Perineural and Systemic Dexamethasone and Ulnar Nerve Block Duration: A Randomized, Blinded, Placebo-controlled Trial in Healthy Volunteers.

BACKGROUND: The authors hypothesized that both perineural and systemic dexamethasone as adjuncts to bupivacaine increase the duration of an ulnar nerve block compared with bupivacaine alone, and that systemic dexamethasone is noninferior to perineural dexamethasone. METHODS: The authors performed bilateral ulnar nerve blocks with 3 ml bupivacaine 5 mg/ml in 16 healthy volunteers on two trial days. According to randomization, subjects received adjunct treatment with 1 ml dexamethasone 4 mg/ml + 1 ml of saline (perineural condition) in one arm and 2 ml saline in the other arm (systemic condition, through absorption and redistribution of the contralaterally administered perineural dexamethasone) on one trial day; and 2 ml saline in one arm (placebo condition) and 2 ml of lidocaine in the other arm (lidocaine condition) on the other trial day. The primary outcome was the duration of the sensory nerve block assessed by temperature discrimination. RESULTS: Mean sensory block duration was 706 ± 94 min for the perineural condition, 677 ± 112 min for the systemic condition, and 640 ± 121 min for the placebo condition. The duration of the sensory nerve block was greater with perineural dexamethasone versus placebo (mean difference 66 min (95% CI, 23 to 108). Block duration was similar between systemic dexamethasone and placebo (mean difference 36 min; 95% CI, -30 to 103). CONCLUSIONS: Perineural dexamethasone as an adjunct to bupivacaine in healthy volunteers resulted in a greater duration of an ulnar nerve block when compared with placebo. Systemic dexamethasone resulted in a similar duration as placebo.

Anterior quadratus lumborum block does not reduce postoperative opioid consumption following laparoscopic hemicolectomy: a randomized, double-blind, controlled trial in an ERAS setting.

BACKGROUND AND AIMS: An opioid-sparing postoperative analgesic regimen following laparoscopic hemicolectomy is optimal to promote minimal postoperative pain, early mobilization, and improved quality of recovery. Various regional anesthesia techniques have been tested to improve postoperative pain management after laparoscopic hemicolectomy. In this study, we aimed to assess the effect of administering a preoperative bilateral ultrasound-guided anterior quadratus lumborum nerve block on postoperative opioid consumption after laparoscopic colon cancer surgery. METHODS: In this randomized, controlled, double-blinded trial, 69 patients undergoing laparoscopic hemicolectomy due to colon cancer were randomized to receive an anterior quadratus lumborum block with ropivacaine 0.375% 30 mL on each side or isotonic saline (placebo). The primary outcome measure was total opioid consumption during the first 24 hours postsurgery. The secondary outcome measures were pain scores, accumulated opioid consumption in 6-hour intervals, nausea and vomiting, ability of postoperative ambulation, time to first opioid, orthostatic hypotension or intolerance, postoperative Quality of Recovery-15 scores, surgical complications, length of hospital stay, and adverse events. RESULTS: The total opioid consumption in the first 24 hours postsurgery was not significantly reduced in the ropivacaine group compared with the saline group (mean 129 mg (SD 88.4) vs mean 127.2 mg (SD 89.9), p=0.93). In addition, no secondary outcome measures showed any statistically significant intergroup differences. CONCLUSION: The administration of a preoperative bilateral anterior quadratus lumborum nerve block as part of a multimodal analgesic regimen for laparoscopic hemicolectomy did not significantly reduce opioid consumption 24 hours postsurgery. Trial registration number NCT03570541.

[Tetanus in Denmark - a forgotten but dangerous disease].

In this review of tetanus in Denmark, it is discussed, why tetanus cases continue to occur especially in elderly people, although it is a preventable disease. The phenomenon is due to a lack of primary or booster vaccination and waning immunity with age, and immediate diagnosis and treatment are crucial to prevent deadly outcome. In Denmark, booster vaccination is recommended every tenth year. Estimation of immunisation status by medical interview is unreliable, and a future solution may be the use of a tetanus quick test and focus on booster vaccination in a primary care setting.

Ultrasound-guided nerve block for inguinal hernia repair: a randomized, controlled, double-blind study.

BACKGROUND AND OBJECTIVES: Open inguinal hernia repair in adults is considered a minor surgical procedure but can be associated with significant pain. We aimed to evaluate acute postoperative pain management in male adults randomized to receive an ultrasound-guided ilioinguinal and iliohypogastric nerve block administered before surgery, in addition to a standard analgesic regimen. METHODS: Sixty patients were included in this randomized, controlled, and double-blind study. Patients were randomized to the administration of a block with 20 mL bupivacaine 0.5% or a placebo block with 20 mL saline. The primary outcome measure was pain at mobilization in the postanesthesia care unit (PACU). Pain at rest, dermatomal anesthesia, time spent in the PACU/ward, opioid consumption, postoperative vomiting and nausea, ability to perform activities of daily living, and perceived ill health status were secondary outcomes. RESULTS: A significant reduction in pain scores at mobilization (P<0.001) and rest (P < 0.005) was recorded in the bupivacaine group upon arrival in the PACU and again after 30 minutes. Pain at rest was similarly reduced in the bupivacaine group at the time of discharge (P < 0.017). There were significantly fewer patients (P < 0.05) with severe (numerical rating scale >5) and moderate (numerical rating scale >3) pain at mobilization and rest, respectively. Opioid consumption and time spent in the PACU were not significantly different between groups. CONCLUSIONS: Ultrasound-guided blocks of the ilioinguinal and iliohypogastric nerves resulted in a statistically significant and clinically relevant reduction in postoperative pain in the PACU both at mobilization and at rest.

[Post-dural headache throughout four years]. / Postdural hovedpine gennem fire år.

A 36-year-old female received an epidural analgesia during a normal vaginal delivery. Post delivery she developed a frontal/occipital headache, which worsened in the erect position. Initial treatment with a blood-patch was without symptom relief. Her past medical history was significant because of occasional migraine headaches. For the next four years the patient complained of persistent headaches. At a Centre for Headaches she was diagnosed with post dural puncture headache. After treatment with bed rest for 3 days and a second blood-patch she was symptom free. This case highlights the need for an additional blood-patch in specific cases of residual post dural puncture headache.