Safety and clinical outcomes of regional anaesthesia in Chinese patients with non-small cell lung cancer undergoing non-intubated lobectomy

Purpose: To determine the safety and clinical outcomes of epidural anaesthesia (EA) relative to internal intercostal nerve block (INB) in Chinese patients with non-small cell lung cancer (NSCLC) who were undergoing non-intubated thoracoscopic lobectomy.Methods: Chinese patients with NSCLC (stage I or II) with no evidence of metastasis were given either EA or INB, with equal number of patients in both groups. The peri-operative outcomes determined were duration of anaesthesia /duration of surgery, SpO2/PaCO2 levels, cases of hypotension, and blood loss. The post-operative outcome indices measured were pain score (determined using visual analogue scale (VAS), post-operative complications, chest drainage, duration of hospital stay, and deaths/mortality.Multiple regression analysis was used to confirm the results obtained in this study by adjusting potential covariates. Peri-operative and post-operative complications were compared between the two groups. The results obtained from 220 patients were subjected to statistical analysis.Results: Peri-operative results showed that patients who underwent INB had shorter duration of anaesthesia (12.3 vs 31.4 min, p < 0.05) and shorter duration of surgery (164.4 vs 197.2 min, p < 0.05) than patients who underwent EA for non-intubated lobectomy. Post-operative results showed that patients who underwent INB had significantly lower number of post-operative complications than those who received EA (29 vs 44 %, p < 0.05). The most common post-operative complications among patients in both treatment groups were nausea, vomiting, emphysema and pulmonary complications. Patients who underwent INB had shorter hospital stay than those who underwent EA (5.1 vs 7.5 days, p < 0.05). These results were confirmed through multiple regression analysis.Conclusion: These findings favour the use of INB for regional anaesthesia in NSCLC patients undergoing non-intubated lobectomy.

Does 3D-Assisted Operative Treatment of Pelvic Ring Injuries Improve Patient Outcome?—A Systematic Review of the Literature

Background: There has been an exponential growth in the use of advanced technologies for three-dimensional (3D) virtual pre- and intra-operative planning of pelvic ring injury surgery but potential benefits remain unclear. The purpose of this study was to evaluate differences in intra- and post-operative results between 3D and conventional (2D) surgery. Methods: A systematic review was performed including published studies between 1 January 2010 and 22 May 2020 on all available 3D techniques in pelvic ring injury surgery. Studies were assessed for their methodological quality according to the Modified McMaster Critical Review form. Differences in operation time, blood loss, fluoroscopy time, screw malposition rate, fracture reduction and functional outcome between 3D-assisted and conventional (2D) pelvic injury treatment were evaluated and a best-evidence synthesis was performed. Results: Eighteen studies fulfilled the inclusion criteria, evaluating a total of 988 patients. Overall quality was moderate. Regarding intra-operative results of 3D-assisted versus conventional surgery: The weighted mean operation time per screw was 43 min versus 52 min; for overall operation time 126 min versus 141 min; blood loss 275 ± 197 mL versus 549 ± 404 mL; fluoroscopy time 74 s versus 125 s and fluoroscopy frequency 29 ± 4 versus 63 ± 3. In terms of post-operative outcomes of 3D-assisted versus conventional surgery: weighted mean screw malposition rate was 8% versus 18%; quality of fracture reduction measured by the total excellent/good rate by Matta was 86% versus 82% and Majeed excellent/good rate 88% versus 83%. Conclusion: The 3D-assisted surgery technologies seem to have a positive effect on operation time, blood loss, fluoroscopy dose, time and frequency as well as accuracy of screw placement. No improvement in clinical outcome in terms of fracture reduction and functional outcome has been established so far. Due to a wide range of methodological quality and heterogeneity between the included studies, results should be interpreted with caution.

Virtual Reality (VR) Simulation and Augmented Reality (AR) Navigation in Orthognathic Surgery: A Case Report

VR and AR technology have gradually developed to the extent that they could help operators in the surgical field. In this study, we present a case of VR simulation for preoperative planning and AR navigation applied to orthognathic surgery. The average difference between the preplanned data and the post-operative results was 3.00 mm, on average, and the standard deviation was 1.44 mm. VR simulation could provide great advantages for 3D medical simulations, with accurate manipulation and immersiveness. AR navigation has great potential in medical application; its advantages include displaying real time augmented 3D models of patients. Moreover, it is easily applied in the surgical field, without complicated 3D simulations or 3D-printed surgical guides.

Operative results after xiphoidectomy in patients with xiphodynia

Background Xiphodynia, the painful xiphoid process, is a rare condition with an atypical presentation. Symptoms differ in severity and site, and can consist of chest, throat, and upper abdominal pain. Primarily, other more severe causes of these symptoms need to be excluded. After this exclusion as xiphodynia is diagnosed, treatment can consist of a multitude of options, since there is no consensus regarding the optimal treatment. The aim of this study was to describe the outcomes and efficacy of one of the options, namely surgical resection of the xiphoid in patients with xiphodynia. Methods In this retrospective case series, all consecutive patients that underwent xiphoidectomy for xiphodynia between January 2014 and December 2017 were included. Patients’ medical files including pre-operative work up, NRS scores, surgical outcomes, and follow up were reviewed. All patients received a questionnaire with follow-up questions. Results A total of 19 patients were included. None of the patients had surgery-related complications. Response rate of the questionnaire was 84% and showed that 94% of patients had an improvement of complaints after surgery, with 10 patients (63%) being totally pain free, after a mean follow-up from 34 months after surgery. Conclusions Xiphoidectomy is feasible and safe for the treatment of patients with xiphodynia with an improvement of complaints in nearly all patients.

Comparison of visual acuity and post-operative inflammation in phacoemulsification and removal of silicone oil with and without injection of Enoxaparin Sodium (40mg/0.04ml)

Background: Phacoemulsification and removal of silicone oil (ROSO) is a combined, frequently done procedure in retina theatre. A common problem in this procedure is the post inflammation that affects the recovery of the patients. Thus to counter this post-operative inflammation, the study has used Enoxaparin Sodium (an anti-inflammatory enoxaparin) to counter the post-operative inflammation in phacoemulsification and ROSO. Patients and methods: Prospective interventional study done at Ophthalmology Department, Lahore General Hospital, included 60 patients which were operated and observed for results over a period of 3 months. Total 60 patients were randomly allocated in two groups, Group A and B. Both groups underwent phacoemulsification and ROSO. Group A had Enoxaparin Sodium, admixed in infusion bottles with a dosage of 40mg/0.04ml while Group B was operated without Enoxaparin Sodium. Patients were examined on slit lamp on the 1st day after the surgery then on the 7th day and every month for 3 months for post-operative inflammation and visual recovery. The effectiveness of the procedure was defined by the comparison of post-operative inflammation as well as speedy recovery of sight. Results: Total 60 patients were randomly allocated in two groups. Group A had 30 patients, 23 males and 7 females, with mean age of 49.43 years. Group B included 30 patients, 19 males and 11 females, with mean age of 47.73 years. Post-operative BCVA in Group A was above vision 6/60 (Snellen’s Chart) in 90% of cases while it improved to vision 6/36 and better in 93% of cases at 7th day while 93% of cases crossed recovery of Vision 6/18 by 3rd Month. While in Group B, Vision 6/60 was observed in 70% of cases while it improved to vision 6/36 and better in 67% of cases at 7th day while 53% of cases crossed recovery of vision 6/18 by 3rd Month. Post-operative results for inflammation of Group B showed grade 3 reaction on first day (94%) while it reduced to grade 2 reaction on 7th day in 97% of the cases. While Group A was observed with occasional activity in 25 out of 30 cases (84%) on the first day and grade 2 reaction in 5 (16%) cases. 100% cases of Group A showed occasional activity on 7th day with better visual recovery. Conclusion: Intraoperative use of Enoxaparin Sodium helped in reducing post-operative inflammation as well as aided in better visual acuity after phacoemulsification and ROSO thus proving to be a viable enoxaparin agent to reduce post-operative reactions in these surgeries.