Blocking Effect Research Articles

The Effect of Ultrasound-Guided Erector Spinae Plane Block on Postoperative Opioid Consumption and Respiratory Recovery in Laparoscopic Sleeve Gastrectomy: A Randomized Controlled Study.

The aim of this prospective, randomized, controlled study was to evaluate the effect of ultrasound (US)-guided bilateral erector spinae plane (ESP) block on postoperative opioid consumption and respiratory recovery in patients with obesity undergoing laparoscopic sleeve gastrectomy (LSG). The study was conducted on 40 patients scheduled for LSG. The patients were randomly allocated into either the ESP block group or the control group. The US-guided bilateral ESP block was performed preoperatively. The control group received no intervention. Postoperative median [IQR] tramadol consumption was significantly lower in the ESP block group [150.0 [100-200] mg vs 450.0 [400-500] mg, p < 0.0001]. Postoperative spirometric variables were significantly impaired in both groups, compared with preoperative variables (p < 0.0001). Intraoperative median [IQR] fentanyl consumption was 200.0 [200-200] µg in the ESP block group, and 350.0 [300-400] µg in the control group (p < 0.0001). Postoperative mean pain scores at rest and during movement were significantly lower in the ESP block group, at all time points (p < 0.05). In terms of mean arterial PH, Horowitz ratio, and PaCO2, there was no statistically significant difference between the groups (p > 0.05). None of the patients experienced postoperative respiratory adverse events and/or block-related complications. US-guided bilateral ESP block significantly reduced both intraoperative and postoperative analgesic consumptions and provided effective postoperative pain control for patients with obesity undergoing bariatric surgery. Following bariatric surgery, all patients' postoperative pulmonary functions deteriorated. The effect of US-guided bilateral ESP block on postoperative respiratory recovery could not be clearly demonstrated. Randomized controlled studies with a larger patient population are necessary.

Postoperative analgesic effect of lumbar erector spinae plane block for developmental hip dysplasia surgery: a randomized controlled double-blind study.

Open surgery for developmental dysplasia of the hip (DDH) may cause severe pain due to tenotomies and pelvic-femoral osteotomies. This study aims to evaluate the analgesic effect of ultrasound-guided Lumbar Erector Spina Plane (L-ESP) Block in pediatric patients undergoing DDH surgery. Sixty children scheduled for DDH surgery were randomly assigned into two groups. Group I (n = 30) received L-ESP with 0.5 mL/kg of 0.25% bupivacaine before surgery. In contrast, Group II (n = 30), as the control group, received the same volume of saline injection. Identical postoperative analgesia protocol was adjusted for both groups. Parental satisfaction, pain levels, ibuprofen, and opioid consumption were recorded. Pain levels were evaluated with the FLACC (Face, Legs, Activity, Crying, Consolability) scale. FLACC scores at the first 24th hours were lower in the L-ESP group than the control group (p < 0.001). Rescue opioid utilization was higher in the control group (15/26) than in the L-ESP group (2/29) (p < 0.001). The consumption of ibuprofen was higher in the control group than in the L-ESP group in the ward (24/26 vs. 3/29, p < 0.001, respectively). Parental satisfaction was superior in the L-ESP group (p = 0.024). To provide postoperative analgesia for DDH surgery, ultrasound-guided L-ESP may be an effective and alternative regional anesthetic technique.

Genetic characterization and mapping of the shell-strength trait in peanut.

Shell strength is an important trait in peanuts that impacts shell breakage and yield. Despite its significance, the genetic basis of shell strength in peanuts remains largely unknown, and the current methods for rating this trait are qualitative and subjective. This study aimed to investigate the genetics of shell strength using a segregating recombinant-inbred-line (RIL) population derived from the hard-shelled cultivar 'Hanoch' and the soft-shelled cultivar 'Harari'. Initially, a quantitative method was developed using a texture analyzer, focusing on the proximal part of isolated shells with a P/5 punching probe. This method revealed significant differences between Hanoch and Harari. Shell strength was then measured in 235 RILs across two distinct environments, revealing a normal distribution with some RILs exhibiting shell strength values beyond those of the parental lines, indicating transgressive segregation. Analysis of variance indicated significant effects for the RILs, with no effects of block or year, and a broad-sense heritability estimate of 0.675, indicating a substantial genetic component. Using an existing genetic map, we identified three QTLs for shell strength, with one major QTL (qSSB02) explaining 18.7% of the phenotypic variation. The allelic status of qSSB02 corresponded significantly with cultivar designation for in-shell or shelled types over four decades of Israeli peanut breeding. Physical and compositional analyses revealed that Hanoch has a higher shell density than Harari, rather than any difference in shell thickness, and is associated with increased levels of lignin, cellulose, and crude fiber. These findings provide valuable insights into the genetic and compositional factors that influence shell strength in peanut, laying a foundation for marker-assisted selection in breeding programs focused on improving pod hardness in peanuts.

Comparative analysis of the effectiveness of quadratus lumborum and transversus abdominis muscle blocks for postoperative pain relief during laparoscopic robot-assisted total hysterectomy.

The purpose of this study was to compare and evaluate the analgesic effectiveness of quadratus lumborum block (QLB) and transversus abdominis plane bloc block (TAPB) after laparoscopic robot-assisted total hysterectomy. Materials and methods. A prospective study of female patients (n=101), with physical status ASA I-II, who underwent laparoscopic robot-assisted total hysterectomy under multicomponent general anesthesia. In random order, patients were randomized into three groups: the first group (CON, n=40) - control, where no blocks were performed, the second group (TAPB, n=30) - a blockade of the transverse abdominis muscle, the third group (QLB, n= 31) – blockade of the quadratus lumborum muscle was performed. After surgery, pain was assessed using a 10-point digital visual analogue scale, and postoperative nausea and vomiting were assessed. (PONV) Average arterial pressure and heart rate were recorded. Additionally, the next morning, a survey was conducted to assess the well-being and satisfaction of patients. Results. There were no differences between the groups in terms of demographic characteristics, duration of surgery, and analgesic consumption during the intraoperative period. The severity of postoperative pain was higher (p&lt;0.05) in the control group than in the blockade groups. Both block groups demonstrated lower pain scores at all time points assessed. The latest need for analgesics was in the QLB group. Mean arterial pressure (MAP) values differed only in the first 2 hours after surgery between the CON and TAPB groups (p&lt;0.05). PONV one hour after surgery was more observed in the control group and less in the QLB group (p&lt;0.05). According to the results of a survey conducted on the day after surgery, the number of patients satisfied with the anesthesia and assistance provided in the recovery room in the groups with blockade (TAPB, QLB) was 2.1-5.3% higher (p&gt;0.05). More patients from the QLB group (p&lt;0.05) noted very good and good health, and most patients (p&lt;0.05) from the CON and TAPB group noted satisfactory health. Conclusion. The use of interfascial blocks for postoperative pain relief (TAPB, QLB) after laparoscopic robot-assisted hysterectomy improves the quality of pain relief and the well-being of patients. Benefits of QLB include better pain relief, reduced incidence of PONV, and greater patient satisfaction. TARP has shown equally good results, and this method is easier to perform.

Comparative Analysis of Ultrasound Guided Transversus Abdominis Plane Block with or without Buprenorphine Following Inguinal Hernia Repair

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.

Effect of Lingual Nerve Block and Localised Somatosensory Abnormalities in Patients With Burning Mouth Syndrome-A Randomised Crossover Double-Blind Trial.

To investigate the effect of a lingual nerve block on spontaneous pain in patients with burning mouth syndrome (BMS) and to estimate associated somatosensory abnormalities by quantitative sensory testing (QST). A standardised QST battery including cold detection threshold (CDT), warmth detection threshold (WDT), thermal sensory limen (TSL), paradoxical heat sensation (PHS), cold pain threshold (CPT), heat pain threshold (HPT), mechanical pain threshold (MPT), wind-up ratio (WUR) and pressure pain threshold (PPT) was performed at the oral mucosa of the most painful site and intraoral control site in 20 BMS patients, and at the tongue and cheek mucosa in 22 age- and gender-matched healthy controls. The effect of a lingual nerve block on spontaneous burning pain reported by the BMS patients on a 0-10 cm visual analogue scale (VAS) was investigated in a randomised double-blind crossover design using (1 mL) lidocaine (lido) or saline (sal) with an interval of 1 week. The BMS patients were grouped into 'central' and 'peripheral' mechanisms based on the effect of the lingual nerve injections. For each BMS patient, Z-scores and Loss/Gain scores were computed. Differences among groups and sites were analysed using a two-way ANOVA. Differences within group were assessed by paired t-test. The 20 BMS patients were characterised on the basis of VAS changes (ΔLido-ΔSal) as a peripheral BMS subgroup (n = 9) with pain relief more than 1 cm on the VAS and a central BMS subgroup (n = 11) with pain relief less than 1 cm. BMS patients (n = 20) had lower sensitivity to thermal stimuli (i.e., CDT, WDT, TSL, CPT, HPT and PPT) and higher sensitivity to mechanical stimuli (i.e., PPT) compared with controls (p ≤ 0.007). Based on Loss/Gain coding, L1G0 (loss of thermal somatosensory function with no somatosensory gain, 55.0%) was the most frequent coding in the BMS group, which was higher than 11.4% in the control group (p < 0.001). Surprisingly, there was no significant difference between the peripheral and central BMS subgroups with regard to the Z-scores of any of the nine QST parameters (p > 0.097). The results of the lingual nerve blocks demonstrated two distinct phenotypes with either peripheral or central mechanisms but no direct impact on somatosensory function. Overall, somatosensory function in BMS patients seems abnormal in the painful areas compared to matched controls with a conspicuous loss of thermosensory function.

Wafer chamfering grinding wheels dressing via dynamic deflection laser beam

Wafer chamfering forming grinding wheels (WCF) is a kind of V-shaped circular groove forming wheel with a large diameter and small grooves. In this study, a dynamic deflection laser beam method is presented to improve the dressing quality of WCF. The compensation effect of deflected laser on the surface laser energy density of materials was analyzed, and the blocking effect caused by oversized deflection angle of laser beam was analyzed. A C-W model was proposed for laser dressing of WCF. Based on C-W model, trajectory planning for laser dressing was carried out, and dressing experiments were completed. The results show that the contour transition of the grinding wheel is more smooth. Compared to single direct laser beam dressing method and static deflection laser dressing method, the contour exhibits better roundness and the PV values reduced to 5.1μm. Surface observation revealed strip-shaped patterns and some flocculent metamorphic layer. The SEM result shows that there are no obvious crack defects on the surface.

Effectiveness of ultrasound-guided ilioinguinal and iliohypogastric nerve block in pediatric inguinal hernia surgery: a systematic review and meta-analysis of randomized controlled trials

Aim: To evaluate the efficacy of ultrasound-guided ilioinguinal and iliohypogastric nerve block (IIHB) in children undergoing surgery for inguinal hernias.Material and methods: PubMed, Embase, Cochrane Library, and Web of Science databases were searched to January 4, 2024. For continuous data, the effect sizes were presented as weighted mean differences (WMDs), and for categorical data, they were reported as relative ratios (RR), each accompanied by 95% confidence intervals (CIs).Results: IIHB demonstrated a longer duration before the need for the first analgesic compared to transverse abdominis plane (TAP), caudal epidural block (CEB), and pre-incisional wound infiltration (PWI), but a shorter duration than quadratus lumborum block (QLB). The IIHB group had a higher probability of requiring rescue analgesics compared to other blocks or PWI (RR: 1.69, 95% CI: 1.25 to 2.28, p=0.001). Higher FLACC scores were noted at 12 hours for the IIHB group (WMD:0.50, 95% CI: 0.13 to 0.86, p=0.008). IIHB required more intraoperative fentanyl compared to controls (RR: 2.14, 95% CI:1.17 to 3.92, p=0.014).Conclusion: While IIHB may have some benefits, it does not appear to be more effective overall in managing postoperative pain in pediatric inguinal hernia surgery patients compared to other blocks or PWI.

The effect of sacral erector spinae plane block on the quality of recovery after total hip arthroplasty: a prospective, randomized, controlled, multicenter study.

Total hip arthroplasty, commonly performed to alleviate hip pain and enhance functionality in elderly patients, requires effective postoperative pain management to reduce opioid consumption and its associated side effects. A novel regional anaesthesia technique, the sacral erector spinae plane block, has the potential to enhance the quality of postoperative recovery significantly. This prospective, randomized, controlled multicenter study investigated the effects of the sacral erector spinae plane block on recovery quality in patients undergoing total hip arthroplasty. The study comprised 50 patients, divided into Group S (patients receiving patients receiving sacral erector spinae plane block [S-ESPB]) and Group C (patients getting just multimodal analgesia). The primary outcome measured was the Quality of Recovery-15 score 24 hours post-surgery. Secondary outcomes included postoperative numerical rating scale scores (A score of 0 indicates no pain, while 10 indicates the most severe pain), total consumption of rescue analgesics, time to first rescue analgesic administration, patient satisfaction, time to first ambulation, the occurrence of complications, and the need for antiemetics. Group S had markedly higher quality of recovery-15 scores compared to Group C (Group S: median 117 percentiles [97-121]; Group C: median 89 percentiles [75-96]; P<0.001). Group S scored higher in postoperative pain, physical comfort, support, emotional state, and general quality of recovery-15 (P<0.001). Nevertheless, the physical independence category ratings were comparable across both groups (P=0.286). Sacral erector spinae plane block is a promising analgesic technique that enhances postoperative recovery and patient comfort in total hip arthroplasty.

Effect of ultrasound-guided lower transverse abdominal muscle plane block on awakening agitation and stress response in laparoscopic inguinal hernia surgery.

Effect of ultrasound-guided lower transverse abdominal muscle plane block on awakening agitation and stress response in laparoscopic inguinal hernia surgery.

The effect of lidocaine splash block followed by suspensory ligament massage in female dogs undergoing ovariohysterectomy. A prospective study

The effect of lidocaine splash block followed by suspensory ligament massage in female dogs undergoing ovariohysterectomy. A prospective study

Dominant Synoptic Systems for Summer Precipitation over the Complex Terrain of Southwestern China

Abstract Understanding precipitation over complex terrain, such as southwestern China, requires the consideration of both multiscale circulation and topography. First, the dominant synoptic system must be clarified, as it determines how multiscale topography affects precipitation. Here, based on a self-organizing map, large-scale winds are categorized into anomalous-westerly types, anomalous-easterly types, and transitional types. Four synoptic-scale systems (vortex type, cold-front type, tropical-depression type, and weak-synoptic-forcing type) dominate the summer precipitation. The vortex type occurs with strengthened large-scale westerlies, and its precipitation is distributed within the moisture convergence region. The cold-front type, tropical-depression type, and weak-synoptic-forcing type exhibit large-scale easterly anomalies. For the cold-front type, a low-level northeasterly blocked by topography shapes the northwest–southeast-oriented front zone at the upper highland slope. The precipitation frequency and intensity are high within the frontal zone, while the intensity is weak on both sides. For the tropical-depression type, moist low-level easterlies uplifted by westward-rising topography anchor precipitation at the lower slope. Large precipitation for the tropical-depression type is attributed to a high frequency. Large-scale horizontal winds are the weakest for the weak-synoptic-forcing type, and the local topography influences the scattered precipitation distribution. Both the frequency and intensity are high for the weak-synoptic-forcing type. Overall, long-lasting nocturnal events dominate the precipitation of the four synoptic types, while large-scale easterlies favor precipitation events with shorter durations and earlier peaks. For obvious synoptic systems, large-scale topography influences precipitation via a dynamic blocking effect, while the thermodynamic role of local topography is important with a weak-synoptic-forcing. Significance Statement Clarifying dominant synoptic systems is highly important for understanding precipitation over complex terrain, as the effect of topography on precipitation varies with different synoptic backgrounds. Taking southwestern China as a representative of complex terrain, this study objectively identified the dominant synoptic systems associated with summer precipitation. The distribution and fine-scale characteristics of precipitation have been further analyzed considering the combined influence of multiscale circulation and topography. In addition to advancing our understanding of precipitation in southwestern China, this study provides a reference for analyzing precipitation in other regions with complex terrains.

Potential objects and transitivity variations: A comparable corpus-driven study of Mandarin Chinese Verb-Object compounds

This study proposes a new approach to the transitivity variation of the Mandarin Verb-Object (VO) compound by focusing on the role of the potential objects instead of the incorporated object. This new approach highlights the interactions between language change and variation. Previous approaches to the transitivity variation of VO compounds, especially Mandarin Chinese VO compounds, have typically focused on the purported blocking effect of the incorporated object (O). Recent corpus-driven studies, however, have attested that Mandarin VO compounds can take objects. This study compared clausal contexts in two Chinese varieties when VO compounds take direct objects and showed that the same noun phrase tends to require a context of higher transitivity to function as a direct object in the Mainland variety, complementing the previously established tendencies that Taiwan Verb-Object compounds have higher object-taking abilities. Both changes and variations can be interpreted as lexical constructionalization, supplemented with insights from noun incorporation and lexical diffusion. Argument advancement after compound formation represents lexical constructionalization, motivated by a tendency to encode transitivity with less compositionality. The contrasting contextual and lexical transitivity trends in the two varieties support the shifting encoding of transitivity generalization, illustrating different stages of lexical constructionalization.

Levels of Effectiveness of Water Curtain Equipment Applied When Mitigating Fire Compartment Installation of Logistics Facilities

Mock-up tests and fire simulations were performed to verify the effectiveness of water curtain equipment in mitigating fire compartment installation of logistics facilities. The radiant-heat-blocking effect of the water curtain equipment differed significantly based on the type of drencher head, and a blocking effect was observed. Additionally, the radiant temperature and heat flux were significantly reduced when the installation intervals of the drencher heads of the water curtain equipment were reduced. Therefore, improving the standards related to the water curtain equipment of logistics facilities, e.g., providing drencher head specifications, restricting the sizes of the openings, and narrowing the installation intervals of the drencher heads, is necessary to ensure the fire safety of water curtain equipment.

Effect of erector spinae plane block and thoracic epidural anesthesia on hospital length of stay and postoperative opioid use after mastectomy

BackgroundAdequate postoperative pain control is essential after mastectomy. This study compares the influence of 2 regional analgesia techniques on length of stay and opioid use to systemic analgesia alone. MethodsPatients treated with mastectomy from 2014 to 2020 were stratified according to perioperative analgesic modality (systemic analgesia versus thoracic epidural anesthesia or erector spinae plane block). Demographic, tumor, and treatment characteristics were compared. Outcome variables included postoperative anesthesia unit and hospital length of stay, postoperative day 1 and 2 discharge rates, and inpatient opioid use (in oral milligram morphine equivalents). ResultsOf 316 patients, 171 received systemic analgesia, 72 thoracic epidural anesthesia, and 73 erector spinae plane block. On univariate analysis, there were significant differences in age, neoadjuvant chemotherapy, bilateral surgery, immediate reconstruction, and Her2 positivity rates. Thoracic epidural anesthesia had the longest hospital length of stay, and erector spinae plane block the shortest, compared with systemic analgesia (52.1 vs 28 vs 30.6 hours, P < .0001). Postoperative day 1 discharge was more likely with erector spinae plane block than systemic analgesia and less likely with thoracic epidural anesthesia (89% vs 68.4% vs 30.6%, P < .0001). Erector spinae plane block required significantly less milligram morphine equivalents than thoracic epidural anesthesia or systemic analgesia on postoperative day 1 (10 vs 18.75 vs 20 milligram morphine equivalents, P < .0009), but no differences on postoperative day 2 (23.5 vs 20 vs 25 milligram morphine equivalents, P = .84). Total hospital opioid use was significantly lower for erector spinae plane block than thoracic epidural anesthesia or systemic analgesia (24 vs 32.3 vs 32 milligram morphine equivalents, P = .024). On multivariate analysis, thoracic epidural anesthesia was associated with significantly longer length of stay, whereas neither thoracic epidural anesthesia nor erector spinae plane block was associated with decreased opioid use. ConclusionRegional analgesia is not significantly associated with decreased opioid use or hospital length of stay.

In vitro study of the treatment of dentin hypersensitivity with gallic acid combined with sodium fluoride

BackgroundDentin hypersensitivity (DH) is a common oral condition that is associated with severe dental pain. Pain relief is a key focus of the treatment of DH. The purpose of this study was to evaluate the blocking and antacid effects of gallic acid (GA) combined with sodium fluoride (NaF) on dentinal tubules in vitro.MethodsNinety dentin discs from human third molars were treated with 6% citric acid for 2 min. Then, the surface morphologies of ten dentin discs were observed by scanning electron microscopy (SEM). The remaining samples were randomly divided into four groups: the NaF group, which was treated with 1000 ppm NaF; the GA group, which was treated with 4000 ppm GA; the GA + NaF group, which was treated with 1000 ppm NaF + 4000 ppm GA; and the blank group, which was treated with deionized water. The dentin permeability of each sample was measured with a water-filled system before processing and after 7 days of treatment. Dentin morphology and surface deposits were observed by SEM. Then, samples from the NaF, GA + NaF and blank groups were subjected to an acid challenge by incubation with 0.02% citric acid for 2 min. SEM and a water-filled system were used to evaluate the blocking and antacid effects of NaF and GA + NaF.Results1. NaF and GA + NaF significantly decreased dentin permeability. The effect of the GA + NaF treatment was more significant. After acid challenge, both groups still exhibited decreased dentin permeability compared with the initial assessment. 2. Compared with the NaF group, the GA + NaF group had more mineral deposits on the dentin surface and dentin tubules. After acid challenge, the deposits in the GA + NaF group were still clearly visible.ConclusionThe combined effect of GA and NaF on reducing dentin permeability by blocking open dentin tubules is better than that of NaF alone. After acid challenge, the GA + NaF treatment still had a better effect.

Optimization of collection efficiency for a dual-row jet mining machine based on CFD-DEM coupling

Deep-sea mineral resources possess vast reserves; yet, the depositional environment is extremely harsh, and the mining challenges are significant. Overcoming the technical hurdles of deep-sea mining and protecting the marine environment to achieve sustainable development and utilization of seabed resources are major challenges in the field of marine resource development. In this work, we employ a coupled Computational Fluid Dynamics-Discrete Element Method (CFD-DEM) approach with the objective of enhancing the collection efficiency of deep-sea polymetallic nodules. The research focuses on adjusting and optimizing the collection parameters of a dual-jet collector. We examine the influence of the collector's jet angle and velocity on the collection efficiency. We conduct a numerical analysis of the movement characteristics of nodules, the distribution of the flow field, and the efficiency of nodule collection. The results indicate that when the rear jet angle is too small, the stripping and blocking effects on the nodules deteriorate. Conversely, when the jet angle is too large, the upwelling flow velocity decreases. The optimal collection effect is achieved with a rear jet angle of 55°. Lower jet velocities result in poorer nodule stripping, collection, and lifting. Higher jet velocities, however, increase seafloor disturbance and reduce the device's energy utilization efficiency. The collection efficiency is optimal at jet velocities ranging from 8 to 9 m/s. This research provides valuable insights for the design of high-efficiency dual-jet collector devices.

Efficacy of Quadratus Lumborum Block Compared to Paravertebral Block on Pediatric Patients Undergoing Abdominal Surgery

Background: Abdominal surgery is a major procedure associated with severe postoperative pain in pediatric patients. Quadratus lumborum block (QLB) is considered an effective pain control in such cases. Paraverterbral block (PVB) is another option for postoperative pain management. The aim of this study was to compare the effectiveness of quadratus lumborum block with paravertebral block. Methods: This single-blind randomized controlled trial included 22 pediatric patients who underwent abdominal surgery at Sanglah Hospital, Denpasar between August – October 2022. Research subjects were divided into 2 treatment groups; group A consisted of general anesthesia combined with quadratus lumborum block and group B consisted of general anesthesia combined with paravertebral block. Duration of analgesia was recorded based on the time to analgesic rescue, FLACC pain scale at 0, 2, 4, 6, 12 and 24 hours and total opioid consumption 24 hours after surgery. Statistical analyses were performed using SPSS. Results: Eleven patients received QLB and PVB respectively. There was a significant difference in mean analgesia duration of 1287 ± 129.69 minutes compared to 750 ± 122.22 minutes (p &lt; 0.001) (CI 95%: 425.18 – 649.36), median FLACC pain scale at 12 (1 (IQR 2) vs 4 (IQR 1)) and 24 hours postoperative (1 (IQR 2) vs 3 (IQR 1)) between QLB and PVB (p &lt; 0.001 and p &lt; 0.007). Mean 24-hour postoperative opioid consumption was significantly lower in the QLB compared to the PVB. Conclusion: QLB has better effectiveness than PVB in pediatrics undergoing abdominal surgery.

Combined SK and K2P channel block cardioverts atrial fibrillation in 82% of cases, doubling the efficacy of single channel block

Abstract Background Inhibiting the atrial-selective SK and K2P channels represents a promising strategy for cardioverting atrial fibrillation (AF), but its efficacy has not been evaluated in a large human cohort. Objectives This study employed in-silico trials in 1000 virtual patients (i.e., clinical trials conducted in a population of virtual human subjects through modelling and simulation) to estimate the efficacy and safety of three pharmacological interventions: single and combined SK and K2P channel block. Methods A large cohort of 1000 virtual patients was developed based on human data, to cover the electrophysiological, anatomical and structural variability encountered in clinical practice. The subset of virtual patients with AF maintenance underwent pharmacological cardioversion (Figure). Results Sustained AF was observed in 654 (65%) virtual patients. In this cohort, cardioversion efficacies of 33% (213 of 654), 43% (278 of 654) and 82% (534 of 654) were obtained for single SK, single K2P and combined channel block, respectively (Figure). The cardioversion efficacy was proportional to an increase in tissue refractoriness (increase of 45.2±43.0, 71.0±55.3 and 133.0±48.4 ms in the atrial refractory period) and depended on the ionic current profile. Virtual patients cardioverted by SK channel block presented lower K2P densities (0.008±0.002 vs. 0.006±0.002 S/mF; non-cardioverted vs. cardioverted virtual patients, respectively). Similarly, a lower SK density favoured the success of K2P channel inhibition (1.87±0.24 vs. 1.46±0.5 S/mF; non-cardioverted vs. cardioverted virtual patients, respectively). Both ionic currents had a crucial role on atrial repolarization, and thus, a synergism resulted from the polypharmacological strategy (i.e., higher efficacy than the additive effects of single channel block). All three interventions, including the multi-channel block, preserved the atrial electrophysiological function (i.e., conduction velocity and calcium transient dynamics) and thus, the atrial contractile properties (safety). Conclusion In-silico trials identify the polypharmacological SK+K2P channel block as an effective and safe strategy for AF management.

A Comparison of Different Doses Efficacy of Isobaric Ropivacaine 0.5% in Spinal Anesthesia in Cesarean Section

Background: Cesarean delivery is a standard surgical procedure in women. Thus, a practical, affordable, and low-risk anesthetic technique is essential for mother and infant safety. Spinal anesthesia is a popular and efficient technique for anesthesia during cesarean delivery. However, other local anesthesia drugs with negligible side effects should be considered. The most selective medication for this purpose is bupivacaine (marcaine), which creates optimal anesthesia at doses of 10 to 12 mg. Objectives: The most available medicine for spinal anesthesia during cesarean delivery is a 0.5% marine solution. However, ropivacaine for spinal anesthesia can occasionally be accessed as a long-acting amide local anesthetic agent used as an alternative to marcaine during the cesarean delivery. The ropivacaine's advantage over marcaine is its less neurotoxicity and cardiotoxicity, as well as the more stable hemodynamical condition of the patients. So far, no proper therapeutic dose of 0.5% isobaric ropivacaine has been proposed to be used during the cesarean delivery. Any increase in the dose may ensure the block performance, but, by contrast, some side effects may arise, including hypotension, bradycardia, vomiting, and nausea. Herewith, the likelihood of maximum block and most minor side effects was attempted to be assessed at the tiniest doses of this anesthetic agent. Methods: This randomized clinical trial was conducted on C-section candidates. Patients were categorized into three groups receiving 22.5, 25, and 20 mg of the 0.5% isobaric ropivacaine solution. Systolic and diastolic blood pressure, heartbeats, the level of sensational and sympathetic nerve block, duration to reach the maximum motor block, the rate of vasopressors and atropine consumption, rate of vomiting and nausea, the rate of using supplementary drugs, block breakdown, and the patient's satisfaction with the anesthesia were measured and recorded. The collected data were analyzed using IBM SPSS Statistics. Results: No significant difference was found between demographic characteristics. Likewise, there was no significant difference in systolic and diastolic blood pressure, heartbeats, the level of sensational and sympathetic nerve block, duration to reach the maximum motor block, the rate of vasopressors and atropine consumption, rate of vomiting and nausea, and the rate of using supplementary drugs between the three groups. The most significant block breakdown and use of supplementary drugs were found in the first group (20 mg), with a significant difference between the three groups. Conclusions: The three doses used did not result in meaningful differences between the three groups. However, the differences were significant for the block breakdown, with the higher block breakdown and supplementary drug use observed when using 20 mg of the 0.5 ropivacaine solution.