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?
Since the drainage would be performed by opening a pericardial window with mini-thoracotomy from the left midclavicular 5th intercostal space, we performed the transversus thoracic muscle plane ...(TTMP) block in combination with the serratus anterior plane (SAP) block, which can effectively block this intervention area. In TTMP block, the blockade of intercostal nerves originated from T2–6 is targeted. ...it acts as a complementary block for the region medial to the midaxillary line. More randomized clinical trials are needed to evaluate the effectiveness of plane blocks in surgical procedures such as drainage of the pericardial tamponate.Funding The authors have no sources of funding to declare for this manuscript.Declaration of Competing Interest The authors declare no conflicts of interest.
Usually, the pain subsides within four to six weeks with non-steroidal anti-inflammatory drugs and the application of heat to the affected area. In recent reports, the TTMP block was generally used ...for acute postoperative pain management in cardiovascular and breast surgery 3; but there is only one case report used for chronic pain 4. The patient used non-steroidal anti-inflammatory drugs for four weeks, applied local heat, and have done stretching exercises but did not see any serious benefit after all procedures.
Aim
Ultrasound‐guided plane blocks are increasingly used in the multi‐modal analgesic concept for reducing opioid consumption. The present study was conducted to compare the analgesic effect of ...intravenous non‐steroidal anti‐inflammatory drugs (NSAIDs) and erector spinae plane (ESP) block in renal colic patients.
Methods
In this prospective randomised study, 40 patients with renal colic pain were randomly assigned into two groups: Group NSAID (n = 20) received an intravenous infusion of 50 mg of dexketoprofen trometamol and Group ESP (n = 20) received ultrasound‐guided ESP block with 30 ml 0.25% bupivacaine at the T8 level. The pain severity of patients was assessed using the visual analogue scale (VAS) at baseline, 5, 15, 30, 45 and 60 minutes after intervention. Opioid consumption, patient satisfaction and side effects were recorded.
Results
In the ESP group, the VAS scores were significantly lower than the NSAID group at 5, 15, 30, 45 and 60 minutes after the procedure (P < .001). Opioid consumption was significantly higher in the NSAID group compared with the ESP group (10/20 vs 0/20, respectively; P < .001). Patient satisfaction was significantly higher in the ESP group (P < .001).
Conclusions
ESP block can be an alternative, efficient and safe method for the relief of acute renal colic pain.
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.
Rib fractures are a common injury, which occur after severe blunt chest trauma. Sufficient and early pain control is essential to avoid respiratory complications. In recent years, the serratus plane ...and the erector spinae plane blocks have been used in ED for pain related to rib fractures. The Rhomboid Intercostal and Sub-Serratus (RISS) block can be utilized for pain control in patients with multiple rib fractures. We report two cases of patients with multiple rib fractures in which pain reduction was achieved with application of the RISS block.
Since initial description by Forero for thoracic region, ultrasound guided erector spinae plane (ESP) block has experienced several surgeries for postoperative pain management, chronic pain or ...surgical anesthesia. Although ESP block has been reported to provide effective analgesia in the thoracic region, its effect in lumbar region still unclear. In this study we aimed to showed our successful experience with lumbar ESP block as a main anesthetic technique in fifteen high risk elderly patients undergoing hip surgery with mild propofol sedation.
In this observational study high risk elderly fifteen patients received lumbar ESP block as a main anesthetic technique with mild propofol sedation. 40 mL of local anesthetic mixture (20 mL bupivacaine 0.5%, 10 mL lidocaine 2%, and 10 mL normal saline) was administered between the erector spinae muscles and transverse process at the level of the 4th lumbar vertebra. Also we demonstrate magnetic resonance images and discuss the anatomic basis of lumbar ESP block.
All patients' surgeries were completed without requirement for general anesthesia or local anesthesia infiltration of the surgical site. All patients' pain scores were <2/10 in the recovery room. Significant contrast spread was observed between the Th12 and L5 transverse process and erector spinae muscle and between multifidus muscle and iliocostal muscle at the L2-4 levels. Contrast material was observed at the anterior of the transverse process spreading to the paravertebral, foraminal and partially epidural area/spaces and also in the areas where the lumbar nerves enter the psoas muscle.
Lumbar ESP block when combined with mild sedoanalgesia provides adequate and safe anesthesia in high risk elderly patients undergoing hip surgery.
During transurethral resection of lateral located bladder tumors (TUR-BT), undesirable adductor muscle spasm may develop due to stimulation of the obturator nerve. PENG Block is a new regional ...anesthesia technique based on blocking the femoral nerve (FN) and accessory obturator nerve between the anterior inferior iliac spine (AIIS) and the iliopubic eminence (IPE). Following negative aspiration, a total of 30 ml of local anesthetic solution (15 ml 0.5% bupivacaine and 15 ml 2% lidocaine) was injected between the psoas tendon and the IPE. 15 min after the injection, the bladder was completely inflated with irrigation solution and TUR was resumed.
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