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Andreas Clipet-Jensen, Hans Fjeldsøe-Nielsen, Peter Roy Kirkegaard Department of Anesthesiology and Intensive Care Medicine, Zealand University Hospital, Nykøbing, DenmarkCorrespondence: Andreas Clipet-Jensen, Email andreas.clipet-jensen.01@regionh.dk; a.clipet.jensen@gmail.comAbstract: Although peripheral nerve blocks are deemed very safe, a significant number of patients for whom this anesthetic technique may be particularly appealing to apply may present with preexisting peripheral neuropathies, putting them at risk for further nerve damage. We present a case with a 74-year-old male with several risk factors for peripheral neuropathy who developed a foot drop following a popliteal sciatic nerve block with ropivacaine. We suggest that the vasoconstrictive properties of ropivacaine may have contributed to a preexisting neuronal ischemia, thus further damaging an already compromised nerve.Keywords: peripheral nerve block, peripheral neuropathy, vasoconstriction, local anesthetics

Majaliwa Shabani,1,* Seydina Alioune Beye,2,* Abdoulaye Traore,3,* Xavier Raingeval,4,* Daouda Coulibaly,5,* Sophie Crespo6,* 1Health_Unit, International Committee of the Red Cross, Bamako, Mali; 2Anesthesia Department, Clinique Périnatale Mohamed VI, Bamako, Mali; 3Anesthesia Department, Hôpital Somine Dolo de Mopti, Mopti, Mali; 4Association de Développement et de Recherche en Anesthésie Locorégionale Echoguidée, Paris, France; 5Surgery Department, Centre de Santé de Référence de Kidal, Kidal, Mali; 6Health Unit, International Committee of the Red Cross, Geneva, Switzerland*These authors contributed equally to this workCorrespondence: Majaliwa Shabani, Health Unit, International Committee of Red Cross (ICRC), Rue 239, Hamdallaye /ACI2000 – B.P. 58, Bamako, Mali, Email mshabani2001@gmail.comPurpose: The management of unstable patients with weapon-wounded lower limb vascular injuries presents significant anesthetic challenges. Regional anesthesia blocks, which combine lumbar and sacral plexus blocks, or their respective branches, minimize systemic effects and are deemed appropriate for high-risk patients requiring lower limb surgery. This case series aims to share our preliminary experiences with a combined anesthetic technique—sciatic nerve (SN), posterior femoral cutaneous nerve (PFCN), and supra-inguinal fascia iliaca (SIFI) blocks —in patients sustaining weapon wounds and undergoing lower limb vascular injury repair in austere environments.Patients and Methods: Seven patients with lower limb vascular injuries resulting from weapons who required surgery at district hospitals supported by the International Committee of the Red Cross were included in this study. Included patients underwent surgery for vascular repair and debridement using a combined nerve block technique involving the SN, PFCN, and SIFI blocks between May and December 2023. The blocks were administered using a 1:1 mixture of 1

Intisar Ahmed Abdi,1 John Mark Kasumba,1 Agnes Wabule,1 Mary T Nabukenya,1 Joseph Kayongo,1 Bernadette Kyoheirwe,1 Abdirizak Abdullahi Sheikdon,2 Kamaludin D Osman3 1Department of Anaesthesia and Critical Care, Makerere University, Kampala, Uganda; 2Department of Orthopedics, Royal Hospital, Mogadishu, Somalia; 3Department of General Surgery, Royal Hospital, Mogadishu, SomaliaCorrespondence: Intisar Ahmed Abdi, Department of Anaesthesia and Critical Care, Makerere University, Kampala, Uganda, Tel +256762635165, Email dr.intisar16@gmail.comIntroduction: Local anaesthetics (LA) are commonly used in dental and surgical emergency wards by both anaesthesia professionals and non-anaesthesia professionals. Anecdotal evidence shows that non-anaesthesia health-care professionals do not monitor vital signs during the use of local anaesthesia, and there are no standard hospital guidelines on the use of LA and management of LA toxicity by non-anaesthesia professionals.Purpose: This study sought to assess the knowledge, attitudes and practices regarding local anaesthetic use among non-anaesthesia health-care professionals at Mulago National Referral Hospital.Patients and Methods: This was a cross-sectional study that utilized a quantitative research approach. The sample size of the study was 43 non-anaesthesia healthcare professionals from the casualty and surgical outpatient wards and Mulago dental ward. Data was collected using a questionnaire and analyzed using STATA 15.Results: Overall, 66.67% of the Specialist, 76.47% of the senior house officers, 100% of medical officers, and 80% of the clinical orthopedic house officers had unsatisfactory levels of knowledge in Mulago casualty and surgical outpatient wards. 20% of the specialist and 16.67% of the senior house officers had unsatisfactory levels of knowledge in Mulago dental ward. 87.5% of the non-anaesthesia health-care professionals do not give a test dose on a routine basis in Mulago casualty and surgical outpatient ward

Danxu Ma,1 Abulaihaiti Maimaitimin,2 Yun Wang3 1Department of Anesthesiology and Pain Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People’s Republic of China; 2Department of Rheumatology and Immunology, Moyu Uighur Medicine Hospital, Xinjiang, People’s Republic of China; 3Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, People’s Republic of ChinaCorrespondence: Yun Wang, Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yongan Road, Xicheng District, Beijing, 100050, People’s Republic of China, Email wangyun129@ccmu.edu.cnObjective: Cervicogenic headache (CEH) is a condition resulting from upper cervical spine dysfunction and associated structural and soft tissue abnormalities, significantly impacting patients’ quality of life. To acquire better therapeutic results, we presented a novel ultrasound-guided “three in one” approach plus interfascial plane (IFP) blocks for the treatment of CEH. This approach allows for the modulation of C2 dorsal root ganglion (DRG), third occipital nerve (TON), and C3 medial branch with one-point puncture. Additionally, it allows for IFP blocks between the upper neck and occipital muscles within the same scanning plane.Patients and Methods: We evaluated patients diagnosed with CEH from July 2021 to December 2022 in our pain clinic. We included those who did not respond to conservative treatment and single occipital nerve block, therefore received nerve block or pulsed radiofrequency (PRF) using the “Three in One” approach plus IFP blocks. The accuracy of the ultrasound-guided C2 DRG puncture procedures was confirmed through fluoroscopy with C-arm and the sensory testing of PRF. The therapeutic effect of these interventions was assessed using the numerical rating scale (NRS) scores during telephone follow-ups at 1, 3, and 6 months.Results: Utilizing the “Three in One” approach, a total of 5 patient

Muhammad Jaffar Khan, Yasir Eltayeb, Arunabha Karmakar, Rohma Malik, Tarig Elsafi Department of Anesthesiology, Critical Care and Perioperative Medicine, Hamad Medical Corporation, Doha, QatarCorrespondence: Muhammad Jaffar Khan, Department of Anesthesiology, Critical Care and Perioperative Medicine, Hamad Medical Corporation, P.O. Box 3050, Doha, Qatar, Tel +97444394444, Email mkhan44@hamad.qaBackground: Patients diagnosed with Heart Failure with Reduced Ejection Fraction (HFrEF) are at high risk of perioperative cardiovascular complications. While it is important to focus on optimizing their cardiac function, it is also crucial to address and optimize any other modifiable risk factors that could potentially impact postoperative outcome. This also includes careful consideration of anesthetic techniques to suit the patient and facilitate the surgery. However, there is a scarcity of evidence regarding the safety of specific anesthetic approaches for heart failure patients.Case Presentation: We describe the case of an adult patient in mid-50s, with a history of ischemic dilated cardiomyopathy with reduced Ejection Fraction (about 25%) who presented with acute gangrenous appendicitis and was scheduled for an open appendectomy. It was deemed to be a high-risk patient for general and spinal anesthesia. With the guidance of a multidisciplinary team, surgery was successfully performed using a quadratus lumborum block with standard monitoring. The patient was comfortable and hemodynamically stable throughout the procedure. The postoperative course was uneventful.Conclusion: Quadratus Lumborum Block for open appendectomy can be a beneficial alternative anesthesia technique in high-risk patients that significantly lowers perioperative cardiovascular risk, maintains hemodynamics, enhances satisfaction, and shortens hospital stay.Keywords: quadratus lumborum block, regional anesthesia, heart failure with reduced ejection fraction, left ventricular ejection fraction, quadratus l

Natalie R Barnett,1 Amanda M Bunnell,1 Matthew A Dow2 1Department of Anesthesiology and Perioperative Medicine, Medical University of South Carolina, Charleston, SC, USA; 2Department of Orthopaedics and Physical Medicine, Medical University of South Carolina, Charleston, SC, USACorrespondence: Natalie R Barnett, Associate Professor in Anesthesiology, Department of Anesthesiology and Perioperative Medicine, Medical University of South Carolina, 10 McClennan Banks Dr, Suite 2190, MSC 940, Charleston, SC, 29425, USA, Tel +1-843-792-5454, Email barnettn@musc.eduAbstract: Charcot Marie Tooth disease is a common cause of pediatric peripheral neuropathy, which can lead to distal muscle wasting and weakness necessitating orthopedic procedures. We present an eleven-year-old male with Charcot Marie Tooth disease who received peripheral nerve blocks for ankle surgery, with a total dose of 1.75 mg/kg of bupivacaine 0.25%. Upon follow-up, it was identified that the sensory blockade did not resolve until thirty-six hours, postoperatively. There were no noted long-term sequalae on surgical follow-up. If a patient with Charcot Marie Tooth receives a peripheral nerve block, the patient should receive close short- and long-term follow-up to monitor for block complication or disease exacerbation.Keywords: regional anesthesia, local anesthesia, peripheral neuropathy

Rui Zhou,1,* Wencai Jiang,2,* Qingyuan Miao,1 Xinyang Li,1 Lize Xiong1 1Shanghai Key Laboratory of Anesthesiology and Brain Functional Modulation, Clinical Research Center for Anesthesiology and Perioperative Medicine, Translational Research Institute of Brain and Brain-Like Intelligence, Department of Anesthesiology and Perioperative medicine, Shanghai Fourth People’s Hospital, School of Medicine, Tongji University, Shanghai City, People’s Republic of China; 2Department of Anesthesiology, Deyang People’s Hospital, Deyang City, People’s Republic of China*These authors contributed equally to this workCorrespondence: Lize Xiong, No. 1279, Sanmen Road, Shanghai, 200434, People’s Republic of China, Tel +86-21-55603002, Fax +86-21-56660851, Email mzkxlz@126.com; lizexiong@tongji.edu.cnPurpose: Rebound pain after regional anesthesia, a common phenomenon when the analgesic effect wears off, has been recognized in the last a few years. The aim of this study is to analyze the status and tendency of this area in a macroscopic perspective.Methods: Bibliometric analysis is the primary methodology of this study. Literature retrieval was conducted in Web of Science (WoS) Core Collection. WoS, Excel, VOSviewer and CiteSpace were employed to do the analyses and visualization. Parameters were analyzed, such as publications, citations, journals, and keywords, etc.Results: In total, 70 articles in the past 10 years were identified eligible. Most articles (14 pieces) were published in 2021, followed by 2022 and 2023 with 13 articles. Researchers come from 134 institutions and 20 countries. Huang Jung-Taek, Hallym College, and USA are the most productive author, institution and country, respectively. The articles were mainly published on the top journals of anesthesiology, orthopedics and surgery. The topic of these articles is primarily about the clinical issues of rebound pain. Peripheral nerve block, brachial plexus block and femoral nerve block are

Majaliwa Shabani,1 Seydina Alioune Beye,2,* Abdoulaye Traore,3 Pablo Echave,4,* Xavier Raingeval,5,* Daouda Coulibaly,6 Sophie Crespo7,* 1Health_unit, International Committee of the Red Cross, Bamako, Mali; 2Anesthesia Department, Clinique Périnatale Mohamed VI, Bamako, Mali; 3Anesthesia Department, Hôpital Somine Dolo de Mopti, Mopti, Mali; 4Anesthesia Department, Université de Sherbrooke, Sherbrooke, Quebec, Canada; 5Association de Développement et de Recherche en Anesthésie Locorégionale Echoguidée (ADRALE), Paris, France; 6Surgery Department, Centre de Santé de Référence de Kidal, Kidal, Mali; 7Health Unit, International Committee of the Red Cross, Geneva, Switzerland*These authors contributed equally to this workCorrespondence: Majaliwa Shabani, Health Unit, International Committee of the Red Cross, HAMDALLAYE RUE 239, Postal Office Box: 58, Bamako, Mali, Email mshabani2001@gmail.comPurpose: The posterior femoral cutaneous nerve (PFCN) block is used in regional anesthesia for lower extremity surgery. This study introduces a new ultrasound-guided technique called the “Gluteus-Deep Investing Fascia compartment Block (GDIF block)“ for blocking the PFCN. This approach involves injecting local anesthetic into the potential space between the gluteus maximus muscle and the deep investing fascia, named the ‘Gluteus Deep Investing Fascia Compartment’. The study discusses the anatomical and sonographic features crucial for identifying this compartment and explores the potential benefits of this approach for achieving effective PFCN block. Additionally, it examines the clinical application of the GDIF block for PFCN block as part of the Complete Lower Extremity Fascia Tri-compartment Block technique, named ”CLEFT Block.” This technique combines the suprainguinal fascia iliaca block with G

Jorge Emilio Salazar-Flórez,1 Leidy Tatiana Arenas-Cardona,2 Ninemy Marhx,2 Eduardo López-Guerrero,2 Ángela Patricia Echeverri-Rendón,1 Luz Stella Giraldo-Cardona1 1Department of Medicine, San Martín University Foundation, Sabaneta, Antioquia, Colombia; 2Department of Medicine, Hospital General de Occidente, University Health Sciences Center of University of Guadalajara, Jalisco, MexicoCorrespondence: Jorge Emilio Salazar-Flórez, Faculty of Medicine, San Martín University Foundation, Calle 75 sur # 34-50, Block 2, Sabaneta, Antioquia, Colombia, Tel +604-5906983 – 5025, Email jorge.salazarf@sanmartin.edu.coBackground: Effective post-operative analgesia profoundly influences patient recovery and outcomes after caesarean delivery. The Transversus Abdominis Plane (TAP) block represents a potential alternative, potentially offering greater effectiveness than epidural analgesia while causing fewer adverse effects.Objective: To assess if the abdominal transverse block provides superior postoperative pain relief in patients undergoing caesarean delivery compared to epidural analgesia.Methods: Participants were divided into parallel groups: an experimental group receiving TAP block (n=25) and a control group receiving epidural analgesia (n=24). All patients received a 10 mg dose of hyoscine at the end of the surgery. Experimental Group received a total of 20 mL of 0.2% ropivacaine. In Epidural group received 0.2% ropivacaine at 4 mL/h for 24 hours. All participants were administered combined with neuroaxial block anesthesia. The patients selected for epidural analgesia received the mentioned dose, while the other group block had the epidural catheter removed after the cesarean section. The primary outcome was post-caesarean pain, evaluated using the Visual Analog Scale (VAS) at four intervals (0, 6, 12, and 24 hours). Also, surgical bleeding and residual motor were evaluated. VAS pain scores between the groups were compared using the Friedman test and Genera

Suwarman,1 Osmond Muftilov Pison,1 Mohammad Fikry Maulana,1 Prapanca Nugraha2 1Department of Anesthesiology and Intensive Therapy, Faculty of Medicine, Universitas Padjadjaran, Bandung, West Java, Indonesia; 2Department of Surgery, Faculty of Medicine, Universitas Padjadjaran, Bandung, West Java, IndonesiaCorrespondence: Suwarman; Mohammad Fikry Maulana, Email suwarman@unpad.ac.id; mohammad19029@mail.unpad.ac.idObjective: Acute postoperative pain is one of the major clinical problems that occurs in patients undergoing cesarean section with a prevalence of 89.8%. Postoperative pain causes discomfort and various complications for the mother. In addition, postoperative pain that is not handled properly can increase the risk of becoming chronic pain by 2.5 times. One of the methods recommended in the Enhanced Recovery After Caesarean Section (ERACS) protocol to prevent acute postoperative pain is the use of intrathecal long-acting opioids, with intrathecal morphine as the gold standard and Transversus Abdominis Plane (TAP) block. This study aims to assess the comparison of opioid needs as analgesic rescue between the administration of 0.1mg spinal morphine and TAP block with bupivacaine 0.2% 10mg in patients undergoing cesarean section.Methods: This study is an observational study in a single Tertiary Hospital in West Java – Indonesia. Patients were given patient-controlled anesthesia (PCA) with fentanyl as analgesic rescue. Statistical analysis of the numerical data used the unpaired t-test and Chi-Square test for categorical data.Results: In the group that was given spinal morphine, the duration of additional opioids was longer (p < 0.05), and the total dose of additional opioids was less than the TAP block group (p < 0.05).Conclusion: The spinal morphine requires fewer additional opioids than the TAP block.Plain Language Summary: Sectio caesarea (SC) is one of the most commonly performed surgeries in health care. One of the most common risks of SC is the occu

James Harvey Jones Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USACorrespondence: James Harvey Jones, Department of Anesthesiology, University of North Carolina at Chapel Hill, N2198 UNC Hospitals, CB &num;7010, Chapel Hill, NC, 27599-7010, USA, Tel +1 (919) 966-5136, Fax +1 (984) 974-4873, Email james.h.jones@med.unc.eduBackground: The aims of this study are to analyze the association between the number of recorded pain scores and baseline pain following surgery, analgesia technique, and patient demographics, as well as the substitution of missing data with the results from mean substitution, last observation carried forward, regression imputation, multiple imputation, and mixed models.Methods: This retrospective chart review was approved by the Institutional Review Board (IRB). The following data were collected: patient demographics (age, gender, body mass index (BMI), race, and ethnicity); surgery type and date; analgesia with or without transversus abdominis plane (TAP) block; as well as the time, date, and value for all postoperative pain scores on the first postoperative day (POD). The following null hypotheses were tested: (1) the number of pain recordings will be independent of TAP block analgesia, baseline pain on POD 1, and patient demographics; and (2) there will be no significant differences in pain scores with and without TAP block analgesia following complete case analysis, mean substitution, last observation carried forward, regression imputation, multiple imputation, and mixed models.Results: This study analyzed 486 patients including 2562 recorded pain scores. An increase in age by one year is, on average, associated with a 0.04 (95% confidence interval (CI) − 0.060 to − 0.025) decrease in the number of pain scores recorded (p < 0.001). Black race is associated with 0.763 less pain scores, on average (95% CI − 1.49 to − 0.039) and this value is statistically significant (p = 0.039). All

Yong-Kang Gui,1,2,&ast; Rui Xiao,3,&ast; Ya-Ru Luo,1,2,&ast; Yang Liu,1,2 Xin Da,1,2 Si-Hui Zhu,1,2 De-Wen Shi,1,2 Xu-Dong Hu,1,2 Guang-Hong Xu1,2 1Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230022, People’s Republic of China; 2Key Laboratory of Anesthesia and Perioperative Medicine of Anhui Higher Education Institutes, Hefei, Anhui, 230022, People’s Republic of China; 3Fuyang Hospital of Anhui Medical University, Fuyang, Anhui, 230022, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Guang-Hong Xu, Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230022, People’s Republic of China, Tel +86-13856949535, Fax +86 551 62923704, Email xuguanghong2004@163.comObjective: Pain after total knee arthroplasty (TKA) remains an unresolved problem. Femoral nerve block (FNB) could relieve pain; however, it alone is insufficient. The local infiltration anesthesia technique (LIA) has been suggested as a supplement to FNB. This study aimed to evaluate the analgesic effects of different LIA combined with FNB in TKA patients.Methods: The femoral nerve was blocked with 0.375% ropivacaine 20mL, and all patients routinely received general anesthesia. The primary indicator was the proportion of patients who did not receive post-operative remedial analgesia. Seventy-eight patients were randomly assigned to PAI (periarticular injection combined with FNB), IAI (intra-articular injection combined with FNB), or control (FNB alone) groups. All patients underwent FNB under general anesthesia. The primary outcome was the proportion of patients who did not receive additional postoperative analgesia within the first 48 h after surgery.Results: Compared with the PAI and control groups, the IAI group had a higher proportion (69.23%) of patients who did not receive remedial analgesia within 48 hours after surgery (P = 0.009

Cassandra Hoffmann,1 Angela Snow,2 Celine Chedid,3 Carol Abi Shadid,3 Eiichi A Miyasaka4 1Pediatric Anesthesiology, Akron Children’s Hospital, Akron, OH, USA; 2Pediatric Anesthesiology, Nemours Children’s Hospital, Wilmington, DE, USA; 3Pediatric Anesthesiology, University Hospitals Rainbow Babies and Children’s Hospital, Cleveland, OH, USA; 4Pediatric Surgery, University Hospitals Rainbow Babies and Children’s Hospital, Cleveland, OH, USACorrespondence: Eiichi A Miyasaka, Pediatric Surgery, University Hospitals Rainbow Babies and Children’s Hospital, 11100 Euclid Ave, MAC 1000, Cleveland, OH, 44106, USA, Tel +1 216-844-3015, Fax +1 216-844-8647, Email eiichi.miyasaka@uhhospitals.orgPurpose: Neonates present unique challenges for pediatric surgical teams. To optimize outcomes, it is imperative to standardize perioperative care by using early extubation and multimodal analgesic techniques. The quadratus lumborum (QL) block provides longer duration and superior pain relief than other single-injection abdominal fascial plane techniques. The purpose of this case series was to report our initial experience with QL blocks in neonatal patients treated with intestinal ERAS.Patients and Methods: Ten neonates requiring intestinal surgery at a single tertiary care center who received QL blocks between December 2019 and April 2022 for enhanced recovery were studied. Bilateral QL blocks were performed with 0.5 mL/kg of 0.25% ropivacaine per side with an adjuvant of 1 mcg/kg of dexmedetomidine.Results: Gestational age at birth ranged from 32.2 to 41 weeks. The median age, weight, and American Society of Anesthesiologists (ASA) score at the time of surgery was 5 days [range 7.5 hours, 60 days], 2.84 kg [range 1.5, 4.5], and 3, respectively. Bilateral QL blocks were performed without complications in all patients. Two patients were outside the neonatal range from birth to surgery, but were under 42 weeks gestational age when corrected for prematurity. All patients were ex

Sigita Kazune,1,2 Inga Nurka,2 Matiss Zolmanis,2 Arturs Paulausks,3,4 Dace Bandere4,5 1Department of Anesthesiology and Intensive Care, Riga Stradins University, Riga, Latvia; 2Department of Anesthesiology, Hospital of Traumatology and Orthopedics, Riga, Latvia; 3Laboratory of Finished Dosage Forms, Faculty of Pharmacy, Riga Stradins University, Riga, Latvia; 4Baltic Biomaterials Centre of Excellence, Headquarters at Riga Technical University, Riga, Latvia; 5Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Riga Stradins University, Riga, LatviaCorrespondence: Sigita Kazune, Department of Anesthesiology, Hospital of Traumatology and Orthopaedics, 22 Duntes Street, Riga, LV-1013, Latvia, Tel +371 67399221, Fax +371 67392348, Email sigita.kazune@rsu.lvPurpose: The study examined the pharmacokinetic profile of fixed formulation mixtures comprising 225 mg of ropivacaine for local infiltration analgesia with or without epinephrine, and femoral nerve block in older patients presenting for orthopedic surgery and explored potential influences of block type, age, and body weight on this profile.Patients and Methods: Twenty four patients scheduled for total knee arthroplasty were randomly assigned to three groups: femoral nerve block, local infiltration analgesia with epinephrine and local infiltration analgesia without epinephrine. Blood samples were collected at 10, 30, 60, and 120 min following the block and total plasma concentrations of ropivacaine were quantified by high performance liquid chromatography.Results: The mean individual peak total plasma concentrations of ropivacaine in local infiltration analgesia with and without epinephrine, and femoral nerve block group were 0.334, 0.490 and 0.545 μg mL− 1 (p = 0.16). Local infiltration with epinephrine group had significantly lower plasma ropivacaine concentrations at 30, 60 and 120 minutes. The plasma ropivacaine concentrations exceeded 2.2 μg mL− 1 in one patient. Age, but not body weight, had a m

Fatma El Sherif,1 Doaa Gomaa Sayed,1 Khaled Mohamed Fares,1 Sahar Abdel-Baky Mohamed,1 Amira Mahmoud Osman,2 Ahmed Kamal Sayed,1 Shereen Mamdouh Kamal1 1Department of Anesthesia, ICU, and Pain Management, South Egypt Cancer Institute, Assiut University, Assiut, Egypt; 2Department of Pediatric Oncology, South Egypt Cancer Institute, Assiut University, Assiut, EgyptCorrespondence: Ahmed Kamal Sayed, Department of anesthesia, ICU, and pain management, South Egypt Cancer Institute, Assiut University, Assiut, Egypt, Tel +20 100677881, Fax +20 88 2348609, Email ahmedkamal86anathesia@gmail.comPurpose: Magnesium sulfate (MgSO4) may enhance the effects of local anesthetics when used as an adjuvant in peripheral nerve blocks. Our objective was to evaluate efficiency and safety of utilizing MgSO4 alongside levobupivacaine in bilateral ultrasound-guided transversus abdominis plane (US-TAP) block for postoperative pain in pediatric cancer patients who underwent abdominal surgery.Methodology: A randomized double-blinded controlled trial at South Egypt Cancer Institute, Assiut University, Assiut, Egypt, included that 40 pediatric patients with Wilms’ tumor or neuroblastoma were randomly allocated to get bilateral (US-TAP) block and divided into two groups; M group: received US-TAP with 0.6 mL/kg levobupivacaine 0.25% + 2 mg/kg MgSO4 and C group: received with 0.6 mL/kg levobupivacaine 0.25% only. FLACC scores (Face, Leg, Activity, Cry, Consolability) were used to evaluate post-operative pain, first analgesic request, total analgesic consumption, adverse effects, as well as hemodynamics were monitored for 24 h and recorded at time points (2, 4, 6, 8, 12, 18, and 24h). Parent’s satisfaction at discharge, also, was evaluated.Results: FLACC score in M group was significantly lower than in C group from 4 h to 24 h with the first analgesic request being longer (15.95 ± 1.99 vs 7.70 ± 0.80 (h); p < 0.001) and lower total analgesic consumption (231.75 ± 36.57 vs 576.00 ± 170.71

Courtney R Carlson Strother,1 Lauren E Dittman,1 Marco Rizzo,1 Steven L Moran,2 Peter C Rhee1 1Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA; 2Department of Plastic Surgery, Mayo Clinic, Rochester, MN, USACorrespondence: Peter C Rhee, Department of Orthopedic Surgery, Mayo Clinic, 200 1st Street SW, Rochester, MN, USA, 55905, Tel +1 507-284-3422, Fax +1 507-266-2533, Email rhee.peter@mayo.eduPurpose: The aim of this study was to evaluate the occurrence of early (< 6 weeks) post-operative complications following ulnar nerve decompressions at the cubital tunnel performed under regional anesthesia compared to those performed under general anesthesia.Methods: In situ ulnar nerve decompressions at the cubital tunnel performed at a single institution from 2012 through 2019 were retrospectively reviewed. Post-operative complications were compared between subjects who underwent the procedure with regional versus general anesthesia.Results: Ninety-one ulnar nerve in situ decompressions were included in the study, which were performed under regional anesthesia in 55 and general anesthesia in 36 cases. The occurrence of post-operative complications was not significantly different between patients who received regional (n = 7) anesthesia and general (n = 8) anesthesia. None of the complications were directly attributed to the type of anesthesia administered. The change in pre- and post-operative McGowan scores were not significantly different between anesthesia groups (p = 0.81).Conclusion: In situ ulnar nerve decompression at the cubital tunnel under regional anesthesia does not result in increased post-operative complications compared to those surgeries performed under general anesthesia. In situ ulnar nerve decompression performed under regional anesthesia is a safe and reliable option for patients who wish to avoid general anesthesia.Level of Evidence: III.Keywords: cubital tunnel, regional anesthesia, ulnar neuropathy

William Mitchell,1,&ast; Thomas Roser,1,&ast; Jessica Heard,2 Shankar Logarajah,2 John Ok,1,2 John Jay,2 Houssam Osman,1,2 D Rohan Jeyarajah1,2 1Burnett School of Medicine at Texas Christian University, Fort Worth, TX, USA; 2Methodist Richardson Medical Center, Richardson, TX, USA&ast;These authors contributed equally to this workCorrespondence: D Rohan Jeyarajah, Tel +1 972 619 3500, Email rohanjeyarajah@tcu.eduBackground: Esophagectomy traditionally has high levels of perioperative morbidity and mortality due to surgical techniques and case complexity. While thoracic epidural analgesia (TEA) is considered first-line for postoperative analgesia after esophagectomy, complications can arise related to its sympathectomy and mobility impairment. Additionally, it has been shown that postoperative outcomes are improved with early extubation following esophagectomy. Our aim is to describe the impact of transversus abdominis plane (TAP) blocks on extubation rates following esophagectomy when uncoupled from TEA.Methods: This is a case series of 42 patients who underwent trans-hiatal esophagectomy between 2019 and 2022 who received a TAP block without TEA. The primary outcomes of interest were the rates of extubation within the operating room (OR) and reintubation. Secondary outcomes included: intensive care unit (ICU) and hospital length of stay (LOS), opioid pain medication use, post-operative hypotension, fluid administration, postoperative pain scores, development of anastomotic leak, and 30-day readmission.Results: The mean age at operation was 63 years and 97.6% of patients were represented by American Society of Anesthesia (ASA) physical status class III or IV. Thirty-four (81%) patients immediately extubated postoperatively. Nine patients (21.4%) underwent reintubation during their hospital course. Only seven patients (16.7%) required vasopressors postoperatively. The median LOS was five days in the ICU and 10 days in the hospital. TAP block alone was fou

Amany F Omara,1 Hadal Hassan Mohsen,2 Alaa Mohammed Abo Hagar,1 Ahmed F Abdelrahman1 1Department of Anaesthesia and Surgical Intensive Care, Faculty of Medicine, Tanta University, Tanta, Egypt; 2Department of Anaesthesia and Surgical Intensive Care, Faculty of Medicine, Ain Shams University, Ciro, EgyptCorrespondence: Amany F Omara, Department of Anaesthesia and Surgical Intensive Care, Faculty of Medicine, Tanta University, Tanta, 31527, Egypt, Tel +201008372249, Email amanyfaheem2011@yahoo.com; Amany.emara@med.tanta.edu.egObjective: This prospective study aimed to compare the analgesic efficacy and adverse effects of intrathecal morphine, dexmedetomidine, and a combination of both in patients undergoing total knee replacement (TKR).Patients and Methods: This randomized prospective study was carried out in Tanta university hospital in orthopedic surgery for 6 months on 105 adult patients with American Society of Anesthesiologists Physical Status Class II and III, aged > 50 years, and scheduled for total knee replacement surgery randomly allocated into morphine group received 0.5% heavy bupivacaine plus 0.1 mg of morphine, morphine/ dexmedetomidine group, received 0.5% heavy bupivacaine plus 0.1 mg of morphine and 5 mcg of dexmedetomidine and dexmedetomidine group received 0.5% heavy bupivacaine plus 5 mcg of dexmedetomidine. The time of the first required analgesia, postoperative pain severity, the total dose of morphine, postoperative complication, and the patient’s level of sedation were recorded.Results: About half of the patients in the dexmedetomidine group requested first rescue analgesia 6 hours after the operation, significantly shorter than the other two groups. On the other hand, the other two groups show no significant difference between them regarding the first required analgesia. At rest, the dexmedetomidine group have significantly higher VAS with a significant increase in patients who required morphine as rescue analgesia than the other two grou

Keito Koh, Onishi Tatsuki, Sonoko Sakuraba, Sho Yamazaki, Hajime Yako, Takeshi Omae Department of Anesthesiology and Pain Medicine, Juntendo University Shizuoka Hospital, Izunokuni, JapanCorrespondence: Keito Koh, Department of Anesthesiology and Pain Medicine, Juntendo University Shizuoka Hospital, 1129 Nagaoka, Izunokuni-shi, Shizuoka, 410-2211, Japan, Tel +81 55 948 3111 ex 7111, Fax +81-55-947-2565, Email mad.mud@star.ocn.ne.jpPurpose: Ultrasound-guided brachial plexus block (UGBPB) has interscalene, supraclavicular, infraclavicular, and axillary approaches. The axillary block is considered to be the safest and with fewer adverse events compared to the interscalene (eg, phrenic nerve block, spinal cord or vertebral artery puncture) and supraclavicular (eg, pneumothorax). However, with regard to postoperative neurological symptoms (PONS), it is controversial whether its incidence after an axillary block was higher than that after non-axillary approaches”. In this study, we investigated whether the incidence of a neuropathy after an axillary block was higher than that after non-axillary approaches.Patients and Methods: This was a single-center, retrospective cohort study. All UGBPBs were performed under general anesthesia between January 2014 and March 2020. The outcomes included the overall incidence of PONS and neuropathies for axillary and non-axillary approaches. The etiology, symptoms, and outcomes of patients were investigated.Results: Of the 992 patients, 143 (14%) and 849 (86%) were subjected to axillary and non-axillary approaches, respectively. Among 19 cases (19.2:1000; 95% confidence interval [CI], 18.2– 20.1) of PONS, four (4.0:1000; 95% CI, 3.8– 4.2) were neuropathies attributed to the UGBPB, three (21.0:1000; 95% CI, 18.1– 23.8) to the axillary and one (2.8:1000; 95% CI, 2.6– 3.1) to non-axillary approaches. The incidence of neuropathies after an axillary block was significantly higher than that after non-axillary approaches (P = 0.005).Co

Kefah Al-Hayk,1 Mahmoud M Smadi,2 Lina M Elsalem,3 Ahmed Yassin,1 Suha Aqaileh,1 Deema H Obiedat,1 Ahmad Kefah Al-Hayk,4 Majdi Al Qawasmeh1 ,†Raid Kofahi,1 Khalid El-Salem1 1Neurology Department, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan; 2Department of Mathematics and Statistics, Faculty of Science and Arts, Jordan University of Science and Technology, Irbid, Jordan; 3Department of Pharmacology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan; 4Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan†Majdi Al Qawasmeh passed away on April 24, 2023Correspondence: Kefah Al-Hayk, Neurology Department- Jordan University of Science and Technology, P.O. Box 3030, Irbid, 22110, Jordan, Tel +962-790606881, Fax +962 2-7095123, Email kaalhayk@just.edu.joPurpose: Procedure discomfort can limit electrodiagnostic studies. Reducing discomfort can maximize the benefits of these diagnostic tools. This study targeted the discomfort associated with nerve conduction studies (NCS).Patients and Methods: This was a prospective randomized double-blind placebo-controlled study comparing the effect of topical lidocaine gel (2%) versus analgesic-free lubricant gel (K-Y gel) on pain perception during NCS. Sequential patients (n=130) referred for routine NCS participated in the study. We applied 1 mL of lidocaine gel to one palm, and 1 mL of K-Y gel to the other as a control. After 20– 45 min of application, graded increments of electrical stimulation intensity were delivered to record the median and ulnar mixed palmar nerve responses. Patients were then asked to score the degree of pain felt from electrical stimulation over each palm using the Wong-Baker Faces Pain Scale (WBFPS) and the Numeric Rating Scale (NRS), independent of baseline pain.Results: Mean WBFPS and NRS scores for lidocaine-treated palms were significantly lower than those for controls using parametric paired t-test (3.79 vs 4

Suzan Adlan,1 Ahmad Abd El-Rahman,2 Sahar Abdel-Baky Mohamed,2 Ahmed M Thabet,3 Eman Maghawry Hamada,1 Basma Rezk Farouk,2 Fatma Adel El Sherif2 1National Cancer Institute, Cairo University, Cairo, Egypt; 2South Egypt Cancer Institute, Assiut University, Assiut, Egypt; 3Faculty of Medicine, Assiut University, Assiut, EgyptCorrespondence: Ahmad Abd El-Rahman, South Egypt Cancer Institute, Assiut University, Assiut, Egypt, Tel +2001149606060, Fax +2 088 2348609, Email ahmad23679@gmail.comPurpose: A subcostal flank incision is required for open radical nephrectomy, which is a surgical procedure used to remove tumors of the kidney that are malignant. The erector spinae plane block (ESPB) and continuous catheter use in children are receiving more and more support by paediatric regional anaesthesiologists. Our objective was to compare systemic analgesic to continuous ESPB for pain relief in paediatric patients undergoing open radical nephrectomy.Methods: Sixty children with cancer ASA I or II and undergoing open radical nephrectomy between the ages of two and seven participated in this prospective, randomized, controlled, and open label study. The cases were divided into two equal groups (E and T groups); Group E received ipsilateral continuous ultrasound-guided ESPB at T9 (thoracic vertebrae), with a bolus of 0.4 mL/kg bupivacaine 0.25%. Immediately postoperatively, Group E (ESPB group) received continuous ESPB with a PCA (patient controlled analgesia) pump at a rate of 0.2 mL/kg/hour bupivacaine 0.125%. Group T (Tramadol group), Tramadol hydrochloride was administered intravenously at a dose of 2 mg/kg/8hour, which could be increased to 2 mg/kg/6hours. Then, we followed up on patients’ total analgesic consumption for 48 hours following surgery, as well as the time it took for them to request rescue analgesic, their FLACC and sedation scores, and their hemodynamics and side effects immediately following surgery as well as at 2, 4, 6, 8, 12, 18, 24, 36, and 48 hours.Res

Vaughna Galvin,1 Dennis J Cheek,2 Yan Zhang,3 Gregory Collins,1 David Gaskin4 1School of Nurse Anesthesia, Texas Christian University, Fort Worth, TX, USA; 2School of Nursing, Texas Christian University, Fort Worth, TX, USA; 3Harris College of Nursing and Health Sciences, Texas Christian University, Fort Worth, TX, USA; 4Republic Pain Specialists, Physicians Centre Hospital, Bryan, TX, USACorrespondence: Vaughna Galvin, School of Nurse Anesthesia, Annie Richardson Bass Building, 2800 West Bowie Street, Suite 3101, Fort Worth, TX, 76109, USA, Tel +1 817-257-7887, Fax +1 817-257-5472, Email V.B.GALVIN@tcu.eduAbstract: One hundred ninety-five patients presenting with post-COVID symptomology, including parosmia and dysgeusia, underwent reversible stellate ganglion blockade. Stellate ganglion blockade was performed at an outpatient facility, and patients were evaluated via survey at seven days post-injection. Of the 195 participants, ages ranged from 18– 69 years of age with the breakdown of sexes being females n = 157 and males n = 38. The most significant finding was a reported improvement in olfaction post-injection in 87.4% of subjects. The effectiveness of this novel treatment for post-COVID is promising and warrants further investigation.Keywords: cervical sympathetic block, COVID, parosmia, dysgeusia, dysautonomia

Medhat Gamal, Ahmed Hasanin, Nada Adly, Maha Mostafa, Ahmed M Yonis, Ashraf Rady, Nasr M Abdallah, Mohammed Ibrahim, Mohamed Elsayad Department of Anesthesia and Critical Care Medicine, Cairo University, Cairo, EgyptCorrespondence: Ahmed Hasanin, Department of Anesthesia and Critical Care Medicine, Faculty of Medicine, Cairo University, 01 Elsarayah Street, Elmanyal, Cairo, 11559, Egypt, Fax +20224168736, Email ahmedmohamedhasanin@gmail.comBackground: Successful brachial plexus blockade produces sympathetic blockade, resulting in increased skin temperature in the blocked segments. This study aimed to evaluate the accuracy of infrared thermography in predicting failed segmental supraclavicular brachial plexus block.Methods: This prospective observational study included adult patients undergoing upper-limb surgery under supraclavicular brachial plexus block. Sensation was evaluated at the dermatomal distribution of the ulnar, median, and radial nerves. Block failure was defined as absence of complete sensory loss 30 min after block completion. Skin temperature was evaluated by infrared thermography at the dermatomal supply of the ulnar, median, and radial nerves at baseline, 5, 10, 15, and 20 min after block completion. The temperature change from the baseline measurement was calculated for each time point. Outcomes were the ability of temperature change at each site to predict failed block of the corresponding nerve using area under receiver-operating characteristic curve (AUC) analysis.Results: Eighty patients were available for the final analysis. The AUC (95% confidence interval [CI]) for the ability of temperature change at 5 min to predict failed ulnar, median, and radial nerve block was 0.79 (0.68– 0.87), 0.77 (0.67– 0.86), and 0.79 (0.69– 0.88). The AUC (95% CI) increased progressively and reached its maximum values at 15 min (ulnar nerve 0.98 [0.92– 1.00], median nerve 0.97 [0.90– 0.99], radial nerve 0.96 [0.89– 0.99]) with negative predictive val

Michael Jiang,1 Varun Peri,1 Bobby Ou Yang,1 Jaewon Chang,2 Douglas Hacking1 1Department of Anaesthesia, Austin Health, Melbourne, Victoria, Australia; 2Department of Surgery, St George Hospital, Sydney, New South Wales, AustraliaCorrespondence: Michael Jiang, Department of Anaesthesia, Austin Health, 145 Studley Road, Heidelberg, 3084, Victoria, Australia, Email Michael.jiang49@gmail.comIntroduction: Rib fractures are a common sequelae of chest trauma and are associated with significant morbidity. The erector spinae nerve block (ESB) has been proposed as an alternative first-line regional technique for rib fractures due to ease of administration and minimal complication profile. We aimed to investigate the current literature surrounding this topic with a focus on pain and respiratory outcomes.Methods: A comprehensive literature search was performed on the Medline, Embase, Web of Science, Scopus, and Cochrane databases. Keywords of “erector spinae block” and “rib fractures” were used to form the search strategy. Papers published in English investigating ESB as an analgesic intervention for acute rib fracture were included. Exclusion criteria were operative rib fixation, or where the indication for ESB was not rib fracture.Results: There were 37 studies which met the inclusion criteria for this scoping review. Of these, 31 studies reported on pain outcomes and demonstrated a 40% decrease in pain scores post administration within the first 24 hours. Respiratory parameters were reported in 8 studies where an increase in incentive spirometry was demonstrated. Respiratory complication was not consistently reported. ESB was associated with minimal complications; only 5 cases of haematoma and infection were (incidence 0.6%) reported, none of which required further intervention.Discussion: Current literature surrounding ESB in rib fracture management provides a positive qualitative evaluation of efficacy and safety. Improvements in pain and respiratory parameters we

Raksha Vedavyas, Ravi Saravanan, Gunaseelan Mirunalini, Balasubramaniam Gayathri Department of Anesthesiology, SRM Medical College Hospital and Research Center, SRMIST, Kattankulathur, Tamil Nadu, IndiaCorrespondence: Gunaseelan Mirunalini, Department of Anesthesiology, SRM MCH RC, SRMIST, No. 219, Second Floor, Block B, SRM Nagar, Chengalpattu District, Kattankulathur, Tamil Nadu, 603203, India, Tel +91 9486131643, Email mirunalini.gunaseelan@gmail.comIntroduction: The ultrasound-guided infraclavicular brachial plexus block by triple-point injection method was aimed at blocking the three individual cords in the infraclavicular region. Recently, a single-point injection method which does not require visualization of cords to produce nerve block has been introduced. This study compared the block onset time, performance time, patient’s satisfaction, and complications between the ultrasound guided triple-point injection and single-point injection methods.Patients and Method: This randomized controlled trial was conducted in a tertiary care hospital. Sixty patients were divided into two groups – Group S: 30 patients received single-point injection method of infraclavicular block. Group T: 30 patients received triple-point injection method of infraclavicular block. Drugs used were 0.5% ropivacaine with 8 mg dexamethasone.Results: The sensory onset time was significantly longer in Group S (11.13 ± 1.83 min) than Group T (6.20 ± 1.19min). No statistically significant difference was found between the two groups regarding mean motor onset time. The composite sensorimotor onset time was similar between the groups. The mean time to perform the block was significantly lesser in Group S (1.35 ± 0.38 min) when compared to group T (3.44 ± 0.61min). The patient satisfaction score, conversion to general anesthesia and complications were not significant among the two groups.Conclusion: We concluded that single-point injection method had a shorter performance time and similar

Ksheerabdhi Sankar, Kuppusamy Anand, Swetha Ramani, Balasubramaniam Gayathri Department of Anesthesiology, SRM Medical College Hospital and Research Centre, Potheri, 603203, IndiaCorrespondence: Kuppusamy Anand, Department of Anesthesiology, SRM Medical College Hospital and Research Centre, Room No. 206, B Block, Second Floor, Potheri, 603203, India, Tel +91-98652 82288, Email anandk@srmist.edu.inBackground and Aim: Percutaneous nephrolithotomy (PCNL) under epidural anesthesia has been reported to have few advantages over general anesthesia, like lower postoperative pain and less need for analgesics. There are limited studies on PCNL being performed under neuraxial anesthesia in supine position. Hence the present study was conceived to compare hemodynamic parameters in patients undergoing percutaneous nephrolithotomy (PCNL) in the supine position under combined spinal-epidural with general anesthesia (GA).Material and Methods: A prospective, randomized control trial was conducted among 90 patients who were posted to undergo elective percutaneous nephrolithotomy in the the supine position, after obtaining Institutional Ethical Committee (IEC) approval and CTRI (Clinical Trial Registry - India) registration. Patients were randomly allotted to undergo surgery either under general anesthesia (group GA) or combined spinal epidural anesthesia (group CSE) by computer-generated random number method. Hemodynamic parameters, postoperative analgesic requirement and incidence of blood transfusion were recorded and analyzed.Results: There was no significant difference between the two groups with respect to gender, ASA grade, surgery duration, calculus size and pulse rate. There was a statistically significant reduction in mean arterial pressure from 5 to 50 minutes of surgery and less incidence of blood transfusion in patients in the CSE group. Patients who underwent PCNL in the supine position under CSE required lesser analgesics postoperatively compared to those under general

Paolo Vincenzi,1 Massimo Stronati,2 Paolo Garelli,3 Diletta Gaudenzi,4 Gianfranco Boccoli,3 Roberto Starnari2 1Department of General Surgery, Ospedali Riuniti Marche Nord, Pesaro, Italy; 2Department of Anesthesiology, IRCSS-INRCA, Ancona, Italy; 3Department of General Surgery, IRCSS-INRCA, Ancona, Italy; 4Department of Perioperative Services, AOU “Ospedali Riuniti di Ancona”, Ancona, ItalyCorrespondence: Paolo Vincenzi, Department of General Surgery, Ospedali Riuniti Marche Nord, Piazzale Cinelli n 1, Pesaro, 61121, Italy, Tel +39 3394578495, Email paolo.vincenzi1981@gmail.comPurpose: Several studies have applied lumbar spinal anesthesia (SA) with isobaric/hyperbaric bupivacaine and opioids in elective laparoscopic cholecystectomy (LC), documenting a superiority of the methodic over general anesthesia (GA) in terms of perioperative pain, nausea, and vomiting, though with a notable incidence of intraoperative right shoulder pain, potentially responsible for conversion to GA. This case series presents an opioid-free scheme of segmental thoracic spinal anesthesia (STSA) with hypobaric ropivacaine, reporting its benefits mainly in terms of shoulder pain occurrence.Patients and Methods: Hypobaric STSA was performed in nine patients undergoing elective LC between May 1 and September 1, 2022. The level of the needle insertion was included between T8 and T9, via a median or a paramedian approach. Midazolam (0.03 mg/kg) and Ketamine (0.3 mg/kg) were used as adjuvants for intrathecal sedation, followed by the administration of hypobaric ropivacaine 0.25% at a dose of 5 mg and then isobaric ropivacaine at a dose of 10 mg. Patients were placed in anti-Trendelenburg position for the entire duration of surgery. LC was conducted through the standard 3 or 4 ports technique with pneumoperitoneum maintained at a pressure of 8– 10 mmHg.Results: Mean patient age was 75.7 (± 17.5) years, with a mean ASA score and Charlson comorbidity index (CCI) of 2.7 (± 0.7) and 4.9 (± 2.7)

Gustavo A Cruz-Suárez,1,2 David E Rebellón Sánchez,3,4 Daniela Torres-Salazar,2 Akemi Arango Sakamoto,4 Leidy Jhoanna López-Erazo,1,2 Iván F Quintero-Cifuentes,1,2 María A Vélez-Esquivia,2 Sergio A Jaramillo-Valencia,1 Antonio JT Suguimoto-Erasso1,2 1Fundación Valle del Lili, Anesthesiology Department, Cali, 760032, Colombia; 2Universidad Icesi, Facultad de Ciencias de la Salud, Departamento de Ciencias Clínicas, Cali, Colombia; 3Centro Internacional de Entrenamiento e Investigaciones Médicas (CIDEIM), Universidad Icesi, Cali, Colombia; 4Fundación Valle del Lili, Centro de Investigaciones Clínicas, Cali, 760032, ColombiaCorrespondence: Gustavo A Cruz-Suárez, Fundación Valle del Lili, Anesthesiology Department, Cra. 98 &num; 18-49, Cali, 760032, Colombia, Tel +576023319090; Ext 4022, Email gustavo.cruz@fvl.org.coIntroduction: There is limited evidence on the impact of erector spinae plane block (ESPB) as part of multimodal analgesia in pediatric population undergoing cardiac surgery.Methods: A retrospective cohort study was conducted in patients under 18 years of age, who underwent cardiac surgery Risk Adjusted classification for Congenital Heart Surgery (RACHS-1) ≤ 3 by sternotomy. The study aims to evaluate the effect of ESPB as part of multimodal analgesia in pediatric patients undergoing cardiac surgery compared to conventional analgesia (CA) on relevant clinical outcomes: length of hospital stay, length of ICU stay, opioid consumption, time to extubation, mortality, and postoperative complications. The participants included were treated in a reference hospital in Colombia from July 2019 to June 2022.Results: Eighty participants were included, 40 in the ESPB group and 40 in the CA group. There was a significant decrease (Log rank test p = 0.007) in days to length of hospital stay in ESPB group (median 6.5 days (IQR: 4– 11)) compared to the CA group (median 10.5 days (IQR: 6– 25)). Likewise, there was a higher probability of discharge from

Jassim Rauf,1 Mohammad Mohsin A M Haji2 1Department of Anesthesiology, ICU & Perioperative Medicine, Hazm Mebaireek General Hospital, Hamad Medical Corporation, Doha, Qatar; 2Department of Anesthesiology, ICU & Perioperative Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, QatarCorrespondence: Jassim Rauf, Department of Anesthesiology, ICU & Perioperative Medicine, Hamad General Hospital, Hamad Medical Corporation, P.O.Box 3050, Doha, Qatar, Tel +97433622191, Email jrauf@hamad.qaBackground: Erector spinae plane block (ESPB) a new block described for post-operative analgesia. Since 2016 the block has become a common practice in many institutions globally. Evidence has shown that ESPB is superior to truncal and abdominal wall blocks for many thoracic and abdominal surgeries.Case Presentation: A 29-year-old male, ASA (American Society of Anesthesiologists) IIE patient presented with acute appendicitis. Patient was scheduled to undergo Laparoscopic Appendicectomy under general anesthesia (GA) with ESPB for post op analgesia. In the operating room after induction of GA patient received an ultrasound (US) guided bilateral ESPB at T10 level of the spinal cord with 20 mls of 0.25% levobupivacaine on each side. Intraoperatively the appendix was found to be normal and there was an incidental finding of perforated superior/first part of duodenum (D1). The duodenum was repaired. Patient remained hemodynamically stable intraoperatively. No intraoperative morphine was required. After uneventful extubation, the patient was transferred to post-operative anesthesia care unit (PACU). Patient reported pain score of zero on a 11-point numerical rating scale (NRS) in PACU. No morphine was required in the next 24 hours on the ward either.Conclusion: ESPB can provide opioid free analgesia for laparoscopic repair of perforated duodenal ulcer both intra and postoperatively.Keywords: erector spinae plane block, perforated duodenal ulcer, regional anesthesia, tru

Shelley Ohliger, Alain Harb, Caroline Al-Haddadin, David P Bennett, Tiffany Frazee, Cassandra Hoffmann Department of Anesthesiology and Perioperative Medicine, University Hospitals/Rainbow Babies and Children’s Hospital, Cleveland, OH, 44106, USACorrespondence: Shelley Ohliger, Department of Anesthesiology and Perioperative Medicine, University Hospitals/Rainbow Babies and Children’s Hospital, 11100 Euclid Ave, Cleveland, OH, 44106, USA, Tel +1 216 844 7340, Fax +1 216 844 3780, Email Shelley.Ohliger@UHhospitals.orgPurpose: This study aims to evaluate if the addition of deep parasternal plane blocks to a pre-existing enhanced recovery pathway for pediatric cardiac surgery improves outcomes.Patients and Methods: A retrospective review through an EMR query from June 2019 to June 2021 was performed for patients less than 18 years of age who underwent cardiac surgery via median sternotomy and were extubated immediately following surgery in a single academic tertiary care hospital. Patients receiving deep parasternal blocks as part of an enhanced recovery protocol were compared to similar patients from the year prior to block implementation.Results: The primary outcome was intraoperative and postoperative opioid consumption. Secondary outcomes were pain scores, intensive care unit (ICU) length of stay and time to first oral intake. There was a statistically significant reduction in intraoperative opioid administration and pain scores in the first 24 hours post-operatively. There was also a statistically significant reduction in ICU length of stay. There was no statistically significant difference in post-operative opioid consumption and time to first oral intake.Conclusion: Bilateral deep parasternal blocks may reduce opioid consumption, provide effective postoperative pain control, and result in decreased length of intensive care unit stay across both simple and complex pediatric cardiac procedures when added to a pre-existing enhanced recovery protocol.Keywords: en