Articles: nerve-block.
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Pediatric femur fractures often necessitate surgical intervention, with pain management being critical for both immediate and long-term outcomes. Peripheral nerve blocks (PNBs) and neuraxial techniques are effective in providing targeted pain relief while minimizing systemic opioid exposure. Despite their benefits, the utilization of these anesthesia techniques in pediatric orthopedic surgeries is limited, particularly among socioeconomically disadvantaged patients. ⋯ The findings underscore significant disparities in the application of regional anesthesia, influenced by socioeconomic factors. Our study highlights the need for standardized guidelines and interventions to address these disparities, ensuring equitable access to effective pain management techniques in pediatric orthopedic care. Further research is warranted to understand the barriers to the utilization of PNB and to develop strategies to enhance its adoption, particularly among underserved populations.
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Curr Opin Crit Care · Feb 2025
ReviewSpontaneous breathing-induced lung injury in mechanically ventilated patients.
Recent experimental and clinical studies have suggested that spontaneous effort can potentially injure the lungs. This review summarizes the harmful effects of spontaneous breathing on the lungs during mechanical ventilation in ARDS and suggests potential strategies to minimize spontaneous breathing-induced lung injury. ⋯ Several potential strategies, including neuromuscular blockade, partial paralysis, phrenic nerve blockade, sedatives, PEEP, and prone positioning, could be useful to minimize spontaneous breathing-induced lung injury.
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The purpose of this study is to determine whether adaptively stepwise increasing the intensity of a high-frequency (10 kHz) biphasic stimulation (HFBS) can produce nerve conduction block without generating a large initial response. ⋯ This study is important for better understanding the possible mechanisms underlying the HFBS-induced nerve block and provides the possibility of developing a new nerve block method for clinical applications in which an initial large response is a concern.
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In this study, the spread of methylene blue was compared between an ultrasound-guided Pericapsular Nerve Group (PENG) block and a double injection technique, where the approach towards the inferomedial acetabulum was added to the latter. ⋯ Our study demonstrates adequate staining of the iliac bone with comparable distal and medial spread in both techniques, indicating that the PENG block with a single injection is adequate in blocking the hip capsule with 10 mL local anesthetics. Staining of the femoral nerve occurred in 2/6 specimens after the PENG block, and staining of the obturator nerve in 1 specimen in each group.
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Peripheral and truncal nerve blocks provide effective analgesia facilitating perioperative care. However, thresholds for clinically relevant effects remain undetermined and are left for clinicians to choose. These choices are fundamental for sample size calculations and interpretation of study results. This systematic scoping review aimed to create an overview of primary outcomes and anticipated effect sizes in randomised clinical trials assessing peripheral and truncal nerve blocks. ⋯ The presented outcomes and effect sizes from published trials on peripheral and truncal nerve block literature can be used in future trials to increase homogeneity in regional anaesthesia research.