Local Block Research Articles

Management of Chronic Nasal Pain Developing After Rhinoseptoplasty or Nasal Trauma.

Background: Management of patients who experience refractory chronic nasal pain (CNP) of no apparent cause can be unclear. Objectives: To measure pain outcomes in managing patients with CNP after rhinoseptoplasty or nasal trauma. Methods: We retrospectively reviewed patients with CNP after rhinoseptoplasty or trauma, treated with a gabapentinoid drug, local nerve block with lidocaine plus dexamethasone, or both. Results: The study included 28 patients, 12 men and 16 women, of mean age 39.1 years (range 22-66), experiencing CNP after rhinoseptoplasty (n = 22) and nasal bone fracture (n = 6). Pain was distributed at the nasal dorsum (53%), periorbital area (15%), septum (13%), nasal tip (13%), and cheek (6%). The most common types of pain pattern, onset time, and duration were pressing and stabbing pain (41%), immediately developed (43%), and lasting 3-6 months (39%), respectively. After treatment, pain was relieved completely in 12 (43%) patients and mild to moderate in 7 (25%), but 9 (32%) showed no response. Conclusions: Postoperative or traumatic CNP can be a complex manifestation with several atypical characteristics. The combination of a gabapentinoid drug and local nerve block with lidocaine plus dexamethasone improved CNP in 68% of patients.

Limited Effects of Pain Control Treatments on Behaviour and Weight Gain of Pure and Crossbred Nellore Heifer Calves When Subjected to Hot-Iron Branding.

Hot-iron branding is still commonly performed in cattle farming in tropical countries, and possibly has negative consequences for animal welfare and weight gain. This study examined the behavioural and weight gain responses of pure and crossbred Nellore heifer calves subjected to hot-iron branding on the cheek, without and with use of anaesthesia and analgesia. Ninety-two heifer calves, around 120 days old, were studied prospectively when subjected to hot-iron branding on the cheek (a statutory procedure in Brazil following brucellosis vaccination). Four randomly selected groups of calves were allocated to four treatments: no pain control (CO); subcutaneous anaesthetic local block (LA); intramuscular analgesia (meloxicam) (LT); and local anaesthesia plus meloxicam (LL). Behaviour, flight speed and body weight were evaluated before, during, and five (5-d) and 60 days (60-d) after branding. For these parameters, the only difference observed was higher tension in the CO group 5-d post-branding, suggesting a short-term negative effect of branding without pain control. The limited effects of the pain control treatments suggest interference in pain assessment by other factors, such as expression of fear and stress. Despite the lack of differences observed in behaviour and production parameters, facial hot-iron branding is an obvious welfare issue and, due to the additional handling involved, adoption of a simple pain relief protocol is not sufficient to minimise the welfare impact.

A novel hybrid transformer-CNN architecture for environmental microorganism classification.

The success of vision transformers (ViTs) has given rise to their application in classification tasks of small environmental microorganism (EM) datasets. However, due to the lack of multi-scale feature maps and local feature extraction capabilities, the pure transformer architecture cannot achieve good results on small EM datasets. In this work, a novel hybrid model is proposed by combining the transformer with a convolution neural network (CNN). Compared to traditional ViTs and CNNs, the proposed model achieves state-of-the-art performance when trained on small EM datasets. This is accomplished in two ways. 1) Instead of the original fixed-size feature maps of the transformer-based designs, a hierarchical structure is adopted to obtain multi-scale feature maps. 2) Two new blocks are introduced to the transformer's two core sections, namely the convolutional parameter sharing multi-head attention block and the local feed-forward network block. The ways allow the model to extract more local features compared to traditional transformers. In particular, for classification on the sixth version of the EM dataset (EMDS-6), the proposed model outperforms the baseline Xception by 6.7 percentage points, while being 60 times smaller in parameter size. In addition, the proposed model also generalizes well on the WHOI dataset (accuracy of 99%) and constitutes a fresh approach to the use of transformers for visual classification tasks based on small EM datasets.

Sediment provenance and stratigraphic correlations of the Paleogene White River Group in the Bighorn Mountains, Wyoming

Detrital zircon ages for tuffaceous sandstones and conglomerates of the White River Group provide insights on Paleogene basin evolution, magmatic activity, and paleodrainage throughout the Laramide broken foreland basin system of the northern Rocky Mountains in the western United States. Nonmarine deposits of the upper Eocene-Oligocene White River Group are preserved irregularly across northern Wyoming and western South Dakota. Residual Laramide uplifts and active magmatic centers supplied clastic and volcaniclastic sediment to broad, low-relief valleys beginning around 40 Ma. Subhorizontal strata of the White River Group are exposed in the elevated Bighorn Mountains (∼2300 to 2800 m), where sections ∼10-50 m thick rest unconformably on Precambrian-Paleozoic rocks along a surface of moderate to low relief (up to 150 m). U-Pb ages were obtained for detrital and igneous (ash-fall) zircons from seven samples (3 tuffaceous sandstones, 2 conglomerates, 2 sandstones) spanning three localities in the Bighorn Mountains (Darton’s Bluff, Hazelton Road, Freeze Out Point). Each locality contains conglomeratic layers, with clasts of local crystalline basement, and interbedded tuffaceous sandstones. Detrital zircon age spectra for four samples reveal peak ages around 2.9 Ga, matching the age of Archean crystalline basement within Bighorn Mountains, and maximum depositional ages (MDAs) of 27 Ma (sample 20BH15; Oligocene) and 35 Ma (sample FO-2; late Eocene). During the Paleogene, the Bighorn Mountains region received sediment from local crystalline basement and long-distance river transport from igneous and sedimentary sources to the west. The Bighorn Mountains were exhumed and stripped of Phanerozoic cover strata by early Eocene time, suggesting that post-Laramide input from Paleozoic-Mesozoic strata was likely from relict highlands of the Cordilleran (Sevier) fold-thrust belt rather than local Laramide block uplifts. In addition, Cenozoic magmatic provinces in the San Juan Mountains and Great Basin are inferred to have contributed volcaniclastic sediment through both eruptive ash clouds and north- to northeast-flowing fluvial systems that reached northeastern Wyoming. The White River Group preserved in the Bighorn Mountains represents localized late Eocene-Oligocene sediment accumulation atop a Laramide basement high coeval with regional deposition across the adjacent Great Plains. Both regions were supplied sediment from alluvial fans and fluvial drainage networks that tapped Laramide basement uplifts, Cordilleran thrust-belt, and foreland sources, along with Cenozoic igneous centers of the western U.S. interior.

USING AREA DEPRIVATION INDEX TO ASSESS RACIAL DISPARITIES IN ASTHMA AMONG CHILDREN WITH FOOD ALLERGY

<h3>Introduction</h3> Previous studies have shown significant racial disparities in food allergy (FA) phenotype and outcomes. Our study sought to understand if higher rates of asthma in African American (AA) children with FA were driven by differences in individual and community-level socioeconomic status (SES), regardless of race. <h3>Methods</h3> We analyzed data from FORWARD, which is a prospective, multicenter cohort study investigating the natural history of pediatric atopy. A validated, multi-component area deprivation index (ADI) was used to estimate patient exposure to low SES at the local census block group level. Higher ADI is associated with greater socioeconomic disadvantage. <h3>Results</h3> Of the 700 children in this study, 51% were non-Hispanic White, 37% AA, and 12% Hispanic. The mean ADI across the analytic sample was 37.7 (95% CI: 35.6-39.7). The highest mean ADI (51.5) was seen among AA patients when compared to non-Hispanic White (mean ADI of 24.2) and Hispanic (mean ADI of 41) patients (p < .0001). The mean ADI was 43.3 in children with asthma as opposed to 31.8 in those without asthma (p < .0001). Asthma was more common among AA children [OR = 2.76 (95% CI: 1.77-4.29)] after adjusting for household income, respondent educational attainment, child gender, and recruitment site. <h3>Conclusion</h3> Our data shows that higher ADI is independently associated with higher odds of asthma among children with FA. These findings demonstrate the role of socioeconomic deprivation in the development of asthma among children with FA. This is especially important considering the obstacles associated with socioeconomic deprivation that hinder appropriate management of asthma.

Cluster Analysis of Dense GNSS Velocity Field Reveals Characteristics Associated With Regional Tectonics in New Zealand

AbstractNew Zealand is located in the converging zone between the Australian and Pacific Plates. The Pacific Plate is descending beneath the Australian Plate in the north of New Zealand, while the Australian Plate is descending beneath the Pacific Plate in the south. The contrastive tectonics is connected by the Alpine Fault, the transform fault with NE‐SW strike along most of the length of New Zealand. Recently, previous studies showed that a cluster analysis of dense Global Navigation Satellite System (GNSS) velocity field objectively yields major velocity discontinuities, which may reflect an important tectonic boundary. We applied two different types of clustering algorithms: hierarchical agglomerative clustering (HAC) and Euler pole clustering (EPC), to the dense GNSS horizontal velocity data in New Zealand. Both methods agree that the primary kinematic boundary lies from the northern Wairarapa region to the southwestern end of the Alpine Fault. The HAC introduces a cluster boundary along the North Island Dextral Fault Belt whereas EPC emphasizes the importance of the Taupo Volcanic Zone (TVZ). Since EPC fits the data reasonably well, it indicates the TVZ is an important boundary. This result displays the limitation of the flat earth assumption. The Chatham Islands is identified as an independent cluster by the HAC, but not by the EPC. Further cluster splits illustrate that the relative motion between the two plates is accommodated by distributed deformation in the Marlborough Fault Zone in the South Island whereas the North Island is characterized by local block rotations.

Use of bupivacaine infiltrative local block in bitches submitted to ovariohysterectomy by celiotomy or video-assisted surgery by two-portals access

This randomized blinded study objected to investigate a local anesthesia (0,5% bupivacaine) in the surgical incision site in dogs underwent to ovariohysterectomy by celiotomy or video-assisted by two-portal. Twenty-eight healthy adults were selected. Dogs were divided into celiotomy control group, celiotomy blocking group (BC), video-assisted control group and blocking video-assisted group (BV). In the BC and BV, bupivacaine was administered SC in the incision line or port sites. Control groups received NaCl 0,9% at the same sites. Three evaluators blinded evaluated postoperative pain, using Melbourne Pain Scale and visual analog scale. The anesthetic infiltrative blockade used was efficient in promoting postoperative comfort in both celiotomy and video assisted OVH.

Reduction of opioid use after orthopedic surgery: a scoping review.

Background:The opioid epidemic is one of the biggest public health crises of our time, and overprescribing of opioids after surgery has the potential to lead to long-term use. The purpose of this review was to identify and summarize the available evidence on interventions aimed at reducing opioid use after orthopedic surgery.Methods:We searched CENTRAL, Embase and Medline from inception until August 2019 for studies comparing interventions aimed at reducing opioid use after orthopedic surgery to a control group. We recorded demographic data and data on intervention success, and recorded or calculated percent opioid reduction compared to control.Results:We included 141 studies (20 963 patients) in the review, of which 113 (80.1%) were randomized controlled trials (RCTs), 6 (4.3%) were prospective cohort studies, 16 (11.4%) were retrospective cohort studies, 5 (3.6%) were case reports, and 1 (0.7%) was a case series. The majority of studies (95 [67.4%]) had a follow-up duration of 2 days or less. Interventions included the use of local anesthetics and/or nerve blocks (42 studies [29.8%]), nonsteroidal anti-inflammatory drugs (31 [22.0%]), neuropathic pain medications (9 [6.4%]) and multimodal analgesic combinations (25 [17.7%]. In 127 studies (90.1%), a significant decrease in postoperative opioid consumption compared to the control intervention was reported; the median opioid reduction in these studies was 39.7% (range 5%–100%). Despite these reductions in opioid use, the effect on pain scores and on incidence of adverse effects was inconsistent.Conclusion:There is a large body of evidence from randomized trials showing the promise of a variety of interventions for reducing opioid use after orthopedic surgery. Rigorously designed RCTs are needed to determine the ideal interventions or combination of interventions for reducing opioid use, for the good of patients, medicine and society.

Localized bioelectrical conduction block from radiofrequency gastric ablation persists after healing: safety and feasibility in a recovery model.

Gastric ablation has demonstrated potential to induce conduction blocks and correct abnormal electrical activity (i.e., ectopic slow-wave propagation) in acute, intraoperative in vivo studies. This study aimed to evaluate the safety and feasibility of gastric ablation to modulate slow-wave conduction after 2 wk of healing. Chronic in vivo experiments were performed in weaner pigs (n = 6). Animals were randomly divided into two groups: sham-ablation (n = 3, control group; no power delivery, room temperature, 5 s/point) and radiofrequency (RF) ablation (n = 3; temperature-control mode, 65°C, 5 s/point). In the initial surgery, high-resolution serosal electrical mapping (16 × 16 electrodes; 6 × 6 cm) was performed to define the baseline slow-wave activation profile. Ablation (sham/RF) was then performed in the mid-corpus, in a line around the circumferential axis of the stomach, followed by acute postablation mapping. All animals recovered from the procedure, with no sign of perforation or other complications. Two weeks later, intraoperative high-resolution mapping was repeated. High-resolution mapping showed that ablation successfully induced sustained conduction blocks in all cases in the RF-ablation group at both the acute and 2 wk time points, whereas all sham-controls had no conduction block. Histological and immunohistochemical evaluation showed that after 2 wk of healing, the lesions were in the inflammation and early proliferation phase, and interstitial cells of Cajal (ICC) were depleted and/or deformed within the ablation lesions. This safety and feasibility study demonstrates that gastric ablation can safely and effectively induce a sustained localized conduction block in the stomach without disrupting the surrounding slow-wave conduction capability.NEW & NOTEWORTHY Ablation has recently emerged as a tool for modulating gastric electrical activation and may hold interventional potential for disorders of gastric function. However, previous studies have been limited to the acute intraoperative setting. This study now presents the safety of gastric ablation after postsurgical recovery and healing. Localized electrical conduction blocks created by ablation remained after 2 wk of healing, and no perforation or other complications were observed over the postsurgical period.

Association of Regional Anesthetic Approach and Center-Level Surgical Volume with Outcomes after Surgical Repair of Pectus Excavatum

INTRODUCTION: Variability in regional anesthetic approach and surgical volume may affect outcomes in patients undergoing surgical management of pectus excavatum. This study investigated how regional anesthetic approach and center-level surgical volume impacts length of stay (LOS), postoperative narcotic use, and operating room (OR) utilization. METHODS: After IRB approval, we conducted a 10-center retrospective chart review of patients younger than 18 who underwent repair of pectus excavatum between 2015 and 2021. High-volume centers (HVC; 6/10 centers) were defined as performing 100 cases or more over the study period. Surgical time was incision to closure and incorporated within OR time. RESULTS: Of 920 patients meeting inclusion criteria, 757 (82%) underwent surgical repair at HVC; 20% received no regional anesthesia, 24% epidural, 15% erector spinae catheter, 19% cryo-analgesia, 10% cryo-analgesia with local rib block (LRB), and 12% other combinations including serratus anterior, paravertebral, and intrathecal morphine. Univariable associations between regional anesthesia type and center volume on outcomes are shown in Table 1. On multivariable analysis, independent predictors of shorter LOS were cryo-analgesia ± LRB and HVC. Epidural and LRB alone were independently associated with increased LOS. HVC, cryo-analgesia ± LRB, and LRB alone were independently predictive of less MME after surgery. Epidural, LRB, and cryo-analgesia with LRB were predictive of increased surgical and OR time; erector spinae catheters were predictive of longer OR time only. Table 1. - Impact of Regional Anesthesia and Surgical Volume on Outcomes Regional anesthesia and surgical volume Length of stay (d) Milligram morphine equivalents (MME) Surgical time (min) OR time (min) Regional type (n) No regional (185) 4 (3–5) 202 (120–338) 89 (72–131) 155 (130–198) Epidural catheter (223) 4 (3–5) 120 (66–218) 106 (77–167) 196 (161–251) Erector spinae catheter (139) 2 (2–2) 68 (51–124) 90 (75–109) 191 (172–216) Local rib block (64) 4 (3–5) 60 (4–100) 104 (76–136) 184 (152–227) Cryo-analgesia (179) 1 (1–1) 61 (23–125) 101 (80–130) 149 (120–186) Cryo-analgesia with local rib block (92) 2 (1–2) 30 (15–83) 141 (125–162) 205 (182–227) Center volume (n): High-volume (757) 3 (2–4) 83 (38–195) 100 (77–132) 180 (150–208) Low-volume (163) 4 (3–4) 122 (68–225) 137 (87–168) 209 (148–261) CONCLUSION: Anesthetic approach and center-level surgical volume are associated with length of stay, postoperative narcotic use, and OR utilization after repair of pectus excavatum.

Ethanol in Aqueous Solution Studied by Microjet Photoelectron Spectroscopy and Theory.

By combining results and analysis from cylindrical microjet photoelectron spectroscopy (cMJ-PES) and theoretical simulations, we unravel the microscopic properties of ethanol-water solutions with respect to structure and intermolecular bonding patterns following the full concentration scale from 0 to 100% ethanol content. In particular, we highlight the salient differences between bulk and surface. Like for the pure water and alcohol constituents, alcohol-water mixtures have attracted much interest in applications of X-ray spectroscopies owing to their potential of combining electronic and geometric structure probing. The water mixtures of the two simplest alcohols, methanol and ethanol, have generated particular attention due to their delicate hydrogen bonding networks that underlie their structural and thermodynamic properties. Macroscopically ethanol-water seems to mix very well, however microscopically this is not true. The aberrant thermodynamics of water-alcohol mixtures have been suggested to be caused by energy differences of hydrogen bonding between water-water, alcohol-alcohol and alcohol-water molecules. These networks may perturb the local character of the interaction between X-rays and matter, calling for analysis that go beyond the normally applied local selection and building block rules and that can combine the effects of light-matter, intra- and intermolecular interactions. However, despite decades of ongoing research there are still controversies of the precise nature of hydrogen bonding networks that underlie the mixing of these simple molecules. Our combined analysis indicates that at low concentration ethanol molecules form a film at the surface since ethanol at the surface can expose its hydrophobic part to the vacuum retaining its two (or three) possible hydrogen bonds, while water at the surface cannot retain all its four possible hydrogen bonds. Thus, ethanol at the surface becomes energetically favorable. Ethanol molecules show a tilting angle variation of the C-C axis with respect to the surface normal as large as 60° at very low concentration. In bulk, around ca. ten %, the ethanol oxygen atoms tend to make a third acceptor hydrogen bond to water molecules. At ca. 20 %, there is a U-shaped change in the CH3 to CH2OH binding energy (BE) shift indicating the presence of ring-like agglomerates called clathrate structures. At the surface, between 5 and 25%, ethanol forms a closely packed layer with the smallest C-C tilting angle variation down to ∼20°. Above 25% and below the azeotrope at the surface, ethanol shows an increase in the tilting angle variation, while at very high ethanol concentrations water tends to move to the surface so giving a microscopic explanation of the azeotrope effect. This migration is connected to the presence of longer (shorter) ethanol chains in the bulk (surface). A brief comparison with discussions and predictions from other spectroscopic techniques is also given. We emphasize the execution of an integrated approach that combines molecular structural dynamics with quantum predictions of the core electronic chemical shift, so establishing a protocol with considerable interpretative as well as predictive power for cMJ-PES measurements. We believe that this protocol can valorize cMJ-PES for studies of properties of other alcohol mixtures as well as of binary solutions in general.

Ultrasound-guided versus conventional peribulbar anaesthesia in cataract surgery: A randomised controlled study.

Blind ophthalmic anaesthetic techniques may have serious complications. To assess the safety of ultrasound as a guide in ophthalmic blocks. Fifty adult patients undergoing cataract surgery under peribulbar block anaesthesia were randomly assigned to ultrasound-guided and conventional block groups. In the ultrasound-guided block group, a large amount of the standard ultrasound gel was applied to the closed eyelids. The globes were scanned in both sagittal and transverse planes. The patients were asked to look straight ahead with closed eyes without clenching the eyelids. The depth and gain were adjusted before performing the block. The primary outcome was the rate of complications. Secondary outcomes included the volume of injected anaesthetics and surgeon and patients' satisfaction. The local anaesthetic volume used was not significantly different between the two groups (7.08 ± 1.66 and 6.72 ± 1.97ml). The block onset, time and quality were comparable in both groups. No complications were reported, and there were no significant differences regarding surgeons' or patients' satisfaction with either procedure. The ultrasound-guided local ophthalmic block is as safe as the conventional method. Although its use was not superior to the conventional procedure, direct visualisation with ultrasound may be important to avoid vulnerable structures such as staphylomas.

Deep locally linear embedding network

Recent years have seen great progress in many deep learning-based super-resolution methods that learn global responses through the non-local strategy. However, improper linear fitting tends to produce unsatisfactory results with notable artifacts. To relieve the improper linear fitting and reuse the hierarchical features, we propose an end-to-end locally linear embedding super-resolution network, termed as LLE-Net, based on the assumption that the local geometric relationship in the low-resolution manifold space also exists in high-level feature manifold space. The proposed LLE-Net includes two major components: 1) the local linear embedding block (LLEB) and 2) the hierarchical non-local block (HNB). In particular, LLEB searches sparse and similar feature maps and embeds the geometric relationship into the high-level feature space, allowing more attention to be paid to objects’ textural details. To promote the representation ability, the proposed HNB is able to explore layer- and pixel-level interdependencies. We conduct extensive experiments to evaluate the superiority of LLE-Net via two groups of experiments: (1) super-resolution tasks on two satellite image datasets and a satellite video image dataset, and (2) the subsequent high-level image processing tasks (i.e., satellite semantic segmentation). The proposed method achieves an 0.7 dB improvement in PSNR value on the Draper dataset and 0.07% segmentation accuracy improvement. The source code of the proposed LLE-Net is publicly available.

Evaluating the Efficacy of Employing Local Anesthetic Prostatic Blocks During Rezum Procedure.

Introduction Rezum is a minimally invasive, outpatient procedure using convective water vapor to relieve outlet obstruction from benign prostatic hyperplasia (BPH). Evidence on the technical approach of Rezum therapy, particularly pain control, is lacking. The purpose of this study was to evaluate the efficacy of utilizing a local anesthetic prostate block for postoperative pain control during Rezum therapy for BPH. A multimodal approach is typically utilized for pain control during and after Rezum. However, little is known about which elements are most critical. Methods This is a single-center retrospective study of 109 patients who underwent Rezum for BPH. Patients were then divided into two groups: Local anesthetic prostatic block verse no local anesthetic prostatic block for the procedure. A phone survey was performed to assess the patients' subjective pain scores and postoperative analgesics usage. A comparison of reported pain scores on a 0-10 Likert scale as well as usage of prescription and non-prescription analgesics medications was performed. Results There were 109 patients who underwent Rezum therapy, and 86 (79%) of patients responded to phone surveys. There was no significant difference in postoperative pain scores between patients who received local anesthetic prostatic block vs those who did not (2.10 vs 3.03). Similarly, there were no significant differences in postoperative narcotics or non-prescription analgesic medications usage. Conclusion Our data suggest that when performing Rezum using conscious sedation in the operating room or cystoscopy suite, it is unnecessary to perform a local anesthetic prostate block as it has no significant effect on patient-reported pain or the use of analgesics in the postoperative period.

Comparison of buffered and non‑buffered lidocaine: pH and pain perception

Commonly used local anaesthetic (LA) solutions in the field of dentistry are acidic, and have been known to cause pain and a burning sensation. The present study aimed to determine the pH levels of commercially available LA solutions with and without adrenaline and 8.4% sodium bicarbonate‑buffered LA solution, and to evaluate the pain during the administration of buffered and non‑buffered LA solutions. For this purpose, 20 patients with deep dentinal carious lesions with pulpal involvement affecting the bilateral posterior teeth and requiring the administration of a local nerve block were randomly selected to receive buffered and non‑buffered LA agents on either side, respectively. The patients were instructed to score the pain perceived during LA administration with the aid of a visual analogue scale (VAS) score of 1‑10. All the data obtained were subjected to statistical analysis. The results revealed that the LA solution of 2% lignocaine with 1:80,000 adrenaline buffered with sodium bicarbonate had a mean (± SD) pH level of 6.92±0.34 and non‑buffered LA solution had a mean pH level of 3.49±0.26. As per the VAS, a greater level of pain was reported during the non‑buffered LA administration (3.15±1.27) compared to the buffered LA administration (1.40±0.68). Buffered local anaesthetics were more likely than non‑buffered solutions to achieve successful anaesthesia [95% confidence interval (CI), 1.09‑2.41; P&lt;0.001]. On the whole, the present study demonstrates that a significant reduction in the pain perceived in patients during the administration of LA agents buffered with sodium bicarbonate when used during pulpal involvement.

Median sternotomy pain after cardiac surgery: To block, or not? A systematic review and meta-analysis.

Inadequate pain control after median sternotomy leads to reduced mobilization, increased respiratory complications, and longer hospital stays. Typically, postoperative pain is controlled by opioid analgesics that may have several adverse effects. Parasternal intercostal block (PSB) has emerged as part of a multimodal strategy to control pain after median sternotomy. However, the effectiveness of this intervention on postoperative pain control and analgesic use has not been fully established. We conducted a meta-analysis to assess the effect of PSB on postoperative pain and analgesic use in adult cardiac surgery patients undergoing median sternotomy. PubMed, Embase, Google Scholar, and the Cochrane database were searched with the following search strategy: ([postoperative pain]or [pain relief]OR[analgesics]or [analgesia]or [nerve block]or [regional block]or [local block]or [regional anesthesia]or [local anesthetic]or [parasternal block]and [sternotomy]) and (humans [filter]). Inclusion criteria were: patients who underwent cardiac surgery via median sternotomy, age >18 and parasternal block (continuous and single dose). Exclusion criteria were: noncardiac surgery, nonparasternal nerve blocks, and the use of NSAIDS in parasternal block. Quality assessment was performed by threeindependent reviewers via the Cochrane risk of bias assessment tool. Of 1165 total citations, 18 were found to be relevant. Of these 18 citations, 7 citations (N = 2223 patients) reported postoperative pain scores in an extractable format and 11 citations (N = 2155 patients) reported postoperative opioid use in an extractable format. For postoperative opioid use, morphine equivalent doses were calculated for all studies and postoperative pain scores were standardized to a 10-point visual analog scale for comparison between studies; both these were reported as total opioid use or cumulative score ranging from 24to 72 h postoperative. All data analyses were run using a random effects model, using a restricted maximum likelihood estimator, to obtain summary standardized mean differences with 95% confidence interval (CI's). For studies which only reported median and interquatile range (IQR), the median was standard deviation was estimated by IQR/1.35. Following median sternotomy both postoperative pain (SMD [95% CI] -0.49 [-0.92 to -0.06]) and postoperative morphine equivalent use (SMD [95% CI] -1.68 [-3.11 to-0.25]) were significantly less in the PSB group. Our meta-analysis suggests that parasternal nerve block significantly reduces postoperative pain and opioid use.

Detection method based on a coupled illumination correction algorithm for the detection of surface defects in ZrO2 ceramic bearing balls.

To address the problem of feature texture loss in defective images of zirconia bearing balls on unbalanced illumination backgrounds, a coupled algorithm of the local gamma function transform-block interpolation balancing equation is designed. A combination of a light reflection imaging model and a three-dimensional Gaussian surround function is used to extract the illumination estimate of the original image. Subsequent illumination balance correction is performed in the value color space. The contrast between the edges of the feature texture and the background is analyzed to construct a locally adaptive gamma function transformation model. We establish local block interpolation balance equations to eliminate the effects caused by illumination that is too high or too low. The experimental results show that the information entropy of the images after illumination correction changes in the range of 5% or less. The standard deviation and mean gradient can be increased by 15.21% and 14.78%, respectively.

Variations in Innervation Pattern to Dorsum of Foot by Medial Dorsal Cutaneous Nerve, Intermediate Dorsal Cutaneous Nerve, Lateral Dorsal Cutaneous Nerve with Surgical and Clinical Correlations: A Cadaveric Dissection Based Study

The complete reconstruction of any soft tissue defect includes even the sensory recovery which is very significant aspect pertaining to prognosis. Superficial nerves in the vicinity of the vascular axis can be considered as vascular relays and neuroskin grafts can be constructed on them. Variations in innervation to various part of the dorsum of the foot by this nerve should be kept in mind while making these grafts. Authors dissected 50 formalinized cadaveric feet and studied normal anatomy and variations in origin, course, branching pattern, communications, and any other variations in medial, intermediate and lateral dorsal cutaneous nerve. The intermediate dorsal cutaneous nerve was innervating larger area of the skin around 3rd and 4th web spaces in 60% of cadaveric feet. The 2nd web space was innervated by medial dorsal cutaneous nerve in 92% of cadaveric feet. In 52% of cadaveric feet communicating branches were found between intermediate dorsal cutaneous nerve and lateral dorsal cutaneous nerve. In 63% cadaveric feet communicating branches were found between medial dorsal cutaneous nerve and branch of deep peroneal nerve to 2nd web space. The mean distance between lateral malleolus and intermediate dorsal cutaneous nerve was 4.05cm. These all observations can provide anatomical basis at the time of preparing medial dorsal cutaneous nerve flaps and intermediate dorsal cutaneous nerve flaps and also can minimize morbidity at donor site. KEY WORDS: Medial Dorsal Cutaneous Nerve, Intermediate Dorsal Cutaneous Nerve, Lateral Dorsal Cutaneous Nerve, Medial Dorsal Cutaneous Nerve Flap, Intermediate Dorsal Cutaneous Nerve Flap, Soft Tissue Defects, Open Reduction And Internal Fixation Of Fibula, Arthroscopy, Local Anesthetic Block, First Dorsal Metatarsal Artery Flap, Defects In Distal Dorsalis Pedis, Compression And Entrapment Neuropathies.

Nerve blocks on forelimbs and hindlimbs as part of a multimodal analgesia plan

Using local blocks in conjunction with other forms of pain relief have been shown to reduce the length of hospital stays and postoperative recovery times in human patients. This article will explain common hindlimb and forelimb local blocks using electrostimulation for the correct location of the nerve to provide superior pain relief in small animals when used as part of a multimodal analgesic plan.

Integrable quantum many-body sensors for AC field sensing

Quantum sensing is inevitably an elegant example of the supremacy of quantum technologies over their classical counterparts. One of the desired endeavors of quantum metrology is AC field sensing. Here, by means of analytical and numerical analysis, we show that integrable many-body systems can be exploited efficiently for detecting the amplitude of an AC field. Unlike the conventional strategies in using the ground states in critical many-body probes for parameter estimation, we only consider partial access to a subsystem. Due to the periodicity of the dynamics, any local block of the system saturates to a steady state which allows achieving sensing precision well beyond the classical limit, almost reaching the Heisenberg bound. We associate the enhanced quantum precision to closing of the Floquet gap, resembling the features of quantum sensing in the ground state of critical systems. We show that the proposed protocol can also be realized in near-term quantum simulators, e.g. ion-traps, with a limited number of qubits. We show that in such systems a simple block magnetization measurement and a Bayesian inference estimator can achieve very high precision AC field sensing.