El lifting cervicofacial de plano profundo: Presentación de la técnica y resultados

Objetivo: El lifting cervicofacial es una técnica que busca devolver una apariencia juvenil y descansada al rostro del paciente. Originalmente, esta técnica se limitaba solamente a una disección en el plano cutáneo. El lifting de plano profundo o deep plane facelft, en cambio, utiliza un plano de disección anatómico por debajo del sistema musculoaponeurótico superficial (SMAS), permitiendo la lisis de los ligamentos de retención faciales y la máxima movilización de los tejidos superficiales, confiriéndole ventajas frente a otras técnicas. Se describe la técnica y se presenta nuestra experiencia. Material y Método: Serie de casos retrospectiva de pacientes sometidos a lifting de plano profundo en nuestro centro. Se describe la técnica quirúrgica, datos demográficos, antecedentes médico quirúrgicos y complicaciones post-operatorias. Resultados: Entre enero de 2021 y junio de 2023 se operaron 18 pacientes, todos de sexo femenino con un promedio de edad de 58,7 años. Solo 2 pacientes presentaron complicaciones (hematoma). Ningún paciente presentó lesión del nervio facial transitoria o permanente. Ningún paciente necesitó re-operación. Discusión y conclusión: La técnica de lifting de plano profundo o deep plane facelft es un método seguro y efectivo para tratar los signos del envejecimiento facial. Las complicaciones descritas por nuestro grupo son acordes a la literatura.

Aim: The facelift is a technique that aims to restore a more youthful and rested appearance to the aging face. Originally it was limited to a skin dissection only. The deep plane facelift, on the other hand, uses an anatomical dissection plane below the superficial muscular aponeurotic system (SMAS), allowing lysis of the facial retention ligaments and maximum mobilization of superficial tissues, with better outcomes than other techniques. The technique is described and our experience is presented. Material and Method: Retrospective case series of patients undergoing deep plane facelift. The surgical technique, demographic data, surgical medical history, and postoperative complications are described. Results: Between January 2021 and June 2023, 18 patients were operated, all female with an average age of 58,7 years old. Only 2 patients presented complications (hematoma). No patient presented facial nerve injury. No patient required re-operation. Discussion and Conclusion: The deep plane facelift is a safe and effective method to treat the signs of the aging face. The complications described are consistent with the literature.

Clinical Adaptation According to Anatomical Types of Nasal Septum / Adaptación Clínica Según Tipos Anatómicos de Tabique Nasal

SUMMARY: The purpose of this study was to inform the anatomical types of the nasal septum of which including variations by dissection and to provide guidelines for clinical adaptation. For this purpose dissections were performed on 70 nasal septums of formalin fixed Korean adult cadavers (20 males, 11 females, and 39 of unknown sex) with an age at death of 13-105 years. The septal deviation was checked before midsagittal section the nasal cavity with the aid of a laryngoscope. The mucosa on the nasal septum was then removed to observe the morphology of the nasal septum. The shape of each component of the nasal septum was identified, and photographs were taken from a midsagittal plane. This study has discovered various anatomical types of the nasal septum and its variations. The correlations between septal types according to their proportions were also analyzed. The results reported herein provide detailed anatomical knowledge that can be used as a valuable reference for rhinoplasty procedures.

El propósito de este estudio fue informar los tipos anatómicos del tabique nasal incluyendo las variaciones por disección y brindar pautas para la adaptación clínica. Para este propósito, se realizaron disecciones en 70 tabiques nasales de cadáveres adultos coreanos fijados con formalina (20 hombres, 11 mujeres y 39 de sexo desconocido) con una edad de muerte de 13 a 105 años. La desviación septal se comprobó antes de la sección medio sagital de la cavidad nasal con la ayuda de un laringoscopio. A continuación, se retiró la mucosa del tabique nasal para observar la morfología del tabique nasal. Se identificó la forma de cada componente del tabique nasal y se tomaron fotografías desde un plano mediano sagital. En el estudio se descubrieron varios tipos anatómicos del tabique nasal y sus variaciones. También se analizaron las correlaciones entre los tipos septales según sus proporciones. Los resultados informados en este documento proporcionan un conocimiento anatómico detallado que se puede utilizar como una referencia valiosa para los procedimientos de rinoplastía.

Relationship between the occlusal plane and three different levels of ala-tragus line in a sample of sudanese adults / Relación entre el plano oclusal y tres niveles diferentes de la línea ala-trago en una muestra de adultos sudaneses

Aim: Correct orientation of the occlusal plane plays a vital role in achieving the perfect occlusal balance and function of complete dentures. This study aimed to evaluate the most reliable posterior reference point of the ala-tragus line (ATL) concerning occlusal plane (OP) in a sample of the dentate Sudanese population. Materials and Methods: A total of 150 subjects with healthy and well-aligned permanent teeth were randomly selected. Right lateral profile photographs were taken with subjects having a fox plane placed intra-orally, contacting the occlusal plane. Reference points corresponding to inferior, middle, and superior borders of the tragus and inferior border of the ala of the nose were marked on photographs. The angles between the lines were measured using the Auto-CAD software program, and the most parallel relationship was determined. Descriptive statistics in terms of means and standard deviations were presented. Independent t-test and one-way ANOVA tests were used to compare as appropriate. A p-value < 0.05 was considered significant. Results: The mean angle formed by the OP and ATL was 8.5±3.69º for the superior level, 4.68±3.13º for the middle line, and 2.89±2.57º for the inferior line. A significant difference was found between the means of the three angles (p< 0.001), while no significant difference (p> 0.05) was found between both genders regarding the measured angles. Conclusions: The line joining the inferior border of the ala of the nose with the inferior border of the tragus of the ear was the most reliable line in terms of parallelism to determine the occlusal plane orientation.

Antecedentes: La orientación correcta del plano oclusal juega un papel vital para lograr el equilibrio oclusal perfecto y la función de las prótesis completas. Este estudio tuvo como objetivo evaluar el punto de referencia posterior más confiable de la línea ala-trago (ATL) con respecto al plano oclusal (OP) en una muestra de la población dentada de Sudán. Materiales y Métodos: Se seleccionaron aleatoriamente un total de 150 sujetos con dientes permanentes sanos y bien alineados. Se tomaron fotografías de perfil lateral derecho de sujetos a los que se les colocó un plano de zorro intraoralmente, en contacto con el plano oclusal. En las fotografías se marcaron los puntos de referencia correspondientes a los bordes inferior, medio y superior del trago y al borde inferior del ala de la nariz. Los ángulos entre las líneas se midieron utilizando el programa de software Auto-CAD y se determinó la relación más paralela. Se presentaron estadísticas descriptivas en términos de medias y desviaciones estándar. Se utilizaron prueba-t independiente y prueba ANOVA unidireccional para las comparaciones, según correspondiera. Se consideró significativo un valor de p<0,05. Resultados: El ángulo medio formado por OP y ATL fue de 8,5±3,69º para el nivel superior, 4,68±3,13º para la línea media y 2,89±2,57º para la línea inferior. Se encontró una diferencia significativa entre las medias de los tres ángulos (p< 0,001), mientras que no se encontró diferencia significativa (p>0,05) entre ambos sexos con respecto a los ángulos medidos. Conclusión: La línea que une el borde inferior del ala de la nariz con el borde inferior del trago de la oreja fue la línea más confiable en términos de paralelismo para determinar la orientación del plano oclusal.

Computer-aided diagnosis system versus conventional reading system in low-dose (< 2 mSv) computed tomography: comparative study for patients at risk of lung cancer

ABSTRACT BACKGROUND: Computer-aided diagnosis in low-dose (≤ 3 mSv) computed tomography (CT) is a potential screening tool for lung nodules, with quality interpretation and less inter-observer variability among readers. Therefore, we aimed to determine the screening potential of CT using a radiation dose that does not exceed 2 mSv. OBJECTIVE: We aimed to compare the diagnostic parameters of low-dose (< 2 mSv) CT interpretation results using a computer-aided diagnosis system for lung cancer screening with those of a conventional reading system used by radiologists. DESIGN AND SETTING: We conducted a comparative study of chest CT images for lung cancer screening at three private institutions. METHODS: A database of low-dose (< 2 mSv) chest CT images of patients at risk of lung cancer was viewed with the conventional reading system (301 patients and 226 nodules) or computer-aided diagnosis system without any subsequent radiologist review (944 patients and 1,048 nodules). RESULTS: The numbers of detected and solid nodules per patient (both P < 0.0001) were higher using the computer-aided diagnosis system than those using the conventional reading system. The nodule size was reported as the maximum size in any plane in the computer-aided diagnosis system. Higher numbers of patients (102 [11%] versus 20 [7%], P = 0.0345) and nodules (154 [15%] versus 17 [8%], P = 0.0035) were diagnosed with cancer using the computer-aided diagnosis system. CONCLUSIONS: The computer-aided diagnosis system facilitates the diagnosis of cancerous nodules, especially solid nodules, in low-dose (< 2 mSv) CT among patients at risk for lung cancer.

Bilateral versus unilateral erector spinae plane block for postoperative analgesia in laparoscopic cholecystectomy: a randomized controlled study

Abstract Introduction Laparoscopic cholecystectomy (LC) is the common surgical intervention for benign biliary diseases. Postoperative pain after LC remains as an important problem, with two components: somatic and visceral. Trocar entry incisions lead to somatic pain, while peritoneal distension with diaphragm irritation leads to visceral pain. Following its description by Forero et al., the erector spinae plane (ESP) block acquired considerable popularity among clinicians. This led to the use of ESP block for postoperative pain management for various operations. Materials and methods This study was conducted between January and June 2019. Patients aged between 18 and 65 years with an American Society of Anesthesiologists (ASA) physical status I-II, scheduled for elective laparoscopic cholecystectomy were included in the study. All the patients received bilateral or unilateral ESP block at the T8 level preoperatively according to their groups. Results There was no significant difference between the groups in terms NRS scores either at rest or while coughing at any time interval except for postoperative 6th hour (p = 0.023). Morphine consumption was similar between the groups but was significantly lower in group B at 12 and 24 hours (p = 0.044 and p = 0.022, respectively). Twelve patients in group A and three patients in group B had shoulder pain and this difference was statistically significant (p = 0.011). Discussion In conclusion, bilateral ESP block provided more effective analgesia than unilateral ESP block in patients undergoing elective LC. Bilateral ESP block reduced the amount of opioid consumption and the incidence of postoperative shoulder pain.

CBCT analysis of condylar and occlusal plane features in skeletal Class Ⅲ malocclusion patients with mandibular asymmetry / 口腔医学

Objective@#To analyze the condylar and inclination of the occlusal plane features in skeletal Class Ⅲ malocclusion patients with mandibular asymmetry by using cone beam computed tomography(CBCT).@* Methods@#Forty eligible patients with Angle Class Ⅲ malocclusion were enrolled. All individuals were classified based on the distance from Me point to median sagittal plane. The left and right angles between OP and FH plane, the position and morphology of the condyle were measured in both groups.Then the data collected were statistically analyzed. @* Results@#Compared to the opposite side, there was a statistically significant difference(P<0.05) in angle between OP and FH plane, the anterior joint space, superior joint space, lateral joint space and condylar mediolateral diameter, with a higher proportion of joint posteriority in deviated side. Mandibular deviations were positively correlated with both the anterior joint space of the deviated side and the angle between OP and FH plane of the opposite side(P<0.01). There was no statistical difference between the left and right side of angles between OP and FH plane, the position and morphology of the condyle in skeletal Class Ⅲ patients without mandibular deviation(P>0.05); the joint was predominantly in anterior and middle position. @*Conclusion@#There is asymmetry on the left and right sides of the inclination ofocclusal plane, the position and morphology of the condyle of skeletal Class Ⅲ malocclusion patients with mandibular asymmetry. Compared with the opposite side, the deviated side has smaller angle between OP and FH plane and smaller condylar mediolateral diameter, and the condyle shows generally more posterior, inferior and inward movement in glenoid fossa. The inclination of the occlusal plane and the position of condyle are significantly and positively correlated with the distance from Me point to median sagittal plane.

Ultrasound-guided erector spine plane block (ESPB) utilization in managing refractory renal colic pain in the emergency department / 世界急诊医学杂志（英文）

@#Due to the acute and terrible pain that patients with renal colic experience, the most essential therapeutic priority for these patients in the emergency department (ED) is to reduce pain.[1] Although numerous medications are utilized to reduce pain in patients with acute renal colic, no therapy has yet been developed to totally and quickly relieve pain.[2,3] Intravenous opioids and nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly administered intravenously to control pain in these patients in the ED; however, the need for frequent monitoring for possible complications and relatively slow-acting features render these strategies undesirable.[4]

Effects of bilateral erector spinae plane block for posterior lumbar spine surgery in elderly patients / 中南大学学报(医学版)

OBJECTIVES@#With the rapid development of aging population, the number of elderly patients undergoing posterior lumbar spine surgery continues to increase. Lumbar spine surgery could cause moderate to severe postoperative pain, and the conventional opioid-based analgesia techniques have many side effects, which are barriers to the recovery after surgery of the elderly. Previous studies have demonstrated that erector spinae plane block (ESPB) could bring about favorable analgesia in spinal surgery. As far as the elderly are concerned, the analgesic and recovery effects of ESPB on posterior lumbar spine surgery are not completely clear. This study aims to observe the effects of bilateral ESPB on elderly patients undergoing posterior lumbar spine surgery, and to improve the anesthesia techniques.@*METHODS@#A total of 70 elderly patients of both sex, who were selected from May 2020 to November 2021, scheduled for elective posterior lumbar spine surgery, and in the age of 60-79 years, with American Society of Anesthesiologists class Ⅱ-Ⅲ, were divided into a ESPB group and a control (C) group using a random number table method, with 35 patients each. Before general anesthesia induction, 20 mL 0.4% ropivacaine was injected to the transverse process of L3 or L4 bilaterally in the ESPB group and only saline in the C group. The score of Numerical Rating Scale (NRS) indicating pain at rest and on movement within 48 h after operation, time of first patient control analgesia (PCA), cumulative consumptions of sufentanil within 48 hours, Leeds Sleep Evaluation Questionnaire (LSEQ) scores on the morning of day 1 and day 2 after operation, Quality of Recovery-15 (QoR-15) scores at 24 and 48 h after operation, full diet intake times, perioperative adverse reactions such as intraoperative hypotension, postoperative dizziness, nausea, vomiting, and constipation were compared between the 2 groups.@*RESULTS@#A total of 70 patients were enrolled and 62 subjects completed the study, including 32 in the ESPB group and 30 in the C group. Compared with the C group, the postoperative NRS scores at rest at 2, 4, 6, and 12 h and on movementat at 2, 4, and 6 h were lower, time of first PCA was later, sufentanil consumptions were significantly decreased during 0-12 h and 12-24 h after operation, LSEQ scores on the morning of day 1 and QoR-15 scores at 24 and 48 h after operation were higher, full diet intakes achieved earlier in the ESPB group (all P<0.05). There were no significant differences in the incidences of intraoperative hypotension, postoperative dizziness, nausea, vomiting, and constipation between the 2 groups (all P>0.05).@*CONCLUSIONS@#Providing favorable analgesic effects with reduced opioids consumption, bilateral ESPB for posterior lumbar spine surgery in the elderly patients could also improve postoperative sleep quality, promote gastrointestinal functional restoration, and enhance recovery with few adverse reactions.

Effects of transversus abdominis plane block on pain, rehabilitation indexes and immune function in patients undergoing laparoscopic colorectal cancer surgery / 中国医师进修杂志

Objective:To observe the effects of ultrasound guided transversus abdominis plane block (TAPB) on pain, rehabilitation indexes and immune function of postoperative in patients undergoing laparoscopic colorectal cancer surgery.Methods:A total of 100 patients undergoing laparoscopic colorectal cancer surgery admitted to Jiading Branch of Shanghai First People′s Hospital/Jiangqiao Hospital of Jiading District and Shanghai First People′s Hospital from February 2020 to February 2021 were selected as the study subjects, including 43 patients performed epidural block (control group) and 57 patients performed TAPB (observation group). The clinical indicators, vital signs parameters, pain degree, immune function in the two groups were compared.Results:The exhausting time, defecation time, getting out of bed time and hospitalization time in observation group were shorter than those in control group: (2.71 ± 0.54) d vs. (2.99 ± 0.66) d, (3.02 ± 0.49) d vs. (3.49 ± 0.56) d, (3.20 ± 0.89) d vs. (3.85 ± 1.08) d, (6.81 ± 0.98) d vs. (7.71 ± 1.08) d, there were statistical differences ( P<0.05). The diastolic blood pressure, systolic blood pressure and heart rate at pre-anesthesia, immediate incision of the skin, end of the surgery between two groups had no significant differences ( P>0.05). The scores of visual analogue scale at 4, 24, 48 and 72 h after surgery in the observation group were significantly lower than those in the control group ( P<0.05). The levels of CD 3+, CD 4+, CD 4+/CD 8+ and IgM after surgery for 3 d in the observation group were higher than those in the control group: 0.512 ± 0.054 vs. 0.487 ± 0.051, 0.280 ± 0.036 vs. 0.222 ± 0.032, 1.36 ± 0.29 vs. 1.17 ± 0.26, (152.53 ± 34.3) kU/L vs. (138.86 ± 31.18) kU/L, there were statistical differences ( P<0.05). Conclusions:TAPB can effectively reduce the degree of postoperative pain and immunosuppression after laparoscopic colorectal cancer surgery, so as to promote postoperative rehabilitation of patients.

Implications of occlusal plane in diagnosis and treatment of malocclusion / 浙江大学学报·医学版

Occlusal plane (OP) is one of the essential factors affecting craniofacial morphology and function. The OP not only assists in diagnosing malocclusion but also serves as an important reference for making treatment plans. Patients with different types of malocclusions have different forms of OP. Compared with patients with standard skeletal facial type, the occlusal plane of patients with skeletal class Ⅱ and high angle is steeper, while that of patients with skeletal class Ⅲ and low angle is more even. In orthodontic treatment, adjusting and controlling the OP can promote the normal growth and development of the mandible in most patients with malocclusion during the early stage of growth, while causing favorable rotation of the mandible in some adults with mild-to-moderate malocclusion. For moderate-to-severe malocclusion, the OP rotation by orthodontic-orthognathic treatment can achieve better long-term stability. This article reviews the evolution of the definition of OP and its implications for diagnosing and the guiding treatment of malocclusion.

Imaging study on the relationship between anterior and posterior occlusal planes and temporomandibular osteoarthrosis / 华西口腔医学杂志

OBJECTIVES@#The aim of this study was to compare the anterior and posterior occlusal plane characteristics of patients with different temporomandibular joint osseous statuses.@*METHODS@#A total of 306 patients with initial cone beam CT (CBCT) and cephalograms were included. They were divided into three groups on the basis of their temporomandibular joint osseous status: bilateral normal (BN) group, indeterminate for osteoarthrosis (I) group, and osteoarthrosis (OA) group. The anterior and posterior occlusal planes (AOP and POP) of the different groups were compared. Then, the regression equation was established after adjusting for confounding factors, and a correlation analysis between the occlusion planes and other parameters was performed.@*RESULTS@#SNA, SNB, FMA, SN-MP, Ar-Go, and S-Go were correlated with the occlusal planes. Relative to the BN and I groups, the FH-OP of the OA group increased by 1.67° on the average, FH-POP increased by 1.42° on the average, and FH-AOP increased by 2.05° on the average.@*CONCLUSIONS@#The occlusal planes were steeper in the patients with temporomandibular osteoarthrosis than in the patients without it, and the mandible rotated downward and backward. The height of the mandibular ramus, the mandibular body length, and the posterior face height were small. In clinical practice, attention should be given to the potential risk of temporomandibular joint osteoarthrosis in such patients. In addition, SNB, FMA, SN-MP, Ar-Go, S-Go, and occlusal planes had moderate correlations.

Application of pulmonary circulation single-blocking method in intersegmental plane identification during segmentectomy / 中国胸心血管外科临床杂志

@#Objective    To introduce a new method for identifying intersegmental planes during thoracoscopic segmentectomy using pulmonary circulation single-blocking in the target segment. Methods    To retrospectively analyze the clinical data of 83 patients who underwent thoracoscopic pulmonary segmentectomy from January 2019 to March 2020 using the pulmonary circulation single-blocking method. There were 33 males and 50 females, with a median age of 54 (46-65) years, and they were divided into a single vein group (SVG, n=31) and a single artery group (SAG, n=52), and the clinical data of two groups were compared. Results    The intersegmental planes were identified successfully in both groups and there were no statistically significant differences between the two groups in terms of intersegmental plane management (P=0.823), operating time (P=0.786), intraoperative blood loss (P=0.775), chest drainage time (P=0.659), postoperative hospital stay (P=0.824) or the incidence of postoperative complications (P=1.000). Conclusion    The use of pulmonary circulation single-blocking for intersegmental plane identification during thoracoscopic segmentectomy is safe and feasible, and the intersegmental plane can be satisfactorily identified by the single-blocking of arteries or veins.

Application of Three-dimensional Computed Tomography Bronchography and Angiography Combined with Perfusion Area Identification Technique in Uniport Thoracoscopic Complex Segmentectomy / 中国肺癌杂志

BACKGROUND@#With the extensive application of segmental lung resection in the treatment of early-stage lung cancer, how to complete segmentectomy more accurately and minimally invasively has become a research hotspot. The aim of this study is to explore the application of three-dimensional computed tomography bronchography and angiography (3D-CTBA) combined with perfusion area recognition technique in single-hole thoracoscopic complex segmentectomy.@*METHODS@#From January 2021 to January 2022, the clinical data of 112 consecutive patients undergoing single-port thoracoscopic complex segmentectomy in the Department of Thoracic Surgery, Xuanwu Hospital, Capital Medical University were retrospectively analyzed. The three-dimensional reconstruction combined with perfusion area identification technique was used to perform the operation and the clinical data were analyzed.@*RESULTS@#The average operation time was (141.1±35.4) min; the initial time of intersegmental plane display was (12.5±1.7) s; the maintenance time of intersegmental plane was (114.3±10.9) s; the intersegmental plane was clearly displayed (100%); the amount of bleeding was [10 (10, 20)] mL; the total postoperative drainage volume was (380.5±139.7) mL; the postoperative extubation time was (3.9±1.2) d; and the postoperative hospitalization time was (5.2±1.6) d. Postoperative complications occurred in 8 cases.@*CONCLUSIONS@#The advantages of 3D-CTBA combined with perfusion area recognition technique are fast, accurate and safe in identifying intersegmental boundary in single-port thoracoscopic complex segmentectomy, which could provide guidances for accuratding resection of tumors, shortening operation time and reducing surgical complications.

Resection of superior polar gland flap of the breast combined with dual plane augmentation through Omega nipple root approach / 中华医学美学美容杂志

Objective:To investigate the feasibility of superior polar gland flap resection combined with biplanar augmentation mammoplasty through the root of the nipple to correct pseudoptosis/mild breast ptosis.Methods:From January 2019 to January 2021, 20 patients (40 breasts) with pseudoptosis/mild breast ptosis underwent augmentation mammoplasty with superior polar gland flap through the root of the nipple and microvilli anatomical silica gel prosthesis.Results:No postoperative complications such as hematoma infection, capsular contracture and abnormal sensation of the nipple and areola were found in 20 patients. During the follow-up of 3 to 18 months, the patients' breasts were plump and straight, the appearance was good, and the prolapse was basically corrected. Postoperative satisfaction was achieved in 20 cases (95%), and the satisfaction of incision scar was 100%.Conclusions:The comprehensive surgery restores the normal anatomical suspension system of the breast, achieves a long-term mechanical stable balance among prosthesis, muscle, breast gland and skin, and receives high satisfaction with breast shape after operation.

The use of erector spinae versus transversus abdominis blocks in ovarian surgery: A randomized, comparative study / Uso del bloqueo del plano erector de la espina versus el plano transverso abdominal en cirugía de ovario: un estudio aleatorizado comparativo

Abstract Introduction: Inadequate pain control after major surgery can lead to significant complications. Ultrasound (US) guided plane blocks account for significant progress in regional anesthesia. Objective: This study explored the analgesic superiority of ultrasound-guided erector spinae (ESPB) and transversus abdominis (TAPB) plane blocks in patients undergoing major ovarian cancer surgery under general anesthesia. There have been no previous studies comparing their efficacy under these circumstances. Methods: This double-blind randomized comparative study included 60 patients undergoing major ovarian cancer surgery under general anesthesia. The ESPB group (n=30), received preoperative ultrasound-guided ESPB and the TAPB group (n=30), received preoperative low TAPB. Opioid consumption, HR, MAP, visual analogue scale (VAS) and adverse events were documented over 24 hours after surgery. Results: There was a highly significant difference in tramadol consumption between the two groups, with (95% CI: 16.23 to 50.43) and (95% CI: 59.23 to 95.43) for ESPB and TAPB groups, respectively. A significant difference (P < 0.01) was shown in intraoperative fentanyl consumption with (95% CI: 113 to 135.6) and (95% CI: 141.8 to 167.6) for ESPB and TAPB groups, respectively. A highly significant longer time to first analgesic request was recorded in the ESPB group (95% CI: 5.5 -15.3) (P < 0.001). VAS had a median of 2 (1-3) and 4 (2-6) for ESPB and TAPB groups, respectively, with F(1)=18.15, P=0.001 between groups. Postoperative HR and MAP in the TAPB group were significantly higher with more incidence of PONV. Conclusions: ESPB provided a more reliable analgesia versus TAPB in patients undergoing ovarian cancer surgery.

Resumen Introducción: El control inadecuado del dolor posterior a cirugía mayor puede generar complicaciones importantes. El bloqueo de los planos guiado por ecografía representa un avance significativo en anestesia regional. Objetivo: En el presente estudio se explora la superioridad analgésica de los bloqueos guiados por ecografía del plano erector de la espina (BPEE) y del plano transverso abdominal (BPTA) en pacientes sometidas a cirugía de cáncer de ovario bajo anestesia general. No se han hecho estudios previamente que comparen su eficacia bajo tales circunstancias. Métodos: Este estudio doble ciego, aleatorizado, comparativo, incluyó a 60 pacientes sometidas a cirugía mayor por cáncer de ovario, bajo anestesia general. El grupo del BPEE (n=30), recibió un BPEE guiado por ecografía, mientras que el grupo de BPTA (n=30), recibió un BPTA preoperatorio bajo. El consumo de opioides, la FC, la PAM, la escala visual analógica (EVA) y los eventos adversos, se documentaron durante las 24 horas posteriores a la cirugía. Resultados: Hubo una diferencia estadísticamente significativa en el consumo de tramadol entre los dos grupos, con un IC del 95% de 16,23 a 50,43 y un IC del 95% de 59,23 a 95,43 para los grupos de BPEE y de BPTA respectivamente. Se demostró una diferencia estadísticamente significativa (P < 0,01) en el consumo de fentanilo con un IC del 95%: 113 a 135,6 y un IC de 95%: 141,8 a 167,6 para los grupos de BPEE y BPTA, respectivamente. El tiempo transcurrido hasta la primera solicitud de analgésico en el grupo de BPEE fue significativamente más prolongado (IC 95%: 5,5 -15,3) (P < 0,001). La escala visual analógica - EVA - tuvo una mediana de 2 (1-3) y 4 (2-6) para los grupos del BPEE y BPTA, respectivamente, con F(1)=18,15, P=0,001 entre grupos. La FC y la PAM postoperatorias en el grupo de BPTA fueron significativamente superiores, con una mayor incidencia de nausea y vómito postoperatorios. Conclusiones: El BPEE proporcionó una analgesia más confiable que BPTA, en pacientes sometidas a cirugía de cáncer de ovario.

Bilateral continuous erector spinae plane block for cardiac surgery: case series / Bloqueo bilateral continúo del plano erector de la espina para cirugía cardiaca: serie de casos

Abstract Multimodal analgesia in cardiac surgery sternotomy includes bilateral continuous erector spinae plane block (BC-ESPB). However, the effectiveness of the local anesthetic regimens is still uncertain. The purpose of this study was to assess pain control achieved with a multimodal analgesia regimen including BC-ESPB at the level of T5 with PCA with a 0.125 % bupivacaine infusion and rescue boluses. This is a descriptive case series study which recruited 11 adult patients undergoing cardiac surgery through sternotomy in whom multimodal analgesia including BC-ESPB was used, between February and April 2021, at a fourth level institution. All patients reported pain according to the numeric rating scale (NRS) ≤ 3 both at rest and in motion, at extubation and then 4 and 12 hours after surgery. After 24 hours the pain was NRS ≤ 3 in 100 % of the patients at rest and in 63.6 % in motion. At 48 h 81 % of the patients reported pain NRS ≤ 3 at rest and in motion. At 72h all patients reported pain NRS ≤ 3 at rest and 82 % in motion. The average intraoperative use of fentanyl was 2.35 µg/kg and postoperative hydromorphone was 5.3, 4.1 and 3.3 mg at 24, 48 and 72 hours, respectively. Hence, bilateral ESP block in continuous infusion plus rescue boluses allows for proper control of acute intra and post-operative pain.

Resumen En cirugía cardiaca mediante esternotomía, la analgesia multimodal incluye el bloqueo bilateral continuo del plano erector de la espina (BBC-ESP). Sin embargo, existe incertidumbre sobre la efectividad de los esquemas de dosificación del anestésico local. Se busca evaluar el control del dolor proporcionado por un esquema de analgesia multimodal que incluye el BBC-ESP a la altura de T5 con ACP de bupivacaína 0,125 % en infusión y bolos de rescate. Se trata de un estudio descriptivo, serie de casos. Se reclutaron 11 pacientes adultos sometidos a cirugía cardiaca mediante esternotomía en quienes se usó analgesia multimodal que incluía BBC-ESP entre febrero y abril del 2021, en una institución de cuarto nivel. Todos los pacientes refirieron dolor, según la escala numérica (EN) ≤ 3 tanto en reposo como en movimiento, a la extubación, a las 4 y a las 12 horas. A las 24 horas el dolor fue EN ≤ 3 en el 100 % de los pacientes en reposo y en el 63,6 % en movimiento. A las 48 h el 81 % de los pacientes refirieron dolor EN ≤ 3 en reposo y en movimiento. A las 72 h todos los pacientes presentaron dolor EN ≤ 3 en reposo y 82 % en movimiento. El consumo intraoperatorio promedio de fentanilo fue de 2,35 ug/kg y de hidromorfona posoperatoria de 5,3, 4,1 y 3,3 mg a las 24, 48 y 72 horas. Así, el BBC-ESP en infusión continua más bolos de rescate permiten el control del dolor agudo intra y posoperatorio.

Relación de los planos anatómicos del cristalino con la posición real del lente intraocular / Relationship of the Anatomical Planes of the Crystalline lens to the Actual Position of the Intraocular Lens

Objetivo: Determinar la relación de los planos anatómicos del cristalino con la posición real de la lente intraocular en pacientes con diagnóstico de catarata atendidos en el Centro de Microcirugía Ocular del Instituto Cubano de Oftalmología durante el período de enero del 2018 a enero 2021. Métodos: Se realizó un estudio observacional, descriptivo, prospectivo longitudinal en 89 ojos de 67 pacientes operados de catarata con implante de lente intraocular (LIO) por técnica de facoemulsificación. Se empleó para el cálculo del poder de la lente el IOL Master 700 y la fórmula de SRK/T. Se utilizó la imagen de OCT ofrecida por el IOL Máster 700 para determinar el plano ecuatorial y plano central del cristalino, así como la posición real de la lente intraocular. Resultados: Predominó el grupo de edad entre 60 - 79 años, el sexo femenino representó el 53 por ciento. Los ojos tamaño promedio y las medidas biométricas oculares en valores promedios estándar fueron los más representativos. El plano ecuatorial mostró menos diferencia con la posición real de la lente intraocular en comparación con la diferencia evidenciada entre el plano central y la posición real de la lente. La adecuada posición del lente intraocular calculado en la bolsa capsular independiente a la longitud axial, permitió obtener un resultado refractivo en correspondencia al esperado previo a la cirugía. Conclusión: Los parámetros anatómicos del cristalino (plano ecuatorial, plano central) constituyen variables importantes a tener en cuenta para el desarrollo y perfeccionamiento de las fórmulas para el cálculo del lente intraocular(AU)

Purpose: To determine the relationship of the anatomical planes of the crystalline lens with the actual position of the intraocular lens in patients with a diagnosis of cataract seen at the Ocular Microsurgery Center of the Cuban Institute of Ophthalmology during the period January 2018 and January 2021. Methods: An observational, descriptive, prospective longitudinal study was performed in 89 eyes of 67 patients operated on for cataract with intraocular lens implantation (IOL) by phacoemulsification technique. The IOL Master 700 and the SRK/T formula were used to calculate lens power. The OCT image provided by the IOL Master 700 was used to determine the equatorial plane and central plane of the crystalline lens, as well as the actual position of the intraocular lens. Results: The age group 60-79 years was predominant, female gender represented 53 percent. Average eye size and ocular biometric measurements in standard average values were the most representative. The equatorial plane showed less difference with the actual intraocular lens position compared to the difference evidenced between the central plane and the actual lens position. The adequate position of the intraocular lens calculated in the capsular bag independent to the axial length, allowed to obtain a refractive result in correspondence to the one expected before surgery. Conclusion: The anatomical parameters of the crystalline lens (equatorial plane, central plane) are important variables to be taken into account for the development and improvement of the formulas for the calculation of the intraocular lens(AU)

A prospective comparative randomized controlled study of erector spinae plane block using local anesthetics versus general anesthesia for the perioperative control of pain in patients undergoing thoracoscopic procedures

Background: Patients posted for video-assisted thoracoscopic surgeries (VATS) are nowadays managed intraoperatively by general anesthesia (GA) with the use of oral and parenteral analgesics in the post-operative period. Ongoing research points out that the erector spinae plane block (ESP Block) with local anesthetics is a safe technique for the perioperative management of pain in thoracoscopic procedures. Aims and Objectives: Our study aimed at comparing ultrasound guided ESP block using local anesthetics versus GA for perioperative pain management in patients who underwent thoracoscopic procedures. The objectives of this research were to assess the hemodynamic changes in patients undergoing the procedure, to calculate the total amount of analgesics required by patients in the next 24 h, to assess the overall patient satisfaction and complications in the post-operative period. Materials and Methods: In this prospective comparative randomized controlled trial, 40 patients aged 18–65 years planned to undergo VATS were enrolled and randomized to either group G or group E in equal numbers depending on the anesthetic technique employed. Group G patients received GA and Group E patients received ultrasound guided ESP block. Both the groups were compared for hemodynamic stability, pain in postoperative period using visual analog scale (VAS), time to first rescue analgesia requested since induction, total amount of rescue analgesia requested, overall patient satisfaction, and post-operative complications. Results: Better control of hemodynamic parameters, less post-operative pain, prolonged duration of analgesia (P < 0.05), and requirement of lesser amount of rescue analgesics were observed in patients of Group E in comparison with patients of Group G. Side effects such as post-operative nausea and vomiting were more in patients of Group G in the first 24 h (P < 0.05). Conclusion: ESP block with local anesthetics can be used as an effective sole anesthetic technique for VATS <60 min providing a longer pain free post-operative period, lesser rescue analgesic requirement, better patient satisfaction, and lesser post-operative complications.

Is Continuous Erector Spinae Plane Block (ESPB) Better than Continuous Serratus Anterior Plane Block (SAPB) for Mitral Valve Surgery via Mini?Thoracotomy? Results from a Prospective Observational Study

Aims:Chest wall blocks are effective alternatives for postoperative pain control inmitral valve surgery in rightmini?thoracotomy (mini?MVS).We compared the efficacy of Serratus Anterior plane block (SAPB) and Erector Spinae plane block (ESPB) on postoperative pain relief aftermini?MVS. Settings and Design: It is a prospective, observational study. Material and Methods: A total of 85 consecutive patients undergoing continuous SAPB and continuous ESPB for mini?MVS from March 2019 to October 2020 were included. The primary outcome was the assessment of postoperative pain evaluated as absolute value of NRS at 12, 24 and 48 h. Secondary outcomes were assessment of salvage analgesia (both opioids and NSAIDs), incidence of mild adverse effects (i.e. nausea, vomiting, and incorrect catheter placement) and timing of postoperative course (ICU and hospital length of stay, duration of mechanical ventilation, ventilator?free days). Results: The median NRS was 0.00 (0.00–3.00) at 12 h and 0.00 (0.00–2.00) at 24 and 48 h. No significant differences were observed between groups. Postoperative morphine consumption in the first 24 h was similar in both groups (P = 0.76), whereas between 24 and 48 h was significantly less in the ESPB group compared with SAPB group, P = 0.013. NSAIDs median consumption and Metoclopramide consumption were significantly lower in the ESPB group compared to SAPB group (P = 0.002 and P = 0.048, respectively). Conclusions: ESPB, even more than SAPB, appears to be a feasible and effective strategy for the management of postoperative pain, allowing good quality analgesia with low consumption of opioids, NSAIDs and antiemetic drugs.

Anesthetic and surgical considerations for staged bilateral nephrectomies in a pediatric patient: A case report / Consideraciones anestésicas y quirúrgicas en nefrectomía bilateral en dos tiempos en un paciente pediátrico: Reporte de caso

Abstract We present a 9-year-old patient with end-stage renal disease, on peritoneal dialysis, who underwent a staged prone retroperitoneoscopic bilateral nephrectomy. Bilateral nephrectomy was indicated in preparation for renal transplant in the context of genetic predisposition malignancy when immunosuppressed. The two mirror-image surgeries enable the comparison of the anesthetic management and outcomes in a single patient. Features of interest to anesthesiologists include approach to a child with chronic kidney disease, different requirements for intraoperative antihypertensives; pain management strategies, including a comparison of erector spinae plane block with and without adjunct dexmedetomidine; anesthetic management of retroperitoneoscopic pediatric surgery and the first description of using a Foley bag attached to a peritoneal dialysis catheter to aid in diagnosis and repair of posterior peritoneal cavity entry.

Resumen Se presenta un paciente de 9 años de edad con enfermedad renal terminal, en diálisis peritoneal, quien se sometió a nefrectomía bilateral retroperitoneoscópica estadificada en posición prona. Se indicó la nefrectomía bilateral en preparación para trasplante renal en el contexto de predisposición genética hacia desarrollar una patología maligna al estar inmunosuprimido. Las dos cirugías en espejo permiten hacer una comparación del manejo anestésico y de los desenlaces en un mismo paciente. Las características de interés para los anestesiólogos incluyen el abordaje de un niño con enfermedad renal crónica, con requisitos diferentes de antihipertensivos intraoperatorios; estrategias para el manejo del dolor, incluyendo una comparación de bloqueo del plano del erector espinal con y sin dexmedetomidina adyuvante; manejo anestésico de cirugía pediátrica retroperitoneoscópica y la primera descripción del uso de una bolsa Foley conectada a un catéter de diálisis peritoneal para ayudar en el diagnóstico y la reparación de la entrada de la cavidad peritoneal posterior.