Saudi Journal of Anaesthesia最新文献

{"title":"Fascial plane blocks for postoperative pain management after fast-track total knee arthroplasty: A narrative review.","authors":"Fabio Costa, Alessandro Ruggiero, Pierfrancesco Fusco, Massimiliano Ricci, Romualdo Del Buono, Alessandro Strumia, Sabrina Migliorelli, Felice E Agrò, Massimiliano Carassiti, Rita Cataldo, Giuseppe Pascarella","doi":"10.4103/sja.sja_99_25","DOIUrl":"https://doi.org/10.4103/sja.sja_99_25","url":null,"abstract":"<p><p>Total knee replacement is a common surgical procedure associated with significant postoperative pain, which can delay recovery and increase healthcare costs. Regional anesthesia techniques, including local infiltration analgesia and fascial plane blocks, play a crucial role in multimodal pain management strategies. These approaches aim to enhance pain relief while minimizing opioid use and preserving motor function. This narrative review evaluates the effectiveness and safety of motor-sparing fascial plane blocks for total knee replacement, categorizing techniques based on their anatomical target areas: anterior, posterior, and other approaches. A comprehensive literature search was conducted using databases such as MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials. The search included studies on motor-sparing regional anesthesia techniques for total knee replacement using relevant keywords such as \"regional anesthesia,\" \"peripheral nerve block,\" \"motor-sparing techniques,\" and specific block names. The selection criteria included randomized controlled trials, systematic reviews, meta-analyses, and relevant case studies. The techniques were analyzed based on their effectiveness in pain relief, impact on motor function, and overall contribution to enhanced recovery after total knee replacement. The review highlights that the most evidence-supported technique for anterior knee pain management is the block targeting the adductor canal, which provides effective analgesia while preserving motor function. For posterior compartment pain relief, the infiltration between the popliteal artery and the knee capsule is the preferred approach. Emerging techniques, such as the dual subsartorial block and the para-sartorial compartment block, show promise but require further validation. The review also underscores the importance of integrating different techniques to ensure adequate pain control for both the anterior and posterior compartments, facilitating early mobilization in fast-track recovery protocols. Achieving optimal postoperative pain management after total knee replacement requires a combination of targeted regional anesthesia techniques. Current evidence supports the use of adductor canal block for anterior knee analgesia and the infiltration between the popliteal artery and the knee capsule for posterior pain relief. While newer techniques show potential, further research is needed to validate their efficacy and safety. Future studies should focus on refining fascial plane block strategies to optimize analgesic benefits while minimizing motor impairment, thereby improving functional recovery and reducing the reliance on opioid medications.</p>","PeriodicalId":21533,"journal":{"name":"Saudi Journal of Anaesthesia","volume":"19 2","pages":"209-220"},"PeriodicalIF":1.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12007851/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144043977","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 wound infusion as a valid alternative to tap block for postoperative analgesia after abdominal hysterectomy: A randomized controlled trial.","authors":"Fabio Costa, Alessandro Ruggiero, Alessandro Strumia, Giuseppe Pascarella, Martina Cuccarelli, Francesco Plotti, Felice Eugenio Agrò, Massimiliano Carassiti, Rita Cataldo, Giovanni Ruggiero, Corrado Terranova, Carlo de Cicco Nardone, Roberto Montera, Roberto Angioli, Francesca Gargano, Eleonora Bruno, Davide Sammartini, Emanuele Sammartini, Arianna Martinelli, Lorenzo Schiavoni, Alessia Mattei","doi":"10.4103/sja.sja_658_24","DOIUrl":"https://doi.org/10.4103/sja.sja_658_24","url":null,"abstract":"<p><strong>Background: </strong>Total abdominal hysterectomy is a procedure associated with moderate to severe postoperative pain. Regional anesthesia techniques, such as fascial plane blocks, have shown promise in improving postoperative pain control. While continuous wound infusion is recommended for cesarean section, it is not recommended for open abdominal hysterectomy. Our aim is to compare surgically placed catheter for wound infusion with the transverse abdominis plane block.</p><p><strong>Methods: </strong>A single-center prospective randomized controlled trial was conducted in Italy from January to July 2023. Patients undergoing elective hysterectomy were randomly assigned to receive either bilateral transverse abdominis plane block or continuous wound infusion. The primary outcome measure was the assessment of static pain in the recovery room and at 6, 12, 24, and 48 hours postoperatively using the numeric rating scale (NRS) for pain. Of the 34 patients assessed for eligibility, 32 were randomized and equally distributed between the continuous wound infusion and transverse abdominis plane block groups.</p><p><strong>Result: </strong>Patients receiving continuous wound infusion consistently reported lower static NRS pain scores compared to those receiving transverse abdominis plane block across all postoperative time points. The median NRS scores were significantly lower in the wound infusion group at 6, 12, 24, and 48 hours post surgery (<i>P</i> < 0.05). Importantly, similar significant differences were also observed between the groups for dynamic NRS scores. However, no significant differences were observed between the groups for secondary outcomes, including nausea and vomiting, and recovery of functional capacity.</p><p><strong>Conclusion: </strong>Continuous wound infusion with a properly positioned catheter is noninferior to transverse abdominis plane block for postoperative pain management following total abdominal hysterectomy and may even provide superior pain control. These findings suggest continuous wound infusion as a viable alternative for effective pain management in total abdominal hysterectomy procedures.</p>","PeriodicalId":21533,"journal":{"name":"Saudi Journal of Anaesthesia","volume":"19 2","pages":"227-234"},"PeriodicalIF":1.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12007848/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143980277","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":"Vastus lateralis nerve block for knee hardware removal.","authors":"Jibran Ikram, Aariya Srinivasan, Cassandra L Williams, Nicholas Swerchowsky, Sabry Ayad","doi":"10.4103/sja.sja_454_24","DOIUrl":"10.4103/sja.sja_454_24","url":null,"abstract":"<p><p>Effective pain management post-knee surgery is critical for recovery and minimizing opioid use. We present a case of a patient undergoing ORIF for a comminuted patellar fracture and subsequent hardware removal because of persistent medial knee pain from hardware prominence. Despite initial opioid administration under general anesthesia, severe postoperative pain necessitated rescue with peripheral nerve blocks. Adductor canal, anterior femoral cutaneous, and vastus lateralis blocks provided significant pain relief without additional opioids. This approach reduces systemic opioid exposure, crucial in the current opioid crisis. Peripheral nerve blocks, especially the vastus lateralis block, effectively managed severe postoperative pain, highlighting their role in opioid-sparing strategies. These findings advocate for the broader adoption of regional anesthesia to enhance perioperative outcomes amid opioid-related challenges while supporting early mobilization and rehabilitation.</p>","PeriodicalId":21533,"journal":{"name":"Saudi Journal of Anaesthesia","volume":"19 1","pages":"112-114"},"PeriodicalIF":1.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11829671/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143433635","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":"Erector spinae plane block in Caesarean sections: A scoping review.","authors":"Kieran Brosnan, Mary Moore, Aisling Ní Eochagáin","doi":"10.4103/sja.sja_523_24","DOIUrl":"10.4103/sja.sja_523_24","url":null,"abstract":"<p><strong>Background: </strong>Pain management for Caesarean section focuses on multimodal analgesia with a growing interest in the use of regional techniques. Currently, there is no gold standard peripheral regional analgesia technique for Caesarean section. The Erector Spinae Plane Block is a relatively new fascial plane block that may be used to provide analgesia for numerous surgical procedures of the trunk. In recent years it is the fascial plane block that has accumulated the most enthusiasm and debate. Its use in Caesarean section has grown over the past three years.</p><p><strong>Objective: </strong>To determine the scope of literature published on ESPB in Caesarean sections and to identify deficits in the literature to guide future research.</p><p><strong>Methodology: </strong>This study was conducted using Arksey and O'Malley's framework for scoping reviews. This included a search of four databases searching for articles published between 2016 and 2022. Studies involving patients receiving ESPB as part of an analgesic strategy after a Caesarean section were included.</p><p><strong>Findings: </strong>Sixteen articles were included for final review. The most common primary outcomes measured were postoperative pain scores and analgesia consumption. Six ESPB studies recorded a statistically significant reduction in pain scores while three studies described a statistically significant reduction in postoperative analgesia consumption.</p><p><strong>Conclusion: </strong>The use of ESPB for Caesarean section is gaining momentum however insufficient evidence currently exists to support its widespread use. Further research is required to evaluate the potential benefits of ESPB in specific patient cohorts and in terms of its efficacy about multidimensional patient-centric outcomes.</p>","PeriodicalId":21533,"journal":{"name":"Saudi Journal of Anaesthesia","volume":"19 1","pages":"77-85"},"PeriodicalIF":1.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11829696/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143433812","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":"Optimization strategy for the early therapeutic intervention of bronchoalveolar lavage for preventing Mendelson syndrome in a geriatric patient before general anesthesia.","authors":"Satish Kumar Mishra, Pitchi Chandrakanth Reddy, Shalendra Singh, Gaurav Pandey, Narayanan Subramanian","doi":"10.4103/sja.sja_321_24","DOIUrl":"10.4103/sja.sja_321_24","url":null,"abstract":"<p><p>Aspiration pneumonia is of great concern in the elderly population, often leading to severe respiratory compromise necessitating ventilator support. This case report highlights the critical care and anesthetic management of a geriatric patient with an intertrochanteric fracture presenting with aspiration pneumonia undergoing orthopedic surgery. The patient's clinical presentation and application of therapeutic bronchoalveolar lavage as a novel intervention are discussed. The report outlines the critical care and perioperative management strategies employed to ensure optimal outcomes in this challenging clinical scenario.</p>","PeriodicalId":21533,"journal":{"name":"Saudi Journal of Anaesthesia","volume":"19 1","pages":"92-94"},"PeriodicalIF":1.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11829680/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143433838","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":"Patent ductus arteriosus device closure in a patient with Sprengel's deformity.","authors":"Ishrat Rawoot, Dheeraj Arora, Rakesh Pandey","doi":"10.4103/sja.sja_459_24","DOIUrl":"10.4103/sja.sja_459_24","url":null,"abstract":"","PeriodicalId":21533,"journal":{"name":"Saudi Journal of Anaesthesia","volume":"19 1","pages":"147-148"},"PeriodicalIF":1.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11829686/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143433855","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":"Ultrasound-assisted spinal anesthesia in morbidly obese elderly patient with bilateral lower limb filariasis.","authors":"Yasha V Kameshwar, Hemavathi Sakthivel","doi":"10.4103/sja.sja_464_24","DOIUrl":"10.4103/sja.sja_464_24","url":null,"abstract":"","PeriodicalId":21533,"journal":{"name":"Saudi Journal of Anaesthesia","volume":"19 1","pages":"145-146"},"PeriodicalIF":1.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11829678/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143432764","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":"Comment on \"Correlation of perfusion index change and analgesic efficacy in transforaminal steroid injection for lumbosacral pain, a prospective observational study\".","authors":"Vinod Krishnagopal, Raghuraman M Sethuraman, Sharanya Krishnakumar","doi":"10.4103/sja.sja_639_24","DOIUrl":"10.4103/sja.sja_639_24","url":null,"abstract":"","PeriodicalId":21533,"journal":{"name":"Saudi Journal of Anaesthesia","volume":"19 1","pages":"157-158"},"PeriodicalIF":1.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11829663/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143433782","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":"Retraction: Correlation of perfusion index change and analgesic efficacy in transforaminal steroid injection for lumbosacral pain, a prospective observational study.","authors":"","doi":"10.4103/sja.sja_713_24","DOIUrl":"10.4103/sja.sja_713_24","url":null,"abstract":"<p><p>[This retracts the article on p. 509 in vol. 18, PMID: 39600461.].</p>","PeriodicalId":21533,"journal":{"name":"Saudi Journal of Anaesthesia","volume":"19 1","pages":"161"},"PeriodicalIF":1.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11829667/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143433862","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":"Retroperitoneal hemorrhage following spinal anesthesia: A case report.","authors":"Haneen Hawsawi, Lamia ALjeraisy, Rothana Aljehani, Majed Alharbi","doi":"10.4103/sja.sja_350_24","DOIUrl":"10.4103/sja.sja_350_24","url":null,"abstract":"<p><p>Serious neurological problems following spinal anesthesia are rare, although they can occur. We report a case of a 31-year-old female patient, parturient, Gravida 2 Para 1, with a body mass index (BMI) of 25 kg/m2 who had a paramedian approach spinal anesthesia using 23-gauge Quincke spinal needle for an emergent cesarean section due to failure to progress. Four attempts were required to achieve successful spinal blockade. The procedure was successfully performed with no complications. On the first postoperative day, the patient started to complain of pressure headache and abdominal pain radiating to the lower back. Magnetic resonance imaging (MRI) lumbar spine revealed right peri-nephric and retroperitoneal subacute hematoma and no evidence of cerebrospinal fluid (CSF) leak or collection. Computed tomography (CT) angiography affirmed the diagnosis of large retroperitoneal hematoma extending to inferior vena cava, measuring about 5 × 15 × 16 cm in its maximum antero-posterior, transverse, and cranio-caudal diameters, respectively, corresponding to about 620 ml volume. No active bleeding was demonstrated.</p>","PeriodicalId":21533,"journal":{"name":"Saudi Journal of Anaesthesia","volume":"19 1","pages":"95-97"},"PeriodicalIF":1.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11829687/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143433863","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}