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Abdominal pain is one of the most common presenting chief complaints in the emergency department. Erector spinae plane block (ESPB) is an ultrasound-guided nerve block with proven effectiveness in treating visceral and somatic abdominal pain. Despite the increasing popularity of ESPB, its role in the management of nonsurgical abdominal pain has not yet been characterized. Our scoping review aims to synthesize current knowledge on the safety and efficacy of ESPB in the management of patients experiencing intractable, nonsurgical abdominal pain. We searched PubMed and Scopus to evaluate the existing literature on ESPB for nonsurgical abdominal pain. A total of 14 journal articles were included: 12 case-based studies, one systematic review, and one narrative review. All cases described the successful use of ESPB in treating abdominal pain refractory to oral or intravenous analgesic medications, and no complications were reported in any cases. This scoping review provides support for the use of ESPB to manage intractable, nonsurgical abdominal pain. ESPB has demonstrated efficacy in alleviating various conditions such as functional abdominal pain, renal colic, pancreatitis, herpetic pain, and cancer-related pain. Theoretical risks such as pneumothorax, bleeding, and infection are possible, although the studies reviewed did not report such complications.

Objectives: Although frequently applied, inferior alveolar nerve block (IANB) is associated with high rate of complications, beside its unpredictable success; partly due to improper needle choice. Evidence of the ideal needle contradicts in literature. Therefore, this review aims to assess the effect of needle characteristics on the outcomes of IANB. Materials and methods: A systematic search was performed on MedLine via Pubmed, Cochrane Library, LILACS, Science Open, EBSCOhost, Scopus, Egyptian Knowledge Bank (EKB), and Google scholar; beside searching grey literature and hand searching. The review included randomized controlled trials comparing needles of difference in any of the characteristics (gauge, length, bevel, alloy) used for IANB regarding their effects on pain, success of anesthesia and aspiration. The authors ran the search, selected the eligible studies, assessed the risk of bias using RoB 1 and extracted the data of the finally included studies. All the steps were performed in duplicates. Results: The search yielded a total of 2,812 records. After de-duplication and excluding ineligible studies by title and abstract then by full text, the review included nine eligible studies. The compared needle interventions included: gauges (23G, 24G, 25G, 26G, 27G and 30G), lengths (12 mm, 25 mm, 32 mm, 35 mm, 42 mm), and internal diameters (0.265 mm, 0.215 mm, 0.3 mm and 0.4 mm). All studies had high risk of bias, adopted different assessment methods for the outcomes, and included participants with differences in baseline characteristics. Conclusions: The level of the available evidence introduced by primary studies hinder concluding the optimal needle characteristics; keeping the research question unanswered. However, within the limitations of the heterogenous studies, available data favors thinner needles for less pain during needle insertion; otherwise, data of the other outcomes was inconclusive. Clinical relevance: Thinner needles are favored for less pain during insertion; but standardized future studies are essentially needed for solid conclusions. A detailed standard protocol is, therefore, proposed. [ABSTRACT FROM AUTHOR]

Purpose: Intravenous lidocaine is a non-opioid analgesic adjunct for perioperative pain relief. The aim of our study was to explore whether concurrent administration of intravenous lidocaine prolongs the duration of sensory block during total knee replacement (TKR) under spinal anaesthesia. Methods: This prospective randomized double blind controlled trial was conducted on 28 patients (14 in lidocaine group and 14 in the control group) undergoing unilateral TKR under spinal anesthesia. In the lidocaine group, intravenous lidocaine 1.5 mg·kg−1 followed by an infusion of 1.5 mg·kg−1·h−1 was administered intraoperatively after spinal anesthesia. The primary outcome was the duration of sensory block of spinal anesthesia. Secondary outcomes included onset time of sensory and motor block, duration of motor block, time to first postoperative analgesic, postoperative visual analog scale (VAS) scores and postoperative analgesia requirement in 24 h after surgery. Results: The duration of sensory and motor block was longer in the lidocaine group (Mean ± SD; 112.50 ± 5.80 min versus 78.21 ± 9.12 min; p < 0.001 and 237.14 ± 9.14 min versus 215.00 ± 10.12 min; p < 0.001, respectively). Time to requirement of first rescue analgesia was 184.29 ± 9.38 min in the lidocaine group and 127.14 ± 23.35 min in the control group (p < 0.001). VAS scores were lower in the lidocaine group at 4, 8, 12 and 24 h after surgery (p < 0.00001, p < 0.00001, p < 0.00006, p = 0.032, respectively). Requirement of additional analgesia in the first 24 h was higher in the control group. There were no clinical signs to suggest lidocaine toxicity in any patient. Conclusion: During unilateral TKR under spinal anaesthesia, concurrent use of intravenous lidocaine prolonged sensory block and reduced postoperative analgesic requirements. [ABSTRACT FROM AUTHOR]

Purpose: While regional anesthesia (RA) is considered preferable to general anesthesia (GA) for Cesarean delivery (CD), certain situations necessitate GA. This study reviewed the practice patterns around the use of GA for CD to identify modifiable predictors of GA with the goal of reducing GA rates. Methods: This was a retrospective, case–control study. Patients undergoing urgent/emergent CD over a 3-year period were identified, from which 102 patients undergoing GA and 102 patients undergoing RA were randomly selected. The data included patient characteristics, obstetrical indications for CD, type/indication of anesthetic, characteristics of airway management (GA group)/neuraxial anesthesia (RA group), and neonatal outcomes. Results: Abnormal fetal heart rate (aFHR) was the most common obstetrical indication for urgent/emergent CD amongst the cases (39%) and controls (39%). GA administration was most commonly due to "limited time due to maternal/fetal compromise" (56%), followed by "maternal contraindication to RA" (25%) and "inadequate RA" (17%). The most frequent modifiable anesthetic indication for GA was inadequate neuraxial anesthesia (17%). Anesthetic and obstetric predictors for GA included ASA classification [OR 0.11 (0.06–0.21)], emergency code activation [OR 13.55 (1.73–106.40)], failure to progress [OR 0.15 ((0.06–0.36)], labor in a patient scheduled for CD [OR 0.16 (0.05–0.57)], pregnancy-related illness [OR 8.63 (1.06–70.38)], cord/fetal prolapse [14.85(1.90–115.94)], and gestational age (OR 0.86 (0.81–0.92)). Conclusion: Abnormal fetal heart rate, specifically bradycardia, was the most common obstetrical indication of GA for urgent/emergent CD, while inadequate neuraxial anesthesia was the most modifiable anesthetic indication. Our data suggest aFHR and cord/fetal prolapse as potentially modifiable risk factors for GA in certain situations. [ABSTRACT FROM AUTHOR]

Peripheral and truncal nerve blocks provide effective analgesia facilitating perioperative care. However, thresholds for clinically relevant effects remain undetermined and are left for clinicians to choose. These choices are fundamental for sample size calculations and interpretation of study results. This systematic scoping review aimed to create an overview of primary outcomes and anticipated effect sizes in randomised clinical trials assessing peripheral and truncal nerve blocks. We searched Cochrane Library's CENTRAL, Medline, and Embase for randomised trials in English in 10 major anaesthesia journals investigating single-injection ultrasound-guided peripheral and truncal nerve blocks for adults undergoing surgery. The primary outcome was the anticipated effect sizes for primary outcomes. Secondary outcomes included reporting of sample size calculations and statistically significant primary outcomes below anticipated effect sizes. The most frequently reported primary outcomes were postoperative pain, analgesic consumption, quality of recovery, mobilisation, and block performance. Median anticipated effect sizes were: 0–24 h opioid consumption: 9 mg i.v. morphine equivalents; pain at rest and during movement: 2 points on Numeric Rating Scale 0–10; quality of recovery: 10 points on Quality of Recovery-40 scale and 8 points on Quality of Recovery-15 scale. Adequate sample size calculations were reported in 85% (156/183) and 91% (29/32) of trials assessing continuous outcomes and dichotomous outcomes, respectively. Statistically significant primary outcomes failed to reach anticipated effect sizes in 24% (24/99) of trials, and only one trial addressed this disparity in the trial conclusion. The presented outcomes and effect sizes from published trials on peripheral and truncal nerve block literature can be used in future trials to increase homogeneity in regional anaesthesia research. [ABSTRACT FROM AUTHOR]

Background: Despite known disparities in pediatric perioperative outcomes, few studies have examined factors associated with the use of regional anesthesia for pediatric orthopedic surgery. Aims: This investigation aimed to determine if minority and developmental disability status were associated with the allocation of peripheral nerve blocks in calcaneal osteotomy. Methods: We conducted a single‐center, retrospective study of records of patients <18 years who underwent calcaneal osteotomy from 2013 to 2023. Regional technique was classified into three groups: popliteal‐sciatic single‐shot block, popliteal‐sciatic catheter, and no block. Patients were classified as either nonminority (white, non‐Hispanic) or minority. Developmental disability status was defined based on medical history and classified as binary. Anesthesiologists were classified as "regional" or "nonregional" based on clinical expertise. A Bayesian hierarchical multinomial model with random intercepts for patients and surgeons was used to investigate the association of minority status, developmental disability, and anesthesiologist expertise with block selection. Results: We analyzed 287 cases in 225 patients; of these, 55% occurred in minority patients and 28% occurred in patients with developmental disability. Catheters were placed in 45% of cases, single shot blocks in 41%, and no block in 14%. Minority and nonminority patients had a similar likelihood of receiving of any block. Patients with developmental disability had a −22% absolute difference of receiving any block (95% credible interval [−38%, −7%]) compared to those without developmental disability (55% vs. 77%), an effect primarily driven by a lower rate of catheter placement in these children. Regional anesthesiologists were more likely to place catheters (23% absolute increase; 36% vs. 13%) and more likely to perform any block in children with developmental disability (30% absolute increase; 67% vs. 37%) than nonregional anesthesiologists. Conclusions: Decision‐making surrounding the placement of regional anesthesia techniques is complex. In this study, developmental disability status and anesthesiologist experience were associated with a difference in the use of regional anesthesia in patients undergoing calcaneal osteotomy. [ABSTRACT FROM AUTHOR]

Peribulbar anesthesia is mainly used for cataract surgery. Many studies had used atracurium and rocuronium as an additive to the local anesthetic (LA) drugs in eye surgery. The aim of this study is to evaluate the efficacy of adding atracurium versus rocuronium to a local anesthetic mixture, in providing an early onset of orbital akinesia and corneal anesthesia during cataract surgery. Ninety-three patients met the inclusion criteria and gave a written informed consent to participate. Patients were randomly allocated in three study groups (31 patients in each group). Group I received either 3 mL of a lidocaine2%(mixed by hyaluronidase 50 IU/ml) and 3 ml bupivacaine mixture, plus 0.5 mL rocuronium (5 mg) total volume 6.5 ml. Group II 3 mL of a lidocaine2%(mixed by hyaluronidase 50 IU/ml) and 3 ml bupivacaine mixture plus 0.5 mL (5 mg) atracurium total volume 6.5 ml. Group III or3 mL of a lidocaine2%(mixed by hyaluronidase 50 IU/ml) and − 3 ml bupivacaine mixture, plus 0.5 mL saline total volume 6.5 ml. The onset time of orbital akinesia was significantly lower in the rocuronium group and the atracurium group compared to the control group. Akinesia score was (0.90 ± 0.30) and (0.19 ± 0.40) in rocuronium group at 4 min and 6 min respectively which result in highly significant difference than atracurium and control groups. The use of rocuronium and atracurium will result in rapid orbital akinesia and rapid orbicularis muscle akinesia. [ABSTRACT FROM AUTHOR]

The skills necessary to perform diagnostic perineural anesthesia in equids belongs to one of the Day One Competences of a veterinarian, so every veterinary graduate should be able to perform them correctly. For logistical, hygienic and ethical reasons, practical exercises on cadaver limbs are not accessible to all students. Two equine distal limb simulators were developed and evaluated as an additional instructional tool to train the required skills. Both simulators were designed and built with an integrated success control, with Simulator I (S1) designed to be a simplified anatomical model and Simulator II (S2), a more realistic model. The simulators were tested by 68 students in the 5th year who were divided into two groups. Thirty-four students received a training session using the simplified anatomical model (S1) and the other 34 students one on cadaver limbs, the usual instructional tool. The practical learning success of both groups was validated using S2. Additionally, data on self-efficacy were collected. The results show that the two groups did not differ significantly in their practical learning success, whereas self-efficacy of both groups increased significantly after the sessions. An evaluation performed by 7 veterinarians and 49 students of the 5th year indicate that the simulators are suitable for teaching perineural anesthesia in the equine distal limb. However, S2 could be more realistic. The simulators will be used as a supplement to exercises on cadaver limbs to enable all students to practice perineural anesthesia. [ABSTRACT FROM AUTHOR]

Objective: This review explores recent advancements in anesthesia care, focusing on the integration of innovative practices to enhance patient outcomes across the perioperative period. Methods: Following the framework of Whitmore and Knafl, we systematically searched six databases (PubMed, Google Scholar, EMBASE, CINAHL, OVID, and Cochrane Library) for studies published from January 2020 to January 2024, relating to advancements in anesthesia care, best practice implementation, and patient outcomes. After independent screening and data extraction by two reviewers, the review focuses on innovations in anesthetic drugs, monitoring technologies, anesthesia techniques, and evidence-based practices in anesthesia and clinical guidelines. Results: Of the 25,984 studies retrieved, 26 met inclusion criteria. Recent developments in anesthetic drugs have improved safety and efficacy, reducing complications. Advanced monitoring devices, such as multiparameter and brain function monitors, have enhanced patient safety through real-time assessments. Innovations in regional anesthesia and ultrasound-guided nerve blocks have led to better pain management, reduced recovery time, and minimized morbidity. Additionally, evidence-based practices like comprehensive preoperative assessment, patient education, and multidisciplinary teamwork significantly improved patient outcomes. Conclusion: Integrating the latest innovations and best practices in anesthesia care is essential for optimizing patient outcomes. Ongoing research and adoption of advanced technologies are crucial to addressing current challenges and enhancing anesthesia quality. This review emphasizes the importance of a holistic approach from preoperative preparation to postoperative recovery to achieve optimal patient outcomes. [ABSTRACT FROM AUTHOR]

Knowledge of drug pharmacokinetics and tissue distribution is precious for ensuring patient safety and optimizing treatments. The varied use of local anesthetics, as well as the fact that anesthetics can sometimes have low therapeutic indices and numerous adverse drug reactions, makes any novel pharmacokinetics information valuable. The present manuscript describes a pharmacokinetic study of ropivacaine carried out after plane block anesthesia on an animal model, using high sensitivity, accurate, and precise LC-MS/MS bioanalysis. Both plasmatic concentrations and tissue distribution of ropivacaine and its primary active metabolite were determined. The results showed a tissue affinity of the anesthetics, a clearance of ropivacaine mainly by hepatic metabolism, and the final, mainly renal excretion of the hydroxylated metabolite. While the results cannot simply and directly be transposed to human pharmacokinetics, they offer a valuable basis for future studies and can contribute to a better understanding of the bioavailability and toxicology of the widely used modern anesthetic. [ABSTRACT FROM AUTHOR]

Background/Objectives: The aim of this study is to identify the most accurate and consistent landmarks for determining the precise location of the mandibular foramen (MF) and the mandibular ramus, suggesting appropriate adjustments to anesthesia techniques based on these variations in order to improve the success rate of the inferior alveolar nerve (IAN) block. Methods: CT scans of the mandibles from 100 patients were analyzed to measure the distance between the MF and various landmarks, including the sigmoid notch, gonion, posterior and anterior margins of the ramus, temporal crest, and the mandibular ramus height from the condyle to the gonion. The width of the mandibular ramus was also assessed, with correlations made to age and gender. Results: The MF was found to be closer to the sigmoid notch (mean = 21.2 mm), p = 0.393, than to the gonion (mean = 22.6 mm), p = 0.801, and closer to the posterior margin of the ramus (mean = 13.1 mm), p = 0.753, than to the anterior margin of the ramus. Additionally, the MF was closer to the temporal crest. Age also influenced the position of the MF, with a posterior and superior movement of the foramen, reducing the distance between the MF and the posterior margin of the ramus as well as the MF and the sigmoid notch (p < 0.001). Conclusions: A precise understanding of the MF's location will help dentists and oral and maxillofacial surgeons improve the success of the IAN block, avoid injury to the inferior alveola neurovascular bundle, and minimize surgical complications such as paresthesia, permanent anesthesia, and hemorrhage. [ABSTRACT FROM AUTHOR]

Background: Thoracic outlet syndrome (TOS) is an uncommon condition defined by the compression of neurovascular structures within the thoracic outlet. When conservative management strategies fail to alleviate symptoms, surgical decompression becomes necessary. The purpose of this study is to evaluate and compare the efficacy and safety of regional anesthesia (RA) using spontaneous breathing in contrast to general anesthesia (GA) for patients undergoing surgical intervention for TOS. Methods: We conducted a retrospective comparative study involving 68 patients who underwent trans-axillary first rib resection for TOS. The patient cohort was divided into two groups: 29 patients in the GA group and 39 patients in the RA group. The RA technique employed consisted of supraclavicular brachial plexus (SBP) and pectoral nerve (PECS II) blocks, accompanied by deep sedation. Key outcome measures such as pain scores, opioid consumption, and various perioperative parameters were systematically analyzed. Results: Postoperative pain levels recorded in the recovery room were significantly lower in the RA group, with a median numerical rating scale (NRS) score of zero compared to two in the GA group (p = 0.0443). Additionally, both intraoperative and postoperative opioid consumption showed a marked reduction in the RA group, with p-values of less than 0.001 and 0.0418, respectively. The RA approach was associated with shorter surgical durations (p = 0.0008), a decrease in the incidence of postoperative nausea and vomiting (PONV) (p = 0.0312), and a lower occurrence of intraoperative lung injuries (p < 0.0001). Furthermore, the length of hospital stay was significantly reduced for patients in the RA group. Conclusions: Although both groups reported low postoperative pain scores, the regional anesthesia approach exhibited distinct advantages in terms of opioid consumption, surgical duration, and overall perioperative outcomes. The utilization of SBP and PECS II blocks facilitated surgical procedures and mitigated complications, thereby positively influencing the postoperative recovery trajectory. Future prospective studies are essential to validate these findings further and to investigate long-term outcomes associated with the use of regional anesthesia in TOS surgery. [ABSTRACT FROM AUTHOR]

Introduction: Regional anesthesia increases in popularity in orthopaedic surgery. It is usually applied in elective surgeries of the extremities. The aim of this study was to assess indication of the use of general anesthesia in the surgical treatment of distal radius fractures. Methods: Patients undergoing surgical fixation for distal radius fractures between January 1st, 2020, and December 31st, 2021, were included. Exclusion criteria encompassed incomplete 12-month follow-up, transferred or multiply injured patients, those with prior upper limb fractures, or admission for revision surgeries. Patients were categorized by anesthesia type: GA or plexus block anesthesia (PA). Primary outcomes comprised tourniquet utilization and duration of surgery, while secondary outcomes encompassed complications (e.g., complex regional pain syndrome [CRPS], local wound infection, implant removal necessity) and range of motion at three, six, and twelve months post-surgery. Fractures were classified using the AO/OTA system. Results: The study enrolled 127 patients, with 90 (70.9%) in Group GA and 37 (29.1%) in Group PA. Mean patient age was 56.95 (± 18.59) years, with comparable demographics and fracture distribution between groups. Group GA exhibited higher tourniquet usage (96.7% vs. 83.8%, p = 0.029) and longer surgery durations (85.17 ± 37.8 min vs. 65.0 ± 23.0 min, p = 0.013). Complication rates were comparable, Group GA 12.2% versus Group PA 5.4% p = 0.407, OR 2.44; 95%CI 0.51 to 11.58, p = 0.343). Short-term functional outcomes favored Group PA at three months (e.g., Pronation: 81.1° ± 13.6 vs. 74.3° ± 17.5, p = 0.046). Conclusion: Solely classifying distal radius fractures does not dictate anesthesia choice. Complexity of injury, anticipated surgery duration, less use of tourniquet, and rehabilitation duration may guide regional anesthesia utilization over GA in distal radius fracture fixation. [ABSTRACT FROM AUTHOR]

Objectives: The current state of the art for c-section anesthesia includes the use of regional anesthesia techniques because of their effectiveness, safety, and extended postoperative analgesia. This study aimed to analyze the anesthetic techniques employed for c-section and postoperative analgesic regimens and to identify predictive factors for postoperative pain, postoperative complications, and hospitalization time. Study Design: A retrospective, observational study was conducted on pregnant women who underwent c-section between January and December 2021. Demographic data, medical comorbidities, indications for c-section, anesthetic techniques, and postoperative outcomes (pain, complications, and hospitalization time) were registered. Linear and logistic regression were applied for data analysis. Results: Data from 925 women who underwent c-sections were analyzed. Combined spinal–epidural anesthesia was the most used technique for elective c-sections (423 out of 430 women), while general anesthesia was commonly used in emergent procedures (29 out of 39 women). Epidural analgesia was the most commonly used technique for postoperative pain management (83%), and pruritus (8.9%) and headaches (4.1%) were the most frequently registered complications. Risk factors for moderate/severe pain included lower body mass index, conversion to general anesthesia, and the use of systemic analgesia. Preeclampsia and intrathecal morphine increased postoperative complications. General anesthesia and some postoperative complications were predictors for longer hospitalization times. Conclusions: This study suggests that a multimodal analgesic approach with neuraxial morphine and/or local anesthetics, nonsteroidal anti-inflammatory drugs, and acetaminophen is central to achieve an effective postoperative analgesia after a c-section. However, further studies should investigate the optimal neuraxial analgesic combination to minimize side effects. [ABSTRACT FROM AUTHOR]

Thoracic surgery is associated with significant postoperative pain, which can hinder recovery and elevate morbidity risks. Traditionally, epidural anesthesia has been the cornerstone for pain management, but its drawbacks including technical challenges, side effects, and complications necessitate exploring alternative methods. This narrative review examined recent advances in perioperative analgesic strategies in thoracic surgery, focusing on regional anesthetic techniques like paravertebral blocks (PVBs), erector spinae plane blocks (ESPBs), intercostal blocks, and serratus anterior blocks. Each approach was evaluated for efficacy, safety, and impact on patient outcomes. PVB can provide effective unilateral analgesia with fewer systemic complications compared to epidurals. ESPB provides analgesia through a superficial, ultrasound-guided approach, minimizing risks and offering an alternative for various thoracic procedures. Intercostal blocks are effective but are limited by the need for multiple injections, increasing the complication risks. Serratus anterior blocks, targeting intercostal and thoracic nerves, show promise in managing lateral thoracic wall pain with a low complication rate. Advancements in surgical techniques including minimally invasive approaches further optimize pain control and recovery. A multimodal analgesic approach combining regional anesthesia and systemic therapies enhances outcomes by addressing somatic and visceral pain components. Despite the efficacy of epidural analgesia, alternative regional techniques offer comparable pain relief with fewer complications, suggesting their growing role in thoracic surgery. Collaborative efforts between surgical, anesthetic, and emergency teams are crucial for tailoring pain management strategies to individual patients, improving recovery and reducing long-term morbidity. Future research should continue exploring these methods to refine their application and broaden their accessibility. [ABSTRACT FROM AUTHOR]

Background: Open surgeries are associated with significant morbidities postoperatively such as pain and restricted ambulation causing delayed recovery. Among the various regional anesthesia techniques quadratus lumborum block (QLB) and erector spinae plane block (ESPB) are found to be effective alternatives. Aims and Objectives: The study intended to assess the post-operative analgesic efficacy of ultrasound-guided (USG) guided QLB and ESPB in open urological procedures. Materials and Methods: Ninety patients of ASA Grade I or II undergoing open urological procedures were divided into three groups. Group Q received USG-guided QLB, Group E received USG-guided ESPB and Group C received standard analgesia regimen. Each patient was assessed for the duration of analgesia, the total dose of rescue analgesics required in 24 h, Visual Analog Scale (VAS) score postoperatively (at 1, 2, 4, 6, 8, 12, 18, and 24 h) at post-anesthetic care unit and the incidence of any adverse events postoperatively. Results: The mean VAS score was higher in the control group compared to both the study groups which was statistically significant (P<0.0001). The mean duration of analgesia was 4.87±1.01 h in Group Q and 5.13±1.01 h in Group E compared to Group C 1.40±0.50 h which was statistically significant (P<0.0001). The total rescue analgesic requirement was low in the study groups compared to the control group (P<0.0001). There was no incidence of any side effects found. Conclusion: Both USG QLB and ESPB provide effective analgesia, decrease intraoperative and post-operative analgesic consumption, and are beneficial to shorten hospital stay in patients undergoing open urological procedures. [ABSTRACT FROM AUTHOR]

Regional anesthetic approach and surgical volume have been shown to outcomes in patients undergoing Nuss procedure for pectus excavatum. However, their independent relationship is not described. We investigated how regional anesthesia and surgical volume are associated with length of stay (LOS), postoperative opioid use, operating room utilization, and complications. This is a 9-center retrospective review of patients ≤21 ys after Nuss procedure for pectus excavatum (2016-2020). High-volume centers and surgeons defined as the upper-quartile for annual procedures. Outcomes were compared with mixed effects linear/logistic regression models with random intercepts by institution as appropriate. A single-center unadjusted analysis was performed of erector spinae catheter (ESC) utilization (due to nonuniform use; high-volume only at 1-center). 780 patients were included. Significant variation existed in anesthetic approach and volume. Cryoablation was independently associated with shorter LOS (−2.1 d; 95% confidence interval [CI]: −2.6,−1.7) and lower postoperative opioid utilization (−120 morphine milligram equivalents, 95% CI: −181, −58.1) but increased surgical time (+45 min; 95% CI: 30.3, 59.8). Individual surgeon volume was associated with decreased LOS (−0.3 d; 95% CI: −0.5, −0.01), though high-volume centers had increased complications (odds ratio 2.2; 95% CI: 1.1, 4.2). There was no association between anesthetic approach and surgical complications. Within the single center utilizing ESCs (n = 138), a shorter LOS (2 versus 3 d, P < 0.01) was observed compared to those not receiving an ESC (n = 19). Analgesic approaches varied significantly across institutions and limited our ability to directly compare cryoablation and ESCs. On multivariate analysis, cryoablation was associated with decreased LOS and postoperative opioid use, irrespective of center and surgeon volume. ESCs were similarly associated with improved outcomes. Rigorous prospective comparison of ESCs and cryoablation is warranted. [ABSTRACT FROM AUTHOR]

Regional anesthesia remains underutilized in vascular surgery; therefore, we retrospectively reviewed and compared the usage of perioperative opioids in patients undergoing lower extremity revascularization surgery, who received the anterior transversus abdominis plane (TAP) block along with local anesthesia at the incision site versus who did not receive any regional anesthesia. We conducted a retrospective review of 107 patients undergoing open or hybrid lower extremity revascularization under general anesthesia at a single institution between 2017 and 2022. Patients were divided into two groups. Regional block group (n = 41 [38%]) (femoral endarterectomy 27%; femoral endarterectomy + endovascular intervention 51%; infrainguinal bypass 22%) received both an intraoperative anterior TAP block and local anesthesia at the incision site; No regional block group (n = 66 [62%]) (femoral endarterectomy 29%; femoral endarterectomy + endovascular intervention 13%; infrainguinal bypass 58%) did not receive either regional or local anesthesia. There were no significant differences in either the procedural metrics or intraprocedural complications between the two groups. The in-hospital stay was shorter in the Regional group, 1 (1, 3) versus the No regional group, 3 (2, 7), P < 0.001. The median intraoperative morphine milliequivalents use was 20 (15, 25) in the Regional block group and 25 (20, 35) in the No regional block group, P = 0.008. The median postoperative opioids use at 24h was 75 (60, 98) in the Regional block group and 113 (83, 151) in the No regional block group, P < 0.001; at 48h was 103 (70, 118) in the Regional block group and 148 (90, 210) in the No regional block group, P = 0.027; at 72h was 105 (70, 138) in the Regional block group and 196 (113, 263) in the No regional block group, P = 0.010. Anterior TAP block combined with local anesthesia at the incision site seems to be a safe postoperative analgesia option for patients undergoing lower extremity revascularization surgery that could potentially help reducing both intra and postoperative opioids requirement. [ABSTRACT FROM AUTHOR]

The evolution of regional anesthesia techniques has markedly influenced the management of postoperative pain, particularly in thoracic surgery. As part of a multimodal analgesic approach, fascial plane blocks have gained prominence due to their efficacy in providing targeted analgesia with minimal systemic side effects. Among these, the superficial intercostal plane (SPIP) block and deep parasternal intercostal plane (DPIP) block are of notable interest. The aim of this study was to investigate the dye spread to the anterior chest wall space and its spread pathway through anatomical morphometric analyses on cadavers for single-injection and double-injection SPIP blocks versus DPIP blocks. In both qualitative and quantitative evaluations, the single-injection SPIP block with 10 mL of dye demonstrated a broader and more extensive spread compared to the double-injection SPIP block, which used 5 mL of dye per injection site (p < 0.05), and the DPIP block with 10 mL of dye (p < 0.05). All the blocks had a positive correlation between the distances from the sternum border and the area of dye spread, suggesting that the crucial role of volume in fascial blocks is that it significantly affects the opening of the fascial compartment, enabling optimal spread of the anesthetic. Adequate volume facilitates proper spread and diffusion across the fascial plane, ensuring more comprehensive fascia coverage and thus enhancing the block's effectiveness. Finally, precise volume management is key to maximizing both efficacy and safety. [ABSTRACT FROM AUTHOR]

Introduction: The erector spinae plane block (ESPB) has recently emerged as a regional anesthesia technique for perioperative pain management in pediatric cardiac surgery. However, evidence comparing its effectiveness with intravenous (IV) opioid‐based analgesia is limited. We aimed to evaluate and compare the analgesic efficacy of ESPB versus IV opioids in this setting. Methods: We systematically reviewed and meta‐analyzed studies comparing ESPB with IV opioid analgesia in pediatric cardiac surgeries with midline sternotomy. Primary outcomes were intraoperative fentanyl consumption and intensive care unit (ICU) length of stay (LOS). Secondary outcomes included postoperative opioid consumption, time to first rescue analgesia, pain scores, postoperative vomiting and other complications, extubation time, and hospital LOS. Statistical analyses were performed using RStudio version 4.2.3. Results: Five studies with 384 patients were included, with 178 receiving ESPB. ESPB significantly reduced intraoperative fentanyl use (MD −1.90 μg.kg−1; 95% CI −3.15 to −0.66 μg.kg−1; p =.003; I2 = 58%) and ICU LOS (MD ‐3.50 h; 95% CI ‐4.32 to −2.69 h; p <.0001; I2 = 0%). No significant differences were found in the remaining outcomes. Conclusion: Our findings suggest the ESPB might be an important adjunct to enhancing analgesia for midline sternotomies in pediatric cardiac surgery, potentially reducing intraoperative opioid requirements and ICU LOS. PROSPERO Registration: CRD 42024526961. [ABSTRACT FROM AUTHOR]

To assess the feasibility of using an adjustable intensity nerve stimulator for evaluating the sensory response after a transversus abdominis plane (TAP) block in guinea pigs (Cavia porcellus). Prospective, randomized, blinded, experimental crossover study. A total of six adult guinea pigs (Cavia porcellus). Trial A involved a unilateral TAP block with 0.5% bupivacaine (1 mL kg–1), and trial B involved a unilateral sham block with an equivalent volume of 0.9% saline. In both trials, the noninjected side served as the control. An electrical stimulus was bilaterally applied at 10, 20, 30, 60, 90 and 120 minutes post-injection. Stimulus intensity was gradually increased and the current intensity (mA) at which a response (body movements and/or voluntary limb withdrawal and/or vocalization) occurred on each side was registered. Measurements over time (Friedman test) and between sides at each time point (Wilcoxon test) were compared. In trial B, nonsignificant differences were observed between sides at each time point. In trial A, when comparing responses at each time point, nonsignificant differences were observed at 60 (p = 0.104), 90 (p = 0.598) and 120 minutes (p = 0.891); however, at 10 (p = 0.043), 20 (p = 0.027) and 30 minutes (p = 0.026), significant differences were observed. The stimulus intensity necessary to evoke a response in the bupivacaine-injected side was at least 23.8% higher than the current intensity required to elicit a response in the control side. The electrical stimulus method appears effective in distinguishing the presence or absence of sensory block in guinea pigs that were administered a TAP block. This approach may also serve to assess the onset time and duration of the block. [ABSTRACT FROM AUTHOR]

The article explores the considerations and challenges of administering neuraxial anaesthesia to parturients with intracranial pathology. Topics discussed include the management of obstetric anaesthesia in patients with intracranial hypertension, the potential risks associated with lumbar puncture, and the complexities of using regional anaesthesia in this clinical setting.

The article focuses on the peripartum management of patients taking anticoagulant medications, addressing the challenges of anticoagulation therapy during pregnancy and childbirth. Topics discussed include the increased risks of venous thromboembolism, the management strategies to balance anticoagulation therapy with the risk of bleeding, and the considerations for the safe use of regional anaesthesia in these patients.

Regional anesthesia is a popular method for surgical anesthesia in clavicular surgery. Selective blocking of the cervical 3, 4, and 5 nerve roots shows promise in clavicle surgery, with its fast onset, good anesthesia and less complications, necessitating evaluation of its impact on diaphragmatic function. The purpose of this study is to examine the safety of C3, 4, and 5 nerve root block for its application in clavicle surgery. We conducted a pragmatic, randomized trial to evaluate the effect of C3, 4, and 5 nerve root block as compared with interscalene with intermediate cervical plexus block in diaphragmatic motion. This study involved forty patients undergoing right clavicle surgery. Patients were assigned in a 1:1 ratio to either a C345 nerve root block (administered with 2, 3, and 5 ml of 0.5% ropivacaine) or an interscalene with intermediate cervical plexus block (ISB + ICPB, each receiving 10 ml of 0.5% ropivacaine). Diaphragmatic kinetics were quantitatively assessed using sonographic techniques. The primary outcome was the incidence of complete hemi-diaphragmatic paralysis, observed at 30 min post-blockade. Secondary outcomes included the rate of complete hemi-diaphragmatic paralysis at 15 min and the degree of diaphragmatic motion restoration at 2, 4, 6, and 8 h post-blockade, onset time of block, motor block score in upper extremity, and adverse events. Results showed that only one patient (5%) in the C345 group vs. fifteen (75%) in the ISB + ICPB group experienced complete hemi-diaphragmatic paralysis at 30 min during deep breathing (P = 0.001). No patients in the C345 group, compared to five (25%) in the ISB + ICPB group exhibited paradoxical movement at 30 min during voluntary sniffing (P = 0.0471). Additionally, the C345 group demonstrated significantly greater diaphragmatic motion and upper limb strength restoration at all measured intervals post-blockade. Moreover, faster onset time and less adverse events were observed in the C345 group vs. in the ISB + ICPB group. Benefit from low volume of local anesthetics, the C345 nerve root block not only significantly reduces the incidence of complete hemi-diaphragmatic paralysis but also facilitates better recovery from diaphragmatic paralysis compared to the ISB + ICPB. It can be inferred that C345 is a more beneficial anesthesia method for early recovery of clavicular patients. Trial registration number: ChiCTR2300078283 04/12/2023. [ABSTRACT FROM AUTHOR]

The muscular dystrophies or muscle-wasting diseases include a diverse group of genetic disorders, which result in progressive degeneration of skeletal muscles, progressive muscle weakness, and comorbid multi-system involvement. Duchenne muscle dystrophy is the most common type of muscular dystrophy with a reported incidence of 1 in every 3500–6000 male live births in the United States. Given the progressive nature of these disorders, skeletal muscle weakness frequently progresses to loss of the ability to ambulate and perform functions of daily life. In addition to affecting the skeletal musculature, many muscular dystrophies have effects on both cardiac and smooth muscles. As respiratory muscles are one of the most frequently affected muscles in patients with muscular dystrophies, progressive respiratory insufficiency may occur with dependance on non-invasive forms of respiratory support. Given the progressive multi-system involvement associated with the muscular dystrophies, perioperative care and the use of general anesthetic agents and opioids may result in postoperative respiratory failure. In an effort to avoid the deleterious effects of anesthetic agents and opioids on hemodynamic and respiratory functions, regional anesthesia may be used as an adjunct to or instead of general anesthesia. This manuscript provides a literature review and educational summary regarding the use of regional anesthetic techniques in pediatric-aged patients with muscular dystrophies. [ABSTRACT FROM AUTHOR]

Background: Cesarean deliveries have increased globally, with regional anesthesia being the preferred technique. Despite the advantages of the procedure, parturients experience apprehension regarding pain, mobility, and complications. The postoperative period following cesarean delivery can also be challenging. However, there is limited qualitative research exploring parturients' experiences with regional anesthesia for cesarean delivery and postoperative recovery. Methods: A qualitative study using in-depth interviews was conducted with 12 primiparous parturients who underwent cesarean delivery under regional anesthesia. Interviews explored knowledge, perceptions, and experiences regarding regional anesthesia, cesarean delivery, and postoperative recovery. Data were analyzed using thematic analysis. Results: Parturients in the study reported experiencing pregnancy-related complications necessitated for opting cesarean delivery instead of vaginal delivery. The study revealed substantial knowledge gaps among parturients regarding cesarean section (CS) and anesthesia. Their decision for CS was driven by prioritizing fetal safety over personal comfort. Parturients did not have many concerns about anesthesia and were focusing mainly on neonatal wellbeing. They had limited recollection of the anesthesia experience but vividly remembered the delivery process and postoperative pain. A strong desire for recovery to provide neonatal care was expressed. Despite challenges, parturients reported overall satisfaction with the CS experience and willingness to recommend it when medically indicated. Conclusion: The study highlights the need for comprehensive education on regional anesthesia, postoperative care, and coping strategies for parturients undergoing cesarean delivery. It emphasizes judicious use of cesarean delivery based on medical necessity while ensuring optimal maternal and neonatal outcomes. Further qualitative research with larger samples is recommended. [ABSTRACT FROM AUTHOR]

Background: Living donor nephrectomies (LDN) at our institution transitioned from open access to laparoscopic and, more recently, to a minimally invasive robotic surgical approach between 2019 and 2022. Concurrently, postoperative analgesia transitioned from regional anesthesia to intravenous patient-controlled analgesia (PCA) and eventually to simple analgesics with additional rescue analgesic agents, as needed, in accordance with individual physicians' preferences. This retrospective study was designed to evaluate the impact of these changes on surgical practice on the analgesic requirements and effectiveness of postoperative pain management. Methods: Electronic records of all LDN cases operated between January 2019 and March 2022 were accessed, and a comparative analysis of patient demographics, surgical approach, duration of surgery, postoperative pain scores, and the analgesics administered within the first 48 h was performed. Results: LDN (n = 527) was performed via laparoscopic (n = 432, 82%), robotic (n = 87, 17%), and open (n = 8, 2%) approaches. All patients were administered regular paracetamol 1 g 6 hourly. IV PCA was used in 85% of cases, predominantly in the laparoscopic (99%) and open (75%) groups (LG and OG, respectively); in contrast, the robotic group (RG) was mostly treated without PCA (81.7%). A variety of analgesic techniques were employed for the remaining patients, including epidural (25% of OG) and rectus sheath/transversus abdominis plane (TAP) block (2% of LG). Additional rescue analgesics were administered to 98% of the patients; 92% of LG needed 1–3 analgesic agents, whereas all of the OG and 37% of RG needed 1–2 rescue analgesics. No correlation was found between patient demographics and surgery duration on pain scores or analgesic requirements. Conclusions: Robotic surgery was associated with the lowest postoperative pain scores and analgesic demand; laparoscopic resection was the most painful of all. [ABSTRACT FROM AUTHOR]

ABSTRACT: Anesthetists pose different challenges in burn cases associated with polytrauma. Here, we present a case of a 35-year-old male electrician with an electric burn and a fall from height who sustained major chest trauma (hemothorax, pneumothorax, emphysema, and multiple rib fracture, and bilateral femur fracture). The collocated burn over the spinal region posed the challenge to administering a subarachnoid block, which was overcome with a paramedian approach anesthesia. The surgical outcome was good, and the patient was stable post-surgery. The paramedian approach provides an excellent alternative to the midline approach for spinal anesthesia. It should be considered in burn patients where it is impossible for the patient to flex, where the intervertebral space is very low, or when there is a burn present over the spinal region. Ultimately, early therapy and mobility goals, two essential components of burn care and rehabilitation, can be achieved with the use of paramedian regional anesthesia. [ABSTRACT FROM AUTHOR]

Background and Aims: Delayed neurocognitive recovery (DNR) and postoperative neurocognitive disorder (P-NCD) are common postoperative complications affecting older patients. This review evaluates perioperative approaches for preventing DNR and P-NCD in older noncardiac surgical patients. Material and Methods: We searched databases for relevant articles from inception through June 2022 and updated in May 2023 (PROSPERO ID CRD42022359289). Randomized controlled trials (RCTs) utilizing intervention for DNR and/or P-NCD were included. Results: We included 39 RCTs involving anesthetic (25 RCTs, 7422 patients) and other pharmacological and nonpharmacological approaches (14 RCTs, 2210 patients). Seventeen trials investigating four interventions were included in the meta-analysis for DNR. Perioperative dexmedetomidine (relative risk [RR]: 0.59, 95% confidence interval [CI]: 0.35–0.97; P = 0.04) and propofol-based total intravenous anesthesia (TIVA) (RR: 0.81, 95% CI: 0.66–0.98; P = 0.03) significantly decreased the risk of DNR versus control. There was no significant decrease in the risk of DNR with regional anesthesia (RA) versus general anesthesia (GA) (RR: 0.89, 95% CI: 0.63–1.26) or bispectral index (BIS) monitoring (RR: 0.79, 95% CI: 0.60–1.04) versus the control groups. Evidence regarding the effects of interventions on P-NCD is limited. Although all included trials were at low risk of bias, the quality of meta-analysis pooled estimates was low. Conclusions: Our meta-analysis of RCTs showed that dexmedetomidine and TIVA decrease the risk of DNR in older patients undergoing noncardiac surgery by 41% and 20%, respectively, versus control. Further RCTs of adequate power and methodology on the effects of interventions on DNR and P-NCD are warranted. [ABSTRACT FROM AUTHOR]

Background and Aims: The optimal analgesia for percutaneous nephrolithotomy (PCNL) remains uncertain. This study aims to conduct a systematic review and network meta-analysis to compare the efficacy of various analgesic strategies for PCNL. Methods: We searched PubMed, ScienceDirect, ClinicalTrials.gov, MEDLINE, Web of Science, Ovid and EMBASE to identify all relevant randomised controlled trials published up to January 2024. Our review was prospectively registered with PROSPERO (ID: CRD42024504578). The identified methods included erector spinae plane block (ESPB), paravertebral block (PVB), intercostal nerve block (ICNB), quadratus lumborum block (QLB) and local infiltration. Our primary outcomes consisted of 24-h cumulative opioid consumption and the time to first use of opioid medication postoperatively. Secondary outcomes encompassed pain scores at 2, 6, 12 and 24 h postoperatively, as well as occurrences of postoperative nausea and vomiting. Results: Overall, 27 trials met our inclusion criteria. QLB, PVB and ESPB demonstrated significant advantages in reducing 24-h postoperative opioid consumption and providing effective analgesia at all measured postoperative time points within 24 h, compared to the placebo group. However, there was no statistical difference between the three interventions. Similarly, there were no statistical differences in all outcomes between the ICNB and infiltration groups compared to the placebo group. Conclusions: ESPB, PVB and QLB offer significant analgesic benefits for PCNL compared to placebo, with no significant differences in efficacy among them. Due to limited evidence, ICNB and local infiltration were found not to be more effective than placebo. [ABSTRACT FROM AUTHOR]

The use of proper sedative and regional anesthetic protocols is essential when performing equine dental surgical procedures under standing sedation. The efficacy of the rostral inferior alveolar nerve block via the mental foramen has not been previously studied. Aims of this study included determining the efficacy of the block, investigating whether any region (labial mucosa, alveolar mucosa, or teeth) was more reliably anesthetized, and if differences in efficacy existed between bilateral and unilateral blocks. In this blinded trial, 10 horses each were randomly assigned to receive a left unilateral block, right unilateral block or bilateral blocks and 5 horses were bilateral controls. For unilateral groups, the contralateral side of the horse acted as its own unilateral control. Mechanical nociceptive stimulus methods were used to determine response to stimulus at time points pre-sedation, post-sedation, and post-injection at 10, 30, 60, and 90 min. Results were evaluated in 4 groups: unilateral blocks, unilateral controls, bilateral blocks and bilateral controls. Overall, all groups were significantly less likely to respond to stimulus at time points post-sedation, T10, and T30, whereas only blocked sites were less likely to respond at T60 and T90 compared to pre-sedation. There was no significant difference in response to stimuli of blocked sites between the 3 regions at all time points. Overall, at T60 and T90, blocks produced regional anesthesia in 73% and 55% of sites, respectively. This study demonstrated the equine mental foramen regional nerve block has varied efficacy, producing partial or incomplete regional anesthesia in some cases. [ABSTRACT FROM AUTHOR]

The effects on the stress response, postanesthetic sedation, and altered behavior were evaluated following regional anesthesia and dental treatment in 40 dogs. Serum cortisol and blood glucose concentrations were measured following the administration of levobupivacaine (LBUP) 0.5% and dexmedetomidine (DEX) (0.5 µg/kg) or a placebo. The dogs were randomly assigned to 4 groups of 10 dogs each. All dogs received a regional nerve block using LBUP 0.5%. Group 1 (LBUP + DEX IV) also received DEX intravenously (IV); group 2 (LBUP + PLC IV) also received a placebo IV; group 3 (LBUP + DEX IO) also received DEX in one infraorbital (IO) block; and group 4 (LBUP + DEX IA) also received DEX in one inferior alveolar (IA) block. Serum cortisol and blood glucose concentrations were determined before the administration of oral blocks and at the end of the procedure. Sedation and behavior scores were assessed before premedication and hourly for 6 h after the end of anesthesia. Cortisol concentration did not change in any group at either evaluation time. The glucose concentration was higher (P <.05) only in the LBUP + DEX IA group at the end of the procedure. The sedation score was higher until the end of the observation period only in the LBUP + DEX IV and LBUP + PLC IV groups. No change in behavior score was observed in any of the groups. The reduction of perioperative stress response in all groups was due to the use of LBUP and not DEX. [ABSTRACT FROM AUTHOR]

Dental disease is common in captive-managed macropods, including Bennett's wallabies, and is a significant cause of morbidity and mortality. Dental extractions and debridement of diseased tissue is often necessary for those undergoing treatment for severe dental disease. Regional anesthesia of the dentition is considered standard of care for domestic animals undergoing orofacial surgery, however, it is not routinely performed in macropods due to limited information on dental anatomy and block approaches. Regional block descriptions for the infraorbital, maxillary, inferior alveolar, and mental blocks in domestic dogs and cats were evaluated and adapted for use in Bennett's wallabies based on descriptions of their anatomy and examination of 2 skulls. These approaches were then performed on cadaver heads with iohexol and methylene blue dye, and block placement was assessed on computed tomography scans and by gross dissection. All block approaches described in this study resulted in appropriate placement of regional anesthesia of the dentition in Bennett's wallabies. They can thus be used by clinicians to improve the intra and postoperative pain control of patients and provide a high level of veterinary care. [ABSTRACT FROM AUTHOR]

Maxillary nerve blocks (MNBs) commonly facilitate dental surgeries in standing horses. The goal of this prospective, blinded, cross-over design trial including 15 client-owned horses was to evaluate 3 methods of sensory function testing for confirming a successful MNB. Testing was performed bilaterally before sedation, 5 min after sedation, and 15 and 30 min after MNB with 0.5% bupivacaine and involved a needle prick dorsal to each naris, hemostat clamping of each nostril, and gingival algometry (measuring sensitivity to pain). Responses to stimulation were numerically scored and scores were summed up to a total score. Total score increases on the blocked side by ≥ 2 between baseline and 30 min Post MNB recordings signified a successful MNB. Sedation in the preceding 6 h, presence of sino-nasal disease, side of dental pathology, age, butorphanol administration, and detomidine dosing (µg/kg/min) throughout the tooth extraction procedure were recorded. In 73% of horses, MNB was successful. Sedation in the preceding 6 h (P =.732), age (P =.936), side of pathology (P =.516), and sino-nasal disease (P =.769) were not associated with total scores. Detomidine dosage and butorphanol use did not differ between horses in which the MNB was considered successful and for those in which it was not (P =.967 and P =.538, respectively). Scores obtained with gingival algometry were less closely associated with total scores (rho =.649) than those obtained with needle prick and nostril clamping (rho =.819 and.892, respectively). Therefore, needle prick and nostril clamping are considered the more reliable methods for use in clinical practice to determine the success of an MNB. [ABSTRACT FROM AUTHOR]

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Background: Ophthalmic procedures are increasingly being performed under regional anesthesia techniques such as peribulbar and incisionless sub-Tenon's blocks. The aim is to compare peribulbar block with incisionless sub-Tenon's block in terms of perioperative complications in patients who underwent cataract and vitreoretinal surgeries. Methods: The patients who underwent cataract or vitroretinal surgery under peribulbar block or incisionless sub-Tenon's block were included in the study. Two groups were compared each other in terms of anesthesia-related complications. Results: A total of 125 patients [peribulbar block (N = 48) and incisionless sub-Tenon's block (N = 77)] were included in the study. All basic characteristics and perioperative hemodynamic parameters were similar between the groups. One (0.8%) patient in the peribulbar block developed retrobulbar hemorrhage, whereas there was no major complication in the incisionless sub-Tenon's group (P = 0.389). At 15th minutes after block and at the end of the operation, minor complications including chemosis and subconjunctival hemorrhage were observed significantly lower in the peribulbar block group in comparison to the incisionless sub-Tenon's block group (P < 0.05). Conclusions: Minor complications including subconjunctival haemorrhage and chemosis were more common in the incisionless sub-Tenon's block; however, this difference was statistically balanced on the first postoperative day. One patient in the peribulbar block developed retrobulbar hemorrhage, whereas there was no major complication in the incisionless sub-Tenon's block. According to those results, incisionless sub-Tenon's block seems to be a safe and reliable alternative for ophthalmic procedures. [ABSTRACT FROM AUTHOR]

Background: The efficacy of regional anesthesia techniques continues to evolve with advancements in ultrasound guidance. This study investigated whether reducing the volume of local anesthetic in ultrasound-guided supraclavicular brachial plexus block could maintain clinical efficacy while potentially reducing complications. We compared two different volumes of 0.5% ropivacaine to determine the optimal volume for upper limb surgeries. METHODS: A prospective, randomized, double-blind study was conducted on seventy patients undergoing elective upper limb surgeries. Participants were randomly allocated into two groups: Group A (n=35) received 20 mL and Group B (n=35) received 30 mL of 0.5% ropivacaine. Primary outcomes included onset and duration of sensory and motor blockade. Secondary outcomes included hemodynamic stability, time to first analgesic requirement, and complications. Results: The demographic characteristics were comparable between both groups. The onset of sensory block in Group A was 14.11 ± 3.279 mins and Group B was 13.46 ± 3.355 mins (P>0.05), while the onset of motor block in Group A was 18.29 ± 3.177 mins and Group B was 17.37 ± 3.473 mins (P>0.05), showing no significant difference in initial block characteristics. The duration of sensory block in Group A was 7.54 ± 1.400 hours and in Group B was 9.11 ± 1.762 hours (P<0.01), and the duration of motor block in Group A was 6.51 ± 1.422 hours and in Group B was 8.26 ± 1.804 hours (P<0.01), demonstrating significantly longer block duration with the larger volume. The mean time for first analgesic requirement in Group A was 10.69 hours and in Group B was 11.69 hours (P<0.05). Hemodynamic parameters remained stable in both groups, though Mean Arterial Pressure was consistently lower in Group B (P<0.05). Group A demonstrated a superior safety profile with fewer adverse effects (2.86% vs 14.3% overall complications, P<0.05). Pain assessment revealed slightly better control in Group B, though both groups maintained clinically acceptable analgesia levels. Conclusion: While both volumes provided effective surgical anesthesia, 20 mL of 0.5% ropivacaine offered adequate block characteristics with fewer side effects, making it suitable for shorter procedures. The reduced volume may be particularly advantageous in day-care surgery settings where faster recovery is desired. [ABSTRACT FROM AUTHOR]

Background: Spinal anesthesia is preferred for infraumbilical surgeries due to its easier administration, reduced morbidity, effective postoperative analgesia and superior hemodynamic profile. This study compared the efficacy of intrathecal hyperbaric ropivacaine with fentanyl versus tramadol. METHODS: This prospective, randomized, double-blind study included 100 ASA I-II patients aged 20-60 years undergoing infraumbilical surgeries. Patients were randomly allocated into two groups: Group RF (n=50) received 3ml of 0.75% hyperbaric ropivacaine with 25µg fentanyl and Group RT (n=50) received 3ml of 0.75% hyperbaric ropivacaine with 25mg tramadol. Onset and duration of sensory and motor blockade, hemodynamic parameters, duration of analgesia, and adverse effects were compared. Results: Analysis of 100 patients revealed comparable demographic characteristics between groups. The onset of sensory block was statistically similar between Group RF (1.69±0.11 min) and Group RT (1.88±0.13 min, p>0.05), demonstrating equivalent initial anesthetic efficacy. However, the duration of sensory block was significantly prolonged in Group RF (396.30±25.57 min) compared to Group RT (316.30±25.97 min, p<0.01), representing an additional 80 minutes of effective sensory blockade. Motor block characteristics showed a similar pattern - comparable onset times between groups (RF: 2.52±0.28 min vs RT: 2.71±0.28 min, p>0.05), but significantly longer duration in Group RF (203.88±10.34 min vs 186.30±13.39 min, p<0.01). The duration of postoperative analgesia was markedly extended in Group RF (411.10±19.78 min) compared to Group RT (325.30±23.59 min, p<0.01), providing an additional 86 minutes of pain relief. Hemodynamic parameters including heart rate, blood pressure, and mean arterial pressure remained stable throughout the procedure in both groups, with no statistically significant differences. Visual Analogue Scale pain scores were significantly lower in Group RF at 4 hours (1.362±1.162 vs 2.931±1.927, p=0.013) and 8 hours (1.699±1.263 vs 3.821±1.924, p=0.022) postoperatively. The ropivacainefentanyl combination demonstrated a more favorable adverse effect profile, with lower incidence of bradycardia (6% vs 12%), hypotension (10% vs 18%), and complete absence of pruritis/shivering (0% vs 6%), though these differences did not reach statistical significance. Conclusion: Intrathecal hyperbaric ropivacaine with fentanyl provides superior postoperative analgesia, longer sensory and motor blockade, and fewer side effects compared to ropivacaine with tramadol for infraumbilical surgeries. [ABSTRACT FROM AUTHOR]

Introduction-Combined femoral nerve block (FNB) and sciatic nerve block (SNB) is a popular method for reducing postoperative pain following orthopaedic surgery on the lower limbs because it effectively reduces pain. Avoiding the negative effects of central neuraxial blockage, FNB delivered via the landmark approach, peripheral nerve stimulation (PNS), or ultrasound (USG) produces efficient analgesia. The application of nerve blocks in clinical practice has been transformed by USG-guided blocks. In this study, the effectiveness of peripheral nerve stimulator (PNS)-guided and ultrasonography (USG) guided combined femoral nerve block and sciatic nerve block in knee arthroscopic operations is compared. Material and method- after ethical approval, the study was carried out on 80 patients, with 40 in each group i.e. group P and group U. Individuals aged between 21-65 years, who were brought to the hospital for elective lower limb operations not extending more than 2 hours, limb surgeries below Knee or at knee level with American Society of Anesthesiologists Physical Status (ASA PS) I, II, and III were included in the study. Statistical analysis: data collected were tabulated and analysed by SPSS software version 20.0. Result- Mean age of the patients in group P was 38.56±7.56 years while it was 40.32±7.75 years in group U. The number of needle repositioning was found to be significantly less in group. Similarly onset times of sensory and motor block in USG guided patients (10.67±1.32 and 14.56±1.05 minutes respectively) were significantly lower than the PNS guided patients (16.68±1.35 and 21.02±1.21 minutes respectively). In the current study the group U had lower incidence of complications as compared to group P. The postoperative VAS at 6 hours did not differ substantially between the two groups, however at 12 and 24 hours, the group U VAS was considerably lower than the group P. Conclusion- When it came to femoral and sciatic nerve localisation, the ultrasound-guided lower limb block outperformed the nerve stimulator-guided method in terms of performance time, precise needle insertion, failure rate, and occurrence of complications. [ABSTRACT FROM AUTHOR]

Background: Dialysis access endovascular procedures, such as arteriovenous fistula (AVF) thrombectomy and angioplasty, require effective anesthesia to ensure patient comfort and procedural success. Supraclavicular brachial plexus block (SCB) is a regional anesthesia method increasingly utilized for upper limb interventions. Objective: This study evaluates the efficacy, safety, and patient satisfaction of SCB in patients undergoing dialysis access endovascular procedures. METHODS: Patients undergoing AVF thrombectomy or angioplasty were administered a single-dose SCB under ultrasonographic guidance. Pain scores were assessed pre- and post-operatively using the Visual Analog Scale (VAS). Intraoperative complications, recovery times, and patient satisfaction were recorded. Results: SCB provided excellent analgesia in 93% of patients, with mild adverse effects such as transient hoarseness noted in 3 cases. Mean VAS scores decreased significantly (p < 0.05), and patient satisfaction was high with minimal supplemental sedation required. Conclusion: SCB is a safe, effective, and well-tolerated anesthesia technique for dialysis access endovascular procedures, significantly improving pain management, patient satisfaction, and recovery times. [ABSTRACT FROM AUTHOR]

The article discusses the use of regional anesthesia in obstetric patients with cardiac disease undergoing cesarean deliveries. Regional techniques like spinal and epidural anesthesia offer advantages over general anesthesia by providing effective pain relief while minimizing cardiovascular stress. The case series highlights successful outcomes and emphasizes the importance of individualized planning and multidisciplinary collaboration in managing these complex cases. Challenges and potential complications are also addressed, underscoring the need for careful selection and monitoring when using regional anesthesia in this high-risk population. [Extracted from the article]

The application of artificial intelligence (AI) in anesthesiology has become increasingly widespread. However, no previous study has analyzed this field from the bibliometric analysis dimension. The objective of this paper was to assess the global research trends in AI in anesthesiology using bibliometric software. Literatures relevant to AI and anesthesiology were retrieved from the Web of Science until 10 April 2024 and were visualized and analyzed using Excel, CiteSpace, and VOSviewer. After screening, 491 studies were included in the final bibliometric analysis. The growth rate of publications, countries, institutions, authors, journals, literature co-citations, and keyword co-occurrences was computed. The number of publications increased annually since 2018, with the most significant contributions from the USA, China, and England. The top 3 institutions were Yuan Ze University, National Taiwan University, and Brunel University London. The top three journals were Anesthesia & Analgesia, BMC Anesthesiology, and the British Journal of Anaesthesia. The researches on the application of AI in predicting hypotension have been extensive and represented a hotspot and frontier. In terms of keyword co-occurrence cluster analysis, keywords were categorized into four clusters: ultrasound-guided regional anesthesia, postoperative pain and airway management, prediction, depth of anesthesia (DoA), and intraoperative drug infusion. This analysis provides a systematic analysis on the literature regarding the AI-related research in the field of anesthesiology, which may help researchers and anesthesiologists better understand the research trend of anesthesia-related AI. [ABSTRACT FROM AUTHOR]

Background/Objectives: In 2021, the Food and Drug Administration approved liposomal bupivacaine injectable suspension for single-dose infiltration in patients ≥ 6 years of age. Liposomal bupivacaine and bupivacaine hydrochloride admixtures may also be administered off-label for pediatric regional anesthesia including peripheral nerve blocks (PNBs). This single-injection, long-acting technique is not well described in pediatrics but may have benefits over traditional continuous catheter-based systems. The purpose of this investigation was to examine an adolescent cohort who received liposomal bupivacaine/bupivacaine hydrochloride PNBs for orthopedic surgery. Methods: Patient, surgical, anesthetic, block characteristics, and post-anesthesia care unit (PACU) outcomes were retrospectively reviewed from February 2020 to June 2024. From February to December 2022, a short follow-up survey was conducted to assess post-discharge patient-reported outcomes. Results: There were 524 liposomal bupivacaine/bupivacaine hydrochloride PNBs (106 upper-extremity and 418 lower-extremity) performed in 374 patients with a mean (standard deviation, range) age of 16 (1.2, 11–17) years. Two unilateral PNBs were performed in 150 (40%) patients to ensure an adequate sensory neural blockade. The interscalene (n = 81, 15%) and adductor canal (n = 140, 27%) blocks were the most common upper- and lower-extremity PNBs, respectively. Intraoperatively, the majority of the cohort (n = 258, 69%) underwent monitored anesthesia care (MAC). No patient required conversion from MAC to general anesthesia due to pain. In PACU, 288 (77%) patients reported no pain. Mild and moderate pain were reported by 56 (15%) and 30 (8%) patients, respectively. No patients developed local anesthetic toxicity. The survey results (n = 66) indicate that the majority of patients (96%) were satisfied with block analgesia postoperatively. Conclusion: Liposomal bupivacaine/bupivacaine hydrochloride PNBs were used successfully in adolescents undergoing a variety of orthopedic surgeries. [ABSTRACT FROM AUTHOR]

Ropivacaine, a widely used regional anesthetic also used for pain management, has been increasingly used in recent years due to its increased efficacy and improved safety compared to similar anesthetics. Biomonitoring of ropivacaine and its metabolites during and after anesthesia is an essential process for ensuring therapeutic efficacy and safe usage for patients. The most useful biomonitoring tool in recent years has been liquid chromatography coupled with mass spectrometry (LC-MS/MS), which offers selectivity, sensitivity, as well as accuracy of measurements. The current manuscript summarizes and discusses the existing liquid chromatographic methods described in the literature, as well as the personal experience with developing bioanalytical and analytical methods for the quantification of ropivacaine in biological samples for clinical applications. It is focused on methodological aspects, recent advancements, challenges, and future perspectives, highlighting the importance of LC-MS/MS techniques in ropivacaine analysis. [ABSTRACT FROM AUTHOR]

Background: Dry needling (DN) has emerged as a popular therapeutic intervention for managing musculoskeletal pain. While major adverse events are generally rare, those that have been reported in vulnerable areas such as the spine and thorax can be serious and warrant further investigation regarding safe techniques in and around these areas. Purpose: The purpose of this study was to reproduce the methods employed by Williams et al. but with an inferior-medial multifidus DN technique to determine if a dry needle can penetrate the ligamentum flavum (LF) and breach the spinal canal at the thoracolumbar junction. Study Design: Descriptive Cadaveric study. Methods: The procedure was performed on a cadaver in the prone position. The needle was advanced under ultrasound guidance to determine if a 0.30 x 40 mm dry needle inserted lateral to the spinous process of T12 and directed inferior-medially could penetrate the LF and enter the spinal canal. Results: A 0.30 x 40 mm dry needle inserted 1.9 cm lateral to the spinous process of T12 was able to traverse the space between the vertebral laminae of T12 and L1, penetrate the LF, and enter the spinal canal with an inferior-medial needle angulation of 33-degrees medial and 18-degrees inferior. Conclusion: The results of this study demonstrate the feasibility of a dry needle entering the spinal canal at the thoracolumbar junction using an inferior-medial technique. These findings support the potential role of ultrasound guidance in the training and clinical practice of DN, especially in regions where safety issues have been documented. Level of Evidence: Level IV. [ABSTRACT FROM AUTHOR]

The editorial discusses a research project on regional anaesthesia priorities in the UK, involving stakeholders like anaesthetists, healthcare professionals, and patients. The study identified top research uncertainties in regional anaesthesia through a consultative process. The article highlights the need for balanced stakeholder representation and addresses potential biases in survey responses. It also emphasizes the importance of converting research questions into testable hypotheses and includes suggestions for future research priorities in regional anaesthesia. The editorial calls for action to design and conduct studies to address these priorities effectively. [Extracted from the article]

The article discusses a study comparing rectus sheath block and erector spinae plane (ESP) block for postoperative pain management in patients undergoing midline abdominal surgery in Ethiopia. The study found a significant decrease in analgesic consumption with the ESP block. However, the article highlights challenges in research surrounding regional techniques, including lack of robust evidence, publication bias, and difficulty in interpreting results due to complex nomenclature. The controversy surrounding the ESP block's efficacy, mechanism of action, and potential adverse events is also discussed, emphasizing the need for further research and standardization in regional anaesthesia. [Extracted from the article]

With crewed deep space exploration on the horizon, preparation for potential astronaut health crises in space missions has become vital. Administration of anaesthesia and analgesia presents many challenges owing to constraints specific to space (physiologic and ergonomic challenges associated with microgravity) and nonspecific factors (isolation and lack of supplies). Regional anaesthesia can be the safest option; however, we hypothesised that the ergonomics of microgravity would compromise ease and accuracy of nerve blocks. We evaluated the feasibility of regional anaesthesia in a simulated microgravity environment (free-floating underwater conditions) using a meat (bovine muscle) model. Forty meat models were randomised for injection under simulated microgravity or normal gravity conditions. Success rates were determined by blinded assessors after injection. Parameters assessed included time to block, ease of image acquisition, and ease of needle placement. The median time to block in normal gravity was 27 (interquartile range 21–69) s vs 35 (interquartile range 22–48) s in simulated microgravity (P =0.751). Ease of image acquisition was similar in both conditions, as was ease of needle placement. There was no significant difference in the rate of accidental intraneural injections (5% vs 5%), with block success rates comparable in both scenarios (80% normal gravity vs 85% microgravity, P >0.999). Regional anaesthesia appears feasible for experts in simulated microgravity despite the ergonomic challenges. Although our model has limitations and might not fully capture the complexities of actual space conditions, it provides a foundation for future research into anaesthesia and analgesia during deep space missions. [ABSTRACT FROM AUTHOR]

Objective: This review aims to provide a synopsis of regional analgesic modalities in the intensive care unit (ICU) context and to evaluate existing literature regarding the benefits and limitations of performing these procedures in critically ill patients. Specifically, we review regional techniques in the setting of traumatic rib fractures and extremity fractures, thoracic surgery, major abdominal surgery, and cardiac surgery. We additionally discuss the limitations of clinical practice in performing regional anesthesia in the ICU setting. Overall, the current literature demonstrates promising benefits of regional analgesia in critically ill patients. However, more extensive high powered studies are needed to determine optimal analgesic strategies in this tenuous population. [ABSTRACT FROM AUTHOR]

Introduction: Chronic post-surgical pain (CPSP) remains a prevalent issue following video-assisted thoracic surgery (VATS), despite advancements in surgical techniques. Various regional anesthesia techniques, including thoracic paravertebral block (PVB), intercostal nerve block (ICNB), serratus anterior plane block (SAPB), erector spinae plane block (ESPB), and thoracic epidural anesthesia (TEA), have been employed in VATS procedures to mitigate this issue. This study aims to compare the efficacy of these analgesia methods in reducing the incidence of CPSP in VATS patients through a network meta-analysis. Methods: A systematic search was conducted in PubMed, the Cochrane Library, and EMBASE for randomized controlled trials (RCTs) comparing the incidence of CPSP associated with PVB, ICNB, SAPB, ESPB, and TEA. The occurrence of CPSP was evaluated at both 2–3 months and 6 months post-surgery. Results: Six RCTs, involving 652 patients, were included in the analysis of CPSP incidence at 2–3 months, while seven RCTs, involving 715 patients, were included for 6 months analysis. PVB, ICNB, or TEA reduced CPSP incidence compared with control group (without regional anesthesia techniques) at both 2–3 months and 6 months post-surgery. However, SAPB was found less effective in reducing CPSP incidence at 2–3 months post-VATS compared to PVB, ICNB, or TEA. Conclusions: PVB, ICNB, and TEA exhibit significant effects on reducing CPSP incidence following VATS. Conversely, SAPB is not recommended for reducing CPSP incidence post-VATS. Nonetheless, considering the limitation of a small sample size in this network meta-analysis, additional RCTs are necessary to validate these conclusions and enhance the management of CPSP after VATS. [ABSTRACT FROM AUTHOR]