Background Minimally invasive knee replacement surgery has grown in early twenty-first century to join international trend of ambulatory joint surgery. Both ultrasound-guided femoral nerve block (FNB) and adductor canal block (ACB) have excellent postoperative analgesia following uni-knee replacement. Minimal motor power affection facilitates early patient ambulation and rehabilitation. Therefore, the objective of this study is to evaluate and compare the functional recovery and analgesic efficacy of both techniques in uni-knee arthroplasty. Methods After University Review Board approval, informed written consent to participate in the study was obtained. Patients scheduled for unicompartmental knee arthroplasty (UKA) with combined spinal-epidural anesthesia were eligible for enrollment in this double blind, randomized trial. Patients received either FNB or ACB with a 20 cc of 0.5% of bupivacaine with 5 μg/ml epinephrine. Quadriceps muscle strength was measured as primary outcome using Medical Research Council scale (MRC). Postoperative pain with visual analog scale (VAS) and total morphine consumption was considered as secondary outcome, all recorded for 48 h post-anesthesia administration. Results Eighty patients were analyzed; quadriceps strength was significantly lower in the FNB group compared with ACB group especially at 12 postoperative hour (2 versus 4), respectively, p value < 0.05. There was no difference between the groups regarding postoperative. VAS at rest except at 24 h was significantly lower in FNB group with p value 0.003. The gate disturbance and the number of falls were significantly lower in the ACB group than the FNB group (2 compared to 9), respectively. There was no difference between groups regarding postoperative nausea, vomiting, and itching. Conclusion ACB preserved quadriceps muscle strength more than FNB, with reduced number of falls and without significant difference in pain relief. Therefore, ACB considered an alternative to FNB when given as supplemental postoperative pain control after unicompartmental knee arthroplasty. Trial registration This clinical trial was registered in the Pan African Clinical Trial Registry (PACTR) http://www.pactr.org/ as a prospective trial with the identification number PACTR201907788767332.

Background Endotracheal intubation is essential for optimal airway control during general anesthesia or resuscitation of critically ill patients. Misplacement of the endotracheal tube (ETT) can lead to devastating, preventable morbidity and mortality. Colorimetric carbon dioxide detectors are considered a simplistic mainstream capnography that contains a pH-sensitive chemical marker that is prone to color change with ventilation. Real-time tracheal ultrasound allows for the dynamic observation of tube passage through the trachea or the esophagus, providing immediate confirmation of placement prior to any ventilation attempts with reported sensitivity/specificity of 100% for adult patients in the operating room. We aimed to compare two different techniques (tracheal real-time ultrasound vs colorimetric capnography) as point of care tools for confirmation of correct endotracheal tube position. Results This study carried out on eligible seventy patients undergoing general anesthesia. Patients were divided randomly and equally into two groups (35 patients each). Group A in which patients’ ETT position was confirmed by real-time tracheal ultrasound and group B in which patients’ ETT position was confirmed by colorimetric capnography. Comparing both groups according to their diagnostic performance for detecting the correct position of the ETT inserted showed the diagnostic sensitivity, specificity, and accuracy of real-time tracheal ultrasound vs colorimetric capnography (93.8%, 66.7%, and 91.4% VS 97%, 50%, and 94.3% respectively). Although there were higher sensitivity and accuracy of colorimetric capnography than real-time tracheal ultrasound, the p value between the two groups was 0.462. Conclusion Both tools are fast, effective, reliable, and accurate with many advantages and few disadvantages including the need for training on ultrasound practice and air-filled stomach in colorimetric capnography. However, these disadvantages can be easily overruled and the benefits from both tools overweigh their disadvantages.

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Background: The postoperative pain after percutaneous nephrolithotomy (PCNL) can be managed by many peripheral blocks techniques (e.g., paravertebral and quadrates lumborum block), and local anesthesia infiltration. Therefore, this prospective study was conducted to evaluate the effect of quadratus lumborum type III versus peritubal local infiltrating on postoperative analgesia for patients undergoing PCNL under general anesthesia.Methods: Eligible subjects after exclusion of COVID-19 patients, with renal stones less than 2 cm undergoing PCNL surgery under general anesthesia. Exclusion criteria were: 21<years of age or > 60 years of age; bleeding disorders; allergies to local anesthetics; psychiatric patients; and American Society of Anesthesia (ASA) physical status III and IV. Eighty patients were randomly allocated to 2 equal groups. In the Quadratus group, participant received 20 mL of bupivacaine 0.25% in the fascial plane between the quadratus lumborum and Psoas muscle; and in the peritubal group, patients received 10 mL of bupivacaine 0.25% around the nephrostomy tube at 6 and 12 o’clock positions (total 20 mL). The quadratus lumborum block and peritubal infiltration were performed by the primary investigator and the urologist, respectively. All patients received standard postoperative analgesia (paracetamol, ketorolac, and morphine via patient-controlled analgesia. Both patients and Data collecting staff were blinded to study group. Primary outcome was the visual analogue score at rest and on coughing or movement at 2, 4, 6, 12, and 24 hours. Secondary outcomes were 24 hours total morphine consumption, 1st use of morphine pump, incidence of side effects (pruritis and nausea and vomiting) and patient satisfaction.Results: Data were analyzed from 78 patients (39 patients in each group). The mean resting VAS score in quadratus group at 6 and 12 hours was (3), while the mean VAS in peritubal group was (5) and (6) at 6 and 12 hours, respectively. Dynamic VAS score in peritubal group at 6 hours was (mean 6) with p<0.0001 when compared to resting value. The 24 hours’ morphine consumption was 8.5-11mg and 16-19 mg, in quadratus and peritubal group, respectively (the difference in mean of 9 at the 95% confidence interval; p<0.0001). patients start to use morphine pump after 121.4 min and 180.2 min in group peritubal and quadratus, respectively. Patients in group quadratus were statistically more satisfied, in both groups incidence of complication was low.Conclusion: Quadratus Lumborum block was more effective than Peritubal LA infiltration regarding postoperative VAS score both at rest and during movement with lower postoperative morphine consumption and more satisfaction in patients undergoing PCNL surgery.

Background. Articaine has been used in many dental and ophthalmic outpatient procedures. In the era of ultrasound-guided regional techniques, we searched for short and potent local anesthetic for patients undergoing ambulatory upper limb procedures. However, studies about articaine efficacy in brachial plexus block are limited. In this study, we compared its safety and efficacy against bupivacaine as a commonly used anesthetic agent for ultrasound-guided supraclavicular brachial plexus block. Methods. This randomized prospective study was performed at Ain Shams University Hospital from January to March 2020. A total of 117 patients aged 20 to 60 years, with the American Society of Anesthesiologists physical status I and II, were enrolled in the study. Patients were randomly allocated into two groups: in group A, patients received 30 ml articaine 2%, and in group B, patients received 30 ml of bupivacaine 0.5%. We measured motor and sensory block duration as a primary outcome. Other secondary outcomes such as onset of block, duration of analgesia, patient satisfaction, and time to home discharge readiness were also measured. Results. We analyzed data collected from 97 patients. The motor block duration was significantly shorter in group A (165.73 ± 20.33 min) than in group B (220.27 ± 37.73 min). The onset of motor block was faster in group A (8.73 ± 4.33 min), and the postoperative VAS score was lower in group B. Patients in group A achieved an earlier home discharge of 289.67 ± 2.73 min. Conclusion. Earlier resolution of articaine block makes it more favorable than bupivacaine for ambulatory surgery. This trial is registered with (NCT04189198).