Analgesic efficacy of ultrasound-guided transversus abdominis plane block in patients undergoing open appendicectomy.

BACKGROUND: Transversus abdominis plane (TAP) block is a new regional anaesthetic technique that blocks abdominal neural afferents by introducing local anaesthetic into the neuro-fascial plane between the internal oblique and the transversus abdominis muscles. We evaluated its analgesic efficacy in patients undergoing open appendicectomy in a randomized controlled double-blinded clinical trial. METHODS: Fifty-two adult patients undergoing open appendicectomy were randomized to undergo standard care (n=26) or to undergo a right-sided TAP block with bupivacaine (n=26). In addition, all patients received patient-controlled i.v. morphine analgesia, regular acetaminophen, and non-steroidal anti-inflammatory drug, as required, in the postoperative period. All patients received standard anaesthetic, and after induction of anaesthesia, the TAP group received an ultrasound-guided unilateral TAP block. Each patient was assessed after operation by a blinded investigator at 30 min and 24 h after surgery. RESULTS: Ultrasound-guided TAP block significantly reduced postoperative morphine consumption in the first 24 h [mean (sd) 28 (18) vs 50 (19) mg, P<0.002]. Postoperative visual analogue scale pain scores were also reduced in the TAP block group soon after surgery [median (IQR) 4.5 (3-5.3) vs 8.5 (7.5-10), P<0.001] and at 24 h [5.2 (4-6.2) vs 8 (7-8.5), P<0.001]. There were no complications attributable to the TAP block. CONCLUSIONS: Ultrasound-guided TAP block holds considerable promise as a part of a balanced postoperative analgesic regimen for patients undergoing open appendicectomy.

Modeling variance structure of body shape traits of Lipizzan horses.

Heterogeneity of variance of growth traits over age is a common issue in estimating genetic parameters and is addressed in this study by selecting appropriate variance structure models for additive genetic and environmental variances. Modeling and partitioning those variances connected with analyzing small data sets were demonstrated on Lipizzan horses. The following traits were analyzed: withers height, chest girth, and cannon bone circumference. The measurements were taken at birth, and at approximately 6, 12, 24, and 36 mo of age of 660 Lipizzan horses born in Croatia between 1948 and 2000. The corresponding pedigree file consisted of 1,458 horses. Sex, age of dam, and stud-year-season interaction were considered fixed effects; additive genetic and permanent environment effects were defined as random. Linear adjustments of age at measuring were done within measuring groups. Maternal effects were included only for measurements taken at birth and at 6 mo. Additive genetic variance structures were modeled by using uniform structures or structures based on polynomial random regression. Environmental variance structures were modeled by using one of the following models: unstructured, exponential, Gaussian, or combinations of identity or diagonal with structures based on polynomial random regression. The parameters were estimated by using REML. Comparison and fits of the models were assessed by using Akaike and Bayesian information criteria, and by checking graphically the adequacy of the shape of the overall (phenotypic) and component (additive genetic and environmental) variance functions. The best overall fit was obtained from models with unstructured error variance. Compared with the model with uniform additive genetic variance, models with structures based on random regression only slightly improved overall fit. Exponential and Gaussian models were generally not suitable because they do not accommodate adequately heterogeneity of variance. Using the unstructured error variance model, the heritability estimates ranged from 0.17 to 0.33 for withers height, 0.07 to 0.27 for chest girth, and 0.14 to 0.30 for cannon bone circumference. This study demonstrated the necessity of accounting for heterogeneity of variances and covariances for body shape traits in Lipizzan horses, and possible difficulties in estimating variance and covariance components when applying more complicated structure models on a small data set. The choice of models depends not only on overall fit but also on the fit of genetic and environmental components.

The prevalence of Echinococcus granulosus in stray dogs in Iraq.

The present paper records the prevalence of Echinococcus granulosus in stray dogs of Al-Tamim (northern Iraq), Diala (mid Iraq) and Theqar province (southern Iraq), where many people are infected with hydatid disease. Of 150 dogs examined in three provinces in Iraq, 57 (38%) were infected with E. granulosus. The prevalence of the worm was higher in the dogs of Theqar province (56%) than in those of Al-Tamim (20%) and Diala Provinces (38%). Infections were light (1-200 worms) in eight (14%) of the infected dogs, medium (201-1000 worms) in 14 (24.6%) and high (over 1000 worms) in 35 (61.4%). The mean worm burden was 1844 and the maximum number of worms was 15,182 recorded in a male dog from Theqar province. The reasons for such a high rate of infection in the dogs are discussed.