Objective:To compare the analgesic effects of femoral nerve block (FNB) and adductor canal block (ACB) after arthroscopic knee surgery. Methods:This was a prospective randomised clinical trial that enrolled 92 patients undergoing arthroscopic knee surgery. Ultrasound-guided FNB or ACB was performed immediately after surgery for pain relief. Visual analogue scale (VAS) scores and modified sedation-agitation scale (SAS) were recorded and analysed immediately following block and at 3, 6, 12 and 24 hours. The satisfaction level was also evaluated using a Likert-based patient questionnaire.Results: VAS scores decreased to 4.1±0.8 from 5.6±1.2 immediately after any nerve block, and within 3 hours, they continued to decrease to 2.0±0.6 in the FNB group and 3.4±1.0 in the ACB group (P=0.014). More patients in the FNB group were satisfied with the quality of the pain control compared to the ACB group. Additionally, patients in the ACB group required more supplemental analgesia compared to the FNB group. Conclusion:This study demonstrated that patients with FNB had denser analgesia after arthroscopic knee surgery and had less analgesic requirement compared with ACB. Greater satisfaction scores also reflected superior analgesia in patients receiving FNB.Keywords: Knee arthroscopy, femoral nerve, saphenous nerve, ultrasound Amaç: Bu çalışmanın amacı artroskopik diz cerrahisi sonrasında kullanılan femoral sinir bloğu (FSB) ve addüktör kanal bloğunun (AKB) analjezik etkilerini karşılaştırmaktır.Yöntemler: Bu prospektif randomize klinik çalışmaya artroskopik diz ameliyatı geçiren 92 hasta dahil edildi. Ağrıyı dindirmek amacıyla cerrahiden hemen sonra ultrason eşliğinde FSB veya AKB uygulandı. Bloğun hemen ardından ve 3., 6., 12. ve 24. saatlerde vizüel analog skalası (VAS) ve modifiye sedasyon-ajitasyon skalası (SAS) skorları kaydedildi ve analiz edildi. Aynı zamanda Likert tipi hasta anketi kullanılarak memnuniyet düzeyi de değerlendi-rildi.Bulgular: VAS skorları her iki sinir bloğundan hemen sonra 5,6±1,2'den 4,1±0,8'ye düştü ve 3 saat içerisinde FSB grubunda 2,0±0,6'ya ve AKB grubunda 3.4±1.0 değerine kadar düştü (p=0,014). AKB grubu ile kıyaslandığında, ağrı kontrolünün kalitesinden memnuniyet duyma oranı FSB grubunda daha yüksekti. Ek olarak, AKB grubundaki hastalarda ilave analjezi ihtiyacının, FSB grubundaki hastalara göre daha yüksek olduğu görüldü.Sonuç: Çalışmanın sonucuna göre, artroskopik diz cerrahisi sonrasında FSB daha yoğun analjezi ve AKB ile kıyaslandığında bu hastalarda daha az analjezik gereksinimi görülmüştür. Ayrıca daha yüksek memnuniyet skorları, FSB uygulanan hastalarda daha iyi analjezi sağlandığını göstermiştir.Anahtar Sözcükler: Diz artroskopisi, femoral sinir, safenöz sinir Abstract / Öz
The case study approach provides students with a better appreciation of how scientists solve problems and conduct themselves in the "real world". When applied to the undergraduate chemistry laboratory, this approach also challenges critical thinking skills and creativity in ways "cook book" experiments very often do not. This approach provides students the opportunity to learn analytical principles in the context of relevant everyday problems, stimulate a sustaining interest, and develop higher cognitive skills and reasoning abilities. The laboratory-based case study described here combines the use of small collaborative groups and a modern instrumental technique, with application to a common consumer product. Students are required to conduct themselves as chemists would, when addressing the problem of product purity claims, and to make a determination based on their experimental results that will be used to direct future action taken by a formulation company. This case study even addresses potential legal exposure issues the company may encounter with the Food and Drug Administration. In that context, students come to realize that a faulty conclusion could potentially have undesirable ramifications. In addition, students are provided with the opportunity to gain useful hands-on experience on instrumentation commonly used in modern analytical laboratories. A "professional" report must also be written by students in journal style format including all relevant data, calculations, and statistical and error analysis. Assessment was made using mixed methods. Results indicate the laboratory was largely successful in meeting its objectives.
ObjectiveTo compare the efficacy of ilioinguinal/iliohypogastric (IINB) nerve block to transversus abdominis plane (TAP) block in controlling incisional pain after open inguinal hernia repair.Patients and methodsThis was a prospective randomized clinical trial of 90 patients who received either IINB (N=45) or TAP block (N=45) using 0.2% bupivacaine 15 mL under ultrasound (US) guidance based on a random assignment in the postanesthesia care unit after having an open repair of inguinal hernia. Numeric Rating Scale (NRS) scores were recorded immediately following, 4, 8, 12, and 24 hours after completion of the block. NRS scores at rest and during movement were recorded 24, 36, and 48 hours after surgery. Analgesic satisfaction level was also evaluated by a Likert-based patient questionnaire.ResultsNRS scores were lower in the IINB group compared to the TAP block group both at rest and during movement. The difference in dynamic pain scores was statistically significant (P=0.017). In addition, analgesic satisfaction was significantly greater in the IINB group than the TAP block group (mean score 2.43 vs 1.84, P=0.001). Postoperative opioid requirements did not differ between the two groups.ConclusionThis study demonstrated that compared to TAP block, local blockade of ilioinguinal and iliohypogastric nerves provides better pain control after open repair of inguinal hernia when both blocks were administered under US guidance. Greater satisfaction scores also reflected superior analgesia in patients receiving IINB.
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