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An investigation on the influence of investor sophistication on the price-earnings response in the UK stock market has yielded interesting results. There are several criticisms about the study, however. For one, neither the details of the event study used as the basis for the investigation nor the methodological weaknesses of this method were included. The fundamental econometric assumptions underlying the single index market model were not cited. Furthermore, no regression diagnostics of the estimated models were provided. A more thorough econometric analysis would have buttressed the results of the study.

ABSTRACT Background and Aims: Ketamine and dexmedet omidine have neuroprotective effects that may reduce the occurrence of postoperative cognitive dysfunction (POCD) when they are used by intravenous infusion in geriatric patients scheduled for cataract extraction. Methods: Ninety patients aged 65-85 years old, ASA physical status II and III, and scheduled for cataract extraction under peribulbar block were randomly distributed equally among three groups: control group, in which patients received normal saline; ketamine group, in which patients received 0.3 mg/kg/h of ketamine; and dexmedetomidine group, in which patients received 0.5 µg/kg/h of dexmedetomidine. Medications were administrated by intravenous infusion and started 10 min before the surgery and continued throughout the duration of surgery. The analysed parameters included the incidence of POCD (primary outcome) through composite score of neuropsychological testing at one week and 3 months after surgery, postoperative pain score, postoperative sedation score, changes in haemodynamic parameters, changes in intraocular pressure, and incidence of complications. Results: In comparison with control group, ketamine and dexmedetomidine groups exhibited a significant decline in number of patients who developed POCD (P < 0.0001), a decrease in the postoperative pain score 4 h after surgery (P = 0.038), and an increase in the postoperative Ramsay sedation Score (P = 0.0002, 0.0003, and 0.011), without significant changes in the vital parameters, intraocular tension, or incidence of complications. Ketamine and dexmedetomidine groups were comparable. Conclusion: Intravenous administration of ketamine or dexmedetomidine in elderly patients undergoing cataract surgery under peribulbar anesthesia significantly decreases the incidence of POCD. Keywords: Cataract, cognitive dysfunction, dexmedetomidine, ketamine, Author(s): Mohamed E Oriby [1,2]; Ayman A Elrashidy [1,2]; Ahmed Elsharkawy [3]; Sameh A Ahmed (corresponding author) [1] INTRODUCTION Postoperative cognitive dysfunction (POCD) is a newly discovered objective decline in [...]

Byline: Mohamed. Oriby, Ayman. Elrashidy, Ahmed. Elsharkawy, Sameh. Ahmed Background and Aims: Ketamine and dexmedet omidine have neuroprotective effects that may reduce the occurrence of postoperative cognitive dysfunction (POCD) when [...]

Author(s): Hesham Elsharkawy [sup.1] [sup.2] , Sanchit Ahuja [sup.3] , Sean DeGrande [sup.4] , Kamal Maheshwari [sup.1] , Vincent Chan [sup.5] Author Affiliations: (Aff1) 0000 0001 0675 4725, grid.239578.2, Department [...], In the case of open urological surgeries, analgesic coverage at mid thoracic dermatomal levels is required. As shown in cadaveric studies, the site of QL block injection is an important determinant of the extent of dye spread and presumably local anesthetic dermatomal coverage. In this case series, we evaluated dermatomal blockade and analgesic efficacy of a subcostal approach to anterior QL block following open urological surgeries. Twenty-two adult patients undergoing renal transplant surgery (60%) and open nephrectomy (40%) received unilateral ultrasound-guided subcostal anterior QL block with catheter insertion. Sensory level, pain score (numeric rating scale, NRS), local anesthetic consumption, and opioid consumption (morphine equivalent dose, MED) were assessed daily for 3 days. The block achieved sensory blockade between T6-7 and L1-2. The most frequently affected dermatomes were T8 -T12 and the number of blocked segments was 3 (mean 2.8). The median (interquartile range Q1, Q3) of NRS pain score was 3.7 (2.8-5.5), 3.3 (2.4-4.7), 2.9 (1.9-3.6), and 2.3 (1.0-4.2) on POD0, POD1, POD2, and POD3, respectively. Our preliminary data showed that the subcostal approach to anterior QL block provides appropriate thoracic dermatome level needed for analgesia following open urological surgical procedures between T6-7 and L1-2.

Author(s): Rovnat Babazade[sup.1] [sup.2] , Thilak Sreenivasalu[sup.2] [sup.3] , Pankaj Jain[sup.4] , Matthew T. Hutcherson[sup.4] , Amanda J. Naylor[sup.4] , Jing You[sup.4] [sup.5] , Hesham Elsharkawy[sup.4] [sup.6] , Ali Sakr [...], Purpose Sciatic nerve block (SNB) is commonly performed in combination with femoral nerve block (FNB) for postoperative analgesia following total knee arthroplasty (TKA). Despite the fact that 10-20 % of TKA patients require SNB for postoperative posterior knee pain, there are no existing studies that suggest a model to predict the need for SNB. The aim of our study was to develop a prediction tool to measure the likelihood of patients undergoing TKA surgery requiring a postoperative SNB. Methods With institutional review board approval, we obtained data from the electronic medical record of patients who underwent TKA at the Cleveland Clinic. A multivariable logistic regression was used to estimate the probability of requiring a postoperative SNB. Clinicians selected potential predictors to create a model, and the potential nonlinear association between continuous predictors and SNB was assessed using the restricted cubic spline model. Results In total 6279 TKA cases involving 2329 patients with complete datasets were used for building the prediction model, including 276 (12 %) patients who received a postoperative SNB and 2053 (88 %) patients who did not. The estimated C statistic of the prediction model was 0.64. The nomogram is used by first locating the patient position on each predictor variable scale, which has corresponding prognostic points. The cut-off of 11.6 % jointly maximizes the sensitivity and specificity. Conclusion This is the first study to be published on SNB prediction after TKA. Our nomogram may prove to be a useful tool for guiding physicians in terms of their decisions regarding SNB.

Author(s): Hesham Elsharkawy[sup.1] , Ankit Maheshwari[sup.2] , Ehab Farag[sup.1] , Edward R. Mariano[sup.3] , Richard W. Rosenquist[sup.1] Author Affiliations: (1) Departments of General Anesthesiology and Pain Management, Outcomes Research Anesthesiology [...], Continuous peripheral nerve block (CPNB) success is largely dependent on placement of the catheter close enough to the nerve to allow effective and sustained analgesia following painful surgeries with a minimum volume of local anesthetic. One of the most common problems associated with CPNB involves accurate placement of the catheter tip, migration, and dislodgement of the catheter. This is of increasing importance now that catheters are left in place for prolonged periods of time to provide postoperative analgesia, and patients with peripheral nerve catheters are being discharged home with ambulatory pumps. In response to the challenges of providing safe, effective, and consistently reliable analgesia, research and development in this field is expanding rapidly. This review article presents results from recent publications addressing the subject of peripheral nerve catheter localization.

Investor sophistication influences stock price changes for a given period, and the nature of its impact depends upon the sign of unexpected earnings. Results of an examination of the influence of investor sophistication on the price-earnings response in the UK market indicate these. Specifically, results show that the investor's level of sophistication is an important factor in explaining abnormal returns around the earnings announcement data.

The perturbational approach that assumes Couette dominance in non-Newtonian elastohydrodynamic lubrication analysis is discussed. The assumption is found valid for non-Newtonian fluid models exhibiting Newtonian properties at low shear strain rate. A general non-Newtonian fluid model which meets that requirement is incorporated into elastohydrodynamic lubrication analysis of line contacts by using the perturbational approach. In the case of a circular fluid model the results obtained from the perturbational approach are in good agreement with those obtained from the direct approach. However, a better convergence and the possibility of avoiding using stress boundary conditions at high shear stress can be achieved by using the perturbational approach. Results are presented for various values of the shape exponent in the general model, and it transpires that this also is an important parameter of the fluid model.

A complete solution for the Newtonian elastohydrodynamic lubrication of coated surfaces in line contact is introduced in this paper. The formulation is based mainly on solving the Reynolds equation coupled with the elasticity equations of the multilayered elastic halfspace. The effects of pressure inside the lubricated conjunction on the lubricant viscosity and density are considered. The mathematical model for this problem is a nonlinear one, and an iterative Newton-Raphson scheme is used for numerical solutions. The effects of coating material and coating thickness on the pressure profiles and the film shapes are presented. Two different coating materials (molybdenum disulfide as a soft coating and titanium nitride as a hard coating) are considered. The results show that the pressure spike is higher for hard coatings than for uncoated surfaces but that the pressure spike disappears for soft coatings. Furthermore, the coating thickness has a significant influence on the minimum film thickness and the maximum contact pressure for both soft and hard coatings.

Byline: A.H. Elkholy, A.A. Elsharkawy A closed-form solution is presented to evaluate load distribution and fillet stresses during single and double tooth contact of straight bevel gears. The procedure outlined is based upon the assumption that the bevel gear can be approximated by an equivalent spur gear using the well known Tredgold principal, and that meshing teeth deflections along contact lines(s) are inversely proportional to stiffnesses, and are determined in such a way so as to avoid interference and physical overlap between mating teeth. Moreover, load distribution is taken to be inversely proportional to stiffness variation along contact line(s). Finally, fillet stress distribution at both tensile and compressive sides of the tooth was determined from contact load and tooth geometry. The results were compared with those obtained experimentally using strain gauge (SG) measurements; and numerically using Finite Element Method (FEM). Good correlation between all these results was found.

In this paper a numerical solution for the elastohydrodynamic lubrication of a finite porous journal bearing is presented. The Brinkman-extended Darcy model was applied within the porous layer to incorporate the viscous shear stresses into the analysis. A simple elastic model is used to describe the elastic deformation of the liner. An inverse model is introduced to estimate the permeability parameter and/or the eccentricity ratio from experimentally obtained pressure data. As experimental measurements were not conducted, these data were simulated numerically. It consists of a direct solution for the pressure, for given parameters (permeability parameter and/or the eccentricity ratio), to which a normally distributed random error is added. The least-squares optimization technique is used to solve the proposed inverse problem. A unique solution was obtained for one-parameter estimation. The two-parameter estimation case, however, leads to multiple solutions lying on a constant load line. [DOI: 10.1115/1.1308025]

This paper presents a solution to an inverse problem for the elastohydrodynamic lubrication of one-layered journal bearings. Eccentricity ratio, viscosity of the lubricant at atmospheric pressure, pressure-viscosity coefficient, and bulk modulus of the lubricant are the parameters to be estimated from a given pressure distribution. The Least-squares optimization technique is used to solve the proposed inverse problem. Results are presented only .for infinite-width journal bearings. The results showed that the proposed inverse algorithm is efficient and accurate. [S0742-4787(00)00703-7]

Byline: E. I. El-Shafeey, A. A. Aboulila, E. H. Wheish, M. A. Ashmawy and M. M. Elsharkawy Keywords: Wheat; stripe rust; Yr Resistance genes; Thymol; Carvacrol; induced resistance; Pathogenesis related [...]

Background and Aims: The optimal analgesia for percutaneous nephrolithotomy (PCNL) remains uncertain. This study aims to conduct a systematic review and network meta-analysis to compare the efficacy of various analgesic strategies for PCNL. Methods: We searched PubMed, ScienceDirect, ClinicalTrials.gov, MEDLINE, Web of Science, Ovid and EMBASE to identify all relevant randomised controlled trials published up to January 2024. Our review was prospectively registered with PROSPERO (ID: CRD42024504578). The identified methods included erector spinae plane block (ESPB), paravertebral block (PVB), intercostal nerve block (ICNB), quadratus lumborum block (QLB) and local infiltration. Our primary outcomes consisted of 24-h cumulative opioid consumption and the time to first use of opioid medication postoperatively. Secondary outcomes encompassed pain scores at 2, 6, 12 and 24 h postoperatively, as well as occurrences of postoperative nausea and vomiting. Results: Overall, 27 trials met our inclusion criteria. QLB, PVB and ESPB demonstrated significant advantages in reducing 24-h postoperative opioid consumption and providing effective analgesia at all measured postoperative time points within 24 h, compared to the placebo group. However, there was no statistical difference between the three interventions. Similarly, there were no statistical differences in all outcomes between the ICNB and infiltration groups compared to the placebo group. Conclusions: ESPB, PVB and QLB offer significant analgesic benefits for PCNL compared to placebo, with no significant differences in efficacy among them. Due to limited evidence, ICNB and local infiltration were found not to be more effective than placebo. Keywords: Analgesia, erector spinae plane block, intercostal nerve block, local infiltration, network meta-analysis, paravertebral block, PCNL, percutaneous nephrolithotomy, quadratus lumborum block, regional anaesthesia, Author(s): Kun Long [1]; Chengfu Zhou [2]; Jingqiu Liang [2]; Xixi Tang [2]; Zhijian Li [1]; Qi Chen (corresponding author) [2] INTRODUCTION Percutaneous nephrolithotomy (PCNL) has recently become the gold [...]

Background and Aims: Upper abdominal surgeries are associated with severe postoperative pain. External oblique intercostal (EOI) block blocks both anterior and lateral cutaneous branches of intercostal nerves. We compared the postoperative analgesic efficacy of unilateral EOI block with conventional unilateral subcostal transversus abdominis plane (TAP) block. Methods: Fifty American Society of Anesthesiologists (ASA) I/II patients scheduled for upper abdominal surgery via subcostal incision were randomly assigned to receive either EOI block (Group E) or subcostal TAP block (Group T) with 25 mL of 0.2% ropivacaine. Postoperatively, these patients received intravenous (IV) fentanyl through a patient-controlled analgesia (PCA) pump with settings of demand-only mode. The primary outcome was the time to activation of PCA postoperatively. Secondary outcomes were 24-hour opioid consumption, pain scores (at 30 minutes and at 1, 2, 4, 6, 12, and 24 hours), patient satisfaction scores (48 hours), and block-related complications. Unpaired t-test and Mann-Whitney U test were used for analysis. A P value less than 0.05 was considered to be statistically significant. Results: Patients in Group E had an increased mean time of activation of PCA [610.28 [standard deviation (SD): 118.95)] minutes vs 409.68 (SD: 101.36) minutes] (P = 0.001). The 24-hour postoperative mean fentanyl consumption was 102.40 (SD: 25.70) μg in Group E versus 123.20 (SD: 34.38) μg in Group T (P = 0.019). Patients in Group E had better satisfaction scores (P < 0.001). Pain scores were better at 30 minutes and 6 hours. Conclusion: EOI block provides effective postoperative analgesia in upper abdominal surgeries as it prolongs the duration of PCA activation with a better patient satisfaction score. Keywords: Abdominal surgery, external oblique intercostal block, fentanyl, patient-controlled analgesia, patient satisfaction, postoperative pain, subcostal transversus abdominis plane block, Author(s): Shruti Shrey [1]; Chandni Sinha [1]; Abhyuday Kumar [1]; Ajeet Kumar (corresponding author) [1]; Amarjeet Kumar [1]; Sreehari Nambiar [1] INTRODUCTION Upper abdominal incisions cause severe intraoperative and postoperative [...]

* Context.--In 2014, the College of American Pathologists developed an evidence-based guideline to address analytic validation of immunohistochemical assays. Fourteen recommendations were offered. Per the National Academy of Medicine standards for developing trustworthy guidelines, guidelines should be updated when new evidence suggests modifications. Objective.--To assess evidence published since the release of the original guideline and develop updated evidence-based recommendations. Design.--The College of American Pathologists convened an expert panel to perform a systematic review of the literature and update the original guideline recommendations using the Grading of Recommendations Assessment, Development and Evaluation approach. Results.--Two strong recommendations, 1 conditional recommendation, and 12 good practice statements are offered in this updated guideline. They address analytic validation or verification of predictive and nonpredictive assays, and recommended revalidation procedures following changes in assay conditions. Conclusions.--While many of the original guideline statements remain similar, new recommendations address analytic validation of assays with distinct scoring systems, such as programmed death receptor-1 and analytic verification of US Food and Drug Administration approved/ cleared assays; more specific guidance is offered for validating immunohistochemistry performed on cytology specimens. (Arch Pathol Lab Med. 2024;148:e111-e153; doi: 10.5858/arpa.2023-0483-CP, In 2014, the Pathology and Laboratory Quality Center for Evidence-Based Guidelines ('The Center') of the College of American Pathologists (CAP) published a clinical practice guideline that created recommendations for analytic [...]

Objective To identify literature on health literacy levels and examine its association with tuberculosis treatment adherence and treatment outcomes. Methods Two authors independently searched Pubmed[R], Embase, CINAHL, PsycINFO, Scopus, LILACS, Global Health Medicus and ScienceDirect for articles reporting on health literacy levels and tuberculosis that were published between January 2000 and September 2023. We defined limited health literacy as a person's inability to understand, process, and make decisions from information obtained concerning their own health. Methodological quality and the risk of bias was assessed using the JBI critical appraisal tools. We used a random effects model to assess the pooled proportion of limited health literacy, the association between health literacy and treatment adherence, and the relationship between health literacy and tuberculosis-related knowledge. Findings Among 5813 records reviewed, 22 studies met the inclusion criteria. The meta-analysis revealed that 51.2% (95% confidence interval, CI: 48.0-54.3) of tuberculosis patients exhibit limited health literacy. Based on four studies, patients with lower health literacy levels were less likely to adhere to tuberculosis treatment regimens (pooled odds ratio: 1.95; 95% CI: 1.37-2.78). Three studies showed a significant relationship between low health literacy and inadequate knowledge about tuberculosis (pooled correlation coefficient: 0.79; 95% CI: 0.32-0.94). Conclusion Health literacy is associated with tuberculosis treatment adherence and care quality. Lower health literacy might hamper patients' ability to follow treatment protocols. Improving health literacy is crucial for enhancing treatment outcomes and is a key strategy in the fight against tuberculosis. Objectif Identifier la litterature consacree aux niveaux d'education a la sante et etudier ses liens avec l'adhesion au traitement de la tuberculose ainsi qu'avec l'issue de ce traitement. Methodes Deux auteurs ont explore Pubmed[R], Embase, CINAHL, PsyclNFO, Scopus, LILACS, Global Health Medicus et ScienceDirect, independamment l'un de l'autre, a la recherche d'articles portant sur les niveaux d'education a la sante et la tuberculose, publies entre janvier 2000 et septembre 2023. Nous avons defini qu'un faible niveau d'education a la sante signifiait qu'une personne etait incapable de comprendre, d'assimiler et de prendre des decisions sur la base des informations qui lui etaient communiquees concernant sa sante. Nous avons utilise les outils devaluation critique du JBI pour determiner la qualite methodologique et le risque de biais. Enfin, nous avons applique un modele a effets aleatoires pour calculer la proportion groupee correspondant a un faible niveau d'education a la sante, le rapport entre l'education a la sante et l'adhesion au traitement, et celui entre l'education a la sante et les connaissances liees a la tuberculose. Resultats Sur 5813 documents examines, 22 correspondaient aux criteres d'inclusion. La meta-analyse a revele que 51,2% (intervalle de confiance de 95%, IC: 48,0-54,3) des patients tuberculeux affichaient un faible niveau d'education a la sante. D'apres quatre etudes, les patients avec un niveau d'education a la sante moins eleve avaient moins tendance a suivre les traitements contre la tuberculose (odds ratio groupe: 1,95; IC de 95%: 1,37-2,78). Trois etudes ont montre un lien significatif entre un faible niveau d'education a la sante et des connaissances insuffisantes sur la tuberculose (coefficient de correlation groupe: 0,79; IC de 95%: 0,32-0,94). Conclusion L'education a la sante a un impact sur l'adhesion au traitement contre la tuberculose et la qualite des soins. Un niveau d'education moindre peut entraver la capacite des patients a suivre les protocoles therapeutiques. Promouvoir l'education a la sante est essentiel pour ameliorer les resultats du traitement et constitue un element cle de la strategie de lutte contre la tuberculose. Objetivo Identificar la bibliografia sobre los niveles de alfabetizacion sanitaria y examinar su asociacion con el cumplimiento terapeutico de la tuberculosis y los resultados del tratamiento. Metodos Dos autores buscaron de manera independiente en Pubmed[R], Embase, CINAHL, PsycINFO, Scopus, LILACS, Global Health Medicus y ScienceDirect articulos que informaran sobre los niveles de alfabetizacion sanitaria y de tuberculosis publicados entre enero de 2000 y septiembre de 2023. Se definio la alfabetizacion sanitaria limitada como la incapacidad de una persona para comprender, procesar y tomar decisiones a partir de la informacion obtenida en relacion con su propia salud. La calidad metodologica y el riesgo de sesgo se evaluaron mediante las herramientas de evaluacion critica de JBI. Se utilizo un modelo de efectos aleatorios para evaluar el porcentaje agrupado de alfabetizacion sanitaria limitada, la asociacion entre la alfabetizacion sanitaria y el cumplimiento del tratamiento y la relacion entre la alfabetizacion sanitaria y los conocimientos relacionados con la tuberculosis. Resultados De los 5813 registros revisados, 22 estudios cumplieron los criterios de inclusion. El metanalisis revelo que el 51,2% (intervalo de confianza del 95%, IC: 48,0-54,3) de los pacientes con tuberculosis presentan conocimientos sanitarios limitados. Segun cuatro estudios, los pacientes con niveles mas bajos de conocimientos sanitarios tenian menos probabilidades de cumplir los regimenes de tratamiento de la tuberculosis (razon de posibilidades acumulada: 1,95; IC del 95%: 1,37-2,78). Tres estudios mostraron una relacion significativa entre los bajos conocimientos sanitarios y los conocimientos insuficientes sobre la tuberculosis (coeficiente de correlacion agrupado: 0,79; IC del 95%: 0,32-0,94). Conclusion La alfabetizacion sanitaria esta asociada al cumplimiento del tratamiento de la tuberculosis y a la calidad de la atencion. Una alfabetizacion sanitaria baja podria dificultar la capacidad de los pacientes para seguir los protocolos de tratamiento. Mejorar la alfabetizacion sanitaria es crucial para mejorar los resultados del tratamiento y constituye una estrategia clave en la lucha contra la tuberculosis. [phrase omitted], Introduction Health literacy is the ability to apply various skills--like reading, counting and problem-solving--to obtain, understand and use health-related information. Such knowledge and skills support informed decision-making, facilitate greater health-care [...]

Dermatomal analgesia achieved with quadratus lumborum blocks is site-dependent and inconsistent. Cadaveric and clinical studies reveal multiple mechanisms of action. We dissected six fresh human cadavers bilaterally and thoroughly studied their neurological linkages to the quadratus lumborum muscle (QLM) to identify neural structures and block targets. At the end of the investigation, only the subcostal nerve (anterolateral) and the ilioinguinal nerves were found near the QLM in all specimens. The iliohypogastric nerve was found in only two specimens. No further neural targets were found in the fascial planes before and posterior to the QLM. Keywords: Cadaver, dissection, nerve block, quadratus lumborum, Author(s): Sandeep Diwan [1]; Xavier S. Blanch [2]; Abhijit S. Nair (corresponding author) [3] INTRODUCTION Three common approaches to quadratus lumborum block (QLB) have been described depending on the site [...]

Objectives This study aimed to evaluate health related quality of life (HRQOL) in Egyptian children with systemic lupus erythematosus (SLE) using 3 different tools. Methods In this questionnaire-based study, 100 children with SLE were included. HRQOL was assessed using the Pediatric Quality of Life Inventory Generic Core Scales (PedsQL[TM] 4.0 GCS), PedsQL[TM] 3.0 Rheumatology Module (PedsQL3-RM) and the Simple Measure of the Impact of Lupus Erythematosus in Youngsters (SMILEY). SLE disease activity index (SLEDAI) was used to evaluate activity and SLE International Collaborating Clinics/ American College of Rheumatology Damage Index (SDI) was used to evaluate chronic damage. Results All mean scores of PedsQL.sup.TM4.0 GCS domains in SLE patients were lower than published normative data and previously published results of Egyptian healthy controls (p < 0.001). All mean scores of PedsQL-3RM domains were significantly lower than published normative data except for the treatment and pain and hurt domains (p = 0.1, 0.2 respectively). SMILEY scores were low and the lowest domain scores was 'Burden of SLE'. Longer duration of illness, higher cumulative steroid doses, higher SLEDAI and SDI scores and presence of obesity were associated with lower scores for all 3 tools (p < 0.001). Conclusion for Practice The Arabic copies of PedsQL[TM] 4.0 GCS, PedsQL3-RM and SMILEY are easily used for Arabic speaking subjects and easily interpreted by physician and can be implemented for frequent monitoring of SLE HRQOL. Controlling the disease activity and using lowest doses of steroids and other immunosuppressive drugs are the corner stone strategies for improving HRQOL in SLE children., Author(s): Riham Eid [sup.1] , Ayman Hammad [sup.1] , Mai S. Korkor [sup.1] , Aya A. Fathy [sup.2] , Dena M. Abd El-Ghafaar [sup.3] , Shaimaa Rakha [sup.4] , Nashwa [...]

This case series describes a novel anaesthetic approach for hip fracture surgery using the deep fascia iliaca block combined with the sacral plexus block. This single-centre, retrospective study involved 15 patients aged 85 years or older and having significant cardiac disease. All the patients were managed with single-shot deep fascia iliaca block (22 or 25 ml of ropivacaine 0.5) and sacral plexus block (12 or 15 ml of ropivacaine 0.5, according to the patients' weight) after the administration of 50 μg of fentanyl intravenously. Intraoperatively, the patients were also administered light-to-moderate sedation. All patients presented a successful sensory block and a high level of haemodynamic stability (nil vasopressor consumption). In hip fracture surgery, low volume deep fascia iliaca block may be combined with sacral plexus block as primary anaesthetic technque, without any neuraxial technique or sympathetic blockade. Keywords: Deep fascia iliaca block, sacral plexus block, hip fracture, analgesia, cardiac disease, Author(s): Carlos R. Almeida (corresponding author) [1] INTRODUCTION Modified regional techniques have been proposed in high-risk cardiac patients to reduce the haemodynamic impact of the standard dose single-shot spinal anaesthesia; [...]

Background and Aims: Analgesia for hip surgery involves cutaneous anaesthesia at the site of the skin incision and the anterior hip capsule. This study aimed to compare continuous ultrasound (US)-guided transmuscular quadratus lumborum block (TQLB) with psoas compartment block (PCB) for analgesia in patients undergoing total hip arthroplasty (THA) under general anaesthesia (GA). Methods: This randomised, observer-blinded trial included 18-70-year-old American Society of Anesthesiologists physical status I-III patients undergoing THA under GA with either US-guided continuous TQLB or PCB. Primary objectives included a visual analogue scale (VAS; 0-100 mm) at rest and mobilisation at 6 h postoperatively (analysed by intention to treat and per protocol) using a non-inferiority margin of 20 mm. Secondary objectives included VAS at other time points, 24-h fentanyl consumption (analysed using the Wilcoxon rank-sum test), sensory dermatomes anaesthetised, motor weakness 30 min after block, and haemodynamic response to skin incision (analysed using the Chi-squared or Fisher's exact test). A P value less than 0.05 was considered statistically significant. Results: VAS (0-100 mm) score at 6 h on rest was 25.34 ± 14.25 and 27.3 ± 9.6, mean difference (MD) was 1.9 [-3.3, 7.1] and at movement was 35.1 ± 23.0 and 38.6 ± 17.0, MD was 3.5 [-5.2, 12.2], in the PCB (n = 29) and QLB (n = 30) groups, respectively (i.e. less than the non-inferiority margin). However, VAS (rest) at 1, 12, and 24 h postoperatively and median (IQR) 24-h fentanyl consumption was significantly higher in the QLB group (1212.5 [300-2345] μg] when compared to the PCB group (635 [100-1645] μg; P = 0.0004). Conclusion: Though statistically, continuous QLB was non-inferior to continuous PCB for pain at rest and mobilisation at 6-hours postoperatively, a higher 24-hour perioperative fentanyl consumption and VAS show that QLB was clinically inferior to PCB. Keywords: Arthroplasty, nerve block, pain, postoperative analgesia, psoas compartment block, transmuscular quadratus lumborum block, ultrasonography, Author(s): Arjun Balakrishnan [1]; Anjolie Chhabra (corresponding author) [1]; Ajeet Kumar [2]; Praveen Talawar [3]; Debesh Bhoi [1]; Heena Garg [1] INTRODUCTION Analgesia for hip surgery involves cutaneous anaesthesia at [...]