TAP Block for Cesarean

There are now a dizzying array of ultrasound guided abdominal wall blocks, e.g. Erector Spinae, Quadratus Lumborum, Rectus Sheath, Ilioinguinal, Iliohypogastric and more, some overlapping terminologically and their overall place in multimodal analgesia to be fully elucidated.

This study finds benefit post-Cesarean in the I-TAP (ilioinguinal transversus abdominis plane block) group after spinal anesthesia despite intrathecal morphine and non-opioid oral analgesia. Use of PCA Fentanyl was less (a study intervention only, and not their usual practice). They plan further study to determine how clinically significant this is, as other studies have not found it to add much to multimodal analgesia.

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Health News

Varenicline appears to be associated with an increased risk of cardiovascular but not neuropsychiatric events, contrary to recent study  link

A study shows that high intakes of oily fish, fresh legumes and vitamin B6 and zinc are associated with a later onset of natural menopause while a high consumption of refined pasta and rice is associated with an earlier age at natural menopause.  link

Adopting a healthy lifestyle could substantially reduce premature mortality and prolong life expectancy in US adults – nothing new except getting people to eat healthy, keep BMI normal, not smoke and exercise, and keep alcohol low  link

Tick and mosquito borne infections spreading rapidly in the US   link

Compared with saphenous venous grafts, use of radial-artery grafts for CABG resulted in a lower rate of adverse cardiac events and a higher rate of patency at 5 years of follow-up. link

Outrageous scandal and accusations of a coverup in Irish cervical cancer screening botching  link

Child mortality in England twice that of Sweden. Socioeconomic disadvantage contributes to child mortality through its association with adverse birth characteristics  link

 

Neuraxial Anesthesia and Thromboembolism

It has been a long held view that spinal and epidural anesthesia reduce thromboembolism but a current study seeks to quantify this. However it seems to be a weak effect with a Number Needed to Treat of 500.

30 day readmission rates (but not mortality) were also reduced.

Neuraxial anesthesia may contribute to thromboembolism reduction but should not be the sole prophylaxis. And of course the ASRA guidelines for its use with anticoagulants enter the equation.

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Music and Surgery

A meta-analysis confirms previous impression that music before and after surgery, and during regional anesthesia reduces anxiety and pain modestly, although studies had some risk of bias. I think the perpetual debate on what type of music can be tolerated by different personnel in the OR can be rendered moot by playing the patients choice of music, this tending to be supported by this evidence.

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Operating Room Attire

This topic is a perennial topic for argument between specialties. Like cellphone usage, policies are best based on evidence and at least all the stakeholders got together and released this statement on the American College of Surgeons site, recommending collaborative recommendations, ear coverage not supported, no favoured hat type but bouffant caps may be the worst, and suggesting further study and evidence.

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