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Over the last few years, percutaneous procedures have undergone great advances, thanks to the ultrasound (US) guidance, due to the technical improvements in the US field, combined with the greater availability, good portability, and reduced cost of US devices. The direct target visualization and the real-time imaging performance enabled by US-guidance account for an improved accuracy in needle placement in several rheumatology interventions. So, ultrasound-guided procedures contribute to several diagnostic or therapeutic procedures such as fluid aspiration or treatment instillations of common joints, tendons, and bursas. In clinical practice, this fact is especially important in the case of depth areas like the hip, small anatomical structures as tendon sheaths or nerves in tenosynovitis or nervous blocks, or complex anatomical structures like the spine's facet joints. The US-guide is an essential tool for performing diagnostic procedures as synovial biopsy. US can also be combined with other imaging techniques, like the establishment portal arthroscopy for instance. Compared to older blind procedures, US-guided injections are more accurate and safer, and they result in better clinical outcomes in terms of joints improvement in function and decreased risk of damages caused by needle misplacement. With the ultrasound guided treatment, we can avoid the instillation of therapeutic products outside the predetermined target, which may be sometimes potentially harmful. The aim of this article is to describe the main generalities of ultrasound-guided procedures in rheumatology, their main advantages and disadvantages, and their particularities in joints where they are most frequently used, such as the shoulder, hip, and knee. [ABSTRACT FROM AUTHOR]

Tennis elbow, also commonly known as lateral epicondylitis or common extensor tendinosis, is a common musculoskeletal injury in the adult population. Currently, the standard treatment regimen prescribed for this injury involves a combination of rest, physical therapy, bracing and anti-inflammatory medications. If refractory to these conservative measures, platelet-rich plasma has been shown effective. However, in the case of full thickness tears, surgery has remained the only treatment option until now. We present a case report of a 56-year-old man with a diagnosis of a left large full thickness tear and rupture with retraction of his common extensor tendon (CET) following a corticosteroid injection. The patient was treated with microfragmented adipose transfer. He was re-evaluated around 7 weeks and again at 15 weeks post-treatment and demonstrated ultrasound evidence of complete bridging and remodeling of his prior full thickness CET tear and resolution of retraction. This case presents a promising option for patients with full thickness CET tears who would like to refrain from or are unable to have surgery. Further research and possible randomized controlled trials are needed to further assess the full efficacy of microfragmented adipose transfer in the treatment of full thickness CET tears. Plain Language Summary Adipose cells from a patient's own body fat are one of the best sources of mesenchymal stem cells (MSC) and growth factors that contribute to the generation of collagen protein fibers. MSC's are versatile cells that can differentiate into a variety of cell types, while collagen is an important component of muscles and tendons, as it provides structure. MSC's can be harvested from one's own fat and then used to help supplement the body's natural repair process of a variety of injured tissues. This case presents a patient with a history of persistent elbow pain caused by a large full-thickness tear and rupture of the common extensor tendon (CET) of the elbow. Full thickness tears are large deep tears that extend across the entirety of the tendon. Generally, partial CET tears of varying severities are some of the most common tendon injuries seen in the elbow and are injuries that historically, are treated with conservative management, such as pain medication, cortisone injection, physical therapy, platelet-rich plasma or surgery once/if conservative interventions fail. Full thickness tears, however, usually require surgery for patients to feel better. In this case, the patient underwent a novel regenerative treatment alternative to surgery, known as microfragmented adipose transfer (MFAT), to repair the torn CET. Fat was harvested from his flanks, was washed and cleaned, then injected into the CET tear of the elbow. He experienced significant improvements in function and pain and tendon healing was documented using ultrasound and MRI imaging. This case supports using MFAT for lateral elbow pain caused by full-thickness CET tears as a novel and significantly less invasive method than surgery. Our case illustrates the need for more research and possible clinical trials evaluating MFAT as a treatment option for common musculoskeletal pathologies. Article highlights Lateral epicondylitis, or more aptly named common extensor tendinosis, is the most common elbow pathology Common extensor tendinosis can typically be managed by conservative measures such as physiotherapy, but for full thickness common extensor tendon (CET) tears, surgery is often the only viable option Microfragmented adipose transfer (MFAT) procedure may be a viable alternative to surgery for patients with full thickness CET/common extensor ruptures with minor retraction who are not good surgical candidates or prefer to avoid surgery MFAT is viable alternative to surgery as it has faster recovery time and reduced risk profile in comparison to surgery 56-year-old man with a large full thickness tear and rupture of his CET was treated with MFAT, along with a follow-up treatment of platelet-rich plasma 15 weeks later. Post-treatment MRI and ultrasound imaging demonstrated evidence of complete bridging of his prior full thickness CET tear at 30 months This case represents a novel documented use of MFAT as a successful treatment modality for full-thickness CET tears Further research is warranted on the efficacy of MFAT for full thickness tendon tears. [ABSTRACT FROM AUTHOR]

Background and Aims Inguinal hernia is a commonly performed surgical procedure globally, which is often accompanied by significant post-operative pain that peaks on the day of the surgery. The transversus abdominis plane block (TAP) offers better postoperative pain relief for lower abdominal procedures. However, the duration of TAP block is restricted by the effects of given local anaesthetic drugs, necessitating the use of an adjuvant, such as buprenorphine, to improve the quality and duration of analgesia. Hence, we designed the present study to analyse the effect of a TAP block with buprenorphine on the relief of pain after inguinal hernia repair surgery. Methods A prospective, randomized, double-blinded study was conducted on fifty American Society of Anaesthesiologists Physical Status I and II patients posted for elective unilateral inguinal hernia repair under spinal anaesthesia. At the end of the surgery, group B patients received 20 ml of 0.25% bupivacaine and group BB patients received 20 ml of 0.25% bupivacaine along with 300 mg of buprenorphine for ultrasound-guided transversus abdominis plane block. The duration of analgesia, postoperative analgesic consumption and pain scores at rest and during sitting up to 24 h were recorded. Results Patients who received perineural buprenorphine experienced prolonged duration of analgesia (870.32 ± 27.86 vs. 385.64 ± 27.86 minutes), lower tramadol consumption (135.08 ± 23.05 vs. 246.72 ± 38.8 mg), and decreased pain scores both at rest and during sitting for up to 24 hours post-surgery. Conclusion The present study shows that the addition of buprenorphine to bupivacaine in TAP block after inguinal hernia repair produces superior postoperative analgesia compared with the control group without any significant side effects.

Background: Percutaneous techniques have transformed vascular cannulation. It has reduced the need for open procedures and the associatedwoundcomplications, but percutaneous techniques have made physicians dependent on relationships between surface anatomic landmarks and deep anatomic structures. Now, percutaneous central venous catheter insertion by physicians has a lesser complication rate. During central venous catheterization, the complications include infection, occlusion, thrombosis and mechanical complications. Aims and Objective: To relate the inner course of cannulating needle, familiarity of surface anatomic landmarks excludes the complication. Deep anatomic relationships visualization does not only improves the efficacy and safety of the procedure but also supplements the operator’s ability to identify difficult cannulations. The safety of internal jugular cannulations increases with ultrasound visualization. Central venous cathetrization (CVC) is done for hemodynamic monitoring (such as central venous pressure) long-term administration of fluids, antibiotics, total parental nutrition, and hemodialysis. Material and Methods: Most commonly, the internal jugular vein (IJV) is cannulated because of its relatively less complications and easy accessibility. Seldinger technique is used for IJV cannulation. Landmark-guided IJV cannulation is associated with a more number of complications compared to ultrasound-guided cannulation. Ultrasound-guided cannulation improves success rate, reduces the number of needle passes, and decreases complications. Two different real-time ultrasound-guided cannulations of IJV using a short axis/out-of-plane (SA) approach and a long axis/in plane (LA) approach are compared in the study. Hence, the present study was done at our tertiary care center to compare ultrasound-guided IJV access between SA and LA technique method with the number of attempts and complications. Results: It was observed in the present study that 4 (10%) patients in Long axis group had posterior wall puncture while 9 (22.5%) patients in short axis group had posterior wall puncture. Conclusion: Posterior wall puncture incidence is lesser in long axis group than short axis group.

A 29-year-old right-handed woman presented to an outside emergency department with right small finger pain, swelling, and concern for a retained wooden splinter. Diagnosis and treatment were delayed for 2 weeks due to the inability to identify the foreign body clinically or radiographically. Ultimately, ultrasonography by a fellowship-trained specialist was used to localize the wooden splinter. It was embedded within the flexor tendon sheath but had migrated away from its initial point of entry. The patient underwent subsequent surgical extraction, irrigation, and debridement. Two weeks following surgery, she had regained full range of motion through her digit without signs of infection. This case highlights the use of diagnostic ultrasound to identify a radiolucent foreign body, such as a wooden splinter, and to guide subsequent surgical extraction.

Introduction: Image-guided invasive procedures on the liver require a steep learning curve to acquire the necessary skills. The best and safest way to achieve these skills is through hands-on courses that include simulations and phantoms of different complications, without any risks for patients. There are many liver phantoms on the market made of various materials; however, there are few multimodal liver phantoms, and only two are cast in a 3D-printed mold. Methods: We created a virtual liver and 3D-printed mold by segmenting a CT scan. The InVesalius and Autodesk Fusion 360 software packages were used for segmentation and 3D modeling. Using this modular mold, we cast and tested silicone- and gelatin-based liver phantoms with tumor and vascular formations inside. We tested the gelatin liver phantoms for several procedures, including ultrasound diagnosis, elastography, fibroscan, ultrasound-guided biopsy, ultrasound-guided drainage, ultrasound-guided radio-frequency ablation, CT scan diagnosis, CT–ultrasound fusion, CT-guided biopsy, and MRI diagnosis. The phantoms were also used in hands-on ultrasound courses at four international congresses. Results: We evaluated the feedback of 33 doctors regarding their experiences in using and learning on liver phantoms to validate our model for training in ultrasound procedures. Conclusions: We validated our liver phantom solution, demonstrating its positive impact on the education of young doctors who can safely learn new procedures thus improving the outcomes of patients with different liver pathologies. [ABSTRACT FROM AUTHOR]

Introduction. Patients with painful shoulder and long head of the biceps (LHB) tendinopathy are candidates for shoulder arthroscopy or other major procedures. However, for patients with comorbidities or to old, a minimally invasive LHB tenotomy may be indicated. We describe the outcomes of ultrasound-assisted LHB tenotomy performed under local anesthesia. Materials and methods. Between 2015 and 2020, 33 patients underwent echo-guided tenotomy surgery. Inclusion criteria were painful shoulder without pseudo paralysis, intact LHB, and inability or refusal to major surgery. Under ultrasound guidance, the LHB is located and fixed with a 18G needle at the proximal biceps groove. After local anesthesia, a mini-open tenotomy is performed. Both a Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score and pain on the visual analog scale (VAS) were recorded at baseline and at follow-up. Satisfaction (1 to 5) and adverse events were recorded. Results. Among the 33 eligible patients, 7 were lost at follow-up. The 26 (of which 17 women) patients enrolled had a median age of 76.5 years (IQR = 7). Mean follow-up was 39.5 months (range 8-63). Median QuickDASH changed from 67.1 to 21.6. Median VAS score before and after tenotomy was 8.5 and 3.5 respectively. Mean satisfaction score was 4.1. We recorded 7 Popeye deformities and 6 hematomas. Four patients presented with cramps and 6 reported a reduction of strength. Only 4/26 would not undergo the procedure again. Conclusions. The ultrasound-assisted LHB tenotomy was confirmed as a reliable and safe. [ABSTRACT FROM AUTHOR]

Objective: This prospective study aimed to compare the efficacy of caudal block (CB) and ilioinguinal/iliohypogastric nerve block (IINB) for providing additional analgesia during unilateral orchidopexy. Methods: Seventy-one boys aged <48 months, classified as ASA I/II, were assigned into CB (n = 37) and IINB (n = 34) groups. Outcome measures included intra- and postoperative analgesic requirements, pain scores, and administration duration. Additional intraoperative analgesia was administered for a 10% increase in heart rate, while postoperative pain was assessed using the Children's and Infants Postoperative Pain Scale (CHIPPS), with scores >4 prompting supplementary analgesia. Monitoring was extended for 24 h post-surgery. Results: CB significantly reduced the need for intraoperative (p < 0.001) and early postoperative (p = 0.008) analgesia compared to IINB. However, the CB group exhibited a slightly higher but non-significant analgesic requirement on the ward. No clinically relevant side effects were observed in either group. Conclusions: Both CB and IINB are effective and safe methods for providing regional analgesia during orchidopexy. CB demonstrates superior efficacy intraoperatively and in the early postoperative period, while IINB may offer advantages in the later recovery phase. However, additional analgesia is often required for orchidopexy, especially in outpatient settings. [ABSTRACT FROM AUTHOR]

Background and objective: Lung cancer is increasingly common, and accurate diagnosis is important for personalized treatment. Ultrasound-guided percutaneous fine-needle aspiration (FNA) is a useful method to obtain a specimen for a histological diagnosis of peripheral lung lesions. The aim of this study is to evaluate the diagnostic accuracy and complication rate of the procedure performed by pulmonologists. The result is compared with that of ultrasound-guided core needle biopsy performed by radiologists. Methods: We retrospectively evaluated the diagnostic accuracy and complication rates of pulmonologist-performed ultrasound-guided FNAs of lung lesions in the period of 1 August 2019 to 30 June 2021 (pulmonologist group) and radiologist-performed ultrasound-guided core needle biopsies (CNBs) of lung lesions in the period of 1 January 2010 to 31 December 2014 (radiologist group). A logistic regression analysis was used to identify independent influence factors associated with diagnostic accuracy in the pulmonologist group and in the combination of both groups. Results: In a 23-month period, pulmonologists in a tertiary center performed 113 episodes of ultrasound-guided fine-needle aspiration for peripheral lung lesions. The diagnostic accuracy and complication rates were 80.4% and 5.3%, respectively, compared to 86.8% and 7.4% in a historical cohort consisting of 68 episodes of ultrasound-guided core needle biopsies performed by radiologists in the same hospital. Lung lesions located in the upper lobe were predictive of successful diagnoses. Conclusions: An ultrasound-guided fine-needle aspiration by a pulmonologist is an easily accessible and reliable method to obtain specimens for histological diagnoses. [ABSTRACT FROM AUTHOR]

Introduction Pectoralis major muscle ruptures, once considered rare, are now more common, especially in young male athletes and weightlifters involved in high-intensity sports. This injury can significantly impair upper limb function, leading to pain, weakness, and potential disability. Exploring and understanding available treatment options, particularly the promising role of orthobiologic therapies like PRP, is essential for optimizing recovery and achieving the best outcomes. Purpose The purpose of this review is to evaluate the effectiveness and the role of orthobiologic treatments such as PRP in enhancing healing and functional recovery for pectoralis major muscle ruptures. Conslusions The treatment of pectoralis major muscle ruptures requires a tailored approach that considers the injury's severity, the patient's activity level, and their goals. Nonoperative treatment can be effective for partial tendinous tears, muscle belly tears, muscle origin tears, and complete tendinous tears in sedentary individuals or when surgery is not feasible. Surgical intervention generally provides superior functional outcomes, particularly for athletes and those with complete ruptures. Orthobiologic treatments, such as ultrasound-guided PRP injections, provide a promising complement to conservative management, with potential benefits in pain reduction and accelerated functional recovery. Studies indicate that PRP-treated patients report higher satisfaction and better outcomes compared to those without PRP treatment. Nevertheless, many questions remain regarding the optimal formulation, dosage, and rehabilitation protocols for PRP. To fully understand PRP's effectiveness and refine its applications in sports medicine, more rigorous and long-term studies are needed. Additionally, further research is required to improve nonoperative treatment and rehabilitation protocols, ensuring optimal outcomes for all patients.

Sternal wound complications following sternotomy need a multidisciplinary approach in high-risk postoperative cardiac surgical patients. Poorly controlled pain during surgical management of such wounds increases cardiovascular stress and respiratory complications. Multimodal analgesia including intravenous opioids, non-opioid analgesics, and regional anesthesia techniques, like central neuraxial blocks and fascial plane blocks, have been described. Pecto-intercostal fascial plane block (PIFB), a novel technique, has been effectively used in patients undergoing cardiac surgery. Under ultrasound (US) guidance PIFB is performed with the aim of depositing local anesthetic between two superficial muscles, namely the pectoralis major muscle and the external intercostal muscle. The authors report a series of five cases where US-guided bilateral PIFB was used in patients undergoing sternal wound debridement. Patients had excellent analgesia intraoperatively as well as postoperatively for 24 hours with minimal requirement of supplemental analgesia. None of the patients experienced complications due to PIFB administration. The authors concluded that bilateral PIFB can be effectively used as an adjunct to multimodal analgesia with general anesthesia and as a sole anesthesia technique in selected cases of sternal wound debridement.

Background: Anterior approach to sciatic nerve (SN) block has been an underutilized technique due to the technical difficulties and lack of accurate landmarks to guide the localization of the nerve. This prospective, observational study was planned to evaluate the sonoanatomical relationship of SN with femoral neurovascular complex and femoral shaft by anterior approach for easy identification. Materials and Methods: After ethics committee approval and written informed consent, sonoanatomy of SN in anteromedial thigh was observed in 30 American Society of Anesthesiologists I–III patients. Measurements of distance between SN, femoral shaft, and femoral neurovascular complex were taken. Surface landmark for probe positioning was also noted. Results: We observed that SN was consistently located in a triangular arrangement with femoral shaft and femoral neurovascular complex. Distance of SN from femoral shaft located superolaterally was 43.4 ± 12 mm. Distance of SN from femoral neurovascular complex located superiorly was 44.8 ± 11.4 mm. Distance between femoral shaft and femoral neurovascular complex was 39.1 ± 9.4 mm and distance of ultrasound probe placement for optimal visualization of SN from inguinal crease was 167 ± 29 mm. Conclusion: We propose a new and more distal sonoanatomical landmark for ultrasound-guided approach to anterior SN block which consistently localizes the SN in relation to femoral shaft and femoral neurovascular complex and can be easily performed in all patients in the supine position.

Purpose: The external oblique intercostal plane (EOI) block is a novel block technique for anterolateral upper abdominal wall analgesia. The superficial nature of the external oblique intercostal plane allows it to be easily identified even in patients with obesity. The aim of this study was to test the hypothesis that EOI block would reduce IV morphine consumption within 24 h after laparoscopic sleeve gastrectomy. Materials and Methods: Patients were randomly assigned to one of two groups: EOI block group and control group. The patients in the EOI block group received ultrasound-guided bilateral EOI block with a total of 40 ml 0.25% bupivacaine after anesthesia induction. The patients in the control group received no intervention. Postoperatively, all the patients were connected to an intravenous patient controlled analgesia (PCA) device containing morphine. The primary outcome of the study was IV morphine consumption in the first postoperative 24 h. Results: The median [interquartile range] morphine consumption at 24 h postoperatively was significantly lower in the EOI block group than in the control group (7.5 [3.5 to 8.5] mg vs 14 [12 to 20] mg, p = 0.0001, respectively). Numerical rating scale (NRS) scores at rest and during movement were lower in the EOI block group than in the control group at 2, 6, and 12 h but were similar at 24 h. No block-related complications were observed in any patients. Conclusion: The results of the current study demonstrated that bilateral EOI block reduced postoperative opioid consumption and postoperative pain in patients with obesity undergoing laparoscopic sleeve gastrectomy. Trial Registration: Clinicaltrials.gov identifier: NCT05663658. [ABSTRACT FROM AUTHOR]

Simple Summary: All animals feel pain and, as vets, we have the ethical obligation to prevent it. This paper describes two anaesthetic events in an emu (Dromaius novaehollandiae) undergoing the surgical repair of a lateral luxation of the Achilles tendon on both hind limbs. An ultrasound-guided mid-femur sciatic nerve block was successfully performed on both occasions for intraoperative and postoperative analgesia. To our knowledge, this is the first published report of an emu who benefited from inhalation anaesthesia associated with a loco-regional block. The current case report describes a successful ultrasound-guided mid-femur sciatic nerve block in an emu. A 2-month-old emu suffering from acute-onset lameness was referred to the University Clinic of Liège, where he was diagnosed with a lateral luxation of the Achilles tendon on both hind limbs. Two surgical procedures were performed for treatment. Both surgical procedures were performed under general anaesthesia with butorphanol, ketamine, midazolam and isoflurane in oxygen. The anaesthesia was continuously monitored. An ultrasound-guided sciatic nerve block was performed to prevent and treat surgically induced nociception. The technique was adapted from what is already described in other species. Levobupivacaine was injected perineurally under ultrasound-guidance. Intraoperative nociception was assessed based on the heart rate and mean arterial pressure changes. The recovery was uneventful and with no clinical signs of postoperative pain. [ABSTRACT FROM AUTHOR]

Sternal wound complications following sternotomy need a multidisciplinary approach in high-risk postoperative cardiac surgical patients. Poorly controlled pain during surgical management of such wounds increases cardiovascular stress and respiratory complications. Multimodal analgesia including intravenous opioids, non-opioid analgesics, and regional anesthesia techniques, like central neuraxial blocks and fascial plane blocks, have been described. Pecto-intercostal fascial plane block (PIFB), a novel technique, has been effectively used in patients undergoing cardiac surgery. Under ultrasound (US) guidance PIFB is performed with the aim of depositing local anesthetic between two superficial muscles, namely the pectoralis major muscle and the external intercostal muscle. The authors report a series of five cases where US-guided bilateral PIFB was used in patients undergoing sternal wound debridement. Patients had excellent analgesia intraoperatively as well as postoperatively for 24 hours with minimal requirement of supplemental analgesia. None of the patients experienced complications due to PIFB administration. The authors concluded that bilateral PIFB can be effectively used as an adjunct to multimodal analgesia with general anesthesia and as a sole anesthesia technique in selected cases of sternal wound debridement. [ABSTRACT FROM AUTHOR]

Objective To evaluate ultrasound guided cervical nerves pathway block (CNPB) for internal jugular vein cannulation in awake patients. Methods A total of 100 patients who underwent elective jugular vein puncture and catheterization at Nanjing Pukou District Hospital of Chinese Medicine from June to December 2021 were selected and divided into ultrasound guided CNPB group (group B, n=50) and local infiltration anesthesia group (group C, n=50). Both groups underwent internal jugular vein catheterization under ultrasound guidance. The outcome indicators were the Numeric Rating Scales (NRS), Bruggrmann Comfort Scale (BCS), hemodynamic parameters, sleeping quality, and the complications. The results were recorded in the morning of the cannulation operation (T0), during the operation (T1), 5 min after the cannulation (T2), that night of the cannulation (T3), postoperative day 1 (T4), postoperative day 2 (T5). Results The NRS of group B were significantly lower than that of group C at T1 and T3. The BCS of group B were higher than group C at T1, T2, T3, and T4. The heart rate and systolic blood pressure at T1 in group B were dramatically lower than group C. At T3 and T4, sleeping quality of group B was better than group C (P＜0.05). Conclusion Ultrasound guided CNPB, as the anesthesia for internal jugular vein cannulation in awake patients, can effectively reduce the NRS scaling and improve the BCS and sleeping quality without obvious adverse reactions.

Abstract Background Regional anesthesia is the favored choice in ruminant animals compared to general anesthesia, primarily due to its high safety margin and reduced demand for cost-intensive equipment in addition to its field applicability. Ultrasound-guided nerve block has gained significant attention in the field of veterinary medicine. This study utilized twenty-seven sheep of the native Rahmani breed to both demonstrate and evaluate the effectiveness of the ultrasound guided inferior alveolar nerve block technique. Methods The research comprised three phases: Phase 1 involved an anatomical examination of mandibles and sheep heads to locate the mandibular foramen and delineate the mandibular nerve course. Phase 2 included ultrasound-guided injection of methylene blue dye at specific sites along the mandibular nerve in cadaveric sheep heads. In Phase 3, clinical implementation of ultrasound-guided inferior alveolar nerve blocks was conducted in 27 live sheep, assessing efficacy, onset, and duration. Results Vertical extraoral ultrasound-guided nerve block was achieved successfully in 25 sheep (98%). A preliminary cadaveric study showed good distribution of the injectate at the mandibular nerve site. The mean onset time was 138 ± 18 s, and the mean duration time was 54 ± 4.1 min. Prominent analgesia of the ipsilateral mandible, medial surface of the cheek, and lateral border of the tongue was observed. Conclusions Ultrasound-guided mandibular nerve block holds promise as a technique for providing effective and safe anesthesia in sheep undergoing mandibular procedures.

ABSTRACTBackground Repair of ventral hernia is associated with pain after operation. We wanted to study the influence of ultrasound-guided (US) erector spine plane (ESP) block on postoperative pain and diaphragmatic dysfunction in obese cases undergoing repair of epigastric hernia.Methods This prospective randomized-controlled double-blinded research was conducted on 50 obese cases with body mass index (30–40), aged (21–65) and scheduled for elective open repair of epigastric hernia. Cases were randomized into two equal groups to receive either general anesthesia alone (Controls) or general anesthesia combined with bilateral ultrasound-guided ESP block. Postoperative pain, 24 h postoperative analgesic dose, and postoperative diaphragmatic excursion were assessed.Results There was a statistically evident decrease in NRS score in the ESP versus controls (30 min, 2 hr, 6 hr, 12 hr)(p

Background: Regional anesthesia is the favored choice in ruminant animals compared to general anesthesia, primarily due to its high safety margin and reduced demand for cost-intensive equipment in addition to its field applicability. Ultrasound-guided nerve block has gained significant attention in the field of veterinary medicine. This study utilized twenty-seven sheep of the native Rahmani breed to both demonstrate and evaluate the effectiveness of the ultrasound guided inferior alveolar nerve block technique. Methods: The research comprised three phases: Phase 1 involved an anatomical examination of mandibles and sheep heads to locate the mandibular foramen and delineate the mandibular nerve course. Phase 2 included ultrasound-guided injection of methylene blue dye at specific sites along the mandibular nerve in cadaveric sheep heads. In Phase 3, clinical implementation of ultrasound-guided inferior alveolar nerve blocks was conducted in 27 live sheep, assessing efficacy, onset, and duration. Results: Vertical extraoral ultrasound-guided nerve block was achieved successfully in 25 sheep (98%). A preliminary cadaveric study showed good distribution of the injectate at the mandibular nerve site. The mean onset time was 138 ± 18 s, and the mean duration time was 54 ± 4.1 min. Prominent analgesia of the ipsilateral mandible, medial surface of the cheek, and lateral border of the tongue was observed. Conclusions: Ultrasound-guided mandibular nerve block holds promise as a technique for providing effective and safe anesthesia in sheep undergoing mandibular procedures. [ABSTRACT FROM AUTHOR]

Objective To compare the short⁃term efficacy and safety of low temperature plasma radiofrequence ablation (LA) vs. high voltage long duration pulsed radiofrequency (HL⁃PRF) in the treatment of cervicogenic headache (CEH). Methods Eighty patients with cervicogenic headache were divided two groups： one treated with low temperature plasma radiofrequence ablation group as group L (n = 50) and the other treated with high voltage long duration pulsed radiofrequency group as group H (n = 30). The two groups were compared in terms of the score by the Visual Analog Scale, score by the Range of Motion Scale, postoperative pain relief rate, postoperative complication incidence, 1, 4, 12, and 24 weeks after the operation, as well as the therapeutic effectiveness and safety. Results Both groups showed significantly lower VAS and ROM scores after operation (P < 0.05). Compared with group L, group H had significantly lower VAS (all P < 0.05) but insignificantly lower ROM scores (all P > 0.05) at each time point. At T4, group H had significantly higher therapeutic effectiveness rate (P < 0.05) and higher incidence of scalp numbness at T3, as compared to group L (P < 0.05). Conclusion The low temperature plasma radiofrequency ablation and high voltage long duration pulsed radiofrequency both are effective and safe in the treatment of CEH, the latter approach can achieve better therapeutic effectiveness 24 weeks after the operation than the former. [ABSTRACT FROM AUTHOR]

Background: Anterior approach to sciatic nerve (SN) block has been an underutilized technique due to the technical difficulties and lack of accurate landmarks to guide the localization of the nerve. This prospective, observational study was planned to evaluate the sonoanatomical relationship of SN with femoral neurovascular complex and femoral shaft by anterior approach for easy identification. Materials and Methods: After ethics committee approval and written informed consent, sonoanatomy of SN in anteromedial thigh was observed in 30 American Society of Anesthesiologists I-III patients. Measurements of distance between SN, femoral shaft, and femoral neurovascular complex were taken. Surface landmark for probe positioning was also noted. Results: We observed that SN was consistently located in a triangular arrangement with femoral shaft and femoral neurovascular complex. Distance of SN from femoral shaft located superolaterally was 43.4 ± 12 mm. Distance of SN from femoral neurovascular complex located superiorly was 44.8 ± 11.4 mm. Distance between femoral shaft and femoral neurovascular complex was 39.1 ± 9.4 mm and distance of ultrasound probe placement for optimal visualization of SN from inguinal crease was 167 ± 29 mm. Conclusion: We propose a new and more distal sonoanatomical landmark for ultrasound-guided approach to anterior SN block which consistently localizes the SN in relation to femoral shaft and femoral neurovascular complex and can be easily performed in all patients in the supine position. [ABSTRACT FROM AUTHOR]

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Simple Summary: The quadratus lumborum (QL) block is an ultrasound-guided locoregional anesthetic technique which aims to provide analgesia to the abdomen. Previous studies in dog cadavers have shown that a dorsal injection point, between the psoas minor muscle and the vertebral body of L1, is able to stain the truncus sympathicus and the T13–L3 rami ventrales, potentially providing analgesia to the abdominal wall and viscera. This dorsal approach could be feasible in cats and is probably able to offer similar results to those in canine cadavers. To assess this objective, 10 cat cadavers were used, and a mixture of methylene blue and iopromide (0.4 mL kg−1) was injected dorsal to the QL muscle in the abovementioned location. Computerized tomography and anatomical dissection were employed to evaluate the injectate spread. Our results showed the feasibility of this approach in cat cadavers as a consistent staining of the truncus sympathicus (T13–L3) and the rami ventrales of the spinal nerves (T13–L3) was observed. These results are compatible with the induction of somatic and visceral analgesia of the abdomen, although the cranial abdominal wall may not be covered. The quadratus lumborum (QL) block is an ultrasound-guided locoregional anesthesia technique which aims to provide analgesia to the abdomen. The main objective of this study was to assess a modified ultrasound-guided dorsal QL block in cat cadavers. For this purpose, a volume of 0.4 mL kg−1 of a mixture of iopromide and methylene blue was administered between the psoas minor muscle and the vertebral body (VB) of the first lumbar vertebra, and its distribution was assessed in thirteen cat cadavers. We hypothesized that this injection point would be feasible, offering a more cranial distribution of the injectate and a more consistent staining of the truncus sympathicus. The study was divided into two phases. Phase 1 consisted of an anatomical study (three cadavers were dissected). Phase 2 consisted of the ultrasound-guided administration of the injectate and the assessment of its distribution by computed tomography and anatomical dissection. The results showed a consistent distribution of contrast media within five (4–8) VBs from T10 to L5. Methylene blue stained three (2–6) rami ventrales, affecting T11 (10%), T12 (20%), T13 (60%), L1 (85%), L2 (95%) and L3 (65%). The truncus sympathicus was dyed in all cadavers with a spread of five (3–7) VBs. Finally, the splanchnicus major nerve was stained in all cadavers (100%). These results suggest that this technique could provide analgesia to the abdominal viscera and the abdominal wall, probably with the exception of the cranial aspects of the abdominal wall. [ABSTRACT FROM AUTHOR]

Background: Repair of ventral hernia is associated with pain after operation. We wanted to study the influence of ultrasound-guided (US) erector spine plane (ESP) block on postoperative pain and diaphragmatic dysfunction in obese cases undergoing repair of epigastric hernia. Methods: This prospective randomized-controlled double-blinded research was conducted on 50 obese cases with body mass index (30-40), aged (21-65) and scheduled for elective open repair of epigastric hernia. Cases were randomized into two equal groups to receive either general anesthesia alone (Controls) or general anesthesia combined with bilateral ultrasoundguided ESP block. Postoperative pain, 24 h postoperative analgesic dose, and postoperative diaphragmatic excursion were assessed. Results: There was a statistically evident decrease in NRS score in the ESP versus controls (30 min, 2 hr, 6 hr, 12 hr)(p < 0.001). There was a statistically evident decrease in the total intraoperative fentanyl (p < 0.001) and total 24 h morphine dose (p < 0.001) in the ESP versus controls. There was a statistically evident decrease in the postoperative diaphragmatic excursion in controls versus the ESP (p = 0.001). Conclusions: The ESP block in obese cases undergoing open repair of epigastric hernia provided efficient postoperative analgesia. It decreased postoperative pain, reduced intraoperative and postoperative analgesic dose, and maintained diaphragmatic excursion. [ABSTRACT FROM AUTHOR]

Introduction: Image-guided invasive procedures on the liver require a steep learning curve to acquire the necessary skills. The best and safest way to achieve these skills is through hands-on courses that include simulations and phantoms of different complications, without any risks for patients. There are many liver phantoms on the market made of various materials; however, there are few multimodal liver phantoms, and only two are cast in a 3D-printed mold. Methods: We created a virtual liver and 3D-printed mold by segmenting a CT scan. The InVesalius and Autodesk Fusion 360 software packages were used for segmentation and 3D modeling. Using this modular mold, we cast and tested silicone- and gelatin-based liver phantoms with tumor and vascular formations inside. We tested the gelatin liver phantoms for several procedures, including ultrasound diagnosis, elastography, fibroscan, ultrasound-guided biopsy, ultrasound-guided drainage, ultrasound-guided radio-frequency ablation, CT scan diagnosis, CT–ultrasound fusion, CT-guided biopsy, and MRI diagnosis. The phantoms were also used in hands-on ultrasound courses at four international congresses. Results: We evaluated the feedback of 33 doctors regarding their experiences in using and learning on liver phantoms to validate our model for training in ultrasound procedures. Conclusions: We validated our liver phantom solution, demonstrating its positive impact on the education of young doctors who can safely learn new procedures thus improving the outcomes of patients with different liver pathologies.

Objective: This prospective study aimed to compare the efficacy of caudal block (CB) and ilioinguinal/iliohypogastric nerve block (IINB) for providing additional analgesia during unilateral orchidopexy. Methods: Seventy-one boys aged n = 37) and IINB (n = 34) groups. Outcome measures included intra- and postoperative analgesic requirements, pain scores, and administration duration. Additional intraoperative analgesia was administered for a 10% increase in heart rate, while postoperative pain was assessed using the Children’s and Infants Postoperative Pain Scale (CHIPPS), with scores >4 prompting supplementary analgesia. Monitoring was extended for 24 h post-surgery. Results: CB significantly reduced the need for intraoperative (p < 0.001) and early postoperative (p = 0.008) analgesia compared to IINB. However, the CB group exhibited a slightly higher but non-significant analgesic requirement on the ward. No clinically relevant side effects were observed in either group. Conclusions: Both CB and IINB are effective and safe methods for providing regional analgesia during orchidopexy. CB demonstrates superior efficacy intraoperatively and in the early postoperative period, while IINB may offer advantages in the later recovery phase. However, additional analgesia is often required for orchidopexy, especially in outpatient settings.

The saphenous nerve, a purely sensory branch of the femoral nerve, supplies the lower limb’s medial, anteromedial and posteromedial aspects from the thigh to the foot. It is generally blocked for anaesthesia during knee, ankle and foot surgeries and to relieve post-operative pain. Knee osteoarthritis is a common joint disorder in middle-aged and older adults with pain, articular stiffness and decreased physical activity. Pain owing to osteoarthritis is most often reported at the anteromedial aspect of the knee. Recently, many researchers have studied using ultrasound-guided saphenous nerve blocks in knee osteoarthritis to relieve pain. For knee pain relief, a saphenous nerve block can be done using one of the techniques, namely peri-femoral, sub-sartorial, trans-sartorial and para-condylar (at the medial femoral condyle). We briefly describe these here, mentioning the pre-requisites, contraindications, possible complications and clinical significance.

The use of ultrasound in regional anaesthesia is being increasingly used in adult and paediatric patients recently. Chances of bony ossification in children are less as compared to adults. Ultrasound imaging helps to delineate sacral and caudal anatomy. It also helps in guiding of caudal needle insertion and to visualize the caudal injectate. Hence ultrasound serves as an important tool in caudal epidural blocks specially in children. After obtaining the approval of ethical committee and parental written informed consent, a total of 70 children undergoing elective lower abdominal surgeries under caudal epidural anaesthesia were included in the study. After having met inclusion and exclusion criteria, patients were randomized based on computer generated randomization table into one of the two groups. Group ACaudal block by traditional method and whoosh test. Group B-Caudal block using ultrasound. In our study, percentage of successful blocks were comparable in group A (31 of 35) and group B (35 of 35) and the difference was statistically nonsignificant (p= 0.12). In the present study motor response after block was seen in only 4 patients in group A while none in group B and hence the difference was statistically nonsignificant (p<0.122). In the present study, the first puncture success rate was higher in Group B (33 of 35 patients) as compared to Group A (10 of 35 patients) and the difference was statistically significant (p value <0.0001). Second attempt was required in 20 of 35 patients in Group A as compared to 2 of 35 patients in Group B. In group A, 5 patients required third attempt while none in Group B required more than two attempts. [ABSTRACT FROM AUTHOR]

Background & Objective: Injecting local anesthetics into the erector spinae plane and obstructing the dorsal and ventral rami could reduce the pain. Pregabalin and gabapentin are used to reduce neuropathic pain; however, pregabalin has demonstrated greater analgesic potency than gabapentin. This work aimed to compare the analgesic effects and complications between preoperative pregabalin and erector spinae plane block (ESPB) for lumbar spine surgery under general anesthesia. Methodology: Sixty patients were allocated to the 2 groups using a computer-generated random number that was hidden in sealed, opaque envelopes. In Group 1, the patients received pregabalin 150 mg twice daily for 3 days before surgery. After preoxygenation and before induction of anesthesia, dexmedetomidine 1 µg/kg was given in both of the groups. In Group 2, after the patient was placed in the prone position for the operation and after the induction of general anesthesia, ESPB was carried out bilaterally under ultrasound guidance. Ropivacaine hydrochloride was administered at a quantity of 20 mL upon confirmation of the needle's proper insertion. Numerical Rating Scale (NRS) was used to assess the pain intensity. Results: There was a longer-lasting analgesia in the ESPB group with significantly lower NRS only at 12 h and 18 h (P = 0.001) compared to the pregabalin group, but they were comparable at 24 h (P = 0.407). The time to request first rescue analgesic and the total morphine consumption were significantly different; a significantly longer time for the first rescue analgesic (17.10 vs. 11.73 h) and a significantly reduced amount of morphine consumption (6.30 vs. 10.33 mg) in ESPB group. Conclusion: Both bilateral erector spinae plane block and preoperative pregabalin seem to be helpful for providing adequate pain management postoperatively for lumbar spine surgery; however, bilateral erector spinae plane block was superior in pain management during the first 24 h postoperatively with fewer side effects. [ABSTRACT FROM AUTHOR]

Background Severe acute pain occurs in more than 10% of patients within the first 36 h after a cesarean section and can significantly impact women's satisfaction. The aim of this study was to compare the transversus abdominis plane (TAP) block for postoperative pain relief following cesarean section operations with the most famous analgesia (intrathecal morphine) used for a cesarean section regarding its efficacy and complications. Patients and methods This interventional double-blinded randomized controlled study was carried out on 60 cases, who underwent an elective cesarean delivery. They were randomized into two groups; patients were divided into two equal groups. Group M received intrathecal 150 μg morphine in a 0.5 ml volume, mixed with 10 mg of hyperbaric bupivacaine 0.5% in a 2 ml volume (total volume 2.5 ml). Group B received intrathecal 10 mg hyperbaric bupivacaine 0.5% 2 ml volume+0.5 saline (total volume 3 ml) and at the end of surgery the patient received bilateral TAP block with a 20 ml volume of 0.25% bupivacaine on each side. Results Postoperative heart rate, respiratory rate, oxygen saturation, mean arterial blood pressure, and intraoperative Bromage score were insignificantly different at all-time measurements between both groups. Visual analog score and postoperative Bromage score at 2, 3, and 4 h were higher in group B than group M (P<0.001). Time of rescue analgesia was significantly prolonged in group M than group B (P<0.001). Total paracetamol and morphine doses were significantly lower in group M than group B (P<0.001). Conclusions TAP block is a good alternative technique to intrathecal morphine in reducing postcesarean section pain, with less postoperative nausea and vomiting and pruritus compared with intrathecal morphine (ITM). [ABSTRACT FROM AUTHOR]

We aimed to explore the efficacy and safety of ultrasound‐guided foam sclerotherapy combined with endoluminal radiofrequency closure in patients with varicose veins of lower extremities (VVLEs); furthermore, we aimed to provide a theoretical basis for the effective management of VVLE patients in clinical work. From January 1, 2020, to March 1, 2021, 88 patients with VVLE admitted to Third Hospital of Shandong Province were included in this retrospective study. Depending on the type of treatment, the patients were divided into study groups and control groups. The study group consisted of 44 patients who were given ultrasound‐guided foam sclerotherapy combined with endoluminal radiofrequency closure. The control group consisted of 44 patients who were given high ligation and stripping of the great saphenous vein. Efficacy indicators included postoperative venous clinical severity score (VCSS) of affected limb and postoperative visual analogue scale (VAS) score. Safety indicators included length of operation, intraoperative blood loss, length of postoperative rest in bed, length of hospital stay, postoperative heart rate, preoperative blood saturation (SpO2), preoperative mean arterial pressure (MAP), and complications. The VCSS score 6 months after operation in the study group was significantly lower than that in the control group (P <.05). The pain VAS score in the study group was significantly lower than that in the control group at 1 and 3 days after operation (both P <.05). Compared with the control group, the study group was significantly lower in length of operation, intraoperative blood loss, postoperative in‐bed time, and hospital stays (all P <.05). Heart rate and SpO2 were significantly higher, and MAP was significantly lower in the study group compared with that in the control group 12 hours after surgery (all P <.05). The overall postoperative complication rate in the study group was significantly lower than that in the control group (P <.05). In conclusion, compared with surgical treatment of high ligation and stripping of the great saphenous vein, ultrasound‐guided foam sclerotherapy combined with endoluminal radiofrequency ablation for the treatment of VVLE disease has better efficacy and safety, which is worthy of clinical promotion. [ABSTRACT FROM AUTHOR]

Background and objective: Lung cancer is increasingly common, and accurate diagnosis is important for personalized treatment. Ultrasound-guided percutaneous fine-needle aspiration (FNA) is a useful method to obtain a specimen for a histological diagnosis of peripheral lung lesions. The aim of this study is to evaluate the diagnostic accuracy and complication rate of the procedure performed by pulmonologists. The result is compared with that of ultrasound-guided core needle biopsy performed by radiologists. Methods: We retrospectively evaluated the diagnostic accuracy and complication rates of pulmonologist-performed ultrasound-guided FNAs of lung lesions in the period of 1 August 2019 to 30 June 2021 (pulmonologist group) and radiologist-performed ultrasound-guided core needle biopsies (CNBs) of lung lesions in the period of 1 January 2010 to 31 December 2014 (radiologist group). A logistic regression analysis was used to identify independent influence factors associated with diagnostic accuracy in the pulmonologist group and in the combination of both groups. Results: In a 23-month period, pulmonologists in a tertiary center performed 113 episodes of ultrasound-guided fine-needle aspiration for peripheral lung lesions. The diagnostic accuracy and complication rates were 80.4% and 5.3%, respectively, compared to 86.8% and 7.4% in a historical cohort consisting of 68 episodes of ultrasound-guided core needle biopsies performed by radiologists in the same hospital. Lung lesions located in the upper lobe were predictive of successful diagnoses. Conclusions: An ultrasound-guided fine-needle aspiration by a pulmonologist is an easily accessible and reliable method to obtain specimens for histological diagnoses.

The current case report describes a successful ultrasound-guided mid-femur sciatic nerve block in an emu. A 2-month-old emu suffering from acute-onset lameness was referred to the University Clinic of Liège, where he was diagnosed with a lateral luxation of the Achilles tendon on both hind limbs. Two surgical procedures were performed for treatment. Both surgical procedures were performed under general anaesthesia with butorphanol, ketamine, midazolam and isoflurane in oxygen. The anaesthesia was continuously monitored. An ultrasound-guided sciatic nerve block was performed to prevent and treat surgically induced nociception. The technique was adapted from what is already described in other species. Levobupivacaine was injected perineurally under ultrasound-guidance. Intraoperative nociception was assessed based on the heart rate and mean arterial pressure changes. The recovery was uneventful and with no clinical signs of postoperative pain.

This brief case report describes a new anesthesia method without endotracheal intubation in open heart surgery. The patient was a 41 years old female. Because the location of the atrial septal defect was not suitable for interventional minimally invasive surgery, she could only undergo open heart surgery under cardiopulmonary bypass. Due to news reports about anesthesia without tracheal intubation, the patient refused to undergo tracheal intubation anesthesia; therefore, we innovatively adopted an anesthesia method of transnasal humidified rapid insufflation ventilatory exchange (THRIVE) combined with intravenous anesthesia and nerve block without endotracheal intubation, and achieved success. The whole operation process was very smooth; the patient was quiet and motionless, and her respiration and circulation were stable. After the operation, the patient opened her eyes without any complaints and was safely sent to the CICU (cardiac intensive care unit).

Background and Aims: Ultrasound-guided transversus abdominis plane (TAP) block is an effective technique for postoperative analgesia in lower abdominal surgeries. This study aims to compare the duration and efficacy of an ultrasound-guided TAP block with those of a caudal epidural for paediatric unilateral lower abdominal surgeries. Methods: After ethical approval, sixty children aged 1 to 9 years were randomised into ultrasound-guided TAP block or caudal block with general anaesthesia for unilateral lower abdominal surgeries. The primary endpoint was time for the first rescue analgesia in the postoperative period. The secondary endpoints were total postoperative opioid consumption, modified Children Hospital of Eastern Ontario Pain Scale (CHEOPS) and the Face, Legs, Activity, Cry and Consolability (FLACC) scale in the postoperative period. Results: The mean time for first rescue analgesia was 11.33 ± 2.80 h in the TAP block group, while in the caudal group, it was 13.18 ± 2.67 h (95% confidence interval [CI] mean difference 2.58-10.58, P = 0.017). The total postoperative morphine requirement was comparable in both groups at both 12 h (TAP block group 0.50 ± 0.12 mg vs. caudal block group 0.56 ± 0.12 mg, 95% CI mean difference 0.09-0.02, P = 0.08) and 24 h (TAP block group 0.96 ± 0.30 mg vs. caudal block group 0.81 ± 0.34 mg, 95% CI mean difference 0.06-0.32, P = 0.06) time period. Conclusion: The mean time for first rescue analgesia was lesser in the TAP block group as compared to caudal group. [ABSTRACT FROM AUTHOR]

Objective This prospective randomized controlled study aimed to compare the ultrasound-guided (USG) technique with the standard single-wall puncture technique for epicutaneo-caval catheter (ECC) placement in neonates. Study Design A total of 100 neonates were included in this study. All enrolled neonates were randomly divided into two groups (n = 50): the USG group and the control group. The control group underwent standard single-wall puncture for ECC placement procedures, and the USG group underwent USG ECC placement procedures. Results The first attempt success rates (62 vs. 38%; p = 0.016) and the total success rates (92 vs. 74%; p = 0.017) were higher in the USG group than in the control group. The procedure time was shorter in the USG group than in the control group: 351.43 (112.95) versus 739.78 seconds (369.13), p < 0.001. The incidence of adverse events was not significantly different between the two groups. Conclusion Compared with the standard single-wall puncture method, USG cannulation is superior for neonatal ECC placement, with a higher success rate, and decreases the total procedural time. Key Points Establishing ECCs in neonates is challenging and lead to multiple attempts and adverse events. Information on the efficiency of USG dynamic needle tip positioning for ECCs in neonates is lacking. Compared with the standard puncture method, USG cannulation is superior for neonatal ECC placement. [ABSTRACT FROM AUTHOR]

Objectives: We compared an ultra‐minimally invasive ultrasound‐guided percutaneous A1 pulley release and a classic open surgery for trigger digit. Methods: We designed a single‐center randomized control trial. All cases had clinical signs of primary grade III trigger digit. Concealed allocation (1:1) was used for assigning patients to each group and data collectors were blinded. The Quick‐Disabilities of the Arm, Shoulder, and Hand (Quick‐DASH) questionnaire was our primary variable. Quick‐DASH, two‐point discrimination, grip strength, time until stopping analgesics, having full digital range of motion and restarting everyday activities were registered on the 1st, 3rd, and 6th weeks, 3rd and 6th months, and 1st year after the procedure. Results: We randomized 84 patients to ultrasound‐guided release and classic open surgery. Quick‐DASH scores significantly favored the percutaneous technique until the 3rd month: 7.6 ± 1.2 versus 15.3 ± 2.4 (mean ± standard error of the mean). The percutaneous group obtained significantly better results in all the variables studied: time until stopping analgesics, achieving full range of motion and restarting everyday activities. Grip strength was significantly better in the percutaneous group for the 1st week only. Five cases of moderate local pain were observed in the open technique. There was one case of transient nerve numbness per group. Conclusions: The ultra‐minimally invasive ultrasound‐guided A1 pulley release was clinically superior to the classic open surgery in functional recovery with a lower complication rate. [ABSTRACT FROM AUTHOR]

Introduction: We sought to determine whether ultrasound-guided arterial cannulation (USGAC) is more successful than traditional radial artery cannulation (AC) as performed by emergency medicine (EM) residents with standard ultrasound training.Methods: We identified 60 patients age 18 years or older at a tertiary care, urban academic emergency department who required radial AC for either continuous blood pressure monitoring or frequent blood draws. Patients were randomized to receive radial AC via either USGAC or traditional AC. If there were three unsuccessful attempts, patients were crossed over to the alternative technique. All EM residents underwent standardized, general ultrasound training.Results: The USGAC group required fewer attempts as compared to the traditional AC group (mean 1.3 and 2.0, respectively; p

Background and Aims: Ultrasound-guided transversus abdominis plane (TAP) block is an effective technique for postoperative analgesia in lower abdominal surgeries. This study aims to compare the duration and efficacy of an ultrasound-guided TAP block with those of a caudal epidural for paediatric unilateral lower abdominal surgeries. Methods: After ethical approval, sixty children aged 1 to 9 years were randomised into ultrasound-guided TAP block or caudal block with general anaesthesia for unilateral lower abdominal surgeries. The primary endpoint was time for the first rescue analgesia in the postoperative period. The secondary endpoints were total postoperative opioid consumption, modified Children Hospital of Eastern Ontario Pain Scale (CHEOPS) and the Face, Legs, Activity, Cry and Consolability (FLACC) scale in the postoperative period. Results: The mean time for first rescue analgesia was 11.33 ± 2.80 h in the TAP block group, while in the caudal group, it was 13.18 ± 2.67 h (95% confidence interval [CI] mean difference 2.58–10.58, P = 0.017). The total postoperative morphine requirement was comparable in both groups at both 12 h (TAP block group 0.50 ± 0.12 mg vs. caudal block group 0.56 ± 0.12 mg, 95% CI mean difference 0.09–0.02, P = 0.08) and 24 h (TAP block group 0.96 ± 0.30 mg vs. caudal block group 0.81 ± 0.34 mg, 95% CI mean difference 0.06–0.32, P = 0.06) time period. Conclusion: The mean time for first rescue analgesia was lesser in the TAP block group as compared to caudal group.

Background To investigate the effect and drawbacks of different LA volumes and concentrations of ESPB on postoperative need for opioids and rescue analgesics, post-mastectomy acute neuropathic pain, and NK cells cytotoxicity.Methods 60 breast cancer patients, ranging in age from 18 to 70 and with an ASA I–II, were randomly assigned to receive ESPB with 20 ml 0.25% bupivacaine (Standard volume ESPB), 40 ml 0.125% bupivacaine (High volume ESPB), or no ESPB (GA only group) after being scheduled for surgery. The primary outcome was total morphine administered over the first 24 postoperative hours. The secondary endpoints were amount of rescue analgesia needed, acute neuropathic pain assessed by DN4 questionnaire, NKC cytotoxicity and complications.Results Total amount of morphine consumed was less in both ESPB groups compared with the control (1.13 ± 1.77 vs. 1.35 ± 3.15 vs. 9.58 ± 5.76, p

Introduction This study aimed to investigate and compare the therapeutic efficacy and safety of ultrasound-guided radiofrequency ablation (RFA), between primary hyperparathyroidism (PHPT) and secondary hyperparathyroidism (SHPT) patients, with or without previous parathyroidectomy (PTX).Subjects and Methods A total of 21 patients (7 PHPT, 14 SHPT) underwent RFA for hyperparathyroidism (HPT) at Kaohsiung Chang Gung Memorial Hospital, Taiwan. Five of the 14 SHPT patients had previously received PTX. The laboratory data, volume change of each parathyroid nodule, symptomatic scores, and complications were analyzed and compared between all groups at 1 and 7 days, and at 1, 3, 6, and 12 months after RFA.Results After RFA, the volume reduction ratio (VRR) for all patients at the last follow-up was 93.76%, and clinical symptoms significantly improved. At 12 months, all PHPT patients achieved successful treatment of intact PTH (iPTH). In SHPT patients, the mean iPTH value significantly decreased 1-day post-RFA, subsequently exhibiting a transient rebound which proceeded to decrease, with 57.1% reaching successful treatment standards. SHPT patients with PTX showed a lower complication score, shorter ablation time, higher iPTH baseline and outcomes, and lower VRR, compared to patients without PTX. The serum calcium level significantly decreased to normal range in 85.7% of all patients at 12 months. Severe hypocalcemia occurred in 23.8% at 1 week, and all were corrected with calcium supplements.Conclusions RFA demonstrates a therapeutic efficacy similar to PTX. It can thus be considered an effective alternative treatment for PHPT, SHPT, or post-PTX patients who are unsuitable for another PTX.

Abstract Background To evaluate the analgesic efficacy and spread of variable volumes of local anesthetics (LA) in Erector spinae plane block (ESPB). Methods Sixty patients aged between 18 and 50 years with an ASA I-II and scheduled for breast cancer surgery were randomized to receive either ESPB with 20 ml 0.25% bupivacaine (Standard volume ESPB), or with 40 ml 0.125% bupivacaine (High volume ESPB), or no ESPB (GA only group). The primary outcome was pain intensity evaluated by the visual analogue scale (VAS), 12 hours after surgery. P-values