Closed reduction of distal radius fractures is painful, and current analgesic strategies may be inadequate. Ultrasound-guided lateral infraclavicular brachial plexus block may offer complete analgesia and muscle relaxation, potentially improving patient comfort and reduction quality. However, benefits and challenges regarding anesthetic agents for this procedure remain unclear. In this randomized, controlled, blinded, noninferiority trial, 63 adults with distal radius fractures requiring closed reduction received a lateral infraclavicular block with either 30 mL of ropivacaine 0.5%, lidocaine 1% with epinephrine, or ropivacaine 0.2%. The primary outcome was block success at 45 min, defined as complete sensory and extensive motor block of the radial, musculocutaneous, ulnar, and median nerves. Noninferiority was assessed using a margin of 20%. Exploratory outcomes included sensory and motor block assessments, time to pain relief, block duration, pain during reduction, patient satisfaction, quality of closed reduction, fracture treatments, and safety. Ropivacaine 0.2% was statistically inferior to ropivacaine 0.5% in achieving block success at 45 min (risk ratio (RR) 0.63, 97.5% CI 0.40-0.99). Lidocaine 1% with epinephrine did not meet the predefined noninferiority criteria for block success (RR 0.95, 97.5% CI 0.73-1.22) but did provide comparable analgesia with a shorter block duration. Pain scores during reduction were low across all groups, with a significant decrease in pain from baseline. Patient satisfaction was high in all groups. No significant differences were found in the quality of closed reduction, safety, or fracture treatments. Lateral infraclavicular block with ropivacaine 0.2% failed to demonstrate noninferiority for block success and was statistically inferior to ropivacaine 0.5%. Inferiority testing should be interpreted cautiously within the context of a noninferiority design, although the results suggest reduced effectiveness for distal radius fracture reduction. Lidocaine 1% with epinephrine yielded inconclusive results for noninferiority on block success, but provided a shorter block duration without compromising analgesia, patient satisfaction, or quality of reduction. ClinicalTrials.gov Identifier NCT06379490 (released April 23, 2024); https://clinicaltrials.gov/study/NCT06379490; EUCT Identifier 2024-510,572-20-00; https://euclinicaltrials.eu/ctis-public/view/2024-510572-20-00.

Effect of Selective Scalp Block Compared With Fentanyl Infusion on Intraoperative Blood Pressure in Patients Undergoing Posterior Fossa Tumor Resection: A Randomized Controlled Trial.

Globally, laparoscopic sleeve gastrectomy (LSG) is the most frequently performed bariatric surgery. Multiple fascial plane blocks are used for postoperative analgesia, but their comparative efficacy remains unclear. A systematic search through January 2026 identified controlled trials comparing fascial plane blocks-including transversus abdominis plane block (TAP), erector spinae plane block (ESPB), quadratus lumborum (QL), external oblique intercostal (EOI), modified thoracoabdominal nerve block via perichondrial approach (M-TAPA), paravertebral block (PVB), and rectus sheath (RS) blocks-against each other, placebo, systemic analgesia (SA), or port-site infiltration (PSI) in LSG. The primary outcome was 24-hour opioid consumption (morphine milligram equivalents, MME). Secondary outcomes included pain scores at 2 to 24 hours, postoperative nausea and vomiting (PONV), and complications. A frequentist network meta-analysis was conducted. Treatment rankings were determined using surface under the cumulative ranking curve (SUCRA) values, and the certainty of evidence was appraised by the Grading of Recommendation Assessment, Development, and Evaluation (GRADE). Twenty-three randomized controlled trials (RCTs) comprising 2,005 patients were included. The EOI block achieved the greatest opioid-sparing effect versus SA (mean difference [MD] -19.66 MME; [SUCRA] 83%). At 24 hours, only ESPB significantly reduced pain intensity (MD -0.44). The QL block significantly decreased PONV incidence compared to placebo (odds ratio [OR] 0.31). No major block-related adverse events were reported. Overall, the quality of evidence ranged from moderate to low. In adults undergoing LSG, ultrasound-guided fascial plane blocks are effective and safe for postoperative analgesia. The EOI block was probabilistically ranked highest for reducing 24-hour opioid consumption (SUCRA 83%), though CIs overlapped with other blocks. The ESPB provided a small but statistically significant reduction in pain at 24 hours (MD -0.44), and the QL was associated with the lowest incidence of PONV (OR 0.31). However, the overall certainty of evidence ranged from moderate to low, with interventions supported by limited data from only one or two trials. SUCRA rankings represent probabilistic hierarchies and should not be interpreted as definitive evidence of superiority. Consequently, technique selection should be guided by specific analgesic goals, local expertise, and individual patient factors.

The dorsal scapular artery (DSA) is one of the key arteries supplying the muscles of the upper back, along with the Suprascapular artery and the Subscapular artery. It lies close to the brachial plexus, making its variations important during regional blocks and flap surgeries. Variations in its origin, course, and relationships in different population groups, as well as its surgical and anaesthetic significance, emphasise its need for study. This descriptive study was performed following a standard dissection manual on 40 bilateral sides of embalmed human cadavers. The origin of the DSA was identified, and its relation to the brachial plexus was noted. DSA was traced until its termination. DSA originated from the subclavian artery in 95% and from the Thyrocervical trunk in 5% of specimens. The course of the artery varied with its origin. It passes through either between the superior and the middle trunk or between the middle and the inferior trunk of the brachial plexus when it arises from the Subclavian artery. It is always tracked above the superior trunk of the brachial plexus when arising from the Thyrocervical trunk. No significant sexual differences for laterality or course was observed. The artery terminated supplying the rhomboids in all the specimens. Knowledge of the anatomical course of the DSA will help improve the design of regional flaps involving the vessel, in diagnosing conditions such as thoracic outlet syndrome. The knowledge of the relationship between the DSA and the brachial plexus improves the effectiveness of nerve block.

To evaluate the efficacy of ultrasound-guided thyroid cartilage plane block (TCPB) on postoperative sore throat (POST) in patients undergoing suspension laryngoscopy vocal cord polypectomy (SLVCP). Ninety patients scheduled for elective SLVCP were randomized to either the TCPB group (general anesthesia + ultrasound-guided TCPB) or the C group (conventional GA), with 45 patients in each. The primary outcome was the incidence of POST at 2h after extubation. Secondary outcomes included the incidence and severity of POST at 0.5, 2, 6, 12, and 24h after extubation; the incidence and severity of hoarseness at 0.5, 2, 6, 12, and 24h after extubation; and cough response during emergence. The incidence of POST was significantly higher in the C group compared to the TCPB group at 0.5h (93% vs. 67%, RR = 0.20, 95% CI [0.06-0.64]; P = 0.003), 2h (78% vs. 47%, RR = 0.42, 95% CI [0.23-0.77]; P = 0.004), and 6h (64% vs. 27%, RR = 0.49, 95% CI [0.32-0.77]; P = 0.001) after extubation. No significant difference in the incidence and severity of hoarseness between the groups at any time point. During extubation, the incidence of cough response in the C group was 60%, significantly higher than the 20% in the TCPB group (RR = 0.50, 95% CI [0.34-0.74]; P = 0.001). Ultrasound-guided TCPB significantly reduces the incidence and severity of POST and cough response in SLVCP patients. This trial was registered in the Chinese Clinical Trial Registry (ChiCTR2500100227) on April 7, 2025 (https://www.chictr.org.cn/).

Comparison of the Effects of Intraoperative Pectoral Nerve Block and Local Wound Infiltration in Pain Management for Breast Cancer Surgery: A Randomized Controlled Trial.

This work was conducted to evaluate the effects of thoracic paravertebral nerve block (TPVB) combined with general anesthesia (GA) on pain and lumbar function in patients undergoing minimally invasive vertebroplasty. One hundred patients scheduled for minimally invasive vertebroplasty were randomly allocated to a GA group (GA alone, n = 50) or a TPVB + GA group (TPVB combined with GA, n = 50). Mean arterial pressure (MAP) and heart rate (HR) were recorded preoperatively (T0), at puncture (T1), at bone cement injection (T2), and at the end of surgery (T3). Operative time, intraoperative blood loss, and anesthetic consumption were compared. Pain was assessed using the visual analogue scale (VAS) on postoperative days 1, 3, and 7. Lumbar function was evaluated using the Oswestry Disability Index (ODI) preoperatively, 1 week postoperatively, and 1 month postoperatively. Adverse events were also recorded. Significant group, time, and interaction effects were observed for MAP, HR, VAS, and ODI (all P < 0.05). Compared with the GA group, the TPVB + GA group showed lower MAP and HR at T1-T3, reduced blood loss and anesthetic use, lower VAS scores, improved ODI scores, and fewer adverse events (all P < 0.05). TPVB combined with GA stabilizes perioperative hemodynamics, alleviates pain, and promotes recovery of lumbar function.

Effective pain management for rib fractures is crucial to prevent pulmonary complications and facilitate recovery. UGPB has emerged as a promising regional analgesic technique for these patients. This systematic review with meta-analysis aims to evaluate the effectiveness of UGPB compared with standard care for managing pain associated with rib fractures. In this review, the term UGPB serves as an umbrella term for various UGPBs, with the erector spinae plane block (ESPB) and serratus anterior plane block (SAPB) being the two specific techniques evaluated in the included studies. This study conducted a comprehensive search of electronic databases including PubMed, Embase, Cochrane Library, Web of science and China National Knowledge Infrastructure (CNKI) up to 31 March 2026. Eligibility criteria were established based on the inclusion of adult patients diagnosed with rib fractures treated with UGPB versus standard care. The primary outcome was pain intensity, assessed using a Visual Analog Scale (VAS) or Numeric Rating Scale (NRS). Secondary outcomes included total amount of analgesic consumption, respiratory function (PaO₂ and PaCO₂ via arterial blood gas analysis), and adverse events. Risk of bias was assessed using the Cochrane Risk of Bias (RoB 2) tool. The certainty of evidence for primary outcomes was assessed using the GRADE framework. Continuous outcomes were pooled as standardized mean differences (SMD) with 95% confidence intervals using a random-effects model; heterogeneity was assessed via I². Nine randomized controlled trials (RCTs) involving 664 participants were included. Most studies raised some concerns regarding risk of bias, primarily related to the randomization process, allocation concealment, or blinding of participants and personnel; four studies were judged to be at high overall risk of bias, and none at low risk. The pooled data from 7 studies (423 participants) showed that UGPB significantly reduced pain scores (SMD = -0.44, 95% CI: -0.72 to -0.16; I² = 51%; p < 0.01). A leave-one-out sensitivity analysis for pain scores (excluding one study at a time from the 7 included studies) yielded SMDs ranging from - 0.49 to -0.38 (all p < 0.05) and I² ranging from 45% to 58%, confirming the robustness of this finding. For respiratory parameters, based on 3 studies (198 participants) there were no significant differences in PaCO₂ levels (SMD = -0.02, 95% CI: -0.56 to 0.61; I² = 75%; p = 0.95). PaO₂ levels remained stable (SMD = 0.04, 95% CI: -0.24 to 0.32; I² = 0%; p = 0.78). The effect on analgesic consumption, from 7 studies (546 participants), was not significant (SMD = -0.09, 95% CI: -1.61 to 1.43; I² = 96%; p = 0.91). The certainty of evidence was low for pain scores and very low for analgesic consumption and blood gas parameters according to GRADE. UGPB reduces pain scores in patients with rib fractures, with a small-to-moderate effect size (SMD = -0.44, 95% CI: -0.72 to -0.16), and does not appear to compromise respiratory function based on stable PaCO₂ and PaO₂ levels. However, given the concerns regarding risk of bias and heterogeneity, these findings should be interpreted cautiously. High heterogeneity in analgesic consumption and other outcomes underscores the need for further high-quality research to standardize protocols and optimize the use of UGPB in clinical practice. CRD420251077539 (registered 20 June 2025).

Rectus sheath block (RSB) is a simple abdominal wall block that can be readily applied. This study evaluated the postoperative analgesic efficacy of ultrasound-guided bilateral RSB in robotic single-site gynecologic surgery. Sixty patients were randomly assigned to the RSB group (n=30) or the control group (n=30). After induction of general anesthesia, patients in the RSB group received ultrasound-guided bilateral RSB with 30 mL of 0.25% ropivacaine. Pain intensity was assessed using a verbal numerical rating scale (VNRS) at 0, 1, 6, 12, 24, and 48 hours postoperatively. Intravenous patient-controlled analgesia was provided to all patients, and fentanyl was administered as rescue analgesia on request. VNRS scores at 0, 1, and 6 hours were significantly lower in the RSB group than in the control group (all P<0.05). Rescue fentanyl use in the post-anesthesia care unit was also significantly lower in the RSB group than in the control group (19.8±21.0 µg vs. 46.3±27.6 µg, P<0.001). Subgroup analysis showed that RSB was associated with lower VNRS scores in patients undergoing ovarian surgery or myomectomy, whereas no significant difference was observed in patients undergoing hysterectomy. Ultrasound-guided bilateral RSB reduced early postoperative pain and rescue analgesic requirements after robotic single-site gynecologic surgery.

Over 75% of women who have post-mastectomy reconstruction feel significant pain right away, and about 50% endure chronic pain. Thus, increasing the efficiency of postoperative pain management is crucial. Our study investigated the effects of ultrasound-guided erector spinae plane blocks (ESPB) and rhomboid intercostal blocks (RIB) on perioperative fentanyl use and pain scores in patients undergoing radical mastectomy surgery. This was a double-blind, randomised controlled trial conducted at a tertiary care hospital. Patients with breast cancer aged 18-70 years and American Society of Anaesthesiologists status I-II who were scheduled for unilateral modified radical mastectomy were included. They were randomly assigned to two groups. ESPB was performed in the ESPB group, and RIB was performed in the RIB group, using ultrasound guidance. Total postoperative fentanyl usage in the first 24 hours was the primary outcome indicator of the study. Intraoperative fentanyl requirements and numerical rating scale (NRS) scores at seven distinct time points were used as secondary outcome measures. The difference between the mean of total postoperative fentanyl consumption in 24 hours in Group ESPB (2.67±0.68 μg kg-1) and Group RIB (3.68±1.22 μg kg-1) was statistically significant (t value: -4.183, df:66, P value: < 0.001). There was no difference in intraoperative opioid consumption between the groups (P=0.7). However, NRS scores were not significantly different between the ESPB group and the RIB group. Our study's outcome demonstrates ultrasound-guided ESPB to be more effective than RIB in terms of lower perioperative fentanyl consumption.

Postoperative follow-up after regional anesthesia is essential for identifying complications, distinguishing expected block effects from pathologic findings, and guiding clinical decision-making. As regional techniques expand into ambulatory settings, scalable and reliable follow-up strategies have become increasingly important, making this a timely area of review. Recent literature highlights the use of mobile applications, automated messaging systems, and telemedicine encounters to improve accessibility and patient engagement in follow-up care. However, these approaches rely heavily on subjective patient-reported data and lack structured, objective assessment, limiting their utility for accurate neurologic evaluation. In-person follow-up remains the gold standard because of its ability to integrate objective examination with clinical judgment. Emerging strategies incorporating structured video-based assessments and artificial intelligence-assisted guidance aim to enhance the quality and consistency of remote evaluations. While digital and remote follow-up models improve scalability, their current limitations necessitate cautious implementation. Hybrid approaches that integrate objective assessment into remote platforms may bridge the gap between accessibility and diagnostic accuracy. Further research is needed to validate these models and define their role in optimizing postoperative care after regional anesthesia.

The aim of this study was to evaluate and compare the skeletal, dental, and soft-tissue effects of the Twin Block, Monoblock, and Invisalign Mandibular Advancement (Invisalign MA) appliances used for functional treatment in individuals with skeletal Class II malocclusion. The study included 45 individuals in the S-MP3cap stage of growth and development who were treated with Monoblock (n = 15), Twin Block (n = 15), or Invisalign MA (n = 15) appliances. Lateral cephalometric radiographs were obtained before functional treatment (T0) and after treatment (T1). A total of 29 measurements were used to assess changes in the dental, skeletal, and soft tissues. Across all treatment groups, significant decreases were observed in ANB°, Wits appraisal, overjet, overbite, and skeletal and soft-tissue convexity angles; similarly, significant increases were identified in SNB°, Co-Gn (mm), Pg-Na Perp, FMA°, GoGn-SN°, LFH/TFH, L1-NB°, IMPA°, and the nasolabial angle throughout the treatment period. No statistically significant differences were found among the groups regarding the changes observed in the soft tissues. The Invisalign MA group showed less increase in vertical parameters than the other groups. Maxillary incisor inclinations decreased more significantly in the Invisalign MA group. Mandibular incisor inclination changes were similar between Monoblock and Invisalign MA groups but greater in the Twin Block group. Maxillary molar eruption was comparable between Invisalign MA and Monoblock groups, while Twin Block showed a more pronounced increase. Finally, mandibular advancement angles were similar across all groups.

ABSTRACTMajor depression, bipolar disorder, and schizophrenia are common mental illnesses, and their potential association with arrhythmias has long been a focus of clinical and research interest. To explore the possible causal relationship between these mental disorders and arrhythmias, we conducted a bidirectional two‐sample Mendelian randomization (MR) analysis using publicly available GWAS summary statistics. The primary analysis employed the inverse‐variance weighted (IVW) method, with sensitivity analyses including MR‐Egger regression and the weighted median estimator to assess robustness and address potential pleiotropy. Results indicated that genetic predisposition to major depression was associated with increased risks of atrial fibrillation/flutter (IVW: OR = 1.214, 95% CI: 1.092–1.349, p < 0.001), paroxysmal tachycardia (IVW: OR = 1.493, 95% CI: 1.261–1.769, p < 0.001), and atrioventricular block (IVW: OR = 1.257, 95% CI: 1.147–1.377, p < 0.001). Reverse MR also suggested a modest effect of atrioventricular block on depression risk (IVW: OR = 1.045, 95% CI: 1.011–1.079, p = 0.008). In conclusion, from the perspective of genetic liability and using the MR framework, our analysis supports a causal role of major depression in increasing the risk of several arrhythmias and suggests potential bidirectional causal effects between depression and atrioventricular block.

Laparoscopic cholecystectomy (LC) is one of the most commonly performed minimally invasive surgical procedures. Postoperative pain may negatively affect patient satisfaction and recovery. External oblique intercostal plane block (EOIB) is proposed as a new regional anaesthesia technique to reduce this pain. The aim of this study was to investigate the effect of ultrasound-guided EOIB on postoperative pain scores, postoperative opioid consumption, intraoperative hemodynamic parameters, and patient satisfaction in patients undergoing LC. After approval of the ethics committee, 64 patients aged 18-65 years, in ASA I-II class, who underwent elective LC for cholelithiasis were included in the study. Patients were randomly allocated into two groups: the EOIB group and the control group. Visual analogue scale (VAS), heart rate, systolic-diastolic-mean arterial pressure, analgesic consumption, nausea-vomiting frequency and patient satisfaction parameters were recorded for 24h postoperatively. VAS scores were significantly lower in favour of EOIB at all time points (p < 0.001). There was a significant difference over time and between groups. (p < 0.001) In addition, patient satisfaction was significantly higher in the EOIB group at 24h (p < 0.001). EOIB improves pain control after LC, reduces the need for analgesics and significantly improves patient satisfaction. ClinicalTrials.gov, NCT06712498; registered 26 November 2024 (retrospectively registered).

BACKGROUND Kidney transplantation (KT) is frequently associated with substantial postoperative pain, while opioid use in these patients increases the risk of adverse outcomes. Peripheral nerve blocks (PNBs) have been proposed as opioid-sparing strategies; however, evidence in kidney transplant recipients remains inconsistent, likely due to heterogeneity in block techniques, variability in perioperative analgesic regimens, and differences in study design and methodological rigor. This systematic review and meta-analysis aimed to evaluate the impact of PNBs on postoperative analgesia in kidney transplant recipients. MATERIAL AND METHODS A systematic search of PubMed, EMBASE, the Cochrane Library, and Web of Science was conducted through April 2025 following the Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies reporting 24-h postoperative opioid consumption in adult kidney transplant recipients were included. The primary outcome was cumulative opioid use within 24 hours after surgery, expressed as intravenous morphine or fentanyl. RESULTS Twelve studies met the inclusion criteria, of which 10 contributed to the quantitative synthesis. Pooled analysis showed that PNBs significantly reduced 24-h morphine consumption compared with control analgesia (pooled mean difference=-16.20 mg of intravenous morphine equivalents, 95% confidence interval -24.66 to -7.74; P=0.0002). Heterogeneity was high (I²=99%), but no study reported higher opioid use or increased adverse events in the PNB groups. CONCLUSIONS PNBs appear to be an effective opioid-sparing adjunct for postoperative analgesia in kidney transplant recipients. However, the available evidence remains limited, and further well-designed comparative trials are needed to define their role within multimodal analgesic strategies in this population.

This study aimed to compare the percentage of local anesthetic spread into the obturator canal between the nerve stimulation-guided interadductor approach (NS-INTAD) and the ultrasound-guided interadductor approach (US-INTAD), and to evaluate anatomical factors influencing the effectiveness of the obturator nerve block (ONB). Eighty patients scheduled for transurethral resection of bladder tumor were randomized to receive either NS-INTAD (n = 40) or US-INTAD (n = 40). In the lithotomy position, a mixture of local anesthetic and contrast medium was injected via the interadductor approach from the medial thigh. Injectate spread into the obturator canal was assessed by fluoroscopy, and the success rate and injection volume were compared between groups. Enhancement in the obturator canal was observed in 75% of patients in the NS-INTAD group and 90% in the US-INTAD group. Although the percentage was higher in the US-INTAD group, the difference was not statistically significant (P = 0.139). The volume of local anesthetic used did not differ significantly between groups (P = 0.07). In patients where the posterior branch of the obturator nerve coursed between obturator externus muscle fascicles, local anesthetic propagation into the obturator canal appeared limited. The percentage of injectate spread into the obturator canal tended to be higher with US-INTAD than with NS-INTAD. Our findings suggest that the lithotomy-position approach facilitates more cephalad local anesthetic spread than the supine-position approach. Furthermore, the development of the superior fascicle of the external obturator muscle appears to be an anatomical factor that inhibits injectate spread into the obturator canal. UMIN Clinical Trials Registry (UMIN-CTR) UMIN000027762; registered 15 June 2017.

Ultrasound-Guided Thoracic Paravertebral Block With Liposomal Versus Standard Bupivacaine for Older Patients After Thoracoscopic Surgery.

Effects of deep parasternal intercostal plane block on opioid consumption and pain after cardiac surgery: a meta-analysis of randomized controlled trials with meta-regression and trial sequential analysis.

Regulating ice type to optimize the failure behavior of the solid-ice interface during the melting process presents a viable approach for enhancing thermal de-icing efficiency, nevertheless, the prevailing notion that ice type is exclusively determined by flow conditions restricts the advancement of solid-ice interface control technologies. Here, we propose a strategy that leverages non-wetting microstructures to induce spontaneous formation of near-wall rime (interfacial-rime) under flow conditions. Thicker interfacial-rime can significantly enhance the de-icing efficiency by modifying conventional solid-liquid-ice interactions into direct solid-ice contact during the melting process. Interestingly, pre-frozen droplets adhering to defined mathematical criteria are fragmented by microstructures with tailored dimensions with the assistance of flow field, significantly reducing the initial ice crystal size. The blocking effect induced by ice crystals with smaller initial size effectively elevates the thickness of interfacial-rime layer, significantly reduces the energy consumption of thermal deicing by roughly 56% without introducing additional energy consumption.

ABSTRACT Mixture experiments often involve process variables, where orthogonal block designs allow independent estimation of mixture component parameters and process variable parameters. Traditionally, the focus in mixture experiments has been on the proportions of components rather than the order in which they are added. This paper introduces the concept of order-of-addition (OofA) effects in mixture blends within orthogonal blocks, where the response depends on both the proportions of the components and their sequence of addition. We also extend this framework to mixture-amount experiments in orthogonal blocks, incorporating OofA effects into component-amount designs. We first construct mixture and component-amount designs in non-orthogonal blocks, including pairwise ordering variables. To improve efficiency, we then employ the Threshold Accepting (TA) algorithm to reduce the number of runs and generate G-optimal orthogonal designs in two blocks for both mixture and component-amount experiments. In accordance, the proposed designs allow estimation of primary mixture or component-amount parameters, as well as their interactions with OofA effects, without confounding with block effects. The efficiency of the methodology is demonstrated through illustrative examples from pharmaceutical applications using simulated responses. The findings highlight the potential of orthogonally blocked OofA designs to provide a more comprehensive understanding of mixture and component-amount systems in biomedical and pharmaceutical research.