Comparison between femoral block and PENG block in femoral neck fractures: A cohort study.

BACKGROUND: Regional analgesia is worth performing in the multimodal postoperative management of hip fracture (HF) because it reduces hospital morbidity and mortality. The aim of this study is to compare the efficacy and side effects of the recently described "Pericapsular Nerve Group (PENG) Block" with those of the femoral block, which is considered the standard of care for postoperative pain control after femoral neck fracture. MATERIALS AND METHODS: We conducted a comparative observational study at a university hospital (Saint Antoine Hospital, Sorbonne University, Paris, France), where the PENG block was introduced in August 2019. We include all patients from June to October 2019, who were coming for femoral neck fractures and who had an analgesic femoral block or PENG block before their surgery. The primary outcome was the comparison of cumulative postoperative morphine consumption 48 hours after surgery. RESULTS: Demographics, medical charts, and perioperative data of 42 patients were reviewed: 21 patients before (Femoral group) and 21 patients after the introduction of PENG block (PENG group) in clinical practice. Thirteen total hip arthroplasties (THA) and eight hemi arthroplasties (HA) were included in each group. Demographics were also comparable. The median, postoperative, morphine equivalent consumption at 48 hours was 10 [0-20] mg and 20 [0-50] mg in Femoral and PENG groups respectively (p = 0.458). No statistically significant differences were found in postoperative pain intensity, time to ambulation, incidence of morphine-related side effects, or length of hospital stay. The postoperative muscle strength of the quadriceps was greater in the PENG group than in the Femoral group (5/5 vs. 2/5, p = 0.001). CONCLUSION: In the management of hip fractures, PENG block is not associated in our study with a significant change in postoperative morphine consumption, compared to femoral block. However, it does significantly improve the immediate mobility of the operated limb, making it appropriate for inclusion in enhanced recovery programs after surgery.

Measurement of cardiac index by transpulmonary thermodilution using an implanted central venous access port: a prospective study in patients scheduled for oncologic high-risk surgery.

BACKGROUND: Transpulmonary thermodilution allows the measurement of cardiac index for high risk surgical patients. Oncologic patients often have a central venous access (port-a-catheter) for chronic treatment. The validity of the measurement by a port-a-catheter of the absolute cardiac index and the detection of changes in cardiac index induced by fluid challenge are unknown. METHODS: We conducted a monocentric prospective study. 27 patients were enrolled. 250 ml colloid volume expansions for fluid challenge were performed during ovarian cytoreductive surgery. The volume expansion-induced changes in cardiac index measured by transpulmonary thermodilution by a central venous access (CIcvc) and by a port-a-catheter (CIport) were recorded. RESULTS: 23 patients were analyzed with 123 pairs of measurements. Using a Bland and Altman for repeated measurements, the bias (lower and upper limits of agreement) between CIport and CIcvc was 0.14 (-0.59 to 0.88) L/min/m2. The percentage error was 22%. The concordance between the changes in CIport and CIcvc observed during volume expansion was 92% with an r = 0.7 (with exclusion zone). No complications (included sepsis) were observed during the follow up period. CONCLUSIONS: The transpulmonary thermodilution by a port-a-catheter is reliable for absolute values estimation of cardiac index and for measurement of the variation after fluid challenge. TRIAL REGISTRATION: clinicaltrials.gov NCT02063009.

Ultrasound-guided bilateral transversus abdominis plane block for postoperative analgesia after breast reconstruction by DIEP flap.

BACKGROUND: Autologous breast reconstruction by deep inferior epigastric perforator (DIEP) flap provides higher postoperative pain at the abdominal donor site than at the thoracic one. The authors evaluated the analgesic efficacy of ultrasound-guided transverse abdominis plane block for postoperative analgesia after immediate breast reconstruction by DIEP flap. METHODS: The authors conducted an open prospective study of 30 consecutive women undergoing immediate DIEP flap breast reconstruction after modified radical mastectomy for cancer. The last 15 patients received a bilateral ultrasound-guided block with 1.5 mg/kg ropivacaine on each side after DIEP flap harvesting, under general anesthesia. All patients received postoperative acetaminophen and patient-controlled intravenous morphine and were assessed for morphine use, satisfaction with pain relief, and adverse effects. RESULTS: Morphine requirements were significantly lower in the block group than in the control group for the 0- to 12-hour (17.7 mg versus 22.7 mg, p = 0.0047) and 12- to 24-hour (14.2 mg versus 17.4 mg, p = 0.01) intervals but not for the 24- to 36-hour (11.3 mg versus 12.2 mg, p = 0.30) and 36- to 48-hour (8.6 mg versus 8.4 mg, p = 0.65) intervals. Cumulative morphine use was lower in the block group than in the control group for the first 24 hours (32.0 mg versus 40.2 mg, p = 0.0057) and the first 48 hours (51.7 mg versus 60.5 mg, p = 0.03). There was no complication attributable to the block, with an average follow-up of 9 months. CONCLUSIONS: Bilateral ultrasound-guided transversus abdominis plane block after breast reconstruction by DIEP flap reduces the interval and cumulative morphine requirements for the first 24 and 48 hours, respectively. CLINICAL QUESTION/LEVEL OF EVIDENCE: : Therapeutic, II.(Figure is included in full-text article.).