bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ultrasound-guided popliteal plexus block versus fascia iliaca block for postoperative analgesia after total knee arthroplasty: a randomized clinical trial
Authors: Abdelraheem Taysser M. , Naguib Tamer M. , Algyar Mohammad Fouad 
Published: February 2024

Background: Regional nerve blocks have attained a popularity for total knee arthroplasty (TKA) because they can anesthetize a wider area with a prolonged postoperative analgesic effect. This clinical trial compared postoperative pain control using popliteal plexus blockade (PPB) and fascia iliaca block (FIB) in cases of TKA.
Methodology: This double-blinded randomized clinical trial enrolled 60 patients planned for unilateral, primary TKA under spinal anesthesia. Participants were randomly allocated to either the PPB group or the FIB group. The blocks were performed at the end of surgery. Postoperative pain was measured on Numeric Rating Scale (NRS) during rest, and on arrival in PACU, then at 1, 2, 4, 8, and 24 h. Time to first rescue, total morphine consumption and any complications / side-effects were noted in both groups.
Results: Numeric rating scale (NRS) scores at 8 h and 12 h during rest, and at 4 h, 8 h, and 12 h during movement were significantly lower in the FIB group than in the PPB group. Morphine consumption in the first 24 h postoperative was significantly lower in the FIB group than in the PPB group. Time to first rescue was delayed significantly in the FIB group than PPB group. Rehabilitation was comparable between the two groups. Patient satisfaction, postoperative nausea and vomiting, hypotension, and bradycardia were comparable between both groups.
Conclusions: Fascia iliaca block was superior to popliteal plexus blockade in controlling postoperative pain after total knee arthroplasty, as evidenced by lower pain scores, lesser postoperative morphine consumption, and delayed time to first analgesic request with comparable minimal adverse events.
Abbreviations: TKA - Total Knee Arthroplasty; PPB - Popliteal Plexus Blockade; FIB - Fascia Iliaca Block; PONV - Postoperative Nausea / Vomiting; IQR - Interquartile Range; NRS - Numerical Rating Scale; PACU - Post Anesthesia Care Unit; LLS - Lower Limb Surgery; PCA - Patient-Controlled Analgesia
Preregistration: The study was performed from June 2022 to March 2023 at Tanta University Hospitals, Egypt, after approval from the Tanta University Hospitals Ethical Committee (approval code: 35431/04/22) and registration of clinicaltrials.gov (ID: NCT05390450).
Key words: Popliteal Plexus Block; Fascia Iliaca Block; Total Knee Arthroplasty; Analgesia
Citation: Abdelraheem TM, Naguib TM, Algyar MF. Ultrasound-guided popliteal plexus block versus fascia iliaca block for postoperative analgesia after total knee arthroplasty: a randomized clinical trial. Anaesth. pain intensive care 2023;27(5):555−561; DOI: 10.35975/apic.v27i5.2311
Received: June 17, 2023; Reviewed: July 05, 2023; Accepted: August 16, 2023
Comparison of intermittent boluses of noradrenaline vs. phenylephrine for spinal anesthesia induced hypotension during cesarean delivery
Authors: Nguyen Thang Toan , Nguyen Hao Canh , Nguyen Anh Thi Hong , Doan Trung Hieu , Ngo Quy Sy 
Published: February 2024

Background and Objective: Maternal hypotension is a common consequence of spinal anesthesia for cesarean delivery (CD). A vasopressor is recommended in addition to adequate fluid loading to raise mean arterial pressure in pregnant women. Phenylephrine, a pure α–adrenergic receptor agonist, is the first-line agent to manage it. However, phenylephrine is associated with dose-dependent reflex bradycardia and decreased cardiac output. Noradrenaline is suggested as an alternative due to its mild beta-adrenergic effect, which results in a greater heart rate and cardiac output than phenylephrine. We compared the effectiveness and adverse effects of intermittent boluses of noradrenaline with phenylephrine to treat spinal-induced hypotension during CD.
Methodology: A randomized controlled trial was conducted at Bach Mai Hospital, Vietnam, from May 2020 to August 2020. There were 120 pregnant women undergoing elective CD under spinal anesthesia enrolled in the study and divided randomly into two groups: the Group N and the Group P. Group N patients were given noradrenaline 6 µg as an intravenous bolus, and Group P patients were given phenylephrine 100 µg to treat spinal-induced hypotension. The primary outcome was the number of bolus doses of vasopressors needed to treat maternal hypotension. Secondary outcomes were bradycardia, hypertension, nausea, vomiting, umbilical arterial blood gases, and APGAR scores.
Results: The number of boluses of vasopressors needed to treat hypotension and maternal hemodynamic changes was equivalent in both groups. The incidence of bradycardia, nausea, and vomiting in the two groups was not significantly different. No pregnant woman suffered from unintended hypertension. APGAR scores were 7 and above at one min and 10 and above at five min for all cases. There were no differences in umbilical arterial pH values between the two groups (7.33 vs. 7.34; P > 0.05).
Conclusion: Noradrenaline 6 µg and phenylephrine 100 µg boluses were equally effective in treating spinal-induced hypotension in parturients undergoing cesarean delivery with similar neonatal and maternal outcomes.
Abbreviations: CD - Cesarean Delivery; HR - Heart Rate; CO - Cardiac Output; SVR - Systemic Vascular Resistance; SBP - Systolic Blood Pressure; ED 90 - 90 Percent Effective Dose
Key words: Anesthesia, Spinal; Hypotension; Cesarean Delivery
Citation: Nguyen TT, Nguyen HC, Nguyen ATH, Doan TH, Ngo QS. Comparison of intermittent boluses of noradrenaline vs. phenylephrine for spinal anesthesia induced hypotension during cesarean delivery. Anaesth. pain intensive care 2023;27(5):562−566.
DOI: 10.35975/apic.v27i5.2312
Received: August 22, 2023; Reviewed: August 23, 2023; Accepted: August 31, 2023
Incidence of preoperative anxiety and associated features in children undergoing general anesthesia for a surgery in Middle East population
Authors: Huda Anwar Ul , Arif Asim , Asim Zohaib 
Published: February 2024

Background: Children usually experience anxiety before undergoing general anesthesia. We did this prospective cross-sectional study to find the incidence of preoperative anxiety in children undergoing surgery in a tertiary care hospital.
Methodology: This study was conducted at Security Forces Hospital, Riyadh, Kingdom of Saudi Arabia. We included children aged 2-12 y, who were planned to undergo general anesthesia for surgery. Preoperatively, children’s anxiety level was assessed using mYPAS (Modified Yale Preoperative Anxiety Scale) scale. We report the incidence of preoperative anxiety as numbers and percentages. We also report the features of children with preoperative anxiety.
Results: A total of 96 children were included in the study. The median anxiety score of children was 26.60 (23.3-41.66). The incidence of preoperative anxiety in pediatric patients was 42.7% (41 cases). The median age of children having preoperative anxiety was lower 55 (44-69.5) months vs 67 (35-90) months in children without anxiety. Sixty-three percent of children with preoperative anxiety underwent ENT and dental surgeries.
Conclusion: We found an incidence of 42.7% of preoperative anxiety in children undergoing surgery at our hospital.
Key words; Preoperative Anxiety; Anxiety Score; General Anesthesia; PACU
Citation: Huda AU, Arif A, Asim Z. Incidence of preoperative anxiety and associated features in children undergoing general anesthesia for a surgery in Middle East population. Anaesth. pain intensive care 2023;27(5):575−578; DOI: 10.35975/apic.v27i5.2314
Received: August 05, 2023; Reviewed: August 21, 2023; Accepted: August 26, 2023
Incidental epidural fluid collection – differential approach considerations
Authors: Khan Ejaz 
Published: February 2024

When patient care requires spinal/epidural needle re-entry at the same level as a recent spinal/epidural procedure, clear fluid may appear at the needle hub. This fluid has a differential: it may be iatrogenic, cerebrospinal fluid that leaked following a prior dural puncture, or cerebrospinal fluid freshly drawn from the spinal column. To date, there is no clear guideline on how to navigate this situation. In this brief case series, we present two distinct clinical scenarios that require properly identifying the source and nature of this fluid. We also highlight the lack of a standardized approach to differentiating clear fluid at the spinal/epidural needle hub, discuss our thoughts on how this can be rectified and what point-of-care tools may be useful.
Key words: Case Report; Epidural Anesthesia; Epidural Blood Patch; Point-Of-Care Testing; Spinal Anesthesia
Citation: Khan E, Rozenfeld L, Nawaz S, Khamash O, Girshin S, Woodruff B, Mendonca R. Incidental epidural fluid collection – differential approach considerations. Anaesth. pain intensive care 2023;27(5):619−621; DOI: 10.35975/apic.v27i5.2321
Received: May 23, 2023; Reviewed: June 27, 2023; Accepted: August 10, 2023
Monitoring in anesthesiology
Authors: Khan Tariq Hayat 
Published: February 2024

Near infrared spectroscopy (NIRS) is a non-invasive monitoring modality, which is still not very commonly available, so most of the anesthesiologist in this part of the world might not have heard it. A case series by Purwoko et al. is being published in this issue of Anaesthesia, Pain & Intensive Care under the title of, ‘How NIRS can predict the outcome of patient in low systemic pressure: a case series’. This editorial is just a complement to that case series, and highlights the importance for the anesthesiologists to keep themselves abridged with the on-going developments. It also emphasizes on provision of training facilities in the centers of postgraduate training. The journey of monitoring during anesthesia has not reached its end point. More and more complex modalities are being introduced. Perhaps, we need to formulate category-wise guidelines for monitoring from basic to more complex monitoring.
Key words: Anesthesia; Guidelines; Monitoring; Near infrared spectroscopy
Citation: Khan TH. Monitoring in anesthesiology. Anaesth. pain intensive care 2023;27(6):622−624; DOI: 10.35975/apic.v27i6.2344
Sphenopalatine ganglion block vs greater occipital nerve block in the management of post dural puncture headache in obstetric patients: a randomized clinical trial
Authors: Abdelrazik Rehab A. , Toulan Heba F. , Ayoub Sabah Naguib Barsoom 
Published: February 2024

Background: With the increased popularity of spinal anesthesia for a variety of surgeries, the anesthesiologists have to face the increased incidence of post dural puncture headache (PDPH). It is especially cumbersome to the obstetric patients. A variety of management techniques have been used. We compared the efficacy of sphenopalatine ganglion block (SPGB) versus greater occipital nerve block (GONB) for the management of PDPH in obstetric cases.
Methodology: This prospective, randomized trial, enrolled 120 PDPH cases into two groups. The SPGB group received bilateral SPGB with a 3 ml mixture of 2% lidocaine and 4 mg dexamethasone (in each nostril). In the GONB group, the greater occipital nerves were blocked utilizing a solution of 3 ml mixture of 2% lidocaine and 4 mg dexamethasone on each side. Prior to the procedure, a pain score on numerical pain scale (NPS) was reported. Pain scores were noted at 15 and 30 min, then at 2, 4, 8, 16, and 24 h after the intervention. Need for and cumulative dose of analgesics used were recorded. Complications, patient satisfaction, hospital stay for epidural blood patch (EBP), and hospital discharges were also recorded.
Results: Pain perception in upright position at 30 min and at 2, 16, and 24 h, the need for rescue analgesia and the cumulative analgesic dose within 24 h were significantly lower in SPGB group. Bitter taste was significantly more frequently complained by the patients of SPGB group. In the SPGB group, the EBP was not significantly less prevalent. In the SPGB group, patient satisfaction was noticeably greater.
Conclusion: The sphenopalatine ganglion block is more effective in relieving PDPH and its associated symptoms than the greater occipital nerve block. Both procedures are easy, safe, more conservative than EBP, and without serious adverse effects. The sphenopalatine ganglion block can be recommended as a first line treatment for PDPH.
Abbreviations: ASA: American Association of Anesthesiologists; CI: Confidence Interval; CSF: Cerebral Spinal Fluid; EBP: Epidural Blood Patch; GON: Greater Occipital Nerve; GONB: Greater Occipital Nerve Block; PDPH: Post-Dural Puncture Headache; RR: Relative Risk; SPGB: Sphenopalatine Ganglion Block; NPS: Numerical Pain Scale
Key words: Nerve Block; Obstetrical Analgesia; Post-Dural Puncture Headache; Sphenopalatine Ganglion Block
Citation: Abdelrazik RA, Toulan HF, Ayoub SNB, Sphenopalatine ganglion block vs greater occipital nerve block in the management of post dural puncture headache in obstetric patients: a randomized clinical trial. Anaesth. pain intensive care 2024;28(1):68-73; DOI: 10.35975/apic.v28i1.2143
Received: January 27, 2023; Reviewed: March 02, 2023; Accepted: March 02, 2023
Role of preoperative dexamethasone nebulization versus ketamine nebulization in reducing complications of nasogastric tube after laparoscopic surgery
Authors: Zakaria Mai Mohammed , Aboulella Sahar Kamal Mohammed , Hassanein Sahar Mohammed Kamal , El Hennawy Ahmed Mohammed Elsayed , Din Shabana Tarek Samir Salah El 
Published: February 2024

Background & objective: Nasogastric (NG) tube insertion is a frequently performed medical procedure. Most of the time, the oropharyngeal discomfort is usually underestimated, and insertions are carried out with just regular lubricant jelly and no additional painkillers, which results in less-than-ideal pain management. We compared the effectiveness of preemptive use of nebulized ketamine and dexamethasone in preventing post-operative sore throat following NG tube insertion in laparoscopic surgery.
Methods: This prospective randomized double-blind controlled study was carried on 108 patients of both sexes with ASA physical status I-II. aged 20-60 years, undergoing laparoscopic abdominal surgeries under general anesthesia. Patients were randomized into 3 equal groups. Group D received a dose of 8 mg nebulized dexamethasone. Group K received 50 mg nebulized ketamine. Group S received 5 ml of nebulized saline. NG tube was passed after induction of general anesthesia. Postoperative sore throat was enquired from the patients at full recovery (zero hour), then at 2, 8, 12 and 24 h. Computer software (SPSS 15.0.1. for Windows; SPSS Inc, Chicago, IL, 2001) was used for data analysis. Non-parametric quantitative data, median, range, percentages, and numbers are given for qualitative data. The appropriate analysis was conducted in line with the data obtained. P < 0.05 was regarded as significant.
Results: The incidence of postoperative sore throat (POST) was lower with both nebulized dexamethasone and nebulized ketamine compared with nebulized saline; and significantly lower with dexamethasone compared with ketamine at 0 h (P < 0.001), 2 h (P < 0.001), 8 h (P < 0.001), 12 h (P < 0.001), and 24 h (P < 0.001).
Conclusion: The current study revealed that preoperative nebulized dexamethasone was more effective than nebulized ketamine in reducing postoperative sore throat.
Abbreviations: NG- Nasogastric; NMDA- N-Methyl-D-Aspartate; PONV- Postoperative Nausea and Vomiting; POST- Postoperative Sore Throat; VAS- Visual Analogue Scale
Key words: Nebulization; Dexamethasone; Ketamine; Laparoscopic Surgery; Nasogastric Tube
Citation: Zakaria MM, Mohammed Aboulella SK, Hassanein SMK, Elsayed El Hennawy AM, Salah El Din Shabana TS. Role of preoperative dexamethasone nebulization versus ketamine nebulization in reducing complications of nasogastric tube after laparoscopic surgery. Anaesth. pain intensive care 2024;28(1):62-67.
DOI: 10.35975/apic.v28i1.2275
Received: 22 July, 2023; Reviewed: 04 October 2023; Accepted: 30 October 2023
Effect on emergence from anesthesia following induction with diazepam and its association with CYP2C9, CYP2C19 and CYP3A4 gene polymorphisms
Authors: Mittal Tulika , Badhe VK , Badhe DS Divekar , Ahluwalia Pallavi , Mittal Balraj , Mittal Rama 
Published: February 2024

Introduction & Objectives: Benzodiazepines are commonly used as adjuvants to IV anesthetic agents. Diazepam dosage varies widely depending on the desired endpoints. The rationale behind such inter-individual variability in drug responses has been attributed to genetically determined alterations in the enzyme activities. We assessed the emergence time in patients after induction of anesthesia with two different doses of diazepam and evaluated if any correlation exists between the emergence time and genetic polymorphism in drug metabolizers CYP2C19, CYP2C9, and CYP3A4 genes.
Methodology: The study was conducted on randomly selected adult patients scheduled for elective surgery between 40-60 y of age with predefined inclusion and exclusion criteria. The patients were distributed into 2 groups, with group 1 receiving 0.2 mg/kg and group 2 given 0.3 mg/kg diazepam. Wake-up time after surgery was determined after a standardized verbal command played by a tape-recorder. Three ml blood in Ethylenediaminetetraacetic acid (EDTA) was collected before administering anesthesia.
Results: Wake-up time between 8-18 min did not vary between the two groups. Comparatively persons having 2C19 2 took longer time to wake-up but this association was not statistically significant. However, CYP2C9 2 and 2 C9 3 and CYP3A4 genotypes had no influence on wake-up time.
Conclusion: The pilot study suggests the emergence time from diazepam is longer in patients having 2C19 2 which confers slow-metabolizer phenotype. However, this study needs to be replicated in larger sample size to arrive at definitive conclusions before clinical applications.
Abbreviations: BDZ- benzodiazepine; EDTA- Ethylenediaminetetraacetic acid; GA-General Anesthesia
Key words: Diazepam; Emergence; Gene Polymorphism; Pharmacogenetics
Citation: Mittal T, Badhe VK, Badhe DSD, Ahluwalia P, Mitta Bl, Mittal R. Effect on emergence from anesthesia following induction with diazepam and its association with CYP2C9, CYP2C19 and CYP3A4 gene polymorphisms. Anaesth. pain intensive care 2024;28(1):126-138. DOI: 10.35975/apic.v28i1.2380
Received: July 20, 2023; Reviewed: December 07, 2023; Accepted: December 07, 2023
Preventing Ocular Surface Foreign Body Complications: Enhancing Awareness and Precaution
Authors: Khalid Amber , Ayoob Muhammad , Masood Ambreen , Nashit Muhammad , Sayeed Faiza Zafar , Fatima Aveen 
Published: February 2024

Background: Ocular surface foreign bodies are the second most common emergency condition in the ophthalmology department OPD, which can be easily prevented through proper precautionary measures. Also, they can be either superficial or embedded into the cornea or conjunctiva. In this study, we aimed to create awareness regarding the prevention and management of such cases to reduce ocular complications.
Methods: This prospective cross-sectional study was carried out in the Ophthalmology department of Ziauddin University Hospital Karachi. The study duration was 4 years from 16th November 2019 to 15 November 2022. Patients presented to the ophthalmology department OPD with complaints of ocular foreign bodies were examined clinically and a total of 427 patients were included in the study who fulfilled the inclusion criteria. The data was collected and analyzed on SPSS 23. The chi-square test was used to compare the variables.
Results: Our study analyzed that ocular surface foreign bodies had a strong association with the profession. The metallic foreign bodies were found in 283(66.3%) patients and the remaining 144 (37.7%) were non-metallic. There was a strong correlation found between the type of foreign body and the site of ocular involvement. The p-value was significant with 0.0001.
Conclusion: The majority of ocular surface foreign bodies were workplace-related due to a lack of awareness of protective measures. A counseling workshop should be arranged regarding its importance for workers in their workplaces which will improve their work capacity, and health and reduce economic burden.
Displasia do Desenvolvimento do Quadril
Authors: dos Santos Coelho Rosylaura , Caleiro Rodrigues Pereira Brunno , Campagnon da Silva Larissa , Lemes Ferreira Thalita , Ilva Franklin Danieli S , Bianchi da Costa Júlia , Silva Larissa Almeida , Selegato Tasso Letícia , Sousa da Silva Rafaela , Fernandes Eleutério Rafael , Matheus Doerner Roberto , Alves Martins de Araújo Tristão Maria Eugênia 
Published: February 2024

Objetivo: O objetivo geral do presente estudo consiste em analisar a produção científica acerca dos métodos de rastreio utilizados para o diagnóstico precoce e oportuno da DDQ, além de averiguar os recursos e métodos terapêuticos disponíveis para o tratamento da mesma. Metodologia: As buscas foram realizadas por meio de pesquisas nas bases de dados PubMed Central (PMC). e Biblioteca Virtual de Saúde (BVS). Foram utilizados seis descritores em combinação com o termo booleano “AND”: Developmental Dysplasia of the Hip, Orthopedics, Clinical Diagnosis, Risk Factors, pediatrics e Signs and Symptoms. Sendo encontrado 200 artigos, posteriormente submetidos aos critérios de seleção. Foram selecionados 16 estudos. Resultados: A displasia do desenvolvimento do quadril (DDQ) é considerada a doença congênita mais comum do sistema músculo-esquelético que acomete recém-nascidos, a DDQ representa um amplo espectro de patologia, se não tratada adequadamente pode causar complicações como danos secundários ao fêmur, destruição da cartilagem articular e até mesmo comprometimento grave do movimento. Conclusão: O rastreio clínico da DDQ é considerado vantajoso em relação a nenhum rastreio, tanto em termos de custo como de resultados favoráveis. O manejo da DDQ varia de acordo com dois fatores, a idade e a gravidade da doença. Em bebês com menos de seis meses a recomendação é aplicar uma tala de abdução e controlar a progressão da doença através de ecografia seriada, se não houver resposta adequada à imobilização ele poderá ser submetido a um procedimento cirúrgico.