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Welcome back, Markelle Fultz! In just his third game back after a long layoff, Fultz threw down a huge dunk in transition against the Hawks. He's baaaaaack! You can see the entire tirade here. Timberwolves star Jimmy Butler took his next step toward rejoining the lineup on Friday, as he was cleared to participate in contact drills. With an awesome camera and gorgeous design, this has to be the best mid-range smartphone on the planet. The Xiaomi Mi 9T is the phone to combat the stigma that euro phones have to sacrifice in design, battery life, camera, performance, and display.
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It's one very balanced smartphone that excels in almost everything. All patients in the present study did not demonstrate symptoms of respiratory depression and excessive sedation in the preoperative waiting period.
The study group did not develop CFICB complications local anesthetic toxicity, puncture site infection and hematoma in preoperative waiting period; data not shown. The number of complications was calculated at four different periods, including hospital admission, preoperative period, surgery and following surgery, and were denoted as N1, N2, N3 and N4, respectively Fig.
The alterations in the number of complications between two different time points were analyzed, as shown in Table III. Analgesic effect observation time points t and complications observation time periods N A total of 3 patients succumbed to mortality in postoperative hospitalization. A total of 2 cases 4.
A patient 2. Patients with hip fracture are often in considerable pain and, if untreated, may develop various complications that delay operative intervention and prolong hospitalization Pain management is believed to be critical in both the pre- and post-operative periods for patients with geriatric hip fractures 26 — For most fractures, administration of systemic analgesics including opioids, paracetamol and non-steroidal anti-inflammatory drugs is preferred for pain management.
Despite the relative safety of paracetamol, both opioids and nonsteroidal analgesia can induce significant adverse effects especially in the elderly population 17 , According to the guidelines from the National Institute for Health and Clinical Excellence, neural blockade by trained personnel is recommended for a reasonable opioid dosage Diakomi et al 31 concluded that performing an FICB prior to positioning for spinal anesthesia provided superior pain management compared with intravenous fentanyl administration facilitated spinal performance.
According to Diakomi et al 31 and the present study, FICB provided superior analgesia not only prior to positioning for spinal anesthesia but also during the preoperative period.
The present results suggested that a fascia iliaca compartment block performed via a catheter provided a significant benefit to very elderly patients with hip fractures. Hip innervation involves the lateral cutaneous nerve of the thigh, the femoral nerve and the obturator nerve Fascia iliaca compartment block utilizes the space under the iliac fascia where the femoral, obturator and lateral cutaneous nerves are located The block acts by suppressing the sensation of pain in the femoral nerve, lateral femoral cutaneous nerve of the thigh and obturator nerve The incidence of nausea and vomiting were similar between the control group and the study group during pre-operative period, which may have been due to the small number of patients enrolled in this study.
In other countries, a majority of patients with hip fracture undergo single fascia iliaca compartment block in the emergency room prior to surgery 21 , 22 , while in the present study, continuous block and perineural catheter placement permitted the provision of continuous peripheral nerve block, thereby extending the duration of analgesia.
Szucs et al 34 have demonstrated that continuous femoral nerve block provided a more effective perioperative analgesia compared with a standard opiate-based regimen for patients undergoing fixation of fractured neck of femur. Another study suggested that both ultrasound-guided continuous femoral nerve block and fascia iliaca compartment block with a novel cannula-over-needle provide effective anesthesia and postoperative analgesia for elderly patients with hip replacement It has been reported that 3-in-1 femoral nerve block is also effective in hip fracture analgesia 20 , Femoral nerve block is recognized as an effective method; however, it is controversial due to its potential for nerve injury and femoral nerve block can cause quadriceps weakness The FICB technique is somehow favorable compared with the femoral nerve block technique, as it is not necessary to use a neurostimulator during the procedure The site of injection with the FICB is distant from any nerves or blood vessels, where intravascular or intraneural injection is contraindicated in principle The fascia iliaca compartment block is more effective compared with the 3-in-1 block in producing simultaneous blockade of the lateral femoral cutaneous nerve of the thigh and femoral nerves in adults In addition, performing the fascia iliaca compartment block is easier to teach and learn compared with the 3-in-1 block, and more convenient and cost-effective Therefore, the continuous FICB was selected in the present study.
The sensorial innervation of the hip is provided by the nerves in the lumbar plexus and sacral plexus Although whether lumbar or sacral plexus have a primary effect on sensorial innervation of the hip remains unknown, according some previous studies 39 , 40 and the present study, the lumbar plexus block can provide effective analgesia. In addition, the two groups of patients included in the present study did not undergo FICB after surgery, as neural blockade could intervene with postoperative mobilization in those patients.
Nerve stimulator-based femoral nerve block is characterized by stimulation of the leg muscles, which may cause discomfort to the patient and compromise the fracture alignment Ultrasound guidance does not require a nerve stimulator, facilitates the FICB technique and reduces the risk of block failure or nerve injury 43 , The results of the present study indicated that the length of stay was shorter and costs of hospitalization were slightly lower in the study group compared with the control group.
After hip fracture, pain is an important determinant of function, which therefore determines length of stay and clinical outcome, defined by complication and mortality rates Adequate analgesia allows for increased mobility of patients and reduced duration of hospitalization 24 , A shorter stay is beneficial to patients in terms of reduced risk of hospital-acquired complications and the associated reduction of costs of hospitalization is economically beneficial for the healthcare system 24 , In addition, in the present study, the duration of hospital stay was shorter in the study group compared with the control group, which may have been associated with the number of patients with increased complications being smaller in the study group compared with the control group.
Patients in the study group were less likely to have increased complications compared with patients in the control group over the N2-N4 period from preoperative period to after surgery , and the results of the analysis of postoperative morbidity outcomes should be interpreted cautiously, as these factors, including the supplement of oxygen, fluid management and mobilization, were not controlled.
However, failure to stabilize the medical conditions prior to surgery poses an increased risk of postoperative cardiac and pulmonary complications, prolonged hospitalization and mortality The present study indicated that ultrasound-guided CFICB induced a satisfactory analgesic effect, which may be associated with decreased incidence of complications in the study group, compared with the control group after surgery. There are several limitations of the present study and it was mainly limited by its size. Due to a small number of cases, whether ultrasound-guided CFICB can reduce the incidence of postoperative cardiovascular, pulmonary and cerebral complications in very elderly patients with hip fracture requires further confirmation by multicenter and large-sample size studies.
Furthermore, the patients were not blind to group allocation due to the ethical considerations. As it was considered ethically unacceptable to insert a placebo fascia iliaca compartment catheter for blinding purposes only, no further damage could be simulated in the control group patients, and, therefore the patients in the control group were not subjected to CFICB and administrated with saline.
Furthermore, the present study only recorded patients' mortality during the hospital stay, without a follow up for a longer period. In conclusion, the present study demonstrated that ultrasound guided continuous fascia iliaca compartment block may provide a superior analgesia for very elderly patients with hip fracture compared with patients receiving systemic analgesia-based regimen during the preoperative period. YM and TW designed the study. JW performed the collection and entry of the data. JX analyzed the data. YM prepared the manuscript. FL participated in the collection of the data and a literature analysis.
All the authors read and approved the final manuscript. Signed written informed consents were obtained from the patients. Johnell O and Kanis JA: An estimate of the worldwide prevalence, mortality and disability associated with hip fracture. Osteoporos Int. Orthop Nurs. Marks R: Hip fracture epidemiological trends, outcomes, and risk factors, — Int J Gen Med. PLoS One.
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