BackgroundThis randomized trial compared ultrasound-guided pericapsular nerve group block and suprainguinal fascia iliaca block in patients undergoing primary total hip arthroplasty. We selected the postoperative incidence of quadriceps motor block (defined as paresis or paralysis of knee extension) at 6 hours as the primary outcome. We hypothesized that, compared with suprainguinal fascia iliaca block, pericapsular nerve group block would decrease its occurrence from 70% to 20%.MethodsForty patients undergoing primary total hip arthroplasty under spinal anesthesia were randomly allocated to receive a pericapsular nerve group block (n=20) using 20 mL of adrenalized levobupivacaine 0.50%, or a suprainguinal fascia iliaca block (n=20) using 40 mL of adrenalized levobupivacaine 0.25%. After the performance of the block, a blinded observer recorded pain scores at 3, 6, 12, 18, 24, 36, and 48 hours; cumulative breakthrough morphine consumption at 24 and 48 hours; opioid-related side effects; ability to perform physiotherapy at 24 and 48 hours; as well as length of stay. Furthermore, the blinded observer also carried out sensory assessment (of the anterior, lateral, and medial aspects of the mid-thigh) and motor assessment (knee extension and hip adduction) at 3, 6, and 24 hours.ResultsCompared with suprainguinal fascia iliaca block, pericapsular nerve group block resulted in a lower incidence of quadriceps motor block at 3 hours (45% vs 90%; p<0.001) and 6 hours (25% vs 85%; p<0.001). Furthermore, pericapsular nerve group block also provided better preservation of hip adduction at 3 hours (p=0.023) as well as decreased sensory block of the anterior, lateral, and medial thighs at all measurement intervals (all p≤0.014). No clinically significant intergroup differences were found in terms of postoperative pain scores, cumulative opioid consumption at 24 and 48 hours, ability to perform physiotherapy, opioid-related side effects, and length of hospital stay.ConclusionFor primary total hip arthroplasty, pericapsular nerve group block results in better preservation of motor function than suprainguinal fascia iliaca block. Additional investigation is required to elucidate the optimal local anesthetic volume for motor-sparing pericapsular nerve group block and to compare the latter with alternate motor-sparing strategies such as periarticular local anesthetic infiltration.Trial registration numberNCT04402450.

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The Biemer and Yasargil microvascular clips that are currently available commercially can traumatize the vascular endothelium. In an effort to resolve this problem, both clip designs were structurally modified by changing the length, width, and surface of the clip blades in various ways. Also, the occlusion force of the clips was set at either 15 or 30 g. Studies on the carotid arteries of 140 rats showed a correlation between the structural and mechanical alterations of the clips and the degree of endothelial trauma produced by temporary occlusion for 1 hour. The most favorable results were obtained with a Biemer clip that had long, wide, smooth blades and an occluding force of 15 g.

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This research aims to contribute to the field of construction history in Chile, specifically in the seaport city of Valparaiso, in the period between the late nineteenth and early twentieth centuries, which was a time of great economic and urban development. The work of Esteban Orlando Harrington-a renowned Chilean engineer and architect who designed more than 20 buildings (mostly masonry structures) in the Valparaiso portwas studied. This type of construction is analyzed according to the materials, building systems, and structural criteria used. A review is carried out on historic information and documents, and an inspection of five buildings with the goal of understanding how they were constructively conceived is done. Here the most significant case is presented for its architectural, historical, and structural characteristics and values: the former Royal Hotel. The results of this research reveal aspects of Valparaiso's construction history through the work of a professional who adapted foreign techniques to local conditions, with results that are valued for their architectural quality and good seismic behavior. Keywords:History of construction; architecture in seismic zones; brick masonry; Valparaíso; construction industry. ResumenLa presente investigación tiene como objetivo aportar al campo de la historia constructiva y técnica de la arquitectura del puerto de Valparaíso en el periodo comprendido entre finales del siglo XIX y principios del Siglo XX. Se estudia la obra del reconocido arquitecto -ingeniero Esteban Orlando Harrington quien diseña y construye más de 20 edificios, muchos de ellos en albañilería de ladrillo. Se analiza esta tipología constructiva desde la caracterización de los materiales empleados, los criterios estructurales y un detallado levantamiento del sistema constructivo utilizado. De esta aproximación se desprenden atributos del sistema replicado, y presumiblemente mejorado, por el arquitecto -ingeniero Harrington que ha condicionado su permanencia en el tiempo, en una zona de fuerte actividad sísmica.Palabras Claves: Historia de la construcción; arquitectura en zonas sísmicas; albañilería; Valparaíso; construcción industrial.

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