Bilateral lower thoracic erector spinae plane block in open abdominal gynecologic oncology surgery: a cases series / Bloqueio bilateral do plano eretor da espinha torácica inferior em cirurgia oncológica ginecológica aberta por via abdominal: série de casos

Abstract Objective and background: Erector spinae plane block is a novel analgesic truncal block that has been popularized due to its ease of performance and perceived safety. Erector spinae plane block has been postulated to target the ventral rami and rami communicates of spinal nerves, thus providing somatic and visceral analgesia. In this case series, we describe our experience of bilateral erector spinae plane block placed at the low thoracic level in open gynecologic oncology surgery in three patients. Method: Under ultrasound guidance, erector spinae plane blocks were done, preoperatively, at the 8th thoracic transverse process bilaterally. Numeric rating scale for pain and opioid consumption of the first 48 postoperative hours were recorded. Results: Pain scores ranged from 0 to 4 among the three patients and 48 h opioid consumption in oral morphine equivalents of 4, 6 and 18 mg. No adverse events were recorded up to patient discharge from the hospital. Conclusions: Erector spinae plane block provided effective analgesia in our case series. While its true mechanism of action remains obscure, the available case reports show encouraging analgesic results with no adverse events recorded. Formal prospective randomized trials are underway to provide further evidence on its efficacy, failure rate and safety.

Resumo Justificativa e objetivo: O bloqueio do plano do músculo eretor da espinha é um novo bloqueio troncular analgésico popularizado devido à sua facilidade de aplicação e segurança percebida. O bloqueio do plano do músculo eretor da espinha foi postulado para atingir os ramos ventrais e os ramos comunicantes dos nervos espinhais, proporcionando analgesia somática e visceral. Nesta casuística, descrevemos nossa experiência com o bloqueio do plano do músculo eretor da espinha bilateral depositado no nível torácico inferior em cirurgia oncológica ginecológica aberta em três pacientes. Método: Os bloqueios do plano do músculo eretor da espinha guiados por ultrassom foram administrados no pré-operatório, entre o 8° e o 10° processo transverso do tórax bilateralmente. Os valores de uma escala de classificação numérica para dor e consumo de opioides nas primeiras 48 horas de pós-operatório foram registrados. Resultados: Os escores de dor variaram de 0-4 entre as três pacientes e o consumo de opioide em 48 horas equivaleu à morfina oral (4, 6 e 18 mg). Nenhum evento adverso foi registrado até a alta hospitalar das pacientes. Conclusões: O bloqueio do plano do músculo eretor da espinha proporcionou analgesia efetiva em nossa casuística. Embora o mecanismo de ação verdadeiro permaneça obscuro, os relatos de casos disponíveis mostram resultados analgésicos encorajadores, sem eventos adversos registrados. Ensaios prospectivos randômicos formais estão em andamento para fornecer mais evidências sobre sua eficácia, taxa de falha e segurança.

Retrospective subjective evaluation of aesthetic outcome in secondary cleft lip deformities operated with Abbe’s flap.

Background: The Abbe’s flap is most commonly used to repair the full thickness defects of the lip that do not involve the commissure. The Abbe flap was first introduced to correct the secondary deformity of bilateral cleft lip. By this pedicled flap, we are able to equalize the disparity which existed between the tight upper lip and excessive lower lip. Aims to study retrospective subjective evaluation of aesthetic outcome in secondary cleft lip deformities operated with Abbe’s flap. Methods: 29 patients operated during the period of January 2007 - December 2011 for correction of secondary cleft lip and nasal deformity with Abbe’s flap with or without rhinoplasty were included in our retrospective study. The secondary corrective surgeries were performed by a single surgeon. The photographs of the patients were retrospectively assessed by two plastic surgeons and one oral and maxillofacial surgeon, other than the one who performed the surgery. 29 patients operated during the period of January 2007 - December 2011 for correction of secondary cleft lip and nasal deformity with Abbe’s flap with or without rhinoplasty were included in our retrospective study. The secondary corrective surgeries were performed by a single surgeon. The photographs of the patients were retrospectively assessed by two plastic surgeons and one oral and maxillofacial surgeon, other than the one who performed the surgery. Results: Out of 29 patients with secondary cleft deformities 12 were male and 17 were female. Average follow up period was 3 years. Multiple variables of the nose and the lips were used to assess the aesthetic outcome of Abbe’s flap. Conclusion: As per the subjective retrospective analysis of our study we have come to the conclusion that Abbe’s flap is a work horse for correction of shortage of tissue for the secondary cleft lip deformities. Uniform satisfactory outcome was obtained with a more natural contour and more satisfactory proportion of both lips.

Oroxylum indicum– a medicinal plant of North East India: An overview of its nutritional, remedial, and prophylactic properties.

Oroxylum indicum (family: Bignoniaceae) or Broken bones tree, which is distributed throughout India and South East Asia. Oroxylum indicum is known by such regional names as Bhatghila, Tona, Bhut-vriksha, Shyonaka, and Hanyu pinyin. Over the past two decades, many reports have appeared in mainstream scientific journals describing its nutritional and medicinal properties. While much of this recent enthusiasm indeed appears to be justified, it is critical to separate rigorous scientific evidence from anecdote. The present review provides the complete information about literatures of Oroxylum indicum as botanical descriptions, vernacular names, biological activity of plant parts, ethanomedicinal uses and current status of research with scope of investigation of Oroxylum indicum for future research. The structures of twenty eight isolated compounds from different parts of Oroxylum indicum with IUPAC names, molecular formula, formula weight, melting points were also reported in this study.

Anti ulcer activity of ethanol extract of the stem bark of Careya arborea Roxb.

The aim of the study was to determine anti ulcer activity of stem bark of Careya arbore Roxb. on the Wister strain albino rats. Dried stem bark of Careya arbore Roxb. was powdered and this coarse powder was extracted with 70% ethanol by soxhlet extraction method to yield a Ethanol extract of stem bark of Careya aborea Roxb. (EECA). The extract was subjected for preliminary phytochemical analysis and was evaluated for anti ulcer activity against various models such as Ethanol induced, cold restraint stress induced and Pylorus ligation induced models. In acute toxicity study, EECA was found to be safe till 3000mg/kg. So the doses of EECA at various concentration of 300 and 600mg/kg body weight was administered orally, twice daily for 5 days for prevention of ulcer from Pylorus ligation, Ethanol and cold restraint stress - induced ulcers. Analytical parameters like Percentage of Ulcer protection was calculated based on Ulcer index and Gastric juice volume, pH and acidity of gastric juice. Preliminary phytochemical analysis of EECA showed the presence of carbohydrates, glycosides, phytosterols, phenolic compounds, tannins and saponins. The EECA has shown significant activity at both 300mg/kg and 600mg/kg dose level in a dose dependent manner. Phytoconstituents like tannins and saponins may be responsible for anti ulcer activity of EECA.

Anti ulcer activity of ethanol extract of the stem bark of Careya arborea Roxb.

The aim of the study was to determine anti ulcer activity of stem bark of Careya arbore Roxb. on the Wister strain albino rats. Dried stem bark of Careya arbore Roxb. was powdered and this coarse powder was extracted with 70% ethanol by soxhlet extraction method to yield a Ethanol extract of stem bark of Careya aborea Roxb. (EECA). The extract was subjected for preliminary phytochemical analysis and was evaluated for anti ulcer activity against various models such as Ethanol induced, cold restraint stress induced and Pylorus ligation induced models. In acute toxicity study, EECA was found to be safe till 3000mg/kg. So the doses of EECA at various concentration of 300 and 600mg/kg body weight was administered orally, twice daily for 5 days for prevention of ulcer from Pylorus ligation, Ethanol and cold restraint stress - induced ulcers. Analytical parameters like Percentage of Ulcer protection was calculated based on Ulcer index and Gastric juice volume, pH and acidity of gastric juice. Preliminary phytochemical analysis of EECA showed the presence of carbohydrates, glycosides, phytosterols, phenolic compounds, tannins and saponins. The EECA has shown significant activity at both 300mg/kg and 600mg/kg dose level in a dose dependent manner. Phytoconstituents like tannins and saponins may be responsible for anti ulcer activity of EECA.