Research priorities in regional anaesthesia: an international Delphi study.

BACKGROUND: Regional anaesthesia use is growing worldwide, and there is an increasing emphasis on research in regional anaesthesia to improve patient outcomes. However, priorities for future study remain unclear. We therefore conducted an international research prioritisation exercise, setting the agenda for future investigators and funding bodies. METHODS: We invited members of specialist regional anaesthesia societies from six continents to propose research questions that they felt were unanswered. These were consolidated into representative indicative questions, and a literature review was undertaken to determine if any indicative questions were already answered by published work. Unanswered indicative questions entered a three-round modified Delphi process, whereby 29 experts in regional anaesthesia (representing all participating specialist societies) rated each indicative question for inclusion on a final high priority shortlist. If ≥75% of participants rated an indicative question as 'definitely' include in any round, it was accepted. Indicative questions rated as 'definitely' or 'probably' by <50% of participants in any round were excluded. Retained indicative questions were further ranked based on the rating score in the final Delphi round. The final research priorities were ratified by the Delphi expert group. RESULTS: There were 1318 responses from 516 people in the initial survey, from which 71 indicative questions were formed, of which 68 entered the modified Delphi process. Eleven 'highest priority' research questions were short listed, covering themes of pain management; training and assessment; clinical practice and efficacy; technology and equipment. CONCLUSIONS: We prioritised unanswered research questions in regional anaesthesia. These will inform a coordinated global research strategy for regional anaesthesia and direct investigators to address high-priority areas.

Ultrasound-guided supracondylar radial nerve block for closed reduction of a distal radius fracture in the emergency department: Case report.

Background: Closed reduction and a closed cast are common treatments for patients with acute distal radius fractures in the emergency room. Many of the common analgesic techniques such as hematoma block may not be effective, which can hinder the stabilization and reduction of fractures. Case report: An 81-year-old woman who had a Colle's fracture (metaphyseal fracture with dorsal angulation) of the left distal radius arrived at the emergency room. Due to intense pain and need for proper pain management, an ultrasound-guided block of the radial nerve prior to its bifurcation into deep and superficial branches was carried out as an alternative to infiltration of the fracture site. The fracture could be reduced and immobilized with a closed cast as a result of the peripheral nerve block, which caused the patient the least amount of discomfort. Conclusions: The reduction of a distal radius fracture in the emergency room can be accomplished with safe and efficient analgesia using an ultrasound-guided supracondylar radial nerve block close to the beginning of the deep and superficial branches. This is, as far as we are aware, the first report of an ultrasound-guided supracondylar nerve block utilized to treat a distal radius fracture in our nation.

Systematic Review of Literature on Prevalence of Vocal Fatigue Among Teachers.

BACKGROUND: Previous results suggest that teaching is a high-risk profession for developing voice disorders. OBJECTIVE: This study aims to determine the prevalence of vocal fatigue among teachers and its relationship with voice acoustic parameters reported in previous studies. METHOD: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement Guidelines, we performed a systematic literature review including five databases: Scopus, Scielo, ScienceDirect, PubMed, and Web of Science. Information on study population, definition and evaluation of vocal fatigue, and teaching characteristics were extracted from each paper. The quality of the included publications was assessed using the "Quality assessment tool for quantitative studies". RESULTS: In total, 14 publications met the inclusion criteria. The two most common work-related factors of vocal fatigue were high levels of noise inside classrooms and loud speaking voice use. Some investigations reported voice acoustic parameters such as fundamental frequency and vocal Sound Pressure Levels as associated with vocal fatigue. CONCLUSION: Vocal fatigue is a prevalent symptom among teachers associated with teaching vocal demands. However, studies on objective parameters that complement self-reports, to quantify vocal fatigue are needed to determine permissible values for healthy occupational voice use.

Ultrasound-guided paravertebral block using an intercostal approach.

We describe an ultrasound-guided technique of continuous bilateral paravertebral block using an intercostal approach in 12 patients undergoing elective abdominal surgery. Postoperatively, each of the patient's paravertebral catheters was bolused with 10 mL lidocaine (15 mg/mL), and each of the patient's catheters was infused with 0.2% ropivacaine at 10 mL/h. Using a pinprick test, the median number of dermatomes blocked after the initial bolus was 5 (interquartile range, 4-6), and 23 of 24 catheters produced a local anesthetic block. The median verbal pain score on postoperative day 1 was 5.5 (interquartile range, 3.5-6), and median dose of IV hydromorphone consumed during the first 24 h after surgery was 1.9 mg (interquartile range, 0.7-5.05). All catheters were removed within 72 h after surgery.

Comparación de concentración mínima inhibitoria y concentración plasmática de cefalotina mediante un modelo matemático / Comparison of the minimal inhibitory concentration and the plasma cephalotin concentration through a mathematical model

Introducción: el uso de fármacos fuera de rangos terapéuticos es un problema hospitalario, pues pocas veces se tienen en cuenta parámetros antropométricos del paciente, determinantes en las concentraciones del medicamento. Objetivo: aplicar un modelo matemático basado en parámetros del paciente, para determinar las posibles concentraciones plasmáticas de cefalotina y compárarlas con las concentraciones mínimas inhibitorias de los microrganismos aislados. Métodos: se seleccionó un grupo de pacientes del sexo masculino entre 18 y 50 años de edad con tratamiento profiláctico posquirúrgico con cefalotina. Se recopiló la información: dosis de cefalotina, peso, talla, edad, hematócrito. Se calcularon volumen extracelular, plasmático y sanguíneo según el modelo informado por Hedin. Luego se calculó la concentración plasmática de cefalotina usando el modelo propuesto en el presente estudio y se comparó con la concentración mínima inhibitoria de los microorganismos aislados. Resultados: se analizaron 24 pacientes con promedio de edad 32,6 años ± 8, peso de 69 kg ± 7,51, talla de 168,87 cm ± 7,10. El 56,3 por ciento de los microorganismos presentó resistencia a concentraciones ³ 32 µg/mL. El agente más común fue Escherichia coli de 18 cepas aisladas. La comparación del volumen de distribución y la concentración plasmática de cefalotina calculada con el modelo informado por Hedin y el desarrollado en presente trabajo, no presentó diferencia significativa después de aplicar la prueba t de Student, con p< 0,05. Conclusiones: al comparar las concentraciones teóricas de cefalotina para uso profiláctico posquirúrgico intrahospitalario, calculadas con el modelo planteado, se encontró que estas no permitieron superar la concentración mínima inhibitoria de los microorganismos aislados(AU)

Introduction: the use of drugs out of therapeutic ranges is a hospital problem since the anthropometric parameters of patients, which are determinants in the drug concentrations, are rarely taken into consideration. Objectives: to implement a mathematical model based on the patient's parameters in order to determine the possible plasma cephalotine concentrations and to compare them with the minimum inhibitory concentrations for isolated microorganisms. Methods: a group of male patients aged 18 to 50 years under postsurgical prophylactic treatment with cephalotine was selected. Data was collected on cephalotin dosage, weight, size, age and hematocrit. Extracellular, plasma and blood volumes were estimated by the Hedin's informed model. Additionally, the plasma cephalotin concentration was measured by using the model suggested in this study and then compared with the minimum inhibitory concentration for the isolated microorganisms. Results: twenty four patients aged 32.6 years ± 8, weighing 69 kg ± 7.51, with size of 168.87 cm ± 7.10 were analyzed. Resistance to concentrations equal to or higher than 32 µg/mL was observed in 56.3 percent of microorganisms. The most common agent was Escherichia coli in 18 isolated strains. The comparison of the distribution volume and of the plasma cephalotin concentration estimated with the Hedin's informed model and with the model devised in the present paper did not show significant differences according to Student's t test result, with p< 0.05. Conclusions: the comparison of the theoretical concentrations of cephalotine for in-hospital postsurgical prophylactic use estimated by the model yielded that these concentrations did not allow overcoming the minimum inhibitory concentration for the isolated microorganisms(AU)