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.
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.
Lumbosacral pathologies can lead to infertility. Onuf's nucleus changes in these pathologies may have a role in low sperm number. This study aims to investigate the relationship between Onuf's ...nucleus degeneration and sperm number following spinal subarachnoid haemorrhage. 22 rabbits were used. They were divided into three groups; five of them were used as the control (GI), five as the SHAM (GII) and twelve as the study groups (GIII). The study group received 0.7 ccs autologous blood into the spinal subarachnoid space at the T12‐L1 level. After two weeks, all animals were decapitated, and S1–S3 laminectomy was done. Neurodegenerative changes of Onuf's nucleus, pudendal ganglia (S3) following two weeks after spinal SAH, were examined; sperm numbers were calculated. Degenerated neuron density of the Onuf's nucleus (n/mm3), the pudendal ganglia (S3) (n/mm3) and mean sperm numbers were calculated as 5 ± 2, 8 ± 3/mm3 and 98.345 ± 12.776/mm3 in the control (GI), 20 ± 5/mm3, 243 ± 66/mm3 and 91.841 ± 9.654/mm3 in the SHAM (GII), 143 ± 39/mm3, 2,350 ± 320/mm3 and 68.549 ± 5.540/mm3 in the study group (GIII). In conclusion, there were statistically significant differences between groups. Onuf's nucleus may be responsible for decreased sperm number following spinal SAH.
Acute herpetic neuralgia has a profound negative impact on functional status and quality of life and usually results in substantial health service utilization. ...as the duration of pain increases in ...the first episode, the rate of recurrence increases. ...reader ask: “What other methods of analgesia were used with their ESP block technique up to the one month follow up period?” Primarily, we indicated that patient's VAS score decreased to 0/10 at the 15th minute, 30th minute and the next day following ESP block. ...anyone who makes an in-plane technique ESP block from caudal to cranial knows that; our needle entry point always remains one or two level below of the transverse process.
Herpes zoster is a painful, eruptive, viral condition occurring with reactivation in immunosuppressed individuals. The selection of an effective analgesic method in the acute phase of herpes zoster ...can decrease the incidence of postherpetic neuralgia by reducing neural sensitization. The erector spinae plane block has been reported to provide diffuse and effective analgesia in the cervical, thoracic, and lumbar regions. We report an effective decrease in pain with the application of the high-thoracic erector spinae plane block in the emergency department in a patient with herpes zoster pain in the cervicothoracic and shoulder region.
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.
Defined in the last decade, erector spinae plane block (ESPB) is one of the more frequently used interfacial plans, and it has been the most discussed block among the recently defined techniques. ...Lumbar ESPB administered at lumbar levels is relatively novel and is a new horizon for regional anesthesia and pain practice. In this article, we aim to explain and introduce different approaches and explain the possible mechanism of action of lumbar ESPB. The objective of this review is to analyze the case reports, clinical and cadaveric studies about lumbar ESPB that have been published to date. We performed a search in "Pubmed" and "Google Scholar" database. After a selection of the relevant studies, 59 articles were found eligible and were included in this review. While we believe that lumbar ESPB is reliable and easy, we suggest that its efficacy and indications should be verified with anatomical and clinical studies, and its safety should be confirmed with pharmacokinetic studies. Moreover, the possibility of complications must be considered. Keywords: lumbar erector spinae block, regional anesthesia, interfascial plane blocks
Black soldier fly larvae are a sustainable protein source and play a vital role in the emerging food-waste recycling industry. One of the challenges of raising larvae in dense aggregations is their ...rise in temperature during feeding, which, if not mitigated, can become lethal to the larvae. We propose applying air-fluidization to circumvent such overheating. However, the behavior of such a system involves complex air-larva interactions and is poorly understood. In this combined experimental and numerical study, we show that the larval activity changes the behavior of the ensemble when compared to passive particles such as dead larvae. Over a cycle of increasing and then decreasing airflow, the states (pressure and height) of the live larva aggregates are single-value functions of the flow speed. In contrast, dead larva aggregates exhibit hysteresis characteristic of traditional fluidized beds, becoming more porous during the ramp down of airflow. This history-dependence for passive particles is supported by simulations that couple agent-based dynamics and computational fluid dynamics. We show that the hysteresis in height and pressure of the aggregates decreases as the activity of simulated larvae increases. To test if air fluidization can increase larval food intake, we performed feeding trials in a fluidization chamber and visualized the food consumption via x-ray imaging. Although the food mixes more rapidly in faster airflow, the consumption rate decreases. Our findings suggest that providing moderate airflow to larval aggregations may alleviate overheating of larval aggregations and evenly distribute the food without reducing feeding rates.
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