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Local anesthesia with sedoanalgesia and general anesthesia are widely used in percutaneous kyphoplasty (PKP) for vertebral compression fractures (VCF). The aim of this study was to compare erector spinae block (ESP) with conventional local infiltration anesthesia (CLIA) and extrapedicular infiltration anesthesia (EPIA) with respect to analgesic efficacy in patients who underwent elective PKP for VCF.&#xa0; Methods: A total of 90 American Society of Anesthesiologists (ASA) 1-3 patients were randomly assigned into 3 groups: group CLIA (n = 30), group EPIA (n = 30), and group ESP (n = 30). The same amount of local anesthetic mixture (6 mL lidocaine 1% and 14 mL bupivacaine 0.5%) was used for regional anesthetic techniques in all groups. Fentanyl 0.1 &#x3bc;g/kg and midazolam 0.1 mg/kg were administered intravenously (IV) before prone positioning. Pain was evaluated using the visual analog scale (VAS) and sedation level using the Ramsay Sedation Scale (RSS) during the procedure. Primary outcome measure were VAS and RSS scores. Secondary outcome measures were hemodynamic changes and additional analgesic and sedative consumptions.&#xa0; Results: Mean baseline VAS scores were similar between groups (5.62 &#xb1; .39; P > .05). Intraoperative mean VAS scores were significantly higher in group CLIA compared to EPIA and ESP groups at all timepoints (P < .01). Time-bound changes in VAS scores showed a progressive decrease from baseline until the end of the procedure in EPIA (5.60 &#xb1; 1.38 to 1.10 &#xb1; 0.85; P < .01) and ESP groups (5.30 &#xb1; 1.44 to 1.17 &#xb1; 0.95; P < .01), while an increase was detected from baseline to the 20th minute in group CLIA (5.97 &#xb1; 1.35 to 7.07 &#xb1; 0.94; P < .01) that followed a decrease until the end of the procedure (3.47 &#xb1; 0.86; P < .01). The mean RSS scores were similar at baseline and at the end of the procedure in all groups (P > .01), but significantly lower in group CLIA compared to EPIA and ESP groups at the other timepoints (P < .001). Time-bound changes in RSS scores showed a progressive increase from baseline until the 20th minute of the procedure that followed a decrease until the end of the procedure in EPIA (5.60 &#xb1; 1.38 to 1.10 &#xb1; 0.85; P < .01) and ESP groups (5.30 &#xb1; 1.44 to 1.17 &#xb1; 0.95; P < .01).&#xa0; Conclusion: Better anesthetic advantages of ESP and EPIA over CLIA concerning intra-operative analgesia, analgesic and sedative consumption were demonstrated. ESP and EPIA can be used as a suitable anesthetic method in VCF patients undergoing single-level PKP, with stable hemodynamic parameters and analgesia in the intra-operative period.&#xa0; &#xa0; Cite this article as: E&#x15f;kin MB, &#xd6;zhan M&#xd6;, &#x15e;im&#x15f;ek F, Eksert S, Ceylan A, Ba&#x15f;ak AM. Anesthesia for vertebral compression fractures treated with percutaneous kyphoplasty: comparison of erector spinae plane block, extrapedicular infiltration anesthesia, and conventional local infiltration anesthesia. Acta Orthop Traumatol Turc., 2026; 60(1), 0549, doi: 10.5152/j.aott.2026.25549.

The 2023 iteration of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) estimated prevalence, incidence, and health burden for 375 diseases and injuries, including 12 mental disorders. We assess past, current, and emerging trends in the prevalence and burden of mental disorders across sexes and age groups, for 21 regions, 204 countries and territories, and by Socio-demographic Index (SDI) quintile, from 1990 to 2023. Mental disorders included in GBD 2023 were anxiety disorders, major depressive disorder, dysthymia, bipolar disorder, schizophrenia, autism spectrum disorders, conduct disorder, attention-deficit hyperactivity disorder, anorexia nervosa, bulimia nervosa, idiopathic developmental intellectual disability, and a residual category of other mental disorders. A literature review identified epidemiological data for each disorder. These were analysed via a Bayesian meta-regression to estimate prevalence by disorder, sex, age, location, and year. Disorder-specific prevalence was multiplied by disability weights representing the severity of health loss associated with each disorder to estimate years lived with disability (YLDs). Deaths due to anorexia nervosa were assessed with a Cause of Death Ensemble modelling strategy to estimate deaths by sex, age, location, and year, and then multiplied by the standard life expectancy at age of death to estimate years of life lost (YLLs). YLDs equalled disability-adjusted life-years (DALYs) for all mental disorders except anorexia nervosa (the only mental disorder considered as an underlying cause of death in GBD), for which DALYs represented the sum of YLDs and YLLs. We presented prevalence, deaths, YLDs, YLLs, and DALYs as counts, age-specific rates per 100&#x2008;000 population, and age-standardised rates per 100&#x2008;000 population. We estimated 1&#xb7;17 billion (95% uncertainty interval 1&#xb7;06-1&#xb7;31) prevalent cases of mental disorders globally in 2023, equivalent to an age-standardised prevalence rate of 14&#x2008;210&#xb7;7 cases (12&#x2008;849&#xb7;5-15&#x2008;940&#xb7;1) per 100&#x2008;000 population. These estimates represented a 95&#xb7;5% (75&#xb7;0-121&#xb7;2) increase in prevalent cases and 24&#xb7;2% (11&#xb7;4-41&#xb7;4) increase in age-standardised prevalence rate between 1990 and 2023. All mental disorders showed increases in prevalent cases between 1990 and 2023, while notable increases were seen in age-standardised prevalence rates for anxiety disorders, major depressive disorder, dysthymia, anorexia nervosa, bulimia nervosa, schizophrenia, and conduct disorder. There were an estimated 171 million (127-228) DALYs due to mental disorders globally across sex and age in 2023, equivalent to an age-standardised DALY rate of 2070&#xb7;5 DALYs (1519&#xb7;1-2750&#xb7;5) per 100&#x2008;000 population. Mental disorders contributed to 6&#xb7;1% (4&#xb7;8-7&#xb7;6) of all-cause DALYs in 2023, making them the fifth leading cause of global DALYs (up from 12th in 1990). DALYs were almost entirely composed of YLDs. Mental disorders were the leading cause of YLDs in 2023 (up from second in 1990), explaining 17&#xb7;3% (14&#xb7;8-20&#xb7;6) of all-cause global YLDs. Leading causes of mental disorder DALYs were anxiety disorders (ranked 11th among the 304 diseases and injuries at Level 4 of the GBD cause hierarchy), major depressive disorder (15th), and schizophrenia (41st). Globally in 2023, mental disorder age-standardised DALY rates were higher among females (2239&#xb7;6 [1643&#xb7;7-3014&#xb7;1] per 100&#x2008;000) than among males (1900&#xb7;2 [1399&#xb7;8-2510&#xb7;8] per 100&#x2008;000), and peaked in the 15-19 years age group (2617&#xb7;3 [1850&#xb7;6-3696&#xb7;8] per 100&#x2008;000). All locations showed increased mental disorder DALY rates in 2023 compared with 1990, ranging across countries and territories from 1302&#xb7;4 (952&#xb7;7-1683&#xb7;7) per 100&#x2008;000 in Viet Nam to 3555&#xb7;8 (2661&#xb7;9-4715&#xb7;0) per 100&#x2008;000 in the Netherlands. Across SDI quintiles, DALY rates ranged from 1853&#xb7;0 (1352&#xb7;1-2469&#xb7;3) per 100&#x2008;000 for middle SDI to 2184&#xb7;1 (1606&#xb7;1-2890&#xb7;3) per 100&#x2008;000 for high SDI. A significant health burden was imposed by mental disorders in all countries and territories in 2023, irrespective of the health resources available. In some instances, this burden has increased over time and is unevenly distributed across populations. Stronger surveillance systems, particularly in low-income and middle-income countries, are required. Additionally, we need more coordinated and inclusive policies to reduce the burden through early treatment and prevention, tailored to sex and age differences across locations. Responding to the mental health needs of our global population, especially those most vulnerable, is an obligation, not a choice. Gates Foundation, Queensland Health, and University of Queensland.

This was a preliminary study to investigate a comprehensive comparative evaluation of the head region morphology of Beetal goats and Kajali sheep using gross anatomical, osteometric, radiographic, and computed tomographic data to support species-specific interventions like dehorning, dental procedures, and trauma management. The present study was conducted on 24 heads, comprising 12 Beetal goats and 12 Kajali sheep. Samples were six male and six female animals of each breed, all aged 7-8 months, in good health, and with body weights of 30-45&#x202f;kg, collected from local slaughterhouses and the ILFC of the college. The collected head region samples from goats and sheep were used for gross anatomy, morphometry, radiography, and CT scan in the present study. Beetal goat skulls were elongated, narrow, and dolichocephalic, whereas Kajali sheep skulls were shorter, broader, and ranged from mesaticephalic to brachycephalic types. Distinct species-specific differences were observed in cranial bones. Beetal goats exhibited a pentagonal occipital base, posteriorly placed facial tuberosity, and a consistently present intercondyloid cleft, while Kajali sheep showed a quadrilateral occipital base, premolar-level facial tuberosity, and absence of the cleft. Mandibular variations included a higher frequency of accessory mental foramina in sheep (87.5%) compared to goats (12.5%), and a longer, caudally curved coronoid process in sheep. Osteometric analysis revealed pronounced sexual dimorphism, with 25 cranial parameters significantly differing in Beetal goats and 12 in Kajali sheep. Goats had longer skulls, while sheep had relatively broader skulls, resulting in a higher skull index. Radiographic assessment confirmed morphological differences in craniofacial landmarks and mandibular processes between the two species. CT imaging provided detailed visualization of nasal conchae, paranasal sinuses, cranial and orbital cavities, and auricular structures, while 3D reconstructions highlighted external landmarks, including various skull foramina and facial tuberosity. It is concluded that the anatomical morphology, morphometry, radiography, and CT scan of the head region presented in this study are directly relevant to surgical orientation, regional anesthesia, and trauma management in both species. Data presented in this study aid precise nerve blocks at the infraorbital, mental, and mandibular foramina in both species.

Introduction: Hysterectomies are one of the most common major open gynecologic surgeries. Open gynecological surgery results in a large wound and severe postoperative pain, and adequate postoperative analgesia is necessary. As part of multimodal analgesia strategies, regional anesthesia techniques are widely used in such surgeries to reduce opioid consumption and enhance analgesic efficacy. Spinal anesthesia, as a regional anesthesia technique, and Rectus Sheath Block (RSB) can provide adequate anesthesia and are explored in this prospective randomized study. Objective: The aim of this study was to evaluate and compare the effect of standard general endotracheal anesthesia, regional block-spinal anesthesia, and bilateral Ultrasound (US)-guided RSB on the quality of recovery after open gynecological surgery. Patients and Methods: This prospective randomized study was carried out on 51 females, ASA I or II presented for elective gynecological surgery randomly classified into 3 equal groups (each of 17 patients): Group C (n=17) is control group where the patients received standard general endotracheal anesthesia; patients in Group S (n=17) - received regional- spinal block with applied intrathecal 20 mg (4.0 ml) of 0.5 % hyperbaric bupivacaine and 20 &#xb5;g fentanyl; patients in Group R (n=17)- received Rectus sheath block with 40 ml ropivacaine 0.375% (20ml each side) before the surgery and standard endotracheal anesthesia. The primary outcome, the quality of recovery, was assessed by the 15-item Quality of Recovery questionnaire (QoR-15). Secondary outcomes included intraoperative opioid consumption, time to first flatus, time to first discharge from bed, postoperative nausea and vomiting (PONV), postoperative analgesic consumption and patient satisfaction. Results and conclusion: Postoperative global QoR-15 scores in the patient group R were in the range of 101.94-117.30 (103-119), and those among the in-patient Group S were in the range of 98.71-107.58 (102-109). The patients from Group R, with applied preoperative RSB, had reduced intraoperative opioid consumption, moderate time to first flatus and time to first discharge from bed, low postoperative analgesic consumption, and shorter post-anesthesia care unit discharge time (p<0.05). Patients from Group S, with applied spinal anesthesia, had less or absent initial postoperative pain, abbreviated time to first flatus and time to first discharge from bed, a lower incidence of postoperative nausea and vomiting (PONV), and an early ability to ambulate. Regarding patient satisfaction, for patient group C was average, group S displayed moderate patient satisfaction and group R had high patient satisfaction. According to the obtained results, the use of regional techniques (RSB or spinal anesthesia) are recommended for open gynecological surgery.

Opioid-associated risks and the opioid epidemic have accelerated interest in multimodal analgesia in the emergency department (ED). Regional anesthesia offers a targeted approach with reduced risk of systemic adverse effects and is increasingly used under ultrasound guidance. This concise, evidence-based review explores pharmacological principles of local anesthetics describing key aspects of structure-activity relationship, providing context for agent selection. Additional considerations include dosing strategy, adjunctive medications, potential risks, toxicity mitigation, and operationalization of regional anesthesia in the ED. Regional anesthesia is used with increased frequency in the ED. Pharmacologic properties of commonly used local anesthetics and adjunctive agents determine their advantages and limitations as well as place in therapy. There are a variety of anesthetic agents, including amides (e.g., lidocaine, bupivacaine, ropivacaine, levobupivacaine) and esters (e.g., articaine, chloroprocaine) with differences in onset, duration, and toxicity profiles that influence agent selection in ED patient populations. Adjuncts such as epinephrine, dexamethasone, and alpha-2 agonists may extend nerve block duration or improve analgesia but introduce safety and operational considerations. Recognition of local anesthetic systemic toxicity (LAST) remains central to safe practice, underscoring the importance of weight-based dosing, ultrasound guidance, monitoring, and immediate access to lipid emulsion therapy. Systems-based approaches such as order sets, pharmacist involvement, and structured training support consistent and safe application of regional anesthesia in the ED setting. Safe integration of regional anesthesia in the ED requires pharmacologic literacy, standardized systems, and multidisciplinary support to optimize analgesia while minimizing risk.

The pericapsular nerve group (PENG) block is a novel regional technique that provides adequate postoperative analgesia without producing motor weakness during hip surgery. We sought to compare the postoperative analgesic effectiveness of the PENG block with varying concentrations of local anesthetic in total hip arthroplasty. Prospective, randomized, double-blind trial registered with the ClinicalTrials.gov (NCT04900116). Department of Anesthesiology, Istanbul University Faculty of Medicine, Istanbul, Turkey. Ninety-one patients aged 18-80 with an American Society of Anesthesiologists Physical Status Classification of I-III undergoing total hip arthroplasty under spinal anesthesia with a PENG block were included in this study. Patients were divided into 4 groups: Group One received 20 mL of 0.5% bupivacaine; Group 2 received 20 mL of 0.25% bupivacaine; Group 3 received 20 mL of 0.125% bupivacaine; and Group 4 received 20 mL of saline as a control. Visual Analog Scale pain scores, morphine consumption, nausea, vomiting, and quadriceps weakness were evaluated at postoperative hours 0 (the end of surgery), 6, 12, 24, and 48. In addition, we recorded the first ambulation time; breakthrough morphine need; hospitalization duration; patient and surgeon satisfaction; preoperative and postoperative first month Beck-depression scores; and any complications. Groups One and 2 had significantly lower Visual Analog Scale scores and morphine consumption than the control group (P = 0.001 and P = 0.001, respectively). Quadriceps weakness was significantly higher in Group One at postoperative hour 0 (P = 0.011). Nausea and vomiting were significantly lower in Group One than in the other groups at postoperative hours 12 and 24 (P = 0.007 and P = 0.027, respectively). The length of hospital stay was significantly shorter in Group One than in the control group (P = 0.048). This was a single-center study with no standardized quantitative measurement method for assessing quadriceps weakness. The PENG block with 20 mL of 0.5% bupivacaine in total hip arthroplasty provides effective postoperative analgesia by reducing opioid side effects and hospital stay, as evidenced by low pain scores and morphine consumption.

This study evaluates impact of converting from local to general anesthesia on transcarotid artery revascularization (TCAR) outcomes and identifies risk factors predictive of conversions. A total of 58,960 TCAR cases from the Vascular Quality Initiative (2018-2024) were categorized by anesthesia type: 6,831 local/regional anesthesia (LRA), 51,851 general anesthesia (GA), and 278 conversions from LRA to GA. In-hospital outcomes were compared using multivariate logistic regression, with stroke/death as the primary endpoint. Preoperative predictors of conversion were also assessed. Converted patients were oldest, more often obese, and more likely to undergo urgent procedures. Compared to LRA, conversion was associated with increased odds of in-hospital stroke/death (adjusted odds ratio [aOR] = 3.01; 95% confidence interval [CI], 1.54-5.36; P < 0.001), stroke/death/MI (aOR = 2.92; 95% CI, 1.58-5.00; P < 0.001), and prolonged hospital stay (aOR = 1.38; 95% CI, 1.05-1.80; P = 0.020). Compared to GA, converted patients had higher odds of stroke/death (aOR = 2.95; 95% CI, 1.55-5.09; P < 0.001) and stroke/death/MI (aOR = 2.75; 95% CI, 1.52-4.57; P < 0.001). Compared to LRA, GA was only associated with longer hospital stay. Age and urgent procedures were significant preoperative predictors of conversion to GA (P < 0.05). Conversion from LRA to GA during TCAR is associated with higher rates of stroke, death, and MI compared to LRA or initial GA. Age and urgent TCAR procedures were identified as critical preoperative factors influencing conversion risk. These findings underscore the importance of meticulous preoperative risk assessment and optimal anesthesia selection to minimize conversions and enhance safety in TCAR.

Critically ill adults are at risk for stress-related upper gastrointestinal bleeding (UGIB). Regional variations in gastrointestinal bleeding incidence, infection epidemiology, formulary access, and the relative value placed on bleeding versus infection outcomes by patients and clinicians necessitate contextualized recommendations. This guideline provides regionally adapted, evidence-based recommendations for the use of stress ulcer prophylaxis (SUP) in Saudi Arabia, Kuwait, and the Nordic countries using the GRADE-ADOLOPMENT methodology. A multidisciplinary panel from both regions prioritized PICO questions and ranked outcomes by patient importance. The 2024 Society of Critical Care Medicine (SCCM) and American Society of Health-System Pharmacists (ASHP) guideline served as the source guideline and was evaluated for credibility; contextual fit in Saudi Arabia, Kuwait, and the Nordic countries; and alignment with the GRADE methodology. Evidence profiles and Evidence-to-Decision frameworks were adapted or developed, incorporating updated data, local epidemiology, drug access, and health system variables such as equity, cost, and feasibility. The panel adopted the following five recommendations. In critically ill adults with coagulopathy, shock, or chronic liver disease, the panel suggests using SUP over no SUP (conditional recommendation; moderate certainty). In enterally fed patients at high risk of UGIB, the panel suggests using SUP over no SUP (conditional recommendation; very low certainty); in those at low risk, the panel suggests not using SUP (conditional recommendation; very low certainty). For patients receiving SUP, the panel suggests using a proton pump inhibitor (PPI) or a histamine-2 receptor antagonist (H2RA) rather than sucralfate (conditional recommendation; low to moderate certainty) and suggests enteral or intravenous administration based on clinical feasibility (conditional recommendation; very low to low certainty). In critically ill adults receiving SUP, low-dose PPI or H2RA therapy should be used rather than high-dose regimens (best practice statement; not GRADEd). Regarding SUP discontinuation, the panel suggests discontinuing SUP in critically ill adults with resolved risk factors for UGIB (conditional recommendations; very low certainty) and in critically ill adults without UGIB risk factors but receiving SUP prior to intensive care unit (ICU) admission in the absence of an active indication (conditional recommendations; very low certainty). Differences in drug availability, ICU discharge practices, and health equity considerations shaped the panel's judgments and highlighted key implementation challenges. This guideline offers five context-specific, evidence-informed recommendations for SUP in critically ill adults in Saudi Arabia, Kuwait, and the Nordic countries. While grounded in the health system realities of these regions, the recommendations may inform practice in other settings with similar ICU structures and resource contexts. The panel also identified key research priorities to address remaining evidence gaps and support future updates.

Celiac plexus block (CPB) and celiac plexus neurolysis (CPN) are interventions used to treat chronic abdominal pain, particularly in cancer patients with pancreatic malignancy and patients who have chronic pancreatitis. Both CPB and CPN have been shown to significantly improve pain in patients with abdominal cancers while decreasing opioid consumption and side effects. Existing data on the technical variations and complications associated with both CPB and CPN are limited. We sought to examine the technical factors, patient demographic data, and intra- and post-operative complications and side effects of CBP and CPN. We conducted a retrospective analysis of all patients at our institution who underwent CPB and/or CPN between September 2017 and February 2023. The study primarily included a chart review of patient data followed by statistical analysis. Computed tomography-guided imaging was used for all patients' CPB and/or CPN procedures, which included injections of either lidocaine or ethanol, respectively. Data were collected on patient demographics and baseline disease status, procedural indications, procedural technique, and intra- and post-procedural complications. Patients were stratified based on malignant and nonmalignant pain indications. Of the 141 patients included in the study, 70.2% of were found to have undergone treatment for malignancy-related pain. When assessing needle position, there were no significant differences in technical data between groups. Rates of side effects, including hypotension, diarrhea, and localized pain, were overall low and similar to those reported in meta-analyses. There was a subjective improvement in pain in 67.4% of all patients. This study is limited by its retrospective observational nature and the inability to perform standardized pain scoring pre- and post-procedurally. Data on opioid use and consumption was inferred from prescribing data, which might not have accurately reflected real-world use. Despite these issues, this study provides insight into key patient data around CPB and/or CPN. This study bridges a gap in the literature to address both technical variables and procedural complications of the CPB for patients with malignant and nonmalignant pain.

Elective caesarean section is a common and painful procedure. Uncontrolled pain following caesarean section can profoundly and negatively on a wide range of patient and healthcare-centred outcomes. The aim of this systematic review was to update existing recommendations for postoperative pain management after elective caesarean section performed under neuraxial anaesthesia. A systematic review using the PROcedure SPEcific Postoperative Pain ManagemenT (PROSPECT) methodology was undertaken. Randomised trials evaluating the efficacy of analgesic, anaesthetic and surgical interventions were retrieved. Systematic reviews and meta-analyses of randomised controlled trials were also reviewed. Trials evaluating pain management for emergency surgical deliveries or caesarean section performed under general anaesthesia were not included. Sixty-one randomised controlled trials were included. For patients undergoing elective caesarean section performed under neuraxial anaesthesia, we recommend that clinicians administer intrathecal morphine 50-100&#x2009;&#x3bc;g or diamorphine 300&#x2009;&#x3bc;g pre-operatively, and paracetamol, non-steroidal anti-inflammatory drugs and dexamethasone after delivery. If a neuraxial opioid is not administered, clinicians should use one of a range of recommended fascial plane blocks; alternatively, the wound should be infiltrated with local anaesthetic. The postoperative regimen should include regular paracetamol and non-steroidal anti-inflammatory drugs, with opioids used for rescue. The surgical technique should include a Joel-Cohen incision. The peritoneum should not be closed. An analgesic regimen to manage pain safely and effectively after elective caesarean section based on up-to-date evidence is presented. Consideration has been given to balancing analgesic efficacy and potential adverse effects. Future research should determine the optimal dose of dexamethasone and epidural long-acting opioid, establish the most effective regional analgesic technique and develop standardised outcome sets to better compare techniques. We looked at many good&#x2010;quality research studies to find the best ways to manage pain after a planned caesarean section. We only included studies where the caesarean was planned and done using spinal or epidural anaesthesia. In total, we reviewed 61 studies. A caesarean birth can be very painful, and poor pain control can make recovery harder for parents and babies. We wanted to update advice for doctors so they can give the safest and most effective pain relief after a planned caesarean section. Giving a small amount of strong pain medicine into the spine during the operation helps reduce pain afterwards. After the baby is born, regular pain relief with paracetamol and anti&#x2010;inflammatory medicines works well. If spinal pain medicine is not used, doctors can use numbing injections or nerve blocks to help control pain. Strong pain medicines (opioids) should be used only if needed. Using certain surgical methods can also help reduce pain and improve recovery. These findings give clear, up&#x2010;to&#x2010;date advice to help people recover more comfortably and safely after a planned caesarean section.

Regional anaesthesia has well established benefits in paediatric perioperative care and acute pain interventions. This article explores current controversies and emerging evidence in paediatric regional anaesthesia. Despite rates of local anaesthetic systemic toxicity (LAST) remaining low, dosing of local anaesthetics in children remains controversial, particularly in neonates, in whom maximum safe doses can easily be exceeded. Local anaesthetic additives, such as dexamethasone, dexmedetomidine, and clonidine, are commonly used to prolong regional anaesthesia and have demonstrated good efficacy and safety, though best route of administration remains debated. Peripheral nerve catheters prolong analgesia and can be safely managed in ambulatory settings. Enhanced recovery after surgery (ERAS) is rapidly expanding in paediatric anaesthesia, and regional anaesthesia forms a key component. Fear of masking compartment syndrome is not supported by current literature and not a contraindication to regional anaesthesia. Studies exploring the utility of awake regional anaesthesia in children have successfully demonstrated the avoidance of general anaesthesia. Anaesthetic training increasingly demands proficiency in ultrasound-guided regional techniques. Regional anaesthesia is a safe and effective analgesic modality in children, including in trauma patients and as part of ERAS protocols, with good evidence for use of additives and low rates of complications, including LAST.

The influence of obstetric anesthesia on neonates is still under investigation. We aimed to investigate the influence of type of anesthesia; either general anesthesia (GA) or spinal anesthesia (SA); during elective or emergency cesarean section (CS) on neonatal outcomes. A retrospective cohort study was conducted and all neonatal admissions to the neonatal intensive care unit for mothers who underwent elective or emergency CS as the mode of delivery during the period from 2017 to 2021 were enrolled in the study. The primary outcome of the study was to investigate the difference between SA and GA. The enrolled cohort was divided into two groups: GA and SA groups. A total of 997 patients were included in the study cohort. Among these, 628 patients underwent CS under SA. On univariate analysis, it was revealed that SA was associated with better Apgar score (8.56 &#xb1; 0.04 vs 8.16 &#xb1; 0.05, P =0.0001), less incidence of respiratory distress syndrome (RDS) (35.5% vs 42.3%, P =0.02), intraventricular hemorrhage (IVH) (0.8% vs 13.6%, P =0.0001), and neonatal thrombocytopenia (12.4% vs 17.3%, P =0.021). Moreover, GA was linked to higher mortality rates (10.8% vs 4%, P =0.0001) and more birth depression (10.6% vs 4.3%, P =0.0001). On the other hand, GA was related to less incidence of transient tachypnea of the newborn (TTN) (6.2% vs 12.6%, P =0.001). On multivariate logistic regression analysis, mode of anesthesia was related to RDS, TTN, IVH, birth depression and neonatal death. GA use may be related to more adverse and worse neonatal outcomes. This is related to the utilization of GA more frequently in higher-grade emergencies and is associated with more adverse baseline predictors including lower gestational age, lower birth weight, and greater obstetric complications. SA could offer a localized effect for the anesthetic drugs. Further prospective trials are needed to justify the risk of both types of anesthesia.

Caudal block remains a standard regional anesthesia technique for pediatric lower abdominal and lower limb surgeries. The conventional weight-based Armitage formula does not consider patient body habitus, which can lead to under- or over-dosing-especially in lean or obese children. Ultrasound guidance permits visualization of epidural spread and may facilitate individualized dosing. In this retrospective single-center study, anesthetic records of 25 pediatric patients (age 10-106 months) undergoing ultrasound-guided caudal blocks for lower abdominal or lower extremity surgery were analyzed. Volumes of 0.25% levobupivacaine required to achieve cranial spread to vertebral levels S1, L2 and L1 were recorded. Univariate and multivariate linear regression models, incorporating weight, height, age, and BMI, were compared using adjusted R2, mean squared error (MSE), Akaike information criterion (AIC), and Bayesian information criterion (BIC) to determine the most predictive dosing formulae. Univariate regression revealed injected volume correlated strongest with weight: for S1 spread, volume = 0.1458 &#xd7; weight (kg) (p = 0.006); for L2 spread, volume = 0.4898 &#xd7; weight (kg) (p = 0.0079). The optimal multivariate model for S1-level spread combined weight and height: Volume (mL) = 0.1741 &#xd7; weight (kg) - 0.0234 &#xd7; height (cm) (adjusted R2 = 0.1369; lowest AIC/BIC). For L2-level spread, a weight-only model (volume = 0.5339 &#xd7; weight [kg]) provided the best fit (adjusted R2 = 0.2112). Both models predicted lower volumes than the traditional Armitage guideline, reducing the likelihood of excessive cephalad spread. In pediatric caudal anesthesia, a dosing formula that uses both weight and height improves prediction of the volume required for S1-level blocks, whereas a weight-based formula is adequate for L2-level spread. Real-time ultrasound guidance enhances procedural accuracy and safety by confirming epidural spread and detecting anatomical variation. These data support development of an individualized dosing nomogram for pediatric caudal anesthesia.

Hip fractures (HF) are a serious and increasingly common condition in the geriatric population. Favorable clinical outcomes require early postoperative rehabilitation, which relies on effective pain management. Intrathecal morphine (ITM) is a well-established method of perioperative analgesia, but concerns have been raised about potential adverse effects in the elderly population. This superiority trial was designed to compare the efficacy and safety of low-dose intrathecal morphine, with adverse effect prevention, versus a standard multimodal analgesic regimen in elderly patients undergoing surgery for hip fracture repair. Patients aged 60-90 years scheduled for HF surgery under single spinal anesthesia were randomized into two groups: bupivacaine/levobupivacaine with 100&#xa0;&#xb5;g ITM, and bupivacaine/levobupivacaine alone. The primary outcome was pain intensity (11-point numeric rating scale; NRS) during the first 24&#xa0;hours after surgery. Secondary outcomes included postoperative analgesic consumption, time to first analgesic, and incidence and severity of adverse effects. This study enrolled 82 patients; 47 (57.3%) were allocated to the intervention group, 34 (41.5%) to the control group. The median 24-hour postoperative NRS score was 0.39 (IQR 0.00-0.90) in the intervention group, and 1.70 (IQR 1.23-1.91) in the control group (p < 0.001). Time to first analgesic was 16.5&#xa0;hours (IQR 8.75-24.00) in the intervention group, and 7&#xa0;hours (IQR 4.62-9.88) in the control group (p < 0.001). No postoperative analgesics were required for 29.8% of patients in the intervention group, and 2.9% of patients in the control group (p = 0.001). The incidence and severity of adverse effects did not significantly differ between the groups. Compared to standard multimodal analgesia, low-dose ITM significantly reduced postoperative pain and analgesic consumption, and prolonged the time to first analgesic administration, without an increased incidence or severity of adverse effects in elderly patients with HF.

To describe and compare a retrobulbar (RBA) and two peribulbar (PBA-1 and PBA-2) injection techniques in rabbit cadavers. Prospective experimental cadaveric study. A total of 30 New Zealand White Rabbit cadavers. Computed tomography (CT) was performed to evaluate the needle position and the distribution of contrast agent. A total of 60 retrobulbar spaces underwent one of the three techniques (20 each) with a mixture of 1:2:2 iodinated contrast medium, methylene blue, and 0.9% saline solution with 0.7 mL for RBA, 1 mL for ventrolateral PBA-1 and 1 mL twice for dorsomedial and ventrolateral PBA-2. Intra-versus extraconal contrast distribution were compared. p < 0.05. In 13/20 RBA cases, the contrast distribution was intra- and extraconal, in 6/20 purely extraconal, and in 1/20 intraocular (into the globe). RBA showed a statistically significant extraconal distribution (p < 0.001). In group PBA-1, intra- and extraconal contrast distribution were present in 7/20 orbits, in 11/20 extraconal, and in 2/20 intraocular. There was a statistically significant extraconal distribution in the PBA-1 (p < 0.001). PBA-2 showed a mixed intra- and extraconal contrast accumulation in 7/20 orbits, extraconal in 5/20, and intraocular in 8/20. The dorsally placed needle resulted in a statistically significant intraocular location compared with the ventral needle. The injection resulted in a change in the needle position in one orbit in the PBA-2 group compared with the pre-injection scan. In all other cases with an intraocular contrast distribution, no change in needle position could be detected. The lowest number of complications (intraocular contrast accumulation) was with RBA, but there was no pure intraconal distribution of contrast medium. This technique may be suitable if extraconal anesthesia is desired. Due to the high intraocular distribution, PBA-2 does not appear to be a suitable technique.

To assess anaesthesia capacity and practice in Sierra Leone by enumerating the anaesthesia workforce by volume, training level and distribution across urban and rural areas and facility ownership; estimating the prevalence of anaesthesia methods used for common surgical procedures by provider category; and evaluating hospital infrastructure and the availability of essential anaesthesia-related medications and equipment. A nationwide, cross-sectional, facility-based study combining structured questionnaires administered through face-to-face interviews with facility leads and retrospective review of surgical and anaesthesia logbooks. Public and private hospitals and clinics in Sierra Leone providing surgical care with general, regional or local anaesthesia within an operating theatre. 69 of 78 eligible surgical facilities nationwide were included. Facilities providing surgical services between September 2022 and August 2023 were eligible; facilities without registries or declining participation were excluded. Across participating facilities, the anaesthesia workforce comprised 198 full-time positions, predominantly non-physician providers, with only 40.4% (80/198) trained to administer anaesthesia independently. Ketamine-based and spinal anaesthesia were most common, while general anaesthesia with a protected airway accounted for just 5.0% (415/8339) of procedures. Anaesthesia practices varied by provider training level. Essential infrastructure, equipment and medications fell below international minimum standards, with shortages most pronounced in rural facilities. Severe shortages of certified anaesthesia providers, limited anaesthesia techniques and inadequate material resources remain major barriers to safe anaesthesia and surgical care in Sierra Leone. Targeted investments in workforce development, infrastructure and resource allocation-particularly in rural areas-are required to improve the safety, quality and equity of anaesthesia care nationwide.

This study aims to compare the analgesic efficacy and procedural efficiency of pectoral (PECS II) blocks performed using artificial intelligence (AI)-integrated ultrasonography (USG) versus conventional USG in patients undergoing modified radical mastectomy (MRM). Between November 2021 and March 2023, a total of 70 female patients scheduled for unilateral MRM under general anesthesia were included in this randomized study. The patients were randomly allocated into two groups: USG group (n = 35) and AI-USG group (n = 35). A fourth-year anesthesiology resident performed the PECS II blocks under the supervision of a senior anesthesiologist. The primary outcome was the postoperative pain score as assessed by Visual Analog Scale (VAS) at 12 hours. Secondary outcomes included pain scores at other postoperative time points, total opioid consumption, time first to rescue analgesia request within 24 hours, and the resident's skill development at the end of the study. The mean age was 55.3&#xb1;11.4 (range, 35 to 75) years. Intraoperative remifentanil consumption was higher in USG group than in AI-USG group; however, the difference was not statistically significant (p > 0.05). The durations of anesthesia and surgery were shorter in AI-USG group (p = 0.005 and p = 0.008, respectively). A comparison of local anesthetic injection times between the first 35 and the last 35 patients revealed a statistically significant decrease in the USG group (4.0 min vs. 3.0 min, p = 0.014). The VAS pain scores in the post-anesthesia care unit were initially higher in the AI-USG group (p = 0.05); however, at 12 and 24 postoperative hours, VAS scores were significantly lower than those in the USG group (p = 0.005 and p < 0.001, respectively). There was no significant difference in total tramadol consumption via PCA during the first 24 hours postoperatively (p > 0.05). Surgeon satisfaction scores were lower in the AI-USG group (p = 0.037). Our study results suggest that AI-enhanced USG guidance is associated with improved analgesic outcomes and may offer clinical and educational advantages in the performance of PECS II blocks, particularly for residents in training. The integration of AI into routine USG-guided regional anesthesia practice holds promise for improving procedural consistency and supporting novice practitioners.

To evaluate the nociceptive, motor and proprioceptive response after ultrasound-guided perineural sciatic nerve injections of bupivacaine 0.25% and 0.5% in Wistar rats. Prospective, randomized, blinded crossover study. A group of eight healthy adult female Wistar rats. Rats underwent isoflurane anesthesia and were given ultrasound-guided sciatic nerve injections of 0.1 mL of 0.25% or 0.5% bupivacaine, with a 1 week recovery period between injections. Nociceptive function [electronic von Frey (grams, response)], motor function [grip test, gait response (1-3 scale)] and proprioceptive function [tactile placing (0-3 scale) and paw positioning (clubbed digits/normal splaying)] were evaluated at baseline and at 5, 10, 20, 30, 40, 60, 90, 120, 180, 240, 300 and 360 minutes after anesthesia. Data were analyzed using mixed models with significance set at p < 0.05. Sciatic nerve blockade was effective from 20 minutes into recovery, with treatment, time and interaction on nociceptive function being significant from 20 to 240 minutes (p < 0.05). In Group 0.25%, sensory function peaked at 60 minutes [111.2 g, 95% confidence interval (CI) 100.8-121.5] and returned to a baseline response at 240 minutes (55.5 g, 95% CI: 45.2-65.9). Significant differences between treatment groups were observed from 5 to 240 minutes. Motor and proprioceptive functions were reduced at 20 minutes [median score: 1, interquartile range (IQR: 1)] and returned to baseline at 240 minutes. In Group 0.5%, sensory function peaked at 90 minutes (133.7 g, 95% CI: 123.3-144.1) and returned to baseline (52.0 g, 95% CI: 41.6-62.4) in 300 minutes. Motor and proprioceptive functions were reduced at 10 minutes [1 (IQR: 0.25)] and returned to baseline by 300 minutes. Both 0.25% and 0.5% bupivacaine concentrations produced effective sciatic nerve blockade in all rats, demonstrating a concentration-dependent effect on the duration and magnitude of nociceptive, motor and proprioceptive block.

Local anesthetic systemic toxicity is a rare but potentially life-threatening complication of regional anesthesia that can occur when high doses of local anesthetics are administered. This study aimed to evaluate the frequency of local anesthetic doses exceeding safe thresholds in axillary brachial plexus blocks using four different calculation methods. This retrospective study analyzed 2395 patients who underwent axillary brachial plexus block between 2017 and 2021 at Geneva University Hospitals. Four progressively more conservative sets of dosing rules were systematically applied. These included standard package insert recommendations, weight-based limits using actual weight, weight-based limits using ideal body weight, and consensus-based rules adapted to patients' comorbidities and treatments. For local anesthetic mixtures, proportional calculations were applied to determine cumulative maximum safe doses. Using the most conservative calculation method, local anesthetic doses exceeded maximum safe thresholds in 64.8% of cases, compared to 29.5% using package insert recommendations. Potentially unsafe doses were consistently more frequent with local anesthetic mixtures (85.4%) compared to single agents (32.4%) across all calculation methods. Symptoms compatible with local anesthetic systemic toxicity occurred in 19 patients (0.79%), with severe manifestations in 9 cases (0.38%). No significant relationship was found between these symptoms and potentially unsafe doses, regardless of the calculation method used. This study reveals substantial variation in local anesthetic dosing practices for axillary brachial plexus blocks. Rates of potentially unsafe doses varied significantly depending on the criteria applied. The consistent pattern of higher rates of potentially unsafe doses with mixture use highlights opportunities for practice standardization and improved safety protocols in regional anesthesia. The multiple calculation approaches allow clinicians to compare findings with their own institutional practices.