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Menglin Liu,1 Mingyang Gao,1 Yufei Hu,1 Xiaoqin Ren,1 Yanan Li,1 Fang Gao,1 Jianglong Dong,1 Jiangtao Dong,2 Qiujun Wang1 1Department of Anesthesiology, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, People’s Republic of China; 2Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, People’s Republic of ChinaCorrespondence: Qiujun Wang, Third Hospital of Hebei Medical University, No. 139, Ziqiang Road, Shijiazhuang City, Hebei, People’s Republic of China, Tel/Fax +86-311-8860-2072, Email wangqiujunsy@163.comPurpose: Patients undergoing arthroscopic hip surgery (AHS) require good analgesia and early rehabilitation after surgery, and there is no consensus on the optimal nerve block. We aimed to compare the efficacy of the pericapsular nerve group (PENG) block with lateral femoral cutaneous nerve (LFCN) block compared to fascia iliaca compartment block (FICB) in patients with AHS.Patients and Methods: A total of 80 patients receiving AHS under general anesthesia were randomized to receive either FICB (group F) or PENG block in combination with LFCN block (group P). The primary outcomes were the rate of quadriceps weakness after block on the afflicted side, as well as muscle strength grading and pain score after block, and the quality of recovery on the second postoperative day.Results: Compared with group F, group P had a lower incidence of quadriceps weakness 48 h after block (76.9% vs 28.2%, P < 0.001), and had less impact on muscle strength grade and lower static pain score at 6, 12, 18, 24, 36, and 48 h after block (P < 0.001), and a lower dynamic pain score at 6 and 12 h after block in group P (p < 0.05). The quality of recovery on the second postoperative day improved (p < 0.05).Conclusion: In comparison to FICB, PENG block in combination with LFCN block can affect less quadriceps muscle strength and reduce the use of postoperative analgesics, which is beneficial for the postoperative recovery of AHS patients.Keywords: analgesia, fascia iliaca compartment block, hip arthroscopy, nerve group block, pericapsular, postoperative pain

Background: An adequate early mobilization followed by an effective and pain-free rehabilitation are critical for clinical and functional recovery after hip and proximal femur fracture. A multimodal approach is always recommended so as to reduce the administered dose of analgesics, drug interactions, and possible side effects. Peripheral nerve blocks should always be considered in addition to spinal or general anesthesia to prolong postoperative analgesia. The pericapsular nerve group (PENG) block appears to be a less invasive and more effective analgesia technique compared to other methods. Methods: We conducted multicenter retrospective clinical research, including 98 patients with proximal femur fracture undergoing osteosynthesis surgery within 48 h of occurrence of the fracture. Thirty minutes before performing spinal anesthesia, 49 patients underwent a femoral nerve (FN) block plus a lateral femoral cutaneous nerve (LCFN) block, and the other 49 patients received a PENG block. A non-parametric Wilcoxon–Mann–Whitney (α = 0.05) test was performed to evaluate the difference in resting and dynamic numerical rating scale (NRS) at 30 min, 6 h, 12 h, and 24 h. Results: the PENG block administration was more effective in reducing pain intensity compared to the FN block in association with the LFCN block, as seen in the resting and dynamic NRS at thirty minutes and 12 h follow-up. Conclusion: the PENG block was more effective in reducing pain intensity than the femoral nerve block associated with the lateral femoral cutaneous nerve block in patients with proximal femur fracture undergoing to osteosynthesis. [ABSTRACT FROM AUTHOR]

Frozen shoulder is a condition of varying severity characterized by the gradual development of global limitation of active and passive shoulder motion where radiographic findings are limited and associated with severe shoulder pain. Frozen shoulder is also referred to as adhesive capsulitis, painful stiff shoulder, and periarthritis. Treatment typically focuses on reducing shoulder pain and restoring joint mobilisation. In the context of shoulder mobilization, the predominant nerve blocks encompass the interscalene, supraclavicular upper trunk block collectively referred to as the SCUT block, as well as the axillary nerve block. These nerve blocks demonstrate high efficacy in delivering targeted analgesia. However, a notable limitation of these interventions is the concomitant motor blockade and phrenic nerve block induced by them. This motor blockade poses a significant impediment to the initiation of early rehabilitation, thereby delaying the commencement of rehabilitative exercises and intervention. Shoulder Anterior Capsular Block is a motor sparing block which can be effectively used in shoulder mobilisation.

BACKGROUND: The pallidum is a target for stereotactic surgery either by lesioning or deep brain stimulation (DBS) and it plays an important role in the functional stereotactic neurosurgery. DBS is a high cost method for treatment of parkinsonism especially for low income countries like Egypt, but it is reversible. On the contrary, ablation is a low cost method but it is irreversible. OBJECTIVE: The aim of this study was to introduce a novel application for mechanical pallidotomy by air concussion and intermittent inflation and deflation for treatment of parkinsonism and as a pre-DBS maneuver. PATIENTS AND METHODS: We operated on 6 patients with parkinsonism. We injected 2ml of hypertonic saline through 5ml syringe at the pericapsular area using Leksell stereotactic frame. RESULTS: Five cases (83.3%) showed good response to the maneuver with disappearance of the tremors for 1-6 months, while only one patient 16.7% showed no response. CONCLUSION: Non-destructive pallidal disruption for management of parkinsonism is a safe and effective transient maneuver. We are planning to apply microballoning and air concussion techniques to make it permanent and our future directions is to include more cases. We can use this maneuver as a pre-DBS stage to ensure the patient is a good candidate for DBS. [ABSTRACT FROM AUTHOR]

Background: Postoperative pain after hip arthroscopy remains a major cause of patient dissatisfaction in the immediate postoperative period. Adequate postoperative analgesia is associated with increased patient satisfaction, earlier mobilization, and decreased opioid consumption., Objectives: Therefore, there is a need for safe, reliable, and opioid- and motor-sparing methods of achieving postoperative analgesia following hip arthroscopy. We evaluated the efficacy of pericapsular nerve group (PENG) block vs fascia iliaca block (FIB) in reducing postoperative pain and analgesic consumption in the first 24 hours following hip arthroscopy., Study Design: A prospective randomized double-blinded control clinical trial., Setting: At the arthroscopy unit of the orthopedic department of Assiut University Hospitals, Assiut, Egypt from 2019 to 2022., Methods: Forty-three patients comprising 18 women and 25 men scheduled for hip arthroscopy were randomized to receive a preoperative block with PENG or FIB from March 2019 to March 2022. The mean age was 27.9 years (standard deviation [SD], 6.2 years; range, 18-42 years) and the mean body mass index was 25.13 kg/m2 (SD, 5.08 kg/m2). Patients were randomized into 2 groups: group A comprising 20 patients that received FIB; and group B comprising 23 patients that received PENG block. The efficacies of FIB and PENG block were evaluated using Visual Analog Scale scores., Results: Statistically significant differences in median pain scores and mean at rest pain scores were observed between the 2 groups at all measured time points following surgery (i.e., 6, 12, 18, and 24 hours). Further, dynamic pain scores (with hip flexion) scores significantly differed between the 2 groups at 24 hours postoperatively (P = 0.001). PENG block significantly decreased postoperative opioid use compared to FIB. Total opioid use in the 24-hour postoperative period was lower in the PENG group compared to the FIB group (16.5 ± 9.9 vs 27.5 ± 9.6; P < 005)., Limitations: Different hip pathologies and different interventions lead to different outcomes. Also, a larger sample size and longer follow-up duration are required., Conclusions: PENG block may represent the ideal regional anesthesia modality for hip arthroscopy as an alternative to more conventional regional nerve blocks, such as FIB, femoral nerve block, and lumbar plexus block. PENG block is reproducible, easily performed in the preoperative setting, and appears to spare motor function while providing prolonged sensory analgesia.