Saudi Journal of Anaesthesia最新文献

{"title":"Regional anesthesia for hip surgery: A review of current approaches and their application to clinical practice.","authors":"Tiberio Evangelista, Camilla Pugno, Simone Finazzi, Alessandro Colombi, Dario Bugada","doi":"10.4103/sja.sja_68_25","DOIUrl":"https://doi.org/10.4103/sja.sja_68_25","url":null,"abstract":"<p><p>Hip surgery is extremely common and ranges from surgery for hip fracture to elective procedures in younger adults. Pain can mark the postoperative period and compromise functional recovery. Nevertheless, major comorbidities may occur in the perioperative period, especially in elderly fragile patients. The approach to patients undergoing hip surgery has significantly evolved, focusing on multimodal strategies to optimize pain control while minimizing side effects, prompting patients' recovery. The seek for motor-sparing, analgesic techniques with a better risk benefit profile has promoted the application of new peripheral nerve blocks, with special attention paid to the newest fascial plane blocks. However, significant interest is addressed toward other outcomes (such major comorbidities and deaths) that may influence intermediate and long-term recovery. Specific strategies have been investigated to improve outcomes after hip surgery in elderly patients, considering the higher risk for complications, including delirium. In this narrative review, we aim to summarize the role of regional anesthesia and analgesia in the context of hip surgery by detailing on the effects of regional anesthesia on major outcomes. Considering the specific innervation of hip joint, we summarize the available evidence on newer peripheral nerve blocks for hip patients by focusing on potential complications associated with each technique, especially the occurrence of motor block. In this review, we aim to provide an updated and concise overview of the available evidence to help the reader planning the most appropriate strategy for hip surgery.</p>","PeriodicalId":21533,"journal":{"name":"Saudi Journal of Anaesthesia","volume":"19 2","pages":"164-173"},"PeriodicalIF":1.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12007850/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144030168","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 ultrasound-guided PecS II block on the incidence of chronic postmastectomy pain in patients after radical mastectomy: A randomized controlled trial.","authors":"Huiying Hu, Zisu Luo, Bixi Li, Tingting Wang, Tanguan Wu, Bin Li, Xiaoyang Song","doi":"10.4103/sja.sja_398_24","DOIUrl":"https://doi.org/10.4103/sja.sja_398_24","url":null,"abstract":"<p><strong>Background: </strong>The pectoral nerve (PecS) II block is a recently introduced technique utilized for surgical anesthesia and postoperative analgesia during breast surgery. This study aims to investigate the impact of ultrasound-guided PecS II block on the incidence of chronic postmastectomy pain in patients following radical mastectomy.</p><p><strong>Methods: </strong>Ninety-eight patients undergoing selective radical mastectomy were included in this study. Based on whether the ultrasound-guided PecS II block was performed, the patients were randomly divided into the PecS II block group (group P) and the control group (group C). The primary outcomes included the incidence of chronic pain at 12 weeks after surgery, and the secondary outcomes included intraoperative dosage of remifentanil, the amount of oxycodone used in 48 h after surgery, time for the first analgesia administration, postoperative acute pain score 48 h after surgery, and HADS score at 48 h and 12 weeks after surgery. The presence or absence of pain in the previous week was recorded every 7 days after surgery (beginning on the 8^th day after surgery). The postoperative pain duration curves of the two groups were plotted and compared by Kaplan-Meier estimation and log-rank test.</p><p><strong>Results: </strong>Compared with group C, the incidence of chronic pain in group P at 12 weeks after surgery was significantly decreased by 14.13% (20.65% vs. 34.78%, <i>P</i> < 0.05). The amount of remifentanil used in group P was significantly reduced (1.46 ± 0.11 mg vs. 2.66 ± 0.18 mg, <i>P</i> < 0.001), and the amount of oxycodone used 48 h after surgery in group P was remarkably reduced than that in group C (22.57 ± 3.21 mg vs. 31.62 ± 4.71 mg, <i>P</i> < 0.001). The first analgesic requirement time of group P was significantly longer than that of group C (368.80 ± 157.68 min vs. 96.60 ± 40.12 min, <i>P</i> < 0.001). Compared with group C, the postoperative acute pain score 48 h after surgery and the HADS score 48 h and 12 weeks after surgery in group P were significantly decreased (<i>P</i> < 0.05). The postoperative pain duration curve of the two groups was significantly different (<i>P</i> < 0.05), and the postoperative pain duration of group P was lower than that of group C (<i>P</i> < 0.05).</p><p><strong>Conclusions: </strong>PecS II block can reduce the incidence of chronic postmastectomy pain after radical mastectomy, reduce perioperative opioid consumption, provide better analgesia, and improve the degree of anxiety and depression of patients.</p><p><strong>Trial registration: </strong>ChiCTR2200066968, 22/12/2022.</p>","PeriodicalId":21533,"journal":{"name":"Saudi Journal of Anaesthesia","volume":"19 2","pages":"235-242"},"PeriodicalIF":1.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12007852/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143995573","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":"Advancing regional anesthesia - Innovations, insights, and impact on patient care.","authors":"Alessandro De Cassai, Abdelazeem Eldawlatly","doi":"10.4103/sja.sja_140_25","DOIUrl":"https://doi.org/10.4103/sja.sja_140_25","url":null,"abstract":"","PeriodicalId":21533,"journal":{"name":"Saudi Journal of Anaesthesia","volume":"19 2","pages":"163"},"PeriodicalIF":1.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12007857/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143980274","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":"Fascial plane blocks in pediatric anesthesia: A narrative review.","authors":"Nur N Yucal, Can Aksu","doi":"10.4103/sja.sja_146_25","DOIUrl":"https://doi.org/10.4103/sja.sja_146_25","url":null,"abstract":"<p><p>Regional anesthesia techniques have become a cornerstone of pain management in the adult population, providing adequate analgesia while minimizing systemic side effects. Despite the numerous benefits demonstrated in pediatric studies, the implementation of regional anesthesia in children remains insufficiently adopted in clinical settings. One primary concern preventing broader application is the potential for complications of these techniques in pediatric patients, which understandably raises apprehension among clinicians. However, the introduction of fascial plane blocks in the literature has led to a significant advancement in this field. These regional anesthesia techniques are increasingly being incorporated into routine clinical practice, as they are relatively easy to learn and apply and safe techniques. Fascial plane blocks provide adequate pain management while minimizing opioid consumption, which not only helps reduce the risk of opioid-related side effects but also contributes to a more comfortable perioperative and postoperative experience for young patients. These blocks can significantly enhance patient recovery and satisfaction by facilitating analgesia. This narrative review briefly summarizes different indications of fascial plane blocks and their effectiveness in managing pain among pediatric patients, illuminating critical points to consider when applying these techniques.</p>","PeriodicalId":21533,"journal":{"name":"Saudi Journal of Anaesthesia","volume":"19 2","pages":"190-197"},"PeriodicalIF":1.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12007847/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143976616","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":"PENG Block: A superior alternative for pain management in intracapsular hip fractures.","authors":"Paula Gil Esteller, Carles Espinós Ramírez, Miquel Juarez-Pomes, Juan C Martín Sanchez, Maria Martínez Garcia","doi":"10.4103/sja.sja_96_25","DOIUrl":"https://doi.org/10.4103/sja.sja_96_25","url":null,"abstract":"<p><strong>Background and objectives: </strong>Previous studies have demonstrated the effectiveness of regional analgesic techniques for pain management after hip surgery; however, no clear superiority between these techniques has been established. A key limitation of these studies is the lack of differentiation between fracture subtypes. This prospective, comparative cohort study aims to evaluate the effectiveness of two regional techniques-pericapsular nerve group block (PENG) and suprainguinal iliac fascia block (FICB)-in providing perisurgical analgesia for intracapsular femoral fractures.</p><p><strong>Materials and methods: </strong>Sixty-four patients undergoing elective surgery for intracapsular femoral fractures were randomly assigned to receive either a PENG block or an FICB block, each with 15 mL of 0.2% ropivacaine. Intradural anesthesia and conventional intravenous analgesia were administered during surgery. The primary outcome was pain scores in the recovery room and 24 hours post-surgery. Secondary outcomes included the need for intravenous opioid rescue medication during the first 24 hours.</p><p><strong>Results: </strong>The PENG group demonstrated significantly lower postoperative pain scores compared to the FICB group both immediately after surgery (<i>P</i> = 0.006) and at 24 hours (<i>P</i> < 0.001). Additionally, fewer patients in the PENG group required weak opioids in the first 24 hours following surgery (<i>P</i> = 0.001).</p><p><strong>Conclusions: </strong>The PENG block provides superior postoperative analgesia for intracapsular femoral fractures compared to the FICB block following hip surgery, with reduced opioid consumption observed in the PENG group.</p><p><strong>Clinical trial registration: </strong>NCT05377541.</p>","PeriodicalId":21533,"journal":{"name":"Saudi Journal of Anaesthesia","volume":"19 2","pages":"251-256"},"PeriodicalIF":1.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12007853/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144034660","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":"Regional anesthesia in obese patients: Challenges, considerations, and solutions.","authors":"Alessandro De Cassai, Francesco Zarantonello, Elisa Pistollato, Tommaso Pettenuzzo, Veronica Busetto, Nicolò Sella, Annalisa Boscolo","doi":"10.4103/sja.sja_132_25","DOIUrl":"https://doi.org/10.4103/sja.sja_132_25","url":null,"abstract":"<p><p>The increasing global prevalence of obesity has significant implications for anesthesiologists, particularly in the context of regional anesthesia. Anesthesiologists face numerous challenges during anesthesia in obese patients, including compromised respiratory function, altered pharmacokinetics of local anesthetics, and difficulties in identifying anatomical landmarks. Obesity often leads to reduced respiratory reserve, increased risk of hypoventilation, and conditions such as obstructive sleep apnea syndrome and obesity hypoventilation syndrome, which increase the likelihood of postoperative complications. Additionally, altered body composition in obese patients affects the distribution of local anesthetics, requiring adjustments in dosing based on lean body weight rather than total body weight. Furthermore, excess adipose tissue complicates the identification of anatomical landmarks and the use of ultrasound for regional block procedures, as the increased tissue depth and reduced image resolution hinder needle placement. Proper positioning, the use of low-frequency transducers, and harmonic imaging techniques are essential for optimizing ultrasound guidance. Additionally, the use of longer needles and the application of trigonometric calculations based on ultrasound scans can help determine the appropriate needle length. To overcome these challenges, anesthesiologists should adopt strategies that involve adjusting drug dosages, utilizing specialized equipment, and continuously monitoring patients for potential complications. A holistic approach involving knowledge of these technical and pathological challenges, as well as adapting techniques and equipment, is crucial for ensuring the safety and effectiveness of regional anesthesia in obese patients.</p>","PeriodicalId":21533,"journal":{"name":"Saudi Journal of Anaesthesia","volume":"19 2","pages":"221-226"},"PeriodicalIF":1.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12007849/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144028369","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 evolution of teaching and learning regional anesthesia at every career stage: The U.S. perspective.","authors":"Lisa To, Mia Ye, Sean Chang, Edward R Mariano","doi":"10.4103/sja.sja_162_25","DOIUrl":"https://doi.org/10.4103/sja.sja_162_25","url":null,"abstract":"<p><p>Regional anesthesia and analgesia are integral to modern perioperative medicine and contribute to multimodal analgesia and enhanced recovery protocols. Over the past two decades, regional anesthesia practice has changed dramatically with the incorporation of real-time ultrasound guidance. Anesthesiologists in the U.S. who completed residency training in the early 2000s were not routinely taught how to use ultrasound for regional anesthesia, and subspecialty fellowships in regional anesthesia at that time were relatively few and varied widely in terms of educational experience. Today, the state of regional anesthesia education in the U.S. is completely different and has embraced a multipronged, multigenerational approach that addresses the needs of anesthesiologists in training, as well as anesthesiologists in practice throughout the career lifecycle. This review will cover the current state of regional anesthesia education for residents, fellows, and practicing anesthesiologists and will note important historical advances, as well as future trends that may shape the curricula for regional anesthesia learners in formal training and continuing education.</p>","PeriodicalId":21533,"journal":{"name":"Saudi Journal of Anaesthesia","volume":"19 2","pages":"174-180"},"PeriodicalIF":1.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12007846/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144051828","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":"Interscalene nerve block with plain bupivacaine versus liposomal bupivacaine for arthroscopic rotator cuff repair: A randomized controlled trial.","authors":"Paul Sang Lee, Yasuko M Mano, Brian M Hom, Ioanna K Bolia, Roy P Yu, Alexander Weber, Seth Gamradt, Beamy Sharma, Gligor Gucev","doi":"10.4103/sja.sja_44_25","DOIUrl":"https://doi.org/10.4103/sja.sja_44_25","url":null,"abstract":"<p><strong>Background: </strong>Although single injections with anesthetics are commonly administered given their safety, their short-acting nature limits pain control. Liposomal bupivacaine represents a promising alternative to plain bupivacaine in interscalene nerve blocks. The goal of our study was to determine whether an interscalene block with liposomal bupivacaine provides superior analgesia and reduces opioid requirements compared to plain bupivacaine in patients undergoing arthroscopic rotator cuff repair (ARCR).</p><p><strong>Methods and materials: </strong>A single-center, double-blinded, randomized controlled trial of patients undergoing ARCR was performed. Patients received a single-shot interscalene nerve block with plain bupivacaine or liposomal bupivacaine. Visual analog scale pain scores at rest and with activity, as well as morphine milligram equivalents, were recorded in postoperative recovery and on postoperative days 1, 2, 3, and 7. Comparisons between groups were made using descriptive statistics; the significance level was set at <i>P</i> < 0.05.</p><p><strong>Results: </strong>A total of 41 patients were randomized into the liposomal bupivacaine (<i>n</i> = 18 patients) and plain bupivacaine (<i>n</i> = 23 patients) groups. The differences in visual analog scale and morphine milligram equivalents between the two groups were not significant, with or without movement, on all postoperative days assessed.</p><p><strong>Conclusion: </strong>There was no difference in the visual analog scale or morphine milligram equivalents after arthroscopic rotator cuff repair with interscalene blocks using liposomal bupivacaine versus plain bupivacaine. Given the increased cost associated with liposomal bupivacaine use and the variation in multimodal pain regimens worldwide, multicenter clinical trials are necessary to examine the clinical benefit and cost-effectiveness of liposomal bupivacaine in patients undergoing rotator cuff repair.</p>","PeriodicalId":21533,"journal":{"name":"Saudi Journal of Anaesthesia","volume":"19 2","pages":"243-250"},"PeriodicalIF":1.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12007854/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144046457","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":"Fascial plane blocks as the main anesthetic method: A narrative review.","authors":"Serkan Tulgar, Ali Ahıskalıoğlu, Alper Kilicaslan, Bahadır Çiftçi, Burhan Dost, Muhammed Enes Aydın, Yavuz Gürkan","doi":"10.4103/sja.sja_844_24","DOIUrl":"https://doi.org/10.4103/sja.sja_844_24","url":null,"abstract":"<p><p>This narrative review evaluates the efficacy of fascial plane blocks (FPB) as sole anesthetic method for surgery. Particularly in selected high-risk patients, fascial plane blocks may be a more useful and convenient option than general anesthesia or neuraxial anesthesia. In recent years, with the use of ultrasound, newly defined FPBs have emerged and these techniques have become popular. There are case reports in the literature reporting the use of these blocks for anesthesia, but clinical studies are limited and clinicians may be undecided about which block or combination to apply in which case. In this narrative review, which is the first in this field in the literature, we aimed to discuss the use of FPBs and which combinations can be used in which incisions and which surgeries.</p>","PeriodicalId":21533,"journal":{"name":"Saudi Journal of Anaesthesia","volume":"19 2","pages":"198-208"},"PeriodicalIF":1.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12007856/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143996340","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":"Chronic postsurgical pain after cardiac surgery: A narrative review.","authors":"Burhan Dost, Yunus Emre Karapinar, Deniz Karakaya, Zeliha Asli Demir, Sibel Baris, Ersin Koksal, Muhammed E Aydin, Bahadir Ciftci, Serkan Tulgar","doi":"10.4103/sja.sja_829_24","DOIUrl":"https://doi.org/10.4103/sja.sja_829_24","url":null,"abstract":"<p><p>Chronic postsurgical pain (CPSP) is a prevalent and debilitating sequela of cardiac surgery, exerting a profound impact on patients' quality of life, functional recovery, and healthcare systems. Its pathophysiology includes complex mechanisms, including peripheral and central sensitization, neuroplastic alterations, and inflammatory pathways, influenced by demographic, psychological, and perioperative factors. Inadequate management of acute pain is a critical contributor to its development. This review examines the etiology of CPSP, presents key risk factors, and critically evaluates pharmacological and nonpharmacological interventions. Particular attention is devoted to the role of regional anesthesia techniques and emerging preventive and therapeutic strategies, highlighting the necessity of multidisciplinary, evidence-informed approaches to address this persistent clinical challenge.</p>","PeriodicalId":21533,"journal":{"name":"Saudi Journal of Anaesthesia","volume":"19 2","pages":"181-189"},"PeriodicalIF":1.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12007855/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143976612","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}