Objectives: Quadratus Lumborum Block in contrast to Transversus Abdominis Plane Block contains a unique component which not only stops somatic pain but also inhibits visceral pain by spreading the local anesthetic to the paravertebral space. This study was designed to determine whether performing the Quadratus Lumborum Block type I in patients undergoing cesarean section would be associated with both decreased morphine consumption and decreased pain levels in the postoperative 48-hour period. Material and methods:Sixty patients undergoing caesarean section under spinal anesthesia were randomly and equally assigned to one or other of two groups: QLB I (who received Bilateral Quadratus Lumborum Block type I with the use of 24 mL 0.375% ropivacaine per side) or a Control group. In both groups, on-demand morphine analgesia was administered postoperatively within the first 48 hours. The following were measured: the morphine consumption; the time elapsed from the C-section until the first dose of morphine; and the levels of pain intensity among patients in rest (numeral pain rating scale).Results: There were no statistically significant demographic data differences between the QLB I and Control groups. The following significant differences were observed in the 48-hour postoperative period: morphine consumption was higher in the Control group (p = 0.000); the time elapsed from the C-section until the first dose of morphine was longer in QLB I group (p < 0.05); and the median of the pain numeric rating scale was higher in the Control group (p < 0.05). Conclusions:Quadratus Lumborum Block type I significantly reduces morphine consumption and pain levels up to 48 hours postoperatively.

BACKGROUND Several studies have shown an analgesic efficacy of a transversus abdominis plane block (TAPB) in reducing opioid requirements during and after cadaveric renal transplantation surgery, but the effect of a quadratus lumborum block (QLB) in this type of surgery is unclear. OBJECTIVES The main objective of this prospective, randomised, double-centre clinical study was to compare the analgesic efficacy of a one-sided lateral approach TAPB with a unilateral QLB type 2 in cadaveric renal transplantation surgery. DESIGN Randomised, single-blinded trial. SETTING Two University-affiliated tertiary care hospitals between April 2016 and May 2017. PATIENTS A total of 101 patients aged more than 18 years, scheduled for cadaveric renal transplantation. INTERVENTIONS On receiving ethical board approval and individual informed consent, consecutive patients were allocated randomly to receive either an ultrasound-guided single-shot lateral TAPB or an ultrasound-guided single-shot QLB type 2 on the surgical side using 20 ml of bupivacaine 0.25% with adrenaline after a standardised induction of general anaesthesia. All patients on surgical completion and recovery from general anaesthesia were admitted to the postanaesthesia care unit for 24 h. They received standardised intravenous patient-controlled analgesia with fentanyl, and their pain scores were noted at regular intervals. MAIN OUTCOME MEASURES The primary endpoint was total cumulative fentanyl dose used per kg body mass in the first 24 h after surgery. Secondary outcomes were the need to start a continuous infusion of fentanyl in addition to patient-controlled analgesia boluses during the stay in post-anaesthesia care unit, postoperative pain severity measured using a numerical rating scale, patient satisfaction with analgesic treatment, evidence of postoperative nausea and vomiting, pruritus and sedation level. RESULTS The 49 patients allocated to the QLB type 2 group used significantly less fentanyl per kg in the first 24 h after surgery than the 52 patients who received a TAPB (median [IQR] 4.2 [2.3 to 8.0] μg kg−1 versus 6.7 [3.5 to 10.7] μg kg−1, P = 0.042). No statistically significant differences were noted in the secondary endpoints within the study, including the frequency of adverse effects of opioids. CONCLUSION The reduction of fentanyl consumption in the first 24 h after renal transplantation with no difference in pain intensity and patient satisfaction shows a beneficial effect of one-sided QLB type 2 over a one-sided TAPB in regards to postoperative analgesia. However, the reduction in opioid consumption did not affect the frequency of opioid-related adverse effects. TRIAL REGISTRATION ClinicalTrials.gov ID: NCT02783586.

Background: New regional techniques can improve pain management after nephrectomy. Methods: This study was a randomized controlled trial conducted at two teaching hospitals. Patients undergoing elective open and laparoscopic nephrectomy were eligible to participate in the trial. A total of 100 patients were divided into a quadratus lumborum block (QLB) group (50 patients) and a control (CON) group (50 patients). At the end of surgery, but while still under general anesthesia, unilateral QLB with ropivacaine was performed on the side of nephrectomy for patients in the QLB group. The main measured outcome of this study was oxycodone consumption via a patient-controlled anesthesia (PCA) pump during the first 24 h following surgery; other measured outcomes included postoperative pain intensity assessment, patient satisfaction with pain management, and persistent pain evaluation. Results: Patients undergoing QLB needed less oxycodone than those in the CON group (34.5 mg (interquartile range 23 to 40 mg) vs. 47.5 mg (35–50 mg); p < 0.001). No difference between the groups was seen in postoperative pain intensity measured on the visual analog scale, except for the evaluation at hour 2, which was in favor of the QLB group (p = 0.03). Patients who received QLB were more satisfied with postoperative pain management than the CON group. Persistent postoperative pain was assessed with the Neuropathic Pain Symptom Inventory (NPSI) at months 1, 3, and 6, and was found to be significantly lower in the QLB group at each evaluation (p < 0.001). We also analyzed the impact of the surgery type on persistent pain severity, which was significantly lower after laparoscopic procedures than open procedures at months 1, 3, and 6. Conclusions: QLB reduces oxycodone consumption in patients undergoing open and laparoscopic nephrectomy and decreases persistent pain severity months after hospital discharge.

Background: Quadratus lumborum block (QLB) provides a reduction in pain scores and opioid consumption after cesarean section (CS). Intrathecal morphine (ITM) is still considered as the gold standard of acute postoperative pain therapy, but it does have some significant side effects. The aim of this clinical study was to evaluate whether performing the quadratus lumborum block type I in patients undergoing CS would be associated with an increased satisfaction of pain therapy and a decreased incidence of chronic postsurgical pain (CPSP). Methods: Sixty patients scheduled for elective CS were enrolled. All patients received spinal anesthesia and were randomly allocated to either the QLB group (received bilateral quadratus lumborum block type I with the use of 24 m mL 0.375% ropivacaine) or the control group (received no block). The level of satisfaction was evaluated using a three-step scale and the answers provided in a questionnaire regarding the patients’ satisfaction with the method of postoperative pain treatment in the first 48 h. After a 6-month period, all patients were interviewed to evaluate the incidence and possible severity of CPSP. Results: Satisfaction scores were significantly lower in the QLB group than in the control group (p = 0.0000). There were no significant differences between the QLB and control groups regarding the occurrence of chronic postsurgical pain after 6 months following CS (p = 0.102). No statistical differences between the groups were recorded when we compared the results of the questionnaire after a period of 48 h from CS (the number of participants were limited in number). Conclusions: QLB type I is an analgetic option that increased the satisfaction of parturients with pain therapy after CS compared to patients who did not receive the block, and there is a tendency for a lower incidence of CPSP.

I n t r o d u c t i o n : ���tic ��oc� i� d�� n�d �� � �i���t�r��t�nin� or��n ��i�ur� c�u� ���tic ��oc� i� d��n�d �� � �i���t�r��t�nin� or��n ��i�ur� c�u� sed by an abnormal response of the body to infection. Urinary tract infections (UTI�) con�titut� �bout 10%-20% o� ��� community��cquir�d in��ction� �nd �bo� ut 40%-50% o� �o��it����cquir�d in��ction�. In ��ti�nt� wit� im��ir�d immunity they may lead to sepsis. Strains of Klebsiella pneumoniae are often multidrug resi� stant, and therapeutic chances are limited where they occur. A i m : T�� �im o� t�i� ����r i� to di�cu�� t�� mo�t r�c�nt �uid��in�� in di��no�The aim of this paper is to discuss the most recent guidelines in diagno� sing and treating sepsis, referring to a clinical case report. C a s e s t u d y : T�� �tudy �r���nt� � c��� o� ���tic ��oc� in � 44�y��r�o�d ��m��� ��ti�nt in � community��cquir�d UTI c�u��d by K. pneumoniae �xt�nd�d����c� trum ��ct�m���� (E�BL + ). R e s u l t s a n d d i s c u s s i o n : The course of septic shock proved fatal. As the stay in the intensive care unit (ICU) was short, this precluded implementing full diagnostic procedures and identifying the source of infection. A post mortem examination was performed to establish the cause of death and aetiology of the infection.C o n c l u s i o n s : K. pneumoniae ESBL + has become a growing epidemiological problem in Poland and all over the world. This pathogen increasingly often leads to community��cquir�d in��ction� �nd it� mu�tidru� r��i�t�nc� m���� t�� ��� plied therapies ineffective. Diabetes, one of the modern lifestyle diseases, impairs resistance and accelerates rapidly progressing septic shock with multiple organ failure. Late diagnosis of sepsis, because of considerable metabolic and cellular changes, brings about tragic results. Despite implementing new diagnostic me� thods and therapies, the mortality rate in sepsis still remains very high.

No abstract

Background The erector spinae plane (ESP) block has recently been shown to effectively alleviate postoperative pain and reduce opioid consumption in breast surgery patients. However, data are still limited concerning the quality of recovery in patients following this procedure. Methods This study was a randomized controlled trial (RCT) performed in a university hospital. We randomly allocated patients to one of three groups: ESP, SHAM, and control (CON). Procedures in the ESP and SHAM blocks were performed ipsilaterally with 0.375% ropivacaine or 0.9% saline (0.4 mL/kg). Our primary outcome was the assessment of the patient’s improvement with quality-of-recovery 40 (QoR-40) a day after surgery. Other outcome assessments included postoperative pain evaluation on the visual analog scale (VAS), 24-hour opioid consumption with patient-controlled analgesia (PCA), time to the first opioid demand, and global satisfaction with perioperative treatment. Results Overall, patients in the ESP group had improved QoR-40 compared to the CON group, 186 [177–193] vs. 175 [165–183] (medians and interquartile ranges). Pain severity was significantly higher in the CON group compared to the ESP group at hours 2 (38 [23–53] vs. 20 [7–32]) and 4 (30 [18–51] vs. 19 [7–25]). Moreover, we observed lower oxycodone consumption after 24 hours with the PCA pump between the ESP (4 [2–8] mg) and the CON (9.5 [5–19]) groups. Patients in the CON group used PCA sooner than those in the ESP group. Participants in the ESP group were more satisfied with treatment than those in the CON group. We found no statistical difference between SHAM and the other groups. Conclusions Compared to the CON group, the ESP block improved the quality of recovery, alleviated pain intensity, and lowered opioid consumption in patients undergoing breast surgery. However, we did not observe this superiority in comparison with the SHAM group. Trial registration NCT04726878.

Background: Modifications of tibial tuberosity advancement are well accepted for cranial cruciate rupture repair. We compared the loads that were needed to pull the TTA CF cage out in the two groups. The first group consisted of five sheep in which osteotomy and TTA CF cage fixation were performed as assumed preoperatively. The second group consisted of five sheep in which intraoperative or postoperative discrepancies from preoperative planning were found. This is also the first report describing biomechanical testing after tibial tuberosity advancement with cranial implant fixation (TTA CF) surgical procedures. Results: A total of 10 ovine proximal tibiae were tested biomechanically by tearing out TTA CF implants from the bone. The mean maximal loaded forces to pull out the cage in Group 1, in which fixation of the implant was performed as assumed preoperatively, was 878 ± 61 N, and in Group 2, in which discrepancies from preoperative planning were found, was 330 ± 55 N. The mean implant displacement under maximal load to failure was 2.6 mm and 2.2 mm in Groups 1 and 2, respectively. There was a significant difference between Group 1 and Group 2 in the maximal loads-to-failure; however, the difference in the displacement at maximal loaded forces to pull out the cage was not significant between the groups. Conclusions: The mean maximal loaded forces to pull out the cage was significantly lower in Group 2, where discrepancies from preoperative planning were found (878 ± 61 N vs. 330 ± 55 N). The lower forces that were needed to extract the TTA CF implant from the tibia can lead to the conclusion that biointegration of the implant is also weaker. Correct positioning of the osteotomy line and TTA CF implant is essential for good biointegrity and thus for limiting complications in the form of tibial tuberosity avulsion fracture or tibial shaft fracture.