Compared with FNB, ACB results in significant quadriceps motor sparing and significantly preserved balance.

US reduces the number of attempts, LA volume, and postoperative pain when compared with NS for ISB.

Patients exposed to a surgical safety checklist experience better postoperative outcomes, but this could simply reflect wider quality of care in hospitals where checklist use is routine.

The analgesic benefits of CISB found in the PACU and immediately after discharge extend through the intermediate recovery period ending on postoperative day 7.

The role of thoracic paravertebral block (PVB) in preventing chronic postsurgical pain (CPSP) after breast cancer surgery (BCS) has gained interest, but existing evidence is conflicting, and its methodological quality is unclear. This meta-analysis evaluates efficacy of PVB, compared with Control group, in preventing CPSP after BCS, in light of the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT) recommendations. Electronic databases were searched for randomized trials comparing PVB with Control group for CPSP prevention after BCS. Eligible trials were assessed for adherence to IMMPACT recommendations. The primary outcomes were CPSP at 3 and 6 months, whereas secondary outcomes were PVB-related complications. Data were pooled and analyzed using random-effects modelling. Trial sequential analysis was used to evaluate evidence conclusiveness. Data from 9 studies (604 patients) were analyzed. The median (range) of IMMPACT recommendations met in these trials was 9 (5, 15) of 21. Paravertebral block was not different from Control group in preventing CPSP at 3 months, but was protective at 6 months, with relative risk reduction (95% confidence interval) of 54% (0.24-0.88) (P = 0.02). Meta-regression suggested that the relative risk of CPSP was lower when single-injection (R = 1.00, P < 0.001) and multilevel (R = 0.71, P = 0.01) PVB were used. Trial sequential analysis revealed that 6-month analysis was underpowered by at least 312 patients. Evidence quality was moderate according to the GRADE system. Evidence suggests that multilevel single-injection PVB may be protective against CPSP at 6 months after BCS, but methodological limitations are present. Larger trials observing IMMPACT recommendations are needed to confirm this treatment effect and its magnitude.

This article qualitatively assesses and summarizes randomized, controlled studies regarding benefits of ultrasound (US) for brachial plexus block and also examines those studies that have compared different brachial plexus block techniques using US.Studies were identified by a search of PUBMED and EMBASE databases using the MeSH terms anesthetic techniques, brachial plexus, and ultrasound. Included studies were limited to randomized trials that compared a US technique with another accepted method of performing brachial plexus block or those studies that compared 2 different US-guided techniques. Studies were further classified according to methodological quality using accepted methods. Quality scores were compared using Mann-Whitney U test, and significance assumed at P < 0.05.Twenty-five studies met inclusion criteria, with 19 studies comparing US techniques with other nerve location methods and 6 studies comparing different US techniques. Of the former, there was convincing evidence to support the use of US, with 15 of 19 studies demonstrating improved outcomes compared with existing techniques.Ultrasound provides significant advantages when performing brachial plexus block including faster sensory block onset and greater block success.

The evidence in these data suggests that the difference in average pain intensity after FIB versus SB was not significant (95% confidence interval, -2.2-1.4 NRS units).

A rthroscopic shoulder surgery is a common procedure for outpatients, but often pain is severe, interfering with sleep and requiring oral opioid treatment for several days, with its attendant adverse effects. The interscalene brachial plexus block (ISB) and the continuous ISB (CISB) have been compared with general anesthesia (GA) for anesthesia management in these patients, but follow-up periods in these studies rarely went beyond 48 hours. This prospective, randomized study was designed to assess the postoperative recovery profile for patients receiving singleinjection ISB (SISB), CISB, or GA for arthroscopic rotator cuff repair surgery throughout the first 7 days.Seventy-one patients were enrolled. Patients in the SISB group received 20 mL 0.5% ropivacaine through a 5-cm, 22-gauge insulated block needle with the needle tip at the C5-C6 level. For patients in the CISB group, the same aseptic technique and positioning were followed. After the 5-cm, 18-gauge insulated stimulating needle was inserted, a nonstimulating catheter was inserted~3 cm beyond the tip of the needle, and the needle was then withdrawn over the catheter. A 1-mL 0.05% ropivacaine injection confirmed the position of the catheter tip at C5-C6, then the rest of 20 mL 0.5% ropivacaine was injected. Block success for both techniques was defined as complete sensory loss to pinprick on the skin over the deltoid muscle at 30 minutes and ability to complete surgery with intravenous sedation using a propofol infusion while maintaining meaningful patient contact, spontaneous breathing with an oxygen mask, and no need for conversion to GA. Patients in the GA group received a standardized anesthesia protocol with propofol, fentanyl, and rocuronium, and maintenance with sevoflurane in nitrous oxide/oxygen. Anesthesia duration was defined as the time between induction of anesthesia and time when the patient left the operating room after tracheal extubation. Postoperative numeric rating scale (NRS) scores were obtained through the first 7 postoperative days (PODs), in addition to time to first pain, analgesic consumption, fast-tracked postanesthesia care unit (PACU) bypass rate, length of stay (LOS) in the PACU, time to discharge home, total hours of sleep, and adverse effects recorded in the PACU and at home on PODs 1, 2, 3, and 7. The primary outcome was the highest pain score at POD 7.Among 70 patients randomized, 63 completed the study, with 20, 23, and 20 subjects in the CISB, SISB, and GA groups, respectively. The groups did not differ in demographic characteristics. By POD 7, 74% of patients in the CISB group reported NRS of less than 4 compared with 83% and 58% in the SISB and GA groups, respectively, who had NRS of 4 or greater (P ≤ 0.05 for both). On PODs 1 and 2, mean NRS was lower for those in the CISB group than in the other 2 groups. The 3 groups did not differ in duration of surgery and anesthesia care, although it took longer (mean ± SD) to accomplish the block in the CISB group compared with SISB group (11 ± 11 vs 6 ± 3 minutes, respectively; ...