Although ultrasound-guided supraclavicular block has a good success rate, it remains unclear whether multiple injections are superior to single injection (SI). We compared the sensory block success rate of SI versus triple injection (TI). In this randomized double-blind study, 96 end-stage renal disease patients undergoing arteriovenous fistula creation or superficialization were randomly allocated to receive either SI or TI. The primary outcome was the combined score of sensory blockade of the 5 nerves (median, ulnar, radial, medial cutaneous nerve of the forearm, and musculocutaneous) measured at 5, 10, 15, and 20 minutes after injection. Secondary outcome variables were the time to onset of the blockade, performance time (time to do the block), separate success rate for each of the above nerves, success rate of surgical anesthesia, and the complication rate. The combined success of the sensory block was 20% to 31% higher in the TI group than in the SI group at 10, 15, and 20 minutes after injection (all P < 0.035). The block of the musculocutaneous nerve in the TI group was faster and more successful than in the SI group, at all time points (all P < 0.026). The average time needed to perform the block was significantly longer in the TI than the SI group (6.5 ± 2.1 vs 4.7 ± 2.1 minutes, P = 0.001). The overall success of surgical anesthesia measured at 30 minutes did not differ significantly between the 2 groups (96% in TI vs 87% in SI, P = 0.253). Although the performance time of the SI technique was shorter, TI had a faster onset and resulted in a more successful block of all nerves in the first 20 minutes.

Background and Objectives: Awake “no touch” extubation requires performing extubations only when the patient spontaneously wakes up without any kind of stimulation during emergence from general anesthesia. The aim of this study was to evaluate absolutely awake extubation “no touch” technique in adult patients, scheduled for elective nasal and paranasal sinus surgeries under general anesthesia as regard to emergence airway complications. Methods: A total of 60 adult patients were randomly allocated into one of two equal groups according to the method of extubation: Group I: Standard fully awake, Group II: Absolutely “no touch” awake extubation (absolutely no stimulation no touch was allowed until patients were able to open their eyes). The incidence of laryngospasm and its grade according to a four-point scale was reported. Occurrence of airway events (excessive secretions, breath-holding, coughing, hoarseness, biting, as well as the number and severity of any desaturation episodes), oozing from the wound, and postoperative sore throat were also recorded. The heart rate (HR), systolic (SBP) and diastolic (DBP) blood pressure measured at the end of surgery served as baseline values, and subsequent measurements were taken within 30 minutes after the end of surgery. Results: There was absolutely no case of laryngeal spasm or episode of desaturation among patients who were extubated with the “no touch” technique. On the other hand, there were 3 cases of laryngeal spasm in standard fully awake group. Severity of coughing, excessive secretions and breath holding, hoarseness, biting, and occurrence of non-purposeful movements of the limbs were significantly less in the absolutely “no touch” technique awake technique. The changes in HR, SBP, and DBP during emergence extubation were significantly less in “no touch” technique technique group. However, oozing from the wound was significantly higher with standard fully awake extubation. However, there were no significant differences between the two groups regarding the incidence of postoperative sore throat (39 and 36%, respectively). Conclusion: The results of the present study showed that awake “no touch” technique technique for tracheal extubation produces less airway-related complications, as well as minimal hemodynamic response during emergence from general anesthesia in nasal and paranasal surgeries. It could be a safe alternative for tracheal extubation in airway surgery.

The ongoing opioid epidemic in the United States highlights the need for novel analgesics with reduced risk of misuse, dependence, and adverse central nervous system effects. Suzetrigine (trade name Journavx), a first-in-class selective Nav1.8 (a sodium channel expressed in peripheral nociceptors) inhibitor, was approved by the FDA in early 2025 and marketed as the first non-opioid analgesic in over two decades. Current studies have shown that suzetrigine has potential in treating acute pain perioperatively for minimally to moderately painful ambulatory procedures. However, suzetrigine appears less potent than hydrocodone-acetaminophen in this context, and it remains unclear how effective suzetrigine is in treating more severe postoperative pain. Notably, all current studies are limited to short durations of treatment; further studies will be required to delineate suzetrigine’s long-term efficacy, safety, and addiction potential to be utilized in the management of chronic pain patients. This article provides a review of the current literature available on the use of suzetrigine in treating acute pain.