Comparative Study to Evaluate the Effect of Ultrasound-Guided Pericapsular Nerve Group Block Versus Fascia Iliaca Compartment Block on the Postoperative Analgesic Effect in Patients Undergoing Surgeries for Hip Fracture under Spinal Anesthesia.

Background: Fractures in and around the hip are a major concern in young as well as the elderly. Ultrasound-guided (USG) peripheral nerve blocks help in early surgical fixation of these fractures by providing perioperative pain relief as well as early mobilization resulting in reduced morbidity and mortality. Aims: This study aims to compare the efficacy of USG pericapsular nerve group (PENG) block versus fascia iliaca compartment (FIC) block. Setting and Design: Prospective, randomized, double-blind, controlled study. Materials and Methods: Twenty-four patients above 18 years of age with hip fracture belonging to the American Society of Anaesthesiologists physical status Classes I and II scheduled for hip surgery were randomly allocated into two groups. Group 1(PENG block) received USG-guided PENG block and Group 2 (FIC block) received USG guided FIC block for postoperative pain relief. Postoperative pain relief (at rest) was evaluated by Numeric Rating Scale score from 20th min and at regular interval for 24 h. The total analgesic consumption in the first 24 h was also noted. Statistical Analysis Used: Data were analyzed by using nonparametric test and Chi-square test. Hemodynamic variables and pain scores were analyzed using analysis of variance for two groups and independent t-test was used for comparison between two groups. Results: Postoperative NRS score was higher in FIC block than PENG block which was statistically significant at 1 h (P = 0.035) and at 4 h (P = 0.001). The first requirement of analgesic was significantly late in PENG block group (8.17 ± 3.129) as compared to FIC block group (4.00 ± 1.477). Conclusions: PENG block provides better postoperative analgesia, with reduced requirement of rescue analgesics in 24 h as compared to FIC block in patients undergoing surgeries for hip fracture under spinal anesthesia.

Myasthenia Gravis and COVID-19 - A Clinical Checkmate.

Myasthenia gravis (MG) patients with coronavirus disease (COVID-19) pose a unique challenge for intensive care management. Higher risk of infection is observed in patients with MG due to the immunosuppressant medications they are prescribed. The underlying component of respiratory muscle weakness predisposes these patients to experience a more severe form of illness. In the case of diagnosis of COVID-19 in MG patients, judicious continuation of immunosuppressants, avoiding drugs that worsen MG along with the continuation of cholinesterase inhibitors is prudent. Early diagnosis in cases with high-index of suspicion, extra precautions, COVID-appropriate behavior, and early immunization is paramount for the health of MG patients during this pandemic.

Analysis of Changes in Right Ventricular Systolic Function by Point-of-Care Ultrasound in Patients Undergoing Corrective Surgeries for Femur Fracture.

BACKGROUND: Fat embolism syndrome (FES) following major orthopedic injuries and surgeries is a well-known phenomenon where acute depression of right ventricular (RV) systolic function is a potential possibility. Clinical presentation of FES may vary from mild self-limiting nature to severe life-threatening multiorgan dysfunction syndrome with pulmonary manifestations being most common. AIMS: This study was aimed to know whether perioperative assessment of RV function by measuring tricuspid annular plane systolic excursion (TAPSE) with point-of-care transthoracic echocardiogram will identify patients at risk of developing FES and its sequelae. SETTINGS AND DESIGN: This was a prospective observational study. MATERIALS AND METHODS: This study was carried out in 142 patients with femur fractures posted for correction surgeries of both genders who require intramedullary (IM) reaming. TAPSE was recorded four times perioperatively. Time taken for IM reaming was also recorded. STATISTICAL ANALYSIS USED: Recorded data were analyzed using professional statistics package Epi Info 7.0 version for Windows. Descriptive data were represented as mean ± standard deviation for numeric variables, percentages, and proportions for categorical variables. Repeated-measure ANOVA was applied to assess the changes in TAPSE from baseline to immediate postoperative, after 6-h postoperative, and after 24-h postoperatively. Pearson's correlation was utilized to be applied to assess the relationship between TAPSE and other numerical variables. RESULTS: All four readings of TAPSE were well above 17 mm (mean of 19.06, 19.05, 19.04, and 19.04, respectively). Mean reaming time was found to be 6.92 min. None of the patients developed any postoperative pulmonary complications. CONCLUSION: Assessment of RV function can be done with relative ease using TAPSE as a noninvasive method without any complications. Reaming time not exceeding 12 min did not produce any changes in RV function as measured by TAPSE as well as any postoperative pulmonary complications.

Comparison of Postoperative Analgesic Efficacy of Wound Site Infiltration and Ultrasound-guided Transversus Abdominis Plane Block with 0.5% Ropivacaine in Lower Abdominal Surgeries under Spinal Anesthesia.

CONTEXT: Optimization and providing excellent quality of postoperative analgesia after total abdominal hysterectomy is a determinant factor of better clinical outcome, increases patient satisfaction, and allows early mobilization of the patient. AIMS: The aim of this study is to compare the postoperative analgesic efficacy of wound site infiltration (WSI) and ultrasound-guided transversus abdominis plane block (TAPB) with 0.5% ropivacaine in lower abdominal surgeries under spinal anesthesia. SETTINGS AND DESIGN: This was a randomized controlled study. SUBJECTS AND METHODS: One hundred and ten patients undergoing lower abdominal surgeries were randomly allocated to two groups (WSI and TAP) of 55 patients in each. At the end of the surgical procedure, 2.5 mg/kg of the drug ropivacaine 0.5% was administered by an anesthesiologist through either of the routes of study. Visual analog score (VAS) assessment was done at every 30 min, for 1½ h, every 2 for 24 h postoperatively. Injection diclofenac sodium 75 mg intramuscularly was given whenever VAS was >3 as rescue analgesic. STATISTICAL ANALYSIS USED: Epi Info 7.0 version software for Windows was used. All analyses were performed using Kolmogorov-Smirnov test. Mann-Whitney test was applied to detect the difference between the two groups. P < 0.05 was considered statistically significant. RESULTS: Postoperative VAS scores in Group TAP were significantly reduced at 30 min, 1st h, 1 h 30 min, 2, 4, 6, 8, 10, 12, 18, and 24 h (P < 0.001). The total doses of rescue analgesics administered were also low in the Group TAP (1.41 ± 0.538) with P < 0.0001 in comparison to Group WSI (2.24 ± 0.637) with P < 0.001. CONCLUSIONS: The quality of analgesia along with lesser rescue analgesic requirement and their side effects makes the TAPB, a good and safer option for lower abdominal gynecological surgeries. Both WSI and USG TAPB are effective in providing postoperative analgesia as a part of multimodal analgesia in lower abdominal surgeries. However, in our study the quality of analgesia along with lesser rescue analgesic requirement and their side effects makes the TAPB, a good and safer option for lower abdominal gynecological surgeries.

Caudal Epidural Analgesia in Pediatric Patients: Comparison of 0.25% Levobupivacaine and 0.25% Ropivacaine in Terms of Motor Blockade and Postoperative Analgesia.

CONTEXT: Ropivacaine and Levo-Bupivacaine have been safely used for caudal anaesthesia in children, but there are limited studies comparing the efficacy of 0.25% Ropivacaine and 0.25% Levo-Bupivacaine for caudal anaesthesia in infraumbilical surgeries. AIMS: The aim of this study was to compare the incidence of motor blockade and postoperative analgesia with 0.25% ropivacaine and 0.25% levobupivacaine for the caudal block in children receiving infraumbilical surgery. SETTINGS AND DESIGN: This was a randomized double-blinded study. SUBJECTS AND METHODS: Sixty patients of either sex, between 1 and 10 years posted for elective infraumbilical surgeries, to receive caudal block with either (Group R) ropivacaine 0.25% or (Group L) levobupivacaine 0.25% of volume 1 ml/kg were included in the study. Motor blockade was assessed using motor power scale, and pain was assessed every 1 h for first 6 h, then 2nd hourly for following 18 h using modified Hannallah objective pain scale. If pain score is ≥4, the patients were given paracetamol suppositories 20 mg/kg as rescue analgesia. STATISTICAL ANALYSIS USED: All analyses were performed using Chi-square test, Student's independent t-test, Kruskal-Wallis test, Mann-Whitney U-test. RESULTS: The time for full motor recovery was similar in both groups; in Group R, ropivacaine: 180.50 ± 14.68 min, and in Group L, levobupivacaine: 184.50 ± 18.02 min, with P = 0.163. The duration of postoperative pain relief between the groups was 330.50 ± 9.54 min in Group L (levobupivacaine) and 312.67 ± 5.56 min in Group R (ropivacaine) with P = 0.165 not statistically significant. CONCLUSIONS: Both ropivacaine 0.25% and levobupivacaine 0.25% have similar recovery from motor blockade and postoperative analgesia.

Comparison of i-gel™ and laryngeal mask airway Classic™ in terms of ease of insertion and hemodynamic response: A randomized observational study.

CONTEXT: Laryngeal mask airway (LMA) Classic™ has an inflatable cuff while i-gel™ has a noninflatable cuff made of thermoplastic elastomer. AIMS: To compare ease of insertion, number, and duration of insertion attempts among the two device. Secondary objectives were to evaluate the hemodynamic response and SpO2 during device insertion and during maintenance of general anesthesia. SETTINGS AND DESIGN: This study was conducted as randomized observational study in a teaching hospital. SUBJECTS AND METHODS: One hundred American Society of Anesthesiologists I and II, patients posted for surgery under general anesthesia were divided in two groups of fifty each. LMA Classic™ and i-gel™. Ease of insertion, duration of insertion, hemodynamic data, and episodes of hypoxia during insertion, 1, 3 and 5 min for 30 min, during removal and 1 min after removal. STATISTICAL ANALYSIS USED: Descriptive analyses were expressed as a mean ± standard deviation. Independent t-test used for parametric data, Chi-square test for nonparametric data and hemodynamic data were analyzed using repeated measures ANOVA to find statistical difference within the groups. RESULTS: Devices were easy to insert, the mean duration of insertion attempts was 15.92 ± 1.62 s in the i-gel™ group, while it was 26.06 ± 5.12 s in the LMA Classic™ group, was statistically significant (P = 0.0001). CONCLUSIONS: Successful and shorter duration of insertion, with less hemodynamic response makes i-gel™ a suitable alternative to LMA Classic™ during general anesthesia.