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Thursday 05 September
08:00	"Thursday 05 September" Added to your list of favorites Deleted from your list of favorites A20 08:00 - 09:55 SPECIAL SESSION Nerve injury after regional anesthesia, trauma or surgery - what to do? Chairperson: Urs EICHENBERGER (Head of Department) (Chairperson, Zürich, Switzerland) 08:00 - 08:05 Introduction. Urs EICHENBERGER (Head of Department) (Keynote Speaker, Zürich, Switzerland) 08:05 - 08:30 What kind of imaging Is appropriate at What time? Hannes PLATZGUMMER (Radiology Consultant) (Keynote Speaker, Vienna, Austria) 08:30 - 08:55 What kind of neurophysiological examinations are appropriate? Anne PEYER (senior consultant) (Keynote Speaker, Basel, Switzerland) 08:55 - 09:20 Experiences of a peripheral nerve injury clinic. Thomas Fichtner BENDTSEN (Professor, consultant anaesthetist) (Keynote Speaker, Aarhus, Denmark) 09:20 - 09:45 Diagnostic Nerve ultrasound in the evaluation of perioperative Nerve injuries and neuropathic pain. David LORENZANA (Head Pain Therapy) (Keynote Speaker, Zürich, Switzerland) 09:45 - 09:55 Q&A.	CONGRESS HALL
	"Thursday 05 September" Added to your list of favorites Deleted from your list of favorites B20 08:00 - 09:50 NETWORKING SESSION State of the art labour analgesia Chairperson: Eva ROOFTHOOFT (Anesthesiologist) (Chairperson, Haacht, Belgium) 08:00 - 08:05 Introduction. Eva ROOFTHOOFT (Anesthesiologist) (Keynote Speaker, Haacht, Belgium) 08:05 - 08:27 Defining the mobile epidural. Alexandra SCHYNS-VAN DEN BERG (Consultant anesthesiology) (Keynote Speaker, Dordrecht, The Netherlands) 08:27 - 08:49 Initiation and maintenance of neuraxial analgesia. Eva ROOFTHOOFT (Anesthesiologist) (Keynote Speaker, Haacht, Belgium) 08:49 - 09:11 Managing the failing epidural. Tatiana SIDIROPOULOU (Professor and Chair) (Keynote Speaker, Athens, Greece) 09:11 - 09:33 #43393 - B20 Non-neuraxial labour analgesia. Non-neuraxial labour analgesia. 1. Introduction Currently, a wide variety of nonpharmacologic interventions and pharmacological agents are used to alleviate maternal pain in labour. Non-pharmacological methods can be used as a principal method or complementary to pharmacologic agents. Studies have shown their positive impact on subjective experiences of childbirth. This is emphasized by the fact that worldwide, nearly 73% of women use at least 1 nonpharmacological method during their childbirth. (1) The reported leading methods are breathing techniques, position changes, massage, mental strategies-relaxation. Thus far there is little high-quality evidence as an analgesic method during labour. (2) Nevertheless, patient satisfaction combined with infrequent incidence of adverse events have led professional societies to acknowledge its utility as an adjunct to pharmacologic agents upon maternal request. (3) Pharmacologic options for pain relief during labour can be divided according to route of administration, systemic and regional (epidural). In this section we will focus on systemic pharmacologic agents only. 2. *Nitrous oxide (N2O)* N2O has been used worldwide for labour analgesia for several decades. (4) Its analgesic effectiveness is achieved from increasing the release of endogenous endorphins, dopamine, and other natural opioids in the brain and neuromodulation in the spinal cord that offers rapid onset inhaled analgesia. (5) It also affects several other hormones that are important during labour and birth including prolactin, cortisol, and epinephrine/norepinephrine, but it does nor reduce the relies or effectiveness of endogenous oxytocin and has no effects on uterine contractions or labour progress. (5) When given in a 1:1 mix with oxygen, N2O has a good safety profile. (4) Adverse effects associated with N2O use, such as nausea, dizziness, and drowsiness, have been reported. N2O was found to have some analgesic effect, it decreases woman’s perception of pain, and has an anxiolytic effect that may be helpful if women are restless or doubt their ability to cope as commonly occurs near the end of the first stage of labour. Nitrous oxide is eliminated quickly and entirely by the neonatal lungs, with no effect on Apgar and neonatal neurobehavioral scores. (6) In a study of 1300 Chinese women randomized to inhale either 50% nitrous oxide or 50% oxygen during labour, the women who inhaled N2O had shorter active phases of labour (153 vs. 187min) and fewer caesarean births (11,6% vs 19.3%). (7) That could be attributed to the inhibition of the excitatory stimulation in the neocortex which inhibits the involuntary physiological processes of birth. Studies comparing nitrous oxide with epidural analgesia found the former less effective. (8) In a postpartum survey of 2482 parturients, 80% rated EA as very effective, compared with 44% among those who were using nitrous oxide. (9) Richardson et al., on the other hand, reported a heterogeneity in nitrous oxide analgesic activity. In a postpartum survey in 6507 parturients who delivered vaginally by either EA or nitrous oxide, 50% of those with nitrous oxide reported high analgesic effectiveness scores, the reminder split between intermediate (27%) and low scores (21%). Despite that, the satisfaction scores were uniformly high in all groups and like those who either chose EA from the beginning or swich from nitrous oxide to EA. (10,11) The use of nitrous oxide in labour and delivery wards is associated with certain occupational exposure risks. This is due to deactivation of vitamin B_12,which is used by methionine synthase to convert homocysteine into methionine, which uses folate to synthesize myeline and DNA and RNA. When cobalamin is not available, methionine synthase cannot convert homocysteine, and plasma levels of homocysteine rise. After chronic exposure, this can lead to hematologic complications such as megaloblastic anaemia and demyelinating neuronal injury, potentially exerting relevant genotoxicity, which was not detected after exposure to other volatile anaesthetics. (12,13) Occupational exposure to N2O has been significantly reduced over the last 25 years due to scavenging and ventilation. N2O is a greenhouse gas and is considered an environmental pollutant. 3. *Opioids* Opioids are commonly used for pain relief during labour, as they are widely available, easy to use and are of low cost. Their main advantage is that they produce analgesia with milder effect on sensation and proprioception. They act through opioid receptors distributed throughout the CNS including brain structures (thalamus, nucleus raphe, locus coeruleus and limbic system), and the dorsal horn of the spinal cord where their action is pre-and postsynaptic. Given systematically, opioids act through all sites simultaneously with the supraspinal systems being most sensitive. Opioid use during labour is associated with maternal side effects including nausea, vomiting, pruritus, sedation, and respiratory depression. After crossing the placenta, opioids may lead to reduced baseline foetal heart rate and foetal heart rate variability, neonatal respiratory depression, lower Apgar scores, neurobehavior alternations, and decreased early breastfeeding. (14) A. *Meperidine/pethidine* Meperidine is the most frequently used systemic opioid. Onset of action is 5-10 min after iv. injection and up to 45 min after im. injection with a half-life of 2-4 hours. Meperidine is metabolized to an active longer lasting normeperidine, which has a prolonged half-life in adults and a half-life of up to 72 hours in neonates. Maximal foetal exposure, and hence neonatal respiratory depression and metabolic acidosis are seen if pethidine was given between 1-4 hours before birth. (14) The neonatal side effects are dose- and time dependant, and comprise of depressed respiration, Apgar scores, neurobehavioral scores, muscle tone and suckling and detrimental effect on breast feeding. Meperidine provides only mild pain relief. It is equally effective than nitrous oxide and less effective than neuraxial analgesia. A recently published RCT compared the efficacy of intravenous (IV) meperidine and inhaled N2O for intrapartum pain relief among multiparous, term, singleton gestations. The results showed that pain intensity after 20 to 30 minutes of analgesic administration, as assessed by VAS score, was comparable between the groups (primary outcome). The mean VAS scores that were between 7 and 8 in both groups at baseline, and at 20 and 30 minutes after analgesia administration, suggests that neither technique provided adequate analgesia. Secondary outcomes, which included rate of additional analgesic use, labour length, mode of delivery, breastfeeding, satisfaction, and maternal and neonatal adverse effects, were similar between the groups. The authors concluded that pain intensity and adverse effects were comparable between the 2 analgesic methods. (15) Douma et al. compared pethidine PCA with remifentanil PCA and reported two main findings. The rate of crossovers to EA was higher for pethidine, and pain relief was greater with remifentanil, but this difference disappeared after one hour. (16) Pethidine is still very popular among midwifes and obstetricians due to belief of its effect on labour duration and cervical ripening. Various reports described the mechanism underlying these effects. During cervical ripening, pethidine increases urokinase activity which converts plasminogen into active plasmin, which further converts pro-collagenase into active collagenase. Sosa and colleagues conducted a randomized controlled trial to examine meperidine use in the management of women with dystocia during the first stage of labour. The authors found no differences between the intervention and placebo groups in duration of labour or in any of the maternal secondary outcomes. (17) B. *Remifentanil patient-controlled analgesia (remifentanil-PCA)* From the pharmacological viewpoint, remifentanil-PCA provides advantages in comparison with other opioids. Remifentanil is a potent synthetic μ-opioid receptor agonist with a rapid onset and ultrashort duration of action making it suitable for labour analgesia. When administered by patient-controlled analgesia (PCA), it can mimic the intermittent profile of labour contractions. Remifentanil is rapidly metabolized by plasma esterizes into inactive metabolites, independently of renal and liver function. With a very short context sensitive half-life of 3.5 min, it does not accumulate even when administered during prolonged infusion. Remifentanil crosses the placenta and is quickly redistributed and metabolized by the neonate. The potential side effects for mother and child are therefore very short-lived, which makes it extremely well steerable. (18) In terms of analgesic efficacy, remifentanil-PCA provides only mild pain relief which helps women better coping with pain. The reduction of pain spans from severe-unbearable (VAS 8-10) to intermediate-bearable (VAS 5-7), lasting up to one hour. The RESPITE study compared remifentanil IV-PCA to intramuscular meperidine in a non- blinded, 1:1 randomized controlled trial. Remifentanil-PCA was associated with a significantly lower proportion of women requesting epidural analgesia (19% vs. 41%). The mean VAS scores were significantly lower with remifentanil as compared to meperidine (50 vs. 65), while the reduction in VAS scores was similar in both groups. Women in the remifentanil group were more satisfied with their pain relief as compared to those in the meperidine group, while no differences were observed in the overall birth satisfaction between the groups. (19) Compared to neuraxial analgesia, several randomized controlled trials and 2 meta-analyses reported higher pain scores and shorter duration of pain relief with remifentanil-PCA. (20, 21) Consequently, neuraxial analgesia was associated with greater satisfaction with pain relief as compared to remifentanil-PCA. (22,23) In 2019, two large audits were published, one from Ulster hospital and another from Remi-PCA SAFE Network with over 13000 remifentanil-PCA applications, which by 2022 counted for over 25000 documented cases. REMI-PCA Network with over 13000 remifentanil-PCA applications. (24, 25) For comparison, in our institution (Dpt. of Perinatology, UMC Ljubljana, Slovenia), the remifentanil-PCA has been used routinely for labour analgesia since 2013 per the standard operative protocol of the Department of Anaesthesiology and Intensive Therapy, University Medical Centre Ljubljana. By 2023, our institution alone reached over 13000 remifentanil applications. Indications for remifentanil-PCA are parturient request, when EA is contraindicated, after unsuccessful epidural administration, accidental dural puncture or technical failure, in an advanced labour or rapidly progressing labour and for obstetric indications such as breech or tween vaginal deliveries and a trial of labour after CS. During this 10-year period, no severe maternal complications in terms of cardiorespiratory arrest or respiratory depression requiring mask ventilation have been observed in any of our parturient. That could be attributed to the established safe operative standards which have been constantly reviewed and adjusted during the extensive routine use of remifentanil-PCA in our institution. Nevertheless, several RCT and meta-analysis reported a higher incidence of respiratory depression associated with remifentanil-PCA as compared to neuraxial analgesia. (20,21) However, this incidence of respiratory adverse effects associated with remifentanil-PCA does not appear to be significantly different from hypoxic episodes during labour with nitrous oxide and or long-acting opioids. (26) Hypoxic episodes can also occur during labour with epidural analgesia or without any analgesic treatment. Continuous care by the midwife, who intervenes immediately in the event of mild hypoxia or sedation, prevents the escalation of a benign, self-limiting situation and is one major aspects of safe administration. The short half-life of remifentanil contributes significantly to the fact that the regime settings can be adjusted quickly and efficiently in case of adverse reactions. Regular training of the personnel, clear standards for critical values and appropriate interventions are paramount for a high level of safety, while the parturient additionally benefit from the continuous professional care which contributes significantly to overall satisfaction with labour experience. (27, 28) In addition, since the expectations of women also depend on the cultural and personal environment and their personality, careful information about the benefits and drawbacks of remifentanil or any other method of pain relief is of great importance when counselling patient to be sure that their labour experience will meet their expectations as much as possible. (29) In terms of labour progress and outcomes, no differences in the rate of spontaneous delivery were reported by meta-analysis of 9 RCT trials comparing remifentanil-PCA with epidural analgesia. (20) On the other hand, a cohort study with more than 10000 deliveries comparing epidural vs remifentanil analgesia found remifentanil-PCA to be associated with lower CS and OVD rates in nulliparous women with spontaneous and induced labour and in multiparous women with spontaneous onset of labour, respectively. No differences in neonatal outcomes were recorded between the two analgesic techniques within any of the studied groups. (30) However, the associations observed in that study may not necessarily imply a causal relationship. Favourable results of non-operative delivery with Remifentanil-PCA may also point to the fact that more complicated labours require EA to assist in their management. On the other hand, the women with normal labour progress or expectations of faster labour are more likely to choose remifentanil-PCA to avoid the potential adverse/side effects of EA (31). This is particularly true of multiparous women who can combine a fast delivery with rapid availability and a short use of pain relief. (28) Additionally, certain obstetric conditions, such as a history of previous CD, twin gestation, or a breech presentation, may pose heightened risks with epidural analgesia, prompting a preference for alternative analgesic approaches. (32,33) In a retrospective analysis of 127 planned vaginal breech and 244 twin deliveries obtained from the Slovenian National Perinatal Information System, no statistically significant nor clinically relevant differences between the EA and remifentanil-PCA groups were observed in the rates of CS in labour and neonatal outcomes suggesting that both EA and remifentanil-PCA are safe and comparable in terms of labour outcomes in singleton breech and twin deliveries. (34) In conclusion, given the increasing environmental issues of nitrous oxide and disadvantageous pharmacokinetic/dynamic of meperidine as compared to remifentanil-PCA, the routine use of remifentanil-PCA for labour analgesia should be seriously considered in all labour wards to increase the confidence with its usage while reducing potential for complications. Literature 1. Öztürk R, Emi Nov A, Ertem G. Use of complementary and alternative medicine in pregnancy and labour pain: a cross-sectional study from turkey. BMC Complement Med Ther. 2022 Dec 14;22(1):332. doi: 10.1186/s12906-022-03804-w. PMID: 36517809; PMCID: PMC9749170. 2. Zuarez-Easton S, Erez O, Zafran N, Carmeli J, Garmi G, Salim R. Pharmacologic and nonpharmacologic options for pain relief during labor: an expert review. Am J Obstet Gynecol. 2023 May;228(5S):S1246-S1259. doi: 10.1016/j.ajog.2023.03.003. Epub 2023 Mar 20. PMID: 37005099. 3. Bohren MA, Hofmeyr GJ, Sakala C, Fukuzawa RK, Cuthbert A. Continuous support for women during childbirth. Cochrane Database Syst Rev. 2017 Jul 6;7(7):CD003766. doi: 10.1002/14651858.CD003766.pub6. PMID: 28681500; PMCID: PMC6483123. 4. Likis FE, Andrews JC, Collins MR, Lewis RM, Seroogy JJ, Starr SA, Walden RR, McPheeters ML. Nitrous oxide for the management of labor pain: a systematic review. Anesth Analg. 2014 Jan;118(1):153-67. doi: 10.1213/ANE.0b013e3182a7f73c. Erratum in: Anesth Analg. 2014 Apr;118(4):885. PMID: 24356165. 5. Sanders RD, Weimann J, Maze M. Biologic effects of nitrous oxide: a mechanistic and toxicologic review. Anesthesiology. 2008 Oct;109(4):707-22. doi: 10.1097/ALN.0b013e3181870a17. PMID: 18813051. 6. Rosen MA. Nitrous oxide for relief of labor pain: a systematic review. Am J Obstet Gynecol. 2002 May;186(5 Suppl Nature):S110-26. doi: 10.1067/mob.2002.121259. PMID: 12011877. 7. Su F, Wei X, Chen X, Hu Z, Xu H. [Clinical study on efficacy and safety of labor analgesia with inhalation of nitrous oxide in oxygen]. Zhonghua Fu Chan Ke Za Zhi. 2002 Oct;37(10):584-7. Chinese. PMID: 12487929. 8. Harrison RF, Shore M, Woods T, Mathews G, Gardiner J, Unwin A. A comparative study of transcutaneous electrical nerve stimulation (TENS), entonox, pethidine + promazine and lumbar epidural for pain relief in labor. Acta Obstet Gynecol Scand. 1987;66(1):9-14. doi: 10.3109/00016348709092945. PMID: 3300138. 9. Waldenström U, Irestedt L. Obstetric pain relief and its association with remembrance of labor pain at two months and one year after birth. J Psychosom Obstet Gynaecol. 2006 Sep;27(3):147-56. doi: 10.1080/01674820500433432. PMID: 17214449. 10. Richardson MG, Lopez BM, Baysinger CL, Shotwell MS, Chestnut DH. Nitrous Oxide During Labor: Maternal Satisfaction Does Not Depend Exclusively on Analgesic Effectiveness. Anesth Analg. 2017 Feb;124(2):548-553. doi: 10.1213/ANE.0000000000001680. PMID: 28002168. 11. Richardson MG, Raymond BL, Baysinger CL, Kook BT, Chestnut DH. A qualitative analysis of parturients' experiences using nitrous oxide for labor analgesia: It is not just about pain relief. Birth. 2019 Mar;46(1):97-104. doi: 10.1111/birt.12374. Epub 2018 Jul 22. PMID: 30033596. 12. Buhre W, Disma N, Hendrickx J, DeHert S, Hollmann MW, Huhn R, Jakobsson J, Nagele P, Peyton P, Vutskits L. European Society of Anaesthesiology Task Force on Nitrous Oxide: a narrative review of its role in clinical practice. Br J Anaesth. 2019 May;122(5):587-604. doi: 10.1016/j.bja.2019.01.023. Epub 2019 Feb 22. PMID: 30916011. 13. Rooks JP. Safety and risks of nitrous oxide labor analgesia: a review. J Midwifery Womens Health. 2011 Nov-Dec;56(6):557-65. doi: 10.1111/j.1542-2011.2011.00122.x. Epub 2011 Oct 21. PMID: 22060215. 14. Zuarez-Easton S, Erez O, Zafran N, Carmeli J, Garmi G, Salim R. Pharmacologic and nonpharmacologic options for pain relief during labor: an expert review. Am J Obstet Gynecol. 2023 May;228(5S):S1246-S1259. doi: 10.1016/j.ajog.2023.03.003. Epub 2023 Mar 20. PMID: 37005099. 15. Zuarez-Easton S, Zafran N, Garmi G, Dagilayske D, Inbar S, Salim R. Meperidine Compared With Nitrous Oxide for Intrapartum Pain Relief in Multiparous Patients: A Randomized Controlled Trial. Obstet Gynecol. 2023 Jan 1;141(1):4-10. doi: 10.1097/AOG.0000000000005011. Epub 2022 Dec 2. PMID: 36701604. 16. Douma MR, Verwey RA, Kam-Endtz CE, van der Linden PD, Stienstra R. Obstetric analgesia: a comparison of patient-controlled meperidine, remifentanil, and fentanyl in labour. Br J Anaesth. 2010 Feb;104(2):209-15. doi: 10.1093/bja/aep359. Epub 2009 Dec 14. PMID: 20008859. 17. Sosa CG, et al. Meperidine for dystocia during the first stage of labor: a randomized controlled trail. Am J Obstet Gynecol. October 2004; 191:1212-8. 18. Melber AA. Remifentanil patient-controlled analgesia (PCA) in labour - in the eye of the storm. Anaesthesia. 2019 Mar;74(3):277-279. doi: 10.1111/anae.14536. Epub 2018 Dec 14. PMID: 30549009. 19. Wilson MJA, MacArthur C, Hewitt CA, Handley K, Gao F, Beeson L, Daniels J; RESPITE Trial Collaborative Group. Intravenous remifentanil patient-controlled analgesia versus intramuscular pethidine for pain relief in labour (RESPITE): an open-label, multicentre, randomised controlled trial. Lancet. 2018 Aug 25;392(10148):662-672. doi: 10.1016/ 20. Lee M, Zhu F, Moodie J, Zhang Z, Cheng D, Martin J. Remifentanil as an alternative to epidural analgesia for vaginal delivery: A meta-analysis of randomized trials. J Clin Anesth. 2017 Jun;39:57-63. doi: 10.1016/j.jclinane.2017.03.026. Epub 2017 Mar 30. PMID: 28494909. 21. Stourac P, Kosinova M, Harazim H, Huser M, Janku P, Littnerova S, Jarkovsky J. The analgesic efficacy of remifentanil for labour. Systematic review of the recent literature. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2016 Mar;160(1):30-8. doi: 10.5507/bp.2015.043. Epub 2015 Oct 7. PMID: 26460593. 22. Freeman LM, Bloemenkamp KW, Franssen MT, Papatsonis DN, Hajenius PJ, van Huizen ME, Bremer HA, van den Akker ES, Woiski MD, Porath MM, van Beek E, Schuitemaker N, van der Salm PC, Fong BF, Radder C, Bax CJ, Sikkema M, van den Akker-van Marle ME, van Lith JM, Lopriore E, Uildriks RJ, Struys MM, Mol BW, Dahan A, Middeldorp JM. Remifentanil patient controlled analgesia versus epidural analgesia in labour. A multicentre randomized controlled trial. BMC Pregnancy Childbirth. 2012 Jul 2;12:63. doi: 10.1186/1471-2393-12-63. PMID: 22748068; PMCID: PMC3464937. 23. Logtenberg S, Oude Rengerink K, Verhoeven CJ, Freeman LM, van den Akker E, Godfried MB, van Beek E, Borchert O, Schuitemaker N, van Woerkens E, Hostijn I, Middeldorp JM, van der Post JA, Mol BW. Labour pain with remifentanil patient-controlled analgesia versus epidural analgesia: a randomised equivalence trial. BJOG. 2017 Mar;124(4):652-660. doi: 10.1111/1471-0528.14181. Epub 2016 Jun 27. PMID: 27348853. 24. Melber AA, Jelting Y, Huber M, Keller D, Dullenkopf A, Girard T, Kranke P. Remifentanil patient-controlled analgesia in labour: six-year audit of outcome data of the RemiPCA SAFE Network (2010-2015). Int J Obstet Anesth. 2019 Aug;39:12-21. doi: 10.1016/j.ijoa.2018.12.004. Epub 2018 Dec 21. PMID: 30685299. 25. Murray H, Hodgkinson P, Hughes D. Remifentanil patient-controlled intravenous analgesia during labour: a retrospective observational study of 10 years' experience. Int J Obstet Anesth. 2019 Aug;39:29-34. doi: 10.1016/j.ijoa.2019.05.012. Epub 2019 Jun 5. PMID: 31230993. 26. Messmer AA, Potts JM, Orlikowski CE. A prospective observational study of maternal oxygenation during remifentanil patient-controlled analgesia use in labour. Anaesthesia. 2016 Feb;71(2):171-6. doi: 10.1111/anae.13329. Epub 2015 Nov 30. PMID: 26617275. 27. Stocki D, Matot I, Einav S, Eventov-Friedman S, Ginosar Y, Weiniger CF. A randomized controlled trial of the efficacy and respiratory effects of patient-controlled intravenous remifentanil analgesia and patient-controlled epidural analgesia in laboring women. Anesth Analg. 2014 Mar;118(3):589-97. doi: 10.1213/ANE.0b013e3182a7cd1b. PMID: 24149580. 28. Blajic, I.; Zagar, T.; Semrl, N.; Umek, N.; Lucovnik, M.; Pintaric, T.S. Analgesic Efficacy of Remifentanil Patient-Controlled Analgesia versus Combined Spinal-Epidural Technique in Multiparous Women during Labour. Ginekol Pol 2021, 92, 797–803, doi:10.5603/GP.A2021.0053. 29. Aksoy H, Yücel B, Aksoy U, Acmaz G, Aydin T, Babayigit MA. The relationship between expectation, experience and perception of labour pain: an observational study. Springerplus. 2016 Oct 11;5(1):1766. doi: 10.1186/s40064-016-3366-z. PMID: 27795908; PMCID: PMC5056917. 30. Markova L, Lucovnik M, Verdenik I, Stopar Pintarič T. Delivery mode and neonatal morbidity after remifentanil-PCA or epidural analgesia using the Ten Groups Classification System: A 5-year single-centre analysis of more than 10 000 deliveries. Eur J Obstet Gynecol Reprod Biol. 2022 Oct;277:53-56. doi: 10.1016/j.ejogrb.2022.08.011. Epub 2022 Aug 18. PMID: 35998385. 31. Bergant J, Sirc T, Lucovnik M, Verdenik I, Stopar Pintaric T. Obporodna analgezija in izidi porodov v Sloveniji : retrospektivna analiza porodov v obdobju 2003-2013. Zdravniški vestnik: glasilo Slovenskega zdravniškega društva. [Tiskana izd.]. feb. 2016, letn. 85, št. 2, str. 83-91, tabele. ISSN 1318-0347. http://vestnik.szd.si/index.php/ZdravVest/article/view/1518, http://www.dlib.si/details/URN:NBN:SI:doc-2UD4E23Y. 32. Parissenti, T.K.; Hebisch, G.; Sell, W.; Staedele, P.E.; Viereck, V.; Fehr, M.K. Risk Factors for Emergency Caesarean Section in Planned Vaginal Breech Delivery.Arch. Gynecol. Obstet.2017,295, 51–58. [CrossRef] 33. Jaschevatzky, O.E.; Shalit, A.; Levy, Y.; Günstein, S. Epidural Analgesia during Labour in Twin Pregnancy.Br. J. Obstet. Gynaecol.1977,84, 327–331. 34. Lucovnik M, Verdenik I, Stopar Pintaric T. Intrapartum Cesarean Section and Perinatal Outcomes after Epidural Analgesia or Remifentanil-PCA in Breech and Twin Deliveries. Medicina (Kaunas). 2023 May 25;59(6):1026. doi: 10.3390/medicina59061026. PMID: 37374230; PMCID: PMC10301128. Tatjana STOPAR PINTARIC (Ljubljana, Slovenia) 09:33 - 09:50 Q&A.	PANORAMA HALL
	"Thursday 05 September" Added to your list of favorites Deleted from your list of favorites C20 08:00 - 08:50 LIVE DEMONSTRATION QLB blocks Demonstrator: Rafael BLANCO (Pain medicine) (Demonstrator, Abu Dhabi, United Arab Emirates)	South Hall 1A
	"Thursday 05 September" Added to your list of favorites Deleted from your list of favorites E20 08:00 - 08:50 PRO CON DEBATE Meta-Analyses: Still the ‘Gold Standard’ For Guideline Development? Chairperson: Kenneth CANDIDO (Speaker/presenter) (Chairperson, OAK BROOK, USA) 08:00 - 08:05 Introduction. Kenneth CANDIDO (Speaker/presenter) (Keynote Speaker, OAK BROOK, USA) 08:05 - 08:17 For the PROs. Nabil ELKASSABANY (Professor) (Keynote Speaker, Charlottesville, USA) 08:17 - 08:29 For the CONs. Louise MORAN (Consultant Anaesthetist) (Keynote Speaker, Letterkenny, Ireland) 08:29 - 08:34 Q&A.	South Hall 2A
	"Thursday 05 September" Added to your list of favorites Deleted from your list of favorites F20 08:00 - 09:05 EXPERT OPINION DISCUSSION Lumbar facet denervation - controversies Chairperson: David PROVENZANO (Faculty) (Chairperson, Bridgeville, USA) 08:00 - 08:20 Introduction. David PROVENZANO (Faculty) (Keynote Speaker, Bridgeville, USA) 08:20 - 08:35 What is an optimal test? Michele CURATOLO (Endowed Professor for Medical Education and Research) (Keynote Speaker, Seattle, USA) 08:35 - 08:50 Does the technique affect the outcome. Jan VAN ZUNDERT (Chair) (Keynote Speaker, Genk, Belgium) 08:50 - 09:05 Q&A.	South Hall 2B
	"Thursday 05 September" Added to your list of favorites Deleted from your list of favorites G20a 08:00 - 08:30 REFRESHING YOUR KNOWLEDGE Efficacy of LIA in various surgical procedures Chairperson: Ezzat SAMY AZIZ (Professor of Anesthesia) (Chairperson, Cairo, Egypt) 08:00 - 08:05 Introduction. Ezzat SAMY AZIZ (Professor of Anesthesia) (Keynote Speaker, Cairo, Egypt) 08:05 - 08:25 Efficacy of LIA in various surgical procedures. Livija SAKIC (anaesthesiologist) (Keynote Speaker, Zagreb, Croatia) 08:25 - 08:30 Q&A.	Small Hall
	"Thursday 05 September" Added to your list of favorites Deleted from your list of favorites O20 08:00 - 11:00 OFF SITE - Hands - On Cadaver Workshop 4 - RA UPPER & LOWER LIMB BLOCKS, TRUNK BLOCKS WS Leader: Margaretha (Barbara) BREEBAART (anaesthestist) (WS Leader, Antwerp, Belgium) Unique and exclusive for RA & Pain Cadaveric Workshops: Only whole-body cadavers will be available for the workshops. This is a fantastic opportunity to master your needling skills, perform the actual blocks on fresh cadavers and to improve your ergonomics under direct supervision of world experts in regional anaesthesia and chronic pain management. There won’t be an organized transportation for going/back from the Cadaver workshop. 08:00 - 11:00 Workstation 1. Upper Limb Blocks. Slobodan GLIGORIJEVIC (senior consultant) (Demonstrator, Zürich, Switzerland) ISB, SCB, AxB, cervical plexus (Supine Position) 08:00 - 11:00 Workstation 2. Upper Limb and chest Blocks. Can AKSU (Professor) (Demonstrator, Kocaeli, Turkey) ICB, IPPB/PSPB (PECS), SAPB (Supine Position) 08:00 - 11:00 Workstation 3. Thoracic trunk blocks. Robert TIRPAK (lead physician) (Demonstrator, Prague, Czech Republic) Th PVB, ESP, ITP(Prone Position) 08:00 - 11:00 Workstation 4. Abdominal trunk Blocks. Suwimon TANGWIWAT (Staff anesthesiologist) (Demonstrator, Bangkok, Thailand) TAP, RSB, IH/II (Supine Position) 08:00 - 11:00 Workstation 5. Lower limb blocks. Marcus NEUMUELLER (Senior Consultant) (Demonstrator, Steyr, Austria) SiFiB, PENG, FEMB, FTB, Aductor Canal B, Obturator (Supine Position) 08:00 - 11:00 Workstation 6. Lower limb blocks. Lubos BENO (Doctor) (Demonstrator, USTI NAD LABEM, Czech Republic) QLBs, proximal and distal sciatic B, iPACK (Lateral Position)	Anatomy Institute
	"Thursday 05 September" Added to your list of favorites Deleted from your list of favorites H20 08:00 - 10:00 SIMULATION TRAININGS Demonstrators: Josip AZMAN (Consultant) (Demonstrator, Linkoping, Sweden), Kassiani THEODORAKI (Anesthesiologist) (Demonstrator, Athens, Greece), Roman ZUERCHER (Senior Consultant) (Demonstrator, Basel, Switzerland)	NORTH HALL
	"Thursday 05 September" Added to your list of favorites Deleted from your list of favorites I20 08:00 - 10:00 HANDS - ON CLINICAL WORKSHOP 2 - PAEDIATRIC Blocks for Elective Abdominal Surgery in the Paediatric Patient WS Leader: Eleana GARINI (Consultant) (WS Leader, Athens, Greece) 08:00 - 10:00 Workstation 1: TAP, Ilioinguinal, Iliohypogastric and Rectus Sheath Nerve Blocks. Christian BERGEK (Anaesthetist) (Demonstrator, Gothenburg, Sweden) 08:00 - 10:00 Workstation 2: QLB. Juan Carlos DE LA CUADRA FONTAINE (Associate Clinical Professor/ Anesthesiologist/ LASRA President) (Demonstrator, Santiago, Chile) 08:00 - 10:00 Workstation 3: Paravertebral Block. Rajnish GUPTA (Professor of Anesthesiology) (Demonstrator, Nashville, USA) 08:00 - 10:00 Workstation 4: ESPB. Vicente ROQUES (Anesthesiologist consultant) (Demonstrator, Murcia. Spain, Spain)	220a
	"Thursday 05 September" Added to your list of favorites Deleted from your list of favorites J20 08:00 - 10:00 HANDS - ON CLINICAL WORKSHOP 3 - POCUS Focused Cardiac Ultrasound WS Leader: Rosie HOGG (Consultant Anaesthetist) (WS Leader, Belfast, United Kingdom) 08:00 - 10:00 Workstation 1: Basic Focused Assessed Transthoracic Echocardiography (FATE). Barbara RUPNIK (Consultant anesthetist) (Demonstrator, Zurich, Switzerland) 08:00 - 10:00 Workstation 2: Focused Echocardiography in Emergency Life Support (FEEL). Maria TILELI (Anaesthesiologist) (Demonstrator, Athens, Greece) 08:00 - 10:00 Workstation 3: Standard Cardiac Views and Inferior Vena Cava (IVC) Imaging. Jan BOUBLIK (Assistant Professor) (Demonstrator, Stanford, USA) 08:00 - 10:00 Workstation 4: Application of Focused Cardiac Ultrasound in the Real Clinical "World". Wolf ARMBRUSTER (Head of Department, Clinical Director) (Demonstrator, Unna, Germany)	221a
	"Thursday 05 September" Added to your list of favorites Deleted from your list of favorites K20 08:00 - 10:00 HANDS - ON CLINICAL WORKSHOP 8 - RA Ultrasound-Guided Fascial Plane Blocks of the Chest Wall WS Leader: Edward MARIANO (Speaker) (WS Leader, Palo Alto, USA) 08:00 - 10:00 Workstation 1: Anterolateral Chest Wall Blocks - PECS1, PECS2, Serratus Anterior Plane Blocks. Francois RETIEF (Head Clinical Unit) (Demonstrator, Cape Town, South Africa) 08:00 - 10:00 Workstation 2: Anteromedial Chest Wall Blocks - Transversus Thoracis Plane Block & Pecto-Intercostal Fascial Plane Block. Amit PAWA (Consultant Anaesthetist) (Demonstrator, London, United Kingdom) 08:00 - 10:00 Workstation 3: Posterior Chest Wall Blocks (I) - ESPB, Retrolaminar Block, Midpoint Transverse Process-to-Pleura (MTP) Block. Yavuz GURKAN (Faculty member) (Demonstrator, Istanbul, Turkey) 08:00 - 10:00 Workstation 4: Posterior Chest Wall Blocks (II) - Paraspinal Intercostal Plane Blocks, Rhomboid Intercostal Subserratus Plane (RISS) Block. Romualdo DEL BUONO (Member) (Demonstrator, Milan, Italy)	223a
	"Thursday 05 September" Added to your list of favorites Deleted from your list of favorites L20 08:00 - 10:00 HANDS - ON CLINICAL WORKSHOP 9 - RA US Guided PNBs for Arm-Hand and Ankle-Foot Surgery WS Leader: Morne WOLMARANS (Consultant Anaesthesiologist) (WS Leader, Norwich, United Kingdom) 08:00 - 10:00 Workstation 1: Axillary Block for Hand Surgery and How to Rescue Block Failures. Sebastien BLOC (Anesthésiste Réanimateur) (Demonstrator, Paris, France) 08:00 - 10:00 Workstation 2: Important Cutaneous Branches for Arm and Hand Surgery. John MCDONNELL (Professor of Anaesthesia and Intensive Care Medicine) (Demonstrator, Galway, Ireland) 08:00 - 10:00 Workstation 3: Popliteal Block for Foot Surgery and How to Rescue Block Failures. Gernot GORSEWSKI (Bereichsleitender Oberarzt für Regionalanästhesie & Akutschmerztherapie) (Demonstrator, Feldkirch, Austria) 08:00 - 10:00 Workstation 4: PNBs at the Ankle and Foot Level. Ana Eugenia HERRERA (Regional Anesthesiologist) (Demonstrator, San José, Costa Rica)	241
	"Thursday 05 September" Added to your list of favorites Deleted from your list of favorites M20 08:00 - 10:00 HANDS - ON CLINICAL WORKSHOP 6 - CHRONIC PAIN UG Guided Treatment of Abdominal, Pelvis and Lower Limb Chronic Pain Conditions WS Leader: Andrzej DASZKIEWICZ (anesthesiologist) (WS Leader, Cieszyn, Poland) 08:00 - 10:00 Workstation 1: Pudendal Neuropathy - Pudendal Nerve Block. Vaishali WANKHEDE (consultant) (Demonstrator, Switzerland, Switzerland) 08:00 - 10:00 Workstation 2: Cancer Pain - Coeliac Plexus & Superior Hypogastric Plexus. Michal BUT (Consultant pain clinic) (Demonstrator, Koszalin, Poland) 08:00 - 10:00 Workstation 3: Gluteal Pain Syndrome (GPS) - Caudal Epidural Injection, Sacroiliac Joint Injection, Piriformis Muscle, Hamstring Tendonitis. Ammar SALTI (Anesthesiologist and Pain Physician) (Demonstrator, abu Dhabi, United Arab Emirates) 08:00 - 10:00 Workstation 4: Ankle and Foot - Plantar Fascitis, Morton Neuroma, Baxter's Nerve Periarticular Injections. Dan Sebastian DIRZU (consultant, head of department) (Demonstrator, Cluj-Napoca, Romania)	245
	"Thursday 05 September" Added to your list of favorites Deleted from your list of favorites D20 08:00 - 09:50 NETWORKING SESSION Pain assessment beyond pain intensity scales Chairperson: Patricia LAVAND'HOMME (Clinical Head) (Chairperson, Brussels, Belgium) 08:00 - 08:05 Introduction. Girish JOSHI (Professor) (Keynote Speaker, Dallas, Texas, USA, USA), Patricia LAVAND'HOMME (Clinical Head) (Keynote Speaker, Brussels, Belgium) 08:05 - 08:27 Regional anesthesia and current outcome measures: in and out of the anesthesiological radar. Thomas VOLK (Chair) (Keynote Speaker, Homburg, Germany) 08:27 - 08:49 Minimal clinically important difference: bridging the gap between statistical and clinical significance. Marc VAN DE VELDE (Professor of Anesthesia) (Keynote Speaker, Leuven, Belgium) 08:49 - 09:11 Core outcomes and patient related outcome domains for assessing effectiveness in perioperative pain management. Esther POGATZKI ZAHN (Full Professor) (Keynote Speaker, Muenster, Germany) 09:11 - 09:33 Cultural influence on pain and related outcomes. Magdalena ANITESCU (Professor of Anesthesia and Pain Medicine) (Keynote Speaker, Chicago, USA) 09:33 - 09:50 Q&A.	South Hall 1B
08:40	"Thursday 05 September" Added to your list of favorites Deleted from your list of favorites G20b 08:40 - 09:10 REFRESHING YOUR KNOWLEDGE Cannabinoids Chairperson: Admir HADZIC (Director) (Chairperson, New York, USA) 08:40 - 08:45 Introduction. Admir HADZIC (Director) (Keynote Speaker, New York, USA) 08:45 - 09:05 Perioperative Management of patients on cannabinoids. Samer NAROUZE (Professor and Chair) (Keynote Speaker, Cleveland, USA) 09:05 - 09:10 Q&A.	Small Hall
09:00	"Thursday 05 September" Added to your list of favorites Deleted from your list of favorites C21 09:00 - 09:50 LIVE DEMONSTRATION Rheumatoid Arthritis: The Role of US in Diagnosis and Treatment Demonstrator: Ismael ATCHIA (Consultant Rheumatologist) (Demonstrator, Newcastle, United Kingdom)	South Hall 1A
	"Thursday 05 September" Added to your list of favorites Deleted from your list of favorites TARA 09:00 - 12:30 TARA SESSION Exploring Innovations in Migraine and Headache Treatments Chairperson: Ashish GULVE (Consultant in Pain Medicine) (Chairperson, Middlesbrough, United Kingdom) 09:00 - 09:05 Welcome. Ashish GULVE (Consultant in Pain Medicine) (Keynote Speaker, Middlesbrough, United Kingdom) 09:05 - 09:30 Overview of the TARA project. Fergal WARD 09:30 - 10:00 Assessing the burden of Migraine. Jozef MAGDIC 10:00 - 10:30 Coffee break. 10:30 - 11:00 Engineering medical devices for human implant. Fergal WARD 11:00 - 11:30 Interventional treatment of headaches. Vaishali WANKHEDE (consultant) (Keynote Speaker, Switzerland, Switzerland) 11:30 - 12:00 Prevention of Migraine. Jozef MAGDIC 12:00 - 12:30 Neuro stimulation for headache. Ashish GULVE (Consultant in Pain Medicine) (Keynote Speaker, Middlesbrough, United Kingdom)	CLUB B
09:20	"Thursday 05 September" Added to your list of favorites Deleted from your list of favorites E21b 09:20 - 09:50 TIPS & TRICKS Protocols for critical Patients Chairperson: Aleksejs MISCUKS (Professor) (Chairperson, Riga, Latvia, Latvia) 09:20 - 09:25 Introduction. Aleksejs MISCUKS (Professor) (Keynote Speaker, Riga, Latvia, Latvia) 09:25 - 09:45 #43410 - E21b POINT OF CARE ULTRASOUND FOR POST ANESTHESIA CARE UNIT. POINT OF CARE ULTRASOUND FOR POST ANESTHESIA CARE UNIT. Until a few years ago, the use of ultrasound in anesthesia was primarily for vascular access and regional anesthesia. However, in the last decade, its development and application have been exponential. Point of Care Ultrasound (POCUS) refers to the use of portable ultrasound devices at the patient's bedside to provide immediate diagnostic and therapeutic insights. This approach enables to perform real-time imaging to guide clinical decisions in a difference scenario such as emergency departments, intensive care units, operating rooms, and outpatient clinics. POCUS has been described as a useful tool for anaesthesiologist in all the perioperative period and now is an integral part of anesthesia practice, contributing to enhanced patient safety and procedural efficacy¹. Additionally, several cardiopulmonary protocols have been proven to be effective in the perioperative setting². Focusing on the postoperative period, episodes of hypoxia and hypotension are common complications in the PACU setting. Implementing standardized POCUS protocols ensures consistency, accuracy, and efficiency in patient management. Consequently, POCUS could be used to differentiate diagnoses in patients experiencing hemodynamic instability or acute respiratory failure. Focus cardiac ultrasound (FOCUS) is an echocardiographic examination performed at the bedside and includes a series of specific cardiac views that provide valuable information about heart´s structure and function and identify potential causes of haemodynamic instability. The Parasternal Long-Axis (PLAX) view, Apical Four-Chamber (A4C) view, and Subcostal view are used to assess global cardiac function, left ventricular size and function, pericardial effusion, and the diameter and collapsibility of the inferior vena cava (IVC)³. Based on these findings, different types of shock can be identified. In hypovolemic shock, left ventricular function is normal or hyperdynamic and the IVC is small and collapsible more than 50%. In cardiogenic shock, left ventricular function is reduce with possible regional wall motion abnormalities or dilated left ventricle. Obstructive shock, such as cardiac tamponade, presents with a pericardial effusion with diastolic collapse of right ventricle. Pulmonary embolism shows a dilated right ventricle with septal flattening and a small left ventricle. Distributive shock, including septic shock, typically shows hyperdynamic or normal cardiac function and a collapsible IVC due to relative hypovolemia⁴. Respiratory complications are common in the postoperative period and lung ultrasound (LUS) is increasingly being recognized as a valuable tool in the PACU. LUS offers several advantages, including being non-invasive, easily repeatable, and capable of providing real-time diagnostic information⁵. Patients in this setting are particularly susceptible to various respiratory complications due to the residual effects of anesthesia, the stress of surgery, and any preexisting pulmonary conditions. LUS has shown high sensitivity and specificity for detecting common postoperative complications, such a pulmonary oedema, pleura effusion, atelectasis and pneumothorax⁶. LUS scanning technique examinate bilateral thoracic regions, covering anterior, lateral and posterior-lateral thoracic areas. LUS finding include the presence of lung sliding; A-lines, suggesting normal aeration or pneumothorax; B-lines, indicating interstitial syndrome or pulmonary oedema; consolidation image, which may signify atelectasis or pneumonia; and pleura effusion. The Blue Protocol, developed by Daniel Lichtenstein, is a standardized approach to using lung ultrasound in critically ill patients⁷. It is particularly useful in the PACU for rapidly diagnosing causes of acute respiratory failure. Therefore, perioperative point of care ultrasound value is particularly evident in emergent cases and in unstable patients, since it provides crucial information for decision making. These advancements facilitate the regular use of bedside ultrasound in anesthesia practice, where it now assumes a crucial role similar to the fifth pillar of the physical examination⁸. A new concept in anesthesia practice involves the introduction of bedside ultrasound at "Minute Zero." This approach emphasizes the use of ultrasound at the beginning of the perioperative period, providing an image of the patient´s baseline status and providing a basis for comparison with subsequent evaluations. Minute Zero evaluation aims to have a global picture of patients´clinical condition and not only to answer targeted question⁹. There are two critical moments in which patients should be evaluated: upon arrival at the operating room – pre-operative Minute Zero; and upon arrival at the post-anaesthetic care unit (PACU) – PACU Minute Zero. Minute Zero ultrasound examination consists of a lung ultrasound to detect lung sliding, B lines, pleura effusion or areas of consolidation; focus echocardiography to evaluate global and regional contractility, compare the relationship between the right and left ventricles, and assess the inferior vena cava; abdominal ultrasound to examine the bladder and assess gastric content before surgery; in the PACU Minute Zero, this can be replaced with scanning to detect intraperitoneal free fluid in abdominal surgery. Performing ultrasound at Minute Zero allows anesthesiologists to assess the patient's baseline status before anesthesia induction and/or in the immediately postoperative time. This early assessment can detect hidden pathologies such as cardiac abnormalities (, lung conditions (e.g., bilateral B lines, pleural effusions, atelectasis), or abdominal issues (e.g., small intraperitoneal free fluid, urinary retention), which may not be evident on physical examination alone. Identifying these abnormalities early helps in risk stratification and can guide the anesthesia plan or recovery plan. For instance, knowing about cardiac abnormalities can influence fluid management or choice of anesthetic agents. Therefore, this proactive approach not only improves diagnostic accuracy but also has the potential to anticipate several complications and optimize patient outcome by facilitating timely interventions and personalized care strategies⁹. In conclusion, POCUS is an invaluable tool for anesthesia that should be used routinely, not only in the presence of complications but also as a routine bedside ultrasound examination in patient with previous moderate or severe pathology, patient having major surgery and elderly patients. By integrating POCUS and Minute Zero into the standard perioperative assessment, we can more effectively recognize patients baselines and identify any pathologies that may influence the intraoperative and postoperative outcomes. References 1. Mahmood F, Matyal R, Skubas N, Montealegre-Gallegos M, Swaminathan M, Denault A, Sniecinski R, Mitchell JD, Taylor M, Haskins S, Shahul S, Oren-Grinberg A, Wouters P, Shook D, Reeves ST. Perioperative Ultrasound Training in Anesthesiology: A Call to Action. Anesth Analg. 2016 Jun;122(6):1794-804. doi: 10.1213/ANE.0000000000001134. PMID: 27195630. 2. Haskins SCV, Ansara M, Garvin S. Perioperative point-of-care ultrasound for the anesthesiologist. Journal of Anesthesia and Perioperative Medicine. 2018;5(2):92–6. 3. Li L, Yong RJ, Kaye AD, Urman RD. Perioperative Point of Care Ultrasound (POCUS) for Anesthesiologists: an Overview. Curr Pain Headache Rep. 2020 Mar 21;24(5):20. doi: 10.1007/s11916-020-0847-0. PMID: 32200432. 4. Labovitz AJ, Noble VE, Bierig M, Goldstein SA, Jones R, Kort S, Porter TR, Spencer KT, Tayal VS, Wei K. Focused cardiac ultrasound in the emergent setting: a consensus statement of the American Society of Echocardiography and American College of Emergency Physicians. J Am Soc Echocardiogr. 2010 Dec;23(12):1225-30. doi: 10.1016/j.echo.2010.10.005. PMID: 21111923. 5. Lichtenstein D. Lung ultrasound in the critically ill. Curr Opin Crit Care. 2014 Jun;20(3):315-22. doi: 10.1097/MCC.0000000000000096. PMID: 24758984. 6. Miskovic A, Lumb AB. Postoperative pulmonary complications. Br J Anaesth. 2017 Mar 1;118(3):317-334. doi: 10.1093/bja/aex002. PMID: 28186222. 7. Lichtenstein DA, Mezière GA. Relevance of lung ultrasound in the diagnosis of acute respiratory failure: the BLUE protocol. Chest. 2008 Jul;134(1):117-25. doi: 10.1378/chest.07-2800. Epub 2008 Apr 10. Erratum in: Chest. 2013 Aug;144(2):721. PMID: 18403664; PMCID: PMC3734893. 8. Narula J, Chandrashekhar Y, Braunwald E. Time to Add a Fifth Pillar to Bedside Physical Examination: Inspection, Palpation, Percussion, Auscultation, and Insonation. JAMA Cardiol. 2018 Apr 1;3(4):346-350. doi: 10.1001/jamacardio.2018.0001. PMID: 29490335. 9. Segura-Grau E, Antunes P, Magalhães J, Vieira I, Segura-Grau A. Minute Zero: an essential assessment in peri-operative ultrasound for anaesthesia. Anaesthesiol Intensive Ther. 2022;54(1):80-84. doi: 10.5114/ait.2022.112886. PMID: 35142158; PMCID: PMC10156489. Elena SEGURA (Viseu, Portugal) 09:45 - 09:50 Q&A.	South Hall 2A
	"Thursday 05 September" Added to your list of favorites Deleted from your list of favorites F21 09:20 - 09:50 TIPS & TRICKS Clavicle Fracture Chairperson: Philippe GAUTIER (MD) (Chairperson, BRUSSELS, Belgium) 09:20 - 09:25 Introduction. Philippe GAUTIER (MD) (Keynote Speaker, BRUSSELS, Belgium) 09:25 - 09:45 RA for clavicle fractures. Luis Fernando VALDES VILCHES (Clinical head) (Keynote Speaker, Marbella, Spain) 09:45 - 09:50 Q&A.	South Hall 2B
	"Thursday 05 September" Added to your list of favorites Deleted from your list of favorites G21 09:20 - 09:50 TIPS & TRICKS For Needle Navigation Chairperson: Isabel BRAZAO (Consultant) (Chairperson, Madrid, Spain) 09:20 - 09:25 Introduction. Isabel BRAZAO (Consultant) (Keynote Speaker, Madrid, Spain) 09:25 - 09:45 Secrets on Needle and Syringe Control. Ruediger EICHHOLZ (Owner, CEO) (Keynote Speaker, Stuttgart, Germany) 09:45 - 09:50 Q&A.	Small Hall
10:00	"Thursday 05 September" Added to your list of favorites Deleted from your list of favorites EP03S2 10:00 - 10:30 ePOSTER Session 3 - Station 2 Chairperson: Nat HASLAM (Consultant Anaesthetist) (Chairperson, Sunderland, United Kingdom) 10:00 - 10:05 #41512 - EP091 Neuroprotective effects of xanthine oxidase inhibition in experimental cerebral ischemia. EP091 Neuroprotective effects of xanthine oxidase inhibition in experimental cerebral ischemia. It was found that inhibition of xanthine oxidase are accompanied by anti-ischemic and neuroprotective effects in the experiment and clinic. The study of cerebral ischemia in the experiment was carried out on 4 groups of outbred rats: I- sham-operated - control, II- ligation of the left carotid artery without additional intervention, III- administration of allopurinol before ligation of the carotid artery, IV- ligation of the carotid artery + administration of allopurinol 1 hour after surgery. In a histological examination of brain preparations made in the frontal plane at the level of the mid-central part, covering both cortical and other structures, 5 μm thick, stained with hematoxylin-eosin, in animals of group I the following morphological picture was observed: there were no significant differences in both halves of the brain. In rats of group II, zones of damage to the nervous tissue were found in the cortex on the side of occlusion. No clear architectural division into cortical plates was recorded. In group IV, the changes were identical to group II. When studying brain slices in rats of group III, the degree of alterative disorders was less pronounced compared to groups II and IV. This was expressed both in a smaller area of damaged areas and in a relatively smaller number of cortical cells subjected to deep degeneration, meaning pyknotically wrinkled with eosinophilic cytoplasm. In addition, none of the animals in this group had perivascular hemorrhages or leukodiapedesis. Preliminary inhibition of xanthine oxidase before modeling experimental ischemia, has neuroprotective effects. Evgeny ORESHNIKOV (Cheboksary, Russia), Svetlana ORESHNIKOVA, Alexander ORESHNIKOV, Denisova TAMARA, Elvira VASILJEVA 10:05 - 10:10 #41631 - EP092 How Effective is Peer Review? Measuring the Association Between Reviewer Rating Scores, Publication Status, and Article Impact. EP092 How Effective is Peer Review? Measuring the Association Between Reviewer Rating Scores, Publication Status, and Article Impact. Peer-review represents a cornerstone of the scientific process, yet few studies have evaluated its effectiveness to predict scientific impact. The objective of this study is to assess the effectiveness of peer-review on measures of impact for manuscripts submitted for publication. We analyzed all submitted manuscripts with abstracts (3,327) to Regional Anesthesia & Pain Medicine (RAPM) between August 2018 and October 2021. Initially, we categorized each article by topic, type, acceptance status, author demographics, and open-access status via a double-review process. Articles were scored based on the initial peer review recommendation. With any reviewer from RAPM designating the “reject” classification, we further investigated if the article was published in any indexed journal comparing total citations. The primary outcome was measured via the number of citations each article had on ClarivateTM within the last two years; the number of citations from Google Scholar was also collected, along with the Altmetric score. Out of 424 articles that met our inclusion criteria for analysis, we found no significant correlation between the number of Clarivate 2-year review citations and reviewer rating score (r=0.042, p=0.47), Google Scholar citations (p=0.42) or Altmetrics (p=0.70). There was no significant difference in two-year Clarivate citations between accepted (mean 7.48, SD 8.80) and rejected manuscripts (mean 5.51, SD 5.02; p=0.39). Altmetric score was significantly higher for RAPM-published papers compared to RAPM-rejected ones (mean 24.04, 63.93 vs. 2.55, 4.96; p<0.001). The ratings from peer review did not correlate with citation counts, leaving uncertain their influence on quality and other measures. Anuj PATEL (Lebanon, USA), Brian SITES, Steve COHEN, Aidan WEITZNER, Matthew DAVIS, Andrew HAN, Olivia LIU 10:10 - 10:15 #42168 - EP093 Randomized comparison between ultrasound-guided proximal and distal approaches of intercostobrachial nerve block as adjuncts to supraclavicular brachial plexus block for upper arm arteriovenous access procedures. EP093 Randomized comparison between ultrasound-guided proximal and distal approaches of intercostobrachial nerve block as adjuncts to supraclavicular brachial plexus block for upper arm arteriovenous access procedures. This prospective, randomized, observer-blinded trial aimed to compare the efficacy of ultrasound-guided proximal and distal intercostobrachial nerve block (ICBNB) as adjuncts to supraclavicular brachial plexus block (SC-BPB) for upper arm arteriovenous access procedures. We hypothesized that the proximal approach would achieve higher success rates than the distal approach. Sixty end-stage renal disease patients undergoing upper arm arteriovenous access surgery were randomly assigned to receive either proximal (n=30) or distal (n=30) ICBNB. Both groups received a 10-mL mixture of 0.25% levobupivacaine-1% lidocaine with epinephrine 2.5 μg/mL. A blinded observer recorded successful ICBNB (primary endpoint), defined as sensory blockade at the medial upper arm and axilla. Imaging, needling times, and block-related complications were recorded. Subsequently, SC-BPB with 30 mL of local anesthetic was performed in both groups. Surgical anesthesia, postoperative pain scores, intravenous tramadol requirement, and sensory blockade duration were also recorded. The proximal group had a higher percentage of sensory blockade at the axilla (97% vs 73%, P=0.026) but comparable blockade at the medial upper arm (97% vs 97%, P=1.000). Ultrasound image acquisition was faster with the proximal approach (13.4 [10.0-18.3] vs 18.8 [14.0-26.5] seconds, P=0.015). No differences were observed in needling time, ICBNB onset time, block-related complications, surgical anesthesia, or postoperative outcomes. Proximal ICBNB consistently reduced sensation at the medial upper arm and axilla, while one-fourth of distal blocks spared the axillary area. Both approaches, combined with SC-BPB, effectively facilitated upper arm arteriovenous access procedures; however, proximal ICBNB might be preferable for axillary surgery. Artid SAMERCHUA (Chiang Mai, Thailand), Prangmalee LEURCHARUSMEE, Kittitorn SUPPHAPIPAT, Pornpailin THAMMASUPAPONG, Sratwadee LORSOMRADEE 10:15 - 10:20 #42517 - EP094 Is Pericapsular Nerve (PENG) Block the Answer for Hip Surgeries? - A Systematic Review and Meta-Analysis. EP094 Is Pericapsular Nerve (PENG) Block the Answer for Hip Surgeries? - A Systematic Review and Meta-Analysis. Ultrasound-guided Pericapsular Nerve Group (PENG) block is an emerging regional anesthesia technique for patients undergoing hip surgeries. PENG blocks target the articular sensory branches of the hip capsule and it is thought to spare the motor branches. This review evaluates the analgesic efficacy and effectiveness of PENG block in patients undergoing hip surgeries. We conducted a meta-analysis of randomized controlled trials (RCTs) in patients undergoing hip surgeries where PENG block was compared to no block, placebo, or other analgesic techniques. Our primary outcome is the postoperative opioid consumption during the first 24 hours. Secondary outcomes were postoperative rest and dynamic pain scores at 6-12, 24 and 48 hours, sensory motor assessment, quadriceps weakness, incidence of postoperative falls, first analgesic request, PACU and hospital length of stay, functional outcomes, and persistent post-surgical pain. We analyzed 24 RCTS with a total of 1474 patients. There is moderate quality of evidence to suggest that PENG block decreased 24 hour morphine consumption by a mean difference (MD) of 2.54mg (95% CI: -3.69, -1.40). The greatest difference was found when PENG block was compared to sham/no block. However, after adjusting for publication bias, the MD decreased to 1.05mg (95%CI: -2.25, 0.15). Our meta-analysis regarding the use of PENG block for analgesia in hip surgeries suggests that there was minimal difference with no clinical significance in the first 24 hours after hip surgery but the reduction of morphine milliequivalent was seen more in total hip arthroplasty cohorts than in hip fracture patients. Rayna WALBURGER (New York, USA), Nicholas CIRRONE, Ghislaine ECHEVARRIA, Pai POONAM 10:20 - 10:25 #42579 - EP095 FRAILTY ASSESSMENT IN ELDERLY SURGICAL PATIENT BY POINT OF CARE ULTRASOUND MEASUREMENT OF QUADRICEPS AND RECTUS FEMORIS MUSCLE. EP095 FRAILTY ASSESSMENT IN ELDERLY SURGICAL PATIENT BY POINT OF CARE ULTRASOUND MEASUREMENT OF QUADRICEPS AND RECTUS FEMORIS MUSCLE. In elderly patients undergoing surgery frailty can lead to adverse perioperative outcomes. The present study aimed to evaluate the diagnostic accuracy of ultrasound (USG) measurements of rectus femoris (RF) and quadricep muscle in discriminating frailty in elderly patients and to assess their predictive ability for perioperative outcomes In this prospective observational study, we enrolled 87 elderly patients who were scheduled to undergo elective surgeries under anaesthesia. In the preoperative period, frailty was assessed by the Clinical Frailty Score. Preoperative USG measurements of the RF and quadricep muscles were obtained. These measurements were standardized for different body habitus and gender. Patients were followed up to 30 days after surgery and the perioperative clinical outcomes such as the occurrence of complications, intensive care admission, and mortality were noted. A total of 87 patients were enrolled for participation in the present study out of which 6 were lost to follow-up. Using the Clinical Frailty Scale (CFS), we found that out of 81 patients, 28 were non-frail and 53 patients were frail. There was a statistically significant difference in the USG parameters between frail and non-frail patients. We found that USG parameters have good diagnostic ability for frailty (AUC=0.7) and when these were adjusted for the body surface area their diagnostic ability increased (AUC=0.8). However, the USG parameters have fair accuracy for predicting postoperative clinical outcomes ( AUC 0.6 to 0.7). USG measurement of thigh muscles in preoperative patients may be used as a marker for frailty to predict their clinical outcomes after surgery Prathap TH, Sukhyanti KERAI (New Delhi, India), Rahil SINGH, Kirti Nath SAXENA 10:25 - 10:30 #42860 - EP096 Does Pregabalin Reduce Postoperative Pain After Orthopedic Surgery Under Spinal Anesthesia? EP096 Does Pregabalin Reduce Postoperative Pain After Orthopedic Surgery Under Spinal Anesthesia? Postoperative pain after orthopedic surgery is severe and prolonged. Persistent severe postoperative pain in the first 24 hours is a significant factor in the chronicization of pain. The treatment should be early, multimodal, and aimed at antinociceptive, anti-inflammatory, and antihyperalgesic effects. Several studies have reported that preoperative use of gabapentinoids primarily reduces initial postoperative pain and spares the use of opioids. We conducted a prospective, randomized, single- blind study to evaluate the effect of this molecule in reducing postoperative pain and overall analgesic consumption, particularly morphine. Sixty patients aged between 20 and 75 years, scheduled for non-urgent orthopedic surgery under spinal anesthesia and classified as ASA I/II, were randomized into two groups: G1 and G2 (receiving 75 mg of pregabalin orally 2 hours before the surgery).We evaluated intraoperative hemodynamic parameters, patient anxiety at arrival and departure from the operating room, postoperative pain using the visual analog scale The demographic characteristics of our population were comparable between the two groups, as was the surgical indication. There was a significant difference in pain evaluation scores at H6 and H24, which were lower in the G2 group, along with a reduction in morphine consumption in the same group, although without significant difference. The administration of 75 mg of pregabalin preoperatively reduces postoperative pain and morphine consumption. All therapeutic strategies should be implemented perioperatively to relieve the patient and prevent the risk of chronic postoperative pain. Controlling postoperative pain allows for early patient mobilization, which is beneficial for better functional outcomes. Mtir MOHAMED KAMEL, Imen TRIMECH (Paris), Maha BEN MANSOUR, Boubakar YOSR, Bouksir KHALIL, Zoubeidi RAFIF, Sakly HAYFA, Sawsen CHAKROUN
	"Thursday 05 September" Added to your list of favorites Deleted from your list of favorites EP03S3 10:00 - 10:30 ePOSTER Session 3 - Station 3 Chairperson: Ivan KOSTADINOV (ESRA Council Representative) (Chairperson, Ljubljana, Slovenia) 10:00 - 10:05 #40382 - EP097 Intradiscal Pulsed Radiofrequency plus Platelet-Rich Plasma for chronic discogenic pain. EP097 Intradiscal Pulsed Radiofrequency plus Platelet-Rich Plasma for chronic discogenic pain. Discogenic pain is the most common cause of low back pain (LBP). Intradiscal Pulsed Radiofrequency (ID-PRF) is used for the treatment of discogenic LBP. The effect of Platelet-Rich Plasma (PRP) on IVD degeneration has been investigated in vitro and in animal models, with significant reparative effects. We investigated the efficacy of ID-PRF plus PRP in patients with discogenic LBP. We collect patients treated with ID-PRF and PRP in our hospital from January 2023 to January 2024. Thirty-four patients were included. The patients were treated with ID-PRF plus PRP into pulpous nucleus. Treatment efficacy was evaluated using the Numeric Rating Scale (NRS-11) at 1, 3 and 6-months. Success was defined as a reduction in NRS11 of 50% or more. The mean age was 50.1 (SD 9.9) years, with 53% of female patients and 23% of patients received opioids, mainly tramadol. The treated levels were thirteen patients L4-L5, fourteen L5-S1 and five L4-L5 and L5-S1. The preprocedural NRS was 7.76 (SD 1.18) in a 0 to 10 scale. There was a median decrease of NRS of 2 points at 1 month, 4 points at 3 months and 2 points at 6 months, being statistically significant (Kruskall-Wallis p<0.001) (Figure 1). The relief of 50% or more of baseline pain is observed in 46% of patients at the first month and in 60% of patients at 3 and 6 months. In patients with discogenic LBP, ID-PRF plus PRP significantly decreased pain at one month and this improvement was improved, at 3 and 6 months. César GRACIA (Barcelona, Spain), Carmen BATET, Mauricio POLANCO, Patricia MAGALLÓ, Sandra MARMAÑA, Rubén CHACÓN, Miquel MONCHO, Joan COMA 10:05 - 10:10 #42420 - EP098 Evaluation of the Safety of Trans-sacral Epiduroscopic Plasma Decompression in Living Pigs. EP098 Evaluation of the Safety of Trans-sacral Epiduroscopic Plasma Decompression in Living Pigs. Trans-sacral epiduroscopic plasma decompression (SEPD) refers to the procedure of relieving pressure on epidural structures by utilizing a plasma reaction, conducted through a trans-sacral route. Using bipolar radiofrequency energy for ablation and coagulation, known as the Coblation® technique, it is feasible to decrease intradiscal pressures and disc volume by removing disc material. This study represents the inaugural research on SEPD utilizing a plasma catheter in animals. Its primary objective is to validate the safety of SEPD. Epiduroscopes were inserted through the sacral hiatus in two pigs and then advanced to the lumbar segment's epidural space.(Figure1) A plasma catheter was inserted through the working channel of the epiduroscope. This catheter was then placed into the epidural structures, where ablation was conducted using a plasma reaction. Following plasma ablation, the walking and physical activity of the two pigs were assessed. One month after the plasma ablation, autopsies were conducted.(Figure2) Following the experiments, the pigs were subjected to tests for allodynia to assess nerve injuries. However, neither abnormal motor behavior nor any signs of pain, allodynia, or paresis were observed in the pigs. During the autopsy, the spinal cord and spinal nerve roots were dissected and examined histologically under a microscope. However, no thermal damage was observed in the nervous tissues.(Figure3) In conclusion, SEPD did not demonstrate severe complications in pigs. This suggests that SEPD could be a promising method for spinal decompression in humans. Jae Ho CHO (Suwon-si, Republic of Korea), Jong Bum CHOI, Jong Yeop KIM 10:10 - 10:15 #42452 - EP099 Effect duration of lumbar sympathetic ganglion neurolysis in patients with complex regional pain syndrome: a prospective observational study. EP099 Effect duration of lumbar sympathetic ganglion neurolysis in patients with complex regional pain syndrome: a prospective observational study. Lumbar sympathetic ganglion neurolysis (LSGN) has been used for long-term pain relief in patients with complex regional pain syndrome (CRPS). However, the actual effect duration of LSGN has not been accurately measured. This prospective observational study measured the effect duration of LSGN in CRPS patients and investigated the relationship between temperature change and pain relief. After performing LSGN with 2.5 mL of 99% ethanol, the skin temperatures of both the maximum pain site and the plantar area in the affected and unaffected limbs were measured by infrared thermography(Fig. 1, 2), and pain intensity was assessed before and at 2 weeks, 1 month, and 3 months. The median time to return to baseline temperature was calculated using survival analysis. The skin temperature increased significantly at all-time points relative to baseline in both regions (maximum pain site: 1.4°C ± 1.0°C, plantar region: 1.28°C ± 0.8°C, all P < 0.001). The median time to return to baseline temperature was 12 (95% confidence interval [CI]: 7.7–16.3) weeks at the maximum pain site and 12 (95% CI: 9.4–14.6) weeks at the plantar area. Pain intensity decreased significantly relative to baseline, at all-time points after LSGN.(Fig. 3, 4) The effect of LSGN on reducing pain and increasing temperature in the affected extremity was sustained for ≤ 12 weeks post-treatment, with a significant reduction in pain intensity after LSGN. These results support the use of LSGN as a prolonged pain management strategy in patients with CRPS. Eun Joo CHOI, Minhye CHANG (Seoul, Republic of Korea), Francis Sahngun NAHM 10:15 - 10:20 #42492 - EP100 Anesthetic challenges in hemipelvectomy with custom-made prosthetic reconstruction for pelvic sarcoma surgery: our experience from a case series. EP100 Anesthetic challenges in hemipelvectomy with custom-made prosthetic reconstruction for pelvic sarcoma surgery: our experience from a case series. Hemipelvectomy and reconstruction with limb salvage stands as the primary treatment for periacetabular pelvic sarcomas. Anesthetic management is challenging due to highly aggressive surgery and the complex pelvic anatomy (Figure 1). Intraoperative bleeding management, coagulation disturbances and postoperative pain are particularly relevant. We describe our clinical practice in these surgeries. A case series of 10 patients with periacetabular pelvic sarcomas that underwent hemipelvectomy and pelvic reconstruction with custom prosthesis between 2016 and 2022 was analyzed. Approval by IRB was requested (IIBSP-COO-2024-72). All patients underwent combined epidural and intravenous general anesthesia. Monitoring included arterial pressure waveform for hemodynamic parameters and goal-directed fluid therapy, alongside thromboelastometry for coagulopathy correction guidance. Two patients underwent preoperative arterial embolization. A pre-incisional bolus of 10-15mg/kg tranexamic acid followed by an infusion of 10-15mg/kg over 8 hours was administered. Median blood loss was 2375 ml (1500 – 4500 ml). Intraoperative fluid and transfusion therapy are detailed in Table 1. Four patients required plastic surgical reconstruction. Median surgical time was 7 hours (6.5 – 13.5), ICU stay 2.5 days (1 – 10) and hospital stay 36 days (18 – 116). Epidural infusion of 2mg/ml ropivacaine with 2mcg/ml fentanyl achieved optimal pain control. Two accidental catheter dislodgements were registered (Figure 2). Pelvic reconstruction with custom prosthesis after large oncologic resection is a long-lasting painful procedure associated with high morbidity. Perioperative management of major bleeding and optimal pain management with epidural analgesia are primary goals for the anesthesiologist. Subcutaneous tunnelling of epidural catheters should be considered to prevent accidental dislodgement. Gerard MORENO GIMÉNEZ (Barcelona, Spain), Mireia RODRÍGUEZ PRIETO, Ana PEIRÓ IBÁÑEZ, Miguel MARTÍN-ORTEGA, Adrià FONT GUAL, Pau ROBLES SIMÓN, Diego TORAL FERNÁNDEZ, Sergi SABATÉ TENAS 10:20 - 10:25 #42654 - EP101 Effect of the erector spina plan (ESP) block on postoperative delirium in spinal surgery patients. EP101 Effect of the erector spina plan (ESP) block on postoperative delirium in spinal surgery patients. Postoperative Delirium (PD), Postoperative Neurocognitive Dysfunction (PND) and Postoperative Chronic Persistent Pain (PCPP) are common in geriatric surgery patients and are associated with postoperative acute pain and opioid consumption. ESP block is used as part of multimodal analgesia in spinal surgery. In the present study, the purpose was to test the hypothesis that ESP block applied to patients undergoing lumbar spinal surgery will reduce PD, PND, and PCPP by reducing the severity of acute pain and opioid consumption. After obtaining Clinical Research Ethics Committee and patient approvals, 128 patients aged 60 years and above who underwent elective lumbar spinal fusion surgery were randomized with or without ESP block. NRS scores and opioid consumption were recorded in the postoperative 24 hours. PD was assessed with the CAM ICU test for 5 days postoperatively or during hospital stay. PCPP was assessed with the Brief Pain Scoring System 3 months after the spinal surgery. PND was assessed with the MOCA scale administered 3 months later. The number of patients with delirium, cognitive dysfunction, and chronic persistent pain was lower in Group 1 and no statistically significant differences were detected between the groups (p>0.05). In the acute period, NRS scores, and total opioid and rescue analgesic use amounts were significantly higher in Group 2 patients (P<001). Considering that the ESP block reduces postoperative pain intensity and opioid consumption, contributing to the decrease in the incidence of PD, PND, and PCPP, we believe that it is appropriate to use it for analgesia following vertebra surgeries. Bulut POLAT, Sinem SARI, Ferdi GULASTI, Ismet TOPCU, Alp ERTUGRUL (Aydin, Turkey), Osman Nuri AYDIN, Zahir KIZILAY, Mehmet TURGUT 10:25 - 10:30 #42722 - EP102 Enhanced procedural care: A step forward for an ideal sedation? EP102 Enhanced procedural care: A step forward for an ideal sedation? Background: Perioperative administration of benzodiazepines is considered a risk factor for early postoperative cognitive decline; however, the association between Remimazolam, a newly developed ultrashort-acting benzodiazepine for anesthetic purpose and postoperative cognitive decline is under research. Aims: The primary aim of this prospective randomized study was to evaluate whether Remimazolam administration during elective surgery under spinal anesthesia influences the incidence of early cognitive decline in patients with no prior cognitive disorders. Secondary outcomes included the evaluation of mean arterial pressure and heart rate. 80 patients (age>65 years) scheduled for short surgical procedures under spinal anesthesia were randomized 1:1 to receive Propofol (PRO group) or Remimazolam (RMZ group) aiming a Modified Observer’s Assessment of Alertness/Sedation score of 3 or 4. Both groups were assessed through the Mini-Cog test at three time points: preoperative, first 24 hours and 48 hours postoperative. Both groups were similar in terms of age, gender, BMI, ASA score and comorbidities. Preoperative Mini-Cog score were similar across both groups. Patients receiving Remimazolam demonstrated a better Mini-Cog score at both 24 and 48 hours compared to those receiving Propofol (4,41 vs. 4,0, diff means=-0,41± 0,18, 95%CI 0,79-0,04, p=0,02; 4,3 vs. 3,9, diff means=-0,41± 0,19, 95% CI 0,813-0,0160, p=0,04). Patients in RMZ group had a lower incidence of hypotension and bradycardia during procedural sedation. Remimazolam usage for procedural sedation is safe and does not worsen early cognitive outcome in older patients undergoing short elective surgical procedures. Furthermore, it offers a better hemodynamic profile which can improve patients outcome. Ana Maria DUMITRIU (Bucharest, Romania), Cristian COBILINSCHI, Raluca UNGUREANU, Ioana Marina GRINTESCU, Liliana MIREA
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	"Thursday 05 September" Added to your list of favorites Deleted from your list of favorites EP03S7 10:00 - 10:30 ePOSTER Session 3 - Station 7 Chairperson: Maria Teresa FERNÁNDEZ MARTÍN (Anaesthesiologist and researcher) (Chairperson, Valladolid, Spain) 10:00 - 10:05 #41450 - EP121 The FLACC Behavioral Scale for Post-operative Pain: Validity and Reliability in Children of more than 6 Years Old. EP121 The FLACC Behavioral Scale for Post-operative Pain: Validity and Reliability in Children of more than 6 Years Old. The evaluation of the postoperative acute pain (PAP) is sometimes difficult in children more than six-years old, such as the visual analogue scale (VAS). The objective of this study is to assess the existence or not of a difference in the scores obtained by two evaluation scales at the same time. This is a prospective study which includes children who had limbs surgery. In order to identify patients “difficult to be evaluated” during the first 24 hours of the post-operative phase at : H0, H4, H8, H12, H18, H24. self-assessment of pain combined with the behavioral pain assessment scale were proposed at the same time to patients (VAS and FLACC ¬[Face Legs Activity Cry Consolability]). The data was analyzed by the SPSS “20” software program. The threshold of significance was 5% (P < 0,05). An intra-category correlation test was realized between the two above-mentioned scales. 355 patients were included in this study. The average age was 9,29 ± 4,13 years.The average of the postoperative pain scores were 1,03 ± 1,61 for the VAS and 0,48 ± 1,23 for the FLACC. We also found that the intra-category coefficients were stated between r = 0,79 and 0,81 with a very good reproducibility of the two scales. These results sustain the possibility of using the FLACC scale as reliable instrument in case of doubt regarding the VAS obtained score in more-than-6-years-old children. Samir BOUDJAHFA (ORAN, Algeria), Mohammed KENDOUSSI 10:05 - 10:10 #41452 - EP122 Analgesic efficacy of continuous erector spinae plane block versus intravenous patient-controlled analgesia following multi-level spine surgery: An open-label RCT. EP122 Analgesic efficacy of continuous erector spinae plane block versus intravenous patient-controlled analgesia following multi-level spine surgery: An open-label RCT. Patients undergoing spine surgery experience intense pain in the postoperative period. Multimodal pain management protocols, including regional anaesthetic techniques are one of the cornerstones of the enhanced recovery after surgery pathway. We compared continuous ESP block and opioid-based intravenous (IV) patient-controlled analgesia (PCA) following multi-level spine surgery. The present prospective, randomized, open-label study enrolled 54 patients scheduled for elective multi-level spine surgery who were randomly divided into ESP and PCA group. Postoperatively, bilateral continuous ESP block was performed in patients who were allocated to group ESP. All patients were given fentanyl-based IV PCA pumps. For patients in group PCA, the background infusion rate was kept at 1 µg/kg/hr with a bolus dose of 0.5 µg/kg and lockout interval of 30 min while in group ESP, a similar PCA setting without background infusion was set. The primary objective of the study was to compare postoperative analgesia using visual analogue scale (VAS) score. Secondary objectives were comparison of total opioid consumption, number of rescue analgesics used and satisfaction score. The worst VAS scores at rest and during movement were significantly lower in group ESP at all predefined time points (p<0.05). The total opioid consumed over 24h was significantly lower in patients receiving ESP block compared to those maintained on IV PCA (p<0.05). More rescue analgesic doses were required with higher opioid-related side effects in group PCA. Continuous ESP block is a safer and more effective alternative to opioid-based analgesia as a component of multimodal analgesia protocol for patients undergoing multilevel spine surgery. Sadik MOHAMMED (JODHPUR, India), Priyadarshan A M, Deepanshu DANG, Swati CHHABRA, Bharat PALIWAL, Pradeep BHATIA, Deepak Kumar JHA 10:10 - 10:15 #41742 - EP123 Cost-Effectiveness and Cost-Utility Analyses in Thailand of Continuous Intrathecal Morphine Infusion Compared with Conventional Therapy in Cancer Pain: A 10-Year Multicenter Retrospective Study. EP123 Cost-Effectiveness and Cost-Utility Analyses in Thailand of Continuous Intrathecal Morphine Infusion Compared with Conventional Therapy in Cancer Pain: A 10-Year Multicenter Retrospective Study. Because of the high initial cost of intrathecal drug delivery (ITDD)-therapy, this study investigated the cost-effectiveness and cost-utility of ITDD-therapy in refractory cancer pain management in Thailand over the past ten years. The retrospective study was conducted in cancer pain patients who underwent ITDD-therapy from January 2011-2021 at three university hospitals. Clinical outcomes included the numerical rating scale (NRS), Palliative Performance Scale and the European-Quality of Life Measure-5 Domain. The direct medical and non-medical, as well as indirect costs, were also recorded. Cost-effectiveness and cost-utility analyses were performed comparing ITDD-therapy with conventional therapy (interpolated from costs of the same patient before having ITDD-therapy). Twenty patients (F:M: 10:10) aged 60 ± 15 years who underwent implantation of an intrathecal percutaneous port (IT-port; n =15) or programmable intrathecal pump (IT-pump; n =5) were included. The median survival time was 78 (IQR 121-54) days after ITDD therapy. At 2-month follow-up, the incremental cost-effectiveness ratio (ICER)/ pain reduction of an IT port (US $862.73/NRS reduction/lifetime) was lower than for an IT-pump group (US $ 2,635.68/NRS reduction/lifetime) compared with continued conventional therapy. The ICER/quality-adjusted life years (QALY)-gained for an IT-port compared with conventional treatment was US $93,999.31/QALY-gained, which is above the cost-effectiveness threshold for Thailand. The cost-effectiveness and cost-utility of IT-port therapy for cancer pain was high relative to the cost of living in Thailand, above the cost-effectiveness threshold. Prospective cost-analysis studies enrolling more patients with diverse cancers that investigate the benefit of early ITDD-therapy with different-priced devices are warranted. Arpawan THEPSUWAN, Nuj TONTISIRIN (Bangkok, Thailand), Pramote EUASOBHON, Patt PANNANGPETCH, Oraluck PATTANAPRATEEP, Steven COHEN 10:15 - 10:20 #42521 - EP124 TRENDS IN USE OF NON-OPIOID ANALGESIC MODES OVER TIME IN INPATIENT AND OUTPATIENT TOTAL JOINT ARTHROPLASTY. EP124 TRENDS IN USE OF NON-OPIOID ANALGESIC MODES OVER TIME IN INPATIENT AND OUTPATIENT TOTAL JOINT ARTHROPLASTY. Postoperative pain management has shifted towards multimodal analgesia in an effort to limit opioid use. Moreover, there has been a recent shift towards outpatient surgery for a variety of surgeries. It is unclear how this has impacted trends in use of multimodal analgesia. Here, we report trends in use of individual non-opioid analgesic modes for total knee and hip arthroplasties (THA/TKA), stratified by inpatient/outpatient settings. After institutional review board approval (#2012-050), this retrospective study included all primary THA (n=1,248,761 all / n=21,922 outpatient) and TKAs (n=2,157,056 all / n=54,997 outpatient) from 2006-2022 for both inpatient/outpatient surgeries and 2018-2022 for outpatient surgeries (national US Premier Healthcare data). We calculated the annual percent use of eight non-opioid analgesic modes: acetaminophen, non-steroidal anti-inflammatory drugs (NSAIDs), COX-2-inhibitors, ketamine, gabapentinoids, steroids, peripheral nerve blocks (PNB), and neuraxial anesthesia. Data were stratified by procedure type and inpatient/outpatient setting. Visual representation of trends can be found in Figures 1 and 2. From 2006-2022, PNB use increased more rapidly in TKAs (13.8%-29.7%) than in THAs (9.0%-12.3%). Neuraxial anesthesia followed the same trend in TKAs (31.0%-39.0%) compared to THAs (27.0%-29.0%). Among both procedures and settings, the use of NSAID’s, COX-2-inhibitors, and gabapentinoids peaked in 2017-2018 and have since declined. Overall, similar trends among most modes of analgesia existed for both TKAs and THAs, excluding PNBs and neuraxial anesthesia use which increased more rapidly in TKAs. Several modes have declined since 2017-2018. Further research is needed to elucidate mechanisms behind these trends. Alex ILLESCAS, Jashvant POERAN, Haoyan ZHONG (NEW YORK, USA), Lisa REISINGER, Crispiana COZOWICZ, Jiabin LIU, Stavros MEMTSOUDIS 10:20 - 10:25 #42749 - EP125 Orchestrating Comfort: the harmonious impact of music on anxiety and pain under general anesthesia. EP125 Orchestrating Comfort: the harmonious impact of music on anxiety and pain under general anesthesia. Music or Silence has proven effective in many medical conditions undergoing procedures with various depth of anesthesia. We aimed that integrating music or noise-blocking interventions could lead to reduced anxiety, pain, and analgesic requirements and increased satisfaction patients undergoing general anesthesia. We conducted a prospective randomized study involving 90 patients undergoing traumatic surgeries in the OR. Patients were divided into 3 groups; music (earphones with music), silence (earphones with no music), and noise (exposure to ambient) groups. Objective and subjective assessments, including validated anxiety scales (STAI-trait and STAI-state) pain, and satisfaction were measured pre- and post-operatively to measure the impact of interventions on patient well-being. Significant reductions in anxiety (p= 0.032) and pain scores (p= 0.021) were observed in the Music and Silence groups compared to the Noise group. Satisfaction scores were higher in these groups (p = 0.026). No differences in analgesic use except rescue analgesics, hemodynamic variables, or intraoperative drug amounts were noted. The environmental noise was consistent across groups, and no postoperative side effects were reported. Correlations between postoperative STAI-state and pain scores were notable. Harnessing the power of music and noise-blocking interventions dramatically reduced anxiety, significantly alleviated pain, cut down on analgesic use, and vastly increased patient satisfaction in the high-stress environment of trauma operating rooms. Embracing the therapeutic potential of music and silence is paramount for revolutionizing the intraoperative experience and transforming patient care in these intense surgical settings. Hye-Min SOHN (Suwon, Republic of Korea), Na Young KIM 10:25 - 10:30 #42864 - EP126 Interobserver and Intra-observer Variability in the Assessment of Epidural Catheter Localization and Efficacy in Abdominal Surgery Using Color Doppler and M-Mode Ultrasound. EP126 Interobserver and Intra-observer Variability in the Assessment of Epidural Catheter Localization and Efficacy in Abdominal Surgery Using Color Doppler and M-Mode Ultrasound. Epidural catheter placement is crucial for effective postoperative pain management in abdominal surgery. However, its success relies on accurate localization within the epidural space, which can be challenging due to anatomical variations and operator-dependent factors. In this study, ultrasound is compared with sensory assessment of the block (pinprick and cold pressure). Ultrasound, particularly using color Doppler and M-mode, has shown promise for catheter localization, but its interobserver and intraobserver variability remain unclear. Determine the interobserver and intraobserver variability of ultrasound in detecting epidural catheters and assessing their efficacy in abdominal surgery. Methods: A diagnostic test study was conducted to analyze interobserver and intraobserver variability in measuring skin-to-posterior complex and skin-to-anterior complex distances and determining catheter placement in the epidural space using qualitative method with color Doppler and M-mode ultrasound. Three anesthesiologists were included. Statistical analysis, including intraclass correlation for continuous variables and kappa coefficient for categorical variables, was performed. Bland-Altman plots were constructed to visualize agreement between observers. The study included 125 patients who provided consent to participate, 75 were women. Preliminary analysis revealed a good intraclass correlation for distances. Kappa index for M-mode was better (see table 1 and 2), indicating consistency in measurements and catheter placement assessment. Initial findings suggest promising interobserver and intra-observer agreement in ultrasound-guided epidural catheter localization and efficacy assessment. The low inter- and intra-observer variability observed in this study supports the clinical applicability of ultrasound. Further analysis with a larger sample size is warranted to validate these results. Juan Carlos DELACUADRA-FONTAINE (Santiago, Chile)
	"Thursday 05 September" Added to your list of favorites Deleted from your list of favorites EP03S1 10:00 - 10:30 ePOSTER Session 3 - Station 1 Chairperson: Dmytro DMYTRIIEV (chief of pain medicine department) (Chairperson, Vinnitsa, Ukraine) 10:00 - 10:05 #42690 - EP085 Evaluation of the spread towards nerve to the quadratus femoris muscle after a posterior pericapsular deep-gluteal block: a pilot study in body donors. EP085 Evaluation of the spread towards nerve to the quadratus femoris muscle after a posterior pericapsular deep-gluteal block: a pilot study in body donors. A posterior pericapsular deep-gluteal block (PPD) is a regional approach aiming to anaesthetize the sensory fibres originating from the sacral plexus. Branches of the sciatic nerve, gluteal nerves and the nerve to the quadratus femoris muscle (NQF) provide sensory innervation of the posterior hip capsule and are therefore the main targets of a PPD. However, further experimental validation of a PPD is needed. In this study, we describe the spread of dye in the posterior hip region after PPD injection in a body donor, focusing on the NQF. Two male, unembalmed bodies were obtained from the human body donation program of the university and included in the study. Using ultrasound guidance, a PPD (Vermeylen et al.) was performed injecting 5 ml, 10 ml, 15 ml or 20 ml of dye using a custom-made mixture (10% latex, 1.5% methylene blue 10 mg/ml and 88.5% water) in the targeted area. Each of the four posterior hip regions were dissected and dimensions of the spread were obtained. Despite consistent coverage of the posterior hip joint area, none of the hip regions showed staining of the NQF after PPD injection. Inconsistent injections, too low volumes of dye and post-mortem disruption of tissue integrity are possible explanations for the inadequate spread towards the target nerve. In this study, we could not demonstrate an adequate spread to the NQF using a PPD injection of dye in the posterior hip region. We conclude that the effectiveness of the PPD block requires further anatomical and clinical validation . Bernard LAUREYS, Matties NEIRYNCK, Simon DEBUSSCHERE, Evie VEREECKE, Janou DE BUYSER, Matthias DESMET, Kris VERMEYLEN (ZAS ANTWERP, Belgium) 10:05 - 10:10 #42428 - EP086 Analgesic efficacy and safety of erector spinae plane block in adults undergoing liver resection: a systematic review and meta-analysis. EP086 Analgesic efficacy and safety of erector spinae plane block in adults undergoing liver resection: a systematic review and meta-analysis. ERAS Society recommends intrathecal opiates and continuous local anaesthetic wound infusion for post-operative analgesia following liver resection. However, patients with contraindications to central neuraxial block may receive suboptimal analgesia. Emerging evidence suggests that erector spinae plane block (ESPB) may be a promising alternative, but a systematic review has not been available thus far. This systematic review and meta-analysis aims to compare the analgesic efficacy and safety of single or continuous ESPB with any other peripheral regional anaesthetic (RA) technique or with no block in adults for liver resection under general anaesthesia. This review was undertaken according to a prospectively registered protocol on PROSPERO website under the registration number CRD42023445867. It follows the guidance on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). The literature search included PubMed, Embase, Web of Science Citation Index, Europe PMC and Cochrane Central Register of Controlled Trials until 17th July 2023. The primary outcomes of this review were 24-hour postoperative pain score at rest and ESPB-related complications. Eleven randomized controlled trials with a total of 629 participants were included in the systematic review and meta-analysis. At 24-hour after liver resection, ESPB provided better analgesia compared to no block or other peripheral regional block, while analgesic effect was inferior to intrathecal morphine (ITM). ESPB reduced opioid consumption and its related complications. No ESPB procedure-related complications were reported. ESPB provides effective pain control after liver resection where ITM is not an option. It has a high safety margin and reduces opioid-related complications. Haili YU (Oxford, United Kingdom), Joanna CARVALHO, Lee TEE 10:10 - 10:15 #42459 - EP087 Pulmonary Ultrasound for the Assessment of Atelectasis in Anesthetized Children using an Airway Laryngeal Mask: a Randomized Double-Blinded Controlled Trial that Compares the Spontaneous Ventilation and Pressure Support Ventilation. EP087 Pulmonary Ultrasound for the Assessment of Atelectasis in Anesthetized Children using an Airway Laryngeal Mask: a Randomized Double-Blinded Controlled Trial that Compares the Spontaneous Ventilation and Pressure Support Ventilation. Anesthesia is known to diminish FRC,leading to atelectasis and compromised gas exchange.PEEP administration has been observed to enhance FRC optimization.PSV is known for its potential to improve gas exchange during GA.However, there is a scarcity of data regarding the ideal PEEP and PS levels for children undergoing GA with LMA for minor outpatient surgeries. This study aimed to assess the impact of inspiratory PS levels on the prevention of atelectasis following induction of anesthesia and residual atelectasis in the early postoperative phase using LUS,as well as,to evaluate the influence of this pressure support on ventilation parameters in pediatric patients undergoing GA with a LMA for minor and outpatient surgery. A randomized double-blinded CT was conducted on ASA I-II pediatric patients scheduled for minor outpatient surgery under GA and locoregional anesthesia.Ventilation parameters such as ETCO2,tidal volume,and respiratory rate were evaluated and compared between two groups at three phases during the procedure. Significant differences were observed in lung aeration scores based on LUS between the PSV group and the SV group,with higher scores in the SV group.ETCO2 levels were significantly higher in the SV group,while tidal volume was significantly lower and respiratory rate was significantly higher in the SV group compared to the PSV group.No significant difference was noted in saturation levels between the two groups. PSV has been shown to enhance ventilation parameters and mitigate the occurrence of post-induction and residual atelectasis in the immediate postoperative phase among children undergoing GA with mechanical ventilation utilizing a LMA for minor outpatient surgeries. Mariana CARVALHO GRAÇA, Andrea CARINI (Brussels, Belgium) 10:15 - 10:20 #42648 - EP088 The Impact of Intraoperative Esmolol Administration on Postoperative Recovery and Chronic Pain after Inguinal Hernia Repair:A double-blinded randomized study. EP088 The Impact of Intraoperative Esmolol Administration on Postoperative Recovery and Chronic Pain after Inguinal Hernia Repair:A double-blinded randomized study. Recent studies suggest a possible antinociceptive effect of esmolol. The aim of this study is to investigate the effect of an infusion of esmolol on intraoperative nociception, as well as on postoperative acute and chronic pain. In this interim analysis, 35 patients scheduled for inguinal hernia repair were randomized with identical blinded syringes to either the esmolol group, receiving a loading dose of 0.5 mg/kg of esmolol and maintenance dose of 50 mcg/Kg/min or to the placebo group, receiving saline. Intraoperative nociception as assessed by the percentage of anesthesia time during which NOL was<25 as well as postoperative acute and chronic pain with NRS and DN4 scores were analyzed. Intraoperatively, the percentage of time NOL was<25 was higher in the esmolol group versus the control group (p=0.007). The esmolol group demonstrated lower NRS scores on arrival to PACU than the control group at rest and during movement (p 0.019 and 0.015 respectively) and lower NRS scores at discharge from PACU than the control group at rest and during movement (p 0.037 and 0.014 respectively). More patients required additional analgesia in PACU in the control group versus the esmolol group (p=0.01). Cumulative morphine consumption in the PACU was lower in the esmolol group versus the control group (p=0.004). No effect of esmolol on chronic neuropathic pain was demonstrated. Intraoperative esmolol administration seems to decrease intraoperative nociception and to affect aspects of postoperative recovery by mitigating early postoperative pain levels and decreasing the need for opioid rescue medication following inguinal hernia repair. Vassiliki SAMARTZI, Kassiani THEODORAKI (Athens, Greece) 10:20 - 10:25 #42812 - EP089 Efficacy of intraoeprative sub-anesthetic dose of ketamine on postoperative analgesia and presence of nausea for patients undergoing laparoscopic atireflux surgery. EP089 Efficacy of intraoeprative sub-anesthetic dose of ketamine on postoperative analgesia and presence of nausea for patients undergoing laparoscopic atireflux surgery. Laparoscopic antireflux fundoplication,despite being less invasive surgery,require adequate postoperative analgesia.Sub-anesthetic dose of ketamine have proven efficacy for reducing pain scores as well as reducing postoperative opioid consumption in a wide variety of surgical procedures. This is a prospective randomized controlled study enrolling 64 patients aged over 18 years who underwent laparoscopic antireflux fundoplication.Before scin incision, in Ketamine group,0,4 mg/kg of Ketamine was injected as a bolus followed by a 0,25mg/kg/h Ketamine infusion continued till the scin was closed.Control group received normal saline.The visual analogue scale (VAS) of 0-10, was used to measure each patients level of pain an 1, 2, 6, 12, 24, 36 and 48h after surgery.Total postoperative tramadol consumption, time of the first dose,hospital length of stay,side effects and presence of nausea and consumption of metoclopramide on the first postoperative day were recorded. The total intraoperative opioid (Fentanil) consumption,extubation time,hospital length of stay, and presence of nausea and consumption of metoclopramide have significant difference between the groups.The present study showed that there were significant differences between groups in terms of VAS at 1h, 2h. 6h. 12h, 24h, 36h and 48h (p<0.001).The total postoperative consumption of Tramadol was lower in the Ketamine group, and the time of the first administration of the drug was longer, but without statistical significance between the groups.There was no reported side effects in either group. In laparoscopic antireflux surgery,intraoperative Ketamine infusion at sub-anesthetic doses could be an effective and safe technique for reducing postoperative pain,hospital length of stay and presence of nausea. Bojana MILJKOVIĆ (Belgrade, Serbia), Dubravka ĐOROVIĆ, Jelena VELIČKOVIĆ, Danka PERIĆ, Aleksandra KOLUNDŽIĆ, Ivan PALIBRK 10:25 - 10:30 #42813 - EP090 Comparison of efficacy between programmed intermittent epidural bolus and continuous epidural infusion for thoracic epidural analgesia after open upper abdominal surgery, A randomized controlled trial. EP090 Comparison of efficacy between programmed intermittent epidural bolus and continuous epidural infusion for thoracic epidural analgesia after open upper abdominal surgery, A randomized controlled trial. Programmed intermittent epidural bolus (PIEB) has shown to reduce local anesthetic consumption compared to continuous epidural infusion (CEI) during labor analgesia. This study aimed to compare the efficacy of PIEB versus CEI in thoracic epidural analgesia (TEA) for providing postoperative pain control after open upper abdominal surgery. After receiving ethics committee approval, 120 adults who underwent open upper abdominal surgery were randomly allocated to receive epidural solution either as PIEB(4ml/40min) or as CEI(6ml/h) via thoracic epidural catheter for 60h postoperatively. Patient-controlled epidural analgesia (PCEA) for additional boluses as needed was standardized across both groups. The primary outcome was 24-hour epidural drug consumption. Secondary outcomes included epidural drug consumption on postoperative hour 24-60h, time to first PCEA demand, pain scores, rescue analgesics, side effects, recovery, and satisfaction. The PIEB group demonstrated a significant reduction in mean 24-hour epidural drug consumption compared to the CEI group (173.46±32ml vs 200.75±46ml, respectively; mean difference -27.29ml; 95%CI -39.74 to -14.84; P<0.001). Additionally, the median time to first PCEA demand was significantly longer in the PIEB group (188 minutes, IQR 30-778) versus the CEI group (44 minutes, IQR 21-120) (P=0.002). There were no significant differences between the groups in terms of pain scores, rescue analgesic consumption, side effects, recovery outcomes, or patient satisfaction. PIEB reduced epidural drug consumption in the first 24-hour after open upper abdominal surgery compared to CEI, suggesting PIEB may provide more efficacy in early postoperative period. Further research is needed to assess the optimal regimen of epidural drug delivery in TEA. Pongkwan JINAWORN (Bangkok, Thailand), Rattanaporn BURIMSITTICHAI, Kirada APISUTIMAITRI, Titipon PAYONGSRI, Panas LERTPRAPAI, Vissuta UPALA, Panatchakorn PITUGCHAIYAWONG
	"Thursday 05 September" Added to your list of favorites Deleted from your list of favorites EP03S6 10:00 - 10:30 ePOSTER Session 3 - Station 6 Chairperson: Maria Paz SEBASTIAN (Anaestheics and Acute Pain) (Chairperson, London, United Kingdom) 10:00 - 10:05 #40686 - EP079 Feasibility of Regional Anesthesia in Microgravity: A Proof-of-concept study. Feasibility of Regional Anesthesia in Microgravity: A Proof-of-concept study. The ambitious goals of crewed deep space missions, like Nasa's Artemis program and SpaceX's colonization targets, require preparations for potential astronaut health crises. Innovative solutions are necessary to overcome the challenges of administering anesthesia in the unique environment of space and the physiologic changes associated with prolonged microgravity exposure. Regional anesthesia offers a viable solution to these challenges, but its feasibility is yet to be tested. Our study assessed the feasibility of single-shot peripheral nerve blocks in a simulated microgravity environment (free-floating underwater) using a meat model. We randomized forty meat models to be injected under simulated microgravity and normal Earth gravity conditions. Post-injection, blinded assessors determined success rates. Assessed parameters included, "time to block", ease of needle placement, and ease of image acquisition. Block success rates were comparable in both scenarios (80% normal gravity versus 85% microgravity, p > 0.999) and there was no difference in the rate of accidental intra-neural injections (5% versus 5%). The median time to block on land was 27 [IQR 21-69] seconds versus 35 [IQR 22-48] seconds in simulated microgravity (p = 0.751). Ease of needle placement and ease of image acquisition were similar in both conditions. Despite challenges, regional anesthesia appears to be feasible in simulated microgravity. While our model is not a perfect analogue to true space conditions, it provides a foundation for subsequent research into the provision of anesthesia and analgesia during crewed space missions. Matthew KIBERD, Regan BROWNBRIDGE (Halifax, Canada), Mathew MACKIN, Dan WERRY, Sally BIRD, Barry GARRETT, Jon BAILEY 10:05 - 10:10 #40912 - EP116 Efficacy and safety of percutaneous balloon compression for primary trigeminal neuralgia: a systematic review and meta‑analysis. EP116 Efficacy and safety of percutaneous balloon compression for primary trigeminal neuralgia: a systematic review and meta‑analysis. This study's objective was to assess the effectiveness and safety of percutaneous balloon compression (PBC) versus other surgical modalities（microvascular decompression [MVD]、radiofrequency thermocoagulation [RFT]、glycerol rhizolysis [GR]、gamma knife radiosurgery [GKRS]）for treating primary trigeminal neuralgia (PTN). A thorough search was conducted throughout the six electronic databases of PubMed, Embase, Web of Science, CNKI, Wanfang Date and VIP, with a timeframe from the creation of the database to August 2023. We selected the clinical studies that included PBC compared with MVD, RFT, GR, or GKRS for the treatment of primary trigeminal nerve and performed Meta-analysis using Review Manager 5.4 and Stata 12.0. It included 29 studies in total. Among the included studies, there was only 1 study in each of the PBC versus GR group and the PBC versus GKRS group, which did not allow for meta-analysis, so these two subgroups were excluded. We found that the pain relief at last follow-up of PBC much more than RFT; the reccurence of pain of PBC much more than MVD. PBC was associated with a significantly higher incidence of facial numbness, a noticeably higher incidence of masticatory muscle weakening and incidence of herpes simplex compared with MVD and RFT, respectively. PBC was superior to RFT for pain relief at last follow-up in primary trigeminal neuralgia. PBC was linked to an increased likelihood of pain recurrence. Following PBC treatment, there was a significant increase in the incidence of three common complications (facial numbness, masticatory muscle weakness, and herpes simplex). Yongzhe LIU (BEIJING CHINA, China) 10:10 - 10:15 #42515 - EP117 The role of neuromodulation after trapeziometacarpal osteoarthritis surgery. EP117 The role of neuromodulation after trapeziometacarpal osteoarthritis surgery. Osteoarthritis (OA) of the trapeziometacarpal (TMC) joint is a common disabling condition with potential surgical resolution. However, complications following these procedures can include superficial radial neuropathy, contributing to hand disability. The aim of our study was to analyze pain management by neuromodulation of the superficial radial nerve (SRN). Patients undergoing TMC OA surgical procedures at Hospital Center between March 2012 and March 2022 were included. SRN diagnosis block was performed at the first visit with local anesthetic. One month after a successful diagnostic nerve block, pulsed radiofrequency (PRF) of the SRN was performed. Primary endpoint was pain at rest and the secondary outcomes were: hand grip, Functional Index Questionnaire (FIHOA) and Kapandji score. 30 patients met the inclusion criteria. Of the total, 13 patients reported pain and paresthesia on the dorsolateral aspect of the hand, but only 6 patients agreed to participate. Of the total patients, 5 were female, with 2 patients reporting symptoms bilaterally. Pain at rest was described with a median of 8 [IQR 7-8] at baseline and 0 [IQR 0-1,24] after PFR (P = 0.011). Median hand grip (kg) after PFR was 26.8 [IQR 24-31.6] compared to 23.3 [IQR 22.5-25.7] from baseline (P = 0.025) and Kapandji score improved from 6 [IQR 5.8-7.3] from baseline to 7 [IQR 6-8] (P = 0.102). FIHOA index improved 16.5 [IQR 10-21] at baseline to 13.5 [IQR 7.8-18] (P = 0.02). Neuromodulation of SRN may represent a safe and effective approach to treat pain associated with TMC OA surgery. Catarina CHAVES (Porto, Portugal), Andre VARANDAS BORGES, Irene PINTO 10:15 - 10:20 #42718 - EP118 effectiveness of fentanyl and dexamethasone as adjunct to low volume 0.5% bupivacaine in supraclavicular brachial plexus block. EP118 effectiveness of fentanyl and dexamethasone as adjunct to low volume 0.5% bupivacaine in supraclavicular brachial plexus block. The dose of local anaesthetics is reduced when using ultrasound (USG) for supraclavicular brachial plexus block (SCBPB). The aim of this study is to observe the clinical effectiveness of combined fentanyl and dexamethasone in 0.5% 9ml bupivacaine with USG and nerve locator guided SCBPB. This was a prospective double blind randomised control trial. After assessing inclusion and exclusion criteria, total 72 patients were included (gr-a: 36, gr-b: 36). All patients received USG and electrical nerve locator guided SCBPB. Drug was injected with multi-injection technique within the brachial plexus sheath with current intensity 0.3 mA at 0.1 ms duration. Control group (gr-a) received 20 ml 0.5% bupivacaine, Gr-B received 13 ml of drug soup containing 9 ml bupivacaine 0.5%, fentanyl 100 μg, dexamethasone 10 mg. All patient received morphine patient controlled analgesia in postoperative period. Mean time to sensory block was 11.8 minutes (gr-a) and 14.7 minutes (gr-b). Mean time to motor block was 15.6 minutes (gr-a) and 23.5 minutes (gr-b). Mean duration of sensory block was 555.5 minutes (gr-a) and 528.3 minutes (gr-b). Mean duration of motor block was 452.6 minutes (gr-a) and 245.7 minutes (gr-b). Mean morphine requirement in postoperative period 14.2 mg (gr-a) and 8.3 mg (gr-b). Postoperative morphine consumption in first 24 hours was 14.2 mg (gr-a) and 8.3 mg (gr-b). Combined dexamethasone and fentanyl with low volume bupivacaine doesn't shorten time to block initiation and produce short duration of motor block but reduces postoperative opioid consumption. Salah Uddin Al AZAD (Dhaka, Bangladesh), Shyama Prosad MITRA, Aftab UDDIN, Hasina AKHTER, Masrufa HOSSAIN, Sylvia KHAN, Md Mahfujur RAHMAN, Lutful AZIZ 10:20 - 10:25 #42775 - EP119 Same-Day Hip Arthroplasty: An Analysis of Factors Impeding Discharge. EP119 Same-Day Hip Arthroplasty: An Analysis of Factors Impeding Discharge. Same-day hip arthroplasty (SDHA) is becoming increasingly popular due to its association with quicker rehabilitation and enhanced patient satisfaction. However, standard guidelines for discharging patients after SDHA are lacking. Reported discharge rates range between 88% to 95%, and readmission rates vary between 0.03 to 4.6%. This study reports our experience with SDHA at our institution in Genk, Belgium. We analyzed data from patients scheduled for SDHA over a 14-month period. The perioperative protocol included short-acting spinal anesthesia, pericapsular nerve group block, and a standardized multimodal analgesia regimen. Patient demographics such as age and BMI were collected. Medical records were searched for incidence of complications including nausea, vomiting, urinary retention, hypotension, and vagal responses. Reasons for delays in same-day discharge and rate of readmissions were also assessed. Ninety-three patients underwent the SDHA pathway. The average age was 57 (11) years and the average BMI of 26 (4) kg/m2, while 57% were men. Eighty three percent were discharged on the day of surgery. Factors affecting discharge included orthostatic hypotension and vasovagal reactions (31%), nausea and vomiting, (12%), wound oozing (6%), and/or inadequate analgesia (12%). The average pain score on the first postoperative day was 3,7 (1,8) and there were no readmissions. Discharge rates in our institution align with the existing literature. The most common impediments to timely discharge were orthostatic hypotension and vasovagal reactions. We plan to further investigate predisposing factors and develop strategies to address these obstacles, with the goal of enhancing our discharge rates. William AERTS, Thomas HERMANS, Ana LOPEZ GUTIÉRREZ, Catherine VANDEPITTE, Leander MANCEL, Walter STAELENS (Genk, Belgium), Kristoff CORTEN, Imré VAN HERREWEGHE 10:25 - 10:30 #42778 - EP120 Morphine Use and Pain Outcomes in Total Knee Arthroplasty with Intermittent Morphine Administration. EP120 Morphine Use and Pain Outcomes in Total Knee Arthroplasty with Intermittent Morphine Administration. Total knee arthroplasty (TKA) is associated with severe postoperative pain. A combination of motor-sparing blocks (femoral triangle block) with multimodal analgesia is the analgesic strategy in our center. We aimed to assess the efficacy of analgesia in patients receiving TKA. Data was collected from patients undergoing TKA from November to December 2023. Patients received our institutional standard analgesia protocol, which includes a femoral triangle block, and subcutaneous morphine every 4 hours as per patient request. The acute pain service team assessed the maximum pain score using a Numeric Rating Scale (NRS) and the cumulative dose of subcutaneous morphine the first 24 hours following surgery. The postoperative pain of 75 patients who underwent TKA was examined for the first 24 hours. The median postoperative pain score, measured using the NRS, was 5, with an interquartile range of 2 to 7. Severe pain (NRS ≥ 8) was experienced by 20% of patients (n=15). Forty percent (n=30) required postoperative subcutaneous morphine, with a mean cumulative dose of 9.6 mg (standard deviation 8.0 mg). Figure 1 presents a histogram of the postoperative NRS pain scores, annotated with the cumulative morphine doses. This study revealed that TKA is a painful procedure and that 40% of the patients received postoperative opioids. Systematic assessment and audit of the efficacy of postoperative analgesia protocols are essential and can provide information for optimizing pain management strategies. In fact, based on these findings we decided to start a project at our center that could improve morphine administration following TKA. Sarah SHIBA (Genk, Belgium), William AERTS, Leander MANCEL, Walter STAELENS, Amy BELBA, Ana LOPEZ GUTIÉRREZ, Admir HADZIC, Imré VAN HERREWEGHE
	"Thursday 05 September" Added to your list of favorites Deleted from your list of favorites EP03S5 10:00 - 10:30 ePOSTER Session 3 - Station 5 Chairperson: Wojciech GOLA (Consultant) (Chairperson, Kielce, Poland) 10:00 - 10:05 #40727 - EP109 Research trends and highlights toward artificial intelligence in pain: Bibliometric analysis on Web of Science from 2014 to 2023. EP109 Research trends and highlights toward artificial intelligence in pain: Bibliometric analysis on Web of Science from 2014 to 2023. This study aims to use bibliometric methods to identify the contribution of countries, journals, authors, research themes, and emerging trends in artificial intelligence (AI) in pain. Articles on AI in pain were obtained from the Web of Science database which was accessed on 22 February 2024. TheVOSviewer program was used to visualize trends in research on artificial intelligence in pain. Analyses of 767 original articles revealed that the total number of publications has continually increased over the last 10 years. From 2014 to 2023, it was determined that there was an increase in the number of studies on the use of AI in pain [n:13(2014); n:240(2023)] (Figure 1). Scientific Reports (n=31) and Journal of Clinical Medicine are the journals that published the most studies on the use of AI in pain (n=22). The countries with the highest number of studies are the United States (n=174), China (n=131), South Korea (n=88), Germany (n=72), Taiwan (n=59), England (n=54), Canada (n=43), Italy (n=41), Netherlands (n=36), India (n=35), Spain (n=34), Japan (n=33), Australia (n=21), Switzerland (n=24), Saudi Arabia (n=20). In the keyword co-occurrence analysis, 12 clusters were found; machine learning; spine, pain perception, pain, mhealth, pain management, blood sampling, epidural anesthesia, acute coronary syndrome, algorithmic approach, and pain assessment (Figure 2). The present study evaluated research on acupuncture for pain control using bibliometric methods and revealed current trends in artificial intelligence in pain research, as well as potential future hot spots of research in this field. Korukcu OZNUR (Antalya, Turkey) 10:05 - 10:10 #41158 - EP110 Optimizing Pain Management in Patients with Severe L4-L5, L5-S1 Disc Herniation: Synergistic Effects of Common Peroneal Nerve Blockade and Transforaminal Steroid Injections. EP110 Optimizing Pain Management in Patients with Severe L4-L5, L5-S1 Disc Herniation: Synergistic Effects of Common Peroneal Nerve Blockade and Transforaminal Steroid Injections. Stabbing pain deriving from a herniated disc at L4-L5, L5-S1 levels poses a significant clinical challenge. Some patients diagnosed with lumbar disc herniation experience not only typical pain but also hyperalgesia over the sensory territory of the common peroneal nerve. Therefore, exhaustive approaches are emerging for effective pain management. Among these emerging techniques are transforaminal steroid injections associated with common peroneal nerve blockade. Consequently, the study aims to investigate the potential synergistic effects of integrating these two interventions to improve pain relief in patients with lumbar radiculopathy. Prospective, single-center study conducted from September 2022 to September 2023. Included patients were aged 25 to 65 years, with L4-L5, L5-S1 radicular pain, and discomfort throughout the common peroneal nerve's sensory territory. Participants were blindly assigned to two groups: the first receiving ultrasound-guided common peroneal nerve blockade in addition to transforaminal steroid epidural injection, while the second group received only the standard transforaminal injection method. Pain intensity was assessed using a visual analog scale (VAS) for all participants before and after interventions to evaluate changes in scores and duration of pain relief. 180 patients were included in the study, with 60% of the population being female and 40% male. Preliminary results showed a remarkable depletion in pain scores after combining both interventions in 100% of participants. This combined approach appears promising for managing severe radiculopathy. Further investigations through larger-scale studies with long-term follow-up are crucial to confirm these findings and establish the role of this combined intervention in the management of lumbar radiculopathies. Elianore KHADRA, Souhail CHAMANDI (Jbeil, Lebanon) 10:10 - 10:15 #41257 - EP111 Comparative Study of Ultrasound Guided vs Landmark Technique of Subarachnoid Block in patients of Ankylosing Spondylitis undergoing Total Hip Replacement. EP111 Comparative Study of Ultrasound Guided vs Landmark Technique of Subarachnoid Block in patients of Ankylosing Spondylitis undergoing Total Hip Replacement. Ankylosing spondylitis (AS), a persistent inflammatory condition targeting sacroiliac joints and spine, induces stiffness and a distinctive bamboo spine, presenting challenges in anesthetic management due to airway complexity and spinal rigidity. The aim of this is to determine whether an ultrasound-assisted technique could reduce the number of needle passes required for a successful dural puncture in patients with abnormal spinal anatomy compared with conventional landmark-guided techniques This prospective randomized controlled comparative study will be conducted in cooperative patients aged between 18 and 60 years of either sex, belonging to American Society of Anaesthesiologists physical status I and II, scheduled to undergo elective total hip replacement under spinal anesthesia. Patients were randomly assigned to two groups via a computer-generated random table: Group 1 received ultrasound-guided subarachnoid blocks, and Group 2 received blocks using the surface landmark technique After taking sterile precautions, the puncture site was prepared, and the subarachnoid block was administered using the assigned method. Hemodynamic variables such as heart rate, mean arterial pressure, SpO2, and ECG readings were continuously monitored, along with the total number of attempts taken to administer the block. In Group I using the USG method, most participants achieved block success on the first attempt, whereas Group II using the landmark technique had a lower first-attempt success rate, resulting in a significant difference. The USG method marginally increased procedure time, though not significantly. The preprocedural ultrasound-assisted sub arachnoid block can increase the first-pass success rate in patients of ankylosing spondylitis undergoing total hip replacement surgery Prem Raj SINGH (lucknow, India), Risabh MISHRA 10:15 - 10:20 #42438 - EP112 Effect of Epidural Analgesia on Regional Lung Ventilation in Parturient Women as Assessed by Thoracic Impedance. EP112 Effect of Epidural Analgesia on Regional Lung Ventilation in Parturient Women as Assessed by Thoracic Impedance. The electrical impedance tomography (EIT) measures non-invasively atelectasis, through changes in the thoracic impedance. The purpose of the present study was to assess by EIT the effects of lumbar epidural analgesia on ventilation, in pregnant women, during labor, in sitting position. After Institutional Ethics Committee approval and written consent, 37 adult ASA 2 at term pregnant patients were studied. The belt of the EIT was placed around the patient’s thorax at Th4–Th6 level. The study recordings were done 10 minutes before and after insertion and loading of the epidural analgesia. Student’s paired t-test with the Bonferroni correction was applied to compare data before and after epidural analgesia, for the global and regional ventilation. Data are expressed as mean [95%CI]. Good levels of analgesia were obtained in all cases (VAS 8,43 vs 0,97 [ -8,208 to -6,710], p<0.001), with upper sensory levels reaching from Th4 to Th10. Atelectasis was seen in all patients before the epidural analgesia, with better ventilated regions centrally than peripherally. No effects of epidural analgesia on atelectasis were noted neither for the global, nor for regional ventilation (Figure 1). This is the first study assessing lung atelectasis before and after epidural analgesia during labor. The changes in lung volumes, as demonstrated by this study, are mostly due rather to the mechanical pushing of the abdominal content towards the diaphragm and lung, and not to shallow breathing due to pain. Further studies in left lateral position are needed. Stefano DORIA (Brussels, Belgium), Alexandra COLESNICENCO, Senada YMERAJ, Thibaut DECOEUR, Annalinda CIORRA, Younes GHAMGUI, Turgay TUNA, Laszlo SZEGEDI 10:20 - 10:25 #42465 - EP113 Refining anatomical precision for procedure specific analgesia in total knee arthroplasty: a comprehensive review of randomized controlled trials. EP113 Refining anatomical precision for procedure specific analgesia in total knee arthroplasty: a comprehensive review of randomized controlled trials. This comprehensive review critically assesses the anatomical precision of adductor canal block (ACB) and its impact on analgesic efficacy in total knee arthroplasty (TKA). By conducting subgroup analyses on the femoral triangle block (FTB), proximal ACB (p-ACB), and distal ACB (d-ACB), this study investigates the motor-sparing effects and analgesic efficacy of ultrasound-guided techniques. The intricate anatomical complexities within the femoral triangle, adductor canal, and subsartorial region are synthesized to elucidate the intricacies of nerve targeting. A critical evaluation of published randomized controlled trials from 2013 to 2023 revealed flaws in the technique of ACB administration, leading to potentially misleading conclusions. To address these shortcomings, a novel approach called Dual subsartorial block (DSB) is advocated, which rectifies the identified flaws and provides superior analgesia for TKA by covering both the anterior and posterior components of pain. The findings highlight the inadequacy of conventional ACB methods in achieving procedure-specific analgesia, underscoring the importance of anatomical precision and nerve localization. In contrast, the DSB approach shows promise by leveraging selective motor effects and optimizing local anesthetic delivery. This study emphasizes the necessity of refining anatomical representations for procedure-specific analgesia in TKA. Existing randomized controlled trials and meta-analyses are critiqued for proposing guidelines based on flawed anatomical understanding. By delineating the nuances of ACB and advocating for DSB, a paradigm shift towards tailored analgesic strategies is encouraged, aiming to enhance patient outcomes and post-surgical recovery. Kartik SONAWANE, Pratiksha NAYAK PRAMOD (Bangalore, India) 10:25 - 10:30 #42508 - EP114 A comparison of the efficacy of transforaminal epidural triamcinolone and magnesium injection in chronic low back pain. EP114 A comparison of the efficacy of transforaminal epidural triamcinolone and magnesium injection in chronic low back pain. Administration of steroids in lumbar transforaminal epidural injection in lumbar radicular pain is considered one of the preferred treatment methods, though associated with some complications. Adding magnesium sulfate to local anesthetics has potentiate the effects of peripheral and neuraxial blocks. The effects and side effects of triamcinolone and magnesium sulfate in the lumbar transforaminal epidural injections are investigated in the present study. Sixty patients, aged 40 - 70 years, suﬀering from unilateral lumbar radicular pain arising from the lumbar disc protrusion were equally divided into two groups of triamcinolone (T) and magnesium (M). They all underwent fluoroscopic guided lumbar transforaminal epidural injections. In the T group, the injection solution contained triamcinolone (20 mg) plus ropivacaine (0.2%), and in M group was magnesium (150mg) plus ropivacaine (0.2%). If the spinal nerve involvement was in two levels, the same injection solution would be repeated. Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) were measured at 0, 2 weeks, 1, and 3 months post-procedure. The potential complications were evaluated. There was a statistically significant improvement in pain score (VAS) and functional disability (ODI) during the measurement times in the both groups (p<0.05). The pain intensity and disability index were not significantly different between the triamcinolone and magnesium groups (p>0.05). No complications were observed in both groups. The lumbar transforaminal epidural injection with triamcinolone or magnesium attenuates lumbar radicular pain. In patients where corticosteroid is not a suitable adjuvant to local anesthetic, or its use is limited, magnesium may be an appropriate alternative. Farnad IMANI, Poupak RAHIMZADEH, Kambiz SADEGI (Zabol, Islamic Republic of Iran), Seyed-Hossein KHADEMI, Mahnaz NARIMANI-ZAMANABADI, Mahshid VAZIRI
	"Thursday 05 September" Added to your list of favorites Deleted from your list of favorites EP03S4 10:00 - 10:30 ePOSTER Session 3 - Station 4 Chairperson: Lara RIBEIRO (Anesthesiologist Consultant) (Chairperson, Braga-Portugal, Portugal) 10:00 - 10:05 #40095 - EP103 Comparison of Differences in Hypotension Frequency Between Propofol and Remimazolam Sedation in Patients Undergoing Hip Joint Surgery Under Spinal Anesthesia. EP103 Comparison of Differences in Hypotension Frequency Between Propofol and Remimazolam Sedation in Patients Undergoing Hip Joint Surgery Under Spinal Anesthesia. The prevalence of intraoperative hypotension has garnered significant attention due to its impact on organ perfusion and potential adverse effects. Both spinal anesthesia and sedation contribute to hypotension occurrence, heightening the risk for patients who receive sedative drugs during spinal anesthesia. This study was designed to explore the differences in hypotension frequency between propofol and remimazolam sedation, a traditional and emerging sedative choice respectively, known for their rapid onset and offset of action, during hip surgeries in spinal anesthesia. A total of 78 patients of age group 20-65 years of American Society of Anesthesiologists grade I-III, posted for hip surgeries under spinal anesthesia were randomly divided into two groups (n=39 each) to receive remimazolam (Group R) or propofol (Group P) infusion targeting a Modified Observer’s Assessment of Alertness/Sedation(MOAA/S) score of 3. The primary outcome was the frequency of hypotensive episodes, defined by mean blood pressure < 65mmHg, in the first hour of infusion. Secondary outcomes included the incidence of hypotension during surgery, other hemodynamic variables, the incidence of rescue phenylephrine use, and postoperative adverse outcomes. The incidence of hypotension during surgery was significantly lower with remimazolam than propofol(23 vs 33; P=0.02). However, there were no significant differences in the frequency of hypotensive episodes, other hemodynamic variables, use of hemodynamic rescue drugs, or postoperative adverse outcomes. Remimazolam, with its minimal effects on hemodynamic, could be a valuable adjunct for intraoperative sedation during hip surgery under spinal anesthesia. Jung Min LEE, Ha-Jung KIM, Won Uk KOH (Seoul, Republic of Korea), Hyungtae KIM, Young-Jin RO 10:05 - 10:10 #41590 - EP104 Comparative analysis of postoperative incentive spirometry performance: Erector spinae plane block versus systemic opioid analgesia in open abdominal surgery. EP104 Comparative analysis of postoperative incentive spirometry performance: Erector spinae plane block versus systemic opioid analgesia in open abdominal surgery. Incentive spirometry is a method commonly used for prevention of postoperative pulmonary complications in patients after abdominal surgery. However, pain after surgery can cause diminished incentive spirometry volumes. By effectively controlling postoperative pain, patient performance in incentive spirometry can be enhanced. The aim of this study is to determine whether erector spinae plane (ESP) block added to a standard analgesic regimen can improve incentive spirometry performance in patients after open abdominal surgery. This retrospective cohort study was approved by the Institutional Ethics Review Committee of St. Luke’s Medical Center. The records of 110 patients who underwent open abdominal surgery were reviewed. For the opioid-based group (n=55), a standard analgesic regimen of Paracetamol and a Non-steroidal Anti-inflammatory Drug (Parecoxib, Ketorolac or Dexketoprofen) was given in the first 24 hours post-surgery. Tramadol, Oxycodone, or Fentanyl was given as needed for breakthrough pain. For the ESP group (n=55), ultrasound-guided single shot bilateral ESP block with 0.2%-0.4% Ropivacaine was administered as an adjunct to the aforementioned standard analgesic regimen. The first recorded incentive spirometry scores in the first 24 hours postoperatively were compared between the two groups. Mean peak effort volume on incentive spirometry within 24 hours postoperatively was significantly higher with the ESP group (1212.7 ml +/- 523.4 ml) compared to the opioid-based group (541.8 ml +/- 437.7 ml) with p-value <0.001 (Fig 1). Addition of ESP block to the analgesic regimen of patients undergoing abdominal surgeries facilitates more effective incentive spirometry compared to an opioid-based analgesic regimen alone. Wilgelmyna AMBAT (Taguig City, Philippines), Samantha Claire BRAGANZA, Emmanuel BRAGANZA, Ray Carlo ESCOLLAR, Alexis Katrina DE LA VICTORIA 10:10 - 10:15 #42099 - EP105 Comparison of Analgesic Efficacy of Ultrasound-Guided Anterior Quadratus Lumborum Block and Suprainguinal Fascia Iliaca Block in Adult Patients Undergoing Total Hip Arthroplasty via Posterior Approach: A Randomized, Assessor-Blinded Study. EP105 Comparison of Analgesic Efficacy of Ultrasound-Guided Anterior Quadratus Lumborum Block and Suprainguinal Fascia Iliaca Block in Adult Patients Undergoing Total Hip Arthroplasty via Posterior Approach: A Randomized, Assessor-Blinded Study. Total hip arthroplasty (THA) is a frequent orthopedic procedure, leading to substantial perioperative pain. Suprainguinal fascia iliaca block (SIFIB) and anterior quadratus lumborum block (A-QLB) are two modern regional anesthesia methods used for THA analgesia. This study compares their efficacy in THA via a posterior approach. This randomized, assessor blinded study was conducted between January 2023 and May 2024 following IRB approval and registration (NCT05684471). ASA I-III patients aged 18-75y scheduled for THA were included. Blocks were performedat the end of surgery with 50 mL of 0.25% bupivacaine in the SIFIB group, and with 40 mL of 0.25% bupivacaine in the A-QLB group. The primary outcome assessed was the 24-hour cumulative morphine requirement, delivered via patient-controlled analgesia (PCA). Secondary outcomes encompassed pain scores, time to first opioid demand, and presence of quadriceps weakness. Additionally, occurrences of nausea, vomiting, and Quality of Recovery-15 (QoR-15) scores were recorded. In this study of 65 patients (SIFIB: 33, A-QLB: 32), morphine consumption at various time points showed no difference between groups (p>0.05). At 24 hours, opioid usage was similar (SIFIB: 9.94±7.64 mg, A-QLB: 11.31±6.85 mg, p: 0.449). Pain scores, time to first analgesic requirement, and QoR scores were comparable (p>0.05). Notably, quadriceps weakness varied, with the SIFIB group having an 18/15 absence/presence ratio and the A-QLB group a 25/7 ratio by 24 hours post-op. Although opioid demands and pain scores showed no significant differences among patients undergoing THA with either SIFIB or A-QLB for postoperative pain relief, A-QLB demonstrated superior motor sparing effects. Ramazan Burak FERLI (Samsun, Turkey), Serkan TULGAR, Kadem KOÇ, Lokman KEHRIBAR, Nizamettin GUZEL, Mustafa SUREN 10:15 - 10:20 #42458 - EP106 Novel diagnostic morphological parameter for the suprascapular nerve entrapment syndrome - The supraspinatus muscle cross-sectional area. EP106 Novel diagnostic morphological parameter for the suprascapular nerve entrapment syndrome - The supraspinatus muscle cross-sectional area. Suprascapular nerve entrapment syndrome (SSNES) is a neuropathy caused by compression of the nerve. Previous research has demonstrated that it often causes the weakness of supraspinatus muscles, as well as pain of the shoulder. We considered that the supraspinatus muscle cross-sectional area (SMCSA) might be a morphological parameter to analyze SSNES. We acquired supraspinatus muscle data from 10 patients with SSNES and from 10 control subjects who revealed no evidence of SSNES. T1-weighted sagittal magnetic resonance imaging of the shoulder (MRI-S) images were acquired. We analyzed the supraspinatus muscle thickness (SMT) and SMCSA at the shoulder on the MRI-S using our image analysis program. The SMCSA was measured as the whole supraspinatus muscle cross-sectional area that was most hypertrophied in the sagittal MRI-S images. The SMT was measured as the thickest level of supraspinatus muscle. The mean SMT was 20.05 ± 1.85mm in the normal group and 18.16 ± 1.58mm in the SSNES group. The mean SMCSA was 653.24 ± 100.55mm2 in the normal group and 503.06 ± 117.89mm2 in the SSNES group. SSNES patients had significantly lower SMT (p < 0.001) and SMCSA (p < 0.001) than the normal group. ROC curve analysis suggested that the best cut-off scores of the SMT was 18.49 mm, with 70.0% sensitivity, 70.0% specificity, and an AUC of 0.80 (95% CI, 0.60-0.99). The optimal cut-off value of the SMCSA was 612.60mm2, with 80.0% sensitivity, 80.0% specificity, and AUC of 0.85 (95% CI, 0.68-1.00). The SMCSA test is more sensitive than the SMT test. Jungmin LEE (YI) (Seoul, Republic of Korea) 10:20 - 10:25 #42474 - EP107 Antibiogram Profile in the setting of high frequency of multidrug resistant organisms. EP107 Antibiogram Profile in the setting of high frequency of multidrug resistant organisms. Antimicrobial resistance(AMR) has become a global issue. Not only decreasing the treatment options but a serious threat to low-income countries associated with both misuse of antibiotics. Antibiogram is essential for a hospital to track changes in AMR and to guide empirical antimicrobial therapy. The goals of the current study is to ascertain burden of nosocomial infections in ICU patients, pinpoint involved pathogens, and sensitivity to antimicrobial drugs. This study was retrospective cross-sectional in nature. Study was conducted at SICU of Doctors Hospital and Medical Center, Lahore over a period of one year from January 2021 to December 2021. Patients of both genders with age above 18years were included in this study. 364 patients were recorded for the purpose of study and analyzed. All cultures were processed in accordance with standard microbiological protocols defined by CLSI.The antibiogram was constructed according to CLSI and Stanford University’s web-based antibiogram. Among 364 patients analyzed in the study, the cultures obtained from different sites were Blood (54%), Urine (33%) and tracheal (13%). Among blood cultures, no organism was isolated. E coli was most common organism among urine and Klebsiella Pneumonia was most frequently encountered in tracheal cultures. Vancomycin and Linezolid showed zero percent resistance to Staphylococcus. Collistin showed zero percent resistance for Acinetobacter and Klebsiella. The high frequency of multidrug resistance bacteria in ICU suggests that we need to prescribe broad-spectrum antibiotics more wisely to reduce pressure on sensitive strains. Vancomycin and Linezolid for Gram positive organisms and Collistin for Gram negative organisms. Sami UR REHMAN (Dublin, Ireland) 10:25 - 10:30 #42574 - EP108 Nurses' Challenges in Treating Chronic Pain Among Women. EP108 Nurses' Challenges in Treating Chronic Pain Among Women. Chronic pain is a prevalent and debilitating condition affecting millions of women worldwide and often resulting from conditions such as fibromyalgia, endometriosis, and chronic migraines. Managing chronic pain effectively is crucial for improving patients' quality of life, yet nurses face numerous challenges in delivering optimal care. This review aims to identify and analyze the primary challenges faced by nurses in treating chronic pain among women, exploring both clinical and non-clinical factors. A comprehensive literature review was conducted, analyzing peer-reviewed articles, clinical studies, and professional reports published between 2010 and 2023. Key databases searched included PubMed, CINAHL, and and PsycINFO. The review focused on studies that addressed challenges in pain assessment, communication, interdisciplinary collaboration, education, and psychosocial factors in the context of chronic pain management in women. Nurses often encounter difficulties in accurately assessing chronic pain due to its subjective nature, variability in pain expression, and the influence of emotional and psychological factors. Effective communication between nurses and patients is critical for understanding pain levels and treatment efficacy. Third significant challenge id interdisciplinary collaboration. Chronic pain management requires a multidisciplinary approach. However, nurses frequently face obstacles in coordinating with other healthcare professionals, leading to fragmented care and inconsistent pain management strategies. There is also a need for enhanced education and training for nurses in pain management techniques, pharmacology, and non-pharmacological interventions alongside with the need to psychological support. Nurses encounter multiple challenges in managing chronic pain among women, stemming from issues in pain assessment, communication, interdisciplinary collaboration, education, and psychosocial support. Keren GRINBERG (4025000, Israel)
10:30	"Thursday 05 September" Added to your list of favorites Deleted from your list of favorites B21 10:30 - 11:30 Special session The right imaging modality for the right intervention in interventional pain therapy Chairperson: Urs EICHENBERGER (Head of Department) (Chairperson, Zürich, Switzerland) 10:30 - 10:35 Introduction. Urs EICHENBERGER (Head of Department) (Keynote Speaker, Zürich, Switzerland) 10:35 - 10:48 Fluoroscopy. Jose DE ANDRES (Tenured Professor) (Keynote Speaker, Valencia (Spain), Spain) 10:48 - 11:01 Ultrasound. Manfred GREHER (Medical Hospital Director and Head of Department) (Keynote Speaker, Vienna, Austria) 11:01 - 11:14 #43478 - B21 Hybrid. Hybrid. Introduction XXI century has brought high resolution ultrasound (HRUS) to contemporary interventional pain practice. It has been taken enthusiastically by many practitioners with more reservation from others. In 2012 it has been only few hundred publications related to ultrasound in pain medicine (USPM) in comparison to more than 2000 dedicated to ultrasound guided regional anaesthesia (UGRA). By 2023 it has been around 1500 articles concerning USPM with around 5000 of UGRA. ( Pubmed search- September 2023). Teaching and training have been thriving around the world. After initiation by dr Barry Nicholls in 2008 author of this abstract has been running RA-UK USPM course in London coming to 16^th edition next year. We have been proudly hosting the Faculty who have been pioneering USPM combining clinical expertise with anatomical knowledge: Bernhard Moriggl, Urs Eichenberger, Manfred Greher, Samer Narouze, Philip Peng just to mention a few. We trained few generations of pain physicians by now, some of them becoming faculty of the course and teaching globally. HRUS opened a new horizon for pain medicine bringing precision, safety, diagnostic potential and as the result, better outcome. Pain medicine has become more interdisciplinary involving radiology, rheumatology, sport medicine, neurology, physiotherapy and other specialities. HRUS has changed our clinical practice in pain interventions such as stellate ganglion, occipital nerves, cervical roots, peripheral nerves diagnostic, peripheral nerve stimulation(neuromodulation) , musculoskeletal including joint injections . For some procedures, especially around lumbar spine, although confirmed by feasibility study, HRUS does not offer advantage over fluoroscopy especially in patients with increased body habitus. Figure 1 shows author’s classification of clinical applications of ultrasound in interventional pain practice. There are specific procedures where information from ultrasound and fluoroscopy imaging complements each other making given procedure safer, more precise and less time consuming. Following are highlights of combined / hybrid techniques: ultrasound and fluoroscopy Cervical spine Cervical Medial Branch Blocks: There is plethora of fluoroscopy guided techniques: posterior, lateral, anterior, oblique approach involving multiple x-ray beam adjustment to position the tip of the needle in the middle of articular pillar. Ultrasound technique described by Siegenthaler et al. (1) consist of long axis scan visualising wavy, sinusoid with top being facet joints and bottom waist of articular pillar. Out of plane, anterior to posterior needle direction has been advocated to avoid inadvertent vertebral artery puncture. “In Plane “approach described by Finlayson et al. (2) follows in plane path from posterior to anterior and place the needle on the target at the middle upper part of the waist of articular pillar. Reversed fluoroscopy/ ultrasound techniques has been published by Krol et al (3) and in Ultrasound-guided interventions in chronic pain management (4). Patient in prone position, needle entrance under fluoroscopy tunnel view in AP projections form posterior to anterior. Lateral projection assesses advance to the articular pillar of the desired level. Finally, under ultrasound in transverse, short axis view needle is adjusted to rest in final position close to the bone, behind the posterior tubercle, away from the nerve root. Presence of vessels and spread of the injectate is observed directly. Long axis view also confirms accurate needle position. Figure 2 - Described technique reduces significantly amount of radiation used for each intervention yet easily defines the level of vertebra addressed. Final adjustment with ultrasound allows confident, safe injections and radiofrequency thermal lesion. One entry point can be used for most levels reducing procedure discomfort. Cervical Nerve Roots Ultrasound guidance allows not only visualise nerve roots leaving foramina but appreciate associated arteries including vertebral artery (VA), other neural structures and to certain extend spread of the solution. Ultrasound identification of the nerve root in question is relatively straightforward once pattern of recognition is followed. Dynamic scanning is required for counting the right level. Figure 3 - Showing C7 nerve root and VA as a two black (hypoechoic) round structures. Colour doppler shows VA in front of the nerve root Fluoroscopy picture shows spread of the contrast extraforaminal or epidural in AP and lateral projection. Plastic model shows transverse probe position at C7 level. The course of the nerve within the foramen is only few mm and its often occupies the whole space especially if narrowed. The needle tip position just outside the foramen seems to be safe and effective. Injection pressure monitoring is recommended to detect intraneural needle position and avoid inadvertent spread. (5) Thoracic spine Fluoroscopy and HRUS are perfect hybrid technique. Exact level required for interventions and bony landmarks are easily identified by x-ray image. HRUS allows direct needle visualisation reaching the targets: thoracic nerve root, paravertebral space, intercostal nerve, medial branches, costotransverse joint and ligament. Erector spinae fascial plane can be easily targeted if one wishes so. The main indications for interventions are persistent post-surgical pain (PPSP – post thoracotomy, breast surgery, chest trauma), intercostal neuralgia, postherpetic neuralgia, costotransverse, costovertebral and thoracic facet pain. Figure 4 - shows diagram of typical targets and US probe position, US images and paravertebral contrast spread with needle on target. Lumbar Sympathectomy Lumbar sympathetic chain is targeted at anterior-lateral surface of L2 and L3 vertebral body. Fluoroscopy technique requires estimate needle angulation to reach the level. HRUS allows to see the needle trajectory and appreciate thoracolumbar fasciae and muscular layers: latissimus dorsi, erector spinae, quadrats lumborum, psoas. Each of the fasciae or muscles can be a target for intervention if required. Figure 5 Sacroiliac Joint block and denervation Sacroiliac joint (SI) is the largest synovial joint in human body and often overlooked source of pain. Blind technique achieves intraarticular location in only 20% of cases. 68% are within 1 cm of the joint, epidural and sacral foramina flow appear in 24% and 44% respectively. (6) Therefore, image guidance is recommended. Fluoroscopy guidance requires alignment of anterior and posterior part of the joint and does not appreciate iliac bone overlapping and obscuring access to the joint. It has been confirmed by feasibility study that around 60 ultrasound guided injection are required to achieve proficiency. (7) Lower part of the joint is usually accessible at the level of S2 foramen. Needle direction from medial to lateral. With progressing age, I synovial cleft become narrower making intraarticular injection very difficult or even impossible forcing needle to be withdrawn. Periarticular injection is acceptable. Fluoroscopy with oblique angulation aiming at “tunnel vision” of the needle completes the procedure. Figure 6 HRUS may be also used to assist SI joint denervation with Simplicity probe as described by Krol et al. (8) Entry point, advancing the probe close to the bone surface, alignment lateral to the line of foramina and medial to the SI reduces the risk of visceral damage or entering the spinal canal. Reduced radiological exposure time is highlight of the procedure. Figure 7 shows ultrasound and fluoroscopy imaging of the procedure Caudal epidural Caudal epidurals in chronic pain management are not used for they efficacy but potential safety by entering the epidural space away from spinal stenosis level or postoperative changes. Catheter can be inserted and advanced cranially if desired. Fluoroscopy guided caudal epidural can be surprisingly challenging especially in patient with increased body habitus. HRUS allows to identify sacral cornua in transverse projection and after 90 degrees probe turn, in plane needle trajectory leads to the epidural space. Radiological contrast injection confirms the tip position, visualise epidurogram and excludes intravascular spread. Figure 8 Hip articular branches Clinical need refreshed anatomical knowledge of the articular, sensory branches innervating the hip joint. It has sparked interest amongst regional anaesthetist, pain physicians and orthopaedic surgeons. The main indication being palliative treatment of inoperable hip fracture and patients with hip OA who are on waiting list for THA for whom simple intraarticular injections stopped being effective, patients for whom operation risk outweigh the benefits, or simply do not have access to such treatment. Femoral articular branches (FAB), accessory obturator nerve (AON) and obturator articular branch (OAB)are the targets. There are only case reports and case series describing the approach under fluoroscopy guidance, ultrasound guidance or combination of both. Hybrid technique provides the safest approach with ultrasound not only visualising targets but also neurovascular structures to be avoided on the needle trajectory. The inferiomedial acetabulum (radiological teardrop), target for OAB might be difficult to visualize by ultrasound alone. Based on fluoroscopy and US imaging the needle path is chosen on case-to-case bases. Local anaesthetics (LA), radiofrequency ablation and small volume of neurolytic agents 0.5-1.0ml can be used. Figure 9 shows both imaging modalities. Knee articular branches- Genicular nerves Publication by Choi et al (9) demonstrating long term benefit after ablation of sensory branches innervating anterior knee joint drawn international attention. Initial description of targeting superiolateral, superiomedial and inferiomedial branches under fluoroscopy guidance has been translated to ultrasound guided technique described also by the author group. (10) Both techniques stand and complement each other eg. Fluoroscopy may help in defining inflexion point of diaphysis and epiphysis easily lost with ultrasound when 90 degrees probe adjustment is exercise for in plane needle introduction. Beside precise position, many new anatomical studies described large variety of genicular nerves numbers, their course and origin explaining not consistent outcome after intervention. There are various ways to increase the lesion size not to be discussed in this manuscript. One of the ways to improve the outcome could be adding inferolateral branches from inferolateral genicular nerve and recurrent articular branch which has become author routine practice. Common peroneal nerve is traced from popliteal area until division to deep and superficial branch and recurrent articular branch along with artery traced cranially to the level of Gerdy’s tubercle. Figure 10 Ultrasound and fluoroscopy approach with needles inserted at 4 points including inferolateral as described. Summary Hybrid imaging with combination of ultrasound and fluoroscopy has been increasingly used providing safer approach, precise position on target resulting in better outcome for both patient and provider satisfaction. Author institution St George’s University Hospital Anaesthetic Department and Chronic Pain Service has been recognized ESRA training centre offering hands on experience for those holding GMC registration. References 1. Siegenthaler A, Mlekusch S, Trelle S, Schliessbach J, Curatolo M, Eichenberger U. Accuracy of ultrasound-guided nerve blocks of the cervical zygapophysial joints. Anesthesiology. 2012 Aug;117(2):347-52. doi: 10.1097/ALN.0b013e3182605e11. PMID: 22728783. 2. Finlayson RJ, Gupta G, Alhujairi M, Dugani S, Tran DQ. Cervical medial branch block: a novel technique using ultrasound guidance. Reg Anesth Pain Med. 2012 Mar-Apr;37(2):219-23. doi: 10.1097/AAP.0b013e3182374e24. PMID: 22030725. 3. Krol A, Van Tilburg K, Goroszeniuk T, My patient presents whiplash injury. What to do? The best of both worlds-Fluoroscopy and Ultrasound Combined guidance for cervical medial branch block and radiofrequency denervation. Reg Anesth Pain Med. Vol 42, Number 5, Supplement 1, pp 22-5; Sep-Oct 2017 4. Simpson G, Krol A, Nicholls B, Silver Ultrasound Guided Interventions in Chronic Pain Management ESRA 2019 ISBN 978-2-8399-2741-3 5. Krol A. Can we increase the safety of transforaminal injections? A place for injection pressure monitoring Journal of Observational Pain Medicine – Volume 1, Number 5 pp 29-36 (2015) ISSN 2047-0800 6. Rosenberg, Jack M. M.D.; Quint, Douglas J. M.D.†; de Rosayro, A. Michael M.D.. Computerized Tomographic Localization of Clinically Guided Sacroiliac Joint Injections. The Clinical Journal of Pain 16(1):p 18-21, March 2000. 7. Pekkafalı, Mehmet Zekai, et al. "Sacroiliac joint injections performed with sonographic guidance." Journal of Ultrasound in Medicine 22.6 (2003): 553-559. 8. Krol, A, Ponnussamy, K , Evans N. , Nicolaou A Ultrasound assisted Simplicity III probe placement for Sacroiliac joint radiofrequency denervation- case report and description of the novel technique. JOOPM 2014 Vol 1 (4):84-91 9. Choi WJ, Hwang SJ, Song JG, Leem JG, Kang YU, Park PH, Shin JW. Radiofrequency treatment relieves chronic knee osteoarthritis pain: a double-blind randomized controlled trial. Pain. 2011 Mar;152(3):481-487. doi: 10.1016/j.pain.2010.09.029. Epub 2010 Nov 4. PMID: 21055873. 10. Ghasemi-Nejad, Tavakkolizadeh M, Krol A ULTRASOUND GUIDED GENICULAR NERVE BLOCK- TECHNIQUE DESCRIPTION, Proceeding, EFIC Congress, Vienna, Austria Andrzej KROL (LONDON, United Kingdom) 11:14 - 11:30 Consensus. Urs EICHENBERGER (Head of Department) (Keynote Speaker, Zürich, Switzerland)	PANORAMA HALL
	"Thursday 05 September" Added to your list of favorites Deleted from your list of favorites C22 10:30 - 11:50 LIVE DEMONSTRATION Ultrasound-Guided invasive treatments for joint pain: Shoulder - Hip - Knee Demonstrators: Thomas HAAG (Consultant) (Demonstrator, Oswestry, United Kingdom), Philip PENG (Office) (Demonstrator, Toronto, Canada), Raja REDDY (Consultant Anaesthetist & Pain Physician) (Demonstrator, Kent, United Kingdom), Martina REKATSINA (Assistant Professor of Anaesthesiology) (Demonstrator, Athens, Greece)	South Hall 1A
	"Thursday 05 September" Added to your list of favorites Deleted from your list of favorites D22 10:30 - 11:20 ASK THE EXPERT POCUS on Diaphragm Chairperson: Moira ROBERTSON (Head of department) (Chairperson, Nyon, Switzerland) 10:30 - 10:35 Introduction. Moira ROBERTSON (Head of department) (Keynote Speaker, Nyon, Switzerland) 10:35 - 11:05 Standardizing diaphragmatic function. Hari KALAGARA (Assistant Professor) (Keynote Speaker, Florida, USA) 11:05 - 11:20 Q&A.	South Hall 1B
	"Thursday 05 September" Added to your list of favorites Deleted from your list of favorites E22 10:30 - 11:20 ASK THE EXPERT ESP myths and facts Chairperson: Ana SCHWARTZMANN BRUNO (President) (Chairperson, Montevideo, Uruguay) 10:30 - 10:35 Introduction. Ana SCHWARTZMANN BRUNO (President) (Keynote Speaker, Montevideo, Uruguay) 10:35 - 11:05 ESP myths and facts. Dario BUGADA (Consultant anesthesiologist) (Keynote Speaker, Bergamo, Italy) 11:05 - 11:20 Q&A.	South Hall 2A
	"Thursday 05 September" Added to your list of favorites Deleted from your list of favorites F22 10:30 - 11:20 EXPERT OPINION DISCUSSION Setting up a block room Chairperson: Siska BJORN (Postdoc, Resident) (Chairperson, Aarhus, Denmark) 10:30 - 10:35 Introduction. Siska BJORN (Postdoc, Resident) (Keynote Speaker, Aarhus, Denmark) 10:35 - 10:50 Pitfalls. Steve COPPENS (Head of Clinic) (Keynote Speaker, Leuven, Belgium) 10:50 - 11:05 key to success. Rosie HOGG (Consultant Anaesthetist) (Keynote Speaker, Belfast, United Kingdom) 11:05 - 11:20 Conclusion and Q&A.	South Hall 2B
	"Thursday 05 September" Added to your list of favorites Deleted from your list of favorites G22 10:30 - 11:00 TIPS & TRICKS To presonalized treatments Chairperson: Brian SITES (Faculty) (Chairperson, Plainfield, USA) 10:30 - 10:35 Introduction. Brian SITES (Faculty) (Keynote Speaker, Plainfield, USA) 10:35 - 10:55 Interventional pain medicine: challenges and limitations for personalized treatments. Jan VAN ZUNDERT (Chair) (Keynote Speaker, Genk, Belgium) 10:55 - 11:00 Q&A.	Small Hall
	"Thursday 05 September" Added to your list of favorites Deleted from your list of favorites H22 10:30 - 11:20 EXPERT OPINION DISCUSSION How to teach ultrasound-guided peripheral nerve blocks to residents Chairperson: Louise MORAN (Consultant Anaesthetist) (Chairperson, Letterkenny, Ireland) 10:30 - 10:35 Introduction. Louise MORAN (Consultant Anaesthetist) (Keynote Speaker, Letterkenny, Ireland) 10:35 - 10:50 #43023 - H22 Opinion 1: How to teach ultrasound-guided peripheral nerve blocks to residents? Opinion 1: How to teach ultrasound-guided peripheral nerve blocks to residents? Mireia Rodriguez Prieto (1), Adrià Font Gual (1), Marisa Moreno Bueno (1), Gerard Moreno Giménez (1), Sergi Sabaté Tenas (1) 1. Anesthesiology, Hospital de Sant Pau, Barcelona, Spain Regional anaesthesia (RA) plays an important role in the success of most surgical procedures, providing multiple benefits¹^,². Its use is increasingly widespread, including outside the operating room³^,⁴. That is why RA is considered a core component of peri-operative care⁵^,⁶^,⁷^,⁸^,⁹^, This importance of RA makes it essential for residents to complete their anaesthesiology training programme? by mastering the knowledge and skills surrounding ultrasound guided regional anaesthesia (UGRA)¹⁰^,¹¹^,¹²^,¹³^,¹⁴ This proficiency enables them to perform the main blocks used in daily clinical practice¹⁵ with quality and security, from which the greatest number of patients can benefit. Currently, there is no standardized educational approach to teaching UGRA in anaesthesiology training; only guidelines and recommendations are published in RA Fellowship programs⁷^,¹⁶. As UGRA and acute pain medicine are now considered essential knowledge and skills for anaesthesiologists, it is necessary to develop a standardized UGRA curriculum for residency training. This curriculum should be applicable to the majority of anaesthesiologists worldwide, improving the quality of training and nerve blocks for the benefit of patients. The way of teaching has changed over the years. We have moved from an *apprenticeship training model¹⁷^,¹⁸^,¹⁹ based on “seeing and doing” to directly performing the procedure on the patient in the clinical setting, often compromising patient safety. This traditional approach relied on time-based training without performance indicators and provided a limited number of procedure exposures. Additionally, the increased number of trainees has further challenged this model. Now, we are shifting towards a competency-based education (CBE) model.¹⁸^,²⁰^.²¹^,²²^,²³ CBE focuses on acquiring specific skills and competencies rather than completing a set number of hours. Trainees advance as they demonstrate mastery in key areas, allowing them to progress at their own pace and focus on areas that need improvement. Residency training programs worldwide are transitioning from time - or volume-based requirements to a CBE model with simulation-based education¹⁷. The principles of a CBE in RA are focused on defining specific competencies, developing tailored learning pathways (individualized learning plans for residents)²⁴ and competency-based assessment¹⁶^,²⁵^,²⁶. The UGRA core competencies* outlined by the ASRA-ESRA joint committee comprise six domains: patient care, medical knowledge, system-based practice, practice-based learning and improvement, interpersonal and communication skills, and professionalism¹⁷. The Dreyfus Model of Skill Acquisition is a framework that describes how learners progress through different stages of skill development, from novice to expert. This model is based on experiential learning, adaptation and judgment (Figure 1). As residents gain experience, they advance through the different stages, becoming more adept at decision-making, problem-solving, and adapting to various clinical scenarios responding effectively. In the context of RA, integrating the Dreyfus Model of Skill acquisition with competence-based education (CBE) principles can provide a structured and effective approach to training anaesthesiology residents in UGRA, resulting in (Figure 2): 1. Progression learning through skill levels. Trainees advance from one step to the next after demonstrating the acquisition of specific competences according to defined objective proficiency benchmarks. Each step is accompanied by an assessment and feedback. 2. Development of structured curriculum with specific definitions of learning objectives related to RA and assessment to document achievement of competencies. It is necessary to provide a mix of didactic education, hands-on training, simulation exercises and clinical experiences to support residents’ development. 3. Continuous feedback and reflection on their performance, highlighting strengths and areas for improvement, as well as encouraging self-reflection and self-assessment to help residents monitor their progress and identify learning goals. 4. Mastery-based progression. Residents advance to the next stage of the Dreyfus Model and take more complex challenges in RA once they demonstrate mastery of competencies at each level through assessment. Performance of successful UGRA requires theoretical knowledge and manual skills. According to CBE and Dreyfus integrated model, we can describe 4 stages of proficiency-based progression (PBP) training programme for UGRA during anaesthesiology residency. We describe competencies to achieve in the different stages/steps: First step Competences: KNOWLEDGE In this stage, didactic education should include: principles of ultrasonography, local anaesthetics, anatomy of peripheral nerve blocks (PNBs), applied anatomy to different surgery indications, understanding the role of RA as a core component of perioperative care and multimodal analgesia, indications and contraindications of common blocks, preparation for the block and management of RA complications. Educational resources for knowledge are textbooks, e-learning methods like video materials, and e-learning text. Tools for knowledge assessment: Multiple Choice Questions (MCQs), Short Answer Questions (SAQs), Case-Based Discussions (CBDs). Second Step Competences: SKILLS. Technical skills acquisition is very important in UGRA, and together with the vigilance of the anaesthesiologist, they are probably the most important component of patient safety during RA. In addition, high skill acquisition (proficiency) is associated with better outcomes. The specific interrelated skills required to perform UGRA are image acquistion, anatomical interpretation²⁸, hand-needle-eye coordination for precise alignment of the needle and ultrasound beam and accurate needle placement. Deliberate practice of component skills with feedback may accelerate the rate of skill acquisition¹⁸^,²⁹. The most common errors made by residents during the learning of UGRA are related to skills acquisition. The first is the advancement of the needle when the tip is not visualized, followed by unintentional probe movement associated with poor ergonomics³⁰, and failures in identifying the incorrect spread of local anaesthetic²⁷. It is recommended that these skills be acquired first in a simulation environment before being applied in clinical practice.²⁹^,¹⁷. Third and fourth Step: CLINICAL PRACTICE. The final step involves performing UGRA blocks in the clinical environment, on patients, under supervision and feedback. Supervision will gradually decrease until residents demonstrate, after assessment, the acquisition of all competencies in the clinical practice. Other tasks and skills can be learned through clinical experience, such as using an aseptic technique, marking of block site, monitoring of vital signs and patient comfort, providing informed consent, management of complex patients or complications, explaining post-procedure care and multidisciplinary of postoperative care. A key aspect of PBP programs is assessment to demonstrate competency in the curricular goals, although there is no standard tool for assessing UGRA competency.²¹^,³¹^,²³^,³²^,³³^,²¹^,²⁸^,³⁴^,³⁵^,³⁶^,³⁷^,³⁸^,³⁹ Task-specific checklists are the most reliable form of assessment and can be used in simulation and clinical settings. Example checklist tasks include ¹¹: visualizing key landmarks, identifying nerves/plexus, confirming normal anatomy or recognizing variations, maintaining an aseptic technique, following the needle in real time, identifying the correct pattern of local anaesthetic spread and following safety guidelines. Other assessment tools include: Global Rating Scores, Quality-compromising behaviours (QCB), Direct observation of procedural skills (DOPS), Cumulative sum scoring (CUSUM), Key Performance Indicators (KPIs) or new technologies like tracking motion devices (digits/arms/eye gaz⁴⁰, 360-degree video, augmented and virtual reality. Simulation-based education and training (SBET)¹⁷^,⁴¹^,⁴²^,⁴³^,⁴⁴^,⁴⁵is an essential component of an UGRA teaching curriculum and plays a primary role in competency-based learning in the preclinical phase¹⁶^,³⁵, although it is only partially or poorly implemented in many countries, including Europe⁴². Simulation is useful for training both technical (understanding devices operations, imagine optimization, image interpretation, visualization of needle insertion and of LA.) and non-technical skills (leadership, communication, team working, situation awareness and decision-making). SBET offers several advantages over traditional training methods: it allows safe and ethical learning without risk or consequences for patients. This provides the opportunity for repetitive practice in a safe environment, creates low-stress learning conditions without time pressure. Additionally, it offers individualized expert feedback, increases trainees’ self-confidence (which improves problem solving in the clinical practice and reduces the likelihood of complications), shortens the learning curve and achieves long-term retention of skills. All of these benefits ultimately improve clinical competency, block success, and patient safety. Debriefing and feedback have been identified as the most important aspects of simulation-based learning. There are diverse simulation modalities with different applications in regional anaesthesia training (Table 1). Simulation, artificial intelligence and new technologies³⁵ play an increasingly important role in the field of RA⁴⁶. There are several high-quality websites and online resources dedicated to teaching regional anaesthesia, each offering a range of educational materials, including tutorials, videos, guidelines, applications and interactive modules to enhance knowledge and skills in regional anaesthesia. Machine learning systems for RA have been incorporated in recent years as artificial intelligence-based devices for ultrasound image interpretation¹⁸^,⁴⁷^,⁴⁸^,⁴⁹^,⁵⁰, and other wearable devices for needle tasking⁴⁷, virtual³⁵^,⁵¹ and augmented reality⁵²,⁵³. Randomized control trials are still missing for application of AI-guided UGRA in clinical anaesthetic practice⁴⁷^,⁵⁴. To sum up, the ASRA-ESRA-UK guidelines suggest the implementation of a PBP training and assessment in UGRA to enhance quality of training and quality of nerve blocks, thereby improving patient outcomes²⁰^,¹⁷. Through a combination of didactic education, hands-on clinical experience and continuous assessment, residents can achieve proficiency and confidence in UGRA, an essential area of anaesthesiology. Foundation training should be aimed at the learning and deliberate practice of a small number of versatile techniques that cover the vast majority of surgical procedures²⁶^,²⁸ (Plan A¹⁵: interscalene, axillary, femoral, adductor canal, sciatic in the popliteal fossa, erector spinae plane and rectus sheath blocks). This approach ensures patient access to reliable and safe RA. Competence in more advanced blocks should be acquired during an advanced fellowship in regional anaesthesia. Training to competence in the preclinical setting using simulation has become and essential part of the learning process, as well as the continuous assessment of competence acquisition rather than the volume of practice. Residents will require more than the established minimum number to become proficient in regional anaesthesia and periodic retraining is necessary to consolidate and maintain proficiency in technical skills introduced during training¹⁷^,⁵⁵. Certainly, it's imperative to be familiar with all the educational sources and evaluation tools. Based on our resources, we should prioritize those that are most reproducible in our environment, utilizing a competence-based model of teaching. There continues to be controversial issues such as curricular goals (like which peripheral blocks and how many), universal assessment tools for achieving competences in UGRA, limited access to simulation to train in preclinical setting, and understanding if knowledge and technical skills are transferable. Future work should focus on standardizing the UGRA curriculum and determining the most effective teaching and assessment methodologies for achieving competencies in UGRA. Additionally, there should be increased investment in expanding access to simulation and research for new technologies applied to RA educational practices. Mireia RODRIGUEZ PRIETO (Barcelona, Spain) 10:50 - 11:05 #43464 - H22 Opinion 2. How To Teach Ultrasound-guided Peripheral Nerve Blocks To Residents. Opinion 2. How To Teach Ultrasound-guided Peripheral Nerve Blocks To Residents. Ultrasound-guided (US-guided) peripheral nerve blocks (PNB) are widely considered an essential component of modern anesthesia. The learning process in US – guided blocks require residents to learn different cognitive, technical and behavioral skills. Most important cognitive skills are knowledge in anatomy and sonoanatomy, equipment for blocks and ultrasound, ultrasound physics, local anesthetic pharmacology and stages of block procedures. Lectures, hands-on practical sessions, books of regional anesthesia, online applications, video and practical demonstrations, interactive learning experiences, radiological imaging can be used depending on availability in local hospitals and universities. Furthermore, essentials of ultrasound, ergonomics and positioning are fundamental knowledge for residents when they initially start to work with the ultrasound for the first time. From behavioral skills it is important to understand the concept of teamwork. For some residents the most difficult component is to develop technical skills: imaging acquisition and interpretation, eye-hand coordination and 3D thinking, transducer orientation, manipulation with a probe and needle, identification of artefacts. Particulary, visualization of the needle insertion and injection often is challenging and must be explained and supervised during the procedure. Independent predictors of the needle visibility are type of needle (p < 0.001) and plane of insertion (p = 0.08). It is known that visibility of echogenic needles are superior to the non-echogenic needles if the needle insertion angle ranges between 60° and 70°. Therefore, echogenic needles in conjunction with peripheral nerve stimulation could be helpful tools for deep or difficult blocks in the teaching process. How should we bridge the gap between theoretical knowledge to good practical skills? Simulation based medical education and training skills including cadaveric sessions, US-guided training on simulated participants, on manikins or on 3D phantom models may be useful since they increase acquisition of clinical knowledge and skills. Residents had reported feeling more confident in recognizing anatomical structures after practice on cadavers. Additionally, Liu et al. evaluated three different types of simulators for regional anesthesia and concluded that new practitioners decrease the number of errors in a simulated block with each additional practice attempt in simulation, regardless of the type of simulator used. Therefore, ultrasound models increase accessibility for residents to gain early exposure in a safe manner. More recently artificial intelligence for image interpretation and needle insertion may facilitate US-guided teaching in RA as well. We know that learning practical (motor) skills requires constant practice and repeating procedures multiple times to assimilate psychomotor skill interaction. There are three stages: 1. cognitive - resident behave timidly, inconsistently, and inaccurately; make many mistakes while doing the task; and need help interacting with the environment. 2. associative - movements get more fluid, there are fewer mistakes, and resident can interact with the care team or patient. 3. autonomous - movements are consistent, mistakes are rare, and resident can recognize them, solve unexpected situations, concentrate on other issues, and connect with the care team and patient. How many blocks are required for competency? Strong association between number of blocks performed (> 20 vs. 0 - 5 blocks), and self-reported ability to perform blocks independently exist, OR 20.9 (95% CI 9.38e53.2). Therefore, the importance of clinical experience and access to training in regional anaesthesia is essential for residents to develop practical skills. Although, in each University and hospital teaching methods may differ depending on education opportunities, the safe teaching process theoretically consist of 6 steps: Learn, See, Practice, Prove, Do, and Maintain as described by T. Sawyer et al. which should be adopted for residents teaching. Learn - acquire cognitive knowledge. See – observe the procedure. Practice - practice on a simulator. Prove - simulation-based mastery learning is employed to allow the trainee to prove competency prior to performing the procedure on a patient. Do - once competency is demonstrated on a simulator, the trainee is allowed to perform the procedure on patients with direct supervision, until they can be entrusted to perform the procedure independently. Maintain - continue clinical practice, supplemented by simulation-based training as needed. It is essential to identify the level of clinical competence of your trainee before allowing the practical performance of blocks on a patient. Miller’s Pyramid of clinical competences might be a relevant tool for assessment of competences. At the pyramid’s base lies “Knows,” where residents acquire factual knowledge about RA techniques, relevant anatomy, and pharmacology. Moving up, “Knows How” reflects their ability to demonstrate the procedural steps and principles in controlled environments, such as simulation labs. The next level, “Shows How,” pertains to their ability to apply RA under direct supervision in natural clinical settings. The final and more recent level “Is Trusted”. Trainers must ask and be informed about the competence level of the resident (supervision level and autonomously), difficulty of the block and appropriate patient. 7 Plan A blocks (femoral block, popliteal block, interscalene block, axillary block, rectus sheath block, serratus block and erector spine plane block) and more superficial PNB approaches under supervision would be appropriate to start for those who are at competence level “knows how” as reflected by Miller’s Pyramid. 7 Plan A blocks are those that cover the key areas of surgery/acute pain and is suggested that every anesthetist should know as defined by RA-UK. Additionally, ESA have listed superficial PNB that seems to be safer regarding to bleeding risk (femoral nerve; axillary block; sciatic popliteal level and others). Those “safe” blocks increase the level of success which builds confidence and motivation of residents. However, all residents must be informed about safety issues of PNB before practical performance on a patient: nerve injury, vascular injury and local anesthetic toxicity. Although, the risk of nerve injury after RA is very low compared to nerve injury after surgery (0.04% vs.4%), residents should always follow these guidelines: do not perform PNB in patients under general anesthesia, use a short bevel needle, avoid needle – nerve contact and reduce the number of needle passes. After evaluating practical steps of the procedure: level of supervision required, case complexity, patient safety, decision-making, PNB efficiency, communication skills, documentation, adherence to guidelines and problem-solving skills of the trainee, self-assessment and reflection and continuous feedback should be provided. Feedback - allows the residents to compare their previous concepts of the tasks with their actual performance, helping to understand strengths and areas for growth of the resident. In conclusion, there is not a fully standardized educational approach for training residents and teaching methods. However, evidence shows that combination of theoretical knowledges with access to simulation-based training and regular, supervised clinical practice may enhance the confidence and practical skills of residents in US-guided regional anesthesia. References: 1. Hargett MJ et al, RAPM, 2005;30(3) 2. Haskins SC et al, RAPM, 2021;46(12) 3. Vanka a. et al, The Clinical Teacher. 2019;16(6):570-574 4. Slater RJ et al, RAPM, 2014;39(3):230-239 5. Kim TE, Tsui BCH. Korean Journal of Anesthesiology. 2019;72(1):13-23 6. Bosse HM et al, BMC Medical Education. 2015;15:22 7. Chen XX et al, RAPM. 2017;42(6):741-750 8. Beller B. et al, BJA Open, 8(C):100241 (2023) 9. Reg Anesth Pain Med.2009 Jan-Feb;34(1):40-6 10. By prof. Ki-Jinn Chin, Fundamentals of US-guided nerve block 11. Liu Y et al, Simul Healthc. 2013;8(6):368–375 12. Bowness J. et al, Anaesthesia 2021, 76,602-607 13. Gadsden J.C. Anaesthesia 2021,76 (suppl.1( 65-73) 14. T. Sawyer et al, Acad Med. Aug; 90(8), 2015 15. Ten Cate O et al, Entrustment decision making: Extending Miller’s pyramid. . Acad Med 2021 Feb 1;96(2):199-204 16. https://www.ra-uk.org/ 17. Eur J Anaesthesiol 2022;39:100-132 18. Ecoffey et al, EJA, 2014 Agnese OZOLINA (Riga, Latvia) 11:05 - 11:20 Q&A.	NORTH HALL
	"Thursday 05 September" Added to your list of favorites Deleted from your list of favorites I23 10:30 - 12:30 HANDS - ON CLINICAL WORKSHOP 7 - CHRONIC PAIN US Use in Chronic Pain Medicine - Truncal and Plane Blocks WS Leader: Senthil JAYASEELAN (Consultant in Anaesthesia and Pain Management) (WS Leader, UK, United Kingdom) 10:30 - 12:30 Workstation 1: Erector Spinae (ESP) Block. Vicente ROQUES (Anesthesiologist consultant) (Demonstrator, Murcia. Spain, Spain) 10:30 - 12:30 Workstation 2: Quadratus Lumborum Block (QLB). David LORENZANA (Head Pain Therapy) (Demonstrator, Zürich, Switzerland) 10:30 - 12:30 Workstation 3: TAP and Fascia Iliaca Blocks. Graham SIMPSON (Consultant in Anaesthetics and Pain Management) (Demonstrator, EXETER, United Kingdom) 10:30 - 12:30 Workstation 4: Paravertebral, Intercostal and PECS Blocks. Esperanza ORTIGOSA (Chief of the Acute and Chronic Pain Unit) (Demonstrator, Madrid, Spain)	220a
	"Thursday 05 September" Added to your list of favorites Deleted from your list of favorites FP30 10:30 - 11:25 ULTRASOUND GUIDED RA (UGRA) Free Papers 5 Chairperson: Jens BORGLUM (Clinical Research Associate Professor) (Chairperson, Copenhagen, Denmark) 10:30 - 10:37 #40848 - OP047 Impact of the bilateral deep parasternal intercostal plane block on intraoperative opioid consumption in open heart surgery: a pilot study. OP047 Impact of the bilateral deep parasternal intercostal plane block on intraoperative opioid consumption in open heart surgery: a pilot study. Recently, opioid-sparing methods in cardiac surgery have been developed for faster emergence from anesthesia and recovery after surgery. Several cardiac surgery protocols used multimodal analgesia with the application of regional anesthesia techniques. This study aims to assess the effect of preoperative bilateral ultrasound-guided deep parasternal intercostal plane block (DPIPB) on intraoperative adult open-heart surgery opioid consumption. The Institutional Ethics Committee has approved this study. This was a double-blind, randomized, controlled study with two parallel groups. Patients aged 19–75 years old who would undergo elective open-heart surgery with a median sternotomy approach were included in this study. Participants were randomly assigned to either DPIPB or control group with a 1:1 allocation. The measured outcomes were total intraoperative fentanyl consumption, the time of first intraoperative analgetic rescue, and the injury of the internal thoracic artery. Thirty-four patients were recruited, and two subjects were withdrawn. The subject’s baseline characteristics were comparable. The total intraoperative fentanyl consumption was significantly higher in the control group than in the DPIPB group (median of 200 [100] vs 100 [50] mcg, p=<0.001). The time of the first intraoperative analgetic rescue was significantly longer in the DPIPB group than in the control group (median of 121.5 [141.5] vs 4.5 [4.75] minutes, p=<0.001). No injury of the internal thoracic artery was found. The preoperative bilateral DPIPB is effective for reducing intraoperative opioid consumption in adult open-heart surgery and, therefore, can be used as a regional anesthesia technique as part of multimodal analgesia for enhanced recovery after cardiac surgery protocol. Aida Rosita TANTRI, A A Gde Putra Semara JAYA (Bali, Indonesia), Aldy HERIWARDITO, Arif MANSJOER, Ratna Farida SOENARTO 10:37 - 10:44 #40396 - OP048 Clinical Impact of Pectoral Nerve II Block on Postoperative Pain, Opioid Usage, and Patient Recovery Experience in Robot-Assisted Transaxillary Thyroidectomy: A Prospective, Randomized Controlled Trial. OP048 Clinical Impact of Pectoral Nerve II Block on Postoperative Pain, Opioid Usage, and Patient Recovery Experience in Robot-Assisted Transaxillary Thyroidectomy: A Prospective, Randomized Controlled Trial. This study aims to assess the effectiveness of the pectoral nerve II (PECS II) block in diminishing postoperative pain, reducing opioid consumption, and enhancing the overall quality of recovery in patients undergoing robot-assisted transaxillary thyroidectomy (RATT). The Ethics Committee of Seoul University, Mary’s Hospital (KC22EISI0542) approved this prospective, randomized controlled trial (September 29, 2022). This trial involved 83 patients, aged between 19 and 60, scheduled for elective RATT. These participants were then allocated into two groups: 42 received the PECS II block (block group), and 41 did not (non-block group). The study's primary focus was on evaluating postoperative pain levels. Secondary measures included the frequency of opioid use and the self-assessed quality of recovery post-surgery. Pain levels were gauged using the Visual Analog Scale at intervals of 1, 4, 24, and 48 hours post-surgery, alongside monitoring rescue opioid usage. On the day of discharge, patients completed the Korean version of the Quality of Recovery-15 (QoR-15K) questionnaire. Data indicated that the block group experienced significantly lower levels of postoperative pain at the 1, 4, and 24-hour marks compared to the non-block group. The latter exhibited a higher dependency on opioids, notably in the Post Anesthesia Care Unit. The QoR-15K outcomes suggested superior pain management in the block group. Other recovery aspects, such as physical comfort and emotional well-being, were similarly rated in both groups. The PECS II block demonstrates considerable potential in enhancing the postoperative recovery experience for RATT patients, primarily through improved pain management. Jingyu HONG, Kwangsoon KIM, Min Suk CHAE (Seoul, Republic of Korea) 10:44 - 10:51 #41128 - OP050 An observational study comparing the efficacy of ultrasound guided Serratus Anterior Plane (SAP) block vs Erector Spinae Block (ESPB) for postoperative pain management and stress response in patients undergoing Minimally Invasive Cardiac Surgery (MICS). OP050 An observational study comparing the efficacy of ultrasound guided Serratus Anterior Plane (SAP) block vs Erector Spinae Block (ESPB) for postoperative pain management and stress response in patients undergoing Minimally Invasive Cardiac Surgery (MICS). Early extubation and optimal pain control and minimizing stress response is an important aspect after Minimally Invasive Cardiac Surgery (MICS). Erector Spinae Plane Block (ESPB) and Serratus Anterior Plane Block (SAPB) are recently described techniques for chest wall analgesia. Their role in MICS is yet to be well determined. We tried to assess efficacy and safety of ultrasound guided SAPB compared to ESPB in the management of pain and stress response in patient undergoing MICS Patients undergoing MICS for coronary artery bypass grafting were randomly assigned into two groups. Both SAPB group (group A) and ESPB (group B) were given 0.2% of 20 ml Ropivacaine followed by catheter insertion for continuous infiltration at the end of the procedure. The primary outcome measured were changes in VAS Score (Pain) and cortisol levels (for stress response) in both the groups There was no significant difference of mean VAS score between the two groups. Hemodynamic parameters were stable in both the groups. Stress response in the form of serum cortisol level showed no major difference between the two groups. There was a statistically significant difference in the spirometry values between the two groups. The duration of ICU stay was significantly lower in the ESPB group as compared to SAPB group Both ESPB and SAPB offer good quality of analgesia in MICS.ESPB is better as it blocks both dorsal and ventral rami of the thoracic spinal nerves and elicits some degree of sympathetic blockade, while SAPB, targets only branches of the nerve Saikat SENGUPTA (KOLKATA, India) 10:51 - 10:58 #42642 - OP051 Comparison of ultrasound guided External Oblique Intercostal Plane Block and Subcostal Transversus Abdominis Plane Block in patients undergoing upper abdominal surgery: A randomized clinical study. OP051 Comparison of ultrasound guided External Oblique Intercostal Plane Block and Subcostal Transversus Abdominis Plane Block in patients undergoing upper abdominal surgery: A randomized clinical study. Interfascial plane blocks have been successfully used for upper abdominal surgeries with subcostal incision. External oblique intercostal (EOI) plane block is a novel technique for providing upper abdominal analgesia. In this study we have compared the analgesic efficacy of ultrasound (US) guided EOI Block and subcostal Transversus Abdominis Plane (STAP) block in adult patients undergoing surgery with unilateral subcostal incisions. Fifty, ASA I-II patients(18-65 years) undergoing upper abdominal surgery were randomised into two groups: Group E received US-guided EOI Plane block and Group T received US-guided STAP block.(Fig 1) Both groups received the block with 25ml of 0.2% Ropivacaine after general anaesthesia. Primary outcome was time to first rescue analgesia. Secondary outcomes were intraoperative fentanyl consumption, 24 hour postoperative fentanyl consumption, postoperative pain scores at 0,1,2,4, 6, 12 and 24 hrs and adverse effects. Demographic and surgical characteristics were comparable in both the groups. Mean time for first rescue analgesia in Group E was 610±118.90 minutes and Group T was 409.68±101.36 minutes(P=0.001). Intraoperative fentanyl consumption did not show any significant difference while 24 - hour postoperative fentanyl consumption was more in in Group T ( 123.20±34.48mcg vs 102.40±25.70 mcg) in group E. (P=0.019). Pain scores remained lower in Group E as compared to Group T throughout 24 hours with statistically significant difference at 1 and 6 hour. Ultrasound guided EOI Plane Block is a better analgesic technique than Subcostal TAP Block in patients undergoing upper abdominal surgeries with less opioid consumption and pain scores. Dr. Shruti SHREY (PATNA, India), Dr.chandni SINHA, Dr.amarjeet KUMAR, Dr.ajeet KUMAR, Dr.abhyuday KUMAR, Dr. Sreehari R NAMBIAR 10:58 - 11:05 #41242 - OP052 Bilateral ultrasound-guided external oblique intercostal block vs modified thoracoabdominal nerve block through perichondrial approach for postoperative analgesia in patients undergoing laparoscopic sleeve gastrectomy surgery: a prospective study. OP052 Bilateral ultrasound-guided external oblique intercostal block vs modified thoracoabdominal nerve block through perichondrial approach for postoperative analgesia in patients undergoing laparoscopic sleeve gastrectomy surgery: a prospective study. The objective of the present study was to evaluate morphine consumption and pain scores 24 hours postoperatively to compare the effects of a bilateral External Oblique Intercostal (EOI) block with those of a Modified Thoracoabdominal Nerve Block Trough Perichondrial Approach (M-TAPA) block in laparoscopic sleeve gastrectomy (LSG). Fifty-eight patients aged between 18 and 65 years of with American Society of Anesthesiologists class II-III were included in this prospective, randomized, double blinded study. Patients were assigned into two groups either EOI block or M-TAPA block. The primary outcome was cumulative morphine consumption within the first postoperative 24 hours. Secondary outcomes were numerical rating scale (NRS) scores at rest and during activity, QoR-15 Patient Questionnaire scores, incidence of postoperative nausea and vomiting (PONV), number of patients requiring rescue analgesic and antiemetics drugs, and complications. There was no statistically significant difference between the groups in terms of morphine consumption in the first 24 hours (EOI block; 10.74 ± 3.94 mg vs. M-TAPA block; 11.67 ± 4.66 mg, respectively). In addition, no significant difference between the two groups in the NRS and PONV scores, total QoR-15 scores, and the number of patients requiring rescue analgesics and antiemetics. EOI block and M-TAPA block showed similar effectiveness for morphine consumption within 24 hours postoperatively and in pain scores in LSG. Esra TURUNC, Burhan DOST (Samsun, Turkey), Elif Sarıkaya OZEL, Cengiz KAYA, Yasemin Burcu USTUN, Sezgin BILGIN, Gökhan Selçuk ÖZBALCI, Koksal ERSIN 11:05 - 11:12 #41518 - OP053 Effect of Erector Spinae Plane Block on Postoperative Quality of Recovery in Patients Undergoing Transforaminal or Oblique Lumbar Interbody Fusion: A Randomized Controlled Trial. OP053 Effect of Erector Spinae Plane Block on Postoperative Quality of Recovery in Patients Undergoing Transforaminal or Oblique Lumbar Interbody Fusion: A Randomized Controlled Trial. Erector spinae plane block (ESPB) can be used for analgesia after lumbar spine surgery. However, its effect on postoperative quality of recovery (QoR) remains underexplored in patients undergoing transforaminal lumbar interbody fusion (TLIF) or oblique lumbar interbody fusion (OLIF). This study hypothesized that ESPB would improve the postoperative QoR in such patients. Patients scheduled to undergo TLIF or OLIF were randomized into ESPB (n = 38) and control groups (n = 38). For the ESPB group, 25 mL of 0.375% bupivacaine was injected into each erector spinae plane at the T12 level under ultrasound guidance before skin incision. Multimodal analgesia, including wound infiltration, was uniformly applied to both groups. To assess perioperative QoR, the QoR-15 score was measured before surgery and 1 (primary outcome measure) and 3 days after surgery. Postoperative pain at rest and during ambulation and postoperative ambulation were also evaluated for 3 days after surgery. Perioperative QoR-15 scores were not significantly different between the ESPB and control groups including that 1 day after surgery (80 ± 28 vs. 81 ± 25). Although other postoperative pain scores did not significantly differ between the groups, the ESPB group had a significantly lower pain score during ambulation 1 h after surgery (7 ± 3 vs. 9 ± 1) and significantly shorter time to the first ambulation after surgery (2.0 [1.0–5.5] h vs.5.0 [1.8–10.0] h). ESPB did not provide additional benefits for the postoperative QoR in patients who underwent TLIF or OLIF with multimodal analgesia. Jo WOO-YOUNG (Seoul, Republic of Korea), Shin KYUNG WON, Lee HYUNG-CHUL, Park HEE-PYOUNG, Oh HYONGMIN 11:12 - 11:19 #42426 - OP057 Cooled vs. Standard Radiofrequency Ablation of the Medial Branch Nerves in the Management of Chronic Facetogenic Low Back Pain. Cooled vs. Standard Radiofrequency Ablation of the Medial Branch Nerves in the Management of Chronic Facetogenic Low Back Pain. The study objective was to compare effectiveness of cooled and standard radiofrequency (RF) ablation in the management of lumbar facetogenic back pain at 6- and 12-month timepoints. This prospective, multi-center, randomized study was registered on ClinicalTrials.gov (NCT04803149). Participants were eligible if they had a positive response from dual medial branch blocks (MBB). Bilateral lumbar medial branch radiofrequency ablation was performed according to Figure 1 with either CRFA (17 gauge with a 4mm active tip) or SRFA (20 gauge curved probe with a 10mm active tip). Following treatment, follow-up visits were performed at months 1, 3, 6, 9 and 12. The primary effectiveness endpoint was defined as the proportion of subjects whose back pain was reduced by > 50%. Difficulty with participants meeting our dual medial branch block criteria challenged enrollment early on. Eighteen months into the study, enrollment ended early. 74 participants were treated (37 in each cohort). Usual NRS scores for both cohorts are reported in Table 1. At 6 months in the CRFA group, 20 out of 27 (74.1%) were responders and in the SRFA group, 22 out of 34 (64.7%) (p = 0.0069 between groups). Both groups demonstrated a reduction in pain of greater than 2 points on NRS, from baseline to 6 months. Secondary endpoints reported in Table 2 show results for secondary endpoints SF-36 (Physical Function Domain), ODI, EQ-5D-5L Index Score and GPE for both cohorts. A single treatment of radiofrequency ablation in appropriately selected patients with lumbar facet pain result in clinically significant improvements. David PROVENZANO (Bridgeville, USA), Sean LI, Zach MCCORMICK, Leo KAPURAL, Timothy DEER, Fred KHALOUF, Francesco VETRI, Keith ZORA 11:19 - 11:25 #40887 - OP049 Comparison of single versus triple injection costoclavicular block in upper limb surgery: Randomised Controlled trial. OP049 Comparison of single versus triple injection costoclavicular block in upper limb surgery: Randomised Controlled trial. The costoclavicular approach of infraclavicular brachial plexus block targets proximal infraclavicular fossa where medial, lateral and posterior cords lie close to each other. This trial compared the efficacy of single injection with the triple aliquot injection technique for costoclavicular block in terms of onset, success and duration of the block. The research hypothesis was that the triple aliquot injections result in quicker onset time and less failure rate as compared to single injection costoclavicular block. The primary objective of the study was to compare the anaesthesia onset time between two groups. Forty-two patients undergoing upper limb surgery were randomly allocated to receive either single (n=21) or triple point (n=21) ultrasound-guided costoclavicular brachial plexus block. The local anaesthetic volume of 20 ml of 0.75% ropivacaine plus 10 ml of 2% lignocaine with 1 mcg/kg clonidine solution was same in both groups. After completion of the block, imaging, needling, performance time, and block onset time, success of surgical anaesthesia and pain score was recorded. Compared to the single injection technique, the triple injection group displayed a faster onset time ( 15.71 ± 4.55 vs 25.95±3.4 min; p-value < 0.001). However, imaging time and performance time were more in the triple aliquot injection group ( performance time 12.05 ± 3.51 vs 5.52±1.47 min ; p value< 0.001). The triple injection ultrasound-guided costoclavicular brachial plexus block had shorter onset time than its single injection counterpart. Single point costoclavicular block as compared to triple point costoclavicular block had less imaging, needling and performance time. Sourav SAHA (New Delhi, India, India)	CHAMBER HALL
	"Thursday 05 September" Added to your list of favorites Deleted from your list of favorites J23 10:30 - 12:30 HANDS - ON CLINICAL WORKSHOP 10 - RA US Guided PNBs for Hip, Femur and Knee Surgery WS Leader: Emmanuel GUNTZ (Anaesthesiologist-Course leader for Anesthesiology ULB) (WS Leader, Marseille, France) 10:30 - 12:30 Workstation 1: Analgesia for NOF Surgery - Femoral Nerve Block, Suprainguinal Fascia Iliaca Block, PENG Block. David MOORE (Pain Specialist) (Demonstrator, Dublin, Ireland) 10:30 - 12:30 Workstation 2: The Complex Knee Case - Transgluteal and Parasacral Approaches for the Sciatic Nerve. Patrick SCHULDT (Consultant) (Demonstrator, Uppsala, Sweden) 10:30 - 12:30 Workstation 3: Lumbosacral Blocks Revisited for Hip, Femur and Knee Surgery - Shamrock, Parasagittal and Modified Intertransversal Approaches. Madan NARAYANAN (Annual congress and Exam) (Demonstrator, Surrey, United Kingdom, United Kingdom) 10:30 - 12:30 Workstation 4: Best PNB Option for Knee Surgery - Femoral Nerve Block, Femoral Triangle or Adductor Canal Block (ACB)? Vishal UPPAL (Professor) (Demonstrator, Halifax, Canada, Canada)	221a
	"Thursday 05 September" Added to your list of favorites Deleted from your list of favorites K23 10:30 - 12:30 HANDS - ON CLINICAL WORKSHOP 4 - POCUS POCUS - The FAST Examination WS Leader: Andrea SAPORITO (Medical Director) (WS Leader, Bellinzona, Switzerland) 10:30 - 12:30 Workstation 1: The Subcostal View. Wojciech GOLA (Consultant) (Demonstrator, Kielce, Poland) 10:30 - 12:30 Workstation 2: The Left Upper Quadratant View. David DOLEZAL (Consultant) (Demonstrator, Hradec Králové, Czech Republic) 10:30 - 12:30 Workstation 3: The Right Upper Quadratant View. Denisa ANASTASE (Head of the Anesthesiology and Intensive Care Department, Senior Consultant Anesthesia and Intensive) (Demonstrator, Bucharest, Romania) 10:30 - 12:30 Workstation 4: The Pelvis. Anju GUPTA (Faculty) (Demonstrator, New Delhi, India)	223a
	"Thursday 05 September" Added to your list of favorites Deleted from your list of favorites L23 10:30 - 12:30 HANDS - ON CLINICAL WORKSHOP 11 - RA Four Basic Blocks for Knee Surgery WS Leader: Ismet TOPCU (Anesthesiologist) (WS Leader, İzmir, Turkey) 10:30 - 12:30 Workstation 1: Femoral Nerve Block. Dusan MACH (Clinical Lead) (Demonstrator, Nové Město na Moravě, Czech Republic) 10:30 - 12:30 Workstation 2: Adductor Canal Block (ACB). Thomas WIESMANN (Head of the Dept.) (Demonstrator, Schwäbisch Hall, Germany) 10:30 - 12:30 Workstation 3: Genicular Nerve Block. Thomas Fichtner BENDTSEN (Professor, consultant anaesthetist) (Demonstrator, Aarhus, Denmark) 10:30 - 12:30 Workstation 4: iPACK. Peter POREDOS (consultant) (Demonstrator, Ljubljana, Slovenia, Slovenia)	241
	"Thursday 05 September" Added to your list of favorites Deleted from your list of favorites M23 10:30 - 12:30 HANDS - ON CLINICAL WORKSHOP 12 - RA Basic Peripheral Nerve Blocks in the Obese Patient undergoing Orthopaedic Surgery WS Leader: Philippe GAUTIER (MD) (WS Leader, BRUSSELS, Belgium) 10:30 - 12:30 Workstation 1: Interscalene and Supraclavicular Nerve Blocks. Elena SEGURA (regional and pocus ultrasound rotation coordinator, acute pain unit coordinator) (Demonstrator, Viseu, Portugal) 10:30 - 12:30 Workstation 2: Axillary Nerve Block. Roman ZUERCHER (Senior Consultant) (Demonstrator, Basel, Switzerland) 10:30 - 12:30 Workstation 3: Femoral Nerve Block. Kausik DASGUPTA (Consultant Anaesthetist) (Demonstrator, NUNEATON,UK, United Kingdom) 10:30 - 12:30 Workstation 4: Popliteal Fossa Block. Josip AZMAN (Consultant) (Demonstrator, Linkoping, Sweden)	245
	"Thursday 05 September" Added to your list of favorites Deleted from your list of favorites A21 10:30 - 12:20 NETWORKING SESSION Paediatric Anaesthesia PAEDIATRIC Chairperson: Karen BORETSKY (Senior Associate in Perioperative Anesthesia, Department of Anesthesiology, Critical Care and Pain Medicine) (Chairperson, Boston, USA) 10:30 - 10:35 Introduction. Karen BORETSKY (Senior Associate in Perioperative Anesthesia, Department of Anesthesiology, Critical Care and Pain Medicine) (Keynote Speaker, Boston, USA) 10:35 - 10:57 RA in pediatric interventions. An TEUNKENS (Clinical Head, associate professor KU Leuven) (Keynote Speaker, Leuven, Belgium) 10:57 - 11:19 Regional analgesia in children during wartime. Dmytro DMYTRIIEV (chief of pain medicine department) (Keynote Speaker, Vinnitsa, Ukraine) 11:19 - 11:41 Where Does RA fit in pediatric ERAS protocols. Fatma SARICAOGLU (Chair and Prof) (Keynote Speaker, Ankara, Turkey) 11:41 - 12:03 Opioid free pediatric surgery. Luc TIELENS (pediatric anesthesiology staff member) (Keynote Speaker, Nijmegen, The Netherlands) 12:03 - 12:20 Q&A.	CONGRESS HALL
11:10	"Thursday 05 September" Added to your list of favorites Deleted from your list of favorites G22b 11:10 - 11:40 TIPS & TRICKS Silver Trauma Chairperson: Edward MARIANO (Speaker) (Chairperson, Palo Alto, USA) 11:10 - 11:15 Introduction. Edward MARIANO (Speaker) (Keynote Speaker, Palo Alto, USA) 11:15 - 11:35 Silver Trauma. Conor SKERRITT (President of the Irish Society of Regional Anaesthesia (ISRA)) (Keynote Speaker, Dublin, Ireland) 11:35 - 11:40 Q&A.	Small Hall
11:30	"Thursday 05 September" Added to your list of favorites Deleted from your list of favorites D23 11:30 - 12:20 ASK THE EXPERT Challenges in Implementing Regional Anesthesia in Different Settings Chairperson: James BOWNESS (Consultant Anaesthetist) (Chairperson, London, United Kingdom) 11:30 - 11:35 Introduction. James BOWNESS (Consultant Anaesthetist) (Keynote Speaker, London, United Kingdom) 11:35 - 12:05 Challenges in Implementing Regional Anesthesia in Different Settings. Dan Sebastian DIRZU (consultant, head of department) (Keynote Speaker, Cluj-Napoca, Romania) 12:05 - 12:20 Q&A.	South Hall 1B
	"Thursday 05 September" Added to your list of favorites Deleted from your list of favorites E23 11:30 - 12:20 ASK THE EXPERT Lumbar Neuraxial approaches Chairperson: Patricia LAVAND'HOMME (Clinical Head) (Chairperson, Brussels, Belgium) 11:30 - 11:35 Introduction. Patricia LAVAND'HOMME (Clinical Head) (Keynote Speaker, Brussels, Belgium) 11:35 - 12:05 Taylor approach. Matthias HERTELEER (Anesthesiologist) (Keynote Speaker, Lille, France) 12:05 - 12:20 Q&A.	South Hall 2A
	"Thursday 05 September" Added to your list of favorites Deleted from your list of favorites F23 11:30 - 12:20 EXPERT OPINION DISCUSSION Rethinking Relief: A Second Opinion on Multimodal Approaches to Acute Pain Management Chairperson: Narinder RAWAL (Mentor PhD students, research collaboration) (Chairperson, Stockholm, Sweden) 11:30 - 11:35 Introduction. Narinder RAWAL (Mentor PhD students, research collaboration) (Keynote Speaker, Stockholm, Sweden) 11:35 - 11:50 Nonpharmacological components in multimodality. Rafael BLANCO (Pain medicine) (Keynote Speaker, Abu Dhabi, United Arab Emirates) 11:50 - 12:05 Multi modal analgesia after caesarean section. Sarah DEVROE (Head of clinic) (Keynote Speaker, Leuven, Belgium) 12:05 - 12:15 Conclusion and Q&A.	South Hall 2B
	"Thursday 05 September" Added to your list of favorites Deleted from your list of favorites O25 11:30 - 14:30 OFF SITE - Hands - On Cadaver Workshop 5 - RA UPPER & LOWER LIMB BLOCKS, TRUNK BLOCKS WS Leader: Alexandros MAKRIS (Anaesthesiologist) (WS Leader, Athens, Greece) Unique and exclusive for RA & Pain Cadaveric Workshops: Only whole-body cadavers will be available for the workshops. This is a fantastic opportunity to master your needling skills, perform the actual blocks on fresh cadavers and to improve your ergonomics under direct supervision of world experts in regional anaesthesia and chronic pain management. There won’t be an organized transportation for going/back from the Cadaver workshop. 11:30 - 14:30 Workstation 1. Upper Limb Blocks. Lukas KIRCHMAIR (Chair) (Demonstrator, Schwaz, Austria) ISB, SCB, AxB, cervical plexus (Supine Position) 11:30 - 14:30 Workstation 2. Upper Limb and chest Blocks. Ivan KOSTADINOV (ESRA Council Representative) (Demonstrator, Ljubljana, Slovenia) ICB, IPPB/PSPB (PECS), SAPB (Supine Position) 11:30 - 14:30 Workstation 3. Thoracic trunk blocks. Nabil ELKASSABANY (Professor) (Demonstrator, Charlottesville, USA) Th PVB, ESP, ITP(Prone Position) 11:30 - 14:30 Workstation 4. Abdominal trunk Blocks. Mario FAJARDO PEREZ (Anesthesia) (Demonstrator, Madrid, Spain) TAP, RSB, IH/II (Supine Position) 11:30 - 14:30 Workstation 5. Lower limb blocks. Slobodan GLIGORIJEVIC (senior consultant) (Demonstrator, Zürich, Switzerland) SiFiB, PENG, FEMB, FTB, Aductor Canal B, Obturator (Supine Position) 11:30 - 14:30 Workstation 6. Lower limb blocks. Ruediger EICHHOLZ (Owner, CEO) (Demonstrator, Stuttgart, Germany) QLBs, proximal and distal sciatic B, iPACK (Lateral Position)	Anatomy Institute
	"Thursday 05 September" Added to your list of favorites Deleted from your list of favorites H23 11:30 - 12:25 ESRA-ASRA SESSION Current and future developments Chairperson: Steven COHEN (Professor) (Chairperson, Chicago, USA) 11:30 - 11:35 Introduction. Steven COHEN (Professor) (Keynote Speaker, Chicago, USA) 11:35 - 11:55 ESRA. Eleni MOKA (faculty) (Keynote Speaker, Thessaloniki, Greece, Greece) 11:55 - 12:15 ASRA. David PROVENZANO (Faculty) (Keynote Speaker, Bridgeville, USA) 12:15 - 12:25 Q&A.	NORTH HALL
	"Thursday 05 September" Added to your list of favorites Deleted from your list of favorites FP31 11:30 - 12:25 CHRONIC PAIN MANAGEMENT Free Papers 6 Chairperson: Aleksejs MISCUKS (Professor) (Chairperson, Riga, Latvia, Latvia) 11:30 - 11:37 #42676 - OP023 Improving thoracic epidural analgesia success rates: pilot study on a comprehensive metric system. Improving thoracic epidural analgesia success rates: pilot study on a comprehensive metric system. Primary failure of thoracic epidural (TE) analgesia remains an important clinical challenge as its incidence can exceed 20% in teaching centers.1 Reasons for failure include incorrect primary placement or secondary migration of the catheter. Optimal patient positioning, technical approach, and method used to secure the catheter affect success rate.2 Procedural difficulties may drive anesthesiologists away from an effective and unmatched pain management option. We hypothesize that implementing specific metrics to improve and refine the learning process of in-training anesthesiologists will increase success rate of TE analgesia above 80%. A metric system including 67 items was developed. The protocol withstood an iterative process, including literature review and feedback from experienced anesthesiologists. The metric system was assessed on trainee anesthesiologists with low procedural experience (less than 50 performed TEs). Type of surgery, level of puncture, number of attempts, immediate complications, compliance with the metrics and failure rates (supervisor taking over or inadequate analgesia in the immediate post-operative period) were documented. A total of 13 TEs were performed for thoracic (46%) or abdominal procedures (54%) and the first attempt of catheter placement was performed at T6-T7 or T9-T10 level, respectively. In five cases, an attempt at another level was conducted. No immediate complications were reported. Adherence to the metrics was deemed satisfactory, with 70% of the checklist being effectively completed. The failure rate was 31%. A metric system for TE can provide a standardized, consistent, readily accessible tool to steep procedural learning curve and reduce failure rates. Antonio IACULLI, Sara RIBEIRO (Porto, Belgium), Steve COPPENS, Van Loon PHILIPPE, Hoogma DANNY 11:37 - 11:44 #41303 - OP055 Non-invasive neurostimulation of the sphenopalatine ganglion: a novel approach for intractable primary headache. OP055 Non-invasive neurostimulation of the sphenopalatine ganglion: a novel approach for intractable primary headache. The sphenopalatine ganglion (SPG) is a well described therapeutical target to treat primary headaches (migraine, tension headache, cluster headache and other primary headache disorders). Until recently, electrical neurostimulation of the SPG required invasive approaches. We described here a case series of non-invasive intranasal neurostimulation of the SPG. Patients with primary headache disorders and failed multiple pharmacological treatments were selected for low frequency intra-nasal non-invasive neuromodulation of the SPG, using the Remedius ExStim neurostimulator and Remedius nasal catheter (10-minute weekly session, frequency of 2Hz and amplitude determined by feedback from the patient of a comfortable pulsing sensation felt over the maxillary region of the face). 26 patients (21F/5M, mean age 49) were enrolled: 12 migraines, 6 tension headaches, 3 cluster headaches and 5 other primary headache disorders. The mean duration of symptom was 15 years. The average number of sessions was 5. Changes from baseline to post-treatment scores were respectively 0.225 to 0.864 for EQ-5D-5L index and 14.3 to 86.5 for EQ-5D-5L VAS. The EQ-5D-5L index at the latest follow-up (mean duration of 72 months) was 0.855. Patient global impression of changes (PGIC) at the latest follow-up was 7 in 12 patients, 6 in 7, 5 in 3, 4 in 2 and 3 in 2 (mean PGIC 6,5). Results are summarized in figure 1. The case series corroborated the efficacy of a new non-invasive neurostimulation approach targeting the SPG for management of refractory primary headaches. Quality of life and PGIC were drastically improved and maintained over time. Wojciech NIERODZINSKI (Bialystok, Poland), Christophe PERRUCHOUD 11:44 - 11:51 #42688 - OP056 POSTERIOR QUADRATUS LUMBORUM BLOCK AS ANALGESIC TECHNIQUE IN CHRONIC HIP PAIN: COHORT STUDY. OP056 POSTERIOR QUADRATUS LUMBORUM BLOCK AS ANALGESIC TECHNIQUE IN CHRONIC HIP PAIN: COHORT STUDY. The management of chronic hip pain requires accurate diagnosis and a multimodal approach. This study aimed to evaluate the effect of posterior quadratus lumborum block (QLB) on pain and quality of life in patients with chronic hip pain. After Ethical Committee’s approval (PI 21-PI104 on June 26,2021) and register (Trial registration number: NCT04438265) we started this prospective, observational cohort study. We present the results of 100 patients affected of chronic hip pain (50 treated with posterior QLB as an analgesic technique and 50 control). Pain (numeric rating scale, NRS) and quality life (WOMAC scale) were assessed at baseline, after three weeks and three months. There were no differences in demographic data. Pain (NRS mean value 7.28 /4.79) and quality of life (WOMAC mean value 54.31/35) for the QLB group patients improved at the third visit compared to baseline values (P value .001) and control group maintained the scores NRS 7.69/8.07 and WOMAC (61.10/61.3)(Figure 1). Forty patients exhibited an improvement in NRS pain scores and WOMAC quality life of scores of >50% at third month (ten patients more than one year), Fifteen less than 3 months. Only ten patients didn’t have any improvement. Table 1 shows the significance of the study. We observed that patients with avascular necrosis showed a minor improvement. Only two adverse events were registered (an unexpected spread and an allergic reaction) Our results show that posterior QLB could represent a minimally invasive option in hip chronic pain. María Teresa FERNÁNDEZ (Valladolid, Spain), Laura LEAL, Ignacio AGUADO, Laura LOPEZ, Esperanza ORTIGOSA, Jose A. AGUIRRE 11:51 - 11:58 #42472 - OP054 Comparative study between transforaminal epidural steroid injection versus high volume lumbar erector spinae block in patients with low backache and radicular pain-A prospective randomized trial. OP054 Comparative study between transforaminal epidural steroid injection versus high volume lumbar erector spinae block in patients with low backache and radicular pain-A prospective randomized trial. Chronic LBP is a disabling chronic pain condition causing excessive burden on health services and severely affecting the quality of life. The study aims to compare TFESI with high-volume lumbar ESP block in patients with low backache and radicular pain. After institution's ethical committee clearance, this prospective, randomised controlled study was conducted in patients aged 18-50 yrs, ASA I/II having single-level lumbar disc herniation with radiculopathy not responding to medications were included, whereas, patient refusal, coagulation disorders, allergy to LA, H/O spinal surgery, spinal injury, or deformities, ≥ 2 levels of disc hernia, degenerated and sequestered disc were excluded. Sixty patients were randomly allocated into 2 groups of 30 each- Group T and Group E. Group ESP (E) using 30 ml of 0.25% Bupivacaine + Triamcinolone 20 mg using USG. Group TFESI (T) 2.0 ml of 0.25% Bupivacaine + Triamcinolone 20 mg using Fluoroscopy. The primary objective is to compare the pain relief using the NRS scale at immediate post-intervention, at 1& 3 mo. To compare improvement in disability using modified Oswestry disability index (MODI), requirement of rescue analgesia were secondary. The mean NRS and MODI in group T were significantly lower than in group E (p<0.05). NRS and MODI were significantly lower in both groups post treatment (p<0.001). The requirement of rescue analgesics were significantly higher in group E (p<0.03). Both TFESI and ESP are effective in low backache with radiculopathy: TFESI provided better control of pain. However, compared to ESP more complications were observed in TFESI group. Amrita RATH (Varanasi, India) 11:58 - 12:05 #41458 - OP058 Patients’ experiences living with chronic pain: A qualitative study. OP058 Patients’ experiences living with chronic pain: A qualitative study. Chronic pain is a multifaceted condition with debilitating biopsychosocial effects. The experience of living with chronic pain is highly subjective and influenced by social and cultural factors. In this study, we aimed to elucidate the lived experiences of patients suffering from chronic pain and explore the challenges and barriers they face in their daily care. This qualitative study was conducted with patients seeking out-patient care at a pain management clinic at a tertiary hospital in Singapore. Participants were recruited according to the following criteria: 1) have experienced non-cancer, chronic pain for more than 3 months; 2) above 21 years of age; 3) no visual or hearing impairment; 4) English-literate. Semi-structured interviews were conducted face-to-face with individual participants. Structured interview guide formulated by the study team was used to ensure similar lines of enquiry. 18 patients were interviewed, and their demographic characteristics are presented in Figure 1. Our analysis reveals three themes that capture participants’ experiences living with chronic pain. This is summarised in Figure 2. Our findings reveal that patients with chronic pain experience significant disruptions to their physical, mental, and social well-being. This study expands current knowledge regarding the impact of chronic pain on patients. Understanding these lived experiences opens opportunities for the healthcare team to develop and implement targeted and focused strategies to better support our patients in their chronic pain care. Lydia LI (Singapore, Singapore) 12:05 - 12:12 #42442 - OP059 Investigation of the Frequency of Chronic Pain Development After Thoracotomy. OP059 Investigation of the Frequency of Chronic Pain Development After Thoracotomy. Chronic post-thoracotomy pain is defined as persistent pain for at least two months after thoracic surgery that is a complication and may affect quality of life. The aim of this study was to investigate the pain of patients who have undergone thoracotomy in the last year to determine the incidence of patients with chronic pain, as a descriptive study. In this retrospective observational study, with ethics committee approval (2023/61), a list of patients who were operated on between 15 June 2022-15 June 2023 were recruited. Patients who had been thoracotomy on for at least 3 months were included in the study. Age, gender, height, weight, history of surgery that would affect chronic pain, postoperative pain management and complications were recorded from the patients' files. The data information was obtained by contacting the patients by phone. Thoracotomy was performed on 70 patients during a 1-year period. Out of 70 patients, 56 patients, 17 women and 49 men, could be contacted. The rate of patients feeling pain 3 months after surgery was 54.5%. The rate of patients stating that it affects their daily activities and they have to use medication is 51.5%. It was determined that the rate of those who had taken medication on their own was 64.7%, while the rate of those who used medication after consulting a doctor was 11.8%. Chronic pain is still a common complication of thoracic surgery, which can significantly impact patient’s daily life. The high incidence of chronic pain after thoracotomy cannot be ignored. Ferda YAMAN (ESKİŞEHİR, Turkey), Dilek CETINKAYA, Ilker UGURLU, Erhan DURCEYLAN 12:12 - 12:19 #42558 - OP060 Comparison of Energy Delivery Across Cooled, Three-Tined Protruding and Monopolar Probes. OP060 Comparison of Energy Delivery Across Cooled, Three-Tined Protruding and Monopolar Probes. Recent preclinical studies performed in an in-vivo rodent model have determined that the amount of energy delivered to the target nerve may play a significant role in the clinical durability of effect for cooled radiofrequency ablation (1). To date, no research has been published relating to the energy delivery of standard, tined and cooled probes using the same generator. RF ablation lesions were generated ex-vivo in non-perfused chicken breast using the Avanos Cooled Radiofrequency Generator (CRG-ADVANCED). Each probe underwent RF at the time and temperature settings they are commercially suggested for (i.e., the Standard RF ran for 90s at 80°C, the three-tined ran for 120s min at 80°C, and the Cooled ran for 150s at 60°C.) The lesions were created using approved standard test method that underwent test method validation (TMV). Total energy delivery (in Joules) was collected from the generator output. The results for total energy delivered and standard deviation for each probe can be found in Table 1. When comparing different probe sizes across the same technology (i.e. cooled probes), there was a correlation between larger probe size and more energy delivery. When comparing energy delivery across probe technologies, all cooled probes delivered more energy than the standard and tined probes. The tined probe, although a smaller active tip size, delivered more energy than the standard RF probe. These results suggest the internal-cooling mechanism in cooled probes, and its ability to effectively manage the temperature at the tissue-tip interface, is the driving factor in terms of energy delivery. Wang ROY, Cleveland HANNAH, Brown MICHAEL, Gideon JENNIFER (Atlanta, USA), Eric MOORHEAD	CHAMBER HALL
11:35	"Thursday 05 September" Added to your list of favorites Deleted from your list of favorites B22 11:35 - 12:25 PRO CON DEBATE Do we still need cadaver lab to teach regional anaesthesia and pain procedures? Chairperson: Peter MERJAVY (Consultant Anaesthetist & Acute Pain Lead) (Chairperson, Craigavon, United Kingdom) 11:35 - 11:40 Introduction. Peter MERJAVY (Consultant Anaesthetist & Acute Pain Lead) (Keynote Speaker, Craigavon, United Kingdom) 11:40 - 11:55 #43039 - B22 For the PROs: yes, we do. For the PROs: yes, we do. The successful performance of an ultrasound-guided interfascial or peripheral nerve block is a highly complex process. These include to visualize nervous structures, to guide the needle to the target and to deposit local anesthetic solution around the nerve. Since it is unethical to learn such a complex process on the patient, there are different phantom models for acquiring one's skills in ultrasound-guided regional blocks. The most realistic and closest to the patient are cadavers. All components of nerve block such as nerve anatomy, needle movement, fascial penetration, perineural fluid injection and inadvertent intraneural injection can be shown and learned. Therefore, when properly prepared, the use of cadavers is second to none for proper ultrasound procedural training and learning. Cadavers provide an ideal tool for learning sonoanatomy and skills required for performing us-guided regional anaesthesia. In the meantime, the requirements for cadaver course have increased. The purely descriptive anatomy is no longer sufficient; newer conservation techniques make it possible to imitate a complete us-guided nerve block. This means first of all searching for and recognizing the target structure, advancing the puncture needle and injecting and perineural spreading the local anesthetic, another key component of successful block. Even an intraneural needle position and spread of the local anesthetic as a sign of nerve damage can be demonstrated, a process that must be avoided at all times on the patient. Continuous procedures with catheter advancement and correct placement are also possible in cadavers. Often it is not possible to identify the position of the catheter tip even with US and injection of fluid. Cadavers allow targeted search for the catheter tip by means of tissue dissection. Various needling techniques, in-plane and out-of-plane, can be learned, alignment of needle and US beam as well as hand-eye coordination. For learning fascia blocks the feeling of the passage of fascias (pop sound) is important, which is felt very well with especially embalmed cadavers. Likewise, the correct spread of the local anesthetic between two layers of fascia is shown in cadavers. While non-dissected cadavers are required for us-guided as well as for landmark-guided blocksa, the topographical anatomy of the nerves and the surrounding tissue can be demonstrated particularly well on dissected cadavers. Paul KESSLER (Frankfurt, Germany) 11:55 - 12:10 For the CONs: no we don't. Matthew SZARKO (Anatomist) (Keynote Speaker, Malaga, Spain) 12:10 - 12:25 Q&A.	PANORAMA HALL
11:50	"Thursday 05 September" Added to your list of favorites Deleted from your list of favorites G23 11:50 - 12:20 REFRESHING YOUR KNOWLEDGE Pharmacology Chairperson: Matthieu CACHEMAILLE (Médecin chef) (Chairperson, Geneva, Switzerland) 11:50 - 11:55 Introduction. Matthieu CACHEMAILLE (Médecin chef) (Keynote Speaker, Geneva, Switzerland) 11:55 - 12:15 UPDATE on Headache with new pharmacological approaches. Sarah LOVE-JONES (Anaesthesiology) (Keynote Speaker, Bristol, United Kingdom) 12:15 - 12:20 Q&A.	Small Hall
12:30	LUNCH BREAK
13:15	"Thursday 05 September" Added to your list of favorites Deleted from your list of favorites H24 13:15 - 13:45 MANAGING CHRONIC PAIN:HANDS-ON WITH COOLED RADIOFREQUENCY AB Keynote Speaker: Thomas HAAG (Consultant) (Keynote Speaker, Oswestry, United Kingdom)	NORTH HALL
14:00	"Thursday 05 September" Added to your list of favorites Deleted from your list of favorites B23 14:00 - 14:50 PRO CON DEBATE Spinal injections in the treatment of spinal canal stenosis Chairperson: Kiran KONETI (Consultant) (Chairperson, SUNDERLAND, United Kingdom) 14:00 - 14:05 Introduction. Kiran KONETI (Consultant) (Keynote Speaker, SUNDERLAND, United Kingdom) 14:05 - 14:20 For the PROs. Ovidiu PALEA (head of ICU and Pain Department) (Keynote Speaker, Bucharest, Romania) 14:20 - 14:35 #43466 - B23 For the CONs. For the CONs. Spinal injections are a valuable tool in the management of spinal canal stenosis, providing significant pain relief, aiding in diagnosis, improving mobility, and potentially delaying or avoiding the need for surgery. The use of imaging guidance and proper technique are crucial to minimizing these risks. Careful patient selection and adherence to procedural guideline are important to avoid associated risks. Epidural steroid injections, while providing significant pain relief, their efficacy varies. They typically offer only temporary relief which translates to patients requiring multiple injections over time to maintain pain relief, which can be inconvenient and costly. Masking symptoms is another reason for questioning spinal injections in the basis of spinal stenosis. Many clinicians may support that they can lead to a delay in seeking more definitive treatments, such as physical therapy or surgery, which may be necessary for long-term improvement. The procedure itself involves risks associated with needle insertion near the spinal column. Side effects can include infection, bleeding, dural puncture, increased pain post-injection, allergic reactions and devastating nerve damage. Regarding the latter, the careful use of the steroid formulation is of utmost importance in order to avoid vessel infraction. Repeated use of steroid injections may cause increased blood sugar levels, osteoporosis, and weakening of the immune system. References Shin DA, Choo YJ, Chang MC. Spinal Injections: A Narrative Review from a Surgeon’s Perspective. Healthcare (Basel). 2023;11(16):2355. doi:10.3390/healthcare11162355. Kennedy DJ, Huynh L, Wong J, Schramm E, Palmer W. Epidural steroid injections for lumbar spinal stenosis: A systematic review. PM R. 2015;7(10):1026-31. doi:10.1016/j.pmrj.2015.04.002. Bicket MC, Gupta A, Brown CH, Cohen SP. Epidural injections for spinal pain: a systematic review and meta-analysis evaluating the "control" injections in randomized controlled trials. Anesthesiology. 2013;119(4):907-31. doi:10.1097/ALN.0b013e31829862d2. Buenaventura RM, Datta S, Abdi S, Smith HS. Systematic review of therapeutic lumbar transforaminal epidural steroid injections. Pain Physician. 2009;12(1):233-51. Kennedy DJ, Huynh L, Wong J, Schramm E, Palmer W. Epidural steroid injections for lumbar spinal stenosis: A systematic review. PM R. 2015;7(10):1026-31. doi:10.1016/j.pmrj.2015.04.002. Martina REKATSINA (Athens, Greece) 14:35 - 14:50 Q&A.	PANORAMA HALL
	"Thursday 05 September" Added to your list of favorites Deleted from your list of favorites C24 14:00 - 14:50 LIVE DEMONSTRATION Spinal Pain Ultrasound Guided Targets 14:00 - 14:50 Spinal Pain Ultrasound Guided Targets. Manfred GREHER (Medical Hospital Director and Head of Department) (Demonstrator, Vienna, Austria)	South Hall 1A
	"Thursday 05 September" Added to your list of favorites Deleted from your list of favorites D24 14:00 - 14:50 ASK THE EXPERT Fascial plane blocks Chairperson: Alain BORGEAT (Senior Research Consultant) (Chairperson, Zurich, Switzerland) 14:00 - 14:05 Introduction. Alain BORGEAT (Senior Research Consultant) (Keynote Speaker, Zurich, Switzerland) 14:05 - 14:35 Fascial plane blocks: mechanism of action and optimal volume and dosing. Jens BORGLUM (Clinical Research Associate Professor) (Keynote Speaker, Copenhagen, Denmark) 14:35 - 14:50 Q&A.	South Hall 1B
	"Thursday 05 September" Added to your list of favorites Deleted from your list of favorites E24 14:00 - 14:50 ASK THE EXPERT AI our future for good Chairperson: David MOORE (Pain Specialist) (Chairperson, Dublin, Ireland) 14:00 - 14:05 Introduction. David MOORE (Pain Specialist) (Keynote Speaker, Dublin, Ireland) 14:05 - 14:35 How I use AI for good. Vicente ROQUES (Anesthesiologist consultant) (Keynote Speaker, Murcia. Spain, Spain) 14:35 - 14:50 Q&A.	South Hall 2A
	"Thursday 05 September" Added to your list of favorites Deleted from your list of favorites F25 14:00 - 14:25 REFRESHING YOUR KNOWLEDGE Spinal MRI Chairperson: Thomas WIESMANN (Head of the Dept.) (Chairperson, Schwäbisch Hall, Germany) 14:00 - 14:03 Introduction. Thomas WIESMANN (Head of the Dept.) (Keynote Speaker, Schwäbisch Hall, Germany) 14:03 - 14:20 #43468 - F25 Spine MRI Interpretation: Common Findings and Advancements in Imaging Techniques. Spine MRI Interpretation: Common Findings and Advancements in Imaging Techniques. Introduction Magnetic Resonance Imaging (MRI) has become an indispensable tool in the diagnosis and management of spinal disorders (1). This text aims to provide an overview of common findings in spine MRI and introduce advanced imaging modalities such as MR neurography and muscle imaging. It also addresses the importance of interdisciplinary collaboration and the use of standardized nomenclature to describe imaging findings. Identifying clinically relevant pathologies in spine MRI is crucial for guiding effective patient management and treatment strategies. Certain common conditions such as acute bone fractures, spinal canal stenosis and spinal nerve root compressions, have significant implications for patient outcomes and require prompt and accurate diagnosis. Common Findings in Spine MRI One of the most frequently encountered conditions in spine MRI is degenerative disc disease (DDD) (2). Characterized by the deterioration of intervertebral discs, DDD often presents with disc desiccation, decreased disc height, and disc bulging. These changes are typically associated with aging but can also be accelerated by mechanical stress and genetic factors. Bone marrow edema (BME) is a key indicator of underlying pathology in the spine, often associated with acute trauma, inflammatory conditions, or degenerative changes. It appears as hyperintense areas on T2-weighted and STIR images. Recognizing BME is essential because it may signify conditions such as vertebral fractures and osteitis, which necessitate targeted interventions to prevent further complications. Spinal fractures can result from trauma, osteoporosis, or pathological processes such as metastatic disease. MRI is superior to other imaging modalities in detecting acute fractures, particularly in cases where conventional radiographs may be inconclusive. Disc herniation is a common finding, where the nucleus pulposus protrudes through a tear in the annulus fibrosus. Spinal nerve root compressions are common in conditions such as herniated discs, spinal stenosis, and foraminal narrowing. These compressions can lead to radiculopathy, characterized by pain, weakness, or sensory deficits along the affected nerve's distribution. MRI provides detailed visualization of nerve roots and their surrounding structures, enabling precise localization of compression sites. This information is vital for planning surgical decompression or other therapeutic measures aimed at relieving symptoms and preventing long-term neurological deficits. Spinal stenosis involves the narrowing of the spinal canal, which can compress the spinal cord or nerve roots. This condition is often seen in the cervical and lumbar spine as a consequence of degenerative changes, such as hypertrophy of the ligamentum flavum or spondylophyte formation. MRI helps in evaluating the degree of stenosis and planning appropriate intervention strategies. Spondylolisthesis refers to the displacement of one vertebra over another, which can cause significant spinal instability and pain. Radiographs, computed tomography, and MRI aid in assessing the alignment of the vertebrae, the integrity of the intervertebral discs, and any involvement of the spinal cord or nerve roots. Advancements in Spine Imaging MR Neurography Brachial, lumbar, and lumbosacral MR neurography represents a significant advancement in the imaging of the spine (3,4). Utilizing high-resolution MR neurography techniques, this imaging method allows for detailed visualization of the nerves, which is often involved in conditions such as trauma, inflammation, or neoplastic infiltration. Advanced techniques provide insights into nerve integrity and pathology that were previously unattainable. Additionally, recent advancements in MRI have also enhanced our ability to image large muscle groups. Muscle denervation changes, atrophy and fatty infiltration, which are common in acute and chronic spinal conditions, can now be quantified using advanced imaging sequences. Personalized MRI protocols, tailored to address these specialty-specific questions, can significantly enhance patient care. Challenges in Interdisciplinary Work and the Importance of Common Nomenclature Interdisciplinary collaboration is essential in the management of spinal disorders, involving radiologists, orthopedic surgeons, pain therapists, neurologists, physiotherapists, and other healthcare professionals. However, this collaboration brings challenges, primarily due to differences in terminology and expectations across specialties. The use of a common nomenclature is vital to ensure clear communication and effective treatment planning (5). To characterize lumbar disc morphology and pathology, the NASS nomenclature was introduced in 2014 and has been in widespread use since (6). This common language can facilitate better interdisciplinary communication. The NASS nomenclature provides clear definitions for terms like disc bulge, protrusion, extrusion, and sequestration. By adopting such standardized terms, radiologists can provide reports that are easily understood by all members of the treatment team, reducing the risk of miscommunication and ensuring that each specialist receives the precise information needed for their role. Conclusion Spine MRI interpretation remains a cornerstone in the diagnosis and management of spinal disorders. Familiarity with common findings such as degenerative disc disease, disc herniation and its nomenclature, spinal stenosis, and spondylolisthesis is essential for accurate diagnosis and treatment planning. Advancements in imaging techniques, particularly MR neurography and muscle imaging, are expanding our diagnostic capabilities and enhancing our understanding of spinal pathologies. Personalized MRI protocols tailored to address the clinicians' needs promise to improve outcomes by providing precise and relevant information to all members of the healthcare team. 1. Carrino JA, Lurie JD, Tosteson ANA, Tosteson TD, Carragee EJ, Kaiser J, et al. Lumbar spine: reliability of MR imaging findings. Radiology [Internet]. 2009 Jan [cited 2024 Jun 29];250(1):161–70. Available from: https://pubmed.ncbi.nlm.nih.gov/18955509/ 2. Parenteau CS, Lau EC, Campbell IC, Courtney A. Prevalence of spine degeneration diagnosis by type, age, gender, and obesity using Medicare data. Sci Rep [Internet]. 2021 Mar 8 [cited 2024 Jun 29];11(1):5389. Available from: https://pubmed.ncbi.nlm.nih.gov/33686128/ 3. Chhabra A, Andreisek G, Soldatos T, Wang KC, Flammang AJ, Belzberg AJ, et al. MR neurography: Past, present, and future. American Journal of Roentgenology [Internet]. 2011 Sep 23 [cited 2024 Jun 29];197(3):583–91. Available from: https://ajronline.org/doi/10.2214/AJR.10.6012 4. Chazen JL, Cornman-Homonoff J, Zhao Y, Sein M, Feuer N. MR Neurography of the Lumbosacral Plexus for Lower Extremity Radiculopathy: Frequency of Findings, Characteristics of Abnormal Intraneural Signal, and Correlation with Electromyography. AJNR Am J Neuroradiol [Internet]. 2018 Nov 1 [cited 2024 Jun 29];39(11):2154. Available from: /pmc/articles/PMC7655367/ 5. D’Anna G, Shah L, Kranz PG, Hirsch JA, Khan M, Johnson M, et al. Results of an International Survey on Spinal Imaging by the ASNR/ASSR/ESNR/ESSR Nomenclature 30 Working Group. Semin Musculoskelet Radiol. 2023 Oct 10;27(5):561–5. 6. Fardon DF, Williams AL, Dohring EJ, Murtagh FR, Gabriel Rothman SL, Sze GK. Lumbar disc nomenclature: version 2.0: Recommendations of the combined task forces of the North American Spine Society, the American Society of Spine Radiology and the American Society of Neuroradiology. Spine J [Internet]. 2014 Nov 1 [cited 2024 Jun 29];14(11):2525–45. Available from: https://pubmed.ncbi.nlm.nih.gov/24768732/ Hannes PLATZGUMMER (Vienna, Austria) 14:20 - 14:25 Q&A.	South Hall 2B
	"Thursday 05 September" Added to your list of favorites Deleted from your list of favorites G25 14:00 - 14:25 TIPS & TRICKS Cervical Blocks Chairperson: Livija SAKIC (anaesthesiologist) (Chairperson, Zagreb, Croatia) 14:00 - 14:20 Update on cervical plexus blocks for Carotid surgery. Wolf ARMBRUSTER (Head of Department, Clinical Director) (Keynote Speaker, Unna, Germany) 14:20 - 14:25 Q&A.	Small Hall
	"Thursday 05 September" Added to your list of favorites Deleted from your list of favorites H25 14:00 - 16:00 SIMULATION TRAININGS Demonstrators: Clara LOBO (Medical director) (Demonstrator, Abu Dhabi, United Arab Emirates), Roman ZUERCHER (Senior Consultant) (Demonstrator, Basel, Switzerland)	NORTH HALL
	"Thursday 05 September" Added to your list of favorites Deleted from your list of favorites FP32 14:00 - 14:55 POSTOPERATIVE PAIN MANAGEMENT Free Papers 7 14:00 - 14:07 #42755 - OP061 Pericapsular nerve group (PENG) block for hip arthroscopy: is it worth it? OP061 Pericapsular nerve group (PENG) block for hip arthroscopy: is it worth it? Hip arthroscopy is associated with significant postoperative pain. The pericapsular nerve group (PENG) block is a relatively novel ultrasound-guided regional technique that may provide analgesia to patients undergoing hip arthroscopy. The evidence from studies conducted so far has been inconclusive. We performed this review to investigate the efficacy of PENG block in reducing postoperative pain in patients undergoing hip arthroscopy. Studies from electronic databases such as MEDLINE, Embase, PubMed, CINAHL, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials databases and clinicaltrials.gov were included in our study. We investigated immediate postoperative pain scores, pain scores at 24 hours after the procedure and amount of opioid analgesia required. Following our search 5 studies were found and included in our review. These included 3 RCTs and 2 retrospective studies. Data from 280 patients were analysed. It seems that while PENG block can reduce pain at 24 hours after the procedure, pain scores in post-anaesthesia care unit (PACU) are not improved. Similarly, a smaller amount of opioids is required at 24 hours, but not immediately after the surgical procedure. PENG block for hip arthroscopy offers better postoperative analgesia with less opioid consumption at 24 hours postoperatively, but not in the immediate postoperative period. Iosifina KARMANIOLOU, Kassiani THEODORAKI (Athens, Greece), Martina REKATSINA, Suresh ANANDAKRISHNAN 14:07 - 14:14 #42817 - OP062 Role of melatonin in early postoperative pain and catheter related bladder discomfort in patients undergoing transurethral resection of prostrate under subarachnoid block- A prospective, randomized control study. OP062 Role of melatonin in early postoperative pain and catheter related bladder discomfort in patients undergoing transurethral resection of prostrate under subarachnoid block- A prospective, randomized control study. Catheter-related bladder discomfort (CRBD) is characterized by a burning sensation at the urethra, an urgent need to void, frequent urination, and painful discomfort in the suprapubic area following the insertion of an indwelling urinary catheter. This study aims to assess the effectiveness of pre-emptive oral melatonin in reducing early postoperative pain and preventing CRBD in patients undergoing transurethral resection of the prostate (TURP) surgery during the immediate postoperative period. Following ethical clearance and written informed consent, 70 ASA 1 or 2 patients undergoing TURP surgery under spinal anaesthesia were included. Exclusion criteria were refusal, liver or renal failure, or chronic analgesic use. Patients were randomly assigned into two groups of 35 each. Group M received 5 mg of oral melatonin one day before and on the morning of surgery. Group D received an oral vitamin C placebo at the same time. The primary outcome was pain using the visual analogue scale (VAS) at 0, 2, 8, 12, and 24 hours post-surgery. Secondary outcomes were the assessment of the incidence and severity of CRBD using a four-point severity scale. Group M had significantly reduced VAS scores at all time points compared to group D(p=0.002 at 0 hr, p=0.001 at 2,8,12, and 24 hrs ). The incidence and severity of CRBD were also significantly lower in Group M at all intervals (p<0.05). Pre-emptive administration of melatonin effectively reduces the immediate post-operative pain, incidence and severity of CRBD in patients undergoing TURB surgery under spinal anaesthesia. Amrita RATH (Varanasi, India) 14:14 - 14:21 #42746 - OP063 Comparison of analgesic quality and incidence of adverse effects between epidural analgesia and continuous incisional infusion in planned abdominal laparotomy. OP063 Comparison of analgesic quality and incidence of adverse effects between epidural analgesia and continuous incisional infusion in planned abdominal laparotomy. Epidural analgesia is traditionally used for postoperative pain control after abdominal laparotomy, but continuous incisional infusion is being considered as a comparable alternative with potentially fewer side effects. This study aimed to determine if incisional catheters provide equivalent analgesia to epidurals and if they are associated with fewer adverse effects. A prospective observational study included 498 patients from January 1, 2022, to January 31, 2024, with 390 using epidural catheters (Epi) and 108 using incisional catheters (Inc). Analgesic effectiveness was measured using EVA scores, QoR15, SCQIPP, and incidence of adverse effects. Data analysis included Student's t-test for continuous variables and chi-square for discrete variables, with normal distribution confirmed by the Shapiro-Wilks test. Results showed that epidural catheters provided superior analgesia in the first two hours postoperatively (EVA 1-2 hours: 4.22±2.49 in Inc, 1.54±1.13 in Epi, p<0.05), but pain perception equalized at 24 and 48 hours (EVA 24h: 2.79±1.84 in Inc, 2.59±1.86 in Epi; EVA 48h: 1.7±1.34 in Inc, 1.57±1.26 in Epi, p>0.05). There were no significant differences in QoR15 scores at 24 and 48 hours or SCQIPP scores at discharge. Incisional catheters were associated with significantly fewer adverse effects such as nausea, motor block, and paresthesias, but there were no differences in the incidence of hypotension or urinary retention. In conclusion, while epidural analgesia provides better immediate pain relief, incisional catheters offer similar analgesic quality after the first two hours and result in fewer adverse effects, making them a viable alternative for postoperative pain management. Víctor FIBLA ANTOLÍ (VALENCIA, Spain), Javier Jesús PÉREZ REY, Carlos DELGADO NAVARRO, Ignacio Manuel LEDESMA, Pablo GINER MARTÍN, José DE ANDRÉS IBÁÑEZ 14:21 - 14:28 #42667 - OP064 Effect of Erector Spina Plane Block and Transversus Abdominis Plane Block on Recovery Quality and Postoperative Pain After Laparoscopic Hysterectomy. OP064 Effect of Erector Spina Plane Block and Transversus Abdominis Plane Block on Recovery Quality and Postoperative Pain After Laparoscopic Hysterectomy. The erector spinae plane (ESP) block is used in various surgical procedures as an effective and safe regional analgesia technique. Unlike other plane blocks, the ESP block provides cutaneous and visceral analgesia by involving both ventral and dorsal roots. This study compared the ESP block and the transversus abdominis plane (TAP) block after laparoscopic hysterectomy, aiming primarily to compare quality of recovery and secondarily to compare pain scores. A prospective randomized controlled study involved 64 patients. After ethical approval and patient consent patients undergoing elective laparoscopic hysterectomy were randomly assigned to two groups: Group E received a bilateral ESPblock, and Group T received a bilateral lateralTAP block. In the recovery room, patients with an NRS of 4 or above received intravenous meperidine as rescue analgesia. The same postoperative analgesia plan was applied to all patients, including intravenous paracetamol and intramuscular diclofenac sodium. Tramadol was administered if the NRS score was 4 or above. Preoperative and postoperative quality of recovery scores, pain scores, local anesthetic effect duration, rescue analgesia use, nausea and vomiting, antiemetic use, unexpected side effects, mobilization time, and discharge time were recorded. When comparing preoperative and postoperative quality of recovery scores, it was found that the decreases in scores were less in Group E. NRS scores were lower at the 4th, 8th, 12th, and 16th hours in Group E. Mobilization times were also shorter in Group E. The ESP block is more effective than the TAP block in improving quality of recovery and pain scores after laparoscopic hysterectomy. Pelin DILSIZ, İsmail GOKBEL, Yasam UMUTLU, Alp ERTUGRUL (Aydin, Turkey), Sinem SARI 14:28 - 14:35 #42625 - OP065 Epidural morphine vs local anaesthetics after major gynaecological oncological surgery within an enhanced recovery programme: A retrospective audit from a tertiary cancer center in India. OP065 Epidural morphine vs local anaesthetics after major gynaecological oncological surgery within an enhanced recovery programme: A retrospective audit from a tertiary cancer center in India. Epidural analgesia with local anaesthetics while recommended by enhanced recovery pathways can exacerbate haemodynamic instability. Epidural morphine provides profound analgesia owing to its hydrophilic properties. This retrospective analysis was aimed to compare the analgesic efficacy and adverse effects of epidural morphine with that of local anaesthetic infusions after major gynaecological oncological surgery. This audit included all open surgeries for gynaecological malignancies lasting for more than 4 hours conducted between June 2022 and March 2024. After ethical clearance, prospectively maintained data from the Acute Pain Service was divided into two, Group L (local anaesthetics) and Group M (morphine), according to the epidural drug regimen. Outcomes assessed included pain scores on postoperative days 1 to 3, need for rescue analgesia, incidence of adverse effects, interruption of epidural drug therapy, vasopressor support beyond postoperative day 1 and length of hospital stay. Students t test and chi squared tests were used where appropriate. A total of 186 patients were included with 138 patients in Group L and 58 in Group M. There were no significant differences in the mean age, blood loss or duration of surgery. The mean resting and dynamic pain scores and need for rescue analgesia were comparable between the two groups. The incidence of adverse effects and epidural interruption were also comparable. There were no significant differences in vasopressor requirement and length of hospital stay between the two groups. The analgesic efficacy and adverse effect profile of epidural morphine was found to be comparable to local anaesthetic infusions. Shikhar MORE (Kolkata, India), Srimanta HALDAR, Sumantra Sarathi BANERJEE, Rudranil NANDI, Suparna Mitra BARMAN, Anshuman SARKAR 14:35 - 14:42 #42663 - OP066 Comparison of the postoperative analgesic efficacy of adjuvant quadratus lumborum block in laparoscopic cholecystectomies. OP066 Comparison of the postoperative analgesic efficacy of adjuvant quadratus lumborum block in laparoscopic cholecystectomies. Quadratus Lumborum Block (QLB) is employed as a component of multimodal analgesia in laparoscopic cholecystectomy (LC) procedures. The aim of this study is to evaluate the effect of adding adjuvants to the QLB block used for postoperative analgesia in laparoscopic cholecystectomies on postoperative NRS scores and opioid consumption. This study was designed as a randomized prospective double-blind trial. Eighty-three patients were divided into two groups to receive either adjuvant QLB (Group A-QLB) or non-adjuvant QLB (Group QLB). Preoperative bilateral QLB-III was applied to all patients. In Group A-QLB, 4 mg of dexamethasone was added bilaterally to the local anesthetic solution. Patients' resting NRS (rNRS) and dynamic NRS (dNRS) scores and opioid consumption were recorded at 1, 4, 8, 12, and 24 hours postoperatively. Analgesic consumption in the first 24 hours postoperatively was significantly lower in Group A-QLB compared to Group QLB (Table 1). The rNRS and dNRS values at 4, 8, 12, and 24 hours postoperatively were also significantly lower in Group A-QLB (Table 2). There was no significant difference between the two groups in terms of the time to the first rescue analgesia and intraoperative remifentanil consumption. Since the addition of an adjuvant to the QLB block was associated with lower NRS scores and reduced opioid analgesic consumption in the first 24 hours postoperatively, we believe that the use of adjuvants provides more effective postoperative analgesia. Serpil SEHIRLIOGLU (istanbul, Turkey), Oguz OZAKIN, Dondu GENC MORALAR, Batuhan BURHAN 14:42 - 14:49 #41567 - OP067 Multimodal analgesia and outcomes after hysterectomy surgery – a population-based analysis using United States data. OP067 Multimodal analgesia and outcomes after hysterectomy surgery – a population-based analysis using United States data. Multimodal analgesia is increasingly used in various surgeries, including in hysterectomy surgery. However, large scale comparative and outcome data are lacking. We investigated associations between multimodal analgesia use and postoperative outcomes among patients underwent hysterectomy. After Institutional Review Board approval, we identified adult patients underwent hysterectomy from the Premier Healthcare claims dataset (n= 1,307,923 from 2006-2022). Multimodal analgesia was defined as opioid use with the addition of non-opioid analgesic modalities, including non-steroidal anti-inflammatory drugs, cyclooxygenase-2 inhibitors, paracetamol, steroids, gabapentin/pregabalin, ketamine, neuraxial anesthesia, or peripheral nerve block. This was stratified into 4 categories: opioids-only, and multimodal analgesia with the addition of 1, 2 or ≥3 non-opioid analgesic modalities. Regression models measured associations between multimodal analgesia categories and postoperative complications, naloxone use (as proxy for opioid-related complication), hospital length of stay, and opioid use. We report odds ratios (OR or % change) and 95% confidence intervals (CI). Overall, we found that opioids-only, and addition of 1, 2 or ≥3 non-opioid analgesic modalities represented 15.4% (n=200,904), 49.9% (n=652,872), 23.7% (n=309,334), and 11.1% (n=144,813) of patients, respectively. Opioid-only analgesic regimens decreased from 25.3% in 2006 to 5.1% in 2022 (Figure 1). In multivariable models, multimodal analgesia was consistently associated with lower risk of a composite complication outcome, decreased opioid consumption, and hospital length of stay. Interestingly, multimodal analgesia was associated with higher risk of naloxone use. (Table 1) Application of multimodal pain management has increased in hysterectomy surgeries coinciding with reductions in postoperative complications, reduced opioid use and shortened patient recovery. Hannah GERNER (Graz, Austria), Crispiana COZOWICZ, Haoyan ZHONG, Alex ILLESCAS, Lisa REISINGER, Jiabin LIU, Jashvant POERAN, Stavros MEMTSOUDIS	CHAMBER HALL
	"Thursday 05 September" Added to your list of favorites Deleted from your list of favorites Ia26 14:00 - 15:00 "Mini" HANDS - ON CLINICAL WORKSHOP 19 US Guided RA Techniques for Breast Surgery WS Expert: Rafael BLANCO (Pain medicine) (WS Expert, Abu Dhabi, United Arab Emirates)	220a
	"Thursday 05 September" Added to your list of favorites Deleted from your list of favorites Ib26 14:00 - 15:00 "Mini" HANDS - ON CLINICAL WORKSHOP 20 Fascial Plane Blocks for Abdominal Surgery WS Expert: Corey KULL (Junior Consultant) (WS Expert, Lausanne, Switzerland)	220b
	"Thursday 05 September" Added to your list of favorites Deleted from your list of favorites Ic26 14:00 - 15:00 "Mini" HANDS - ON CLINICAL WORKSHOP 21 Tips and Tricks for fluoroscopic procedures WS Expert: Reda TOLBA (Department Chair and Professor) (WS Expert, Abu Dhabi, United Arab Emirates)	221a
	"Thursday 05 September" Added to your list of favorites Deleted from your list of favorites Id26 14:00 - 15:00 "Mini" HANDS - ON CLINICAL WORKSHOP 22 UGRA for Ankle and Foot Surgery WS Expert: Ana Eugenia HERRERA (Regional Anesthesiologist) (WS Expert, San José, Costa Rica)	221b
	"Thursday 05 September" Added to your list of favorites Deleted from your list of favorites Ja26 14:00 - 15:00 "Mini" HANDS - ON CLINICAL WORKSHOP 23 Clavicular Fractures: What RA technique is the best? WS Expert: Balaji PACKIANATHASWAMY (regional anaesthesia) (WS Expert, Hull, UK, United Kingdom)	221c
	"Thursday 05 September" Added to your list of favorites Deleted from your list of favorites Jb26 14:00 - 15:00 "Mini" HANDS - ON CLINICAL WORKSHOP 24 Peripheral Nerve Blocks for Analgesia in Hip Fracture Surgery WS Expert: David JOHNSTON (ESRA diploma examiner) (WS Expert, Belfast, United Kingdom)	221d
	"Thursday 05 September" Added to your list of favorites Deleted from your list of favorites Jc26 14:00 - 15:00 "Mini" HANDS - ON CLINICAL WORKSHOP 25 Sono Anatomy of the Paediatric Spine WS Expert: Eleana GARINI (Consultant) (WS Expert, Athens, Greece)	223a
	"Thursday 05 September" Added to your list of favorites Deleted from your list of favorites Jd26 14:00 - 15:00 "Mini" HANDS - ON CLINICAL WORKSHOP 26 Caudal block in the Paediatric Population WS Expert: Valeria MOSSETTI (Anesthesiologist) (WS Expert, Torino, Italy)	223b
	"Thursday 05 September" Added to your list of favorites Deleted from your list of favorites Ka26 14:00 - 15:00 "Mini" HANDS - ON AI WORKSHOP 2 Improving presentations by AI WS Expert: Rajnish GUPTA (Professor of Anesthesiology) (WS Expert, Nashville, USA)	223c
	"Thursday 05 September" Added to your list of favorites Deleted from your list of favorites Kb26 14:00 - 15:00 "Mini" HANDS - ON CLINICAL WORKSHOP 28 Basic Blocks for Ophthalmic Surgery WS Expert: Friedrich LERSCH (senior consultant) (WS Expert, Berne, Switzerland)	223d
	"Thursday 05 September" Added to your list of favorites Deleted from your list of favorites Kc26 14:00 - 15:00 "Mini" HANDS - ON CLINICAL WORKSHOP 29 Fascia Iliaca Compartment Block WS Expert: Ufuk YOROKOGLU (MD) (WS Expert, Kocaeli, Turkey)	241
	"Thursday 05 September" Added to your list of favorites Deleted from your list of favorites Kd26 14:00 - 15:00 "Mini" HANDS - ON CLINICAL WORKSHOP 30 PNBs in the trauma patient WS Expert: Jose Alejandro AGUIRRE (Head of Ambulatory Center Europaallee) (WS Expert, Zurich, Switzerland)	242
	"Thursday 05 September" Added to your list of favorites Deleted from your list of favorites La26 14:00 - 15:00 "Mini" HANDS - ON CLINICAL WORKSHOP 31 PNBs in massive disaster circumstances WS Expert: Dmytro DMYTRIIEV (chief of pain medicine department) (WS Expert, Vinnitsa, Ukraine)	243
	"Thursday 05 September" Added to your list of favorites Deleted from your list of favorites Lb26 14:00 - 15:00 "Mini" HANDS - ON CLINICAL WORKSHOP 32 Blocks for Awake Shoulder Surgery: Tips and Tricks for Success WS Expert: Ashwani GUPTA (Faculty and ESRA-DRA board member and examiner) (WS Expert, Newcastle Upon Tyne, United Kingdom)	244
	"Thursday 05 September" Added to your list of favorites Deleted from your list of favorites Lc26 14:00 - 15:00 "Mini" HANDS - ON CLINICAL WORKSHOP 33 Basic Blocks for Pain Free Knee Surgery WS Expert: Morne WOLMARANS (Consultant Anaesthesiologist) (WS Expert, Norwich, United Kingdom)	245
	"Thursday 05 September" Added to your list of favorites Deleted from your list of favorites Ma26 14:00 - 15:00 "Mini" HANDS - ON CLINICAL WORKSHOP 34 Tips and Tricks for Successful QLB WS Expert: Madan NARAYANAN (Annual congress and Exam) (WS Expert, Surrey, United Kingdom, United Kingdom)	246
	"Thursday 05 September" Added to your list of favorites Deleted from your list of favorites Mb26 14:00 - 15:00 "Mini" HANDS - ON CLINICAL WORKSHOP 35 Tips and Tricks for Successful Brachial Plexus Block WS Expert: Juan Carlos DE LA CUADRA FONTAINE (Associate Clinical Professor/ Anesthesiologist/ LASRA President) (WS Expert, Santiago, Chile)	247
	"Thursday 05 September" Added to your list of favorites Deleted from your list of favorites Mc26 14:00 - 15:00 "Mini" HANDS - ON CLINICAL WORKSHOP 36 Ultrasound Guided Invasive Treatments for Muscleskeletal Pain WS Expert: Ammar SALTI (Anesthesiologist and Pain Physician) (WS Expert, abu Dhabi, United Arab Emirates)	248
	"Thursday 05 September" Added to your list of favorites Deleted from your list of favorites A23 14:00 - 14:50 ASK THE EXPERT Awake Hip Surgery PERIPHERAL NERVE BLOCKS (PNBs) Chairperson: Luc TIELENS (pediatric anesthesiology staff member) (Chairperson, Nijmegen, The Netherlands) 14:00 - 14:05 Introduction. Luc TIELENS (pediatric anesthesiology staff member) (Keynote Speaker, Nijmegen, The Netherlands) 14:05 - 14:35 Awake hip surgery in High-Risk Octogenarians under Lumbosacral Plexus Block. Sandeep DIWAN (Consultant Anaesthesiologist) (Keynote Speaker, Pune, India) 14:35 - 14:50 Q&A.	CONGRESS HALL
14:30	"Thursday 05 September" Added to your list of favorites Deleted from your list of favorites F26 14:30 - 15:00 REFRESHING YOUR KNOWLEDGE Neurophysiology Chairperson: Jan BLAHA (Head of the Department) (Chairperson, Praha 2, Czech Republic) 14:30 - 14:35 Introduction. Jan BLAHA (Head of the Department) (Keynote Speaker, Praha 2, Czech Republic) 14:35 - 14:55 Basics of Neurophysiology. Anne PEYER (senior consultant) (Keynote Speaker, Basel, Switzerland) 14:55 - 15:00 Q&A.	South Hall 2B
	"Thursday 05 September" Added to your list of favorites Deleted from your list of favorites G26 14:30 - 15:00 TIPS & TRICKS Central Block Chairperson: Peñafrancia CANO (Associate Professor; Chief, Division of Regional Anesthesia, University of the Philippines) (Chairperson, Manila, Philippines) 14:30 - 14:35 Introduction. Peñafrancia CANO (Associate Professor; Chief, Division of Regional Anesthesia, University of the Philippines) (Keynote Speaker, Manila, Philippines) 14:35 - 14:55 Is PIEB the best we can do with continuous catheters? Marc VAN DE VELDE (Professor of Anesthesia) (Keynote Speaker, Leuven, Belgium) 14:55 - 15:00 Q&A.	Small Hall
15:00	"Thursday 05 September" Added to your list of favorites Deleted from your list of favorites O28 15:00 - 18:00 OFF SITE - Hands - On Cadaver Workshop 6 - PAIN ABDOMEN, CHEST, THORAX, LUMBAR SPINE, PELVIS, HIP & KNEE WS Leader: David LORENZANA (Head Pain Therapy) (WS Leader, Zürich, Switzerland) Unique and exclusive for RA & Pain Cadaveric Workshops: Only whole-body cadavers will be available for the workshops. This is a fantastic opportunity to master your needling skills, perform the actual blocks on fresh cadavers and to improve your ergonomics under direct supervision of world experts in regional anaesthesia and chronic pain management. There won’t be an organized transportation for going/back from the Cadaver workshop. 15:00 - 18:00 Workstation 1. Intrathecal implantation: puncture and pump pocket implantation under the abdominal skin. Denis DUPOIRON (Head of Department) (Demonstrator, Angers, France) 15:00 - 18:00 Workstation 2. Abdomen. Matthew SZARKO (Anatomist) (Demonstrator, Malaga, Spain) Abdominal wall Neuropathy after Surgery: Ilioinguinal, Iliohypogastric, Genitofemoral Nerve Block. Management of Meralgia Parasthetica: Lateral Femoral Cutaneous Nerve Block. 15:00 - 18:00 Workstation 3. Hip and Knee Osteoarthritis. Ismael ATCHIA (Consultant Rheumatologist) (Demonstrator, Newcastle, United Kingdom) Intraarticular Injections and Periarticular Nerves Blocks: Femoral, Obturator, AON, Geniculars and their Origin 15:00 - 18:00 Workstation 4. Chest and Thorax. Humberto-Costa REBELO (Physician) (WS Expert, Villa Nova Gaia, Portugal) Post-Thoracotomy Pain - Intercostal Nerve Block. Thoracic Spine Pain - Medial Branch, Facet Joint and Costovertebral Joint Injections. Paravertebral Block - Thoracolumbar Fascia Plane Blocks. 15:00 - 18:00 Workstation 5. Lumbar Spine. Gustavo FABREGAT (Anesthesiologist) (Demonstrator, Valencia, Spain) Lumbar Spine Pain: Lumbar Medial Branch and Facet Joint Injections. 15:00 - 18:00 Workstation 6. Pudendal Neuropathy & Gluteal Pain Syndrome (GPS) Sacroiliac Joint Injection. Nicole PORZ (Leitende Ärztin) (Demonstrator, Bern, Switzerland) Caudal Epidural Injections.	Anatomy Institute
	"Thursday 05 September" Added to your list of favorites Deleted from your list of favorites EP04S3 15:00 - 15:30 ePOSTER Session 4 - Station 3 Chairperson: Vicente ROQUES (Anesthesiologist consultant) (Chairperson, Murcia. Spain, Spain) 15:00 - 15:05 #42575 - EP139 Brachial plexus variants: a cadaver study. EP139 Brachial plexus variants: a cadaver study. The brachial plexus (BP) branching pattern is highly variable. Due to their clinical implications, the study determines the BP variants and interconnections (ICs) between its trunks, lateral and medial cords (LC and MC), and peripheral nerves. Coexisted arterial variants are also described. Twelve (7 male and 5 female) formalin-embalmed donated Greek cadavers (72-91 years of age) were dissected. After written informed consent, the donated cadavers were bilaterally dissected at the neck, axilla, and arm by following a well-established dissection protocol. Various ICs were identified in 70% of the cases. Special findings were: 1. The musculocutaneous nerve (MCN) and the lateral root (LR) of the median nerve (MN) were found to have atypical right-side formations and course. 2. On the right side, the MCN was absent, the anterior arm muscles were supplied by the MN, and contralaterally, the MCN-MN IC existed. 3. a right-sided MN bifurcation after its formation 4. a right-side LR duplication, along with an MCN duplication and an IC between LC and MC 5. a right-side IC of the MCN-MN 6. a right-side IC of the LR with the MR and the BP medial cord (MC) 7. 3 cases of IC between median and ulnar nerve (MN-UN) 8. 1 case of IC between intercostobrachial nerve (ICBN) and RN Most of the findings were consistent with the literature. Knowledge of these variants is important during surgical, therapeutic, and diagnostic upper limb procedures, especially for anesthesiologists who perform peripheral nerve blocks. Theodoros MILOUSIS (Athens, Greece), Evmorfia STAVROPOULOU, George TSAKOTOS, George TRIANTAFYLLOU, Annita – Ioanna GKIOKA, Aggeliki BAIRAKTARI, Fani ALEVROGIANNI, Maria PIAGKOU 15:05 - 15:10 #42662 - EP140 Evaluation of the recruitment potential in cardiac surgery patients using the collection of pulmonary compliance and calculation of the R/I ratio. EP140 Evaluation of the recruitment potential in cardiac surgery patients using the collection of pulmonary compliance and calculation of the R/I ratio. Cardiac surgery influences respiratory morbidity through multiple mechanisms. In our institution, the anesthesia team uses classic protective ventilation strategies. Optimization of ventilation could still be possible. The primary endpoint is to evaluate the potential for alveolar recruitment, in patients undergoing cardiac surgery, at 2 times (after intubation, and after cardiopulmonary bypass (CPB), by collecting the values of pulmonary compliance and the R/I ratio. The secondary endpoint is to determine if there are statistically significant differences, in terms of respiratory and hemodynamic parameters between patients with a ratio to patients who are above or below the median. This is a prospective and observational study. The patients studied are undergoing cardiac surgery. Patients' perioperative data were recorded. With a maneuver we calculates the R/I ratio and the recruited volume and the compliance of the recruited lung. The ratio of this compliance to the compliance at low PEEP gave the recruitment-to-inflation ratio. Intermediate results show significant differences with improvement of compliance 10 min after recruitment. The median R/I was 1.58 +/- 0.67 before CPB and, 1.15 +/- 64 after CPB indicating a potential for recruitment. P/F values did not show a statistically significant increase, which could reflect good pulmonary vasoconstriction in pulmonary atelectasis. Recruitment maneuvers, with moderate PEEP, are well tolerated in our patients. R/I ratio highlights a potential for recruitment in our cardiac surgery patients. This test is hemodynamically well tolerated and could differentiate patients who are candidates for an increase in PEEP. A larger study is needed to confirm these results. Jenny Adriana CARVALHO BADAS (Bruxelles, Belgium), Delphine VAN HECKE, Jaime FRANCO GUEMBE, Celia NOVIALS DE LA FLOR, Giulia SCANDURRA, Denis SCHMARTZ, Turgay TUNA, Laurent PERRIN 15:10 - 15:15 #42686 - EP141 Preliminary in vivo data on the analgesic effect of an EU-GMP-certified Cannabis sativa L. strain in an animal model of chemotherapy-induced chronic neuropathic pain. EP141 Preliminary in vivo data on the analgesic effect of an EU-GMP-certified Cannabis sativa L. strain in an animal model of chemotherapy-induced chronic neuropathic pain. Thirty percent of cancer patients experience chemotherapy-induced chronic neuropathy (CIN), which is still an unmet clinical challenge because current standard treatments have significant side effects and are not very effective. Because they are highly expressed in the nervous system, cannabinoid receptors offer a promising target for CIN treatment. Although the plant itself might not have the same analgesic effect as an active pharmaceutical substance, its use as an adjuvant to traditional analgesic treatment would be justified given its reduced adverse effects when administered orally. The aim of this study was to evaluate the in vivo efficacy of an EU-GMP-certified Cannabis sativa L. in a paclitaxel-induced chronic neuropathy (PIN) mouse model. To evaluate the analgesic effects on PIN in mice, a standard pain test battery was used, consisting of two thermal sensitivity tests and one pressure test. The experimental study was performed in accordance with the European Directive 2010/63/EU and has been approved by the university’s Research Ethics Committee (no. 47/17.02.2021) and authorized by the National Sanitary Veterinary and Food Safety Authority (no. 34/07.04.2021). The tested product exhibited a variable analgesic effect across the three tests used, with the effect being more noticeable in the pressure stimulus test. It is challenging to translate cannabis into the clinic, but finding novel ways to reduce CIN could significantly enhance the quality of life for millions of cancer survivors. Although more research is required to confirm these results, the existing findings are encouraging. Leontina Elena FILIPIUC, Leontina Elena FILIPIUC (Iasi, Romania), Daniela-Carmen ABABEI, Bogdan-Ionel TAMBA, Veronica BILD 15:15 - 15:20 #42751 - EP142 Microscopic Analysis of Crystallization of Clinically used Local Anesthetics Mixture when Combined with Dexamethasone and Dexmedetomidine. EP142 Microscopic Analysis of Crystallization of Clinically used Local Anesthetics Mixture when Combined with Dexamethasone and Dexmedetomidine. The use of adjuvants like dexamethasone, clonidine, and bicarbonate helps prolong the duration of the effect of local anesthetics (LA). Only a few studies are available about the pH dependency, magnitude, or timing of crystal precipitation effects for various LA adjuvant combinations. The study aimed to quantify the crystallization effect of the addition of varying doses of dexamethasone and dexmedetomidine to a combination mixture of 0.75% ropivacaine and 2% lignocaine with and without epinephrine. The LAs and adjuvants tested in this study were a combination of equal volumes of ropivacaine 0.75% with plain lignocaine 2% or lignocaine 2% with epinephrine (5mcg/ml) to a total volume of 20 ml. Varying doses of dexamethasone 2mg, 4 mg, and 8 mg were added to this LA mixture and were observed for crystallization. Subsequently, dexmedetomidine in a dose of 50 mcg was added to each of the LA + dexamethasone mixture to assess for crystallization. pH of all the solutions was noted. Crystallization occurred in the 2% lignocaine and 0.75% ropivacaine group with all doses of dexamethasone and dexmedetomidine 50 mcg. The crystallization was seen with in 5 minutes dexmedetomidine was added. The crystallization occurred at a pH of 4.5. The crystallization wasn’t seen in 2% lignocaine and epinephrine with 0.75% ropivacaine groups, with either adjuvant, pH being 6.5. Crystallization in local anesthetic solutions occurred with dexamethasone starting at 2mg dose. Dexmedetomidine appeared to expedite crystallization when added as a second adjuvant. The crystallization could be pH dependent occurring at a lower pH. Debesh BHOI, Lipika SONI (Delhi, India), Heena GARG, Rupinder KAUR, Pramod Kumar GAUTAM 15:20 - 15:25 #42792 - EP143 Pre-operative peripheral nerve blockade: effect on discharge and longer-term opiate requirement. A single-centre, retrospective observational study. EP143 Pre-operative peripheral nerve blockade: effect on discharge and longer-term opiate requirement. A single-centre, retrospective observational study. Aimed to identify whether the use of peripheral nerve blockade (PNB) pre-traumatic limb amputation reduced long-term opiate requirements. Evidence suggests that epidural anaesthesia may reduce post-surgical pain. Data to show the longer-term effects PNB has on opiate use is limited. This was a retrospective observational study. Patients who underwent orthopaedic limb amputation between 21/07/2020 and 19/10/23 were included. Anaesthetic charts, notes and community prescriptions were reviewed to assess pre-admission, discharge, and present opiate prescription. 69 patients identified. 72% had a PNB (single shot or infusion), 28% did not. 42/69 (61%) patients were prescribed an opiate prior to admission for amputation. This observational study did not show that PNB pre-amputation reduces opiate prescription at or beyond discharge. The data highlights that fewer (62% vs 81%) patients who were on opiates pre-admission were given a PNB compared to those who were not prescribed opiates pre-admission. In those who had a PNB, 88% of patients taking opiates pre-admission were discharged with opiates compared to 63% of those not on a pre-admission opiate. Results suggest that pre-admission opiate use may not always be used as a considering factor for PNB in current practice. Limitations to this study include a small cohort size, unrecorded indications for opiate prescriptions and unclear reasons as to why patients did not receive PNB. Further work to establish whether PNB reduces long-term opiate use is needed. A study where patients (PNB vs non-PNB) are monitored at set time intervals post amputation to assess change in opiate requirement would be useful. Louise MANSON (Glasgow, United Kingdom), Rebecca VERE, Christiana PAGE, Stephen HICKEY 15:25 - 15:30 #42847 - EP144 Evidence-based protocol vs liberal drug prescription for postoperative pain management in inguinal hernia surgery at MAS. EP144 Evidence-based protocol vs liberal drug prescription for postoperative pain management in inguinal hernia surgery at MAS. This study aimed to standardize postoperative pain management in major outpatient surgery by developing evidence-based protocols, as recommended by the PROSPECT guidelines. The study compared the effectiveness of these protocols with the traditional liberal management of postoperative pain prescribed by surgeons for patients undergoing inguinal hernia surgery at MAS. A sample of 60 ASA I and ASA II patients undergoing inguinal hernia surgery at MAS was collected. Thirty patients followed a protocol-based home analgesic regimen of Paracetamol 1 g alternated with Tramadol 75 mg and Dexketoprofen 25 mg every 8 hours for 3 days. The other thirty patients received a surgeon-prescribed regimen of Paracetamol 1 g alternated with Ibuprofen 600 mg every 8 hours, with Tramadol 50 mg as rescue analgesia for 5 days. Pain levels were assessed using the VAS scale at 24 and 48 hours, and adverse effects were recorded. The protocol group had a mean VAS score of 2.3 points at 24 hours, compared to 4.1 points in the conventional treatment group. At 48 hours, the protocol group scored 1.2 points, while the control group scored 2 points. The Student's t-test indicated a significant reduction in postoperative pain for the protocol group at both 24 and 48 hours (p<0.05). Analgesic guidelines based on the developed protocol offer a significantly more effective alternative for managing postoperative pain than the liberal analgesia prescribed by surgeons in patients undergoing inguinal hernia surgery at MAS. Mar ALONSO ANDRES (Sagunto, Spain), Carlos DELGADO NAVARRO, Cristina RODRIGUEZ OLIVA, Pérez Hernández LEYRE, Jose DE ANDRÉS IBAÑEZ
	"Thursday 05 September" Added to your list of favorites Deleted from your list of favorites EP04S4 15:00 - 15:30 ePOSTER Session 4 - Station 4 Chairperson: Dan Sebastian DIRZU (consultant, head of department) (Chairperson, Cluj-Napoca, Romania) 15:00 - 15:05 #41080 - EP145 Efficacy and safety of crisugabalin for the treatment of perioperative analgesia in patients undergoing orthopedic surgery: a multi-centre, randomized, double-blind, placebo-controlled, phase 2 trial. EP145 Efficacy and safety of crisugabalin for the treatment of perioperative analgesia in patients undergoing orthopedic surgery: a multi-centre, randomized, double-blind, placebo-controlled, phase 2 trial. The management of perioperative analgesia in clinical practice is often distressing and full of challenges. Opioids are recommended as perioperative analgesic treatment for patients undergoing orthopedic surgery, but there are not widely use resulted from adverse effects. This study aimed to assess the efficacy and safety of Crisugabalin for perioperative analgesia in patients undergoing orthopedic surgery. Subjects (18-75 years) scheduled for elective orthopedic surgery under general anesthesia, which was expected to take no more than 4 h, postoperative analgesia expected to last >24 h were randomized to preoperative 40mg Crisugabalin and postoperative placebo (40mgPre), preoperative 60mg Crisugabalin and postoperative placebo (60mgPre), preoperative and postoperative 40mg Crisugabalin (40mgPre&Post), preoperative and postoperative 60mg Crisugabalin (60mgPre&Post) and placebo. The primary endpoint was total morphine dose in the 24 h postoperative period. A total of 235 subjects from 20 institutions were randomized to receive Crisugabalin groups and placebo group (figure 1). Morphine consumption within 24 h after surgery was 9.9±8.2mg, 10.3±8.8mg, 9.7±10.1mg and 15.7±12.1mg for Crisugabalin 60mgPre, 40mgPre&Post, 60mgPre&Post and placebo group, showing statistical significance for Crisugabalin groups versus placebo group (P=0.0239, P=0.0261 and P=0.0076, respectively, table 1). Except that the incidence of dizziness and somnolence in Crisugabalin groups were higher than in the placebo group, there were similar types and incidence of TEAEs related to these groups, and most TEAEs were mild to moderate, and spontaneously resolved without necessitating interventions. The trial demonstrated that Crisugabalin reduced postoperative opioid consumption, and well tolerated for the treatment of perioperative analgesia in patients undergoing orthopedic surgery. Yang MENGCHANG, Deng JIA, Yang LINA (Chengdu, China), Ma SHIJIN, Hu YUNXIA, Li PENG 15:05 - 15:10 #41611 - EP146 Determinants of hospital length of stay following accidental dural puncture in obstetric patients: insights from a retrospective study. EP146 Determinants of hospital length of stay following accidental dural puncture in obstetric patients: insights from a retrospective study. Accidental dural punctures (ADP) during neuraxial analgesia/anesthesia pose significant concerns in obstetrics, prompting post-dural puncture headache (PDPH) in 50-88% of cases. Understanding the determinants of post-ADP length of stay (LOS) is crucial for optimizing care. This study aims to identify such determinants in parturients. This retrospective study included all patients diagnosed with ADP after neuraxial labor analgesia at our institution, between October 2013 and 2023. All relevant data were obtained from medical records’ review. Seventy-four ADP were identified. The mean post-ADP LOS was 4.69 days, exceeding the average LOS for uncomplicated deliveries at our institution. Moderate-to-severe PDPH was associated with prolonged hospitalization (mean LOS: 4.91 vs 3.43 days, p<0.05). Interestingly, epidural blood patch (EBP) administration did not reduce the LOS. However, when headache onset occurred within 48 hours after ADP, early EBP (<48 hours after ADP) was linked to earlier discharge (mean LOS 3.5 vs 5.11 days, p<0.05). Premature birth, ASA classification and cesarean delivery were associated with extended hospitalization. These factors were not associated with PDPH development or severity. Age, BMI, and technical aspects related to neuraxial approach showed no association with LOS. PDPH-related factors, as headache intensity and early EBP in parturients displaying early symptoms, were associated with the hospitalization duration. Although there’s evidence in the literature that an early EBP may increase the need to repeat the procedure, our study didn’t demonstrate that. Determinants of obstetric post-ADP LOS are multifactorial and also depend on obstetric factors. Managing ADP-related hospital stays is complex and further research is needed. Mariana FERREIRA NEVES, José MOREIRA (Porto, Portugal), Catarina SAMPAIO 15:10 - 15:15 #42036 - EP147 Effect of percutaneous acupoint electrical stimulation on gastrointestinal function and pain management after laparoscopictotal hysterectomy. EP147 Effect of percutaneous acupoint electrical stimulation on gastrointestinal function and pain management after laparoscopictotal hysterectomy. This study investigates the therapeutic potential of Transcutaneous Electrical Acupoint Stimulation (TEAS) in enhancing gastrointestinal recovery and alleviating postoperative acute pain among laparoscopic total hysterectomy From May 2022 to May 2023, 120 patients undergoing laparoscopic total hysterectomy were studied. The TEAS group (T group) received preoperative, intraoperative, and postoperative electrical stimulation, while the control group (C group) did not. Outcomes measured included gastrointestinal function, postoperative nausea and vomiting, postoperative acute pain，patient-reported outcomes on the GSRS and VAS, and plasma levels of gastrin and motilin analyzed using ELISA. Relative to the C group, the T group exhibited a statistically significant acceleration in postoperative gastrointestinal recovery markers, including earlier occurrences of first flatus, defecation, bowel sound resumption, and initial solid food consumption. Additionally, this group demonstrated a notable reduction in the incidence rates of PONV within the initial six hours post-surgery. Furthermore, a marked decrease in both GSRS and VAS scores was observed at 2 hours and 1 day postoperatively, indicating an alleviation in gastrointestinal symptoms and pain. This clinical improvement was accompanied by a significant increase in plasma gastrin and motilin concentrations, suggesting a physiological enhancement in gastrointestinal functionality post-TEAS intervention(P<0.05). TEAS group's significant improvement in gastrointestinal recovery reduced PONV and alleviated postoperative acute pain, suggesting TEAS's potential as a beneficial intervention in laparoscopic total hysterectomy. Yun WU, Chao FANG (yes, China), Mengyun LI 15:15 - 15:20 #42692 - EP148 Co-relation between ultrasound measured epidural depth with actual depth and BMI (Tri-variate analysis). EP148 Co-relation between ultrasound measured epidural depth with actual depth and BMI (Tri-variate analysis). Co-relation between USG measured epidural depth with actual depth together and BMI 94 patients undergoing gynaecological procedures were recruited and study was done with supervision of professor from radiology. Problem 1: Co-relation between measured depth (with the ultrasound) and the actual depth (with the needle) together with BMI- correlation can be identified by Scatter Matrix three variables (file attached as number 1) Correlations Needle depth USG BMI Needle depth 1 USG .668 1 BMI .643 .535 1 Also all the correlations are statistically significant at 95% level of confidence with reported p value <0.0001 Problem 2: Does BMI affect the needling A procedure of mediation analysis has been attempted which explains the casual relationship between two measuring methods that is being influenced by BMI. Underlying model ( image attached) Results: Direct and total effects Coeff s.e t Sig(two) c .6008 .0830 7.2395 .0000 a 3.2417 .4793 6.7634 .0000 b .0321 .0213 1.5085 .1363 c' .4968 .1073 4.6309 .0000 Indirect effect (ab) and significance using normal distribution Value s.e LL95CI UL95CI Z Sig (two) Effect .1040 .0714 -.0359 .2439 1.4572 .1450 Bootstrap results for indirect effect (ab) Data Mean s.e LL95CI UL95CI Effect .1040 .1040 .0849 -.0557 .2967 Number of bootstrap re samples: 1000 This is statistical significance (p value <0.001) of total effect with positive (0.6008). Though the effect size of BMI is of same direction (0.1040) it is not statistically significant as can be observed from the p-value >0.05 (0.1450) Azra Zahoor KAKROO (United kingdom, United Kingdom), Mohanraj A 15:20 - 15:25 #42826 - EP149 A-E of POCUS: POCUSCLUB a comprehensive education and training programme for regional anaesthetists. EP149 A-E of POCUS: POCUSCLUB a comprehensive education and training programme for regional anaesthetists. Point-of-care ultrasound (POCUS) has emerged as a valuable tool for all regional anaesthetists to help diagnose relevant complications of anaesthesia and guide perioperative management. POCUSCLUB was organised as a comprehensive education and training programme to improve competency in and encourage the use of perioperative POCUS. A 5 session schedule was designed to teach the A-E of POCUS: A - airway, B - lung, C - cardiac, D - regional anaesthesia blocks for ICU and E - FAST and gastric. POCUSCLUB sessions lasted one hour encompassing an interactive presentation followed by hands-on scanning on live models. A pre- and post- course questionnaire survey was utilised to assess the competency of trainee and consultant anaesthetists in POCUS. In the pre-course survey, we found that most anaesthetists used POCUS for vascular access, regional anaesthesia and US guided invasive procedures. However, 80% indicated they did not feel competent in using POCUS in perioperative situations and the most wanted to learn to use ultrasound for airway, lung, cardiac and abdominal FAST. 100% of participants agreed POCUSCLUB would be useful in learning how to integrate POCUS effectively into clinical practice. Perioperative POCUS is a critical skill for regional anasthetists. Our comprehensive POCUSCLUB training programme can help bridge the gap between desire and achievement of competency in POCUS. Eunice FRANCIS, Martin Shao Foong CHONG (London, United Kingdom) 15:25 - 15:30 #42848 - EP150 The Role of Melatonin in Reducing Perioperative Anxiety and Preventing Postoperative Delirium in Elderly Patients. EP150 The Role of Melatonin in Reducing Perioperative Anxiety and Preventing Postoperative Delirium in Elderly Patients. The hospitalization of elderly patients for urgent surgeries has seen a significant increase in recent years due to demographic aging. These fragile patients are more vulnerable to perioperative anxiety, delirium, and postoperative pain. The objective of our study is to evaluate the effect of different dosages of melatonin on perioperative anxiety, perioperative stability, and the prevention of postoperative delirium in elderly patients admitted to theorthopedic department of CHU Fattouma Bourguiba for osteosynthesis of a fracture of the upper extremity of the femur. This is a prospective, randomized, double-blind study conducted in the operating rooms of the orthopedic surgery and traumatology department of CHU Fattouma Bourguiba, Monastir. We included 123 patients over 65 years old admitted for pertrochanteric fracture,divided into three groups: control group M0, group M3 (3 mg of melatonin), and group M6 (6 mg of melatonin). We evaluated perioperative anxiety, sedation, delirium, and postoperative pain. The majority of patients were female with a mean age of 78.8±9.2 years, ranging from 65 to 101.The majority of patients had an ASA score of 2 (74%). A comparison of the three study groups, after premedication revealed: A lower anxiety score (VAS) in the M3 and M6 groups than in the control group. A lower level of sedation in the control group. Better hemodynamic stability in the M6 group. Analysis of postoperative data showed:A dose-dependent analgesic effect of melatonin, with the M6 group being superior to the other groups. Melatonin has demonstrated numerous benefits in theperioperative management of elderly patients. Sakly HAYFA, Maha BEN MANSOUR (Monastir, Tunisia), Mtir MOHAMED KAMEL, Bouksir KHALIL, Ben Fredj MYRIAM, Ben Saad NESRINE, Sabrine BEN YOUSSEF, Sawsen CHAKROUN
	"Thursday 05 September" Added to your list of favorites Deleted from your list of favorites EP04S2 15:00 - 15:30 ePOSTER Session 4 - Station 2 Chairperson: Aleksejs MISCUKS (Professor) (Chairperson, Riga, Latvia, Latvia) 15:00 - 15:05 #41415 - EP133 Evaluation of chronic pain development in patients undergoing shoulder arthroscopy. EP133 Evaluation of chronic pain development in patients undergoing shoulder arthroscopy. Chronic postoperative pain remains a significant barrier in patients who have undergone shoulder surgery. We evaluated the predictors of chronic pain following shoulder arthroscopy. This was a retrospective, observational study of patients who underwent shoulder arthroscopy at Ankara University between 2012 and 2017. This study was approved by the local ethics committee. Telephone contact was established with 178 patients who met the study criteria. Demographic data, comorbidities, preoperative interscalene block application, intraoperative opioid use, and records of postoperative patient-controlled analgesia were obtained by reviewing patient files. Upon contact, each patient's psychological state and pain level were assessed. An interscalene block was administered to 33 (18.5%) of the patients, while patient-controlled analgesia was provided to 97 (54.5%). The analgesic method of 48 patients’ were not achieved from the records. Chronic pain was identified in 92 patients (51.7%). Body weight, comorbidities, and the combined use of opioids and non-opioids were found to be significant risk factors (p=0.024, 0.016, and 0.010, respectively) for chronic pain. Multivariate Logistic Regression analysis revealed that the risk of chronic pain in patients with comorbidities and combined opioid-non-opioid use was 9.27 times higher than in those without comorbidities. In the presence of comorbidities, the risk of chronic pain was found to be 7.18 times higher in patients who did not use a combination of opioids and non-opioids. This study indicates that higher body weight, the presence of comorbidities, and the use of both opioids and non-opioids are significant predictors of increased chronic postoperative pain following shoulder arthroscopy. Kadir Teoman ETIKCAN, Süheyla KARADAĞ ERKOÇ, Hanzade Aybuke UNAL (Ankara, Turkey), Keziban Sanem ÇAKAR TURHAN 15:05 - 15:10 #41856 - EP134 The incidence of accidental dural puncture and post dural puncture headache following labour epidural analgesia. EP134 The incidence of accidental dural puncture and post dural puncture headache following labour epidural analgesia. Accidental Dural Puncture (ADP) is the unintentional rupture of the dura mater. ADP-associated Post-Dural Puncture Headache (PDPH) can cause considerable morbidity. The aim of this retrospective study was to identify the incidence of ADP and PDPH following epidural placement for labour analgesia. Cases of ADP and PDPH were identified retrospectively from MN-CMS(The Maternal and New-born Clinical Management System).Further cross reference was undertaken using a written departmental communications book. Analysis of this data was carried out using Microsoft Excel. Between 1st July and 31st December 2023, 1262 women received an epidural for labour analgesia. ADP was identified in 5 women. Two of these women developed PDPH. The incidence of ADP and ADP-related PDPH were 3.9 and 1.58 per 1000 cases respectively. Six additional cases of PDPH after labour epidural analgesia were identified without having a recognised dural puncture, from a written departmental communications book. The overall incidence of PDPH was therefore 6.3 per 1000 cases. Six women required an epidural blood patch, one woman required a second blood patch. PDPH resolved without blood patch in two women. The observed incidence of ADP complicating epidural anaesthesia is within published ranges. The incidence of post-dural puncture headache after ADP was lower than anticipated. Interestingly three of the women with documented ADP, showed no signs of PDPH. PDPH occurred in the absence of documented ADP. Santosh KUMAR, Seema BHAYLA (Cork ,Ireland, Ireland) 15:10 - 15:15 #42685 - EP135 Use of Ultrasound in Pediatric Caudal Anesthesia: A Randomized Comparative Study. EP135 Use of Ultrasound in Pediatric Caudal Anesthesia: A Randomized Comparative Study. This comparative study aimed to assess the efficacy and safety of ultrasound-guided caudal anesthesia versus blind caudal anesthesia for subumbilical surgery in pediatric patients. Pediatric patients undergoing subumbilical surgery were prospectively included and divided into two groups: ultrasound-guided caudal anesthesia and blind caudal anesthesia. Primary outcomes evaluated included block placement success rate, onset and duration of sensory and motor blockade, analgesic requirements, and perioperative complications. The study included 40 patients, with 20 in each group. Ultrasound-guided caudal anesthesia showed a significantly higher success rate of block placement (p < 0.001), faster onset of sensory and motor blockade (p < 0.05), and longer duration of analgesia (p < 0.05) compared to blind caudal anesthesia. Postoperative analgesic requirements were significantly lower in the ultrasound-guided group (p < 0.001). There were no significant differences in perioperative complications between the two groups. Ultrasound-guided caudal anesthesia was superior to blind caudal anesthesia for subumbilical surgery in pediatric patients. It provided higher success rates, faster onset, longer duration of blockade, reduced analgesic requirements, and comparable safety. Ultrasound guidance should be preferred for caudal anesthesia in this patient population. Mohamed MATOUK (Alger, Algeria) 15:15 - 15:20 #42689 - EP136 Sciatic nerve involvement after PPD block is unrelated to volume. EP136 Sciatic nerve involvement after PPD block is unrelated to volume. A significant portion of patients experience posterior pain after hip surgery. Vermeylen et al. established a new approach to alleviate this pain by the development of the posterior pericapsular deep-gluteal block (PPD). Since the relatively recent development of this approach, the clinical characteristics lack further research. It is hypothesized that the volume of the injection plays a crucial role in determining the success of the block. In this cadaveric study, the spread of different volumes of dye is compared. Two fresh-frozen human specimens (specimen 821 & 823: both men, 91 and 81 years old respectively) were obtained from the human body donation program of the university and included in the study. Using ultrasound guidance, 5 ml, 10 ml, 15 ml or 20 ml of dye (10% latex, 1.5% methylene blue 10 mg/ml and 88.5% water) was injected in the targeted area. Each of the four hip regions were dissected. Dimensions of the dye spread were obtained. The sciatic nerve was affected by dye above the branch of the nerve going to the quadratus femoris (NQF) in two of the four injections. The injected volume of the dye doesn’t seem to matter. The sciatic nerve was only stained with the injection of 20 ml and 5 ml of dye. Following PPD injection, none of the hip regions showed staining of the NQF itself. There was an inconsistent staining of the sciatic nerve, which was unrelated to the injection volume. The effectiveness of the PPD block requires further anatomical and clinical validation. Simon DEBUSSCHERE, Bernard LAUREYS, Matties NEIRYNCK, Evie VEREECKE, Janou DE BUYSER, Matthias DESMET, Kris VERMEYLEN (ZAS ANTWERP, Belgium) 15:20 - 15:25 #42735 - EP137 Ultrasound guided genicular nerve block: Revealing anatomy by cadaveric dissection and effectiveness of postoperative analgesia in knee artroscopic anterior cruciate ligament repair surgery. EP137 Ultrasound guided genicular nerve block: Revealing anatomy by cadaveric dissection and effectiveness of postoperative analgesia in knee artroscopic anterior cruciate ligament repair surgery. Genicular nerve block is defined as infiltration of the sensory branches innervating knee joint before they enter knee capsule. Inconsistency in the terminology and origin of genicular nerves in the literature may be related to variations in anatomical descriptions. Aim of this study was to provide the dissection of genicular nerves and to evaluate efficacy in postoperative analgesia in arthroscopic anterior cruciate ligament(ACL) repair by ultrasound guided blocking of identifiable nerves. In the first phase, four cadaveric knees were dissected. N.obturatorius, n.ischiadicus, n.peroneus communis and n.tibialis branches were found. Genicular nerves of knee capsule were demonstrated. In the second stage, 60 patients aged 18-75 years who were planned for ACL operation were randomly divided into two equal groups. Group G; preoperative genicular block was applied from four different injection points, while Group K received no block. All patients were operated under general anesthesia. Postoperative fentanyl IV patient-controlled analgesia was administered. Postoperative VAS scores at rest and motion, analgesic drug consumption and side effects were measured at 1-6-12-24 hours. Superior medial and lateral genicular branches originated from n. tibialis, inferior lateral branches originated from n. peroneus communis, inferior medial branches originated from n. tibialis and branches originated from n. saphenus participated in sensory innervation. In our study, additional analgesic was required in Group K at 1-6-24 hours. Postoperative VAS values were lower in Group G at all times. Knee capsule has a very rich nerve network. Genicular block should be considered as a good postoperative analgesia option after ACL repair surgery. İsmet TOPÇU, Ertuğrul TATLISUMAK, Ayşe TUÇ YÜCEL, Onur KUMCU (Manisa, Turkey), Hüseyin Serhat YERCAN 15:25 - 15:30 #42858 - EP138 Transversus Abdominis Plane (TAP) Block for robotic assisted gynaecologic surgery: a review. EP138 Transversus Abdominis Plane (TAP) Block for robotic assisted gynaecologic surgery: a review. Even though the robotic-assisted approach to the abdominal cavity is less invasive than conventional laparotomy, postoperative pain may still affect early recovery after gynaecological surgery. Transversus Abdominis Plane (TAP) block has been studied for robotic gynaecological surgery with inconsistent results. We performed a review of the literature to evaluate the effect of TAP block in postoperative pain following robotic-assisted gynaecologic surgery. We searched PubMed, Embase and MEDLINE using the key words gynaecology, surgery, robotic, postoperative and pain. We investigated postoperative pain scores, amount of analgesia required, and adverse events associated with the block. Four studies were included in our review. Pain scores at 4 hours and at 7 days postoperatively were lower in patients that had received TAP block when urogynaecological procedures were studied. Reduced opioid use was noted at 24, 48 and 72 hours after the surgical procedure for robotic-assisted hysterectomy when liposomal bupivacaine was used for the TAP block. However, no difference in pain scores, opioid consumption or nausea/vomiting at 24 hours was found when plain bupivacaine was used for the TAP block. TAP block doesn’t seem to offer any advantage for gynaecological surgery in terms of postoperative pain relief and opioid consumption unless liposomal bupivacaine is used. It seems to reduce pain scores after urogynaecological procedures but further studies are needed. Konstantinos LAMPROU, Iosifina KARMANIOLOU, Kassiani THEODORAKI (Athens, Greece), Christos CHAMOS
	"Thursday 05 September" Added to your list of favorites Deleted from your list of favorites EP04S7 15:00 - 15:30 ePOSTER Session 4 - Station 7 Chairperson: David MOORE (Pain Specialist) (Chairperson, Dublin, Ireland) 15:00 - 15:05 #41067 - EP163 Psychological Characteristics, Quality of Life, and Self-Efficacy in Women with Rheumatoid Arthritis. EP163 Psychological Characteristics, Quality of Life, and Self-Efficacy in Women with Rheumatoid Arthritis. Rheumatoid Arthritis (RA) is a chronic autoimmune inflammatory joint disease affecting approximately 0.5-1% of the world population, with a higher prevalence in women. In addition to physical limitations, RA imposes restrictions in psychological, emotional, and social aspects of patients' lives. Effective management and coping often require high levels of self-efficacy. Psychological disorders, are prevalent in RA cases. However, the relationship between personality traits and self-perceived capabilities among diagnosed women remains understudied. This study aimed to (1) examine the relationship between anxiety, depression, quality of life, and self-efficacy in women with RA; and (2) compare these factors between women with RA and healthy counterparts. The study included 248 women, 104 with RA and 144 without any background diseases, aged 18 and above. The questionnaire covered sociodemographics, Beck Depression Inventory (BDI), State and Trait Anxiety questionnaire, SF12 Quality of Life questionnaire, and Self-Efficacy questionnaire. Depression correlated significantly with quality of life (rp(104)=-0.559, p<0.01) and self-efficacy (rp(104)=-(0.536, p<0.01)) in women with RA. Self-efficacy was related to anxiety (rp(104)=-0.230, p<0.05). However, no distinct correlation was found between anxiety levels and overall quality of life in women with RA. Depression levels were higher in women with RA (t(246)=-5.331, p<0.05), while self-efficacy levels were lower (t(186.075)=8.189, p<0.05). No significant differences were found in anxiety levels and overall life quality between the groups Depression and self-efficacy significantly differ between healthy women and those with RA. In women with RA, depression affects life quality and self-efficacy, while anxiety relates to self-efficacy. Keren GRINBERG (4025000, Israel) 15:05 - 15:10 #41428 - EP164 Comparing sciatic nerve block in novel convenient supine position via medial approach versus lateral position via lateral approach. EP164 Comparing sciatic nerve block in novel convenient supine position via medial approach versus lateral position via lateral approach. Popliteal sciatic nerve block performed in lateral position usually requires a change in position for the patient. This is time consuming and may cause discomfort to the patient. This prospective study compared patients' preference and peri-operative outcomes in supine position via medial approach to the sciatic nerve and lateral position via lateral approach to the nerve. 50 patients from Ng Teng Fong General hospital (NTFGH) who were undergoing popliteal sciatic nerve block with or without sedation from July 2022 to February 2024 were recruited for the study and randomised to either receive the block in supine or lateral position. This study showed that there were significantly more patients in the supine group preferring to be in supine position during the block with p-valve <0.001. 45.8% of patients who had the block performed in lateral position preferred supine position instead. There was no significant difference in the peri-operative outcomes or duration taken for block completion. Most patients preferred to be in the supine position for popliteal sciatic nerve block as it was more comfortable. Performing the block in supine position is non-inferior to performing it in lateral position in terms of safety, efficacy and efficiency profile. Janice Wan Lin LIM, Yiling CHENG, Alex KOH, Janice Wan Lin LIM (Singapore, Singapore) 15:10 - 15:15 #42449 - EP165 Evaluation of the influence of virtual reality hypnosis on the perception of experimental heat pain in healthy volunteers. EP165 Evaluation of the influence of virtual reality hypnosis on the perception of experimental heat pain in healthy volunteers. Therapeutic virtual reality (VR) can alleviate pain and anxiety (Colloca 2020, Terzulli 2022, Terzulli 2023). This study aimed to assess VR hypnosis (VRH) on pain and anxiety during heat stimulation in healthy volunteers. French ethic committee approved the study on 04/02/2020. After written consent obtention, heat nociceptive stimulations (45°C/25s, 46°C/20s and 47°C/10s) were applied to the wrist of 22 healthy volunteers with a contact probe (QST.Lab, Strasbourg, France). The control period (without VRH, CTRL) was compared with the VRH period (HypnoVR Biofeedback®, VRH). Data on demographics, anxiety (STAI-trait/80), suggestibility (Stanford/12), pain intensity (Visual analog scale VASi/10), unpleasantness (VASu/10), and state anxiety (STAI-State/80) before CTRL (State 1), between CTRL and VRH (State 2) and after VRH (State 3), were collected. Significant reductions were observed in VASi (4.7 ± 2.3 vs. 3.8/10 ± 2.5, p=0.002), VASu (5.3 ± 1.9 vs. 3.7/10 ± 2.5; p < 0.001), and anxiety State 3 vs. State 2 (26.6/80 ± 9.9 vs. 31.7 ± 10.9; p < 0.001), whereas not between State 1 and 2 (p>.05). Responders to VRH (i.e., decreased pain intensity > 10%, non-responders as those with no change (-10 to +10%), and inverse responders as those with an increase > 10%. For intensity, proportions were 59%, 32%, and 9%, respectively. For unpleasantness, proportions were 77%, 14%, and 9%, respectively. HypnoVR Biofeedback® reduced pain intensity, unpleasantness, and anxiety during heat stimuli. However, 9% of volunteers responded negatively, it is comparable with our previous study2. Further studies on patients are needed to correctly characterize these patients. Claire TERZULLI, Denis GRAFF (STRASBOURG), Chloé CHAUVIN, Coralie GIANESINI, André DUFOUR, Eric SALVAT, Pierrick POISBEAU 15:15 - 15:20 #42547 - EP166 Prospective comparative study of adjuvants in locoregional anesthesia: dexmedetomidine. EP166 Prospective comparative study of adjuvants in locoregional anesthesia: dexmedetomidine. Dexmedetomidine is used as a perineural adjuvant associated with local anesthetic, which exerts protective effects in addition to its sedative and analgesic properties. Dexmedetomidine provides prolongation of the peripheral nerve block as well as postoperative analgesia We conducted a prospective comparative study including a series of 194 Sick since August 2014, the patients were randomly divided into two groups undergoing knee surgery such as ligamentoplasty. Group M: a series of 97 patients who received dexmedetomidine a reason (0.5 μg/kg) or 50 μg in 15 ml of 0.5% ropivacaine. Group C: a series of 97 patients who received clonidine at a rate of 1μg/kg with ropivacaine at 0.5% and implemented at the end of the procedure of a nerve analgesia catheter in the saphenous vein maintains with ropivacaine 0.2% in 8ml/h The two groups were comparable in terms of age, sex, BMI and ASA. most of the patients were done with 4 blocks therefore associated with the lateral thigh, and the surgery done under arthroscopy; Patients in both groups received on average the same volumes of local anesthetic. The average duration of the intervention was one hour. Dexmedetomidine is a promising agent for the improvement and prolongation of peripheral nerve blocks by combining it with a long-lasting local anesthetic. The aim of which is to combat postoperative pain for very painful surgeries. The methods of use of adjuvants are based as much on their pharmacodynamic properties as on the overall strategy for postoperative pain management. Yacine HOUMEL (alger, Algeria) 15:20 - 15:25 #42550 - EP167 UNILATERAL SPINAL AESTHESIS IN AMBULATORY ORTHOPEDIC SURGERY. EP167 UNILATERAL SPINAL AESTHESIS IN AMBULATORY ORTHOPEDIC SURGERY. INTRODUCTION: Lateralized spinal anesthesia is based on the difference in density of the anesthetic solutions compared to the CSF which defines their baricity. OBJECTIVE: The aim of our study is to evaluate the anesthetic technique of unilateral spinal anesthesia in an outpatient setting. Namely the time of appearance of the block, the success rate, the recovery profile of spinal anesthesia as well as the hemodynamic state. For this we used levobupivacaine at 0.5% hypobaric as a drug. MATERIALS AND METHODS: We conducted a prospective randomized study, including 44 patients proposed for orthopedic surgery since January 2016. They were divided into three groups: Group A: a series of 13 patients received 8 mg of 0.5% hypobaric levobupivacaine intrathecally 2.5 sufentanyl. Group B: a series of 17 patients received 10 mg of levobupivacaine 0.5% hypobaric intrathecally 2.5 sufentanyl. Group C: a series of 14 patients received 12 mg of levobupivacaine 0.5% hypobaric 2.5 sufentanyl. RESULTS: In table n°1 and n°2 summarizes the demographic data, 44 patients were included, the patients were comparable for age, sex, ASA score and BMI. The type of surgery was noted as well as the duration of the intervention. Note when there were no cases of transient radicular irritation syndrome, No bladder globus or post-spinal headache in our series. CONCLUSION: Unilateral spinal anesthesia is of great interest for ambulatory practice: reliability, simplicity, less toxicity, compared to multiple blocks, associated with rapid recovery of fitness for the street, particularly due to early ambulation. Yacine HOUMEL (alger, Algeria) 15:25 - 15:30 #42683 - EP168 Addition of adjuvant Midazolam with intrathecal Bupivacaine and Fentanyl to potentiate analgesic effect. EP168 Addition of adjuvant Midazolam with intrathecal Bupivacaine and Fentanyl to potentiate analgesic effect. Subarachnoid block has been extensively practiced for infraumbilical surgeries.Intrathecal adjuvants like Fentanyl, Midazolam are added to local anaesthetic Bupivacaine to improve the quality of neuraxial block and prolong the duration.To investigate the potentiation of analgesic effect by adding adjuvant Midazolam to local anesthetic Bupivacaine and adjuvant Fentanyl combination in subarachnoid block to the patients undergoing lower limb orthopedic surgery. Subjects were randomized to two groups according to the anaesthetic medication used. Group A received 2.8 ml of hyperbaric 0.5% Bupivacaine with 0.5 ml (25μg) of Fentanyl and 0.2 ml of Normal saline; Group B received 2.8 ml of hyperbaric 0.5% Bupivacaine with 0.5 ml (25μg) of Fentanyl and 0.2 ml (1 mg) of Midazolam. The onset and duration of sensory and motor blockade, duration of post-operative analgesia were recorded in a case record form. Statistical significance defined as p-value < 0.05 and confidence interval set at 95% level. In this study, mean onset time of sensory block were 4.57±0.3 minutes and 4.29±0.1 minutes in group A and group B respectively. The mean onset times of motor block between two groups were 7.70±0.4 minutes and 7.35±0.3 minutes in group A and group B respectively. The mean (±SD) duration of analgesia was 307.3±11.3 minutes in group A and 364.9±16.6 minutes in group B. The comparison between outcome variables of two groups showed very highly significant (p<0.001) difference. Addition of intrathecal Midazolam to Bupivacaine and Fentanyl combination potentiates the analgesic effects in terms of prolonged duration of analgesia and sensory- motor block. Rumana AFROZ (Dhaka, Bangladesh), Mahin MUNTAKIM, Sylvia KHAN
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	"Thursday 05 September" Added to your list of favorites Deleted from your list of favorites EP04S1 15:00 - 15:30 ePOSTER Session 4 - Station 1 Chairperson: Steve COPPENS (Head of Clinic) (Chairperson, Leuven, Belgium) 15:00 - 15:05 #42687 - EP132 Posterocranial spread after pericapsular nerve group block, a pathway to failure? EP132 Posterocranial spread after pericapsular nerve group block, a pathway to failure? A pericapsular nerve group (PENG) block can be used to reduce pain after hip surgery as part of a multimodal postoperative pain management. This approach targets the sensory branches of the anterior portion of the hip capsule originating from the lumbar plexus (L2-L4). More research is needed to fully understand the characteristics of this block. Since this approach is a field block, its efficacy is volume-dependent. In this study, we compared the spread of different volumes of dye using a PENG block approach in two body donors. Two male unembalmed human bodies were obtained from the human body donation program of the university (with written informed consent). The four hip regions were injected respectively with 5 ml, 10 ml, 15 ml or 20 ml of a custom-made mixture (10% latex, 1.5% methylene blue 10 mg/ml and 88.5% water) by an experienced anaesthesiologist under ultrasound guidance. The spread of the injectates was measured and compared using dissection of the hip regions. Injections with 5 and 10 ml of dye did not result in staining of the targeted nerves. With 15 and 20 ml of dye, we observed a posterocranial spread without staining the targeted femoral, obturator or accessory obturator nerves. The dye was located on top of the ilium. To our knowledge, this is the first time a spread over the ilium has been described. This atypical posterocranial spread might explain clinical failure of PENG blocks in some patients, suggesting a steep learning curve to apply this relatively new block effectively. Matties NEIRYNCK, Simon DEBUSSCHERE, Bernard LAUREYS, Evie VEREECKE, Janou DE BUYSER, Matthias DESMET, Kris VERMEYLEN (ZAS ANTWERP, Belgium) 15:05 - 15:10 #41522 - EP128 One-Month pain recovery patterns after total knee arthroplasty: two distinct patient groups identified by an unsupervised learning algorithm. EP128 One-Month pain recovery patterns after total knee arthroplasty: two distinct patient groups identified by an unsupervised learning algorithm. While much research exists on patterns of pain scores in the perioperative period, much less data exists on longer term follow-up of pain scores, especially after total knee arthroplasty (TKA). Re-using data from a published prospective study capturing patients' pain scores recorded over 29 days post-TKA, we aimed to assess whether unsupervised machine learning can discern distinct postoperative recovery patterns. This study was approved by an Institutional Review Board as it re-used data from a published study that prospectively enrolled 103 patients undergoing primary TKA (2020-2021) at a single university hospital. Patients recorded daily numeric rating scale pain scores at morning, lunchtime, evening, and nighttime for 29 days. A K-Means clustering algorithm (unsupervised) was applied to identify distinct pain recovery patterns after which the identified recovery groups were compared based on available patient and surgical characteristics. Two clusters of patients with distinct recovery patterns were discovered: patients in Cluster 1 (versus Cluster 2) had higher pain levels throughout the recovery period (Figure 1); Cluster 1 also represented patients that were more likely female and with higher Knee Society Scores (KSS) at both week 1 and 4 post-TKA, as well as a higher KSS Functional Score at week 1. (Table 1) Machine learning algorithms applied to longitudinal pain level data have identified two distinct postoperative recovery patterns after TKA. Notably, patients who experienced higher pain levels early postoperatively exhibited consistently higher pain levels later within the first month of recovery. Haoyan ZHONG (NEW YORK, USA), Schindler MELANIE, Park JIWOO, Yendluri AVANISH, Crispiana COZOWICZ, Jiabin LIU, Stavros MEMTSOUDIS, Jashvant POERAN 15:10 - 15:15 #41537 - EP129 Ultrasound-guided erector spinae plane block versus intrathecal morphine for postoperative analgesia in open gastrectomy: a randomized, single blinded, controlled trial. EP129 Ultrasound-guided erector spinae plane block versus intrathecal morphine for postoperative analgesia in open gastrectomy: a randomized, single blinded, controlled trial. The large surgical incisions and manipulation of internal organs in open gastrectomy cause severe postoperative pain. Intrathecal morphine (ITM) has been evidenced to provide effective analgesia in abdominal surgeries. Erector spinae plane block (ESPB) has the potential to provide both somatic and visceral sensory block. This study aimed to compare the analgesic efficacy of ESPB and ITM in open gastrectomy. Adult patients with American Society of Anesthesiologists physical status II-III undergoing elective open gastrectomy surgery were randomly assigned to either the ESPB or ITM groups. Before induction of anesthesia, patients received either 200 mcg ITM or bilateral ESPB using 20 mL of 0.25% bupivacaine. The primary outcome was to compare first postoperative 24-hour total opioid consumption, while secondary outcomes included evaluating postoperative pain using NRS scores and CAPA Tool, requirement for rescue analgesia, and assessing postoperative complications. Sixty-three patients were included in the analysis. 24-hour opioid consumption was similar in ESPB and ITM groups (mean 24.5 ± 17.56 and 23.33 ± 16.3 respectively) (p = 0.831). Intraoperative remifentanyl consumption was lower in ESPB group (p = 0.002). NRS scores were <4/10 at all time intervals and similar among the groups. ITM group experienced notably superior comfort levels at 2nd hour (p = 0.008) and better pain management at 2nd and 6th hours compared to the ESPB group (p = 0.025; p = 0.006, respectively) according to CAPA Tool. Ultrasound-guided ESPB resulted in similar total opioid consumption with ITM at the first 24 hour after open gastrectomy. Irmak CIMENOGLU (Istanbul, Turkey), Beliz BILGILI 15:15 - 15:20 #42453 - EP130 Evaluation of the use of 3D models in difficult neuraxial interventions. EP130 Evaluation of the use of 3D models in difficult neuraxial interventions. 3D software technology has been utilized in various medical fields by enabling the creation of reliable models with excellent details for both normal and pathological anatomy. The aim of this study is to compare our conventional epidural/spinal anesthesia practices with the preoperative personalized real-sized 3D modeling obtained in a group of patients where difficult neuraxial anesthesia application is anticipated during preoperative anesthesia examination. Approval was received from the Ege University medical research ethics committee.(19-10.1T/63-2019) Twenty patients over the age of 18, who were anticipated to have difficult neuraxial intervention due to ankylosing spondylitis or operated lumbar disc herniation, and had completed preoperative radiological examinations were included in the study, and archive CT images were evaluated. The cases were divided into 2 groups, one group (Group N) (n=10) received anesthesia without using a model, and in the other group (Group D) (n=10), personalized 3D models obtained from the images were used before and during anesthesia. Successful anesthesia application was achieved in 100% of cases where 3D models were used, whereas this rate was 80% in cases where models were not used. The success rate in the first attempt was 80% in cases where 3D models were used, while it was 20% in cases where models were not used. We concluded that 3D modeling increases the success of anesthesia application in cases where difficult neuraxial anesthesia is anticipated while potentially reducing the risk of complications due to multiple attempts. Zeynep PESTILCI CAGIRAN, Inanc CAGIRAN, Semra KARAMAN (İzmir, Turkey), Figen GOKMEN, Mehmet Asım OZER, Nezih SERTOZ 15:20 - 15:25 #42673 - EP131 Comparison of the Postoperative Analgesic Efficacy of Ultrasound-Guided Sub-omohyoid Plane Block and the Combination of Infraclavicular Brachial Plexus Block (Costoclavicular Approach) and Superficial Cervical Plexus Blocks in Patients Undergoing Shoulder. EP131 Comparison of the Postoperative Analgesic Efficacy of Ultrasound-Guided Sub-omohyoid Plane Block and the Combination of Infraclavicular Brachial Plexus Block (Costoclavicular Approach) and Superficial Cervical Plexus Blocks in Patients Undergoing Shoulder. Arthroscopic shoulder repair (ASR) is less invasive than open surgery, yet perioperative pain management poses challenges. While the interscalene brachial plexus block is effective, its complications drive exploration of alternative techniques. Studies demonstrate analgesic efficacy of sub-omohyoid plane (SOP) block and combinations of infraclavicular brachial plexus block (costoclavicular approach, CC) with superficial cervical plexus (SCP) block comparable to interscalene block. Our study aims to compare their analgesic efficacy, pain scores, complications, and block properties. This assessor-blinded study (January 2023 - May 2024) involved ASA I-III patients (aged 18-75) undergoing ASR, (NCT05683522). Both groups received blocks pre-surgery: SOP block with 15 mL of 0.25% bupivacaine; combination block with 20 mL for CC and 10 mL for SCP. The primary outcome was 24-hour morphine consumption. Secondary outcomes included NRS scores, time to first opioid request, and complications. Quality of recovery-15 scores were also documented. In this study consisting of 61 patients (SOP: 31, CC+SCP: 30), no significant difference was found in morphine consumption, pain scores and QoR scores (p>0.05). Time to first analgesia request was shorter in the SOP group than CC+SCP group (490±393 vs 280±256 minutes, respectively; p: 0.015),(Table1-2). Hemi-diaphragmatic paralysis was not observed, however, Horner syndrome was noted in only 1 patient in SOP group. Ultrasound guided SOP block and CC+SCP blocks were similar in terms of analgesic consumption and pain scores in ASR, and the number of complications was almost non-existent. The SOP group caused less forearm motor block and may be more operator-friendly due to its single injection. Kadem KOÇ (Samsun, Turkey), Serkan TULGAR, Ahmet Emin OKUTAN, Harun ALTINAYAK, Ramazan Burak FERLI, Mustafa SUREN 15:25 - 15:30 #41493 - EP127 Regional Anaesthesia on spontaneously breathing patients facilitates surgery and enhances perioperative analgesia after Trans-Axillary approach for Thoracic Outlet Syndrome: A Retrospective Comparative Study. EP127 Regional Anaesthesia on spontaneously breathing patients facilitates surgery and enhances perioperative analgesia after Trans-Axillary approach for Thoracic Outlet Syndrome: A Retrospective Comparative Study. Thoracic outlet syndrome (TOS) is a rare condition characterized by compression of neurovascular structures in the thoracic outlet. Surgical decompression is indicated when conservative treatments fail. This study compares the efficacy and safety of regional anaesthesia (RA) combined with spontaneous breathing versus general anaesthesia (GA) for TOS surgery (Fig.1). A retrospective comparative study was conducted on 68 patients undergoing trans-axillary first rib resection for TOS. Patients were divided into GA (29) and RA (39) groups. RA involved supraclavicular brachial plexus (SBP) (Fig. 1) and pectoral nerves (PECS II) blocks with deep sedation. Pain scores, opioid consumption, and perioperative outcomes were analyzed. Postoperative pain was significantly lower in the RA group in the recovery room (median NRS 0 vs. 2, p = 0.0443) (Fig.2). Intraoperative fentanil and remifentanil consumption were significantly lower in the RA group (96.15 ± 62.18 mcg vs 312.07 ± 92.24 mcg and 73.13 ± 132.75 mcg vs 390.57 ± 390.71 mcg, respectively; p< 0.05). Postoperative morphine was required only by 18% of patients in the RA group (vs. 55% in GA group). RA was associated with shorter surgical times and reduced nausea and/or vomiting. Moreover, in RA group fewer intraoperative lung injuries occurred due to lung collapse during spontaneous breathing (0% vs. 41%; p < 0.001) (Fig.3). Length of hospital stay was also shorter in the RA group. RA combined to spontaneous breathing significantly reduced opioid consumption and surgical times, facilitating surgical maneuvers and decreasing complications, compared to GA. Further studies are warranted to validate these findings. Alessandro STRUMIA, Giuseppe PASCARELLA (ROME, Italy), Costa FABIO, Ruggiero ALESSANDRO, Francesco STILO, Francesco SPINELLI, Massimiliano CARASSITI
	"Thursday 05 September" Added to your list of favorites Deleted from your list of favorites EP04S6 15:00 - 15:30 ePOSTER Session 4 - Station 6 Chairperson: Michal VENGLARCIK (Head of anesthesia) (Chairperson, Banska Bystrica, Slovakia) 15:00 - 15:05 #41178 - EP157 Interscalene and superficial cervical plexus blocks for surgical anesthesia of clavicle fractures in a tertiary orthopedic hospital. EP157 Interscalene and superficial cervical plexus blocks for surgical anesthesia of clavicle fractures in a tertiary orthopedic hospital. The hospital serves as the center for orthopedic cases in the country and is in constant pursuit of means to safely and efficiently cater to large volume of surgeries on a daily basis. Clavicle surgery has always been performed under general anesthesia in the institution. This is often associated with longer turnaround time, moderate to severe post op pain, increased opioid consumption and prolonged stay in the recovery room. Recent advances in the center have enabled clavicle surgeries to be executed solely under interscalene and superficial cervical plexus blocks (ISB+SCPB). This retrospective study presents the outcome of the technique done in a tertiary orthopedic hospital. Upon approval of Institutional Ethics Review Board, chart of patients who underwent clavicle surgery from 2021-2023 were reviewed. Forty two patients received ISB+SCPB as sole anesthetic for open reduction, internal fixation (ORIF) of clavicle. Outcomes were described. Vital signs of patients were all stable pre-, intra- and postoperatively. No adverse outcomes were reported. Mean duration of sensory and motor block was 19 and 17.42 hours respectively. No patient required rescue opioid dose for severe pain in the 1st 24 hours. Interscalene and superficial cervical plexus blocks provided adequate anesthesia and enhanced postoperative outcome. The combined techniques may be considered as alternative to general anesthesia for clavicle surgeries. Larger prospective studies are recommended. Krystle Ayn ARCANGEL, Paolo ZABALA, Maria Rhodelia VINLUAN (Quezon City, Philippines) 15:05 - 15:10 #42421 - EP158 The Impact of Peripheral Nerve Blocks on Chronic Opioid Use After Distal Total Joint Arthroplasty. EP158 The Impact of Peripheral Nerve Blocks on Chronic Opioid Use After Distal Total Joint Arthroplasty. Peripheral nerve blocks (PNB), either single shot injection or continuous catheter infusion, are increasingly used in total (hip/knee) joint arthroplasties (TJA). A recent meta-analysis concluded equivalence between single shot and continuous catheter infusion PNBs in immediate perioperative analgesia. However, comparative data on longer term outcomes such as chronic opioid use is scarce. Using national US data we aimed to address this evidence gap. After institutional review board approval, we utilized US Merative Marketscan commercial claims data (n= 223069 TJAs from 2017-2021). Three groups were compared: 1) no PNB, 2) single shot PNB, and 3) continuous catheter infusion PNB. Risk of chronic opioid use (Table 1) was compared between these 3 groups using a multivariable inverse-probability-of-censoring weighting model; we report odds ratios (OR) and 95% confidence intervals (CI). Chronic postoperative opioid use was found in 12.3%, 15.1% and 15.5% of patients without PNB, with single shot PNB, and with continuous catheter, respectively. Our multivariable model showed no difference in chronic opioid use between single shot and continuous catheter PNB use. However, our pairwise comparisons did identify that single shot (versus no) PNB is associated with slightly higher odds of chronic opioid use: OR 1.02 95% CI 1.01-1.03. Our analysis of large data shows no significant difference on chronic postoperative opioid use between single shot and continuous PNB patients. Hereby, we have added to the evidence with more long-term outcomes. Lisa REISINGER (New York, USA), Crispiana COZOWICZ, Jashvant POERAN, Haoyan ZHONG, Alex ILLESCAS, Jiabin LIU, Stavros MEMTSOUDIS 15:10 - 15:15 #42553 - EP159 Comparison of Radiofrequency Lesion Volumes with a Cooled, Three-Tined Protruding, and Monopolar Probes. EP159 Comparison of Radiofrequency Lesion Volumes with a Cooled, Three-Tined Protruding, and Monopolar Probes. Non-perfused chicken breast models have been utilized to determine the relative lesion size across the various radiofrequency (RF) electrode types (1). To date, no research has been conducted on comparison of lesion sizes of three commercially available probes (standard, three-tined and cooled) utilizing the same RF generator manufacturer. Each probe underwent RF at the time and temperature settings they are commercially suggested for (i.e. standard probes for 90s at 80°C, three-tined probes for 120s at 80C, and cooled probes for 150s at 60°C. Lesioning was performed with Avanos Pain Management and Cooled Radiofrequency Generators. The lesions were created and measured using internally approved standard test method that underwent test method validation (TMV). Each lesion was measured for width and height with calibrated calipers under a 0.5X lens microscope, following previously published methodology (1). The minimum lesion data set was n≥30, where the sample mean is normally distributed and statistical significance can be recognized (2). Mean lesion sizes and standard deviations are reported in table 1. Lesions created by standard RF probes were elliptical in shape, whereas cooled and three-tined probes had a more spherical shape with more distal projection from the probe tip. Mean lesion volume for cooled probes increased as probe active tip (AT) size increased. The standard RF probe created a larger lesion than the smallest cooled probe, but a smaller lesion when compared to the other cooled probes. The three-tined probe created lesions significantly larger than the standard RF probe, despite having a smaller active tip size. Wang ROY (Alpharetta, USA), Cleveland HANNAH, Gideon JENNIFER, Brown MICHAEL, Eric MOORHEAD 15:15 - 15:20 #40852 - EP001 Comparison of the postoperative analgesic efficacy of quadratus lumborum block and ilioinguinal-iliohypogastric nerve block in cesarean sections. Comparison of the postoperative analgesic efficacy of quadratus lumborum block and ilioinguinal-iliohypogastric nerve block in cesarean sections. Quadratus Lumborum Block III(QLB-III) and Ilioinguinal-Iliohypogastric (II-IH) nerve blocks can be utilized for postoperative analgesia after cesarean operations. The aim of this prospective randomized study is to evaluate the postoperative analgesic effectiveness of QLB-III and II-IH blocks in patients undergoing cesarean delivery. In this study, 70 patients were analyzed. Patients undergoing cesarean delivery under spinal anesthesia were divided into two groups after the operation, and trunkal blocks were applied. Group QLB (n=34) received bilateral QLB-III block with 20 ml of 0.25% bupivacaine under ultrasound guidance. Group II-IH (n=36) received bilateral 20 ml of 0.25% bupivacaine under ultrasound guidance. Tramadol consumption, NRS scores were recorded at 2, 4, 8, 12, and 24 hours. Total tramadol consumption in the first 24 hours postoperatively was significantly lower in the QLB-III group. When the resting NRS (rNRS) and dynamic NRS (dNRS) values were compared between the groups, there was no significant difference at all time points. However, intragroup analyses revealed that in the QLB-III group, rNRS values at 24 hours were significantly higher than those at 2 hours. In the II-IH group, both rNRS and dNRS values at 24 hours were significantly higher than those at 2 hours. In the postoperative period following cesarean delivery, both the QLB-III block and the II-IH block resulted in low NRS scores within the first 24 hours. Since the QLB-III block is associated with lower opioid consumption compared to the II-IH block, we believe it can be preferred for postoperative analgesia in cesarean deliveries. Serpil SEHIRLIOGLU (istanbul, Turkey), Dondu GENC MORALAR, Gullu CIGRANIS ISIK 15:20 - 15:25 #42742 - EP161 Efficacy of platelet rich plasma via selective nerve root injection patients with radicular cervical spine pain. EP161 Efficacy of platelet rich plasma via selective nerve root injection patients with radicular cervical spine pain. Chronic neck and arm pain (CNAP) is a common problem in the adult population with a typical 12-month prevalence of 30% to 50%, that has a substantial impact on health care and society, remaining a debilitating problem among adults. The current orientation of conservative therapy includes the use of nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen, muscle relaxants or short course of opioid pain medication, all of which lead to a temporary improvement in a majority of patients. If conservative therapy does not provide symptomatic relief, selective nerve root PRP injections can be used. The aim of this study is to evaluate the efficacy of PRP treatment in patients with CNAP. The rationale of using PRP is that they promote an inflammatory response that will lead to healing 40 patients with CNAP were injected 2 mLs of autologous platelet plasma rich via selective nerve root injection, under ultrasound guidance into the affected area. The patients were followed up using NRS and ODI (before / after). PRP was obtain and prepared from patients own blood under strict aseptic technique. 24 mL of blood was centrifuged for 2 minutes at 3450 rpm, the resulting 12 mL were again centrifuged at 3550 rpm for 5 minutes, the resulting 2 mls from the lower part of the tube were administered next to the affected nerve root, with 22G needle using ultrasound guidance. Patients showed improvement in their scores at the 3 months follow up with no complications. PRP injection is an effective therapy for cervical pain. Alin PANDEA (bucharest, Romania) 15:25 - 15:30 #42779 - EP162 Ultrasound-Guided Popliteal Sciatic Nerve Block: Evaluation of Block Dynamics After a Twin Subparaneural Injection Below the Divergence with Alkalinized Lignocaine. EP162 Ultrasound-Guided Popliteal Sciatic Nerve Block: Evaluation of Block Dynamics After a Twin Subparaneural Injection Below the Divergence with Alkalinized Lignocaine. Background and Aims: Achieving rapid onset of surgical anaesthesia after a popliteal sciatic nerve block remains a challenge, which this study aimed to determine using a twin subparaneural injection below its divergence with alkalinized lignocaine After ethical approval 20 ASA I-III patients scheduled for elective foot and ankle surgery, under an ultrasound-guided popliteal sciatic nerve block (PSNB), were recruited for this non-randomized study of intervention. All patients received two separate injections into the individual subparaneural compartments of the common peroneal (CPN) and tibial nerve (TN) below the divergence, each with 14.5 ml of 1.5% lignocaine and 0.5 ml of 8.4% sodium bicarbonate. To achieve this, the subparaneural compartment of the sciatic nerve was initially distended with normal saline at its divergence. Sensory and motor blockade was assessed using a numeric rating scale (0-100; 0=anaesthesia) and Likert scale (0-2; 0=paralysis) respectively. Time to achieve complete anaesthesia (sensory score 0/100 and motor score 0/2) and duration of sensory-motor blockade were the primary and secondary outcomes, respectively. The median [IQR] time to complete anaesthesia was 10[5-15] min for the CPN and 15[10-25] min for the TN and it was effective for surgery in all patients studied. The median[IQR] duration of self-reported sensory motor blockade was 7.4 [5.9-9.7] hours. An USG subparaneural PSNB when performed as two separate injections below the divergence of the sciatic nerve, with alkalinized lignocaine, produces surgical anaesthesia within 15 minutes. We believe this is the fastest onset-time reported for a PSNB in the literature. Ranjith Kumar SIVAKUMAR, Chayapa LUCKANACHANTHACHOTE (Bangkok, Thailand), Manoj Kumar KARMAKAR
	"Thursday 05 September" Added to your list of favorites Deleted from your list of favorites EP04S5 15:00 - 15:30 ePOSTER Session 4 - Station 5 Chairperson: Andrea SAPORITO (Medical Director) (Chairperson, Bellinzona, Switzerland) 15:00 - 15:05 #41455 - EP151 Double simultaneous targeted epidural blood patch in refractory spontaneous intracranial hypotension: A case report. EP151 Double simultaneous targeted epidural blood patch in refractory spontaneous intracranial hypotension: A case report. Spontaneous intracranial hypotension (SIH) is caused by a cerebrospinal fluid (CSF) leak without a specific history. The symptoms of SIH include orthostatic headache accompanied or not by symptoms such as neck pain, nausea, and vomiting. EBP is considered the treatment of choice when SIH does not respond to conservative treatment, and if symptoms do not improve, EBP can either be repeated or targeted to the leakage site. However there are some cases where repeated EBP does not show any improvement and are difficult to treat In the described case, symptoms persisted despite repetitive targeted EBP, and thus, we performed a simultaneous two-site EBP procedure. Briefly, with a needle placed simultaneously at C7/T1 and T11/12 levels, 8 ml and 12 ml of autologous blood were injected, respectively. Subsequently, symptoms improved without any side effects After 2-site simultaneous EBP, the symptom improvement was well maintained, and the patient was discharged without any side effects. Brain CT images obtained a month after simultaneous targeted EBP confirmed complete absorption of the bilateral fluid collection 2-site simultaneous EBP can be an alternative treatment option in cases of spontaneous intracranial hypotension refractory to conservative therapy and traditional epidural blood patch. Younghoon JUNG (Busan, Republic of Korea) 15:05 - 15:10 #42767 - EP156 Does IPACK (infiltration between popliteal artery and capsule of the knee) block with adductor canal block provide superior analgesia compared to adductor canal block with local infiltration analgesia in elective total knee arthroplasty? EP156 Does IPACK (infiltration between popliteal artery and capsule of the knee) block with adductor canal block provide superior analgesia compared to adductor canal block with local infiltration analgesia in elective total knee arthroplasty? Patients undergoing elective Total Knee Arthroplasty (TKA) often experience significant postoperative pain, hindering early mobilisation and rehabilitation. Motor-sparing regional analgesia techniques, such as the Infiltration between Popliteal Artery and Capsule of the Knee (IPACK) block, aim to reduce pain, opioid use, and muscle weakness. However, the analgesic efficacy of the IPACK block remains unclear. This study investigates whether Adductor Canal Block (ACB) with IPACK reduces postoperative opioid consumption at 24 and 48 hours post-TKA compared to ACB with local infiltration of anaesthetic (LIA). This retrospective cohort study analysed 130 elective TKA cases at a regional NSW hospital over one year that received ACB + IPACK (n=71, 54.6%) and ACB + LIA (n=59, 45.4%). Linear regression analysis was then used to determine postoperative mean oral morphine equivalent daily dosage (OMEDD) at 24 and 48 hours, adjusting for age, sex, chronic opioid use, neuraxial anaesthesia, peripheral nerve infusion, and adjuvant analgesia. This study demonstrated significant reductions in mean OMEDD at 24 hours with IPACK + ACB compared to ACB + LIA (IPACK + ACB: Mean OMEDD=54.8 mg; ACB + LIA: Mean OMEDD=76.4 mg, p=0.02). At 48 hours, no clinically or statistically significant reduction in OMEDD was observed. This study found that the addition of the IPACK block to ACB provides superior analgesia in the first 24 hours post-TKA when compared with ACB and LIA. These results support incorporating the IPACK block into standard care to reduce opioid consumption and associated adverse effects. Amie SWEETAPPLE (Orange, Australia), Emma CHENG, Glen ABBOTT, Sam KENT, Timothy DUONG 15:10 - 15:15 #42406 - EP153 The optimal position in spinal anesthesia for patients with difficulties: A cross-sectional study using ultrasonography. EP153 The optimal position in spinal anesthesia for patients with difficulties: A cross-sectional study using ultrasonography. When conducting spinal anesthesia, pregnant patients and patients with lower limb injuries may have difficulties taking the optimal position. This study investigates whether the posture of the trunk, flexing of the lower limbs and tilting of the head affects the interspinous distance. This cross-sectional study was conducted on 25 healthy adult volunteers with their consent and approval by the Institutional Ethics Committee of Shizuoka general hospital (No. SGHIRB#2023051). We performed lumbar ultrasonography in the left lateral position to measure the interspinous distance at the L2/3, L3/4 and L4/5 interspace, in seven different positions: P1: straight-back with bilateral lower limb extension, P2: straight-back with unilateral lower limb flexion, P3: straight-back with bilateral lower limb flexion, P4: P3 with head tilted forward, P5: forward bending with bilateral lower limb flexion, P6: forward bending with unilateral lower limb flexion, P7: forward bending with bilateral lower limb extension. Using P1 as the reference, each position was compared using linear regression analysis with statistical significance set at p<0.0071 after Bonferroni adjustment for multiple comparisons. Positions that significantly affected the widening of the interspinous distance were P5 at the L2/3, L3/4 and L4/5 interspace (P<0.001, P<0.001, and P<0.001, respectively) and P6 at the L2/3 and L4/5 interspace (P<0.003, and P<0.003, respectively). Whereas the tilting position of the head did not affect the interspinous space. In healthy adults, forward bending with even unilateral lower limb flexion affects widening of the interspinous space, while tilting of the head does not have an impact. Yoko FUJITA TRAM (Shizuoka, Japan), Takashi OGASAWARA, Naoko KOH, Kyoko YANAGITA, Teiichi SANO, Kazuyuki ATSUMI 15:15 - 15:20 #42483 - EP154 Rebound pain incidence and related factors in patients who received standard multimodal analgesia protocol. EP154 Rebound pain incidence and related factors in patients who received standard multimodal analgesia protocol. This prospective observational study aimed to explore the frequency and risk factors of rebound pain (RP) in patients treated with multimodal analgesia and intravenous dexamethasone following peripheral nerve block (PNB) for anesthesia and multimodal analgesia in orthopedic surgeries. This study included patients who received preoperative PNB from August 2022 to December 2023. All patients received a standard multimodal analgesia regimen and intravenous dexamethasone. Motor and sensory block durations, RP severity and frequency were measured for the first 24 h post-PNB using a semi-structured questionnaire. RP was identified as acute postoperative pain within the first 12-24 h after sensory blockade resolution. The severity of RP was determined through the rebound pain score. Contributing risk factors (patient, surgical, or anesthesia-related) to the development of RP were investigated. Following PNB worn off, RP developed in 107 out of 386 patients (27.72%). The following were identified as independent risk factors for RP: patient age, with an adjusted odds ratio (AOR) of 2.323 and a 95% confidence interval (CI) of 1.379–3.915; the use of bupivacaine in combination with lidocaine or prilocaine (AOR: 2.128, 95%CI: 1.206–3.754); preoperative pain (AOR:2.751, 95%CI:1.345–5.623); bone surgery (AOR:1.761, 95% CI:1.025–3.023); and the duration of the surgery (AOR:2.785, 95%CI:1.510–5.137). With standard multimodal analgesia methods and intravenous dexamethasone, the incidence of RP can be lessened. By correctly identifying RP risk factors, we can establish preventative strategies that target changeable factors, leading to optimized use of PNB, decreased RP incidence, and improved results. Funda ATAR (Ankara, Turkey), Fatma OZKAN SIPAHIOGLU, Filiz KARACA AKASLAN, Eda MACIT AYDIN, Evginar SEZER, Derya OZKAN 15:20 - 15:25 #42529 - EP155 Oblique Subcostal Transversus Abdominis Plane Block Versus Transmuscular Quadratus Lumborum Block for Pain Management in Laparoscopic Gynecological Surgery. EP155 Oblique Subcostal Transversus Abdominis Plane Block Versus Transmuscular Quadratus Lumborum Block for Pain Management in Laparoscopic Gynecological Surgery. We aimed to prospectively compare the effects of Oblique Subcostal Transversus Abdominis Plane (OSTAP) block and Transmuscular Quadratus Lumborum (TQL) block on postoperative analgesia and quality of recovery in gynecological laparoscopic surgery, using a randomized controlled, double-blind approach. We hypothesized that TQL block would provide effective analgesia in gynecological laparoscopic surgeries, thereby reducing need for analgesics. 68 patients undergoing gynecological laparoscopic surgery were prospectively evaluated and randomized into two groups: OSTAP group (n=34) and TQL group (n=34). Following the block, anesthesia induction was administered. Postoperative rest and movement VAS scores, consumption of paracetamol and tramadol within the first 24 hours, time to first requirement of paracetamol and tramadol, nausea-vomiting, mobilization and discharge times, preoperative-postoperative 24th hour QoR-15 scores were recorded. Patient-surgeon satisfactions were measured with a 5-point Likert scale. In TQL group, significantly lower VAS scores were observed at rest and in movement at the 6th hour and in movement before discharge (p=0.019, p=0.004, p=0.023, respectively). However no differences were found between the groups at other time intervals. The number of patients requiring paracetamol, time to first requirements of paracetamol and tramadol, total doses of tramadol were similar between groups. Conversely, total dose of paracetamol and number of patients requiring tramadol were significantly higher in OSTAP group (p=0.002, p=0.006, respectively). There were no differences in nausea-vomiting, need for antiemetics, preoperative-postoperative QoR-15 scores, discharge times and patient-surgeon satisfactions. TQL block has been shown to be more effective than OSTAP block in managing postoperative pain, underscoring its importance in multimodal analgesia protocols. Kubra CEBECI (Bursa, Turkey), Selcan AKESEN, Seda CANSABUNCU, Alp GURBET, Gurkan UNCU 15:25 - 15:30 #41726 - EP152 Multiple sclerosis and perioperative nerve blockade - a systematic review. EP152 Multiple sclerosis and perioperative nerve blockade - a systematic review. Multiple sclerosis (MS) is a common chronic, immune mediated demyelinating disorders with a preponderance towards the female population.Here we made an attempt to analyse the literature to create a systematic review with regards to nerve blockade (central and peripheral) and its effects in patients with MS. Search for RCTs and case-series studies were carried out using MEDLINE, EMBASE and cochrane CENTRAL trials register. RefWorks system was used to de-duplicate the studies collected. Eight RCTs were found, five were decided to be of inadequate strength to analyse further. We also found no strong case series reports to be added to the study. Regarding Central Neuraxial Blocks (CNBs), low dose epidural is considered safer as compared to spinal anaesthesia (Bajaj et al). Spinal anaesthesia is considered to be a relative contra-indication (Cimenti et al). Furthermore, Lumbar plexus blocks and para-vertebral blocks were noted to have prolonged duration in patients with MS while Peripheral Nerve Blocks (PNBs) is thought to be relatively safer as compared to CNB (Schneider 2005). Despite compelling evidence suggesting that spinal anaesthesia should be avoided in certain situations, low-dose epidurals present a relatively safer alternative when CNBs are necessary. It is important to consider that some plexus blocks, like the paravertebral block, may have a prolonged duration in patients with MS. PNBs are generally safer, although the anaesthetist must be aware that approximately 5% of patients with MS may have peripheral nerve involvement. In all cases, a thorough discussion with the patient and meticulous documentation are essential. Arun MOHANRAJ, Ifunanya ONYEMUCHARA (Manchester, United Kingdom)
15:30	"Thursday 05 September" Added to your list of favorites Deleted from your list of favorites B25 15:30 - 16:20 PRO CON DEBATE Lidocaine and ketamine infusion for chronic pain are effective Chairperson: Maria Luz PADILLA DEL REY (Anesthesiologist and Pain Physician) (Chairperson, MURCIA, Switzerland) 15:30 - 15:35 Introduction. Maria Luz PADILLA DEL REY (Anesthesiologist and Pain Physician) (Keynote Speaker, MURCIA, Switzerland) 15:35 - 15:50 For the PROs. Magdalena ANITESCU (Professor of Anesthesia and Pain Medicine) (Keynote Speaker, Chicago, USA) 15:50 - 16:05 For the CONs. Kiran KONETI (Consultant) (Keynote Speaker, SUNDERLAND, United Kingdom) 16:05 - 16:20 Q&A.	PANORAMA HALL
	"Thursday 05 September" Added to your list of favorites Deleted from your list of favorites C25 15:30 - 16:20 LIVE DEMONSTRATION Physical examination of spinal pain syndromes 15:30 - 16:20 Clinical examination of the cervical spine. Sandeep MIGLANI (Consultant) (Keynote Speaker, Dublin, Ireland) 15:30 - 16:20 Clinical examination of the lumbar spine. Esperanza ORTIGOSA (Chief of the Acute and Chronic Pain Unit) (Keynote Speaker, Madrid, Spain)	South Hall 1A
	"Thursday 05 September" Added to your list of favorites Deleted from your list of favorites D25 15:30 - 16:20 ASK THE EXPERT Green RA Chairperson: Alexandros MAKRIS (Anaesthesiologist) (Chairperson, Athens, Greece) 15:30 - 15:35 Introduction. Alexandros MAKRIS (Anaesthesiologist) (Keynote Speaker, Athens, Greece) 15:35 - 16:05 #43290 - D25 Green-gional anaesthesia: Aligning the Triple Bottom Line. Green-gional anaesthesia: Aligning the Triple Bottom Line. Conflict of Interests: Dr. Vivian Ip is the Chair of the Environmental Sustainability Section, the Chair of the Regional Anesthesia Section at the Canadian Anesthesiologists’ Society, and the Chair of the Green Anesthesia Special Interests Group at the American Society of Regional Anesthesia and Pain Medicine. Introduction Environmental Sustainability involves making responsible choices that ensure long-term health of our planet and supply of resources. It ultimately affects human health in numerous ways, especially those at the extremes of ages. The health effects of these disruption include increased respiratory [1] and cardiovascular disease [2-3], injuries, and premature deaths related to extreme weather events, changes in the prevalence and geographical distribution of food- and water-borne illnesses and other infectious disease, and threats to mental health. [4] A record 2.2 million hectares was burnt across Alberta, Canada, displacing adjacent community and interrupting healthcare provision. [5] About 60 wildfires (10 times more than average) that begin in the previous seasons and smoulder underground for months before reigniting in the spring once the snow melts, and the cycle continues. [5] Climate change, has received increasing attention in recent years with the extremes of weather events, retreating glacier leading to rising sea-level threatens food and water supply, as well as altering natural ecosystems on which human depends, is now a climate crisis as action is urgently needed. [6] The Lancet Climate Change Commission declared climate change as the greatest health threat of the 21^st Century. [7] The World Health Organization is projecting an additional 250,000 deaths per year attributable to climate change in the coming decades. [8] If global health care sector were a country, it would be the fifth largest greenhouse gas emitter on the planet. [9] Health care’s climate footprint is equivalent to 4.4% of global net emissions (2 gigatons of carbon dioxide equivalent), or equivalent to the annual greenhouse gas emissions from 514 coal-fired power plants. [9] Until recently, there was limited awareness on the significant contribution the health care sector makes to the carbon footprint. The European Union as a political union is forging a collective political response to the climate crisis. It has set goals to drive action on a national level. [9] Some regions in Europe, particularly in Scandinavia and the Netherlands, zero emissions hospital buildings, innovative climate-smart technologies, and strategies to address supply chain emissions. [10] In the United Kingdom, the National Health Service is leading the environmental sustainability efforts in health care with over a decade of experience with sustainable practice in anesthesia. They have set targets to reach net zero by 2040 with an ambition to reach an 80% reduction by 2028 to 2032. [11] Across the Atlantic in Canada, it has committed to a 40-45% emission reduction by 2030 and to reach net zero emission by 2050. Given that carbon footprint of 1 hospital bed equals that of 5 households, [12] curbing carbon emissions in healthcare could play a major role. As with other industries, health care needs to adopt the ‘Triple Bottom Line’ which was fist described in the business model by John Elkington in 1990s where he suggests that competing corporate entities seek to main their relative position by addressing people and planet issues as well as profit maximization, [13] namely, the 3 ‘Ps’: People, Planet, Profit. Therefore, rather than focusing on profit alone, social equity, wellbeing of people, as well as environmental sustainability and energy conservation are equally important. This framework is applicable in regional anesthesia as it suggests that patient care has three domains and by maximizing patient safety and care does not necessarily result in financial and environmental trade-offs. Aligning all 3 ‘Ps’ helps the bottom line when considering the significant future costs than otherwise. It is often assumed that regional anesthesia is more environmentally sustainable than alternatives. In fact, recent publication has shown the significant amount of carbon dioxide emission (an equivalent of 26, 900 lbs of coal burnt, or 2750 gallons of gasoline consumed) by increasing the amount of regional anesthesia performed for total knee arthroplasty. [14] Contrastingly, the publication from Australia showed that regional anesthesia, general anesthesia and the combination of both, could be comparable depending on the specifics of institutional anesthesia practices. [15] It is an observational study evaluating their different anesthesia practice for total knee arthroplasty. Upon examining the breakdown of the life cycle analysis, it is apparent that the specifics of their practice in general anesthesia is much more environmentally sustainable, with the use of sevoflurane, and reusable operating attire and equipment. On the other hand, their practice in regional anesthesia is less environmentally sustainable owing to the use of high flow oxygen, as the process of compressing oxygen into liquid oxygen for medical use is highly energy intensive. Furthermore, a large amount of procedure attire was used and towels for hand-drying, despite being reusable, contributed to substantial environmental impact in the regional anesthesia group. This highlights the need to reflect on clinical practice in regional anesthesia to balance infection control and environmental sustainability. As a result, a Delphi consensus study across multiple countries was conducted, to provide guidance on environmentally sustainable practice in regional anesthesia from experts within various subspecialties, including regional anesthesia, obstetrics anesthesia, intensive care, and infection prevention, reconciling infection control with resource stewardship. It was found that infection control practices which are rooted in evidence often do not interfere with sustainability and reach consensus, while less evidence-supported measures, only gained weak consensus. [16] There were strong consensus that a sterile gown was unnecessary for either single injection of peripheral nerve blocks or spinal, and trending towards not required for catheter techniques. [16] There was also strong consensus that minimal equipment should be included in the pre-made pack and the pre-existing packaging for equipment such as nerve block catheter, can be used as sterile work space. [16] Only weak consensus was obtained in using small plastic adhesive cover for the ultrasound transducer for single injection peripheral nerve blocks and catheter-over-needle assembly with very short catheters. [16] Another unexpected finding was a high degree of uncertainty amongst the experts regarding reusable versus disposable attires, despite existing life cycle analysis data appraising the environmental impact, demonstrating the need to raise awareness of such data, which is less familiar for most anesthetists. [16] Electricity contributes significantly to the carbon footprint in healthcare, [9] and opportunity to reduce this is by reflecting on how ultrasound machines are used in regional anesthesia. Recently, we performed a study on energy consumption used by a single ultrasound machine, comparing control group: standard practice of leaving ultrasound machine on during the day, against intervention: turning off the ultrasound machine when not in use. The primary outcome was energy consumption. Our unpublished data showed 87% reduction in energy consumption when accounting for the differences in duration of use between the groups. A total of 1.55kWh of energy saving per day was logged which equates to 161.2kg reduction in carbon dioxide emissions and almost 74 Euros yearly cost savings per ultrasound machine. [17] Given the scale of ultrasound use in healthcare, even minor changes can contribute to a cumulative impact on an ever-increasing environmental impact from healthcare. This is a simple measure to contribute to a responsible resource stewardship. Another area where regional anesthesia reduces carbon emission is the ambulatory program where patients can be discharged with a nerve block catheter infusion. In Canada, carbon footprint for 1 hospital bed is equivalent to that of 5 household, by discharging those patients who only required to stay as in-patient due to pain control can both reduce environmental impact and benefit patient in terms of better pain control with minimal opioid, if any. This also reduces the potential for improper opioid disposal and opioid diversion in the community. The second ‘P’-profit is divided into short- and long-term, both favoring regional anesthesia, especially when used solely for surgical anesthesia. This approach negates the need for costly volatile agents, which are potent greenhouse gases. Regional anesthesia also reduces opioid use and the associated complications, and ambulatory regional anesthesia programs can lower the cost of hospital stay. Long-term cost savings are supported by large meta-analyses demonstrated a reduction in major complications post total joint arthroplasty in the neuraxial anesthesia group compared to the general anesthesia, with the former associated with lower odds or no difference in virtually all reported complications, except for urinary retention. [18] Similar benefits are observed with peripheral nerve blocks, improving outcomes such as lower odds for cognitive dysfunction, respiratory failure, cardiac complications, surgical site infection, thromboembolism and blood transfusion. [18] Fewer complications reduce both costs and the environmental impact on the healthcare system, creating a positive cycle by reducing associated morbidities and mortalities. With the last ‘P’ being people, encompasses social equity, well-being and patient safety. Prioritizing patient care while reducing environmental footprint can optimize costs by accounting for future expense of not addressing environmental impact on healthcare. Numerous studies highlight the benefits and safety of regional anesthesia. Increasing patient access to the regional anesthetics requires educating more anesthetists on basic blocks (Plan A). [20] Increasing the complexity of regional anesthesia only widens the gap between the generalists and regional anesthesia experts, diminishing access for patients to regional anesthesia. To enhance patient equity, regional anesthesia techniques should balance technical complexity with analgesia benefits, improving operating room efficiency, postoperative recovery and length of stay. Furthermore, public education is crucial to align their perceptions of regional anesthesia aligns with those of the physicians, ensuring informed choices regarding benefits of regional anesthesia techniques, while being realistic about complications. [21] Implementing changes can be challenging, especially in a complex system such as healthcare. The norms, values, and the basic assumptions i.e. Culture of a given organization are constructed by interactions of individuals and groups within that organization, each with their own beliefs, values and skills. [22] Measuring culture and initiating changes in complex organization with the unpredictable nature of healthcare is challenging. Recognizing the complex dynamic interactions of different perspectives, individual’s experiences and values, components, and politics of healthcare is essential to promote sustained and ever-improving changes. [22] In conclusion, regional anesthesia can reduce carbon emission, but only if the specifics to the practice is with environmental sustainability and resource stewardship in mind. Climate change is now a climate crisis and with cumulative action aligning with the triple bottom line from all within the healthcare system, positive impact in carbon reduction can be possible before the environmental impact becomes irreversible. References 1) 1) Grant E, Runkle J. Long-term health effects of wildfire exposure: A scoping review. J Clim Change and Health 2022;6:100110. https://doi.org/10.1016/j.joclim.2021.100110 2) 2) Chen H, Samet JM, Bromberg PA, et al. Cardiovascular health impacts of wildfire smoke exposure. Part Fibre Toxicol 2021;18:2. 3) 3) Karanasiou A, Alastuey A, Amato F et al. Short-term health effects from outdoor exposure to biomass burning emissions: A review. Sci Total Environ 2021;781:146739. 4) 4) Centers for disease control and prevention. Climate effects on Health. Climate Effects on Health \| Climate and Health \| CDC Accessed on May 23, 2024. 5) 5) Sousa A. Alberta has dozens of wildfires still burning this winter. Here’s why. Alberta has dozens of wildfires still burning this winter. Here's why. \| CBC News Accessed on May 23, 2024. 6) 6) Pelto M, WGMS Network. Alpine glacier [in State of the Climate in 2019]. Bulletin of the American Meterological Society 2020;101(8):S37-38. https://doi.org/10.1175/2020BAMSStateoftheClimate.1. 7) 7) Atwoli L, Baqui AH, Benfield T, et al. Call for emergency action to limit global temperature increases, restore biodiversity, and protect health. The Lancet 2021;398(10304):939-941. 8) 8) World Health Organization. Climate change 2023. Climate change (who.int) Accessed May 23, 2024. 9) 9) Karliner J, Slotterback S, (Health care without harm) Boyd R, Ashby b, Steele K. (Arup). Heatlh care’s climate footprint. HealthCaresClimateFootprint_092319.pdf (noharm-global.org) Accessed May 23, 2024. 10) 10) Skåne – Fossil fuel-free by 2020, Region Skane (Budapest - 25.11.14).pdf (noharm-europe.org) Accessed May 23, 2024. 11) 11) National Health Service. Delivering a net zero NHS. Greener NHS » Delivering a net zero NHS (england.nhs.uk) Accessed on May 23, 2024. 12) 12) Cimprich A, Young SB. Environmental footprinting of hospitals: Organizational life cycle assessment of a Canadian hospital. J of Industrial Ecology 2023; DOI:10.1111/jiec.13425. 13) 13) Elkington J. Cannibals with Forks: the triple bottom line of 21^st century business. Capston (Jan 1 1601) 14) 14) Kuvadia M, Cummis CE Liguori G et al. ‘Green-gional’ anesthesia: the non-polluting benefits of regional anesthesia to decrease greenhouse gases and attenuate climate change. Reg Anesth Pain Med 2020;45(9):744-745. 15) 15) McGain F, Sheridan N, Wickramarachchi K, Yates S, Chan B, McAlister, S. Carbon footprint of general, regional, and combined anesthesia for total knee replacements. Anesthesiology 2021;135:976-91. 16) 16) Ip VHY, Shelton C, McGain F, et al. Environmental sustainability practice in regional anesthesia, reconciling infection control with resource stewardship: CAS Delphi consensus study. CJA 2024. Submitted. May 2024. 17) 17) Deacon T, Salem T, Fouts-Palmer E, et al. Environmentally sustainable measures for regional anesthesiologists and beyond: a quality improvement initiative (2024 CAS Annual Meeting Abstracts). Can J Anesth 2024;Suppl. Pending publication. 18) 18) Memtsoudis S G, Cozowicz C, Bekeris J, et al. Anaesthetic care of patients undergoing primary hip and knee arthroplasty: consensus recommendations from the international consensus on anaesthesia-related outcomes after surgery group (ICAROS) based on a systematic review and meta-analysis. Brit J Anesth 2019;123(3):269-287. 19) 19) Memtsoudis S, Cozowic C, Bekeris J, et al. Peripheral nerve block anesthesia/analgesia for patients undergoing primary hip and knee arthroplasty: recommendations from the international consensus on anesthesia-related outcomes after surgery (ICAROS) group based on a systematic review and meta-analysis of current literature. Reg Anesth Pain Med 2021;46(11):971-985. 20) 20) Turbitt LR, Mariano ER, El-Boghdadly K. Future directions in regional anaesthesia: not just for the cognoscenti. Anaesthesia 2020;75(3):293-297. 21) 21) Matthey P, Finegan BA, Finucane BT. The public’s fears about the perceptions of regional anesthesia. Reg Anesth Pain Med 2004;29(2):96-101. 22) 22) Ip VHY, Shelton CL, Zimmermann GL. Promoting practice change towards environmentally sustainable health care: more than meets the eye. Can J Anaesth 2023;70(3):295-300. Vivian IP (Calgary, Canada) 16:05 - 16:20 Q&A.	South Hall 1B
	"Thursday 05 September" Added to your list of favorites Deleted from your list of favorites E25 15:30 - 16:20 ASK THE EXPERT Hygienic standards for RA Chairperson: Tatjana STOPAR PINTARIC (Head of Obstetric Anaesthesia Division) (Chairperson, Ljubljana, Slovenia) 15:30 - 15:35 Introduction. Tatjana STOPAR PINTARIC (Head of Obstetric Anaesthesia Division) (Keynote Speaker, Ljubljana, Slovenia) 15:35 - 16:05 Hygienic standards for RA. Madan NARAYANAN (Annual congress and Exam) (Keynote Speaker, Surrey, United Kingdom, United Kingdom) 16:05 - 16:20 Q&A.	South Hall 2A
	"Thursday 05 September" Added to your list of favorites Deleted from your list of favorites F27 15:30 - 16:20 EXPERT OPINION DISCUSSION How I do it: Awake Major Breast Surgery Chairperson: Kris VERMEYLEN (Md, PhD) (Chairperson, ZAS ANTWERP, Belgium) 15:30 - 15:35 Introduction. Kris VERMEYLEN (Md, PhD) (Keynote Speaker, ZAS ANTWERP, Belgium) 15:35 - 15:50 #43228 - F27 How I do it. How I do it. Oncological breast surgery, in most cases, is performed under general anaesthesia, with postoperative continuous intravenous analgesia. The practice of surgical interventions on awake patients under local anaesthesia, with or without sedation, has gained popularity in recent years. This technique played a very important role during the COVID-19 period. There is emerging evidence that volatile anesthetics may be linked with cancer recurrence, providing a greater interest to use RA techniques. The enhanced recovery after surgery (ERAS) and procedure specific postoperative pain management (PROSPECT) guidelines on breast surgery highly recommend the use of multimodal analgesia, in order to facilitate early mobilization, optimal pain control and fast discharge, supporting the use of local anesthetic infiltration or regional anesthesia techniques, with the adoption of opioid-sparing and opioid-free regimens. Thanks to its optimal intraoperative and postoperative analgesia, regional anesthesia can be successfully used for breast surgery, in combination with sedation, without the need for general anesthesia. Awake breast surgery combines the reduction of hospitalization, postoperative stress, and postoperative lymphopenia, furthermore local anesthesia and peripheral nerve block provide better analgesia during glandular displacement techniques, as during oncoplastic and axillary surgery. Fast track awake breast surgery provides a reduction of operative room time length of stay and potentially surgical treatment for a wider number of oncological patients. There are several regional techniques, depending on the type of surgery to be performed, among them are proximal to nerve origin as Paravertebral and Erector Spinae Blocks and more distal to nerve origin as Pecs, Serratus Anterior Plane Block and Parasternal Block. The main limitation of fascial plane blocks is that they require high volumes of local anesthetics, carrying the risk of local anesthetic systemic toxicity. The addition of dexamethasone and dexmedetomidine to 0.2% levobupivacaine has been published for a bilateral breast cancer surgery by Falso et al. Costa et al proposed, to perform regional anesthesia for breast procedures, a combination of three techniques: Pecs II block to cover muscles, axilla and lateral cutaneous branches of intercostal nerves (reliably from T2 to T4), erector spinae block block to cover lateral cutaneous branches from T4 to T7 and parasternal block or transversus thoracic muscle plane block to cover anterior cutaneous branches. Santonastaso et al, wonder if the secret to obtaining perfect anesthesia/analgesia for radical mastectomy procedures associated with sentinel lymph node biopsy, when we need to avoid general anesthesia, could be the association of multiple techniques between Pecs, Serratus Anterior Block and Erector Spinae Block. In occasions it might be useful to cover the supraclavicular branches with a superficial cervical plexus block. Recently, Marrone et al described a case report, undergoing awake bilateral mastectomy with reconstruction, where two 'paravertebral-by-proxy' blocks were performed: the thoracic erector spinae plane and inter-transverse plane blocks, with intravenous sedation. References: 1. Falso F, Giurazza R, Crovella C, De Rosa RC, Corcione A. Ultrasound-Guided Regional Anesthesia Using a Mixture of Dexamethasone, Dexmedetomidine, and 0.2% Levobupivacaine for Bilateral Breast Cancer Surgery Under a Spontaneous Breathing Opioid-Free Anesthesia: A Case Report. Cureus. 2024 Apr 16;16(4):e58394. 2. Vanni, G., Pellicciaro, M., Materazzo, M. et al. Awake breast cancer surgery: strategy in the beginning of COVID-19 emergency. Breast Cancer 2021; 28: 137–144. 3. Costa F, Strumia A, Remore LM, Pascarella G, Del Buono R, Tedesco M, et al. Breast surgery analgesia: another perspective for PROSPECT guidelines. Anaesthesia 2020;75:1404–5. 4. Santonastaso D, Dechiara A, Bagaphou CT, Cittadini A, Marsigli F, Russo E, Agnoletti V. Erector spinae plane block associated to serratus anterior plane block for awake radical mastectomy in a patient with extreme obesity. Minerva Anestesiologica 2021 June;87(6):734-6. 5. F Marrone 1, P F Fusco 2, S Paventi 1, M Tomei 1, S Failli 1, F Fabbri 1, C Pullano 3. Combined thoracic erector spinae plane and inter-transverse plane blocks for awake breast surgery. Case Reports Anaesth Rep 2024 May 1;12(1):e12294. doi: 10.1002/anr3.12294. eCollection 2024 Jan-Jun. Teresa PARRAS (Spain, Spain) 15:50 - 16:05 How I do it. Amit PAWA (Consultant Anaesthetist) (Keynote Speaker, London, United Kingdom) 16:05 - 16:20 Q&A.	South Hall 2B
	"Thursday 05 September" Added to your list of favorites Deleted from your list of favorites G27 15:30 - 17:00 TRAINEES SESSION Tables are turned! What can be learned from trainees Chairpersons: Fani ALEVROGIANNI (Resident) (Chairperson, Athens, Greece), Louise MORAN (Consultant Anaesthetist) (Chairperson, Letterkenny, Ireland) 15:30 - 17:00 Introduction. Rosie HOGG (Consultant Anaesthetist) (Keynote Speaker, Belfast, United Kingdom) 15:30 - 17:00 Case 1. Manpreet BAHRA (ST6 Anaesthesia) (Keynote Speaker, London, United Kingdom) 15:30 - 17:00 Case 2. Laurens MINSART (Consultant Anaesthetist) (Keynote Speaker, Cork (Ireland), Ireland) 15:30 - 17:00 Case 3. Katharina POLITT (Physician) (Keynote Speaker, Marburg, Germany) 15:30 - 17:00 Case 4. Lua RAHMANI (Anaesthetist) (Keynote Speaker, Toronto, Canada)	Small Hall
	"Thursday 05 September" Added to your list of favorites Deleted from your list of favorites I28 15:30 - 17:30 HANDS - ON CLINICAL WORKSHOP 13 - RA UGRA Repertoire for the Abdominal Surgery OR WS Leader: Siska BJORN (Postdoc, Resident) (WS Leader, Aarhus, Denmark) 15:30 - 17:30 Workstation 1: Basic Blocks for Pain Free Abdominal Surgery (I) - Transabdominal Plane Blocks (TAP). Rafael BLANCO (Pain medicine) (Demonstrator, Abu Dhabi, United Arab Emirates) 15:30 - 17:30 Workstation 2: Basic Blocks for Pain Free Abdominal Surgery (II) - Rectus Sheath, Ilioinguinal and Iliohypogastric Nerve Blocks. Nat HASLAM (Consultant Anaesthetist) (Demonstrator, Sunderland, United Kingdom) 15:30 - 17:30 Workstation 3: Quadratus Lumborum Blocks (QLB). Lara RIBEIRO (Anesthesiologist Consultant) (Demonstrator, Braga-Portugal, Portugal) 15:30 - 17:30 Workstation 4: US Guided Central Blocks - Low Thoracic PVB. Ismet TOPCU (Anesthesiologist) (Demonstrator, İzmir, Turkey)	220a
	"Thursday 05 September" Added to your list of favorites Deleted from your list of favorites FP32bis 15:30 - 16:25 MISCELLANEOUS Free Papers 8 Chairperson: Dmytro DMYTRIIEV (chief of pain medicine department) (Chairperson, Vinnitsa, Ukraine) 15:30 - 15:37 #42456 - OP068 PECSATT (PECtoralis-Serratus Anterior-Transverse Thoracis) plane block- a paradigm shift in breast surgery anesthesia: a new advance towards Opioid free anesthesia. OP068 PECSATT (PECtoralis-Serratus Anterior-Transverse Thoracis) plane block- a paradigm shift in breast surgery anesthesia: a new advance towards Opioid free anesthesia. Opioid-based general anaesthesia is associated with increased nausea and vomiting, respiratory depression, prolonged sedation, urine retention, ileus, hyperalgesia, tolerance, and chronic pain. The aim of this study was to assess the impact of various regional block techniques for opioid free anaesthesia in breast surgeries in the peri-operative period. This prospective, randomized controlled study included 40 women ASA I to III for modified radical mastectomy at a tertiary care institute between September 2021-2022. Group PST (n-20) received opioid free general anaesthesia followed by quadruple block (PECS I & II, Serratus anterior plane muscle block, transverse thoracic muscle plane block) and Group PS (n-20) had general anaesthesia followed by PECS I & II and Serratus anterior plane muscle block. The primary outcome measured was the impact of various regional block techniques for opioid free anaesthesia in breast surgeries perioperatively. Secondary outcomes were the effect of regional block techniques on fasttracking, analgesic requirement, surgeon and patient satisfaction scores. Real-time ultrasound-guided regional blocks was performed by single experienced operator. The intraoperative intravenous fentanyl requirement was statistically lower in PST group as compared with the PS group (p value= 0.01447). Group PS had significantly increased (p < 0.05) HR during skin incision and 10 mins after whereas for MAP there was significantly increase during skin incision, after 10 mins, 20 mins and 30 mins than in group PST (p < 0.05). Postoperative data were comparable between the groups The quadruple block provided complete analgesia for the breast surgeries thereby decreasing the perioperative opioid requirements. Omshubham ASAI, Bhuvaneswari BALASUBRAMANIAN, Himangi BHOKARE (Nagpur, India), Amrusha RAIPURE 15:37 - 15:44 #41104 - OP069 Comparing oxygen therapies for hypoxemia prevention during gastrointestinal endoscopy under sedation: A systematic review and network meta-analysis. OP069 Comparing oxygen therapies for hypoxemia prevention during gastrointestinal endoscopy under sedation: A systematic review and network meta-analysis. Hypoxemia (low blood oxygen) is the most common problem during gastrointestinal endoscopy with sedation. The best way to deliver oxygen for prevention is unclear. This study aimed to compare different oxygen delivery methods to prevent hypoxemia. Researchers searched major medical databases in June 2023. They included studies comparing oxygen therapies (vs. placebo or other methods) in adults undergoing endoscopy with sedation. Two reviewers independently analyzed the data following standard guidelines. The study included 27 studies with over 7,500 patients. Compared to a nasal cannula (standard method), non-invasive ventilation (NIPPV) was most effective in preventing hypoxemia, followed by the Wei nasal jet tube (WNJT). Efficacy ranked: NIPPV > WNJT > other methods > nasal cannula. All advanced oxygen therapies were better than the standard nasal cannula for preventing hypoxemia during endoscopy with sedation. NIPPV and WNJT seem most effective. Clinicians should choose the best method based on patient risk, procedure type, and potential side effects. This provides valuable evidence for clinical practice. Jiaming JI (guangzhou, China) 15:44 - 15:51 #40399 - OP070 Greenhouse emissions associated with general or regional anaesthesia for open reduction and internal fixation of distal radius fractures. OP070 Greenhouse emissions associated with general or regional anaesthesia for open reduction and internal fixation of distal radius fractures. Total intravenous anaesthesia (TIVA) and regional anaesthesia (RA) have been touted as environmentally preferable alternatives to volatile anaesthesia, however few studies have investigated the relative environmental impact of these anaesthetic techniques. A retrospective observational database study was conducted, in which theatre billing records were obtained. For each pharmaceutical, single-use disposable and their primary packaging, carbon equivalent emissions (CO2e) were calculated using a bottom-up cradle-to-grave life cycle methodology. These values were summated for each case and compared between patients receiving desflurane (DES), sevoflurane (SEVO), RA or TIVA. Theatre time for each case was used to model CO2e contributions from medical gas, carbon dioxide absorber and theatre energy consumption. Total solid waste was also compared. A total of 2 061 cases were studied. Mean CO2e for DES was 147.02 (95%CI 137.98 – 156.06)kgCO2e, SEVO 13.87 (95% CI 13.58 – 14.18)kgCO2e, RA 8.05 (95% CI 7.27 – 8.83)kgCO2e and TIVA 8.97 (95% CI 8.50 – 9.44)kgCO2e. When including the contributions modelled from theatre time, mean CO2 for DES was 147 (95% CI 138.41 – 156.51) kgCO2e, SEVO 14.29 (95%CI 13.98 – 14.60)kgCO2e, RA 9.204 (95% CI 8.358 – 10.051) kgCO2e and TIVA 9.86 (95% CI 9.37 – 10.34)kgCO2e. Mean solid waste contribution for DES was 0.84 (95% CI 0.81 – 0.87) kg, SEVO 0.82 (95% CI 0.81 – 0.84)kg, RA 0.74 (95% CI 0.68 – 0.80)kg; and TIVA 0.95 (95% CI 0.91 – 0.99)kg. The current study suggests that regional anaesthesia is preferable to alternatives when considering carbon emissions and solid waste production. Gwen MORGAN (George, South Africa), Alexis OOSTHUIZEN, Philippa NOTTEN, Karim MUKHTAR 15:51 - 15:58 #41059 - OP071 INFLUENCE OF DILUENTS ON PH OF LOCAL ANESTHETIC SOLUTIONS. OP071 INFLUENCE OF DILUENTS ON PH OF LOCAL ANESTHETIC SOLUTIONS. Local anesthetics (LAs) are commonly prepared in acidic solutions for stability. Alkalinization with sodium bicarbonate may enhance onset, duration, and reduce pain (1)(2)(3). We assessed the pH effects of normal saline and sterile water on LA preparations at different dilution ratios, an aspect currently unexplored in the literature. Approved by the department, this service evaluation project was conducted in an accredited lab. Baseline pH measurements were taken for each solution. LA preparations were mixed with diluents at ratios of 1:1, 1:2, and 1:3 using a calibrated micropipette. Three pH measurements per dilution were averaged. Table 1 depicts significant pH increases in bupivacaine with both diluents, notably higher with normal saline. Lignocaine diluted with normal saline showed non-significant pH fluctuations. Significant pH drops were noted with 2% lignocaine diluted with sterile water at 1:2 and 1:3 ratios. In Table 2, normal saline yielded more favorable pH levels for lignocaine and bupivacaine, particularly evident with 2% lignocaine. This study is the first to focus on pH measurement when diluting local anesthetics with normal saline and sterile water.While some emphasize alkalinization, caution against sodium-containing solutions exists due to increased competetion at sodium channels.(4)(5). We believe pH and the unionized fraction of local anesthetic are deemed clinically crucial. We propose using normal saline for diluting local anesthetics as it typically yields a better pH change. However, patient trials are required to confirm pH's impact on onset and effectiveness. Sathishkumar SELVARAJ, Muhammad CHAUDHURY, Beverly HOEPELMAN, Balachandar SARAVANAN (Karaikal, India) 15:58 - 16:05 #42464 - OP072 Role of anaesthesiologists in diagnosing and treating intracranial hypotension secondary to spinal leak. OP072 Role of anaesthesiologists in diagnosing and treating intracranial hypotension secondary to spinal leak. Spontaneous intracranial hypotension (SIH) is a rare syndrome with diverse presentations and potential complications, including the formation of subdural hematomas (SDHs). This study aimed to investigate the role of anesthesiologists in diagnosing and treating SIH with associated SDHs. Twenty-two patients, aged 24 to 65, presenting with orthostatic headache were included in this study. Seventeen of them were diagnosed with SDHs. Diagnostic procedures included contrast-enhanced MRI of the brain and whole spine 3D-T2FS imaging, revealing spinal longitudinal extradural CSF collection (SLEC). Following positive imaging for SIH, prone ultrafast dynamic CT Myelogram was performed by the anesthesiologist to localize the tear. Targeted epidural blood patching using 10-20ml of autologous blood was then administered, with seventeen thoracic, three cervical, and two lumbar patches performed. All patients reported complete resolution of SIH symptoms after the targeted epidural blood patching. Substantial improvement was also observed in MRI scans. This report demonstrates the successful management of SIH and associated SDHs using a multidisciplinary approach involving anesthesiologists. The utilization of advanced imaging techniques, such as contrast-enhanced MRI and prone ultrafast dynamic CT Myelogram, facilitated accurate diagnosis and tear localization. Targeted epidural blood patching with smaller volumes of autologous blood proved to be an effective treatment for these patients. In conclusion, early recognition and intervention using advanced imaging modalities, coupled with targeted epidural blood patching, offer an effective management strategy for SIH and its associated complications. The involvement of anesthesiologists in the diagnosis and treatment of SIH is crucial in providing optimal care for patients. Santhosh C KARAYI, Pratiksha NAYAK PRAMOD (Bangalore, India) 16:05 - 16:12 #41580 - OP073 An unusual Intraosseous diffusion after a PENG block: A Cadaver Study. OP073 An unusual Intraosseous diffusion after a PENG block: A Cadaver Study. PENG block is routinely implemented as a part of multi-modal analgesia for hip surgical procedures. However, a recent cadaver dissection suggest it is not a true pericapsular block. We in 2 cadavers executed cross-sections after PENG injection with methylene blue dye. In 2 fresh (4 sides) cadavers (76 and 86 years), ultrasound guided PENG block (0 mL 0.1% methylene blue dye) was administered with linear probe (sonosite 3-12mHz) in real time. The cadavers were cross-sectioned at the level of ASIS and below the inguinal ligament. The spread of the dye was noted. In 4 specimens, the spread of dye was noted in following areas table1. Intra-osseous spread was noted in 2 specimens. Fig1 In all specimens the dye was dorsal and lateral to iliacus muscle. Cross-sections reveal a more deeper tissue plane diffusion. In our study, the intra-osseous identification in 2 specimens was a revelation. To our knowledge, this is the first occasion where dye spread from an inter-fascial plane is recognized inside the marrow. We recommend applying colour mode for PENG injection to be scrutinize abnormal vasculature. Sandeep DIWAN, Rasika TIMANE (Nagpur, India) 16:12 - 16:19 #41581 - OP074 Identification of pathway to Phrenic nerve after an Infra-omohyoid Suprascapular Injection: A Cadaveric Injection Study. OP074 Identification of pathway to Phrenic nerve after an Infra-omohyoid Suprascapular Injection: A Cadaveric Injection Study. Interscalene block is gold standard for shoulder surgeries, but the phrenic paresis (PP) is persisting problem. The anterior approach to suprascapular nerve (SSN) has been advocated, but 20% times PP occurs. We in cadaveric study wanted to evaluate the path of dye diffusion from infra-omohyoid SSN to the phrenic nerve. In 2 fresh cadavers (4 sides), an infra-omohyoid SSN block were administered with 5ml of 0.1% methylene blue dye is injected at 5ml/minute. Spread of the dye was inspected in real time. Dissection is performed at 30 minutes post injection. The stain pattern of suprascapular nerve, divisions of superior trunk, cephalad and caudal spread and stain of phrenic nerve was investigated. The suprascapular nerve was stained in all 4 specimens. The posterior and anterior divisions, the lateral edge of superior trunk and C5 were stained. Table 1 Following the stain path the dye was dorsal to the brachial plexus divisions-trunks, winded around the C5 and appeared in the proximal part of the phrenic nerve (PN). The PN was stained in all specimens. Figure 1 The pathway to phrenic nerve from the suprascapular nerve injection exists. The dye tracked along the posterior fascial sheath of the dorsal aspect of the brachial trunks and cervical rami and spilled ventrally on the PN. Sandeep DIWAN, Rasika TIMANE (Nagpur, India)	CHAMBER HALL
	"Thursday 05 September" Added to your list of favorites Deleted from your list of favorites J28 15:30 - 17:30 HANDS - ON CLINICAL WORKSHOP 14 - RA UGRA For Carotid and Thoracic Surgery WS Leader: Peter MERJAVY (Consultant Anaesthetist & Acute Pain Lead) (WS Leader, Craigavon, United Kingdom) 15:30 - 17:30 Workstation 1: Blocks for Awake Carotid Surgery. Luc SERMEUS (Head of department) (Demonstrator, Brussels, Belgium) 15:30 - 17:30 Workstation 2: US Guided Thoracic Epidurals. John MCDONNELL (Professor of Anaesthesia and Intensive Care Medicine) (Demonstrator, Galway, Ireland) 15:30 - 17:30 Workstation 3: Paravertebral Blocks. Marcus NEUMUELLER (Senior Consultant) (Demonstrator, Steyr, Austria) 15:30 - 17:30 Workstation 4: Paravertebral Blockade by Proxy (MTP). Kausik DASGUPTA (Consultant Anaesthetist) (Demonstrator, NUNEATON,UK, United Kingdom)	221a
	"Thursday 05 September" Added to your list of favorites Deleted from your list of favorites K28 15:30 - 17:30 HANDS - ON CLINICAL WORKSHOP 15 - RA Necessary Blocks to Know for Pain Free TKA WS Leader: Neel DESAI (Consultant in Anaesthetics) (WS Leader, London, United Kingdom) 15:30 - 17:30 Workstation 1: Femoral Nerve Block. Sari CASAER (Anesthesiologist) (Demonstrator, Antwerp, Belgium) 15:30 - 17:30 Workstation 2: Blocks of Obturator Nerve and Lateral Femoral Cutaneous Nerve of the Thigh. Balavenkat SUBRAMANIAN (Faculty) (Demonstrator, Coimbatore, India) 15:30 - 17:30 Workstation 3: Sciatic Nerve Block. Laurent DELAUNAY (Anaesthesiologist, Intensivist and perioperative medicine) (Demonstrator, ANNECY, France) 15:30 - 17:30 Workstation 4: Adductor Canal Block & iPACK. Romualdo DEL BUONO (Member) (Demonstrator, Milan, Italy)	223a
	"Thursday 05 September" Added to your list of favorites Deleted from your list of favorites L28 15:30 - 17:30 HANDS - ON CLINICAL WORKSHOP 16 - RA Analgesia for Hip Fracture Surgery WS Leader: Sandeep DIWAN (Consultant Anaesthesiologist) (WS Leader, Pune, India) 15:30 - 17:30 Workstation 1: PENG Block. Philip PENG (Office) (Demonstrator, Toronto, Canada) 15:30 - 17:30 Workstation 2: Quadratus Lumborum Block (QLB). Axel SAUTER (consultant anaesthesiologist) (Demonstrator, Oslo, Norway) 15:30 - 17:30 Workstation 3: Erector Spinae Plane Block (ESPB). Attila BONDAR (Consultant Anaesthetist) (Demonstrator, Cork, Ireland) 15:30 - 17:30 Workstation 4: Suprainguinal Fascia Iliaca Block - Anterior Approach. Vedran FRKOVIC (Senior Consultant in Anaesthesiology and pain medicine) (Demonstrator, Linkoping/ Sweden, Sweden)	241
	"Thursday 05 September" Added to your list of favorites Deleted from your list of favorites M28 15:30 - 17:30 HANDS - ON CLINICAL WORKSHOP 17 - RA Basic PNBs Useful in Daily Clinical Practice WS Leader: Mark CROWLEY (EDRA Faculty) (WS Leader, Oxford, United Kingdom) 15:30 - 17:30 Workstation 1: Basic Knowledge for Shoulder and Elbow Surgery - Interscalene and Supraclavicular Nerve Blocks. Mireia RODRIGUEZ PRIETO (Anesthesiologist in Orthopaedics and Trauma surgery) (Demonstrator, Barcelona, Spain) 15:30 - 17:30 Workstation 2: Basic Knowledge for Elbow and Hand Surgery - Axillary Nerve Block. Thomas WIESMANN (Head of the Dept.) (Demonstrator, Schwäbisch Hall, Germany) 15:30 - 17:30 Workstation 3: Basic Knowledge for Hip and Knee Surgery - Femoral Nerve Block, Fascia Iliaca Block and Blocks of Obturator Nerve and Lateral Cutaneous Nerve of the Thigh. Ruediger EICHHOLZ (Owner, CEO) (Demonstrator, Stuttgart, Germany) 15:30 - 17:30 Workstation 4: Basic Knowledge for Knee and Foot Surgery - Proximal Subgluteal Sciatic and Popliteal Nerve Blocks. Mariana CORREIA (Consultant) (Demonstrator, Lisboa, Portugal)	245
	"Thursday 05 September" Added to your list of favorites Deleted from your list of favorites A25 15:30 - 16:20 ASK THE EXPERT High Precision Blocks are preferred to low precision fascial plane Chairperson: Per-Arne LONNQVIST (Professor) (Chairperson, Stockholm, Sweden) 15:30 - 15:35 Introduction. Per-Arne LONNQVIST (Professor) (Keynote Speaker, Stockholm, Sweden) 15:35 - 16:05 Epidural stimulation for thoracic epidural catheter placement in neonates and young infants: benefits and technical considerations. Manoj KARMAKAR (Professor, Consultant, Director of Pediatric Anesthesia) (Keynote Speaker, Shatin, Hong Kong) 16:05 - 16:20 Q&A.	CONGRESS HALL
16:10	"Thursday 05 September" Added to your list of favorites Deleted from your list of favorites H28 16:10 - 18:00 BEST FREE PAPER SESSION - RA Chairperson: Thomas VOLK (Chair) (Chairperson, Homburg, Germany) Jurys: Christian BERGEK (Anaesthetist) (Jury, Gothenburg, Sweden), Dario BUGADA (Consultant anesthesiologist) (Jury, Bergamo, Italy), Patrick SCHULDT (Consultant) (Jury, Uppsala, Sweden), Ana SCHWARTZMANN BRUNO (President) (Jury, Montevideo, Uruguay) 16:10 - 16:21 #42745 - OP001 Chronic Pain and Health-Related Quality of Life after Major Breast Cancer Surgery: A Randomised Double-blind Study Comparing Single-level Vs. Multi-level Thoracic Paravertebral Block. OP001 Chronic Pain and Health-Related Quality of Life after Major Breast Cancer Surgery: A Randomised Double-blind Study Comparing Single-level Vs. Multi-level Thoracic Paravertebral Block. Primary breast cancer surgery (PBCS) is associated with chronic post-surgical pain, which can negatively affect health related quality of life (HRQOL). This randomized double-blind study aimed to determine if the number of injections with a thoracic paravertebral block (TPVB) can affect the risk of developing chronic pain after a PBCS. After ethics approval, 220 women undergoing PBCS were randomized to one of the two study groups: Group I: single-level TPVB (SL) with 25 ml of the study drug (0.5% levobupivacaine with 1:200,000 adrenaline) at T3 level and sham intramuscular injections at T1 and T5 level, or Group II: three-level TPVB (TL) at the T1,3 and 5 levels with 8,8, and 9 ml of the study drug respectively. All patients also received a standardized general anaesthesia (GA). The incidence of chronic pain between the groups at 3 and 6 months after surgery was our primary outcome measure. P<0.05 was considered statistically significant. There was no significant difference in the incidence of chronic pain at 3 months (63% vs. 64%, P=0.92) and 6 months (63% vs. 61%, P=0.63) between SL and TL, respectively. The quality of recovery, risk of developing chronic pain, and physical and mental HRQOL also did not differ between the study groups (Tables 1 & 2). The incidence, and risk, of chronic pain at 3 and 6 months after a PBCS is similar whether a single or three-level TPVB injection is used in conjunction with GA. Manoj Kumar KARMAKAR, Ranjith Kumar SIVAKUMAR (Hong Kong, Hong Kong), Winnie SAMY, Grace Pick Yi HOU, Anna LEE 16:21 - 16:32 #42794 - OP002 Comparison between erector spine block (ESPB) to thoracic paravertebral plane block (TVPB) using ropivacaine plasma concentration analysis: a randomized double-blind clinical trial. OP002 Comparison between erector spine block (ESPB) to thoracic paravertebral plane block (TVPB) using ropivacaine plasma concentration analysis: a randomized double-blind clinical trial. Ultrasound-guided anesthesia popularized erector spinae plane block (ESPB) as an alternative to thoracic paravertebral block (TPVB) in video-assisted thoracic surgery (VATS). Concerns about systemic toxicity persist due to the large doses of local anesthetic used. This study compares arterial plasma concentration curves of ropivacaine between ESPB and TPVB to assess safety and toxicity. This clinical trial was prospective, randomized, double-blind, controlled and with two parallel arms: 18 patients who received ESPB and 16 received TPVB (figure 1). Epidemiologic data were collected (table 1). All blockades were performed with the aid of ultrasound and after induction of general anesthesia. Ropivacaine plasma concentration were quantified every 2.5 minutes until 30 minutes. Continuous ropivacaine infusion via catheter began post-surgery and lasted 24 hours, with a subsequent blood sample collected. Both groups showed similar modest plasma concentrations, with mean peak levels of 1.62 μg/ml (ESPB) and 1.70 μg/ml (TPVB). After continuous infusion, all concentrations dropped below 2 μg/ml (figure 2). No adverse intra or post-operative events were noted, and total plasma concentrations of unbound and free fraction of ropivacaine at 30 minutes did not significantly differ between groups. Both blocks exhibited comparable plasma concentration curves, possibly due to factors beyond anatomical location, such as the pharmacokinetic properties of the local anesthetic or individual patient variability. In addition, similar unbound and free fraction plasma concentrations indicate uniformity in terms of proteinemia across the population. These results suggest that ESPB and TPVB are safe alternatives with comparable pharmacokinetics, guiding future dosage selection and more clinical studies. Victor EGYPTO PEREIRA, Waynice NEIVA DE PAULA GARCIA, Luiz SEVERO BEM JUNIOR, Luís VICENTE GARCIA, Idrys Henrique LEITE GUEDES (Campina Grande-PB, Brazil) 16:32 - 16:43 #42737 - OP003 Magnesium sulfate in neuropathic pain: a systematic review, meta-analysis, and sequential trial analysis. OP003 Magnesium sulfate in neuropathic pain: a systematic review, meta-analysis, and sequential trial analysis. The use of Magnesium Sulfate (MS) has shown favorable effects in the modulation of postoperative pain, however its efficacy in the context of neuropathic pain has not been conclusively established. Our objective was to evaluate the available evidence to determine the therapeutic potential of its use in the management of neuropathic pain. Randomized controlled trials (RCT) comparing the use of MS (intravenous or oral route) with placebo or other neuromodulators in adult patients with neuropathic pain were included. Comprehensive searches were conducted in PubMed, EMBASE, Google Scholar, and BVS-LILACS databases from 1990 to May 2023. The risk of bias in the individual studies was assessed using the Cochrane "Risk of Bias 2.0" tool. The results were synthesized using the Mantel-Haenszel random-effects method to calculate mean differences and their 95% confidence intervals. Heterogeneity was evaluated using the I2 statistic. Registration: PROSPERO CRD42023441885. 7 RCTs with 274 patients were included. The pooled analysis of the studies comparing magnesium sulfate to placebo showed a non-significant mean difference of -1.13 (95% CI: -2.64, 0.38) in neuropathic pain scores, despite a favorable trend towards magnesium sulfate observed in the sequential trial analysis, but with high heterogeneity (I2 = 81%). The comparison between magnesium sulfate and ketamine revealed a decrease in the mean difference of -0.67 (95% CI: -1.84, 0.49), without reaching statistical significance, moderate heterogeneity (I2 = 62%). Magnesium sulfate could be an effective therapeutic alternative for neuropathic pain, but further primary studies are required to establish the optimal dosing regimens and clinical contexts Fabricio Andres LASSO ANDRADE (Medellín- Colombia, Colombia) 16:43 - 16:54 #42655 - OP004 Comparison of Conventional Radiofrequency Thermocoagulation to Femoral and Obturatory Nerve Articular Branches with Intra-Articular Steroid Injection and PENG Block in Chronic Hip Pain. OP004 Comparison of Conventional Radiofrequency Thermocoagulation to Femoral and Obturatory Nerve Articular Branches with Intra-Articular Steroid Injection and PENG Block in Chronic Hip Pain. Chronic hip pain presents a significant challenge in pain management. This study aimed to compare the efficacy of three interventions: radiofrequency thermocoagulation(RFT), intra-articular steroid injection(IAI), and PENG block, in alleviating pain and improving functional capacity among chronic hip pain patients. A prospective randomized controlled study involved 57 patients. After ethical approval and patient consent, they were randomly assigned to three treatment groups: conventional RFT (Group1), IAI (Group2), and PENG block(Group3). Pain intensity was assessed using the Numerical Rating Scale (NRS) pre-procedure and at 2 hours, 1 month, and 3 months post-procedure. Functional capacity was evaluated using the Western Ontario and McMaster Universities Arthritis Index (WOMAC) scale at baseline, and at 1 and 3 months post-procedure. At 2 hours post-procedure, all groups exhibited a significant reduction in NRS scores compared to baseline, with no significant inter-group differences. By 1 month, NRS and WOMAC scores in Groups1 and 2 were significantly lower than baseline, while Group3 showed comparable NRS scores but higher WOMAC scores. At 3 months, Group1 demonstrated significantly lower NRS and WOMAC scores compared to baseline and other groups. Group2 maintained reduced NRS and WOMAC scores, while Group3 showed no significant improvement. Complications related to the procedures were not observed. Our findings suggest that PENG block, RFT, and IAI effectively managed acute pain in chronic hip pain patients. While IAI and RFT were effective in managing chronic pain up to the first month, only RFT remained effective at the 3-month follow-up. PENG block did not demonstrate effectiveness in chronic follow-ups. Bilge ERGUN DEMIROZ, Sinem SARI, Yusufcan EKIN, Alp ERTUGRUL (Aydin, Turkey), Osman Nuri AYDIN 16:54 - 17:05 #41568 - OP005 Ultrasound evaluation reduces the incidence of Difficult Spinal Anesthesia: a prospective observational study. OP005 Ultrasound evaluation reduces the incidence of Difficult Spinal Anesthesia: a prospective observational study. Although Spinal Anesthesia (SA) it is considered a safe procedure, it may give complications including headache and spinal hematoma, whose incidence increases during multiple attempts. This prospective observational study aimed to analyze the impact of pre-procedural Ultrasound (US) in reducing the incidence of difficult SA, defined as the need for a second skin puncture. Data collection included incidence of failed and difficult SA and if US evaluation (Fig. 1) was performed before SA . Moreover, we calculated the neuraxial block assessment (NBA) score to predict a high probability of difficult SA, defined as the presence of almost two risk factors (N score) including: absence of spinous processes visibility/palpability, column deformities, history of difficult SA. 824 patients were included. Among them, 382 underwent preprocedural US evaluation and 442 did not. US assisted SA was associated with a significant lower risk of failure (1.6% vs. 8.1%) and difficult procedure (13% vs. 87%); p < 0.001 (Fig.2). A subgroup analysis was performed on 400 patients with difficult SA predictors. In this case, the difference in failed SA between US assisted and blind procedures was even greater (1.6 % vs. 16.2%, respectively); p < 0.001. A similar trend was observed for the incidence of difficult SA (15% vs. 41.8); p < 0.001. (Fig. 3) Ultrasound evaluation can significantly reduce the incidence of failed and difficult spinal anesthesia, especially in those patients with predicted difficult SA. This may lead to save time, increase patient comfort and reduce the risk of complications. Giuseppe PASCARELLA (ROME, Italy), Alessandro STRUMIA, Romualdo DEL BUONO, Ruggiero ALESSANDRO, Massimiliano RICCI, Felice E. AGRÒ, Massimiliano CARASSITI, Rita CATALDO 17:05 - 17:16 #41182 - OP006 Ultrasound-Guided Approach to the Superior Gluteal Nerve: An Anatomical Study. OP006 Ultrasound-Guided Approach to the Superior Gluteal Nerve: An Anatomical Study. Ultrasound-guided block of the superior gluteal nerve (SGNB) for pelvic girdle analgesia is sparsely documented in medical literature, motivating us to conduct an anatomical study aiming to describe a straightforward approach to this nerve, guided by clear anatomical references. An anatomical study was conducted on fifteen cadaveric models (thirty pelvic girdles), utilizing ultrasound-guided SGNB with a low-frequency convex ultrasound probe. The probe was positioned over the iliac bone in a superolateral oblique plane, scanning from superolateral to inferomedial. Structures identified included: continuous iliac bone (Figure 1-A), beginning of the greater sciatic foramen (Figure 1-B), and piriformis muscle (Figure 1-C). Subsequently, the probe was retracted towards the continuous iliac bone (Figure 1-A) in the fascial plane between the gluteus medius and minimus muscles, identifying the superior gluteal artery, and injecting 5 ml of a solution mixture (methylene blue + iodine). Three-dimensional reconstruction (3D) using computed tomography (CT) and subsequent sectional anatomy were performed on five cadaveric models. Anatomical dissection by planes of each hemipelvis was carried out on ten cadaveric models. In the 3D reconstruction via CT, contrast dispersion over the supero-lateral gluteal region was visualized (Figure 2). In anatomical dissection and sectional anatomy, methylene blue distribution was observed in the muscular fascial plane between the gluteus medius and minimus, affecting the superior gluteal vasculonervous bundle (Figure 3). Intergluteal SGNB consistently affects the superior gluteal vasculonervous bundle, proving to be a straightforward technique guided by clear anatomical references. Hipolito LABANDEYRA (Barcelona, Spain), Xavier SALA-BLANCH 17:16 - 17:27 #42728 - OP007 Comparison of Conventional Epidural and Dural Puncture Epidural Analgesia Techniques in Gynecological Surgeries Guided by Intraoperative Nociception Level Index: A Prospective Randomized Double-Blind Study. OP007 Comparison of Conventional Epidural and Dural Puncture Epidural Analgesia Techniques in Gynecological Surgeries Guided by Intraoperative Nociception Level Index: A Prospective Randomized Double-Blind Study. Conventional Epidural (CE) and Dural Puncture Epidural (DPE) are prevalent analgesic methods in gynecological surgeries under general anesthesia. Utilizing the Nociception Level (NOL) index, which objectively measures intraoperative pain, facilitates the assessment of these techniques' efficacy. This study aims to compare the effectiveness of CE and DPE analgesia, guided by the NOL index, in enhancing intraoperative and postoperative comfort in gynecological surgeries. In this randomized study, 36 patients undergoing gynecological open surgeries were divided into two groups; one receiving CE and the other DPE for intraoperative analgesia. Both groups were administered 10 ml of 0.1% bupivacaine through the epidural catheter, with further doses adjusted based on the NOL index. Parameters such as total bupivacaine consumption, hemodynamic stability, use of vasoactive drugs, time with NOL ≥ 25 during surgery, post-anesthesia care unit discharge time, and postoperative adverse effects were recorded. Comparative analysis showed no significant difference in total local anesthetic consumptions between groups (p> 0.05). Hemodynamic parameters, need for vasoactive agents do not differ in terms of groups (p> 0.05). There was also no difference in time to discharge from the post-anesthesia care unit , and postoperative side effects. The study indicates no significant disparity in analgesic effectiveness between CE and DPE when guided by the NOL index, suggesting equivalent potential of both techniques in managing intraoperative pain in gynecological surgeries. Yunus Emre KARAPINAR (Erzurum, Turkey), Aysenur DOSTBIL, Mehmet AKSOY, Kamber KASALI, Gamze Nur CIMILLI SENOCAK, Ilker INCE 17:27 - 17:38 #39986 - OP008 Dexamethasone as a perineural adjuvant to a ropivacaine popliteal sciatic nerve block for foot surgery. A double-blind randomized controlled trial. OP008 Dexamethasone as a perineural adjuvant to a ropivacaine popliteal sciatic nerve block for foot surgery. A double-blind randomized controlled trial. This study aimed to assess the effect of two doses of perineural dexamethasone (DXM) on sensory and motor block duration, opioid requirement, blood glucose levels, and stress response to surgery expressed by the neutrophile-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR), following foot and ankle surgery. In this RCT, 90 patients aged 2-5 years old, ASA 2-3 were randomized into 3 equal groups, each receiving an ultrasound-guided single-shot popliteal sciatic nerve block with 0.5ml/kg 0.2% ropivacaine, supplemented with saline, DXM 0.1mg/kg, or DXM 0.05mg/kg. The sensory block was significantly longer for DEX 0.1mg/kg 18.42 (2.62) h and DEX 0.05mg/kg 16.27 (2.82) h, compared to saline 8.52 (1.45) h, p<0.0001. The motor block was significantly longer for DEX 0.1mg/kg 17.25 (2.47) and DEX 0.05mg/kg 15.23 (2.65), compared to saline 7.78 (1.14), p=0.0006. Total opioid consumption was lower in both DEX groups (p=0.0006), as seen in Tab.2. The NLR, PLR and glucose levels before, 24h and 48h after surgery, did not differ in all groups, as seen in Tab.4. The addition of DXM to ropivacaine significantly prolonged the duration of postoperative sensory and motor block. DXM did not influence the NLR, PLR and blood glucose levels. Malgorzata DOMAGALSKA (Poznan, Poland), Tomasz REYSNER, Kowalski GRZEGORZ, Milud SHADI, Piotr JANUSZ, Przemysław DAROSZEWSKI, Katarzyna WIECZOROWSKA-TOBIS, Tomasz KOTWICKI 17:38 - 17:49 #42859 - OP009 Comparison between transversus abdominis plane block (TAP) and wound infiltration for postsurgical pain management in abdominal surgeries. OP009 Comparison between transversus abdominis plane block (TAP) and wound infiltration for postsurgical pain management in abdominal surgeries. Abdominal surgeries often cause significant postoperative pain, affecting recovery and quality of life. Techniques like transversus abdominis plane (TAP) block and wound infiltration are used for pain control, but their comparative efficacy remains unclear. A systematic review and meta-analysis were conducted accordingly to PRISMA guidelines to compare TAP block versus wound infiltration for postoperative pain control in abdominal surgeries. A search was conducted in PubMed, Embase and Scopus databases using a high sensitivity search strategy. Retrieved randomized clinical trials were screened by title, abstract and full text. In addition, statistical analysis was conducted using a random effects model, focusing on pain scores at 24h after abdominal surgical procedures. A total of 573 studies was retrieved, resulting in 15 randomized clinical trials included in this systematic review and meta-analysis after screening. A random effects model was applied to assess the pain between the TPA and control group. Mean difference (MD) result favored the TPA group (MD: -1.11 (95% CI: -1.75 to -0.47), p = 0.0007). However, a notable heterogeneity was present among the results (I2 = 97%, p < 0.00001). This meta-analysis shows the TAP block is more effective than wound infiltration for reducing postoperative pain in abdominal surgeries. Despite high heterogeneity, TAP block improves pain management and may enhance patient recovery and quality of life. Further research is needed to confirm these results. Idrys Henrique LEITE GUEDES (Campina Grande-PB, Brazil), Anna Luisa DE SOUZA HOLANDA, Pawel ŁAJCZAK, Martin KOTOCHINSKY, Yasmin PICANÇO SILVA	NORTH HALL
16:30	"Thursday 05 September" Added to your list of favorites Deleted from your list of favorites D29 16:30 - 17:20 PRO CON DEBATE Sedation and Regional Anesthesia: Yes or No? Chairperson: Alain BORGEAT (Senior Research Consultant) (Chairperson, Zurich, Switzerland) 16:30 - 16:35 Introduction. Alain BORGEAT (Senior Research Consultant) (Keynote Speaker, Zurich, Switzerland) 16:35 - 16:50 Advocating for sedation. Morne WOLMARANS (Consultant Anaesthesiologist) (Keynote Speaker, Norwich, United Kingdom) 16:50 - 17:05 Advocating against sedation. Margaretha (Barbara) BREEBAART (anaesthestist) (Keynote Speaker, Antwerp, Belgium) 17:05 - 17:20 Conclusion and Q&A.	South Hall 1B
	"Thursday 05 September" Added to your list of favorites Deleted from your list of favorites E29 16:30 - 17:20 PRO CON DEBATE PNB in patients at risk for compartment Chairperson: Matthew OLDMAN (Consultant Anaesthetist) (Chairperson, Plymouth, United Kingdom) 16:30 - 16:35 Introduction. Matthew OLDMAN (Consultant Anaesthetist) (Keynote Speaker, Plymouth, United Kingdom) 16:35 - 16:50 #43475 - E29 For the PROs. For the PROs. Anju Gupta (1), Nishkarsh Gupta (2) 1. , AIIMS, New Delhi, India 2. , AIIMS, Delhi, Delhi, India Background The soft tissue of the limb is divided into various compartments confined by the fascia and skeletal system. In compartment syndrome, an increase in tissue pressure in a closed, nonelastic fascial compartment compromises the circulation to the neurovascular bundle and affects their function. Acute compartment syndrome (ACS) is a rare complication of certain fractures and surgeries and constitutes a serious medical emergency. The key to managing patients with ACS is its early detection and treatment. Its onset can be fast and lead to permanent tissue damage within no time. So, any delay in the diagnosis may be devastating to the patient as an emergent fasciotomy within six hours is crucial to prevent sequelae and the risk of complications such as loss of function in the limb or amputation due to muscle necrosis, delayed fracture union, Volkmann ischemic contraction, neurological deficits, cardiac arrhythmias, myoglobinuria, renal failure, and potentially death increases as time of tissue anoxia is prolonged. Diagnosis of ACS The diagnosis of ACS is mainly based on clinical symptoms and one needs to have a high index of suspicion. The cardinal symptoms of ACS include pain, pallor, paraesthesias, pulselessness, and paralysis. The initial and most consistent indicator and a sign of impending compartment syndrome is pain that increases on passive muscle stretch in the concerned compartment. Pain on a passive stretch of the affected compartment is associated with a 68% chance of compartment syndrome. Particularly, if a patient experiences progressive pain not relieved by opioids and increases disproportionately on examination and passive motion, one should be worried and consider the likelihood of ACS. Change in sensation and weakness of muscle may also occur but it is not confirmatory of ACS. Regional anesthesia (RA) is often considered to relieve pain in patients with trauma to limb. However, the increased use of RA may lead to delayed diagnosis of ACS and may increase subsequent morbidity. The increasing use of RA in the management of orthopedic and trauma patients, specifically on tibial fractures, does raise concern regarding a possible delayed diagnosis of ACS by ‘‘masking’’ important initial symptoms and signs, therefore delaying the diagnosis. Various case reports have highlighted the role of RA in possible delay in the diagnosis and treatment of ACS. The invasive measurement of intramuscular pressure (IMP) is the only objective measurement method to monitor ACS and has been advocated in high-risk patients. Proper risk stratification and monitoring protocols are essential for the safe use of RA in patients at risk of ACS. Causes and risk factors A fracture causes up to 75% of ACS cases. The most common cause is a fracture of the shaft of the tibia due to injury in up to 36% of all ACS, followed by 9 % due to a fracture of the forearm. In open fractures, there is an added space for expansion of compartment tissue, which reduces the risk of ACS. The ACS is more common in males than females(up to ten times), perhaps due to a elevated mass of muscle. The risk factors for ACS include males less than 35 years old with fractures of the tibia (specifically ballistic injury to tibial diaphysis). The large injuries to tissue and vessels that require intramedullary rod and vessel repair also increase the risk. Mechanism of ACS Injury dilates the arterioles, collapses small vessels, and increases the extravasation of fluid which raises interstitial fluid pressure. Thus, an increase in pressure in the compartment decreases perfusion to tissues and leads to hypoxia, increased oxidative stress, and f hypoglycemia. This leads to cell edema as ATPase channels, which manage osmotic balance at the cellular level close. In early ACS, a microvascular dysfunction leads to decreased capillary perfusion and increased cell injury. The compromised microcirculation due to elevated pressure reduces oxygen and nutrient delivery, resulting in tissue anoxia and myonecrosis. The loss of cell-membrane potential leads to chloride ions influx, further increasing tissue swelling and deteriorating hypoxic state. Prolonged ischemia can lead to a “no-reflow phenomenon” due to occlusion of capillaries by swelling of endothelial and clogged capillaries with red and white blood cells, further increasing compartment pressure. Subsequent reperfusion releases derivatives of cell necrosis and ischemia in blood, like potassium, creatine kinase, organic acids, phosphate, myoglobin, and thromboplastin. This may result in metabolic acidosis, hyperphosphatemia, hyperkalemia, and myoglobinuria. This may result in an acute kidney injury and disseminated intravascular coagulation. The ultimate solution to ACS is a surgical fasciotomy within a stipulated time. If fasciotomies are performed more than 8 hours after the onset of ACS, they are contraindicated as they were associated with a significantly higher risk of infection. It is better to do a fasciotomy, which may prove to be futile later, than to perform one late in a symptomatic patient. Reperfusion after fasciotomy may cause local and systemic effects that may be life-threatening. An increase in muscle blood flow after restoring normal tissue pressure may lead to edema. Animal studies suggest cellular damage begins three hours after ischemic injury and is almost complete within six hours. The tolerance level varies in humans, and not all ischemic insults are complete. Diagnosis Classically, ACS is characterized by the “five Ps” (pain, pallor, pulselessness, paralysis, and paraesthesia). Swelling and tense tissue over a muscle compartment are some of the earliest signs of ACS and manifest as increased pressure. Pain is often portrayed as burning, deep-seated pain produced by stretching the muscles passively. Paralysis and pulselessness are rare and may occur if there is an injury to the artery. Physical signs include a firm, wood-like feeling on palpation and a reduction in the two-point sense of vibration sense in the early stages. A sensory deficit occurs in an advanced stage. Thus, combining palpation and clinical signs can help to establish a diagnosis of ACS with high specificity. In many cases, an objective measurement method like direct intramuscular pressure (IMP) measurement would be beneficial when diagnosing ACS. The physiological value of IMP is 8 mm Hg at rest and up to 16 mm Hg in children, and it may be beneficial in patients who cannot give feedback to the physician. IMP should be measured in all patients with fractures who are at high risk of developing ACS. It may help detect the development of ACS before the symptom onset and reduce the waiting time for diagnosis and enable a timely intervention for a better prognosis. Though the thresholds of IMP for ACS vary from 30 mm Hg to 45 mm Hg, it depends on the blood pressure of the patient and should be compared with it. Perfusion pressure(PP) is difference between diastolic blood pressure and IMP, and any decrease in PP to less than 30 mm Hg is indicative of ACS. Perfusion pressure has a high negative predictive value and is a better test to rule out ACS than to confirm it. Studies indicate that if PP is low for ACS diagnosis, it is usually not present. IMP measurement is an accurate method but not infallible. It may vary among compartments, where the anterior compartment may show higher values of IMP than other compartments. In patients with fractures, it also varies on the measurement distance from the fracture site, as maximum values occur within 5 cm of the fracture. A simple, noninvasive method to measure IMP could allow reliable, continuous monitoring of patients at risk of developing ACS and enhance the quality of care. Various trials are validating near-infrared spectroscopy (NIRS) to measure the oxygenation of muscle compartments. Other methods include ultrasound, bioimpedance measurements, elastography using ultrasound, and measurement of quantitative tissue hardness. What are regional anesthesia (RA) benefits in patients with limb fractures? In the surgical setting, the use of RA has produced enormous results for the perioperative pain management of patients. The ability to provide procedure-specific analgesia reduces the need for parenteral medications and their side effects. Multiple studies demonstrate the benefits of peripheral nerve blocks (PNB), including improved wound healing, reduced stress response, greater hemodynamic stability, and improved local blood flow, which may benefit trauma patients. Hence, PNB is considered a safe and effective modality for analgesia in patients after injury and surgery. PNB improves pain scores and decreases opioid requirement, associated side effects, duration of stay, and overall cost of health care. Enhanced recoveries after surgery (ERAS) protocols include RA as a part of a multimodal strategy. RA may provide added benefits in patients at risk for ACS by decreasing catecholamine release and stress response and enhancing blood flow through the extremity due to sympatholysis. So, RA should be combined to multimodal analgesia regimes in the at-risk ACS population also. What is the concern about the use of RA in patients at risk for ACS? It has been a widely prevalent belief that PNB in this cohort is dangerous as dense analgesia via PNB blocks pain, may alter the baseline values of nerve examination and mask diagnosis of early ACS. However, this assumption is flawed because in the absence of PNB in extremity trauma, one has to use opioids and other multimodal drugs for analgesia, which is no better and case reports have suggested a missed ACS due to systemic opioids. What is the evidence in favour of RA in patients at risk of ACS? Several case reports have shown severe pain despite an intact dense PNB. Kucera and Boezaart purported that ischemic pain provoked by ACS may be transferred via a pathway distinct from the common sensory-motor pathway blocked by PNB. This pathway in perivascular sympathetic fibres may be unaffected by PNB, ensuring that one can detect ischemic pain. A decent knowledge of ischemic pain transmission may ensure a targeted PNB without masking ACS. So, the argument that PNB masking an impending ACS is based on several outdated published literature. Moreover, an alternative to providing opioid-based analgesia is no more protective. It is paramount that large registries should be evaluated to compare the actual risk of ACS by using different analgesia options. A systematic review by Driscoll et al. on the use of PNB in patients requiring orthopedic extremity procedures documented that in 75% of the cases, RA does not delay ACS diagnosis. What strategies will optimize adequate analgesia without jeopardizing patient safety with the use of RA in these patients? The fear of RA masking an early ACS is based on the assumption that RA leads to dense motor and sensory blockade for an extended duration. However, advancements in PNB allow for suitable analgesia without compromising timely neurological examinations. The use of diluted local anesthetics, continuous infusions which can be that can be intermittently stopped, and direct targeting of sensory nerves provide adequate analgesia without affecting appropriate nerve function. So, a developing breakthrough pain due to ACS may easily detected. However, due to assumptions without evidence, patients with minimal to no risk of ACS are often denied PNB. Moreover, patients in high-risk groups often require prophylactic fasciotomy and are ideal candidates for PNB. Nathanson et al. suggested a validated ACS risk stratification scoring system that allows for PNB in low-risk patients and careful consideration in high-risk patients. So, dedicated RA and acute pain service (APS) must be done based on case-specific risk. APS clinicians should also know risk stratification and be experienced with modifications in PNB based on ACS risk. The APS team should empower nurses, patients, and their families regarding the earliest signs and symptoms of ACS. Opposition to PNB in these patients should be based on the maintenance of the patient’s ability to voice deterioration in pain as the ACS worsens. However, one cannot rely only on subjective complaints in patients with trauma as they may have an altered sensorium due to various reasons which may hinder their capability to report pain or respond appropriately to demonstrate an accurate neurological examination. PNB in these patients offers better analgesia without altering objective assessments of the extremity, which include pulse check, capillary refill, and compartment pressure. Bae et al. reported that around 10% of ACS cases in pediatric patients with isolated injury to extremity present without pain. Moreover, disproportionate pain is nonspecific, with most patients experiencing increased pain without other signs of compartment syndrome. PNB may prevent the escalation of nociceptive trauma pain to a level that may necessitate a negative decompressive fasciotomy. Also, patients may better tolerate repeated invasive intracompartmental pressure checks in presence of PNB. Conclusion ACS is a rare entity and can be detected early and permanent sequelae prevented with emergent surgical fasciotomies. Though traditional teaching dictates avoiding RA in patients at risk for compartment syndrome, recent literature and new understanding on the topic, however, highlight the safety and benefits of PNB in these patients provided adequate precautions are in place to enable early detection of ACS. We perceive the urgent need for guidelines focusing on the role of RA in patients with fracture of lower limb, to reduce morbidity due to the delays in t ACS diagnosis with multidisciplinary drive of education on the techniques of early diagnosis of acute compartment syndrome. Further, there is a need for more research endeavours directed towards outlining the best analgesia protocol in this cohort, which preserves safety and optimal analgesia in tandem. Suggested reading 1. Abbal B, Capdevila X. The use of regional anesthesia when the risk of compartment syndrome exists: Yes! In: Dillane D, editor. Regional Anesthesia in the Patient at Risk for Acute Compartment Syndrome. ASRA News. Pittsburgh, PA: American Society of Regional Anesthesia and Pain Medicine; 2013:4–6. Available at: https://www.asra.com/content/documents/31513_asra_may2013newsletter.pdf. Accessed August 22, 2016. 2. Elliott KGB, Johnstone AJ. Diagnosing acute compartment syndrome. J Bone Joint Surg Br. 2003;85-B(5):625–632. 3. Harvey EJ, Sanders DW, Shuler MS, et al. What’s new in acute compartment syndrome? J Orthop Trauma. 2012;26(12):699–702. 4. Yang J, Cooper MG. Compartment syndrome and patient-controlled analgesia in children – analgesic complication or early warning system? Anaesth Intensive Care. 2010;38(2):359–363. 5. Gamulin A, Wuarin L, Zingg M, Belinga P, Cunningham G, Gonzalez AI. Association between open tibia fractures and acute compartment syndrome: a retrospective cohort study. Orthop Traumatol Surg Res. 2022;108(5):103188. doi:10.1016/j.otsr.2021.103188 6. Mar GJ, Barrington MJ, McGuirk BR. Acute compartment syndrome of the lower limb and the effect of postoperative analgesia on diagnosis. Br J Anaesth. 2009;102(1):3–11. doi:10.1093/bja/aen330 7. Sees JA, Cutler GJ, Ortega HW. Risk factors for compartment syndrome in pediatric trauma patients. Pediatr Emerg Care. 2020;36(3):e115–e119. doi:10.1097/PEC.0000000000001636 8. Johnson DJG, Chalkiadis GA. Does epidural analgesia delay the diagnosis of lower limb compartment syndrome in children? Paediatr Anaesth. 2009;19(2):83–91. doi:10.1111/j.1460-9592.2008.02894.x 9. Yurgil JL, Hulsopple CD, Leggit JC. Nerve blocks: part I. upper extremity. Am Fam Physician. 2020;101(11):654–664. 10. American Academy of Orthopedic Surgeons (AAOS): Guideline: Management of Acute Compartment Syndrome. Available from: https:// www.orthoguidelines.org/go/cpg/detail.cfm?id=1456. Accessed October 10, 2022. 11. Ivani G, Suresh S, Ecoffey C, et al. The European Society of Regional Anesthesia and Pain Therapy and the American Society of Regional Anesthesia and Pain Medicine joint committee practice advisory on controversial topics in pediatric regional anesthesia. Reg Anesth Pain Med. 2015;40(5):526–532. 12. Driscoll EB, Maleki AH, Jahromi L, Hermecz BN, Nelson LE, Vetter IL, Evenhuis S, Riesenberg LA. Regional anesthesia or patient-controlled analgesia and compartment syndrome in orthopedic surgical procedures: a systematic review. Local Reg Anesth. 2016;9:65-81. Anju GUPTA (New Delhi, India) 16:50 - 17:05 For the CONs. Dileep N. LOBO (Professor of Gastrointestinal Surgery) (Keynote Speaker, Nottingham, United Kingdom) 17:05 - 17:20 Q&A.	South Hall 2A
	"Thursday 05 September" Added to your list of favorites Deleted from your list of favorites F28 16:30 - 17:20 EXPERT OPINION DISCUSSION Research Priorities in RA Chairperson: Geert-Jan VAN GEFFEN (Anesthesiologist) (Chairperson, NIjmegen, The Netherlands) 16:30 - 16:35 Introduction. Geert-Jan VAN GEFFEN (Anesthesiologist) (Keynote Speaker, NIjmegen, The Netherlands) 16:35 - 16:50 Research Priorities in RA. Alan MACFARLANE (Consultant Anaesthetist) (Keynote Speaker, Glasgow, United Kingdom) 16:50 - 17:05 Research Priorities in RA. Kariem EL BOGHDADLY (Consultant) (Keynote Speaker, London, United Kingdom) 17:05 - 17:20 Q&A.	South Hall 2B
	"Thursday 05 September" Added to your list of favorites Deleted from your list of favorites A26 16:30 - 17:40 PANEL DISCUSSION Injectable Pharmacology for the Interventional Pain Physician CHRONIC PAIN MANAGEMENT Chairperson: Dan Sebastian DIRZU (consultant, head of department) (Chairperson, Cluj-Napoca, Romania) 16:30 - 16:45 #43467 - A26 Steroid formulations. Steroid formulations. Steroid injections are commonly used by interventional pain physicians to manage pain, inflammation, and other symptoms associated with various conditions, including spinal and peripheral blocks. Steroids typically function by inhibiting the rate-limiting step carried out by the enzyme PLA2, which releases arachidonic acid from cell membranes. Arachidonic acid then participates in the activation of cyclo-oxygenase (blocked by non-steroidal anti-inflammatory drugs) and the production of lipoxygenase enzymes. These enzymes subsequently increase the levels of hyperalgesic prostaglandins, thromboxanes, and leukotrienes, all of which contribute to inflammation and pain. Additionally, steroids are believed to have actions beyond their effects on the inflammatory cascade. Methylprednisolone, for example, has been shown to inhibit transmission in thin unmyelinated C-fibers while not affecting myelinated Aβ fibers, likely due to a direct membrane-stabilizing effect rather than an indirect action through mediators. These combined direct and indirect effects reduce intraneural edema and venous congestion, thereby alleviating ischemia and improving pain. Currently, particulate steroids (methylprednisolone acetate, triamcinolone, betamethasone) as well as non-particulate (dexamethasone) are the commonest formulations utilised in pain management. A study by Derby and colleagues documented the size and aggregation of corticosteroids used in epidural injections. They found that only dexamethasone and methylprednisolone have particles consistently smaller than a red blood cell (7.5–7.8 µm) but noted that methylprednisolone tends to aggregate and pack densely, potentially causing emboli and blocking small arterioles, whereas dexamethasone does not. It is also noteworthy that dexamethasone is a water-soluble preparation (thus it can be administered intravenously), while methylprednisolone is a suspension. Although dexamethasone is technically particulate, it is generally deemed safer because it is water-soluble, does not aggregate densely, and is considered non-particulate in the context of chronic pain management. Potential side effects include local tissue atrophy, increased blood sugar levels, and potential systemic effects with repeated use such as adrenal suppression, osteoporosis and increased risk of infection. Spinal cord injuries have been reported following cervical and lumbar transforaminal injections. Various mechanisms have been proposed for these injuries, including direct trauma to the cord, infarction of the cord from the injection of particulate steroid suspension into the vertebral artery or a radicular or communicating artery, compression of the cord due to epidural hematoma or abscess, and infarction caused by vascular spasm or compression of vasculature after the injection of a large volume of injectate. The prevailing hypothesis suggests that the injection of particulate steroid suspension into a small artery leads to the development of anterior spinal artery syndrome, making it difficult to rule out intra-arterial placement with contrast. No serious complications have been linked to the use of non-particulate steroids. Current guidelines suggest that below the level of L3 the vascular risk is smaller, and that particulate steroids still have a place. Although steroid formulations are a valuable tool in the management of pain and inflammation for the interventional pain physicians, the selection of the appropriate steroid formulation requires careful consideration to avoid potential complications and side effects. References Kim SJ, Park JM, Kim YW, Yoon SY, Lee SC. Comparison of Particulate Steroid Injection vs Nonparticulate Steroid Injection for Lumbar Radicular Pain: A Systematic Review and Meta-analysis. Arch Phys Med Rehabil. Published online January 17, 2024. doi:10.1016/j.apmr.2024.01.002 Cohen SP, Greuber E, Vought K, Lissin D. Safety of Epidural Steroid Injections for Lumbosacral Radicular Pain: Unmet Medical Need. Clin J Pain. 2021;37(9):707-717. doi:10.1097/AJP.0000000000000963 Neil Collighan, Sanjeeva Gupta, Epidural steroids, Continuing Education in Anaesthesia Critical Care & Pain, Volume 10, Issue 1, February 2010, Pages 1–5, https://doi.org/10.1093/bjaceaccp/mkp043 Derby R, Lee S-H, Date ES, Lee J-H, Lee C-H. Size and aggregation of corticosteroids used for epidural injections. Pain Med 2008; 9: 227–34 Van Boxem K, Rijsdijk M, Hans G, et al. Safe Use of Epidural Corticosteroid Injections: Recommendations of the WIP Benelux Work Group. Pain Pract. 2019;19(1):61-92. doi:10.1111/papr.12709 Martina REKATSINA (Athens, Greece) 16:45 - 17:00 Local anaesthetic. Dan Sebastian DIRZU (consultant, head of department) (Keynote Speaker, Cluj-Napoca, Romania) 17:00 - 17:15 The Use of iodinated Contrast Agents in Interventional Pain Procedures. Ovidiu PALEA (head of ICU and Pain Department) (Keynote Speaker, Bucharest, Romania) 17:15 - 17:30 The use of Gadolinium and the risk of neurotoxicity with interventional pain procedures. David PROVENZANO (Faculty) (Keynote Speaker, Bridgeville, USA) 17:30 - 17:40 Q&A.	CONGRESS HALL
	"Thursday 05 September" Added to your list of favorites Deleted from your list of favorites B26 16:30 - 17:20 PRO CON DEBATE Neurolytic blocks for CNMP Chairperson: Andrzej DASZKIEWICZ (anesthesiologist) (Chairperson, Cieszyn, Poland) 16:30 - 16:35 Introduction. Andrzej DASZKIEWICZ (anesthesiologist) (Keynote Speaker, Cieszyn, Poland) 16:35 - 16:50 For the PROs. Graham SIMPSON (Consultant in Anaesthetics and Pain Management) (Keynote Speaker, EXETER, United Kingdom) 16:50 - 17:05 For the CONs. Michal BUT (Consultant pain clinic) (Keynote Speaker, Koszalin, Poland) 17:05 - 17:20 Q&A.	PANORAMA HALL
	"Thursday 05 September" Added to your list of favorites Deleted from your list of favorites C26 16:30 - 17:40 EXPERT OPINION DISCUSSION Abdominal blocks Chairperson: Gernot GORSEWSKI (Bereichsleitender Oberarzt für Regionalanästhesie & Akutschmerztherapie) (Chairperson, Feldkirch, Austria) 16:30 - 16:35 Introduction. Gernot GORSEWSKI (Bereichsleitender Oberarzt für Regionalanästhesie & Akutschmerztherapie) (Keynote Speaker, Feldkirch, Austria) 16:35 - 16:50 #43465 - C26 Anterior QLB For which surgery should we use it. Anterior QLB For which surgery should we use it. Anterior QLB: For which surgery should we use it? Steve Coppens^1,2, , Liesbeth Brullot¹, Antonio Iaculli¹, Sara Ribeiro¹ ,Danny Feike Hoogma^1,2 1 Department of Anesthesiology, University Hospitals of Leuven, Leuven, Belgium 2 Department of Cardiovascular Sciences, Biomedical Sciences Group, University of Leuven, Leuven, Belgium * Correspondence to: Steve Coppens Department of Anesthesiology Leuven, Belgium steve.coppens@uzleuven.be Twitter: @Danny_Hoogma, @Steve_Coppens Introduction Enhanced recovery with focus on quick recovery and increasing mobilisation of the patients are considered pivotal in current up to date surgical pathways. In combination with ever shifting minimal invasive surgical techniques this has changed the postoperative pain management drastically. Multimodal analgesia has become the cornerstone of postoperative pain management, with an increasing emphasis on developing procedure-specific recommendations and guidelines. Regional anesthesia also still plays a crucial role in this multimodal approach, enhancing pain control while minimizing opioid consumption and associated side effects. While regional is still key, the thoracic epidural anesthesia is no longer considered the gold standard. Instead, the focus has shifted to other techniques, the fascial plane blocks. However, the efficacy of these methods remains a subject of debate. Initially, studies on these blocks showed increasingly beneficial effects, but the number of studies reporting neutral outcomes has increased over time . This can be attributed to the fact that most wall blocks, primarily target somatic pain originating from the abdominal wall. These blocks do not facilitate the spread of local anesthetics to the paravertebral space, leaving the ventral branches of the spinal nerves, which transmit visceral pain, unaffected. In the course of this editorial we will examine the quadratus lumborum blocks and their impact on surgery at this moment. Discussion The Quadratus lumborum blocks (QLB) were first described by Blanco et al in 2007.[1] Three to even four modifications were made (QLB 1,2,3 and even a 4^th not universally accepted) Recently a delphi consensus paper to standardize nomenclature consolidated more anatomical precise nomenclature (Posterior, Lateral and Anterior QLB)[2] A systematic review of the evidence was published 4 years ago. Unfortunately heterogeneity, risk of bias and lack of results when compared to the other fascial plane blocks resulted in a sobering conclusion. Moreover most trials were performed using one of the three techniques without enough thorough background or anatomical sense. More research was definitely needed.[3] The lateral Quadratus lumborum block (LQLB) was the first of the proposed variations. It’s exact injection point is actually similar to a posterior transverse abdominis plane block (TAP). Initial trials showed efficacy compared to placebo or no regional techniques.[4]In anatomical view it targets the thoracolumbar fascia at the lateral border of the quadratus lumborum muscle next to the aponeurosis formed of the abdominal wall muscles (external and internal oblique and transverse abdominis) It lies extremely close to the fascia transversalis too. (See figure) Most of these studies involved postoperative pain following caesarean section. The procedure-specific postoperative pain management (PROSPECT) still has the (lateral) QLB as a recommendation in its current update.[5] In more recent double blinded trials investigating colorectal surgery with correct blinding methods the results were less positive. [6]This ineffectiveness is likely due to advances in minimally invasive surgical techniques. Laparoscopic surgery, with increased use of low flow/low pressure pneumoperitoneum and fewer entrance ports, has significantly reduced the severity of somatic wall pain. However, these advancements have not mitigated visceral pain, which remains largely unaffected and still requires systemic opioids for effective management. Figure 1 Injection points of all in close proximity, figure copyright of UZ Leuven LOCAL group. FT: fascia transversalis; Post TAP : posterior transversus abdominus plane ; LQLB : lateral quadradus lumborum block The posterior quadratus lumborum block (PQLB) was a second variation and the injection point is the posterior border of the quadratus lumborum muscle, next to the transverse process and the erector spinae muscle group. In this regards it could be considered as an early variant of the erector spinae plane block. The PQLB has been used for almost all the same indications as the lateral version. This includes abdominal, gynaecological and renal surgery. A recent systematic review looking only at this posterior version again identified the huge research gaps. Bias, heterogeneity and lack of effect when compared to other more effective techniques like intrathecal morphine.[7] In our expert opinion the posterior technique lacks anatomical backing targeting mostly the posterior rami in the thoracolumbar fascia. It is therefor also probably the least investigated technique and should probably be avoided altogether. An emerging alternative was the anterior quadratus lumborum block (AQLB), first described by Borglum et al. and also previously known as the transmuscular quadratus lumborum block (TQLB or QLB3).[8] (see figure 2) The AQLB potentially offers superior postoperative pain control. Analgesia from an AQLB is achieved through the paravertebral and craniocaudal spread of local anesthetics, which cover the lateral cutaneous branches of the thoracoabdominal nerves T4-T12/L1 (ventral rami) . Several cadaveric studies have demonstrated that the dye used in AQLB spreads into the thoracic paravertebral space, intercostal spaces surrounding somatic nerves, and even the thoracic sympathetic trunk. Figure 2 Injection points of AQLB with spread , figure copyright of UZ Leuven LOCAL group. PMM: psoas major muscle; QLM : Quadratus lumborum muscle ; ESM: Erector spinae muscle group Despite its potential, clinical evidence supporting the efficacy of the AQLB remains limited, consisting primarily of small studies and case reports focused on caesarean sections and kidney surgeries.[9–11] More extensive clinical trials are still needed to establish the AQLB's effectiveness in providing better postoperative pain management across various surgical fields. Unfortunately more recent trials examining the efficacy of the AQLB in colorectal surgery have shown no effect when compared to placebo.[12,13] At this moment we cannot recommend the addition of this block to any other mid to upper abdominal surgery either. Especially because the QLB’s also have their fare share of caveats. First of all the AQLB is considered a deep block by recent regional guidelines.[14] This removes one of the essential advantages fascial plane blocks have over neuraxial techniques, namely safety. Indeed when using ultrasound doppler; as recommended; the steep slope to advance the needle into the AQLB position is often dotted with lumbar arteries. Secondly patient positioning in both lateral right/left decubitus position for needling adds a layer of difficulty and challenge to the technique. It is also time-consuming and does not add to patient comfort. Thirdly, needling in a steep position with a curvilinear probe requires a great deal of experience or training. Fourthly obese patients could add a whole extra layer of challenge to these already significant downsides. The fourth modified QLB was the so-called intramuscular (in the psoas major muscle) or QLB4. As we see no indication for this block, it is potentially dangerous targeting the lumbar plexus without good identification and also leads to a motor block we can not support the use of this block, nor endorse any clinical indication for it. It is best omitted from any practice setting in our opinion. There are a few specific niche indications which we would like to elaborate further on. The AQLB frequently covers dermatomes at L1 up to T10 covering much of the anterior hip and lateral iliac crest region. As such some have proposed to use this block for iliac bone grafting.[15] In our clinical experience we have often used this as rescue block in postoperative care units when bone grafting was the primary culprit of pain. It might also be considered as a sole anesthetic technique. The so-called shamrock approach to the lumbar plexus lying in the psoas muscle, is not a QL block, however thorough knowledge of the anatomy helps identify the target quickly. In our clinical practice we use this block for extensive unilateral surgery and pediatric orthopedic cases in combination with catheters. (see figure 3) This technique was common knowledge for some, however got attention trough the paper by Sauter et al.[16] Figure 3 Injection points of lumbar plexus using shamrock sign , figure copyright of UZ Leuven LOCAL group. Conclusion The QLB disperses local anesthetic broadly, typically achieving sensory inhibition from T7 to L1. This should make it effective for postoperative pain relief in the abdominal and pelvic areas. Consequently, QLBs are commonly utilized to manage pain following abdominal, obstetric, gynaecologic, and urologic surgeries. Evidence is poor however and apart from its use in post caesarean pain relief there are no hard recommendations. The anterior QLB still remains the most likely anatomical candidate for postoperative pain relief. Using the shamrock sign to identify lumbar plexus, or using its unique sensory block at the hip and iliac crest for bone graft surgery are specific indications that need more research. It remains an expert technique requiring significant experience and should not be considered as a first line option in regional anesthesia for postsurgical pain. References 1. Blanco R. Tap block under ultrasound guidance: the description of a “no pops” technique. Regional Anesthesia & Pain Medicine 2007; 32: 130. 2. El-Boghdadly K, Wolmarans M, Stengel AD et al. Standardizing nomenclature in regional anesthesia: an ASRA-ESRA Delphi consensus study of abdominal wall, paraspinal, and chest wall blocks. Regional Anesthesia & Pain Medicine 2021; 46: 571–80. 3. Uppal V, Retter S, Kehoe E, McKeen DM. Quadratus lumborum block for postoperative analgesia: a systematic review and meta-analysis. Canadian Journal of Anesthesia/Journal canadien d’anesthésie 2020; 67: 1557–75. 4. Blanco R, Ansari T, Girgis E. Quadratus lumborum block for postoperative pain after caesarean section: A randomised controlled trial. European journal of anaesthesiology 2015; 32: 812–8. 5. Barazanchi AWH, MacFater WS, Rahiri JL et al. Evidence-based management of pain after laparoscopic cholecystectomy: a PROSPECT review update. British Journal of Anaesthesia, 2018. 6. Dewinter G, Coppens S, Van de Velde M et al. Quadratus lumborum block versus perioperative intravenous lidocaine for postoperative pain control in patients undergoing laparoscopic colorectal surgery: A Prospective, Randomized, Double-blind Controlled Clinical Trial. Annals of Surgery 2018; 268: 769–75. 7. Lin C, Wang X, Qin C, Liu J. Ultrasound-Guided Posterior Quadratus Lumborum Block for Acute Postoperative Analgesia in Adult Patients: A Meta-Analysis of Randomized Controlled Trials. Therapeutics and clinical risk management 2022; 18: 299–313. 8. Børglum J, Moriggl B, Jensen K et al. Ultrasound-Guided Transmuscular Quadratus Lumborum Blockade. BJA: British Journal of Anaesthesia 2013; 111. 9. Hansen CK, Steingrimsdottir GE, Dam M et al. Anterior quadratus lumborum catheters for elective cesarean section: A double‐blind, randomized, placebo‐controlled trial. Acta Anaesthesiologica Scandinavica 2024; 68: 254–62. 10. Dam M, Hansen CK, Poulsen TD et al. Transmuscular quadratus lumborum block for percutaneous nephrolithotomy reduces opioid consumption and speeds ambulation and discharge from hospital: a single centre randomised controlled trial. British Journal of Anaesthesia 2019; 123: e350–8. 11. Dam M, Hansen CK, Poulsen TD et al. Transmuscular quadratus lumborum block for percutaneous nephrolithotomy reduces opioid consumption and speeds ambulation and discharge from hospital: a single centre randomised controlled trial. British Journal of Anaesthesia 2019; 123: e350–8. 12. Tanggaard K, Hasselager RP, Hølmich ER et al. Anterior quadratus lumborum block does not reduce postoperative opioid consumption following laparoscopic hemicolectomy: a randomized, double-blind, controlled trial in an ERAS setting. Regional Anesthesia & Pain Medicine 2022: rapm-2022-103895. 13. Coppens S, Somville A, Hoogma DF et al. The effect of anterior quadratus lumborum block on morphine consumption in minimally invasive colorectal surgery: a multicentre, double‐blind, prospective randomised placebo‐controlled trial. Anaesthesia 2024; 79: 54–62. 14. Horlocker TT, Vandermeuelen E, Kopp SL, Gogarten W, Leffert LR, Benzon HT. Regional Anesthesia in the Patient Receiving Antithrombotic or Thrombolytic Therapy: American Society of Regional Anesthesia and Pain Medicine Evidence-Based Guidelines (Fourth Edition). Regional Anesthesia and Pain Medicine, 2018. 15. Sondekoppam R V, Ip V, Johnston DF et al. Ultrasound-guided lateral-medial transmuscular quadratus lumborum block for analgesia following anterior iliac crest bone graft harvesting: a clinical and anatomical study. Canadian journal of anaesthesia = Journal canadien d’anesthesie 2018; 65: 178–87. 16. Sauter AR. The “Shamrock Method” - a new and promising technique for ultrasound guided lumbar plexus blocks. BJA: British Journal of Anaesthesia 2013; 111. Steve COPPENS (Leuven, Belgium) 16:50 - 17:05 Iliopsoas Block: For which surgery should we use it? Thomas Fichtner BENDTSEN (Professor, consultant anaesthetist) (Keynote Speaker, Aarhus, Denmark) 17:05 - 17:20 Q&A.	South Hall 1A
18:00	"Thursday 05 September" Added to your list of favorites Deleted from your list of favorites FP33 18:00 - 19:00 HONOURS & DIPLOMATES CEREMONY 18:00 - 18:03 Introduction. Eleni MOKA (faculty) (ESRA President, Thessaloniki, Greece, Greece) 18:03 - 18:20 PART I of the CEREMONY / ESRA People. 18:20 - 18:35 PART II of the CEREMONY / ESRA European Diploma of Regional Anaesthesia. Morne WOLMARANS (Consultant Anaesthesiologist) (ESRA Board, Norwich, United Kingdom) 18:35 - 18:50 PART III of the CEREMONY / ESRA European Diploma of Pain Medicine. Andrzej KROL (Consultant in Anaesthesia and Pain Medicine) (ESRA Board, LONDON, United Kingdom)	PANORAMA HALL
19:30	DIPLOMATES & TRAINEES RECEPTION


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"Thursday 05 September"

SPECIAL SESSION Nerve injury after regional anesthesia, trauma or surgery - what to do?

"Thursday 05 September"

NETWORKING SESSION State of the art labour analgesia

"Thursday 05 September"

LIVE DEMONSTRATION QLB blocks

"Thursday 05 September"

PRO CON DEBATE Meta-Analyses: Still the ‘Gold Standard’ For Guideline Development?

"Thursday 05 September"

EXPERT OPINION DISCUSSION Lumbar facet denervation - controversies

"Thursday 05 September"

REFRESHING YOUR KNOWLEDGE Efficacy of LIA in various surgical procedures

"Thursday 05 September"

OFF SITE - Hands - On Cadaver Workshop 4 - RA UPPER & LOWER LIMB BLOCKS, TRUNK BLOCKS

"Thursday 05 September"

SIMULATION TRAININGS

"Thursday 05 September"

HANDS - ON CLINICAL WORKSHOP 2 - PAEDIATRIC Blocks for Elective Abdominal Surgery in the Paediatric Patient

"Thursday 05 September"

HANDS - ON CLINICAL WORKSHOP 3 - POCUS Focused Cardiac Ultrasound

"Thursday 05 September"

HANDS - ON CLINICAL WORKSHOP 8 - RA Ultrasound-Guided Fascial Plane Blocks of the Chest Wall

"Thursday 05 September"

HANDS - ON CLINICAL WORKSHOP 9 - RA US Guided PNBs for Arm-Hand and Ankle-Foot Surgery

"Thursday 05 September"

HANDS - ON CLINICAL WORKSHOP 6 - CHRONIC PAIN UG Guided Treatment of Abdominal, Pelvis and Lower Limb Chronic Pain Conditions

"Thursday 05 September"

NETWORKING SESSION Pain assessment beyond pain intensity scales

"Thursday 05 September"

REFRESHING YOUR KNOWLEDGE Cannabinoids

"Thursday 05 September"

LIVE DEMONSTRATION Rheumatoid Arthritis: The Role of US in Diagnosis and Treatment

"Thursday 05 September"

TARA SESSION Exploring Innovations in Migraine and Headache Treatments

"Thursday 05 September"

TIPS & TRICKS Protocols for critical Patients

"Thursday 05 September"

TIPS & TRICKS Clavicle Fracture

"Thursday 05 September"

TIPS & TRICKS For Needle Navigation

"Thursday 05 September"

ePOSTER Session 3 - Station 2

"Thursday 05 September"

ePOSTER Session 3 - Station 3

"Thursday 05 September"

ePOSTER Session 3 - Station 7

"Thursday 05 September"

ePOSTER Session 3 - Station 1

"Thursday 05 September"

ePOSTER Session 3 - Station 6

"Thursday 05 September"

ePOSTER Session 3 - Station 5

"Thursday 05 September"

ePOSTER Session 3 - Station 4

"Thursday 05 September"

Special session The right imaging modality for the right intervention in interventional pain therapy

"Thursday 05 September"

LIVE DEMONSTRATION Ultrasound-Guided invasive treatments for joint pain: Shoulder - Hip - Knee

"Thursday 05 September"

ASK THE EXPERT POCUS on Diaphragm

"Thursday 05 September"

ASK THE EXPERT ESP myths and facts

"Thursday 05 September"

EXPERT OPINION DISCUSSION Setting up a block room

"Thursday 05 September"

TIPS & TRICKS To presonalized treatments

"Thursday 05 September"

EXPERT OPINION DISCUSSION How to teach ultrasound-guided peripheral nerve blocks to residents

"Thursday 05 September"

HANDS - ON CLINICAL WORKSHOP 7 - CHRONIC PAIN US Use in Chronic Pain Medicine - Truncal and Plane Blocks

"Thursday 05 September"

ULTRASOUND GUIDED RA (UGRA) Free Papers 5

"Thursday 05 September"

HANDS - ON CLINICAL WORKSHOP 10 - RA US Guided PNBs for Hip, Femur and Knee Surgery

"Thursday 05 September"

HANDS - ON CLINICAL WORKSHOP 4 - POCUS POCUS - The FAST Examination

"Thursday 05 September"

HANDS - ON CLINICAL WORKSHOP 11 - RA Four Basic Blocks for Knee Surgery

"Thursday 05 September"

HANDS - ON CLINICAL WORKSHOP 12 - RA Basic Peripheral Nerve Blocks in the Obese Patient undergoing Orthopaedic Surgery

SPECIAL SESSION
Nerve injury after regional anesthesia, trauma or surgery - what to do?

NETWORKING SESSION
State of the art labour analgesia

LIVE DEMONSTRATION
QLB blocks

PRO CON DEBATE
Meta-Analyses: Still the ‘Gold Standard’ For Guideline Development?

EXPERT OPINION DISCUSSION
Lumbar facet denervation - controversies

REFRESHING YOUR KNOWLEDGE
Efficacy of LIA in various surgical procedures

OFF SITE - Hands - On Cadaver Workshop 4 - RA
UPPER & LOWER LIMB BLOCKS, TRUNK BLOCKS

HANDS - ON CLINICAL WORKSHOP 2 - PAEDIATRIC
Blocks for Elective Abdominal Surgery in the Paediatric Patient

HANDS - ON CLINICAL WORKSHOP 3 - POCUS
Focused Cardiac Ultrasound

HANDS - ON CLINICAL WORKSHOP 8 - RA
Ultrasound-Guided Fascial Plane Blocks of the Chest Wall

HANDS - ON CLINICAL WORKSHOP 9 - RA
US Guided PNBs for Arm-Hand and Ankle-Foot Surgery

HANDS - ON CLINICAL WORKSHOP 6 - CHRONIC PAIN
UG Guided Treatment of Abdominal, Pelvis and Lower Limb Chronic Pain Conditions

NETWORKING SESSION
Pain assessment beyond pain intensity scales

REFRESHING YOUR KNOWLEDGE
Cannabinoids

LIVE DEMONSTRATION
Rheumatoid Arthritis: The Role of US in Diagnosis and Treatment

TARA SESSION
Exploring Innovations in Migraine and Headache Treatments

TIPS & TRICKS
Protocols for critical Patients

TIPS & TRICKS
Clavicle Fracture

TIPS & TRICKS
For Needle Navigation

Special session
The right imaging modality for the right intervention in interventional pain therapy

LIVE DEMONSTRATION
Ultrasound-Guided invasive treatments for joint pain: Shoulder - Hip - Knee

ASK THE EXPERT
POCUS on Diaphragm

ASK THE EXPERT
ESP myths and facts

EXPERT OPINION DISCUSSION
Setting up a block room

TIPS & TRICKS
To presonalized treatments

EXPERT OPINION DISCUSSION
How to teach ultrasound-guided peripheral nerve blocks to residents

HANDS - ON CLINICAL WORKSHOP 7 - CHRONIC PAIN
US Use in Chronic Pain Medicine - Truncal and Plane Blocks

ULTRASOUND GUIDED RA (UGRA)
Free Papers 5

HANDS - ON CLINICAL WORKSHOP 10 - RA
US Guided PNBs for Hip, Femur and Knee Surgery

HANDS - ON CLINICAL WORKSHOP 4 - POCUS
POCUS - The FAST Examination

HANDS - ON CLINICAL WORKSHOP 11 - RA
Four Basic Blocks for Knee Surgery

HANDS - ON CLINICAL WORKSHOP 12 - RA
Basic Peripheral Nerve Blocks in the Obese Patient undergoing Orthopaedic Surgery

NETWORKING SESSION
Paediatric Anaesthesia
PAEDIATRIC

TIPS & TRICKS
Silver Trauma

ASK THE EXPERT
Challenges in Implementing Regional Anesthesia in Different Settings

ASK THE EXPERT
Lumbar Neuraxial approaches

EXPERT OPINION DISCUSSION
Rethinking Relief: A Second Opinion on Multimodal Approaches to Acute Pain Management

OFF SITE - Hands - On Cadaver Workshop 5 - RA
UPPER & LOWER LIMB BLOCKS, TRUNK BLOCKS

ESRA-ASRA SESSION
Current and future developments

CHRONIC PAIN MANAGEMENT
Free Papers 6

PRO CON DEBATE
Do we still need cadaver lab to teach regional anaesthesia and pain procedures?

REFRESHING YOUR KNOWLEDGE
Pharmacology

PRO CON DEBATE
Spinal injections in the treatment of spinal canal stenosis

LIVE DEMONSTRATION
Spinal Pain Ultrasound Guided Targets

ASK THE EXPERT
Fascial plane blocks

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AI our future for good

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Cervical Blocks

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US Guided RA Techniques for Breast Surgery

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Fascial Plane Blocks for Abdominal Surgery

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Tips and Tricks for fluoroscopic procedures

"Mini" HANDS - ON CLINICAL WORKSHOP 22
UGRA for Ankle and Foot Surgery

"Mini" HANDS - ON CLINICAL WORKSHOP 23
Clavicular Fractures: What RA technique is the best?

"Mini" HANDS - ON CLINICAL WORKSHOP 24
Peripheral Nerve Blocks for Analgesia in Hip Fracture Surgery

"Mini" HANDS - ON CLINICAL WORKSHOP 25
Sono Anatomy of the Paediatric Spine

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Caudal block in the Paediatric Population

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Improving presentations by AI

"Mini" HANDS - ON CLINICAL WORKSHOP 28
Basic Blocks for Ophthalmic Surgery

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Fascia Iliaca Compartment Block

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PNBs in the trauma patient

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PNBs in massive disaster circumstances

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Blocks for Awake Shoulder Surgery: Tips and Tricks for Success

"Mini" HANDS - ON CLINICAL WORKSHOP 33
Basic Blocks for Pain Free Knee Surgery

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Tips and Tricks for Successful QLB