Effects of Ultrasound-Guided Bilateral Cervical Plexus Block Combined with General Anesthesia in Patients Undergoing Total Parathyroidectomy and Partial Gland Autotransplantation Surgery

Local Reg Anesth. 2021 Apr 23;14:75-83. doi: 10.2147/LRA.S299312. eCollection 2021.ABSTRACTBACKGROUND: The aim of this study is to evaluate the effect of ultrasound-guided bilateral cervical plexus block on general anesthesia, postoperative analgesia, and surgical outcomes in patients undergoing total parathyroidectomy with autotransplantation.PATIENTS AND METHODS: Forty-eight ASA III-IV patients with hyperparathyroidism secondary to renal failure were included: 24 patients received ultrasound-guided bilateral superficial and deep cervical plexus block combined with general anesthesia (group A), and 24 patients received general anesthesia alone (group B). Postoperative patient-controlled intravenous analgesia was provided with sufentanil 2 μg/kg. The primary outcome is the postoperative pain scores. Secondary outcomes include intraoperative remifentanil dosage, changes in hemodynamics, extubation time, and sufentanil consumption. Surgical outcomes regarding calcium, phosphorus and parathormone values were also noted.RESULTS: The patients in group A required less remifentanil than group B (2.56±0.92mg vs 3.38±0.84mg, P=0.002) and lower VAS scores at 1, 3, 10, 24, and 48h postoperatively (P
Source: Local and Regional Anesthesia - Category: Anesthesiology Authors: Source Type: research

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​The wrist is not commonly aspirated in the emergency department, but emergent arthrocentesis may be indicated for extreme or concerning cases, and tapping the wrist to determine the underlying pathology or relieve pain may be of great value. The synovial fluid from the joint space can be analyzed for crystals, infection, and blood. This information may help determine the overall plan and aid in decision-making and consultation. The ultimate treatment plan may include admission, intravenous antibiotics, multiple aspirations, and even surgical washout.A swollen, painful wrist that is hot to the touch is concerning for sep...
Source: The Procedural Pause - Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Conclusion: Results from our study show that most of the patients with renal hyperparathyroidism were symptomatic preoperatively and the most common clinical presentations were bone pain and muscle weakness. The significant predictor of early postoperative hypocalcemia after total parathyroidectomy was the preoperative alkaline phosphatase levels. PMID: 31909044 [PubMed]
Source: Annals of Surgical Treatment and Research - Category: Surgery Tags: Ann Surg Treat Res Source Type: research
Conclusion: PTX is a safe and effective therapy for treating SHPT that is refractory to medical therapies and accompanied by related signs and symptoms in dialysis patients. All three operative techniques were effective in controlling SHPT. PMID: 31573378 [PubMed - in process]
Source: Renal Failure - Category: Urology & Nephrology Tags: Ren Fail Source Type: research
Rationale: Secondary hyperparathyroidism (SHPT) is often complicated with chronic renal failure. Though the total parathyroidectomy (TPTX) with forearm autotransplantation (FAT) has been commonly used to treatment refractory renal SHPT, the recurrence of SHPT is not infrequent, resulting from hyperplastic autograft, remnant parathyroid tissues, and supernumerary parathyroid gland (SPG). Patient concerns: A 67-year-old man undergoing TPTX+FAT 4 years previously for renal SHPT, who received regular hemodialysis with active vitamin D supplements of Rocaltrol treatment postoperatively, was admitted to our hospital with pr...
Source: Medicine - Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research
End-stage renal disease (ESRD) is often complicated by hyperparathyroidism (HPT), leading to high serum levels of parathyroid hormone (PTH), calcium, and phosphate. HPT related to ESRD is associated with an increased risk of (cardiovascular) mortality, mineral and bone disorders, and clinical features such as abdominal pain, fatigue, and forgetfulness. These debilitating symptoms, in addition to the burden of chronic renal failure and its treatment, often lead to a decreased quality of life (QoL).
Source: Surgery - Category: Surgery Authors: Source Type: research
End-stage renal disease (ESRD) is often complicated by hyperparathyroidism (HPT), leading to high serum levels of parathyroid hormone (PTH), calcium, and phosphate. HPT related to ESRD is associated with an increased risk of (cardiovascular) mortality, mineral and bone disorders, and clinical features such as abdominal pain, fatigue, and forgetfulness. These debilitating symptoms, in addition to the burden of chronic renal failure and its treatment, often lead to a decreased quality of life (QoL).
Source: Surgery - Category: Surgery Authors: Source Type: research
ConclusionThe importance of the prompt diagnosis of the brown tumor is to establish a multidisciplinary management to prevent progression, neurologic complications and sequelae despite its benign behavior.
Source: International Journal of Surgery Case Reports - Category: Surgery Source Type: research
Leontiasis ossea (LO) involves facial and cranial bone hypertrophy associated with a group of diseases, and rarely occurs in patients with chronic renal failure. Few cases of LO have been reported in the literature, but none in patients below 18 years of age. A 14-year-old girl was referred for our service showing enlargement of the jaws and facial bones, with pain and tooth mobility. Renal failure and secondary hyperparathyroidism were reported in the medical history. The imagologic examination showed maxillary and mandibular enlargement with a ground-glass appearance, and multiple impacted teeth.
Source: Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics - Category: ENT & OMF Authors: Tags: Oral and Maxillofacial Pathology Source Type: research
We report a case of a 72 year old male with hyperparathyroidism secondary to end stage diabetic renal disease and coexisting bilateral chromophobe renal cell carcinomas. The patient presented with back and groin pain, right pelvic hemorrhage, and multiple lytic bone lesions concerning for metastatic renal cell carcinoma. Fine needle aspiration cytology demonstrated benign appearing osteoclasts and spindled cells. A concurrent core biopsy showed foci of spindled cell proliferation populated by osteoclast‐like giant cells with stromal hemorrhage without evidence of metastatic carcinoma. The cytologic and histologic finding...
Source: Diagnostic Cytopathology - Category: Pathology Authors: Tags: BRIEF REPORT Source Type: research
This article presents a clinical, biochemical and genetic approach to investigating the causes of pediatric hypercalcemia.
Source: Journal of Bone and Mineral Research - Category: Orthopaedics Authors: Tags: Review Source Type: research
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