Bilateral pericapsular end nerve blocks for steroid-induced avascular necrosis following COVID-19 infection requiring bilateral total hip replacement

BACKGROUND Osteonecrosis or avascular necrosis(AVN)of the hip was one of the dreaded complications of coronavirus disease 2019(COVID-19),which emerged in patients who received steroid therapy.Corticosteroids have been a mainstay in the treatment protocol of COVID-19 patients.Popular corticosteroid drugs used in patients suffering from COVID-19 were intravenous(IV)or oral dexamethasone,methylprednisolone or hydrocortisone.The use of such high doses of corticost-eroids has shown very positive results and has been lifesaving in many cases.Still,long-term consequences were drug-induced diabetes,osteoporosis,Cushing syndrome,muscle wasting,peripheral fat mobilization,AVN,hirsutism,sleep disturbances and poor wound healing.A significant number of young patients were admitted for bilateral total hip replacements(THR)secondary to AVN following steroid use for COVID-19 treatment.AIM To assess the efficacy of bilateral pericapsular end nerve group(PENG)blocks in patients posted for bilateral THR post-steroid therapy after COVID-19 infection and assess the time taken to first ambulate after surgery.METHODS This prospective observational study was conducted between January 2023 and August 2023 at Care Hospitals,Hyderabad,India.Twenty young patients 30-35 years of age who underwent bilateral THR were studied after due consent over 8 months.All the patients received spinal anaesthesia for surgery and bilateral PENG blocks for postoperative analgesia.RESULTS The duration of surgery was 2.5 h on average.Seventeen out of twenty patients(85%)had a Visual Analog Score(VAS)of less than 2 and did not require any supplementation.One patient was removed from the study,as he required re-exploration.The remaining two patients had a VAS of more than 8 and received IV morphine post-operatively as a rescue analgesic drug.Fifteen out of seventeen patients(88.2%)could be mobilized 12 h after the procedure.CONCLUSION Osteonecrosis or AVN of the hip was one of the dreaded complications of COVID-19,which surfaced in patients who received steroid therapy requiring surgical intervention.Bilateral PENG block is an effective technique to provide post-operative analgesia resulting in early mobilization and enhanced recovery after surgery.

Geochronology and Tectonic Implications of Diabase Intruded Into Xiangshan Group in the Southeastern Alxa Block, NW China

The southeastern Alxa Block(i.e.,the Hexi Corridor)is a tectonic junction between the North China Block(NCB)to the east,the Alxa Block to the north,and the western Qinling–North Qilian Orogenic Belt to the southwest(Fig.1).The southeastern Alxa Block had undergone

An Improved Group Space-Time Block Code Through Constellation Rotation

A new improved group space-time block code (G-STBC) based on constellation rotation for four transmit antennas was proposed. In comparison with the traditional G-STBC coding scheme, the proposed space-time code has longer code length and adopts proper rotation-based symbols, which can increase the minimum distance of space-time codes and thereby improve code gain and achieve full diversity performance. The simulation results verify that the proposed group space-time code can achieve better bit error performance than both the traditional group space-time code and other quasi-orthogonal space-time codes. Compared with Ma’s full diversity full rate (FDFR) codes, the proposed space-time code also can achieve the same excellent error performance. Furthermore, the design of the new space-time code gives another new and simple method to construct space-time codes with full diversity and high rate in case that it is not easy to design the traditional FDFR space-time codes.