[Translated article] Pericapsular nerves block (PENG) is an effective and safe alternative for postoperative pain management after primary total hip arthroplasty: A randomised clinical trial

BACKGROUND

Postoperative pain after total hip arthroplasty can affect postoperative rehabilitation and delay hospital discharge. The objective of this study is to compare pericapsular nerves group (PENG) block with pericapsular infiltration (PAI) and plexus nerve block (PNB) for postoperative pain management, response to physical therapy, opioid consumption, and length of hospital stay after a primary total hip arthroplasty.

METHODS

Randomised clinical trial of parallel and blinded groups was performed. Sixty patients who underwent elective THA between December 2018 and July 2020 were randomised into the different groups (PENG, PAI and PNB). The visual analogue scale was used to assess pain; and motor function was measured with the Bromage scale. We also record opioid usage, length of hospital stay, and related medical complications.

RESULTS

Pain level at discharge was similar in all groups. Hospital stay was 1 day shorter in the PENG group (p<0.001) and they also had lower opioid consumption (p=0.044). Optimal motor recovery was similar in the groups (p=0.678). Pain control when performing physical therapy was better in the PENG group (p<0.0001).

CONCLUSIONS

PENG block is an effective and safe alternative for patients undergoing THA as it reduces opioid consumption and hospital stay compared to other analgesic methods.

Pericapsular nerves block (PENG) is an effective and safe alternative for postoperative pain management after primary total hip arthroplasty: A randomized clinical trial

BACKGROUND

Postoperative pain after total hip arthroplasty can affect postoperative rehabilitation and delay hospital discharge. The objective of this study is to compare pericapsular nerves group (PENG) block with pericapsular infiltration (PAI) and plexus nerve block (PNB) for postoperative pain management, response to physical therapy, opioid consumption, and length of hospital stay after a primary total hip arthroplasty.

METHODS

Randomized clinical trial of parallel and blinded groups was performed. Sixty patients who underwent elective THA between December 2018 and July 2020 were randomized into the different groups (PENG, PAI and PNB). The visual analog scale was used to assess pain; and motor function was measured with the Bromage scale. We also record opioid usage, length of hospital stay, and related medical complications.

RESULTS

Pain level at discharge was similar in all groups. Hospital stay was 1 day shorter in the PENG group (p<0.001) and they also had lower opioid consumption (p=0.044). Optimal motor recovery was similar in the groups (p=0.678). Pain control when performing physical therapy was better in the PENG group (p<0.0001).

CONCLUSIONS

PENG block is an effective and safe alternative for patients undergoing THA as it reduces opioid consumption and hospital stay compared to other analgesic methods.

Erotomania: A case and review

Introduction

Erotomania (“Clérambault's syndrome”) is a rare syndrome characterized by a delusional belief of being loved by another person, usually of higher social status.

Objective

This case report aims to describe and discuss a case of erotomania, providing an updated review on this disorder.

Methods

Regular clinical interviews were performed during admission period to collect information about the clinical case and to promote an intervention approach to the patient. A literature review in Science Direct database, with the keyword “erotomania”, was also conducted.

Results

A 51-year-old woman was admitted in Beatriz Ângelo Hospital psychiatric ward with delusional beliefs of being loved by the ex-boss. Positive misperceptions and persecutory delusions regarding her husband as the obstacle for the love were manifested. The lack of insight for the situation and the necessity of treatment created some difficulties. A clinical report and a bibliographic review were made to allow a better understanding about the case and to orient the case evidence based.

Conclusions

Despite the evidence about the good response of atypical antipsychotics (e.g. risperidone) in erotomania, in our case study, the partial remission was only achieved with high dose of the old typical antipsychotic, pimozide.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Effects of Ribose Supplementation Prior to and during Intense Exercise on Anaerobic Capacity and Metabolic Markers

This study examined whether ribose supplementation before and during intense anaerobic exercise impacts anaerobic capacity and metabolic markers. Twelve moderately trained male cyclists (22.3 ± 2.2 y; 181 ± 6 cm, 74.8 ± 9 kg) participated in the study. Subjects were familiarized and fasted for 8 h after standardizing nutritional intake. In a double blind and crossover manner subjects ingested either a 150 mL placebo or ribose (3 g ribose + 150 μg folate). Subjects rested for 25 min and completed 5 × 30 s anaerobic capacity tests with 3 min passive rest. Six capillary blood samples were taken prior to and after sprints for adenine nucleotide breakdown determination. The experiment was repeated 1 wk later with alternative drink. Data were analyzed by repeated measures ANOVA. No significant interactions were observed for any performance or blood variables. D-ribose supplementation has no impact on anaerobic exercise capacity and metabolic markers after high-intensity cycling exercise.

Effects of oral D-ribose supplementation on anaerobic capacity and selected metabolic markers in healthy males

Oral D-ribose supplementation has been reported to increase adenine nucleotide synthesis and exercise capacity in certain clinical populations. Theoretically, increasing adenine nucleotide availability may enhance high intensity exercise capacity. This study evaluated the potential ergogenic value of D-ribose supplementation on repetitive high-intensity exercise capacity in 19 trained males. Subjects were familiarized to the testing protocol and performed two practice-testing trials before pre-supplementation testing. Each test involved warming up for 5 min on a cycle ergometer and then performing two 30-s Wingate anaerobic sprint tests on a computerized cycle ergometer separated by 3 min of rest recovery. In the pre- and post-supplementation trials, blood samples were obtained at rest, immediately following the first and second sprints, and following 5 min of recovery from exercise. Subjects were then matched according to body mass and anaerobic capacity and assigned to ingest, in a randomized and double blind manner, capsules containing either 5 g of a dextrose placebo (P) or D-ribose (R) twice daily (10 g/d) for 5 d. Subjects then performed post-supplementation tests on the 6th day. Data were analyzed by ANOVA for repeated measures. Results revealed a significant interaction (p =.04) in total work output. Post hoc analysis revealed that work significantly declined (-18 +/- 51 J) during the second post-supplementation sprint in the P group while being maintained in the R group (-0.0 +/- 31 J). No significant interactions were observed in peak power, average power, torque, fatigue index, lactate, ammonia, glucose, or uric acid. Results indicate that oral ribose supplementation (10 g/d for 5 d) does not affect anaerobic exercise capacity or metabolic markers in trained subjects as evaluated in this study.

Effects of creatine supplementation on repetitive sprint performance and body composition in competitive swimmers

In a double-blind and randomized manner, 18 male and female junior competitive swimmers supplemented their diets with 21 g.day-1 of creatine monohydrate (Cr) or a maltodextrin placebo (P) for 9 days during training. Prior to and following supplementation, subjects performed three 100-m freestyle sprint swims (long course) with 60 s rest/recovery between heats. In addition, subjects performed three 20-s arm ergometer maximal-effort sprint tests in the prone position with 60 s rest/recovery between sprint tests. Significant differences were observed among swim times, with Cr subjects swimming significantly faster than P subjects following supplementation in Heat 1 and significantly decreasing swim time in the second 100-m sprint. There was also some evidence that cumulative time to perform the three 100-m swims was decreased in the Cr group. Results indicate that 9 days of Cr supplementation during swim training may provide some ergogenic value to competitive junior swimmers during repetitive sprint performance.

Effects of ingesting supplements designed to promote lean tissue accretion on body composition during resistance training

This study examined the effects of ingesting nutritional supplements designed to promote lean tissue accretion on body composition alterations during resistance training. Twenty-eight resistance-trained males blindly supplemented their diets with maltodextrin (M), Gainers Fuel 1000 (GF), or Phosphagain (P). No significant differences were observed in absolute or relative total body water among groups. Energy intake and body weight significantly increased in all groups combined throughout the study with no group or interaction differences observed. Dual energy x-ray absorptiometry-determined body mass significantly increased in each group throughout the study with significantly greater gains observed in the GF and P groups. Lean tissue mass (excluding bone) gain was significantly greater in the P group, while fat mass and percent body fat were significantly increased in the GF group. Results indicate that total body weight significantly increased in each group and that P supplementation resulted in significantly greater gains in lean tissue mass during resistance training.

Paracoccidioidomycosis with palpebral and conjunctival involvement

A case of pulmonary and lymphatic paracoccidioidomycosis followed by conjunctivo-palpebral involvement is studied in Sao Paulo (Brazil). The Brazilian literature is reviewed. The most frequent clinic forms of ocular lesions in natural infection are described. The small number of human cases observed is discussed. The severity and frequency of ocular lesions in experimental animals, intracardiacally inoculated with P. brasilensis cultures suggest haematogenic ocular dissemination of the fungus, which may occur in the septicemic stage of the human paracoccidioidomycosis.