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BackgroundThere is potential for adverse events from corticosteroid injections, including increase in blood glucose, decrease in bone mineral density and suppression of the hypothalamic-pituitary axis. Published studies note that doses lower than those commonly injected provide similar benefit.MethodsDevelopment of the practice guideline was approved by the Board of Directors of American Society of Regional Anesthesia and Pain Medicine with several other societies agreeing to participate. The scope of guidelines was agreed on to include safety of the injection technique (landmark-guided, ultrasound or radiology-aided injections); effect of the addition of the corticosteroid on the efficacy of the injectate (local anesthetic or saline); and adverse events related to the injection. Based on preliminary discussions, it was decided to structure the topics into three separate guidelines as follows: (1) sympathetic, peripheral nerve blocks and trigger point injections; (2) joints; and (3) neuraxial, facet, sacroiliac joints and related topics (vaccine and anticoagulants). Experts were assigned topics to perform a comprehensive review of the literature and to draft statements and recommendations, which were refined and voted for consensus (≥75% agreement) using a modified Delphi process. The United States Preventive Services Task Force grading of evidence and strength of recommendation was followed.ResultsThis guideline deals with the use and safety of corticosteroid injections for sympathetic, peripheral nerve blocks and trigger point injections for adult chronic pain conditions. All the statements and recommendations were approved by all participants after four rounds of discussion. The Practice Guidelines Committees and Board of Directors of the participating societies also approved all the statements and recommendations. The safety of some procedures, including stellate blocks, lower extremity peripheral nerve blocks and some sites of trigger point injections, is improved by imaging guidance. The addition of non-particulate corticosteroid to the local anesthetic is beneficial in cluster headaches but not in other types of headaches. Corticosteroid may provide additional benefit in transverse abdominal plane blocks and ilioinguinal/iliohypogastric nerve blocks in postherniorrhaphy pain but there is no evidence for pudendal nerve blocks. There is minimal benefit for the use of corticosteroids in trigger point injections.ConclusionsIn this practice guideline, we provided recommendations on the use of corticosteroids in sympathetic blocks, peripheral nerve blocks, and trigger point injections to assist clinicians in making informed decisions.

Background: Opioid-reduced multimodal analgesia has been used clinically for many years to decrease the perioperative complications associated with opioid drugs. We aimed to assess the clinical effects of opioid-reduced anesthesia during thoracoscopic sympathectomy. Methods: Surgical patients (n = 151) with palmar hyperhidrosis were randomly divided into control (Group C, 73 patients) and test (Group T, 78 patients) groups. All patients were administered general anesthesia using a laryngeal mask. In Group C, patients received propofol, fentanyl, and cisatracurium for anesthesia induction, and maintenance was achieved with propofol and remifentanil, along with mechanical ventilation during the operation. In Group T, anesthesia was induced with propofol, dezocine, and dexmedetomidine (DEX) and maintained with propofol, DEX, and an intercostal nerve block, along with spontaneous breathing throughout the operation. Perioperative complications related to opioid use include hypotension, bradycardia, hypertension, tachycardia, hypoxemia, nausea, vomiting, urine retention, itching, and dizziness were observed. To assess the impact of these complications, we recorded and compared vital signs, blood gas indices, visual analogue scale (VAS) scores, adverse events, and patient satisfaction between the two groups. Results: Perioperative complications related to opioid use were similar between groups. There were no significant differences in the type of perioperative sedation, analgesia index, respiratory and circulatory indicators, blood gas analysis, postoperative VAS scores, adverse reactions, propofol dosage, postoperative recovery time, and patient satisfaction. Conclusions: In minimally invasive surgeries such as thoracoscopic sympathectomy, opioid-reduced anesthesia was found to be safe and effective; however, this method did not demonstrate clinical advantages. Trial registration: Chinese Clinical Trial Register: ChiCTR2100055005, on December 30, 2021. [ABSTRACT FROM AUTHOR]

Background: Pulsed radiofrequency (PRF) treatment targeting the greater occipital nerve (GON) has shown efficacy in treating various conditions. This double-blind, randomized controlled study aimed to evaluate the effects of combining PRF therapy with GON block (GONB) therapy in patients with chronic migraine. Methods: The study consisted of two groups: GONB and GONB + PRF, each comprising 16 patients with chronic migraine. Using 0.5-Hz sensorial stimulation, a 5-cm-long radiofrequency needle was inserted under ultrasound guidance in both groups. Subsequently, all patients received a GONB by administering 2 mL of 0.25% bupivacaine. In the GONB + PRF group, patients underwent 4 min of PRF at 42℃, whereas the GONB group did not receive any PRF treatment. Follow-up examinations were performed at 1, 2, 3 and 6 months after the procedure to evaluate the frequency and severity of migraine attacks, number of headache days, and analgesic consumption. Results: In the GONB + PRF group, the visual analog scale (VAS) score, number of migraine attacks, number of headache days, and analgesic consumption were significantly lower compared to the GONB group (P < 0.05). Significant decreases (60%) in mean VAS scores, number of migraine attacks, number of headache days, and consumption of analgesic medications were observed in the GONB + PRF group at the 1-, 2-, 3-, and 6-month follow-ups compared with the pre-treatment period (P < 0.05). Conclusions: The combination of GONB and PRF presents a promising new treatment option for patients with chronic migraine. This approach has demonstrated efficacy in minimizing analgesic use, decreasing the frequency of migraine attacks, reducing the number of headache days and decreasing the severity of migraine attacks. Trial Registration: NCT05464212. [ABSTRACT FROM AUTHOR]

Introduction: Total knee arthroplasty (TKA) is accompanied by severe postoperative pain, which is reported to be an important cause of chronic pain. Ultrasound-guided adductor canal block (ACB) combined with infiltration between the popliteal artery and posterior capsular of the knee (IPACK) has been proven to have a better effect on relieving acute pain after TKA. However, whether it has a significant effect on the incidence of chronic pain after TKA has not been reported. This trial was designed to investigate the effect of ultrasound-guided ACB combined with IPACK on the incidence and intensity of chronic pain after TKA. Methods: In this prospective, randomized, double-blind, placebo-controlled study, 100 subjects scheduled for TKA were randomly (1:1) divided into two groups: the ropivacaine group and the placebo group. Patients in each group received ultrasound-guided ACB + IPACK procedures with 0.25% ropivacaine or equal volume normal saline. All patients received multimodal analgesia. Pain intensity was assessed using the Numerical Rating Scale (NRS). The primary outcome was the incidence of chronic pain at 3 months after TKA by telephone follow-up. In addition, pain intensity in early resting and mobilized states, chronic pain intensity, the time to first rescue analgesia; opioid consumption; CRP and IL-6 after the operation; length of postoperative hospital stay; and cost of hospitalization and postoperative complications; as well as the function of the knee in the early stage after the operation, were recorded. Results: Ninety-one participants were included in the final analysis. At 3 months, the incidence of chronic pain was 30.4% in the ropivacaine group, significantly lower than 51.1% in the placebo group. Compared with the placebo group, the ACB + IPACK with ropivacaine group had significantly lower pain scores at 4 hours, 8 hours, 16 hours, and 24 hours after the operation; increased the knee range of motion at 8 hours and 24 hours after the operation; and a significantly decreased incidence of chronic pain at 3 months after the operation. During the follow-up period, there were no nerve block-related complications in either group. Conclusion: In the context of multimodal analgesia protocols, ACB combined with IPACK before surgery decreases the incidence and intensity of chronic pain 3 months after TKA compared with placebo injection. In addition, it reduces the NRS scores, whether at rest or during mobilization, and improves knee function within 24 hours after TKA. Trial registration: This trial was registered in the China Clinical Trial Center (registration number ChiCTR2200065300) on November 1, 2022. [ABSTRACT FROM AUTHOR]

Background: The study aimed to compare the pain-relieving effectiveness of anterior quadratus lumborum block (QLB3) and erector spinae plane block (ESPB), both of which have been documented to provide relief during abdominal surgery. Methods: This prospective observational study, conducted between February and July 2023, included 96 patients who had undergone percutaneous nephrolithotomy (PCNL). Patients were divided into three groups: QLB3, ESPB, and control (no block) and received the corresponding nerve block in the preanesthetic room for regional block. Cumulative morphine consumption during the initial 24 h after PCNL, numerical rating scale resting/movement scores, intraoperative remifentanil usage, rescue analgesic requirements, time when the first analgesic was requested, and postoperative nausea and vomiting scores were documented and compared between the groups. Results: Total median morphine consumption in the first 24 h postoperatively was similar in the QLB3 and ESPB groups but higher in the control group (QLB3, 7 mg [(Q1-Q3) 7–8.5]; ESPB, 8 mg [6.5–9]; control, 12.5 [10–17]; P < 0.001). Similarly, median intraoperative remifentanil consumption did not differ between the block groups but was higher in the control group (QLB3, 1082 µg [IQR 805.5–1292.7]; ESPB, 1278 µg [940.2–1297.5]; control, 1561 µg [1315–2068]; P < 0.001). The number of patients receiving rescue analgesic medication was similar in the block groups but higher in the control group (QLB3, n = 9 [30%]; ESPB, n = 14 [46.7%]; control, n = 21 [70%]; P = 0.008). Conclusions: QLB3 and ESPB were adequate and comparable in providing postoperative analgesia as part of multimodal analgesia after PCNL. Trial registration: The study was registered on ClinicalTrials.gov (Identifier: NCT05822492). [ABSTRACT FROM AUTHOR]

Background & aims: Chronic migraine poses a global health burden, particularly affecting young women, and has substantial societal implications. This study aimed to assess the efficacy of Greater Occipital Nerve Block (GONB) in individuals with chronic migraine, focusing on the impact of local anesthetics compared with placebo. Methods: A meta-analysis and systematic review were conducted following the PRISMA principles and Cochrane Collaboration methods. Eligible studies included case-control, cohort, and randomized control trials in adults with chronic migraine, adhering to the International Classification of Headache Disorders, third edition (ICHD3). Primary efficacy outcomes included headache frequency, duration, and intensity along with safety assessments. Results: Literature searches across multiple databases yielded eight studies for qualitative analysis, with five included in the final quantitative analysis. A remarkable reduction in headache intensity and frequency during the first and second months of treatment with GONB using local anesthetics compared to placebo has been reported. The incidence of adverse events did not differ significantly between the intervention and placebo groups. Conclusion: The analysis emphasized the safety and efficacy of GONB, albeit with a cautious interpretation due to the limited number of studies and relatively small sample size. This study advocates for further research exploring various drugs, frequencies, and treatment plans to enhance the robustness and applicability of GONB for chronic migraine management. [ABSTRACT FROM AUTHOR]

Background: Thoracoscopic-guided thoracic paravertebral nerve block (TG-TPVB) and thoracoscopic-guided intercostal nerve block (TG-INB) are two postoperative analgesia technology for thoracic surgery. This study aims to compared the analgesic effect of TG-TPVB and TG-INB after uniportal video-asssited thoracic surgery (UniVATS). Methods: Fifty-eight patients were randomly allocated to the TG-TPVB group and the TG-INB group. The surgical time of nerve block, the visual analog scale (VAS) scores, the consumption of sufentanil and the number of patient-controlled intravenous analgesic (PCIA) presses within 24 h after surgery, the incidence of adverse reactions were compared between the two groups. Results: The VAS scores were significantly lower during rest and coughing at 2, 6, 12, and 24 h in the TG-TPVB group than in the TG-INB group (P < 0.05). The consumption of sufentanil and the number of PCIA presses within 24 h after surgery were significantly lower in the TG-TPVB group than in the TG-INB group (P < 0.001).The surgical time of nerve block was significantly shorter in the TG-TPVB group than in the TG-INB group (P < 0.001). The incidence of bleeding at the puncture point was lower in the TG-TPVB group than that in the TG-INB group (P < 0.05). Conclusion: TG-TPVB demonstrated superior acute pain relieve after uniVATS, shorter surgical time and non-inferior adverse effects than TG-INB. [ABSTRACT FROM AUTHOR]

Objective: This randomized controlled and double-blind study aimed to investigate whether the analgesic effect of the adductor canal block (ACB) combined with the genicular nerve block (GNB) after total knee arthroplasty is noninferior to that of the adductor canal block combined with local infiltration analgesia (LIA). Methods: A total of 102 patients undergoing total knee arthroplasty under general anesthesia were included and randomly divided into: ACB + GNB and ACB + LIA groups; the ACB + LIA group received 80 mL of 0.2% ropivacaine with adrenaline 10 µg/mL for LIA, whereas the ACB + GNB group received 4 mL of 0.2% ropivacaine for the blockade of five peri-knee nerves. The primary outcome was the median difference in the visual analog scale scores at rest at 24 h between the two groups. Secondary outcomes involved the median differences in the pain scores at other time points. Other outcomes included the cumulative dosage of opioids calculated in morphine equivalents in the first 24 h and indicators related to knee joint functional recovery. Results: In total, 36 and 38 patients were included in the ACB + GNB and ACB + LIA groups, respectively. We found that the median difference (95% confidence internal) in postoperative rest pain at 24 h (noninferiority criteria, △ = 1) was − 0.5 (− 1 to 0, p = 0.002). The median difference in cumulative opioid consumption was 1 mg (− 1 to 3, p = 0.019), meeting the noninferiority criteria, △ = 7.7 mg. Conclusions: ACB combined with GNB provides noninferior analgesia compared to ACB with LIA on the first day after total knee arthroplasty while significantly reducing local anesthetic use. Trial registration: Name of the Registry: Chinese Clinical Trial Registry; Trial Registration Number: ChiCTR2300074274; Date of Registration. August 2, 2023. [ABSTRACT FROM AUTHOR]

Background: This study aims to investigate the efficacy of five analgesic strategies combined with conventional physiotherapy program (CPT) in managing chronic shoulder pain. Methods: Two authors independently screened studies, extracted data using a pre-formatted chart, and assessed bias using the Cochrane Risk of Bias tool. A network meta-analysis was performed by the Stata 17.0 and R 4.3.2 software. Results: A total of 14 studies with 862 subjects were identified. These analgesic strategies included extracorporeal shock wave therapy (ESWT), suprascapular nerve block (SSNB), corticosteroid injection (CSI), hyaluronic acid injection (HAI), and kinesio taping (KT). ESWT plus CPT was the most efficient intervention in alleviating pain intensity and improving physical function. SSNB plus CPT was the optimal intervention in improving shoulder mobility. Compared to CPT alone, CSI + CPT only significantly improved the SPADI total score, but showed no difference in pain intensity or shoulder mobility. HAI + CPT showed no significant difference in improving pain intensity, physical function, or shoulder mobility compared to CPT alone. Adding KT to CPT did not yield additional benefits in improving shoulder mobility. Conclusion: Overall, in managing chronic shoulder pain, ESWT + CPT was the most effective intervention for reducing pain intensity and improving physical function. SSNB + CPT was optimal for enhancing shoulder mobility. Future rigorous clinical trials with larger sample sizes and higher methodological rigor are strongly required to confirm the current results. [ABSTRACT FROM AUTHOR]

Background Purpose Methods Results Conclusions In clinical anesthesia, precise segmentation of muscle layers from abdominal ultrasound images is crucial for identifying nerve block locations accurately. Despite deep learning advancements, challenges persist in segmenting muscle layers with accurate topology due to pseudo and weak edges caused by acoustic artifacts in ultrasound imagery.To assist anesthesiologists in locating nerve block areas, we have developed a novel deep learning algorithm that can accurately segment muscle layers in abdominal ultrasound images with interference.We propose a comprehensive approach emphasizing the preservation of the segmentation's low‐rank property to ensure correct topology. Our methodology integrates a Semantic Feature Extraction (SFE) module for redundant encoding, a Low‐rank Reconstruction (LR) module to compress this encoding, and an Edge Reconstruction (ER) module to refine segmentation boundaries. Our evaluation involved rigorous testing on clinical datasets, comparing our algorithm against seven established deep learning‐based segmentation methods using metrics such as Mean Intersection‐over‐Union (MIoU) and Hausdorff distance (HD). Statistical rigor was ensured through effect size quantification with Cliff's Delta, Multivariate Analysis of Variance (MANOVA) for multivariate analysis, and application of the Holm‐Bonferroni method for multiple comparisons correction.We demonstrate that our method outperforms other industry‐recognized deep learning approaches on both MIoU and HD metrics, achieving the best outcomes with 88.21%/4.98 (pmax=0.1893$p_{max}=0.1893$) on the standard test set and 85.48%/6.98 (pmax=0.0448$p_{max}=0.0448$) on the challenging test set. The best&worst results for the other models on the standard test set were (87.20%/5.72)&(83.69%/8.12), and on the challenging test set were (81.25%/10.00)&(71.74%/16.82). Ablation studies further validate the distinct contributions of the proposed modules, which synergistically achieve a balance between maintaining topological integrity and edge precision.Our findings validate the effective segmentation of muscle layers with accurate topology in complex ultrasound images, leveraging low‐rank constraints. The proposed method not only advances the field of medical imaging segmentation but also offers practical benefits for clinical anesthesia by improving the reliability of nerve block localization. [ABSTRACT FROM AUTHOR]

Background: Migraine is a primary headache defined as moderate-to-severe pain lasting 4 to 72 h, ranking 2nd among the disabling conditions for both genders regardless of the age and the greater occipital nerve (GON) block has been reported as an efficient treatment method for migraine. The present study aims to evaluate and compare the efficiency of the two methods of GON block, i.e., the ultrasound (US)-guided technique and the landmark-based technique. Method: Having a prospective and randomized design, the study assigned the patients with chronic migraine into two groups after which a neurologist performed landmark-based GON block in the first group while an algologist performed US-guided GON block in the second group. During the 3-month follow-up period, the number of days with pain, the duration of pain, the number of analgesic drugs taken in a month, and Visual Analogue Scale (VAS) scores were compared with the values ​​before treatment and at the 1st week, 1st month, and 3rd month after treatment. Results: US-guided GON block group included 34 patients while there were 32 patients in the landmark-based GON block group. US-guided GON block group showed significantly reduced VAS scores and frequency of attacks compared to the landmark-based GON block group at Month 1 after the procedure. After a 3-month follow-up period of the two groups, the frequency of attacks, analgesic intake and the duration of attacks were lower in both groups compared to the baseline. At 3-month follow-up, the mean of VAS scores decreased from 9,47 ± 2,69 to 4,67 ± 1,9 in US-guided GON block group and from 9,46 ± 0,98 to 7 ± 2,5 in the landmark-based GON block group. Conclusion: It was determined that both US-guided and landmark-based GON block were efficient techniques in patients with chronic migraine. US-guided GON block technique resulted in lower VAS scores, shorter durations of pain, lower frequencies of attack, and lower intake of analgesics compared to the landmark-based GON block technique. [ABSTRACT FROM AUTHOR]

Background: The analgesia after lower third molar alveolectomy is based on the use of non-steroidal anti-inflammatory drugs (NSAIDs) that have significant risks, and are contraindicated in the third trimester of pregnancy. Aiming to reduce NSAIDs use after this surgery, we quantified analgesic effects of ultrasound (US)-guided extraoral mandibular nerve block. Methods: Thirty-six patients were equally allocated to the experimental or control group, based on their willingness to receive experimental US-guided extraoral mandibular nerve block for postoperative analgesia. The experimental block applied prior to lower third molar alveolectomy, was followed by standard intraoral inferior alveolar nerve block. In the control group, patients received only intraoral block of inferior alveolar nerve. All patients reported pain level (visual analogue scale, VAS) right after the application of blocks. The next day, patients reported duration of pain-free time and the use of analgesic. Results: The US-guided extraoral mandibular nerve block prolonged the pain-free time to 8 h (vs. 4 in control group, P < 0.001) and reduced NSAIDs use (12 patients needed analgesic in experimental vs. 17 patients in control group, P = 0.038). The application of experimental block was less painful (VAS = 2) than the application of intraoral inferior alveolar nerve block (VAS = 4, P = 0.011). In 8/18 patients in the experimental group US-guided extraoral mandibular nerve block solely achieved adequate surgical anesthesia. Conclusion: US-guided extraoral mandibular nerve block prolonged pain-free period and reduced the use of NSAIDs after lower third molar alveolectomy, thus proving to be successful analgesia method for this dental surgery. Clinical trial registration: https://classic.clinicaltrials.gov/ct2/show/NCT06009302, identification number: NCT06009302, date of registration: 18/08/2023. [ABSTRACT FROM AUTHOR]

Introduction Inguinal hernia most frequent problem in human being adult as well as children suffer with it. Inguinal hernia repair done under “anesthesia” {such as local anesthesia, spinal anesthesia, nerve block, epidural anesthesia, & general anesthesia}, depending upon number of variables i.e. patient’s acceptance, surgeon’s preference, safety, practicality and cost effectiveness. Objectives To compare nerve block versus spinal Anesthesia in Lichtenstein tension-free mesh inguinal hernia repair Methods The Present study, conducted as a hospital-based comparative prospective study at the Department of General Surgery, Muzaffarnagar Medical College & Hospital, Muzaffarnagar, U.P., aimed to investigate the efficacy of two different anesthesia techniques in inguinal hernia repair. Over an 18-month period, 100 patients meeting the inclusion criteria. The study utilized a combination of ilioinguinal and iliohypogastric nerve blocks alongside field blocks for anesthesia administration, ensuring proper analgesia and relaxation. Cases were grouped based upon fitness for spinal anesthesia, comorbidities, and patient preference. Group A underwent mesh repair under spinal anesthesia, while Group B received nerve block via inguinal field block technique. Results In the <40 year group, Nerve Block accounts for 2.0% of cases while Spinal Anaesthesia accounts for 10.0%. In the 41-50year group, Nerve Block represents 64.0% of cases, whereas Spinal Anaesthesia represents 60.0%. In the >50 age group, Nerve Block represents 34.0% of cases, and Spinal Anesthesia represents 30.0%. On comparison of seroma occurrence between Group A and Group B revealed interesting insights. In Group A, comprising 50 cases, 45 cases (90.0%) exhibited seroma, while 5 cases (10.0%) did not. Similarly, in Group B, consisting of another 50 cases, 47 cases (94.0%) showed seroma, with 3 cases (6.0%) without it. When considering both groups collectively, out of 100 cases, 92 cases (92.0%) had seroma, while 8 cases (8.0%) did not. Conclusion We came to the conclusion that all patients with primary inguinal hernias benefit from Lichtenstein mesh repair performed under local anesthesia for a number of reasons. Simpleness, dependability, efficacy, safety, a smooth recovery period marked by easily managed pain, a prompt return to full range of activities, and high patient satisfaction are a few of these. [ABSTRACT FROM AUTHOR]

To compare efficacy and safety of two different doses of Dexmedetomidine as an adjuvant to Ropivacaine compared to Ropivacaine in block and intravenously Dexmedetomidine in upper limb surgeries under supraclavicular brachial plexus block. INTRODUCTION Supraclavicular block is a reliable, rapid-onset approach to brachial plexus anaesthesia. The supraclavicular block provides anesthesia and analgesia to the upper extremity below the shoulder. It is an excellent choice for elbow and hand surgery. Adjuvants are added to local anesthetics in peripheral nerve blocks to fasten the onset of action, to prolong the duration of action and improve the quality of blockade. Various adjuvants like morphine, fentanyl, sufentanil, clonidine, midazolam, ketamine, neostigmine, dexmedetomidine are added to local anesthetics. Since dexmedetomidine has α2:α1 selectivity ratio of 1620:1 as compared to 220:1 for clonidine, it decreases unwanted side effects of α1 and much more sedative and analgesic. Ropivacaine is a long-acting amide local anaesthetic agent and first produced as a pure enantiomer structurally related to Bupivacaine. Dexmedetomidineis d-enantiomer of medetomidine. It belongs to imidazole subclass of α2 receptor agonist. It is a newer α2-adrenoreceptor agonist is currently in focus for its sedative, anxiolytic and analgesic properties.It is rapidly distributed and metabolized in liver, excreted in urine and faeces. [ABSTRACT FROM AUTHOR]

Modified radical mastectomy, usually performed for the treatment of breast cancer, is associated with considerable acute post-operative pain and restricted shoulder mobility.1 Although the thoracic paravertebral block (TPVB) is the most widely used technique to provide postoperative analgesia after breast surgeries,2-6 patients having radical mastectomy under TPVB frequently complain of pain in the axilla and upper limb, because TPVB does not block medial and lateral pectoral nerves as effectively as long thoracic and thoracodorsal nerves, leading to inadequate analgesia.The PECS is a more effective technique, provides better pain relief for longer time in contrast with the TPVB, and reduces postoperative opioid consumption with less hemodynamic changes. Accordingly, the PECS is more effective and safe when combined with general anesthesia for postoperative analgesia after modified radical mastectomy with axillary dissection. [ABSTRACT FROM AUTHOR]

Background: The Transversus Abdominis Plane (TAP) block is the most common peripheral nerve block that provides acceptable postoperative analgesia for a variety of abdominal surgeries. A long-acting local anesthetic called ropivacaine is used to relieve pain following surgery. The duration of analgesia may be extended by the adjuvant administration of dexmedetomidine. Aim: The current study aimed to evaluate the effects of dexmedetomidine combined with Ropivacaine in ultrasound-guided Transversus Abdominis plane block on post-operative analgesia following cesarean section. Materials and Method: A total of 70 patients scheduled for CS were divided randomly into two groups: $ (Ropivacaine) group, which received 3 mg/kg of Ropivacaine diluted to 40 mL in normal saline with 20 mL on each side, and B (dexmedetomidine) group, which received 3 mg/kg of Ropivacaine plus 0.5 µg/kg of dexmedetomidine diluted to 40 mL in normal saline with 20 mL on each side. The primary outcome was pain-free duration, with secondary outcomes included heart rate (HR) and mean blood pressure (MBP) readings, visual analogue scale (VAS) pain scores, number of patients requiring rescue analgesia, time to first seek analgesia, and patient satisfaction. Results were analysed using SPSS 20.0 version and the association was tested using the Student's t-test, Fisher's exact test or Pearson's χ² test. Results: As compared to group A, group B experienced a significantly longer period of sensory block and analgesia (p<0.05). In comparison to Group A, group B showed longer pain-free duration (6.25±1.47 vs. 9.74±1.31 hours; p<0.05), a longer mean time to initial reporting of postoperative pain (5.12±1.23 vs. 7.07±1.48; p<0.05), a lower number of patients requiring rescue analgesic (27(77.14%) vs. 8(22.86%); p<0.05), a longer time to first request for analgesia (5.76±1.87 vs. 7.63±2.07 hours; p<0.05), and better patient satisfaction (3.5 vs. 4.5; p<0.05). Postoperative VAS pain scores in group B were considerably lower at 6, 8, and 10 hours than in group A. Bradycardia was noted in 1 (2.86%) and 3 (8.57%) of the patients in Groups A and B, respectively. Conclusion: Extending the duration and improving the quality of analgesia without causing any notable side effects is possible with the adjuvant addition of dexmedetomidine to Ropivacaine for TAP block. [ABSTRACT FROM AUTHOR]

In patients who are candidates for craniotomy, scalp nerve blocks have been shown to be effective in relieving pain intensity as well as postoperative hemodynamic stability after surgery, but the results have been inconsistent. We aimed to assess the effect of scalp block on pain control, intraoperative drug use under Analgesia Nociception Index (ANI) monitoring, and postoperative pain in patients who were candidates for elective craniotomy. In this randomized, single-blinded clinical trial study, candidates for craniotomy were randomly (using the block randomization method) divided into 2 groups before entering the operating room. The first group received a scalp block with bupivacaine (intervention), and the second group did not receive a scalp block (control) besides the routine anesthetic procedure in these patients. ANI, hemodynamic parameters, and the amounts of received remifentanil were conducted and compared. Patients under scalp block received less dosage of fentanyl than the nonscalp block group (mean = 57.14 ± 15.59 mcg vs. 250.00 ± 65.04 mcg, respectively). Similarly, the dose of remifentanil required in the scalp block group was less (mean = 3.04 ± 1.95 mg and 5.54 ± 2.57 mg, respectively). No difference was observed in hemodynamic parameters such as blood pressure and heart rate (before, during, and after surgery). However, the group receiving scalp block had higher ANI means than the control group. Scalp nerve block has an effective role in pain control (increasing ANI), consequently reducing the need for analgesic drugs such as fentanyl and remifentanil following craniotomy without changing the hemodynamic condition. [ABSTRACT FROM AUTHOR]

Objective To investigate the predictive value of thoracic sympathetic ganglion block (TSGB) in response to ketamine infusion therapy (KIT) and spinal-cord stimulation (SCS) in patients with chronic upper-extremity pain including complex regional pain syndrome (CRPS). Design Retrospective Setting Tertiary hospital single-center Subjects Patients who underwent TSGB receiving KIT or SCS within a 3-year window. Methods Positive TSGB outcomes were defined as ≥2 0–10 Numerical Rating Scale (NRS) score reduction at 2 weeks post-procedure. Positive KIT and SCS outcomes were determined by ≥2 NRS score reduction at 2–4 weeks post-KIT and ≥4 NRS score reduction at 2–4 weeks post-SCS implantation, respectively. Results Among 207 patients who underwent TSGB, 38 received KIT and 34 underwent SCS implantation within 3 years post-TSGB; 33 patients receiving KIT and 32 patients receiving SCS were included. Among 33 patients who received KIT, 60.6% (n  = 20) reported a ≥ 2 0–10 NRS pain-score reduction. Positive response to TSGB occurred in 70.0% (n  = 14) KIT responders, significantly higher than that in 30.8% (n  = 4) KIT non-responders. Multivariable analysis revealed a positive association between positive responses to TSGB and KIT (OR 7.004, 95% CI 1.26–39.02). Among 32 patients who underwent SCS implantation, 68.8% (n  = 22) experienced short-term effectiveness. Positive response to TSGB was significantly higher in SCS responders (45.5%, n  = 10) than in non-responders (0.0%). However, there were no associations between pain reduction post-TSGB and that post-KIT or post-SCS. Conclusions A positive response to TSGB is a potential predictor for positive KIT and SCS outcomes among patients with chronic upper-extremity pain, including CRPS. [ABSTRACT FROM AUTHOR]

Background Given the high prevalence of chronic shoulder pain and encouraging early results of terminal sensory articular branch radiofrequency ablation to treat shoulder pain, research is warranted to refine the procedural technique on the basis of updated neuroanatomic knowledge with the goal of further improving patient outcomes. Objective We describe an updated radiofrequency ablation protocol that accounts for varied locations of the terminal sensory articular branches of the suprascapular, axillary, subscapular, and lateral pectoral nerves within individual patients. Design Technical note. Methods Cadaveric studies delineating the sensory innervation of the shoulder joint were reviewed, and a more comprehensive radiofrequency ablation protocol is proposed relative to historical descriptions. Conclusions The proposed radiofrequency ablation protocol, which is based on neuroanatomic dissections of the shoulder joint, will provide a safe means of more complete sensory denervation and potentially improve clinical outcomes compared with historical descriptions, the efficacy of the new protocol must be confirmed in prospective studies. [ABSTRACT FROM AUTHOR]

Background There are few studies on continuous intercostal nerve block after single operation hole thoracoscopic surgery, that is, two-port thoracoscopic surgery. Objective To evaluate the analgesic effect of continuous intercostal nerve block after thoracoscopic surgery. Methods A total of 80 patients who underwent single operation hole thoracoscopic surgery in our hospital between September 2020 and June 2021 were enrolled and divided into two groups. Based on basic analgesia, an intercostal catheter was placed during the operation for continuous intercostal block analgesia after the operation in the experimental group (group A, n = 40). The control group (group B, n = 40) was treated with sufentanil intravenous analgesia after surgery, which is namely "basic analgesia." The postoperative pain scores, restlessness during the recovery period, effect on reducing opioid use, postoperative chest complications, patient satisfaction, etc., were compared between the two groups. Results The pain scores of patients in group A were significantly lower compared with those in group B at 12, 24, 36, and 48 hours after surgery (3.325 ± 1.163 vs. 4.550 ± 1.176, 2.650 ± 1.001 vs. 4.000 ± 1.038, 2.325 ± 0.917 vs. 3.700 ± 0.966, and 1.775 ± 1.050 vs. 3.150 ± 1.075, p < 0.001, respectively). Sufentanil consumption in group A was significantly lower than in group B at 48 hours after surgery (98.625 ± 4.158 vs. 106.000 ± 7.228, p < 0.001). Conclusion Multimodal analgesia is ideal for early pain control after thoracotomy. A continuous intercostal nerve block can effectively reduce postoperative pain in patients. [ABSTRACT FROM AUTHOR]

Postherpetic neuralgia results from varicella-zoster virus reactivation post--chickenpox infection, manifesting as persistent and severe pain lasting a minimum of 3-mo post--herpes zoster onset. Traditional postherpetic neuralgia management comprises antiviral, analgesic medications, corticosteroids, and various agents. Ultrasound-guided nerve blocks have recently emerged as a promising postherpetic neuralgia treatment. In a case involving a 58-year-old man with severe thoracic herpes zoster lesions, the serratus posterior superior intercostal plane block was employed under ultrasound guidance, significantly reducing pain scores and enhancing quality of recovery. This study underscores serratus posterior superior intercostal plane block's secure, effective role in managing thoracic herpes zoster, and mitigating postherpetic neuralgia risk. This case report represents the pioneering application of serratus posterior superior intercostal plane block for postherpetic neuralgia, offering a promising avenue for relieving patients suffering from this condition. [ABSTRACT FROM AUTHOR]

The article presents an update review of pediatric facial lacerations, including considerations to take into account when evaluating facial or scalp laceration, options for anesthetics, anxiolysis and sedation, importance of proper wound preparation to the success of laceration repair, suture material/needle size and alternatives to sutures, approximation technique, postrepair care and use of antibiotics.

Summary: Perineural anaesthesia is a useful technique in equine surgery, providing pre‐emptive targeted anaesthesia of the surgical site, reducing volatile anaesthetic requirements, improving recovery quality and providing postoperative pain relief. Surgery under standing sedation in horses has increased in popularity, mandating the need for effective locoregional anaesthesia and analgesic techniques. Nerve location techniques offer greater accuracy than blind techniques when placing injectate. These methods can help to avoid structures such as blood vessels and minimise direct nerve damage during needle placement, reducing the risk of procedure‐related complications. This review will discuss the most pertinent research in the veterinary literature where objective methods of nerve location have been used to perform peripheral nerve blocks in horses. The efficacy of using objective methods to perform nerve blocks in equine anaesthesia is discussed by the authors, providing useful information to equine anaesthetists, and potentially improve the quality of anaesthesia and analgesia in horses. [ABSTRACT FROM AUTHOR]

The management of acute burn pain poses significant challenges. Regional techniques have become increasingly popular in perioperative burn pain management. Continuous nerve block catheters are particularly useful for split-thickness skin grafts where donor site pain can exceed that of the burn-injured site. Donor skin is frequently harvested from the anterolateral thigh. The fascia iliaca (FI) compartment block provides blockade of both the lateral femoral cutaneous nerve and the femoral nerve, and thus, it is a useful modality for burn donor pain. Our institution initiated a protocol in which continuous FI catheters were placed in patients undergoing split-thickness skin grafting of the anterolateral thigh. This retrospective review seeks to assess the impact of this modality on postoperative pain scores and opioid requirements. Oral morphine equivalent (OME) administration was significantly lower in the FI group than the control group, starting with POD 0, which is the day of the FI catheter insertion (188 vs 327 mg, P <.001). Over the next 4 postoperative days (PODs), OME administration remained lower in the FI group compared to control patients, although not statistically significant on PODs 3-4. There was a significant difference in OME administered between the FI group and the control group on POD 5 (159.5 vs 209.2 mg, P <.05). Our retrospective study evaluating the role of FI catheters in burn patients undergoing split-thickness skin grafting surgery showed significantly lower opioid consumption on PODs 1-5 compared to patients without an FI catheter. [ABSTRACT FROM AUTHOR]

Background: Local anesthesia (LA) during routine dental treatment in children fails in 5%–35% of first attempts. No data, however, are available on the success rates of subsequent attempts. Aim: To evaluate the effectiveness of primary, secondary, and tertiary LA attempts (P‐LA, S‐LA, and T‐LA, respectively) for anesthetizing molars during routine dental treatments in children. Design: We retrospectively analyzed dental records of all children (2–18 years) who had been administered LA for the treatment of primary or permanent molars by a single paediatric dentist, between 2011 and 2022. All LAs were delivered using a computer‐controlled local anesthetic delivery (CCLAD) system. Results: The failure rate of P‐LA in 1312 molars was 13% and correlated with age (p <.001), type of tooth (p <.001), type of treatment (p <.001), and treated arch (p <.001). The effectiveness of S‐LA for buccal infiltration, intrasulcular, inferior alveolar nerve block, greater palatine nerve block (GPNB), posterior superior alveolar nerve block (PSANB), or a combination of the last two was 50%, 87.2%, 66.7%, 63.6%, 33.3%, and 100%, respectively, and was not significantly associated with age or the type of tooth, treatment, or P‐LA. Conclusion: The optimal choice of S‐LA for anesthetizing maxillary molars was a combination of PSANB and GPNB, whereas for mandibular molars, it was IS‐CCLAD system. [ABSTRACT FROM AUTHOR]