Rejected

Retrospective, database review.

Optimal analgesia is an integral part of enhanced recovery after surgery (ERAS) programs designed to improve patients' perioperative experience and outcomes. Regional anesthetic techniques in a form of various fascial plane chest wall blocks are an important adjunct to the optimal postoperative analgesia in cardiac surgery. The most common application of fascial plane chest wall blocks has been for minimally invasive cardiac surgical procedures. An abundance of case reports has been described in the anesthesia literature and reports appear promising, yet higher-level safety and efficacy evidence is lacking. Those providing anesthesia for minimally invasive cardiac procedures should become familiar with fascial plane anatomy and block techniques to be able to provide enhanced postsurgical analgesia and facilitate faster functional recovery and earlier discharge. The purpose of this review is to provide an overview of contemporary fascial plane chest wall blocks used for analgesia in cardiothoracic surgery. Specifically, we focus on relevant anatomic considerations and technical descriptions including pectoralis I and II, serratus anterior, pectointercostal fascial, transverse thoracic muscle, and erector spine plane blocks. In addition, we provide a summary of reported local anesthetic doses used for these blocks and a current state of the literature investigating their efficacy, duration, and comparisons with standard practices. Finally, we hope to stimulate further research with a focus on delineating mechanisms of action of novel emerging blocks, appropriate dosing regimens, and subsequent analysis of their effect on patient outcomes.

Intracranial hypotension (IH) is a pathophysiological condition of reduced intracranial pressure caused by low cerebrospinal fluid (CSF) volume due to dural injuries like lumbar puncture, surgery etc. Understanding the prognosis of IH in small animal models is important to gain insights on the complications associated with it such as orthostatic headache, cerebral venous thrombosis, coma, etc. Photoacoustic tomography (PAT) offers a novel and cost-effective way to perceive and detect IH in small animal models. In this study, a pulsed laser diode (PLD) based PAT imaging system was used to examine the changes in the venous sinuses of the rat brain due to IH, induced through CSF extraction. After the CSF extraction an increase in the sagittal sinus area by ~30% and width by 40±5% was observed. These results provides supportive evidence that the PLD-PAT can be employed for detecting changes in sagittal sinus due to IH in rat model. This article is protected by copyright. All rights reserved.

Capparis tomentosa Lam. root is one of the commonly used traditional medicines for the treatment of pain and inflammatory conditions by the Kunama ethnic group of Ethiopia. Yet, its ethnomedicinal claim has not been scientifically investigated.

The transient receptor potential ankyrin 1 (TRPA1), a member of the TRP superfamily, is widely distributed in the central nervous system (CNS) and plays an important role in pain and inflammation. However, no data has been reported regarding the effects of TRPA1 on epileptic seizures. Thus, this study was designed to investigate the sub-chronic effect of trans-cinnamaldehyde (TCA), an agonist of TRPA1, in pentylenetetrazole (PTZ) induced kindling model via electrocorticography (ECoG). Furthermore, the expressions of cAMP response element binding protein (CREB), brain-derived neurotrophic factor (BDNF), and NMDA receptor subunit NR2B were measured using Western blotting. Rats were kindled by intraperitoneal (i.p.) PTZ (35 mg/kg) injections. After electrode implantation and healing period, 10 and 30 mg/kg TCA was given i.p. for 14 consecutive days. On the next day, ECoG recordings were obtained after the injection of PTZ (35 mg/kg, i.p.), and twenty-four hours later, rats were decapitated for molecular analyses. TCA, at a dose of 30 mg/kg, decreased the first myoclonic jerk latency and increased seizure duration and total spike activity. Additionally, both doses of TCA enhanced CREB, BDNF, and NR2B expressions, which were increased by the kindling. The evidence from this study suggests that long term activation of TRPA1 channels causes an exacerbated seizure activity. Moreover, PTZ-induced increases in CREB, BDNF, and NR2B levels were enhanced by the repeated administrations of TCA.

The molecular mechanisms of prostate inflammation, a common disease of the prostate with symptoms of pain and/or heighten immune response, are still poorly understood. In this study, we hypothesized that heme oxygenase-1 (HO-1), an enzyme responsible for degradation of heme to carbon monoxide (CO), bilirubin, and iron is an important regulator of inflammation and epithelial responses in the prostate. Injection of non-uropathogenic E. coli (MG1655 strain) or PBS into the urethra of mice led to increased numbers of CD45+ leukocytes and mitotic markers (phosphorylated histone H3 and phosphorylated extracellular signal-regulated kinase; Erk1/2) in the prostate glands. Leukocyte infiltration was elevated in prostates harvested from mice lacking HO-1 in the myeloid compartment. Conversely, exogenous CO (250 ppm) increased IL-1β levels and suppressed cell proliferation in the prostates. Of note, CO did not affect the number of infiltrating CD45+ cells in the prostates of either E. coli- or PBS-treated mice. Interestingly, immunomodulatory effects of HO-1 and CO correlated with early induction of the long-chain acyl-CoA synthetase 1 (ACSL1). ACSL1 was induced in response to E. coli infection in macrophages and was in part required for IL-1β expression and prostate cancer cell colony growth in soft agar. In summary, these results suggest that HO-1/CO might play a distinctive role in modulating prostate inflammation, cell proliferation and IL-1β induction in part via an ACSL1-mediated pathway.

Patients undergoing noncardiac surgery after coronary stent implantation are at an increased risk of thrombotic complications. Volatile anesthetics are reported to have organ-protective effects against ischemic injury. Propofol has an anti-inflammatory action that can mitigate ischemia-reperfusion injury. However, the association between anesthetic agents and the risk of major adverse cardiovascular and cerebral event (MACCE) has never been studied before. In the present study, a total of 1630 cases were reviewed. Four different propensity score matchings were performed to minimize selection bias (propofol-based total intravenous anesthesia (TIVA) vs. volatile anesthetics; TIVA vs. sevoflurane; TIVA vs. desflurane; and sevoflurane vs. desflurane). The incidence of MACCE in these four propensity score-matched cohorts was compared. As a sensitivity analysis, a multivariable logistic regression analysis was performed to identify independent predictors for MACCE during the postoperative 30 days both in total and matched cohorts (TIVA vs. volatile agent). MACCE occurred in 6.0% of the patients. Before matching, there was a significant difference in the incidence of MACCE between TIVA and sevoflurane groups (TIVA 5.1% vs. sevoflurane 8.2%, = 0.006). After matching, there was no significant difference in the incidence of MACCE between the groups of any pairs (TIVA 6.5% vs. sevoflurane 7.7%; = 0.507). The multivariable logistic regression analysis revealed no significant association of the volatile agent with MACCE (odds ratio 1.48, 95% confidence interval 0.92-2.37, = 0.104). In conclusion, the choice of anesthetic agent for noncardiac surgery did not significantly affect the development of MACCE in patients with previous coronary stent implantation. However, further randomized trials are needed to confirm our results.

Cav. (Asteraceae) is an ancient medicinal plant commonly used to alleviate pain. Nevertheless, scientific studies validating this property are lacking in the literature. Animal models of pain were used to evaluate the antinociceptive and anti-inflammatory activities of essential oil (TLEO) and a bioactive metabolite. The chemical constitution and possible toxicity of the extract and the mechanism of action of β-caryophyllene were also explored. Temporal course curves and dose-response graphics were generated using TLEO (0.1-10 mg/kg or 3.16-31.62 mg/kg) and β-caryophyllene (3.16-10 mg/kg). Metamizole (80 mg/kg) and indomethacin (20 mg/kg) were used as reference drugs in the formalin assay and writhing test in rats and mice, respectively. The β-caryophyllene mechanism of action was explored in the presence of naloxone (1 mg/kg), flumazenil (10 mg/kg), WAY100635 (0.16 mg/kg), or nitro-l-arginine methyl ester (L-NAME) (20 mg/kg) in the formalin test in rats. GC/MS analysis demonstrated the presence of geranyl acetate (49.89%), geraniol (7.92%), and β-caryophyllene (6.27%). Significant and dose-dependent antinociceptive response was produced by TLEO and β-caryophyllene without the presence of gastric damage. In conclusion, β-caryophyllene was confirmed as a bioactive compound in the analgesic properties by involving the participation of receptors like opioids, benzodiazepines, and Serotonin 1A receptor (5-HT), as well as nitric oxide.

Multiple physiological and neuroendocrine changes consistent with stress and pain have been demonstrated in cattle spayed via the Willis dropped ovary technique (WDOT). The procedure is routinely conducted without the use of anaesthetics or analgesics and has major implications for animal welfare. This study aimed to evaluate the effect of a topical anaesthetic (TA), haemostatic wound dressing, and meloxicam on pain behaviour and haemorrhage in the acute period following spaying. Yearling Brahman heifers ( = 75) were randomly allocated to the following treatment groups: (1) rectal palpation/control (CON); (2) WDOT spay (S); (3) WDOT spay with meloxicam (SM); (4) WDOT spay with TA (STA); and (5) WDOT spay with TA and meloxicam (STAM). Individual behavioural responses, body weight, packed cell volume (PCV), and total plasma protein (TPP) were monitored for up to 24 h following treatment. Head tucking behaviour and tail stiffness was increased in all spay groups compared to the CON group ( < 0.001), with the lowest proportional increase in the SM group. Rumination was initially reduced in S, SM, and STA heifers compared to CON heifers ( < 0.001), though SM heifers ruminated more than S heifers ( < 0.001). CON and SM heifers stood with an arched back the least, spent the most time eating, and spent less time lying down and more time standing compared to other treatment groups ( < 0.001). There was no significant effect of treatment on weight change ( = 0.519), PCV ( = 0.125) or TPP ( = 0.799). The administration of meloxicam is suggested as an effective, currently available method for improving the welfare of cattle undergoing WDOT spaying.

Appropriate pain management is essential to improve the postoperative recovery after total hip arthroplasty (THA). Various case reports have indicated that anterior quadratus lumborum block (QLB) provides effective postoperative analgesia in lower limb surgeries. However, few randomized controlled trials have confirmed the efficacy of anterior QLB for lower limb surgeries. The aim of this single-center, double-blind, randomized controlled trial is to confirm the efficacy of anterior QLB for postoperative recovery after THA.