Continuous lumbar erector spinae plane block as an alternative to epidural analgesia in pain treatment in patients undergoing hip replacement surgery - a prospective pilot study.

INTRODUCTION: Postoperative pain associated with hip replacement surgery can be severe, decreasing the patient's mobility and satisfaction with perioperative treatment. Regional techniques are commonly used as postoperative analgesia in hip surgery patients. MATERIAL AND METHODS: We performed a prospective pilot study on patients undergoing hip replacement surgery. We anesthetized each participant with spinal technique and allocated patients according to postoperative analgesia to the continuous epidural group and the continuous lumbar erector spinae plane block (ESPB) group. We measured postope-rative oxycodone consumption with patient-controlled analgesia (PCA) demands. At several points, we evaluated the patients' pain at rest and during activity on the visual analog scale (VAS, 0-10), their quadriceps femoris' muscle strength on the Lovett scale (0-5), and their ability to sit, stand upright, and walk on the Timed Up and Go test. Moreover, we assessed the patients' recovery through the Quality of Recovery 40 (QoR-40) questionnaire on the first postoperative day. RESULTS: We found lower oxycodone consumption via PCA in the epidural than in the ESPB group (9.1 (mean) mg (5.2-13.0) (confidence interval) vs. 15.5 mg (9.8-21.3), P = 0.049). Patients in the ESPB group had more demands with PCA than participants in the epidural group (10.5 (median) (6-16) (interquartile range) vs. 25 (16-51), P = 0.016). We did not find differences between the groups in the other outcomes or in terms of postoperative complications. CONCLUSIONS: The results suggest that the continuous lumbar ESPB group is equivalent to epidural analgesia as a pain treatment technique in patients undergoing hip replacement surgery.

Malnutrition risk in elective surgery patients and effectiveness of preoperative nutritional interventions at a pre-anaesthetic clinic: a 4-year apart, single-centre, observational study.

INTRODUCTION: Approximately 44% of all patients hospitalised for an elective surgical procedure have a malnutrition risk. In this study, we assessed the prevalence of malnutrition risk at a pre-anaesthetic clinic and the feasibility of introducing nutritional support. The primary objective of this study was to assess malnutrition risk prevalence in patients referred to a pre-anaesthetic clinic. MATERIAL AND METHODS: This was a prospective observational study. The study was divided into two phases: one in 2020 and the other in 2023. Consecutive patients scheduled for an elective surgical procedure at a pre-anaesthetic clinic were asked to participate in the study by filling out the questionnaire. We divided the patients into two groups based on the GLIM criteria. RESULTS: We included a total of 467 patients, including 214 from 2020 and 253 from 2023. In the total sample, 93 (19.9%) patients met the GLIM criteria for malnutrition risk, and 37 (7.9 %) fulfilled the ESPEN criteria for preoperative nutritional support. Out of 93 patients at malnutrition risk, 41 (44%) had BMI > 25 kg m -2 . The number of patients with indications for preoperative nutritional support in all departments remained similar across both time points. However, the number of patients receiving preoperative ONS almost doubled over the study period (36.8% in 2020 vs. 72.2% in 2023). CONCLUSIONS: Malnutrition risk was consistently high among our elective surgery patients. Not all patients with indications for preoperative nutritional support received it. As such, pre-anaesthetic clinics might be one of the major links in the nutritional programme chains of hospitals.