This document summarizes regional anesthesia techniques for spine surgery. It discusses the use of spinal, epidural, and combined spinal-epidural anesthesia. Spinal anesthesia provides adequate anesthesia for select spine procedures and offers advantages like hemodynamic stability and reduced postoperative nausea and vomiting compared to general anesthesia. Epidural anesthesia provides postoperative analgesia but takes longer to administer and has unpredictable anesthesia levels, limiting its use. New regional analgesia techniques aim to improve pain control and recovery for spine surgery patients.
This document provides an overview of regional anesthesia techniques for total joint arthroplasty (TJA), including total hip arthroplasty (THA) and total knee arthroplasty (TKA). It discusses the evidence regarding general versus regional anesthesia, as well as various regional techniques for intraoperative anesthesia and postoperative analgesia. While regional anesthesia is associated with improvements in some outcomes like pain control and reduced side effects, the evidence on other outcomes like infection rates and length of stay is mixed compared to general anesthesia. A variety of regional techniques can provide effective analgesia after TJA, including neuraxial blocks, peripheral nerve blocks, and extended-release epidural morphine, but they each have specific risks and benefits to consider.
Analysis of Spinal Decompression via Surgical Methods and Traction TherapyPaige Barrett
This document summarizes various surgical and non-surgical methods for spinal decompression to treat back pain. For surgical decompression of the cervical spine, early surgery (<24 hrs) after spinal cord injury produces better outcomes than delayed surgery. Circumferential decompression and fusion is effective for cervical myelopathy. In the thoracic spine, posterior decompression with instrumented fusion improves neurological functioning for thoracic myelopathy. Video-assisted thoracoscopic surgery and percutaneous laser disc decompression are suitable minimally invasive options for the thoracic spine. For the lumbar spine, indirect decompression using an interbody cage is effective for degenerative lumbar stenosis, while decompression without fusion significantly decreases leg pain and disability. Minimally invasive
Pain management and accelerated rehabilitation for total hip and knee arthrop...FUAD HAZIME
This article discusses improved pain management techniques and accelerated rehabilitation programs for total hip and knee arthroplasty. The key aspects of the discussed program include:
1. Regional anesthesia using spinal anesthesia supplemented with perioperative nerve blocks and local periarticular injections for multimodal pain control.
2. Preemptive analgesia beginning preoperatively to control pain from onset and minimize narcotic use postoperatively.
3. Accelerated rehabilitation programs enabled by adequate pain control, allowing some patients to begin rehabilitation on the day of surgery to reduce length of stay.
4. Ongoing research into longer-acting local injectable agents and improved periarticular injection cocktails for superior pain management.
Effectiveness of intra-articular dexmedetomidine as postoperative analgesia i...iosrphr_editor
Background And Objectives: To study the effect of inj.Ropivacaine (0.25%) 2mg/kg with and without Inj.Dexmedetomidine (1-2μg/kg) intraarticularly for postoperative analgesia in arthroscopic knee surgery.1:To Evaluate Onset, Duration and analgesic efficacy of Intraarticular Dexmedetomidine2: To monitor the safety of Dexmedetomidine and Ropivacaine.
Methods: A prospective randomized double blind study, was conducted in 50 patients undergoing elective arthroscopy of knee joint under spinal anaesthesia. At the completion of the surgery, all patients were divied into two groups;GroupP(n=25):received Inj. Ropivacaine 0.25% and GroupD(n=25):received Inj.Ropivacaine(0.25%)+Inj. Dexmedetomidine(1μg/kg) total volume 20 ml was deposited intra-articularly.Patients were monitored in the postoperative ward for the hemodynamic parameters and their Sedation score was assessed.. The efficacy of the drug was determined by improvement in VAS score, duration of analgesia and total number of rescue analgesics during 24 hr in post operative period.
Results: There was no statistically significant differences observed in heart rate except changes at 6 and 8 hr. At 6 and 8 hr in group P pulse (82.48 ± 7.49, 81.44 ± 8.78) as compared to group D (75.38 ± 6.52, 74.96 ± 5.70),because of duration of action of ropivacaine with or without dexmedetomidine.There was no statistically significant difference in blood pressure was found, except at 12 hour and 24 hour (p=0.018), because of longer duration of action of intrarticular dexmedetomidine with ropivacaine in group D.At 6 hrs patients in Group P had a mean VAS score of 3.2 as compared to VAS score values of 1.8 in Group D which is statistically significant..At 2 , 4, 6 and 8 hour VAS score in P group was 1.64, 2.44, 3.24, 2.84 respectively. As compared to group P, in group D VAS score at 2, 4, 6 and 8 hour was 0.92, 1.04, 1.79 and 2.08 respectively. So VAS score lower in group D as compared to group P at 2, 4, 6 and 8 hrs.
Clinical effect and safety of pulsed radiofrequency treatment for pudendal ne...Jason Attaman
This study compared the clinical effectiveness and safety of pulsed radiofrequency (PRF) treatment combined with pudendal nerve block (NB) versus NB alone for treating pudendal neuralgia. 80 patients were randomly assigned to receive either PRF+NB or NB. Patients in the PRF+NB group had significantly lower pain scores and depression scores at 2 weeks, 1 month, and 3 months compared to the NB group. The PRF+NB group also had higher clinical effectiveness rates and less postoperative analgesic usage. No severe adverse events occurred in either group. The results suggest that PRF+NB provides more long-lasting pain relief and better outcomes for pudendal neuralgia than NB alone.
This study retrospectively analyzed 2399 pregnant patients who underwent neuraxial blockade (spinal, epidural, or combined spinal-epidural anesthesia) for cesarean section, vaginal delivery, or forceps delivery. The study aimed to describe the incidence of neurological complications, specifically post-dural puncture headache and nerve damage, and identify risk factors. The results found that 3% of patients developed post-dural puncture headache, 0.3% developed lower limb paresthesias, and 0.1% developed transient radicular irritation. Patients who remained in the gynecological position for over 60 minutes had an odds ratio of 1.75 for developing lower limb paresthesias, and
Le degré de relâchement musculaire en chirurgie coelioscopique de la vésicule biliaire fait partie du quotidien des discussions entre anesthésistes et chirurgiens au bloc opératoire. Au fond tous sont convaincus de l'efficacité du curare : le chirurgien qui le demande et l'anesthésiste qui pense lui à sa décurarisation.
Cette étude teste curarisation profonde versus curarisation de routine dans la chirurgie coelioscopique de la vésicule biliaire. Avec comme première question "est-ce qu'une curarisation profonde permet de travaillert avec une pression abdominable moindre?", pression dont on sait qu'elle est pourvoyeuse de douleur post-opératoire.
La réponse est que le degré de curarisation participe de façon marginale au confort du chirurgien... et ne permet pas plus fréquemment de travailler à pression abdominale basse.
Postoperative pain is a major concern for patients and doctors. This preliminary study investigated the use of a wearable pulsed radiofrequency energy (PRFE) device to control postoperative pain in 18 women undergoing breast augmentation surgery. Patients were randomly assigned to receive either an active or placebo PRFE device. Those receiving the active device experienced significantly lower pain scores over 7 days as measured by a visual analog scale. They also took fewer narcotic pain medications than those receiving the placebo. The findings suggest PRFE therapy is an effective non-drug method for controlling postoperative pain.
This document provides an overview of regional anesthesia techniques for total joint arthroplasty (TJA), including total hip arthroplasty (THA) and total knee arthroplasty (TKA). It discusses the evidence regarding general versus regional anesthesia, as well as various regional techniques for intraoperative anesthesia and postoperative analgesia. While regional anesthesia is associated with improvements in some outcomes like pain control and reduced side effects, the evidence on other outcomes like infection rates and length of stay is mixed compared to general anesthesia. A variety of regional techniques can provide effective analgesia after TJA, including neuraxial blocks, peripheral nerve blocks, and extended-release epidural morphine, but they each have specific risks and benefits to consider.
Analysis of Spinal Decompression via Surgical Methods and Traction TherapyPaige Barrett
This document summarizes various surgical and non-surgical methods for spinal decompression to treat back pain. For surgical decompression of the cervical spine, early surgery (<24 hrs) after spinal cord injury produces better outcomes than delayed surgery. Circumferential decompression and fusion is effective for cervical myelopathy. In the thoracic spine, posterior decompression with instrumented fusion improves neurological functioning for thoracic myelopathy. Video-assisted thoracoscopic surgery and percutaneous laser disc decompression are suitable minimally invasive options for the thoracic spine. For the lumbar spine, indirect decompression using an interbody cage is effective for degenerative lumbar stenosis, while decompression without fusion significantly decreases leg pain and disability. Minimally invasive
Pain management and accelerated rehabilitation for total hip and knee arthrop...FUAD HAZIME
This article discusses improved pain management techniques and accelerated rehabilitation programs for total hip and knee arthroplasty. The key aspects of the discussed program include:
1. Regional anesthesia using spinal anesthesia supplemented with perioperative nerve blocks and local periarticular injections for multimodal pain control.
2. Preemptive analgesia beginning preoperatively to control pain from onset and minimize narcotic use postoperatively.
3. Accelerated rehabilitation programs enabled by adequate pain control, allowing some patients to begin rehabilitation on the day of surgery to reduce length of stay.
4. Ongoing research into longer-acting local injectable agents and improved periarticular injection cocktails for superior pain management.
Effectiveness of intra-articular dexmedetomidine as postoperative analgesia i...iosrphr_editor
Background And Objectives: To study the effect of inj.Ropivacaine (0.25%) 2mg/kg with and without Inj.Dexmedetomidine (1-2μg/kg) intraarticularly for postoperative analgesia in arthroscopic knee surgery.1:To Evaluate Onset, Duration and analgesic efficacy of Intraarticular Dexmedetomidine2: To monitor the safety of Dexmedetomidine and Ropivacaine.
Methods: A prospective randomized double blind study, was conducted in 50 patients undergoing elective arthroscopy of knee joint under spinal anaesthesia. At the completion of the surgery, all patients were divied into two groups;GroupP(n=25):received Inj. Ropivacaine 0.25% and GroupD(n=25):received Inj.Ropivacaine(0.25%)+Inj. Dexmedetomidine(1μg/kg) total volume 20 ml was deposited intra-articularly.Patients were monitored in the postoperative ward for the hemodynamic parameters and their Sedation score was assessed.. The efficacy of the drug was determined by improvement in VAS score, duration of analgesia and total number of rescue analgesics during 24 hr in post operative period.
Results: There was no statistically significant differences observed in heart rate except changes at 6 and 8 hr. At 6 and 8 hr in group P pulse (82.48 ± 7.49, 81.44 ± 8.78) as compared to group D (75.38 ± 6.52, 74.96 ± 5.70),because of duration of action of ropivacaine with or without dexmedetomidine.There was no statistically significant difference in blood pressure was found, except at 12 hour and 24 hour (p=0.018), because of longer duration of action of intrarticular dexmedetomidine with ropivacaine in group D.At 6 hrs patients in Group P had a mean VAS score of 3.2 as compared to VAS score values of 1.8 in Group D which is statistically significant..At 2 , 4, 6 and 8 hour VAS score in P group was 1.64, 2.44, 3.24, 2.84 respectively. As compared to group P, in group D VAS score at 2, 4, 6 and 8 hour was 0.92, 1.04, 1.79 and 2.08 respectively. So VAS score lower in group D as compared to group P at 2, 4, 6 and 8 hrs.
Clinical effect and safety of pulsed radiofrequency treatment for pudendal ne...Jason Attaman
This study compared the clinical effectiveness and safety of pulsed radiofrequency (PRF) treatment combined with pudendal nerve block (NB) versus NB alone for treating pudendal neuralgia. 80 patients were randomly assigned to receive either PRF+NB or NB. Patients in the PRF+NB group had significantly lower pain scores and depression scores at 2 weeks, 1 month, and 3 months compared to the NB group. The PRF+NB group also had higher clinical effectiveness rates and less postoperative analgesic usage. No severe adverse events occurred in either group. The results suggest that PRF+NB provides more long-lasting pain relief and better outcomes for pudendal neuralgia than NB alone.
This study retrospectively analyzed 2399 pregnant patients who underwent neuraxial blockade (spinal, epidural, or combined spinal-epidural anesthesia) for cesarean section, vaginal delivery, or forceps delivery. The study aimed to describe the incidence of neurological complications, specifically post-dural puncture headache and nerve damage, and identify risk factors. The results found that 3% of patients developed post-dural puncture headache, 0.3% developed lower limb paresthesias, and 0.1% developed transient radicular irritation. Patients who remained in the gynecological position for over 60 minutes had an odds ratio of 1.75 for developing lower limb paresthesias, and
Le degré de relâchement musculaire en chirurgie coelioscopique de la vésicule biliaire fait partie du quotidien des discussions entre anesthésistes et chirurgiens au bloc opératoire. Au fond tous sont convaincus de l'efficacité du curare : le chirurgien qui le demande et l'anesthésiste qui pense lui à sa décurarisation.
Cette étude teste curarisation profonde versus curarisation de routine dans la chirurgie coelioscopique de la vésicule biliaire. Avec comme première question "est-ce qu'une curarisation profonde permet de travaillert avec une pression abdominable moindre?", pression dont on sait qu'elle est pourvoyeuse de douleur post-opératoire.
La réponse est que le degré de curarisation participe de façon marginale au confort du chirurgien... et ne permet pas plus fréquemment de travailler à pression abdominale basse.
Postoperative pain is a major concern for patients and doctors. This preliminary study investigated the use of a wearable pulsed radiofrequency energy (PRFE) device to control postoperative pain in 18 women undergoing breast augmentation surgery. Patients were randomly assigned to receive either an active or placebo PRFE device. Those receiving the active device experienced significantly lower pain scores over 7 days as measured by a visual analog scale. They also took fewer narcotic pain medications than those receiving the placebo. The findings suggest PRFE therapy is an effective non-drug method for controlling postoperative pain.
This document summarizes a project that compared the effects of prone lumbar traction versus supine lumbar traction when combined with an extension-oriented treatment approach for chronic low back pain. The project reviewed literature showing mixed results on the effectiveness of lumbar traction and a lack of evidence for supine traction. The project aimed to determine if prone traction was more effective for reducing pain and disability when combined with exercises to promote lumbar extension. Outcome measures of pain and disability were collected before and after treatment to evaluate the two approaches. The results were statistically analyzed to determine if prone traction provided greater benefits for patients with chronic low back pain.
Clinical effect and safety of pulsed radiofrequency treatment for pudendal ne...Jason Attaman
The document describes a prospective, randomized controlled clinical trial that compared the clinical effect and safety of pulsed radiofrequency (PRF) treatment combined with pudendal nerve block (NB) to NB alone for treating pudendal neuralgia. Eighty patients were randomly assigned to receive either PRF+NB or NB. Pain levels, depression scores, treatment effects, analgesic use, and adverse events were assessed over 3 months. The results showed that PRF+NB provided significantly greater pain relief and improved depression scores compared to NB alone, with no severe adverse events reported for either group.
The document discusses the erector spinae plane (ESP) block anesthetic technique for managing postoperative pain in patients undergoing mastectomy. It provides background on post-mastectomy pain and the use of opioids for management. The document then describes the ESP block procedure and reviews literature supporting its efficacy in reducing postoperative pain and opioid use compared to other techniques. The rationale and objectives of studying ESP are to improve pain management strategies and reduce opioid dependency after breast surgery.
FUNCTION AFTER OPEN ABDOMINAL AORTIC POSOPERATIVE PULMONARY ANEURYSM REPAIR ...Felipe Posada
1) The study compared postoperative pulmonary function and pain control in COPD patients undergoing open abdominal aortic aneurysm repair with either epidural (Group I) or intravenous (Group II) analgesia.
2) Pulmonary function test (FEV1 and FVC) results were significantly better preserved in Group I patients on postoperative days 1 and 4.
3) Group I patients also had significantly less reported pain on postoperative days 1, 2, and 4 both at rest and during activity.
4) There were no differences in length of hospital stay, morbidity, or mortality between the groups.
A guide to beginners helping writing thesis protocol.
Comparison between USG guided Suprascapular Nerve block and Interscalene Nerve Block post operative analgesia after arthroscopic shoulder surgery- a prospective randomized double blind study.
This systematic review evaluated regional analgesic techniques for post-thoracotomy pain management, including thoracic epidural, paravertebral block, intrathecal, intercostal, and interpleural methods. The review found that continuous paravertebral block provided analgesia comparable to thoracic epidural with fewer side effects. Paravertebral block also reduced pulmonary complications versus systemic opioids, though epidural did not. Epidural was superior to intrathecal or intercostal techniques, which were still better than systemic opioids. Interpleural analgesia was inadequate. The review concluded that either epidural with local anesthetic plus opioid or continuous paravertebral block with local anesthetic can be recommended, with intrathecal opioid
The document summarizes a study that investigated whether adding hyaluronidase to ropivacaine reduces the time to achieve complete sensory block after axillary brachial plexus block. Patients were randomly assigned to receive ropivacaine with or without hyaluronidase. The study found that the group receiving ropivacaine with hyaluronidase had a significantly shorter mean time to achieve complete sensory block, sensory block onset time, and time to reach surgical anesthesia compared to the control group receiving ropivacaine alone. Addition of hyaluronidase to ropivacaine resulted in faster blockade times for axillary brachial plexus blocks.
1. This study compared general anesthesia (GA) and spinal anesthesia (SA) for 100 patients undergoing lumbar disk surgery through a randomized controlled trial.
2. Intraoperatively, mean blood loss was less with GA but not significantly. Surgeon satisfaction was higher with GA. No major complications occurred with either.
3. Postoperatively, hypertension was more common after GA, and nausea/vomiting were more frequent after SA.
4. Contrary to previous studies, the findings revealed SA had no advantages over GA, and GA may reduce risks and complications.
This document summarizes research on anticoagulation therapy for patients with proximal femoral fractures. It discusses two parts:
1) Guidelines for thromboprophylaxis in patients not previously on anticoagulants, which recommend early mechanical prophylaxis and starting chemical prophylaxis like LMWH after surgery.
2) Studies of patients previously on anticoagulants like warfarin. One study found pharmacological reversal of elevated INR with vitamin K and plasma reduced time to surgery from 6.8 to 2.8 days without increasing complications. Another found pharmacological reversal reduced time to surgery from 4.4 to 2.4 days on average. In summary, the document reviews protocols to prevent clots in femoral
1. This document describes a study protocol to evaluate if pre-procedural ultrasound of the lumbar spine can improve the procedural skill of performing subarachnoid blocks.
2. The study aims to compare outcomes like success on the first needle pass, number of needle passes, time taken between groups who receive pre-procedure ultrasound versus those who do not.
3. A review of previous literature found that ultrasound can help identify anatomy like the posterior longitudinal ligament that indicates ease of dural puncture, and may help predict difficult procedures. Simulation training and deliberate practice was also found to improve residents' skills in performing subarachnoid blocks.
This document describes a randomized clinical trial that aims to compare the incidence of blocking all three nerves (femoral, lateral femoral cutaneous, and obturator nerves) when performing ultrasound-guided fascia iliaca compartment block using either a supra-inguinal approach versus an infra-inguinal approach. Sixty patients undergoing lower limb surgery will be randomly assigned to receive the block using one of the two approaches. The primary outcome is the incidence of a three-nerve block, while secondary outcomes include time of nerve block onset and distance of injection point from the inguinal ligament.
This case report describes the anesthetic management of a 55-year-old male who suffered multiple traumatic injuries including a humerus fracture, pneumothorax, and fractures of the right distal radius, right scapula, right clavicle, and multiple ribs after a workplace accident. After initial stabilization and 20 days of conservative management, the patient underwent surgery including humerus plating and bone grafting. He was safely anesthetized using a supraclavicular and axillary brachial plexus block supplemented with spinal anesthesia, avoiding the risks of positive pressure ventilation exacerbating the occult pneumothorax. Regional anesthesia allowed for adequate pain management and surgery was completed without complications. The report concludes that regional anesthesia
Effect of Intravenous Dexmedetomidine on Prolongation of Intrathecal Spinal A...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
This retrospective study examined the use of neuromuscular blockade monitors (NMBMs) to stimulate the P6 acupoint intraoperatively for the prevention of post-operative nausea and vomiting (PONV) in two craniotomy patients. Both patients received standard anti-emetic pharmacological prophylaxis in addition to unilateral P6 electrostimulation via NMBM throughout surgery. Neither patient experienced PONV in the post-anesthesia care unit. The study suggests that P6 electrostimulation using NMBMs may decrease PONV when used as an adjunct to pharmacological prophylaxis, with minimal additional time, training or expense required. However, a randomized controlled trial is needed to verify the
Rischke_Viscoelastic Disc Arthroplasty Provides Superior Back and Leg Pain Re...Kari Zimmers
This study compared outcomes of patients receiving a viscoelastic total disc replacement (VTDR) to patients receiving anterior lumbar interbody fusion (ALIF) for lumbar disc degeneration using data from two independent spine registries. Linear regression models showed that VTDR was associated with significantly greater back and leg pain relief compared to ALIF, with differences of 2.76 and 2.12 points respectively. Additional factors influencing pain relief included female sex, monosegmental surgery, higher preoperative pain levels, and surgical level. The results suggest that viscoelastic total disc replacement may provide superior pain relief compared to anterior lumbar interbody fusion for patients with degenerative lumbar disc disease.
Neural blockade for persistent pain after breast cancer surgery Jason Attaman
1) The review examined evidence for neural blockade as a diagnostic tool or treatment for persistent pain after breast cancer surgery.
2) Only 7 studies with a total of 135 patients were identified that used blocks targeting the stellate ganglion, paravertebral plexus, or intercostal nerves.
3) The quality of evidence from the studies was low and inconclusive about the efficacy of neural blockade for treating persistent pain after breast cancer surgery. More high-quality studies are needed to evaluate this common clinical problem.
To Determine Preference of Shoulder Pain Management by General Physicians in ...suppubs1pubs1
Rotator cuff muscles are functionally active and provide stability to the shoulder joint and also thereby allow the full Range of Motion (ROM) by moving the head of humerus in the glenoid cavity. Any tear or fragility of the rotator cuff muscles can cause the dislocation or instability and hence damaging other muscles specially the long head of biceps muscle. The diseases related to the supraspinatus tendon are frequently linked with the long head of the biceps tendon. Other cause of chronic shoulder pain is the adhesive capsulitis with large prevalence rates of more than 5.3% in the general target population [3].
This document describes a research study protocol to evaluate the efficacy of intrathecal dexmedetomidine as an adjuvant to levobupivacaine spinal anesthesia for abdominal hysterectomy. The study will randomly assign 104 patients to receive either levobupivacaine with normal saline or levobupivacaine with 10 μg dexmedetomidine intrathecally. The primary outcomes will be postoperative analgesia duration measured by VAS scores and time to first rescue analgesic. Secondary outcomes include sensory and motor block durations and any intraoperative hemodynamic changes or side effects. Standard protocols will be followed for preoperative, intraoperative and postoperative care.
Anti-Universe And Emergent Gravity and the Dark UniverseSérgio Sacani
Recent theoretical progress indicates that spacetime and gravity emerge together from the entanglement structure of an underlying microscopic theory. These ideas are best understood in Anti-de Sitter space, where they rely on the area law for entanglement entropy. The extension to de Sitter space requires taking into account the entropy and temperature associated with the cosmological horizon. Using insights from string theory, black hole physics and quantum information theory we argue that the positive dark energy leads to a thermal volume law contribution to the entropy that overtakes the area law precisely at the cosmological horizon. Due to the competition between area and volume law entanglement the microscopic de Sitter states do not thermalise at sub-Hubble scales: they exhibit memory effects in the form of an entropy displacement caused by matter. The emergent laws of gravity contain an additional ‘dark’ gravitational force describing the ‘elastic’ response due to the entropy displacement. We derive an estimate of the strength of this extra force in terms of the baryonic mass, Newton’s constant and the Hubble acceleration scale a0 = cH0, and provide evidence for the fact that this additional ‘dark gravity force’ explains the observed phenomena in galaxies and clusters currently attributed to dark matter.
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This document summarizes a project that compared the effects of prone lumbar traction versus supine lumbar traction when combined with an extension-oriented treatment approach for chronic low back pain. The project reviewed literature showing mixed results on the effectiveness of lumbar traction and a lack of evidence for supine traction. The project aimed to determine if prone traction was more effective for reducing pain and disability when combined with exercises to promote lumbar extension. Outcome measures of pain and disability were collected before and after treatment to evaluate the two approaches. The results were statistically analyzed to determine if prone traction provided greater benefits for patients with chronic low back pain.
Clinical effect and safety of pulsed radiofrequency treatment for pudendal ne...Jason Attaman
The document describes a prospective, randomized controlled clinical trial that compared the clinical effect and safety of pulsed radiofrequency (PRF) treatment combined with pudendal nerve block (NB) to NB alone for treating pudendal neuralgia. Eighty patients were randomly assigned to receive either PRF+NB or NB. Pain levels, depression scores, treatment effects, analgesic use, and adverse events were assessed over 3 months. The results showed that PRF+NB provided significantly greater pain relief and improved depression scores compared to NB alone, with no severe adverse events reported for either group.
The document discusses the erector spinae plane (ESP) block anesthetic technique for managing postoperative pain in patients undergoing mastectomy. It provides background on post-mastectomy pain and the use of opioids for management. The document then describes the ESP block procedure and reviews literature supporting its efficacy in reducing postoperative pain and opioid use compared to other techniques. The rationale and objectives of studying ESP are to improve pain management strategies and reduce opioid dependency after breast surgery.
FUNCTION AFTER OPEN ABDOMINAL AORTIC POSOPERATIVE PULMONARY ANEURYSM REPAIR ...Felipe Posada
1) The study compared postoperative pulmonary function and pain control in COPD patients undergoing open abdominal aortic aneurysm repair with either epidural (Group I) or intravenous (Group II) analgesia.
2) Pulmonary function test (FEV1 and FVC) results were significantly better preserved in Group I patients on postoperative days 1 and 4.
3) Group I patients also had significantly less reported pain on postoperative days 1, 2, and 4 both at rest and during activity.
4) There were no differences in length of hospital stay, morbidity, or mortality between the groups.
A guide to beginners helping writing thesis protocol.
Comparison between USG guided Suprascapular Nerve block and Interscalene Nerve Block post operative analgesia after arthroscopic shoulder surgery- a prospective randomized double blind study.
This systematic review evaluated regional analgesic techniques for post-thoracotomy pain management, including thoracic epidural, paravertebral block, intrathecal, intercostal, and interpleural methods. The review found that continuous paravertebral block provided analgesia comparable to thoracic epidural with fewer side effects. Paravertebral block also reduced pulmonary complications versus systemic opioids, though epidural did not. Epidural was superior to intrathecal or intercostal techniques, which were still better than systemic opioids. Interpleural analgesia was inadequate. The review concluded that either epidural with local anesthetic plus opioid or continuous paravertebral block with local anesthetic can be recommended, with intrathecal opioid
The document summarizes a study that investigated whether adding hyaluronidase to ropivacaine reduces the time to achieve complete sensory block after axillary brachial plexus block. Patients were randomly assigned to receive ropivacaine with or without hyaluronidase. The study found that the group receiving ropivacaine with hyaluronidase had a significantly shorter mean time to achieve complete sensory block, sensory block onset time, and time to reach surgical anesthesia compared to the control group receiving ropivacaine alone. Addition of hyaluronidase to ropivacaine resulted in faster blockade times for axillary brachial plexus blocks.
1. This study compared general anesthesia (GA) and spinal anesthesia (SA) for 100 patients undergoing lumbar disk surgery through a randomized controlled trial.
2. Intraoperatively, mean blood loss was less with GA but not significantly. Surgeon satisfaction was higher with GA. No major complications occurred with either.
3. Postoperatively, hypertension was more common after GA, and nausea/vomiting were more frequent after SA.
4. Contrary to previous studies, the findings revealed SA had no advantages over GA, and GA may reduce risks and complications.
This document summarizes research on anticoagulation therapy for patients with proximal femoral fractures. It discusses two parts:
1) Guidelines for thromboprophylaxis in patients not previously on anticoagulants, which recommend early mechanical prophylaxis and starting chemical prophylaxis like LMWH after surgery.
2) Studies of patients previously on anticoagulants like warfarin. One study found pharmacological reversal of elevated INR with vitamin K and plasma reduced time to surgery from 6.8 to 2.8 days without increasing complications. Another found pharmacological reversal reduced time to surgery from 4.4 to 2.4 days on average. In summary, the document reviews protocols to prevent clots in femoral
1. This document describes a study protocol to evaluate if pre-procedural ultrasound of the lumbar spine can improve the procedural skill of performing subarachnoid blocks.
2. The study aims to compare outcomes like success on the first needle pass, number of needle passes, time taken between groups who receive pre-procedure ultrasound versus those who do not.
3. A review of previous literature found that ultrasound can help identify anatomy like the posterior longitudinal ligament that indicates ease of dural puncture, and may help predict difficult procedures. Simulation training and deliberate practice was also found to improve residents' skills in performing subarachnoid blocks.
This document describes a randomized clinical trial that aims to compare the incidence of blocking all three nerves (femoral, lateral femoral cutaneous, and obturator nerves) when performing ultrasound-guided fascia iliaca compartment block using either a supra-inguinal approach versus an infra-inguinal approach. Sixty patients undergoing lower limb surgery will be randomly assigned to receive the block using one of the two approaches. The primary outcome is the incidence of a three-nerve block, while secondary outcomes include time of nerve block onset and distance of injection point from the inguinal ligament.
This case report describes the anesthetic management of a 55-year-old male who suffered multiple traumatic injuries including a humerus fracture, pneumothorax, and fractures of the right distal radius, right scapula, right clavicle, and multiple ribs after a workplace accident. After initial stabilization and 20 days of conservative management, the patient underwent surgery including humerus plating and bone grafting. He was safely anesthetized using a supraclavicular and axillary brachial plexus block supplemented with spinal anesthesia, avoiding the risks of positive pressure ventilation exacerbating the occult pneumothorax. Regional anesthesia allowed for adequate pain management and surgery was completed without complications. The report concludes that regional anesthesia
Effect of Intravenous Dexmedetomidine on Prolongation of Intrathecal Spinal A...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
This retrospective study examined the use of neuromuscular blockade monitors (NMBMs) to stimulate the P6 acupoint intraoperatively for the prevention of post-operative nausea and vomiting (PONV) in two craniotomy patients. Both patients received standard anti-emetic pharmacological prophylaxis in addition to unilateral P6 electrostimulation via NMBM throughout surgery. Neither patient experienced PONV in the post-anesthesia care unit. The study suggests that P6 electrostimulation using NMBMs may decrease PONV when used as an adjunct to pharmacological prophylaxis, with minimal additional time, training or expense required. However, a randomized controlled trial is needed to verify the
Rischke_Viscoelastic Disc Arthroplasty Provides Superior Back and Leg Pain Re...Kari Zimmers
This study compared outcomes of patients receiving a viscoelastic total disc replacement (VTDR) to patients receiving anterior lumbar interbody fusion (ALIF) for lumbar disc degeneration using data from two independent spine registries. Linear regression models showed that VTDR was associated with significantly greater back and leg pain relief compared to ALIF, with differences of 2.76 and 2.12 points respectively. Additional factors influencing pain relief included female sex, monosegmental surgery, higher preoperative pain levels, and surgical level. The results suggest that viscoelastic total disc replacement may provide superior pain relief compared to anterior lumbar interbody fusion for patients with degenerative lumbar disc disease.
Neural blockade for persistent pain after breast cancer surgery Jason Attaman
1) The review examined evidence for neural blockade as a diagnostic tool or treatment for persistent pain after breast cancer surgery.
2) Only 7 studies with a total of 135 patients were identified that used blocks targeting the stellate ganglion, paravertebral plexus, or intercostal nerves.
3) The quality of evidence from the studies was low and inconclusive about the efficacy of neural blockade for treating persistent pain after breast cancer surgery. More high-quality studies are needed to evaluate this common clinical problem.
To Determine Preference of Shoulder Pain Management by General Physicians in ...suppubs1pubs1
Rotator cuff muscles are functionally active and provide stability to the shoulder joint and also thereby allow the full Range of Motion (ROM) by moving the head of humerus in the glenoid cavity. Any tear or fragility of the rotator cuff muscles can cause the dislocation or instability and hence damaging other muscles specially the long head of biceps muscle. The diseases related to the supraspinatus tendon are frequently linked with the long head of the biceps tendon. Other cause of chronic shoulder pain is the adhesive capsulitis with large prevalence rates of more than 5.3% in the general target population [3].
This document describes a research study protocol to evaluate the efficacy of intrathecal dexmedetomidine as an adjuvant to levobupivacaine spinal anesthesia for abdominal hysterectomy. The study will randomly assign 104 patients to receive either levobupivacaine with normal saline or levobupivacaine with 10 μg dexmedetomidine intrathecally. The primary outcomes will be postoperative analgesia duration measured by VAS scores and time to first rescue analgesic. Secondary outcomes include sensory and motor block durations and any intraoperative hemodynamic changes or side effects. Standard protocols will be followed for preoperative, intraoperative and postoperative care.
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Anti-Universe And Emergent Gravity and the Dark UniverseSérgio Sacani
Recent theoretical progress indicates that spacetime and gravity emerge together from the entanglement structure of an underlying microscopic theory. These ideas are best understood in Anti-de Sitter space, where they rely on the area law for entanglement entropy. The extension to de Sitter space requires taking into account the entropy and temperature associated with the cosmological horizon. Using insights from string theory, black hole physics and quantum information theory we argue that the positive dark energy leads to a thermal volume law contribution to the entropy that overtakes the area law precisely at the cosmological horizon. Due to the competition between area and volume law entanglement the microscopic de Sitter states do not thermalise at sub-Hubble scales: they exhibit memory effects in the form of an entropy displacement caused by matter. The emergent laws of gravity contain an additional ‘dark’ gravitational force describing the ‘elastic’ response due to the entropy displacement. We derive an estimate of the strength of this extra force in terms of the baryonic mass, Newton’s constant and the Hubble acceleration scale a0 = cH0, and provide evidence for the fact that this additional ‘dark gravity force’ explains the observed phenomena in galaxies and clusters currently attributed to dark matter.
Signatures of wave erosion in Titan’s coastsSérgio Sacani
The shorelines of Titan’s hydrocarbon seas trace flooded erosional landforms such as river valleys; however, it isunclear whether coastal erosion has subsequently altered these shorelines. Spacecraft observations and theo-retical models suggest that wind may cause waves to form on Titan’s seas, potentially driving coastal erosion,but the observational evidence of waves is indirect, and the processes affecting shoreline evolution on Titanremain unknown. No widely accepted framework exists for using shoreline morphology to quantitatively dis-cern coastal erosion mechanisms, even on Earth, where the dominant mechanisms are known. We combinelandscape evolution models with measurements of shoreline shape on Earth to characterize how differentcoastal erosion mechanisms affect shoreline morphology. Applying this framework to Titan, we find that theshorelines of Titan’s seas are most consistent with flooded landscapes that subsequently have been eroded bywaves, rather than a uniform erosional process or no coastal erosion, particularly if wave growth saturates atfetch lengths of tens of kilometers.
JAMES WEBB STUDY THE MASSIVE BLACK HOLE SEEDSSérgio Sacani
The pathway(s) to seeding the massive black holes (MBHs) that exist at the heart of galaxies in the present and distant Universe remains an unsolved problem. Here we categorise, describe and quantitatively discuss the formation pathways of both light and heavy seeds. We emphasise that the most recent computational models suggest that rather than a bimodal-like mass spectrum between light and heavy seeds with light at one end and heavy at the other that instead a continuum exists. Light seeds being more ubiquitous and the heavier seeds becoming less and less abundant due the rarer environmental conditions required for their formation. We therefore examine the different mechanisms that give rise to different seed mass spectrums. We show how and why the mechanisms that produce the heaviest seeds are also among the rarest events in the Universe and are hence extremely unlikely to be the seeds for the vast majority of the MBH population. We quantify, within the limits of the current large uncertainties in the seeding processes, the expected number densities of the seed mass spectrum. We argue that light seeds must be at least 103 to 105 times more numerous than heavy seeds to explain the MBH population as a whole. Based on our current understanding of the seed population this makes heavy seeds (Mseed > 103 M⊙) a significantly more likely pathway given that heavy seeds have an abundance pattern than is close to and likely in excess of 10−4 compared to light seeds. Finally, we examine the current state-of-the-art in numerical calculations and recent observations and plot a path forward for near-future advances in both domains.
TOPIC OF DISCUSSION: CENTRIFUGATION SLIDESHARE.pptxshubhijain836
Centrifugation is a powerful technique used in laboratories to separate components of a heterogeneous mixture based on their density. This process utilizes centrifugal force to rapidly spin samples, causing denser particles to migrate outward more quickly than lighter ones. As a result, distinct layers form within the sample tube, allowing for easy isolation and purification of target substances.
BIRDS DIVERSITY OF SOOTEA BISWANATH ASSAM.ppt.pptxgoluk9330
Ahota Beel, nestled in Sootea Biswanath Assam , is celebrated for its extraordinary diversity of bird species. This wetland sanctuary supports a myriad of avian residents and migrants alike. Visitors can admire the elegant flights of migratory species such as the Northern Pintail and Eurasian Wigeon, alongside resident birds including the Asian Openbill and Pheasant-tailed Jacana. With its tranquil scenery and varied habitats, Ahota Beel offers a perfect haven for birdwatchers to appreciate and study the vibrant birdlife that thrives in this natural refuge.
SDSS1335+0728: The awakening of a ∼ 106M⊙ black hole⋆Sérgio Sacani
Context. The early-type galaxy SDSS J133519.91+072807.4 (hereafter SDSS1335+0728), which had exhibited no prior optical variations during the preceding two decades, began showing significant nuclear variability in the Zwicky Transient Facility (ZTF) alert stream from December 2019 (as ZTF19acnskyy). This variability behaviour, coupled with the host-galaxy properties, suggests that SDSS1335+0728 hosts a ∼ 106M⊙ black hole (BH) that is currently in the process of ‘turning on’. Aims. We present a multi-wavelength photometric analysis and spectroscopic follow-up performed with the aim of better understanding the origin of the nuclear variations detected in SDSS1335+0728. Methods. We used archival photometry (from WISE, 2MASS, SDSS, GALEX, eROSITA) and spectroscopic data (from SDSS and LAMOST) to study the state of SDSS1335+0728 prior to December 2019, and new observations from Swift, SOAR/Goodman, VLT/X-shooter, and Keck/LRIS taken after its turn-on to characterise its current state. We analysed the variability of SDSS1335+0728 in the X-ray/UV/optical/mid-infrared range, modelled its spectral energy distribution prior to and after December 2019, and studied the evolution of its UV/optical spectra. Results. From our multi-wavelength photometric analysis, we find that: (a) since 2021, the UV flux (from Swift/UVOT observations) is four times brighter than the flux reported by GALEX in 2004; (b) since June 2022, the mid-infrared flux has risen more than two times, and the W1−W2 WISE colour has become redder; and (c) since February 2024, the source has begun showing X-ray emission. From our spectroscopic follow-up, we see that (i) the narrow emission line ratios are now consistent with a more energetic ionising continuum; (ii) broad emission lines are not detected; and (iii) the [OIII] line increased its flux ∼ 3.6 years after the first ZTF alert, which implies a relatively compact narrow-line-emitting region. Conclusions. We conclude that the variations observed in SDSS1335+0728 could be either explained by a ∼ 106M⊙ AGN that is just turning on or by an exotic tidal disruption event (TDE). If the former is true, SDSS1335+0728 is one of the strongest cases of an AGNobserved in the process of activating. If the latter were found to be the case, it would correspond to the longest and faintest TDE ever observed (or another class of still unknown nuclear transient). Future observations of SDSS1335+0728 are crucial to further understand its behaviour. Key words. galaxies: active– accretion, accretion discs– galaxies: individual: SDSS J133519.91+072807.4
PPT on Alternate Wetting and Drying presented at the three-day 'Training and Validation Workshop on Modules of Climate Smart Agriculture (CSA) Technologies in South Asia' workshop on April 22, 2024.
PPT on Sustainable Land Management presented at the three-day 'Training and Validation Workshop on Modules of Climate Smart Agriculture (CSA) Technologies in South Asia' workshop on April 22, 2024.