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Introduction. Due to the increase in vaccination coverage worldwide, there has been a significant decline in tetanus cases and deaths over the past decades. In developed countries, cases of tetanus are sporadically reported, mainly in elderly people who have not been vaccinated for a long time. If left untreated, the death rate from tetanus is almost 100%. Case reports. The publication presents the course of severe tetanus in two elderly patients treated in the ICU with positive results. The patients required mechanical ventilation, intensive pharmacological treatment and a long period of hospitalization. Conclusions. Every contaminated wound is risky of Clostridium tetani infection. Unvaccinated people and those for whom more than 5 years have passed since the last vaccination are particularly at risk of developing the disease. A severe course of the disease requiring treatment in the ICU may occur primarily in elderly people and involve a long period of hospitalization. Summary. Based on the description of two cases and a review of the literature, the article discusses the procedure for treating patients infected with tetanus. [ABSTRACT FROM AUTHOR]

Disseminated intravascular coagulation (DIC) in the course of septic shock is a very serious clinical event that requires immediate specialist medical care. Often, DIC occurs in people with a severe inflammatory response. As a rule, the prognosis is poor. The activation of the coagulation cascade leads to the occlusion of small blood vessels, which results in organ failure. In addition, secondary fibrinolysis leads to an increased risk of bleeding and is problematic in the selection of appropriate pharmacological therapy. In our paper, we will present the case of a patient with postpartum DIC in the course of septic shock in the course of urinary tract infection. [ABSTRACT FROM AUTHOR]

Abdominal aortic aneurysms (AAA-aneurysma aortale abdominalis) are most often located below the opening of the renal arteries and above the bifurcation of the aorta. They appear more often in men and in smokers. In the vast majority of cases, an aneurysm of the abdominal aorta is caused by excessive degradation of the extracellular matrix, which results from inflammatory infiltrates in atherosclerotic foci and the production of destructive proteolytic enzymes in these places. Atherosclerotic plaques interfere with the diffusion of nutrients and products of changes between light and the wall, and additionally, they also directly press the underlying medial membrane. This leads to intimal necrosis and thinning of the arterial wall. In very rare cases, complications may occur, for example, formation of an aortic-caval fistula. The authors wanted to present the causes of the abdominal aortic aneurysm and the risk of complications based on a case report and a literature review. [ABSTRACT FROM AUTHOR]

Herpes simplex virus (HSV) was the first human herpes virus reported [1]. Both types (HSV-1 and HSV-2) mainly infect and replicate in mucosal epithelial cells, cause symptoms at the site of infection, and then develop latent infection in surrounding neurons. HSV-1 is usually associated with infections above and HSV-2 below the waistline. The e stimated worldwide i ncidence of HSV-1 i nfection among people a ged 0-49 years in 2012 was on average 67% for all age groups [2]. Herpes simplex encephalitis is relatively rare with an estimated incidence of 1-3 cases per million, but it is also the most common cause of occasional fatal encephalitis [3]. In the absence of treatment, the prognosis is poor, with a mortality rate of around 70% [4]. The authors wanted t o present t he c auses of encephalitis a nd t he r isk of such a s erious complication i n a young person based on a case report and a literature review. [ABSTRACT FROM AUTHOR]

In Poland, chronic pain is experienced by 27% of the population, while neuropathic pain, which is the greatest therapeutic challenge, occurs in approximately 7-10% of the general population and in approximately 30% of cancer patients. One of the mechanisms responsible for the occurrence of pain sensations and its chronification is known as the central sensitization consisting in the hypersensitivity of spinal cord neurons and the upper levels of the central nervous system. The stimulation of the N-methyl-D-aspartate receptor complex (NMDAR) by excess of excitatory amino acids plays an important role in the emergence and maintenance of this phenomenon. Ketamine, which is one of the NMDAR antagonists, reduces central hypersensitivity, especially in relation to neuropathic pain components such as allodynia (pain responses to pain stimuli) and hyperalgesia (increased sensitivity to pain stimuli). The article presents characterization and application of ketamine, taking into account all its mechanisms of action based on the results of selected studies. [ABSTRACT FROM AUTHOR]

Background: Effective postoperative pain control remains a challenge for patients undergoing cardiac surgery. Novel regional blocks may improve pain management for such patients and can shorten their length of stay in the hospital. To compare postoperative pain intensity in patients undergoing cardiac surgery with either erector spinae plane (ESP) block or combined ESP and pectoralis nerve (PECS) blocks. Methods: This was a prospective, randomized, controlled, double-blinded study done in a tertiary hospital. Thirty patients undergoing mitral/tricuspid valve repair via mini-thoracotomy were included. Patients were randomly allocated to one of two groups: ESP or PECS + ESP group (1:1 randomization). Patients in both groups received a single-shot, ultrasound-guided ESP block. Participants in PECS + ESP group received additional PECS blocks. Each patient had to be extubated within 2 h from the end of the surgery. Pain was treated via a patient-controlled analgesia (PCA) pump. The primary outcome was the total oxycodone consumption via PCA during the first postoperative day. The secondary outcomes included pain intensity measured on the visual analog scale (VAS), patient satisfaction, Prince Henry Hospital Pain Score (PHHPS), and spirometry. Results: Patients in the PECS + ESP group used significantly less oxycodone than those in the ESP group: median 12 [interquartile range (IQR): 6–16] mg vs. 20 [IQR: 18–29] mg (p = 0.0004). Moreover, pain intensity was significantly lower in the PECS + ESP group at each of the five measurements during the first postoperative day. Patients in the PECS + ESP group were more satisfied with pain management. No difference was noticed between both groups in PHHPS and spirometry. Conclusions: The addition of PECS blocks to ESP reduced consumption of oxycodone via PCA, reduced pain intensity on the VAS, and increased patient satisfaction with pain management in patients undergoing mitral/tricuspid valve repair via mini-thoracotomy. Trial registration: The study was registered on the 19th July 2018 (first posted) on the ClinicalTrials.gov identifier: NCT03592485. [ABSTRACT FROM AUTHOR]

Introduction: One of the main challenges in cardiac surgery is effective postoperative analgesia. Erector spinae-plane block (ESP block) is a novel regional technique, introduced by Forero in 2016 for neuropathic chest pain, then used successfully for mastectomy. Aim: To establish the efficacy of the ESP block in patients undergoing mitral and/or tricuspid valve repair through a right mini-thoracotomy. Material and methods: It is a prospective observational cohort study performed in a tertiary health center. In the treatment group, a single-shot ESP block was performed before anesthetic induction. General anesthesia was induced with etomidate, remifentanil, and rocuronium, and continued with sevoflurane and remifentanil. Remifentanil infusion was continued for 2 h post-operatively, then stopped, and the patient's trachea was extubated. Patient-controlled analgesia was started with oxycodone immediately. Total oxycodone consumption and pain severity on the visual analog scale during the first 24 h were analyzed. In the control group, no regional block was performed. Instead of remifentanil, fentanyl was used. Patients were extubated on the second day. Pain was treated with morphine, administered according to nurses' discretion. Pain intensity was evaluated on the numerical rating scale. Results: Nineteen patients were evaluated in the ESP and 25 in the control group. Mechanical ventilation time was shorter in the ESP group (0.6 (0.4-1.1) h) than in the control one (10 (8-17) h, p = 0.00001). Moreover, patients in the ESP group spent fewer days in the intensive care unit (1 (1-1) vs. (2 (2-2), p = 0.0001). Conclusions: The ESP block seems to be safe and efficient for pain control in patients undergoing right mini-thoracotomy for mitral and/or tricuspid valve repair. [ABSTRACT FROM AUTHOR]

There is a constant increase in the number of total knee replacements (TKR) as a result of many factors, such as sedentary lifestyle leading to overweight/obesity. The observed higher average life expectancy determines this type of surgical procedures performed in order to improve the quality of life in this group of patients. TKR is routinely done under spinal anaesthesia and surgical incision typically stretches from above the patella to tibial tuberosity (parapatellar medial arthrotomy). In the postoperative period, this procedure generates pain sensations assessed by patients as moderate or severe pain. Multimodal analgesia is routinely used to provide optimal postoperative pain relief and decrease the risk of unwanted side - effects of analgesics. Combination of two different regional anaesthesia techniques: femoral triangle block and distal adductor canal block can further enhance postoperative analgesia. Using two separate blocks allows us to anaesthetise the anterior and posterior joint capsule with little motor block which is crucial for early mobilization. Good pain relief translates not only into decreased hospital length of stay, decreased costs, increase patient satisfaction but also into decreased rate of chronic postoperative pain. [ABSTRACT FROM AUTHOR]

In recent years, scientists published results of studies confirming the improvement of treatment results related to the operation within the framework of enhanced recovery after surgery (ERAS) in various surgical disciplines. ERAS requires the involvement and cooperation of people from various medical specialties. The aim of the work is to discuss the assumptions of a multi-faceted and interdisciplinary care program for a patient undergoing cardiac surgery with a mini thoracotomy to reduce perioperative complications, shorten the patient's stay in the hospital and need to re-hospitalize, which ultimately reduces the cost of treatment. This work was developed on the basis of the analysis of the results of scientific research published in peer-reviewed journals between 2008 and 2018 (the last 10 years) and our own experience. Knowing the principles of ERAS among medical staff allows for fully professional care over the patient. [ABSTRACT FROM AUTHOR]

Patients' condition, especially during treatment in ICU may different pharmacokinetic properties of medicines. Appropriate antibiotics' dosages corresponding to in vivo drugs concentration influence antimicrobial agents activity and the therapy outcome. This paper was presented some fundamental pharmacological and microbiological concepts and their impact on nowadays critical care treatment. [ABSTRACT FROM AUTHOR]

Background: New regional techniques can improve pain management after nephrectomy. Methods: This study was a randomized controlled trial conducted at two teaching hospitals. Patients undergoing elective open and laparoscopic nephrectomy were eligible to participate in the trial. A total of 100 patients were divided into a quadratus lumborum block (QLB) group (50 patients) and a control (CON) group (50 patients). At the end of surgery, but while still under general anesthesia, unilateral QLB with ropivacaine was performed on the side of nephrectomy for patients in the QLB group. The main measured outcome of this study was oxycodone consumption via a patient-controlled anesthesia (PCA) pump during the first 24 h following surgery; other measured outcomes included postoperative pain intensity assessment, patient satisfaction with pain management, and persistent pain evaluation. Results: Patients undergoing QLB needed less oxycodone than those in the CON group (34.5 mg (interquartile range 23 to 40 mg) vs. 47.5 mg (35–50 mg); p < 0.001). No difference between the groups was seen in postoperative pain intensity measured on the visual analog scale, except for the evaluation at hour 2, which was in favor of the QLB group (p = 0.03). Patients who received QLB were more satisfied with postoperative pain management than the CON group. Persistent postoperative pain was assessed with the Neuropathic Pain Symptom Inventory (NPSI) at months 1, 3, and 6, and was found to be significantly lower in the QLB group at each evaluation (p < 0.001). We also analyzed the impact of the surgery type on persistent pain severity, which was significantly lower after laparoscopic procedures than open procedures at months 1, 3, and 6. Conclusions: QLB reduces oxycodone consumption in patients undergoing open and laparoscopic nephrectomy and decreases persistent pain severity months after hospital discharge. [ABSTRACT FROM AUTHOR]

Anaesthesia is derived from two Greek words that literally mean "senseless". It can therefore be concluded that anaesthesia consists in interrupting the conduction of nerve impulses in both directions, both afferent nerve impulses from receptor cells and efferent nerve impulses to effector cells. Anaesthesia is also referred to as general anaesthesia or colloquially narcosis.A characteristic feature of any general anaesthesia is the ability to end it and return the patient's consciousness back to its initial state. The story of anaesthesia describes the gradual realization of a human dream to sleep through everything unknown and painful and wake up happy and without bad memories. Initially, natural resources were used. Later, gas anaesthesia was used to eliminate pain. In contrast, intravenous anaesthesia is the most common nowadays. [ABSTRACT FROM AUTHOR]

Severe postoperative pain affects most patients after thoracotomy and is a risk factor for post-thoracotomy pain syndrome (PTPS). This randomized controlled trial compared preemptively administered ketamine versus continuous paravertebral block (PVB) versus control in patients undergoing posterolateral thoracotomy. The primary outcome was acute pain intensity on the visual analog scale (VAS) on the first postoperative day. Secondary outcomes included morphine consumption, patient satisfaction, and PTPS assessment with Neuropathic Pain Syndrome Inventory (NPSI). Acute pain intensity was significantly lower with PVB compared to other groups at four out of six time points. Patients in the PVB group used significantly less morphine via a patient-controlled analgesia pump than participants in other groups. Moreover, patients were more satisfied with postoperative pain management after PVB. PVB, but not ketamine, decreased PTPS intensity at 1, 3, and 6 months after posterolateral thoracotomy. Acute pain intensity at hour 8 and PTPS intensity at month 3 correlated positively with PTPS at month 6. Bodyweight was negatively associated with chronic pain at month 6. Thus, PVB but not preemptively administered ketamine decreases both acute and chronic pain intensity following posterolateral thoracotomies. [ABSTRACT FROM AUTHOR]

Background: Renal replacement therapy (RRT), widely used in the treatment of renal injury during sepsis, aims to eliminate the toxins and proinflammatory cytokines involved in the pathomechanism underlying septic shock. Dialysis filters are characterized by a high adsorption potential for cytokines in RRT in the case of septic renal injury. For the treatment of sepsis with antibiotics, it is of key importance to achieve the desired values of PK/PD indices. Continuous renal replacement therapy (CRRT) may affect antimicrobial clearance, increasing their elimination in some cases. Methods: The aim of this study was to determine the degree of adsorption for linezolid on three different types of filters used in CRRT. In our in vitro study, a continuous veno-venous hemofiltration (CVVH) was conducted using three types of filters: polysulfone (PS), polyethyleneimine-treated polyacrylonitrile (PAN PEI), and non-PEI-treated polyacrylonitrile (PAN). Each type of filter was used in three CVVH cycles, involving the use of 600 mg of linezolid dissolved in 700 mL of bovine blood or in 700 mL of 0.9% NaCl. In each case, the total volume of the obtained solution was 1000 mL. Blood samples were collected at particular time points to measure their drug concentration. The differences in mean drug/NaCl adsorption and drug/blood adsorption were determined using a one-way ANOVA with multiple comparisons via Tukey's post hoc test; a p-value of <0.05 was considered significant. Results: A significant adsorption of linezolid was found for PAN PEI filters, both in samples obtained from bovine blood and 0.9% NaCl solutions, at the endpoint. In PAN PEI samples, the concentration of linezolid in 0.9% NaCl solutions decreased from 594.74 μg/mL to 310.66 μg/mL after 120 min (the difference was established at 52%). In blood samples, the initial concentration was 495.18 μg/mL, which then decreased to 359.84 μg/mL (73% of the beginning value). No significant adsorption was demonstrated on PAN or PS filters. Conclusion: There is a need for in vivo research to confirm the effect of filter type on linezolid concentration in patients undergoing CRRT. [ABSTRACT FROM AUTHOR]

Background: Current pain assessment and treatment does not address every patient's requirements. Although the Polish national guidelines for post-operative pain management have been published, many patients experience severe pain in the postoperative period. The main goal of our study was to assess pain severity among patients from different types of hospitals (primary, secondary, and tertiary centers) after similar types of surgeries. We also aimed to determine if there were any differences in pain severity associated with anesthesia technique, type of surgery, and the patient's age and sex. Methods: This was a prospective, observational study. A questionnaire form was used to collect demographic data, type of hospital, surgery, anesthesia, and patient satisfaction of pain control in the postoperative period. The visual analogue scale (VAS) was used to measure pain severity at four time points after surgery (4, 8, 12, and 24 h). Results: The study was conducted from November 2015 to June 2016 in seven hospitals in Eastern Poland, and 269 women and 293 men participated. At the 4-h measurement, 39.32% of patients assessed the pain as moderate and 19.75% as severe. A difference was found in pain intensity between patients treated in primary and secondary hospitals. Vascular surgery patients had the lowest pain intensity (19 (13–26)), especially in comparison to those undergoing thoracic surgery (30 (27–33)). A sudden elevation in pain severity among patients anesthetized with single-shot spinal technique was observed. Only 4.9% of participants received strong opioids during the first 24 h after surgery. Conclusions: Postoperative pain control seems to be unexpectedly poor after single-shot subarachnoid anesthesia. Despite concerns, the use of analgesics may be insufficient in some groups of patients. Our study indicates new variables that influence the severity of pain, such as operated region, anesthetic technique, and type of surgical department. The results obtained in our study are in discrepancy with recommendations presented by the national guidelines for post-operative pain management. [ABSTRACT FROM AUTHOR]

Background: Nutrition plays a major role in intensive care unit (ICU) treatment, influencing ICU length of stay and patient's survival. If preferable enteral nutrition administration is not feasible, ESPEN and ASPEN guidelines recommend initiation of a supplemental parenteral route between the first and seventh day, but exact timing remains elusive. While rapid development in critical care enabled significant reduction in the mortality rate of ICU patients, this improvement also tripled the number of patients going to rehabilitation. Thus, it is quality of life after ICU that has become the subject of interest of clinicians and healthcare policy-makers. A growing body of evidence indicates that protein turnover in the early phase of critical illness may play a crucial role in the preservation of lean body mass. A negative protein balance may lead to muscle wasting that persists weeks and months after ICU stay, resulting in deterioration of physical functioning. Folliwing oncological gastrointestinal tract surgery, patients are threatened with negative protein turnover due to cancer and extensive surgical insult.Methods: This is a multi-centre, single-blinded, randomised controlled trial. The study population includes patients admitted to ICU units after major oncological gastrointestinal surgery that require supplemental parenteral nutrition. After initiation of enteral nutrition, the intervention group receives remaining daily requirement via supplemental parenteral nutrition on the first day of ICU stay while the control group is not supplemented parenterally until the seventh day of ICU stay while enteral nutrition is gradually increased. Primary endpoint: long-term quality of life measured in the physical component score (PCS) of SF-36 questionnaire at 3 and 6 months after ICU admission.Discussion: To our knowledge, this is the first trial to investigate the influence of early supplemental parenteral nutrition on long-term quality of life after major oncological gastrointestinal surgery. We assume that, particularly in this population of patients, early supplemental parenteral nutrition may increase the long-term quality of life. The study construction also allows establishment of patients' PCS SF-36 score prior to surgery and mean change in PCS SF-36 score during the recovery period, which is rarely seen in studies on critically ill patients.Trial Registration: ClinicalTrials.gov: NCT03699371 registered on 12 October 2018. [ABSTRACT FROM AUTHOR]

Background and Objective: The risk of thrombotic complications in critical patients with COVID-19 remains extremely high, and multicenter trials failed to prove a survival benefit of escalated doses of low-molecular-weight heparins (nadroparin calcium) in this group. The aim of this study was to develop a pharmacokinetic model of nadroparin according to different stages of COVID-19 severity. Methods: Blood samples were obtained from 43 patients with COVID-19 who received nadroparin and were treated with conventional oxygen therapy, mechanical ventilation, and extracorporeal membrane oxygenation. We recorded clinical, biochemical, and hemodynamic variables during 72 h of treatment. The analyzed data comprised 782 serum nadroparin concentrations and 219 anti-Xa levels. We conducted population nonlinear mixed-effects modeling (NONMEM) and performed Monte Carlo simulations of the probability of target attainment for reaching 0.2–0.5 IU/mL anti-Xa levels in study groups. Results: We successfully developed a one-compartment model to describe the population pharmacokinetics of nadroparin in different stages of COVID-19. The absorption rate constant of nadroparin was 3.8 and 3.2 times lower, concentration clearance was 2.22 and 2.93 times higher, and anti-Xa clearance was 0.87 and 1.1 times higher in mechanically ventilated patients and the extracorporeal membrane oxygenation group compared with patients treated with conventional oxygen, respectively. The newly developed model indicated that 5.900 IU of nadroparin given subcutaneously twice daily in the mechanically ventilated patients led to a similar probability of target attainment of 90% as 5.900 IU of subcutaneous nadroparin given once daily in the group supplemented with conventional oxygen. Conclusions: Different nadroparin dosing is required for patients undergoing mechanical ventilation and extracorporeal membrane oxygenation to achieve the same targets as those for non-critically ill patients. Clinical Trial Registration: ClinicalTrials.gov identifier no. NCT05621915. [ABSTRACT FROM AUTHOR]

Background. Transfusion-related acute lung injury (TRALI) is a common complication, but still under-reported and under-diagnosed syndrome. The frequency associated with TRALI is estimated between 0.08 and 15.1%. The typical clinical presentation includes acute respiratory distress syndrome characterized by hypoxemia and non-cardiogenic pulmonary edema, which occurs during or within 6 hours. Approximately 80% of patients recover during 48-96 hours, whenever the proper diagnosis and treatment were established. Case report. The aims of this study are to describe diagnostic problems associated with recognition of this syndrome, ways to prevent the onset of this disease and the treatment of TRALI. The presented case report shows the typical manifestation of TRALI syndrome, but new methods of monitoring and treatment were implemented. [ABSTRACT FROM AUTHOR]

Background. The role and professional qualifications of anaesthesiologists seem not to be properly recognized in society. Aim of study. The main aim of this study was to assess patients' knowledge about anaesthesiologists' qualifications. The other objective was to evaluate the level of patients' satisfaction regarding perioperative care. Material and methods. This survey-study was performed among 200 patients of surgical wards in the southeastern Poland. The study protocol consisted eleven close-ended questions concerning patients' knowledge about anaesthesiologists and the assessment of preanaesthetic visit and the conduct of anaesthesia. Additional information obtained during the study included patients' demographic data, level of education, kind of surgery, as well as type of hospital and ward. The survey was conducted students of Medical University of Lublin, who were not involved in medical procedures. Results. 74% of the respondents were aware of the fact that anaesthesiologists are physicians. Patients with high or secondary education more often recognized an anaesthetist as a doctor than people with basic one (Pearson Chi2 = 11.66649, p = 0.00862). Patients were offered to choose the type of anaesthesia in 59.5% of cases. This opportunity was more frequently given to patients in tertiary (university) hospitals (Pearson Chi2 = 17.59179, p = .00734). A preanaesthetic visit reduced anxiety of 67,5% of patients. The quality of anaesthesia was satisfactory according to 90.5% of patients. Conclusions. In the presented study, the patients' knowledge about professional qualifications of anaesthesiologists was similar to the data found in the literature. [ABSTRACT FROM AUTHOR]

Up to 56% of patients develop chronic postsurgical pain (CPSP) after coronary artery bypass grafting (CABG). CPSP can affect patients' moods and decrease daily activities. The primary aim of this study was to investigate CPSP severity in patients following off-pump (OP) CABG using the Neuropathic Pain Symptom Inventory (NPSI). This was a prospective cohort study conducted in a cardiac surgery department of a teaching hospital. Patients undergoing OP-CABG were enrolled in an erector spinae plane block (ESPB) group (n = 27) or a control (CON) group (n = 24). Before the induction of general anesthesia, ESPB was performed on both sides under ultrasound guidance using 0.375% ropivacaine. The secondary outcomes included cumulative oxycodone consumption, acute pain intensity, mechanical ventilation time, hospital length of stay, and postoperative complications. CPSP intensity was lower in the ESPB group than in the CON group 1, 3, and 6 months post-surgery (p < 0.001). Significant between-group differences were also observed in other outcomes, including postoperative pain severity, opioid consumption, mechanical ventilation time, and hospital length of stay, in favor of the ESPB group. Preemptive ESPB appears to decrease the risk of CPSP development in patients undergoing OP-CABG. Reduced acute pain severity and shorter mechanical ventilation times and hospital stays should improve patients' satisfaction and reduce perioperative complications. [ABSTRACT FROM AUTHOR]

Background: The erector spinae plane (ESP) block has recently been shown to effectively alleviate postoperative pain and reduce opioid consumption in breast surgery patients. However, data are still limited concerning the quality of recovery in patients following this procedure. Methods: This study was a randomized controlled trial (RCT) performed in a university hospital. We randomly allocated patients to one of three groups: ESP, SHAM, and control (CON). Procedures in the ESP and SHAM blocks were performed ipsilaterally with 0.375% ropivacaine or 0.9% saline (0.4 mL/kg). Our primary outcome was the assessment of the patient's improvement with quality-of-recovery 40 (QoR-40) a day after surgery. Other outcome assessments included postoperative pain evaluation on the visual analog scale (VAS), 24-hour opioid consumption with patient-controlled analgesia (PCA), time to the first opioid demand, and global satisfaction with perioperative treatment. Results: Overall, patients in the ESP group had improved QoR-40 compared to the CON group, 186 [177–193] vs. 175 [165–183] (medians and interquartile ranges). Pain severity was significantly higher in the CON group compared to the ESP group at hours 2 (38 [23–53] vs. 20 [7–32]) and 4 (30 [18–51] vs. 19 [7–25]). Moreover, we observed lower oxycodone consumption after 24 hours with the PCA pump between the ESP (4 [2–8] mg) and the CON (9.5 [5–19]) groups. Patients in the CON group used PCA sooner than those in the ESP group. Participants in the ESP group were more satisfied with treatment than those in the CON group. We found no statistical difference between SHAM and the other groups. Conclusions: Compared to the CON group, the ESP block improved the quality of recovery, alleviated pain intensity, and lowered opioid consumption in patients undergoing breast surgery. However, we did not observe this superiority in comparison with the SHAM group. Trial registration: NCT04726878. [ABSTRACT FROM AUTHOR]

Bleomicin is the main drug used in chemotherapy of testicular germ cell tumor, however, it causes a number of side effects for instance -- lung fibrosis. An early diagnosis of lung fibrosis combined with quick treatment implementation improve patient's survival prognosis. The pathogenesis and mechanism of fibrosis is not fully understood. Currently, high doses of corticosteroids are used to treat fibrosis, but there are reports of the use of prifenidone and tacrolimus. Authors of the article aimed to present pathogenesis, risk factors and treatment of lung fibrosis caused by bleomicin, on the basis of the literature review and case report study. [ABSTRACT FROM AUTHOR]

Background. Toxic epiderm al necrolysis (TEN) is a rare, severe autoimmune reaction, most commonly formed as a response to drug treatment. Together with Stevens-Johnson syndrome (SJS), it creates a spectrum of disease, with TEN being more severe. Case report. We presented a successful treatment of three patients with severe TEN. Due to the rarity of the disease, there is no specific treatment guideline. Results. In our cases, patients were treated with plasmapheresis with a positive outcome. [ABSTRACT FROM AUTHOR]