Hip fracture is one of the most common traumatic fractures in geriatric patients. With the increase in the geriatric population, physicians are more concerned about anesthetic management of these patients and a lot of articles have been published in relation to geriatric hip fracture. Due to age related comorbidities and physical status, perioperative management of these patients are complex and related to mortality and morbidity. Anesthesia and pain control for these patients are directly related to the postoperative outcome. This article summarizes the most recent opinions about perioperative management of geriatric hip fracture patients at the point of preoperative evaluation, anesthetic managements, and pain control.
Anesthesia ; Arthroplasty, Replacement, Hip ; Comorbidity ; Hip Fractures ; Hip* ; Humans ; Mortality

No abstract available.
Delusions

PURPOSE: Although papillary thyroid microcarcinoma (PTMC) has very excellent prognosis, lymph node metastases are found frequently. This study identifies the risk factors of clinically negative cervical lymph node metastasis (cN0) and investigates the need for central lymph node dissection in cN0 PTMC. METHODS: From Jan. 1(st) 2007 to Dec. 30(th) 2013, 1593 patients received surgery for papillary thyroid carcinoma. Seven hundred and eleven patients were diagnosed with cN0 PTMCs. They all received thyroidectomy (total thyroidectomy or lobectomy) with prophylactic central neck dissection. We reviewed the medical records and analyzed the risk factors affecting central lymph node metastasis (CLNM). RESULTS: Of 711 PTMCs patients without clinical lymph node metastasis, 170 (23.9%) patients had CLNM. CLNM was frequent in males than females (P<0.001). The larger the primary tumor, the higher the risk of CLNM (P<0.001). Extra-thyroidal extension was an independent risk factor of CLNM (P<0.001). Recurrence rates in the CLNM negative group was 1.3%, and in the CLNM positive group 2.4%. The CLNM positive group recurred at a slightly higher rate, but not statistically significantly (P=0.329). Five year disease free survival in the CLNM negative was 96.8%, and in the positive group 94.1%, not a statistically significant (P=0.630). CONCLUSION: In this study, male gender, the size of primary tumor, and extra-thyroidal extension were the risk factors of occult LNM but occult LNM in PTMC was not associated with recurrence rate or five-year disease free survivals. Therefore, we can omit prophylactic central lymph node dissection in patient with cN0 PTMC.
Disease-Free Survival ; Female ; Humans ; Lymph Node Excision* ; Lymph Nodes* ; Male ; Medical Records ; Neck Dissection ; Neoplasm Metastasis ; Prognosis ; Recurrence ; Risk Factors ; Thyroid Gland* ; Thyroid Neoplasms ; Thyroidectomy

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

Cervical plexus blocks (CPBs) have been used in various head and neck surgeries to provide adequate anesthesia and/or analgesia; however, the block is performed in a narrow space in the region of the neck that contains many sensitive structures, multiple fascial layers, and complicated innervation. Since the intermediate CPB was introduced in addition to superficial and deep CPBs in 2004, there has been some confusion regarding the nomenclature and definition of CPBs, particularly the intermediate CPB. Additionally, as the role of ultrasound in the head and neck region has expanded, CPBs can be performed more safely and accurately under ultrasound guidance. In this review, the authors will describe the methods, including ultrasound-guided techniques, and clinical applications of conventional deep and superficial CPBs; in addition, the authors will discuss the controversial issues regarding intermediate CPBs, including nomenclature and associated potential adverse effects that may often be neglected, focusing on the anatomy of the cervical fascial layers and cervical plexus. Finally, the authors will attempt to refine the classification of CPB methods based on the target compartments, which can be easily identified under ultrasound guidance, with consideration of the effects of each method of CPB.
Airway Obstruction ; Analgesia ; Anesthesia ; Cervical Plexus Block* ; Cervical Plexus* ; Classification ; Head ; Methods ; Neck ; Ultrasonography

Background: Commonly used epidural or systemic analgesics for pain control after hip surgery carry risk for potential adverse effects. In contrast, the quadratus lumborum block (QLB) utilizes a simple and easy fascial plane technique and provides a wide area of sensory blockade. Thus, the QLB may be beneficial as analgesia after total hip arthroplasty. CaseHere, we report the case of an 83-year-old man who received a continuous transmuscular QLB as part of a multimodal analgesia after hardware removal and total hip arthroplasty. The patient received a continuous infusion of 0.2% ropivacaine at 8 ml/h through an indwelling catheter in addition to patient-controlled analgesia with intravenous fentanyl and oral celecoxib. The patient’s pain scores did not exceed 4, and no additional analgesics were required until postoperative day 5. Conclusions Transmuscular QLB may be a suitable option for multimodal analgesia after total hip arthroplasty.

Analgesia ; Anesthetics, Local ; Humans ; Nephrolithotomy, Percutaneous ; Nerve Block ; Paraspinal Muscles

Anesthetics, Local ; Brachial Plexus ; Injections