Impact of the pericapsular nerve group (PENG) block on postoperative analgesia and functional recovery following total hip arthroplasty: a randomised, observer-masked, controlled trial.

The pericapsular nerve group (PENG) block is a novel regional anaesthesia technique that aims to provide hip analgesia with preservation of motor function, although evidence is currently lacking. In this single-centre, observer-masked, randomised controlled trial, patients undergoing total hip arthroplasty received pericapsular nerve group block or no block (control group). Primary outcome measure was maximum pain scores (0-10 numeric rating scale) measured in the first 48 h after surgery. Secondary outcomes included postoperative opioid consumption; patient mobilisation assessments; and length of hospital stay. Sixty patients were randomly allocated equally between groups. The maximum pain score of patients receiving the pericapsular nerve group block was significantly lower than in the control group at all time-points, with a median (IQR [range]) of 2.5 (2.0-3.7 [0-7]) vs. 5.5 (5.0-7.0 [2-8]) at 12 h; 3 (2.0-4.0 [0-7]) vs. 6 (5.0-6.0 [2-8]) at 24 h; and 2.0 (2.0-4.0 [0-5]) vs. 3.0 (2.0-4.7 [0-6]) at 48 h; all p < 0.001. Moreover, the pericapsular nerve group showed a significant reduction in opioid consumption, better range of hip motion and shorter time to ambulation. Although no significant difference in hospital length of stay was detected, our results suggest improved postoperative functional recovery following total hip arthroplasty in patients who received pericapsular nerve group block.

Use of GlideScope® in adults: an overview.

This paper is an overview of the literature concerning the "know how" of the GlideScope® use in adults. We summarized the main evidences of the last 10 years with particular attention to experts' suggestions about clinical practice of the GlideScope®, noticing matters still debated on GlideScope® use. We used PubMed to search publications from January 2003 to June 2013 using the search terms "GlideScope", "video laryngoscope" and "videolaryngoscopy". These publications were searched manually or references to further publication not identified using PubMed. All works that made a point worth including were cited in the discussion. Our research confirms the value of GlideScope® use in airway management and highlights the debate about the use of videolaryngoscopes in routine cases and the operators who may use them in clinical practice.

Force and pressure distribution using Macintosh and GlideScope laryngoscopes in normal and difficult airways: a manikin study.

BACKGROUND: The forces applied to the soft tissues of the upper airway may have a deleterious effect. This study was designed to evaluate the performance of the GlideScope compared with the Macintosh laryngoscope. METHODS: Twenty anaesthetists and 20 trainees attempted tracheal intubation of a Laerdal SimMan manikin. Forces and pressure distribution applied by both laryngoscope blades onto the soft upper airway tissues were measured using film pressure transducers. The minimal force needed to achieve a successful intubation, in the same simulated scenario, was measured; additionally, we considered the visualization score achieved by using the Cormack-Lehane grades. RESULTS: All participants applied, on average, lower force with the GlideScope than with the Macintosh in each simulated scenario. Forces [mean (sd)] applied in the normal airway scenario [anaesthetists: Macintosh 39 (22) N and GlideScope 27 (15) N; trainees: Macintosh 45 (24) N and GlideScope 21 (15) N] were lower than forces applied in the difficult airway scenario [anaesthetists: Macintosh 95 (22) N and GlideScope 66 (20) N; trainees: Macintosh 100 (38) N and GlideScope 48 (16) N]. All the intubations using the GlideScope were successful, regardless of the scenario and previous intubation experience. The average pressure on the blades was 0.13 MPa for the Macintosh and 0.07 MPa for the GlideScope, showing a higher uniformity for the latter. CONCLUSIONS: The GlideScope allowed the participants to obtain a successful intubation applying a lower force. A flatter and more uniform pressure distribution, a higher successful rate, and a better glottic view were observed with the GlideScope.

Static forces variation and pressure distribution in laryngoscopy performed by straight and curved blades.

A theoretical analysis of the forces acting on the laryngoscope during the lifting of the epiglottis is carried out by applying the basic principles of statics. The static model of a laryngoscope equipped with a straight and a curved blade and the forces variation, as a function of the introduction angle and of tissue reaction application point, are described. The pharyngeal tissues and epiglottis pressure distribution on the blade is obtained, with a 1mm(2) resolution, by measurements performed in-vitro on a simulation mannequin, using straight and curved blades. The straight blade requires more effort than the curved one to obtain the same visualization of vocal cords, however forces exerted by using a laryngoscope with a curved blade do not vary linearly with the application point of tissue reaction. Average intensity of the tissue reaction has been found in the order of 32+/-11 N. Pressure distribution is maximally concentrated on the tip of curved blades (0.5 MPa on 5mm axial length), whereas it is more dispersed on straight blades (0.2 MPa on 10mm axial length). The inclination of the handle also influences the effort of the operator: for both blades, from 0 rad to 1.57 rad, the lifting force shows a total variation of about 13% of the top value, the transversal forces vary less than 6% of the top value.

New devices and techniques for airway management.

Innovation over the past 25 years in the field of the airway management has led to the proliferation of new and improved techniques and devices. It is important to emphasize that the definition of a failed airway must include the inability to maintain acceptable oxygenation and not only the evidence of unsuccessful laryngoscopy and impossible intubation. We must ask ourselves: is it always necessary to intubate? Is it necessary in all patients? Our answer is absolutely ''no." Patients' oxygenation is the absolute priority, where the choice of whether or not to intubate represents only a technical problem. The existing literature primarily supports the use of the classic laryngeal mask airway (LMA) for providing effective ventilation and oxygenation; it suggests the use of the intubating LMA as an important rescue device and the use of the Combitube as a well-established emergency airway. The role in managing complex airway problems of many new extraglottic devices has not yet been completely investigated and will likely be better defined in the coming years. The videolaryngoscopes seem to be an interesting and promising option in the field of airway management. Furthermore, the applicability of associated techniques could represent an efficacious strategy to overcome the limitations of the single device by strengthening their capabilities and chances of successful airway management. To date there is no technique found to be effective in every case or that can solve all airway problems. It is not the latest device or the latest technique that can solve an airway management problem, but the operator's experience and skill with the device and technique that he knows best and uses daily.