Preoperative pericapsular nerve group (PENG) block for total hip arthroplasty: a randomized, placebo-controlled trial

BackgroundWe hypothesized that the addition of a preoperative pericapsular nerve group (PENG) block to intra-articular local anesthetic injection would improve analgesia after total hip arthroplasty.MethodIn this double-blinded trial, 71 patients scheduled for primary total hip arthroplasty were randomized to receive preoperative PENG block with 20 mL 0.5% ropivacaine (PENG group) or 20 mL saline (placebo group). All the patients received an intra-articular injection of 20 mL 0.5% ropivacaine by surgeon after the completion of the procedure. The primary outcome was the highest pain score reported in the recovery room. The secondary outcomes included quadriceps strength, pain scores, opioid use, and opioid-related side effects up to 48 hours after surgery.ResultsSeventy patients were included in the final analysis. The highest visual analog scale in the recovery room showed significant intergroup difference (placebo: 5.2±3.1 vs PENG: 3.3±2.7, p<0.01) but the difference did not persist after discharge from the recovery room. The two groups’ postoperative pain scores at rest were similar. A lower intraoperative morphine equivalent dose and lower postoperative vomiting were found in the PENG group. There were no differences in the other outcomes.ConclusionThe addition of a preoperative PENG block to intra-articular injections of local anesthetic provides a limited benefit to postoperative analgesia in the recovery room with no discernible benefits thereafter.Trial registration numberNCT04480320.

Effects of the Two Doses of Dexmedetomidine on Sedation, Agitation, and Bleeding During Pediatric Adenotonsillectomy

Background: Due to the importance of dexmedetomidine and its different dosages, here, we aimed to investigate and compare the effectiveness of the doses of 1 µg/kg and 2 µg/kg of dexmedetomidine in sedation, agitation, and bleeding in pediatrics undergoing adenotonsillectomy. Methods: This double-blinded randomized clinical trial was performed on 105 pediatric patients that were candidates for adenotonsillectomy. Then, the patients were divided into three groups receiving dexmedetomidine at a dose of 2 µg/kg, diluted dexmedetomidine at 1 µg/kg, and normal saline. The drugs were administered 15 minutes before operations via the intravenous method. The duration of extubation, mean arterial pressure (MAP), heart rate (HR), and SPO2 in the recovery were recorded. We also collected data regarding patients’ sedation and agitation every 15 minutes. Results: Our data showed no significant differences between the groups of patients regarding MAP, HR, and SPO2. However, the mean sedation score was significantly higher in patients receiving dexmedetomidine (2 µg/kg), and this score was lowest in the control group at the time of entrance to the recovery room. The patients that received dexmedetomidine at a dose of 1 µg/kg had the lowest agitation score after 45 minutes of being in the recovery room, and the patients treated with dexmedetomidine at a dose of 2 µg/kg had the lowest agitation score after 60 minutes of being in the recovery compared to other groups of patients. Conclusions: The use of the doses of 1 µg/kg and 2 µg/kg of dexmedetomidine was associated with proper sedation and a significant reduction in agitation. The patients also had lower amounts of bleeding. We recommend that anesthesiologists should pay more attention to dexmedetomidine at a dose of 2 µg/kg, especially in pediatric surgical procedures.

Warm and humidified insufflation gas during gynecologic laparoscopic surgery reduces postoperative pain in predisposed patients—a randomized, controlled multi-arm trial

Background Postoperative pain remains a common problem in gynecologic laparoscopy, especially in head zone-related regions, triggered by intra-abdominal pressure during capnoperitoneum. Humidified and prewarmed insufflation gas may ameliorate pain and be beneficial. Methods This prospective randomized controlled parallel group multi-arm single-center study investigated the effects of temperature and humidity of insufflation gas on postoperative pain during gynecologic laparoscopy with a duration ≥ 60 min. Female participants (18—70 years) were blinded and randomly assigned—computer generated—to either insufflation with dry cold CO2 with forced air warming blanket (“AIR”), humidified warm gas without forced air warming blanket (“HUMI”), or humidified warm gas with forced air warming blanket (“HUMI +”). We hypothesized that using humidified warm gas resulted in lower pain scores and less analgesic consumption. The primary endpoint postoperative pain was assessed for different pain localizations every 12 h during 7 days after surgery. Secondary endpoints were demand for painkillers and epidural anesthetics, length of stay in recovery room, and hospital stay. (Registration: ClinicalTrials.gov NCT02781194—completed). Results 150 participants were randomized. Compared to group “AIR” (n = 48), there was significantly less pain in group “HUMI +” (n = 48) in the recovery room (− 1.068; 95% CI − 2.08 to − 0.061), as well as significantly less ibuprofen use at day two (− 0.5871 g ± 0.258; p-value = 0.0471). Other variables did not change significantly. Stratification for presence of endometriosis or non-previous abdominal surgery in patient history revealed significantly less pain in both groups “HUMI” (n = 50) and “HUMI +” versus group “AIR.” Related side effects were not noted. Conclusion In the overall population, the use of warm, humidified insufflation gas did not yield clinically relevant effects; however, in predisposed patients with endometriosis and who could otherwise expect high pain levels, warm and humidified gas may be beneficial.

Relationship between Spinal Anesthesia and Hypothermia Incidence among Post Operative Patients in the Operating Recovery Room "JIH" Hospital Yogyakarta

Introduction: Complications of surgery may lead the patient to experience ill and even death. One of the complications in the patient after surgery with spinal anesthesia is the incidence of hypothermia. Hypothermia can occur as a result of a combination of anesthesia and surgery that causes disturbance in body temperature regulation that can make decreasing body temperature. Method: This research uses a descriptive correlational method with a retrospective approach, with total sampling technique amount of 106 respondents, using a checklist sheet research instrument.Data analysis techniques spearman rank. Results: The characteristics of surgery patients with spinal anesthesia in the operating room of Yogyakarta "JIH" Hospital were mostly female, 87.9%, most of whom were adults 74.1%, the highest frequency of surgery with spinal anesthesia duration >2 hours 55.7% and had an incidence of hypothermia 54.7%. Correlational statistical analysis obtained a Cramer's value of 0.371, a correlation coefficient value of 0.348 with a probability value (p-value) of 0.000. Conclusion: There is a relationship between spinal anesthesia and hypothermia incidence among postoperative patients in the operating recovery room "JIH" Hospital Yogyakarta. The direction of the correlation is positive and closeness is sufficient.

Improving the efficiency of the technology and organization of the longwall face move during the intensive flat-lying coal seams mining at the Kuzbass mines

The reasons for the lag of the indicators of the leading Russian coal mines engaged in the longwall mining of the flat-lying coal seams from similar foreign mines are considered. The analysis of the efficiency of the longwall face move operations at the JSC SUEK-Kuzbass mines was carried out. A significant excess of the planned deadlines for the longwall face move during the thick flat-lying seams mining, the reasons for the low efficiency of disassembling operations and the main directions for improving the technology of disassembling operations are revealed. The directions of ensuring the operational condition of the recovery room formed by the longwall face are considered. The recommended scheme of converged coal seams mining and a three-dimensional model of a rock mass to justify its parameters are presented. Numerical studies using the finite element method are performed. The results of modeling the stress-strain state of a rock mass in the vicinity of a recovery room formed under conditions of increased stresses from the boundary part of a previously mined overlying seam are shown. The main factors determining the possibility of ensuring the operational condition of the recovery rooms are established. It is shown that it is necessary to take into account the influence of the increased stresses zone when choosing timbering standards and organizing disassembling operations at a interbed thickness of 60 m or less. A sufficient distance from the gob of above- or undermined seams was determined to ensure the operational condition of the recovery room of 50 m, for the set-up room – 30 m. Recommendations are given for improving technology and organization of the longwall face move operations at the mines applied longwall mining of flat-lying coal seams with the formation of a recovery room by the longwall face.