The understanding of ergonomics is a vital competency for all peripheral nerve block operators. The essence of physical ergonomics for peripheral nerve block procedures can be summarised into three significant components: brain, musculoskeletal and needling. The first component includes strategies to optimise visuospatial neuroprocessing using equipment configuration. The second component reflects the careful planning of posture and position to improve procedural technique and reduce physical fatigue. The final component focuses on strategies to achieve needle beam alignment for optimal needle visualisation.

Continuous spinal anaesthesia (CSA) is a cardio-stable technique used in high-risk patients undergoing surgery. However, this technique appeared to decline over the last decades due concerns of complications that arise from using this technique, such as post-dural puncture headaches and neurological deficits. We report two cases of elderly patients, one at high cardiac risk and one with dementia and multiple comorbidities, under CSA for orthopaedic surgery with no reported complications. CSA is an adequeate anaesthetic technique with a low failure rate and complications. Proper technique should be taken into consideration to increase the success rate for this procedure.

Background & objective: Pneumonia is a leading cause of morbidity and mortality globally, accounting for 15.2% of deaths in Malaysia in 2023. Community-acquired pneumonia (CAP) poses diagnostic challenges due to the non-specificity of clinical presentations and inconsistencies in imaging interpretation. This study evaluates the diagnostic utility of biomarker interleukin-6 (IL-6), C-reactive protein (CRP) and procalcitonin (PCT), individually and in combination, to improve the diagnosis of CAP in critically ill patients. Methodology: This prospective cohort study was conducted in an intensive care unit. Adult patients admitted with dyspnea and respiratory failure were recruited, with 33 patients classified as CAP by standardized definition, and 42 as non-CAP. Biomarker levels were assessed in both groups, and diagnostic performance was evaluated with optimum cutoff levels. Results: Individually, IL-6, CRP and PCT showed poor diagnostic accuracy (AUC < 0.7). The IL-6 and CRP combination achieved the highest AUC (0.759, sensitivity 78%, specificity 67%). The IL-6 and PCT combination provided the highest sensitivity (91%) and negative predictive value (85%), aiding in ruling out CAP. Conclusion: Combined biomarker evaluation enhances diagnostic accuracy for community-acquired pneumonia, providing a basis for early treatment. These findings warrant further multicenter validation to confirm their clinical applicability in community-acquired pneumonia diagnosis. Abbreviations: CAP: community-acquired pneumonia, CRP: C-reactive protein, IL-6: interleukin-6, PCT: procalcitonin, ICU: intensive care unit Keywords: Biomarker; Interleukin-6; C-Reactive Protein; Procalcitonin; Community-Acquired Pneumonia; Dyspmea; Respiratory Failure Citation: Ramly NF, Wah LK, Nanyan S, Abdul Ghani MR, Ab Rashid I. Combination of interleukin-6 and C-reactive protein levels as predictive biomarkers for early diagnosis of community-acquired pneumonia in ICU patients. Anaesth. pain intensive care 2025;29(2):254-260. DOI: 10.35975/apic.v29i2.2713 Received: May 09, 2024; Reviewed: October 26, 2024; Accepted: January 01, 2025