A Comprehensive Review of Analgesia and Pain Modalities in Hip Fracture Pathogenesis.

PURPOSE OF REVIEW: Hip fracture is common in the elderly population, painful and costly. The present investigation was undertaken to review epidemiology, socio-economic and medical implications, relevant anatomy, and anesthetic and pain modalities of hip fracture. RECENT FINDINGS: A literature search of PubMed, Ovid Medline, and Cochrane databases was conducted in December 2018 to identify relevant published clinical trials, review articles, and meta-analyses studies related to anesthetic and pain modalities of hip fracture. The acute pain management in these situations is often challenging. Common issues associated with morbidity and mortality include patients' physiological decrease in function, medical comorbidities, and cognitive impairment, which all can confound and complicate pain assessment and treatment. Perioperative multidisciplinary and multimodal approaches require medical, surgical, and anesthesiology teams employing adequate preoperative optimization. Reduction in pain and disability utilizing opioid and non-opioid therapies, regional anesthesia, patient-tailored anesthetic approach, and delirium prevention strategies seems to ensure best outcomes.

Successful Use of Peripheral Nerve Blocks as the Primary Anesthetic in High-Risk Patients Undergoing Hip Surgery: A Case Series.

The incidence of hip fractures in the United States is increasing as the population ages. Elderly patients are more likely to have extensive comorbidities, which contribute to long-term consequences after a hip fracture. These patients often experience permanent disability, restrictions in activities of daily life, higher rates of depression, cardiovascular disease, and mortality rate. The authors describe a combination of peripheral nerve blocks to provide surgical anesthesia for corrective hip surgery in 5 high-risk patients.

Herpetofauna of Nísia Floresta National Forest, Rio Grande do Norte, Brazil: Richness and abundance differences among natural and secondary forests / Herpetofauna da Floresta Nacional de Nísia Floresta, Rio Grande do Norte, Brasil: Diferenças na riqueza e abundância entre florestas naturais e secundarias

Abstract In the Atlantic Forest, species distributions are not uniform. The biome has been divided into 8 biogeographic sub-regions, such as the Pernambuco Center of Endemism (PCE), in northeastern Brazil. Nísia Floresta National Forest (Flona) is a protected area situated in the municipality of Nísia Floresta, Rio Grande do Norte state, harboring native vegetation (Atlantic Forest and "Restingas or Tabuleiros") as well regenerating areas, with experimental plots of exotic plants for timber production. Herein, we present, for the first time, a species list of the herpetofauna surveyed at Flona over the past 10 years, using a standardized, long-term sampling design along with visual encounter surveys. We conducted monthly surveys across the area using 84 pitfall traps randomly distributed in 21 arrays throughout the forest's three phytogeographic zones (Restinga, Atlantic Forest, and Regeneration). In addition, we characterized ground-dwelling herpetofauna community diversity across these three zones over the course of an entire year. We collected a total of 39 species of reptiles (among lizards, snakes, chelonians, alligators, and amphisbaenians) and 24 species of frogs. The most frequent family found for reptiles was Dipsadidae, followed by Colubridae. In frogs, Leptodactylidae was the most common, followed by Hylidae. Herpetofaunal diversity in regeneration areas is smaller than forests, which in turn are marginally less diverse than the Restinga. Community descriptors such as equity, presence of exclusive species, and differences in abundances and composition indicate that distinct management strategies for each zone are needed for this protected area. At last, albeit smaller, diversity in regenerating areas is similar to natural areas, a reassuring result considering the significant deforestation the Atlantic Forest has suffered and the urgent need for restoration initiatives.

Resumo Na Mata Atlântica, as distribuições de espécies não são uniformes. O bioma foi dividido em 8 sub-regiões biogeográficas, como o Centro de Endemismo de Pernambuco (CEP), no nordeste do Brasil. A Floresta Nacional de Nísia Floresta (Flona) é uma área protegida situada no município de Nísia Floresta, no Estado do Rio Grande do Norte, abrigando vegetação nativa (Mata Atlântica e "Restingas ou Tabuleiros"), bem como áreas em regeneração, com parcelas experimentais de plantas exóticas para produção de madeira. Aqui, apresentamos, pela primeira vez, uma lista de espécies da herpetofauna levantada na Flona ao longo dos últimos 10 anos, utilizando uma amostragem padronizada e de longo prazo, juntamente encontros visuais e ocasionais. Realizamos levantamentos mensais em toda a área utilizando 84 armadilhas de queda distribuídas aleatoriamente em 21 conjuntos ao longo das três zonas fitogeográficas da floresta (Restinga, Mata Atlântica e Regeneração). Além disso, caracterizamos a diversidade da herpetofauna terrestre nessas três zonas ao longo de um ano inteiro. Coletamos um total de 39 espécies de répteis (entre lagartos, serpentes, quelônios, crocodilianos e anfisbênios) e 24 espécies de anfíbios. A família mais frequente encontrada para os répteis foi Dipsadidae, seguida por Colubridae. Para anfíbios, Leptodactylidae foi a mais comum, seguida por Hylidae. A diversidade da herpetofauna em áreas de regeneração é menor do que em florestas, que por sua vez são marginalmente menos diversas do que a Restinga. Descritores da comunidade, como equidade, presença de espécies exclusivas e diferenças em abundâncias e composição indicam que estratégias de manejo distintas para cada área são necessárias para esta área protegida. Por fim, embora menor, a diversidade em áreas de regeneração é semelhante às áreas naturais, um resultado animador considerando o significativo desmatamento que a Mata Atlântica sofreu e a urgente necessidade de iniciativas de restauração.