Ultrasound-guided sphenopalatine ganglion block for effective analgesia during awake fiberoptic nasotracheal intubation: A case report.

BACKGROUND: Awake fiberoptic nasotracheal intubation (AFNI) is the preferred airway management strategy for patients with difficult airways. However, this procedure can cause significant physical and psychological distress. This case report explores the application of a sphenopalatine ganglion (SPG) block as an alternative analgesic modality to mitigate the discomfort associated with AFNI. CASE SUMMARY: A 63-year-old female with a history of right maxillary osteosarcoma underwent craniotomy for a suspected malignant brain lesion. The patient's medical history included prior surgery, chemotherapy, and radiation therapy, resulting in significant jaw impairment and limited neck mobility. Considering the anticipated airway challenges, AFNI was planned. A SPG block was performed under real-time ultrasound guidance, providing effective analgesia during nasotracheal intubation. CONCLUSION: The SPG block represents a promising analgesic approach in AFNI, offering potential benefits in alleviating pain involving the nasal and nasopharyngeal regions as well as improving patient cooperation.

Combinations of nerve blocks in surgery for post COVID-19 pulmonary sequelae patient: A case report and review of literature.

BACKGROUND: Regional anesthesia is a promising method in patients with post coronavirus disease 2019 (COVID-19) pulmonary sequelae for preserving pulmonary function and preventing postoperative pulmonary complications, compared with general anesthesia. CASE SUMMARY: We provided surgical anesthesia and analgesia suitable for breast surgery by performing pectoral nerve block type II (PECS-II), parasternal, and intercostobrachial nerve blocks with intravenous dexmedetomidine administration in a 61-year-old female patient with severe pulmonary sequelae after COVID-19 infection. CONCLUSION: Sufficient analgesia for 7 h was provided via PECS-II, parasternal, and intercostobrachial blocks perioperatively.

Efficacy of Scrambler Therapy for Management of Chronic Pain: A Meta-Analysis of Randomized Controlled Trials.

BACKGROUND: Although several randomized controlled trials (RCTs) have reported the efficacy of scrambler therapy (ST) for the management of chronic pain, those findings remain inconsistent. OBJECTIVES: This meta-analysis aimed to investigate the efficacy of ST for the management of chronic pain. STUDY DESIGN: A meta-analysis of RCTs. METHODS: We searched core databases including PubMed, EMBASE, and the Cochrane library for RCTs in October 2021. Standardized mean differences (SMDs) with 95% confidence intervals (CIs) for pain reduction were calculated using a random-effects model meta-analysis. RESULTS: Out of 348 studies, a total of 7 RCTs (n = 287 patients) that met the inclusion criteria were included in the final analysis. Overall, ST marginally decreased pain scores after the end of the treatment compared with the control group, with substantial heterogeneity (SMD, -0.85; 95% CI, -1.66 to -0.03; I2 = 89.5%, n = 7). A subgroup meta-analysis found that the use of ST significantly reduced analgesic consumption compared to the control group (SMD, -0.54; 95% CI, -0.93 to -0.14; I2 = 0.0%; n = 2). However, no significant efficacy was observed in the subgroup meta-analyses by methodological quality, type of diseases causing pain, and follow-up period. LIMITATIONS: The included trials have a small sample size and low methodological quality. CONCLUSIONS: ST seems to be effective in the management of patients with chronic pain. However, further, large RCTs are warranted to confirm our findings.

Caudal block with steroid in the treatment of acute voiding dysfunction and pain caused by sacral herpes zoster: A case report.

RATIONALE: Herpes zoster (HZ) involving sacral dermatome is very rare, which can sometimes cause voiding dysfunction. PATIENT CONCERNS: A 52-year-old man presented with acute pain and voiding dysfunction, following HZ in his right sacral dermatomes. DIAGNOSES: Twenty two days before presentation HZ occurred and 9 days after the onset of the HZ, he had trouble with starting urination and weak urine stream which was managed with tamsulosin 0.4 mg orally once a day and intermittent urinary catheterization. He was treated with 150 mg of pregabalin 2 times a day, tramadol 50 mg 2 times, and acetaminophen 600 mg 2 times a day. However, his pain intensity was 5 on the numerical analogue scale (NRS) from 0 (no pain) to 10 (worst pain imaginable). INTERVENTIONS: Fluoroscopy guided caudal block was performed with a mixture of 0.5% lidocaine 10 mL and triamcinolone 40 mg. OUTCOMES: One day after the procedure, the pain decreased to 1 on the NRS score. In addition, voiding difficulty greatly improved. Three days after the intervention, the patient reported complete resolution of pain and voiding dysfunction. He currently remains symptom free at a 3-month follow-up. LESSONS: A caudal block with steroid can be an effective option for treatment of acute voiding dysfunction and pain following sacral HZ.

Failure to awaken from general anesthesia due to infratentorial hemorrhage after cervical spine surgery: A case report.

RATIONALE: Emergence is not simply the reverse process of induction. Many dynamic situations could occur in this period by distinct neurobiology as recent studies indicated. Herein we report a rare case of failure of emergence from general anesthesia after cervical spine surgery. PATIENT CONCERNS: Despite the perioperative vital signs and laboratory results were unremarkable, the patient could not recover his mental status and spontaneous breathing during emergence. 20 minutes after cessation of anesthetic drug administration, his blood pressure suddenly began to decrease requiring transfusion and vasopressor. DIAGNOSIS: After thorough inspection of intraoperative alterations of hemodynamic and metabolic values, which showed no significant changes except possible signs of delayed volume loss, cerebrovascular bleeding was most suspected as the cause of the event. Computed tomography was performed and infratentorial hemorrhage after cervical spine surgery was checked. INTERVENTIONS: Decompression operation was required for removing the hemorrhage. However, the patient's family refused further management considering his limited life expectancy. OUTCOMES: The patient expired on postoperative day 5. LESSONS: Failure to awaken is a relatively rare event. It could be confused with simple delayed emergence, which is often caused by residual drug effect. However, when it occurs, the result could be devastating. Therefore, appropriate recognition and prompt response are required to decrease the mortality and morbidity of the patient.

Traumatic severe tricuspid regurgitation diagnosis after the progression of right ventricle function deterioration.

Traumatic tricuspid regurgitation is a rare complication of blunt cardiac injury and frequently misdiagnosed during the initial assessment. Unfortunately, it may be diagnosed after deterioration of right ventricle function, which may be fatal to the patient. Here, we report a case of a patient with blunt chest injury complicated by a diagnosis of traumatic severe tricuspid regurgitation after deterioration of the right ventricle function even after the patient was subjected to serum cardiac enzyme normalization. The patient was a driver and admitted to the hospital owing to multiple traumatic injuries. Echocardiography was performed suspicious of blunt cardiac injury, which revealed no abnormal findings. Initial cardiac enzyme levels were high, but after serial follow-up, the levels improved. However, on day 4 of hospitalization, hemodynamic deterioration occurred owing to severe tricuspid regurgitation and delayed right ventricle dysfunction. Immediate tricuspid valve replacement was performed, however, the patient had a pronged recovery period. We believe that it is important to take into account the nature of the accident and the presentation of clinical signs and symptoms and not be blinded by laboratory test results alone; it is also important to consider performing repeated serial echocardiographic examinations for blunt cardiac injury patients.

The Effect of Nitric Oxide on Remote Ischemic Preconditioning in Renal Ischemia Reperfusion Injury in Rats.

Although remote ischemic preconditioning (RIPC) is an organ-protective maneuver from subsequent ischemia reperfusion injury (IRI) by application of brief ischemia and reperfusion to other organs, its mechanism remains unclear. However, it is known that RIPC reduces the heart, brain, and liver IRI, and that nitric oxide (NO) is involved in the mechanism of this effect. To identify the role of NO in the protective effect of RIPC in renal IRI, this study examined renal function, oxidative status, and histopathological changes using N-nitro-L-arginine methyl ester (L-NAME), an NO synthase inhibitor. Remote ischemic preconditioning was produced by 3 cycles of 5 minutes ischemia and 5 minutes reperfusion. Blood urea nitrogen, creatinine (Cr), and renal tissue malondialdehyde levels were lower, histopathological damage was less severe, and superoxide dismutase level was higher in the RIPC + IRI group than in the IRI group. The renoprotective effect was reversed by L-NAME. Obtained results suggest that RIPC before renal IRI contributes to improvement of renal function, increases antioxidative marker levels, and decreases oxidative stress marker levels and histopathological damage. Moreover, NO is likely to play an important role in this protective effect of RIPC on renal IRI.