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Background: This study aimed to investigate the effects of ultrasound-guided quadratus lumborum block (QLB) on perioperative multimodal analgesia and postoperative outcomes in patients undergoing radical prostatectomy. Methods: A total of 80 patients undergoing radical prostatectomy were randomly divided into two groups: general anaesthesia with QLB (QLB group; n = 40) and general anaesthesia with sham QLB (normal saline [NS] group; n = 40). QLB or sham QLB was performed before the induction of anaesthesia. Sufentanil was intravenously administered for postoperative analgesia. The primary outcome was the pain score (measured using a numerical rating scale [NRS]) at different time points within 48 h postoperatively. Secondary outcomes included the cumulative dose of sufentanil within 48 h postoperatively, subjective comfort, grip strength, first time of exhaustion, first fluid intake time, time to get out of bed, length of postoperative hospital stay and overall satisfaction. The SPSS software, version 17.0, was used for all statistical analyses. Results: Postoperative NRS at rest was significantly lower at 2 h (1.7 ± 1.1 versus 3.0 ± 2.1), 4 h (1.8 ± 1.2 versus 4.1 ± 2.3), 6 h (1.9 ± 2 versus 4.4 ± 2) and 12 h (3.5 ± 2.3 versus 5 ± 3.3) and was also lower when coughing at 2 h (2.3 ± 1.1 versus 4 ± 2.1), 4 h (2.3 ± 1. 1 versus 4.3 ± 2) and 6 h (2.4 ± 1.1 versus 5.9 ± 2.3) in the QLB than that in the NS group. The cumulative dose of sufentanil was significantly lower in the QLB than that in the NS group at 4 h, 6 h, 12 h, 24 h and 48 h. The nausea score was significantly lower in the QLB group at 24 h postoperatively, and the first time of exhaustion and time to get out of bed were significantly shorter (P < 0.05). The overall satisfaction score was significantly higher in the QLB than in the NS group (4 ± 0.7 versus 2.6 ± 0.9). Conclusion: Ultrasound-guided bilateral QLB can provide effective postoperative analgesia for patients undergoing radical prostatectomy, reduce the need for sufentanil, facilitate comfort and improve postoperative outcomes. QLB can be a good component of multimodal analgesia. Trial registration: The clinical trial is registered in the Chinese Clinical Trial Registry (ChiCTR). Current Controlled Trials:ChiCTR1900022009. the date of registration:2019/03/20. [ABSTRACT FROM AUTHOR]

To our knowledge, no studies have reported clinical results at a midterm follow-up after two-stage revision for periprosthetic shoulder infection (PSI). Our purpose was to determine the recurrent infection rate and clinical outcomes of two-stage revision for PSI at a minimum follow-up of 5 years. The secondary aim was to evaluate the application of the new guidelines from the International Consensus Meeting (ICM) in 2018 for diagnosis of PSI in this cohort. We identified 17 patients with infection after shoulder arthroplasty between 2005 and 2014 who were treated with a two-stage revision and had a minimum follow-up of 5 years (range, 5-9 years). The mean time from the involved arthroplasty to first-stage revision was 40 months. All patients were revised to a reverse shoulder arthroplasty at second-stage revision. Complications, patient-reported outcomes (PROs), visual analogue scale for pain, American Shoulder and Elbow Surgeons (ASES) score, Simple Shoulder Test (SST) score, Western Ontario Osteoarthritis of the Shoulder (WOOS) score, and range of motion (ROM) were noted. Patients were retrospectively scored and categorized using the ICM 2018 diagnostic criteria. Mean patient age was 64 ± 7 years, and 65% of patients were male. A recurrent infection developed in 3 (18%) of the 17 patients. The cumulative incidence of recurrence of infection was 0% at 1 year, 6% at 2 years, and 18% at 5 years. There were 6 (36%) other complications, including 4 periprosthetic fractures, 1 spacer fracture, and 1 dislocation. Two (12%) patients had scapular notching. At latest follow-up, patients who did not have recurrent infection had a statistically and clinically meaningful improvement from preoperative to postoperative PROs, including VAS for pain, ASES score, SST score, and WOOS score, and active ROM, including abduction and forward flexion. Using the ICM 2018 criteria at first-stage revision surgery, the category of PSI for 10 (59%) patients was "definite PSI," 4 (23%) patients was "probable PSI", and 3 (18%) patients was "possible PSI." The rate of reinfection after a two-stage revision surgery for PSI at midterm follow-up was 18%. Clinical outcomes were favorable in the patients who remained free of infection. Further prospective study of the ICM criteria as they apply to making the diagnosis of infection in these patients would be beneficial. Level IV; Case Series; Treatment Study [ABSTRACT FROM AUTHOR]

Unlabelled: Neuropathic pain in patients with total brachial plexus avulsion has always been a sophisticated problem in clinical practice.Objectives: For further researches on objective diagnosis, alleviation or even cure of neuropathic pain, we need to conclude the basic clinical features including pain intensity, distribution, type and possible risk factors.Methods: Thirty cases of patients with total brachial plexus avulsion were included and their baseline information was collected. Pain was evaluated by Present Pain Index using a visual analog scale; Douleur Neuropathique 4 was used for screening neuropathic pain. For more detailed pain description, the Neuropathic Pain Symptoms Inventory questionnaire and a picture showing the exact pain district were both fulfilled by all the eligible participants. The relationship between neuropathic pain and basic information, injury conditions, accompanied conditions and quality of life was tested.Results: All the participants were male in both groups. The neuropathic pain group contained 22 patients (73.33%) with the mean age of 30.18±9.47; while 29.00±7.95 in the other group. Patients with neuropathic pain presented variously in pain degree, location, type and time phase, according to the results of the Neuropathic Pain Symptoms Inventory questionnaire. Nevertheless, most pain distributed on the region of hand. Among several related factors, alcohol abuse may be possible risk factors of neuropathic pain (p=0.03). Quality of life was significantly affected by pain (p<0.01).Conclusion: Neuropathic pain in patients with total brachial avulsion was characterized with heterogeneity in pain distribution, intensity, type and also time phase. Bad life habits might be risk factors associated with neuropathic pain. Neuropathic pain might affect quality of life of the patients with total brachial plexus avulsion remarkably. [ABSTRACT FROM AUTHOR]

Abstract: A rapid and highly sensitive liquid chromatography-tandem mass spectrometric (LC–MS/MS) method for simultaneous determination of cefoperazone sodium and sulbactam sodium in human plasma was developed. The analytes and internal standard (IS), cefuroxime sodium, were extracted from human plasma via liquid–liquid extraction with ethyl acetate and separated on a Waters Xterra C18 column within 3.5min. Quantitation was performed on a triple quadrupole mass spectrometer employing electrospray ionization technique, operating in selected reaction monitoring (SRM) and negative ion mode. The precursor to product ion transitions monitored for cefoperazone, sulbactam and IS were m/z 644.1→528.0, 232.1→140.0, and 423.0→362.0, respectively. The assay was validated in the linear range of 0.1–20μg/mL for cefoperazone and 0.02–4μg/mL for sulbactam. The intra- and inter-day precisions (CV%) were within 8.39% for each analyte. The recoveries were greater than 87.3% for cefoperazone and 87.2% for sulbactam. Each analyte was found to be stable during all sample storage, preparation and analytical procedures. The method was successfully applied in a pharmacokinetic study of Sulperazon injection in six hospital-acquired pneumonia (HAP) patients. [Copyright &y& Elsevier]