Comparison of US elastography and chemical shift magnetic resonance imaging in multifidus muscle fatty degeneration.

OBJECTIVE: The purpose of this study was to investigate the feasibility of the use of shear wave elastography (SWE) in comparison to chemical shift encoding (CSE) magnetic resonance imaging (MRI) for the evaluation of multifidus muscle fatty degeneration in patients with chronic low back pain. METHOD: Multifidus muscles were evaluated with the CSE-MRI and SWE examinations in control and patient groups. With the in-phase and out-phase sequences in CSE-MRI, signal intensity index (SII), and signal intensity suppression ratio (SISR) values; with the SWE method, shear wave velocity values were determined. Differences in the mean values of these parameters per level and study group were analyzed by Student's t-test. RESULTS: SWE revealed significantly lower stiffness at the L2-3 level, consistent with the signal index values (SII-SISR) showing increased fatty infiltration on MRI in the patient group. No such relationship was found at the L4-5 level or in control group. CONCLUSIONS: SWE may be a promising method to show muscle fatty infiltration at L2-3 level in patients with chronic low back pain.

OBJETIVO: Investigar la viabilidad del uso de la elastografía de ondas de corte en comparación con la resonancia magnética con codificación de desplazamiento químico (RM-CDQ) para la evaluación de la degeneración grasa del músculo multífido en pacientes con dolor lumbar crónico. MÉTODO: Los músculos multífidos se evaluaron con RM-CDQ y elastografía de ondas de corte en los grupos de control y de pacientes. Se consideraron las secuencias en fase y fuera de fase en RM-CDQ, y los valores del índice de intensidad de señal y del índice de supresión de intensidad de señal; con el método de elastografía de ondas de corte se determinaron los valores de velocidad de onda de corte. Las diferencias en los valores medios de estos parámetros por nivel y por grupo de estudio se analizaron mediante la prueba t de Student. RESULTADOS: La elastografía de ondas de corte reveló una rigidez significativamente menor en el nivel L2-3, consistente con los valores de los índices de señal que muestran una mayor infiltración grasa en la RM en el grupo de pacientes. No se encontró tal relación en el nivel L4-5 ni en el grupo de control. CONCLUSIONES: La elastografía de ondas de corte puede ser un método prometedor para mostrar la infiltración grasa muscular a nivel L2-3 en pacientes con dolor lumbar crónico.

Erector spinae plane block as a rescue therapy in following cholecystectomy: a historical cohort study.

OBJECTIVE: The aim of this study is to evaluate the effect of erector spinae plane block (ESPB) as a rescue therapy in the recovery room. MATERIALS AND METHODS: This single-center historical cohort study included patients who received either ESPB or intravenous meperidine for pain management in the recovery room. Patients' numeric rating scale (NRS) scores and opoid consumptions were evaluated. RESULTS: One hundred and eight patients were included in the statistical analysis. Sixty-two (57%) patients received ESPB postoperatively (pESPB) and 46 (43%) patients were managed with IV meperidine boluses only (IV). The cumulative meperidine doses administered were 0 (0-40) and 30 (10-80) mg for the pESPB and IV groups, respectively (p < 0.001). NRS scores of group pESPB were significantly lower than those of Group IV on T30 and T60. CONCLUSION: ESPB reduces the frequency of opioid administration and the amount of opioids administered in the early post-operative period. When post-operative rescue therapy is required, it should be considered before opioids.

OBJETIVO: Evaluar el efecto del bloqueo del plano erector espinal (ESPB) como terapia de rescate en la sala de recuperación. MÉTODO: Este estudio de cohortes histórico de un solo centro incluyó a pacientes que recibieron ESPB o meperidina intravenosa para el tratamiento del dolor en la sala de recuperación. Se evaluaron las puntuaciones de la escala de calificación numérica (NRS) de los pacientes y los consumos de opiáceos. RESULTADOS: En el análisis estadístico se incluyeron 108 pacientes. Recibieron ESPB 62 (57%) pacientes y los otros 46 (43%) fueron manejados solo con bolos de meperidina intravenosa. Las dosis acumuladas de meperidina administradas fueron 0 (0-40) y 30 (10-80) mg para los grupos de ESPB y de meperidina sola, respectivamente (p < 0.001). Las puntuaciones de dolor del grupo ESPB fueron significativamente más bajas que las del grupo de meperidina sola en T30 y T60. CONCLUSIONES: El ESPB reduce la frecuencia de administración de opiáceos y la cantidad de estos administrada en el posoperatorio temprano. Cuando se requiera terapia de rescate posoperatoria, se debe considerar antes que los opiáceos.

Lumbar multifidus layers stiffness at L5-S1 level in prone and sitting posture measured by shear wave elastography.

BACKGROUND: Multifidus is an important lumbar muscle with distinct superficial and deep fibers responsible for torque production and stabilization, respectively. Its mechanical properties change when transitioning from lying to sitting positions, necessitating enhanced stability. It holds crucial clinical relevance to assess these layers separately, especially in the sitting posture, which demands increased neuromuscular control compared to the prone position. OBJECTIVE: To compare lumbar multifidus stiffness in lying versus sitting postures, analyzing both superficial and deep layers. METHODS: Supersonic Shear Imaging captured elastographic images from 26 asymptomatic volunteers in prone and seated positions. RESULTS: Left multifidus shear modulus in lying: 5.98 ± 1.80/7.96 ± 1.59 kPa (deep/superficial) and sitting: 12.58 ± 4.22/16.04 ± 6.65 kPa. Right side lying: 6.08 ± 1.97/7.80 ± 1.76 kPa and sitting: 13.25 ± 4.61/17.95 ± 7.12 kPa. No side differences (lying p= 0.99, sitting p= 0.43). However, significant inter-postural differences occurred. CONCLUSION: Lumbar multifidus exhibits increased stiffness in sitting, both layers affected, with superior stiffness in superficial versus deep fibers. Applying these findings could enhance assessing multifidus stiffness changes, for classifying tension-induced low back pain stages.

A novel comparison of erector spinae plane block and paravertebral block in laparoscopic cholecystectomy.

OBJECTIVE: Erector spinae plane block is an updated method than paravertebral block, possessing a lower risk of complications. This study aimed to compare erector spinae plane and paravertebral blocks to safely reach the most efficacious analgesia procedure in laparoscopic cholecystectomy cases. METHODS: The study included 90 cases, aged 18-70 years, classified as American Society of Anesthesiologists I-II, who underwent an laparoscopic cholecystectomy procedure. They were randomly separated into three groups, namely, Control, erector spinae plane, and paravertebral block. No block procedure was applied to Control, and a patient-controlled analgesia device was prepared containing tramadol at a 10 mg bolus dose and a 10-min locked period. The pain scores were recorded with a visual analog scale for 24 h postoperatively. RESULTS: The visual analog scale values at 1, 5, 10, 20, and 60 min at rest and 60 min coughing were found to be significantly higher in Control than in paravertebral block. A significant difference was revealed between Control vs. paravertebral block and paravertebral block vs. erector spinae plane in terms of total tramadol consumption (p=0.006). Total tramadol consumption in the first postoperative 24 h was significantly reduced in the paravertebral block compared with the Control and erector spinae plane groups. CONCLUSION: Sonography-guided-paravertebral block provides sufficient postoperative analgesia in laparoscopic cholecystectomy surgery. Erector spinae plane seems to attenuate total tramadol consumption.

Study on Analgesic Effects of Combined Thoracic Paravertebral Block Anesthesia or Erector Spinae Plane Block with Ultrasound Guided Transversus Abdominis Plane Block in Endoscopic Esophagectomy: A Clinical Anatomical Approach / Estudio sobre los Efectos Analgésicos de la Anestesia Combinada con Bloqueo Paravertebral Torácico o el Bloqueo del Plano del Erector de la Columna con Bloqueo del Plano Transverso del Abdomen Guiado por Ultrasonido en la Esofagectomía Endoscópica: Un Enfoque Anatómico Clínico

SUMMARY: The application effect of transversus abdominis plane block (TAPB) combined with thoracic paravertebral block (TPVB) or erector spinae plane block (ESP) under ultrasound guidance in endoscopic radical resection of esophageal cancer under general anesthesia was studied. From March 2021 to February 2022, patients who underwent endoscopic radical resection of esophageal cancer in our hospital were selected as the research object, and 90 patients were selected as the samples. Patients were divided into groupA and group B according to the difference of blocking schemes. Group A received ESP and Group B received TPVB. The dosage of sufentanil, nerve block time, awakening time and extubation time of the two groups were counted. The postoperative pain, sedation effect, sleep satisfaction and analgesia satisfaction of the two groups were compared, and the complications of the two groups were observed. The nerve block time and extubation time in group A were shorter than those in group B (P0.05). At T2, T3 and T4, the visual analogue scale (VAS) scores of group A at rest and cough were significantly lower than those of group B (P0.05). The satisfaction of sleep and analgesia in group A was higher than that in group B (P0.05). The analgesic effect of ultrasound-guided TAPB combined with ESP is better than that of ultrasound-guided TAPB combined with TPVB, and it can shorten the time of nerve block and extubation, which is worth popularizing.

Se estudió el efecto de la aplicación del bloqueo del plano transverso del abdomen (TAPB) combinado con el bloqueo paravertebral torácico (TPVB) o el bloqueo del plano del erector de la columna (ESP) bajo guía ecográfica en la resección radical endoscópica del cáncer de esófago bajo anestesia general. Desde marzo de 2021 hasta febrero de 2022, en nuestro hospital, se seleccionaron como objeto de investigación pacientes sometidos a resección radical endoscópica de cáncer de esófago, y como muestra se seleccionaron 90 pacientes. Los pacientes se dividieron en el grupo A y el grupo B según la diferencia de esquemas de bloqueo. El grupo A recibió ESP y el grupo B recibió TPVB. Se contaron la dosis de sufentanilo, el tiempo de bloqueo nervioso, el tiempo de despertar y el tiempo de extubación de los dos grupos. Se compararon el dolor posoperatorio, el efecto de la sedación, la satisfacción del sueño y la satisfacción de la analgesia de los dos grupos y se observaron las complicaciones de los dos grupos. El tiempo de bloqueo nervioso y el tiempo de extubación en el grupo A fueron más cortos que los del grupo B (P0,05). En T2, T3 y T4, las puntuaciones de la escala visual analógica (EVA) del grupo A en repo- so y tos fueron significativamente más bajas que las del grupo B (P 0,05). La satisfacción del sueño y la analgesia en el grupo A fue mayor que en el grupo B (P0,05). El efecto analgésico de la TAPB guiada por ecografía combinada con ESP es mejor que el de la TAPB guiada por ecografía combinada con TPVB, y puede acortar el tiempo de bloqueo nervioso y extubación, lo que vale la pena popularizar.

Piomiositis multifocal por Staphylococcus aureus: a propósito de un caso pediátrico / Multifocal pyomyositis due to Staphylococcus aureus: a clinical case study / Piomiosite multifocal por Staphylococcus aureus: relato de caso

Introducción: la piomiositis (PMS) es una infección bacteriana aguda o subaguda del músculo esquelético. Entidad rara en pediatría, suele acompañarse de la formación de abscesos. Se presenta más frecuentemente en preescolares de sexo masculino, afectando mayoritariamente a extremidades y región pélvica. La manifestación multifocal es frecuente. El principal agente etiológico es Staphylococcus aureus. Caso clínico: 3 años, sexo masculino, sano. Consulta por fiebre continua de hasta 39 ºC de seis días de evolución, dolor de ambos miembros inferiores a predominio izquierdo, cojera y repercusión general. Examen físico: tumoración en muslo izquierdo de límites difusos de 13 x 5 cm, lisa, firme, impresiona adherida a planos musculares, dolorosa. Sin elementos fluxivos en la piel. Ecografía de partes blandas: aumento de tejidos blandos de la extremidad. Resonancia magnética (RM): abscesos que comprometen logia de los aductores del miembro izquierdo, el vasto externo del muslo derecho, musculatura paravertebral lumbar izquierda y cérvico-torácica izquierda. Tratamiento: drenaje, requiere de múltiples limpiezas quirúrgicas y antibioticoterapia prolongada. Cultivo de la lesión: Staphylococcus aureus meticilino resistente (SAMR). Buena evolución clínica e imagenológica. Discusión: la PMS ha presentado una incidencia creciente con la aparición del SAMR. La ecografía es un método adecuado para realizar diagnóstico local. La experiencia en la interpretación de la RM permite pesquisar el compromiso multifocal, identificando focos sin traducción clínica. La antibioticoterapia y el drenaje quirúrgico son los pilares del tratamiento. El pronóstico es bueno en la mayoría de los casos.

Introduction: pyomyositis (PMS) is an acute or subacute bacterial infection of the skeletal muscle. It is a rare infection in pediatrics, and it is usually accompanied by abscess formation. It occurs more frequently in male preschoolers, mostly affecting the extremities and pelvic region. The multifocal manifestation is frequent. The main etiological agent is Staphylococcus aureus. Clinical case: 3 year-old, male, healthy patient. He consulted for continuous fever of up to 39ºC of 6 days of evolution, pain in both lower limbs predominantly on the left, lameness and general repercussions. Physical examination: a 13 x 5 cm tumor in the left thigh with diffuse limits, smooth, firm, adhered to muscle layers, painful. Without fluxive elements on the skin. Soft tissue ultrasound: enlargement of the soft tissues of the extremity. Magnetic resonance imaging (MRI): abscesses involving the adductor lodge of the left limb, the vastus lateralis of the right thigh, left lumbar paravertebral musculature and left cervical-thoracic musculature. Treatment: drainage, requires multiple surgical cleanings and prolonged antibiotic therapy. Culture of the lesion: methicillin-resistant Staphylococcus Aureus (MRSA). Good clinical and imaging evolution. Discussion: PMS has had an increasing incidence with the appearance of MRSA. Ultrasound is a suitable method for local diagnosis. Experience in the interpretation of MRI has enabled us to research multifocal involvement, identifying unobserved foci during clinical check-up. Antibiotic therapy and surgical drainage are the main treatments. The prognosis is good in most cases.

Introdução: Ia Piomiosite (TPM) é uma infecção bacteriana aguda ou subaguda do músculo esquelético. É uma entidade rara em pediatria, costuma vir acompanhada de formação de abscessos. Ocorre com maior frequência em pré-escolares do sexo masculino, afetando principalmente as extremidades e a região pélvica. A manifestação multifocal é comum. O principal agente etiológico é o Staphylococcus aureus. Caso clínico: paciente 3 anos, sexo masculino, hígido. Consulta por febre contínua de até 39ºC há 6 dias, dor em ambos os membros inferiores predominantemente esquerdo, claudicação e repercussão geral. Exame físico: tumor na coxa esquerda com limites difusos de 13 x 5 cm, liso, firme, aparentemente aderido aos planos musculares, doloroso. Sem elementos fluidos na pele. Ultrassonografia de tecidos moles: aumento dos tecidos moles da extremidade. Ressonância magnética (RM): abscessos envolvendo o alojamento adutor do membro esquerdo, vasto lateral da coxa direita, músculos paravertebrais lombares esquerdos e cérvico-torácicos esquerdos. Tratamento: drenagem, requer múltiplas limpezas cirúrgicas e antibioticoterapia prolongada. Cultura da lesão: Staphylococcus aureus resistente à meticilina (MRSA). Boa evolução clínica e imagiológica. Discussão: a TPM tem tido uma incidência crescente com o aparecimento do MRSA. A ultrassonografia é um método adequado para diagnóstico local. A experiência na interpretação de ressonância magnética permite-nos investigar o envolvimento multifocal, identificando focos sem tradução clínica. A antibioticoterapia e a drenagem cirúrgica são os pilares do tratamento. O prognóstico é bom na maioria dos casos.

Effect of ultimate pH on quality of aged Longissimus dorsi muscle of Zebu Nellore (Bos indicus) during long-term frozen storage.

Despite the relatively high occurrence of bovine meat with intermediate to high ultimate pH (pHu), there is a lack of studies focused on the effects of long-term conventional air-blasting freezing storage on quality parameters of commercial beefs of Zebu Nellore (Bos indicus) with varying pHu ranges. The objective of this work was to evaluate the influence of pHu ranges [normal (≤5.79), intermediate (5.80 to 6.19), and high (≥6.20)] and long-term frozen storage on quality parameters of aged Longissimus dorsi beefs of Zebu Nellore (Bos indicus). The aging conditions were set at 2 °C for 14 days, while the freezing conditions were set at - 20 °C, and samples were collected after 3, 6, 9, and 12 months of storage. The results indicated that the pHu influenced meat quality parameters, as well as the chemical forms of myoglobin, which changed throughout the frozen storage, leading to a brighter red color, especially for the normal pHu beef samples, likely due to increased oxymyoglobin content. Frozen storage improved tenderness, with high pHu beef samples being the more tender after 12 months, potentially due to lower protein oxidation, as measured by the carbonyl content. Increased drip loss was observed over freezing time, with a concomitant decrease in protein solubility, especially for myofibrillar and sarcoplasmic proteins, which differed among the pHu ranges. These findings are valuable for determining freezing time as a preservation strategy to maintain beef quality within different pHu ranges.

Evaluation of different percentages of Duroc genes and gender on growth, carcass and meat quality traits for pigs.

The effect of different percentages of Duroc genes in crossbreeding (5, 50 and 100%), the gender (immunocastrated males - ICM and females) and their interaction was evaluated on growth, carcass and meat quality traits for pigs. Crossbreds (50% Duroc) had greater average daily feed intake, hot carcass weight and backfat thickness but lower meat yield when compared to 5% Duroc crossbreds and purebred (100% Duroc) animals (P < 0.05). Purebred (100% Duroc) animals had the lowest backfat thickness and subcutaneous fat thickness, and the greatest muscle depth and meat yield (P < 0.05). ICM animals had better feed conversion, greater average daily gain, hot carcass weight and amount of meat, and lower hot carcass yield, cold carcass weight, Longissimus thoracis depth, rib with belly and ham weights compared to females (P < 0.05). Marbling scores were greater in purebred (100%) animals (P < 0.05). The meat from 50% Duroc crossbreds and 100% Duroc purebred pigs was more reddish pink in color than 5% Duroc crossbreds (P < 0.05). Also, marbling scores were greater for females compared to ICM (P < 0.05). Purebred (100% Duroc) animals required more medications during production (P < 0.05).

Impact of a passive upper-body exoskeleton on muscle activity, heart rate and discomfort during a carrying task.

OBJECTIVE: The goal of this study was to compare erector spinae muscle fatigue, upper limb muscle activity, body areas discomfort, and heart rate during a 10-min carrying task with and without a passive upper-body exoskeleton (CarrySuitⓇ) while considering sex influences. BACKGROUND: Passive exoskeletons are commercially available to assist lifting or carrying task. However, evidence of their impact on muscle activity, fatigue, heart rate and discomfort are scarce and/or do not concur during carrying tasks. METHOD: Thirty participants (16 females and 14 male) performed a 10-min, 15kg load-carrying task with and without the exoskeleton in two non-consecutive days. Heart rate, and erector spinae, deltoid, biceps and brachioradialis muscle activity were recorded during the carrying tasks. In addition, erector spinae electromyography during an isometric hold test and discomfort ratings were measured before and after the task. RESULTS: While without the exoskeleton upper limb muscle activity increased or remained constant during the carrying task and showing high peak activation for both males and females, a significant activity reduction was observed with the exoskeleton. Low back peak activation, heart rate and discomfort were lower with than without the exoskeleton. In males muscle activation was significantly asymmetric without the exoskeleton and more symmetric with the exoskeleton. CONCLUSION: The tested passive exoskeleton appears to alleviate the physical workload and impact of carrying heavy loads on the upper limbs and lower back for both males and females.

Utilidad de la medición de los músculos psoas y paraespinales mediante tomografía computarizada y resonancia magnética / Usefulness of the measurement of the psoas and paraspinal muscles by computed tomography and magnetic resonance

Introducción: La sarcopenia está revistiendo importancia en el estudio de diferentes enfermedades para predecir la morbimortalidad en el perioperatorio. Los objetivos de este estudio fueron evaluar la eficacia de la tomografía y la resonancia en la medición de la musculatura del psoas y los paraespinales, y comparar estos índices con la edad, el sexo y la enfermedad. materiales y métodos: Se utilizaron las tomografías computarizadas y las resonancias magnéticas de pacientes ambulatorios. La medición de los músculos se realizó en los pedículos de L3 y L4. Resultados: El estudio incluyó 18 tomografías y 34 resonancias. El rango de edad de los pacientes era de 15 a 80 años, divididos en grupos etarios. En los promedios globales, en ambos estudios, el sexo masculino estaba por encima del promedio global. Con respecto a los rangos etarios, se observó que el primer grupo (15-29 años) tenía un mayor volumen muscular y de unidades Hounsfield en el psoas comparado con el grupo >60 años. Los pacientes que consultaron por espondilolistesis tenían menos masa muscular que aquellos con discopatías. Conclusiones: No existe diferencia entre la resonancia magnética y la tomografía computarizada en cuanto a la medición de los músculos paraespinales y psoas. Queda en evidencia que la disminución del volumen muscular es común en pacientes de mayor edad y con enfermedades que afectan el balance espinal. Nivel de Evidencia: IV

background: Sarcopenia is becoming increasingly significant in the research of various diseases to predict morbidity and mortal-ity in the perioperative period. Objectives: The objectives of this study were to evaluate the efficacy of computed tomography and magnetic resonance imaging in measuring the psoas and paraspinal muscles and to compare these indexes with age, sex, and pathology. materials and methods: Computed tomography and magnetic resonance imaging of outpatients were used. Muscle measurements were taken at the L3 and L4 pedicles. Results: The study included 18 CT and 34 MRI scans. The patients were divided into groups based on their age range, which was 15 to 80 years. In the overall averages, males were above the global average in both studies. Regarding age ranges, it was observed that the first group (15-29 years) had a higher muscle volume and Hounsfield units in the psoas compared to the >60 age group. Patients consulting for spondylolisthesis had less muscle mass than those with discopathy. Conclusions: There is no difference between magnetic resonance imaging and computed tomography in measuring the paraspinal and psoas muscles. It is evident that the decrease in muscle volume is common in older patients and those with diseases that affect spinal balance. Level of Evidence: IV

Fenolización del plano erector espinal en el manejo de dolor por cáncer. Reporte de casos / Erector spinal plane phenol injection in cancer pain management

Cáncer pain is a frecuent symptom in patients with primary or metastastic neoplasm and is a clinical challenge due to the difficulty in achieving adequate control despite múltiple strategies, generating suffering and great impact on the quality of life. When there is a tumoral iinvasion to the thoracic wall, it generates Progressive respiratory symptoms and severe pain that require multidisciplinary management, multimodal analgesic pharmacological management with different strategies, such as no opioids, strong opioids and opiooids rotation through different routes of administration, adjuvant analgesics, and added to these, the use of interventional options to achieve a good response. In most cases the patients have an advanced disease and a objective of palliative management then, the control of the symptoms and the quality of life are the priority. We report 2 cases of chest wall pain due to cancer refractory to pharmacological management that were managed with the use of phenol neurolysis of the spinal erector plane, achieving an adequate response.

El dolor por cáncer es una manifestación frecuente en los pacientes con tumores primarios o metastásicos y un reto para los clínicos por la dificultad para lograr un control adecuado a pesar de múltiples estrategias, lo que genera gran impacto en la calidad de vida y sufrimiento. Cuando se presenta invasión tumoral de la pared torácica se generan síntomas respiratorios progresivos y dolor severo que requiere un manejo multidisciplinario, manejo farmacológico analgésico multimodal con diferentes estrategias como uso de no opioides, opioides potentes y rotación de opioides a través de diferentes vías de administración, analgésicos adyuvantes, y sumado a estos, el uso de opciones interventivas para alcanzar una adecuada respuesta. En muchos casos los paciente se presentan con enfermedades en estadios avanzados y en plan de manejo paliativo; así, el control de síntomas y la calidad de vida son los objetivos mas importantes. Reportamos 2 casos de dolor de pared torácica por cáncer refractario a manejo farmacológico que fueron manejados con el uso de neurolisis con fenol del plano erector espinal alcanzando adecuada respuesta.

Comparison of ultrasound-guided thoracic erector spinae plane block versus paravertebral block for analgesia after pediatric cardiac surgery / Analgesia en cirugía cardíaca pediátrica: Comparación entre bloqueo erector espina y bloqueo paravertebral

BACKGROUND: In pediatric cardiac surgery, the use of multimodal analgesia, including a regional analgesic technique reduces opioid consumption and adverse effects. OBJECTIVE: This study aimed to compare the effect of the ultrasound-guided bilateral thoracic erector spinae plane block (ESPB) and paravertebral block (PVB) on postoperative pain score and opioid consumption. METHODS: This is a single center randomized, controlled, double-blinded, non-inferiority study. A total of 50 eligible pediatric patients, aged 2-10 years, scheduled for elective open cardiac surgery via median sternotomy were recruited. Bilateral ultrasound-guided thoracic ESPB at T4 was performed in patients included in the ESPB group and bilateral PVB was done in patients included in the PVB group by injecting 0.25% bupivacaine 0.4mL/kg on each side. The primary end point was fentanyl consumption during the first 24 h following extubation, while the secondary endpoints were postoperative modified objective pain score (MOPS), time needed to perform the block, intraoperative fentanyl consumption, time to the first analgesic request and the incidence of mechanical complications. RESULTS: Both ESPB and PVB similarly reduced fentanyl consumption during the first 24 h following extubation and MOPS at all time points of measurement. Intraoperative fentanyl consumption and time to first analgesic request were similar in both ESPB and PVB group. The time needed to perform the block was significantly shorter in the ESPB group than the PVB group. Mechanical complications of needle advancement did not occur in any patients. CONCLUSION: In pediatric patients scheduled for open cardiac surgery via median sternotomy, ultrasound-guided bilateral thoracic ESPB is non-inferior to PVB in providing postoperative analgesia in terms of opioid consumption and pain score. Moreover, ESPB is easier and its performance requires a shorter period than PVB.

ANTECEDENTES: En cirugía cardíaca pediátrica, el uso de analgesia multimodal, incluida una técnica analgésica regional, reduce el consumo de opioides y los efectos adversos. OBJETIVO: Este estudio tuvo como objetivo comparar el efecto del bloqueo bilateral del plano del erector de la columna torácica (ESPB) guiado por ecografía y el bloqueo paravertebral (PVB) sobre la puntuación del dolor posoperatorio y el consumo de opiáceos. MÉTODOS: Este es un estudio de no inferioridad, aleatorizado, controlado, doble ciego, en un solo centro. Se reclutó un total de 50 pacientes pediátricos entre 2 a 10 años, programados para cirugía cardíaca abierta electiva mediante esternotomía media. A los pacientes incluidos en el grupo BES se les realizó EL bloqueo bilateral guiado por ecografía en T4 y a los pacientes incluidos en el grupo BPV se les realizó bilateral mediante la inyección de bupivacaína al 0,25% 0,4 ml/kg en cada lado. El objetivo principal fue el consumo de fentanilo durante las primeras 24 h después de la extubación, mientras que los objetivos secundarios fueron el puntaje de dolor objetivo modificado (MOPS) posoperatorio, el tiempo necesario para realizar el bloqueo, el consumo de fentanilo intraoperatorio, el tiempo hasta la primera solicitud de analgésico y la incidencia de dolor mecánico. complicaciones

Influence of Chronic Lameness on Thoracolumbar Musculus Multifidus Structure in the Horse.

The clinical relationship between equine limb lameness and secondary back dysfunction is largely unknown. Proper function of the spine is critical to maintain the integrity of the kinetic chain and attenuate forces from the appendicular skeleton. The musculus multifidus (m. multifidus) is the primary muscle providing spinal intersegmental stabilization and a functional relationship between m. multifidus hypertrophy and equine postural stability has been established. The relationship between equine thoracolumbar m. multifidus cross-sectional area (CSA) and limb lameness is unknown. The objective was to evaluate ultrasonographic changes in thoracolumbar m. multifidus CSA in horses with chronic single limb lameness, compared with sound horses. We hypothesized that the CSA of m. multifidus, ipsilateral to the lame limb would be smaller than the contralateral side, and within the sound group there would be no difference between sides. Thirty-six horses were enrolled, with twelve horses per group: sound, forelimb lame, and hindlimb lame. M. multifidus CSA was measured ultrasonographically at multiple spinal levels and compared between groups, spinal levels, and sides. M. multifidus CSA at the spinal level T18 was significantly larger than at all other measured levels, regardless of group (P ≤ .05). CSA at all levels was significantly larger in sound horses than the forelimb lame group, regardless of side (P = .002). This is the first study to evaluate the impact of chronic lameness on the axial skeleton and showed a decrease in m. multifidus CSA with forelimb lameness. These results support that axial skeletal adaptation occurs in response to naturally occurring chronic lameness.

Erector spinae plane blockade in the first stage of labour: a case series.

INTRODUCTION: The objective of this case series was to present the importance of labour analgesia and the preference for erector spinae plane (ESP) block as a new technique that can be used for labour analgesia. CASE REPORTS: The three patients were 25-year-old primipara with 5-cm cervical dilation, a 30-year-old multiparous with 5-cm cervical dilatation, and a 32-year-old primipara with 4-cm cervical dilation. CONCLUSIONS: Bilateral ESP block may be an alternative analgesic technique for the first stage of labour.

Effects of erector spinae plane block and retrolaminar block on analgesia for multiple rib fractures: a randomized, double-blinded clinical trial.

OBJECTIVE: To investigate the effects of Erector Spinae Plane Block (ESPB) and Retrolaminar Block (RLB) on intra- and postoperative analgesia in patients with Multiple Rib Fractures (MRFs). METHODS: A total of 80 MRFs patients were randomly divided into the ESPB (Group E) and RLB (Group R) groups. After general anesthesia, ESPB and RLB were performed under ultrasound guidance, respectively, together with 20 mL of 0.5% ropivacaine and Patient-Controlled Intravenous Analgesia (PCIA). RESULTS: Thirty-four cases in Group E and 33,cases in Group R showed unclear paravertebral spaces. The intraoperative dosage of remifentanil (mean ± SD) (392.8 ± 118.7 vs. 501.7 ± 190.0 µg) and postoperative morphine PCIA dosage, (7.35 ± 1.55 vs. 14.73 ± 2.18 mg) in Group R were significantly less than those in Group E; the Visual Analog Scale (VAS) scores in Group R at 2 (2.7 ± 1.2 vs. 3.4 ± 1.4), 4 (2.2 ± 1.1 vs. 2.8 ± 0.9), 12 (2.5 ± 0.9 vs. 3.0 ± 0.8), and 24 hours (2.6 ± 1.0 vs. 3.1 ± 0.9) after surgery were significantly lower than those in Group E. Finally, the normal respiratory diaphragm activity (2.17 ± 0.22 vs. 2.05 ± 0.19), pH (median [IQR] (7.38 [7.31-7.45] vs. 7.36 [7.30-7.42]), and partial pressure of carbon dioxide (PaCO2) (44 [35-49] vs. 42.5 [30-46]) after the operation in Group R were significantly better than those in Group E (p < 0.05). CONCLUSIONS: RLB was a more effective analgesic method than ESPB in the treatment of MRF.