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The recently introduced pectoral nerve (Pecs) block is a simple alterative to the conventional thoracic paravertebral block or epidural block for breast surgery. It produces excellent analgesia and can be used to provide balanced anesthesia and as a rescue block in cases where performing a neuraxial blockade is not possible. In the thoracic region, a neuraxial blockade is often used to manage zoster-associated pain. However, this can be challenging for physicians due to the increased risk of hemodynamic instability in the upper thoracic level, and comorbid and contraindicated medical conditions such as coagulopathy. Here, we introduce an ultrasound-guided Pecs block for the management of herpes zoster-associated pain, which could be an effective alternative to other interventional options in the thoracic region., Author(s): Yeon-Dong Kim [sup.1] , Seon-Jeong Park [sup.1] , Junho Shim [sup.2] , Hyungtae Kim [sup.2] Author Affiliations: (Aff1) 0000 0004 0533 4755, grid.410899.d, Department of Anesthesiology and Pain Medicine, [...]

Background and objectives: Anesthesia maintenance agents affect the incidence of postoperative shivering (PS) after general anesthesia. This study compared the effects of remimazolam with sevoflurane on PS in patients undergoing laparoscopic gynecologic surgery under general anesthesia. Materials and methods: Seventy-four patients were allocated into one of two groups. In anesthesia maintenance, group S received sevoflurane and remifentanil, and group R received remimazolam and remifentanil. Results: The incidence and severity of postoperative shivering, mean arterial pressure (MAP), heart rate (HR), core body temperature, and the association of PS with hypothermia, MAP, or HR in the post-anesthesia care unit (PACU) were measured. Group R had significantly lower rates of perioperative hypothermia (58.8 vs. 27.8%, p = 0.009) and postoperative shivering (41.2 vs. 19.4%, p = 0.047). The severity of PS was also lower in group R than in group S (p = 0.034). Core body temperature was significantly higher in group R than in group S from 10 min after induction (p = 0.047) to the PACU (p = 0.009). MAP and HR were significantly higher in group R than in group S from 20 min after induction (p = 0.047) to the PACU (p = 0.009). In group S, the correlation between the severity of PS and the incidence of hypothermia (φc = 0.414, p = 0.121) was moderate but not significant. In group R, the correlation between PS severity and hypothermia (φc = 0.418, p = 0.043) was moderate and significant. Conclusions: Remimazolam showed better results than sevoflurane in anesthesia maintenance regarding hypothermia and PS. [ABSTRACT FROM AUTHOR]

Background and Objectives: Staggered bilateral total knee arthroplasty, two procedures performed 4–7 days apart during a single hospitalization, has an increased risk of blood transfusion. This observational study aimed to evaluate whether immediate post‐operative single, high‐dose intravenous iron supplementation could reduce transfusion requirements and facilitate anaemia recovery in patients. Materials and Methods: We retrospectively analysed 131 patients who underwent staggered bilateral total knee arthroplasty. The ferric carboxymaltose (FCM) group received 1000 mg of FCM after the first operation. The non‐FCM group did not receive intravenous iron. The transfusion rate and post‐operative complications were compared between the groups. The anaemia rate was evaluated pre‐operatively, during hospitalization, and 5 weeks after the second total knee arthroplasty. Results: The FCM group comprised 78 patients (59.5%). The rate (21.8% vs. 47.2%, p = 0.004) and amount of transfusion (0 [0–2] vs. 0 [0–0], p = 0.001) was significantly lower in the FCM group than in the non‐FCM group. Although both groups' pre‐operative haemoglobin concentrations were not significantly different, the FCM group demonstrated higher haemoglobin values 5 weeks post surgery (12.25 ± 0.83 mg/dl vs. 11.48 ± 1.36 mg/dl, p < 0.001). More non‐FCM patients developed moderate to severe anaemia at 5 weeks post surgery (p < 0.001). The mortality and complication rates were not significantly different. Conclusions: Immediate post‐operative, high‐dose, intravenous iron treatment may contribute to reduced transfusion rates, facilitate haemoglobin recovery after staggered bilateral total knee arthroplasty, and minimize the development of moderate to severe anaemia. [ABSTRACT FROM AUTHOR]