Career opportunities and guidance among early-career anaesthesiologists - A questionnaire-based cross-sectional survey.

Background and Aims: The opportunities to work for early-career anaesthesiologists are in various sectors such as teaching institutes, private practice, and corporate hospitals in India or abroad. The primary aim of the survey was to determine whether early-career anaesthesiologists wanted to work in India or abroad. The secondary objectives were to determine the proportion of early-career anaesthesiologists who wished to pursue further studies and what degree they wanted to pursue. Methods: A validated questionnaire containing questions related to career preferences was circulated by social media among early-career anaesthesiologists via Google Forms. The survey questionnaire focussed on whether the respondents wanted to work in India or abroad or pursue further studies. The survey results were tabulated in an Excel sheet. Descriptive statistics were used to analyse the data, and the Chi-square test was applied where appropriate. Age-group preferences and gender preferences were also analysed. Results: A total of 684 responses were received. The mean (SD) age of the respondents was 31.4 (2.8) years. Among the respondents, 64.1% were female, and 35.9% were male. Of the respondents, 309 (72.5%) were in a job, 50 (11.7%) were pursuing Society-recognised fellowships, and the rest were pursuing super-specialisation degrees or University-recognised fellowships. Two hundred and eighty-six respondents (75.5%) wanted to study outside India. Only 155 (36.6%) had career guidance from immediate contacts or mentors. Conclusion: Early-career anaesthesiologists want to pursue further degrees and fellowships after their graduation in anaesthesiology. Career guidance is an important aspect of anaesthesiology training.

Artificial intelligence in regional anaesthesia.

Ultrasound-guided regional anaesthesia is used to facilitate the real-time performance of the regional block, increase the block success and reduce the complication rate. Artificial intelligence (AI) has been studied in many medical disciplines with high success rates, especially radiology. The purpose of this article was to review the evolution of AI in regional anaesthesia. The role of AI is to identify and optimise the sonography image, display the target, guide the practitioner to advance the needle tip to the intended target and inject the local anaesthetic. AI supports non-experts in training and clinical practice and experts in teaching ultrasound-guided regional anaesthesia.

Comparing Analgesic Efficacy of a Novel Dual Subsartorial Block Using Two Different Volumes in Patients Undergoing Total Knee Arthroplasty: A Prospective, Double-Blind, Monocentric, Randomised Trial.

INTRODUCTION: Total knee arthroplasty (TKA) is a life-changing joint surgery that improves health-related quality of life and functional status. Patients in need of this surgery mostly belong to the geriatric age group with limited functional reserves and multiple co-morbidities requiring utmost perioperative care with the most suitable analgesic modalities. Regional analgesia (RA) should provide effective analgesia while allowing early mobility, reduced opioid consumption, and early discharge. Dual subsartorial block (DSB) is a novel procedure-specific, motor-sparing, and opioid-sparing RA technique for TKA surgeries. Our study compared the analgesic efficacy of the two different combinations of volumes used in DSB. METHODS: This prospective randomized comparative study included patients between 25-75 years of age of American Society of Anesthesiology (ASA) I-II grades who underwent an elective cemented unilateral total knee replacement performed via medial approaches under neuraxial anesthesia. A total of 104 patients were divided into two equal groups based on the local anesthetic (LA) volumes (Group A 10/20 ml and Group B 20/10 ml) used in the DSB. Postoperative pain scores (using a visual analog scale) and quadriceps strengths (using neurological exam), and opioid consumption were measured at regular intervals till discharge. RESULTS: Most patients (71.2%) remained pain-free and comfortable until discharge, while 28.8% complained of pain within 12 hours of DSB. Mean quadriceps strength remained almost normal (4-5/5) until the discharge with no incidences of buckling or fall in either group. Over time, the postoperative trend between the groups showed a significant difference for dynamic pain (p = 0.002) and quadriceps strength (p = <0.001). There was an insignificant difference (p = 0.161) between the groups regarding opioid consumption, with the median oral morphine equivalent of zero in both groups.  Discussion: The effective analgesic coverage of DSB is based on the involvement of all innervations of the procedure-specific pain generators of TKR surgeries. The specific focus on selective sensory innervations and the type/volume of the LA used makes DSB a motor-sparing RA alternative that facilitates early mobility and discharge. It can provide effective postoperative analgesia without compromising the motor strength of the quadriceps muscle when administered in either 10/20 or 20/10 volumes.

Therapeutic intervention for iatrogenic thoracolumbar pseudomeningocele using ultrasound-guided aspiration and ultrasound-assisted epidural blood patch - A case report.

Cerebrospinal fluid (CSF) leakage causing a pseudomeningocele is a well-recognized complication after spine surgery. It presents as a recurrence of low-back pain, radiculopathy, subcutaneous swelling, symptoms of intracranial hypotension, and delayed myelopathy. Definitive surgical repair is needed if not resolved spontaneously or with minimally invasive measures like lumbar subarachnoid drainage and an epidural blood patch (EBP). We report a case of iatrogenic thoracic pseudomeningocele, successfully treated with dual therapeutic intervention (CSF aspiration and EBP) using an ultrasound. This minimally-invasive intervention helped our patient resolve symptoms, avoid radiation, and make it cost-effective by avoiding surgical intervention and polypharmacy of general anesthesia.

Awake Single-Stage Bilateral Clavicle Surgeries Under Bilateral Clavipectoral Fascial Plane Blocks: A Case Report and Review of Literature.

The clavicle is a frequently fractured bone with an infrequent bilateral occurrence. Regional anesthesia (RA) for clavicle surgeries is always challenging due to its complex innervation arising from the two plexuses (cervical and brachial). Various RA techniques described for clavicle surgeries include plexus blocks, fascial plane blocks, and truncal blocks. Plexus blocks are associated with undesirable effects, such as phrenic nerve blockade and paralysis of the entire upper limb, limiting their application for bilateral regional clavicle surgeries. The clavipectoral fascial plane block (CPB) is a novel, procedure-specific, phrenic-sparing, and motor-sparing RA technique that can provide anesthesia or analgesia for clavicle surgeries. The decision to use the CPB and/or other RA techniques may depend on the site of clavicle injury or variations in clavicular innervation. We report a case of single-stage bilateral clavicle surgery successfully managed with a bilateral CPB alone using ultrasound guidance and landmark guidance separately. The patient was kept awake and comfortable throughout the surgery. In conclusion, CPB can be an effective alternate RA technique in avoiding undesired side effects of more proximal techniques such as phrenic nerve involvement and motor blockade of upper limbs. Landmark-guided CPB can be an alternative with equianalgesic efficacy as of ultrasound-guided CPB in resource-poor or emergency settings.

Regional anesthesia for scapular fracture surgery: an educational review of anatomy and techniques.

Scapular fractures are very rare, and those requiring surgical interventions are even rarer. Most scapula surgeries are done under general anesthesia with or without the regional anesthesia (RA) technique as an adjunct. Since scapular innervation is complicated, a thorough review of the relevant anatomy is warranted. In this RAPM educational article, we aimed to summarize the target nerves and blocks needed to optimize analgesia or even to provide surgical anesthesia for scapula surgeries. In this review, we are describing an algorithmic "identify-select-combine" approach, which enables the anesthesiologist to understand detailed innervation of the scapula and to obtain a procedure-specific RA technique. Procedure-specific RA would probably be the way forward for defining future RA practices.