Hemodynamic changes after interscalene brachial plexus block depending on its side

Background and Goal of Study: Interscalene brachial plexus block (ISB) is a first choice method performing shoulder surgery or diagnostic procedures around the world. Despite this common procedure there are still many undesirable events concerning hemodynamic changes. Exact causes are not yet fully determined. The goal of our study is to find how hemodynamics of patient is af fected by ISB depending on its side. Materials and methods: We investigated 78 patients, who needed shoulder surgery. All subjects were in sinus rhythm, and no abnormalities were detected with medical history and physical examination. Patient exclusion criteria: refused consent of enrollment in the investigation; coexisting diseases that were likely to impact changes in hemodynamics during the surgery. Af ter obtaining the approval from the Ethics Committee the patients were included randomly into 2 groups depending on operating side. Two equal groups of 39 patients underwent one side ISB. All patients received 0.5% 20 ml bupivacaine and 2% 20 ml lidocaine Ultrasound-Guided ISB. Hemodynamic changes were registered with impedance cardiography test and standard patient monitoring in various periods of operation for the first hour. Results and discussion: The patient population included both sexes, median age was 42,3 years with the ASA physical status I and II, weight from 50 to 98 kg and height between 155 and 192 cm. We found statistically significant difference between lef t and right side block. Lef t side ISB caused lower cardiac index af ter 10, 20 and 40 min. Systemic vascular resistance index was lower in every stage af ter 10 min. Mean blood pressure was lower af ter positioning the patients, 20, 30 and 60 min. Drop in heart rate was observed af ter 20 and 40 min. in lef t side block group. Acceleration index was higher in lef t side group af ter 10, 20 and 30 min. There was no statistically significant differences concerning systolic index and cardiac output. ISB has a dif fere

Jaunų sportininkų artroskopinis peties sąnario viršutinės-priekinės-užpakalinės lūpos komplekso pažeidimų gydymas: perspektyvusis randomizuotas tyrimas

Rimtautas Gudas1, Romas Jonas Kalesinskas1, Ramūnas Tamošiūnas2Kauno medicinos universiteto klinikų ,1 Ortopedijos ir traumatologijos klinikos Sporto traumų ir artroskopijos sektorius,2 Anesteziologijos ir reanimatologijos klinika,Eivenių g. 2, LT-50009 KaunasEl. paštas: [email protected] Tikslas Perspektyviuoju būdu išanalizuoti jaunų fiziškai aktyvių sportininkų minimaliai invazinių artroskopinio peties sąnario SLAP pažeidimų operacinio gydymo rezultatus. Ligoniai ir metodai Perspektyviuoju tyrimu įvertinome 38 sportininkus, kuriems 2000–2003 metais KMUK Ortopedijos ir traumatologijos klinikos Sporto traumų ir artroskopijos sektoriuje dėl peties sąnario sąnarinės lūpos žiedo pažeidimų ir su tuo susijusių įvairaus intensyvumo simptomų buvo atliktos minimaliai invazinės artroskopinės peties sąnario operacijos. Gydymo rezultatai vertinti pagal Constant skale ir rentgeno tyrimą praėjus vidutiniškai 19,2 mėn. po operacijų. Operuojamų pacientų amžiaus vidurkis buvo 27,2 metų (nuo 16 iki 38 metų). Rezultatai 24 (63%) pacientams atlikta II ir IV tipo sąnarinės lūpos pažeidimo rekonstrukcinė operacija, naudojant tirpius inkaruojančius siūlus, 4 (11%) – I, III, V ir VI tipų sąnarinės lūpos pažeidimo rekonstrukcinė operacija naudojant tirpius inkaruojančius siūlus, 5 (13%) – esant I ir III tipo pažeidimams, atplaišų pašalinimas, 5 (13%) – dvigalvio raumens sausgyslės nukirpimas ir tenodezė. Kartu su minėtomis procedūromis 5 (13%) ligoniams atlikta sukamųjų raumenų ir užpakalinės sąnario kapsulės sutraukimas siūlais. Priešoperacinis Constant skalės įvertis buvo 58 ± 5,15 taško, po operacijos praėjus 19,2 mėn. – 96 ± 5,82 taško (p < 0,05). Išvados Praėjus 19,2 mėn. po peties sąnario SLAP pažeidimų artroskopinės rekonstrukcijos naudojant tirpius inkaruojančius siūlus, gautas statistiškai reikšmingas peties sąnario funkcijos pagal Constant skalę pagerėjimas ir skausmo išnykimas (p = 0,005). Artroskopinės minimaliai invazinės peties sąnario operacijos yra veiksmingos gydant jaunų fiziškai aktyvių žmonių peties sąnario SLAP pažeidimus ir 93% sportininkų grąžina prieš pažeidimus turėtą fizinio aktyvumo lygį. Pagrindiniai žodžiai: peties artroskopija, SLAP pažeidimas Arthroscopic shoulder SLAP injury treatment in young athletes: prospective randomized trial Rimtautas Gudas1, Romas Jonas Kalesinskas1, Ramūnas Tamošiūnas2Kaunas Medical University,1 Clinic of Ortopedics and Traumatology, Division of Sport Trauma and Artroscopy,2 Clinic of Anesthesiology and Reanimatology,Eivenių str. 2, LT-50009 Kaunas, LithuaniaE-mail: [email protected] Objective To evaluate the arthroscopic procedures for the treatment of the shoulder joint SLAP lesions in young active athletes under the age of 38. Patients and methods Between 2000 and 2003, a total of 38 athletes with a mean age of 27.2 years (16 to 38) and with a symptomatic lesion of the biceps-labrum complex in the shoulder were evaluated 19.2 months post operations on the Constant scale and with X-rays. All athletes were available for a follow-up. The mean duration of symptoms was 13.32 ± 5.57 months and none of the athletes had prior surgical interventions to the affected shoulder. Type of study: prospective nonrandomized clinical study. Results After 19.2 months, all athletes showed a significant clinical improvement (p < 0,05). Final evaluation revealed a statistically significant improvement of the Constant results from 58 ± 5.15 preoperatively to 96 ± 5.82 postoperatively (p < 0.05). According to the Constant score, the functional and objective assessment showed that 96% had excellent or good results after the suture anchor SLAP repair (p < 0.001). No serious complications were reported. X-ray evaluation demonstrated no osteolythic changes in the suture anchor insertion zones or osteoarthritic changes of the shoulder joint after operations. 36 (95%) athletes following SLAP repair returned to sports activities at the pre-injury level at an average of 5.2 months (range 5 to 9 months) after the operations. Others showed a decline in the sport activity level. Conclusion At an average of 19.2 months (range from 19 to 21 months) of follow-up, our prospective clinical study in young active athletes under the age of 38 (16 to 38) has shown significant improvement in terms of pain and the function of the suture anchor repair for SLAP lesions in the shoulder. Limitations of our study included a small number of athletes and a relatively short follow-up, while a long-term follow-up is needed to assess the durability of SLAP lesion repair using these methods in young active athletes. Key words: shoulder arthroscopy, SLA

Measurements of Inferior Vena Cava Diameter for Prediction of Hypotension and Bradycardia during Spinal Anesthesia in Spontaneously Breathing Patients during Elective Knee Joint Replacement Surgery

Background and objective: Hypotension and bradycardia are the most common hemodynamic disorders and side effects of spinal anesthesia (SA) on the cardiovascular system. SA-induced sympathetic denervation causes peripheral vasodilatation and redistribution of central blood volume that may lead to decreased venous return to the heart. The aim of the study was to evaluate the changes of inferior vena cava collapsibility index (IVC-CI) during SA in spontaneously breathing patients during elective knee joint replacement surgery to prognose manifestation of intraoperative hypotension and bradycardia. Materials and methods: 60 patients (American Society of Anesthesiologists (ASA) physical status I or II, no clinically significant cardiovascular pathology) of both sexes undergoing elective knee joint replacement surgery under SA were included in the prospective study. Inspiratory and expiratory inferior vena cava (IVCin, IVCex) diameters were measured using an ultrasound device in supine position before and immediately after SA, then 15 min, 30 min, and 45 min after SA was performed. The heart rate, along with systolic, diastolic, and mean arterial blood pressures were collected. The parameters were measured at the baseline and at the next four time points. Results: There were no significant changes in IVCin, IVCex, and IVC-CI compared to baseline and other time point measurements in hypotensive versus nonhypotensive and bradycardic versus nonbradycardic patients (p > 0.05). Changes in IVC diameter do not prognose hypotension and/or bradycardia during SA: the area under the curve (AUC) of the receiver operating characteristic (ROC) curve for IVC-CI at all measuring points was <0.7, p > 0.05. Conclusions: Reduction in IVC diameters and increase in IVC-CI do not predict hypotension and bradycardia during SA in spontaneously breathing patients undergoing elective knee joint replacement surgery

Skeletal pathological conditions of Lithuanian mummies

This report examines the bone lesions found during CT investigations of mummies from the Dominican Church of the Holy Spirit in Vilnius, Lithuania. Observed pathological conditions include a single fracture, osteoarthritis, malpositions and dental disease, as well as some normal variants of the human skeleton. These palaeopathological data provide a clearer picture of the mummies’ osteobiographies, and serve as a reminder about the importance of noninvasive techniques for the investigation of historical preserved remains

Role of multimodal analgesia in the evolving enhanced recovery after surgery pathways

Enhanced recovery after surgery (ERAS) are specially designed multimodal perioperative care pathways which are intended to attain and improve rapid recovery after surgical interventions by supporting preoperative organ function and attenuating the stress response caused by surgical trauma, allowing patients to get back to normal activities as soon as possible. Evidence-based protocols are prepared and published to implement the conception of ERAS. Although they vary amongst health care institutions, the main three elements (preoperative, perioperative, and postoperative components) remain the cornerstones. Postoperative pain influences the quality and length of the postoperative recovery period, and later, the quality of life. Therefore, the optimal postoperative pain management (PPM) applying multimodal analgesia (MA) is one of the most important components of ERAS. The main purpose of this article is to discuss the concept of MA in PPM, particularly reviewing the use of opioid-sparing measures such as paracetamol, nonsteroid anti-inflammatory drugs (NSAIDs), other adjuvants, and regional techniques