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Hormonsko nadomjesno liječenje i karcinom dojke: Dokazi iz randomiziranih kliničkih ispitivanja
No full textThe use of menopausal hormone therapy (MHT) significantly declined after 2002, primarily due to the Women's Health Initiative's (WHI) report suggesting that the combination of conjugated equine estrogen (CEE) and medroxyprogesterone acetate (MPA) increased breast cancer risk and did not enhance quality of life. More recently, WHI publications have recognized MHT as the
most effective treatment for managing menopausal vasomotor symptoms, reporting that CEE alone decreases the risk of breast cancer by 23% and reduces breast cancer mortality by 40%. The only remaining concern is a slight increase in breast cancer incidence with CEE and MPA (1 per 1,000 women per year), but with no increased risk of breast cancer mortality. Recently, reanalyses of the WHI trial have been published that dispute even this claim about breast cancer risk, pointing out the WHI's presentation of insignificant results as if they were conclusive, misinterpretation of its own data, and the false claim that the WHI findings, and consequent decline in the use of MHT, led to a reduction in breast cancer incidence in the United States. As a result, a generation of women has been largely deprived of MHT due to this widely publicized misinterpretation of the data. Furthermore, clinical trials performed on other types of progesterone do not agree with the results obtained from the WHI study, which analyzed the use of one specific type of progesterone - medroxyprogesterone acetate. This article aims to present and interpret relevant randomized trials, with the intention of assisting patients and physicians in making informed decisions about the use of MHT.Korištenje hormonskog nadomjesnog liječenja (HNL) značajno se smanjilo nakon 2002. godine, prvenstveno zbog izvješća Inicijative za zdravlje žena (WHI) koje sugerira da kombinacija konjugiranog konjskog estrogena (CEE) i edroksiprogesteron acetate (MPA) povećava rizik od raka dojke, a ne poboljšava kvalitetu života. Nedavno objavljene reanalize WHI ispitivanja
prepoznale su HNL kao najučinkovitije liječenje za vazomotornih menopauzalnih tegoba, izvješćujući da primjenjena samih CEE smanjuje rizik od raka dojke za 23% te smrtnost od raka dojke za 40%. Jedina preostala zabrinutost je blagi porast incidencije raka dojke uz korištenje kombinacija CEE i MPA (1 na 1000 žena godišnje), ali bez povećanog rizika od smrtnosti od raka dojke. Nedavno su objavljene ponovne analize WHI ispitivanja koje osporavaju čak i ovu tvrdnju
o riziku od raka dojke, ističući predstavljanje beznačajnih rezultata WHI ispitivanja kao da su konačnih, pogrešno tumačenje vlastitih podataka i lažnu tvrdnju da su nalazi WHI-a i posljedični pad korištenja HNL, doveli do smanjenje incidencije raka dojke u Sjedinjenim Državama. Kao rezultat toga, zbog ovog objavljenog pogrešnog tumačenja podataka, jednoj generaciji žena je uskraćeno korištenje HNL-a. Nadalje, klinička ispitivanja provedena sa drugim vrstama progesterona bila u suglasnoti s rezultatima dobivenim iz studije WHI, koja je analizirala upotrebu jedne specifične vrste progesterona - medroksiprogesteron acetata. Cilj ovog članka je predstaviti i protumačiti relevantna randomizirana ispitivanja, s namjerom da pomogne pacijentima i liječnicima u donošenju informiranih odluka o upotrebi HNL-a
Dječja katarakta
No full textCataract is characterized by the clouding of the lens in the eye. In adults, it predominantly arises from age-related degenerative changes or as secondary effects from medications, ocular trauma, or metabolic disorders. In contrast, pediatric cataracts can be congenital, often resulting from TORCH infections, metabolic diseases, or genetic conditions. Newborns are routinely screened for cataract using the red reflex test, and any abnormalities warrant immediate referral to a pediatric ophthalmologist to prevent the risk of deprivation amblyopia. While cataracts in adults may develop insidiously and remain unnoticed until significant visual impairment occurs, the diagnosis is usually confirmed through a comprehensive patient history and visualization using slit-lamp microscopy. Treatment generally involves surgical removal of the cloudy lens and replacement with an artificial intraocular lens, especially when the visual function is severely compromised. If left untreated, cataracts can progress to complete blindness.Katarakta karakterizira zamućenje leće u oku. Kod odraslih, ona uglavnom nastaje zbog degenerativnih promjena povezanih sa starošću ili kao sekundarna posljedica korištenja lijekova, traume oka ili metaboličkih poremećaja. Nasuprot tome, dječja katarakta može biti kongenitalna, često posljedica TORCH infekcija, metaboličkih bolesti ili genetskih stanja. Novorođenčad se rutinski pregledava za kataraktu pomoću crvenog refleksnog testa, a bilo kakve abnormalnosti zahtijevaju hitno upućivanje pedijatrijskom oftalmologu kako bi se spriječio rizik od deprivacijske ambliopije. Dok se katarakta kod odraslih može podmuklo razviti i ostati nezapažena sve dok se ne dogodi značajno oštećenje vida, dijagnoza se obično potvrđuje kroz sveobuhvatnu povijest bolesnika i vizualizaciju pomoću mikroskopije s procjepnom svjetiljkom. Liječenje obično uključuje kirurško uklanjanje mutne leće i ugradnju umjetne intraokularne leće, osobito kada je vidna funkcija ozbiljno ugrožena. Ako se ne liječi, katarakta može napredovati do potpune sljepoće
Bolest povezana s mijelinskim oligodendrocitnim glikoproteinom (MOGAD)
No full textMyelin Oligodendrocyte Glycoprotein (MOG) is a component of myelin found in the mammalian Central Nervous System (CNS) and is present on both myelin sheaths and oligodendrocyte plasma membranes. In 2007, MOG became popular since anti-MOG antibodies were found in patients with neuroinflammatory conditions like optic neuritis, myelitis, and neuromyelitis optica spectrum disorder (NMOSD) lacking aquaporin 4 (AQP4) antibodies, along with brainstem and cerebral cortical encephalitis. This discovery has led to the classification of Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease (MOGAD), a clinical condition distinct from multiple sclerosis (MS) and traditional NMOSD. Diagnosing MOGAD poses a unique challenge due to varying interpretations of clinical symptoms, imaging, and serological findings among researchers and its similarity with MS and AQP4 IgG+ NMOSD.
Treatment strategies for MOGAD attacks include intravenous steroids or plasma exchange, while long-term management approaches are still being studied. Current treatments draw heavily from NMOSD protocols, such as immunosuppressants like azathioprine and mycophenolate mofetil. However, the fact that there is moderate effectiveness of drugs like Rituximab in MOGAD, a key player in NMOSD treatment, proves that more than one size fits treatment plan will be needed on MOGAD. Research on therapies targeting interleukin 6 (IL 6), a cytokine involved in the immune response, and other innovative methods such as T cell modulation, is ongoing to keep up with the changing landscape of MOGAD treatment.
The ongoing research on MOGAD is a beacon of hope, underscoring the need for implementation of global diagnostic criteria and deeper insights into its causes. This research is instrumental in supporting tailored treatments and understanding the disease's prevalence and genetic influences. The collaborative efforts across countries, focused on personalized treatment plans, are essential for improving outcomes and minimizing complications in individuals with MOGAD.Mijelinski oligodendrocitni glikoprotein (MOG) sastavni je dio mijelina koji se nalazi u središnjem živčanom sustavu (CNS) sisavaca i prisutan je i na mijelinskim ovojnicama i na plazma membranama oligodendrocita. Godine 2007. MOG je postao popularan jer su anti-MOG antitijela pronađena kod pacijenata s neuroupalnim stanjima kao što su optički neuritis, mijelitis i
poremećaj optičkog spektra neuromijelitisa (NMOSD) kojima nedostaju antitijela na akvaporin 4 (AQP4), zajedno s zahvaćanjem moždanog debla i cerebralnim kortikalnim encefalitisom. Ovo otkriće dovelo je do klasifikacije bolesti povezane s mijelinskim oligodendrocitnim glikoprotein antitijelima (MOGAD), kliničkog stanja koje se razlikuje od multiple skleroze (MS) i tradicionalnog NMOSD-a. Dijagnosticiranje MOGAD-a predstavlja jedinstveni izazov zbog različitih tumačenja kliničkih simptoma, neuroradioloških slika i seroloških nalaza među istraživačima te njegove sličnosti s MS-om i AQP4 IgG+ NMOSD-om.
Strategije liječenja za MOGAD relapse uključuju intravenske steroide ili izmjenu plazme, dok se dugoročni pristupi liječenju još proučavaju. Trenutačni tretmani uvelike se oslanjaju na NMOSD protokole, te uključuju imunosupresive kao što su azatioprin i mikofenolat mofetil. Međutim, činjenica da postoji umjerena učinkovitost lijekova poput rituximaba u MOGAD-u, ključnom lijeku u liječenju NMOSD-a, dokazuje da će za MOGAD biti potreban drugačiji plana liječenja.
Istraživanje terapija usmjerenih na interleukin 6 (IL 6), citokin uključen u imunološki odgovor, i druge inovativne metode kao što su imodulacija T stanica, nastavljaju se kako bi se išlo u korak s promjenjivim krajolikom MOGAD liječenja.
Istraživanje MOGAD-a koje je u tijeku je svjetionik nade, naglašavajući potrebu za implementacijom globalnih dijagnostičkih kriterija i dubljim uvidom u njegovu etiologiju. Ovo istraživanje je ključno u podržavanju prilagođenih tretmana i razumijevanju prevalencije bolesti i genetskih utjecaja. Zajednički napori među zemljama, usmjereni na personalizirane planove liječenja, ključni su za poboljšanje ishoda i minimiziranje komplikacija kod pojedinaca s MOGAD-om
Ozljede žučnih vodova tijekom laparoskopske kolecistektomije
No full textLaparoscopic cholecystectomy stands as one of the most frequently conducted surgical procedures globally, offering a minimally invasive approach for treating cholecystitis, biliary colic and symptomatic gallbladder stones. Despite its widespread adoption and numerous advantages, such as reduced postoperative pain, shorter hospital stays, and quicker recovery times compared to open surgery, the occurrence of bile duct injuries (BDIs) remains a persistent concern in clinical practice.
This comprehensive review delves into the extensive body of literature surrounding laparoscopic cholecystectomy and its associated bile duct injuries. By meticulously analyzing data from various studies, this review aims to provide a thorough understanding of the incidence, prevalence, risk factors, classification, management strategies, and preventative measures related to BDIs during laparoscopic cholecystectomy.
BDIs during laparoscopic cholecystectomy represent a significant complication, encompassing a spectrum of clinical implications ranging from minor ductal leaks to more severe injuries requiring complex surgical interventions.
By synthesizing the wealth of information available in the literature, this review aims to contribute to the body of knowledge surrounding BDIs during laparoscopic cholecystectomy. With a deeper understanding of the incidence, risk factors, classification, management strategies, and preventative measures associated with BDIs, clinicians can strive to minimize the occurrence of these complications and optimize patient outcomes in clinical practice.Laparoskopska kolecistektomija jedna je od najčešće provedenih kirurških procedura na globalnoj razini, nudeći minimalno invazivan pristup za liječenje kolecistitisa i bilijarne kolike. Unatoč širokoj primjeni i brojnim prednostima, poput smanjenja postoperativne boli, kraćeg boravka u bolnici i bržeg oporavka u usporedbi s otvorenom operacijom, pojava ozljeda žučnih vodova (BDI) i dalje ostaje trajna briga u kliničkoj praksi.
Ovaj sveobuhvatan pregled istražuje opsežnu literaturu vezanu uz laparoskopske kolecistektomije i pridružene ozljede žučnih vodova. Pažljivom analizom podataka iz različitih studija, ovaj pregled ima za cilj pružiti temeljito razumijevanje učestalosti, prevalencije, čimbenika rizika, klasifikacije, strategija upravljanja i preventivnih mjera vezanih uz BDI tijekom laparoskopske kolecistektomije.
Ozljede žučnih vodova tijekom laparoskopske kolecistektomije predstavljaju značajnu komplikaciju, obuhvaćajući spektar kliničkih implikacija od manjih curenja iz vodova do težih ozljeda koje zahtijevaju složene kirurške intervencije.
Sintetiziranjem bogatstva informacija dostupnih u literaturi, ovaj pregled ima za cilj doprinijeti bazi znanja o BDI tijekom laparoskopske kolecistektomije. S dubljim razumijevanjem učestalosti, čimbenika rizika, klasifikacije, strategija upravljanja i preventivnih mjera povezanih s BDI, kliničari mogu nastojati smanjiti pojavu ovih komplikacija i optimizirati ishode za pacijente u kliničkoj praksi
Acute mesenteric ischemia
No full textAkutna mezenterijalna ishemija (AMI) je hitno medicinsko stanje, karakterizirano brzom progresijom te visokim mortalitetom. U podlozi AMI-ja nalazi se naglo smanjenje mezenterijalnog krvnog protoka koje, ovisno o trajanju, može uzrokovati transmuralnu nekrozu crijevne stijenke. Etiološki, AMI dijelimo na okluzivne mezenterijalne ishemije (OMI) i neokluzivne mezenterijalne ishemije (NOMI). Od tri česta uzroka OMI-ja, najčešći je embolija mezenterične arterije (EMA), potom tromboza mezenterične arterije (TMA) te mezenterična venska tromboza (MVT). NOMI se prvenstveno javlja kod teških kardiovaskularnih pacijenata u jedinicama intenzivnog liječenja (JIL). Najčešće zahvaćena krvna žila je gornja mezenterična arterija (GMA), i to u više od 85% slučajeva. Zbog velike prilagodljivosti crijeva na smanjeni protok krvi i brojnih kolaterala, tek stenoza gornje mezenterične arterije viša od 90 % ili stenoza preko 70% lumena dvije mezenterične žile uzrokovati će AMI. S prevalencijom od oko 0.1% te incidencijom 5.3–8.4 na 100000 stanovnika godišnje, AMI je rijetki uzrok akutnog abdomena. Incidencija raste i do 10 puta u pacijenata starijih od 75 godina. Ovisno o težini ishemije, može biti zahvaćena samo mukoza, a može napredovati i sve do zahvaćenosti pune debljine stijenke i transmuralne nekroze. Klinička slika AMI-ja je vrlo nespecifična, uključuje intenzivnu difuznu abdominalnu bol, povraćanje, proljev te ostale simptome ovisno o podražaju peritoneuma. Laboratorijski biomarkeri nemaju veliku ulogu u dijagnostici AMI-ja. Zlatni standard u dijagnostici je kompjuterizirana tomografija (CT) angiografija. AMI je dijagnoza koja se prvenstveno liječi kirurški. Otvoreno i endovaskularno liječenje modaliteti su liječenja, svaki sa svojim nedostacima i prednostima. Nova tehnika liječenja – retrogradna otvorena mezenterična ugradnja stenta, kao kombinacija obaju modaliteta, pruža obečavajuće rezultate. Medikamentno liječenje antikoagulansima ima ulogu u postoperativnom liječenju te kao primarna metoda liječenja u slučaju MVT-a. Unatoč napredcima u dijagnostici i liječenju, AMI ostaje entitet koji se često dijagnosticira tek na obdukciji, a glavni prognostički čimbenik je upravo vrijeme potrebno do dijagnoze.Acute mesenteric ischemia (AMI) is an emergency condition, characterized by fast progression and a high mortality rate. The underlying cause of AMI is a sudden decrease in mesenterial blood flow, which can cause transmural necrosis, depending on the duration. Etiologically, AMI is divided into occlusive (OMI) and nonocclusive (NOMI). Of the three common OMI causes, the most common is embolism of the mesenteric artery (EMA), followed by thrombosis of the mesenteric artery (TMA) and mesenteric vein thrombosis (MVT). NOMI is primarily found in Intensive care units (ICU) in patients with severe cardiovascular disease. The most affected mesenteric vessel is the superior mesenteric artery (SMA), in more than 85% of cases. Due to the high adaptability of the bowel to decreased blood flow as well as many collaterals, a stenosis greater than 90% of 1 vessel or greater than 70% of 2 mesenteric vessels is needed for AMI to occur. With a prevalence of around 0.1% and an incidence of 5.3-8.4 at 100000 population per year, AMI is a rare cause of acute abdomen. However, the incidence increases tenfold in patients over the age of 75. Depending on the depth of ischemia, only the mucosa can be affected, all the way to full bowel wall thickness and transmural necrosis. Symptoms of AMI are very non-specific and include intense diffuse abdominal pain, vomiting, diarrhea as well as other symptoms depending on peritoneum involvement. Laboratory biomarkers do not have a major role in diagnosing AMI. The gold standard in AMI diagnostics is computed tomography (CT) angiography. AMI is primarily treated surgically. Open and endovascular treatment are treatment options, each with its pros and cons. Retrograde open mesenteric stenting (ROMS) is a new treatment option, combining both treatment options, with promising results. Medication treatment with anticoagulants is used in postoperative treatment as well as the primary treatment option in MVT. Despite the advances in diagnostics and treatment, AMI remains a clinical entity that is still often diagnosed at an autopsy, with the main prognostic factor being time to diagnosis
Neurosonology Survey in Europe and Beyond
No full textPurpose: To provide an overview on education, training, practice requirements, and fields of application of neurosonology in Europe and beyond.
Materials and Methods: National representatives and experts in neurosonology were surveyed regarding neurosonology requirements and practice in their countries. Descriptive statistics were used to report the data.
Results: Between February 1 and March 31, 2023, 42/46 (91.3%) national representatives responded to our questionnaire and the completion rate was 100%. Most countries (71.4%) offer a neurosonology training program during neurology residency, but it is part of the undergraduate medical program only in 30.9%. National certification is available in 47.6% of the countries surveyed and most countries (76.2%) require certification to practice. In 50% of the countries, candidates are assessed by a board examination, while in 26.2% they just need to document their practice. There is no formal accreditation of neurosonology centers in 78.6% of the countries surveyed. Only a few require certified personnel and appropriate equipment. Adequate teaching and research activities are only rarely necessary elements for laboratory accreditation.
Conclusion: Our results indicate that there is a substantial need for transnational harmonization of neurosonological standards to guarantee uniformity and quality of performance. This survey will also provide guidance to promote an international accrediting council and create a quality-controlled laboratory network for implementing neurosonology in clinical trials
Rare SH2B3 coding variants in lupus patients impair B cell tolerance and predispose to autoimmunity
No full textSystemic lupus erythematosus (SLE) is a heterogeneous autoimmune disease with a clear genetic component. While most SLE patients carry rare gene variants in lupus risk genes, little is known about their contribution to disease pathogenesis. Amongst them, SH2B3—a negative regulator of cytokine and growth factor receptor signaling—harbors rare coding variants in over 5% of SLE patients. Here, we show that unlike the variant found exclusively in healthy controls, SH2B3 rare variants found in lupus patients are predominantly hypomorphic alleles, failing to suppress IFNGR signaling via JAK2-STAT1. The generation of two mouse lines carrying patients’ variants revealed that SH2B3 is important in limiting the number of immature and transitional B cells. Furthermore, hypomorphic SH2B3 was shown to impair the negative selection of immature/transitional self-reactive B cells and accelerate autoimmunity in sensitized mice, at least in part due to increased IL-4R signaling and BAFF-R expression. This work identifies a previously unappreciated role for SH2B3 in human B cell tolerance and lupus risk
Bearing variant alleles at uridine glucuronosyltransferase polymorphisms UGT2B7 -161C > T (rs7668258) or UGT1A4*3 c.142 T > G (rs2011425) has no relevant consequences for lamotrigine troughs in adults with epilepsy
No full textPurpose: To estimate whether epilepsy patients with variant UGT2B7 -161C > T (rs7668258) or UGT1A4*3 c.142 T > G (rs2011425) alleles differ from their wild-type (wt) peers in exposure to lamotrigine.
Methods: Consecutive adults on lamotrigine monotherapy or lamotrigine + valproate co-treatment undergoing routine therapeutic drug monitoring, otherwise generally healthy and free of interacting drugs, were genotyped for UGT2B7 -161C > T and UGT1A4*3 c.142 T > G. Heterozygous, variant homozygous, or combined heterozygous/variant homozygous subjects were compared to their wt controls for dose-adjusted lamotrigine troughs with adjustment for age, sex, body weight, rs7668258/rs2011425, polymorphisms of efflux transporter proteins ABCG2 c.421C > A (rs2231142) and ABCB1 1236C > T (rs1128503), and level of exposure to valproate using covariate entropy balancing.
Results: Of the 471 included patients, 328 (69.6%) were on monotherapy and 143 were co-treated with valproate. Dose-adjusted lamotrigine troughs in UGT2B7 -161C > T heterozygous (CT, n = 237) or variant homozygous (TT, n = 115) subjects were closely similar to those in their wt controls (CC, n = 119): geometric means ratios (GMRs) (frequentist and Bayes) 1.00 (95%CI 0.86-1.16) and 1.00 (95%CrI 0.83-1.22) for CT vs. CC; and 0.97 (0.81-1.17) and 0.97 (0.80-1.20) for TT vs. CC subjects. Lamotrigine troughs were also closely similar in UGT1A4*3 c.142 T > G variant carriers (n = 106: 102 TG + 4 GG subjects) and wt controls (TT, n = 365): GMR = 0.95 (0.81-1.12) frequentist, 0.96 (0.80-1.16) Bayes. GMRs for variant carriers vs. wt controls were around unity also at different levels of exposure to valproate.
Conclusion: Dose-adjusted lamotrigine troughs in epilepsy patients with variant UGT2B7 -161C > T or UGT1A4*3 c.142 T > G alleles are equivalent to those in their respective wt peers
Comparison of ultrasound-guided FICB (Fascia Iliaca Compartment Block) and intrathecal morphine after hip fracture surgery in unilateral hypobaric spinal anesthesia
No full textStarenjem populacije raste i broj pacijenata s prijelomom kuka, a kirurški zahvat je standard u liječenju istih. Operativno liječenje uključuje vrstu osteosinteze, tzv. gamma nail (GN), dinamični kompresivni vijak (DHS), parcijalnu (PEP) ili totalnu endoprotezu kuka (TEP). Operativno liječenje prijeloma kuka može se obaviti u općoj ili regionalnoj anesteziji (obuhvaća neuroaksijalnu anesteziju i periferne živčane blokove). Odabir anestezije ovisi o komorbiditetima pacijenta i trajanju zahvata (1). Spinalnom anestezijom se lokalni anestetik, sam ili u kombinaciji s drugim lijekovima, primjenjuje intratekalno s ciljem anestezije ispod mjesta primjene. Ovisno o baricitetu otopine lijeka za intratekalnu primjenu u odnosu na cerebrospinalni likvor, razlikujemo izobaričnu, hiperbaričnu i hipobaričnu otopinu. Adekvatna postoperativna analgezija je vrlo važna jer doprinosi boljoj fizikalnoj terapiji, ranijoj mobilizaciji te smanjenju incidencije postoperativnih komplikacija poput upale pluća, dekubitusa te duboke venske tromboze. Sistemski učinci parenteralno primijenjenih analgetika mogu se izbjeći primjenom perifernih živčanih blokova.
Pacijenti su bili podijeljeni u dvije skupine primjenom generatora nasumičnih brojeva. Prva grupa je kao mješavinu za spinalnu anesteziju dobila 0.5%-tni levobupivakain 1.5 mL, morfij 80 mcg i sterilnu vodu 1 mL, a druga grupa 0.5%-tni levobupivakain 1.5 mL i sterilnu vodu 1 mL uz postoperativno učinjen S-FICB vođen UZV-om kojim je primijenjen 0.2%-tni levobupivakain 30-40 ml ovisno o težini pacijenta. Postoperativno se bilježila primjena analgetika parenteralno i jačina boli koristeći NRS skalu.
Istraživanjem je dokazano da je ultrazvukom vođen S-FICB dobra alternativa intratekalno primijenjenom morfiju za analgeziju pacijenata s prijelomom kuka. Sve više pažnje je posvećeno FICB-u, no nema dovoljno dokaza na kojima bi se temeljile preporuke za idealan pristup kod izvođenja FICB.As the population gets older, incidence of hip fracture increases too and timely surgery is a standard in managing these patients. Operative treatment includes „Gamma nail“ (a type of osteosynthesis), DHS, partial and total hip replacement. Hip surgery can be performed under general or regional anesthesia (includes neuroaxial anesthesia and peripheral nerve blocks). The choice of anesthesia depends on patient comorbidities and the duration of the procedure (1). In performing spinal anesthesia, a local anesthetic, alone or in combination with other drugs, is administered intratechally. Depending on the baricity of the drug solution for intrathecal administration in relation to cerebrospinal fluid, we distinguish isobaric, hyperbaric and hypobaric solution.
Adequate postoperative analgesia is important because it contributes to better physical therapy, earlier mobilization and a reduction in the incidence of postoperative complications such as pneumonia, pressure ulcers and deep vein thrombosis. Systemic effects of parenterally given analgesics can be avoided by performing peripheral nerve blocks.
Patients were divided into two groups using a random number generator. The first group received 0.5% levobupivacaine 1.5 mL, intrathecal morphine 80 mcg and sterile water 1 mL, as a mixture for spinal anesthesia, and the second group received 0.5% levobupivacaine 1.5 mL and sterile water 1 mL with postoperative ultrasound performed suprainguinal FICB using 0.2% levobupivacaine 30-40 ml depending on the weight of the patient. Postoperatively, the use of parenteral analgesics and pain intensity were recorded using the NRS.
Ultrasound-guided S-FICB is a good alternative to intrathecally given morphine in providing postoperative analgesia in patients with hip fracture. There is good evidence that peripheral nerve blocks provide effective analgesia in the hip fracture patients, but there is insufficient evidence to make guidelines regarding the optimal approach