Intra-articular injection versus interscalene brachial plexus block for acute-phase postoperative pain management after arthroscopic shoulder surgery.

BACKGROUND: The minimally invasive approach of arthroscopic shoulder surgery is beneficial; however, for optimal outcomes, perioperative pain management is essential. This cross-sectional study aimed to examine the analgesic effectiveness of intra-articular injection (IA) versus interscalene brachial plexus block (ISPB) among patients treated with arthroscopic shoulder surgeries. METHODS: We reviewed 100 consecutive patients who underwent shoulder arthroscopic surgery, of whom 50 each underwent IA (February 2019─January 2020; IA group) and ISPB (October 2018─July 2019; ISPB group). The primary outcome was the postoperative pain score measured using a Wong-Baker FACES Pain Rating Scale preoperatively and at 2, 6, 12, 24, and 48 h postoperatively. We performed multiple regression analysis to examine whether IA/ISPB selection is associated with acute-phase postoperative pain and adjusted for intra-articular injection, interscalene brachial plexus block, postoperative pain management, arthroscopic shoulder surgery, IA with 10 mg of morphine previously reported prognostic factors for postoperative pain (e.g., surgical procedures, operative time, older age, and preoperative pain). Furthermore, we examined induction time, total pentazocine dosage, and total postoperative nausea and vomiting (PONV) events. RESULTS: There were no significant differences between the IA and ISPB groups in perioperative pain control during the acute-phase periods (p = 0.12, repeated analysis of variance). The difference in anesthesia method was not a prognostic factor for acute-phase postoperative pain (p = 0.11). The IA group (15.06 ± 4.00 min) had a significantly shorter mean anesthesia induction time than the ISPB group (29.23 ± 9.22 min) (p = 0.0001). There was no significant between-group difference in the total pentazocine dosage during the first 7 days (p = 0.3934) postoperatively. PONV was observed in eight (17.0%) and two (4.2%) patients in the IA and ISPB groups, respectively. There was no significant between-group difference in the PONV incidence (p = 0.1582). CONCLUSIONS: There was no significant difference in acute-phase postoperative pain management between the IA and ISPB groups. The induction time was significantly shorter in IA. IRB: Approval number: UOEHCRB20-078, IRB approval date: September 9th, 2020; study duration: October 2018 to January 2020.

A novel transperitoneal abdominal wall nerve block for postoperative pain in laparoscopic colorectal surgery.

BACKGROUND: Although the laparoscopic approach reduces pain associated with abdominal surgery, postoperative pain remains a problem. Ultrasound-guided rectus sheath block and transversus abdominis plane block have become increasingly popular means of providing analgesia for laparoscopic surgery. METHODS: Ninety patients were enrolled in this study. A laparoscopic puncture needle was inserted via the port, and levobupivacaine was injected into the correct plane through the peritoneum. The patients' postoperative pain intensity was assessed using a numeric rating scale. The effects of laparoscopic nerve block versus percutaneous anesthesia were compared. RESULTS: This novel form of transperitoneal anesthesia did not jeopardize completion of the operative procedures. The percutaneous approach required more time for performance of the procedure than the transperitoneal technique. CONCLUSION: This new analgesia technique can become an optional postoperative treatment regimen for various laparoscopic abdominal surgeries. What we mainly want to suggest is that the transperitoneal approach has the advantage of a higher completion rate. A percutaneous technique is sometimes difficult with patients who have severe obesity and/or coagulation disorders. Additional studies are required to evaluate its benefits.

Novel technique of abdominal wall nerve block for laparoscopic colostomy: Rectus sheath block with transperitoneal approach.

A 62-year-old man who had acute rectal obstruction due to a large rectal cancer is presented. He underwent emergency laparoscopic colostomy. We used the laparoscopic puncture needle to inject analgesia with the novel transperitoneal approach. In this procedure, both ultrasound and laparoscopic images assisted with the accurate injection of analgesic to the correct layer. The combination of laparoscopic visualization and ultrasound imaging ensured infiltration of analgesic into the correct layer without causing damage to the bowel. Twenty-four hours postoperatively, the patient's pain intensity as assessed by the numeric rating scale was 0-1 during coughing, and a continuous intravenous analgesic was not needed. Colostomy is often necessary in colon obstruction. Epidural anesthesia for postoperative pain cannot be used in patients with a coagulation disorder. We report the use of a novel laparoscopic rectus sheath block for colostomy. There has been no literature described about the nerve block with transperitoneal approach. The laparoscopic rectus sheath block was performed safely and had enough analgesic efficacy for postoperative pain. This technique could be considered as an optional anesthetic regimen in acute situations.

Transperitoneal rectus sheath block and transversus abdominis plane block for laparoscopic inguinal hernia repair: A novel approach.

INTRODUCTION: A laparoscopic approach for inguinal hernia repair is now considered the gold standard. Laparoscopic surgery is associated with a significant reduction in postoperative pain. Epidural analgesia cannot be used in patients with perioperative anticoagulant therapy because of complications such as epidural hematoma. As such, regional anesthetic techniques, such as ultrasound-guided rectus sheath block and transversus abdominis plane block, have become increasingly popular. However, even these anesthetic techniques have potential complications, such as rectus sheath hematoma, if vessels are damaged. We report the use of a transperitoneal laparoscopic approach for rectus sheath block and transversus abdominis plane block as a novel anesthetic procedure. MATERIAL AND SURGICAL TECHNIQUE: An 81-year-old woman with direct inguinal hernia underwent laparoscopic transabdominal preperitoneal inguinal repair. Epidural anesthesia was not performed because anticoagulant therapy was administered. A Peti-needle™ was delivered through the port, and levobupivacaine was injected though the peritoneum. Surgery was performed successfully, and the anesthetic technique did not affect completion of the operative procedure. The patient was discharged without any complications. DISCUSSION: This technique was feasible, and the procedure was performed safely. Our novel analgesia technique has potential use as a standard postoperative regimen in various laparoscopic surgeries. Additional prospective studies to compare it with other techniques are required.

Combination of high spatial resolution and low minimum detection limit using thinned specimens in cutting-edge electron probe microanalysis.

The effect of sample thickness on the spatial resolution and minimum detection limit (MDL) has been investigated for field-emission electron probe microanalysis with wavelength dispersive X-ray spectroscopy (FE-EPMA-WDX). Indium gallium phosphide samples thinned to thicknesses of about 100, 130, 210, 310, and 430 nm provided effective thin-sample FE-EPMA-WDX in the resolution range of 40-350 nm and MDL range of 13,000-600 ppm (mass). A comparison of the FE-EPMA results for thin and bulk samples demonstrated that thin-sample FE-EPMA can achieve both higher sensitivity and better spatial resolution than is possible using bulk samples. Most of the X-rays that determine the MDL are generated in a surface region of the sample with a depth of approximately 300 nm. The spatial resolution and MDL can be tuned by the sample thickness. Furthermore, analysis of small amounts of Cl in SiO2 indicated that thin-sample FE-EPMA can realize a spatial resolution and MDL of 41 nm and 446 ppm at Iprob=50 nA, respectively, whereas bulk-sample FE-EPMA offers a resolution of only 348 nm and MDL of 426 ppm.

In-plane ultrasound imaging of the vertebral artery for safe pediatric internal jugular vein cannulation.

Before cannulation of the internal jugular vein (IJV) in 4 pediatric patients, we obtained in-plane and out-of-plane ultrasound images of the vertebral artery (VA). In 2 of 4 patients, abnormalities were identified and best imaged in the in-plane view. In one patient, the right VA had an anomalous origin and course behind the IJV. In another patient, the in-plane image of both the IJV and the VA clearly showed a narrowed IJV. In some cases, the relationship between the VA and IJV may be more clearly understood with in-plane imaging.

[A report of 6 cases with facial flushing, decreased arterial blood pressure and increased heart rate during thoracic surgery].

We report 6 cases with facial flushing, decreased arterial blood pressure and increased heart rate during thoracic surgery. These symptoms appeared 28 +/- 9 minutes (mean +/- SD) after the beginning of the surgery. Arterial blood pressure decreased significantly from 92/48 mmHg to 72/40 mmHg. While heart rate increased significantly from 66 to 83 beats x min(-1). Arterial blood pressure returned to the original values 22 +/- 9 minutes from the appearance of the symptoms. When facial flushing concomitant with circulatory instability occurs during lung surgery, it is important to rule out immediately anaphylactic reaction to the drugs administered and to maintain circulation appropriately.

Minimum detection limit and spatial resolution of thin-sample field-emission electron probe microanalysis.

The minimum detection limit and spatial resolution for a thinned semiconductor sample were determined by electron probe microanalysis (EPMA) using a Schottky field emission (FE) electron gun and wavelength dispersive X-ray spectrometry. Comparison of the FE-EPMA results with those obtained using energy dispersive X-ray spectrometry in conjunction with scanning transmission electron microscopy, confirmed that FE-EPMA is largely superior in terms of detection sensitivity. Thin-sample FE-EPMA is demonstrated as a very effective method for high resolution, high sensitivity analysis in a laboratory environment because a high probe current and high signal-to-noise ratio can be achieved.

[Management of cesarean section under general anesthesia using sugammadex].

BACKGROUND: In cesarean section, residual neuromuscular blockade is often observed at the end of the operation. Sugammadex (SGX) is a selective relaxant-binding agent which reverses the blockade at any depth in 2-3 minutes. We investigated whether SGX improves the efficient management of operating rooms. METHODS: Thirty-six patients were divided into two groups (Group A: 19 patients before SGX became commercially available, Group B: 17 patients after SGX became available). The dosage of SGX, time to extubate and time to discharge from operating rooms after surgery were extracted from anesthetic records retrospectively. RESULTS: The mean dosage of SGX was 192 mg in 15 of the 17 patients in group B. Eight of the 19 patients in group A were extubated within 30 minutes. Five of the 19 were not extubated in the operating rooms. All 17 in group B were extubated within 30 minutes in the operating rooms. CONCLUSIONS: SGX decreased the time to extubation after cesarean section under general anesthesia after surgery, and could improve the efficient management of operating rooms.

Highly reproducible secondary electron imaging under electron irradiation using high-pass energy filtering in low-voltage scanning electron microscopy.

The reproducibility of contrast in secondary electron (SE) imaging during continuous electron irradiation, which caused surface contamination, was investigated using SE high-pass energy filtering in low-voltage scanning electron microscopy (SEM). According to high-pass energy-filtered imaging, dopant contrast in an indium phosphide remained remarkably stable during continuous electron irradiation although the contrast in unfiltered SE images decreased rapidly as a contamination layer was formed. Charge neutralization and the SE energy distributions indicate that the contamination layer induces a positive charge. This results in a decrease of low-energy SE emissions and reduced dopant contrast in unfiltered SE images. The retention of contrast was also observed in high-pass energy-filtered images of a gold surface. These results suggest that this imaging method can be widely used when SE intensities decrease under continuous electron irradiation in unfiltered SE images. Thus, high-pass energy-filtered SE imaging will be of a great assistance for SEM users in the reproducibility of contrast such as a quantitative dopant mapping in semiconductors.

Energy-filtered imaging in a scanning electron microscope for dopant contrast in InP.

We demonstrate that energy-filtered secondary electron (SE) imaging can be used effectively to observe dopant contrast from an InP surface covered with a contamination layer formed by continuous electron irradiation. Although dopant contrast from a surface covered with a contamination layer was almost invisible in a normal SE image, it was still clearly seen in the energy-filtered image. The contrast mechanism is explained in terms of a metal-semiconductor contact charging model and energy shift between the SE distributions across p-type and n-type regions. The results suggest that energy-filtered imaging can reduce the effects of a contamination layer.