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This scoping review aims to map studies, reports and other relevant sources from the grey literature that reported on the access to essential medicines among migrants and the barriers that limited their access to medicines at different stages of the migratory phases in addition to the policies and actions taken to address these barriers.

Background: The large surgical incision and extensive tissue trauma in posterior spinal fusion for adolescent idiopathic scoliosis causes severe acute postoperative pain. Furthermore, posterior spinal fusion is associated with a risk of persistent postsurgical pain. Six months after posterior spinal fusion, the incidence of persistent postsurgical pain is as high as 22% of the patients. Optimizing pain management therefore remains crucial, but challenging. Objective: The study objective is to design and implement an enhanced recovery pathway for patients with adolescent idiopathic scoliosis undergoing posterior spinal fusion integrating all aspects of biopsychosocial care. Its outcomes are assessed, including its effect on postoperative pain and early mobilization. Design and settings: A prospective cohort study was performed at the Antwerp University Hospital. Methods: In December 2019, a prospective cohort study was set up in which an enhanced recovery pathway substitutes more than the patient controlled intravenous analgesia containing morphine postoperatively. This pathway consists of m/ eHealth based psychological screening questionnaires, patient education, early mobilization, and a multimodal analgesia protocol consisting of preemptive gabapentin, an intraoperatively given single dose of methadone (0.2 mg kg-1), non-steroidal anti-inflammatory drugs, and acetaminophen. Results: We treated 25 adolescents (10 males and 15 females) with the developed enhanced recovery pathway with a mean age of 16.5 years ( range 12-22). The mean number of spinal levels fused was 10 (range 6- 13). Mean numerical rating scale scores were 4.17 at postoperative day 1, 4.46 at postoperative day 2, and 3.74 at postoperative day 3 in enhanced recovery pathway treated patients. Mean bladder catheterization duration was 3.04 days and enhanced recovery pathway patients stayed in the hospital for an average of 7.4 days. Conclusions: Using an enhanced recovery pathway for patients undergoing posterior spinal fusion could not only reduce the acute and chronic opioid consumption and its side effects, but could also result in less postoperative pain, shorter hospital stay and higher patient satisfaction. Further reevaluation and improvement focused on these variables will likely further improve the effectiveness of enhanced recovery pathways.

Purpose : The erector spinae plane block is a novel block performed at a thoracic level with a spread via the thoracolumbar fascia. The objective of this cadaveric study is to evaluate the spread of the injectate after a lumbar erector spinae plane block. Methods : Four lumbar erector spinae blocks were perfonned in two non-embalmed cadavers with 20 ml of a methylene blue or black ink solution injected in a plane between the transverse processes and the erector spinae muscles. After dissection, the extent of the dye spread, and the staining of neuronal structures were documented. Laminectomy was performed to determine the epidural spread. A thoracic erector spinae plane block was also performed in both cadavers to determine the epidural spread of dye. Results : In the lumbar region, the craniocaudal dye spread underneath the erector spinae muscle varied between two and five intervertebral levels. The staining of the spinal nerves was limited to the level of the intervertebral foramina in one cadaver. Dye was also observed at the inner side of the ligamenta flava at the lumbar region. An epidural spread was present after both thoracic erector spinae blocks, with an extension to the contralateral side in one of them. Conclusion : A lumbar erector spinae block (ESB) can spread over multiple vertebral levels in the proximity of the neuroforamen and the spinal nerves and, potentially to the epidural space. This may suggest analgesia for lower spine surgery. A thoracic ESB may spread epidurally and contralaterally. Further research is desirable.

This report is developed in the context of the project Assessing Integration Measures for Vulnerable Migrant Groups (ASSESS) which aims to monitor and assesses the effectiveness of integration measures for vulnerable migrant groups in ten EU Member States. The three main target groups of the project include migrant women, children and victims of trafficking. This national report is the outcome of the Belgian study conducted in the first phase of the ASSESS project which is focused on identifying of the existing monitoring and data collection mechanisms in the area of migrant integration in ten EU Member States. nrpages: 74 status: published