The effect of Interscalene Plexus Block (ISPB) on intraoperative opioid consumption during an open shoulder surgery

Shoulder surgery is a growing field in geriatric orthopedics and sports medicine. Surgical methods are applied to diseases where non-invasive treatment techniques have failed. In recent years, the efficacy of peripheral nerve blocks has been repeatedly compared, but studies have focused primarily on their postoperative effects without evaluating intraoperative analgesia and opioid consumption.Aim: The aim of this study was to evaluate the benefits of preoperatively administered ISPB in terms of intraoperative pain control and total intraoperative opioid analgesic consumption.Materials and Methods: A total of 89 patients undergoing open shoulder surgery were included in this study. Of these, 21 underwent shoulder joint replacement surgery, 59 underwent surgery for proximal humeral fracture, and 9 patients underwent open shoulder surgery other than the above-mentioned. Preoperatively, 57 patients underwent ISPB, and 32 patients were without a brachial plexus block. The study was prospective and retrospective because we obtained the data of patients without preoperative ISPB from the hospital records.Results: Administered preoperatively, the ISPB effectively reduced intraoperative opioid analgesic consumption during open shoulder joint and proximal humerus surgery.Conclusion: Interscalene plexus block is an excellent adjunct to multimodal analgesia, not only for postoperative pain control but also as part of intraoperative analgesia

Ultrasound-guided peripheral nerve blocks, a safety method of anesthesia in patients with sepsis with an initial acute respiratory failure - presentation of two clinical cases

Anesthetic management of patients with severe sepsis is a great challenge. Systemic inflammation and acute organ dysfunction in response to infection is a major problem, especially respiratory failure and hemodynamic instability. Avoidance of lung injury during mechanical ventilation is possible with peripheral nerve blocks.Clinical case 1: We present a 73-year-old male hemodialysis patient with sepsis. He had infectious complication of aneurysm formation of A-V fistula. The patient was hypoxic – SpO2 86-88%, with presence of tachypnea, RR-150/75, HR-125/min, Temp -380 C, coagulation abnormalities - INR 1, 58 (clopidogrel intake), elevated CRP and WBC.The patient was indicated for emergency procedures of incision, drainage and ligation of A-V fistula. We performed supraclavicular brachial plexus block + sedation.Clinical case 2: We present a 61-year-old woman with sepsis, with past medical history of diabetes, COPD, and endometrial cancer. She was with clinical presentation of necrotizing fasciitis of the upper extremity.We performed ultrasound-guided supraclavicular brachial plexus block – ”in plane” technique, 30 mL/25 mL ropivacaine 0.5% in moderate sedated patients.During the operation the patients were conscious, hemodynamically and respiratory stable, with oxygen supply by a mask, and with excellent intraoperative and postoperative pain control.We think that ultrasound-guided peripheral nerve blocks are safe and effective alternatives for septic patients with/without coagulation abnormalities

Endoscopic imaging of the human laryngeal complex in an experimental setting - methodology and clinical significance

AIM: The human laryngeal complex has been an endoscopic sight since the late 19th century, however despite the technological advances little has changed in the standard observational methodology, with optical distortion of the image being a major setback in all endoscopic studies. The aim of this study is to evaluate different endoscopes and image correction algorithms in the endoscopic imaging of the laryngeal complex.METHODS AND MATERIALS: Conventional rigid 00, 300, 700 and 900 endoscopes and a flexible otorhinolaryngoscope with two-dimensional imaging capabilities, a digital camera and a direct laryngoscope were used together with an intubation mannequin to obtain endoscopic images of the laryngeal complex. Images of a custom made lens distortion grid were taken to compare the different optical systems and used as a benchmark for image correction. Both sets of images were superimposed in order to digitally correct for angle and lens distortion and to show the true size and proportions of the human laryngeal complex, so far seen only during an intubation or autopsy.RESULTS: After comparing the fiber optic and rigid endoscope obtained images, the rigid endoscopes proved to have better imaging qualities and therefore a better potential for future in depth study of laryngeal anatomy. The rigid 700 endoscope, compared to other rigid systems, allowed for an atraumatic perpendicular to the glottis view of the laryngeal complex, best suited for the study, despite the higher image distortion.CONCLUSION: Based on the collected data the 700 rigid otorhinolaryngoscope together with a standard software correction is an affordable, atraumatic and reliable method for anatomical and proportionate measuring of the human laryngeal complex in a model study

Application of dexamethasone as an adjuvant to the local anesthetic in the performance of a US-guided femoral block for postoperative analgesia on patients after total knee joint replacement

Introduction: The article discusses the use of dexamethasone as an adjuvant to local anesthetic solution for ultrasound (US)-guided femoral nerve block in patients after total knee joint replacement. A literature review on the clinical use of other adjuvants is also presented.Design: This was a clinical prospective randomized study.Aim: The aim of this article is to investigate the effect of dexamethasone adjuvant on the local anesthetic solution when performing a US-guided femoral block in patients after total knee joint replacement.Methods: The study included 53 patients, randomized into two groups:  Group 1: single shot femoral nerve block (FNB) + constant infusion through a perineural catheter 15 mL bolus (ropivacaine 0.5%/levobupivacaine 0.375%) with a subsequent infusion of 5-9 mL per hour, including 20 patients; Group 2: single shot FNB  20 mL bolus (ropivacaine 0.5%/levobupivacaine 0.375%) +/- dexamethasone 4 mg, including 33 patients.  In Group 2, 2 subgroups were formed: patients with single shot FNB with chirocain - 10 patients; patients with single shot FNB with ropivacaine - 23 patients. Of these, 15 patients were fasted with single shot FNB  with ropivacaine + dexamethasone 4 mg, and 8 patients with pure ropivacaine.Evaluation of effective control of pain relief symptoms was done on 2nd, 4th, 6th, 12th, 18th, 24th, and 36th hours postoperatively according to the Visual Analogue Scale (VAS).Results: No statistically significant difference in VAS scores was observed between the two groups in the 2nd, 6th, 12th, 18th and 36th hours. Such was found only in the 24th hour. We did not detect statistically significant benefits of this adjuvant. We do not have clinically registered adverse drug reactions (ADRs). We have not established a correlation between these occurrences and the use of dexamethasone.Conclusion: Although our results correspond to those of authors who refute the benefits of dexamethasone as an adjuvant to the peripheral nerve block (PNB), we believe, based on clinical observation data, that it actually attenuated reversible hyperalgesia (patients did not report abruptly, acute, sudden onset of pain), therefore prolongation of the analgesic effect was observed until the 18th, 20th postoperative hour