Ultrasound-guided continuous erector spinae plane block for perioperative opioid sparing analgesia in breast cancer surgery: A randomized controlled trial.

Background: Erector spinae plane (ESP) block provides postoperative analgesia in breast surgeries but has limited duration of action that restricts its efficacy to early postoperative period. This study aims to evaluate the analgesic efficacy and opioid sparing effect of ultrasound (US)-guided continuous erector spinae plane (CESP) block in perioperative period in breast cancer surgery. Methods: Fifty ASA I/II patients aged more than 18 years, scheduled for elective breast cancer surgery were randomized to either Group B (Block group) or Group C (Control group). Patients in group B received US-guided CESP block, whereas patients in group C did not receive the block prior to general anesthesia. The primary outcome of this study was to measure total tramadol consumption in 24 h postsurgery. Intraoperative fentanyl consumption, pain scores, postoperative nausea/vomiting, and patient satisfaction score at discharge were also recorded. Results: Total tramadol consumption was 94.6% lower in the block group as compared to the control group (5.4 ± 18.7 mg in CESP block group as compared to 99.7 ± 49.6 mg in control group). Intraoperative fentanyl requirement and pain scores were significantly lower in CESP group. Postoperative incidence of nausea/vomiting was similar, but satisfaction score was significantly better in block group. Conclusion: US-guided CESP block provides effective and prolonged peri operative analgesia and opioid sparing in breast cancer surgeries.

Linguistic compentence in positive and negative subtypes of schizophrenia.

Twenty patients of positive schizophrenia and 20 patients of negative schizophrenia, individually matched for age, sex, place of residence and education were studied to assess their linguistic competence and its relationship with psychopalhology and subsequent course of the disorder over a follow-up period of 6 months. It was observed that positive schizophrenics had significantly higher linguistic competence than negative schizophrenics. Linguistic competence was significantly related not only to the type of symptoms (positive or negative) but also to the severity of these symptoms. High linguistic competence was an indicator of poor prognosis in positive schizophrenia whereas in negative schizophrenia it was indicative of good prognosis.

Neuroleptic malignant syndrome with trifluperidol.

In a case of NMS subsequent to administration of trifluperidol to a young man, the patient responded remarkably quickly to bromocriptine. The authors point out the deficiencies in the diagnostic criteria, which need further refinement for a better understanding of the syndrome.