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Background: Multimodal analgesia is now widely practised to minimise postoperative opioid consumption while optimising pain control. The aim of this meta-analysis was to assess the analgesic efficacy of erector spinae plane block (ESPB) in patients undergoing laparoscopic abdominal surgeries. This will be determined by perioperative opioid consumption, subjective pain scores, and incidences of postoperative nausea and vomiting. Methods: The authors systemically searched electronic databases for randomised controlled trials (RCTs) published up to February 2023 comparing ESPB with other adjuvant analgesic techniques in laparoscopic abdominal surgeries. Nine randomised controlled trials encompassing 666 subjects were included in our study. Results: ESPB was shown to reduce postoperative opioid consumption [mean difference (MD) of -5.95 mg (95% CI: -8.86 to - 3.04; P< 0.0001); I2= 89%], intraoperative opioid consumption MD of - 102.4 mcg (95% CI: - 145.58 to -59.21; P< 0.00001); I2=39%, and incidence of nausea [RR 0.38 (95% CI: 0.25-0.60; P<0.0001); I2=0%] and vomiting [RR 0.32 (95% CI: 0.17-0.63; P =0.0009); I2=0%] in laparoscopic abdominal surgeries. Subgroup analysis on laparoscopic colorectal surgeries further showed reduction in postoperative pain scores MD of -0.68 (95% CI: - 0.94 to - 0.41); P<0.00001; I2= 0%]. Conclusions: This study concludes that ESPB is a valuable technique with proven efficacy to potentially promote faster postoperative recovery through optimising pain control while minimising opioid requirements. [ABSTRACT FROM AUTHOR]

Anterior neck haematoma is a rare but potentially fatal emergency due to airway obstruction after a surgical intervention of the neck. Complete airway obstruction can be rapid and deteriorate exponentially. In a patient with a previously normal laryngeal view during his Sistrunk procedure, we describe the challenges and considerations faced in his second surgery for the evacuation of neck haematoma, which involved an unanticipated difficult airway after rapid sequence induction, necessitating rescue measures using low-skill fibreoptic intubation (LSFOI)., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Lim Yiqi et al.)

Background: Multimodal analgesia is now widely practised to minimise postoperative opioid consumption while optimising pain control. The aim of this meta-analysis was to assess the analgesic efficacy of erector spinae plane block (ESPB) in patients undergoing laparoscopic abdominal surgeries. This will be determined by perioperative opioid consumption, subjective pain scores, and incidences of postoperative nausea and vomiting., Methods: The authors systemically searched electronic databases for randomised controlled trials (RCTs) published up to February 2023 comparing ESPB with other adjuvant analgesic techniques in laparoscopic abdominal surgeries. Nine randomised controlled trials encompassing 666 subjects were included in our study., Results: ESPB was shown to reduce postoperative opioid consumption [mean difference (MD) of -5.95 mg (95% CI: -8.86 to -3.04; P <0.0001); I2 =89%], intraoperative opioid consumption MD of -102.4 mcg (95% CI: -145.58 to -59.21; P <0.00001); I2 =39%, and incidence of nausea [RR 0.38 (95% CI: 0.25-0.60; P <0.0001); I2 =0%] and vomiting [RR 0.32 (95% CI: 0.17-0.63; P =0.0009); I2 =0%] in laparoscopic abdominal surgeries. Subgroup analysis on laparoscopic colorectal surgeries further showed reduction in postoperative pain scores MD of -0.68 (95% CI: -0.94 to -0.41); P <0.00001; I2 =0%]., Conclusions: This study concludes that ESPB is a valuable technique with proven efficacy to potentially promote faster postoperative recovery through optimising pain control while minimising opioid requirements., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)

Background Over the past decade, telemedicine has experienced significant growth due to technological advancement, and the coronavirus disease 2019 (COVID-19) pandemic further accelerated its adoption. However, the field of anesthesiology has been slow in integrating and embracing telemedicine compared to other medical specialties. Methods We conducted an observational pilot feasibility study at a tertiary hospital in Singapore to assess the viability of a telemedicine hybrid protocol for preoperative anesthetic assessment. The study included patients aged 21 to 65 years, classified as American Society of Anesthesiology (ASA) physical status class 1 or 2, with a body mass index (BMI) below 35 kg/m 2 , who were capable of managing video conferencing. The patients selected were scheduled for low-risk surgeries. The primary objective was to evaluate the medical and technical feasibility of our telemedicine hybrid protocol, while the secondary objectives included assessing patient satisfaction and obtaining feedback from relevant stakeholders. Results From November 2021 to April 2022, a total of 116 patients were recruited, with 96 patients completing the study. No technical difficulties, surgical case cancellations, or incidents of unanticipated difficult airways were reported. The majority of survey respondents (88%) expressed satisfaction with the video consultation and indicated a preference for it over physical consultations for future preoperative anesthesia evaluations. Conclusion Based on our findings, a telemedicine hybrid protocol for preoperative anesthetic assessment demonstrated both technical and medical feasibility while yielding high patient satisfaction. Future research could focus on expanding the protocol to encompass more complex surgeries and include patients with higher ASA status., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Chai et al.)