Transmuscular Quadratus Lumborum Block for Postoperative Analgesia in Laparoscopic Colorectal Surgery

Background: Transmuscular Quadratus Lumborum Block (TQLB) is a newer modality for postoperative pain management. But, its efficacy after laparoscopic colorectal surgery is little researched. The aim of our trial was to access the analgesic efficacy of TQLB in colorectal surgery.Methods:This study was done in 64 patients posted for colorectal surgery who were divided into two groups of 32 each. TQLB was given bilaterally in group RQ with 20 ml of 0.375% ropivacaine and in group SQ with 20 ml saline. Patients were operated under general anesthesia and were examined for pain at different time points postoperatively. Time required for first analgesic demand was our primary endpoint. Secondary endpoints were total rescue analgesia (paracetamol) required in 24 hrs, pain scores, nausea, vomiting, sedation and any other complications.Results:The time required for first analgesic demand was 3.9± 0.8hrs in RQ group and 0.1± 0.2 hrs in group SQ which was statistically significant. The total paracetamol consumption in 24 hours was1.2± 0.4 gm in group RQ and 2.9± 0.7gm in group SQ ,the difference being remarkable.Conclusion:Transmuscular quadratus lumborum block can produce quality analgesia after laparoscopic colorectal surgery. TQLB not only improves the visual analogue scale (VAS) score but also decreases the rescue analgesic consumption without any complications.

Is lumbar erector spinae plane block (L-ESPB) a lumbar plexus block?: a case report of three cases

Background Lumbar erector spinae plane block (L-ESPB) is being used in fractured hip patients for the postoperative pain relief and as a sole anesthetic technique. Various clinical and cadaveric studies have differences of opinion about its mechanism of action and pathways of local anesthetic spread; however, the role of lumbar plexus (LP) in the mechanism of action is still not considered. In our clinical experience, we observed that the action on LP could be a pathway for the analgesic action of local anesthetic along with paravertebral spread. Case presentation We report here three cases of the fractured hip who were given L-ESPB for postoperative pain management. The radiological examination was done after injection of non-ionic contrast to know the spread of local anesthetic. In two cases, the contrast spread was seen towards LP and in one case spread of contrast was observed towards the paravertebral area. Conclusions Effect of local anesthetic on the lumbar plexus is one of the plausible pathways in L-ESPB for its analgesic mechanism of action.

Pericapsular Nerve Group Block (PENG Block) and Spinal Anesthesia as Multimodal Analgetic in Patient with Bipolar Hip Arthroplasty: A Case Report

Introduction. Intertrochanteric fractures are defined as extracapsular fractures of the proximal femur that occur between the greater and lesser trochanter. Bipolar hip arthroplasty is one of the most common major orthopaedic procedures to improve patient’s functional status and quality of life. Spinal anesthesia is a regional anesthetic technique that is performed by injecting local anesthetic drugs into the subarachnoid space to obtain dermatome-level analgesia and skeletal muscle relaxation. Pain after hip replacement originates mainly from the anterior pelvic capsule. The main target for pelvic analgesia is the anterior capsule which is the most richly innervated part of the joint. PENG block is used to block the articular branches to the pelvis. The patient was assessed with an NRS (numeric rating scale) instrument pre and post operative. Case presentation. A-74 year old woman admitted with complaints of pain in the right hip and diagnosed with a closed fracture of the right intertrochanter and planned for bipolar hip arthroplasty with PENG block and spinal anesthesia. Preoperatively the patient was assessed with an NRS (numeric rating scale) instrument with a score of 6. After the procedure, we reevaluated the pain score using NRS was 2 post operative. Conclusion. Patients receiving a PENG block and spinal anesthesia for intraoperative and postoperative analgesia during hip fracture surgery. Prior to spinal anesthesia, PENG block can be performed as a multimodal analgesia in the patient, PENG block expected to facilitate a sitting position during spinal anesthesia and for postoperative pain management

Factors influencing postoperative pain management among nurses in selected district hospitals in Ghana

Background: Poorly managed postoperative pain is linked to numerous postoperative complications worldwide and in Ghana. This is due to the myriad of physical and psychological problems, such as lifelong chronic pain syndromes, impaired functionality and death. Purpose: The aim of this study was to assess the barriers and factors influencing postoperative pain management by Ghanaian nurses working in four hospitals. Methods: A quantitative descriptive cross-sectional design was employed for this study. Participants were recruited using a multistage sampling technique by which 146 returned their questionnaires out of 194 participants. The statistical analysis of data was done with the Statistical Package of Social Sciences (SPSS) 20.0 version. Results: Findings revealed that some verbal and non-verbal cues from patients such as facial grimacing, restlessness, irritability and distress, lack of concentration and moaning or crying (verbalisation) influenced how nurses controlled postoperative pain with analgesia. The participants also identified several barriers to influence postoperative pain management by nurses. Conclusion: In conclusion, postoperative pain control by nurses is influenced by several factors, and hence, nurses need to manage patients’ pain effectively in Ghana and abroad using multiple approaches.