Total hip arthroplasty (THA) is a common orthopedic procedure, and effective postoperative pain management is crucial for enhancing recovery. Regional anesthesia techniques, such as the pericapsular nerve group (PENG) and lateral quadratus lumborum block (QLB), are designed to reduce opioid use while providing pain relief. This study compares the efficacy of these two techniques in managing postoperative pain and reducing opioid consumption after THA. Study objective and methods The primary objective of this randomized controlled trial was to assess whether the PENG block, when combined with a lateral femoral cutaneous nerve (LFCN) block, provided superior analgesia compared to the lateral QLB in patients undergoing elective THA. A total of 106 patients participated in this study, all of whom were randomly assigned to receive either the PENG + LFCN block or the lateral QLB. Primary outcome: The cumulative opioid consumption was measured over 72 hours post-surgery, using intravenous morphine milligram equivalents (MMEs) to standardize results. This allowed for a direct comparison of opioid use between the two groups. Secondary outcomes: Additional outcomes included postoperative pain scores during both movement and rest, time to ambulation, length of hospital stay, and functional outcomes. Functional outcomes were assessed using the Hip Disability and Osteoarthritis Outcome Score (HOOS JR) and the Patient-Reported Outcome Measures Information System (PROMIS-10). Key findings Opioid consumption: At 72 hours post-surgery, patients in the QLB group consumed significantly fewer opioids than the PENG + LFCN group (mean difference of 33 mg, p = 0.001). Statistically significant differences in opioid consumption were also observed at 36 hours (mean difference of 18 mg, p = 0.040), 48 hours (23 mg, p = 0.011), and 60 hours (28 mg, p = 0.004). Pain with movement: The lateral QLB group reported lower pain scores during movement from 36 to 72 hours postoperatively. Resting pain scores: […]
A recent study by Hallo-Carrasco et al. highlights the potential dangers of gadolinium-based contrast media (GCM) in interventional pain medicine. This research, published in Regional Anesthesia & Pain Medicine (2024), investigates adverse events linked to using GCM during spine procedures where inadvertent intrathecal administration is a risk. Here’s a comprehensive look at the findings, implications, and best practices surrounding GCM use in these procedures. Overview of gadolinium-based contrast media (GCM) Gadolinium-based contrast agents are an alternative for patients with documented allergies to iodinated contrast media (ICM). While traditionally safer for imaging, GCM carries specific risks: Toxicity risks: Gadolinium ions (Gd3+) are inherently toxic; chelating agents stabilize the compound and reduce these risks. Neurotoxicity: When inadvertently injected into the intrathecal (spinal) space, GCM can cause severe neurotoxic effects. Brain retention: There are concerns about gadolinium deposits in brain tissues following repeated exposure. Key findings Conducted via a retrospective review of medical records, the study investigated 508 patients who received GCM for spine-related procedures between 2019 and 2022. Here’s what was uncovered: Adverse event rate: 23 patients (3.3%) experienced adverse events potentially related to GCM. Common symptoms included severe pain, dizziness, headache, and, in one case, multifocal stroke. Patient demographics: A significant majority of patients were white females with a mean age of 67.55 years. Indications for GCM use: The predominant reason for using GCM was a documented iodine-related allergy. However, only 1% of these cases involved high-risk allergy reactions that could justify substituting ICM. Severity of adverse events: While most were manageable, some cases required hospitalization. The study documented one severe incident of stroke following GCM administration. Adverse reactions and symptoms Adverse effects following inadvertent intrathecal injection of GCM included: Severe pain: Reported within days of the procedure, sometimes requiring hospitalization. Headaches: Particularly postural headaches, which align with findings from other […]
In recent years, advancements in the study of fascial tissues have significantly impacted anesthesia and pain management practices. One area where these developments are particularly noteworthy is the use of fascial plane blocks (FPBs). These blocks have gained popularity due to their safety profile, ease of performance, and effectiveness in various clinical settings. This article dives into the microscopic anatomy of fasciae and the role this plays in optimizing FPBs for clinical applications. What are fascial plane blocks? Fascial plane blocks (FPBs) are a type of regional anesthesia that involves injecting local anesthetics (LAs) into the potential space between two fascial layers. The goal is to block the nerves that travel within or cross through these layers, providing pain relief. These blocks are highly versatile, being used for both surgical and nonsurgical procedures, particularly in areas such as the torso and extremities. Their popularity has been bolstered by the relative ease with which physicians can learn and perform them, especially with the use of modern ultrasound imaging techniques. Fascial microanatomy Fasciae are complex connective tissues that support and separate muscles, nerves, and other structures in the body. From a microscopic perspective, fasciae are composed of various cell types embedded within an extracellular matrix (ECM) rich in collagen and hyaluronan. This structure allows fasciae to serve as an effective medium for the spread of LAs during FPBs. Key components of fascia Fibroblasts are the most abundant in fascial tissues and play a key role in maintaining the ECM. They help produce collagen and other fibers that provide structural support. Fasciacytes are specialized cells that are primarily responsible for producing hyaluronan (HA), a glycosaminoglycan that facilitates the gliding of fascial layers. This function is crucial for the spread of LAs during FPBs. Myofibroblasts are fibroblasts with contractile abilities, helping regulate the basal […]