In the sensory examination performed 20 min later, sensory loss was noted in the LFCN, genitofemoral, anterior femoral cutaneous, obturator, and saphenous nerves. ...patient reported significant ...quadriceps weakness with the inability to achieve a straight leg raise. The advantages of PENG block to LPB are as follows: it can be applied in the supine position; injection point is far from neurovascular tissues; it is relatively safer for patients using anticoagulants; and bilateral block probability is nearly zero. ...although quadriceps weakness has been previously reported after PENG block 2, its probability is delivered at high volumes as in our case 1. ...although it is not yet possible, in the future, cadaveric, radiologic, and randomized controlled studies will provide answers to the following questions: can PENG block be an alternative to lumbar plexus block?
Purpose
Although different forms of lidocaine are used for migraine attack headaches, the effect of intravenous lidocaine is still limited. This study aimed to investigate the effects of intravenous ...lidocaine infusion for the treatment of migraine attack headaches.
Methods
A hundred patients with migraine attacks, aged between 18 and 65, were randomly divided into two groups. The lidocaine group (
n
= 50) received a 1.5 mg/kg lidocaine bolus and a 1 mg/kg infusion (first 30 min), followed by a 0.5 mg/kg infusion for a further 30 min intravenously. The non-steroidal anti-inflammatory drug (NSAID) group (
n
= 50) received 50 mg dexketoprofen trometamol and saline at the same volume as the lidocaine at the same time intervals intravenously. The Visual Analog Scale (VAS) pain scores, additional analgesia requirement, side effects, and revisits to the emergency department were recorded.
Results
The VAS score was significantly lower in the lidocaine group than in the NSAID group for the first 20th and 30th minutes (
p
= 0.014 and
p
= 0.024, respectively). There was no difference between the VAS scores for the remaining evaluation times (
p
> 0.05). In terms of secondary outcomes, rescue medication requirement was not different between the two groups at both the 60th and 90th minutes (
p
> 0.05). However, the number of patients revisiting ED within 48–72 h was statistically less in the lidocaine group than in the NSAID group (1/50 vs. 8/50;
p
= 0.031).
Conclusion
Intravenous lidocaine may be an alternative treatment method for patients with migraine attack headaches in the emergency department.
Purposes
The postoperative analgesic effect of tizanidine has not yet been evaluated sufficiently. The role of bilateral superficial cervical plexus block (BSCPB) for postoperative analgesia after ...thyroidectomy remains questionable. We aimed to evaluate the analgesic effect of combined use of BSCPB and a single-dose oral tizanidine in patients undergoing elective thyroid surgery.
Methods
Sixty patients undergoing thyroidectomy were randomized into 3 groups. The control group (Group C,
n
= 20) received BSCPB with 0.9% saline plus oral placebo. The superficial cervical group (Group SC,
n
= 20) received BSCPB with 0.25% bupivacaine plus oral placebo. The superficial cervical and tizanidine group (Group SC + T,
n
= 20) received BSCPB with 0.25% bupivacaine plus tizanidine 6 mg capsule. Surgical site pain scores, opioid consumption, rescue analgesia, posterior neck pain, headache, and opioid-related side effects were assessed for the first 24 h.
Results
Compared with Group C, rest and swallowing pain scores in Group SC and Group SC + T were statistically lower at all postoperative time points (
p
< 0.05). Fentanyl consumption was lower in Group SC and Group SC + T than in Group C at time periods 0–4 and 4–8 h (
p
< 0.05). Fentanyl consumption was lower in Group SC + T than in Group SC at 0–4 h (
p
= 0.006). Total fentanyl consumption was higher in Group C than in the other groups (
p
< 0.001). Postoperative cervical pain and occipital headache were significantly lower in Group SC + T than in the other groups (
p
< 0.05).
Conclusions
Ultrasound-guided BSCPB with or without preemptive oral tizanidine was effective at reducing postoperative pain and opioid consumption in patients undergoing total thyroidectomy. Addition of preemptive oral tizanidine to BSCPB reduced the early postoperative opioid consumption, posterior neck pain, and occipital headache.
Clinical trials registry
The study was registered with a clinical trials registry (ClinicalTrials.gov. identifier NCT02725359).
Background and Aim
The endoscopic retrograde cholangiopancreatography (ERCP) procedure is generally performed in patients with high comorbidity. We aimed to reduce the consumption of propofol by ...adding lidocaine before ERCP.
Methods
Eighty ERCP patients with ASA I–III, aged between 45–75 years, were randomly divided into two groups. Lidocaine group (group L, n = 40), received 1‐mg midazolam, 1.5 mg/kg lidocaine, and 1 mg/kg propofol intravenously. The control group (group C, n = 40) received 1‐mg midazolam, saline in the same volume as the lidocaine group, and 1 mg/kg propofol intravenously. Propofol was administered with intermittent bolus doses. Propofol consumption, oropharyngeal reflex, recovery time, endoscopist satisfaction, ketamine need, and side‐effects were recorded.
Results
Propofol consumption during the procedure was statistically lower in group L than in the control group (157.25 ± 39.16 mg vs 228.75 ± 64.62 mg respectively, P < 0.001). Additionally, recovery time was statistically faster in group L compared with the control group (7.78 ± 3.95 min vs 11.92 ± 3.24 min respectively, P < 0.001). The oropharyngeal reflex was less in group L than control group (6/40 vs 15/40 respectively, P = 0.042). There was no significant difference between the two groups regarding visual analogue scale scores and endoscopist satisfaction (P > 0.05).
Conclusions
We recommend the use of intravenous lidocaine before the ERCP procedure as it reduces propofol consumption, recovery times, and oropharyngeal reflex.
Plane blocks have a potential to take the place of neuroaxial techniques due to their being easily performed with an ultrasound, having low complication rates and providing adequate postoperative ...analgesia and reducing opioid consumption 1. After touching the transverse process of T4 by needle using the in-plane technique on the cranial-caudal route, the needle was directed under the erector spinae muscle. 2 ml of saline solution was injected to confirm the erector spinae muscle plane, and 15 ml 0.5% bupivacaine and 15 ml 2% lidocaine was injected (Fig. 1d). ...SPB and ESPB provide effective surgical anesthesia during superficial procedures of chest wall.
Plane blocks have become very popular in recent years with the introduction of ultrasonography into the regional anesthesia and algology practice. Erector spinae plane (ESP) block involves injection ...of local anesthetics between erector spinae muscles and transverse process of vertebrae and can block the dorsal and ventral rami of thoracolumbar spinal nerves. The primary factor in the great popularity of this block is easy sonographic identification of landmarks and lower complication rate compared to paravertebral or central neuroaxial blocks. These characteristics mean that it will in all probability be widely used in the future, not just for anesthetists, but also for emergency physicians. Here we first report a novel indication for ESP block in emergency department; renal colic.
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