Local and Regional Anesthesia最新文献

{"title":"Combined Occipital Nerve and Sphenopalatine Ganglion Neuromodulation for Refractory Craniofacial Pain with Trigeminal Autonomic Features: A 12-Year Follow-Up (Case Report).","authors":"Vadim Tashlykov, Ruth Gur, Gabriel Ricardo Lichtenstein, Itay Goor-Aryeh, Evgeni Brotfain","doi":"10.2147/LRA.S595517","DOIUrl":"https://doi.org/10.2147/LRA.S595517","url":null,"abstract":"<p><p>Craniofacial complex regional pain syndrome (CRPS) is a rare, diagnostically challenging condition characterized by sympathetically maintained pain, allodynia, and autonomic features in the craniofacial region. Its overlap with trigeminal autonomic cephalalgias (TACs) creates significant diagnostic complexity. We report the case of a 41-year-old male with a 12-year history of severe right-sided hemicranial and facial pain with prominent autonomic features (facial edema, ptosis, lacrimation, allodynia) following plastic surgery in occipital area, in a patient with a prior history of CRPS. After failing extensive pharmacological management (including indomethacin, verapamil, topiramate, pregabalin, carbamazepine, lamotrigine, lithium and lidocaine infusions) and numerous interventional procedures (peripheral nerve blocks, Sphenopalatine ganglion (SPG) blocks, pulsed radiofrequency of SPG and Gasserian ganglion), the patient underwent sequential neuromodulation: occipital nerve stimulation (ONS) followed by sphenopalatine ganglion (SPG) stimulation seven years later. This combined approach resulted in sustained pain reduction from NRS 9-10/10 to 1-2/10, attack frequency reduction from 1-2 daily to rare exacerbations, and complete discontinuation of all analgesic medications over a 12-year follow-up. This case demonstrates that combined ONS and SPG stimulation may provide effective long-term pain relief in refractory craniofacial pain irrespective of whether the underlying diagnosis is craniofacial CRPS or secondary TAC, and highlights the value of sequential neuromodulation when single-modality approaches are insufficient.</p>","PeriodicalId":18203,"journal":{"name":"Local and Regional Anesthesia","volume":"19 ","pages":"595517"},"PeriodicalIF":1.9,"publicationDate":"2026-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13148261/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147839801","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Continuous Suprainguinal Fascia Iliaca Block vs Epidural Analgesia for Pediatric Hip Surgery: A Retrospective Cohort Study.","authors":"Lloyd M Halpern, Zackary Correll, De-An Zhang, Clark J Kogan, Kirk A Ryan, Ted Sousa","doi":"10.2147/LRA.S575230","DOIUrl":"https://doi.org/10.2147/LRA.S575230","url":null,"abstract":"<p><strong>Introduction: </strong>The primary aim of this study was to compare the continuous suprainguinal fascia iliaca block (CSFI) and continuous epidural analgesia (CEA) for procedures of the proximal femur and acetabulum in children. We hypothesized that CSFI would provide equivalent opioid requirements while both blocks were in place, reduced opioid requirements after epidural removal, earlier mobilization, and decreased length of stay compared to CEA.</p><p><strong>Materials and methods: </strong>We retrospectively examined all pediatric patients who underwent a procedure of the proximal femur or acetabulum between January 1, 2013, and December 31, 2023. Outcome measures included opioid usage, verbal pain scores (0-10), sedation scores, time to ambulation and length of hospital stay. The primary endpoint was daily opioid requirements.</p><p><strong>Results: </strong>There were 82 patients in the cohort, 35 patients in the CEA group and 47 patients in the CSFI group. We found no evidence for differences in daily mean opioid requirements (parenteral and oral) for the two groups on the day of surgery (DOS) and POD 1 when both blocks were in place. CSFI was strongly associated with lower mean opioid requirements on POD 2 and POD 3 following removal of the epidural catheter, earlier time to ambulation, shorter length of stay and less sedation on the DOS, POD 1, and 2. Four patients reported persistent anterior thigh numbness 6 weeks after the procedure, all in the CSFI group. (8.5%).</p><p><strong>Conclusion: </strong>CSFI was associated with similar parenteral and oral opioid requirements compared to CEA while both blocks were in place, earlier mobilization, reduced length of stay, less sedation and reduced opioid usage after epidural removal. CSFI appears to offer significant advantages over CEA for procedures of the proximal femur and acetabulum in pediatric patients, but persistent thigh numbness in the CSFI group warrants further investigation.</p>","PeriodicalId":18203,"journal":{"name":"Local and Regional Anesthesia","volume":"19 ","pages":"575230"},"PeriodicalIF":1.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13142259/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147839762","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lumbar Erector Spinae Plane Block as a Main Anesthetic Technique versus Spinal Anesthesia Combined with PENG Block for Urgent Intertrochanteric Fracture Surgery in Elderly Patients: Preliminary Results from a Multicenter Pilot Study.","authors":"Antonio Coviello, Giorgio Ranieri, Dario Cirillo, Maria Rita Capuano, Andrea Uriel De Siena, Flavia Pontecorvi, Paolo Scimia, Giuseppe Servillo","doi":"10.2147/LRA.S592174","DOIUrl":"https://doi.org/10.2147/LRA.S592174","url":null,"abstract":"<p><strong>Background and aim: </strong>Neuraxial anesthesia is commonly used for intertrochanteric fracture surgery but may be contraindicated in frail elderly patients, particularly in the presence of anticoagulation or urgent surgical settings. The Lumbar Erector Spinae Plane Block (L-ESPB) has been proposed as a para-neuraxial technique potentially suitable as a main anesthetic strategy. This study aimed to evaluate whether L-ESPB could represent a viable alternative to Spinal Anesthesia (SA) combined with a Pericapsular Nerve Group (PENG) block in patients undergoing urgent intramedullary nailing for intertrochanteric fractures.</p><p><strong>Methods: </strong>This multicenter comparative pilot study included ≥65 years undergoing surgery within 48 hours of hospital admission, between May and November 2025. Fifty patients were analyzed: 24 received L-ESPB as the sole anesthetic technique, and 26 received SA combined with a PENG block. The comparison focused on anesthesiologic plane adequacy, intraoperative hemodynamic stability, and postoperative recovery outcomes.</p><p><strong>Results: </strong>An adequate anesthesiologic plane was achieved in all patients. Sensory and motor block onset was faster and more intense in the PENG + SA group. Intraoperatively, hemodynamic stability was more frequently preserved in the L-ESPB group (58.3% vs 19.2%, p = 0.02), despite similar surgical duration. Intraoperative ketamine rescue was required in a small proportion of patients in the L-ESPB group. Postoperatively, time to mobilization was shorter in the PENG + SA group, whereas pain scores remained low in both groups, with minimal need for rescue analgesia and no relevant anesthesia-related adverse events.</p><p><strong>Conclusion: </strong>L-ESPB provided effective surgical anesthesia and was associated with greater intraoperative hemodynamic stability compared with SA combined with PENG block. These preliminary findings suggest that L-ESPB may represent a feasible alternative in elderly patients with contraindications to neuraxial anesthesia, warranting confirmation in larger prospective studies.</p>","PeriodicalId":18203,"journal":{"name":"Local and Regional Anesthesia","volume":"19 ","pages":"592174"},"PeriodicalIF":1.9,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13134565/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147816756","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Periarticular Vasoconstrictor Infiltration in a Tourniquet-Free Total Knee Arthroplasty: A Case Report of Effective Blood Loss Control in High-Thrombotic-Risk Patient.","authors":"Giorgio Ranieri, Bruno Violante, Federico Tamburi, Dario Cirillo, Antonio Coviello","doi":"10.2147/LRA.S557355","DOIUrl":"10.2147/LRA.S557355","url":null,"abstract":"<p><p>Effective perioperative pain control is essential in Total Knee Arthroplasty (TKA) to support early mobilization and enhance recovery, particularly within Enhanced Recovery After Surgery (ERAS) protocols. The use of a thigh tourniquet, although common, is increasingly questioned due to its association with postoperative pain and thromboembolic risk, especially in patients with a history of Deep Vein Thrombosis (DVT). Periarticular Vasoconstrictor Infiltration (PVI) is a recently described technique aimed at achieving localized hemostasis through epinephrine-based infiltration. This case report illustrates the clinical utility of ultrasound-guided PVI as part of a multimodal, tourniquet-free strategy in high-risk patient. A 66-year-old female with severe right knee osteoarthritis and a history of right lower limb DVT underwent primary TKA under spinal anesthesia. Due to the patient's elevated thrombotic risk-defined by a high Caprini score-a tailored regional anesthesia protocol was adopted, combining multi-target PVI with a proximal adductor canal block and spinal anesthesia. The PVI solution included ropivacaine, dexmedetomidine, and epinephrine. No tourniquet was inflated during the procedure. The surgical field remained bloodless throughout the 72-minute procedure. Intraoperative blood loss was less than 200 mL, and no transfusion was required. Postoperative analgesia was effective, opioid use was minimized, and the patient mobilized the same evening without complications. No clinical or ultrasound signs of early postoperative thrombotic events were observed. This case demonstrates the feasibility and clinical benefit of integrating ultrasound-guided PVI into a multimodal, tourniquet-free anesthetic strategy for TKA in high-thrombotic-risk patients. The approach provided effective analgesia and hemostasis, aligned with ERAS principles, and may represent a valuable alternative for personalized perioperative care in orthopedic surgery.</p>","PeriodicalId":18203,"journal":{"name":"Local and Regional Anesthesia","volume":"19 ","pages":"557355"},"PeriodicalIF":1.9,"publicationDate":"2026-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13007669/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147513109","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correlation Between Injected Volume and Cranial Spread in Broad-Aged Pediatric Caudal Anesthesia: A Retrospective Ultrasound-Guided Study.","authors":"Feng-Fang Tsai, Ming-Han Hsieh, Hsing-Hao Huang, Chih-Min Liu","doi":"10.2147/LRA.S561773","DOIUrl":"https://doi.org/10.2147/LRA.S561773","url":null,"abstract":"<p><strong>Purpose: </strong>Caudal block remains a standard regional anesthesia technique for pediatric lower abdominal and lower limb surgeries. The conventional weight-based Armitage formula does not consider patient body habitus, which can lead to under- or over-dosing-especially in lean or obese children. Ultrasound guidance permits visualization of epidural spread and may facilitate individualized dosing.</p><p><strong>Patients and methods: </strong>In this retrospective single-center study, anesthetic records of 25 pediatric patients (age 10-106 months) undergoing ultrasound-guided caudal blocks for lower abdominal or lower extremity surgery were analyzed. Volumes of 0.25% levobupivacaine required to achieve cranial spread to vertebral levels S1, L2 and L1 were recorded. Univariate and multivariate linear regression models, incorporating weight, height, age, and BMI, were compared using adjusted R², mean squared error (MSE), Akaike information criterion (AIC), and Bayesian information criterion (BIC) to determine the most predictive dosing formulae.</p><p><strong>Results: </strong>Univariate regression revealed injected volume correlated strongest with weight: for S1 spread, volume = 0.1458 × weight (kg) (p = 0.006); for L2 spread, volume = 0.4898 × weight (kg) (p = 0.0079). The optimal multivariate model for S1-level spread combined weight and height: Volume (mL) = 0.1741 × weight (kg) - 0.0234 × height (cm) (adjusted R² = 0.1369; lowest AIC/BIC). For L2-level spread, a weight-only model (volume = 0.5339 × weight [kg]) provided the best fit (adjusted R² = 0.2112). Both models predicted lower volumes than the traditional Armitage guideline, reducing the likelihood of excessive cephalad spread.</p><p><strong>Conclusion: </strong>In pediatric caudal anesthesia, a dosing formula that uses both weight and height improves prediction of the volume required for S1-level blocks, whereas a weight-based formula is adequate for L2-level spread. Real-time ultrasound guidance enhances procedural accuracy and safety by confirming epidural spread and detecting anatomical variation. These data support development of an individualized dosing nomogram for pediatric caudal anesthesia.</p>","PeriodicalId":18203,"journal":{"name":"Local and Regional Anesthesia","volume":"19 ","pages":"561773"},"PeriodicalIF":1.9,"publicationDate":"2026-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12915407/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146227381","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Therapeutic Efficacy of Modified Cocktail Analgesia After Minimally Invasive Chevron Osteotomy for Hallux Valgus: A Retrospective Case Series Study.","authors":"Jiahe Liu, Tao Zhang, Zewen Wang, Ting He, Wanqi Xiong, Yan Cui, Zhenhao Li, Fan Yang, Baoyi Liu","doi":"10.2147/LRA.S558076","DOIUrl":"10.2147/LRA.S558076","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the efficacy of modified cocktail analgesia in relieving pain after minimally invasive chevron osteotomy for hallux valgus.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted to analyze the clinical data of 90 patients with moderate to severe hallux valgus admitted to our hospital from January 2020 to December 2023. Based on the treatment method and the number of affected limbs, the patients were divided into three groups: the modified group (Imp) treated with minimally invasive chevron and Akin (MICA) osteotomy combined with modified cocktail therapy, the traditional group (Tro) treated with MICA osteotomy combined with conventional cocktail therapy, and the control group (NC) treated with MICA osteotomy alone without cocktail therapy. The visual analog scale (VAS) scores for ankle-foot pain from 6 hours preoperatively to 14 days postoperatively, the need for postoperative rescue analgesia, adverse reactions, and complications were observed and compared among the three groups.</p><p><strong>Results: </strong>There were no significant differences in basic conditions such as age and BMI among the three groups. It is in line with the epidemiological statistics of hallux valgus in terms of gender. The VAS scores at 6 hours and 1 day postoperatively were significantly lower in the modified group [(0.67±0.60), (0.68±0.59) respectively] compared to the traditional group [(0.82±0.50), (0.78±0.90) respectively] (P < 0.05). There were no statistically significant differences in VAS scores between groups at 6 hours preoperatively and 7 days and 14 days postoperatively (P > 0.05). Five patients (5.56%) in the modified group required postoperative rescue analgesia, which was significantly fewer than the 12 patients (13.33%) in the traditional group (P < 0.05).</p><p><strong>Conclusion: </strong>Based on the comprehensive statistical results and clinical significance, the modified cocktail therapy has certain clinical reference value in the short-term analgesia management after MICA. It is beneficial for the early postoperative rehabilitation functional exercise of patients and has a good safety effect. It can be used as an optional option for early postoperative pain control. However, it is necessary to objectively recognize the timeliness of its therapeutic advantages. Its long-term analgesic effect shows no significant clinical difference from the traditional cocktail therapy and the simple MICA procedure.</p>","PeriodicalId":18203,"journal":{"name":"Local and Regional Anesthesia","volume":"19 ","pages":"558076"},"PeriodicalIF":1.9,"publicationDate":"2026-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12794548/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145966484","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prolonged Neural Block After Lower-Limb Nerve Blocks in a Patient with Inherited Antithrombin III Deficiency: Implications for Regional Anesthesia.","authors":"Takeaki Aizawa, Nami Sugiura, Shinji Sugita","doi":"10.2147/LRA.S563087","DOIUrl":"10.2147/LRA.S563087","url":null,"abstract":"<p><strong>Purpose: </strong>Peripheral nerve block safety and pharmacology for patients with inherited antithrombin III (ATIII) deficiency remains unclear because of the rarity of the disease. Here, we report a case of unexpectedly prolonged motor and sensory inhibition following single-shot femoral and sciatic nerve blocks in a patient with inherited ATIII deficiency. We hypothesized that venous stasis, microcirculatory impairment, elevated peripheral venous pressure, and increased local tissue pressure might have contributed to prolonged nerve dysfunction and peripheral nerve injury.</p><p><strong>Case report: </strong>The patient was a 58-year-old man (170 cm, 69 kg) with inherited ATIII deficiency. He was scheduled for 1-hour surgical debridement of recurrent venous stasis ulcers with microcirculatory impairment on his lower left leg. Nerve blocks resulted in motor and sensory deficits in the lower leg that lasted 2 and 8 days, respectively. The prolonged duration of this nerve block might have been related to his inherited ATIII deficiency. This condition can contribute to thrombosis of vessels such as the inferior vena cava, potentially leading to venous microcirculatory impairment in the lower limbs and complex coagulopathy.</p><p><strong>Conclusion: </strong>While peripheral nerve blocks are widely used for their efficacy and safety, the risk-benefit profile of regional anesthesia may be atypical in patients with coagulation disorders. This case highlights the need for cautious nerve block administration in patients with inherited ATIII deficiency.</p>","PeriodicalId":18203,"journal":{"name":"Local and Regional Anesthesia","volume":"18 ","pages":"151-156"},"PeriodicalIF":1.9,"publicationDate":"2025-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12755098/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145889290","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Analgesic Effects of a Saddle Block with Intrathecal Morphine for Penile-Inversion Vaginoplasty: A Retrospective Study.","authors":"Laura Girón-Arango, Kyle Robert Kirkham, Alexandra L Millman, Yonah Krakowsky, Yulia Wilk Goldsher, Olivia Drodge, Qixuan Li, Ella Huszti, Richard Brull","doi":"10.2147/LRA.S537907","DOIUrl":"10.2147/LRA.S537907","url":null,"abstract":"<p><strong>Background: </strong>Despite its association with severe postoperative pain, the use of regional anesthesia techniques for penile-inversion vaginoplasty surgery is understudied. This retrospective study aimed to assess the analgesic effects of a saddle block (ultra-low dose hyperbaric spinal anesthesia) with intrathecal (IT) morphine in transgender females undergoing penile inversion vaginoplasty.</p><p><strong>Methods: </strong>We performed a single-centre, retrospective chart review of 72 patients who underwent penile-inversion vaginoplasty with or without saddle block with IT morphine at our institution over a 26-months period. All patients received standard multimodal intravenous analgesia, and the surgeon administered both a pudendal nerve block and a spermatic cord block as part of routine care. Our primary outcome was cumulative opioid consumption (oral morphine equivalent) at 24h postoperatively. Secondary outcomes included postoperative pain severity, duration of stay in the postoperative care unit and in-hospital, time to first opioid request and incidence of opioid- and block-related side effects.</p><p><strong>Results: </strong>30 patients received a saddle block with IT morphine and 42 patients received standard analgesia. We found no statistical difference in cumulative opioid consumption at 24h postoperatively (control group: 17.7 mg [5.6, 30.8] vs intervention group 12.5 mg [7.5, 22.5] P: 0.249). The addition of a saddle block was associated with clinically and statistically significant improvements in short-term postoperative pain-related outcomes in the recovery room, including mean and maximum pain severity scores, time to first analgesic request, and duration of stay. While no difference in pain scores was detected at the 24-hour time point, mixed-effects modelling demonstrated lower pain trajectories over time among patients in the intervention group, suggesting a time-dependent benefit. However, the significant time-by-group interaction (p = 0.024) indicates that the difference in pain scores between groups decreased over time. We found no differences in the rates of nausea and vomiting between groups. No saddle block procedure-related complications were reported.</p><p><strong>Conclusion: </strong>This retrospective study suggests that despite no statistically significant difference in 24-hour opioid consumption, the addition of a saddle block with 100 mcg of IT morphine is associated with improved PACU pain scores, a longer time to first analgesic request, and a shorter PACU stay. These findings are hypothesis-generating and merit further investigation in a prospective double-blind randomized controlled trial.</p>","PeriodicalId":18203,"journal":{"name":"Local and Regional Anesthesia","volume":"18 ","pages":"143-150"},"PeriodicalIF":1.9,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12716076/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145804913","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of External Oblique Intercostal Block on Postoperative Analgesia and Early Recovery in Patients Undergoing Open Liver Resection for Hepatocellular Carcinoma or Intrahepatic Bile Duct Stones: A Randomized Controlled Clinical Trial.","authors":"Qilu Ying, Manhua Zhu, Song Zhang, Lingzhi Wang, Ruifen Zhou, Kaiyun Xie","doi":"10.2147/LRA.S557373","DOIUrl":"10.2147/LRA.S557373","url":null,"abstract":"<p><strong>Purpose: </strong>External oblique intercostal (EOI) block has recently emerged as a promising analgesic method for the upper abdominal surgery. This study aimed to assess the effect of EOI block on postoperative analgesia and early recovery following open liver resection (OLR).</p><p><strong>Patients and methods: </strong>In this prospective, randomized, controlled trial, 64 patients scheduled for OLR were randomly allocated into EOI group and control group. EOI group received 30 mL of 0.25% ropivacaine bilaterally 30 min before induction of general anesthesia, whereas control group did not receive any block. The primary outcomes were sufentanil consumption 24 h after surgery. The secondary outcomes mainly included: the visual analogue scale (VAS) pain scores at rest and on coughing at 2, 12, 24, 48 h postoperatively; number of analgesia pump compression 24 h postoperatively; quality of recovery-15 (QoR-15) scale score 48 h after surgery; Pittsburgh sleep quality index (PSQI) score the first night postoperatively; and plasma levels of norepinephrine (NE), cortisol (Cor), high mobility group box protein 1 (HMGB1), tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) 1h before surgery and 6 h postoperatively.</p><p><strong>Results: </strong>A total of 60 patients had completed the study (n = 30 per group). Sufentanil consumption 24 h postoperatively in EOI group was less than that in control group (mean difference: 4.45 μg, 95% CI, 1.6-7.2, <i>P</i>=0.003). The VAS scores at 2, 12, 24 h postoperatively; number of analgesia pump compression; and PSQI scores were significantly lower in EOI group than in control group. QoR-15 scale scores were higher in EOI group. The plasma levels of NE, Cor, HMGB1, TNF-α and IL-6 at 6 h postoperatively in EOI group were significantly lower than in control group.</p><p><strong>Conclusion: </strong>EOI block given to patients undergoing OLR could provide effective postoperative analgesia, enhance the quality of postoperative recovery, and attenuate postoperative stress and inflammation.</p>","PeriodicalId":18203,"journal":{"name":"Local and Regional Anesthesia","volume":"18 ","pages":"131-142"},"PeriodicalIF":1.9,"publicationDate":"2025-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12684249/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145714738","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spinal Anesthesia and Postoperative Complications Following Pediatric Hypospadias Repair: A Retrospective Review.","authors":"Grant Heydinger, Josiane Kerbage, Catherine Roth, Sibelle Aurelie Yeleme Kitio, Giorgio Veneziano, Joseph D Tobias, V Rama Jayanthi","doi":"10.2147/LRA.S552555","DOIUrl":"10.2147/LRA.S552555","url":null,"abstract":"<p><strong>Introduction: </strong>Recently, concerns have been raised regarding the impact of anesthetic choice on outcomes for patients undergoing hypospadias repair. It has been suggested that caudal epidural anesthesia (CEA) may be associated with increased postoperative complications, such as urethrocutaneous fistula and glanular dehiscence. However, subsequent studies have found no association between CEA and increased complications. Spinal anesthesia (SA) is another technique that can provide surgical blockade during hypospadias repair. However, no studies have examined outcomes for pediatric patients undergoing hypospadias repair under awake SA.</p><p><strong>Methods: </strong>We performed a single-center retrospective review on all patients who underwent single-stage primary hypospadias repair from 2016 until 2023. Data collected included patient demographics, anesthetic details, severity of hypospadias, duration of procedure, and postoperative complications.</p><p><strong>Results: </strong>805 patients underwent single-stage hypospadias repair during the study period. 117 (14.5%) had GA alone, 563 (70%) had GA with CEA, and 125 (15.5%) had SA. Duration of surgery was significantly longer for patients in the GA and CEA groups compared to the SA group, and more patients in the GA and CEA groups had a higher severity of hypospadias. We did not find significant differences in the odds ratio for postoperative complications between groups.</p><p><strong>Discussion: </strong>In our retrospective analysis, we did not find a difference between anesthetic groups in the rate of postoperative complications. Patients who had SA were younger and had a shorter median surgical time. Because SA has a limited duration, patients with more complicated pathologies may not be offered SA as an option. SA is an underutilized technique for pediatric urologic procedures, but has several benefits over GA for infants and young children.</p><p><strong>Conclusion: </strong>SA can be successfully utilized for hypospadias surgery in pediatric patients without an increase in postoperative complications. Future studies on this topic are warranted due to significant baseline differences between patient groups.</p>","PeriodicalId":18203,"journal":{"name":"Local and Regional Anesthesia","volume":"18 ","pages":"121-129"},"PeriodicalIF":1.9,"publicationDate":"2025-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12584795/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145452230","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}