Investigation into the clinical performance of rectus sheath block in reducing postoperative pain following surgical intervention: A systematic review and meta-analysis of randomised controlled trials.

Background and Aims: Rectus sheath block (RSB) is an effective postoperative pain control technique in abdominal surgical procedures. This systematic review evaluated the efficacy and outcome data of patients undergoing RSB compared to the standard of care in both laparoscopic and open surgical procedures. Methods: This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PROSPERO ID: CRD42022372596). The search was restricted to randomised controlled trials (RCTs) comparing RSB effectiveness on postoperative pain to any standard general anaesthesia technique (control). We systematically explored PubMed, Medline, Central, Scopus and Web of Science for RCTs from inception to September 2023. The primary outcome was the evaluation of pain scores at rest 0-2, 10-12 and 12-24 h postoperatively. The secondary outcome was the analysis of postoperative intravenous (IV) morphine equivalent consumption at 24-h. A risk-of-bias tool for randomised trials (ROB 2.0, Cochrane, Copenhagen, Denmark) assessment and Grades of Recommendation, Assessment, Development and Evaluation (GRADE, Cochrane, Copenhagen, Denmark) analysis was conducted to evaluate the quality of the RCTs. Results: Twenty RCTs involving 708 participants who received RSB intervention and 713 who received alternative analgesic care were included. RSB pain scores were significantly lower than control at 0-2 h (P < 0.001) and 10-12 h (P < 0.001) postoperatively. No significant effect was observed at 24 h (P = 0.11). RSB performance compared to control in 24-h IV morphine equivalency in milligrams was significantly lower (P < 0.001). Conclusion: RSB implementation was associated with reduced postoperative pain scores and decreased opioid consumption in IV morphine equivalency up to 24 h following surgical intervention.

Robotic Anesthesia: A Vision for 2050.

The last 2 decades have brought important developments in anesthetic technology, including robotic anesthesia. Anesthesiologists titrate the administration of pharmacological agents to the patients' physiology and the needs of surgery, using a variety of sophisticated equipment (we use the term "pilots of the human biosphere"). In anesthesia, increased safety seems coupled with increased technology and innovation. This article gives an overview of the technological developments over the past decades, both in terms of pharmacological and mechanical robots, which have laid the groundwork for robotic anesthesia: target-controlled drug infusion systems, closed-loop administration of anesthesia and sedation, mechanical robots for intubation, and the latest development in the world of communication with the arrival of artificial intelligence (AI)-derived chatbots are presented.

Ultrasound Calculation of Fat Volume for Liposuction: A Clinical Software Validation.

BACKGROUND: Fat manipulation procedures such as liposuction contain a degree of subjectivity primarily guided by the surgeon's visual or tactile perception of the underlying fat. Currently, there is no cost-effective, direct method to objectively measure fat depth and volume in real time. OBJECTIVES: Utilizing innovative ultrasound-based software, the authors aimed to validate fat tissue volume and distribution measurements in the preoperative setting. METHODS: Eighteen participants were recruited to evaluate the accuracy of the new software. Recruited participants underwent ultrasound scans within the preoperative markings of the study area before surgery. Ultrasound-estimated fat profiles were generated with the in-house software and compared directly with the intraoperative aspirated fat recorded after gravity separation. RESULTS: Participants' mean age and BMI were 47.6 (11.3) years and 25.6 (2.3) kg/m2, respectively. Evaluation of trial data showed promising results following the use of a Bland Altman agreement analysis. For the 18 patients and 44 volumes estimated, 43 of 44 measurements fell within a confidence interval of 95% when compared with the clinical lipoaspirate (dry) volumes collected postsurgery. The bias was estimated at 9.15 mL with a standard deviation of 17.08 mL and 95% confidence interval between -24.34 mL and 42.63 mL. CONCLUSIONS: Preoperative fat assessment measurements agreed significantly with intraoperative lipoaspirate volumes. The pilot study demonstrates, for the first time, a novel companion tool with the prospect of supporting surgeons in surgical planning, measuring, and executing the transfer of adipose tissues.

Description of a Novel Web-Based Liposuction System to Estimate Fat Volume and Distribution.

BACKGROUND: Preoperative planning for liposuction is vital to ensure safe practice and patient satisfaction. However, current standards of fat assessment before surgery are guided by subjective methods such as visual inspection, skin-pinch tests, and waist circumference measurements. OBJECTIVES: This study aimed to develop an inexpensive software-based tool that utilizes ultrasound (US) imaging and an online platform to accurately simulate regional subcutaneous adipose tissue (SAT) distribution and safe volume estimation for liposuction procedures. METHODS: The authors present a web-based platform with integrated 2-dimensional (2D) and 3-dimensional (3D) simulations of SAT to support liposuction planning and execution. SAT-Map was constructed using multiple sub-applications linked with the python framework programming language (Wilmington, DE). RESULTS: The SAT-Map interface provides an intuitive and fluid means of generating patient-specific models and volumetric data. To further accommodate this, an operational manual was prepared to achieve consistent visualization and examination of estimated SAT content. The system currently supports static 2D heatmap simulation and 3D interactive virtual modelling of the SAT distribution. Supplementary clinical studies are needed to evaluate SAT-Map's clinical performance and practicality. CONCLUSIONS: SAT-Map revolutionizes the concept of preoperative planning for liposuction by developing the first combined web-based software that objectively simulates fat distribution and measures safe liposuction volume. Our software approach presents a cost-efficient, accessible, and user-friendly system offering multiple advantages over current SAT assessment modalities. The immediacy of clinically accurate 3D virtual simulation provides objective support to surgeons towards improving patient conversation, outcomes, and satisfaction in liposuction procedures.