Reduced Concentrations of NSE, S100β, Aβ, and Proinflammatory Cytokines in Elderly Patients Receiving Ultrasound-Guided Combined Lumbar Plexus-Sciatic Nerve Block during Hip Replacement

An ultrasound-guided modified iliac fascia and sacral plexus block application in a critically ill patient undergoing artificial femoral head replacement surgery: a case report

BACKGROUND

Hip fractures have become a significant clinical concern on a global scale in recent years. The burgeoning aging population has exacerbated this issue, leading to a rise in the number of hip fracture cases coupled with concomitant geriatric ailments. Therefore, it poses a huge challenge to anesthesiologists with the increasing number of critically ill patients who are not suitable for general anesthesia and intrathecal anesthesia. Ultrasound-guided nerve blocks combined with sedation have not previously been documented in critically ill patients.

CASE PRESENTATION

We administered an ultrasound-guided modified iliac fascia block combined with sacral plexus block to an 88-year-old male patient with a left femoral fracture suffering from severe multi-systemic diseases. Concurrently, the patient received intravenous anesthesia via propofol and dexmedetomidine, with monitoring conducted through bispectral index. Subsequently, the surgery was completed smoothly and the patient demonstrated accelerated postoperative recovery without significant discomfort and a successful discharge.

CONCLUSIONS

This innovative approach significantly contributed to achieving successful surgical anesthesia and postoperative analgesia, thereby facilitating early recovery and discharge from the hospital. We propose that ultrasound-guided nerve blocks with sedation show promise for critically ill patients.

Effect of acute hypervolemic hemodilution with bicarbonated Ringer's solution on perioperative S100β and NSE in elderly patients undergoing spine surgery

To explore the effect of acute hypervolemic hemodilution (AHH) with bicarbonated Ringer's solution (BRS) on perioperative serum S100β protein (S100β) and neuron-specific enolase (NSE) in elderly patients undergoing spine surgery. Ninety patients with lumbar spondylolisthesis and fracture surgery admitted to our hospital from January 2022 to August 2022 were selected as the study subjects, and they were randomly and equally divided into group H1 (AHH with BRS), group H2 (AHH with lactated Ringer's solution) and group C (no hemodilution). The serum contents of S100β and NSE of the three groups at different times were evaluated. There were significant differences in the incidence of postoperative cognitive dysfunction (POCD) among the three groups at T1 and T2 (P < 0.05). There were obvious differences in the contents of S100β and NSE among the three groups at T1 and T2 (P < 0.001), with no overt difference in the incidence of perioperative complications among the three groups (P > 0.05). The use of AHH with BRS can effectively reduce the effect on cognitive function in the elderly with spine surgery, which greatly reduces the nervous system injury, and has certain application value in clinic.

Use of Peripheral Nerve Blocks for Total hip Arthroplasty

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.

Peripheral Nerve Blocks for Hip Fractures

The incidence of hip fractures has continued to increase as life expectancy increases. Hip fracture is one of the leading causes of increased morbidity and mortality in the geriatric population. Early surgical treatment (<48 h) is often recommended to reduce morbidity/mortality. In addition, adequate pain management is crucial to optimize functional recovery and early mobilization. Pain management often consists of multimodal therapy which includes non-opioids, opioids, and regional anesthesia techniques. In this review, we describe the anatomical innervation of the hip joint and summarize the commonly used peripheral nerve blocks to provide pain relief for hip fractures. We also outline literature evidence that shows each block's efficacy in providing adequate pain relief. The recent discovery of a nerve block that may provide adequate sensory blockade of the posterior capsule of the hip is also described. Finally, we report a surgeon's perspective on nerve blocks for hip fractures.

Anesthesia, Anesthetics, and Postoperative Cognitive Dysfunction in Elderly Patients

Postoperative cognitive dysfunction (POCD) remains a major issue that worsens the prognosis of elderly surgery patients. This article reviews the current research on the effect of different anesthesia methods and commonly utilized anesthetics on the incidence of POCD in elderly patients, aiming to provide an understanding of the underlying mechanisms contributing to this condition and facilitate the development of more reasonable anesthesia protocols, ultimately reducing the incidence of POCD in elderly surgery patients.

Effect of peripheral nerve block versus general anesthesia on the hemodynamics and prognosis of diabetic patients undergoing diabetic foot Surgery

BACKGROUND

Diabetic foot ulcers (DFUs) represent a significant foot-related concern for patients with multiple co-morbidities, and surgical intervention is often employed. Notably, peripheral nerve block anesthesia (PNB) has emerged as a new approach for the surgical management of DFUs, providing sustained hemodynamic stability and superior postoperative pain control compared to general anesthesia (GEA).

METHODS

The present study utilized a retrospective analysis of hospitalized patients who met the inclusion criteria for DFUs over a period of 7 years. Patients were categorized into two groups based on the type of anesthesia employed during the procedure: GEA or PNB. Extensive patient information was gathered and analyzed, such as demographics, intraoperative hemodynamic parameters, numeric rating scale (NRS) scores, and healing outcomes. The preliminary results assessed in this study were intraoperative hemodynamic stability and postoperative analgesic efficacy.

RESULTS

During the study period, 117 patients received surgical therapy based on GEA, while 145 patients received PNB. Notably, the mean intraoperative blood pressure was significantly lower in the GEA group, and this difference remained statistically significant even after Bonferroni adjustment using linear mixed models. Additionally, the frequency of hypotensive episodes was higher in the GEA group (P < 0.05). Furthermore, the perioperative transfusion volume, overall intraoperative fluid input, and intraoperative bleeding volume were significantly more significant in the GEA group than in the PNB group. The postoperative pain NRS scores differed considerably between the two groups (Bonferroni corrected P < 0.01), with the GEA group exhibiting higher opioid consumption on the day of surgery and the first postoperative day when using patient-controlled intravenous analgesia (PCIA). Supplemental analgesic medication was more significant in the GEA group 24 h postoperatively. However, the two groups had no difference in hospital stay or treatment outcomes. There was no difference between the two groups regarding secondary surgery and amputation procedures. Although the 5-year mortality rate is 30.5%, no significant difference in mortality rates between the two groups was observed.

CONCLUSIONS

Compared to GEA, PNB is a safe and effective alternative therapy for managing DFUs. Our findings suggest that PNB administration during surgical intervention for this condition results in more stable intraoperative hemodynamics and superior postoperative analgesic effects, despite no significant difference in overall treatment outcomes between the two groups. The two groups did not differ in re-surgery, amputation, or 5-year mortality.

Analysis of Efficacy, Complications, and Inflammatory Reactions of Bridge Combined Internal Fixation System for Periarticular Fractures of the Shoulder

Objective

The aim of the present research is to analyze the impact of the bridge combined internal fixation system (BCFS) on efficacy, complications, and inflammatory reactions of periarticular fractures of the shoulder.

Methods

A retrospective analysis was performed on 100 patients with periarticular fractures of the shoulder admitted between January 2016 and January 2020. Patients were assigned to the observation group (OG) and control group (CG) according to different treatment schemes, with 50 cases in each group. Patients in OG were intervened by BCFS, while those in CG were routinely given plate fixation. The treatment outcome, complications, and inflammatory reaction of the two groups were compared.

Results

The results showed better treatment outcome, shoulder joint function recovery, and inflammatory reaction alleviation of OG compared with CG. Besides, statistically shorter fracture healing and hospitalization time as well as fewer complications were determined in OG.

Conclusion

These results demonstrate that compared with the plate fixation system, BCFS can significantly improve the surgical efficacy and healing efficiency and alleviate the inflammatory response of patients, with a low complication rate, all of which contribute to faster recovery of periarticular fractures of the shoulder. Hence, BCFS is an ideal choice for periarticular fractures of the shoulder that deserves clinical promotion.