Anesthesiologists' Perspective on the Use of Artificial Intelligence in Ultrasound-Guided Regional Anaesthesia in Terms of Medical Ethics and Medical Education: A Survey Study.

OBJECTIVE: Controversy exists around the world as experts disagree on what artificial intelligence will imply for humanity in the future. Medical experts are starting to share perspectives on artificial intelligence with ethical and legal concerns appearing to prevail. The purpose of this study was to determine how anesthesiology and reanimation specialists in Turkey perceive the use of artificial intelligence in ultrasound-guided regional anesthetic applications in terms of medical ethics and education, as well as their perspectives on potential ethical issues. MATERIALS AND METHODS: This descriptive and cross-sectional survey was conducted across Turkey between July 1 and August 31. Data were collected through an online questionnaire distributed by national associations and social media platforms. The questionnaire included questions about the descriptive features of the participants and the possible ethical problems that may be encountered in the use of artificial intelligence in regional anesthesia and 20 statements that were requested to be evaluated. RESULTS: The average age of the 285 anesthesiologists who took part in the study was 42.00 ± 7.51, 144 of them were male, the average years spent in the field was 10.95 ± 7.15 years, 59.3% were involved in resident training, and 74.7% habitually used ultrasound guidance regional anesthetic applications. Of the participants, 80% thought artificial intelligence would benefit patients, 86.7% thought it would benefit resident training, 81.4% thought it would benefit post-graduate medical education, and 80.7% thought it would decrease complications in practice. There will be no ethical issues if sonographic data are captured anonymously, according to 78.25%, while 67% are concerned about who will be held accountable for inaccuracies. CONCLUSION: The majority of anesthetists believe that using artificial intelligence in regional anesthetic applications will decrease complications. Although ethical concerns about privacy and data governance are low, participants do have ethical worries about "accountability for errors."

Comparison of the Effectiveness of Ultrasound-Guided Proximal, Mid, or Distal Adductor Canal Block after Knee Arthroscopy.

OBJECTIVE: Adductor canal block has been used for effective post-operative analgesia; however, the optimal location of adductor canal block placement is still controversial. We aimed to assess the opioid consumption and pain intensity in patients undergoing proximal, mid, and distal adductor canal block after knee arthroscopy. METHODS: A total of 90 patients who had undergone an arthroscopic knee surgery and proximal, mid, or distal adductor canal block for postoperative analgesia were examined. All groups received 20 mL of bupivacaine (0.375%) to the adductor canal. Post-operative pain scores, tramadol consumption, Bromage scores, additional analgesic need, and other complications were recorded. RESULTS: Our results demonstrated that proximal adductor canal block group significantly reduced opioid consumption compared to the midadductor canal block group (P < .001), and mid-adductor canal block group provided significantly decreased opioid consumption than the distal adductor canal block group (P = .004). The visual analog scale values were significantly lower in the proximal adductor canal block group compared to the mid-adductor canal block group at 0, 2, 4, 8, 12, and 24 hours, except in resting visual analog scale values at 24 hours. When the proximal and distal groups were compared, visual analog scale values were significantly lower in the proximal adductor canal block group. The Bromage score was 0 in all groups at each follow-up point. Post-operative nausea was observed in only 3 (3.3%) patients, all of these patients were in the distal adductor canal block group. CONCLUSION: Ultrasound-guided adductor canal block can be applied reliably at proximal, mid, and distal locations. The proximal adductor canal block approach provides significantly lower tramadol consumption and post-operative visual analog scale values than the mid- and distal adductor canal block groups.

Ultrasound-guided genicular nerve radiofrequency treatment: prospective randomized comparative trial of a 3-nerve protocol versus a 5-nerve protocol.

OBJECTIVES: Genicular nerve radiofrequency procedures increasingly are being performed to treat chronic pain due to knee osteoarthritis. Targeting additional sensory nerves and improving target identification by using ultrasound guidance could improve treatment success. The aim of this study was to compare the effectiveness of targeting only the traditional genicular nerves versus targeting the traditional genicular nerves plus 2 additional sensory nerves in ultrasound-guided genicular nerve radiofrequency procedures in patients with chronic knee osteoarthritis. METHODS: A total of 80 patients were randomized into 2 groups. Patients in the 3-nerve-targeted group received a genicular radiofrequency procedure in which the traditional genicular nerves were targeted: the superior lateral, superior medial, and inferior medial nerves. The 5-nerve-targeted group received a genicular radiofrequency procedure in which the recurrent fibular and infrapatellar branches of the saphenous nerve were targeted in addition to the traditional genicular nerves. The numeric rating scale, Short Form-36, Western Ontario and McMaster Universities Arthritis Index, Quantitative Analgesic Questionnaire, and patient satisfaction were evaluated before treatment, at week 1 after treatment, and at months 1, 3, and 6 after treatment. RESULTS: Both techniques provided significant pain reduction and functional improvement up to 6 months after the procedure (P < .05). The 5-nerve-targeted group showed significant improvement with regard to the numeric rating scale, Western Ontario and McMaster Universities Arthritis Index total, and Short Form-36 score compared with the 3-nerve-targeted group at each follow-up point. No differences in the Quantitative Analgesic Questionnaire or patient satisfaction scores were observed between the groups. CONCLUSIONS: The ultrasound-guided 5-nerve-targeted technique is a safe method and a more effective therapeutic procedure than the traditional 3-nerve-targeted technique for chronic knee osteoarthritis. TRIAL REGISTRATION: www.ClinicalTrials.gov ID: NCT05073887.

Fluoroscopy-Guided Versus Fluoroscopy-Confirmed Ultrasound-Guided S1 Transforaminal Epidural Injection with Pulsed Radiofrequency: A Prospective, Randomized Trial.

OBJECTIVE: The aim of this prospective randomized controlled study was to compare the effectiveness and accuracy of the ultrasound- and fluoroscopy-guided S1 transforaminal epidural injection combined with pulsed radiofrequency in patients with lumbosacral radicular pain caused by S1 nerve involvement. MATERIALS AND METHODS: A total of 60 patients were randomized into 2 groups. Patients received S1 transforaminal epidural injection combined with pulsed radiofrequency under either ultrasound or fluoroscopy guidance. Primary outcomes were estimated with Visual Analog Scale scores at 6 months. Secondary outcomes included Oswestry Disability Index, Quantitative Analgesic Questionnaire, and patient satisfaction scores during the 6-month follow-up period and procedure-related variables including procedure time and accuracy of the needle replacement. RESULTS: Both techniques provided significant pain reduction and functional improvement for 6 months compared to baseline (P < .001), without statistical significance between groups at each follow-up point. There was no significant difference in pain medication consumption (P=.441) and patient satisfaction scores (P=.673) between groups. The fluoroscopy guidance for combined transforaminal epidural injection with pulsed radiofrequency at S1 provided a greater accuracy for the cannula replacement (100%) than the ultrasound (93.3%), without significant difference between groups (P=.491). CONCLUSION: The ultrasound-guided combined transforaminal epidural injection with pulsed radiofrequency at S1 level is a feasible alternative to fluoroscopy guidance. In this study, we reported that the ultrasoundguided technique resulted in similar treatment benefits including improvement in pain intensity and functionality and reduction in pain medication consumption as those in the fluoroscopy group, while reducing the risk for radiation exposure.

Ultrasound-guided rhomboid intercostal block versus erector spinae plane block for unilateral dorsal back myofascial pain syndrome: a prospective, randomized trial.

BACKGROUND: The aim of this study was to investigate the effects of erector spinae plane block (ESPB) and rhomboid intercostal block (RIB) on pain, disability, quality of life and patient satisfaction in patients with myofascial pain syndrome (MPS). METHODS: In this prospective randomized controlled double-blind study, 60 patients with a diagnosis of MPS were randomized into two groups. In group ESPB (N.=30), US-guided ESPB was performed, and in group RIB (N.=30), US-guided RIB was performed. The pain severity of the patients was assessed using the Numerical Rating Scale before treatment, and immediately after the intervention, on the first day, and one, two, four and six weeks after the intervention. The Short Form-36 Health Survey (SF-36) for health-related Quality of Life, the Neck Disability Index (NDI), and patient satisfaction were evaluated before treatment and six weeks after treatment. RESULTS: In both groups, significant improvements were observed in all parameters during the six-week follow-up period compared to pretreatment values (P<0.05). There was no statistically significant difference between groups for any parameters at any time interval. CONCLUSIONS: This study showed that ESPB and RIB blocks are effective techniques for pain, disability, and quality of life in patients with MPS. We suggest that the interfascial space can be useful in the administration of analgesic agents for the treatment of MPS.

Brain death and the internet: evaluating the readability and quality of online health information.

BACKGROUND: Brain death has been accepted medically and legally as biological death. Nevertheless, it is a difficult concept for the public to understand, resulting in a reliance on online resources for clarity. When the information is inaccurate, misleading, or elusive, the internet could have adverse effects on the public's decision-making. Here we aimed to assess the quality and readability of information regarding brain death on the internet. METHODS: The five most popular search engines were queried using the keyword 'brain death' and the top 30 websites of each search engine were evaluated. Authorship was classified as medical or public. Gunning Fog Index (GFI) and Flesch Reading Ease Score (FRES) were calculated to analyze readability. The LIDA was used to assess quality. RESULTS: The overall LIDA score was 60,3%, with a mean score of 60.8%, 60.7%, and 59.3% for accessibility, usability, and reliability, respectively, indicating a moderate level. The accessibility of medical websites (P=0.037) and the reliability of public websites (P=0.031) were found to be significantly weaker. The average FRES was 41.6±14.6 rated as difficult, and the mean GFI was 15.7±3.4, indicating mean readability at "difficult, grade >10". CONCLUSIONS: Online health information on brain death exceeds the National Institutes of Health recommended reading levels. Our results emphasize the need to establish quality guidelines to improve the comprehensiveness of health website content. Brain death is still a contentious topic; therefore, reliable, and easy-to-read online educational materials can help public understand the concept of brain death and potentially improve the transplant rate.

Chronic Pain: An Update of Clinical Practices and Advances in Chronic Pain Management.

Chronic pain affects a significant amount of the population and represents a heavy personal and socioeconomic burden. Chronic pain mechanisms can be categorized as nociceptive, neuropathic, or nociplastic. Although mechanism-based pain treatment is optimal, different types of pain mechanisms may overlap in patients. Recently, the biopsychosocial model with the multidisciplinary pain management program is widely accepted as one of the most effective methods to assess and manage chronic pain. The treatment of chronic pain consists of a personalized, stepwise, and multimodal approach that includes pharmacotherapy, psychotherapy, integrative treatments, and interventional procedures. Somatic and peripheral nerve blocks for the treatment of chronic pain are often deferred. With the increasing use of ultrasound in pain medicine, newly defined interfascial plane blocks, which may be performed alone or as an adjuvant to multimodal management, have gained popularity. Adequate pain management can improve physical functioning, mental health and quality of life indicators, and reduce pain chronification. The aim of this current article is to perform a comprehensive and updated review of existing treatment options, particularly interfascial plane blocks in chronic pain syndromes.

Evaluation of ultrasound-guided adductor canal block with two different concentration of bupivacaine in arthroscopic knee surgery: A feasibility study.

STUDY OBJECTIVE: The application of regional anaesthesia techniques as a component of multimodal analgesia in knee arthroscopic surgeries increases the quality of postoperative analgesia. Adductor canal block (ACB) is an effective "motor sparing" analgesia technique used in knee surgeries. This study aimed to evaluate the efficacy of ACB using two different concentrations of local anaesthetic in terms of analgesic requirements and pain density in patients undergoing knee arthroscopy. DESIGN: Prospective, randomised, controlled. SETTING: Tertiary hospital. PATIENTS: A total of 60 patients (ASA I-II) were evaluated in three groups, with 20 patients in each group. INTERVENTIONS: Standardised postoperative analgesia was performed in all groups. In addition, ultrasound-guided ACB (same volume/two different concentrations of bupivacaine: 0.25% vs 0.16%) was applied to the experimental groups. MEASUREMENTS: Tramadol consumption, rescue analgesic requirement and Numeric Rating Scores (NRS). MAIN RESULTS: Tramadol requirement in the first 24 hours was significantly higher in the control group (209.5 ± 23.27 mg) (P < .001), and there was no difference between the experimental groups (63 ± 42.06 mg vs 80.5 ± 36.63 mg). Although the mean NRS scores in the first three hours were higher in the control group when compared with both block groups, it was similar in all groups in the following measurements. CONCLUSION: In arthroscopic knee surgery, ACB interventions with 0.25% and 0.16% concentrations of bupivacaine were similar in terms of postoperative analgesic efficacy, and they increased the quality of multimodal analgesics when compared with the control group.