Methods for Clinical Monitoring of Neuromuscular Transmission in Anesthesiology - A Review.

The administration of general anesthesia is a crucial aspect of surgery. However, it can pose significant risks to patients, such as respiratory depression and prolonged neuromuscular blockade. To avoid such complications, it is essential to monitor neuromuscular transmission during anesthesia. While clinical tests have been used for decades to evaluate muscle function, they are now known to be unreliable, and relying on them increases the risk of postoperative complications. Thankfully, there are now six methods available for neuromuscular monitoring during anesthesia: mechanomyography, acceleromyography, electromyography, kinemyography, phonomyography, and compressomyography. Each of these methods differs in terms of their approach and methodology, and their importance in clinical practice varies accordingly. Mechanomyography involves measuring the mechanical response of a muscle to nerve stimulation, while acceleromyography measures the acceleration of muscle contraction. Electromyography records the electrical activity of muscles, while kinemyography tracks muscle movement. Phonomyography records the sound waves produced by contracting muscles, and compressomyography involves monitoring the pressure changes in a muscle during contraction. Overall, understanding the differences between these methods and their clinical significance is crucial for anesthesiologists. This review aims to provide an updated understanding of the current methods available for neuromuscular monitoring during anesthesia, so that anesthesiologists can make informed decisions about patient care and reduce the risk of postoperative complications.

A quadrigeminal arachnoid cyst as a cause of neurological symptoms in an 11-month-old Brussels Griffon - A case study.

An intracranial arachnoid cyst (IAC) is a rare developmental disorder that is consistent with cerebrospinal fluid accumulation between the brain and the arachnoid membrane. A quadrigeminal cyst is a specific type of cyst that is identified based on its localization. To the best of our knowledge, this is the first study to report on this type of pathology in a Brussels Griffon. This case study describes an 11-month-old female Brussels Griffon with symptoms of reluctance to lower the head and eat from a bowl placed on the ground, combined with episodes of vocalization. The patient was subsequently diagnosed with a quadrigeminal cyst during a low-field magnetic resonance imaging (MRI) exam, and she tested positive for toxoplasmosis in the blood test. Arachnoid cysts are often described as incidental findings, but the characteristics of neurological symptoms in the presented patient suggest that the cyst was clinically significant. The currently known options of pharmacological and surgical treatment give some hope for symptomatic patients, although their definitive success rate is not yet fully known.

Neurological Complications of Regional Anesthesia: An Updated Review with Clinical Guidelines.

The main purpose of this article is to present the neurological complications of regional anesthesia. Our analysis may help clinicians determine when regional anesthesia can be administered safely and in which patients it needs additional precautions. Regional anesthesia has a major role in anesthesia practice. Here, we focus especially on the most common neurological complications: epidural hematoma, post-anesthesia headaches, and peripheral nerve function defect. We investigated risk factors of these states and propose ways of reducing the risks. This work is based on the available literature and the authors' experience. The research process involved using relevant keywords in various electronic databases, resulting in the selection of 32 articles published between 1989 and 2022. This manuscript provides an overview and analysis of the existing literature related to neurological complications of regional anesthesia. We believe that our article provides up-to-date information on the most common regional anesthesia complications, emphasizing differences concerning children and pregnant women and provides important guidance for clinicians in preparing for and performing anesthesia.

Mechanical Testing of the New Cage for Tibial Tuberosity Advancement with the Cranial Implant Fixation (TTA CF) Technique-Ex Vivo Study on Sheep Model.

Background: Modifications of tibial tuberosity advancement are well accepted for cranial cruciate rupture repair. We compared the loads that were needed to pull the TTA CF cage out in the two groups. The first group consisted of five sheep in which osteotomy and TTA CF cage fixation were performed as assumed preoperatively. The second group consisted of five sheep in which intraoperative or postoperative discrepancies from preoperative planning were found. This is also the first report describing biomechanical testing after tibial tuberosity advancement with cranial implant fixation (TTA CF) surgical procedures. Results: A total of 10 ovine proximal tibiae were tested biomechanically by tearing out TTA CF implants from the bone. The mean maximal loaded forces to pull out the cage in Group 1, in which fixation of the implant was performed as assumed preoperatively, was 878 ± 61 N, and in Group 2, in which discrepancies from preoperative planning were found, was 330 ± 55 N. The mean implant displacement under maximal load to failure was 2.6 mm and 2.2 mm in Groups 1 and 2, respectively. There was a significant difference between Group 1 and Group 2 in the maximal loads-to-failure; however, the difference in the displacement at maximal loaded forces to pull out the cage was not significant between the groups. Conclusions: The mean maximal loaded forces to pull out the cage was significantly lower in Group 2, where discrepancies from preoperative planning were found (878 ± 61 N vs. 330 ± 55 N). The lower forces that were needed to extract the TTA CF implant from the tibia can lead to the conclusion that biointegration of the implant is also weaker. Correct positioning of the osteotomy line and TTA CF implant is essential for good biointegrity and thus for limiting complications in the form of tibial tuberosity avulsion fracture or tibial shaft fracture.

The quality of recovery after erector spinae plane block in patients undergoing breast surgery: a randomized controlled trial.

BACKGROUND: The erector spinae plane (ESP) block has recently been shown to effectively alleviate postoperative pain and reduce opioid consumption in breast surgery patients. However, data are still limited concerning the quality of recovery in patients following this procedure. METHODS: This study was a randomized controlled trial (RCT) performed in a university hospital. We randomly allocated patients to one of three groups: ESP, SHAM, and control (CON). Procedures in the ESP and SHAM blocks were performed ipsilaterally with 0.375% ropivacaine or 0.9% saline (0.4 mL/kg). Our primary outcome was the assessment of the patient's improvement with quality-of-recovery 40 (QoR-40) a day after surgery. Other outcome assessments included postoperative pain evaluation on the visual analog scale (VAS), 24-hour opioid consumption with patient-controlled analgesia (PCA), time to the first opioid demand, and global satisfaction with perioperative treatment. RESULTS: Overall, patients in the ESP group had improved QoR-40 compared to the CON group, 186 [177-193] vs. 175 [165-183] (medians and interquartile ranges). Pain severity was significantly higher in the CON group compared to the ESP group at hours 2 (38 [23-53] vs. 20 [7-32]) and 4 (30 [18-51] vs. 19 [7-25]). Moreover, we observed lower oxycodone consumption after 24 hours with the PCA pump between the ESP (4 [2-8] mg) and the CON (9.5 [5-19]) groups. Patients in the CON group used PCA sooner than those in the ESP group. Participants in the ESP group were more satisfied with treatment than those in the CON group. We found no statistical difference between SHAM and the other groups. CONCLUSIONS: Compared to the CON group, the ESP block improved the quality of recovery, alleviated pain intensity, and lowered opioid consumption in patients undergoing breast surgery. However, we did not observe this superiority in comparison with the SHAM group. TRIAL REGISTRATION: NCT04726878 .

Effect of Bilateral Quadratus Lumborum Block Type I on Patient Satisfaction and Incidence of Chronic Postsurgical Pain Following Cesarean Section-A Randomized Controlled Trial.

BACKGROUND: Quadratus lumborum block (QLB) provides a reduction in pain scores and opioid consumption after cesarean section (CS). Intrathecal morphine (ITM) is still considered as the gold standard of acute postoperative pain therapy, but it does have some significant side effects. The aim of this clinical study was to evaluate whether performing the quadratus lumborum block type I in patients undergoing CS would be associated with an increased satisfaction of pain therapy and a decreased incidence of chronic postsurgical pain (CPSP). METHODS: Sixty patients scheduled for elective CS were enrolled. All patients received spinal anesthesia and were randomly allocated to either the QLB group (received bilateral quadratus lumborum block type I with the use of 24 m mL 0.375% ropivacaine) or the control group (received no block). The level of satisfaction was evaluated using a three-step scale and the answers provided in a questionnaire regarding the patients' satisfaction with the method of postoperative pain treatment in the first 48 h. After a 6-month period, all patients were interviewed to evaluate the incidence and possible severity of CPSP. RESULTS: Satisfaction scores were significantly lower in the QLB group than in the control group (p = 0.0000). There were no significant differences between the QLB and control groups regarding the occurrence of chronic postsurgical pain after 6 months following CS (p = 0.102). No statistical differences between the groups were recorded when we compared the results of the questionnaire after a period of 48 h from CS (the number of participants were limited in number). CONCLUSIONS: QLB type I is an analgetic option that increased the satisfaction of parturients with pain therapy after CS compared to patients who did not receive the block, and there is a tendency for a lower incidence of CPSP.

Quadratus Lumborum Block Reduces Postoperative Opioid Consumption and Decreases Persistent Postoperative Pain Severity in Patients Undergoing Both Open and Laparoscopic Nephrectomies-A Randomized Controlled Trial.

BACKGROUND: New regional techniques can improve pain management after nephrectomy. METHODS: This study was a randomized controlled trial conducted at two teaching hospitals. Patients undergoing elective open and laparoscopic nephrectomy were eligible to participate in the trial. A total of 100 patients were divided into a quadratus lumborum block (QLB) group (50 patients) and a control (CON) group (50 patients). At the end of surgery, but while still under general anesthesia, unilateral QLB with ropivacaine was performed on the side of nephrectomy for patients in the QLB group. The main measured outcome of this study was oxycodone consumption via a patient-controlled anesthesia (PCA) pump during the first 24 h following surgery; other measured outcomes included postoperative pain intensity assessment, patient satisfaction with pain management, and persistent pain evaluation. RESULTS: Patients undergoing QLB needed less oxycodone than those in the CON group (34.5 mg (interquartile range 23 to 40 mg) vs. 47.5 mg (35-50 mg); p < 0.001). No difference between the groups was seen in postoperative pain intensity measured on the visual analog scale, except for the evaluation at hour 2, which was in favor of the QLB group (p = 0.03). Patients who received QLB were more satisfied with postoperative pain management than the CON group. Persistent postoperative pain was assessed with the Neuropathic Pain Symptom Inventory (NPSI) at months 1, 3, and 6, and was found to be significantly lower in the QLB group at each evaluation (p < 0.001). We also analyzed the impact of the surgery type on persistent pain severity, which was significantly lower after laparoscopic procedures than open procedures at months 1, 3, and 6. CONCLUSIONS: QLB reduces oxycodone consumption in patients undergoing open and laparoscopic nephrectomy and decreases persistent pain severity months after hospital discharge.

The Effect of Horse Shoeing with Egg Bar Shoes and Shoes with Wedge Pads on the Results of Thermal Imaging of the Equine Distal Limb.

The presented manuscript provides reference for practitioners when measuring normal hoof temperature, as well as controlling the temperature after shoeing with particular shoes. The aim of this study was to determine the effect of horse shoeing with egg bar shoes and shoes with wedge pads on hoof temperature measured by thermography. This was a prospective study conducted on 16 horses. The horses were divided into two groups: horses from group 1 were shod with egg bar shoes, while horses from group 2 were shod with shoes with wedge pads. Thermographic examination was performed below the metacarpophalangeal joint before and one month after shoeing. After shoeing with egg bar shoes, there was a decrease in the median of the minimal temperature in the palmar view. After shoeing with wedge pads, thermography revealed decreased hoof temperature in the dorsal and palmar views. Horse shoes may have a negative impact on the blood circulation and metabolism within the distal part of the limb; however, our study found this only to a minor extent.

Transversus abdominis plane block versus quadratus lumborum block type 2 for analgesia in renal transplantation: A randomised trial.

BACKGROUND: Several studies have shown an analgesic efficacy of a transversus abdominis plane block (TAPB) in reducing opioid requirements during and after cadaveric renal transplantation surgery, but the effect of a quadratus lumborum block (QLB) in this type of surgery is unclear. OBJECTIVES: The main objective of this prospective, randomised, double-centre clinical study was to compare the analgesic efficacy of a one-sided lateral approach TAPB with a unilateral QLB type 2 in cadaveric renal transplantation surgery. DESIGN: Randomised, single-blinded trial. SETTING: Two University-affiliated tertiary care hospitals between April 2016 and May 2017. PATIENTS: A total of 101 patients aged more than 18 years, scheduled for cadaveric renal transplantation. INTERVENTIONS: On receiving ethical board approval and individual informed consent, consecutive patients were allocated randomly to receive either an ultrasound-guided single-shot lateral TAPB or an ultrasound-guided single-shot QLB type 2 on the surgical side using 20 ml of bupivacaine 0.25% with adrenaline after a standardised induction of general anaesthesia. All patients on surgical completion and recovery from general anaesthesia were admitted to the postanaesthesia care unit for 24 h. They received standardised intravenous patient-controlled analgesia with fentanyl, and their pain scores were noted at regular intervals. MAIN OUTCOME MEASURES: The primary endpoint was total cumulative fentanyl dose used per kg body mass in the first 24 h after surgery. Secondary outcomes were the need to start a continuous infusion of fentanyl in addition to patient-controlled analgesia boluses during the stay in post-anaesthesia care unit, postoperative pain severity measured using a numerical rating scale, patient satisfaction with analgesic treatment, evidence of postoperative nausea and vomiting, pruritus and sedation level. RESULTS: The 49 patients allocated to the QLB type 2 group used significantly less fentanyl per kg in the first 24 h after surgery than the 52 patients who received a TAPB (median [IQR] 4.2 [2.3 to 8.0] µg kg versus 6.7 [3.5 to 10.7] µg kg, P = 0.042). No statistically significant differences were noted in the secondary endpoints within the study, including the frequency of adverse effects of opioids. CONCLUSION: The reduction of fentanyl consumption in the first 24 h after renal transplantation with no difference in pain intensity and patient satisfaction shows a beneficial effect of one-sided QLB type 2 over a one-sided TAPB in regards to postoperative analgesia. However, the reduction in opioid consumption did not affect the frequency of opioid-related adverse effects. TRIAL REGISTRATION: ClinicalTrials.gov ID: NCT02783586.

Comparison of two methods of continuous femoral nerve block with elastomeric pump after total knee arthroplasty.

BACKGROUND: The best method of continuous femoral nerve block (CFNB) after total knee arthroplasty (TKA) has not been determined. The study aimed to assess the effectiveness of CFNB based on patient-controlled regional analgesia (PCRA) with basal infusion of local anesthetic in decreasing pain and providing functional restoration after TKA and to compare it with the method of basal infusion only. METHODS: The prospective randomized controlled trial included 90 patients who were divided into three groups. Group I: control group with basal morphine infusion, without CFNB. Group II: CFNB with continuous infusion of ropivacaine. Group III: CFNB with basal infusion of ropivacaine plus boluses. Intensity of pain, morphine consumption, patient satisfaction, adverse effects, the effect on range of motion (ROM) in the knee joint, as well as using the measure of a distance were analyzed. RESULTS: A lower level of pain was observed (P < 0.005), as was reduced opioid consumption (P < 0.005), a greater ROM (P < 0.005), a longer distance covered (P < 0.005), and a smaller incidence of nausea in group III when compared with group II. No statistically significant difference was noted between the groups in terms of other side effects. There was higher satisfaction between group II and group III on days 1 and 2 (P < 0.08). CONCLUSIONS: It was demonstrated that CFNB with continuous infusion of 5 mL h-1 of 0.2% ropivacaine plus 5 mL as a bolus causes a greater reduction in pain intensity and opioid consumption; it also shortens the time of functional restoration in comparison to perineural infusion of 5mL h-1 only during the first 4 days after TKA and constitutes an effective and safe alternative to using an electronic pump.

Evaluation of the effectiveness of the Quadratus Lumborum Block type I using ropivacaine in postoperative analgesia after a cesarean section - a controlled clinical study.

OBJECTIVES: Quadratus Lumborum Block in contrast to Transversus Abdominis Plane Block contains a unique component which not only stops somatic pain but also inhibits visceral pain by spreading the local anesthetic to the paravertebral space. This study was designed to determine whether performing the Quadratus Lumborum Block type I in patients un-dergoing cesarean section would be associated with both decreased morphine consumption and decreased pain levels in the postoperative 48-hour period. MATERIAL AND METHODS: Sixty patients undergoing caesarean section under spinal anesthesia were randomly and equally assigned to one or other of two groups: QLB I (who received Bilateral Quadratus Lumborum Block type I with the use of 24 mL 0.375% ropivacaine per side) or a Control group. In both groups, on-demand morphine analgesia was administered postoperatively within the first 48 hours. The following were measured: the morphine consumption; the time elapsed from the C-section until the first dose of morphine; and the levels of pain intensity among patients in rest (numeral pain rating scale). RESULTS: There were no statistically significant demographic data differences between the QLB I and Control groups. The following significant differences were observed in the 48-hour postoperative period: morphine consumption was higher in the Control group (p = 0.000); the time elapsed from the C-section until the first dose of morphine was longer in QLB I group (p < 0.05); and the median of the pain numeric rating scale was higher in the Control group (p < 0.05). CONCLUSIONS: Quadratus Lumborum Block type I significantly reduces morphine consumption and pain levels up to 48 hours postoperatively.