Anesthesia or analgesia? New block for shoulder surgery: pericapsular nerve group block

Abstract Interscalene brachial plexus (ISB) block is considered the analgesic technique of choice for shoulder surgery. However, the hemidiaphragmatic paresis that may occur after the block has led to the search for an alternative to the ISB block. In this case report, the pericapsular nerve group (PENG) block was performed for both surgical anesthesia and postoperative analgesia in two patients who underwent shoulder surgery. It is suggested that the PENG block can be safely applied for analgesia and can be part of surgical anesthesia, but alone is not sufficient for anesthesia. The block of this area did not cause motor block or pulmonary complications, nor result in muscle laxity, blocking only the shoulder and the upper third of the humerus. It was demonstrated that the PENG block may be safely applied for both partial anesthesia and analgesia in selected shoulder surgery cases.

Preoperative proteinuria is associated with increased rates of acute kidney injury after partial nephrectomy

ABSTRACT Purpose We investigated the association between preoperative proteinuria and early postoperative renal function after robotic partial nephrectomy (RPN). Patients and Methods We retrospectively reviewed 1121 consecutive RPN cases at a single academic center from 2006 to 2016. Patients without pre-existing CKD (eGFR≥60 mL/min/1.73m2) who had a urinalysis within 1-month prior to RPN were included. The cohort was categorized by the presence or absence of preoperative proteinuria (trace or greater (≥1+) urine dipstick), and groups were compared in terms of clinical and functional outcomes. The incidence of acute kidney injury (AKI) was assessed using RIFLE criteria. Univariate and multivariable models were used to identify factors associated with postoperative AKI. Results Of 947 patients, 97 (10.5%) had preoperative proteinuria. Characteristics associated with preoperative proteinuria included non-white race (p<0.01), preoperative diabetes (p<0.01) and hypertension (HTN) (p<0.01), higher ASA (p<0.01), higher BMI (p<0.01), and higher Charlson score (p<0.01). The incidence of AKI was higher in patients with preoperative proteinuria (10.3% vs. 4.6%, p=0.01). The median eGFR preservation measured within one month after surgery was lower (83.6% vs. 91%, p=0.04) in those with proteinuria; however, there were no significant differences by 3 months after surgery or last follow-up visit. Independent predictors of AKI were high BMI (p<0.01), longer ischemia time (p<0.01), and preoperative proteinuria (p=0.04). Conclusion Preoperative proteinuria by urine dipstick is an independent predictor of postoperative AKI after RPN. This test may be used to identify patients, especially those without overt CKD, who are at increased risk for developing AKI after RPN.

Effects of Haloperidol, Asenapine and Paliperidone on MK-801-Induced Memory Deterioration in Morris Water Maze and Radial Arm Maze Tests in Mice

Objective: One of the most important problems of schizophrenic patients is the impairment of cognitive functions. Methods: The aim of this study was to investigate the effects of haloperidol, asenapine and paliperidone on spatial learning and memory using the Morris water maze (MWM) and radial arm maze (RAM) tests; moreover the effects of haloperidol, asenapine, and paliperidone on MK-801 induced cognitive dysfunction were also evaluated in mice. Results: Both asenapine (0.05 mg/kg) and paliperidone reversed MK-801 induced increment in escape latency in 2nd, 3rd, and 4th acquisition sessions while haloperidol failed to reverse MK-801 induced this effect. Time spent in escape platform’s quadrant significantly decreased while the mean distance to platform significantly increased in MK-801 group in the probe trial of MWM test and administration of asenapine and paliperidone significantly reversed MK- 801 induced these effects while haloperidol had no effect. MK-801 significantly increased the speed of the animals in probe trial of the MWM test while both asenapine and paliperidone reversed this effect. In the RAM test, MK- 801 significantly increased the number of errors in the retention trial and haloperidol failed to reverse this effect. Both asenapine (0.075 mg/kg) and paliperidone reversed MK-801-induced increment in a number of errors and improved MK-801 induced prolongation in latency. Conclusions: The results of this study revealed that MK-801 exerted spatial memory impairment in MWM and RAM tests; haloperidol failed to improve MK-801 induced memory deterioration in mice. Moreover both asenapine and paliperidone improved MK-801 induced spatial learning and memory impairment in the MWM and RAM tests.