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BACKGROUND Moderate-to-severe pain exists in the early postoperative period after laparoscopic renal surgery. OBJECTIVE We investigated the analgesic effect of quadratus lumborum block (QLB) via two approaches in patients undergoing laparoscopic renal nephrectomy. DESIGN A randomised controlled trial. SETTING An academic tertiary care hospital in Beijing, China. PARTICIPANTS Ninety-six patients aged 18 to 70 years who were scheduled for elective laparoscopic radical or partial nephrectomy. INTERVENTIONS Eligible patients were allocated randomly to a control group (no block), lateral QLB group or posterior QLB group. Ultrasound-guided QLB was performed via either the lateral or posterior approach with 30 ml of 0.4% ropivacaine before surgery. MAIN OUTCOME MEASURES The primary outcome was sufentanil equivalent consumption within 24 h. Among secondary outcomes, somatic and visceral pain intensity at rest and on coughing were assessed with a numerical rating scale (where 0 = no pain and 10 = the worst pain) until 24 h postoperatively. RESULTS Sufentanil equivalent consumption did not differ among the three groups (118 ± 36 μg in the control group, 115 ± 47 μg in the lateral QLB group and 119 ± 40 μg in the posterior QLB group; P = 0.955). However, both somatic (lateral QLB vs. control, median difference -1, P

Objective To evaluate the effect of multilevel single-shot thoracic paravertebral blockade (PVB) on the occurrence of chronic postsurgical pain (CPSP) in patients undergoing breast cancer surgery. Design A randomized controlled trial with two parallel groups. Setting A tertiary hospital. Methods Patients scheduled for breast cancer surgery were randomized to receive either ultrasound-guided multilevel single-shot PVB from T2 to T5 (the PVB group) or nothing (the control group). Surgery was then performed under general anesthesia. Patients were followed up for 12 months after surgery. The primary end point was incidence of CPSP at six months after surgery. Results A total of 218 patients were enrolled and randomized; of these, 208 and 204 completed six- and 12-month follow-up, respectively. The incidence of CPSP at six months was significantly lower in the PVB group (12.5% [13/104]) than in the control group (24.0% [25/104], relative risk = 0.52, 95% CI = 0.28–0.96, P = 0.031). Pain scores within 48 hours both at rest and with movement were lower in the PVB group than the control group (P = 0.006 and P Conclusions For patients undergoing breast cancer surgery, multilevel single-shot PVB reduces the incidence of CPSP at six months; it also improves early postoperative analgesia and reduces neuropathic pain at six and 12 months after surgery.

Postherpetic neuralgia (PHN) is the most common chronic complication following the onset of herpes zoster (HZ). Both the incidence of HZ and the proportion of patients with HZ who develop PHN rise with age. Ultrasound-guided erector spinae plane blockade (ESPB) has been reported to relieve neuropathic pain and PHN in elderly patients, but no randomized controlled trials have been conducted regarding the effect of ESPB on elderly patients with HZ in the acute or subacute phases.To evaluate the effect of repeated ESPB on the occurrence of PHN in elderly patients with acute or subacute HZ.A randomized double blind placebo-controlled trial with 2 parallel groups.A university hospital in China.Patients diagnosed with acute or subacute HZ were randomized to receive either ultrasound-guided ESPB (the ESPB group) or placebo subcutaneous injection (the control group) every 24 hours for 3 days. Patients were followed up at 12 weeks after the final treatment. The primary end point was the incidence of PHN at 12 weeks.A total of 52 patients were enrolled and randomized; 50 completed 12 weeks of follow-up. The incidence of PHN at 12 weeks was significantly lower in the ESPB group (15.4% [4/26]) than in the control group (41.7% [10/24]); relative risk 0.37, 95% confidence interval 0.13-1.02, P = 0.039. At 12 weeks, the VAS scores at rest and the total scores from the Short-Form McGill Pain Questionnaire-2 were significantly decreased in the ESPB group (P = 0.046 and P = 0.001, respectively). The incidence of neuropathic pain, sleep disturbance, and anxiety/depression were significantly reduced in the ESPB group (P = 0.002, P = 0.002, and P = 0.025, respectively). Patients using tramadol and hypnotics as well as total complications with oral medicines were remarkably decreased in the ESPB group (P = 0.008, P = 0.002, and P = 0.042 respectively). The adverse events during or after the procedure were comparable between the groups.This trial was carried out in a single center with a 12-week follow-up. Nearly 8% of patients in the control group were lost to follow-up.For elderly patients suffering acute or subacute HZ, ESPB reduces the incidence of PHN at 12 weeks after treatment; it also decreases the occurrence of neuropathic pain, sleep disturbance, and anxiety/depression.

BackgroundOptimizing educational programs for obtaining and maintaining competency in ultrasound-guided regional anesthesia (UGRA) is needed for anesthesia residents. This study aimed to assess the effectiveness of simulation-based training programs on the UGRA skills of senior anesthesia residents.MethodsThis prospective assessor-blind randomized controlled trial was conducted in a tertiary hospital in November 2019. Twenty anesthesia residents who had been in a clinical rotation in anesthesiology for 3-5 years were randomly allocated to either the workshop group (WG) or the control group (CG) for pretechnical procedure training on UGRA. Following didactic lectures for both groups, simulation-based workshops were performed only for the WG. All participating trainees were assessed by written examination, ultrasound scanning and anatomy recognition in live human models and ultrasound-guided target injections in porcine meat models. The written examination score, sonographic proficiency scores, time taken to perform the injections and errors were recorded and analyzed.ResultsThe simulation-based training program significantly reduced the time taken for target injections performed by trainees in the WG (183.9±44.8 seconds) compared with those in the CG (239.6±64.2 seconds): mean difference -55.8 (-107.7, -3.7), P=0.037. The error score was also significantly lower in the WG than in the CG. The sonographic proficiency scores of the thoracic paravertebral structures, brachial plexus and femoral nerve scanning were significantly higher for trainees in the WG than for those in the CG, as were the total scores for the four stations on live human models.ConclusionsFor senior anesthesia residents, the simulation-based training program can improve UGRA skills and might enhance clinical competence.Trial RegistrationChinese clinical trial registry, ChiCTR-IPR-1900027585, Principal investigator: Hong Zhang, Date of registration: November 19, 2019 URL: http://www.chictr.org.cn/

Background Ultrasound-guided lateral transversus abdominis plane (TAP) block can provide definite analgesia to the anterior abdominal wall. However, whether this method is useful in renal surgery through the lateral abdominal wall pathway remains unknown. The study aimed to evaluate the analgesic efficacy of lateral TAP block for retroperitoneoscopic partial or radical nephrectomy. Method In this prospective, randomized, double-blind, placebo-controlled trial, eligible patients were randomized into two groups. After anaesthesia induction, ultrasound-guided lateral TAP block was performed with either 30 ml of 0.4% ropivacaine (Group T) or an equivalent volume of normal saline (Group C). The primary outcomes were opioid consumption during surgery and in the first 24 h after surgery. Secondary outcomes included postsurgical pain intensity immediately awakening from anaesthesia and at 0.5, 1, 2, 6, 12, and 24 h after surgery, as well as recovery variables including the incidence of postoperative nausea and vomiting (PONV), sleep quality, time to first ambulation, drainage and length of hospital stay. Results A total of 104 patients were enrolled and randomized (53 in Group T and 51 in Group C). Laparoscopic surgery was converted to open surgery in one patient of Group T; this patient was excluded from the outcome analysis. The opioid consumption during surgery (intravenous morphine equivalent dose: median 35.0 mg [interquartile range 18.0, 49.6] in Group C vs. 40.3 mg [20.9, 59.0] in Group T, P = 0.281) and in the first 24 h after surgery (10.8 mg [7.8, 21.7] in Group C vs. 13.2 mg [8.0, 26.6] in Group T, P = 0.311) did not differ significantly between groups. There were no significant differences between groups regarding the pain intensity at all time points after surgery and the recovery variables (all P > 0.05). Conclusions Our results showed that, in patients undergoing retroperitoneoscopic renal surgery, preoperative lateral TAP did not decrease intra- and postoperative opioid consumption, nor did it relieve pain intensity or promote postoperative recovery in the first 24 h after surgery. However, the trial might be underpowered. Trial registration This study was registered on November 4, 2017, in the Chinese Clinical Trail Registry with the identification number ChiCTR-INR-17013244.

Objective: This study aimed to explore the expression of tissue factor (TF), protease activated receptor-2 (PAR-2), and matrix metalloproteinase-9 (MMP-9) in the MCF-7 breast cancer cell line and influence on invasiveness. Methods: Stable MCF-7 cells transfected with TF cDNA and with TF ShRNA were established. TF, PAR-2, and MMP-9 protein expression was analyzed using indirect immunofluorescence and invasiveness was evaluated using a cell invasion test. Effects of an exogenous PAR-2 agonist were also examined. Results: TF protein expression significantly differed between the TF cDNA and TF ShRNA groups. MMP-9 protein expression was significantly correlated with TF protein expression, but PAR-2 protein expression was unaffected. The PAR2 agonist significantly enhanced MMP-9 expression and slightly increased TF and PAR-2 expression in the TF ShRNA group, but did not significantly affect protein expression in MCF-7 cells transfected with TF cDNA. TF and MMP-9 expression was positively correlated with the invasiveness of tumor cells. Conclusion: TF, PAR-2, and MMP-9 affect invasiveness of MCF-7 cells. TF may increase MMP-9 expression by activating PAR-2.