Regional versus general anesthesia in knee arthroplasty in patients with different classes of BMI: A matched analysis of the NSQIP database.

BACKGROUND: Knee arthroplasty for knee arthritis is a commonly performed surgery yielding excellent functional results and good pain relief. It is associated with post-surgical complications according to the type of anesthesia and BMI class. METHODS: The National Surgical Quality Improvement Project database for the years 2005-2012 for patients >18 years of age who underwent knee arthroplasty, condyle and plateau, medial and/or lateral compartment. The surgical site complications, bleeding occurrences necessitating transfusion, unplanned readmissions, and mortality stratified according to anesthesia type and BMI class over a period of 30-days were examined. RESULTS: A total of 78,275 patients were included for analysis; regional anesthesia showed a consistent protective effect from surgical site complications more prominent with increasing obesity class with respective ORs and their corresponding 95% CI for pre-obesity, class I, II, and III obesity being 0.95 [0.89-1.09], 0.75 [0.68-0.83], 0.64 [0.57-0.72], and 0.61 [0.54-0.7]. CONCLUSIONS: Higher BMI values are a protective factor for the risk of bleeding requiring transfusion in patients undergoing total knee arthroplasty. Moreover, regional anesthesia is the preferred choice of anesthesia as well if postoperative complications are considered. A significant decrease in the rate of post-operative blood transfusions was seen in patients with high BMI and regional anesthesia.

Is there a place for regional anesthesia in nonoperating room anesthesia?

PURPOSE OF REVIEW: General anesthesia and monitored anesthesia care (MAC) are the most widely used techniques in nonoperating room anesthesia (NORA). However, regional anesthesia is slowly finding viable applications in this field. This review aims at providing an update on the current practice of regional anesthesia techniques outside of the operating theatre. RECENT FINDINGS: Some anesthetic departments have implemented the use of regional anesthesia in novel applications outside of the operating room. In most cases, it remains an adjunct to general anesthesia but is sometimes used as the sole anesthetic technique. The use of the paravertebral block during radiofrequency ablation of different tumors is a recent application in interventional radiology. In emergency medicine, regional anesthesia is gaining traction in analgesia for trauma patients. SUMMARY: Regional anesthesia is finding its way into broader applications every day, offering a range of potential benefits in anesthetic care. Its implementation in NORA is promising and may aid in decreasing patient morbidity. However, great care should be taken in applying the recommended safety precautions for regional anesthesia in any setting.

Comparison between femoral block and PENG block in femoral neck fractures: A cohort study.

BACKGROUND: Regional analgesia is worth performing in the multimodal postoperative management of hip fracture (HF) because it reduces hospital morbidity and mortality. The aim of this study is to compare the efficacy and side effects of the recently described "Pericapsular Nerve Group (PENG) Block" with those of the femoral block, which is considered the standard of care for postoperative pain control after femoral neck fracture. MATERIALS AND METHODS: We conducted a comparative observational study at a university hospital (Saint Antoine Hospital, Sorbonne University, Paris, France), where the PENG block was introduced in August 2019. We include all patients from June to October 2019, who were coming for femoral neck fractures and who had an analgesic femoral block or PENG block before their surgery. The primary outcome was the comparison of cumulative postoperative morphine consumption 48 hours after surgery. RESULTS: Demographics, medical charts, and perioperative data of 42 patients were reviewed: 21 patients before (Femoral group) and 21 patients after the introduction of PENG block (PENG group) in clinical practice. Thirteen total hip arthroplasties (THA) and eight hemi arthroplasties (HA) were included in each group. Demographics were also comparable. The median, postoperative, morphine equivalent consumption at 48 hours was 10 [0-20] mg and 20 [0-50] mg in Femoral and PENG groups respectively (p = 0.458). No statistically significant differences were found in postoperative pain intensity, time to ambulation, incidence of morphine-related side effects, or length of hospital stay. The postoperative muscle strength of the quadriceps was greater in the PENG group than in the Femoral group (5/5 vs. 2/5, p = 0.001). CONCLUSION: In the management of hip fractures, PENG block is not associated in our study with a significant change in postoperative morphine consumption, compared to femoral block. However, it does significantly improve the immediate mobility of the operated limb, making it appropriate for inclusion in enhanced recovery programs after surgery.

[Anaesthesia during COVID-19 epidemic]. / L'anesthésie au temps du COVID.

Surgical pathway has gained in complexity thanks to the recent COVID-19 pandemic. The anesthetic management of the SARScoV-2 (+) patient imposes several modifications, and remains a work in progress. As a consequence there has been a shift to distant anaesthetic consultations while in-hospital consultations are more difficult to organize. Patients scheduled for surgery may benefit from a preoperative diagnostic testing for SARS coV2 infection if they have been in close contact with a COVID-19 patient, or if they are symptomatic or in case of major surgery. According to the PCR results, patients could have their surgery postponed, or may alternatively follow a specific clinical pathway in the operating and recovery rooms with an adapted anaesthetic plan.