Combined thoracic erector spinae plane and inter-transverse plane blocks for awake breast surgery.

Worldwide, breast cancer is the most commonly diagnosed cancer in women. Surgical procedures are typically performed using general anaesthesia, often complemented by regional anaesthesia to manage postoperative pain. However, avoidance of general anaesthesia for breast surgery may be desirable for clinical reasons or patient choice. It is theorised that the use of regional anaesthesia and the avoidance of volatile anaesthetics and opioid analgesia may have beneficial effects on oncological outcomes, and there is some evidence to support this. While many patients successfully undergo awake breast surgery, a limited number of anaesthetists possess direct experience of this approach, despite familiarity with regional anaesthesia techniques. Undertaking regional anaesthesia for awake breast surgery requires patient cooperation and excellent staff teamwork. Here, we present a case of a patient who underwent awake bilateral mastectomy with reconstruction. This was carried out under two 'paravertebral-by-proxy' blocks: the thoracic erector spinae plane and inter-transverse plane blocks, with intravenous sedation.

Unilateral sacral erector spinae plane block for hip fracture surgery.

The provision of anaesthesia for hip fracture surgery in elderly and frail patients can be challenging, with potentially significant risks associated with both general and neuraxial techniques. Here, we report the use of a sacral erector spinae plane block as an alternative to conventional anaesthetic approaches for a frail 89-year-old woman with significant cardiovascular and respiratory comorbidity who underwent intramedullary nailing for a proximal femoral fracture. A unilateral injection of local anaesthetic at the intermediate crest of the second sacral vertebra resulted in bilateral sensory block of the T12 to S2 dermatomes. The technique did not result in hypotension or motor block of the limbs, and the surgery was completed uneventfully. Sacral erector spinae plane block warrants further investigation as an alternative to spinal and general anaesthesia for hip and lower limb surgery.

Techno-environmental and economic assessment of color removal strategies from textile wastewater.

The textile industry is one of the most chemical-intensive processes, resulting in the unquestionable pollution of more than a quarter of the planet's water bodies. The high recalcitrant properties of some these pollutants resulted on the development of treatment technologies looking at the larger removal efficiencies, due to conventional systems are not able to completely remove them in their effluents. However, safeguarding the environment also implies taking into account indirect pollution from the use of chemicals and energy during treatment. On the other hand, the emerged technologies need to be economically attractive for investors and treatment managers. Therefore, the costs should be kept under control. For this reason, the present study focuses on a comparative Life Cycle Assessment and Life Cycle Costing of four scale-up scenarios aiming at mono and di-azo reactive dyes removal from textile wastewater. Two reactors (sequencing batch reactor and two-phase partitioning) were compared for different reaction environments (i.e., single anaerobic and sequential anaerobic-aerobic) and conditions (different pH, organic loading rates and use of polymer). In accordance with the results of each scenario, it was found that the three technical parameters leading to a change in the environmental profiles were the removal efficiency of the dyes, the type of dye eliminated, and the pollutant influent concentration. The limitation of increasing organic loading rates related to the biomass inhibition could be overcame through the use of a novel two-phased partitioning bioreactor. The use of a polymer at this type of system may help restore the technical performance (84.5 %), reducing the toxic effects of effluents and consequently decreasing the environmental impact. In terms of environmental impact, this is resulting into a reduction of the toxic effects of textile effluents in surface and marine waters compared to the homologous anaerobic-aerobic treatment in a sequencing batch reactor. However, the benefits achieved for the nature comes with an economic burden related to the consumption of the polymer. It is expected that the cost of investment of the treatment with the two-phase partitioning bioreactor rises 0.6-8.3 %, depending on market prices, compared to the other analyzed sequential anaerobic-aerobic technologies. On the other side, energy and chemical consumption did not prove to be limiting factors for economic feasibility.