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Subsequently, however, an insufficient sensorial blockade of the medial part of the thigh (innervated by the obturator nerve) was reported in patients undergoing L-ESPB in hip surgery, and we also found similar findings in our clinic [3]. The patients received 1000 mg paracetamol every 6 h and patient controlled analgesia (PCA) with fentanyl. Case Age Sex ASA status Pathology Opioid consumption Pain scores at 1, 2, 4, 8, 12, 24 h respectively 1 86 F IV Right FNF 80 μg fentanyl with PCA (8 mg morphine equivalent) 0, 0, 0, 1, 1, 0 2 96 M IV Left IFF 70 μg fentanyl with PCA (7 mg morphine equivalent) 0, 0, 0, 2, 2, 0 3 72 M III Right IFF 60 μg fentanyl with PCA (6 mg morphine equivalent) 0, 0, 2, 3, 1, 0 Table 1 Patient characteristics, analgesic requirements and pain scores.

While common approaches to clavicle fracture surgery are general anaesthesia, regional anaesthesia techniques such as interscalene brachial plexus block (ISBP) combined with superficial cervical plexus (SCP) block [2]. Since the skin sensory blockade could not achieved with CPB block, a SCP block should be implemented to provide block of the supraclavicular branch of the superficial cervical plexus. While, ISBP block combined with a SCP block is commonly used regional anaesthesia technique, the CPB block may provide an alternative option in case of interscalene brachial plexus block is either contraindicated or technically challenging.

This study aimed to compare the effects of high doses of ondansetron and granisetron before spinal anesthesia on hemodynamic parameters in patients undergoing elective cesarean section. A double-blinded randomized placebo-controlled trial. Operating room. A total of 120 parturients with term pregnancy undergoing elective cesarean section with combined spinal-epidural anesthesia were included. Three groups (n = 40 for each group) were formed by randomization. Five minutes before the anesthesia procedure, Group I received 8 mg intravenous (IV) ondansetron diluted in 10 ml normal saline, Group II received IV 3 mg granisetron diluted in 10 ml normal saline, and Group III received IV 10 ml normal saline. Following intrathecal drug administration, intraoperative hemodynamic changes were recorded every 2 min for 20 min and then every 5 min until the end of the operation. Twenty patients (50%) in Group I, 12 patients (30%) in Group II, and 29 patients (72.5%) in Group III had hypotension requiring treatment with IV ephedrine (P = 0.001). The ephedrine requirement in Group III was significantly higher than in Groups I (P = 0.033) and II (P < 0.001). Also, the ephedrine requirement in Group II was lower than in Group I, but the difference was not statistically significant (P = 0.055). The mean arterial pressure for the three groups differed in the 10th, 18th, and 60th minutes. The number of patients with nausea or vomiting was lower in Groups I and II than in Group III (P < 0.001). At 5 min, the Apgar scores were higher than 8 for all neonates. Postoperative scores for the visual analogue scale were similar for all groups. It was concluded that prophylactic IV administration of 3 mg of granisetron or 8 mg of ondansetron before spinal anesthesia results in a significantly lower ephedrine requirement compared to placebo. •Spinal anesthesia is commonly used in cesarean section surgeries.•The most important adverse effect in spinal anesthesia is hypotension.•These decreases may cause harmful effects for both parturients and neonate.•Both prophylactic granisetron and ondansetron decrease the ephedrine requirement.

Lumbar ESP block was first described by Tulgar et al. as a postoperative pain management technique after hip surgery [3]. In our case, since the surgical technique involved both pelvic and femoral bones, we used a combination of PENG and ESP to control postoperative pain after a major surgery like Pemberton and proximal femur varus-derotational osteotomy (Fig. 1). [...]evaluation through clinical studies is required.Funding The authors have no sources of funding to declare for this manuscript.Declaration of competing interest The authors declare no conflicts of interest.

Rhomboid intercostal block (RIB) is a new interfascial plane block which has been performed for pain management after thoracotomy, scapular surgery and mastectomy successfully for adult patients. Herein we report a successful rhomboid intercostal plane block with a catheter placement in a pediatric patient undergoing thoracic hydatid cyst surgery. [...]a catheter was inserted and the catheter tip was confirmed with injection of 5 ml normal saline under ultrasound visualization.

Background Hypotension is associated with serious complications, including myocardial infarction, acute kidney injury, and mortality. Consequently, predicting and preventing hypotension may improve outcomes. We will therefore determine if use of a novel hypotension prediction tool reduces the duration and severity of hypotension in patients having non-cardiac surgery. Methods/design We will conduct a two-center, pragmatic, randomized controlled trial ( N  = 213) in noncardiac surgical patients > 45 years old who require intra-arterial blood pressure monitoring. All participating patients will be connected to a Flortrac IQ sensor and EV1000 platform (Edwards Lifesciences, Irvine). They will be randomly assigned to blinded or unblinded arms. The Hypotension Prediction Index (HPI) and advanced hemodynamic information will be universally recorded, but will only be available to clinicians when patients are assigned to unblinded monitoring. The primary outcome will be the effect of HPI software guidance on intraoperative time-weighted average mean arterial pressure under a threshold of 65 mmHg, which will be assessed with a Wilcoxon-Mann-Whitney 2-sample, two-tailed test. Discussion Our trial will determine whether the Hypotension Prediction Index and associated hemodynamic information substantively reduces hypotension during non-cardiac surgery. Trial registration ClinicalTrials.gov, NCT03610165 . Registered on 1 August 2018.

The other large layer, the so-called minor retropectoral layer, is thicker and more posterior, which is inserted into the posterior side of the clavicle, communicates with the investing layer of the deep cervical fascia, extends posterior and lateral encompassing the axillary artery and vein in conjunction with the brachial plexus, completely isolating them from the anterior compartments as it can be observed in Fig. 1A–B. [...]a majority of anatomical studies show that there is a complex connection between all the fascias around the clavicle: the pectoral fascia, subclavius fascia, prevertebral and investing layer of deep cervical fascia, and the clavipectoral fascia. [...]the connection between all of the fascial layers form an envelope encasing the clavicle, and the injection inside this envelop represent the target for the CPB. [...]the clavipectoral fascia is the largest of all of them and the one that gives name to this block, the Clavipectoral Fascia Plane Block (CPB).Funding Dr. Elsharkawy has received unrestricted educational funding from PAJUNK (GA, USA), and consultant for PACIRA (Troy Hills, NJ, USA).

Different types of analgesia including opioids, gabapentinoids, nonsteroidal anti-inflammatory drugs, intraoperative ketamine are commonly used for postoperative pain management. Following institutional ethics committee approval and obtaining written informed consent, 40 patients who aged 18–85 years, ASA I-III, failure of conservative treatment and scheduled for single-level discectomy were included in the study. According to our results, we conclude that wound infiltration is as effective as TLIP block for postoperative pain relief after single-level discectomy.