Erector Spinae Plane Block versus Transversus Abdominis Plane Block for Robotic Inguinal Hernia Repair: A Blinded, Active-Controlled, Randomized Trial.

BACKGROUND: Regional anesthetic nerve blocks are widely used in the treatment of pain after outpatient surgery to reduce opioid consumption. Erector spinae plane (ESP) block is a recently described technique with promising results in different scenarios. OBJECTIVES: To compare ESP block efficacy with the commonly used transversus abdominis plane (TAP) block in patients undergoing robot-assisted inguinal hernia repair. STUDY DESIGN: This was a randomized, blinded, active controlled, superiority trial with 2 parallel groups. The study was approved by the local ethics committee. Registration took place on; www. CLINICALTRIALS: gov with the identifier NCT04750512. SETTING: Adults undergoing robotic inguinal hernia repair were recruited between January 2021 and April 2022 in a single referral center of southern Switzerland. METHODS: To ensure blinding, the study employed a "double dummy" design, where all patients underwent both TAP and ESP blocks, but only one block was therapeutically active. The therapeutic block contained ropivacaine 0.2%, while the other infiltration contained placebo. The therapeutic intervention varied between groups, with one group receiving the TAP block as the active treatment and the other group receiving the ESP block as the active treatment. Computer generated 1:1 randomization determined allocation, which took place immediately prior to the intervention. As a result, blinding included patients, anesthesia, and surgery providers, outcome assessors and statistical analysts. The main outcome measure was the highest reported pain score on a Visual Analog Scale (VAS) during the 6 hours following the end of general anesthesia. Secondary outcomes included pain scores at set intervals, analgesic consumption, and complications. RESULTS: A total of 50 patients (25 per arm) were enrolled and included in the analysis. The study found no significant difference in the mean maximal VAS scores between the 2 groups (TAP block 22.2, ESP block 20, difference 2.2, 95% CI is -12.1 to 16.5). Secondary endpoints, including VAS pain scores at different time points, use of rescue analgesics, time to first walk, duration of stay, and frequency of adverse events, did not show any significant differences between the 2 groups. However, post-hoc analysis suggested a more stable effect over time for the ESP block compared to the TAP block. LIMITATIONS: The main limitation is a higher variance in VAS scores than expected in the power calculations. CONCLUSIONS: ESP block was not superior to TAP block in the treatment of post-operative pain among patients undergoing robotic inguinal hernia repair.

Ultrasound-guided pudendal nerve block in patients undergoing open hemorrhoidectomy: a double-blind randomized controlled trial.

PURPOSE: In this double-blind randomized trial, we aimed to compare the postoperative pain, complications, and length of hospital stay in patients undergoing open hemorrhoidectomy under spinal anesthesia with or without the pudendal nerve block. METHODS: Patients undergoing Milligan-Morgan hemorrhoidectomy under spinal anesthesia were randomized to undergo a pudendal nerve block or no intervention. Postoperative pain on the visual analogue scale (VAS) at 6, 12, 24, and 48 h; opioid administration; and length of hospital stay were recorded and analyzed. RESULTS: Over the study period, 49 patients were included and 23 randomized in the treatment arm. No differences in terms of age, gender, and preoperative risk factors were noted between groups. The pain on the VAS at 6, 12, 24, and 48 h was 2.8 vs. 4.6 (p = 0.046), 3.4 vs. 4.7 (p = 0.697), 1.4 vs. 3.1 (p = 0.016), and 1.0 vs. 2.1 (p = 0.288) in the treatment and control groups respectively. No differences in opioids use or complications were noted. Length of hospital stay was 1.2 vs. 1.8 days respectively (p = 0.046). No complications directly associated to the pudendal nerve block were observed. Multivariate analysis revealed that the pudendal nerve block was an independent factor reducing the postoperative pain. CONCLUSIONS: The ultrasound-guided pudendal nerve block in patients undergoing open hemorrhoidectomy under spinal anesthesia showed a statistically significant reduction in postoperative pain and length of hospital stay. The proposed technique appeared to be safe and feasible and may be recommendable in patients undergoing open hemorrhoidectomy. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04251884.

Sleepiness at the time of testing impairs olfactory performance.

BACKGROUND: We aimed to investigate the differential roles of hypocretin versus dopamine dysfunction versus excessive daytime sleepiness (EDS) in the development of hyposmia. Olfaction in patients with Parkinson disease, restless leg syndrome, narcolepsy with cataplexy, EDS, and healthy controls was compared. METHODS: Sixty-six subjects participated in the study: 14 with PD, 13 with NC, 12 with RLS, 8 with EDS, and 20 healthy controls. Olfaction was tested using standardized Sniffin'Sticks test. Sleepiness was assessed using Karolinska, Stanford and Epworth sleepiness scales. RESULTS: Olfactory discrimination correlated negatively with subjective momentary sleepiness. A significant deficit in olfaction was found in PD patients with respect to all other groups in all olfactory domains. No significant differences were found between the other groups. CONCLUSION: We could not confirm decreased olfaction in patients with NC. Yet the significant correlation between momentary sleepiness and olfactory function suggests that sleepiness is a potential confounding factor in the assessment of olfaction, e.g. in NC. Furthermore, our results confirm that olfaction is impaired in PD, whereas it is normal in RLS.