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This systematic review aimed to compare the analgesic effectiveness and complications rates for anterior suprascapular nerve blocks (ASSB) compared to interscalene brachial plexus blocks (ISB) for arthroscopic and outpatient shoulder surgery. Only randomized controlled trials (RCTs) comparing the ASSB versus ISB in the context of arthroscopic shoulder surgery were eligible for inclusion. The primary outcomes included pain scores (Numeric Rating Scale of 0 to 10) up to 24 h postoperatively and analgesic consumption. Secondary outcomes included block complications. Meta-analysis was performed using random-effects modeling and result certainty was determined using the GRADEpro tool. Six RCTs (709 patients) were included for analysis. ISB displayed a statistically significant reduction in pain scores by 0.40 (95%CI = 0.36 to 0.45; p < 0.00001) but not morphine equivalent consumption (mean difference = 0.74 mg; 95%CI = - 0.18 to 1.66 mg; I.sup.2 = 60%; p = 0.11; moderate certainty) immediately in the postoperative care unit. Opioid consumption and pain scores at 6 to 24 h were not significantly different. There was no difference in respiratory events postblock. ASSB demonstrated a significantly lower incidence of Horner's syndrome (relative risk (RR) = 0.17; 95%CI = 0.08 to 0.39; p < 0.00001; high certainty), voice hoarseness (RR = 0.24; 95%CI = 0.10 to 0.57; p < 0.00001; high certainty) and impaired respiratory function (p < 0.00001). The ASSB could be considered an appropriate analgesic option for arthroscopic shoulder surgery with potentially fewer complications than the ISB., Author(s): Leigh White [sup.1], Damon Reardon [sup.1], Keiran Davis [sup.1], Gina Velli [sup.2], Matthew Bright [sup.3] [sup.4] Author Affiliations: (1) Department of Anesthesia and Perioperative Medicine, Sunshine Coast Hospital and [...]

Byline: Chethan. Vamshi, Chandni. Sinha, Ajeet. Kumar, Abhyuday. Kumar, Poonam. Kumari, Amarjeet. Kumar, Sudeep. Kumar, S. Arun Background and Aims: Hip replacement surgery is a commonly performed surgery with the [...]

Byline: Suman. Saini, Shruti. Rao, Nidhi. Agrawal, Anju. Gupta Background and Aims: Arthroscopic orthopaedic surgery may lead to significant postoperative pain. Interscalene block (ISB) is associated with undesirable effects like [...]

Byline: Isha. Sharma, Shelly. Rana, Bharti. Choudhary, Tanvi. Dhiman, Sheena. Sharma, Mahesh. Kumar Background and Aim: Intrathecal and intravenous dexmedetomidine has been used as adjuvant in subarachnoid block [SAB]. The [...]

Background: The increasing incidence of hip fractures in our aging population challenges orthopedic surgeons and hospital administrators to effectively care for these patients. Many patients present to regional hospitals and are transferred to tertiary care centres for surgical management, resulting in long delays to surgery. Providing timely care may improve outcomes, as delay carries an increased risk of morbidity and mortality. Methods: We retrospectively reviewed the cases of all patients with hip fractures treated in a single Level 1 trauma centre in Canada between 2005 and 2012. We compared quality indicators and outcomes between patients transferred from a peripheral hospital and those directly admitted to the trauma centre. Results: Of the 1191 patients retrospectively reviewed, 890 met our inclusion criteria: 175 who were transferred and 715 admitted directly to the trauma centre. Transfer patients' median delay from admission to operation was 93 hours, whereas nontransfer patients waited 44 hours (p < 0.001). The delay predominantly occurred before transfer, as the patients had to wait for a bed to become available at the trauma centre. The median length of stay in hospital was 20 days for transfer patients compared with 13 days for nontransfer patients (p < 0.001). Regional policy changes enacted in 2011 decreased the median transfer delay from regional hospital to tertiary care centre from 47 to 27 hours (p = 0.005). Conclusion: Policy changes can have a significant impact on patient care. Prioritizing patients and expediting transfer will decrease overall mortality, reduce hospital stay and reduce the cost of hip fracture care. Contexte: L'incidence croissante des fractures de la hanche dans notre population vieillissante pose un defi aux chirurgiens orthopedistes et aux administrateurs hospitaliers qui souhaitent offrir des soins efficaces a ces patients. De nombreux patients se presentent dans des hopitaux regionaux avant d'etre transferes dans des centres de soins tertiaires pour y etre operes, ce qui retarde la chirurgie. Fournir les soins requis en temps voulu pourrait ameliorer les resultats etant donne que tout retard s'accompagne d'un risque accru de morbidite et de mortalite. Methodes: Nous avons effectue une revue retrospective de tous les cas de fracture de la hanche traites dans un centre canadien de traumatologie de niveau 1 entre 2005 et 2012. Nous avons compare les indicateurs de qualite et les resultats entre les patients transferes d'un hopital regional et les patients admis directement au centre de traumatologie. Resultats: Parmi les 1191 cas analyses retrospectivement, 890 repondaient a nos criteres d'inclusion: 175 avaient ete transferes et 715 avaient ete admis directement au centre de traumatologie. Le delai median entre l'admission et la chirurgie chez les patients transferes a ete de 93 heures, alors que les patients non transferes ont attendu 44 heures (p < 0,001). Le delai est principalement survenu avant le transfert, car les patients devaient attendre qu'un lit se libere au centre de traumatologie. La duree mediane du sejour hospitalier a ete de 20 jours pour les patients transferes, contre 13 jours pour les patients non transferes (p < 0,001). Les changements apportes a la politique regionale en 2011 ont abrege de 47 a 27 heures (p = 0,005) le delai median avant le transfert des hopitaux regionaux vers le centre de soins tertiaires. Conclusion: Les changements de politiques peuvent avoir un impact significatif sur les soins aux patients. Prioriser les cas et accelerer les transferts reduiront la mortalite globale, abregeront les sejours hospitaliers et reduiront les couts associes au traitement des fractures de la hanche., Hip fractures are among the most common orthopedic injuries requiring hospital admission. As the incidence of hip fractures increases, surgeons and administrators are increasingly challenged to provide care for these [...]