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.

Efficacy of parasternal block to decrease intraoperative opioid use in coronary artery bypass surgery via sternotomy: a randomized controlled trial.

OBJECTIVE: This study aims to assess the effect of a preoperative parasternal plane block (PSB) on opioid consumption required to maintain hemodynamic stability during sternotomy for coronary artery bypass graft surgery. METHODS: This double-blind, randomized, placebo-controlled trial prospectively enrolled 35 patients scheduled for coronary artery bypass graft surgery under general anesthesia with propofol and remifentanil. Patients were randomized to receive preoperative PSB using either ropivacaine (PSB group) or saline solution (placebo group) (1:1 ratio). The primary endpoint was the maximal effect-site concentration of remifentanil required to maintain heart rate and blood pressure within the recommended ranges during sternotomy. RESULTS: Median maximum concentration of remifentanil necessary to maintain adequate hemodynamic status during sternotomy was significantly reduced in PSB group (4.2 (2.5-6.0) ng/mL) compared with placebo group (7.0 (5.2-8.0) ng/mL) (p=0.02). Mean maximum concentration of propofol used to control depth of anesthesia was also reduced (3.9±1.1 µg/mL vs 5.0±1.5 µg/mL, PSB vs placebo, respectively; p=0.02). This reduction in propofol consumption during sternotomy enabled a more adequate level of sedation to be maintained in patients (minimum patient state index was 11.7±8.7 in placebo group and 18.3±6.8 in PSB group; p=0.02). PSB reduced postoperative inflammatory response by limiting concentrations of proinflammatory cytokines IL-8, IL-18, IL-23, IL-33 and MCP-1 measured in the first 7-day after surgery (p<0.05). CONCLUSIONS: Preoperative PSB reduced the maximum concentrations of remifentanil and propofol required to maintain hemodynamic stability and depth of anesthesia during sternotomy. TRIAL REGISTRATION NUMBER: NCT03734159.Sébastien Bloc, M.D.1,2; Brieuc P. Pérot, Ph.D.3; Hadrien Gibert, M.D.1; Jean-Dominique Law Koune, M.D.1; Yannick Burg, M.D.1; Didier Leclerc, M.D.1; Anne-Sophie Vuitton, M.D.1; Christophe De La Jonquière, M.D.1; Marine Luka, L.S.3; Thierry Waldmann, M.D.4; Nicolas Vistarini, M.D.4; Stéphane Aubert, M.D.4; Mickaël M. Ménager, Ph.D.3; Messaouda Merzoug, Ph.D.2; Cécile Naudin, Ph.D.2; Pierre Squara, M.D.2,5.

[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.

[Erratum to "Acute renal failure during COVID-19 epidemic" [Prat. Anesth. Reanim. 24 (2020) 207-11]]. / Erratum à « COVID-19 et insuffisance rénale aiguë en réanimation ¼ [Prat. Anesth. Reanim. 24 (2020) 207­11].

[This corrects the article DOI: 10.1016/j.pratan.2020.07.004.].

[Acute renal failure during COVID-19 epidemic]. / COVID-19 et insuffisance rénale aiguë en réanimation.

Renal impairment is a common complication in patients hospitalized in intensive care unit for acute respiratory distress syndrome (ARDS) due to COVID-19 infection. However, the prevalence of SARS-CoV-2 kidney injury is difficult to estimate worldwide. Several pathophysiological mechanisms are involved, including decreased renal perfusion related to mechanical ventilation, sepsis and cytokines release, as well as direct virus toxicity on proximal tubular cells and podocytes, mediated by angiotensin 2 conversion receptors (ACE 2) and TMPRSS proteases. More than 20 % of ICU COVID-19 patients require extra renal replacement therapy (ERT) for acute renal failure that is made difficult by the hypercoagulable state of these patients, responsible for filter thrombosis.