IntroductionThe posterior lumbar plexus block (LPB) has been used for decades to provide acute pain management after hip surgery. Unfamiliarity with the technique and its perceived difficulty, potential risks, and possible adverse effects such as quadriceps weakness have limited broader use. The quadratus lumborum block (QLB) has been reported to be effective for postoperative pain control following hip surgery and may thus offer another regional alternative for practitioners. This study hypothesized that the QLB type 3 (QLB3) can produce a non-inferior analgesic effect compared with LPB for primary hip replacement.MethodsThis double-blinded, non-inferiority trial randomized 46 patients undergoing primary hip replacement to receive either QLB3 or LPB. Outcomes were assessed on postanesthesia care unit arrival and at postoperative hours 6, 12, and 24. The primary outcome measured was numeric rating scale (NRS) pain score 24 hours after surgery. Secondary outcomes included opioid consumption, presence of quadriceps weakness at first postoperative physical therapy (PT) session, and time to achieve 100 feet of walking.ResultsThe QLB3 did not cross the non-inferiority delta of 2 points on the NRS pain score (mean difference −0.43 (95% CI −1.74 to 0.87)). There were no significant differences between groups in total opioid consumption at 24 hours or in time to achieve 100 feet of walking. Quadriceps weakness at first PT session was less common with QLB3 (26% vs 65%) and time to perform the block was significantly less with QLB3 (10 min vs 5 min).ConclusionThis trial supported the hypothesis that the QLB3 yields non-inferior analgesia compared with LPB for hip replacement surgery.Trial registration numberNCT03801265.
BACKGROUND:The representation of women among leaders in the field of anesthesia continues to trail that of their male counterparts. This qualitative study was conducted to understand the pathway of leadership acquisition among women in the field of anesthesiology. METHODS: Using constructivist grounded theory, we sought to determine whether there were specific internal or external factors that were common to women in leadership in the specialty field of anesthesiology, and specifically, how they obtained leadership positions. Semistructured interviews were conducted for data collection. A total of 26 women in leadership positions in anesthesiology participated in this study. RESULTS: The analysis of these interviews resulted in the development of 4 common themes related to career pathways for these women in leadership. Each theme was examined in depth to determine the qualities necessary for individuals to advance in the field and the pathway to obtaining leadership positions. The findings of this study showed that early-career, high-value mentorship and sponsorship were important factors in leadership acquisition. Most participants (n = 20; 76%) had early mentors. Of those with early mentorship, 13 (65%) had high-value mentors, who we define as someone with power or authority. Sponsorship was the leading factor contributing to leadership acquisition. CONCLUSIONS: The results of this qualitative study may serve as a guide for encouraging female anesthesiologists with leadership aspirations. We suggest that the specialty field of anesthesiology institute targeted measures to help increase the percentage of women leadership with formal sponsorship programs at the local and national levels. (Anesth Analg 2023;136:6-12) KEY POINTS• Question: How do female anesthesiologists close the gender leadership gap in anesthesiology? • Findings: Early-career, high-value mentors may be advantageous, and sponsorship is crucial to acquiring leadership positions for women in anesthesiology. • Meanings: Opportunities exist in the specialty field of anesthesiology to reduce the gender gap in leadership with formalized mentorship and sponsorship programs at the local and national levels.
Tarlov cysts are extradural meningeal cysts with a collection of cerebrospinal fluid that most often affects sacral nerve roots, causing chronic low back pain and radiculopathy. Still, there is no consensus regarding the best treatment for symptomatic cysts. We describe a patient who developed worsening lower back pain and radiculopathy after interventional drainage and surgical management. Medication and various procedures failed to relieve the pain. Subsequently, the patient received significant pain relief from spinal cord stimulation (SCS). This case provides evidence that SCS could be used to manage refractory pain from Tarlov cysts that have failed to respond to other treatment modalities.
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