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Diwan S, Shivamallappa S, Timane R, Pai P, Gupta A. Anatomic evaluation to compare the dye spread with ultrasound-guided pericapsular nerve group (PENG) injection with or without an additional suprainguinal fascia iliaca (SIFI) injection in soft embalmed cadavers. J Anesth 2024; 38:445-454. [PMID: 38466404 DOI: 10.1007/s00540-024-03333-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 02/23/2024] [Indexed: 03/13/2024]
Abstract
BACKGROUND Novel interfascial plane blocks like PEricapsular Nerve Group (PENG) and SupraInguinal Fascia Iliaca (SIFI) blocks are effective for management of hip fracture pain. We compared the difference in the distribution of the dye injected and nerves stained by the addition of the SIFI block to the PENG block. METHODS A total of 24 designated dye injections were performed in eight soft-embalmed cadavers. Under ultrasound guidance 20 ml green ink injected bilaterally in PENG block and 30 ml methylene blue dye was injected in the SIFI block on the right side. The cadavers were dissected 24 h later to assess the extent of dye spread. RESULTS Extensive spread of dyes was seen on both side of iliacus muscle on the right side, but blue dye was not visible medial to the psoas tendon. The subcostal and iliohypogastric nerves were stained green in the infra-inguinal region. On the left side (PENG alone), the anterior division of the obturator, femoral and saphenous nerve (7/8) and iliohypogastric nerves (3/8) were stained in the infrainguinal region. In the suprainguinal region, the femoral nerve (5/8), accessory obturator nerve (3/8), lateral femoral cutaneous (1/8) and nerve to rectus femoris (4/8) were stained. The main obturator nerve trunk was spared with both injections while its anterior branch and accessory obturator nerve were stained with the PENG injection. CONCLUSION The study findings indicate that combined PENG + SIFI injections lead to an extensive craniocaudal and longitudinal spread along the iliacus muscle. We perceive that the combination of these two injections will have a superior clinical outcome.
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Affiliation(s)
- Sandeep Diwan
- Department of Anaesthesiology, Sancheti Hospital, Pune, Maharashtra, India
| | | | - Rasika Timane
- Department of Anaesthesia and critical care, Critizone Hospital, Nagpur, Maharashtra, India
| | - Pallavi Pai
- Department of Anaesthesiology, Dinanath Mangeshkar Hospital, Pune, Maharashtra, India
| | - Anju Gupta
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences (AIIMS), No. 6, 4th Floor, Porta Cabin, Teaching Block, New Delhi, 110029, India.
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Grinman L, Elmore B, Ardon AE, Hussain A, Malik MF, Hernandez N, Jacoby MJ. Use of Peripheral Nerve Blocks for Total hip Arthroplasty. Curr Pain Headache Rep 2024:10.1007/s11916-024-01287-7. [PMID: 38907794 DOI: 10.1007/s11916-024-01287-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2024] [Indexed: 06/24/2024]
Abstract
PURPOSE OF REVIEW The purpose of this review is to summarize the recent literature regarding regional anesthesia (RA) techniques and outcomes for total hip arthroplasty (THA) in the face of changing surgical techniques and perioperative considerations. RECENT FINDINGS Based on large meta-analyses, peripheral nerve blocks are indicated for THA. Each block has its own risks and benefits and data for outcomes for particular techniques are limited. New surgical techniques, improved use of multimodal analgesia, and improved ultrasound guided regional anesthetics lead to better pain control for patients undergoing THA with less associated risks. Block selection continues to be influenced by provider comfort, surgical approach, patient anatomy, and postoperative goals. Head-to-head studies of particular nerve blocks are warranted.
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Affiliation(s)
- Leon Grinman
- Department of Anesthesiology and Perioperative Medicine, University of Virginia, PO Box 800710, Charlottesville, VA 22908-0710, USA.
| | - Brett Elmore
- Department of Anesthesiology and Perioperative Medicine, University of Virginia, PO Box 800710, Charlottesville, VA 22908-0710, USA
| | - Alberto E Ardon
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, India
| | - Adnan Hussain
- Department of Anesthesiology and Perioperative Medicine, Henry Ford Health, Detroit, USA
| | - Mohammed Faysal Malik
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, India
| | - Nadia Hernandez
- Department of Anesthesiology and Perioperative Medicine, University of Texas McGovern Medical School, Austin, USA
| | - Mackenzie Janice Jacoby
- Department of Anesthesiology and Perioperative Medicine, University of Texas McGovern Medical School, Austin, USA
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Pun M, Ng T, Vermeylen K, Tran J. Innervation of the hip joint: implications for regional anaesthesia and image-guided interventional pain procedures. BJA Educ 2024; 24:191-202. [PMID: 38764441 PMCID: PMC11096440 DOI: 10.1016/j.bjae.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2024] [Indexed: 05/21/2024] Open
Affiliation(s)
- M. Pun
- Tuen Mun Hospital, Tuen Mun, Hong Kong
| | - T. Ng
- Tuen Mun Hospital, Tuen Mun, Hong Kong
- University of Hong Kong, Pok Fu Lam, Hong Kong
- Frankston Pain Management, Melbourne, VIC, Australia
- Center for Regional Anesthesia and Pain medicine, Wan Fang Hospital, Taipei Medical Univeristy, Taipei, Taiwan
| | | | - J. Tran
- University of Toronto, Toronto, ON, Canada
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Luo X, Zhao Y. Ultrasound-Guided Superior Cluneal Nerve Block: A Narrative Review. J Pain Res 2024; 17:1829-1836. [PMID: 38799273 PMCID: PMC11128254 DOI: 10.2147/jpr.s462166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 05/01/2024] [Indexed: 05/29/2024] Open
Abstract
Low back pain (LBP) is common and has a complex etiology. Superior cluneal nerve (SCN) entrapment has come to the attention of pain physicians as a cause of LBP. SCN block is the mainstay of treatment for LBP due to SCN entrapment. The aim of this narrative review is to summarize the approaches and techniques for ultrasound-guided SCN block. Meanwhile, the evidence for the clinical use of SCN block is reviewed, based on relevant and recent literature. The authors expect this article to provide a reference point for the diagnosis and treatment of LBP.
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Affiliation(s)
- Xiaohui Luo
- Department of Anesthesiology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
| | - Yan Zhao
- Department of Anesthesiology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
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5
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Pascarella G, Costa F, Strumia A, Ruggiero A, Remore LM, Lanteri T, Hazboun A, Longo F, Gargano F, Schiavoni L, Mattei A, Agrò FE, Carassiti M, Cataldo R. Lateral Femoral Cutaneous Nerve Block or Wound Infiltration Combined with Pericapsular Nerve Group (PENG) Block for Postoperative Analgesia following Total Hip Arthroplasty through Posterior Approach: A Randomized Controlled Trial. J Clin Med 2024; 13:2674. [PMID: 38731203 PMCID: PMC11084625 DOI: 10.3390/jcm13092674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 04/28/2024] [Accepted: 04/30/2024] [Indexed: 05/13/2024] Open
Abstract
Background: Pericapsular nerve group (PENG) block, although effective for pain management following total hip arthroplasty (THA), does not cover skin analgesia. In this randomized controlled trial, we compared the effectiveness of PENG block combined with lateral femoral cutaneous nerve (LFCN) block or wound infiltration (WI) on postoperative analgesia and functional outcomes. Methods: Fifty patients undergoing posterior-approached THA under spinal anesthesia were randomly allocated to receive LFCN block with 10 mL of 0.5% ropivacaine or WI with 20 mL of 0.5% ropivacaine. In both groups, PENG block was performed by injecting 20 mL of 0.5% ropivacaine. Primary outcomes were static and dynamic pain scores (0-10 numeric rating scale) measured in the first 24 h after surgery. Secondary outcomes included postoperative opioid consumption, functional assessment and length of hospital stay. Results: Postoperative static NRS of patients receiving LFCN was higher than that of patients receiving WI at 6 h but lower at 24 h, with a median (IQR) of 3 (2-4) vs. 2 (1-2) (p < 0.001) and 2 (2-3) vs. 3 (3-4) (p = 0.02), respectively. Static pain scores at 12 h did not show significant differences, with an NRS of 3 (2-4) for WI vs. 3 (3-4) for LFCN (p = 0.94). Dynamic pain and range of movement followed a similar trend. No significant differences were detected in other outcomes. Conclusions: LFCN block was not inferior to WI for postoperative analgesia and functional recovery in association with PENG block during the first postoperative day, although it had worse short-term pain scores. Based on these results, it is reasonable to consider LFCN block as a valid alternative to WI or even a complementary technique added to WI to enhance skin analgesia during the first 24 h after THA. Future studies are expected to confirm this hypothesis and find the best combination between PENG block and other techniques to enhance analgesia after THA.
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Affiliation(s)
- Giuseppe Pascarella
- Unit of Anesthesia and Intensive Care, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (G.P.); (F.C.); (L.M.R.); (T.L.); (A.H.); (F.L.); (F.G.); (L.S.); (A.M.); (F.E.A.); (M.C.); (R.C.)
| | - Fabio Costa
- Unit of Anesthesia and Intensive Care, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (G.P.); (F.C.); (L.M.R.); (T.L.); (A.H.); (F.L.); (F.G.); (L.S.); (A.M.); (F.E.A.); (M.C.); (R.C.)
| | - Alessandro Strumia
- Unit of Anesthesia and Intensive Care, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (G.P.); (F.C.); (L.M.R.); (T.L.); (A.H.); (F.L.); (F.G.); (L.S.); (A.M.); (F.E.A.); (M.C.); (R.C.)
| | - Alessandro Ruggiero
- Unit of Anesthesia and Intensive Care, Department of Medicine, Università Campus Bio-Medico, 00128 Rome, Italy;
| | - Luigi Maria Remore
- Unit of Anesthesia and Intensive Care, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (G.P.); (F.C.); (L.M.R.); (T.L.); (A.H.); (F.L.); (F.G.); (L.S.); (A.M.); (F.E.A.); (M.C.); (R.C.)
| | - Tullio Lanteri
- Unit of Anesthesia and Intensive Care, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (G.P.); (F.C.); (L.M.R.); (T.L.); (A.H.); (F.L.); (F.G.); (L.S.); (A.M.); (F.E.A.); (M.C.); (R.C.)
| | - Anton Hazboun
- Unit of Anesthesia and Intensive Care, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (G.P.); (F.C.); (L.M.R.); (T.L.); (A.H.); (F.L.); (F.G.); (L.S.); (A.M.); (F.E.A.); (M.C.); (R.C.)
| | - Ferdinando Longo
- Unit of Anesthesia and Intensive Care, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (G.P.); (F.C.); (L.M.R.); (T.L.); (A.H.); (F.L.); (F.G.); (L.S.); (A.M.); (F.E.A.); (M.C.); (R.C.)
| | - Francesca Gargano
- Unit of Anesthesia and Intensive Care, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (G.P.); (F.C.); (L.M.R.); (T.L.); (A.H.); (F.L.); (F.G.); (L.S.); (A.M.); (F.E.A.); (M.C.); (R.C.)
| | - Lorenzo Schiavoni
- Unit of Anesthesia and Intensive Care, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (G.P.); (F.C.); (L.M.R.); (T.L.); (A.H.); (F.L.); (F.G.); (L.S.); (A.M.); (F.E.A.); (M.C.); (R.C.)
| | - Alessia Mattei
- Unit of Anesthesia and Intensive Care, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (G.P.); (F.C.); (L.M.R.); (T.L.); (A.H.); (F.L.); (F.G.); (L.S.); (A.M.); (F.E.A.); (M.C.); (R.C.)
| | - Felice Eugenio Agrò
- Unit of Anesthesia and Intensive Care, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (G.P.); (F.C.); (L.M.R.); (T.L.); (A.H.); (F.L.); (F.G.); (L.S.); (A.M.); (F.E.A.); (M.C.); (R.C.)
- Unit of Anesthesia and Intensive Care, Department of Medicine, Università Campus Bio-Medico, 00128 Rome, Italy;
| | - Massimiliano Carassiti
- Unit of Anesthesia and Intensive Care, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (G.P.); (F.C.); (L.M.R.); (T.L.); (A.H.); (F.L.); (F.G.); (L.S.); (A.M.); (F.E.A.); (M.C.); (R.C.)
- Unit of Anesthesia and Intensive Care, Department of Medicine, Università Campus Bio-Medico, 00128 Rome, Italy;
| | - Rita Cataldo
- Unit of Anesthesia and Intensive Care, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (G.P.); (F.C.); (L.M.R.); (T.L.); (A.H.); (F.L.); (F.G.); (L.S.); (A.M.); (F.E.A.); (M.C.); (R.C.)
- Unit of Anesthesia and Intensive Care, Department of Medicine, Università Campus Bio-Medico, 00128 Rome, Italy;
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Marrone F, Fusco P, Tulgar S, Paventi S, Tomei M, Fabbri F, Iacovazzi M, Pullano C. Combination of Pericapsular Nerve Group (PENG) and Sacral Erector Spinae Plane (S-ESP) Blocks for Hip Fracture Pain and Surgery: A Case Series. Cureus 2024; 16:e53815. [PMID: 38332999 PMCID: PMC10850927 DOI: 10.7759/cureus.53815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2024] [Indexed: 02/10/2024] Open
Abstract
A hip fracture is a serious injury with life-threatening complications, and its risk rises with increasing age. A hip fracture can be a very painful condition, and prompt surgical treatment is recommended to reduce pain and complications. Pain management is considered integral to the management of a broken hip. The choice between general and regional anesthesia in hip fracture surgery continues to be a topic of debate because risks are potentially associated with both approaches. Nerve blockades have proven to be effective in reducing acute pain after a hip fracture and in the perioperative period. For this reason, many regional techniques have been introduced, such as the lumbar plexus block, fascia iliac block, femoral nerve block, and recently, the pericapsular nerve group (PENG) block. Hip joint innervation is complex, not limited to the lumbar plexus but also depending on the sciatic nerve and branches of the sacral plexus (superior and inferior gluteal nerves and an articular branch from the quadratus femoris nerve). We hypothesized that a combination of two emerging regional anesthesia techniques, such as the PENG block and sacral erector spinae plane (S-ESP) block, could represent a good option to obtain pain control of the whole hip joint without opioid administration intraoperatively and postoperatively. Here, we report the cases of three frail patients with significant comorbidities who underwent hip fracture surgery (two cases of intramedullary nailing and one hemiarthroplasty), in which we preoperatively performed PENG and S-ESP blocks. We registered optimal intraoperative and postoperative pain control up to 48 hours after surgery without complications and without opioid administration, allowing the surgery to be performed with intravenous sedation or laryngeal mask general anesthesia. The surgeries were uneventful, and no complications were reported. This approach warrants further investigation in hip fracture surgery.
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Affiliation(s)
| | - Pierfrancesco Fusco
- Anesthesiology and Intensive Care Unit, San Filippo e Nicola Hospital, Avezzano, ITA
| | - Serkan Tulgar
- Anesthesiology, Samsun University Faculty of Medicine, Samsun, TUR
| | - Saverio Paventi
- Anesthesiology and Critical Care, Santo Spirito Hospital, Rome, ITA
| | - Marco Tomei
- Anesthesiology and Critical Care, Azienda Sanitaria Locale - Roma 1 (ASL Roma 1), Rome, ITA
| | - Fabio Fabbri
- Anesthesiology and Critical Care, Santo Spirito Hospital, Rome, ITA
| | - Michele Iacovazzi
- Anesthesiology and Critical Care, Azienda Sanitaria Locale - Bari (ASL Bari) Ospedale Della Murgia "Fabio Perinei", Bari, ITA
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Sripriya R, Janani G, Sivashanmugam T. Comparison of ultrasound-guided transversalis fascia and posterior transversus abdominis plane block for postoperative analgesia following caesarean delivery: A double-blinded randomised controlled trial. Indian J Anaesth 2023; 67:893-900. [PMID: 38044921 PMCID: PMC10691614 DOI: 10.4103/ija.ija_931_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 08/21/2023] [Accepted: 08/23/2023] [Indexed: 12/05/2023] Open
Abstract
Background and Aims Posterior-transversus abdominus plane (TAP) block and transversalis fascia plane (TFP) block have been used for postoperative analgesia following caesarean delivery. We compared the analgesic efficacy of the TAP vs TFP plane blocks in patients undergoing elective caesarean delivery. Methods We randomised 90 women undergoing caesarean delivery under spinal anaesthesia to receive either a posterior-TAP (Group-TAP), TFP (Group-TFP) or no block (Group-C) postoperatively. The primary objective was the postoperative analgesic requirements. Secondary objectives were duration of analgesia, pain scores and infra-umbilical sensory loss, which were recorded at specific intervals for 24 h. Statistical analysis was carried out using Statistical Package for Social Sciences version 16.0 software. Results The patients requiring one, two or nil rescue analgesics were comparable between the interventions and the control (P = 0.32). The duration of analgesia was longer in Group-TAP when compared to Group-C, 4.76 (1.2) vs. 6.89 (2.4); P < 0.001, whereas Group-TFP, 5.64 (2.1) h, was not significantly different from Group-C. The static pain score in Group-TAP was significantly less than that in Group-C at 4 h and beyond 12 h (P < 0.001), whereas Group-TFP was comparable with Group-C at all time points except at 4 h and 24 h (P = 0.002). Only Group-TAP demonstrated midline infraumbilical sensory loss. Conclusion TAP and TFP blocks did not decrease the rescue analgesic requirement compared with the control group. The posterior-TAP block prolonged the duration of analgesia by 2 h, maintained the median static pain score at 0 beyond 12 h, and demonstrated sensory loss at the infraumbilical dermatomes.
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Affiliation(s)
- R Sripriya
- Department of Anaesthesiology, All India Institute of Medical Sciences, Mangalagiri, Guntur, Andhra Pradesh, India
| | - G Janani
- Department of Anaesthesiology and Critical Care, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth University, Pillaiyarkuppam, Puducherry, India
| | - T Sivashanmugam
- Department of Anaesthesiology and Critical Care, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth University, Pillaiyarkuppam, Puducherry, India
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Wang X, Zhang H, Chen Y, Xie Z, Chen M, Chen Y, Zhang J. The anesthetic efficacy of ultrasound-guided lumbar plexus combined with quadratus lumborum block with Shamrock approach in total hip arthroplasty: study protocol for a randomized controlled trial. Trials 2023; 24:596. [PMID: 37718446 PMCID: PMC10506336 DOI: 10.1186/s13063-023-07619-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 09/02/2023] [Indexed: 09/19/2023] Open
Abstract
INTRODUCTION The lumbar plexus originates from multiple segments of the spinal cord. Both single-level lumbar plexus block (LPB) and transmuscular quadratus lumborum block (TQLB) are commonly used to provide analgesia for the patients undergoing total hip arthroplasty (THA). However, neither of them can completely cover the lumbar plexus. Multiple-level LPB is also not recommended since this expert technique involves more potential risks. To achieve a better anesthetic effect and avoid risks, we propose to combine ultrasound-guided LPB with TQLB with Shamrock approach. We aim to assess the anesthetic efficacy of this combination technique and expect it will be an ideal alternative for conventional LPBs in THA. METHODS AND ANALYSIS In this prospective randomized controlled trial, 84 patients schedule for THA will be enrolled. The patients will be randomly assigned at a 1:1:1 ratio to receive LPB at L3 level (P group), T12 paravertebral block combined with LPB at L3 and L4 levels (TP group), or LPB combined with TQLB at L3 level (PQ group). Each method will be evaluated in terms of the successful rate of sensory blockade, postoperative pain, performance time of block, requirement for intraoperative sufentanil, cumulative doses of intraoperative vasoactive medications, and adverse events. ETHICS AND DISSEMINATION The study protocol has been approved by the institutional review board (IRB) at Shanghai Jiao Tong University Affiliated Sixth People's Hospital, China (No.2020-031). The results will be disseminated in a peer-reviewed journal and the ClinicalTrials.gov registry. TRIAL REGISTRATION ClinicalTrials.gov, NCT04266236 . Registered on 10 February 2020. CLINICALTRIALS gov PRS: Record Summary NCT04266236 .
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Affiliation(s)
- Xiaofeng Wang
- Department of Anesthesiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No.600 Yishan Road, Xuhui District, Shanghai, 200233, China
| | - Hui Zhang
- Department of Anesthesiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No.600 Yishan Road, Xuhui District, Shanghai, 200233, China
| | - Yongzhu Chen
- Department of Anesthesiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No.600 Yishan Road, Xuhui District, Shanghai, 200233, China
| | - Zhenwei Xie
- Department of Anesthesiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No.600 Yishan Road, Xuhui District, Shanghai, 200233, China
| | - Moxi Chen
- Department of Anesthesiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No.600 Yishan Road, Xuhui District, Shanghai, 200233, China
| | - Yonglin Chen
- Department of Anesthesiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No.600 Yishan Road, Xuhui District, Shanghai, 200233, China
| | - Junfeng Zhang
- Department of Anesthesiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No.600 Yishan Road, Xuhui District, Shanghai, 200233, China.
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Aygun H, Tulgar S, Yigit Y, Tasdemir A, Kurt C, Genc C, Bilgin S, Senoğlu N, Koksal E. Effect of ultrasound-guided pericapsular nerve group (PENG) block on pain during patient positioning for central nervous blockade in hip surgery: a randomized controlled trial. BMC Anesthesiol 2023; 23:316. [PMID: 37715173 PMCID: PMC10503118 DOI: 10.1186/s12871-023-02245-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 08/16/2023] [Indexed: 09/17/2023] Open
Abstract
BACKGROUND Most patients with hip fractures are elderly patients with comorbidities, and well-managed pain management is associated with positive postoperative outcomes. In recent years, new indications for regional anesthesia techniques have been defined, and they have found more place in clinical practice. Herein we investigate the effect of US-guided PENG block on positioning pain and compare that effect to intravenous opioid in patients undergoing surgery under spinal anesthesia for hip fractures. Additionally, we sought to investigate the effect of PENG block on pain scores, opioid intake, time to first analgesic requirement, and quality of recovery within the first 24 h following surgery. METHODS In this study, patients were divided into the PENG (n = 42) and control group (n = 42) one hour prior to surgery. A team who was blinded to the assigned groups, collected and evaluated all data such as spinal anesthesia positioning pain, postoperative pain, opioid requirement. RESULTS Patients that underwent PENG had statistically significantly lower NRS scores after interventions, immediately before positioning, at positioning and at end of spinal anesthesia. Pain scores during positioning for spinal anesthesia were statistically significantly lower in the PENG group than in the control group (p < 0.001). Total morphine use over the first 24 h was extremely statistically significantly lower in the PENG group (p < 0.001). CONCLUSIONS Positive outcomes of PENG block in patient positioning pain before spinal anesthesia, postoperative pain scores, and morphine consumption are consistent with similar studies. High patient satisfaction in patients who underwent PENG block contributes to the literature. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04871061.
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Affiliation(s)
- Hakan Aygun
- Department of Anesthesiology, Bakircay University Faculty of Medicine Cigli Training and Research Hospital, Izmir, Turkey
| | - Serkan Tulgar
- Department of Anesthesiology, Samsun University Faculty of Medicine, Samsun Training and Research Hospital, Samsun, Turkey
| | - Yavuz Yigit
- Department of Emergency Medicine, Hamad Medical Corporation, Hamad General Hospital, Doha, Qatar.
- Blizard Institute, Queen Mary University, London, United Kingdom.
| | - Ayşe Tasdemir
- Department of Anesthesiology, Bakircay University Faculty of Medicine Cigli Training and Research Hospital, Izmir, Turkey
| | - Cengizhan Kurt
- Department of Orthopedic Surgery, Bakircay University Faculty of Medicine Cigli Training and Research Hospital, Izmir, Turkey
| | - Caner Genc
- Department of Anesthesiology, Samsun University Faculty of Medicine, Samsun Training and Research Hospital, Samsun, Turkey
| | - Sezgin Bilgin
- Department of Anesthesiology, Ondokuz Mayıs University Faculty of Medicine, Samsun, Turkey
| | - Nimet Senoğlu
- Department of Anesthesiology, Bakircay University Faculty of Medicine Cigli Training and Research Hospital, Izmir, Turkey
| | - Ersin Koksal
- Department of Anesthesiology, Samsun University Faculty of Medicine, Samsun Training and Research Hospital, Samsun, Turkey
- Department of Emergency Medicine, Hamad Medical Corporation, Hamad General Hospital, Doha, Qatar
- Department of Orthopedic Surgery, Bakircay University Faculty of Medicine Cigli Training and Research Hospital, Izmir, Turkey
- Department of Anesthesiology, Ondokuz Mayıs University Faculty of Medicine, Samsun, Turkey
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10
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Carella M, Beck F, Piette N, Denys S, Lecoq JP, Bonhomme VL. Comparison between supra-inguinal fascia iliaca and pericapsular nerve group blocks on postoperative pain and functional recovery after total hip arthroplasty: A noninferiority randomised clinical trial. Eur J Anaesthesiol 2023; 40:660-671. [PMID: 37395511 DOI: 10.1097/eja.0000000000001875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
BACKGROUND Pain after a posterolateral approach for total hip arthroplasty (THA) may affect early functional recovery. Supra-inguinal fascia iliaca (SFIB) and pericapsular nerve group (PENG) blocks have been proposed as promising analgesia techniques. OBJECTIVES This trial was conducted to compare a PENG with a SFIB for controlling postoperative pain and for providing functional recovery. DESIGN Noninferiority monocentric randomised controlled study. SETTING One hundred and two patients scheduled for a total hip arthroplasty via the posterolateral approach under spinal anaesthesia were prospectively allocated to two groups. Data acquisition occurred between October 2021 and July 2022 at the University Hospital of Liege. PATIENTS One hundred and two patients completed the trial. INTERVENTIONS Group SFIB received supra-inguinal fascia iliaca block (SFIB) (40 ml ropivacaine 0.375%), whereas group PENG received a PENG block (20 ml ropivacaine 0.75%). MAIN OUTCOME MEASURES Rest and mobilisation pain on a 0 to 10 numeric rating scale at fixed time points: 1 and 6 h after surgery, on day-1 and day-2 at 8 a.m.,1 p.m. and 6 p.m. On day-1 and day-2, evolution of quality-of-recovery-15 score was assessed, and timed-up-and-go, 2 and 6 min-walking tests. The noninferiority margin was set as 1 numeric rating scale point 6 h after surgery. RESULTS Six hours after surgery, pain scores in group PENG were noninferior to those of group SFIB, with a difference between medians at 0 (95% CI -0.93 to 0.93). There were no significant differences between the groups regarding rest and dynamic pain trajectories during the first 48 postoperative hours, with no significant effects of group (rest P = 0.800; dynamic P = 0.708) or interaction between group and time (rest P = 0.803; dynamic P = 0.187). Similarly, no significant differences were observed regarding motor and functional recovery as assessed by timed-up-and-go ( P = 0.197), 2 min ( P = 0.364), and 6 min walking ( P = 0.347) tests and quality-of-recovery-15 ( P = 0.417) score. CONCLUSION Following a total hip arthroplasty via the posterolateral approach, a PENG block is noninferior to SFIB regarding postoperative pain control 6 h after surgery, and functional recovery. TRIAL REGISTRATION European Clinical Trial Register under EudraCT-number 2020-005126-28 ( https://www.clinicaltrialsregister.eu/ctr-search/trial/2020-005126-28/BE ).
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Affiliation(s)
- Michele Carella
- From the Department of Anaesthesia and Intensive Care Medicine, Liege University Hospital (MC, FB, NP, J-PL, VLB), Inflammation and Enhanced Rehabilitation Laboratory (Regional Anaesthesia and Analgesia), GIGA-I3 Thematic Unit, GIGA-Research (MC, NP, J-PL), Anaesthesia and Perioperative Neuroscience Laboratory, GIGA-Consciousness Thematic Unit, GIGA-Research (FB, VLB) and Department of Physical Medicine, Rehabilitation and Sports Traumatology, Liege University Hospital, Liege, Belgium (SD)
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Kim ED, Lee Y, Choi S, Lee H, Ohn C, Kwon W. Abdominal Wall Block Decreases Intraoperative Opioid Con-Sumption by Surgical Pleth Index-Guided Remifentanil Administration in Single-Port Laparoscopic Herniorrhaphy: A Prospective Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16012. [PMID: 36498087 PMCID: PMC9736213 DOI: 10.3390/ijerph192316012] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 11/26/2022] [Accepted: 11/27/2022] [Indexed: 06/17/2023]
Abstract
Abdominal wall blocks (AWBs) can reduce pain during surgery and lessen opioid demand. Since it is difficult to know the exact level of intraoperative pain, it is not known how much the opioid dose should be reduced. In this study, using the surgical pleth index (SPI), which indicates pain index from sympathetic fibers, the amount of remifentanil consumption was investigated. We conducted single-port laparoscopic hernia repair in 64 patients, as follows: the regional block group (R group) was treated with AWB, while the control group (C group) was only subjected to general anesthesia. In both groups, the remifentanil concentration was adjusted to maintain the SPI score between 30 and 40 during surgery. The primary parameter was the amount of remifentanil. A total of 52 patients completed the study (24 in the R group, 28 in the C group). The remifentanil dose during surgery was decreased in the R group (29 ± 21 vs. 56 ± 36 ng/kg/min; p = 0.002). Visual analogue scale score and additional administrated analgesics were also low in the R group. As such, AWB can reduce the remifentanil dose while maintaining the same pain level.
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Tavoletti D, Nanka O, Rosano’ E, Cerchiara P, Cerutti E, Pecora L. A novel technique of ultrasound‐guided lateral cutaneous branch of the iliohypogastric nerve block: a cadaveric study. Acta Anaesthesiol Scand 2022; 66:1003-1008. [DOI: 10.1111/aas.14110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 05/17/2022] [Accepted: 05/27/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Diego Tavoletti
- Anaesthesia and Intensive care of Transplantation and Major Surgery, Department of Emergency, Ospedali Riuniti di Ancona Italy
| | - Ondrej Nanka
- Institute of Anatomy, First Faculty of Medicine Charles University Prague Czech Republic
| | - Elisabetta Rosano’
- Anaesthesia and Intensive care of Transplantation and Major Surgery, Department of Emergency, Ospedali Riuniti di Ancona Italy
| | - Paolo Cerchiara
- Anaesthesia and Intensive care of Transplantation and Major Surgery, Department of Emergency, Ospedali Riuniti di Ancona Italy
| | - Elisabetta Cerutti
- Anaesthesia and Intensive care of Transplantation and Major Surgery, Department of Emergency, Ospedali Riuniti di Ancona Italy
| | - Luca Pecora
- Anaesthesia and Intensive care of Transplantation and Major Surgery, Department of Emergency, Ospedali Riuniti di Ancona Italy
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Huang C, Zhang X, Dong C, Lian C, Li J, Yu L. Postoperative analgesic effects of the quadratus lumborum block III and transversalis fascia plane block in paediatric patients with developmental dysplasia of the hip undergoing open reduction surgeries: a double-blinded randomised controlled trial. BMJ Open 2021; 11:e038992. [PMID: 33542037 PMCID: PMC7925863 DOI: 10.1136/bmjopen-2020-038992] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To evaluate the analgesic effectiveness of two novel regional nerve blocks in paediatric patients with developmental dysplasia of the hip (DDH) after open reduction surgeries. DESIGN Prospective, double-blinded, randomised controlled trial. SETTING 2 tertiary teaching hospitals in China between August 2017 and July 2018. PARTICIPANTS 110 paediatric patients aged 2-10 years with DDH undergoing open reduction surgeries were recruited, 95 were randomised and 90 were included in the final analysis. INTERVENTIONS Random assignment to quadratus lumborum block III (QLB III) group, transversalis fascia plane block (TFPB) group and the control (no region nerve block) group. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was the Face, Legs, Activity, Cry and Consolability (FLACC) Scale Scores. Secondary outcomes included perioperative opioid consumption, the time until first press of nurse-controlled analgesia/patient-controlled analgesia (NCA/PCA) pump and the total counts number of pressing, length of postanaesthesia care unit (PACU) stay, length of hospital stay, parental satisfaction with pain management and adverse events. RESULTS Mean FLACC Scores were significantly lower in QLB III group and TFPB group while in the PACU and for 48 hours postoperatively, compared with control group (p<0.0001, p<0.0001, respectively). No differences were found for FLACC Scores between QLB III group and TFPB group, neither at rest (p=0.0402) nor while posture changing (p=0.0306). TFPB prolonged the first-time request for NCA/PCA analgesia, and decreased the total number of pressing counts, compared with QLB III (22.5 (16.2 to 28.7) vs 11.7 (6.6 to 16.8), p<0.0001; 2.4 (1.3 to 3.6) vs 3.8 (2.8 to 4.8), p=0.0111, respectively). No patient experienced any adverse events. CONCLUSIONS We suggested that both ultrasound-guided QLB III and TFPB should be considered as an option for perioperative analgesia in children with DDH undergoing open reduction surgeries. TFPB was superior to the QLB III because it prolonged the first-time request for NCA/PCA analgesia and decreased the total counts number of pressing. TRIAL REGISTRATION NUMBER NCT03189966/2017.
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Affiliation(s)
- Congcong Huang
- Department of Pain Management, Jinan Central Hospital Affiliated to Shandong University, Jinan, Shandong, China
- Department of Anesthesiology and Perioperative Medicine, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University;Key Laboratory of Anesthesiology of Zhejiang Province, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xiaoguang Zhang
- Department of Anesthesiology, Beijing Jishuitan Hospital, Beijing, China
| | - Chaoxuan Dong
- Department of Anesthesiology, First Affiliated Hospital of Jinan University and Guangzhou Overseas Chinese Hospital, Guangzhou, Guangdong, China
| | - Chunwei Lian
- Department of Anesthesiology and Perioperative Medicine, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University;Key Laboratory of Anesthesiology of Zhejiang Province, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Jun Li
- Department of Anesthesiology and Perioperative Medicine, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University;Key Laboratory of Anesthesiology of Zhejiang Province, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Lingzhi Yu
- Department of Pain Management, Jinan Central Hospital Affiliated to Shandong University, Jinan, Shandong, China
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Tulgar S, Aydin ME, Ahiskalioglu A, De Cassai A, Gurkan Y. Anesthetic Techniques: Focus on Lumbar Erector Spinae Plane Block. Local Reg Anesth 2020; 13:121-133. [PMID: 33061562 PMCID: PMC7532310 DOI: 10.2147/lra.s233274] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 09/16/2020] [Indexed: 12/11/2022] Open
Abstract
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.
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Affiliation(s)
- Serkan Tulgar
- Maltepe University Faculty of Medicine, Department of Anesthesiology and Reanimation, Istanbul, Turkey
| | - Muhammed Enes Aydin
- Ataturk University School of Medicine, Department of Anaesthesiology and Reanimation, Erzurum, Turkey.,Clinical Research, Development and Design Application and Research Center, Ataturk University School of Medicine, Erzurum, Turkey
| | - Ali Ahiskalioglu
- Ataturk University School of Medicine, Department of Anaesthesiology and Reanimation, Erzurum, Turkey.,Clinical Research, Development and Design Application and Research Center, Ataturk University School of Medicine, Erzurum, Turkey
| | | | - Yavuz Gurkan
- Koc University, Faculty of Medicine Department of Anesthesiology and Reanimation, Istanbul, Turkey
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Single injection Quadratus Lumborum block for postoperative analgesia in adult surgical population: A systematic review and meta-analysis. J Clin Anesth 2020; 62:109715. [DOI: 10.1016/j.jclinane.2020.109715] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 11/26/2019] [Accepted: 01/11/2020] [Indexed: 12/25/2022]
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Steingrimsdottir G, Hansen CK, Dam M, Tanggaard KB, Nielsen MV, Børglum J. Quadratus lumborum block for total hip arthroplasty: anatomical knowledge is always key for choice of blocks and execution. Reg Anesth Pain Med 2020; 46:92-93. [PMID: 32376784 DOI: 10.1136/rapm-2019-101222] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Revised: 03/24/2020] [Accepted: 03/25/2020] [Indexed: 11/03/2022]
Affiliation(s)
| | - Christian K Hansen
- Department of Anesthesiology, Zealand University Hospital, Roskilde, Denmark
| | - Mette Dam
- Department of Anesthesiology, Zealand University Hospital, Roskilde, Denmark
| | - Katrine B Tanggaard
- Department of Anesthesiology, Zealand University Hospital, Roskilde, Denmark
| | | | - Jens Børglum
- Department of Anesthesiology, Zealand University Hospital, Roskilde, Denmark
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Ahiskalioglu A, Tulgar S, Celik M, Ozer Z, Alici HA, Aydin ME. Lumbar Erector Spinae Plane Block as a Main Anesthetic Method for Hip Surgery in High Risk Elderly Patients: Initial Experience with a Magnetic Resonance Imaging. Eurasian J Med 2020; 52:16-20. [PMID: 32158307 DOI: 10.5152/eurasianjmed.2020.19224] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Objective 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. Materials and Methods 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. Results 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. Conclusion Lumbar ESP block when combined with mild sedoanalgesia provides adequate and safe anesthesia in high risk elderly patients undergoing hip surgery.
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Affiliation(s)
- Ali Ahiskalioglu
- Department of Anesthesiology and Reanimation, Ataturk University School of Medicine, Erzurum, Turkey.,Clinical Research, Development and Design Application and Research Center, Ataturk University School of Medicine, Erzurum, Turkey
| | - Serkan Tulgar
- Department of Anesthesiology and Reanimation, Maltepe University School of Medicine, Istanbul, Turkey
| | - Mine Celik
- Department of Anesthesiology and Reanimation, Ataturk University School of Medicine, Erzurum, Turkey.,Clinical Research, Development and Design Application and Research Center, Ataturk University School of Medicine, Erzurum, Turkey
| | - Zeliha Ozer
- Department of Anesthesiology and Reanimation, Maltepe University School of Medicine, Istanbul, Turkey
| | - Haci Ahmet Alici
- Department of Pain Clinic, Medipol University School of Medicine,Istanbul, Turkey
| | - Muhammed Enes Aydin
- Department of Anesthesiology and Reanimation, Ataturk University School of Medicine, Erzurum, Turkey.,Clinical Research, Development and Design Application and Research Center, Ataturk University School of Medicine, Erzurum, Turkey
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Evaluation of ultrasound-guided transversalis fascia plane block for postoperative analgesia in cesarean section: A prospective, randomized, controlled clinical trial. J Clin Anesth 2020; 59:56-60. [DOI: 10.1016/j.jclinane.2019.06.025] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 05/22/2019] [Accepted: 06/24/2019] [Indexed: 12/27/2022]
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19
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Hansen C, Dam M, Moriggl B, Bendtsen TF, Børglum J. Fascia transversalis plane block for elective cesarean section: simpler but not necessarily better. Reg Anesth Pain Med 2019; 45:395-396. [PMID: 31822525 DOI: 10.1136/rapm-2019-101148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 11/14/2019] [Indexed: 11/03/2022]
Affiliation(s)
- Christian Hansen
- Department of Anaesthesiology, Zealand University Hospital, Roskilde, Denmark
| | - Mette Dam
- Department of Anaesthesiology, Zealand University Hospital, Roskilde, Denmark
| | - Bernhard Moriggl
- Anatomy, Histology and Embryology, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Jens Børglum
- Department of Anaesthesiology, Zealand University Hospital, Roskilde, Denmark
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Li J, Tang S, Lam D, Hergrueter A, Dennis J, Liu H. Novel utilization of fascial layer blocks in hip and knee procedures. Best Pract Res Clin Anaesthesiol 2019; 33:539-551. [DOI: 10.1016/j.bpa.2019.07.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 07/09/2019] [Indexed: 12/26/2022]
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Tulgar S, Yılmazer MS, Kızıltunc B, Thomas DT, Manukyan MN. The combination of ultrasound guided transversalis fascia plane block and transversus abdominis plane block: An alternative method for anesthesia in inguinal herniorrhaphy. J Clin Anesth 2019; 56:129-130. [DOI: 10.1016/j.jclinane.2019.02.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 02/12/2019] [Indexed: 11/29/2022]
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