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.

[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.