A comparison of efficacy of erector spinae plane block versus serratus anterior plane block plus subcostal transversus abdominus plane block for bariatric laparoscopic sleeve gastrectomy surgery: study protocol for a randomised clinical trial.

BACKGROUND: Obesity is a rapidly growing global health concern. Limited long-term success of diet, behavioural modification and medical therapy have led to the increased performance of bariatric surgery. Laparoscopic sleeve gastrectomy, which permanently reduces the size of the stomach, has been shown to cause considerable weight loss, as well as improving or even eliminating obesity related medical comorbidities such as diabetes, obstructive sleep apnoea and hypertension. Unfortunately, this surgery can also result in significant postoperative pain which, when combined with the dangers of perioperative opioid administration for bariatric patients, can lead to a significantly reduced quality of recovery. Opioid-sparing analgesia has been widely recommended for perioperative bariatric patients, but research into the optimum regional analgesia approach for this surgery is lacking, with no trials to date comparing different regional analgesic techniques. This study protocol describes a randomised clinical trial aimed at answering this question, comparing the quality of recovery after laparoscopic sleeve gastrectomy for patients who receive erector spinae plane block, versus those who receive serratus anterior plane block plus subcostal TAP block. METHODS: We propose a prospective, randomised, blinded (investigator) clinical trial in a tertiary hospital in Ireland. Seventy patients presenting for laparoscopic sleeve gastrectomy will be randomised to two study groups-group A will receive bilateral erector spinae blockade; group B will receive left sided serratus anterior plane block plus subcostal TAP blocks. Both groups will receive the same dose of the same local anaesthetic and the different regional technique performed will be the only difference in their care. The primary outcome will be QoR-15 scores at 24 h postoperatively, a validated international tool for assessing a patient's overall postoperative recovery. DISCUSSION: Regional analgesia should be a mainstay of perioperative opioid-sparing analgesia where possible. This is especially important in the bariatric cohort who are particularly susceptible to the complications of perioperative opioid administration. To the best of our knowledge, this trial will be the first to compare efficacy of two different regional analgesia techniques for bariatric patients undergoing laparoscopic sleeve gastrectomy surgery. TRIAL REGISTRATION: This trial was pre-registered on clinicaltrials.gov, registration number NCT05839704, on March 5, 2023. All items from the World Health Organisation Trial Registration Data Set have been included.

Comparison of the impact of powerpoint and chalkboard in undergraduate medical teaching: an evidence based study.

OBJECTIVE: To compare the impact of the PowerPoint multimedia presentation and chalkboard in teaching by assessing the knowledge based on the marks obtained. STUDY DESIGN: Cross-sectional study. PLACE AND DURATION OF STUDY: Department of Physiology, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia, from December 2007 - June 2009. METHODOLOGY: Three-hundred male medical students were divided into three groups and a selected content-based lecture in physiology was delivered. For one group lecture was delivered using PowerPoint presentation, for second group using chalkboard and for third group the lecture was delivered by using both PowerPoint as well as chalkboard. Single-best Multiple Choice Questions [MCQs] paper was used for assessing the knowledge gained. The same exercise was repeated in another medical science school for the confirmation of validity and reliability of the results. RESULTS: Students who attended the class on both PowerPoint and chalkboard obtained significantly higher score in single best MCQ examination compared to those students who attended the same content based lecture on the PowerPoint or chalkboard alone (p = 0.05). CONCLUSION: The integrated (PowerPoint and chalkboard) method of teaching was found more suitable tool of teaching and learning than PowerPoint or chalkboard alone.

Effect of drinking Arabian Qahwa on fractional exhaled nitric oxide levels in healthy nonsmoking Saudi adults.

OBJECTIVES: Fractional exhaled nitric oxide (FENO) is an emerging marker of inflammation in respiratory diseases. However, it is affected by a number of confounding factors. We aimed to study the effect of drinking Arabian Qahwa on FENO in non-smoking Saudi healthy adults. METHODS: We recruited 12 nonsmoker healthy male adults aged 36.6 ± 2.7 (21-50) years. All subjects were free from acute respiratory infections or allergies and had normal ventilatory functions and serum IgE levels. At 8 am in the morning, their baseline values of FENO were recorded. They had not taken tea or coffee in the morning and had taken similar light breakfast. They were given three cups of Arabian Qahwa to drink and then after every 30 minutes, serial levels of FENO were recorded. RESULTS: Average FENO levels at baseline were 28.73 ± 9.33 (mean ± SD) parts per billion (ppb). The mean FENO levels started to decrease significantly after 30 minutes of drinking Arabian Qahwa (P=0.002). This decrease in FENO level was further observed till two hours after Qahwa drinking and then it started to increase in next 90 minutes but still was significantly lower than the baseline (P=0.002). The mean FENO level recorded after 4 hours was 27.22 ± 10.22 (P=0.039). CONCLUSIONS: FENO levels were significantly lowered by intake of Arabian Qahwa and this effect remains for about 4 hours. Therefore, history of recent Qahwa intake and abstinence is essential before performance of FENO and its interpretation.

Effect of cigarette smoking on fractional exhaled nitric oxide in Saudi medical college students.

OBJECTIVE: To see the levels of fractional exhaled nitric oxide (FENO) in young adult smokers and its relationship with duration and dose of smoking. METHODS: This study was conducted at the department of Physiology of College of Medicine and King Khalid University Hospital, Riyadh, Saudi Arabia from January 2009 to June 2009. A total of 60 medical students were initially recruited and 48 were finally selected for the study after fulfilling our selection criteria. FENO measurements were performed online according to the recent American Thoracic Society (ATS) guidelines and ventilatory functions were recorded. RESULTS: The difference in age, Body mass index (BMI), Systolic blood pressure (SBP) and Diastolic blood pressure (DBP) between the two groups was non significant. Lung function parameters included FEV1, FVC and FEV1/FVC ratio and the difference was non significant between the two groups. It was observed that FENO was significantly lower in smokers than non smokers (16.62 +/- 5.13 verses 24.35 +/- 6.17, p=0.0001). No relationship of FENO was observed with duration and dose of smoking. CONCLUSION: Young adult smokers exhibit lower levels of fractional exhaled nitric oxide compared to non smokers. This could be an early indicator of effects of smoking on lungs.