Hip fractures significantly impact the physiological and psychological well-being of elderly patients. Post-operative delirium (POD) is a common complication after hip fractures in this population, severely affecting treatment outcomes and recovery. Effective pain management during the peri-operative period is crucial for reducing POD, yet the best analgesic approach remains debated. A retrospective study (from January 2015 to December 2020) included 198 elderly hip fracture patients who received preoperative (PO-) or intraoperative (IO-) fascia iliaca compartment block (FICB) with 50 mL of 0.25
This study aimed to investigate the effectiveness of safety care and clinical nursing pathways in patients undergoing cardiovascular intervention. This single-center, single-blind, randomized controlled trial enrolled 100 patients who underwent cardiovascular intervention. Patients were randomly assigned to a control group (receiving standard nursing care) or an experimental group (receiving safety care and clinical nursing pathway interventions in addition to the standard care) (n = 50 each). The primary outcome measure included anxiety and depression symptoms assessed using the Hamilton Anxiety and Hamilton Depression (HAMA and HAMD) rating scales. Secondary outcome measures included cardiac function recovery time, surgery time, surgical vascular puncture success rate, puncture preparation time, and hospital stay, along with adverse events and complications, quality of life, and nursing satisfaction. In the experimental group, post-intervention HAMA (6.42 ± 2.41) and HAMD (6.32 ± 1.44) scores were significantly lower than those in the control group (9.24 ± 1.52, 8.76 ± 1.59) (p < 0.05). The incidence of adverse reactions was lower in the experimental group (12.0
Functional endoscopic sinus surgery (FESS) may be followed by poor early QoR-40-assessed patient-reported recovery and emergence agitation. We performed a secondary analysis to evaluate whether perioperative lidocaine plus esketamine was associated with improved early QoR-40-assessed patient-reported recovery. Inflammatory biomarkers, mood-related symptom scores, and peri-emergence neurobehavioral outcomes were assessed as supportive outcomes. This secondary analysis included 140 adults (18–65 years) from a single-center randomized four-arm study of FESS: lidocaine + esketamine (LA), lidocaine (L), esketamine (A), or saline (N), 35 per group. Study infusions were administered from 10 min before induction until the end of surgery. The primary endpoint was QoR-40 total score on postoperative day 1 (POD1), defined as the first assessment 24 ± 6 h after extubation; QoR-40 POD2 was the key secondary endpoint; SAS/SDS, emergence agitation (Riker ≥ 5), Nu-DESC-defined PACU delirium-like symptoms, and IL-6/TNF-α (T1-T4) were supportive secondary outcomes. QoR-40 POD7 total score and comparisons of the five QoR-40 domains (Physical, comfort, emotional state, self-care ability/physical independence, social support/patient support, and pain) were exploratory. QoR-40 total/domain scores and SAS/SDS were analyzed using baseline-adjusted ANCOVA. POD1 QoR-40 was available for 137/140 participants, and exploratory POD7 QoR-40 for 136/140. LA was associated with higher QoR-40 than N on POD1 (adjusted mean difference 10.5; 95
Postoperative hallucinations are underrecognized neuropsychiatric complications of cardiac surgery. Glycemic control may influence their occurrence, particularly in patients with diabetes. This study aimed to estimate the incidence of visual and auditory hallucinations in diabetic and non-diabetic patients after cardiac surgery, and to identify factors independently associated with hallucinations within each group. In this prospective multicenter cohort, hallucinations were assessed daily for 7 days using the Questionnaire for Psychotic Experiences. Cox regression identified predictors within diabetic and non-diabetic cohorts. Visual hallucinations occurred in 12.0
With the increasing prevalence of surgical centers, identifying the safest and most efficient anesthetic techniques is vital. Ultrasound-guided distal peripheral nerve block (US-DPNB) is a technique that has shown promise in published literature for blocking the ulnar, median, and radial nerves at the level of the forearm. This descriptive case series examines 50 patients who underwent hand or wrist surgery with a focus on outcomes following the application of US-DPNB. The technique used in this study was performed by an anesthesiologist, Dr. Angel Saavedra, at an outpatient surgical center. The purpose of this descriptive case series is to describe beneficial clinical outcomes and the feasibility of blocking the median, ulnar, and radial nerves at the level of the forearm in the context of hand and wrist surgeries in surgical centers. The primary outcomes included a pain scale from 1 to 5, block performance time, and postoperative complications. The secondary outcomes are tourniquet time, patient satisfaction, and return of hand movement. With IRB approval, patients were followed up for up to five days post-surgery to assess outcomes. Either a distal or proximal block was performed at the level of the forearm. Exclusion criteria included repeat surgery on the same hand, procedures expected to exceed 20 min of tourniquet time, and patients with pre-existing peripheral nerve disorders, or prior surgeries affecting nerve anatomy. Data were analyzed using descriptive statistics only; no inferential comparisons between groups were performed. The DFB group presented an average block time of 95.59s, whereas the PFB group presented a mean block time of 73.9s. The pain scores decreased in both groups over the five-day follow-up period. Notably, the only recorded complication was postoperative nausea in one patient in the PFB group. This descriptive case series demonstrates the feasibility of US-DPNB as a primary anesthetic technique for short-duration ambulatory hand and wrist procedures, with low complication rates and high patient satisfaction. As a study without a comparator group, claims regarding economic benefit cannot be formally established; however, the opioid-sparing profile and favorable outcomes observed support further investigation through controlled trials. 20245045
