Regional anesthesia has been considered a great tool for maximizing post-operative pain control while minimizing opioid consumption. Post-operative rebound pain, characterized by hyperalgesia after the peripheral nerve block, can however diminish or negate the overall benefit of this modality due to a counter-productive increase in opioid consumption once the block wears off. We reviewed published literature describing pathophysiology and occurrence of rebound pain after peripheral nerve blocks in patients undergoing orthopedic procedures. A search of relevant keywords was performed using PubMed, EMBASE, and Web of Science. Twenty-eight articles (n = 28) were included in our review. Perioperative considerations for peripheral nerve blocks and other alternatives used for postoperative pain management in patients undergoing orthopedic surgeries were discussed. Multimodal strategies including preemptive analgesia before the block wears off, intra-articular or intravenous anti-inflammatory medications, and use of adjuvants in nerve block solutions may reduce the burden of rebound pain. Additionally, patient education regarding the possibility of rebound pain is paramount to ensure appropriate use of prescribed pre-emptive analgesics and establish appropriate expectations of minimized opioid requirements. Understanding the impact of rebound pain and strategies to prevent it is integral to effective utilization of regional anesthesia to reduce negative consequences associated with long-term opioid consumption.

BackgroundThe Coronavirus diseases (COVID-19) pandemic is not abating and there is no approved treatment yet. The development of vaccines is hoped to help in addressing this disease outbreak. However, in the face of anti-vaccines uprise, it is important to understand the factors that may influence the uptake of COVID-19 vaccines as this will influence how successful the fight against COVID-19 will be in the long term.MethodsA cross-sectional study among 776 adult Nigerians (age ≥18 years) was conducted in the 36 States of Nigeria and the Capital City with online questionnaire. The questionnaire consisted of 5 sections: socio-demographic characteristics of respondents, respondent’s knowledge of COVID-19, respondents risk perception of COVID-19, vaccination history of respondents, and willingness to receive COVID-19 vaccine. Descriptive analysis of variables was done and multivariate analysis using logistic regression was carried out to determine the predictors of uptake of a potential COVID-19 vaccine. The level of significance was predetermined at a p-value < 0.05. Data analysis was done with SPSS version 21.ResultsMost of the respondents were male (58.1%). Most participants were willing to take a potential COVID-19 vaccine (58.2%), while 19.2% would not take it with 22.6% indecisive. 53.5% would prefer a single dose COVID-19 vaccine. For vaccine uptake, being male (p= 0.002) and the perception that “vaccines are good” (p< 0.001) were the positive predictor of uptake of a potential COVID-19 vaccine.ConclusionMost Nigerians were willing to take a potential COVID-19 vaccine with the male gender and perception that “vaccines are good” being positive predictors. There is a need for public enlightenment aim at encouraging those that are indecisive or averse to receiving COVID-19 vaccines.

Fluid management has been widely recognized as an important component of the perioperative care in patients undergoing major procedures including spine surgeries. Patient-and surgery-related factors such as age, length of the surgery, massive intraoperative blood loss, and prone positioning, may impact the intraoperative administration of fluids. In addition, the type of fluid administered may also affect post-operative outcomes. Published literature describing intraoperative fluid management in patients undergoing major spine surgeries is limited and remains controversial. Therefore, we reviewed current literature on intraoperative fluid management and its association with post-operative complications in spine surgery.

Background: The Coronavirus Disease 2019(COVID-19) is far from over, although appreciable progress have been made to limit the devastating effects of the pandemic across the globe. Adequate knowledge and risk perception is a critical assessment that is required to ensure proper preventive measures. This study assessed these among Nigerians. Methods: The study was a cross-sectional assessment of 776 consenting Nigerian adults that were distributed across the 6 geo-political zones and the Federal Capital Territory. Online pre-tested, semi-structured questionnaire were used to obtain the socio-demographic data and assessed the knowledge and risk perception of the participants to COVID-19. The knowledge of COVID-19 was assessed based on the number of accurate responses given in comparison to average scores. Chi-square analysis was computed to analysis the association between socio-demographic characteristics and knowledge of COVID-19 and risk perception. Data analysis was done using SPSS version 21, the level of significance was set at value p<0.05 at 95% confidence interval. Results: Majority of the participants were male 451 (58.1%), there was a good knowledge of COVID-19 among 90.3% of respondents with 57% having positive risk perception. There was a statistically significant relationship between good knowledge and positive risk perception of COVID-19 (p < 0.001). Annual income (p =0.012) and the perception that vaccines are good significantly predict positive risk perception of COVID-19 among the respondents. Conclusion: A good knowledge of COVID-19 and vaccination against the virus were the two most important factors that determined risk perception among the population. This may be because of the widespread advocacy, and it portends a good omen at combating COVID-19 menace. Key words: COVID-19, Risk perception, Nigerians

IntroductionNeuromuscular blockade is an essential component of the general anesthesia as it allows for a better airway management and optimal surgical conditions. Despite significant reductions in extubation and OR readiness-for-discharge times have been associated with the use of sugammadex, the cost-effectiveness of this drug remains controversial. We aimed to compare the time to reach a train-of-four (TOF) response of ≥0.9 and operating room readiness for discharge in patients who received sugammadex for moderate neuromuscular blockade reversal when compared to neostigmine during outpatient surgeries under general anesthesia. Potential reduction in time for OR discharge readiness as a result of sugammadex use may compensate for the existing cost-gap between sugammadex and neostigmine.MethodsWe conducted a single-center, randomized, double arm, open-label, prospective clinical trial involving adult patients undergoing outpatient surgeries under general anesthesia. Eligible subjects were randomized (1:1 ratio) into two groups to receive either sugammadex (Groups S), or neostigmine/glycopyrrolate (Group N) at the time of neuromuscular blockade reversal. The primary outcome was the time to reverse moderate rocuronium-induced neuromuscular blockade (TOF ratio ≥0.9) in both groups. In addition, post-anesthesia care unit (PACU)/hospital length of stay (LOS) and perioperative costs were compared among groups as secondary outcomes.ResultsThirty-seven subjects were included in our statistical analysis (Group S= 18 subjects and Group N= 19 subjects). The median time to reach a TOF ratio ≥0.9 was significantly reduced in Group S when compared to Group N (180 versus 540 seconds; p = 0.0052). PACU and hospital LOS were comparable among groups. Postoperative nausea and vomiting was the main adverse effect reported in Group S (22.2% versus 5.3% in Group N; p = 0.18), while urinary retention (10.5%) and shortness of breath (5.3%) were only experienced by some patients in Group N. Moreover, no statistical differences were found between groups regarding OR/anesthesia, PACU, and total admission costs.DiscussionSugammadex use was associated with a significantly faster moderate neuromuscular blockade reversal. We found no evidence of increased perioperative costs associated with the use of sugammadex in patients undergoing outpatient surgeries in our academic institution.Clinical trial registration[https://clinicaltrials.gov/] identifier number [NCT03579589].