Using the iPACK block to reduce chronic pain in a patient with knee osteoarthritis: A case report.

Infiltration between the popliteal artery and capsule of the knee (iPACK) block is an emerging modality to control perioperative knee joint pain. This case report describes the successful control of chronic knee joint pain using iPACK block in a patient with knee osteoarthritis. We suggest that iPACK block could be applied in the fields of both pain medicine and perioperative analgesia. In addition, by placing the needle closely to the popliteal plexus, iPACK block could serve as an intervention for pain related to procedures such as radiofrequency ablation.

Effects of Systemic Administration of Dexmedetomidine on Intraocular Pressure and Ocular Perfusion Pressure during Laparoscopic Surgery in a Steep Trendelenburg Position: Prospective, Randomized, Double-Blinded Study.

Increased intraocular pressure (IOP) during surgery is a risk factor for postoperative ophthalmological complications. We assessed the efficacy of systemically infused dexmedetomidine in preventing the increase in IOP caused by a steep Trendelenburg position, and evaluated the influence of underlying hypertension on IOP during surgery. Sixty patients undergoing laparoscopic surgery in a steep Trendelenburg position were included. Patients in the dexmedetomidine group received a 1.0 µg/kg IV loading dose of dexmedetomidine before anesthesia, followed by an infusion of 0.5 µg/kg/hr throughout the operation. Patients in the saline group were infused with the same volume of normal saline. IOP and ocular perfusion pressure (OPP) were measured 16 times pre- and intraoperatively. In the saline group, IOP increased in the steep Trendelenburg position, and was 11.3 mmHg higher at the end of the time at the position compared with the baseline value (before anesthetic induction). This increase in IOP was attenuated in the dexmedetomidine group, for which IOP was only 4.2 mmHg higher (P < 0.001 vs. the saline group). The steep Trendelenburg position was associated with a decrease in OPP; the degree of decrease was comparable for both groups. In intragroup comparisons between patients with underlying hypertension and normotensive patients, the values of IOP at every time point were comparable. Dexmedetomidine infusion attenuated the increase in IOP during laparoscopic surgery in a steep Trendelenburg position, without further decreasing the OPP. Systemic hypertension did not seem to be associated with any additional increase in IOP during surgery. (Registration at the Clinical Research Information Service of Korea National Institute of Health ID: KCT0001482).

Comparison of postoperative sore throat and hoarseness between two types of double-lumen endobronchial tubes: a randomized controlled trial.

OBJECTIVE: Two types of material are used to manufacture double-lumen endobronchial tubes (DLTs): Polyvinylchloride (PVC) and silicon. PVC DLTs (Broncho-Cath) and silicon DLTs (Silbroncho) not only differ in material, but also subtly differ in structure. The goal of this study was to determine whether the incidences of postoperative sore throat and hoarseness differed between PVC DLTs and silicon DLTs. DESIGN: Prospective, single-blind, balanced (1:1), randomized, controlled trial. SETTING: Single university hospital. PARTICIPANTS: Sixty ASA I-II patients, aged 20 to 65 years, scheduled for thoracoscopic pulmonary lobectomy. INTERVENTIONS: Patients were randomized into the Broncho-cath group (group B, n = 30) and the Silbroncho group (group S, n = 30). Intubation was performed with DLT according to the allocated group by an anesthesiologist. MEASUREMENTS AND MAIN RESULTS: The incidence of sore throat and hoarseness was evaluated at 1 hour and 24 hours after DLT extubation. The intensity of sore throat was assessed by visual analog scale (VAS<0-10) at 1, 2, 4, 12, and 24 hours after DLT extubation. The incidence of sore throat was significantly lower in group S compared with that in group B at 1 h (30% v 66.7%, p = 0.018) and 24 hours (10% v 43.3%, p = 0.014). No significant difference was observed in the incidence of hoarseness between the 2 groups. The VAS scores for sore throat in group B were significantly higher than those in group S throughout the study (p< 0.05). CONCLUSIONS: The use of silicon DLTs resulted in a lower incidence of postoperative sore throat than did the use of PVC DLTs.