Skilled Hands Research Articles

Outcomes of Urinary Diversion for Late Adverse Effects of Gynecologic Radiotherapy

To describe the risks of urinary diversion performed to address adverse effects of gynecologic radiation, with the hypothesis that high grade complications would be more common in sarcopenic women and in those undergoing continent diversion (vs noncontinent) or concomitant cystectomy (vs bladder-sparing diversion). A retrospective review was performed of patient records of women who underwent urinary diversion for urinary adverse effects of gynecologic radiotherapy during the period of 2008-2018 from 3 tertiary centers. Skeletal muscle index was calculated to assess for sarcopenia based on preoperative computed tomography scans. Outcomes include high-grade postoperative complications within 90 days of surgery, 30-day readmission rate, and long-term (>90 days) outcomes. Among 34 women who met the inclusion criteria, the majority were white/Caucasian (73.5%). Twenty-six of 34 (76.5%) underwent noncontinent diversion. Seventy nine percent (27/34) (79.4%) of women experienced complications within 90 days; 9 of 34 (26.5%) experienced high-grade (Clavien grade ≥3) complications. Thirty-two percent (11/34) were readmitted within 30 days. Rates of high-grade complications were not significantly impacted by diversion type (P=.49), concurrent cystectomy (P=.70), or sarcopenia (P=1.0). Urinary diversion for late adverse effects of gynecologic radiotherapy is associated with high peri-operative risk, even in skilled hands. In this series, neither sarcopenia, nor continent diversion, nor cystectomy were associated with increased complications. Patients and surgeons should consider risks and benefits when deciding to proceed with urinary diversion, however further study is needed to elucidate significant preoperative markers which may predispose patients to significant complications.

Comparison of the effects of Kinesio tape and neuromuscular electrical stimulation on hand extensors in children with cerebral palsy

Background/aims Cerebral palsy is a lifelong condition resulting in weakness in the muscles, difficulty moving and excessive tension in the muscles of the arms and legs. This study aimed to investigate the effects of adding Kinesio taping and neuromuscular electrical stimulation to neurodevelopmental treatment on joint range of motion, muscle tone and functional ability in children with cerebral palsy. Methods A total of 30 children were included in the study. They were allocated to one of two groups: Kinesio taping (n=15) or neuromuscular electrical stimulation (n=15). The children in both groups received 20 sessions of twice-weekly neurodevelopmental treatment. Range of motion, Modified Ashworth Scale, Duruoz Hand Index, Manual Ability Classification System, Gross Motor Function Classification System, Minnesota Hand Skill Test and Jebsen Hand Function Test were assessed before and after the treatment programme. Results Statistically significant improvements (P<0.05) were found in all measures except Gross Motor Function Classification System in both groups. Significant between-group differences in left shoulder flexion, left shoulder abduction and unilateral Minnesota Hand Skill Test were found in favour of neuromuscular electrical stimulation; whereas significant improvement in left elbow flexion was found in favour of Kinesio taping. Conclusions The addition of Kinesio taping and neuromuscular electrical stimulation to neurodevelopmental treatment improved the joint range of motion and functional ability of children with cerebral palsy.

What Is WhatsApp for? Developing Transmedia Skills and Informal Learning Strategies Through the Use of WhatsApp—A Case Study With Teenagers From Spain

Smartphones and WhatsApp are, respectively, the medium and application that Spanish teenagers most want. However, research into the use of WhatsApp is still quantitatively and qualitatively limited. In addition, little research has been carried out regarding its impact on the development of transmedia skills and informal learning strategies outside the classroom. This article aims to expand the knowledge on teenagers’ motivations and their development of transmedia skills and informal learning strategies in relation to their use of WhatsApp. Specifically, a qualitative analysis of data gathered from workshops, interviews, and media diaries is applied as part of a case study methodology involving teenagers from 10 schools located in five different Spanish regions. The results reveal the new WhatsApp uses teenagers are applying in their daily lives as well as the skills and strategies they are developing through said uses in the context of interpersonal and group (WhatsApp groups) interactions: on one hand, production, social, content, and individual management skills, and on the other hand, learning by doing, teaching, and evaluating strategies.

Evaluation of Hand Washing Knowledge, Practices, and Skills among Students of Thar Desert Schools

Evaluation of Hand Washing Knowledge, Practices, and Skills among Students of Thar Desert Schools

Pulmonary Arteriovenous Malformations of Late Revelation

Pulmonary arteriovenous malformations are scarce and hard to diagnose. We report a case of a very late discovery at an advanced age. Recent vascular imaging techniques (Three-dimensional Computed Tomographic Angiography) have largely contributed to their diagnosis. The patient is treated with arterial embolization which is effective and carries a low complication rate in skilled hands. This case illustrates the clinical circumstances of diagnosis, the diagnostic algorithm, and the differential diagnosis to be discussed in this radio-clinical presentation, as well as the peculiarity of thinking about this malformation despite the advanced age.

Predictors of preclinical hand skill performance in dental school.

Preclinical dental school instructors often observe some first-year students develop hand skills required for dental procedures more quickly and more easily than their peers. When questioned regarding prior experience, these advanced students often participated in physical activities that seem to predispose them to adapt their previously learned psychomotor hand skills to those required for dentistry. This study examines the results of an Institutional Review Board approved 22-question survey of various lifelong predental school activities and correlations to first-year and second-year simulation clinic practical exam performance. The survey was taken anonymously at the Midwestern University College of Dental Medicine-Arizona by 4 consecutive dental school classes of 2017-2020 composed of 560 students, 552 of which responded. The purpose was to discover associations between lifelong activities and practical exam scores that may act as predictors of preclinical ability to develop visualization and psychomotor hand skills required for dental procedures. Higher preclinical practical scores were found to have the most correlation with higher levels of participation in psychomotor, artistic and outdoor physical activities. Participation in computer, musical instrument and culinary activities had no significant correlation, and prior experience in the medical or dental field had a negative correlation. The lack of participation in these predisposing lifelong activities may predict slower development of dental hand skills and signal the need for more hands-on tutorial instruction in the simulation clinic so these students do not lag behind their peers.

Percutaneous creation of proximal radio-radial arteriovenous hemodialysis fistula before secondary brachial vein elevation.

We evaluate the creation of a percutaneous proximal radial artery-radial vein arteriovenous fistula with Ellipsys® instead of the usual first-stage brachial artery fistula prior to a second-stage brachial vein elevation, in patients with inadequate cephalic and basilic veins. Single center study of eight patients (six males, mean = 54 years) who underwent a two-stage brachial vein elevation procedure between May 2017 and October 2019. Inclusion criteria were life expectancy > 6 months, patent brachial and proximal radial artery (>2 mm in diameter) absent/inadequate cephalic and basilic veins, existence of a brachial vein >3 mm in diameter, and in continuity with a proximal radial vein > 2 mm in diameter. Technical success was 100%. Four patients required angioplasty of a juxta-anastomotic stenosis, accounting for a 6-month primary and secondary patency rates were 68% and 100%, respectively. Access flow averaged 982 mL/min (range 768-1586) at final follow-up evaluation. There were no significant adverse events related to the procedures. All fistulae were elevated at 4-12 (mean: 8) weeks post creation and were successfully cannulated with two needles after healing was completed (2-4 weeks after elevation). No patients developed hand ischemia or arm edema. Percutaneous creation of a proximal radial artery-radial vein fistula followed by brachial vein elevation is a safe and reliable option for autogenous access creation in patients with inadequate cephalic or basilic veins. Minimally invasive radial artery inflow and longer available length of the targeted brachial vein available for elevation are the main advantages in skilled hands.

A Matlab-based toolbox for characterizing behavior of rodents engaged in string-pulling.

String-pulling by rodents is a behavior in which animals make rhythmical body, head, and bilateral forearm as well as skilled hand movements to spontaneously reel in a string. Typical analysis includes kinematic assessment of hand movements done by manually annotating frames. Here, we describe a Matlab-based software that allows whole-body motion characterization using optical flow estimation, descriptive statistics, principal component, and independent component analyses as well as temporal measures of Fano factor, entropy, and Higuchi fractal dimension. Based on image-segmentation and heuristic algorithms for object tracking, the software also allows tracking of body, ears, nose, and forehands for estimation of kinematic parameters such as body length, body angle, head roll, head yaw, head pitch, and path and speed of hand movements. The utility of the task and software is demonstrated by characterizing postural and hand kinematic differences in string-pulling behavior of two strains of mice, C57BL/6 and Swiss Webster.

Impact of simulated patients on students' self-assessment of competency in practice of geriatric dentistry.

The evaluation of the effectiveness of simulation training in dentistry has previously been focused primarily on psychomotor hand skills. This study explored the impact of simulated patient (SP) encounters in simulation on students' self-assessment of competency in their clinical and communication abilities with geriatric patients. Students from 2 cohorts were recruited for this study. Cohort 1 (n=30) participated in the standard curriculum with no simulation training and served as the control group. Cohort 2 (n=34) participated in a SP experience, simulating the initial stages of a care visit for 2 nursing home patients. Students' perceptions of competency to perform these clinical and communication tasks were assessed. A group debriefing session was held 5 weeks post-simulation where Cohort 2 completed a student feedback form. A statistically significant change (P<0.00001) was noted for both cohorts in their self-reported competence to perform clinical tasks following exposure to an independent clinical experience. In addition to this gain, individuals in Cohort 2 demonstrated improvements following simulation and expressed different responses of impact to questions related to treatment, pharmacology, and managing a complex medical history. This study suggests that simulation of patient interactions using SPs can strengthen students' self-assessment of competency in their abilities, leading to more genuine interactions with actual patients. These findings will help inform the design of future SP encounters as a component of an evolving humanistic curriculum.

The Art of Ephemera: Typographic Innovations of Nineteenth-Century Midland Jobbing Printers

ABSTRACT During the nineteenth century jobbing printers in Britain played an important role in the history of printing. In the skilled hands of the provincial printer, new display types were composed into new forms of advertising, contributing to the education and societal orientation of the emergent middle classes. Jobbing printers of the Midlands contributed to the advancement of British typography, making significant innovations in the composition of printed ephemera. This article considers the craft and invention of three influential nineteenth-century jobbing printers in the region: William Joesbury (1838–1919) of Birmingham, and the two members of the Gitton family, George (1746–1825) and George Robert (1801–85) of Bridgnorth. Joesbury printed Timothy Worsey Watton’s Outline Charts of General History (1848), an early example of progressive visual education for grammar schools; and the Gittons printed ephemera of Bridgnorth is a valuable record of the town’s industry and of its social culture.

Hybrid coronary revascularization for the treatment of coronary artery disease

Hybrid coronary revascularization (HCR) combines the respective strengths of coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) for selected patients with multivessel coronary artery disease. HCR includes the minimally invasive direct coronary artery bypass of a left internal thoracic artery graft to the left anterior descending artery (LAD) with stenting of non-LAD lesions with PCI, in onestop or staged hybrid procedures.HCR can prove superiority to conventional CABG in clinical complications. Many available data suggests that HCR is feasible and safe in skilled hands. Further large-scale randomized controlled trials are in great need. HCR may become another more commonly used interventional strategy for certain patients with multivessel coronary artery disease.

The Role of Community Library Rumah Asa in Empowerment of Communities in Karangkajen Yogyakarta

Community Library is an institution that provides various types of learning materials needed by the community. TBM As a place for organizing the ability to read and learn, as well as a place to get information for the community. One of the TBMs carrying out these activities is Rumah Asa TBM. In addition to disseminating information, TBM Rumah Harapan also plays a role in community empowerment. This paper describes community empowerment carried out by Taman Bacaan Masyarakat. To obtain these data this paper uses a literature study in the form of conceptual studies. The role of TBM Rumah Asa in community empowerment includes hand skills for mothers, asakura shops, mukena asakura, and Eco.J print. Keywords: Community Library, Community Empowerment

Hysteroscopy versus transvaginal ultrasound in infertile women prior to intracytoplasmic sperm injection

Objective The aim of this study was to compare the efficacy of transvaginal sonography (TVS) and hysteroscopy regarding the diagnosis of uterine cavity pathologies in a population of infertile women. Background The presence of uterine pathology may negatively affect the chance of implantation. Patients and methods A cross-sectional study at the Department of Obstetrics and Gynaecology at Menoufia University Hospital between March 2018 and March 2019 on 60 women who underwent TVS in the early follicular phase for detection of any uterine cavity abnormalities, followed by diagnostic hysteroscopy for all cases. Results The study included 60 women in the age range of 20–39 years. All cases were divided into two groups, women who were scheduled for first-time in-vitro fertilization (number 52) and women for recurrent in-vitro fertilization (number 8). The cases of primary infertility constituted 46.6% of all participants and 53.3% of cases were of secondary infertility. The abnormal uterine cavity was detected in about 25% of cases evaluated by TVS versus 45% of cases evaluated by hysteroscopy. Using hysteroscopy the most common uterine pathology was endometrial polyp which constituted 18.3% of all cases. TVS missed the diagnosis of 12 cases, three cases of polyps, two case of submucous fibroids, five cases of intrauterine septum, and two cases of intrauterine adhesions in comparison with diagnostic hysteroscopy. Conclusion Diagnostic hysteroscopy is superior to TVS in the diagnosis of intrauterine pathology. Office hysteroscopy takes little time comparable to TVS with little or no complications in experienced skilled hands. TVS has many screening parameters in the detection of polyps and submucous fibroids.

Sleep Quality in Children and Adults with Rett Syndrome.

Over 80% of individuals suffering from Rett syndrome (RTT) are affected over their life period by sleeping disorders. Little is known about the impact of those on the quality of life and a clinical approach to the treatment of sleep disturbances is lacking. Primary aim was to assess sleep quality in children and adults. Secondary aim was to assess behavioral disorders and their relationship to sleep quality. The medication taken by the subjects was also included. Sleep quality and medication were assessed using the sleeping questionnaire for children with neurological and other complex diseases (SNAKE). Behavioral disorders were assessed by the Rett Syndrome Behavior Questionnaire (RSBQ). Questionnaires were sent to the 700 members of the Elternhilfe für Kinder mit Rett Syndrom in Deutschland e.V. (Rett Aid) of which 287 were included. Questionnaires were filled out by the primary caregivers. Sleep quality was rated as very good to good by over 60% of caregivers in contrast to data available in the literature. Behavioral disorders related to regression such as loss of acquired hand skills (p = 0.046) and isolation (p = 0.002) were found to be associated with sleep quality. Melatonin showed a significant association (p = 0.007) with sleep quality. Our study showed sleep dysfunction to be less prevalent in RTT-affected individuals than evidence from past studies has suggested. Nevertheless, this remains a subjective assessment of sleep quality and therefore the need to find objective, disorder-specific parameters that measure sleep quality in RTT patients persists.

What can education bring to entrepreneurship? Formal versus non-formal education

ABSTRACT Building on a dynamic view of human capital for the entrepreneurship field, our article covers research performed in this field by examining: the effect of formal versus non-formal Entrepreneurial Education (EE) investments and the development of entrepreneurial human capital assets on the entrepreneurial intention; learning approaches (behavioral, cognitive, or constructive) that are prevalent in formal and non-formal education systems in terms of teaching methods and acquired competences and their effects on entrepreneurial intention, considering different settings at individual and country context level. More than 650 respondents from three countries (Macedonia, Slovenia, and Lithuania) are included in the sample. The research applies structural equation modeling, using two standardized and relevant measurement tools: Entrepreneurial Intention Questionnaire (EIQ) and Assessment Tools and Indicators for Entrepreneurship Education (ASTEE). Non-formal entrepreneurial education has proven to be a stronger effect on human capital assets. On the other hand, entrepreneurial mindset and constructive entrepreneurial skills have a greater impact on personal attitudes and perceived behavioral control. This could mean that decision-makers should complement formal with non-formal entrepreneurial education, that they should design the entrepreneurial study programs with non-cognitive (that is, constructive) teaching methods and learning outcomes.

Metabolic Signatures Differentiate Rett Syndrome From Unaffected Siblings.

Rett syndrome (RTT, OMIM 312750), a severe neurodevelopmental disorder characterized by regression with loss of spoken language and hand skills, development of characteristic hand stereotypies, and gait dysfunction, is primarily caused by de novo mutations in the X-linked gene Methyl-CpG-binding protein 2 (MECP2). Currently, treatment options are limited to symptomatic management, however, reversal of disease phenotype is possible in mouse models by restoration of normal MECP2 gene expression. A significant challenge is the lack of biomarkers of disease state, disease severity, or treatment response. Using a non-targeted metabolomic approach we evaluated metabolite profiles in plasma from thirty-four people with RTT compared to thirty-seven unaffected age- and gender-matched siblings. We identified sixty-six significantly altered metabolites that cluster broadly into amino acid, nitrogen handling, and exogenous substance pathways. RTT disease metabolite and metabolic pathways abnormalities point to evidence of oxidative stress, mitochondrial dysfunction, and alterations in gut microflora. These observed changes provide insight into underlying pathological mechanisms and the foundation for biomarker discovery of disease severity biomarkers.

Morphological Analysis of Fibre Reinforced Laminate Made By Hand Lay-Up Process

The usage of composite in industries or in aerospace sectors is in increasing demand which is been taken care in this noble work. This experimental study comprises of fabrication of composite by hand lay-up process and their characterization. Specifically laminated composites have been fabricated aiming different orientations of fibre. It is well known that orientation of fibre along the load direction will surely tailor the strength and different mechanical properties of the composite material. Two different kind of laminated composites have been fabricated of which one is randomly oriented and other is structured woven-glass / epoxy laminate. The aim of the research work is to monitor the hand lay-up of the fibres which directly influences the strength of each lamina in a complete laminate. To check the distribution of the fibres different test has been performed like X-Ray Diffractometer (XRD) and Transmission Electron Microscope (TEM). The result procured from the above test justifies the proper distribution and orientation of fibres and their effect on different mechanical properties. The outcome of the work will be helpful in tailoring the strength of the laminate by more specific skilled hand lay-up process.

THE EFFECT OF ERGOTHERAPY ON FUNCTIONAL RECOVERY OF UPPER EXTREMITIES IN PATIENTS WITH TRAUMATIC DISEASE OF THE CERVICAL SPINAL CORD IN THE LATE REHABILITATION PERIOD

Aim. The purpose of the article is to study the effect of physical rehabilitation on the correction of motor disorders in individuals with traumatic disease (TD) of the cervical portion (C6-C7) of the spine in the late rehabilitation period and experimentally substantiate the features of reco­very in the upper extremities. Materials and methods. The experiment involved 30 patients with TD of the cervical portion (C6-C7) of the spine in the late rehabilitation period (2 to 12 months after injury). To assess motor functions in the examined patients, manual muscle testing and dynamometry were performed for measuring muscle strength. The study of the function of the hand was carried out using an adapted modified test. The Barthel scale and the daily activity questionnaire were used to study the formation of self-service skills. The obtained data were processed with the Statistica 10.0 and Microsoft Excel Professional software. Results. The modified method of physical rehabilitation for people with TD of the cervical portion (C6-C7) of the spine in the interim period is a set of practically tested technologies. These technologies include a comprehensive set of activities and the following methods of kinesitherapy: PNF (proprioceptive neuromuscular facilitation), Bobath-therapy, Trankviletati method, Feldenkrais method, as well as mechanotherapy with specialized simulators (Dikul). Ergotherapy is a separate element, which is included in rehabilitation of patients with TD of the cervical portion of the spine together with exercise therapy, daily exercises. Conclusion. As a result of the use of a modified method of physical rehabilitation, in patients of the experimental group, the amplitude and muscle strength of the upper extremities significantly increased, the dynamics of the manipulative function of the hand and self-care skills improved in relation to initial values and the control group.

A Man Absolutely Sure of Himself: Texan George Washington Littlefield by David B. Gracy II

Reviewed by: A Man Absolutely Sure of Himself: Texan George Washington Littlefield by David B. Gracy II M. Scott Sosebee A Man Absolutely Sure of Himself: Texan George Washington Littlefield. By David B. Gracy II. (Norman: University of Oklahoma Press, 2019. Pp. 450. Photographs, notes, bibliography, index.) Texas has had its share of larger-than-life figures, men and women who have captured the state and national imagination and become more legendary after their deaths than they were when they lived. George Washington Littlefield may not be as well-known as Sam Houston, but he certainly fits into that category. He lived when Texas was in transition from an isolated frontier to a modern state, and Littlefield personified that change. Through his life he navigated commercial ventures from agriculture to finance and real estate. Along the way, he offered public service, notably as an influential regent and benefactor of the University of Texas. David Gracy’s title, A Man Absolutely Sure of Himself, is an accurate description of a Texan who imposed his will and personality on almost every venture he undertook. Gracy correctly places Littlefield within the sphere of other late-nineteenth-century business figures like Andrew Carnegie or John D. Rockefeller. George W. Littlefield may not have presided over such memorable industrial enterprises as theirs, but he was still an empire builder who identified and then took advantage of economic opportunities during the Gilded Age. Gracy acknowledges the debate among historians and other chroniclers about whether such capitalists were robber barons or captains of industry. To his credit, he does not categorize Littlefield as either. Although I suspect he has a definite opinion, he allows the reader to form a conclusion. Gracy’s narrative is a fine balance. A Man Absolutely Sure of Himself is no hagiography, but neither is it an exercise in damning a man who, at times, could be accused of exploitation. He places Littlefield squarely in his epoch: despite actions that contemporary commentators would find questionable, or even objectionable, it was not possible for him to act differently. In many ways, Gracy’s account demonstrates how Littlefield grew and changed right along with the state he called home. Born in 1842 on the edge of the new nation’s frontier, Littlefield ended his life as a leader of a growing university, a proponent of advanced education, a benefactor of pursuits of knowledge, and a friend of President Theodore Roosevelt, the era’s emblematic Progressive. Along the way he traversed almost every aspect of a commercial career, founding a ranch, a town, and a bank, and also erecting a building that was the defining feature of Austin for decades, the nine-story Littlefield Building. David Gracy’s work is a fine biography. It is chronologically arranged and a thorough accounting. True to the notable archivist he is, Gracy has delved deeply into primary documents and has methodically and [End Page 103] scrupulously detailed Littlefield’s life. His story traces the transformation of his subject while it also describes the nuance and texture of a man who could have become a caricature in less skilled hands. A relative of Littlefield, Gracy offers valuable insights about the man in a clear and engaging writing style that will draw general as well as academic readers. This book is a beneficial contribution to Texas, western, and southern historical studies. M. Scott Sosebee Stephen F. Austin State University Copyright © 2020 The Texas State Historical Association

An alternative and novel usage for ultrasound-guided erector spinae plane block: Extracorporeal shock wave lithotripsy in a paediatric patient.

Sir, Erector spinae plane block is a novel paraspinal interfascial plane block.[1] It has been performed for several indications, and its usage for paediatric patients have been increased recently.[23] It may be used safely especially in paediatric analgesia management instead of central neuroaxial techniques because of its distance to the important anatomical structures.[23] Herein, we would like to share our experience using erector spinae plane block (ESPB) for management of interventional pain during extracorporeal shock wave lithotripsy (ESWL) in a 2-year-old paediatric patient. Written informed consent for the procedure and future publishing were obtained from parents of patient. Two-year-old boy was scheduled to undergo ESWL due to multiple renal stones. The patient was taken to the ESWL unit. Midazolam (0.1 mg·kg−1) and propofol (1 mg·kg−1) was administered IV for sedation. The patient was placed in the right lateral decubitus position. Under aseptic conditions; ultrasound-guided ESPB was performed from the level of the Th10 with a high frequency, sterile sheath covered, 12 MHz linear US probe. Following the visualisation of the erector spinae muscle above the transverse process, 22G, 50 mm block needle was inserted in a cranial-caudal direction using the in-plane technique into the deep fascia. 6 ml of 0.25% bupivacaine was injected into the interfacial area[2] [Figure 1]. ESWL was commenced 10 minutes after the block. There were no changes in arterial pressure, heart rate, respiratory rate, and SpO2 during ESWL. No additional analgesic drug or sedation was performed to the patient during the procedure. The patient was immobile during ESWL. Patient was comfortable at the postoperative period and started to walk 1 hour after the ESWL.Figure 1: (a) Sonographic anatomy of the block (b) Needle direction and spread of local anaesthetic. LA indicates local anaesthetic (c) Patient position and probe localisation during ESPB performingAnaesthesia and analgesia management is a very important issue during ESWL. ESWL is a daycare procedure, patients usually are discharged in the same day. Effective opioid-free techniques may be used for post-procedural pain management.[4] The patient should be immobile during the procedure, and the sedation should be light for protection of the spontaneous respiration. So, regimens such opioid-free anaesthesia may be preferred. QLB block may be performed in paediatric patients for abdominal procedures like ESWL analgesia and provides at Th7-L1 dermatomes.[4] However, there have been some reports of complications related to QLB. QLB is administered in closer proximity to the intra-abdominal solid organs such as liver and kidney. Ahiskalioglu et al. reported the visualisation of hepatomegaly during the QLB block.[5] If this block is performed in less skilled hands, a number of complications such as solid organ injury may occur during block application. ESPB is a novel block defined for use in both acute and chronic pain and sometimes as the main anaesthesia method in both paediatric and adult patients.[123] ESPB is performed distant to solid organs and vascular structures. The transverse process is a natural anatomical barrier in front of the needle and visualisation is simpler under ultrasound guidance, so it may be performed safely.[12] To conclude, ESPB may provide effective interventional analgesia during paediatric ESWL safely for opioid-free analgesia treatment. Declaration of patient consent The authors certify that they have obtained all appropriate parent consent forms. In the form the parent(s) has/have given his/her/their consent for his/her/their child's images and other clinical information to be reported in the journal. The parents understand that the name and initials of their child will not be published and due efforts will be made to conceal the identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.