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Objective Methods Results Conclusions The serratus anterior plane block (SAPB) is a regional anaesthesia technique with increasing use as an analgesic adjunct in patients with rib fractures. The present study aimed to generate consensus of the requirements of education, training and credentialing for the use of a ‘single shot’ SAPB in the management of rib fractures.A modified Delphi process was designed using online questionnaires. Expert panellists from Australian and Aotearoa New Zealand were invited from the fields of Emergency Medicine and Anaesthesia and were asked to rate the importance of different components of SAPB education, training and credentialling on a 9‐point Likert scale. Consensus was achieved if ≥70% of experts provided a score of seven or greater on this scale for any given statement.Thirty specialists (60% FACEM, 40% FANZCA) representing New Zealand plus all states and territories of Australia formed the expert panel. Participant response rates were 100% (first round), 83% (second round) and 63% (final round). At the end of three survey rounds, 59 consensus statements were formed (27 for education, 5 for training and 17 for credentialing).This series of expert statements provides consensus on the education, training and credentialling of the SAPB for the management of rib fractures. These serve as the minimum standard by which this procedure should be taught while providing clinicians with a syllabus for the development of training programmes. [ABSTRACT FROM AUTHOR]

Background and Aims: In hip surgeries, the pericapsular nerve group (PENG) block and supra-inguinal fascia iliaca (SIFI) block are commonly employed perioperative regional analgesia techniques. This study aimed to compare functional outcomes regarding quadriceps muscle strength and weight-bearing capacity between PENG and SIFI blocks after hip surgery. Methods: In this single-centre, double-blinded, randomised trial, 60 patients undergoing hip surgeries under subarachnoid block were randomised into either Group P (PENG block) or Group S (SIFI block). Blocks were administered under ultrasound guidance with 30 mL of 0.2% ropivacaine and 4 mg dexamethasone. Functional mobility was assessed 24 and 48 h postoperatively by measuring quadriceps strength and maximum weight-bearing capacity. Analgesic efficacy was also evaluated by comparing visual analogue score (VAS) scores at 24 h, total opioid consumption over 24 h, and duration of analgesia. Statistical analysis included Student's t -test, Chi-square, and Z-test as appropriate, with statistical significance set at P < 0.05. Results: Group P demonstrated significantly higher quadriceps-muscle strength at 24 h (P = 0.025) and 48 h (P = 0.002) post surgery. More patients in Group P achieved superior weight-bearing grades at 24 h (P = 0.002) post surgery compared to Group S. VAS scores were significantly lower in Group P at 24 h post surgery (P = 0.006). Group P also showed a prolonged duration of analgesia (P = 0.019) and lower mean opioid consumption (P = 0.001) compared to Group S. Conclusion: The PENG block may be superior to the SIFI block in terms of functional outcomes with better quadriceps strength, enhanced weight-bearing, and provision of more effective postoperative analgesia in hip surgery patients. [ABSTRACT FROM AUTHOR]

With crewed deep space exploration on the horizon, preparation for potential astronaut health crises in space missions has become vital. Administration of anaesthesia and analgesia presents many challenges owing to constraints specific to space (physiologic and ergonomic challenges associated with microgravity) and nonspecific factors (isolation and lack of supplies). Regional anaesthesia can be the safest option; however, we hypothesised that the ergonomics of microgravity would compromise ease and accuracy of nerve blocks. We evaluated the feasibility of regional anaesthesia in a simulated microgravity environment (free-floating underwater conditions) using a meat (bovine muscle) model. Forty meat models were randomised for injection under simulated microgravity or normal gravity conditions. Success rates were determined by blinded assessors after injection. Parameters assessed included time to block, ease of image acquisition, and ease of needle placement. The median time to block in normal gravity was 27 (interquartile range 21–69) s vs 35 (interquartile range 22–48) s in simulated microgravity (P =0.751). Ease of image acquisition was similar in both conditions, as was ease of needle placement. There was no significant difference in the rate of accidental intraneural injections (5% vs 5%), with block success rates comparable in both scenarios (80% normal gravity vs 85% microgravity, P >0.999). Regional anaesthesia appears feasible for experts in simulated microgravity despite the ergonomic challenges. Although our model has limitations and might not fully capture the complexities of actual space conditions, it provides a foundation for future research into anaesthesia and analgesia during deep space missions. [ABSTRACT FROM AUTHOR]

The article discusses a study comparing rectus sheath block and erector spinae plane (ESP) block for postoperative pain management in patients undergoing midline abdominal surgery in Ethiopia. The study found a significant decrease in analgesic consumption with the ESP block. However, the article highlights challenges in research surrounding regional techniques, including lack of robust evidence, publication bias, and difficulty in interpreting results due to complex nomenclature. The controversy surrounding the ESP block's efficacy, mechanism of action, and potential adverse events is also discussed, emphasizing the need for further research and standardization in regional anaesthesia. [Extracted from the article]

Summary Introduction Methods Results Discussion Regional anaesthesia provides important clinical benefits to patients but is underutilised. A barrier to widespread adoption may be the focus of regional anaesthesia research on novel techniques rather than evaluating and optimising existing approaches. Research priorities in regional anaesthesia identified by anaesthetists have been published, but the views of patients, carers and other healthcare professionals have not been considered previously. Therefore, we launched a multidisciplinary research priority setting partnership that aimed to establish key regional anaesthesia research priorities for the UK.Research suggestions from key stakeholders (defined by their interaction with regional anaesthesia) were gathered using an online survey. These suggestions were analysed to identify common themes and then combined to formulate indicative research questions. After an extensive literature review, unanswered and partially answered questions were prioritised via an interim online survey and then ranked as a top 10 list during a final live virtual multidisciplinary prioritisation workshop.In total, 210 individuals completed the initial survey and suggested 518 research questions. Fifty‐seven indicative questions were formed, of which three were considered fully answered after literature review and one not feasible. The interim online survey received 335 responses, which identified the 24 highest priority questions from the 53 presented. At the final live prioritisation workshop, through a nominal group process, we identified the top 10 regional anaesthesia research priorities. These aligned with three broad thematic areas: pain management (two questions); patient safety (six questions); and recovery from surgery (two questions).This initiative has resulted in a list of research questions prioritised by patients, carers and a multidisciplinary group of healthcare professionals that should be used to inform and support future regional anaesthesia research in the UK. [ABSTRACT FROM AUTHOR]

Background: Utilising ultrasound technology has resulted in higher success and lower complication rates during regional anaesthesia (RA) procedures. Proper training is necessary to accurately identify structures, optimise images, and improve hand–eye coordination. Simulation training using immersive virtual environments and simulation models has enabled this competency training to be conducted safely before performing on patients. We conducted a study to compare the simulator performance and users' feedback on a Blue Phantom Regional Anaesthesia Ultrasound Training Block and NeedleTrainer™. Methods: Forty-seven participants were recruited via convenient sampling during a RA workshop for novice practitioners. They were divided into the N or B group and then crossover to experience using both Blue Phantom and NeedleTrainer model. Time-to-reach-target, first-pass success rate, and complication rate were assessed, while the learning and confidence scores were rated using six-item and three-item questionnaires, respectively, via a 5-point Likert scale. Results: Blue Phantom model has a longer time-to-target as compared to the NeedleTrainer model (16 ± 8 vs 8 ± 3 s, p < 0.001), higher first- pass success rate (100% vs 80.9%), and lower complication rate (0% vs 19.1%). Higher overall learning satisfaction scores (28 ± 4 vs 25 ± 4, p = 0.003) and confidence scores after training (13 ± 2 vs 12 ± 2, p < 0.001) were recorded for the Blue Phantom model. Conclusions: We postulated that the artificial intelligence structure recognition software enables NeedleTrainer users to attain shorter time-to-target. That being said, Blue Phantom provides better operator learning satisfaction, improved confidence, higher success and lower complication rates among novice RA practitioners, possibly due to greater tactile feedback during the simulated training. [ABSTRACT FROM AUTHOR]

Background: Open liver surgery remains a primary surgical approach for complex liver resections and liver transplantation. However, the postoperative pain management is still a major challenge. Ultrasound-guided external oblique intercostal (EOI) plane block is a novel approach of regional anaesthesia and has a great potential to relieve postoperative pain after upper abdominal surgeries. This study aims to investigate the efficacy and safety of ultrasound-guided EOI plane block in managing postoperative pain after open liver surgery. Methods: Seventy-four participants scheduled for open liver surgery will be randomly assigned to either the intervention group, receiving an ultrasound-guided EOI plane block with a single dose of 30 ml 0.375% ropivacaine, or the control group, which will not receive this block. All participants will be provided with opioid-based patient-controlled intravenous analgesia (PCIA) postoperatively. The primary outcome is resting pain score at 3 h postoperatively, assessed using numerical rating scale. Secondary outcomes include pain score at 6, 24, 48, and 72 h postoperatively, perioperative opioid consumption, remedial analgesics within 72 h postoperatively, PCIA usage within postoperative 72 h, postoperative recovery, length of hospital stay, postoperative side effects, block-related complications, and ropivacaine plasma concentration of participants receiving the block. Discussion: This study is a randomised controlled trial to evaluate the efficacy and safety of ultrasound-guided EOI plane block for postoperative analgesia after open liver surgery. As regional anaesthesia plays an important role in the multimodal pain management, EOI plane block may prove to be an effective regional technique for enhancing postoperative pain relief and contributing to enhanced recovery after open liver surgery. Trial registration: Chinese Clinical Trial Registry ChiCTR2200065745. Registered on November 14, 2022. [ABSTRACT FROM AUTHOR]

Artificial intelligence (AI) was once considered avant-garde. However, AI permeates every industry today, impacting work and home lives in many ways. While AI-driven diagnostic and therapeutic applications already exist in medicine, a chasm remains between the potential of AI and its clinical applications. This article reviews the status of AI-powered ultrasound (US) applications in anaesthesiology and perioperative medicine. A literature search was performed for studies examining AI applications in perioperative US. AI applications for echocardiography and regional anaesthesia are the most robust and well-developed. While applications are available for lung imaging and vascular access, AI programs for airway and gastric US imaging solutions have yet to be available. Legal and ethical challenges associated with AI applications need to be addressed and resolved over time. AI applications are beneficial in the context of education and training. While low-resource settings may benefit from AI, the financial burden is a considerable limiting factor. [ABSTRACT FROM AUTHOR]

Chronic postsurgical pain (CPSP) significantly impairs quality of life and poses a substantial healthcare burden, affecting up to a quarter of patients undergoing surgery. Although acute pain is recognised as a predictor for CPSP development, the role of patient experience remains underexplored. This study examines the predictive value of patient experience alongside traditional risk factors for CPSP after orthopaedic surgery. An exploratory analysis was conducted on 294 patients from a multicentre randomised clinical trial comparing continuous perineural analgesia and single-injection nerve block in ambulatory orthopaedic surgeries. Patient experience was assessed using the Evaluation du Vecu de l'Anesthésie Générale (EVAN-G) validated questionnaire. Factors associated with CPSP at 90 days after surgery were identified through univariate and multivariate analyses, incorporating patient-reported outcomes and classical variables. Out of 219 patients with complete data, 63 (29%) developed CPSP at day 90. Multivariate analysis revealed a poor pain experience, as assessed by the pain dimension of EVAN-G on postoperative day 2, as an independent predictor of CPSP (odds ratio 6.45, 95% confidence interval 1.65–25.26, P <0.01). Poor pain experience was associated with an augmented risk of CPSP. This study underscores the role of patient-reported outcomes, specifically the pain experience dimension captured by the EVAN-G scale, in prediction of CPSP 90 days after surgery. It suggests a shift from conventional assessments of pain intensity to a comprehensive understanding of pain experience, advocating for tailored pain management approaches that could reduce chronic pain, thereby improving patient quality of life and functional recovery. [ABSTRACT FROM AUTHOR]

Introduction: Hypotension after subarachnoid block is a common occurrence due to sympathetic blockade leading to vasodilation, which causes a decrease in cardiac preload and results in a decrease in cardiac output. Early detection of hypotension and prompt treatment during caesarean delivery under subarachnoid block is the primary responsibility of the anaesthesiologist. Aim: To evaluate and validate the Perfusion Index (PI) as a predictor of hypotension following Subarachnoid Block (SAB) in patients undergoing Lower Segment Caesarean Section (LSCS) and to assess the usefulness of perioperative pulse oximetryderived PI as a monitoring tool. Materials and Methods: This was a prospective hospitalbased observational study was conducted in the Department of Anaesthesiology at BJMC Ahmedabad, Gujarat, India over a period from March 2020 to February 2021, that included 60 American Society of Anaesthesiolgy (ASA) II pregnant patients, divided into two groups (A and B) based on PI, who were planned for elective caesarean delivery under regional anaesthesia. Variables recorded included heart rate, blood pressure, SpO2, and PI at different time intervals. The quantitative data were presented as mean and standard deviation and compared using the Student's t-test. Results: Demographic parameters of both groups A and B, such as mean age (26.93±3,24 years, 28.33±4.02 years), mean height (155.56±4.29 cm, 155.17±4.31 cm), mean weight (62.70±5.87 kg, 60.36±5 kg), Body Mass Index {BMI (25.92±2.42, 25.01±2.14 kg/m2)}, and gestational age (36.03±0.32, 36.53±0.32 weeks) respectively, were comparable between the two groups. There was a statistically significant drop in Mean Arterial Pressure (MAP) in both Group A and Group B after induction, from one minute to 70 minutes (p<0.05) from the baseline. The difference in the proportion of PI between the hypotension groups was statistically significant (p-value=0.002). The number of episodes of hypotension and the total dose of Mephenteramine were significantly higher in Group B (Chi-square=52.500 with 2 degrees of freedom; p<0.001) than in Group A. Conclusion: Parturients with a baseline PI>3.5 were at a higher risk of developing hypotension following a subarachnoid block compared to those with a baseline PI<3.5. Therefore, appropriate preventive measures can be instituted preoperatively to prevent hypotension and improve outcomes in such patients. [ABSTRACT FROM AUTHOR]

Background: Peripheral nerve blocks may provide better conditions for closed reduction of distal radius fractures as compared to other more frequently used modalities. In this systematic review, we evaluate existing evidence on the effect and harm of peripheral nerve blocks for closed reduction of distal radius fractures in adults. Methods: We performed a systematic review with meta‐analysis and trial sequential analysis including trials investigating the use of peripheral nerve blocks for closed reduction of distal radius fractures. Co‐primary outcomes were (1) the quality of the closed reduction measured as the proportion of participants needing surgery afterwards and (2) pain during closed reduction. Results: Six trials (n = 312) met the inclusion criteria. One trial reported on the need for surgery with 4 of 25 participants receiving nerve block compared to 7 of 25 receiving haematoma block needing surgery (RR 0.57, 96.7% CI [0.19; 1.71], p =.50). Four trials reported pain during closed reduction. In a meta‐analysis, pain was not statistically significantly reduced with a nerve block (−2.1 Numeric Rating Scale (NRS) points (0–10), 96.7% CI [−4.4; 0.2], p =.07, tau2 = 5.4, I2 = 97%, TSA‐adj. 95% CI [−11.5; 7.3]). No trial sequential boundaries were crossed, and the required information size was not met. Pre‐planned subgroup analysis on trials evaluating ultrasound guided peripheral nerve blocks (patients = 110) showed a significant decrease in 'pain during reduction' (−4.1 NRS, 96.7% CI [−5.5; −2.6], p <.01, tau2 = 0.9, I2 = 80%). All trial results were at high risk of bias and the certainty of the evidence was very low. Conclusion: The certainty of evidence on the effect of peripheral nerve blocks for closed reduction of distal radius fractures is currently very low. Peripheral nerve blocks performed with ultrasound guidance may potentially reduce pain during closed reduction. High‐quality clinical trials are warranted. [ABSTRACT FROM AUTHOR]

OBJECTIVES Postoperative pain remains a burden for patients after minimally invasive anatomic lung resection. Current guidelines recommend the intraoperative placement of intercostal catheters to promote faster recovery. This trial aimed to determine the analgesic efficacy of continuous loco-regional ropivacaine application via intercostal catheter and establish this method as a possible standard of care. METHODS Between December 2021 and October 2023, patients were randomly assigned to receive ropivacaine 0.2% or a placebo through an intercostal catheter with a flow rate of 6–8 ml/h for 72 h after surgery. Patients were undergoing anatomic VATS lung resection under general anaesthesia for confirmed or suspected stage I lung cancer (UICC, 8th edition). The sample size was calculated to assess a difference in numerical rating scale associated with pain reduction of 1.5 points. RESULTS Fourteen patients were included in the ropivacaine group, whereas the placebo group comprised 18 participants. Patient characteristics and preoperative pain scores were similar in both groups. There was no statistically significant difference in postoperative pain scores and morphine consumption between the 2 groups. The mean numerical rating scale when coughing during the first 24 h postoperatively was 4.9 (SD: 2.2) in the ropivacaine group and 4.3 (SD: 2.4); P  = 0.47 in the placebo group. We were unable to determine any effect of administered ropivacaine on the postoperative pulmonary function (FEV1, PEF). CONCLUSIONS Our preliminary results suggest that continuous loco-regional ropivacaine administration via surgically placed intercostal catheter has no positive effect on postoperative pain scores or morphine requirements. CLINICAL REGISTRATION NUMBER NCT04939545 [ABSTRACT FROM AUTHOR]

As few anaesthetists provide lumbar erector spinae block for disc surgery, there is a need to provide training to enable a randomised controlled trial investigating analgesia after painful spinal surgery (NIHR153170). The primary objective of the study was to develop and measure the construct validity of a checklist for assessment of skills in performing lumbar and thoracic erector spinae fascial plane injection using soft-embalmed Thiel cadavers. Twenty-four UK consultant regional anaesthetists completed two iterations of a Delphi questionnaire. The final checklist consisted of 11 steps conducive to best practice. Thereafter, we validated the checklist by comparing the performance of 12 experts with 12 novices, each performing lumbar and thoracic erector spinae plane injections or fascia iliaca, serrato-pectoral (PEC II) and serratus injections, randomly allocated to the left and right sides of six soft-embalmed Thiel cadavers. Six expert, trained raters blinded to operator and site of block examined 120 videos each. The mean (95% confidence interval) internal consistency of the 11-item checklist for erector spinae plane injection was 0.72 (0.63–0.79) and interclass correlation was 0.88 (0.82–0.93). The checklist showed construct validity for lumbar and thoracic erector spinae injection, experts vs novices {median (interquartile range [range]) 8.0 (7.0–10.0 [1–11]) vs 7.0 (5.0–9.0 [4–11]), difference 1.5 (1.0–2.5), P <0.001}. Global rating scales showed construct validity for lumbar and thoracic erector spinae injection, 28.0 (24.0–31.0 [7–35]) vs 21.0 (17.0–24.0 [7–35]), difference 7.5 (6.0–8.5), P <0.001. The most difficult items to perform were identifying the needle tip before advancing and always visualising the needle tip. Instrument handling and flow of procedure were the areas of greatest difficulty on the global rating scale (GRS). Checklists and GRS scores correlated. There was homogeneity of regression slopes controlling for status, type of injection, and rater. Generalisability analysis showed a high reliability using the checklist and GRS for all fascial plane blocks (Rho [ρ2] 0.93–0.96: Phi [ϕ] 0.84–0.87). An 11-point checklist developed through a modified Delphi process to provide best practice guidance for fascial plane injection showed construct validity in performing lumbar and thoracic erector spinae fascial plane injection in soft-embalmed Thiel cadavers. [ABSTRACT FROM AUTHOR]

Ni Eochagain and colleagues report that programmed intermittent bolus and continuous infusion regimens in continuous erector spinae plane (ESP) block catheters produced similar quality of recovery (QoR-15) scores, pain scores, and use of rescue opioids after video-assisted thoracic surgery. This is a reassuring finding for practitioners without access to pumps with programmed intermittent bolus functionality. Nevertheless, it remains plausible that the benefit of one regimen over another might vary depending on the specific infusion parameters. There continues to be scope for research into optimising programmed intermittent bolus delivery and dosing regimens and identifying the most appropriate clinical applications for this mode of infusion. [ABSTRACT FROM AUTHOR]

Regional anaesthesia techniques, including the erector spinae fascial plane (ESP) block, reduce postoperative pain after video-assisted thoracoscopic surgery (VATS). Fascial plane blocks rely on spread of local anaesthetic between muscle layers, and thus, intermittent boluses might increase their clinical effectiveness. We tested the hypothesis that postoperative ESP analgesia with a programmed intermittent bolus (PIB) regimen is better than a continuous infusion (CI) regimen in terms of quality of recovery after VATS. We undertook a prospective, double-blinded, randomised, controlled trial involving 60 patients undergoing VATS. All participants received ESP block catheters and were randomly assigned to CI or PIB of local anaesthetic regimen for postoperative analgesia. The primary outcome was Quality of Recovery-15 (QoR-15) score 24 h after surgery. Secondary outcomes included postoperative respiratory function, opioid consumption, verbal rating pain score, time to first mobilisation, nausea, vomiting, and length of hospital stay. Overall QoR-15 scores at 24 h after VATS were similar (PIB 115.5 [interquartile range 107–125] vs CI 110 [93–128]; Δ<6, P =0.29). The only quality of recovery descriptor showing a significant difference was nausea and vomiting, which was favourable in the PIB group (10 [10–10] vs 10 [7–10]; P =0.03). Requirement for rescue antiemetics up to 24 h after surgery was lower in the PIB group (4 [14%] vs 11 [41%]; P =0.04). There were no differences in other secondary outcomes between groups. Delivering ESP block analgesia after VATS via a PIB regimen resulted in similar QoR-15 at 24 h compared with a CI regimen. [ABSTRACT FROM AUTHOR]

Introduction: Thyroid surgeries are among the most frequently performed endocrine surgeries globally. Pain control is one of the many challenges faced by perioperative physicians in post-thyroid surgery patients; if, left untreated, it can progress to chronic pain. Regional anaesthesia, such as Bilateral Superficial Cervical Plexus Block (BSCPB), can provide excellent analgesia in the initial postoperative period without the side effects of systemic analgesics. Aim: To assess postoperative pain using Visual Analogue Scale (VAS) scores at various intervals upto 24 hours postoperatively and to evaluate the duration of the superficial cervical plexus block. Secondary objectives include assessing intraoperative haemodynamic stability, analgesic consumption, and block-related complications. Materials and Methods: This randomised double-blinded clinical trial was conducted in the Department of Anaesthesiology at a teritary care centre, BLDE (Deemed to be University) Shri BM Patil Medical College, Hospital and Research Centre in Vijayapur, Karanataka, India, from April 2023 to March 2024 on 74 American Society of Anaesthesiologists (ASA) grades I-II patients undergoing elective thyroid procedures were randomly assigned to two groups: Group Dexmedetomidine (DexD) (n=37), which received US-guided BSCPB with 10 mL of 0.5% bupivacaine and 25 mcg of dexmedetomidine on both sides; and Group Dexamethasone (DexA) (n=37), which received US-guided BSCPB with 10 mL of 0.5% bupivacaine and 4 mg of dexamethasone on both sides. Intraoperative blood pressure, Heart Rate (HR), and Mean Arterial Pressure (MAP) were measured at predefined time periods. Postoperative VAS scores were assessed at predefined intervals, along with the time taken for the first analgesic request and the cumulative postoperative analgesic dose consumed. Student’s t-test and Chi-square test were used for data comparison. Results: The mean age in Group DexD was 42.59±8.64 years, and in Group DexA it was 45.40±8.96 years. Group DexD had significantly lower postoperative VAS scores for upto eight hours (2.108 vs. 2.72; p-value=0.0002), and the time before the first rescue analgesia request was significantly longer than that of Group DexA (688.37±55.75 min vs. 593.64±72.56 min; p-value=0.001). The total postoperative analgesic utilisation in the first 24 hours was significantly lower in Group DexD compared to Group DexA (81.08±20.754 mg vs. 104.17±44.921 mg; p-value=0.006). Group DexA experienced a lower incidence of nausea (p-value=0.002) and vomiting (p-value=0.001) in the postoperative period. Conclusion: Dexmedetomidine performed better than dexamethasone when added to bupivacaine for BSCPB for pain management during the postoperative period in patients undergoing thyroid surgical procedures. However, when added, dexamethasone has the advantage of reducing nausea and vomiting in the postoperative period.

Abstract Background Utilising ultrasound technology has resulted in higher success and lower complication rates during regional anaesthesia (RA) procedures. Proper training is necessary to accurately identify structures, optimise images, and improve hand–eye coordination. Simulation training using immersive virtual environments and simulation models has enabled this competency training to be conducted safely before performing on patients. We conducted a study to compare the simulator performance and users’ feedback on a Blue Phantom Regional Anaesthesia Ultrasound Training Block and NeedleTrainer™. Methods Forty-seven participants were recruited via convenient sampling during a RA workshop for novice practitioners. They were divided into the N or B group and then crossover to experience using both Blue Phantom and NeedleTrainer model. Time-to-reach-target, first-pass success rate, and complication rate were assessed, while the learning and confidence scores were rated using six-item and three-item questionnaires, respectively, via a 5-point Likert scale. Results Blue Phantom model has a longer time-to-target as compared to the NeedleTrainer model (16 ± 8 vs 8 ± 3 s, p

Abstract Background Open liver surgery remains a primary surgical approach for complex liver resections and liver transplantation. However, the postoperative pain management is still a major challenge. Ultrasound-guided external oblique intercostal (EOI) plane block is a novel approach of regional anaesthesia and has a great potential to relieve postoperative pain after upper abdominal surgeries. This study aims to investigate the efficacy and safety of ultrasound-guided EOI plane block in managing postoperative pain after open liver surgery. Methods Seventy-four participants scheduled for open liver surgery will be randomly assigned to either the intervention group, receiving an ultrasound-guided EOI plane block with a single dose of 30 ml 0.375% ropivacaine, or the control group, which will not receive this block. All participants will be provided with opioid-based patient-controlled intravenous analgesia (PCIA) postoperatively. The primary outcome is resting pain score at 3 h postoperatively, assessed using numerical rating scale. Secondary outcomes include pain score at 6, 24, 48, and 72 h postoperatively, perioperative opioid consumption, remedial analgesics within 72 h postoperatively, PCIA usage within postoperative 72 h, postoperative recovery, length of hospital stay, postoperative side effects, block-related complications, and ropivacaine plasma concentration of participants receiving the block. Discussion This study is a randomised controlled trial to evaluate the efficacy and safety of ultrasound-guided EOI plane block for postoperative analgesia after open liver surgery. As regional anaesthesia plays an important role in the multimodal pain management, EOI plane block may prove to be an effective regional technique for enhancing postoperative pain relief and contributing to enhanced recovery after open liver surgery. Trial registration Chinese Clinical Trial Registry ChiCTR2200065745. Registered on November 14, 2022.

Background: The use of regional anaesthetic techniques for caesarean section and labour analgesia is necessary for quality-driven obstetric anaesthesia as required by European minimum standards for obstetric analgesia and anaesthesia departments, which were issued by the European Society of Anaesthesiology and Intensive Therapy in 2020. The aim of this article is to evaluate the rate of caesarean sections performed using regional anaesthetic techniques and the rates of epidural, remifentanil-PCA, and meperidine analgesia for managing labour pain across the 14 Slovenian obstetric units, respectively. Methods: Data from the Slovenian National Perinatal Information System (NPIS) from 2013 to 2021 were analysed. Results: Spinal anaesthesia was used as a primary anaesthetic method (> 50% of elective caesarean sections) in a half of Slovenian obstetric units. For emergency caesarean sections, regional anaesthetic methods (spinal and epidural) were used in > 50% parturients in 3 obstetric units. Eight obstetric units had an epidural rate of >10%. The use of epidural analgesia has progressively increased in 9 of 14 obstetric units. Remifentanil has been routinely used in 6 obstetric units. Accordingly, the consumption of meperidine has dropped in all but one obstetric unit in Slovenia. Conclusion: In the past decade, considerable progress has been observed in obstetric anaesthesia practice in Slovenia. This is evident from the increased use of regional anaesthesia for caesarean section and labour analgesia. However, there are considerable discrepancies in anaesthetic practices between different obstetric units in Slovenia, a situation the parturients should be informed of well in advance to be able to choose the obstetric unit according to their labour and delivery preferences. In order to avoid the differences in the quality and accessibility of anaesthetic practice between units, it is necessary to increase the number of anaesthesiologists involved in obstetric anaesthesia to ensure 24/7 service of labour analgesia to be able to fulfill minimum European standards for obstetric analgesia and anaesthesia departments.

Introduction: Hypotension after subarachnoid block is a common occurrence due to sympathetic blockade leading to vasodilation, which causes a decrease in cardiac preload and results in a decrease in cardiac output. Early detection of hypotension and prompt treatment during caesarean delivery under subarachnoid block is the primary responsibility of the anaesthesiologist. Aim: To evaluate and validate the Perfusion Index (PI) as a predictor of hypotension following Subarachnoid Block (SAB) in patients undergoing Lower Segment Caesarean Section (LSCS) and to assess the usefulness of perioperative pulse oximetry-derived PI as a monitoring tool. Materials and Methods: This was a prospective hospital-based observational study was conducted in the Department of Anaesthesiology at BJMC Ahmedabad, Gujarat, India over a period from March 2020 to February 2021, that included 60 American Society of Anaesthesiolgy (ASA) II pregnant patients, divided into two groups (A and B) based on PI, who were planned for elective caesarean delivery under regional anaesthesia. Variables recorded included heart rate, blood pressure, SpO2, and PI at different time intervals. The quantitative data were presented as mean and standard deviation and compared using the Student’s t-test. Results: Demographic parameters of both groups A and B, such as mean age (26.93±3,24 years, 28.33±4.02 years), mean height (155.56±4.29 cm, 155.17±4.31 cm), mean weight (62.70±5.87 kg, 60.36±5 kg), Body Mass Index {BMI (25.92±2.42, 25.01±2.14 kg/m2)}, and gestational age (36.03±0.32, 36.53±0.32 weeks) respectively, were comparable between the two groups. There was a statistically significant drop in Mean Arterial Pressure (MAP) in both Group A and Group B after induction, from one minute to 70 minutes (p3.5 were at a higher risk of developing hypotension following a subarachnoid block compared to those with a baseline PI

Abstract Introduction Breast cancer is the most prevalent cancer among women, often necessitating surgical intervention. While surgeries like lumpectomy can be performed under local anesthesia, more extensive procedures typically require general anesthesia. Awake breast cancer surgery has emerged as an alternative due to risks associated with general anesthesia and patient preference. Methods This prospective observational study, conducted from July 2022 to July 2023, evaluated the effectiveness of ultrasound-guided fascial plane blocks for awake breast surgery. Patients aged 18–80 years undergoing unilateral breast surgery were included, following ethical committee approval and written informed consent. Exclusion criteria were prior breast surgery, coagulopathies, infections, allergies to local anesthetics, psychiatric disorders, body mass index over 40 kg/m², and chest deformities. The combination of interpectoral, pecto-serratus, and deep serratus plane blocks was used as the primary anesthetic method, with a superficial parasternal block added in cases where complete cutaneous coverage was not achieved. Results Seventeen patients were enrolled. The primary outcome, sufficient surgical anesthesia without deep sedation, was achieved in 15 patients. The combination of the aforementioned blocks proved effective, with an average surgery duration of 59.66 min, and propofol requirements averaging 1.77 mg/kg/hour. Most patients reported high satisfaction levels, and no early or late block-related complications were observed. Conclusion The combination of fascial plane blocks is a viable option for awake breast cancer surgery, potentially eliminating the need for more invasive anesthesia techniques. Further studies are necessary to confirm these findings in larger, homogeneous patient groups.

Background and Aims: Carotid endarterectomy (CEA) is a common procedure conducted under regional anaesthesia, providing real-time cerebral function monitoring. Many different combinations of regional cervical blocks exist, and most offer adequate analgesia in intraoperative and postoperative recovery. This research compares a superficial cervical plexus block (SCB) alone and combined with an ultrasound (US)-guided carotid sheath block (CSB). The primary objective was to explore the length of the sensory block after combining SCB and CSB. Methods: Patients scheduled for nonemergency CEA surgery were randomised into two cohorts. The Subject group (28 participants) received US-guided CSB and SCB. The Control group (31 participants) received only an SCB. Both groups received 0.5% levobupivacaine (2 mg/kg) along with 2% lidocaine (2 mg/kg). The sensory block time and its initiation, analgesia and neutrophil-to-lymphocyte ratio (NLR) were recorded before and after the block. The numeric pain rating scale (NPRS) was used to evaluate analgesia every 2 h for 12 h post block. Analysis of variance, Mann–Whitney U or log-rank test was used to analyse the distinction of selected variables. Results: The demographic characteristics were comparable across the cohorts. The Subject group demonstrated a significantly accelerated onset of sensory block (P = 0.029) and an extended time to first analgesia (P = 0.003). The sensory block was also substantially extended in the Subject group (P = 0.040). Postoperative pain (NPRS ≥1) within the first 12 h was more recurrent in the Control group (P = 0.048). NLR showed minimal disparity between the groups (P = 0.125). Conclusion: Combining SCB and US-guided CSB effectively and safely extends postoperative analgesia for CEA surgery.

Laparoscopic cholecystectomy (LC) is the gold standard of treatments for symptomatic gallstone disease. The aim of this study is to determine if postoperative opiate use is reduced with transversus abdominus plane (TAP) and rectus sheath (RS) regional anaesthetic blocks compared to port site local anaesthetic (LA) infiltration. A prospective, randomised cohort study was conducted of adult patients who underwent an emergency LC between 25 April 2022 and 25 May 2023. An amount of 40 mL of 0.375% ropivacaine was infiltrated as either TAP and RS blocks or to port sites. Patient demographics, operative data, and postoperative opioid use were collected from the medical record. In total, 138 patients were enrolled in this study: 73 patients allocated to the LA to port sites cohort (52.9%) and 65 patients in the TAP and RS cohort (43.5%). The most common indication for surgery was acute cholecystitis. The average amount of opiate analgesia use was 115.2 mg in the LA group compared to 61.2 mg in the TAP and RS group (p < 0.05). Optimisation of postoperative pain allows for early recovery, improved patient satisfaction, and improved cost-effectiveness for the health service. With a trend towards multimodal analgesia, the uptake of TAP and RS regional anaesthesia may help to achieve this goal.

Introduction: Breast cancer is the most prevalent cancer among women, often necessitating surgical intervention. While surgeries like lumpectomy can be performed under local anesthesia, more extensive procedures typically require general anesthesia. Awake breast cancer surgery has emerged as an alternative due to risks associated with general anesthesia and patient preference. Methods: This prospective observational study, conducted from July 2022 to July 2023, evaluated the effectiveness of ultrasound-guided fascial plane blocks for awake breast surgery. Patients aged 18–80 years undergoing unilateral breast surgery were included, following ethical committee approval and written informed consent. Exclusion criteria were prior breast surgery, coagulopathies, infections, allergies to local anesthetics, psychiatric disorders, body mass index over 40 kg/m², and chest deformities. The combination of interpectoral, pecto-serratus, and deep serratus plane blocks was used as the primary anesthetic method, with a superficial parasternal block added in cases where complete cutaneous coverage was not achieved. Results: Seventeen patients were enrolled. The primary outcome, sufficient surgical anesthesia without deep sedation, was achieved in 15 patients. The combination of the aforementioned blocks proved effective, with an average surgery duration of 59.66 min, and propofol requirements averaging 1.77 mg/kg/hour. Most patients reported high satisfaction levels, and no early or late block-related complications were observed. Conclusion: The combination of fascial plane blocks is a viable option for awake breast cancer surgery, potentially eliminating the need for more invasive anesthesia techniques. Further studies are necessary to confirm these findings in larger, homogeneous patient groups. [ABSTRACT FROM AUTHOR]

Background and Aims: Carotid endarterectomy (CEA) is a common procedure conducted under regional anaesthesia, providing real-time cerebral function monitoring. Many different combinations of regional cervical blocks exist, and most offer adequate analgesia in intraoperative and postoperative recovery. This research compares a superficial cervical plexus block (SCB) alone and combined with an ultrasound (US)-guided carotid sheath block (CSB). The primary objective was to explore the length of the sensory block after combining SCB and CSB. Methods: Patients scheduled for nonemergency CEA surgery were randomised into two cohorts. The Subject group (28 participants) received US-guided CSB and SCB. The Control group (31 participants) received only an SCB. Both groups received 0.5% levobupivacaine (2 mg/kg) along with 2% lidocaine (2 mg/kg). The sensory block time and its initiation, analgesia and neutrophil-to-lymphocyte ratio (NLR) were recorded before and after the block. The numeric pain rating scale (NPRS) was used to evaluate analgesia every 2 h for 12 h post block. Analysis of variance, Mann–Whitney U or log-rank test was used to analyse the distinction of selected variables. Results: The demographic characteristics were comparable across the cohorts. The Subject group demonstrated a significantly accelerated onset of sensory block (P = 0.029) and an extended time to first analgesia (P = 0.003). The sensory block was also substantially extended in the Subject group (P = 0.040). Postoperative pain (NPRS ≥1) within the first 12 h was more recurrent in the Control group (P = 0.048). NLR showed minimal disparity between the groups (P = 0.125). Conclusion: Combining SCB and US-guided CSB effectively and safely extends postoperative analgesia for CEA surgery. [ABSTRACT FROM AUTHOR]

Laparoscopic cholecystectomy (LC) is the gold standard of treatments for symptomatic gallstone disease. The aim of this study is to determine if postoperative opiate use is reduced with transversus abdominus plane (TAP) and rectus sheath (RS) regional anaesthetic blocks compared to port site local anaesthetic (LA) infiltration. A prospective, randomised cohort study was conducted of adult patients who underwent an emergency LC between 25 April 2022 and 25 May 2023. An amount of 40 mL of 0.375% ropivacaine was infiltrated as either TAP and RS blocks or to port sites. Patient demographics, operative data, and postoperative opioid use were collected from the medical record. In total, 138 patients were enrolled in this study: 73 patients allocated to the LA to port sites cohort (52.9%) and 65 patients in the TAP and RS cohort (43.5%). The most common indication for surgery was acute cholecystitis. The average amount of opiate analgesia use was 115.2 mg in the LA group compared to 61.2 mg in the TAP and RS group (p < 0.05). Optimisation of postoperative pain allows for early recovery, improved patient satisfaction, and improved cost-effectiveness for the health service. With a trend towards multimodal analgesia, the uptake of TAP and RS regional anaesthesia may help to achieve this goal. [ABSTRACT FROM AUTHOR]

The most effective way of delivering regional anaesthesia training and the best means of demonstrating competency have not been established. Clinical competency, based on the Dreyfus and Dreyfus lexicon, appears unachievable using current training approaches. Lessons should be taken from the worlds of music, chess, and sports. Modern skills training programmes should be built on an explicit and detailed understanding with measurement of a variety of factors such as perception, attention, psychomotor and visuospatial function, and kinesthetics, coupled with quantitative, accurate, and reliable measurement of performance. [ABSTRACT FROM AUTHOR]

Effective training in regional anaesthesia (RA) is paramount to ensuring widespread competence. Technology-based learning has assisted other specialties in achieving more rapid procedural skill acquisition. If applicable to RA, technology-enhanced training has the potential to provide an effective learning experience and to overcome barriers to RA training. We review the current evidence base for use of innovative technologies in assisting learning of RA. Using scoping review methodology, three databases (MEDLINE, Embase, and Web of Science) were searched, identifying 158 relevant citations. Citations were screened against defined eligibility criteria with 27 studies selected for inclusion. Data relating to study details, technological learning interventions, and impact on learner experience were extracted and analysed. Seven different technologies were used to train learners in RA: artificial intelligence, immersive virtual reality, desktop virtual reality, needle guidance technology, robotics, augmented reality, and haptic feedback devices. Of 27 studies, 26 reported a positive impact of technology-enhanced RA training, with different technologies offering benefits for differing components of RA training. Artificial intelligence improved sonoanatomical knowledge and ultrasound skills for RA, whereas needle guidance technologies enhanced confidence and improved needling performance, particularly in novices. Immersive virtual reality allowed more rapid acquisition of needling skills, but its functionality was limited when combined with haptic feedback technology. User friendly technologies enhanced participant experience and improved confidence in RA; however, limitations in technology-assisted RA training restrict its widespread use. Technology-enhanced RA training can provide a positive and effective learning experience, with potential to reduce the steep learning curve associated with gaining RA proficiency. A combined approach to RA education, using both technological and traditional approaches, should be maintained as no single method has been shown to provide comprehensive RA training. [ABSTRACT FROM AUTHOR]

Peripheral nerve blocks may be essential elements in a multimodal pain management regime following foot and ankle surgery. We assessed the effects of ankle blocks compared with no intervention/sham block or a sciatic nerve block in patients undergoing surgery of the foot or ankle. We searched CENTRAL, Medline, and Embase for randomised clinical trials comparing ankle block with no intervention/sham block or a sciatic nerve block for patients undergoing surgery of the foot or ankle. Our primary outcomes were duration of analgesia and cumulative 24-hour opioid consumption. We followed the recommendations of the Cochrane Handbook, and performed meta-analysis, Trial Sequential Analysis (TSA), and assessed the risk of bias and certainty of the evidence using the GRADE approach. We included five trials (362 participants) comparing ankle block with no intervention/sham block and three trials (247 participants) comparing ankle block with a sciatic nerve block. Ankle block may increase the duration of analgesia when compared with no intervention/sham block (MD 431 min; 96.7% CI 208 to 654), but the evidence was very uncertain. Duration was decreased when compared with a sciatic nerve block (MD −410 min; 96.7% CI −462 to −358). The ankle block duration was probably important in both comparisons. The effects on cumulative 24-hour opioid consumption were very uncertain in both comparisons. Ankle block may increase the duration of analgesia when compared with no intervention/sham block, but the evidence was very uncertain, and decrease the duration of analgesia when compared with a sciatic nerve block. The ankle block duration was probably clinically important in both comparisons. The effects on cumulative 24-hour opioid consumption were very uncertain. [ABSTRACT FROM AUTHOR]

Hip replacement surgery can be painful; postoperative analgesia is crucial for comfort and to facilitate recovery. Regional anaesthesia can reduce pain and postoperative opioid requirements. The role of ultrasound-guided suprainguinal fascia iliaca block for analgesia after elective total hip arthroplasty is not well defined. This randomised trial evaluated its analgesic efficacy. Consenting participants (134) scheduled for elective primary total hip arthroplasty under spinal anaesthesia were randomly allocated to receive ultrasound-guided fascia iliaca block with ropivacaine 0.5% or sham block with saline. The primary outcome was opioid consumption in the first 24 h after surgery. Additional outcomes included pain scores at 4, 8, 12, and 16 h, opioid-related side-effects (nausea, vomiting, pruritis), ability to perform physiotherapy on the first postoperative day, and physiotherapist-assessed quadriceps weakness. There were no significant differences in 24-h opioid consumption (block vs sham block, mean difference −3.2 mg oral morphine equivalent, 95% confidence interval −15.3 to 8.1 mg oral morphine equivalent, P =0.55) or any other prespecified outcomes. In patients undergoing primary total hip arthroplasty, ultrasound-guided suprainguinal fascia iliaca block with ropivacaine did not confer a significant opioid-sparing effect compared with sham block. There were no differences in other secondary outcomes including pain scores, opioid-related side-effects, or ability to perform physiotherapy on the first postoperative day. www.clinicaltrials.gov (NCT03069183). [ABSTRACT FROM AUTHOR]

Study design: Prospective randomized placebo controlled double blind trial. Objective: To examine the effect of ESP block after minimally invasive posterior stabilization for vertebral fractures on opioid consumption, pain, blood loss, disability level, and wound healing complications. Methodology: Patients indicated for minimal invasive posterior stabilisation were included to the study. Our primary outcome was the opioid consumption and Visual Analogue Scale (VAS) measured during the first 48 hours. Secondary outcomes used to measure the short-term outcome included Oswestry Disability Index (ODI) and Patient Reported Outcome Spine Trauma (PROST). Results: In total, 60 patients were included with a 93.3% follow-up. Average morphine consumption during the PACU (Post Anaesthesia Care Unit) period was 5.357 mg in ESP group and 8.607 mg in placebo group (P =.004). Average VAS during first 24 hour was 3.944 in ESP group and 5.193 in placebo group (P =.046). Blood loss was 14.8 g per screw in ESP group and 15.4 g in placebo group (P =.387). The day2 PROST value was 33.9 in ESP group and 28.8 in placebo group (P =.008) and after 4 weeks 55.2 in ESP group and 49.9 in placebo group (P =.036). No significant differences in ODI were detected. Conclusion: The use of ESP block in minimally invasive spinal surgery for posterior fracture stabilization leads to a significant reduction of opioid consumption during PACU stay by 37.7%. Reduction of opioid consumption was accompanied with lower pain (VAS). We found positive effect of the ESP block on short term outcome scores, but no effect on perioperative blood loss and wound healing. [ABSTRACT FROM AUTHOR]

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Systemic sclerosis or scleroderma is an uncommon autoimmune condition with a global incidence of 8 to 56 new cases per million per year, which commences from skin and progresses to affect multiple systems in the body. It is marked by abnormalities in blood vessels, sclerosis of connective tissues and atrophy of skin and internal organs. The systemic sclerosis treatment depends on the disease manifestation and are usually treated with vasodilators (for vasculopathy improvement and prevention of Raynaud’s phenomenon), prostacyclin analogues (for the prevention of Raynaud’s phenomenon refractory to oral vasodilators), immunosuppressants like methotrexate, cyclophosphamide, mycophenolate mofetil, low dose corticosteroids (for the treatment of skin hardening, interstitial lung disease and inflammatory arthritis) and antifibrotics like endothelin receptor antagonists (for the treatment of pulmonary artery hypertension). Avascular necrosis in systemic sclerosis can arise as a result of the macrovascular and microvascular effects of vasculitis and corticosteroid therapy. The multisystem involvement of systemic sclerosis can impact every aspect of anaesthetic care especially airway management. During perioperative management, numerous systemic manifestations like pulmonary artery hypertension, interstitial lung disease and cardiac arrhythmia should be considered. The regional anaesthesia serves as a safe alternative to general anaesthesia and useful adjunct in the management of postoperative pain, but can be technically challenging. This case report described a 61-year-old female patient who had a history of systemic sclerosis for past 25 years and was scheduled for a total hip replacement due to avascular necrosis and secondary osteoarthritis of the left hip. The patient was having difficult cannulation, interstitial lung disease and anticipated difficult airway because of microstomia, limited mouth opening and limited flexion and extension at atlantooccipital joint. But the patient was successfully managed with combined spinal epidural anaesthesia, which provided effective pain control and minimised the perioperative risk associated with general anaesthesia.

Regional anaesthesia in children is a growing field of interest in current anaesthesia practice. We report a case of brachial plexus block for a child with severe forearm necrotizing fasciitis and septicaemia. The need to avoid the multiple shortcomings of general anaesthesia in a critically ill child prompted the use of regional anaesthesia. This case is reported to highlight the prospect of regional anaesthesia for critically ill children who require surgical interventions in resource- poor settings.

The article delves into specific nerve pathways and their role in hip joint innervation, highlighting the sensory and motor functions involved. It also discusses common clinical scenarios where knowledge of hip joint innervation is essential for accurate diagnosis and effective treatment, such as in cases of hip pain, trauma, or postoperative management.

Simple Summary: Periorbital surgeries are painful procedures that require effective pain management, and regional anaesthesia is an essential tool used to achieve it. To desensitise the area of the head involved, blockade of the branches of the trigeminal nerve (ophthalmic, maxillary, and mandibular nerves) is warranted. This technique is well described and employed in human medicine, but the literature on veterinary medicine (dogs) is scarce. This study aims to assess and compare two ultrasound-guided approaches for trigeminal nerve block. Thirteen dog heads were utilised, and following a preliminary anatomical assessment, procedures were conducted using temporal and coronoid approaches. The needle was advanced under ultrasonographic guidance from the dorsal aspect of the temporal area or ventral to the zygomatic arch, respectively. A computed tomography scan was performed with the needles in place and repeated after injection of a contrast medium/tissue dye mixture. Dissection of the heads was immediately performed thereafter. Needle position, contrast distribution, and nerve staining were evaluated and compared between the two techniques. Results indicate no significant difference between both techniques. Both methods demonstrate adequate distribution, with minimal intracranial spread of the injectate. Both techniques are promising, although further studies in live animals are required. The trigeminal nerve is responsible for innervating the periorbita. Ultrasound-guided trigeminal block is employed in humans for trigeminal neuralgia or periorbital surgery. There are no studies evaluating this block in dogs. This study aims to evaluate and compare two approaches (coronoid and temporal) of the trigeminal nerve block. We hypothesised superior staining with the coronoid approach. Thirteen dog heads were used. After a preliminary anatomical study, two ultrasound-guided injections per head (right and left, coronoid and temporal approach, randomly assigned), with an injectate volume of 0.15 mL cm−1 of cranial length, were performed (iodinated contrast and tissue dye mixture). The ultrasound probe was placed over the temporal region, visualising the pterygopalatine fossa. For the temporal approach, the needle was advanced from the medial aspect of the temporal region in a dorsoventral direction. For the coronoid approach, it was advanced ventral to the zygomatic arch in a lateromedial direction. CT scans and dissections were conducted to assess and compare the position of the needle, the spread of the injectate, and nerve staining. No significant differences were found. Both approaches demonstrated the effective interfascial distribution of the injectate, with some minimal intracranial spread. Although the coronoid approach did not yield superior staining as hypothesised, it presents a viable alternative to the temporal approach. Studies in live animals are warranted to evaluate clinical efficacy and safety. [ABSTRACT FROM AUTHOR]

Simple Summary: The celiac plexus (CP) is a dense network of ganglia and sensitive fibres receiving nociceptive inputs from most abdominal viscera. In human medicine, the CP is a therapeutic target to control pain originating from pancreatic tumours and chronic pancreatitis. The fluoroscopic-guided block and neurolysis of the CP are commonly used in human analgesia but they have not been described in animals. We describe a fluoroscopically guided transcutaneous approach to the CP in swine cadavers to assess the feasibility of the technique in veterinary species. This technique is shown to be feasible, and its application in veterinary subjects suffering abdominal pain should be assessed. Celiac plexus block (CPB) and neurolysis (CPN) are used for pain management in people suffering from abdominal tumours or chronic pancreatitis. The fluoroscopically guided approach common in human medicine has not been described in veterinary settings. The aim of this study was to describe a fluoroscopic approach to the celiac plexus (CP) in fresh pig cadavers. Twelve animals were included in the procedure. Cadavers were positioned in sternal position and, under fluoroscopic guidance, a Chiba needle was inserted parasagittal at 6 cm from the spinal midline at the level of the last thoracic vertebra. From the left side, the needle was directed medio-ventrally with a 45° angle towards the T15 vertebral body; once the vertebral body was contacted, the needle was advanced 1 cm ventrally towards the midline. Iodinated contrast was injected to confirm the location. Following this, 2 mL of dye (China ink) was injected. A laparotomy was performed, and dyed tissue was dissected and prepared for both histochemical and immunohistochemical techniques. In 10 out of 12 samples submitted for histological evaluation, nervous tissue belonging to CP was observed. Fluoroscopy guidance allows for feasible access to the CP in swine cadavers in this study. Further studies are warranted to determine the efficacy of this technique in swine and other veterinary species. [ABSTRACT FROM AUTHOR]

Intravenous (IV) medication administration error remains a major concern during the perioperative period. This review examines inadvertent IV anaesthesia induction agent administration via high‑risk routes. Using Medline and Google Scholar, the author searched published reports of inadvertent administration via neuraxial (intrathecal, epidural), peripheral nerve or plexus or intracerebroventricular (ICV) route. The author applied the Human Factors Analysis and Classification System (HFACS) framework to identify systemic and human factors. Among 14 patients involved, thiopentone was administered via the epidural route in six patients. Four errors involved the routes of ICV (propofol and etomidate one each) or lumbar intrathecal (propofol infusion and etomidate bolus). Intrathecal thiopentone was associated with cauda equina syndrome in one patient. HFACS identified suboptimal handling of external ventricular and lumbar drains and deficiencies in the transition of care. Organisational policy to improve the handling of neuraxial devices, use of technological tools and improvements in identified deficiencies in preconditions before drug preparation and administration may minimise future risks of inadvertent IV induction agent administration. [ABSTRACT FROM AUTHOR]

To compare the perioperative cumulative opioid consumption and the incidence of cardiovascular complications in dogs undergoing hemilaminectomy in which either an erector spinae plane (ESP) block or systemic opioids were administered. Prospective randomized clinical trial. A total of 60 client-owned dogs. Dogs were randomized to one of three groups: an ESP block (group ESP), a constant rate infusion of fentanyl (group FNT, positive control) or a single dose of methadone as premedication (group MTD, negative control). Intraoperative nociceptive response was treated with fentanyl [1 μg kg–1, intravenously (IV)] boli. Before closure of the surgical site, morphine (0.1 mg kg–1) was applied to the dura mater. The cumulative dose of opioids was recorded and compared between groups. The incidence of intraoperative bradycardia and/or hypotension and the time to extubation were compared between groups. The short form of the Glasgow Composite Pain Scale (SF-GCPS) was used to score nociception before anaesthetic induction and 1, 2, 6, 12,18 and 24 hours postoperatively. Methadone 0.2 mg kg–1 was administered IV if the SF-GCPS score was ≥ 5. Group MTD required more intraoperative rescue analgesia than groups ESP (p = 0.008) and FNT (p = 0.001). The total cumulative intraoperative dose of fentanyl was higher in groups FNT (p < 0.0001) and MTD (p = 0.002) than in group ESP. The incidence of cardiovascular complications was similar between groups. Extubation time was longer in group MTD (p = 0.03). Postoperatively, the time to first rescue analgesia was longer in group ESP than in group MTD (p = 0.03). The cumulative postoperative opioid consumption and pain scores were similar between groups. The ESP block resulted in a reduced intraoperative opioid consumption compared with the control positive and negative groups. [ABSTRACT FROM AUTHOR]

In high-resource countries, health disparities exist in both treatment approaches and health outcomes. Race and ethnicity can serve as proxies for other socioeconomic factors and social determinants of health such as income, education, social support, and residential neighbourhood, which strongly influence health outcomes and disparities. In regional anaesthesia and pain medicine, disparities exist across several surgical specialties including obstetrics, paediatrics, and orthopaedic surgery. Understanding these disparities will facilitate development of solutions aimed at eliminating disparities at the patient, physician/provider, and healthcare system levels. [ABSTRACT FROM AUTHOR]