The Efficacy and Safety of Transversus Abdominis Plane Blocks After Open Cholecystectomy in Low- and Middle-Income Countries.

BACKGROUND: Postoperative pain management is challenging in low- and middle-income countries (LMICs). This study assesses the safety and efficacy of transversus abdominis plane (TAP) blocks as an adjunct for postoperative pain control after an open cholecystectomy in LMICs during short-term surgical missions (STSMs). TAP block is a regional anesthesia technique that has been shown to be effective in providing supplementary analgesia to the anterolateral wall post abdominal surgery. METHODS: A retrospective chart review of patients undergoing open cholecystectomy during STSMs was performed. STSMs took place in Guatemala, the Philippines, and Peru from 2009 to 2019. Measured outcomes including pain scores, presence of postoperative nausea or vomiting, and opioid consumption were compared between TAP block and non-TAP block groups. RESULTS: Of the 48 patients analyzed, 28 underwent TAP block (58%). Non-TAP block patients received, on average, 8 mg of oral morphine equivalents more than the TAP patients (P = 0.035). No significant difference was noted in pain scores, which were taken immediately after surgery, 2 h after surgery, and at multiple times between these time points to calculate an average. Of the patients who received a TAP block, 11% reported nausea or vomiting compared with 45% in the standard group (P < 0.01). There were no reported procedure-related complications. CONCLUSIONS: TAP blocks are safe and effective adjuncts for postoperative pain management on STSMs to LMICs. Additional studies are needed to investigate the potential advantages and disadvantages of more widespread use of TAP blocks in LMICs.

A Retrospective Review of Spinal Radiofrequency Neurotomy Procedures in Patients with Metallic Posterior Spinal Instrumentation - Is it Safe?

BACKGROUND: Recent studies have shown that medial branch radiofrequency neurotomy (RFN) procedures done at the level of a pedicle screw can increase pedicle screw temperature, and it has been speculated that pedicle screw heating may cause thermal injury. There has been a limited amount of investigation into the real-world safety profile of RFN procedures in patients with pedicle screws. OBJECTIVES: We aim to demonstrate that the occurrence of serious adverse events is rare for a medial branch RFN procedure completed at a level with metallic spinal hardware when performed according to the Spine Intervention Society practice standards. STUDY DESIGN: This study involved retrospective chart reviews of every patient who received an RFN procedure for spinal facet joint pain during the 5-year time period from 2012-2016. SETTING: The research took place within a single university-based interventional pain management center. METHODS: The study sample included 507 patient charts. Data collection included patient demographics, RF denervation sites at a level with metallic hardware, and all serious RF-related complications that could be attributable to heated metallic hardware. The research team developed medical-chart abstraction criteria for each of the following categorized complications: a) superficial burns, b) deep burns, c) denervation of dorsal ramus, d) denervation of ventral ramus, and e) coagulation of a spinal vascular structure. RESULTS: Of the 36 patients who met the inclusion criteria for this study, 43.6% were men and 56.4% were women. The mean age was 59.5 years old, with an age range of 25 to 87 years. There were a total of 56 ablations performed at a level with metallic spinal hardware, of which 11 were cervical, 44 were lumbar, and 1 was thoracic . There were zero documented complications found among our patient population in any of the 5 categories of serious complications. LIMITATIONS: As a retrospective chart review, this study was dependent on the availability and accuracy of medical records. Chart abstraction criteria for each outcome measure were developed by the research team without scientific testing. CONCLUSIONS: There have been no reported complications attributable to hardware temperature increases when performing medial branch RFNs at the level of a pedicle screw. For safety, it is important to use multiplanar fluoroscopic imaging techniques to ensure that the RFN cannula is not in contact with the pedicle screw. KEY WORDS: Radiofrequency neurotomy, medial branch nerve ablation, safety, thermal injuries, metallic spinal hardware, pedicle screws, lateral mass screws, cervical facet joints, severe complications, adverse events.

Moles and Mole Control on British Farms, Amenities and Gardens after Strychnine Withdrawal.

Moles are considered pests in Britain, but this issue has been little studied. Lower welfare standards have been tolerated for moles than for most other managed wild mammal species, as use of both the controversial poison, strychnine, and unregulated traps have been permitted. Strychnine was withdrawn in 2006 and there were fears that mole populations would increase as a result. In 2007, we conducted a comprehensive, nationwide survey of land manager perceptions, opinions and behaviour regarding moles and mole control on farms, amenities and domestic gardens in Britain. We surveyed 2150 land managers (achieving a 59% response rate) and ground-truthed 29 responses. Moles were reported to be present on most farms and amenities, and 13% of gardens, and were more common in lighter soils. Where present, moles were usually considered pests, this being more likely in Wales, Scotland and northern England, on livestock and mixed farms, and on large, high-value amenities, e.g., racecourses and golf courses. Mole control followed similar patterns to mole presence. More control may occur than is economically, and therefore potentially ethically, justified. Control should be more carefully considered and, where necessary, more effectively targeted. Kill-trapping was the favoured recent and future method on farms and amenities, even if strychnine was to be reintroduced; however, because mole traps are currently unregulated, some might not meet current welfare standards if tested. We found no evidence for an increase in moles since a farm questionnaire survey conducted in 1992; this could have wider implications for future wildlife management policy changes.

Global positioning system derived performance measures are responsive indicators of physical activity, disease and the success of clinical treatments in domestic dogs.

OBJECTIVE: To assess the use of Global Positioning System receiver (GPS) derived performance measures for differentiating between: 1) different outdoor activities in healthy dogs; 2) healthy dogs and those with osteoarthritis; 3) osteoarthritic dogs before and after treatment with non-steroidal anti-inflammatory analgesia. DESIGN: Prospective study. ANIMALS: Ten healthy dogs and seven dogs with osteoarthritis of the elbow joint (OA dogs). PROCEDURE: Healthy dogs were walked on a standard route on-lead, off-lead and subjected to playing activity (chasing a ball) whilst wearing a GPS collar. Each dog was walked for five consecutive days. Dogs with OA were subjected to a single off-lead walk whilst wearing a GPS collar, and then administered oral Carprofen analgesia daily for two weeks. OA dogs were then subjected to the same walk, again wearing a GPS collar. RESULTS: GPS derived measures of physical performance could differentiate between on-lead activity, off-lead activity and playing activity in healthy dogs, and between healthy dogs and OA dogs. Variation in the performance measures analysed was greater between individual dogs than for individual dogs on different days. Performance measures could differentiate healthy dogs from OA dogs. OA Dogs treated with Carprofen analgesia showed improvements in their physical performance, which returned to values indistinguishable from those of healthy dogs on nearly all the measures assessed. CONCLUSIONS AND CLINICAL RELEVANCE: GPS derived measures of physical performance in dogs are objective, easy to quantify, and can be used to gauge the effects of disease and success of clinical treatments. Specific stimuli can be used to modulate physical performance beyond the self-governed boundaries that dogs will naturally express when allowed to exercise freely without stimulation.

Climate and the individual: inter-annual variation in the autumnal activity of the European badger (Meles meles).

We establish intra-individual and inter-annual variability in European badger (Meles meles) autumnal nightly activity in relation to fine-scale climatic variables, using tri-axial accelerometry. This contributes further to understanding of causality in the established interaction between weather conditions and population dynamics in this species. Modelling found that measures of daylight, rain/humidity, and soil temperature were the most supported predictors of ACTIVITY, in both years studied. In 2010, the drier year, the most supported model included the SOLAR*RH interaction, RAIN, and 30cmTEMP (w = 0.557), while in 2012, a wetter year, the most supported model included the SOLAR*RH interaction, and the RAIN*10cmTEMP (w = 0.999). ACTIVITY also differed significantly between individuals. In the 2012 autumn study period, badgers with the longest per noctem activity subsequently exhibited higher Body Condition Indices (BCI) when recaptured. In contrast, under drier 2010 conditions, badgers in good BCI engaged in less per noctem activity, while badgers with poor BCI were the most active. When compared on the same calendar dates, to control for night length, duration of mean badger nightly activity was longer (9.5 hrs ±3.3 SE) in 2010 than in 2012 (8.3 hrs ±1.9 SE). In the wetter year, increasing nightly activity was associated with net-positive energetic gains (from BCI), likely due to better foraging conditions. In a drier year, with greater potential for net-negative energy returns, individual nutritional state proved crucial in modifying activity regimes; thus we emphasise how a 'one size fits all' approach should not be applied to ecological responses.

Mechanical performance of rat, mouse and mole spring traps, and possible implications for welfare performance.

Lethal spring traps are widely used for killing small mammals in the UK. Many require government approval, based primarily on humaneness. However, mole traps and break-back traps for rats and mice are exempt; those available vary widely in price and apparent quality. The EU is considering implementing a Trapping Directive that would alter UK legislation, and a recent report advised the EU that trapping legislation should cover all trapped species and encourage improvement of traps. Mechanical trap performance is often used as an indicator of welfare impact. We examined the mechanical evidence for scope to improve the welfare standards of rat, mouse and mole spring traps. We measured mechanical performance among a range of rat, mouse and mole traps. Impact momentum values varied 6-8 fold, and clamping force values 4-5.5 fold, among traps for killing each species. There was considerable overlap in the performance of rat and mouse traps. Trap-opening angle and spring type were related to impact momentum and clamping force in traps for both species. There was no relationship between price and mechanical performance in traps for any species, except talpa mole traps. We are unable to judge the direct welfare impact of the traps tested, but rather the potential welfare threat associated with their exemption from approval. The wide variation in mechanical performance in traps for each species, overlap in performance between rat and mouse traps and increasing availability of weaker plastic rodent traps indicate considerable scope for improving the humaneness of spring traps for rats, mice and moles. We conclude that all such traps should be subject to the UK approval process. New welfare categories might improve trap standards further. Our results could also help improve rodent trap design and assist consumers in selecting more powerful traps. Many thousands of rats, mice and moles might benefit.