Is quadratus lumborum block combined with low dose-spinal anesthesia an effective alternative to general anesthesia in patients undergoing percutaneous nephrolithotomy?

Background: General anesthesia in high-risk patients has many complications and needs long preoperative preparations and postoperative intensive care unit (ICU). Therefore the present study aimed to evaluate the efficacy of combined low-dose spinal anesthesia with quadratus lumborum block (QLB) as an alternative to general anesthesia for patients undergoing percutaneous nephrolithotomy. Patients and methods: A prospective study was conducted at the urology department of Al-Azhar University Hospitals in Cairo, Egypt, from January 2021 to January 2022. The study included 60 patients of ASA ll-lll scheduled for percutaneous nephrolithotomy. All patients received low-dose spinal anesthesia (5 mg bupivacaine) and QLB (QL1-QL2-QL3) approaches. The primary observation parameter was the efficacy of this technique as an alternative to general anesthesia. The secondary parameters measured were evaluation of need for intraoperative narcotics, postoperative pain score (VAS), and patients satisfaction as assessed using a 5-point Likert Scale. Results: None of the patients was given general anesthesia, and intraoperative sedation was given to nineteen patients (32.2%). No hemodynamic changes were observed in all patients. There was a significant correlation between the use of intraoperative sedation and stone site, intraoperative blood loss, and hospital stay. Pain intensity on VAS at rest and movement was low until the 24th postoperative hour. Patient satisfaction score was 3, 4, and 5 in 1 (1.7%), 4 (6.7%), and 55 (91.6%) patients, respectively. Conclusions: Combined low-dose spinal anesthesia with quadratus lumborum block is an effective alternative to general anesthesia in patients undergoing PCNL procedures with good postoperative analgesia. Patients with lower calyceal punctures have a lower incidence of intraoperative sedation requirements

Feasibility of ultrasonography compared to plain radiography in detection of pneumoperitoneum in patients presenting with acute abdominal pain in the ED

Background: Pneumoperitoneum is frequently considered one of the commonest surgical emergencies due to its association with gastrointestinal perforation that can result in peritonitis, septic shock, multiorgan failure and death. Accurate and Timely detection of these emergencies is of paramount importance in the management and outcome of the patients. Thus prompt diagnosis is a vital to avoid unnecessary interventions. Objectives: The study aimed to verify the feasibility and usefulness of Ultrasound in the diagnosis of pneumoperitoneum through comparing both Ultrasound and plain radiography findings with the intraoperative findings (the gold standard diagnosis). Methodology: The study was carried out in the Emergency Medicine and Traumatology department at Tanta University Hospitals in the period from September 2019 to September 2021, included eighty three adult patients presented with acute abdominal pain with suspected gastrointestinal perforation. Ultrasound examination was performed by the emergency physician and Plain radiography (erect or lateral decubitus) was done as an important diagnostic tool in acute abdominal pain. All enrolled patients underwent surgical intervention. Results: Sensitivity of ultrasound was higher than that of plain radiography in the diagnosis of pneumoperitoneum (89.39% and 86.63% ) respectively. While plain radiography was more specific than ultrasound (88.24% and 94.12% ) respectively.&nbsp