectus sheath blockade may enhance analgesia in laparoscopic surgery, but the magnitude of this benefit may not be clinically relevant. Limited evidence supports the use of QL block in laparoscopic urologic surgery. There is insufficient recent evidence to support the use of TAP or QL block for laparoscopic gynecologic surgery.