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The dural puncture epidural (DPE) technique is a novel approach for neuraxial anesthesia. While effective for cesarean sections and labor analgesia, its use in orthopedic surgery for elderly patients remains unexplored. This study evaluates the efficacy and safety of DPE in elderly patients undergoing orthopedic surgery. A total of 126 elderly patients were randomly assigned to three groups: epidural block (EPL), combined spinal epidural block (CSE), and DPE. The primary outcome was the onset time of anesthesia. Secondary outcomes included maximum anesthesia level, Onset time of motor block, blood pressure, and heart rate at key points, anesthetic efficacy, and adverse reactions such as hypotension, respiratory depression, nausea and vomiting, chills, and bradycardia. The onset time of anesthesia in the DPE group was significantly shorter than in the EPL group (17.6±4.0 min vs 19.2±3.9 min, P=0.037) but longer than in the CSE group (17.6±4.0 min vs 7.0±2.8 min, P<0.001). The Onset time of motor block was notably longer in the DPE group compared to the CSE group (20.6±3.8 min vs 9.2±3.9 min, P<0.001). At five minutes post-anesthesia, mean arterial pressure was significantly higher in the DPE group than in the CSE group (88.2±7.0 mmHg vs 84.4±7.6 mmHg, P=0.018); however, no significant difference was found between the EPL and DPE groups. Additionally, there were no significant differences among all three groups regarding hemodynamic parameters at other assessed time points, incidence of adverse reactions, or anesthetic effects. The onset time of DPE is faster than that of EPL, its impact on the circulatory system is less than that of CSE, and it has a satisfactory anesthetic effect, which may improve the anesthesia management in elderly orthopedic surgeries.

Prior to designing our study, we were interested in the results from the above-mentioned authors’ study.3 Their investigation showed that the bolus administration of dye in the porcine epidural space resulted in increased circumferential spread within that space. Because of those results, we were interested to see if we could reasonably infer circumferential spread with anteroposterior and lateral plain film X-rays using epidural contrast. In consultation with the attending veterinarian at our institution, this was identified as an anatomical difference between human and porcine spine. Because of this identified difference, our study was unable to assess for increases in caudal spread. Do epidural catheter size and flow rate affect bolus injection pressure in different programmed intermittent epidural bolus regimens? an in vitro study.

Oxytocin is a key hormone in breastfeeding. No recent review on plasma levels of oxytocin in response to breastfeeding is available. Systematic literature searches on breastfeeding induced oxytocin levels were conducted 2017 and 2019 in PubMed, Scopus, CINAHL, and PsycINFO. Data on oxytocin linked effects and effects of medical interventions were included if available. We found 29 articles that met the inclusion criteria. All studies had an exploratory design and included 601 women. Data were extracted from the articles and summarised in tables. Breastfeeding induced an immediate and short lasting (20 minutes) release of oxytocin. The release was pulsatile early postpartum (5 pulses/10 minutes) and coalesced into a more protracted rise as lactation proceeded. Oxytocin levels were higher in multiparous versus primiparous women. The number of oxytocin pulses during early breastfeeding was associated with greater milk yield and longer duration of lactation and was reduced by stress. Breastfeeding-induced oxytocin release was associated with elevated prolactin levels; lowered ACTH and cortisol (stress hormones) and somatostatin (a gastrointestinal hormone) levels; enhanced sociability; and reduced anxiety, suggesting that oxytocin induces physiological and psychological adaptations in the mother. Mechanical breast pumping, but not bottle-feeding was associated with oxytocin and prolactin release and decreased stress levels. Emergency caesarean section reduced oxytocin and prolactin release in response to breastfeeding and also maternal mental adaptations. Epidural analgesia reduced prolactin and mental adaptation, whereas infusions of synthetic oxytocin increased prolactin and mental adaptation. Oxytocin infusion also restored negative effects induced by caesarean section and epidural analgesia. Oxytocin is released in response to breastfeeding to cause milk ejection, and to induce physiological changes to promote milk production and psychological adaptations to facilitate motherhood. Stress and medical interventions during birth may influence these effects and thereby adversely affect the initiation of breastfeeding.

Cervical transforaminal epidural block (CTEB) is a useful option in the diagnosis and treatment of cervical radicular pain. However, inadvertent intravascular injection can lead to severe neurologic complications. Blunt needles are considered to displace instead of penetrate vessels because of their dull needle tip. To investigate whether there is a difference between blunt and sharp needles in intravascular injection rates during CTEB. Prospective, randomized, clinical trial. A tertiary hospital in South Korea. After institutional review board approval, 108 patients undergoing CTEB for treatment of radicular pain resulting from spinal stenosis and herniated nucleus pulposus were randomly assigned to one of 2 needle groups (blunt needle or sharp needle). The needle position was confirmed using biplanar fluoroscopy, and 2 mL of nonionic contrast medium was injected to detect intravascular injection. Intravascular injection was defined as the contrast medium spreading out through the vascular channel during injection under real-time fluoroscopy. This study was registered in ClinicalTrials.gov. The intravascular injection rate was not significantly different between the blunt needle and sharp needle groups (35.2% vs. 33.3%, P > 0.05). The procedure time was longer in the blunt needle group than in the sharp needle group (101.00 ± 12.4 seconds vs. 56.67 ± 8.3 seconds, P < 0.001). This was a single-center study. Additionally, the physicians could not be blinded to the type of needle used. In the present study, use of a blunt needle did not reduce the rate of intravascular injection during CTEB compared to use of a sharp needle. In addition, procedure time significantly increased with blunt needle use compared to sharp needle use. Analgesia, bleeding, blunt needle, cervical spine, clinical trials, complications, intravascular injection, radiculopathy, sharp needle, transforaminal epidural block.

Please confirm that an ethics committee approval has been applied for or granted: Not relevant (see information at the bottom of this page)Background and AimsPost-Puncture Headache Recurrence (PPHR) is a complication of performing neuraxial techniques. Performing a blood patch is a recognized treatment with a high success rate, however, recurrence of headaches after it has been described.MethodsClinical case: 33 years pregnant. Admitted for induction of labor. An epidural block was performed for labor analgesia, which complicated with accidental perforation of the dura mater with a Touhy needle. Six hours after delivery, headache typical of PPHR started, so conservative treatment was instituted. Due to the lack of symptoms improvement, a sphenopalatine block was carried out with no symptomatic improvement. For that reason, a blood patch was decided upon, resulting in complete resolution of the symptoms and the patient was discharged the following day. That night, she returned to the hospital due to a relapse of severe headache. After discussing the case with a Neurology specialist, a Magnetic Resonance Imaging performed that showed no signs of cerebral spine fluid hypotension. Conservative treatment was decided. The patient was discharged 4 days later with partial improvement of her condition.ResultsPPHR after performing a blood patch has been described. The risks and benefits of performing a new blood patch or conservative treatment must be weighed. Before starting treatment for PPHR, it is necessary to make a differential diagnosis with other causes of headache in the puerperium after performing neuraxial techniques.

Objective: There is no consensus on the use of optimal analgesic method after pediatric circumcision, although, caudal block (CB), dorsal penile nerve block (DPNB), topical local anesthetic application and systemic analgesic administration are frequently used methods. In this study, we aimed to compare the postoperative analgesic effects and side effects, as well as parental satisfaction concerning these methods. Patients and Methods: Eighty children, aged 3-12 years, undergoing circumcision were randomized into four groups (n=20). Group Caudal Anesthesia (CA), Group Dorsal Penile Blok (DP), Group Topical Analgesia (TA), Group Systemic Analgesics (SA). The severity of pain was measured with NRS or CHEOPS scores. Time to awakening, first analgesic requirement, hospital discharge, side effects and parental satisfaction were recorded. Results: In groups CA and DP, pain scores during the first postoperative hour were lower than the pain scores of other groups and in group CA, the first analgesic requirement time was significantly longer compared to other groups (p<0.05). In the early postoperative hour, parental satisfaction was higher in group CA compared to other groups. Conclusion: In the early postoperative period, CB and DPNB reduce pain more effectively and provide more parental satisfaction than other applications, (in children who underwent) circumcision.

Purpose of Review This systematic review aimed to compare the efficacy and safety of thoracic epidural block (TEB) and thoracic paravertebral block (TPB) for managing postoperative pain following thoracotomy for pulmonary procedures. Recent Findings A comprehensive search of PubMed, Embase, Web of Science, and Google Scholar identified randomized controlled trials (RCTs) published prior to April 10, 2024. Studies were eligible if they compared TEB and TPB in adult patients undergoing thoracotomy for pulmonary procedures and reported outcomes on postoperative pain, opioid consumption, hemodynamic parameters, or complications. Two reviewers independently screened studies, extracted data, and assessed quality using the Cochrane Risk of Bias tool. The review adhered to PRISMA guidelines. From 1,114 records screened, 7 RCTs comprising 429 patients met the inclusion criteria. TEB demonstrated superior pain relief in the immediate postoperative period, particularly when continuous infusions with opioids were utilized. TPB, however, provided greater hemodynamic stability, with significantly lower rates of hypotension and more stable mean arterial pressure and heart rate during the first 24 h. Beyond 24 h, both techniques offered comparable pain relief and opioid consumption. While the incidence of nausea, vomiting, and urinary retention was similar between groups, TPB was associated with fewer respiratory complications. Summary Both TEB and TPB are effective for postoperative pain management following thoracotomy, each with distinct advantages. TEB provides optimal early pain control, making it suitable for patients with significant early postoperative pain. TPB, with its superior hemodynamic profile, is better suited for patients at risk of hypotension or cardiovascular instability. Tailoring analgesic strategies to patient-specific needs can optimize outcomes. Future large-scale RCTs are necessary to confirm these findings across broader thoracic surgical populations. Registration and Protocol This review was registered with PROSPERO prior to initiation (Registration Number: CRD42024578768).

Background Although the efficacy and safety of epidural block (EB) are fairly high, complications such as inadvertent dural puncture may limit its use. Ultrasound-guided quadratus lumborum block (QLB) is a relatively new regional technique that provides perioperative somatic and visceral analgesia for pediatric patients. This trial compared the quality of pain relief in pediatric patients undergoing abdominal surgery who received either QLB or EB. Methods Patients were randomly allocated into two equal groups: Group E( n  = 29): received EB; Group QL( n  = 29): received QLB. Both groups were injected with 0.25% bupivacaine (0.5 ml/kg). Assessment of total analgesia consumption was the primary outcome measure, whereas the secondary outcome measures were assessment of postoperative analgesic effect by Children’s Hospital of Eastern Ontario Pain Scale (CHEOPS) and time of first analgesic request. Results Our study showed that the mean total fentanyl consumption was comparable between both groups(38.67 ± 5.02 and 36.47 ± 5.13 µg in the E and QL groups, respectively, P  = 0.246). Only five patients did not require rescue analgesia (3 in the E group,2 in the QL group, P  = 0.378). The mean duration of analgesia showed no significant difference between the two groups (9.9 ± 1.58 and 11.02 ± 1.74 h in the E and QL groups, respectively, P  = 0.212). Evaluation of CHEOPS score values immediately in PACU and for the initial 24 h following operation showed no significant difference between the two study groups( P  > 0.05). Conclusion QLB can achieve analgesic effects comparable to those of EB as a crucial part of multimodal analgesia in children undergoing abdominal surgeries. Clinical trial registration number PACTR202203906027106.

Lumbosacral radicular pain (LRP) is usually caused by herniation of intervertebral discs and is characterized by pain arising in the back and radiating to the lower extremities. The current study evaluated the efficacy of gray ramus communicans nerve block (GRCNB) in decreasing LRP in patients with intervertebral disc herniation who underwent transforaminal epidural block. Thirty patients with magnetic resonance imaging indicating a disc herniation on the L4-L5 level participated in this study. All patients were randomly divided into two groups: one whose members underwent GRCNB (n=15) after transforaminal epidural block, and a second group (n=15) whose members underwent only transforaminal epidural block on L4-L5 on the affected side. Follow-up after the procedure ran for a period ranging from 6 to 10 months (mean=8.2±2.1 months) for radicular pain score and the need for analgesics. The mean age of the patients was 54.8±18.4 years (range: 30-65 years). LRP duration in all patients before the procedure was 6-24 months (mean: 12±10.9 months), and there was no significant difference between the two groups. A greater reduction in the numerical rating scale (NRS) one week, 1, and 6 months after the procedure was observed in the group with GRCNB compared to the other group. The reduction in need for analgesics one week, 1, and 6 months after the procedure was statistically significant in the group with GRCNB compared to the group without GRCNB. No major complications were observed in any of the patients in either group. GRCNB is effective in reducing radicular pain and the need for analgesics in patients with lumbosacral radicular pain.

Video-assisted (VATS) lung lobectomy can be associated with stronger postoperative pain than is commonly believed. It is generally accepted to introduce multimodal analgaesic strategies based on regional blockade, opioids and non-steroidal anti-inflammatory drugs. However, there is still no consensus regarding the optimal regional technique. The aim of this study was to compare the analgaesic efficacy of continuous thoracic epidural block (TEA) and percutaneous continuous paravertebral block (PVB) in patients undergoing video-assisted lung lobectomy. Fifty-one patients undergoing VATS lobectomy were enrolled in the present prospective, randomised clinical trial. The same analgaesic regimen in both groups included continuous infusion of 0.25% bupivacaine with epinephrine, intravenous ketoprofen and paracetamol. The doses of local anaesthetics were determined to achieve the spread of at least 4 segments in both groups. Postoperative static and dynamic visual analogue pain scores, as well as patient-controlled morphine usage, were used to compare the efficacy of analgaesia. Side effects and failure rates of both blocks were analysed. Static and dynamic pain scores at 24 postoperative hours were significantly lower in the paravertebral group, as were the static pain score at 36 and 48 postoperative hours (P < 0.05). No difference between the treatment groups was identified regarding postoperative morphine usage. The failure rate was higher in the epidural group than in the paravertebral group. No complications were noted in either group, but side effects (urinary retention, hypotension) were more frequent in the epidural group (P < 0.05). Postoperative pain following VATS lung resection procedures is significant and requires the application of complex analgaesic techniques. Percutaneous paravertebral block is equally effective as thoracic epidural block in providing analgaesia in patients undergoing VATS lobectomy. Paravertebral block has a better safety profile than thoracic epidural block.