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BACKGROUND: Hip preservations surgeries are a type of surgical intervention used to often delay or prevent arthritis in patients before damage has occurred. A hip arthroscopy, a type of hip preservation surgery, allows for a minimally invasive method by using an arthroscope, a small fiber-optic tube with a camera attached, and surgical tools to perform the surgery. Hip preservation surgeries are often linked with moderate to severe postoperative pain, often leading to the use of substantial anesthesia. Nerve blocks have become increasingly popular for certain procedures as there may be advantages with postoperative pain and other same-day recovery advantages. Nerve blocks continue to be investigated in their role in lowering postoperative pain, postoperative opioid consumption, length of stay/time in postoperative anesthesia care unit, and patient satisfaction of pain control. OBJECTIVE: The objective of this systematic review was to determine the efficacy of nerve blocks for postoperative pain management in hip arthroscopies. METHODS: Two reviewers (J.A., E.B.) independently conducted a literature search in January 2022 with adjudication by a third reviewer using the databases Pubmed, EMBASE, and Medline. The included studies were systematically screened and reviewed, and data was analyzed. RESULTS: With a quadratus lumborum block, a study showed a significant difference in postoperative VAS pain scores in the study group with a block compared to the control from admission into the PACU through 24 hours after the operation (P<.001). In postoperative opioid consumption, another significant difference was reported in the group with a lumbar plexus block compared to control from the PACU all the way to 24 hours post operation (P<.001). When comparing a fascia iliaca block versus a local infiltration analgesia, a study found that 1 hour post operation the patients reported a significantly lower mean pain level. However, it was found that a fascia iliaca block may be less effective in reducing the number of opioids consumed in the PACU compared to a lumbar plexus block (P=.020). With a femoral nerve block, reports show a significant reduction in postoperative pain using VAS at 30 minutes (P=.009), 1 hour (P=.004), 2 hours(P=.003), 4 hours(P=.006) and 6 hours (P=.0002). Patients who receive a femoral nerve block consumed a mean amount of 47.6 milligrams of morphine equivalents compared to 59.2 milligrams of morphine equivalents in the control group which is significantly less (P=.006). Patients with a lumbar plexus block reported a lower mean pain score compared to a combined spinal epidural (P=.048) at 48 hours (YaDeau et al., 2012). There was no difference observed in pain scores when a lumbar plexus block was compared to a pericapsular injection. The lumbar plexus block had no differences in opioid consumption when compared to both combined spinal epidural and pericapsular injection. CONCLUSION: The use of nerve blocks provides sufficient pain management in hip arthroscopies. The effectiveness of these blocks may be more than other types of analgesic methods in lowering postoperative pain and postoperative opioid consumption.

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The purpose of this literature review is to discuss the mechanisms of a cardiac arrest and how it contributes to the high-risk classification of congenital heart disease patients. While assessing the diagnoses process and types of treatments applied to cardiac arrest and congenital heart disease separately, we further explain this information’s significance by combining their incidence rates and analyzing their associations as it relates to surgical operations. A narrative review of studies is conducted in pediatrics and adults to reveal distinctions in lesion characteristics and interventions, as well as limitations that permit inconsistencies in data reports on health outcomes. There is not adequate research and data collection in reference to perioperative cardiac arrest in congenital heart disease patients and the aim of this paper is to highlight the need for further studies and to present current research that has been conducted to fill the gaps of this global health issue.

The development of anesthesia has greatly contributed to the safety of surgeries, reduced the level of invasiveness of many procedures, and provided increased comfort for patients. The delivery of anesthetics has been primarily provided by one of two unique health care providers: a trained physician who has specialized in anesthesia, or an advanced practice nurse—the certified registered nurse anesthetist (CRNA). Both providers have a similar scope of practice, are nationally certified, and often work side-by-side. However, in recent years there has been some controversy between the two providers regarding autonomy, safety, and quality of services. The purpose of this study was to utilize current research comparing the two professions to determine if there is a difference in the quality of care and cost effectiveness between these two providers. This research was focused on studies performed in the United States after 1985. Results indicated no significant differences in quality of care between providers; however, a cost difference does exist. CRNA's provide a high quality of care equivalent to their physician counterparts, but at a reduced price. They additionally offer access to care in rural areas that lack anesthesiologists. Limitations include an inability to assess the impact of doctoral level programs for nurse anesthetists (required for entry into practice beginning in 2025) and how this may affect the main components of patient care assessed in this study (quality of care and cost). Future studies should look at ways to improve the relationship between the two providers and to remove barriers to nurse anesthetists’ scope of practice in order to increase overall access to care.

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