Ultrasound-guided pericapsular nerve block compared with IV opioids in hip injuries: A randomised controlled trial.

STUDY OBJECTIVES: The study aimed to compare the analgesic effect of USG-guided PENG (Peri capsular nerve group) block with Intravenous Nalbuphine hydrochloride (IVN) in patients with hip fracture coming to the emergency department (ED). The purpose was also to monitor the adverse effects and rescue analgesic requirements in both treatment modalities. METHODS: The study was an open-label randomised controlled trial (RCT) comparing PENG block versus IVN in treating patients with femoral head and neck fractures, as well as pubic rami fracture of the hip (HF). The participants in the PENG group received a USG-guided PENG block by injection of 25 ml of 0.25% bupivacaine, whereas the IVN group received 0.15 mg/kg of nalbuphine. An emergency physician with expertise in ultrasound-guided nerve blocks performed the PENG blocks. The primary outcome was to measure the improvement of the NRS (Numerical rating scale) score at 30 min in both static position (Patient-chosen position for the best comfort) and dynamic position (15-degree passive affected lower limb elevation). Secondary outcomes were to measure static and dynamic NRS pain scores at 2 h, 4 h, and 6 h after intervention in both groups. The requirement for rescue analgesia, adverse events and any block-related complications were also recorded. RESULTS: A total of 60 patients with HF were included in the final analysis. The static and dynamic NRS score was significantly lower in the PENG group compared to the IVN group at 30 min, 2 h, 4 h, and 6 h post-intervention. In the PENG group, the static NRS score was improved by 5.73 ± 1.17, while In the IVN group, the static NRS score was just improved by 2.13 ± 0.97 at 30 min. In the same duration, the Dynamic NRS score in the PENG group was improved by 6.13 ± 1.38, while In the IVN group, it improved just by 2.43 ± 1.28. Rescue analgesia was required in 50.0% of patients in the IVN group but none in the PENG group. Further, no block-related complications or adverse events were observed in the patients of the PENG group. CONCLUSION: The study provides evidence that the ultrasound-guided PENG block has a better analgesic effect and has fewer adverse events than IV opioids in patients with HF.

Ultrasound-Guided Superficial Radial Nerve Block in the Emergency Department for Pain Management following Centipede Bite.

Centipede bites are reported in many parts of tropical and subtropical countries, such as India. Centipede envenomation produces significant local symptoms, with pain being the most prominent symptom. The emergency department (ED) plays a crucial role in managing the victims through appropriate pain management and control of other local and systemic symptoms. Nonopioids and weak opioids, along with local measures, are often employed, but the intense pain is often refractory to these conventional techniques. Regional anesthesia has numerous benefits over these traditional measures, such as avoidance of polypharmacy and its consequent systemic adverse effects, excellent quality of pain control, and decreased need or avoidance of hospital admission. The applications of regional anesthesia have recently increased tremendously in the ED but are unreported for the management related to centipede bites. We report a case of centipede bite in which conventional analgesics did not help, and the pain was successfully managed by low-volume selective sensory peripheral nerve block.

Comparison of Ultrasound-Guided Anterior, Posterior and Combination of Quadratus Lumborum Block in Laparoscopic Abdominal Surgeries: A Pilot Study.

BACKGROUND: The quadratus lumborum block (QLB) is an effective technique to provide analgesia for upper and lower abdominal surgeries. There are various approaches described in the literature, but the best approach is still to be explored. This study aims to compare the analgesic efficacy of three different approaches of QLBs. METHODS: Sixty-five patients, aged 18-70 years posted for elective laparoscopic abdominal surgery under general anesthesia were enrolled after taking written informed consent. QLB was given using bupivacaine 0.25% 40 mL with injection dexmedetomidine 1 mcg/kg in all the groups. In Group 1 and Group 2, the drug was injected into the anterior and posterior aspects of the muscle respectively. In Group 3, a combination of the anterior-posterior approach was used. Pain scores at various intervals along with analgesic consumption and complications were observed. RESULTS: The demographic variables, hemodynamic parameters, and complications were comparable among the three groups. There were statistically significant differences between treatment groups in fentanyl requirement as assessed using the Kruskal-Wallis test (P = 0.012). Pairwise post-hoc analysis between block groups showed that the differences between Group 1 & Group 2 and Group 2 & Group 3 were significant (P = 0.0098 and P = 0.013). The tramadol requirement was comparable in all the groups (P = 0.75). Patient satisfaction was significantly higher in Group 3 compared to other groups (P = 0.024). CONCLUSION: Further studies can be planned to evaluate the best approach for QLB in terms of perioperative analgesia, which remains a dilemma in this pilot study. The anterior, posterior, and combined anterior-posterior QLB approaches appear equally efficacious as a component of multimodal analgesia in laparoscopic abdominal surgeries.

Macintosh laryngoscope versus AMBU King Vision video laryngoscope for endotracheal intubation using a COVID-19 barrier box: A randomized controlled trial.

BACKGROUND: Coronavirus disease 2019 (COVID-19) barrier box is being used by health-care workers for protection against aerosol-transmitted infection. Usually, a Macintosh laryngoscope (MC) or a video laryngoscope (VL) is used for endotracheal intubation (ETI). We aimed to determine the most suitable laryngoscope blade in terms of time to ETI, ease of ETI, and the first-pass success rate. METHODS: American Society of Anesthesiologists Grade I and II patients undergoing surgery under general anesthesia were randomized into the MC and the King Vision VL groups in a 1:1 ratio. ETI was performed using either the MC (the MC group) or the King Vision VL (the VL group) with a COVID-19 barrier box. The first-pass intubation success rate, intubation time, and ease of ETI were analyzed. RESULTS: The first-pass success rate was higher in the MC group (P = 0.43). The mean duration of ETI was 33 s and 47 s in the MC group and VL group, respectively. The difference was statistically significant between the groups (P = 0.002). The ease of ETI was comparable between the groups (P = 0.57), and the Cormack-Lehane grade was significantly different between the groups (P = 0.0025). CONCLUSION: ETI duration was shorter in the MC group than in the VL group. Hence, a MC can be used along with a COVID-19 barrier box by experienced operators for the prevention of aerosol spread.

Diencephalic syndrome: an anaesthetic challenge.

Diencephalic syndrome is one of the rare causes of failure to thrive in infants and young children. It is caused by a tumour in diencephalon (thalamus and hypothalamus), characterised by profound emaciation with uniform loss of body weight despite normal or slightly decreased appetite, locomotor hyperactivity, euphoria and visual symptoms. Anaesthetic considerations due to decreased body fat include positioning to avoid pressure necrosis, measures to avoid hypothermia, proper drug dosing, treating electrolyte imbalances and delayed recovery. We report successful anaesthetic management of a child with diencephalic syndrome scheduled for an endoscopic biopsy of suprasellar space occupying lesion under general anaesthesia.

Post-total knee arthroplasty herpes zoster activation.

Herpes zoster is a clinical manifestation of reactivation of varicella-zoster virus (VZV) that lies dormant in the dorsal root ganglia after a past primary infection. It can be associated with severe pain, a crop of vesicles in typical dermatomal distribution but the neuralgic pain persists long, making the patient uncomfortable and often disturbing patient's sleep. There are cases reported after trauma or post surgeries that are mainly related to organ transplant or malignancy. In the literature, there is a solitary report of VZV infection along the sciatic nerve post ipsilateral hip and contralateral knee joint replacement. Here, we report a VZV infection in post knee replacement setting along the L2-3 dermatomal distribution.