Comparison of the analgesic efficacy of the ultrasound-guided transversalis fascia plane block and erector spinae plane block in patients undergoing open inguinal hernia repair under spinal anesthesia / 대한마취과학회지

Background@#Open inguinal hernia repair (OIHR) surgery is a common surgical procedure, and ultrasound guided interfascial plane blocks can also be included in current approaches to postoperative multimodal analgesia regimens. This study aimed to compare the postoperative analgesic efficacy of the erector spinae plane block (ESPB) and transversalis fascia plane block (TFPB) in patients undergoing OIHR. @*Methods@#This prospective, randomized, assessor-blinded comparative study was conducted in the postoperative recovery room and ward of a tertiary hospital. A total of 80 patients with American Society of Anesthesiologists physical status I–III were enrolled and allocated equally to either the ESPB or TFPB group. The patients received standard multimodal analgesia in addition to an ultrasound-guided ESPB or TFPB. During the first 24 h postoperatively, tramadol consumption was assessed and pain levels at rest and during movement were compared using numeric rating scale (NRS) scores at 1, 3, 6, 9, 12, 18, and 24 h postoperatively. @*Results@#The results showed no difference in NRS scores at any time point between the groups, except for NRS at rest in the third hour. However, tramadol consumption was lower in the TFPB group than in the ESPB group overall (88 ± 75.2 vs. 131 ± 93.7 mg, respectively; P = 0.027, mean difference: −43, 95% CI [−80.82, −5.18]). @*Conclusions@#The TFPB leads to lower tramadol requirements in the first 24 h postoperatively than the ESPB in patients undergoing OIHR.

The minimum effective concentration (MEC90) of bupivacaine for an ultrasound-guided suprainguinal fascia iliaca compartment block for analgesia in knee surgery: a dose-finding study / 대한마취과학회지

Background@# In recent years, the suprainguinal fascia iliaca compartment block (SFICB) has become more common in clinical practice. This assessor-blinded dose-finding study aimed to determine the minimum effective concentration (MEC90, MEC95) of bupivacaine for a single-injection SFICB in patients undergoing arthroscopic anterior cruciate ligament repair. @*Methods@# This prospective study was conducted at a tertiary hospital (postoperative recovery room and ward). The SFICB was performed as a postsurgical intervention after spinal anesthesia. Seventy patients were allocated using the biased-coin design up-and-down sequential method. The ultrasound-guided SFICB was performed using different bupivacaine concentrations, and standard multimodal analgesia was administered to all patients. Block success was defined as the absence of pain or presence of only tactile sensation during the pinprick test conducted on the anterior and lateral regions of the mid-thigh six hours postoperatively. @*Results@# According to isotonic regression and bootstrap CIs, the MEC90 value of bupivacaine for a successful SFICB was 0.123% (95% CI [0.098, 0.191]) and the MEC95 value was 0.188% (95% CI [0.113, 0.223]). @*Conclusions@# Our study showed that the MEC90 and MEC95 values for bupivacaine administered via an SFICB for analgesia were 0.123% and 0.188%, respectively. One advantage of using lower concentrations of bupivacaine is the associated reduction in quadriceps weakness.

Primary sacral hydatid cyst causing cutaneous fistula

Echinococcus granulosus and Echinococcus multilocularis are the causes of hydatid disease and the main characteristic is endemic. Generally, it affects the liver and lungs. Spinal hydatidosis accounts for less than 1% of the cases. Vertebral hydatidosis is usually silent and a slowly progressive disease with a long latent period. Another rare form is the primary sacral hydatid cyst. Generally, patients suffer from back pain and neural compression symptoms. A 43-year woman was admitted with left leg pain and a fluid leakage from a cutaneous fistula on the left hip. It was diagnosed on MRI as a bilateral cystic lesion which eroded the first sacral wing, extending to the paravertebral region and left intervertebral foramen. We present a case with fluid leakage from cutaneous fistula

use of magnesium sulfate in severely preeclamptic patients for emergency cesarean section

The anaesthetic management in the peripartum period of a pre-eclamptic patient is important. The anesthesiologist must perform a detailed preanesthetic assessment, including a history and physical examination. The morbidity and mortality rates are higher in severe preeclamsia. Magnesium sulfate has been successfully used in obstetrics for inhibiting premature labor and in the treatment of eclampsia-related seizures. Magnesium inhibits the release of acetylcholine in the neuromuscular junction and behaves like a neuromuscular relaxant, potentiating the effects of non-depolarizing neuromuscular blockers. We report two cases of pregnancy with severe preeclampsia, managed with magnesium sulfate, who underwent emergency caesarian section

The Relationship between Presbycusis and Mastoid Pneumatization

Presbycusis is defined as the natural hearing loss accompanying aging, caused by degenerative changes in the inner ear. The etiology of presbycusis is uncertain. However, it would appear that a complex genetic cause is most likely. The determinants of mastoid size continue to be controversial. One of the pneumatization theories is the hereditary theory. In this study, the possible relationship between presbycusis and the extent of mastoid pneumatization was investigated. This study was carried out on 21 patients with presbycusis and 21 normal subjects of similar ages. The pneumatized volume was measured by computerized tomography. The temporal bone was scanned at 2 mm thickness intervals. Exposure (kV 130, mA105). The scan plane was parallel to the orbitomeatal line and the CT images covered the entire mastoid region. The average mastoid pneumatization in presbycusis group was 6.08 +/- 2.52 cm3 in the right ear and 6.19 +/- 2.93 cm3 in the left ear. However, in the control group it was 4.69 +/- 3.17 cm3 in the right ear (p=0.12) and 5.10 +/- 3.49 cm3 in the left ear (p=0.28). No significant difference was found between the presbycusis patients and normal subjects in terms of the volume of mastoid pneumatization.