Background and Objective: Hip fractures among the elderly continue to be a serious public health concern. Hip fractures result in extremely painful injuries and given the higher risk of the elderly for complications, managing pain in this population can be challenging. This study aimed to describe the outcomes of peripheral nerve blocks on elderly patients with fragility hip fractures who will undergo elective or emergency hip surgery. Methods: A single-center prospective cohort study was conducted at the Philippine General Hospital from May 2022 to November 2022. Patients included were aged 60 years old and above with fragility hip fracture, for elective or emergency hip surgery, and with American Society of Anesthesiologists (ASA) Physical Status Score 1–3. Patients’ baseline profile, intraoperative characteristics, and postoperative outcomes were collected using a standard data collection form. The data collector was blinded to the type of block performed. Results: A total of 29 patients who underwent hip surgery were included in the study. Most (65.5%) had Subarachnoid block + Peripheral Nerve Block (SAB+PNB) while 24.1% had General Anesthesia + Peripheral Nerve Block (GA+PNB) and 10.3% had no Peripheral Nerve Block (PNB). The median Numerical Rating Scale (NRS) 30 minutes post block was similar (p=0.977) in those who had PNB blocks (GA+PNB = 0, SAB+PNB = 0). The median NRS at rest during Postoperative day 1 (POD1) was significantly highest (p=0.023) in the No PNB group (3) than in both GA+PNB (0) and SAB+PNB (0). In contrast, the median NRS at rest during POD2 was similar (p=0.713) in the three groups (GA+PNB = 0, SAB+PNB = 0, No PNB = 0). The median NRS at motion during POD1 was significantly highest (p=0.008) in the No PNB group (6) than in both GA+PNB (0) and SAB+PNB (1). Also, the median NRS at motion during POD2 was significantly highest (p=0.009) in No PNB group (4) than in both GA+PNB (0) and SAB+PNB (1). Median Morphine Milligram Equivalent (MME) of postoperative opioid was significantly higher in the No PNB group among the three groups (p=0.047). The median satisfaction score (p=0.210), median delirium score at POD2 (p=0.993), and median length of hospitalization (p=0.173) were all similar in the three groups. Conclusion Peripheral nerve block is effective in elderly patients undergoing surgery for fragility hip fractures. It results in lower pain scores and can be administered with equal effectiveness either with general anesthesia or with subarachnoid block. Mortality rate, incidence of delirium, and hospital length of stay did not vary between those with and without peripheral nerve block.
regional anesthesia ; anesthesia, conduction

Background and Objective: Hip fractures among the elderly continue to be a serious public health concern. Hip fractures result in extremely painful injuries and given the higher risk of the elderly for complications, managing pain in this population can be challenging. This study aimed to describe the outcomes of peripheral nerve blocks on elderly patients with fragility hip fractures who will undergo elective or emergency hip surgery. Methods: A single-center prospective cohort study was conducted at the Philippine General Hospital from May 2022 to November 2022. Patients included were aged 60 years old and above with fragility hip fracture, for elective or emergency hip surgery, and with American Society of Anesthesiologists (ASA) Physical Status Score 1–3. Patients’ baseline profile, intraoperative characteristics, and postoperative outcomes were collected using a standard data collection form. The data collector was blinded to the type of block performed. Results: A total of 29 patients who underwent hip surgery were included in the study. Most (65.5%) had Subarachnoid block + Peripheral Nerve Block (SAB+PNB) while 24.1% had General Anesthesia + Peripheral Nerve Block (GA+PNB) and 10.3% had no Peripheral Nerve Block (PNB). The median Numerical Rating Scale (NRS) 30 minutes post block was similar (p=0.977) in those who had PNB blocks (GA+PNB = 0, SAB+PNB = 0). The median NRS at rest during Postoperative day 1 (POD1) was significantly highest (p=0.023) in the No PNB group (3) than in both GA+PNB (0) and SAB+PNB (0). In contrast, the median NRS at rest during POD2 was similar (p=0.713) in the three groups (GA+PNB = 0, SAB+PNB = 0, No PNB = 0). The median NRS at motion during POD1 was significantly highest (p=0.008) in the No PNB group (6) than in both GA+PNB (0) and SAB+PNB (1). Also, the median NRS at motion during POD2 was significantly highest (p=0.009) in No PNB group (4) than in both GA+PNB (0) and SAB+PNB (1). Median Morphine Milligram Equivalent (MME) of postoperative opioid was significantly higher in the No PNB group among the three groups (p=0.047). The median satisfaction score (p=0.210), median delirium score at POD2 (p=0.993), and median length of hospitalization (p=0.173) were all similar in the three groups. Conclusion Peripheral nerve block is effective in elderly patients undergoing surgery for fragility hip fractures. It results in lower pain scores and can be administered with equal effectiveness either with general anesthesia or with subarachnoid block. Mortality rate, incidence of delirium, and hospital length of stay did not vary between those with and without peripheral nerve block.
regional anesthesia ; anesthesia, conduction

BACKGROUND: Whether regional anesthesia may help to prevent disease recurrence in cancer patients is still controversial. The stage of cancer at the time of diagnosis is a key factor that defines prognosis and is one of the most important sources of heterogeneity for the treatment effect. We sought to update existing systematic reviews and clarify the effect of regional anesthesia on cancer recurrence in late-stage cancer patients. METHODS: Medline, Embase, and Cochrane Library were searched from inception to September 2020 to identify randomized controlled trials (RCTs) and cohort studies that assessed the effect of regional anesthesia on cancer recurrence and overall survival (OS) compared with general anesthesia. Late-stage cancer patients were primarily assessed according to the American Joint Committee on Cancer Cancer Staging Manual (eighth edition), and the combined hazard ratio (HR) from random-effects models was used to evaluate the effect of regional anesthesia. RESULTS: A total of three RCTs and 34 cohort studies (including 64,691 patients) were identified through the literature search for inclusion in the analysis. The risk of bias was low in the RCTs and was moderate in the observational studies. The pooled HR for recurrence-free survival (RFS) or OS did not favor regional anesthesia when data from RCTs in patients with late-stage cancer were combined (RFS, HR = 1.12, 95% confidence interval [CI]: 0.58-2.18, P = 0.729, I2 = 76%; OS, HR = 0.86, 95% CI: 0.63-1.18, P = 0.345, I2 = 48%). Findings from observational studies showed that regional anesthesia may help to prevent disease recurrence (HR = 0.87, 95% CI: 0.78-0.96, P = 0.008, I2 = 71%) and improve OS (HR = 0.88, 95% CI: 0.79-0.98, P = 0.022, I2 = 79%). CONCLUSIONS RCTs reveal that OS and RFS were similar between regional and general anesthesia in late-stage cancers. The selection of anesthetic methods should still be based on clinical evaluation, and changes to current practice need more support from large, well-powered, and well-designed studies.
Anesthesia, Conduction ; Humans ; Neoplasms ; Recurrence

Background: Serratus anterior plane block (SPB) is a relatively new regional anesthetic technique that provides long-lasting anesthesia, extended postoperative analgesia, and demonstrates less consumption of opioid analgesic compared to local infiltration anesthesia (LIA). Objective: To compare the outcomes of SPB and LIA as anesthetic techniques among patients undergoing chest tube thoracostomy (CTT) insertion. Design: Cohort study. Setting: Department of Surgery, Southern Philippines Medical Center, from October 2017 to May 2019. Participants: 110 male and female patients aged >18 years old undergoing CTT given either SPB or LIA. Main outcome measures: Mean VAS during the procedure, at PACU, and 4, 8, 12, 16, 18, and 24 hours postoperatively. Main results: Of the 110 patients undergoing CTT in this study, 55 (50%) where under SPB, and the remaining 50% where under LIA. Compared to those under LIA, patients under the SPB group had significantly lower mean VAS during the procedure (4.02 ± 1.43 vs 2.76 ± 1.35; p<0.0001), and at post-anesthesia care unit (4.25 ± 1.87 vs 3.15 ± 1.56; p=0.0010). The mean level of physician's satisfaction on the procedure was significantly higher in the SPB group than in the LIA group (3.56 ± 0.50 vs 2.96 ± 0.33; p<0.0001). The mean dose of fentanyl as supplemental anesthetic agent was significantly higher in the LIA group than those in the SPB group (1.38 ± 0.59 vs 0.95 ± 0.29; p<0.0001). Similarly, the mean dose of nalbuphine, as rescue opioid dose, was significantly higher in the LIA group than in the SPB group (2.16 ± 0.57 vs 1.53 ± 0.57; p<0.0001). Conclusion Patients under SPB who underwent CTT had less pain during the procedure and at the PACU, and used lower doses of the supplemental anesthetic agent (fentanyl) during the procedure, and of the rescue opioid analgesic (nalbuphine), postoperatively.
Anesthesia, Conduction

Anesthesia, Conduction ; Nerve Block ; Ultrasonography ; Ultrasonography, Interventional

In this case report, we describe the use of ultrasound in the administration regional anesthesia for a super-super obese patient. A 23-year-old female patient (height 167.2 cm, weight 191.5 kg, body mass index 68.6 kg/m²) was admitted to the hospital for surgical repair of an anterior talofibular ligament rupture. We used ultrasound to help facilitate the administration of regional anesthesia. In the sagittal view of the lumbar spine, (with the patient in a sitting position) we were able to identify the border between the sacrum and the lumbar vertebral; in the transverse view, we were able to identify the transverse process, posterior dura, vertebral body, and the distance from the skin to the posterior dura. After skin marking, regional anesthesia was successfully performed. Based on this case study, we suggest that ultrasound can be very useful in regional anesthesia for severely obese patients.
Anesthesia ; Anesthesia, Conduction ; Body Mass Index ; Female ; Humans ; Ligaments ; Obesity ; Rupture ; Sacrum ; Skin ; Spine ; Ultrasonography ; Young Adult

OBJECTIVE: Recently, the cases about successful regional anesthesia using combined superficial cervical plexus block and interscalene brachial plexus block for clavicle surgery have been reported. The aim of this study was to compare regional anesthesia using combined superficial cervical plexus block and interscalene brachial plexus block with general anesthesia. METHODS: In this prospective randomized study, 26 patients scheduled for elective clavicle surgery were divided into two groups: the first group was general anesthesia group (GA group, n=13) and the second group for peripheral nerve block group (PNB group, n=13). Standardized general anesthesia was done to the patients assigned to the GA group and ultrasonography-guided combined superficial cervical plexus block and interscalene brachial plexus block was done to the patients assigned to the PNB group. Postoperative sedation scale was assessed at post-anesthesia care unit, and pain scale using 10-cm Visual Analog Scale (VAS) was assessed at immediate postoperative, 30 minutes, 1 hour, 6 hours, and 24 hours. Patients needed additional analgesics, and time for first analgesic demand and duration from surgery to discharge was recorded. RESULTS: The pain VAS scales were less in PNB group than GA group from immediate postoperative time to 6 hours. The patients' immediate postoperative sedation scale less than 4 were significantly less in PNS group than GA group. The duration from surgery to discharge was shorter in PNS group than GA group. CONCLUSION: Regional anesthesia using combined superficial cervical plexus block and interscalene brachial plexus block is a successful alternative to general anesthesia for clavicle surgery.
Analgesics ; Anesthesia, Conduction ; Anesthesia, General ; Brachial Plexus Block ; Brachial Plexus ; Cervical Plexus Block ; Cervical Plexus ; Clavicle ; Humans ; Peripheral Nerves ; Prospective Studies ; Visual Analog Scale ; Weights and Measures

Regional anesthesia, including central and plane blocks (serratus anterior plane block and erector spinae block), are used for post-thoracotomy pain. The rhomboid intercostal block (RIB) is mainly performed by injection to the upper intercostal muscle plane below the rhomboid muscle. It has been reported to provide analgesia at the T3–T9 levels. The RIB was performed on 5 patients who had been scheduled for thoracotomy. The catheter was advanced in the area under the rhomboid muscle between the intercostal muscles. Postoperative visual analog scale (VAS) scores were observed and each patient’s resting VAS score remained below 3 for 48 hours. The RIB has been observed to be a convenient plane block for post-thoracotomy analgesia. We believe that further information from detailed studies is required.
Analgesia ; Anesthesia, Conduction ; Catheters ; Fascia ; Humans ; Intercostal Muscles ; Pain Management ; Pain Measurement ; Pain, Postoperative ; Ribs ; Thoracotomy ; Visual Analog Scale

BACKGROUND: Although case reports have suggested that the erector spinae plane block (ESPB) may help analgesia for patients after breast surgery, no study to date has assessed its effectiveness. This retrospective observational study analyzed the analgesic effects of the ESPB after total mastectomy. METHODS: Forty-eight patients were divided into an ESPB group (n = 20) and a control group (n = 28). Twenty patients in the control group were selected by their propensity score matching the twenty patients in the ESPB group. Patients in the ESPB group were injected with 30 mL 0.375% ropivacaine, followed by catheter insertion for further injections of local anesthetics every 12 hours. Primarily, total fentanyl consumption was compared between the two groups during the first 24 hours postoperatively. Secondary outcomes included pain intensity levels (visual analogue scale) and incidence of postoperative nausea and vomiting (PONV). RESULTS: Median cumulative fentanyl consumption during the first 24 hours was significantly lower in the ESPB (33.0 μg; interquartile range [IQR], 27.0–69.5 μg) than in the control group (92.8 μg; IQR, 40.0–155.0 μg) (P = 0.004). Pain level in the early postoperative stage (<3 hr) and incidence of PONV (0% vs. 55%) were also significantly lower in the ESPB group compared to the control (P = 0.001). CONCLUSIONS: Intermittent ESPB after total mastectomy reduces fentanyl consumption and early postoperative pain. ESPB is a good option for multimodal analgesia after breast surgery.
Acute Pain ; Analgesia ; Anesthesia, Conduction ; Anesthetics, Local ; Breast ; Catheters ; Fentanyl ; Humans ; Incidence ; Mastectomy ; Mastectomy, Simple ; Nerve Block ; Observational Study ; Pain, Postoperative ; Postoperative Nausea and Vomiting ; Propensity Score ; Retrospective Studies ; Ultrasonography

BACKGROUND: Breast cancer is complicated by a high incidence of chronic postoperative pain (25%–60%). Regional anesthesia might play an important role in lowering the incidence of chronic pain; however it is not known if the pectoral nerve block (PECS block), which is commonly used for breast surgery, is able to prevent this complication. Our main objective was therefore to detect any association between the PECS block and chronic pain at 3, 6, 9, and 12 months in patients undergoing breast surgery. METHODS: We conducted a prospective, monocentric, observational study. We enrolled 140 consecutive patients undergoing breast surgery and divided them in patients receiving a PECS block and general anesthesia (PECS group) and patients receiving only general anesthesia (GA group). Then we considered both intraoperative variables (intravenous opioids administration), postoperative data (pain suffered by the patients during the first 24 postoperative hours and the need for additional analgesic administration) and development and persistence of chronic pain (at 3, 6, 9, and 12 mo). RESULTS: The PECS group had a lower incidence of chronic pain at 3 months (14.9% vs. 31.8%, P = 0.039), needed less intraoperative opioids (fentanyl 1.61 μg/kg/hr vs. 3.3 μg/kg/hr, P < 0.001) and had less postoperative pain (3 vs. 4, P = 0.017). CONCLUSIONS: The PECS block might play an important role in lowering incidence of chronic pain, but further studies are needed.
Analgesics, Opioid ; Anesthesia, Conduction ; Anesthesia, General ; Anesthesia, Local ; Breast Neoplasms ; Breast ; Chronic Pain ; Clinical Study ; Humans ; Incidence ; Nerve Block ; Observational Study ; Pain, Postoperative ; Prospective Studies ; Thoracic Nerves