Background: Post-laparoscopic cholecystectomy (LC) pain control is still an issue postoperatively. Objectives: We investigated the effectiveness of the unilateral right-side ultrasound-guided erector spinae plane block (ESPB) on post-LC pain intensity and opioid consumption. Methods: This is a parallel-arm randomized control trial on 62 adult patients with an American Society of Anesthesiologists (ASA) physical status ≤ 2 who underwent LC. The patients were randomized into 2 groups (the block group [BG] and the control group [CG]; n = 31 per group). BG received a single-shot right-sided T7 ESPB with 20 mL of 0.2% ropivacaine at arrival time in the post-anesthesia care unit (PACU). CG) received no regional anesthesia. Both groups received patient-controlled intravenous fentanyl and rescue meperidine for analgesia. The primary outcome was the pain intensity determined using a Numerical Rating Scale (NRS) in the first 24 hours after surgery. Secondary outcomes included total fentanyl and meperidine consumption within 24 hours. Results: Median pain scores were significantly higher in CG at rest and with coughing up to 12 hours after surgery compared with BG. Pain scores were higher in CG with a cough at 24 hours compared with BG (median 1 [interquartile range (IQR) 1, 2] vs. 1 [1, 0]; P = 0.0005). Total fentanyl consumption and meperidine consumption within 24 hours were significantly lower in BG compared with CG (median 60 µg [IQR 60, 90] vs 250 µg [90, 300]; P < 0.0001 and median 20 µg [IQR 10, 20] vs 25 [20, 25]; P = 0.002, respectively). Conclusions: A single-shot, right-sided, unilateral ESPB decreases post-LC opioid consumption and pain.

Background: Regional anesthesia is widely supported as a part of multimodal analgesia for post-operative pain management following cardiac surgery. A common technique for managing post-sternotomy pain is the parasternal intercostal plane (PIP) block, which involves injecting anesthetics into the fascial planes near the sternum to block the anterior cutaneous branches of the T2 – T6 nerves. Objective: This study aimed to assess the effects of PIP blocks on post-sternotomy pain, narcotic usage, intensive care unit (ICU) stay, and extubation time following adult cardiac surgeries. Methodology: We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) investigating PIP blocks in adult cardiac surgery with midline sternotomy. Studies were retrieved from PubMed, Cochrane Library, and Embase through February 22, 2023. The risk of bias (ROB) in RCTs was assessed using the Cochrane ROB tool, version 2. Twelve RCTs involving 819 adult patients were included. Primary outcomes were pain scores at 12 and 24 h post-surgery and narcotic usage in morphine milligram equivalents (MME). Secondary outcomes included extubation time and ICU stay. Results: The PIP block group had significantly lower pain scores at 12 (mean difference [MD]: −1.21 points, 95% confidence interval [CI]: −2.17, −0.25, p = 0.013) and 24 hours (MD: −0.69 points, 95% CI: −1.35, −0.02, p = 0.042), and reduced MME use (MD: −30.34 MME, 95% CI: −45.80, −14.89, p < 0.001). PIP blocks did not significantly reduce extubation time (MD: −0.77 h, 95% CI: −1.64, 0.09, p = 0.080) but were associated with shorter ICU stay (MD: −0.54 days, 95% CI: −0.94, −0.13, p = 0.009). Conclusion: PIP blocks provided effective analgesia and reduced ICU stay in cardiac surgery patients requiring sternotomy, but due to study heterogeneity, results should be interpreted with caution. Future research is warranted to explore its short- and long-term outcomes.

Background: Accurate tip positioning of a peripherally inserted central catheter (PICC) is crucial for optimal drug delivery and avoiding complications. The objective of this study was to evaluate the amplitude ratios of intravascular electrocardiography (ivECG) and external electrocardiography (exECG) according to the tip location.Methods: This retrospective study analyzed ivECG, exECG, and chest X-ray (CXR) of 278 patients who underwent a PICC procedure. The tip-to-carina distance (TCD) was measured using vertebral body units (VBU) on CXR. Tip locations were categorized as follows: Zone 1, malposition (TCD < 0.8 VBU); Zone 2, suboptimal (0.8 VBU ≤ TCD < 1.5 VBU); Zone 3, optimal (1.5 VBU ≤ TCD ≤ 2.4 VBU); Zone 4, deep (TCD > 2.4 VBU). The amplitude ratios between ivECG and exECG and within ivECG were compared in each zone.Results: The ivECG/exECG amplitude ratios of P-wave (Piv/Pex) and QRS-complex (QRiv/QRex and RSiv/RSex) in Zone 3 were significantly higher than in Zones 1 and 2 (adjusted P < 0.05). The ivECG amplitude ratios of the P-wave and QRS-complex (Piv/QRiv and Piv/RSiv) were significantly lower in Zone 3 than in Zones 1 and 2 (adjusted P < 0.001). The calculated TCD using stepwise multiple regression analysis was estimated to be 1.121 + 0.078 × Piv/Pex – 0.172 × Piv/QRiv.Conclusions: Though caution is required, amplitude ratios such as Piv/Pex and Piv/QRiv can help determine tip location during the PICC catheterization procedure.

Background: Accreditation Council for Graduate Medical Education (ACGME) has been used to evaluate the residents’ competency; however, the thriving of residents needs especial training methods and techniques. Small group learning has been used for this propose. Objectives: This study assessed the attitudes of CA-1 to CA-3 anesthesiology residents toward level-specific small-group blended learning. Methods: Anesthesiology residents from Department of Anesthesiology, Shahid Beheshti University of Medical Sciences (SBMU), Tehran, Iran participated in this cross-sectional attitude assessment descriptive-analytical study throughout the 2nd academic semester (May-October 2019). They took part in a level-specific small-group blended learning program and filled out an attitude assessment questionnaire. The questionnaire included eight closed questions and was filled out anonymously. Results: The residents believed that this program made important contributions to their theory training and clinical skills of anesthesia; while created a greater sense of solidarity. In addition, nearly the majority of the respondents did not believe that participating in the classes made interference in their clinical duties or was a difficult task. Instead, the majority of residents believed that these classes were in favor of reducing their burnout. The reliability of the questionnaire based on Cronbach’s Alpha was 0.885. Conclusions: Anesthesiology residents are in favor of small-group learning, especially when considering their clinical setting and the degree of burnout they tolerate.