Coiling of echogenic perineural catheters with integral stylet: A proof-of-concept randomized control trial in a sciatic nerve block simulator and a pilot study in orthopaedic-trauma patients.

Backround/objectives: We investigated a technique that facilitates the coiling of a regular straight catheter (with integral stylet) behind the sciatic nerve in an ultrasound (US) regional anaesthesia simulator, and then applied our findings to a series of orthopedic-trauma patients.

Methods: We conducted a randomized study of two methods of perineural catheter advancement in a sciatic nerve block Blue Phantom simulator. Two groups of twenty catheters each (method A and method B) were evaluated under real-time ultrasound imaging.

Ropivacaine pharmacokinetics in the arterial and venous pools after ultrasound-guided continuous thoracic paravertebral nerve block.

Background And Aims: Although thoracic paravertebral blockade (TPVB) is employed in thoracic surgery to ensure satisfactory postoperative analgesia, large doses of anesthetics are required and manifestations of local anesthetic systemic toxicity (LAST) may appear. Currently, there are limited data on the pharmacokinetics of ropivacaine after continuous TPVB. The aim of this prospective study was to investigate ropivacaine kinetics, in the arterial and venous pools, after continuous TPVB and assess the risk of LAST.

The History of Orthopedics in the Long Term: From General Medicine to Medical Specialties.

A thorough literature search was done in PubMed and Google Scholar as well as in physical books in libraries to summarize the literature on the history and evolution of medicine and orthopedics. The philosophical ideas that emerged in ancient Greece served as a foundation for the development of medicine. In the 5th century BC, the schools of Knidos and Kos emerged as influential centers for the development of medical thinking.

Ultrasound-Guided Peripheral Nerve Blocks for Hip Surgery: A Concise Perspective.

Ultrasound implementation for the facilitation of peripheral nerve blocks is well established. Ultrasound-guided lumbar plexus, femoral, fascia iliaca and supra-inguinal fascia iliaca compartment, pericapsular nerve group and quadratus lumborum nerve blocks have been employed for analgesia purposes in hip surgery. The combination of motor-sparing regional anesthesia strategies for optimal postoperative pain control with recovery protocols targeting to early and safe patients' mobilization constitute the current dogma of orthopedic surgery.

Enhanced recovery after surgery (ERAS) protocols for total joint replacement surgery.

The enhanced recovery after surgery (ERAS) protocols are a comprehensive therapeutic approach that prioritizes the well-being of patients. It encompasses several aspects such as providing sufficient nutritional support, effectively managing pain, ensuring appropriate fluid management and hydration, and promoting early mobilization after surgery. The advent of ERAS theory has led to a shift in focus within modern ERAS protocols.

Point of care transthoracic echocardiography for the prediction of post - spinal anesthesia hypotension in elderly patients with cardiac diseases and left ventricular dysfunction : Inferior vena cava and post-spinal anesthesia hypotension in elderly patients.

In elderly patients with cardiac diseases, changes in cardiovascular physiology diminish cardiovascular reserve and predispose to hemodynamic instability after spinal anesthesia; hence, such patients could be at risk of postoperative complications. Additionally, transthoracic echocardiography (TTE) is used in clinical practice to evaluate cardiovascular hemodynamics. Therefore, we hypothesized that echocardiographic measurements could display significant diagnostic power in the prediction of post - spinal anesthesia hypotension in elderly patients with cardiac diseases and reduced left ventricular ejection fraction (LV-EF).

A Lumbar Paravertebral Space Ultrasound Lumbar Plexus Block Technique for Hip Fracture Surgery in the Elderly.

Ultrasound imaging of peripheral nerves is challenging in elderly population. In cases involving the lumbar plexus (LP), we have employed ultrasound imaging and neurostimulation guidance for successful localization and block of the LP. The postero-medial segment of the psoas muscle (PSM), superior to the vertebral body and anterior to the transverse process ("corner pocket") was used as an imaging landmark for the implementation of the LP block.

Inferior vena cava ultrasonography in the assessment of intravascular volume status and fluid responsiveness in the emergency department and intensive care unit: A critical analysis review.

Rapid evaluation of intravascular volume status is vital; either excessive or limited fluid administration may result in adverse patient outcomes. In this narrative review, critical analysis of pertinent diagnostic accuracy studies is developed to delineate the role of inferior vena cava ultrasound measurements in the assessment of both intravascular volume status and fluid responsiveness in the emergency department and intensive care unit. In addition, limitations, and technical considerations of inferior vena cava ultrasound measurements as well as directions for future research are thoroughly discussed.

Orthopaedic cardiac considerations in emergency.

Orthopaedic patients undergoing emergency orthopaedic surgery should be referred for cardiac evaluation only when they are symptomatic or when a specific cardiac intervention is expected to reduce the surgical risk. A preoperative delay of 24-48 h of emergency orthopaedic operations has been associated with increased mortality and poor functional status of the patients. Research in the preoperative setting is almost exclusively retrospective because randomized studies are difficult to be performed and pose serious ethical concerns.

The Hippocratic Oath: Analysis and Contemporary Meaning.

The Hippocratic oath is traditionally taken by medical school graduates at the time of their graduation, either in its original form or in a modern variation. It is considered the earliest expression of medical ethics, establishing principles of ethics that remain of paramount significance today. However, it was written in antiquity, whereas medicine has been constantly evolving.

Echinococcosis of the spine.

Echinococcosis or hydatid disease affecting the spine is an uncommon manifestation of infection of the spine.More commonly found in endemic areas, it causes significant morbidity and mortality as it grows slowly and produces symptoms mainly by compressing the spinal cord.As diagnostic methods are non-specific, diagnosis and management are usually delayed until the disease is advanced, thereby therapy is usually unlikely.

The history of intramedullary nailing.

Purpose: To summarize the evolution of intramedullary nailing, highlight important milestones, introduce the atmosphere of the era concerning the first uses and development of intramedullary nailing, and present the status of nailing in modern international orthopaedics and traumatology.

Method: A thorough literature search was undertaken in PubMed and Google Scholar as well as in physical books in libraries to summarize the literature on the history and evolution of intramedullary nailing.

Results: The first use of an intramedullary device was attested in ancient Egypt; however, the first use of intramedullary nailing was reported in 1524 in Mexico, and the first medical journals reported on intramedullary nailing around the mid-1800s.

The Asclepian art of medicine and surgery.

Purpose: To summarize the available information from mythology, archeology, and classical literature aiming to compose the image of Asclepieia, Asclepius, and the Asclepiads, and to depict the atmosphere of medicine in its infancy.

Method: A thorough literature search was undertaken in PubMed and Google Scholar as well as in physical books in libraries to summarize the pharmacies and pain practices used for trauma in ancient Greece.

Results: The antiquity of medicine is confirmed by the worship of God Apollo and Asclepius, who were the persons who possessed the knowledge of medicine and surgery, and delivered it to mortals.

Peripheral nerve blocks in the cervical region: from anatomy to ultrasound-guided techniques.

Cervical plexus nerve blocks have been employed in various head and neck operations. Both adequate anaesthesia and analgesia are attained in clinical practice. Nowadays, ultrasound imaging in regional anaesthesia is driven towards a certain objective that dictates high accuracy and safety during the implementation of peripheral nerve blocks.

Pain is vital in resuscitation in trauma.

Implementation of the ATLS algorithm has remarkably improved the resuscitation of trauma patients and has significantly contributed to the systematic management of multi-trauma patients. However, pain remains the most prevalent complaint in trauma patients, and can induce severe complications, further deterioration of health, and death of the patient. Providing appropriate and timely pain management to these patients prompts early healing, reduces stress response, shortens hospital Length of Stay (LOS), diminishes chronic pain, and ultimately reduces morbidity and mortality.

Ultrasound-guided Saphenous Nerve Block for Saphenous Neuralgia after Knee Surgery: Two Case Reports and Review of Literature.

Saphenous neuralgia is characterized by persistent neuropathic pain at the distribution of the saphenous nerve. Injury to the saphenous nerve, and specifically to its infrapatellar branch of the saphenous nerve has been implicated as a cause of medial knee pain after orthopedic knee surgery or trauma. We present two cases of saphenous neuralgia, one after total knee arthroplasty and the other after anterior cruciate ligament reconstruction, that were adequately treated with ultrasound-guided saphenous nerve blocks distal to the adductor canal.

The Utility of Echocardiography for the Prediction of Spinal-Induced Hypotension in Elderly Patients: Inferior Vena Cava Assessment Is a Key Player.

Objectives: To prospectively assess the diagnostic performance of echocardiographic measurements before spinal anesthesia in elderly patients undergoing lower limb surgery. Emphasis was placed on the dIVCmax-to-IVCCI ratio and IVCCI, where dIVCmax was the maximum diameter of inferior vena cava (IVC) at expiration and IVCCI was the collapsibility index of IVC.

Design: Open cohort, prospective, single-center study.