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Study Objective: Neuraxial hydromorphone provides postoperative pain relief. However, the magnitude of this effect and the optimal dose remain unknown. The objective of this study is to clarify these uncertainties., Design: Systematic review and meta-analysis with trial sequential analysis., Setting: Postoperative recovery area and ward, up to 24 h., Patients: Any patient undergoing any type of surgery or being in labor., Interventions: Neuraxial hydromorphone versus control., Measurements: Our primary outcome was rest pain score (analogue scale, 0-10) at 24 h according to route of administration (epidural versus spinal) and type of surgery (orthopedic versus other). Secondary outcomes included rest pain score at 0-4 and 8-12 h; rates of postoperative nausea and vomiting, and pruritus at 24 h., Main Results: Six trials, including 436 patients, were identified. Rest pain score at 24 postoperative hours was significantly reduced in the hydromorphone group, with a mean difference (95 %CI) of -0.4 (-0.8 to -0.1), I 2  = 74 %, p = 0.01. Neuraxial hydromorphone did not increase postoperative nausea and vomiting (risk ratio [95 %CI]: 1.2 [0.8-1.8], I 2  = 27 %, p = 0.47), but increases pruritus (risk ratio [95 %CI]: 3.1 [1.6-5.9], I 2  = 0 %, p = 0.0005). The quality of evidence was very low for our primary and secondary outcomes. In conclusion, there is very low level of evidence that neuraxial hydromorphone provides effective analgesia after surgery or labor, at the expense of an increased rate of pruritus. The improvement in pain scores appears to be clinically insignificant. With only six trials published over a period of 30 years, we were unable to perform a meta-regression., Conclusions: If neuraxial hydromorphone is to be used regularly, trials focusing on the optimal dose and side-effects should be performed before widely administering this medication into the neuraxial space. More trials focusing on the optimal dose and side-effects should be performed before widely administering this medication into the neuraxial space., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Inconsistent nomenclature and anatomical descriptions of regional anesthetic techniques hinder scientific communication and engender confusion; this in turn has implications for research, education and clinical implementation of regional anesthesia. Having produced standardized nomenclature for abdominal wall, paraspinal and chest wall regional anesthetic techniques, we aimed to similarly do so for upper and lower limb peripheral nerve blocks., Methods: We performed a three-round Delphi international consensus study to generate standardized names and anatomical descriptions of upper and lower limb regional anesthetic techniques. A long list of names and anatomical description of blocks of upper and lower extremities was produced by the members of the steering committee. Subsequently, two rounds of anonymized voting and commenting were followed by a third virtual round table to secure consensus for items that remained outstanding after the first and second rounds. As with previous methodology, strong consensus was defined as ≥75% agreement and weak consensus as 50%-74% agreement., Results: A total of 94, 91 and 65 collaborators participated in the first, second and third rounds, respectively. We achieved strong consensus for 38 names and 33 anatomical descriptions, and weak consensus for five anatomical descriptions. We agreed on a template for naming peripheral nerve blocks based on the name of the nerve and the anatomical location of the blockade and identified several areas for future research., Conclusions: We achieved consensus on nomenclature and anatomical descriptions of regional anesthetic techniques for upper and lower limb nerve blocks, and recommend using this framework in clinical and academic practice. This should improve research, teaching and learning of regional anesthesia to eventually improve patient care., Competing Interests: Competing interests: EA: grants from Swiss Academy for Anesthesia Research, Bbraun, Swiss National Science Foundation. Honoraria from Bbraun and Sintetica. JG: consulting fees from Pacira Biosciences and Pajunk Medical. AP: honoraria from FuijiFilm Sonosite. MW: advisory Board for Sintetica, Honoraria from Wisonic and Medovate. SA: Advisory Panel for DATAR innovations. JA: moderator of the Working Group Regional Anaesthesia Switzerland, Honoraria from Medtronic and Sintetica. AMRA: honoraria form AllerganSébastien Bloc—Consulting fees from BBraun—GE Medical Systems—Pajunk—Pfizer SAS. JB: Consulting fees from Intelligent Ultrasound. BC: jonoraria from Bbraun and Rivanna, Consulting from Stryker and Flat Medical, Research funding from Pacira, Share Options from Flat Medical. AC: speaking honoraria from GE Healthcare, royalties from textbook Oxford University Press. SC: consulting fees from MSD, Bbraun Medical, Wisonic, research grants from BARA (Belgian association of Regional anesthesia), ESRA and BeSARP (Belgian anesthesia society) HE-Consulting/Advisory Board Neuronoff, SPR, GateScience, NeuronoffBenjamin Fox—Speaking fees from Medovate and Sintetica. SG: consulting and speaking fees from MSD Switzerland. PH: royalties from Bestek Products. NH: Honoraria from Butterfly Network. RMGH- Honoraria from GE Healthcare. MH: consulting fees from Pacira Biosciences, Honoraria from Parcira Biosciences and Pajunk Medical. BMI: research funding to institution from SPR Therapeutics, Infutronix, Epimed International. AM: Consultant fees from Intelligent Ultrasound. CM: consultant fees from Masimo Corporation. SGM: Owner SGM Consulting, Partner Parvizi Surgical Innovations, Patent for Multicatheter infusion system. AN: Research support from SPR Therapeutics. SLO: Royalties from book Wolters-Kluwer. APawa: Honoraria from GE Healthcare, Consulting fees from Pacira Biosciences. PP: equipment support from Sonosiite Fujifilm Canada. MPS: Medovate speaking but no honoraria paid. SKS- Cofounder of Gate Science (developing a catheter for performing nerve blocks) JS: consulting fees from Sintetica. RT: Consulting fees from Clarius Mobile Health. VU: Associate Editor of the Canadian Journal of Anesthesia and Regional Anesthesia & Pain Medicine journals. TV: honoraria from CSL Behring, Pajunk., (© American Society of Regional Anesthesia & Pain Medicine 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Intrathecal diamorphine is believed to provide postoperative analgesia but is associated with adverse effects such as nausea and vomiting. There is little evidence of synthesis regarding intrathecal diamorphine in the contemporary literature. We performed a systematic review, meta-analysis with meta-regression and trial sequential analysis to determine the magnitude of intrathecal diamorphine efficacy and safety., Methods: We systematically searched the literature for trials comparing intrathecal diamorphine with a control group in patients undergoing all types of surgery. The primary efficacy and safety outcomes were intravenous morphine consumption and incidence of postoperative nausea and vomiting at 24 h following surgery, respectively., Results: Twelve trials were identified, which included data for 712 patients. Intrathecal doses of diamorphine ranged from 100 μg to 2500 μg. Intravenous morphine consumption at 24 h postoperatively was significantly reduced in the intrathecal diamorphine group, with a mean difference (95%CI) of -8 mg (-11 to -6), I 2  = 93%, p < 0.001. There was a significant difference between three intrathecal diamorphine dosing subgroups but without correlation: mean differences (95%CI) -1 mg (-3-0), -26 mg (-40 to -11) and -6 mg (-15-4) in patients receiving doses of 0-200 μg, 201-400 μg and > 400 μg, respectively (p = 0.003). Intrathecal diamorphine increased postoperative nausea and vomiting with a risk ratio (95%CI) of 1.37 (1.19-1.58), I 2  = 7%, p < 0.001. There were no differences in postoperative nausea and vomiting between the three intrathecal diamorphine dosing subgroups. There was no correlation observed with meta-regression of the primary efficacy and safety outcomes. The quality of evidence for all outcomes was very low., Conclusion: There is very low level of evidence that intrathecal diamorphine provides effective analgesia after surgery, while increasing postoperative nausea and vomiting with doses > 200 μg., (© 2024 The Author(s). Anaesthesia published by John Wiley & Sons Ltd on behalf of Association of Anaesthetists.)

This paper describes the methodology used to create a fuel data library comprising safeguards-relevant quantities that may be useful for verification of spent nuclear fuel (SNF) produced by simulating a concept Molten Salt Reactor (MSR). The Monte-Carlo particle transport code, Serpent2 and the calculation code SOURCES 4C were used to compile this fuel data library. The data library is based on the Compact Molten Salt Reactor (CMSR) concept being developed by Seaborg Technologies (based in Copenhagen, Denmark). The library includes data such as nuclide mass densities for a total of 1398 nuclides (in g/cm 3 ), as well as total decay heat production (denoted by suffix the 'TOT&#95;DH' ) in Watts, total gamma photon emission rates (denoted by the suffix 'TOT&#95;GS' ) in photos per second, and the total activity (denoted by suffix 'TOT&#95;A' ) in Becquerel. Lastly, the data also includes total neutron emission rates from 1) spontaneous fission (denoted by 'SF' and reported in neutrons per second per cm 3 ), and 2) (ɑ, n) reactions (denoted by 'AN' and reported in neutrons per second per cm 3 ) for the fuel salt. These quantities are reported for a range of burnup-initial enrichment-cooling time (or collectively known as, BIC) parameters. The resulting fuel data library is an extension of a previously published data library for the same reactor concept but with one significant change. The current library is based on a more realistic model of the CMSR involving movement of gaseous and volatile fission products (GFP and VFP) from the core via an Off-Gas System (OGS). The dataset is made available for public use in a compressed binary format as an HDF5 (or Hierarchical Data Format) file that can be parsed using data analysis tools such as Pandas., (© 2024 The Author(s).)

This paper describes the creation and description of a nuclear fuel isotopics dataset for irradiated fuel salt from a Molten Salt Reactor (MSR). The dataset has been created using simulations carried out using the Monte-Carlo particle transport code, Serpent 2.1.32 (released February 24, 2021) and the calculation code SOURCES 4C (released October 09, 2002) for computing properties of irradiated molten fuel salt. The dataset comprises isotopic mass densities of 1362 isotopes (including fission products and major and minor actinides) and their corresponding contributions to decay heat, gamma activity, and spontaneous fission rates computed by Serpent 2.1.32 as well as overall neutron emission rates from spontaneous fission and (ɑ, n) reactions computed by SOURCES 4C. These quantities are computed for a model MSR core utilizing a full-core 3D model of the Seaborg Compact Molten Salt Reactor (CMSR). The dataset spans a wide range of values of burnup (BU), initial enrichment (IE) and cooling time (CT) over which the above-mentioned quantities are reported. The structure of the dataset includes isotopic mass densities (in g/cm 3 ), followed by isotope-wise contributions to decay heat (denoted by suffix '&#95;DH' and reported in Watts), gamma photon emission rates (denoted by suffix '&#95;GS' and reported photons per second), and spontaneous fission rates (denoted by suffix '&#95;SF' and reported in fissions per second). In addition to these columns, the data also includes total neutron emission rates from 1) spontaneous fission (denoted by 'SF' and reported in neutrons per second per cm 3 ), and 2) (ɑ, n) reactions (denoted by 'AN' and reported in neutrons per second per cm 3 ). In total, the dataset has 310,575 rows of different combinations of fuel burnup, initial enrichment, and cooling time (BIC) values spanning the realistic possible range of these parameters. The dataset is made available for public use in a comma-separated value file that can be easily read using one of the numerous popular data analysis tools such as NumPy or Pandas., (© 2023 The Author(s).)

Surgical Site Infections account for 15-30% of healthcare-associated infections. Surgical antibiotic prophylaxis is one of well-documented measures to decrease the risk of infections. However, many situations threaten its proper application and thereby its effectiveness: patient already receiving antibiotics or carrying resistant germs, clinicians' misunderstanding about timing and duration of antibiotic prophylaxis or patient history of penicillin allergy. In this article we try to clarify these situations to favour good practice in perioperative antibiotic prophylaxis., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Background: Liposomal bupivacaine is claimed by the manufacturer to provide analgesia for up to 72 h postoperatively., Objectives: To compare the postoperative analgesic efficacy of liposomal bupivacaine versus long-acting local anaesthetics for peripheral nerve or field blocks., Design: A systematic review and meta-analysis with trial sequential analysis., Data Sources: MEDLINE, Embase and Web of Science, among others, up to June 2022., Eligibility Criteria: We retrieved randomised controlled trials comparing liposomal bupivacaine versus bupivacaine, levobupivacaine or ropivacaine for peripheral nerve and field blocks after all types of surgery. Our primary endpoint was rest pain score (analogue scale 0 to 10) at 24 h. Secondary endpoints included rest pain score at 48 and 72 h, and morphine consumption at 24, 48 and 72 h., Results: Twenty-seven trials including 2122 patients were identified. Rest pain scores at 24 h were significantly reduced by liposomal bupivacaine with a mean difference (95% CI) of -0.9 (-1.4 to -0.4), I2  = 87%, P  < 0.001. This reduction in pain scores persisted at 48 h and 72 h with mean differences (95% CI) of -0.7 (-1.1 to -0.3), I2  = 82%, P  = 0.001 and -0.7 (-1.1 to -0.3), I2  = 80%, P  < 0.001, respectively. There were no differences in interval morphine consumption at 24 h ( P  = 0.15), 48 h ( P  = 0.15) and 72 h ( P  = 0.07). The quality of evidence was moderate., Conclusions: There is moderate level evidence that liposomal bupivacaine reduces rest pain scores by 0.9 out of 10 units, when compared with long-acting local anaesthetics at 24 hours after surgery, and by 0.7 up to 72 hours after surgery., (Copyright © 2023 European Society of Anaesthesiology and Intensive Care. Unauthorized reproduction of this article is prohibited.)

Background: Hypnosis can be a beneficial complementary anesthesia technique for a variety of surgical procedures. Despite favorable scientific evidence, hypnosis is still rarely used in the operating room. Obstacles to implementation could be a lack of interest or training, misconceptions, as well as limited knowledge amongst anesthesiology teams. Hence, this study aimed to assess the interest, training, beliefs, and knowledge about hypnosis in the operating room staff., Design: A questionnaire with 21-items, based on a prior survey, was set up on an online platform. The medical and nursing anesthesiology staff of four Swiss academic and large regional hospitals (N = 754) were invited to participate anonymously through e-mails sent by their hierarchy. Results were analyzed quantitatively., Results: Between June, 2020 and August, 2021 353 answers were collected (47% response rate). Most (92%) were aware that hypnosis needs specific training, with 14% trained. A large majority of the untrained staff wished to enroll for conversational hypnosis training. There was a strong agreement for hypnosis playing a role in anesthesia. Nevertheless, many of these professionals believed that hypnosis has a limited field of action (53%) or that it would be too time consuming (33%). The reduction of misconceptions was based more on exposure to hypnosis than on training., Conclusion: Overall, anesthesia providers' attitude was in favor of using hypnosis in the operating room. Misconceptions such as a prolongation of the procedure, alteration of consent, lack of acceptability for patients, and limited indications were identified as potential barriers. These deserve to be challenged through proper dissemination of the recent scientific literature and exposure to practice., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Intrathecal opioids have been used for several decades in different clinical settings. They are easy to administer and provide many benefits in clinical practice, such as better quality of spinal anaesthesia, prolonged postoperative analgesia, decreased postoperative analgesic requirements and early mobilisation. Several lipophilic and hydrophilic opioids are available for intrathecal administration, either in combination with general anaesthesia or as adjuncts to local anaesthetics. Adverse effects after intrathecal lipophilic opioids administration are predominantly short-lived and benign. In contrast, intrathecal hydrophilic opioids may have potentially serious adverse effects, the most feared of which is respiratory depression. In this review, we will focus on the contemporary evidence regarding intrathecal hydrophilic opioids and present their adverse effects and how to manage them., Competing Interests: Declaration of competing interest EA has received grants from the Swiss Academy for Anaesthesia Research (SACAR), Lausanne, Switzerland (no grant numbers attributed), from B. Braun Medical AG, Sempach, Switzerland (no grant numbers attributed), and from the Swiss National Science Foundation to support his clinical research. EA has also received an honorarium from B. Braun Medical AG Switzerland, from Sintetica Ltd UK and MSD AG Switzerland. SG has received a research grant and speakers honoraria from MSD AG Switzerland. KE or his institution has received educational, honorarial or research funding from Fisher and Paykel Healthcare, GE Health, Edwards Lifesciences., (Copyright © 2023 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

The decision to continue or to stop oral anticoagulant therapy in the peri-interventional period is based on the evaluation of bleeding risk associated with the invasive procedure or with the anaesthetic technique, especially when a deep nerve block or a neuraxial block is planned, and on the evaluation of patient-associated risk factors. Anticoagulant bridging during the preoperative period as well as an early resumption of anticoagulation in the postoperative period are associated with increased bleeding rates without reduction of thromboembolic events, thus limiting the indications of bridging to patients with chronic vitamin K agonist therapy and a high thrombotic risk., Competing Interests: Les auteures n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Introduction: Hemidiaphragmatic paresis after ultrasound-guided supraclavicular brachial plexus block is reported to occur in up to 67% of patients. We tested the hypothesis that an injection outside the brachial plexus sheath reduces the incidence of hemidiaphragmatic paresis compared with an intrafascial injection while providing similar analgesia., Methods: Fifty American Society of Anesthesiologists I-III patients scheduled for elective upper limb surgery received a supraclavicular brachial plexus block using 30 mL of 1:1 mixture of mepivacaine 1% and ropivacaine 0.5%. The block procedures were randomized to position the needle tip either within the brachial plexus after piercing the sheath (intrafascial injection) or outside the brachial plexus sheath (extrafascial injection). The primary outcome was the incidence of hemidiaphragmatic paresis 30 min after the injection, measured by M-mode ultrasonography. Additional outcomes included time to surgery readiness, and resting and dynamic pain scores at 24 hours postoperatively (Numeric Rating Scale, 0-10)., Results: The incidence of hemidiaphragmatic paresis 30 min after the injection was 9% (95% CI 1% to 29%) and 0% (95% CI 0% to 15%) in the intrafascial and extrafascial groups respectively (p=0.14). Extrafascial injection was associated with a longer time to surgery readiness (intrafascial: 18 min (95% CI: 16 to 21 min); extrafascial: 37 min (95% CI: 31 to 42 min); p<0.001). At 24 hours, resting and dynamic pain scores were similar between groups., Discussion: Ultrasound-guided supraclavicular brachial plexus block with an extrafascial injection does not reduce the incidence of hemidiaphragmatic paresis although it provides similar analgesia, when compared with an intrafascial injection. The longer time to surgery readiness is less compatible with contemporary operating theater efficiency requirements., Trial Registration Number: NCT03957772., Competing Interests: Competing interests: EA received grants from the Swiss Academy for Anesthesia Research (SACAR), Lausanne, Switzerland, B. Braun Medical AG, Sempach, Switzerland and the Swiss National Science Foundation, Bern, Switzerland to support his clinical research. EA has also received an honorarium from B. Braun Medical AG Switzerland, Sintetica UK and MSD AG Switzerland. SG received a research grant and an honorarium from MSD AG Switzerland., (© American Society of Regional Anesthesia & Pain Medicine 2022. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Both transversus abdominis plane (TAP) block and wound infiltration with local anaesthetic have been used to relieve pain after inguinal or infra-umbilical hernia repair., Objectives: To determine whether TAP block or local anaesthetic infiltration is the best analgesic option after inguinal or infra-umbilical hernia repair., Design: Systematic review and meta-analysis with trial sequential analysis., Data Sources: MEDLINE, Embase, Cochrane Central Register of Controlled Clinical Trials, Web of Science, up to June, 2020., Eligibility Criteria: We retrieved randomised controlled trials comparing TAP block with wound infiltration after inguinal or infra-umbilical hernia repair. Primary outcome was rest pain score (analogue scale 0 to 10) at 2 postoperative hours. Secondary pain-related outcomes included rest pain score at 12 and 24 h, and intravenous morphine consumption at 2, 12 and 24 h. Other secondary outcomes sought were block-related complications such as rates of postoperative infection, haematoma, visceral injury and systemic toxicity of local anaesthetic., Results: Seven trials including 420 patients were identified. There was a significant difference in rest pain score at 2 postoperative hours in favour of TAP block compared with wound infiltration, with a mean (95% confidence interval) difference of -0.8 (-1.3 to -0.2); I2  = 85%; P   =  0.01. Most secondary pain-related outcomes were also significantly improved following TAP block. No complication was reported. The overall quality of evidence was moderate., Conclusion: There is moderate level evidence that TAP block provides superior analgesia compared with wound infiltration following inguinal or infra-umbilical hernia repair., Trial Registry Number: PROSPERO CRD42020208053., (Copyright © 2022 European Society of Anaesthesiology and Intensive Care. Unauthorized reproduction of this article is prohibited.)

Background: Transversus abdominis plane (TAP) block and local anaesthetic wound infiltration are used to relieve pain after caesarean section., Objectives: To determine whether TAP block or local anaesthetic wound infiltration is the better analgesic option after caesarean section., Design: Systematic review and meta-analysis with trial sequential analysis., Data Sources: MEDLINE, Embase, Cochrane Central Register of Controlled Clinical Trials, Web of Science up to June 2020., Eligibility Criteria: We retrieved randomised controlled trials comparing TAP block with wound infiltration after caesarean section. Primary outcome was pain score during rest (analogue scale, 0 to 10) at 2 h postoperatively, analysed according to the TAP block technique (ultrasound-guided/landmark-guided), anaesthetic strategy (spinal/general), intrathecal fentanyl (yes/no) and multimodal analgesia (yes/no). Secondary pain-related outcomes included pain scores during rest at 12 and 24 h, and total intravenous morphine consumption at 2, 12 and 24 h. We sought rates of block complications, including postoperative infection, haematoma, visceral injury and local anaesthetic systemic toxicity., Results: Seven trials, totalling 475 patients, were identified. There was no difference in pain score during rest at 2 h between groups. Subgroup analyses revealed no differences related to TAP block technique (P = 0.64), anaesthetic strategy (P = 0.53), administration of intrathecal fentanyl (P = 0.59) or presence of multimodal analgesia (P = 0.57). Pain score during rest at 12 h and intravenous morphine consumption at 2 and 12 h were identical in both groups. Data were insufficient to compare block complications. Overall quality of evidence was moderate., Conclusion: There is moderate level evidence that TAP block and wound infiltration provide similar postoperative analgesia after caesarean section., Trial Registry Number: PROSPERO CRD42020208046., (Copyright © 2021 European Society of Anaesthesiology and Intensive Care. Unauthorized reproduction of this article is prohibited.)

Widespread adoption of intrathecal morphine into clinical practice is hampered by concerns about its potential side-effects. We undertook a systematic review, meta-analysis and trial sequential analysis with the primary objective of determining the efficacy and safety of intrathecal morphine. Our secondary objective was to determine the dose associated with greatest efficacy and safety. We also assessed the impact of intrathecal morphine on respiratory depression. We systematically searched the literature for trials comparing intrathecal morphine with a control group in patients undergoing hip or knee arthroplasty under spinal anaesthesia. Our primary efficacy outcome was rest pain score (0-10) at 8-12 hours; our primary safety outcome was the rate of postoperative nausea and vomiting within 24 hours. Twenty-nine trials including 1814 patients were identified. Rest pain score at 8-12 hours was significantly reduced in the intrathecal morphine group, with a mean difference (95%CI) of -1.7 (-2.0 to -1.3), p < 0.0001 (19 trials; 1420 patients; high-quality evidence), without sub-group differences between doses (p = 0.35). Intrathecal morphine increased postoperative nausea and vomiting, with a risk ratio (95%CI) of 1.4 (1.3-1.6), p < 0.0001 (24 trials; 1603 patients; high-quality evidence). However, a sub-group analysis by dose revealed that rates of postoperative nausea and vomiting within 24 hours were similar between groups at a dose of 100 µg, while the risk significantly increased with larger doses (p value for sub-group difference = 0.02). Patients receiving intrathecal morphine were no more likely to have respiratory depression, the risk ratio (95%CI) being 0.9 (0.5-1.7), p = 0.78 (16 trials; 1173 patients; high-quality evidence). In conclusion, there is good evidence that intrathecal morphine provides effective analgesia after lower limb arthroplasty, without an increased risk of respiratory depression, but at the expense of an increased rate of postoperative nausea and vomiting. A dose of 100 µg is a 'ceiling' dose for analgesia and a threshold dose for increased rate of postoperative nausea and vomiting., (© 2021 The Authors. Anaesthesia published by John Wiley & Sons Ltd on behalf of Association of Anaesthetists.)

Background: Both transversus abdominis plane (TAP) block and local anesthetic wound infiltration have been used to relieve pain after laparoscopic cholecystectomy. We undertook this systematic review and meta-analysis with trial sequential analysis to determine the best analgesic technique., Methods: We systematically searched the literature for trials comparing TAP block with wound infiltration after laparoscopic cholecystectomy. The primary outcome was pain score during rest (analogue scale, 0-10) at 2 postoperative hours. Secondary pain-related outcomes included pain scores during rest at 12 and 24 h, pain scores during movement and intravenous morphine consumption at 2, 12 and 24 h, and postoperative nausea and vomiting. Other secondary outcomes sought were block-related complications such as rates of postoperative infection, hematoma, visceral injury and local anesthetic systemic toxicity., Results: Ten trials including 668 patients were identified. There was a significant difference in pain score during rest at 2 postoperative hours in favour of TAP block when compared with wound infiltration (mean difference [95%CI]: -0.7 [-1.2, -0.2]; I2 = 71%; p = 0.008). Pain scores during rest at 12 and 24 h and pain scores during movement at 24 h were also significantly lower with TAP block than wound infiltration. Postoperative morphine consumption and the incidence of postoperative nausea and vomiting were significantly lower in patients who received a TAP block. Data were insufficient to compare block-related complications. The overall quality of evidence was moderate-to-high., Conclusions: There is moderate-to-high level evidence that the TAP block provides superior analgesia when compared with wound infiltration in patients undergoing laparoscopic cholecystectomy. Trial registry number: PROSPERO CRD42020208057., (Copyright © 2021 Elsevier Inc. All rights reserved.)

The paper describes a data library containing material composition of spent nuclear fuel. The data is extracted from burnup and depletion calculations with the Serpent2 code. The simulations were done with a PWR fuel pin cell geometry, for both initial UO 2 and MOX fuel load for a wide range of initial enrichments (IE) or initial plutonium content (IPC), discharge burnup (BU) and cooling time (CT). The fuel library contains the atomic density of 279 nuclides (fission products and actinides), the total spontaneous fission rate, total photon emission rate, activity and decay heat at 789,406 different BU, CT, IE configurations for UO 2 fuel and at 531,991 different BU, CT, IPC configurations for MOX fuel. The fuel library is organized in a publicly available comma separated value file, thus its further analysis is possible and simple., Competing Interests: None., (© 2020 The Authors.)

The transversus abdominis plane (TAP) block has been used to relieve pain after bariatric surgery but with conflicting data on its analgesic efficacy. We conducted this systematic review and meta-analysis with trial sequential analysis to clarify whether TAP block provides effective postoperative analgesia in patients undergoing bariatric surgery. We systematically searched the literature for any trials comparing TAP block with a control group (no block or sham injection). The primary outcome was pain scores at rest (analog scale, 0-10) at 2 postoperative hours. Secondary pain-related outcomes included pain scores at rest at 12 and 24 h and both dynamic pain scores and intravenous morphine equivalent consumption at 2, 12 and 24 h. Additional secondary outcomes sought were rates of postoperative infection, haematoma, visceral injury and local anaesthetic systemic toxicity. Thirteen trials totalling 1025 patients were identified. Pain scores at rest at 2 postoperative hours were significantly lower in the TAP block group compared with the control group, with a mean (95% CI) difference of - 1.8 (- 2.5, - 1.1); I2 = 85%; p < 0.00001. All other secondary pain-related outcomes were also significantly lower in the intervention group with the exception of dynamic pain scores and intravenous morphine equivalent consumption at 2 postoperative hours. Rates of block-related complications were not significantly different between groups. The overall quality of evidence was moderate-to-low. There is moderate-to-low level evidence that the TAP block improves postoperative analgesia after bariatric surgery up to 24 postoperative hours, when compared with a control group, without major reported complications. Clinical Trial NumberPROSPERO - registration number: CRD42019136542.

Study Objective: To determine whether pectoral nerves (PECS) blocks provide effective postoperative analgesia when compared with no regional technique in patients undergoing breast surgery., Design: Systematic review, meta-analysis and trial sequential analysis., Setting: Operating room, postoperative recovery area and ward, up to 24 postoperative hours., Patients: Patients undergoing breast surgery under general anaesthesia with either PECS block or no regional technique., Interventions: We searched five electronic databases for randomized controlled trials comparing PECS block with no block or sham injection., Measurements: The primary outcome was rest pain scores (analogue scale, 0-10) at 2 h, analysed according to surgery (mastectomy vs other breast surgery) and regional technique (PECS 2 vs other blocks), among others. Secondary outcomes included morphine equivalent consumption, and rate of postoperative nausea and vomiting at 24 h., Main Results: Sixteen trials including 1026 patients were identified. Rest pain scores at 2 h were decreased in the PECS blocks group, with a mean (95%CI) difference of -1.5 (-2.0, -1.0); I2 = 93%; p < 0.001, with no differences between surgery (mastectomy, mean difference [95%CI]: -1.8 [-2.4, -1.2], I 2  = 91%, p < 0.001; other breast surgery, mean difference [95%CI]: -1.1 [-2.1, -0.1], I 2  = 94%, p = 0.03; p for subgroup difference = 0.25), and regional technique (PECS 2, mean differences [95%CI]: -1.6 [-2.3, -1.0], I 2  = 94%, p < 0.001; other blocks, mean differences [95%CI]: -1.3 [-2.4, -0.1], I 2  = 74%, p = 0.04; p for subgroup difference = 0.57). The rate of postoperative nausea and vomiting was reduced from 30.8% (95%CI: 25.7%, 36.3%) to 18.7% (95%CI, 14.4%, 23.5%; p = 0.01). Similarly, secondary outcomes were significantly improved in the PECS blocks group. The overall quality of evidence was moderate-to-high., Conclusions: There is moderate-to-high level evidence that PECS blocks provide postoperative analgesia after breast surgery when compared with no regional technique and reduce rate of PONV. This might provide the most benefit to those at high-risk of postoperative pain., Competing Interests: Declaration of competing interest EA has received grants from the Swiss Academy for Anaesthesia Research (SACAR), Lausanne, Switzerland (no grant numbers attributed) and from B. Braun Medical AG, Sempach, Switzerland (no grant numbers attributed) and from the Swiss National Science Foundation to support his clinical research. EA has also received an honorarium from B. Braun Melsungen AG, Melsungen, Germany. No interest declared by the other authors., (Copyright © 2020 Elsevier Inc. All rights reserved.)