For elective surgery, a joint statement from the American Society of Anesthesiologists and Anesthesia Patient Safety Foundation recommends a recovery period of four to twelve weeks depending on the ...severity of infection and treatment intensity 1. The patient was already one month post-injury, and there was concern that further delay would decrease the likelihood of successful repair and functional recovery 2. ...the decision was made to proceed with urgent scheduling. After placement, the patient reported numbness only on the medial thigh and knee. ...the regional anesthesia team performed a supplemental ultrasound-guided lateral femoral cutaneous nerve block with 10 ml of mepivacaine 1.5% injected around the nerve, caudal to the anterior superior iliac spine.
Understanding the origins and roles of cardiac progenitor cells is important for elucidating the pathogenesis of congenital and acquired heart diseases. Moreover, manipulation of cardiac myocyte ...progenitors has potential for cell-based repair strategies for various myocardial disorders. Here we report the identification in mouse of a previously unknown cardiac myocyte lineage that derives from the proepicardial organ. These progenitor cells, which express the T-box transcription factor Tbx18, migrate onto the outer cardiac surface to form the epicardium, and then make a substantial contribution to myocytes in the ventricular septum and the atrial and ventricular walls. Tbx18-expressing cardiac progenitors also give rise to cardiac fibroblasts and coronary smooth muscle cells. The pluripotency of Tbx18 proepicardial cells provides a theoretical framework for applying these progenitors to effect cardiac repair and regeneration.
Celotno besedilo
Dostopno za:
DOBA, IJS, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Abstract
Objective
The optimal continuous peripheral nerve block (CPNB) technique for total hip arthroplasty (THA) that maximizes both analgesia and mobility is unknown. Continuous erector spinae ...plane (ESP) blocks were implemented at our institution as a replacement for fascia iliaca (FI) catheters to improve our THA clinical pathway. We designed this study to test the hypothesis that this change will increase early postoperative ambulation for elective primary THA patients.
Methods
We identified all consecutive primary unilateral THA cases six months before and six months after the clinical pathway change to ESP catheters. All other aspects of the THA clinical pathway and multimodal analgesic regimen including perineural infusion protocol did not change. The primary outcome was total ambulation distance (meters) on postoperative day 1. Other outcomes included total ambulation on postoperative day 2, combined two-day ambulation distance, pain scores, opioid consumption, inpatient length of stay, and minor and major adverse events.
Results
Eighty-eight patients comprised the final sample (43 FI and 45 ESP). Postoperative day 1 total ambulation distance was greater for the ESP group compared with the FI group (median 10th–90th percentiles = 24.4 0.0–54.9 vs 9.1 0.7–45.7 meters, respectively, P = 0.036), and two-day ambulation distance was greater for the ESP group compared with the FI group (median 10th–90th percentiles = 68.6 9.0–128.0 vs 46.6 3.7–104.2 meters, respectively, P = 0.038). There were no differences in pain scores, opioid use, or other outcomes.
Conclusions
Replacing FI catheters with continuous ESP blocks within a clinical pathway results in increased early ambulation by elective primary THA patients.
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