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Study objective To determine the analgesic efficacy of ultrasonographic guided transmuscular graduatus lumborum block (QLB) in patients undergoing open inguinal hernia surgery. Design Prospective randomized double-blinded study. Methodology and interventions This prospective randomized double-blinded study was carried out at Sohag University hospital, after local research ethical committee approval and obtaining informed written consent from all patients participating in the study or their guardians. A total of 50 patients (ASA grade I to II) were posted for open inguinal hernia surgery. All patients underwent the operation under general anesthesia. Then patients were randomly divided into two equal groups: group A (QLB group, N=25): were underwent a transmuscular QLB approach, after wound dressing with a single shot of a total volume of 20 ml of mixture (10 ml bupivacaine 0.5% and10 ml normal saline). Group B (control group N=2): patients received only general anesthesia with conventional intravenous analgesia. Measurements Pain intensity between groups was compared using the Visual Analog Score (VAS), furthermore, analgesic consumption (morphine and ketorolac) and additional rescue analgesic requirements were also calculated. Results Postoperative VAS scores at rest and during movement were significantly lower in group (QLB) A than the control group B at 1, 5, 7, 8, 9, 10, and 12 h, the time of first rescue analgesia was significantly delayed in QLB group (15.8±3.94 h) than the control group (8.5±4.29 h). Number of patients required morphine was significantly different between both groups. Number of patients required ketorolac was significantly lower in QLB group than in the control group. Total morphine and ketorolac requirements were significantly lower in group A (2.5±0.71 mg, 75±25.1), respectively than those consumed by the control group B (4.7±0.49, 126±23.24), respectively. Conclusions QLB significantly improves the analgesic quality in patients undergoing inguinal hernia repair compared to the standard intravenous analgesia regimen. [ABSTRACT FROM AUTHOR]

Background Central venous catheterization is an important device that is frequently performed for various purposes in operating theatres and intensive care units, there are many different sites that are commonly used for central venous catheterization, and each site has its own advantages, disadvantages, and possible complications. To avoid catheterization failure and mechanical complications, ultrasound guidance is currently recommended in several guidelines and is widely used for central venous catheterization. It has been shown to reduce the incidence of arterial puncture, hematoma formation, pneumothorax, hemothorax, and catheterization failure. The subclavian vein (SCV) catheterization is more comfortable for patients than other sites but has a higher risk of some complication as pneumothorax. The aim of this study was to compare the Supraclavicular and Infraclavicular approaches for ultrasonographic guided right subclavian venous catheterization as regard the accessibility and the safety of both approaches. Methods This randomized controlled study was conducted in Sohag University Hospital after local ethical committee approval, 210 patients had a right subclavian vein catheterization by either the supraclavicular or the infraclavicular approach (105 for each group), using a two dimensional high-frequency ultrasound guide were enrolled in the study regarding the accessibility (time to first puncture and number of punctures) and the complications like arterial puncture, hematoma formation, arrhythmia, and catheter misplacement. Results The infraclavicular approach is more accessible, regarding the number of punctures, for the Supraclavicular approach there were 56 (53.3%) cases needed only one puncture to achieve successful venous puncture and 27 (25.7%) cases needed 2 punctures and 5 (4.8%) needed 3 punctures and 17 (16.2%) failed in catheterization, for the Infraclavicular approach there were 79 (75.2%) of cases in these group needed only one puncture to achieve successful venous puncture and 17 (16.2%) cases needed 2 punctures and 9 (8.6%) failed in catheterization with a significant difference between both groups P value was 0.003. As regard the puncture time, for the Supraclavicular approach 83 (79%) cases successes in less than 3 min, and 22 (21%) cases needed more than 3 min, in the infraclavicular approach 94 (89.5%) cases succeeded in less than 3 min and 11 (10.5%) cases needed more than 3 min at P value 0.037 and had a lower rate of complications than the supraclavicular approach, like arrhythmia, arterial puncture, hematoma formation, catheter misplacement, and postcatheterization infection, but a higher rate of pneumothorax formation however in a nonsignificant way. Conclusion The infraclavicular approach for ultrasound-guided right subclavian venous catheterization is better than the supraclavicular approach due to a higher chance of first pass success rate and a lower rate of complications. [ABSTRACT FROM AUTHOR]

Background Severe acute pain occurs in more than 10% of patients within the first 36 h after a cesarean section and can significantly impact women's satisfaction. The aim of this study was to compare the transversus abdominis plane (TAP) block for postoperative pain relief following cesarean section operations with the most famous analgesia (intrathecal morphine) used for a cesarean section regarding its efficacy and complications. Patients and methods This interventional double-blinded randomized controlled study was carried out on 60 cases, who underwent an elective cesarean delivery. They were randomized into two groups; patients were divided into two equal groups. Group M received intrathecal 150 μg morphine in a 0.5 ml volume, mixed with 10 mg of hyperbaric bupivacaine 0.5% in a 2 ml volume (total volume 2.5 ml). Group B received intrathecal 10 mg hyperbaric bupivacaine 0.5% 2 ml volume+0.5 saline (total volume 3 ml) and at the end of surgery the patient received bilateral TAP block with a 20 ml volume of 0.25% bupivacaine on each side. Results Postoperative heart rate, respiratory rate, oxygen saturation, mean arterial blood pressure, and intraoperative Bromage score were insignificantly different at all-time measurements between both groups. Visual analog score and postoperative Bromage score at 2, 3, and 4 h were higher in group B than group M (P<0.001). Time of rescue analgesia was significantly prolonged in group M than group B (P<0.001). Total paracetamol and morphine doses were significantly lower in group M than group B (P<0.001). Conclusions TAP block is a good alternative technique to intrathecal morphine in reducing postcesarean section pain, with less postoperative nausea and vomiting and pruritus compared with intrathecal morphine (ITM). [ABSTRACT FROM AUTHOR]

Background and aim Tennis elbow is an abuse condition that out comes in pain over lateral side of elbow, provoked by activities involving gripping and manipulating objects by hand. It is frequently a consequence of participation in activities requiring repetitive manual tasks with awkward wrist positions. Tennis elbow has a variety of treatment options, starting from nonoperative treatment, including conservative treatment, bracing, and physiotherapy, to the last line of treatment being surgical intervention. Materials and methods A systemic review was performed using Google, PubMed, and Medline for a period from 2015 to 2019 comparing three methods of tennis elbow treatment: steroid injection, open surgery, and arthroscopic surgery. Results A total of 21 studies included 2055 patients treated by arthroscopic surgery. Overall, 3638 patients were treated by open surgery and 633 patients were treated by steroid injection. Conclusion This systematic review looked at high-level evidence to compare arthroscopic technique, open surgical technique, and steroid injection. There were no clinically significant differences among the three techniques (open, arthroscopic, and steroid injection) according to postoperative pain intensity (visual analog scale). Steroid injection had the least complication rate, with early return to work, but had higher recurrence rate. [ABSTRACT FROM AUTHOR]

Background Pressure ulcers have complex etiopathogenesis. They are localized mainly in the pelvic region over the bony prominences of sacral, ischial, and trochanteric areas. The fundamental surgical treatments are debridement with excision of the underlying bursa and the involved bone tissue, followed by tissue coverage. Aim This study reports our experience in repairing pelvic pressure sores with the V-Y advancement flaps and analyzes our results in terms of morbidity and recurrence. Methods A prospective study was conducted between Jan 2013 and Dec 2015 of 15 patients (11males, 4 females), withmean age of 43.5 years, with grade IV pelvic pressur sores (9 sacral, 6 ischial). 2 ulcerswere recurrent and 13 were primary. Themean ulcer size was 11.8 × 7.1 cm. The sacral bed sores were covered by the gluteus maximus (GM) fasciocutaneous V-Y advancement flaps (2 unilateral and 7 bilateral flaps) while the ischial bed sores were covered by the biceps femoris (BF) fasciocutaneous V-Y advancement flaps in 4 cases, BF myocutaneous V-Y advancement flap in 1 case and vertical GM fasciocutaneous V-Y advancement flap in 1 case. Results All flaps survived completely with no complications in 11 patients. Complications occurred in 4 cases (26.7%); (1 hematoma, 1 wound infection, 1 small wound dehiscence (1.5 cm) and 1 distal superficial flap necrosis), all treated conservatively without necessitating 2nd operation. During the follow up period from 8 to 20 months (mean- 13.2 months) only one case of ulcer recurrence (6.7%) that was treated by re-advancement of the same flap. Conclusion We can conclude that the success of pressure ulcer surgery depends not only on the appropriate flap choice but also on patient education and compliance. However, the V-Y advancement flaps offer a reliable and robust coverage of sacral and ischial pressure sores even recurrent ones with minimal donor site morbidity, accepted rate of complications, low recurrence rate and preservation of future reconstructive options. [ABSTRACT FROM AUTHOR]