Saudi Journal Of Anaesthesia[JOURNAL]
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200 papers
Nerve block or fascial block: This is the question.
Fusco P, Petroni GM, De Sanctis F … +2 more , Maggiani C, Nazzarro E
Saudi J Anaesth · 2025 · PMID 40642610 · Full text
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Awareness and practices regarding local anesthetic usage and toxicity among OB-GYN and anesthesiology professionals in Saudi Arabia.
Baaj J, Alhaizan M, Alsafar R … +3 more , Muammar AB, Aldaijy M, Alfaifi R
Saudi J Anaesth · 2025 · PMID 40642609 · Full text
BACKGROUND: Local anesthetics (LAs) are commonly used in obstetrics and gynecology (OB-GYN); however, inappropriate administration can cause local anesthetic systemic toxicity (LAST), a life-threatening condition. For sa...
BACKGROUND: Local anesthetics (LAs) are commonly used in obstetrics and gynecology (OB-GYN); however, inappropriate administration can cause local anesthetic systemic toxicity (LAST), a life-threatening condition. For safe medical practice, healthcare providers should carefully follow the guidelines for administering LAs for early identification and proper management of LAST when it occurs. METHODS: This nationwide study used a 36-item self-administered questionnaire administered to healthcare professionals in OB-GYN and anesthesiology. The survey assessed the knowledge, attitudes, and practices of commonly used LA agents, their appropriate dosage, and awareness of LAST's management. RESULTS: A study of 391 Saudi healthcare professionals, between OB-GYN (51.2%) and anesthesiology (48.8%), reported greater engagement in anesthetic training and usage among anesthesiologists (88% trained, 58.1% daily use) than among OB-GYNs (38.5% trained, 30.5% daily use). OB-GYNs most commonly performed perineal tear repairs (88.5%), whereas anesthesiologists mainly performed paracervical blocks (89.5%). Lidocaine was the preferred local anesthetic for OB-GYNs at 93.5%, with anesthesiologists also favoring lidocaine but showing a higher use of bupivacaine (75.4%). Furthermore, the knowledge, attitudes, and practices scores of OB-GYN participants were significantly lower scores in all parameters compared to the anesthesiology participants ( < 0.001). CONCLUSIONS: Healthcare professionals in OB-GYN lack adequate knowledge of the safe and effective use of LA agents. Their knowledge must be increased through education to ensure safe practices.
PENG Block: A superior alternative for pain management in intracapsular hip fractures.
Esteller PG, Ramírez CE, Juarez-Pomes M … +2 more , Martín Sanchez JC, Martínez Garcia M
Saudi J Anaesth · 2025 · PMID 40255360 · Full text
BACKGROUND AND OBJECTIVES: Previous studies have demonstrated the effectiveness of regional analgesic techniques for pain management after hip surgery; however, no clear superiority between these techniques has been esta...
BACKGROUND AND OBJECTIVES: Previous studies have demonstrated the effectiveness of regional analgesic techniques for pain management after hip surgery; however, no clear superiority between these techniques has been established. A key limitation of these studies is the lack of differentiation between fracture subtypes. This prospective, comparative cohort study aims to evaluate the effectiveness of two regional techniques-pericapsular nerve group block (PENG) and suprainguinal iliac fascia block (FICB)-in providing perisurgical analgesia for intracapsular femoral fractures. MATERIALS AND METHODS: Sixty-four patients undergoing elective surgery for intracapsular femoral fractures were randomly assigned to receive either a PENG block or an FICB block, each with 15 mL of 0.2% ropivacaine. Intradural anesthesia and conventional intravenous analgesia were administered during surgery. The primary outcome was pain scores in the recovery room and 24 hours post-surgery. Secondary outcomes included the need for intravenous opioid rescue medication during the first 24 hours. RESULTS: The PENG group demonstrated significantly lower postoperative pain scores compared to the FICB group both immediately after surgery ( = 0.006) and at 24 hours ( < 0.001). Additionally, fewer patients in the PENG group required weak opioids in the first 24 hours following surgery ( = 0.001). CONCLUSIONS: The PENG block provides superior postoperative analgesia for intracapsular femoral fractures compared to the FICB block following hip surgery, with reduced opioid consumption observed in the PENG group. CLINICAL TRIAL REGISTRATION: NCT05377541.
The evolution of teaching and learning regional anesthesia at every career stage: The U.S. perspective.
To L, Ye M, Chang S … +1 more , Mariano ER
Saudi J Anaesth · 2025 · PMID 40255359 · Full text
Regional anesthesia and analgesia are integral to modern perioperative medicine and contribute to multimodal analgesia and enhanced recovery protocols. Over the past two decades, regional anesthesia practice has changed...
Regional anesthesia and analgesia are integral to modern perioperative medicine and contribute to multimodal analgesia and enhanced recovery protocols. Over the past two decades, regional anesthesia practice has changed dramatically with the incorporation of real-time ultrasound guidance. Anesthesiologists in the U.S. who completed residency training in the early 2000s were not routinely taught how to use ultrasound for regional anesthesia, and subspecialty fellowships in regional anesthesia at that time were relatively few and varied widely in terms of educational experience. Today, the state of regional anesthesia education in the U.S. is completely different and has embraced a multipronged, multigenerational approach that addresses the needs of anesthesiologists in training, as well as anesthesiologists in practice throughout the career lifecycle. This review will cover the current state of regional anesthesia education for residents, fellows, and practicing anesthesiologists and will note important historical advances, as well as future trends that may shape the curricula for regional anesthesia learners in formal training and continuing education.
Continuous wound infusion as a valid alternative to tap block for postoperative analgesia after abdominal hysterectomy: A randomized controlled trial.
Costa F, Ruggiero A, Strumia A … +18 more , Pascarella G, Cuccarelli M, Plotti F, Agrò FE, Carassiti M, Cataldo R, Ruggiero G, Terranova C, Nardone CC, Montera R, Angioli R, Gargano F, Bruno E, Sammartini D, Sammartini E, Martinelli A, Schiavoni L, Mattei A
Saudi J Anaesth · 2025 · PMID 40255358 · Full text
BACKGROUND: Total abdominal hysterectomy is a procedure associated with moderate to severe postoperative pain. Regional anesthesia techniques, such as fascial plane blocks, have shown promise in improving postoperative p...
BACKGROUND: Total abdominal hysterectomy is a procedure associated with moderate to severe postoperative pain. Regional anesthesia techniques, such as fascial plane blocks, have shown promise in improving postoperative pain control. While continuous wound infusion is recommended for cesarean section, it is not recommended for open abdominal hysterectomy. Our aim is to compare surgically placed catheter for wound infusion with the transverse abdominis plane block. METHODS: A single-center prospective randomized controlled trial was conducted in Italy from January to July 2023. Patients undergoing elective hysterectomy were randomly assigned to receive either bilateral transverse abdominis plane block or continuous wound infusion. The primary outcome measure was the assessment of static pain in the recovery room and at 6, 12, 24, and 48 hours postoperatively using the numeric rating scale (NRS) for pain. Of the 34 patients assessed for eligibility, 32 were randomized and equally distributed between the continuous wound infusion and transverse abdominis plane block groups. RESULT: Patients receiving continuous wound infusion consistently reported lower static NRS pain scores compared to those receiving transverse abdominis plane block across all postoperative time points. The median NRS scores were significantly lower in the wound infusion group at 6, 12, 24, and 48 hours post surgery ( < 0.05). Importantly, similar significant differences were also observed between the groups for dynamic NRS scores. However, no significant differences were observed between the groups for secondary outcomes, including nausea and vomiting, and recovery of functional capacity. CONCLUSION: Continuous wound infusion with a properly positioned catheter is noninferior to transverse abdominis plane block for postoperative pain management following total abdominal hysterectomy and may even provide superior pain control. These findings suggest continuous wound infusion as a viable alternative for effective pain management in total abdominal hysterectomy procedures.
Advancing regional anesthesia - Innovations, insights, and impact on patient care.
De Cassai A, Eldawlatly A
Saudi J Anaesth · 2025 · PMID 40255357 · Full text
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Regional anesthesia in obese patients: Challenges, considerations, and solutions.
De Cassai A, Zarantonello F, Pistollato E … +4 more , Pettenuzzo T, Busetto V, Sella N, Boscolo A
Saudi J Anaesth · 2025 · PMID 40255356 · Full text
The increasing global prevalence of obesity has significant implications for anesthesiologists, particularly in the context of regional anesthesia. Anesthesiologists face numerous challenges during anesthesia in obese pa...
The increasing global prevalence of obesity has significant implications for anesthesiologists, particularly in the context of regional anesthesia. Anesthesiologists face numerous challenges during anesthesia in obese patients, including compromised respiratory function, altered pharmacokinetics of local anesthetics, and difficulties in identifying anatomical landmarks. Obesity often leads to reduced respiratory reserve, increased risk of hypoventilation, and conditions such as obstructive sleep apnea syndrome and obesity hypoventilation syndrome, which increase the likelihood of postoperative complications. Additionally, altered body composition in obese patients affects the distribution of local anesthetics, requiring adjustments in dosing based on lean body weight rather than total body weight. Furthermore, excess adipose tissue complicates the identification of anatomical landmarks and the use of ultrasound for regional block procedures, as the increased tissue depth and reduced image resolution hinder needle placement. Proper positioning, the use of low-frequency transducers, and harmonic imaging techniques are essential for optimizing ultrasound guidance. Additionally, the use of longer needles and the application of trigonometric calculations based on ultrasound scans can help determine the appropriate needle length. To overcome these challenges, anesthesiologists should adopt strategies that involve adjusting drug dosages, utilizing specialized equipment, and continuously monitoring patients for potential complications. A holistic approach involving knowledge of these technical and pathological challenges, as well as adapting techniques and equipment, is crucial for ensuring the safety and effectiveness of regional anesthesia in obese patients.
Fascial plane blocks as the main anesthetic method: A narrative review.
Tulgar S, Ahıskalıoğlu A, Kilicaslan A … +4 more , Çiftçi B, Dost B, Aydın ME, Gürkan Y
Saudi J Anaesth · 2025 · PMID 40255355 · Full text
This narrative review evaluates the efficacy of fascial plane blocks (FPB) as sole anesthetic method for surgery. Particularly in selected high-risk patients, fascial plane blocks may be a more useful and convenient opti...
This narrative review evaluates the efficacy of fascial plane blocks (FPB) as sole anesthetic method for surgery. Particularly in selected high-risk patients, fascial plane blocks may be a more useful and convenient option than general anesthesia or neuraxial anesthesia. In recent years, with the use of ultrasound, newly defined FPBs have emerged and these techniques have become popular. There are case reports in the literature reporting the use of these blocks for anesthesia, but clinical studies are limited and clinicians may be undecided about which block or combination to apply in which case. In this narrative review, which is the first in this field in the literature, we aimed to discuss the use of FPBs and which combinations can be used in which incisions and which surgeries.
Chronic postsurgical pain after cardiac surgery: A narrative review.
Dost B, Karapinar YE, Karakaya D … +6 more , Demir ZA, Baris S, Koksal E, Aydin ME, Ciftci B, Tulgar S
Saudi J Anaesth · 2025 · PMID 40255354 · Full text
Chronic postsurgical pain (CPSP) is a prevalent and debilitating sequela of cardiac surgery, exerting a profound impact on patients' quality of life, functional recovery, and healthcare systems. Its pathophysiology inclu...
Chronic postsurgical pain (CPSP) is a prevalent and debilitating sequela of cardiac surgery, exerting a profound impact on patients' quality of life, functional recovery, and healthcare systems. Its pathophysiology includes complex mechanisms, including peripheral and central sensitization, neuroplastic alterations, and inflammatory pathways, influenced by demographic, psychological, and perioperative factors. Inadequate management of acute pain is a critical contributor to its development. This review examines the etiology of CPSP, presents key risk factors, and critically evaluates pharmacological and nonpharmacological interventions. Particular attention is devoted to the role of regional anesthesia techniques and emerging preventive and therapeutic strategies, highlighting the necessity of multidisciplinary, evidence-informed approaches to address this persistent clinical challenge.
Fascial plane blocks for postoperative pain management after fast-track total knee arthroplasty: A narrative review.
Costa F, Ruggiero A, Fusco P … +8 more , Ricci M, Del Buono R, Strumia A, Migliorelli S, Agrò FE, Carassiti M, Cataldo R, Pascarella G
Saudi J Anaesth · 2025 · PMID 40255353 · Full text
Total knee replacement is a common surgical procedure associated with significant postoperative pain, which can delay recovery and increase healthcare costs. Regional anesthesia techniques, including local infiltration a...
Total knee replacement is a common surgical procedure associated with significant postoperative pain, which can delay recovery and increase healthcare costs. Regional anesthesia techniques, including local infiltration analgesia and fascial plane blocks, play a crucial role in multimodal pain management strategies. These approaches aim to enhance pain relief while minimizing opioid use and preserving motor function. This narrative review evaluates the effectiveness and safety of motor-sparing fascial plane blocks for total knee replacement, categorizing techniques based on their anatomical target areas: anterior, posterior, and other approaches. A comprehensive literature search was conducted using databases such as MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials. The search included studies on motor-sparing regional anesthesia techniques for total knee replacement using relevant keywords such as "regional anesthesia," "peripheral nerve block," "motor-sparing techniques," and specific block names. The selection criteria included randomized controlled trials, systematic reviews, meta-analyses, and relevant case studies. The techniques were analyzed based on their effectiveness in pain relief, impact on motor function, and overall contribution to enhanced recovery after total knee replacement. The review highlights that the most evidence-supported technique for anterior knee pain management is the block targeting the adductor canal, which provides effective analgesia while preserving motor function. For posterior compartment pain relief, the infiltration between the popliteal artery and the knee capsule is the preferred approach. Emerging techniques, such as the dual subsartorial block and the para-sartorial compartment block, show promise but require further validation. The review also underscores the importance of integrating different techniques to ensure adequate pain control for both the anterior and posterior compartments, facilitating early mobilization in fast-track recovery protocols. Achieving optimal postoperative pain management after total knee replacement requires a combination of targeted regional anesthesia techniques. Current evidence supports the use of adductor canal block for anterior knee analgesia and the infiltration between the popliteal artery and the knee capsule for posterior pain relief. While newer techniques show potential, further research is needed to validate their efficacy and safety. Future studies should focus on refining fascial plane block strategies to optimize analgesic benefits while minimizing motor impairment, thereby improving functional recovery and reducing the reliance on opioid medications.
Effect of ultrasound-guided PecS II block on the incidence of chronic postmastectomy pain in patients after radical mastectomy: A randomized controlled trial.
Hu H, Luo Z, Li B … +4 more , Wang T, Wu T, Li B, Song X
Saudi J Anaesth · 2025 · PMID 40255352 · Full text
BACKGROUND: The pectoral nerve (PecS) II block is a recently introduced technique utilized for surgical anesthesia and postoperative analgesia during breast surgery. This study aims to investigate the impact of ultrasoun...
BACKGROUND: The pectoral nerve (PecS) II block is a recently introduced technique utilized for surgical anesthesia and postoperative analgesia during breast surgery. This study aims to investigate the impact of ultrasound-guided PecS II block on the incidence of chronic postmastectomy pain in patients following radical mastectomy. METHODS: Ninety-eight patients undergoing selective radical mastectomy were included in this study. Based on whether the ultrasound-guided PecS II block was performed, the patients were randomly divided into the PecS II block group (group P) and the control group (group C). The primary outcomes included the incidence of chronic pain at 12 weeks after surgery, and the secondary outcomes included intraoperative dosage of remifentanil, the amount of oxycodone used in 48 h after surgery, time for the first analgesia administration, postoperative acute pain score 48 h after surgery, and HADS score at 48 h and 12 weeks after surgery. The presence or absence of pain in the previous week was recorded every 7 days after surgery (beginning on the 8 day after surgery). The postoperative pain duration curves of the two groups were plotted and compared by Kaplan-Meier estimation and log-rank test. RESULTS: Compared with group C, the incidence of chronic pain in group P at 12 weeks after surgery was significantly decreased by 14.13% (20.65% vs. 34.78%, < 0.05). The amount of remifentanil used in group P was significantly reduced (1.46 ± 0.11 mg vs. 2.66 ± 0.18 mg, < 0.001), and the amount of oxycodone used 48 h after surgery in group P was remarkably reduced than that in group C (22.57 ± 3.21 mg vs. 31.62 ± 4.71 mg, < 0.001). The first analgesic requirement time of group P was significantly longer than that of group C (368.80 ± 157.68 min vs. 96.60 ± 40.12 min, < 0.001). Compared with group C, the postoperative acute pain score 48 h after surgery and the HADS score 48 h and 12 weeks after surgery in group P were significantly decreased ( < 0.05). The postoperative pain duration curve of the two groups was significantly different ( < 0.05), and the postoperative pain duration of group P was lower than that of group C ( < 0.05). CONCLUSIONS: PecS II block can reduce the incidence of chronic postmastectomy pain after radical mastectomy, reduce perioperative opioid consumption, provide better analgesia, and improve the degree of anxiety and depression of patients. TRIAL REGISTRATION: ChiCTR2200066968, 22/12/2022.
Regional anesthesia for hip surgery: A review of current approaches and their application to clinical practice.
Evangelista T, Pugno C, Finazzi S … +2 more , Colombi A, Bugada D
Saudi J Anaesth · 2025 · PMID 40255351 · Full text
Hip surgery is extremely common and ranges from surgery for hip fracture to elective procedures in younger adults. Pain can mark the postoperative period and compromise functional recovery. Nevertheless, major comorbidit...
Hip surgery is extremely common and ranges from surgery for hip fracture to elective procedures in younger adults. Pain can mark the postoperative period and compromise functional recovery. Nevertheless, major comorbidities may occur in the perioperative period, especially in elderly fragile patients. The approach to patients undergoing hip surgery has significantly evolved, focusing on multimodal strategies to optimize pain control while minimizing side effects, prompting patients' recovery. The seek for motor-sparing, analgesic techniques with a better risk benefit profile has promoted the application of new peripheral nerve blocks, with special attention paid to the newest fascial plane blocks. However, significant interest is addressed toward other outcomes (such major comorbidities and deaths) that may influence intermediate and long-term recovery. Specific strategies have been investigated to improve outcomes after hip surgery in elderly patients, considering the higher risk for complications, including delirium. In this narrative review, we aim to summarize the role of regional anesthesia and analgesia in the context of hip surgery by detailing on the effects of regional anesthesia on major outcomes. Considering the specific innervation of hip joint, we summarize the available evidence on newer peripheral nerve blocks for hip patients by focusing on potential complications associated with each technique, especially the occurrence of motor block. In this review, we aim to provide an updated and concise overview of the available evidence to help the reader planning the most appropriate strategy for hip surgery.
Fascial plane blocks in pediatric anesthesia: A narrative review.
Yucal NN, Aksu C
Saudi J Anaesth · 2025 · PMID 40255350 · Full text
Regional anesthesia techniques have become a cornerstone of pain management in the adult population, providing adequate analgesia while minimizing systemic side effects. Despite the numerous benefits demonstrated in pedi...
Regional anesthesia techniques have become a cornerstone of pain management in the adult population, providing adequate analgesia while minimizing systemic side effects. Despite the numerous benefits demonstrated in pediatric studies, the implementation of regional anesthesia in children remains insufficiently adopted in clinical settings. One primary concern preventing broader application is the potential for complications of these techniques in pediatric patients, which understandably raises apprehension among clinicians. However, the introduction of fascial plane blocks in the literature has led to a significant advancement in this field. These regional anesthesia techniques are increasingly being incorporated into routine clinical practice, as they are relatively easy to learn and apply and safe techniques. Fascial plane blocks provide adequate pain management while minimizing opioid consumption, which not only helps reduce the risk of opioid-related side effects but also contributes to a more comfortable perioperative and postoperative experience for young patients. These blocks can significantly enhance patient recovery and satisfaction by facilitating analgesia. This narrative review briefly summarizes different indications of fascial plane blocks and their effectiveness in managing pain among pediatric patients, illuminating critical points to consider when applying these techniques.
Interscalene nerve block with plain bupivacaine versus liposomal bupivacaine for arthroscopic rotator cuff repair: A randomized controlled trial.
Lee PS, Mano YM, Hom BM … +6 more , Bolia IK, Yu RP, Weber A, Gamradt S, Sharma B, Gucev G
Saudi J Anaesth · 2025 · PMID 40255349 · Full text
BACKGROUND: Although single injections with anesthetics are commonly administered given their safety, their short-acting nature limits pain control. Liposomal bupivacaine represents a promising alternative to plain bupiv...
BACKGROUND: Although single injections with anesthetics are commonly administered given their safety, their short-acting nature limits pain control. Liposomal bupivacaine represents a promising alternative to plain bupivacaine in interscalene nerve blocks. The goal of our study was to determine whether an interscalene block with liposomal bupivacaine provides superior analgesia and reduces opioid requirements compared to plain bupivacaine in patients undergoing arthroscopic rotator cuff repair (ARCR). METHODS AND MATERIALS: A single-center, double-blinded, randomized controlled trial of patients undergoing ARCR was performed. Patients received a single-shot interscalene nerve block with plain bupivacaine or liposomal bupivacaine. Visual analog scale pain scores at rest and with activity, as well as morphine milligram equivalents, were recorded in postoperative recovery and on postoperative days 1, 2, 3, and 7. Comparisons between groups were made using descriptive statistics; the significance level was set at < 0.05. RESULTS: A total of 41 patients were randomized into the liposomal bupivacaine ( = 18 patients) and plain bupivacaine ( = 23 patients) groups. The differences in visual analog scale and morphine milligram equivalents between the two groups were not significant, with or without movement, on all postoperative days assessed. CONCLUSION: There was no difference in the visual analog scale or morphine milligram equivalents after arthroscopic rotator cuff repair with interscalene blocks using liposomal bupivacaine versus plain bupivacaine. Given the increased cost associated with liposomal bupivacaine use and the variation in multimodal pain regimens worldwide, multicenter clinical trials are necessary to examine the clinical benefit and cost-effectiveness of liposomal bupivacaine in patients undergoing rotator cuff repair.
A Qualitative analysis of parturients' experience of spinal anesthesia and postoperative complaints.
Arunachalam R, Sudhakar DS, Selvakumar R … +4 more , Bharathi TP, Murugesan K, Anbazhagan R, Dhungana R
Saudi J Anaesth · 2025 · PMID 39958318 · Full text
BACKGROUND: Cesarean deliveries have increased globally, with regional anesthesia being the preferred technique. Despite the advantages of the procedure, parturients experience apprehension regarding pain, mobility, and...
BACKGROUND: Cesarean deliveries have increased globally, with regional anesthesia being the preferred technique. Despite the advantages of the procedure, parturients experience apprehension regarding pain, mobility, and complications. The postoperative period following cesarean delivery can also be challenging. However, there is limited qualitative research exploring parturients' experiences with regional anesthesia for cesarean delivery and postoperative recovery. METHODS: A qualitative study using in-depth interviews was conducted with 12 primiparous parturients who underwent cesarean delivery under regional anesthesia. Interviews explored knowledge, perceptions, and experiences regarding regional anesthesia, cesarean delivery, and postoperative recovery. Data were analyzed using thematic analysis. RESULTS: Parturients in the study reported experiencing pregnancy-related complications necessitated for opting cesarean delivery instead of vaginal delivery. The study revealed substantial knowledge gaps among parturients regarding cesarean section (CS) and anesthesia. Their decision for CS was driven by prioritizing fetal safety over personal comfort. Parturients did not have many concerns about anesthesia and were focusing mainly on neonatal wellbeing. They had limited recollection of the anesthesia experience but vividly remembered the delivery process and postoperative pain. A strong desire for recovery to provide neonatal care was expressed. Despite challenges, parturients reported overall satisfaction with the CS experience and willingness to recommend it when medically indicated. CONCLUSION: The study highlights the need for comprehensive education on regional anesthesia, postoperative care, and coping strategies for parturients undergoing cesarean delivery. It emphasizes judicious use of cesarean delivery based on medical necessity while ensuring optimal maternal and neonatal outcomes. Further qualitative research with larger samples is recommended.
Pulsed radiofrequency treatment for the management of trigeminal neuropathic pain following tooth extraction: A case report.
Hassan M, Gormley C, Murphy P
Saudi J Anaesth · 2025 · PMID 39958317 · Full text
Post-traumatic trigeminal neuropathic pain is one of the rare complications that could follow orofacial procedures such as dental extraction. The incidence of this type of pain following craniofacial trauma ranges betwee...
Post-traumatic trigeminal neuropathic pain is one of the rare complications that could follow orofacial procedures such as dental extraction. The incidence of this type of pain following craniofacial trauma ranges between 3% and 13% depending on the type of surgery. The inferior alveolar and lingual nerves are commonly affected following molar tooth extraction. Pain usually differs from one patient to another concerning intensity and distribution. Pulsed radiofrequency treatment is one of the most widely used techniques in chronic pain management. It focuses on generating heat using radiofrequency waves at higher voltages than conventional radiofrequency while keeping tissue temperature below the neuro-destructive range. This report aims to highlight the benefit of using trigeminal ganglion pulsed radiofrequency to manage neuropathic pain following molar extraction.
Combined thoracic segmental spinal anesthesia and erector spinae plane block in high-risk patients undergoing thoracoscopic surgery: A case series.
Karthik GS, Chandra M, Sudheer R … +1 more , Shwetha AH
Saudi J Anaesth · 2025 · PMID 39958316 · Full text
Thoracoscopic surgery in high-risk patients with severe respiratory disease is associated with a high morbidity and mortality rate. Though general anesthesia is the first-line anesthetic strategy for thoracoscopic surger...
Thoracoscopic surgery in high-risk patients with severe respiratory disease is associated with a high morbidity and mortality rate. Though general anesthesia is the first-line anesthetic strategy for thoracoscopic surgeries, it poses a significant risk. When the hazards of general anesthesia outweigh the benefits of the procedure, there is a moral quandary over whether thoracoscopy should still be the option for patients with severe respiratory disorders. Thoracic segmental spinal anesthesia in combination with erector spinae block may emerge as an excellent alternative to general anesthesia in terms of analgesic efficacy, patient recovery profile, and minimal complication rates if administered by experienced hands. Unfortunately, there is paucity of literature exploring the impact of regional techniques and their outcomes on these patients. In this case series, we aim to emphasize that combined thoracic segmental spinal anesthesia and erector spinae plane block are a safe and effective alternative to general anesthesia in thoracoscopic surgeries.
USG-guided bilateral sphenopalatine ganglion block: A useful anesthetic adjuvant for trans nasal trans sphenoidal pituitary surgery in a patient with severely low ejection fraction.
Chaudhary R, Payal YS, Mohapatra B … +2 more , Sony S, Shekhar S
Saudi J Anaesth · 2025 · PMID 39958315 · Full text
Trans-Nasal Trans-Sphenoidal (TNTS) route has become the preferred conduit for operating on a surgically amenable pathology of pituitary gland. The procedure necessitates close monitoring of perioperative hemodynamic sta...
Trans-Nasal Trans-Sphenoidal (TNTS) route has become the preferred conduit for operating on a surgically amenable pathology of pituitary gland. The procedure necessitates close monitoring of perioperative hemodynamic stability, especially in patients with impaired heart function. Patients with coronary artery disease (CAD) and compromized cardiac function with very low ejection fraction increase the risk of perioperative major adverse cardiac events (MACE). In this case, a 54-year-old obese female, a known case of CAD post-PTCA with left ventricular systolic dysfunction with apical hypokinesia, complete left bundle branch block with an ejection fraction of 30% with hypertension and diabetes in the last 5 years under medication posted for TNTS excision. A combination of regional and general anesthesia was adopted to curb the sympathetic stimulus, blunt the surgical stress response and pressor response at various stimulating time points, and minimize sympathetic stimulation in the perioperative period. Minimal fluctuation in heart rate and blood pressure during the surgery was observed, which was supposedly attributed to sphenopalatine ganglion (SPG) block and lignocaine. This case underscores the importance of implementation of USG-guided bilateral SPG block and lignocaine infusion and represents a novel approach in perioperative anesthetic management, particularly for cardiac patients undergoing TNTS surgery with low ejection fraction.
Ultrasound-guided deep versus superficial continuous serratus anterior plane block for pain management in patients with multiple rib fractures: A prospective randomized double-blind clinical trial.
Mostafa MF, Bakr MA, Seddik MI … +3 more , Mahmoud MMM, Ibrahim GMA, Ahmed AT
Saudi J Anaesth · 2025 · PMID 39958314 · Full text
BACKGROUND: Efficient analgesia is the cornerstone in multiple rib fractures (MRFs) management. The serratus anterior plane block (SAPB) shows promising outcomes. However, it is still provocative whether the superficial...
BACKGROUND: Efficient analgesia is the cornerstone in multiple rib fractures (MRFs) management. The serratus anterior plane block (SAPB) shows promising outcomes. However, it is still provocative whether the superficial or deep approach is more effective in the SAPB procedure. We hypothesized that the deep approach of ultrasound (US)-guided continuous SAPB could be superior for MRFs pain management. METHODS: Sixty-two adult patients having unilateral MRFs, were randomized into two groups to receive continuous superficial SAPB (group S, n = 31) or continuous deep SAPB (group D, n = 31). As a primary outcome, we compared pain numeric rating scale (NRS), while total analgesic consumption, incentive spirometer volume (IS-V), lung ultrasound score (LUSS), basal and 24-h serum beta-endorphin (BE) levels, and any adverse events were secondary outcomes. RESULTS: There was a significant reduction in NRS in favor of group D when compared to group S at 30 minutes ( = 0.001) until 12 hours ( = 0.029); total analgesic consumption was significantly lower in group D ( = 0.005). A significant increase in the median IS-V in group D compared to group S at 90 minutes ( = 0.02) and 12h postblock ( = 0.004) LUSS was significantly lower in D group at 90 min, 12 h, and 24 h ( = 0.04, 0.001, 0.031). No significant differences as regards serum BE levels. No adverse events were noted. CONCLUSION: Either superficial or deep continuous SAPB can be used safely and effectively in managing pain related to MRFs. Notably, the deep approach offered superior analgesia and improved deep breathing compared to the superficial.
Erector spinae plane block in Caesarean sections: A scoping review.
Brosnan K, Moore M, Eochagáin AN
Saudi J Anaesth · 2025 · PMID 39958313 · Full text
BACKGROUND: Pain management for Caesarean section focuses on multimodal analgesia with a growing interest in the use of regional techniques. Currently, there is no gold standard peripheral regional analgesia technique fo...
BACKGROUND: Pain management for Caesarean section focuses on multimodal analgesia with a growing interest in the use of regional techniques. Currently, there is no gold standard peripheral regional analgesia technique for Caesarean section. The Erector Spinae Plane Block is a relatively new fascial plane block that may be used to provide analgesia for numerous surgical procedures of the trunk. In recent years it is the fascial plane block that has accumulated the most enthusiasm and debate. Its use in Caesarean section has grown over the past three years. OBJECTIVE: To determine the scope of literature published on ESPB in Caesarean sections and to identify deficits in the literature to guide future research. METHODOLOGY: This study was conducted using Arksey and O'Malley's framework for scoping reviews. This included a search of four databases searching for articles published between 2016 and 2022. Studies involving patients receiving ESPB as part of an analgesic strategy after a Caesarean section were included. FINDINGS: Sixteen articles were included for final review. The most common primary outcomes measured were postoperative pain scores and analgesia consumption. Six ESPB studies recorded a statistically significant reduction in pain scores while three studies described a statistically significant reduction in postoperative analgesia consumption. CONCLUSION: The use of ESPB for Caesarean section is gaining momentum however insufficient evidence currently exists to support its widespread use. Further research is required to evaluate the potential benefits of ESPB in specific patient cohorts and in terms of its efficacy about multidimensional patient-centric outcomes.
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