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Wednesday 04 September
Time	CONGRESS HALL	PANORAMA HALL	South Hall 1A	South Hall 1B	South Hall 2A	South Hall 2B	Small Hall	NORTH HALL	CHAMBER HALL	CLUB B
08:00	08:00-09:50 Added to your list of favorites Deleted from your list of favorites A10 NETWORKING SESSION Emerging Concepts NETWORKING SESSION Emerging Concepts CHRONIC PAIN MANAGEMENT Chairperson: Giustino VARRASSI (President) (Chairperson, Roma, Italy) 08:00 - 08:05 Introduction. Giustino VARRASSI (President) (Keynote Speaker, Roma, Italy) 08:05 - 08:27 #43302 - A10 Immunotherapy and Chemotherapy Treatment: Do They Influence Pain Therapeutic Modalities/. Immunotherapy and Chemotherapy Treatment: Do They Influence Pain Therapeutic Modalities/. Although progress in cancer treatment and awareness for cancer pain has significantly increased over the last years, the prevalence of cancer pain is still high. The data shows that 1/3 of patients during their treatment and more than half with advanced disease experience moderate to severe pain. ¹ Cancer pain can be characterized as Visceral, Somatic, Neuropathic, and may result from various reasons, including tumor spread in contiguous tissues, metastasis ( bone), cancer treatment ( chemotherapy, radiation, surgery) Chemotherapy is along with surgery the first line of treatment for malignant neoplasms. Chemotherapeutic agents have cytotoxic properties and are used to stop the growth and division of cancer cells but at the same time affect healthy cells causing significant side effects. In relation to pain the most significant side effect, is Chemotherapy Induced Peripheral Neuropathy (CIPN). To understand how chemotherapy treatment influences the pain therapeutic modalities we have to evaluate the mechanisms that cause CIPN and develop mechanistic approaches for its treatment. There are peripheral mechanisms that contribute to the development of CIPN with alterations in the DRG involving activation of protein kinases A and C, PI3/AKT pathway, as well as increased expression of various pro-inflammatory cytokines such as IL1, IL 1-a, IL1-b, IL6, TNF a, CXCL1. Preclinical studies demonstrated that there is an increased expression of the Transient Receptor Potential (TRP) channels TRPV1 and TRPV4 in the DRG eluding in their possible role in CIPN. Voltage gated sodium channels such as Nav1.7 and Nav1.8 play a significant role in the transmission of pain-related signals. Chemotherapy causes activation and increased expression of the Nav1.7 and Nav 1.8 channels in the peripheral nerve terminals and the DRG, contributing to chemotherapy induced pain. It has been demonstrated in preclinical studies that chemotherapy also causes depolarization of potassium channels in peripheral sensory neurons increasing their excitation, as well as increased expression of d-1calcium channels leading to exacerbation of pain.² Mitochondrial damage, oxidative stress, inhibition of transcription factors are additional peripheral mechanisms contributing to the development of CIPN. Spinal mechanisms of CIPN include similarly activation of ion channels, transcription factors, inflammatory mediators, immune regulation on nociceptive signal transmission.² Supraspinal regions such as the amygdala, anterior cingulate cortex and prefrontal cortex NMDA receptors, are involved in chemotherapy induced pain.^3,4 Pharmacological treatment recommended based on the above mechanisms for the development of CIPN include nerve-protective therapy with Erythropoietin, N-acetylcysteine, ion channel targeted therapies, with medications such as Lidocaine, Mexiletine, Gabapentin, Pregabalin, Magnesium, Anti-inflammatory therapy with Metformin, minocycline, Neurotransmitter-based therapy with medications such as Venlafaxine, Duloxetine, and Tricyclic Antidepressants and Antioxidants.⁵ Immunotherapy is based in the appreciation of the whole tumor microenvironment, and it is a rapidly advancing field in cancer therapeutics. The discovery of tumor biomarkers derived from the tumor microenvironment can lead to a shift from the pre-existing immune response to a therapy induced individualized immune response.⁶ Immunotherapy may cause sometimes significant inflammation and immune related adverse events are mostly induced by agents known as immune check point inhibitors (ICI). Occasionally there is a need for an immunosuppressant such as a steroid to attenuate the inflammation at a safer level. Tapering of the steroid course must be quick to avoid risk of infection. The adverse events from immunotherapy when severe may cause pain. The Society for Immunotherapy of Cancer (SITC) Toxicity Management Working Group has developed recommendations for managing toxicities associated with ICI.⁷ Most common ones are hepatobiliary adverse events such as liver, pancreatic toxicities and gallbladder injury. Additionally endocrine adverse events such as hypophysitis and thyrotoxicosis, and pulmonary as well as rheumatologic/musculoskeletal adverse events may be developed. Pain in the above circumstances is treated by applying the WHO algorithm limiting the use of acetaminophen and NSAIDS when appropriate. Also it is important to be mindful of their antipyretic effect that could be masking an underlying infection in the immunosuppressed cancer patients. During chemotherapy/ immunotherapy cancer pain is treated mostly with medications and non-drug treatment options. Interventional therapies are limited due to the risk of infection and bleeding due to chemotherapy induced immunosuppression and thrombocytopenia. While pharmacotherapy is effective for the treatment of mild to moderate and even severe pain when opioids are used the development of tolerance overtime may render it ineffective. It is important to mention that several interventional procedures such as intrathecal drug delivery, or spinal cord and peripheral nerve stimulation amongst others can improve pain control. Although the application of the intrathecal drug delivery systems (IDDS) remains underutilized in patients with cancer pain its effectiveness has been established for significantly improving cancer pain as well as decreasing the risks of adverse events from chronic opioid use.⁸More studies are currently conducted to improve the evidence of the efficacy, the cost effectiveness, risk mitigation, and to establish a common approach for the use of IDDS to improve cancer pain.⁹ References 1) Marieke H. J. van den Beuken-van Everdingen et al. Treatment of Pain in Cancer: Towards Personalized Medicine. Cancers (Basel), 2018 Dec; 10 (12) :502 2) Yuhao Xu et al. Mechanisms underlying paclitaxel-induced neuropathic pain : Channels, Inflammation and Immune regulations. European Journal of Pharmacology, 933 (2022) 1752888 3) Liu J et al. Glutaminergic neurons in the amygdala are involved in Paclitaxel -induced pain and anxiety, Front Psychiatr.13, 869544 4) Liang L et al. Paclitaxel induces sex-biased behavioral deficits and changes in gene expression in mouse prefrontal cortex. 2020, Neuroscience 426, 168-178 5) Lang-Yue Hu et al. Prevention and Treatment for Chemotherapy-Induced Peripheral Neuropathy: Therapies based on CIPN Mechanisms. Current Neuropharmacology, 2019, 17,184-196 6) Wolf H Fridman et al. The immune contexture in cancer prognosis and treatment. Nature Reviews, CLINICAL ONCOLOGY, Volume 14, December 2017,717 7) Puzanov I et al. Managing toxicities associated with immune checkpoint inhibitors: consensus recommendations from the Society for Immunotherapy of Cancer (SITC) Toxicity Management Working Group. Journal of ImmunoTherapy of Cancer (2017) 5:95 8) Rui Duarte et al. Effectiveness and Safety of Intrathecal Drug Delivery Systems for the Management of Cancer Pain: A Systematic Review and Meta-Analysis. Neuromodulation 2023; 26:11-26-1141 9) Shane E Brogan et al. Controversies in Intrathecal Drug Delivery for Cancer Pain. Reg Anesth Pain Med 2023; 48:319-325. Efrossini (Gina) VOTTA-VELIS (Chicago, USA) 08:27 - 08:49 Helping cancer survivor in pain: pre-habilitation, rehabilitation, interventions. Oscar DE LEON CASASOLA (Chief, Division of Pain Medicine and Pain Fellowship Director) (Keynote Speaker, Buffalo, USA) 08:49 - 09:11 Evidence for the efficacy of interventional pain procedure for cancer pain. Magdalena ANITESCU (Professor of Anesthesia and Pain Medicine) (Keynote Speaker, Chicago, USA) 09:11 - 09:33 Intrathecal Drug Delivery for Cancer Pain (ITTDS) /. Denis DUPOIRON (Head of Department) (Keynote Speaker, Angers, France) 09:33 - 09:50 Q&A.	08:00-08:50 Added to your list of favorites Deleted from your list of favorites B10 ROUND TABLE DISCUSSION Evolution and Current Trends in Regional Anesthesia ROUND TABLE DISCUSSION Evolution and Current Trends in Regional Anesthesia Chairperson: Nadia HERNANDEZ (Associate Professor of Anesthesiology) (Chairperson, Houston, Texas, USA) 08:00 - 08:02 Introduction. Nadia HERNANDEZ (Associate Professor of Anesthesiology) (Keynote Speaker, Houston, Texas, USA) 08:02 - 08:16 Prospects for the Future of Continuous Nerve Blocks: A Promising Outlook? Clara LOBO (Medical director) (Keynote Speaker, Abu Dhabi, United Arab Emirates) 08:16 - 08:30 Revolutionary and Time-Tested Medications Sustaining Nerve Block Effectiveness. Maria Paz SEBASTIAN (Anaestheics and Acute Pain) (Keynote Speaker, London, United Kingdom) 08:30 - 08:44 Emerging technologies in peripheral nerve blocks. Graeme MCLEOD (Professor) (Keynote Speaker, Dundee, United Kingdom) 08:44 - 08:50 Discussion.			08:00-09:50 Added to your list of favorites Deleted from your list of favorites E10 NETWORKING SESSION State of the art anaesthesia for CS NETWORKING SESSION State of the art anaesthesia for CS Chairperson: Nuala LUCAS (Speaker) (Chairperson, London, United Kingdom) 08:00 - 08:05 Introduction. Nuala LUCAS (Speaker) (Keynote Speaker, London, United Kingdom) 08:05 - 08:27 Neuraxial techniques for elective CS. Nicoletta FILETICI (Consultant anesthesiologist) (Keynote Speaker, Rome, Italy) 08:27 - 08:49 Neuraxial techniques for emergency CS. Jan BLAHA (Head of the Department) (Keynote Speaker, Praha 2, Czech Republic) 08:49 - 09:11 Choice of vasopressor. Kassiani THEODORAKI (Anesthesiologist) (Keynote Speaker, Athens, Greece) 09:11 - 09:33 Post CS analgesia. Eva ROOFTHOOFT (Anesthesiologist) (Keynote Speaker, Haacht, Belgium) 09:33 - 09:50 Q&A.
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09:00		09:00-09:50 Added to your list of favorites Deleted from your list of favorites B10.1 ASK THE EXPERT POCUS is ultrasound ASK THE EXPERT POCUS is ultrasound Chairperson: Mariana CORREIA (Consultant) (Chairperson, Lisboa, Portugal) 09:00 - 09:05 Introduction. Mariana CORREIA (Consultant) (Keynote Speaker, Lisboa, Portugal) 09:05 - 09:35 Lung ultrasound pocus. Wolf ARMBRUSTER (Head of Department, Clinical Director) (Keynote Speaker, Unna, Germany) 09:35 - 09:50 Q&A.	09:00-09:30 Added to your list of favorites Deleted from your list of favorites C10 TIPS & TRICKS Blocks in the ICU TIPS & TRICKS Blocks in the ICU Chairperson: Thomas WIESMANN (Head of the Dept.) (Chairperson, Schwäbisch Hall, Germany) 09:00 - 09:05 Introduction. Thomas WIESMANN (Head of the Dept.) (Keynote Speaker, Schwäbisch Hall, Germany) 09:05 - 09:25 RA Blocks in the ICU. Lukas KIRCHMAIR (Chair) (Keynote Speaker, Schwaz, Austria) 09:25 - 09:30 Q&A.	09:00-09:50 Added to your list of favorites Deleted from your list of favorites D10 ASK THE EXPERT World at war: benefits, advantages and pitfalls of early analgesic procedures ASK THE EXPERT World at war: benefits, advantages and pitfalls of early analgesic procedures Chairperson: Dmytro DMYTRIIEV (medical director) (Chairperson, Vinnitsa, Ukraine) 09:00 - 09:05 Introduction. Dmytro DMYTRIIEV (medical director) (Keynote Speaker, Vinnitsa, Ukraine) 09:05 - 09:35 Continuous peripheral nerves/ fascial planes catheters. Patrick SCHULDT (Consultant) (Keynote Speaker, Uppsala, Sweden) 09:35 - 09:50 Q&A.		09:00-09:50 Added to your list of favorites Deleted from your list of favorites F11 SECOND OPINION BASED DISCUSSION The best management of post amputation pain SECOND OPINION BASED DISCUSSION The best management of post amputation pain Chairperson: Pavel MICHALEK (Deputy Director for Science, Research and Education) (Chairperson, Praha, Czech Republic) 09:00 - 09:10 Does Epidural still have a role in managing post amputation pain? Michal VENGLARCIK (Head of anesthesia) (Keynote Speaker, Banska Bystrica, Slovakia) 09:10 - 09:20 Local anesthetic peripheral nerves catheters. Andrzej KROL (Consultant in Anaesthesia and Pain Medicine) (Keynote Speaker, LONDON, United Kingdom) 09:20 - 09:30 Stimulating catheters placement: at which stage? Ashish GULVE (Consultant in Pain Medicine) (Keynote Speaker, Middlesbrough, United Kingdom) 09:30 - 09:40 Conclusion. Pavel MICHALEK (Deputy Director for Science, Research and Education) (Keynote Speaker, Praha, Czech Republic) 09:40 - 09:50 Q&A Discussion.	09:00-09:30 Added to your list of favorites Deleted from your list of favorites G11 REFRESHING YOUR KNOWLEDGE - TARA SESSION Headache REFRESHING YOUR KNOWLEDGE - TARA SESSION Headache Chairperson: Sarah LOVE-JONES (Anaesthesiology) (Chairperson, Bristol, United Kingdom) 09:00 - 09:05 Introduction. Sarah LOVE-JONES (Anaesthesiology) (Keynote Speaker, Bristol, United Kingdom) 09:05 - 09:25 Updates on interventional approaches to intractable headache. Samer NAROUZE (Professor and Chair) (Keynote Speaker, Cleveland, USA) 09:25 - 09:30 Q&A.	09:00-11:00 Added to your list of favorites Deleted from your list of favorites H11 SIMULATION TRAININGS SIMULATION TRAININGS Demonstrators: Josip AZMAN (Consultant) (Demonstrator, Linkoping, Sweden), Clara LOBO (Medical director) (Demonstrator, Abu Dhabi, United Arab Emirates), Roman ZUERCHER (Senior Consultant) (Demonstrator, Basel, Switzerland)
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09:35			09:35-10:00 Added to your list of favorites Deleted from your list of favorites C11 TIPS & TRICKS In Obstetric Anesthesia TIPS & TRICKS In Obstetric Anesthesia Chairperson: Suwimon TANGWIWAT (Staff anesthesiologist) (Chairperson, Bangkok, Thailand) 09:35 - 09:38 Introduction. Suwimon TANGWIWAT (Staff anesthesiologist) (Keynote Speaker, Bangkok, Thailand) 09:38 - 09:55 #43474 - C11 Primum non nocere: unresolved issues in obstetric anesthesia. Primum non nocere: unresolved issues in obstetric anesthesia. 3 important issues in obstetric anesthesia: future directions for obstetric anaesthesia research. Alexandra M.J.V. Schyns-van den Berg The relationship between childbirth and anaesthesia has a rich history. In January 1847, just 3 months after the first public demonstration of ether anaesthesia by William Morton in Boston, James Young Simpson in Scotland used ether to provide pain relief during childbirth. Within a few years, inhalation analgesia with chloroform during labour became acceptable in the UK, not only providing pain relief but also facilitating surgical caesarean delivery during obstructed labour. Today, obstetric anaesthesia extends far beyond the provision of analgesia and anaesthesia during childbirth. In countries where anaesthesiology collaborates actively with obstetricians, it has evolved into a subspecialty which contributes to high qualitative obstetric care for both healthy and high-risk obstetric patients. Pain relief methods reduce the burden of delivery, obstetric intensive care optimizes treatment for severely ill pregnant patients, and advanced anaesthesia techniques facilitate interventions crucial for successful pregnancies and optimal outcomes for both mother and child. Obstetric anaesthesiologists aim to minimally interfere with the natural course of childbirth. Contemporary techniques for labour analgesia, refined over the years, are based on optimized techniques, delivery methods and drugs. This has resulted in minimal effects on clinical progress. Recent studies show that the incidence of instrumental deliveries is no longer increased, and the duration of the first and second stage of labour is only minimally affected.^1,2 Providing effective labour analgesia that ensures patient comfort and security while optimizing clinical outcomes and patient satisfaction requires a delicate anaesthesiologic balancing act. In the era of social media, effective communication with patients, partners and professionals should include strategies to educate, manage patients’ expectations and combat misinformation. Potential side effects of the various analgesia options should be discussed and, where possible, prevented. Despite advancements, several important issues in obstetric anaesthesia remain insufficiently understood. 1. Neuraxial analgesia interference with the natural course of labour. Epidural and combined spinal-epidural analgesia are regarded as the optimal methods for managing labour pain, offering superior pain relief with minimal adverse effects and leading to greater maternal comfort and satisfaction compared to alternative techniques. However, the impact of neuraxial analgesia on uterine activity (UA) and contraction frequency remains poorly understood and challenging to measure directly. Historically, epidural analgesia (EDA) was associated with increased rates of instrumental delivery, more frequent use of oxytocin for labour augmentation, and a longer duration of the first and second stage of labour. Contemporary neuraxial techniques, novel drug delivery regimens and the use of lower concentrations of local anaesthetics and opioids have largely mitigated these effects, though an increased need for oxytocin augmentation persists without a clear causal relationship established. Direct measurements of UA following EDA initiation have yielded inconsistent results, with recent studies reporting decreased, unchanged, or enhanced UA.^3–5 These conflicting findings may be attributed to variations in clinical settings, EDA drug compositions, and UA measurement methods. Current obstetric practice mostly relies on external tocodynamometry (TOCO) for UA monitoring, despite its limitations in accuracy and reliability, as the more precise but invasive intrauterine pressure catheters (IUPC) have associated risks which preclude routine use. A recently developed non-invasive monitoring technique which measures the myometrial electrical activity, electrohysterography (EHG), shows promise in providing more accurate and reliable UA measurements compared to TOCO.^6,7EHG may provide a new opportunity to enhance our understanding of the relationship between EDA and UA, potentially leading to improved monitoring and management of labour. 2. Maternal fever during epidural analgesia. The mechanisms causing maternal fever in some patients during epidural analgesia are still incompletely understood, which prevents the development of preventive measures. Maternal fever, defined as a temperature ³ 38⁰C, occurs in approximately 20% of women receiving epidural labour analgesia, with an increased incidence with a longer exposure to EDA. Similarly to infectious fever, there is an underlying primary inflammatory mechanism, with increased risks possibly related to a preexisting inflammatory state. Epidural-associated maternal fever (EAMF) is associated with adverse maternal outcomes such as increased duration of labour, oxytocin augmentation and instrumental delivery, but causality has not been established and unknown confounding factors may be present.^8,9It is accompanied by a higher rate of maternal antibiotic administration, contributes to peripartum anxiety and discomfort and neonates are at increased risk of neonatal sepsis evaluations and neonatal intensive care admission due to fetal tachycardia and hyperthermia. Hyperthermia and inflammation can be independently or synergistically deleterious to the term fetus and neonate and higher perinatal morbidity is reported, including seizures and cerebral palsy.^9,10 The aetiology of EAMF is still unknown, but various underlying mechanisms have been proposed, with increasing evidence for a non-infectious inflammatory process triggered by an anaesthetic drug-induced metabolic dysfunction.^9,11 Distinguishing EAMF from infectious causes of fever such as chorioamnionitis, bacterial or viral infections is vital to initiate adequate treatment wherever possible. Fever associated with EDA presents challenges in the clinical care of parturients. Improve our understanding of the underlying mechanisms may contribute to prevention and management and enhance safety of mothers and newborns. 3. Postdural puncture headache (PDPH). The positional headache which often develops after accidental dural puncture during epidural labour initiation and occasionally after spinal anaesthesia is not always self-limiting nor benign. The current accepted pathophysiology considers PDPH the result from loss of CSF through a breach of the dura mater into the epidural space causing loss of CSF volume, which cannot be replaced by CSF production. The resulting CSF hypovolemia leads to a reduced cushioning and downward displacement of the intracranial brain tissue, causing traction on pain-sensitive structures and a secondary vasodilation.^12–14 But many questions remain unresolved: why do some patients develop severe PDPH after an uneventful spinal anaesthesia with a thin atraumatic needle, while other patients never experience any symptoms after severe spinal CSF loss? In anaesthesia, PDPH is a clinical diagnosis, which according to the international classification of headache Disorders (ICHD-3) is the result of low CSF pressure.¹⁵ It shares symptoms with other orthostatic headache syndromes attributed to low CSF pressure such as spontaneous intracranial hypotension or PDPH after lumbar punctures. And while diagnostic procedures are more often applied in these manifestations of low CSF pressure, there is limited evidence of reduced CSF pressure, nor is radiologic evidence of CSF leakage present in the majority of SIH cases.¹⁶ The development of various non-invasive MRI techniques which allow imaging of the dynamics of intracranial fluid components, recently improved insights in CSF homeostasis and the role of the glymphatic system in cerebrospinal fluid dynamics and increased understanding of cerebral blood flow regulation all raise new questions.^17–21Anaesthesiologists should actively collaborate with neuroscientists and physiologists in future multidisciplinary basic research projects in order to improve our understanding of PDPH, contribute to preventive measures and optimize treatment strategies. Conclusion Most clinical research focuses on optimizing obstetric anaesthesia provision and studies the incidences and circumstances under which undesirable side effects occur. Contemporary basic research in this field, apart from studies into the origins of maternal fever during epidural analgesia, is less developed and many preclinical studies originate from last century. Since then, new tools have been developed and new insights emerged. Obstetricians and anaesthesiologists should collaborate more actively with basic scientists to improve our understanding of labour physiology and how various interventions affect it. Similarly, clarifying the mechanisms underlying epidural-related fever and PDPH will contribute to reduced complications and improved performance of obstetric anaesthesiology. As we continue to advance the field of obstetric anaesthesia, we must never forget the adage: "Primum non nocere" (First, do no harm). This requires a thorough understanding of our interventions and their potential consequences. By addressing these important issues through rigorous basic and clinical research and interdisciplinary collaboration, we can further enhance the safety and efficacy of obstetric anaesthesia, ultimately improving outcomes for mothers and newborns alike. 1. References 1. Wang TT, Sun S, Huang SQ. Effects of epidural labor analgesia with low concentrations of local anesthetics on obstetric outcomes: A systematic review and meta-analysis of randomized controlled trials. Anesth Analg. 2017;124(5):1571-1580. doi:10.1213/ANE.0000000000001709 2. Anim-Somuah M, Smyth RMD, Cyna AM, Cuthbert A. Epidural versus non-epidural or no analgesia for pain management in labour. Cochrane Database of Systematic Reviews. 2018;2018(5). doi:10.1002/14651858.CD000331.pub4 3. Maetzold E. Fetal Heart Changes Following Neuraxial Analgesia in Uteroplacental Insufficiency Pregnancies [30I]. Obstetrics& Gynecology. 2018;131(5):105S. 4. Benfield R, Song H, Salstrom J, Edge M, Brigham D, Newton ER. Intrauterine contraction parameters at baseline and following epidural and combined spinal-epidural analgesia: A repeated measures comparison. Midwifery. 2021;95(January). doi:10.1016/j.midw.2021.102943 5. Poma S, Scudeller L, Verga C, et al. Effects of combined spinal-epidural analgesia on first stage of labor: a cohort studJournal of Maternal-Fetal and Neonatal Medicine. Published online 2018. 6. Frenken MWE, Van Der Woude DAA, Vullings R, Oei SG, Van Laar JOEH. Implementation of the combined use of non-invasive fetal electrocardiography and electrohysterography during labor: A prospective clinical study. Acta Obstet Gynecol Scand. 2023;(March):1-8. doi:10.1111/aogs.14571 7. Vlemminx MWC, Thijssen KMJ, Bajlekov GI, Dieleman JP, Van Der Hout-Van Der Jagt MB, Oei SG. Electrohysterography for uterine monitoring during term labour compared to external tocodynamometry and intra-uterine pressure catheter. Eur J Obstet Gynecol Reprod Biol. 2017;215:197-205. doi:10.1016/j.ejogrb.2017.05.027 8. Lu R, Rong L, Ye L, Xu Y, Wu H. Effects of epidural analgesia on intrapartum maternal fever and maternal outcomes: an updated systematic review and meta-analysis. Journal of Maternal-Fetal and Neonatal Medicine. 2024;37(1). doi:10.1080/14767058.2024.2357168 9. Sultan P, David AL, Fernando R, Ackland GL. Inflammation and Epidural-Related Maternal Fever: Proposed Mechanisms. Anesth Analg. 2016;122(5):1546-1553. doi:10.1213/ANE.0000000000001195 10. Lange EMS, Segal S, Pancaro C, Grobman WA, Russell GB, Toledo P. Association between Intrapartum Magnesium Administration and the Incidence of Maternal Fever. 2018;(December 2017):942-952. 11. Goetzl L. Maternal fever in labor: etiologies, consequences, and clinical management. Am J Obstet Gynecol. 2023;228(5):S1274-S1282. doi:10.1016/j.ajog.2022.11.002 12. Vallejo MC, Zakowski MI. Post-dural puncture headache diagnosis and management. Best Pract Res Clin Anaesthesiol. 2022;36(1):179-189. doi:10.1016/j.bpa.2022.01.002 13. Schyns-van den Berg AMJV, Gupta A. Postdural puncture headache: Revisited. Best Pract Res Clin Anaesthesiol. 2023;37(2):171-187. doi:10.1016/j.bpa.2023.02.006 14. Sachs A, Smiley R. Post-dural puncture headache: The worst common complication in obstetric anesthesia. Semin Perinatol. 2014;38(6):386-394. doi:10.1053/j.semperi.2014.07.007 15. Olesen J. Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition. Cephalalgia. 2018;38(1):1-211. doi:10.1177/0333102417738202 16. Schievink WI. Spontaneous intracranial hypotension. NEJM. 2021;385(23):2173-2178. doi:10.1212/CON.0000000000000193 17. Agarwal N, Lewis LD, Hirschler L, et al. Current Understanding of the Anatomy, Physiology, and Magnetic Resonance Imaging of Neurofluids: Update From the 2022 “ISMRM Imaging Neurofluids Study group” Workshop in Rome. Journal of Magnetic Resonance Imaging. 2024;59(2):431-449. doi:10.1002/jmri.28759 18. Petitclerc L, Hirschler L, Wells JA, et al. Ultra-long-TE arterial spin labeling reveals rapid and brain-wide blood-to-CSF water transport in humans. Neuroimage. 2021;245(November):118755. doi:10.1016/j.neuroimage.2021.118755 19. Orešković D, Radoš M, Klarica M. Role of choroid plexus in cerebrospinal fluid hydrodynamics. Neuroscience. 2017;354(2017):69-87. doi:10.1016/j.neuroscience.2017.04.025 20. Lohela TJ, Lilius TO, Nedergaard M. The glymphatic system: implications for drugs for central nervous system diseases. Nat Rev Drug Discov. 2022;21(10):763-779. doi:10.1038/s41573-022-00500-9 21. Rasmussen MK, Mestre H, Nedergaard M. Fluid transport in the brain. Physiol Rev. 2022;102(2):1025-1151. doi:10.1152/physrev.00031.2020 Alexandra SCHYNS-VAN DEN BERG (Dordrecht, The Netherlands) 09:55 - 10:00 Q&A.
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10:00 - 10:30	COFFEE BREAK

10:30	10:30-12:20 Added to your list of favorites Deleted from your list of favorites A11 NETWORKING SESSION Recent papers that might change the clinical practice NETWORKING SESSION Recent papers that might change the clinical practice PERIPHERAL NERVE BLOCKS (PNBs) Chairperson: Barbara VERSYCK (Anesthesiologist) (Chairperson, Turnhout, Belgium) 10:30 - 10:35 Introduction. Barbara VERSYCK (Anesthesiologist) (Keynote Speaker, Turnhout, Belgium) 10:35 - 10:57 Use of GLP1 agonists and implications for regional anesthesia: compilation of a few articles. Oya Yalcin COK (EDRA Part I Vice Chair, EDRA Examiner, lecturer, instructor) (Keynote Speaker, Türkiye, Turkey) 10:57 - 11:19 Comparison between supra-inguinal fascia Iliaca and pericapsular nerve group blocks on postoperative pain and functional recovery after total hip arthroplasty: a non-inferiority randomised controlled trial. Emine Aysu SALVIZ (Attending Anesthesiologist) (Keynote Speaker, St. Louis, USA) 11:19 - 11:41 The anterior branch of the medial femoral cutaneous nerve innervates cutaneous and deep surgical incisions in total knee arthroplasty. Siska BJORN (Resident) (Keynote Speaker, Aarhus, Denmark) 11:41 - 12:03 Are psychedelics the answer to chronic pain?: a review of current literature. Alain BORGEAT (Senior Research Consultant) (Keynote Speaker, Zurich, Switzerland) 12:03 - 12:20 Q&A.	10:30-11:20 Added to your list of favorites Deleted from your list of favorites B11 ASK THE EXPERT POCUS in obstetric anesthesia ASK THE EXPERT POCUS in obstetric anesthesia Chairperson: Nuala LUCAS (Speaker) (Chairperson, London, United Kingdom) 10:30 - 10:35 Introduction. Nuala LUCAS (Speaker) (Keynote Speaker, London, United Kingdom) 10:35 - 11:05 POCUS in obstetric anesthesia. Peter VAN DE PUTTE (Consultant) (Keynote Speaker, Bonheiden, Belgium) 11:05 - 11:20 Q&A.	10:30-11:20 Added to your list of favorites Deleted from your list of favorites C12 LIVE DEMONSTRATION Blocks above the clavicle LIVE DEMONSTRATION Blocks above the clavicle Demonstrators: Eric ALBRECHT (Program director of regional anaesthesia) (Demonstrator, Lausanne, Switzerland), Sebastien BLOC (Anesthésiste Réanimateur) (Demonstrator, Paris, France)	10:30-11:00 Added to your list of favorites Deleted from your list of favorites D12 REFRESHING YOUR KNOWLEDGE Pharmacology REFRESHING YOUR KNOWLEDGE Pharmacology Chairperson: Christophe PERRUCHOUD (Medical chief officer) (Chairperson, Geneva, Switzerland) 10:30 - 10:35 Introduction. Christophe PERRUCHOUD (Medical chief officer) (Keynote Speaker, Geneva, Switzerland) 10:35 - 10:55 Pharmacokinetics & Pharmacodynamics of PNB drugs for dummies. Jens BORGLUM (Clinical Research Associate Professor) (Keynote Speaker, Copenhagen, Denmark) 10:55 - 11:00 Q&A.	10:30-11:00 Added to your list of favorites Deleted from your list of favorites E12 REFRESHING YOUR KNOWLEDGE Complications REFRESHING YOUR KNOWLEDGE Complications Chairperson: Axel SAUTER (consultant anaesthesiologist) (Chairperson, Oslo, Norway) 10:30 - 10:35 Introduction. Axel SAUTER (consultant anaesthesiologist) (Keynote Speaker, Oslo, Norway) 10:35 - 10:55 #43502 - E12 Complications and Mitigation in Regional Anesthesia. Complications and Mitigation in Regional Anesthesia. Complications and mitigation in Regional Anesthesia In 1996 Stephan Kapral M.D. had the great idea, after he had participated in an echocardiography workshop, that nerve structures could also be scanned and subsequently be blocked by using ultrasound techniques. From that time on the ultrasound guided technique to block nerves became one of the most successful interventions in the entire field of anesthesia. Today USRA provides a very safe technique for our patients without using general anesthesia for a variety of surgical procedures. Regional anesthesia has various advantages over general anesthesia, such as targeted pain relief with less side effects, reduced perioperative morbidity, faster recovery and shorter hospital stays and enhanced postoperative analgesia. But, like any other medical procedure, regional anesthesia is not excluded from certain complications, which every anesthetist should be aware of. Complications in regional anesthesia include anesthetic systemic toxicity (LAST), infection, hematoma, cardiovascular disturbances and allergies. This package of complications is quite similar to all other interventional anesthetic procedures and is all well known. In this abstract the focus is targeted at another serious complication namely the nerve injury. These nerve damages caused by different circumstances can have dramatic consequences for the patient and also for the anesthetist. The majority of axons of the peripheral nerve system are covered by Schwann cells. These myelinated axons are bundled in fascicles surrounded by connective tissue layers called “perineurium”. Within the fascicles the connective tissue layers are called “endoneurium”. Groups of fascicles of an entire nerve are covered by the epineurium. This sheath is the thickest and its collagen fibers are similar to the fibers of the dura. The knowledge of this anatomical neural multi-layer sheath construction network is essential to understand the different types of nerve damage, which are assigned to two different classifications. In daily practice the Seddon classification is more common. Nerve injury, as mentioned above, can lead to very severe complications. It is the most common complication in regional anesthesia. Starting with transient sensoric deficits, which are classified as Neuropraxia, with myelin damage and conduction reduction (s.a.) with a very good prognosis for complete recovery, up to a severe neurotmesis with a complete transection of the axon, myelin and endoneurium. Fortunately this usually does not happen in regional anesthesia. It is usually observed after massive trauma, sharp injuries or intraneural injection of noxious drugs. The incidence of nerve injury (NI) in RA in general is very varying due to the fact that there are a lot of heterogenous studies with “unsharp” definitions. The incidence of long-lasting peripheral nerve injury (PNI) ranges from 2 to 4 per 10,000 patients [7,8]. In a study by Urban et al., mild paresthesias were not uncommon on postoperative day 1, occurring in 19% of axillary blocks and 9% of interscalene blocks. After 2 weeks, the incidence of neuropraxia fell to 5% in the axillary group and 3% in the interscalene group. After 4 weeks, only 0.4% of patients experienced symptoms . Overall, transient deficits lasting up to 2 weeks are not uncommon and can range from 8.2 to 15%. The study of Lupu et al. found out that using ultrasound guided technique nerve blocks with intraneural injections do not regularily result in permanent nerve damage. Interestingly there is no significant difference in postoperative neurologic symptoms comparing ultrasound technique versus stimulation technique Such seemingly rare occurrences of PNB-related nerve injuries might be due to a lack of documentation (underreporting), improper follow-ups, or associated legal implications. Even the mildest, self-limiting, unintentional, and most frequent form of perioperative nerve injury (neuropraxia) can result in a medicolegal claim for extended hospitalization and additional treatment costs. It is also important to know that nerve injuries happen more often in the upper extremities than in lower extremities. The most injured nerve is the radial nerve in the upper limb, followed by the median and ulnar nerves, and the sciatic nerve in the lower limbs, followed by the peroneal and tibial nerves. This sequence is based on the fact that much more blocks are provided on the upper extremity and that e.g. the sciatic nerve contains a lot of connective protective tissue layers comparing to nerves of the brachial plexus. The spinal nerves of the ventral rami of C5, C6, etcc consist of nearly pure nerve structures with very few connective tissue layers. So touching these nerves with the tip of the needle will be remembered by the patients for ever. Nerve injuries can manifest as sensory or motor dysfunction, or both. Sensory dysfunction may present as numbness, tingling, or burning sensations, whereas motor dysfunction may present as weakness or paralysis of muscles supplied by the affected nerve. Risk factors for nerve injury are patient and/or surgery related but also anesthesia related. Patient related risk factors are numerous like age, gender (women>men), smoking, preexisting disorders and of course anticoagulation. There are also a lot of surgery related risk factors like patient’s position, compression (cast, tourniquet), ischaemia, haematoma, perioperative inflammation, infection etc.. Especially the tourniquet issue causes an ongoing endless debate between surgeons and anesthetists. There are conflicting data about duration and pressure level when using a tourniquet. Usually there are fixed values used in daily practice for any kind of surgical procedures and patients. The main features of tourniquet compression result in vascular permeability, intraneural edema and especially in lower leg surgery nerve degeneration, due to higher pressures. According to long-ago recommendations, the tourniquet pressure should not be more than 150 mmHg above the systolic blood pressure, and the duration should not exceed 90minutes, or a maximum of 120 minutes with a 10-15 minute deflation phase. Today we know how important it is to adapt the tourniquet pressure level to different operative settings. The widely used duration of 90 minutes has never been proven by studies, it has been more of a practical habit for decades. Now there are automatic pneumatic tourniquet devices available that are able to adapt the tourniquet pressure continuously with a predifined, adjustable value above the systolic blood pressure. The anesthetic related risk factors are the “4 H” (Hypotension, Hypothermia, Hypovolemia, Hypoxia) but also our needle skills, too deep sedation and last but not least the local anesthetics, which all of them especially combined can lead to nerve injuries. Special attention should be given to patients with diabetes mellitus, especially those with preexisting diabetic neuropathies, which indeed is the most common complication of this metabolic disorder. These patients are highly endangered to suffer from nerve injuries after a “failed” nerve block. The pathogenesis of this diabetic neuropathy is very complex. All the different biochemical cellular pathways lead to neural oxidative stress and subsequently to severe neural damage, which affects the myelin sheaths and also the axonal structures. The impaired vasculature and autoregulation are also very much involved to trigger diabetic neuropathy. The point is, that diabetic patients are at least twice as likely to require surgery than non-diabetics because of their comorbidities and the type of surgery performed. Other patients with preexisting diseases (metabolic, toxic, ischemic, etc...) who additionally suffer from nerve entrapment are on high risk for a double crush syndrome, especially when receiving nerve blocks. To mitigate the risk of double crush syndrome in regional anesthesia, practitioners should be aware of the patient's prior neurological history. Patients with a history of peripheral neuropathy, whatever the reason is, should be evaluated for any signs of nerve compression, such as muscle weakness, sensory defects, or neuropathic pain, before and after the nerve block procedure. Generally, practitioners must be gentle during the procedure, minimizing the amount of pressure or manipulation applied to the patient's nerves. The best way to minimize neural damage is to train RA-skills as good as possible. It is very important to visualize the entire nerve including surrounding structures to avoid direct needle trauma to nerves or perforate close located vessels or other vulnerable structures. It is essential to provide structured professional training to improve fine motor skills because the learning curve in the beginning is quite flat. To visualize the needle in different angles and planes in a dynamic motion and at the same time focusing on the targeted nerve is very challenging in the beginning. Another challenging issue is learning anatomic structures from a 3- dimensional in a 2-dimensional model transmitted on a display. This cognitive challenge often leads to misinterpretations. All anesthesiology departments providing regional anesthesia should therefore implement structured programs for their interested colleagues starting with simple superficial located nerve blocks on the upper and lower extremity. For deep nerve blocks, where nerve visualization can be tricky, dual guidance technique, using ultrasound and nerve stimulator, is recommended. Using pressure monitoring devices to avoid intraneural injections is helpful, although this technique is not widely used because of the high extra costs. It is highly sensitive but lacks specificity. In other words, the absence of high injection pressure effectively rules out an intrafascicular injection. High opening injection pressure (>20 psi) determines the intrafascicular placement of the needle tip. Low opening pressure ( The needle selection is another very sensitive and much discussed topic among anesthetists. Using non-cutting blunt or short bevel tip (45°) needles are much less likely to penetrate epineurium and minimize nerve penetration. But they get easily bended, when piercing through rough skin. This can worsen visualization of the needle and can lead to unexpected nerve damage. Long-bevel tip needles (15°) are much sharper and therefore more likely to puncture epi- or even perineural structures. Self-explanatory the needle diameter is linked to the degree of nerve damage. Summary: Complications in regional anesthesia are multifactorial and very complex. There are multiple surgical, anesthesiologic and patient related factors for nerve injury. The incidence of nerve damage in regional anesthesia varies significantly in a very low range. In most cases there are several combined factors that lead to a nerve damage. Histologically you will find damaged myelin layers and axonal degeneration. Fortunately this neuropraxia has the best outcome and perioperative neurological deficits will disappear completely in more than 95% of the cases. There are a lot of preprocedural precautions to provide good blocks and to avoid nerve injuries. Beginning with the medical explanation, consent of the patient, documentation of all the patients related factors, continuing in the holding area with monitoring, if necessary slight sedations, up to positioning of the patient and ergonomics of the anesthetist. Then choosing the optimal technique with the correct needle under sterile conditions with the minimal dosage of local anesthetics required will avoid side effects or even complications like LATS, hematoma, infections and last but not least nerve injuries. But the key point to mitigate nerve damages are in fact the skills of well trained anesthetists preferably with the support of high quality US machines with high resolution to detect needle and targeted nerves very precisely. In case of poor visibility the provider can use stimulation technique and even go for triple guidance technique using pressure monitoring devices aswell. Keeping all these facts and procedures in mind will provide perfect blocks without any harm to our patients. References: Macfarlane AJR, Prasad GA, Chan VWS, Brull R. Does regional anaesthesia improve outcome after total hip arthroplasty? A system- atic review. Br J Anaesth. 2009;103:335–45. Hadzic A, Karaca PE, Hobeika P, Unis G, Dermksian J, Yufa M, et al. Peripheral nerve blocks result in superior recovery profile compared with general anesthesia in outpatient knee arthroscopy. Anesth Analg. 2005;100:976–81. This is a foundational manu- script that outlines the importance of nerve blocks compared to general anesthesia. compared with general anesthesia in outpatient knee arthroscopy. Brull R, Hadzic A, Reina MA, Barrington MJ. Pathophysiology and etiology of nerve injury following peripheral nerve blockade. Reg Anesth Pain Med. 2015;40:479–90. Franco CD. Connective tissues associated with peripheral nerves. Reg Anesth Pain Med. 2012;37:363–5. Seddon HJ: A classification of nerve injuries. Br Med J 1942;2: 237–239. Sunderland S: A classification of peripheral nerve injuries producing loss of function. Brain 1951;74:491–516. Urban MK, Urquhart B. Evaluation of brachial plexus anesthesia for upper extremity surgery. Reg Anesth United States. 1994;19: 175–82. Sondekoppam RV, Tsui BCH. Factors associated with risk of neu- rologic complications after peripheral nerve blocks. Anesth Analg. 2017;124:645–60. Fredrickson MJ, Kilfoyle DH. Neurological complication analysis of 1000 ultrasound guided peripheral nerve blocks for elective or- thopaedic surgery: a prospective study. Anaesthesia. 2009;64:836– 44. Lupu CM, Kiehl T-R, Chan VWS, El-Beheiry H, Madden M, Brull R. Nerve expansion seen on ultrasound predicts histologic but not functional nerve injury after intraneural injection in pigs. Reg Anesth Pain Med. 2010;35:132–9. Deschner S, Borgeat A, Hadzic A: Chapter 69. Neurologic complications of peripheral nerve blocks: mechanisms & management. NYSORA Textbook of Regional Anesthesia and Acute Pain Management. Hadzic A (ed): McGraw-Hill Medical, New York; 2007. 1109-35. Albers JW, Pop-Busui R: Diabetic neuropathy: mechanisms, emerging treatments, and subtypes . Curr Neurol Neurosci Rep. 2014, 14:473. 10.1007/s11910-014-0473-5 Knowing It Before Blocking It,” the ABCD of the Peripheral Nerves: Part B (Nerve Injury Types, Mechanisms, and Pathogenesis) Kartik Sonawane 1 , Hrudini Dixit 2 , Navya Thota 1 , Tuhin Mistry 1 , Jagannathan Balavenkatasubramanian “Knowing It Before Blocking It,” the ABCD of the Peripheral Nerves: Part C (Prevention of Nerve Injuries) Kartik Sonawane 1 , Hrudini Dixit 2 , Kaveri Mehta 3 , Navya Thota 1 , Palanichamy Gurumoorthi 1 Marcus NEUMUELLER (Steyr, Austria) 10:55 - 11:00 Q&A.	10:30-11:00 Added to your list of favorites Deleted from your list of favorites F12 TIPS & TRICKS The difficult patient TIPS & TRICKS The difficult patient Chairperson: Romualdo DEL BUONO (Member) (Chairperson, Milan, Italy) 10:30 - 10:35 Introduction. Romualdo DEL BUONO (Member) (Keynote Speaker, Milan, Italy) 10:35 - 10:55 #43495 - F12 The Difficult Pain Patient – How to Handle Postoperative Analgesia. The Difficult Pain Patient – How to Handle Postoperative Analgesia. Ioanna Siafaka (1), Athina Vadalouka (2), Eleni Moka (3) 1. ANESTHESIA PAIN PALLIATIVE CARE, ATHENS UNIVERSITY MEDICAL SCHOOL GREECE, ATHENS, Greece 2. Pain Therapy and Palliative Care Centre, Athens Medical Centre, Athens, Greece 3. Anaesthesiology Department, Creta Interclinic Hospital – Hellenic Healthcare Group, Heraklion, Greece Chronic pain (i.e., pain lasting ≥3 months) is a debilitating disease that affects daily work and life activities for many adults worldwide, and has been linked with depression (1), Alzheimer disease and related dementias (2), higher suicide risk (3), and substance use and misuse (4). Research suggests that approximately 20% of adults worldwide, equivalent to over 1.5 billion individuals, suffer from chronic pain (5). Of those who live with chronic pain, 10.4–14.3% were found to have moderate–to –severe disabling chronic pain (6). Chronic pain patients can be especially difficult in management, because they develop: (a) maladaptive changes in their attitudes about ever regaining their health, (b) non–productive and even obstructive behaviors, (c) physiological and anatomic changes in the pain processing and transmission system (termed neuroplasticity), that essentially hardwire the pain response pattern. Chronic opioid use and neuropathic pain, independently decrease the set point threshold in the central nervous system, for a response to nociceptive input, such that patients with longstanding pain or opioid use, have an increased likelihood to experience pain from a remarkably low stimulus intensity (7). Also, difficult pain patients are frustrated with the medical system, experience dysfunction in their personal life, and are irritable and sleep deprived (8). Chronic pain can make the management of acute pain challenging. It might be difficult and challenging to achieve adequate postoperative analgesia in patients who present for surgery with preexisting chronic pain. Patients presenting with anxiety, pain catastrophizing, and high levels of pain before surgery will be at increased risk of experiencing significant acute postoperative pain. Only one in four surgical patients receives adequate relief of acute pain (8). Undertreated acute pain may lead to the development of chronic pain syndromes in several patients (9). Anaesthesiologists, surgeons, and other professionals involved in the care of this patient population must be aware of the physiological changes that occur and increase analgesic requirements. This population has altered perception of pain and reports higher pain scores in the postoperative setting than patients without preexisting chronic pain (10). In the treatment of chronic pain, practitioners often propose multiple analgesics, such as sustained release and transdermal opioids, anticonvulsants, antidepressants, nonsteroidal anti–inflammatory drugs (NSAIDs), in addition to interventional pain procedures (11). These chronic pain management approaches carry the risk of side effects and possible drug interactions, that need to be monitored in the postoperative setting. Chronic opioid users may have increased analgesic requirements postoperatively due to tolerance, dependence, and opioid–induced hyperalgesia (9). Further, patients with chronic pain tend to be more sensitive to painful conditions. They may experience a flare of their underlying pain disorder and may be more physically deconditioned, thus making it more challenging to treat them postoperatively. The guidelines on the management of postoperative pain set forth by the American Pain Society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists’ Committee on Regional Anesthesia acknowledge the challenges of treating patients with a history of chronic opioid use. They recommend multimodal analgesia (MMA), or a variety of analgesic medications and techniques combined to target different mechanisms of action of pain receptors in the peripheral and central nervous systems. In this MMA regimen, acetaminophen and/or NSAIDs, in addition to opioids, are associated with less postoperative pain and opioid consumption versus opioids alone. They also recommend peripheral regional anaesthetic techniques, as part of the MMA regimen, in addition to neuraxial analgesia for major thoracic and abdominal procedures, especially for those with increased risk for cardiac and pulmonary comorbidities or prolonged ileus. Both are associated with decreased use of opioids and lower postoperative pain scores (12). When standard pharmacological regimens are inadequate, or when treating difficult patients at high risk of experiencing uncontrolled postoperative pain, it is recommended to consult a pain management specialist to assist in perioperative pain management Transdermal Opioids are an available treatment option for chronic pain, with the most commonly prescribed transdermal systems containing fentanyl or buprenorphine. If a patient is on a Fentanyl Patch preoperatively, it may be continued postoperatively. If the fentanyl patch is removed, equivalent opioid should be provided to meet the patient’s baseline analgesic requirement. Fentanyl patch is contraindicated in patients who are opioid naive, for use in mild, acute, postoperative, or intermittent pain. Regarding Buprenorphine Patches, evidence is mixed. Buprenorphine administered transdermally generally results in plasma concentrations lower than sublingual buprenorphine. It may be removed 12 hours prior to surgery or continued postoperatively (13). Intrathecal Opioids via Implanted Pumps are used also for the management of difficult chronic pain. The Pain Specialist who manages the pump should be made aware of any planned procedure, and the device should be thoroughly investigated to obtain the drug name, dosage, frequency, and last fill date (14). The delivery of analgesic medications via pump should be maintained perioperatively when the pump does not physically interfere with the procedure. Conversion from intrathecal morphine dosing to oral dosing is impractical, so the administration of additional opioids should be done slowly and carefully. Pumps may contain baclofen, which has been reported to have a synergistic interaction with opioids, increasing their potency (10). Baclofen withdrawal is life–threatening, so it is imperative that the pump is functional postoperatively. Spinal Cord Stimulation is a treatment option for adults with chronic pain of neuropathic origin. Patients with an implanted spinal cord stimulator (SCS) are therefore likely to present for other unrelated procedures. Postoperatively the device should be switched on and interrogated by the pain team to ensure functionality before discharge from the hospital. SCS have no role in the management of acute nociceptive pain, which should be managed by conventional means (15). There is no clear consensus regarding the optimal perioperative management of chronic pain patients. Individual pain management should be determined by the acute pain team based on patient and surgical factors. The creation and development of Transitional Pain Services will allow a safer more effective and smoother transition of the difficult patient into the outpatient setting at a time when inappropriate prescribing, medication misuse and opioid withdrawal could hinder the overall healing process. REFERENCES 1. Zis P, Daskalaki A, Bountouni I, Sykioti P, Varrassi G, Paladini A. Depression and chronic pain in the elderly: links and management challenges. Clin Interv Aging, 2017; 12: 709–220. https://doi.org/10.2147/CIA.S113576 PMID:28461745 2. Khalid S, Sambamoorthi U, Umer A, Lilly CL, Gross DK, Innes KE. Increased odds of incident Alzheimer’s disease and related dementias in presence of common non-cancer chronic pain conditions in Appalachian older adults. J Aging Health, 2022; 34: 158–72. https://doi.org/10.1177/08982643211036219 PMID:34351824) 3. Interagency Pain Research Coordinating Committee. National Pain Strategy: a comprehensive population health-level strategy for pain. Washington, DC: US Department of Health and Human Services, National Institutes of Health; 2016. https://www.iprcc.nih.gov/node/5/national-pain-strategy-report 4. Ditre JW, Zale EL, LaRowe LR. A reciprocal model of pain and substance use: transdiagnostic considerations, clinical implications, and future directions. Annu Rev Clin Psychol, 2019; 15: 503–28. https://doi.org/10.1146/annurev-clinpsy-050718-095440 PMID:30566371 5. Zimmer Z, Fraser K, Grol-Prokopczyk H, Zajacova A. A global study of pain prevalence across 52 countries: Examining the role of country-level contextual factors. Pain, 2022; 163(9): 1740 – 1750. https://doi:10.1097/j.pain.0000000000002557 6. Sarah E.E. Mills, Karen P. Nicolson, and Blair H. Smith. Chronic pain: A review of its epidemiology and associated factors in population-based studies. Br J Anaesth,2019; 123(2): e273–e283. 7. Russell Davenport and John C. Rowlingson. Dealing With the Difficult Patient. https://www.asra.com/news-publications/asra-newsletter/newsletter-item/asra-news/2019/09/26/dealing-with-the-difficult-patient 8. Paul S. Tumber. Optimizing perioperative analgesia for the complex pain patient: Medical and interventional strategies. Can J Anesth/J Can Anesth, 2014; 61: 131–140. https://doi:10.1007/s12630-013-0073-x 9. Natasa Grancaric, Woojin Lee, Madeline Scanlon. Postoperative Analgesia in the Chronic Pain Patient.Otolaryngol Clin N Am, 2020; 53: 843–852. https://doi.org/10.1016/j.otc.2020.05.013 10. Gregory L. Barinsky, Erin Maggie Jones, Anna A. Pashkova, and Carolyn P. Thai. Postoperative Analgesia for the Chronic Pain Patient. © Springer Nature Switzerland AG 2021 79P. F. Svider et al. (eds.), Perioperative Pain Control: Tools for Surgeons, https://doi.org/10.1007/978-3-030-56081-2_7 11. Athina Vadalouca, Evnomia Alexopoulou-Vrachnou, Martina Rekatsina, Irene Kouroukli, Sousana Anisoglou, Fani Kremastinou, Zoi Gabopoulou Panagiota Chloropoulou, Georgia Micha, Athanasia Tsaroucha, Ioanna Siafaka. The Greek Neuropathic Pain Registry: The structure and objectives of the sole NPR in Greece. Pain Pract, 2022; 22(1): 47 – 56. https://doi:10.1111/papr.13049 12. Roger Chou, Debra B. Gordon Y, Oscar A. de Leon-Casasola, et al. Management of Postoperative Pain: A Clinical Practice Guideline From the American Pain Society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists’ Committee on Regional Anesthesia, Executive Committee, and Administrative Council. The Journal of Pain, 2016; 17(2): 131 – 157. Available online at www.jpain.org and www.sciencedirect.com Ioanna SIAFAKA (Athens, Greece) 10:55 - 11:00 Q&A.	10:30-11:00 Added to your list of favorites Deleted from your list of favorites G12 REFRESHING YOUR KNOWLEDGE Caudals REFRESHING YOUR KNOWLEDGE Caudals Chairperson: Nicholas PAPADOMANOLAKIS-PAKIS (Research) (Chairperson, Aarhus, Denmark) 10:30 - 10:35 Introduction. Nicholas PAPADOMANOLAKIS-PAKIS (Research) (Keynote Speaker, Aarhus, Denmark) 10:35 - 10:55 Caudal Blocks. Markus STEVENS (anesthesiologist) (Keynote Speaker, Amsterdam, The Netherlands) 10:55 - 11:00 Q&A.	09:00-11:00 Added to your list of favorites Deleted from your list of favorites H11 SIMULATION TRAININGS SIMULATION TRAININGS Demonstrators: Josip AZMAN (Consultant) (Demonstrator, Linkoping, Sweden), Clara LOBO (Medical director) (Demonstrator, Abu Dhabi, United Arab Emirates), Roman ZUERCHER (Senior Consultant) (Demonstrator, Basel, Switzerland)
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11:10				11:10-11:40 Added to your list of favorites Deleted from your list of favorites D13 REFRESHING YOUR KNOWLEDGE Anatomy REFRESHING YOUR KNOWLEDGE Anatomy Chairperson: Aleksejs MISCUKS (Professor) (Chairperson, Riga, Latvia, Latvia) 11:10 - 11:15 Introduction. Aleksejs MISCUKS (Professor) (Keynote Speaker, Riga, Latvia, Latvia) 11:15 - 11:35 #43284 - D13 Anatomical basic knowledge for the occasional RA anesthesiologist. Anatomical basic knowledge for the occasional RA anesthesiologist. Anatomical basic knowledge for the occasional RA anesthesiologist Regional anesthesia (RA) techniques have become increasingly important in modern anesthetic practice. For anesthesiologists who perform RA procedures infrequently, maintaining a working knowledge of relevant anatomy is crucial for effective and safe practice. This summary aims to provide an overview of essential anatomical concepts and structures important in common RA procedures. 1. The Neck The Origin of the Brachial Plexus: The Roots and Trunci The brachial plexus provides motor and sensory innervation of the upper limb. It commonly originates from the ventral rami of the spinal nerves C5 to C8 and the first thoracic spinal nerve, T1. In some cases, there may be contributions from C4 (prefixed plexus) or T2 (postfixed plexus). These anterior rami are more commonly known as “roots”, which is the common term used in the literature describing ultrasound guided regional anesthesia. These nerve roots emerge from the intervertebral foramina and pass between the anterior and middle scalene muscles. From the roots the three trunks of the brachial plexus are formed in the posterior triangle of the neck: C5 and C6 unite to form the upper trunk, C7 continues as the middle trunk whereas C8 and T1 join to form the lower trunk. In order to perform awake shoulder surgery, the C5 and C6 roots need to be blocked. 2. Periclavicular area Brachial plexus: Divisions and Cords Each of the three trunks (upper, middle, and lower) splits into anterior and posterior divisions. This division occurs behind the clavicle. Anterior division primarily innervates the flexor compartments and posterior division mainly supplies the extensor compartments of the upper limb. The divisions then regroup to form three cords, named according to their relationship to the axillary artery. The cords are formed at the lateral border of the first rib and extend into the axilla. The lateral cord is formed by the anterior divisions of the upper and middle trunks (C5-C7) and gives rise to the musculocutaneous nerve and lateral root of the median nerve, the medial cord, which is a continuation of the anterior division of the lower trunk (C8-T1) and contributes to the ulnar nerve, medial root of the median nerve, and medial cutaneous nerves of the arm and forearm and finally the posterior cord which is formed by the posterior division (C5-T1) and forms the axillary and radial nerves. 3. The Arm Major branches of the brachial plexus In the axilla, the major branches of the brachial plexus are arranged around the axillary artery. The musculocutaneous nerve typically pierces the coracobrachialis muscle and runs between the biceps and brachialis. The median nerve lies anterior to the axillary artery. The ulnar nerve is positioned medial to the axillary artery and the radial nerve, the largest branch, is found posterior to the axillary artery, and courses into the posterior compartment of the arm through the triangular interval. The axillary nervewraps around the surgical neck of the humerus with the posterior circumflex humeral vessel. Musculocutaneous nerve innervates biceps brachii, brachialis, and coracobrachialis and provides sensory innervation to the lateral forearm. The median nerve provides motor supply to the most anterior forearm flexors and thenar muscles and sensory innervation to the lateral palm, thumb, index, middle, and lateral half of ring finger. The ulnar nerve innervates hypothenar muscles, interossei, and some intrinsic hand muscle and provides sensory supply to the medial palm, little finger, and medial half of ring finger. The radial nerve provides motor supply to the posterior arm and forearm extensors and sensory innervation to the posterior arm and forearm, as well as areas of hand dorsolaterally. However, recent research has shown that the sensory innervation of the hand seems to be very variable, thereby complicating the testing of a success of a regional anesthetic block. Finally, the axillary nerve innervates the deltoid and teres minor muscles and provides sensory supply to the lateral shoulder area. 4. Thoracic wall The pectoralis major muscle forms the most superficial layer, originating from the clavicle, sternum, and upper ribs, and inserting onto the humerus. Deep to this lies the pectoralis minor, originating from ribs 3-5 and inserting on the coracoid process. The serratus anterior muscle originates from the lateral aspects of the upper 8-9 ribs and inserts on the medial border of the scapula. It lies on the lateral chest wall, deep to the pectoralis muscles. The lateral pectoral nerve (C5-C7) innervates pectoralis major, medial pectoral nerve (C8-T1) pectoralis minor and partially pectoralis major muscles, whereas the long thoracic nerve (C5-C7) provides motor supply to the serratus anterior muscle. Note that these nerves originate from the brachial plexus. Intercostal nerves, the ventral rami of thoracic spinal nerves T1-T11, run in the intercostal spaces between ribs and provide sensory innervation to the chest wall. The axillary vessels and their branches are important landmarks in the ultrasound guided thoracic wall blocks. The thoracoacromial artery emerges from the axillary artery, pierces the clavipectoral fascia, and divides into four branches (acromial, clavicular, deltoid, and pectoral). The pectoral branch is particularly relevant to the PECS I Block, running between pectoralis major and minor. The lateral thoracic artery descends along the lateral border of pectoralis minor, supplying it and the lateral chest wall and is an important landmark for PECS II block. The long thoracic artery, being a key reference for the serratus anterior block, runs along the lateral chest wall, parallel to the long thoracic nerve and supplies the serratus anterior muscle. Internal thoracic artery is a notable mention, while not directly in the block area, its perforating branches contribute to breast and anterior chest wall blood supply. 5. Abdominal wall The abdominal wall consists of several muscles, the most superficial is the external oblique muscle, followed by the internal oblique and finally the deepest muscle, the transversus abdominis. Rectus abdominis muscles are paired vertical muscles, separated by the linea alba. Key nerves in this area include the thoracoabdominal nerves (T7-T12), that run between internal oblique and transversus abdominis muscles as well as the Ilioinguinal and iliohypogastric nerves (L1) that course through the transversus abdominis plane in the lower abdomen. The key vessels in this area are the superior and inferior epigastric vessels, which run deep to the rectus abdominis muscle and the deep circumflex iliac vessel, that courses along the inner aspect of the iliac crest. Two fascial planes hold a significance for the occasional regional anesthetist: transversus abdominis plane (TAP) between internal oblique and transversus abdominis muscles and the rectus sheath which surrounds the rectus abdominis muscle. 6. Inguinal crease and the thigh In lieu of the modern surgery and its push to an early ambulation, the femoral block itself has lost some of its appeal, however anatomy around the inguinal continues to play an important role in the armamentarium of an occasional regional anesthetist. The Inguinal ligament which runs from the anterior superior iliac spine to the pubic tubercle, represents an important landmark in the performance of the suprainguinal fascia iliaca block as well as the PENG block. The lateral femoral cutaneous nerve passes under or through the inguinal ligament lateral to the anterior superior iliac spine. Two fasciae of the utmost importance in terms of the blocks performed in this area: the fascia lata and the deeper fascia iliaca, which envelops the iliacus and psoas muscles. Femoral nerve lies deep to the fascia iliaca, lateral to the femoral artery, medial to the artery lies the femoral vein. An important structure in the transition from the inguinal crease to the thigh is the femoral triangle, bounded by the inguinal ligament superiorly, sartorius laterally, and adductor longus medially. The floor of the femoral triangle is formed by the iliopsoas muscle and the roof by the fascia iliaca. Key structures at the tip of the femoral triangle are the femoral artery, a central, hyperechoic structures on ultrasound, medial to it, usually compressible with the ultrasound probe, lies the femoral vein. 7. Popliteal fossa and the foot The popliteal fossa is a diamond-shaped space behind the knee, bounded superolaterally by the biceps femoris muscle, superomedially by the semimembranosus and semitendinosus muscles, inferolaterally by the lateral head of gastrocnemius muscle and inferomedially by the medial head of gastrocnemius muscle. Within the popliteal fossa, the sciatic nerve typically bifurcates into tibial and common peroneal nerves, though the level of division can vary considerably, anywhere from the lower thigh to the popliteal fossa. The tibial nerve is larger and lies more superficially and is a continuation of the sciatic nerve's medial component. Common peroneal nerve is smaller and is located lateral to the tibial nerve. The popliteal vein typically lies between the sciatic nerve and the popliteal artery, which is the deepest ultrasound landmark structure, lying closest to the femur bone. The tibial nerve provides motor innervation to the muscles in the posterior compartment of the leg as well as most of the intrinsic muscles of the foot. Sensory supply of the tibial nerve stretches over the posterior aspect of the leg, sole and lateral aspect of the foot, as well as the toes, with the exception of the webspace between the 1st and 2nd toes, which is innervated by the deep peroneal nerve. This is also the only area on the lower limb where the success of the sensory block of the deep peroneal nerve can be tested, as this nerve is a predominantly motor nerve, innervating the anterior compartment and dorsiflexors of the foot and has a limited sensory distribution. The superficial peroneal nerve provides motor innervation to the peroneal muscles (evertors) and extensive sensory innervation to the dorsum of the foot, with the exception of the lateral side of the fifth toe, typically innervated by the sural nerve, which is formed from the tibial and the common peroneal nerve and is a purely sensory nerve. An important exception to the predominantly sciatic sensory supply to the lower leg are the medial aspect of the leg from knee to ankle and in up to 10% of the population the medial aspect of the foot to the base of the big toe, which are innervated by the saphenous nerve, the terminal branch of the femoral nerve. A solid foundation in relevant anatomy is essential for the safe and effective practice of regional anesthesia, even for occasional practitioners. By focusing on key anatomical concepts and structures, anesthesiologists can enhance their ability to perform successful nerve blocks, interpret imaging findings, and manage potential complications. Ongoing anatomical education and review should be an integral part of maintaining competence in regional anesthesia techniques. Barbara RUPNIK (Zurich, Switzerland) 11:35 - 11:40 Q&A.	11:10-11:40 Added to your list of favorites Deleted from your list of favorites E13 TIPS & TRICKS Monitoring TIPS & TRICKS Monitoring Chairperson: Fani ALEVROGIANNI (Resident) (Chairperson, Athens, Greece) 11:10 - 11:15 Introduction. Fani ALEVROGIANNI (Resident) (Keynote Speaker, Athens, Greece) 11:15 - 11:35 Continuous monitoring during block performance and assessing PNB effectiveness. Xavier CAPDEVILA (MD, PhD, Professor, Head of department) (Keynote Speaker, Montpellier, France) 11:35 - 11:40 Q&A.	11:10-11:40 Added to your list of favorites Deleted from your list of favorites F13 TIPS & TRICKS Hip Fracture TIPS & TRICKS Hip Fracture Chairperson: Nat HASLAM (Consultant Anaesthetist) (Chairperson, Sunderland, United Kingdom) 11:10 - 11:15 Introduction. Nat HASLAM (Consultant Anaesthetist) (Keynote Speaker, Sunderland, United Kingdom) 11:15 - 11:35 Hip fractures. Does RA play a role in postoperative pain and outcome? Luis Fernando VALDES VILCHES (Clinical head) (Keynote Speaker, Marbella, Spain) 11:35 - 11:40 Q&A.	11:10-11:40 Added to your list of favorites Deleted from your list of favorites G13 REFRESHING YOUR KNOWLEDGE Platelet Rich Plasma REFRESHING YOUR KNOWLEDGE Platelet Rich Plasma Chairperson: Teodor GOROSZENIUK (Consultant) (Chairperson, London, United Kingdom) 11:10 - 11:15 Introduction. Teodor GOROSZENIUK (Consultant) (Keynote Speaker, London, United Kingdom) 11:15 - 11:35 Scientific Principles, Clinical Applications & Current Evidence. Nicole PORZ (Leitende Ärztin) (Keynote Speaker, Bern, Switzerland) 11:35 - 11:40 Q&A.	11:10-12:20 Added to your list of favorites Deleted from your list of favorites H13 PANEL DISCUSSION Training RA for obstetric anesthesia PANEL DISCUSSION Training RA for obstetric anesthesia Chairperson: Marc VAN DE VELDE (Professor of Anesthesia) (Chairperson, Leuven, Belgium) 11:10 - 11:15 Introduction. Marc VAN DE VELDE (Professor of Anesthesia) (Keynote Speaker, Leuven, Belgium) 11:15 - 11:35 Training models for obstetric anesthesia. Vishal UPPAL (Professor) (Keynote Speaker, Halifax, Canada, Canada) 11:35 - 11:55 Microanatomy of the blood-nerve barrier in human dural sac, nerve root cuffs, and peripheral nerves. Miguel Angel REINA (Professor) (Keynote Speaker, Madrid, Spain) 11:55 - 12:15 Is AI helpful for obstetric anesthesia? James BOWNESS (Consultant Anaesthetist) (Keynote Speaker, London, United Kingdom) 12:15 - 12:20 Q&A.
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11:30		11:30-12:20 Added to your list of favorites Deleted from your list of favorites B12 EXPERT OPINION DISCUSSION POCUS on abdomen EXPERT OPINION DISCUSSION POCUS on abdomen Chairperson: Ezzat SAMY AZIZ (Professor of Anesthesia) (Chairperson, Cairo, Egypt) 11:30 - 11:35 Introduction. Ezzat SAMY AZIZ (Professor of Anesthesia) (Keynote Speaker, Cairo, Egypt) 11:35 - 11:50 Gastric ultrasound for patient care I. Rosie HOGG (Consultant Anaesthetist) (Keynote Speaker, Belfast, United Kingdom) 11:50 - 12:05 Gastric ultrasound for patient care II. Peter VAN DE PUTTE (Consultant) (Keynote Speaker, Bonheiden, Belgium) 12:05 - 12:20 Q&A.	11:30-12:20 Added to your list of favorites Deleted from your list of favorites C13 LIVE DEMONSTRATION Blocks below the clavicle LIVE DEMONSTRATION Blocks below the clavicle Demonstrators: Agnese OZOLINA (faculty member) (Demonstrator, Riga, Latvia), Peter POREDOS (consultant) (Demonstrator, Ljubljana, Slovenia, Slovenia)						11:30-12:25 Added to your list of favorites Deleted from your list of favorites FP11 OBSTETRIC Free Papers 2 OBSTETRIC Free Papers 2 Chairperson: Thomas WIESMANN (Head of the Dept.) (Chairperson, Schwäbisch Hall, Germany) 11:30 - 11:37 #42439 - OP026 Comparison of the Efficacy of Postcesarean Analgesia by Combination of Intraperitoneal Instillation of Local Anaesthetics with Infiltration Through the Wound Site Versus Intratechal Morphine: Prospective, Randomised, Double-Blind Study. OP026 Comparison of the Efficacy of Postcesarean Analgesia by Combination of Intraperitoneal Instillation of Local Anaesthetics with Infiltration Through the Wound Site Versus Intratechal Morphine: Prospective, Randomised, Double-Blind Study. Aim is to evaluate the efficacy of anaesthetic instillation on peritoneum in combination with infiltration through all of the anterior abdominal structures in comparison to intrathecal morphine for post-cesarean analgesia. 46 women scheduled for elective cesarean-section under spinal anaesthesia were randomly allocated into two groups. Spinal anaesthesia in Group II was performed using isobaric 0,5% bupivacaine + 15µg fentanyl considering the height and weight, while in Group I 150µg morphine was also added. At the end of the surgery in Group II, a solution of 15 ml 0,5% bupivacaine + 15 ml 2% lidocaine+1:200.000 epinephrine was instilled on four quadrants of uterus, infiltrated on borders of the rectus aponeurosis and through the wound site. In group I, same volumes of saline were administered instead. Primary outcome was the total opioid consumption in the first 24 hours postoperatively. Secondary outcomes were pain scores at rest and during movement at; 2,4,6,12,24. hours, incidence of adverse effects and the time for first opioid request. (NCT05405049) Demographic data except for height (p=0.23) and total opioid consumption (p=0.075) were similar amongst groups. Time for first opioid request was significantly longer in Group I. (p=0.034). No statistically significant difference was found between groups considering active and passive pain scores and adverse effects except for pruritus(p=0.032) . Combining intraperitoneal local anaesthetic instillation and infiltration through anterior abdominal structures provides post-cesarean analgesia as effectively as intratechal morphine. This combination is non-inferior and can be an alternative to intratechal morphine in cases where it is not possible. Ramazan İNCE, Mehmet Akif YILMAZ, Miraç Selcen ÖZKAL YALIN (ERZURUM, Turkey), Ayşenur DOSTBİL, Kamber KAŞALİ, Gamze Nur CİMİLLİ ŞENOCAK, Mehmet AKSOY, Selvihan TAPANOĞLU KARACA 11:37 - 11:44 #41424 - OP027 The roles of maternal psychological and pain vulnerabilities in sub-acute pain after childbirth. OP027 The roles of maternal psychological and pain vulnerabilities in sub-acute pain after childbirth. Sub-acute pain after childbirth (SAPC) can escalate to chronic pain, impairing maternal well-being. Central sensitisation, a major pain vulnerability, plays a pivotal role in worsening and prolonged pain. We aimed to investigate whether central sensitisation was associated with increased SAPC risk. We also investigated the roles of psychological and pain vulnerabilities, obstetric factors, and analgesic choice in SAPC development. Our prospective cohort study at KK Women’s and Children’s Hospital, Singapore, included pregnant women aged 21 and above with term pregnancies and American Association of Anesthesiologists (ASA) status II. Psychological and pain vulnerabilities, obstetric factors, and analgesic choice were assessed using established self-reporting scales. Univariate and multivariable logistic regression analyses were conducted. Clinically relevant variables with p-value < 0.10 in univariate logistic regression analyses were selected using a stepwise variable selection to construct the final multivariable model. We recruited 816 postpartum patients between 2017 and 2021, 99 (12.1%) developed SAPC at 6 to 10 weeks postpartum. The multivariable model revealed higher Central Sensitisation Inventory (CSI) score, increased number of pain relief administered, having had artificial rupture of membranes and oxytocic induction, increased blood loss during delivery, having had third degree tear and higher infant’s weight were independently associated with higher SAPC incidence. Having had prostin induction was associated with reduced SAPC risk. The area under the curve of the model is 0.727 (95%CI 0.674-0.780). This study explores SAPC development in psychological and pain vulnerabilities, obstetric factors, and analgesic choice. Further investigations should delve into the underlying mechanisms to develop tailored interventions. Yaochen LIU (Singapore, Singapore), Rehena SULTANA, Chin Wen TAN, Ban Leong SNG 11:44 - 11:51 #42436 - OP029 Comparing The Effect Of Three Different Post-Cesarean Analgesic Techniques On Obstetric Quality Of Recovery-10 (ObsQoR-10) Score After Elective Cesarean Section Operations: Prospective, Randomised, Double Blinded Pilot Study. OP029 Comparing The Effect Of Three Different Post-Cesarean Analgesic Techniques On Obstetric Quality Of Recovery-10 (ObsQoR-10) Score After Elective Cesarean Section Operations: Prospective, Randomised, Double Blinded Pilot Study. It is aimed to compare the effect of three different analgesic techniques used for pain control after elective cesarean section operations on quality of recovery as stated by the patient, using the ObsQoR-10 scoring system. 30 women scheduled for cesarean section under spinal anaesthesia were randomly allocated into three groups. Spinal anaesthesia was maintained with 11.2 mg hyperbaric bupivacaine+15 µg fentanyl in Groups II-III, while morphine was also added in Group I. In Group II, bilateral ultrasound-guided QLB-I was performed and in Group III the same volume and concentration of anaesthetic was instilled on uterus, infiltrated on rectus aponeurosis and through the wound site. The patients filled out ObsQoR-10 and EuroQol 5-dimension 3L at 24 hours postoperatively. Validity was evaluated by hypothesis test and structural validity. There was no difference considering ObsQoR-10 scores at 24 hours postoperatively between the groups. Scores were in correlation with age, ambulation time, passive and active pain scores at 24 hours. ObsQoR-10 values were found to be lower in those treated with ondansetrone and who had nausea and vomiting. (p<0.05). There was a moderate correlation of ObsQoR-10 score with EuroQol 5-dimension 3L scores (r=- 0.690). The ObsQoR-10 is found to be consistent internally and has excellent test-retest reliability. The highest ranked items were, nausea or vomiting, dizziness, shivering, and lowest was pain. (NCT06341049) In this study, it was found that groups had no difference in terms of ObsQoR-10 scores and that this scoring sytem is a valid and reliable tool to evaluate pain recovery. Mehmet Akif YILMAZ, Miraç Selcen ÖZKAL YALIN (ERZURUM, Turkey), Ayşenur DOSTBİL, Kamber KAŞALİ, Gamze Nur CİMİLLİ ŞENOCAK, Didem ONK, Muhammed CEREN, İlker İNCE 11:51 - 11:58 #42444 - OP030 Landmark accuracy for spinal anaesthesia in obese obstetric patients: should we use lumbar ultrasound routinely ? OP030 Landmark accuracy for spinal anaesthesia in obese obstetric patients: should we use lumbar ultrasound routinely ? Obesity complicates landmark-based spinal anaesthesia, increasing misidentification of intervertebral levels and needle insertions. While various meta-analyses have compared ultrasound to landmark techniques, obstetric studies remain scarce. In this study, we aimed to determine if obesity impacts injection site accuracy in landmark-based spinal anaesthesia among Obstetric patients. Ethical approval was obtained for this observational prospective cohort study(HRA,England 16/NE/0410). Two cohorts were defined as lower BMI >/=35 kgm-2 or higher BMI <35 Kgm-2, based on our local population's median booking BMI(35 kgm-2). Intervertebral space was determined by the anaesthetist using landmark-based approach which assumes the line intersecting top of iliac crests at the level of L4 vertebra and distal end of spinal cord at L1 vertebra. Using ultrasound(U/S), the research team determined whether there was a difference between the landmark and the U/S-derived spinal level and then quantified the difference in levels. We also recorded difficulty in identifying the landmarks. 111 women were included. Palpating landmarks was significantly easier in the lower BMI group (n=55) than higher BMI group(n=56), (p < 0.0001). Spinal level was correctly determined only approximately 50% of the time in both the lower and the higher BMI group (50.9% v 44.6%, p=0.7); however, with the higher BMI group, 100% inaccuracies resulted from aiming too high, compared to 69.8% in lower BMI group(p=0.001). Obesity increases the risk of aiming higher than intended intervertebral space for spinal anaesthesia in obstetric patients using traditional landmark-based approach, which highlights the need for routinely incorporating pre-procedural ultrasound, especially in this group of patients. Nishant KALRA, Nishant KALRA (Cambridge, United Kingdom), Fleur ROBERTS, Mark PRINCE, Timothy ORR, Ian WRENCH, Phil BONNET, Alison COLHOUN 11:58 - 12:05 #40276 - OP031 Accidental dura puncture during labor epidural analgesia and intrathecal catheter: A perfect camaraderie. OP031 Accidental dura puncture during labor epidural analgesia and intrathecal catheter: A perfect camaraderie. Childbirth is a unique and exciting time for pregnant woman. Epidural analgesia during labor is gold standard technique for pain relief. Accidental dural puncture (ADP) during labor epidural is not uncommon and is distress moment for both patient and anaesthesiologist. Resiting epidural catheter (REC) at same or another space, or placing catheter into intrathecal (IT) space are two available options. We searched the review of literature, meta-analysis and retrospective studies of last ten years, related to ADP, intrathecal catheter (ITC), postdural puncture headache (PDPH), epidural blood patch (EBP) in parturients requesting labor analgesia. The incidence of ADP is 0.2-3.6% and PDPH develops in 66% of patients. ITC reduces the incidence of PDPH to<30% and decreases the need of EBP by>50%, if the catheter is in place for >24 hours. ITC gives advantage of avoiding repeat ADP or failure to place a neuraxial catheter at all. REC carries 10% risk of second ADP. ITC allows immediate pain relief in labor patient with severe pain, difficulty in position, and non-reassuring fetal tracing. Parturients having morbid obesity, history of spine surgery, scoliosis and multiple attempts at epidural placement are candidates of ITC. ITC placed for labor analgesia can be extended for caesarean delivery (CD) using incremental dosing. There are no serious complications reported. The ITC potentially decreases incidence of PDPH and need for EBP. Further, ITC guarantees a rapid onset, high quality and predictable labour analgesia or even surgical anaesthesia, if CD is required. Catheter identification and communication with labor staff avoid errors. Sameer KAPOOR (DUBAI, United Arab Emirates), Ghassan KLOUB, Shrutika PAREKH 12:05 - 12:12 #42743 - OP032 Evaluating the Effect of Labor Analgesia on Recovery of Parturients After Vaginal Delivery Using the Obstetric Quality Of Recovery-10 (ObsQoR-10) Scores: Prospective Single Center Observational Study. OP032 Evaluating the Effect of Labor Analgesia on Recovery of Parturients After Vaginal Delivery Using the Obstetric Quality Of Recovery-10 (ObsQoR-10) Scores: Prospective Single Center Observational Study. It is aimed to evaluate and compare the recovery of parturients giving birth with and without labor analgesia using the ObsQoR-10 score. The women admitted for vaginal birth were allocated into two groups. 20 women who requested labor analgesia were included in Group I while 20 others who didn’t want to have labor analgesia formed Group II. They were asked to fill out ObsQoR-10 and EuroQol 5-dimension 3L at hours 24,48 an 72 postoperatively. Primary outcome was ObsQoR-10 scores at 24. hours postpartum. Secondary outcomes were was ObsQoR-10 scores at 48. and 72. hours postpartum as well as pyschiametric evaluation of ObsQoR-10. (NCT06325475) Data were analysed using validity hypothesis test and structural validity test. In hypothesis test, there was no significant difference between groups in terms of ObsQoR-10 scores. The ObsQoR-10 scores at 48. And 72. hours postpartum were also similar. There was a correlation between ObsQoR-10 scores at 24. hour and postpatum haemoglobin levels. At 48 and 72 hours, ObsQoR-10 scores were correlated with age. In structural validity, a correlation between ObsQoR-10 scores at 24, 48, 72 hours and EuroQol 5-dimension 3L scores. The ObsQoR-10 is found to have good internal consistency. The highest ranked Obstetric Quality of Recovery-10 items were, nausea or vomiting, dizziness and shivering. The lowest ranked item was pain. Although epidural analgesia is an invasive procedure, study shows that there is no significant difference between groups in terms of postpartum ObsQoR-10 scores, and that this scoring is a valid and reliable evaluation tool. Gamze Nur CİMİLLİ ŞENOCAK, Emirhan AKARSU, Ayşenur DOSTBİL, Alp Ertunga DULGEROGLU, Mehmet Akif YILMAZ, Recep KURTBAŞ, Miraç Selcen ÖZKAL YALIN (ERZURUM, Turkey) 12:12 - 12:19 #40185 - OP028 The effect of remimazolam compared to propofol on postoperative shivering in patient undergoing cesarean section under spinal anesthesia with sedation. OP028 The effect of remimazolam compared to propofol on postoperative shivering in patient undergoing cesarean section under spinal anesthesia with sedation. Shivering is known to be a frequent complication in patients undergoing surgery under neuraxial anesthesia with incidence of 40–70% Although many pharmacological agents have been used to treat or prevent postspinal anesthesia shivering (PSAS), the ideal treatment wasn’t found.[1] This study compared the effects of remimazolam with propofol on postoperative shivering(PS) in patients undergoing cesarean section under spinal anesthesia. Seventy patients were allocated into one of two groups. After delivery, group A received propofol and group B received remimazolam for sedation. The incidence and severity of postoperative shivering, core body temperature, and the association of PS with hypothermia, MAP, or HR in the post-anesthesia care unit (PACU) were measured. Group B had significantly lower rates of perioperative hypothermia (50.1 vs. 28.0%, p = 0.04) and postoperative shivering (40.2 vs. 20.1%, p = 0.042). The severity of PS was also lower in group B than in group A (p = 0.032). Core body temperature was significantly higher in group B than in group A from 10 min after induction (p = 0.046) to the PACU (p = 0.02). MAP and HR were more stable in group B than in group A. In group A, the correlation between the severity of PS and the incidence of hypothermia was moderate but not significant. In group B, the correlation between PS severity and hypothermia was moderate and significant. Remimazolam showed better results than propofol in anesthesia maintenance regarding hypothermia. Seunghee CHO (Incheon, Republic of Korea)
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11:50				11:50-12:20 Added to your list of favorites Deleted from your list of favorites D14 REFRESHING YOUR KNOWLEDGE Obstetric REFRESHING YOUR KNOWLEDGE Obstetric Chairperson: Kassiani THEODORAKI (Anesthesiologist) (Chairperson, Athens, Greece) 11:50 - 11:55 Introduction. Kassiani THEODORAKI (Anesthesiologist) (Keynote Speaker, Athens, Greece) 11:55 - 12:15 Optimising outcomes in preeclampsia – what is the role of neuraxial techniques. Sarah DEVROE (Head of clinic) (Keynote Speaker, Leuven, Belgium) 12:15 - 12:20 Q&A.	11:50-12:20 Added to your list of favorites Deleted from your list of favorites E14 TIPS & TRICKS Pediatric RA TIPS & TRICKS Pediatric RA Chairperson: Ivan KOSTADINOV (ESRA Council Representative) (Chairperson, Ljubljana, Slovenia) 11:50 - 11:55 Introduction. Ivan KOSTADINOV (ESRA Council Representative) (Keynote Speaker, Ljubljana, Slovenia) 11:55 - 12:15 #43472 - E14 Adjusting RA to Kids. Adjusting RA to Kids. Regional anaesthetic techniques for paediatric patients undergoing operative procedures have become increasingly popular throughout the world over the past few decades due to their significant benefits. Important among these are prolonged pain control and the ability to avoid opioid analgesia that promote post- operative nausea and vomiting. An overview of the unique features of paediatric anatomy and physiology that allow successful performance of these techniques is presented. Combinations of local anaesthetics and adjuvant medications that prolong caudal and peripheral nerve blocks are reviewed, the use of peripheral nerve blocks and specific recommendations for the use of these blocks in children is also presented. The use of regional anaesthesia is considered very safe and offer the ability to target therapy directly to the site of surgery. With advances in the understanding of pain in children, progress in studying new techniques of regional anaesthesia, update equipment and the use of safe local anaesthetic agents, the use of regional anaesthetic blocks will continue to evolve. Regional anaesthesia remains an important component of the multimodal approach specifically benefitting pediatric patients over opioid-based analgesia. Major goals of regional anaesthesia for paediatric surgery include effective and prolonged pain control and avoidance of unpleasant side-effects that distress patients and their families or that prolong hospital stay. Lara RIBEIRO (Braga-Portugal, Portugal) 12:15 - 12:20 Q&A.	11:50-12:20 Added to your list of favorites Deleted from your list of favorites F14 TIPS & TRICKS Ambulatory Surgery TIPS & TRICKS Ambulatory Surgery Chairperson: Xavier CAPDEVILA (MD, PhD, Professor, Head of department) (Chairperson, Montpellier, France) 11:50 - 11:55 Introduction. Xavier CAPDEVILA (MD, PhD, Professor, Head of department) (Keynote Speaker, Montpellier, France) 11:55 - 12:15 Optimal Pain Management for Ambulatory Surgery. Patrick NARCHI (Anesthesia) (Keynote Speaker, SOYAUX, France) 12:15 - 12:20 Q&A.	11:50-12:20 Added to your list of favorites Deleted from your list of favorites G14 REFRESHING YOUR KNOWLEDGE Emerging techniques for acute pain REFRESHING YOUR KNOWLEDGE Emerging techniques for acute pain Chairperson: Vicente ROQUES (Anesthesiologist consultant) (Chairperson, Murcia. Spain, Spain) 11:50 - 11:55 Introduction. Vicente ROQUES (Anesthesiologist consultant) (Keynote Speaker, Murcia. Spain, Spain) 11:55 - 12:15 Cryoneurolysis for acute pain. Nadia HERNANDEZ (Associate Professor of Anesthesiology) (Keynote Speaker, Houston, Texas, USA) 12:15 - 12:20 Q&A.
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12:30 - 14:00	LUNCH BREAK

14:00	14:00-14:50 Added to your list of favorites Deleted from your list of favorites A13 EXPERT OPINION DISCUSSION Intrathecal opioids EXPERT OPINION DISCUSSION Intrathecal opioids CENTRAL NERVE BLOCKS (CNBs) Chairperson: Narinder RAWAL (Mentor PhD students, research collaboration) (Chairperson, Stockholm, Sweden) 14:00 - 14:05 Introduction. Narinder RAWAL (Mentor PhD students, research collaboration) (Keynote Speaker, Stockholm, Sweden) 14:05 - 14:20 Worldwide use: Results of our questionnaire. Josephine KELLER (-) (Keynote Speaker, Stockholm, Sweden) 14:20 - 14:35 Safety of intrathecal opioid use. Eric ALBRECHT (Program director of regional anaesthesia) (Keynote Speaker, Lausanne, Switzerland) 14:35 - 14:50 Q&A.	14:00-14:50 Added to your list of favorites Deleted from your list of favorites B14 ASK THE EXPERT Blocks in challenging situations ASK THE EXPERT Blocks in challenging situations Chairperson: Ana Eugenia HERRERA (Regional Anesthesiologist) (Chairperson, San José, Costa Rica) 14:00 - 14:05 Introduction. Ana Eugenia HERRERA (Regional Anesthesiologist) (Keynote Speaker, San José, Costa Rica) 14:05 - 14:35 Blocks in challenging situations. Lukas KIRCHMAIR (Chair) (Keynote Speaker, Schwaz, Austria) 14:35 - 14:50 Q&A.	14:00-14:50 Added to your list of favorites Deleted from your list of favorites C15 LIVE DEMONSTRATION Thoracic wall blocks LIVE DEMONSTRATION Thoracic wall blocks Demonstrators: Peter POREDOS (consultant) (Demonstrator, Ljubljana, Slovenia, Slovenia), Valentina RANCATI (Consultant) (Demonstrator, Lausanne, Switzerland)	14:00-14:50 Added to your list of favorites Deleted from your list of favorites D16 EXPERT OPINION DISCUSSION Procedure specific vs. individualized pain management EXPERT OPINION DISCUSSION Procedure specific vs. individualized pain management Chairperson: Eleni MOKA (faculty) (Chairperson, Heraklion, Crete, Greece) 14:00 - 14:05 Introduction. Eleni MOKA (faculty) (Keynote Speaker, Heraklion, Crete, Greece) 14:05 - 14:20 Procedure-specific pain management. Axel SAUTER (consultant anaesthesiologist) (Keynote Speaker, Oslo, Norway) 14:20 - 14:35 Individualized pain management. Esther POGATZKI ZAHN (Full Professor) (Keynote Speaker, Muenster, Germany) 14:35 - 14:50 Conclusion and Q&A.	14:00-14:50 Added to your list of favorites Deleted from your list of favorites E16 PRO CON DEBATE RA is a MUST for every ERAS Protocol PRO CON DEBATE RA is a MUST for every ERAS Protocol Chairperson: Kariem EL BOGHDADLY (Consultant) (Chairperson, London, United Kingdom) 14:00 - 14:05 Introduction. Kariem EL BOGHDADLY (Consultant) (Keynote Speaker, London, United Kingdom) 14:05 - 14:20 For the PROs. Ana LOPEZ (Consultant) (Keynote Speaker, Barcelona, Spain) 14:20 - 14:35 For the CONs. Luis Fernando VALDES VILCHES (Clinical head) (Keynote Speaker, Marbella, Spain) 14:35 - 14:50 Q&A.	14:00-14:50 Added to your list of favorites Deleted from your list of favorites F16 ASK THE EXPERT Blocks for shoulder surgery ASK THE EXPERT Blocks for shoulder surgery Chairperson: Edward MARIANO (Speaker) (Chairperson, Palo Alto, USA) 14:00 - 14:05 Introduction. Edward MARIANO (Speaker) (Keynote Speaker, Palo Alto, USA) 14:05 - 14:35 Blocks for shoulder surgery. Sebastien BLOC (Anesthésiste Réanimateur) (Keynote Speaker, Paris, France) 14:35 - 14:50 Q&A.	14:00-14:50 Added to your list of favorites Deleted from your list of favorites G16 ASK THE EXPERT Conversion ASK THE EXPERT Conversion Chairperson: Steve COPPENS (Head of Clinic) (Chairperson, Leuven, Belgium) 14:00 - 14:05 Introduction. Steve COPPENS (Head of Clinic) (Keynote Speaker, Leuven, Belgium) 14:05 - 14:35 Conversion of labour epidural analgesia to surgical anaesthesia for C-section. Tatiana SIDIROPOULOU (Professor and Chair) (Keynote Speaker, Athens, Greece) 14:35 - 14:50 Q&A.	14:00-16:00 Added to your list of favorites Deleted from your list of favorites H16 SIMULATION TRAININGS SIMULATION TRAININGS Demonstrators: Josip AZMAN (Consultant) (Demonstrator, Linkoping, Sweden), Clara LOBO (Medical director) (Demonstrator, Abu Dhabi, United Arab Emirates), Kassiani THEODORAKI (Anesthesiologist) (Demonstrator, Athens, Greece), Roman ZUERCHER (Senior Consultant) (Demonstrator, Basel, Switzerland)	14:00-14:55 Added to your list of favorites Deleted from your list of favorites FP14 PAEDIATRIC Free Papers 3 PAEDIATRIC Free Papers 3 Chairperson: Luc TIELENS (pediatric anesthesiology staff member) (Chairperson, Nijmegen, The Netherlands) 14:00 - 14:07 #42471 - OP033 Assessment of analgesic efficacy of peribulbar block as adjunct to general anaesthesia in paediatric patients undergoing enucleation for retinoblastoma: a double-blind randomised controlled trial. OP033 Assessment of analgesic efficacy of peribulbar block as adjunct to general anaesthesia in paediatric patients undergoing enucleation for retinoblastoma: a double-blind randomised controlled trial. Enucleation surgery for retinoblastoma is painful. This study compared analgesic efficacy of peribulbar block as adjunct to general anaesthesia (GA) in children. Primary outcome was number of children having moderate to severe pain in 6hours post-surgery. Pain scores (2,6,12 & 24 hrs), perioperative fentanyl (intraoperative and 2 hours postoperative) requirement, time to first postoperative analgesic (TFPA), incidence of OCR and PONV were also assessed. Fifty-four children, aged 0 -10 years were randomised to the peribulbar(PB) or GA group. Post induction of anaesthesia, PB group children were administered peribulbar block using 0.3ml/kg,0.5% ropivacaine. Intraoperative increase in heart rate or mean arterial pressure 20% above baseline was treated with 0.5mcg/kg fentanyl boluses. Number of children with moderate to severe pain was lesser in the PB group [9/29(31%) ] versus the GA group [13/25(52%)] in 6 postoperative hours. TFPA was shorter in GA group, but the difference was not significant, (Table 1). Number of patients requiring intraoperative fentanyl and total perioperative fentanyl requirement was significantly lower in study group (Table 1). Significant tachycardia was observed on traction of eyeball during enucleation (p<0.05) in the GA versus PB group (Figure 1). Pain scores at different time points, incidence of OCR and PONV were comparable between groups, (Table 1). The higher perioperative fentanyl administration in the GA group may have led to comparable pain scores between the two groups. The post-hoc analysis revealed the power of the study to be 78%, suggesting that further larger studies need to be carried out in the future. Shraddha DEWANGAN (Delhi, India), Anjolie CHHABRA 14:07 - 14:14 #41453 - OP035 Intrathecal Morphine as a Strategy to Eliminate IVPCA for the Management of Post-Surgical Pain In Scoliosis Patients. OP035 Intrathecal Morphine as a Strategy to Eliminate IVPCA for the Management of Post-Surgical Pain In Scoliosis Patients. Surgical correction of adolescent idiopathic scoliosis (AIS) requires high doses of opioids, traditionally via intravenous patient-controlled analgesia (IVPCA). An ERAS protocol was implemented at our institution to stop routine use of IVPCA, to be replaced with either intrathecal morphine injection or enteral methadone, and transition to enteral analgesia by morning after surgery. With REB approval, chart review was conducted of all patients who underwent surgical correction for AIS before and after protocol implementation, to compare outcomes and feasibility of managing pain with the ERAS protocol. 62 patients were included, 32 receiving IVPCA and 30 in the ERAS pathway. No significant difference between groups by age, gender or BMI. Majority of patients in the ERAS pathway did not require rescue doses of opioids in the recovery room (53.3%), POD 0 (76.7%) or POD 1 (73.3%). There were statistically significant differences in pain scores between the two groups, with the IVPCA group having higher pain scores at 0 hours (p=0.002), ERAS group having higher pain scores at 24 hours (p=0.02) and 36 hours (0.01), with no difference in pain scores between groups at 12 hours (p=0.12). Length of stay in ERAS pathway (mean 3.16 days) versus IVPCA (2.83 days) pathway were not statistically significantly different (p=0.07). Analgesia after AIS repair can be successfully achieved without IVPCA, with intrathecal morphine or methadone, to allow for increased mobility, reduced use of resources and decreased reliance on intravenous medications. More judicious use of enteral rescue doses should be incorporated to further improve pain management. Deepa KATTAIL (Toronto, Canada), David LEBEL, Elen MULLAJ, Eric GREENWOOD, Mark MCVEY, Mark CAMP 14:14 - 14:21 #42650 - OP036 Effectiveness of Perfusion Index for Predicting Onset of Paediatric Caudal Block under Sevoflurane Anesthesia. OP036 Effectiveness of Perfusion Index for Predicting Onset of Paediatric Caudal Block under Sevoflurane Anesthesia. Caudal block is the most popular regional anesthesia technique in paediatric day case perineal & lower limb surgery. But assessing the onset of caudal block challenging since paediatric surgeries are performed under general anesthesia(GA). Perfusion index (PI), which reflects the ratio of pulsatile to non-pulsatile blood flow at monitoring site, PI is increased in adequate caudal block. This study aims to assess the role of PI alongside mean arterial pressure (MAP), heart rate (HR), and Cremasteric reflex (CR) in promptly detecting paediatric caudal block onset under GA. 120 consecutive patients scheduled to surgery taken in this observational study and 10 patients (8.3%) were excluded due to failed reading, leaving data from 110 patients for analysis. Baseline PI, HR, MAP, CR were recorded prior to and post caudal block at 5,10,15,20 min. Onset of adequate block was defined as 100% increase of PI from baseline, 15% decrease of MAP or HR from baseline, loss of CR. Results show that PI most promptly confirms the onset of caudal block, followed by loss of CR, HR and MBP reductions confirm it later. At 10 minutes, many patients show a ≥100% increase in PI. AUC (Area Under Curve) values moderate discriminatory ability for PI increase (0.364) and absent CR time (0.329) compared to HR and MBP. PI and CR slightly outperform then HR and MBP in predicting successful caudal block. PI proves to be a reliable and continuous indicator for promptly identifying the initial stages of caudal block in pediatric patients undergoing GA. Sylvia KHAN (DHAKA, Bangladesh), Shyama Prosad MITRA, Lutful AZIZ, Hasina AKHTER, Salah Uddin Al AZAD, Md Aftab UDDIN, Anm BADRUDDOZA, Masrufa HOSSAIN 14:21 - 14:28 #42804 - OP037 The readability of patient information leaflets in paediatric post-operative pain. OP037 The readability of patient information leaflets in paediatric post-operative pain. The management of post-operative pain is essential to ensure patient comfort and timely recovery following surgery. Paracetamol and ibuprofen are the recommended analgesics for post operative pain at our tertiary paediatric hospital. Paediatric patients rely on their guardians for the correct administration of their pain relief. Unfortunately, poor literacy skills may lead to guardians not understanding the patient information leaflets (PIL) provided with medications. The literature suggests that health information should be pitched at a reading age level of 11-13 years of age. The "Health Products Regulatory Authority" database was searched for paracetamol and ibuprofen products that were suitable for children. The registered PIL from these products were entered into a readability tool. Five of the tests compared the readability to an American school grade while one of the tests (FRE) rated the readability on a numerical scale. The corresponding cut off for a reading age of 11-13 was a grade of ≤ 7 or >70 for the FRE score. 31 products met our criteria. 14(45%) were paracetamol and 17(55%) were ibuprofen products. The mean grade of all tests were >7 (range 10.95 - 13.56) and mean of FRE was <70 (mean 43.48). Using standardised readability tests, all PIL were above the recommended reading age for medical information. This may affect a guardian's ability to provide appropriate pain relief for children following surgery. Pharmaceutical companies should ensure that PIL are at the recommended reading level to prevent incorrect dosing of pain relief which may lead to pain and patient harm. Conor HAUGH (Dublin, Ireland), Ruth MOONEY, Rachael HORAN 14:28 - 14:35 #42522 - OP038 Use of dexmedetomidine for caudal anesthesia in pediatric patients. OP038 Use of dexmedetomidine for caudal anesthesia in pediatric patients. Caudal anesthesia is one of the most popular, reliable and safe methods of pain relief in children and can provide pain relief for various surgical procedures below the navel. Research material and methods: The subject of the study was 946 children with physical status I and II class of the American Society of Anesthesiologists (ASA), aged 0 to 12 years, who underwent elective surgeries below the navel, such as hernia repair, orchiopexy, hypospadias repair, epispadias, etc. Depending on the drug administered, the patients were divided into two groups: Group A: bupivacaine 2.5 mg / kg + saline 1.2 ml / kg. Group B: bupivacaine 2.5 mg / kg + 1 μg / kg dexmedetomidine + saline 1.2 ml / kg. Research results: The duration of caudal analgesia was determined from complained of pain or the time when the first postoperative analgesia was required. The average the moment the anesthetic was injected until the moment the child first duration of postoperative caudal analgesia in patients of group A was 4.21 ± 0.88, while in patients of group B this duration was 10.18 ± 0.85 hours. Conclusions. Our results show that the addition of dexmedetomidine to the local anesthetic for caudal block significantly increases the duration of analgesia and reduces the need for analgesics. Esmira NASIBOVA (Baku, Azerbaijan) 14:35 - 14:42 #42595 - OP039 In pediatric patients, regional anesthesia decreases opioid use, and hospital length of stay for inpatients. OP039 In pediatric patients, regional anesthesia decreases opioid use, and hospital length of stay for inpatients. Regional anesthesia is not as widely used for pediatric cases as for adults, and whether it significantly decreases intra- and postoperative opioid use or has an impact on short-term outcomes such as time in PACU, discharge and readmission is still unclear. We retrospectively reviewed all pediatric patients (age ≤17) who underwent surgery with general anesthesia at our center between 2016 and 2021. Patients were broken down into a group that did not receive regional anesthesia and a group that did. Data collected included intra-operative opioids in morphine milligram equivalent per kg, PACU LOS, postoperative respiratory complications, postoperative hospital LOS, and 30-day readmission. Out of 21,863 patients, after excluding ASA > 4, patients who were intubated or had a tracheotomy preoperatively, and records with missing data, 20,878 records were included. Analysis included adjusting for confounders. Opioid use (in morphine equivalent per kg) was significantly lower in the regional group (N=1,248) than in the no-regional group (N=19,630): 0.40 ± 1.01 vs. 0.58 ± 1.83; p < 0.001. There was no significant difference in PACU LOS, postoperative respiratory complications, 30-day readmission or postoperative hospital LOS. However, postoperative HLOS was significantly shorter in the regional group when excluding ambulatory patients: 4.8 ± 11.1 vs. 6.9 ± 18.6 days; p = 0.049; adjusted absolute difference 0.19 days or about 4.5 hours. In our sample of pediatric patients, regional anesthesia significantly decreased opioid use. For inpatients, HLOS was also significantly reduced. Arthur HERTLING (New York, USA), Aline GRIMM, Maira RUDOLPH, Matthias EIKERMANN, Felix BORNGAESSER, Ling ZHANG, Jerry CHAO 14:42 - 14:49 #42678 - OP034 Comparison of Caudal epidural block with Multiple injection Costotransverse block for renal surgeries in paediatric patients: A prospective randomised, clinical trial. OP034 Comparison of Caudal epidural block with Multiple injection Costotransverse block for renal surgeries in paediatric patients: A prospective randomised, clinical trial. Renal surgeries in pediatrics often result in significant post-operative pain, necessitating effective analgesia for early recovery and complication minimization. While caudal epidural block is commonly used, its short duration often requires adjuncts like morphine or clonidine, which can cause adverse effects. Recently, the Multiple Injection Costotransverse Block (MICB) has been introduced, showing promising perioperative analgesia. This study aims to compare the analgesic efficacy of MICB to caudal block in pediatric renal surgeries by evaluating the total fentanyl requirement within 24 hours post-surgery In this study, 56 children undergoing renal surgery were divided into two groups with 28 children in each group. Group CB/ caudal block received 0.2% Ropivacaine 1.25ml/kg and Group MICB/multiple injection costo transverse block received 0.2%Ropivacaine 2mg /kg under usg guidance The MICB group showed significantly lower mean fentanyl consumption (0.57 ± 0.17 mcg/kg) compared to the caudal block (0.84 ± 0.31 mcg/kg) (p=0.03). Fewer patients in MICB group(32.14%) needed rescue analgesia within 24 hours compared to caudal block (53.57%). MICB also prolonged time to rescue analgesia (4 hrs vs. 2 hrs) and had higher parental satisfaction (p=0.01). No complications occurred In children undergoing renal surgeries, MICB offers better, safer, and prolonged post-operative analgesia with higher parental satisfaction than caudal epidural block. It should be considered as an alternative, requiring ultrasound-guided expertise. Debesh BHOI, Meenakshi Sundharesan A (India, New Delhi, India)
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15:30	15:30-16:30 Added to your list of favorites Deleted from your list of favorites A15 EXPERT OPINION DISCUSSION Continuous Peripheral Nerve Blocks EXPERT OPINION DISCUSSION Continuous Peripheral Nerve Blocks POSTOPERATIVE PAIN MANAGEMENT Chairperson: Wojciech GOLA (Consultant) (Chairperson, Kielce, Poland) 15:30 - 15:35 Introduction. Wojciech GOLA (Consultant) (Keynote Speaker, Kielce, Poland) 15:35 - 15:50 Optimizing Pain Management Regimens. Emine Aysu SALVIZ (Attending Anesthesiologist) (Keynote Speaker, St. Louis, USA) 15:50 - 16:05 Avoiding Complications in CPNBs. Xavier CAPDEVILA (MD, PhD, Professor, Head of department) (Keynote Speaker, Montpellier, France) 16:05 - 16:20 Post-Procedure Patient Care. Brian KINIRONS (Consultant Anaesthetist) (Keynote Speaker, Galway, Ireland, Ireland) 16:20 - 16:30 Q&A.	15:30-16:30 Added to your list of favorites Deleted from your list of favorites B15 EXPERT OPINION DISCUSSION Anatomy at it's finest EXPERT OPINION DISCUSSION Anatomy at it's finest PERIPHERAL NERVE BLOCKS (PNBs) Chairperson: Thomas Fichtner BENDTSEN (Professor, consultant anaesthetist) (Chairperson, Aarhus, Denmark) 15:30 - 15:35 Introduction. Thomas Fichtner BENDTSEN (Professor, consultant anaesthetist) (Keynote Speaker, Aarhus, Denmark) 15:35 - 15:50 #43494 - B15 Current Insights into Hip Joint Innervation. Current Insights into Hip Joint Innervation. Introduction The innervation of the hip joint has gained attention in recent years, with research highlighting its relevance for treatments of hip osteoarthritis and its importance in contributing to pain and neuromechanics of the hip joint [1]. Hip osteoarthritis is a unique disorder, with a distinct etiopathology, high prevalence in the elderly, and it poses great burden on individual’s quality of life and society, as such early detection and management are paramount [2]. Total hip arthroplasty (THA) aims to resolve the associated pain, however, the success of this procedure is variable [3]. One of the most common reasons for its failure is dislocation, therefore necessitating the requirement for revision surgery [3]. Furthermore, this procedure is not suitable for all, particularly due to co-morbidities [4]. Radiofrequency ablation (RA) has emerged a suitable alternative in such cases, and involves targeting the nerves of the hip joint [4], thus understanding the detailed anatomy is important to inform these procedures. The aim of this work is to highlight the current knowledge on the hip joint innervation and surrounding structures, its clinical relevance, and future directions of research. Detailed Anatomy of the Hip Joint Alongside the osseous stabilizers, the proximal femur and acetabulum, further passive supporting structures exist, namely the ligament of the head of the femur, the hip joint capsular complex, fascia and adipose tissues surrounding the hip [1]. The active stabilisers are the muscles of hip kinematics, while the neural components of the hip core complex of stability are the mechanoreceptive elements, free nerve endings and nerves, with various motor and sensory functions [1]. The original text of Hilton’s law states “The same trunks of nerves whose branches supply the groups of muscles moving a joint furnish also a distribution of nerves to the skin over the insertions of the same muscles; and—what at this moment more especially merits our attention—the interior of the joint receives its nerves from the same source.” [5]. While the literature highlights that this law appears to apply to the hip joint as the muscles surrounding the hip joint are innervated in a compartmental manner with specific branches to each muscle [6], and there is also evidence of sub-compartmental innervation within muscles, such as in the tensor fascia latae [7] and gluteus medius [8]. Additionally, the neural components of the hip capsule are also derived from nerves of the lumbosacral plexus [9], while the specific innervation of fascia, adipose tissue, the transverse acetabular ligament (TAL), ligament of the head of the femur (LHoF) and labrum remains unclear (Table 1) [1, 10-13]. The hip capsule [14], LHoF [10], labrum [10, 11] and TAL [11] were shown to contain free nerve endings and mechanoreceptors and therefore play a role in pain sensation and proprioception. Table 1: Table demonstrating the origin of innervation for the tissues of the hip joint. LHoF=Ligament of the head of the femur. TAL=Transverse acetabular ligament. The nuanced specifics of the distribution and prevalence of each nerve supplying the hip joint innervation is complex and variable [20]. Some nerves are well documented in relation to their course and related osteological landmarks or incisions sites, including the femoral [21], lateral femoral cutaneous [22], pudendal [23], sciatic [23], and superior gluteal nerves [24]. For example, the femoral nerve is located 19-27 mm from the anterior acetabular rim across its circumference [21], crucially understanding this facilitates application of this knowledge into clinical scenarios, such as when developing surgical approaches. Whereas the anatomy of smaller nerve branches is less well understood, these are known to be undulating, and course through hip capsule tissues in various directions [1]. This is thought to result in a discrepancy in the innervation density and distribution at microscopic and macroscopic levels [9, 14]. It remains unclear how nerves specifically course into each muscle, through adipose tissue, fascia, or into the bones of the hip joint [1]. Overall, these nerves are shown to innervate the tissues of the hip in different patterns between individuals [20]. Some differences in innervation patterns include a single or dual innervation of the pectineus with branches from the obturator and femoral nerves [16], differences in consensus on the distribution of nerves across the capsule [9, 14], age and sex related changes in the course of the sciatic nerve [25], which each can have potential functional implications if damaged. Despite these variations, generally the distal-medial aspect and the proximal-lateral aspect of the hip capsule appear regions of higher density, and likely receive innervation derived from the femoral and obturator nerves, but also potentially other sources [1, 9]. Despite this, greater focus has been on macroscopic nerve distribution [9, 20], microscopic mechanoreceptor distribution [1] and therefore it remains unclear which regions contain greater density of free nerve endings alone. Clinical Relevance and Applications The nerves supplying the hip joint or their neural elements may be targeted for regional anaesthesia [4], or avoided intraoperatively such as during THA, and arthroscopy [7, 21], therefore understanding of their spatial distribution and variation is imperative to achieve desired outcomes. From a regional anaesthesia perspective, there are multiple methods to target the nerves of the hip joint, including a regional or specific nerve targeted approach [4]. These are used in different scenarios, such as: - Pre-operatively: deep posterior gluteal block for the posterior hip [26], fascia iliaca block [27], and femoral nerve block [27] for the anterior hip. - Acute pain: PENG block to target the femoral nerve [28], and iliopsoas plane block, which both provide a generally motor-sparing effect [29]. - Chronic pain: RA of the obturator, femoral nerve [4] and branches to greater trochanter [30] are shown to be effective. Whereas from a surgical perspective, understanding the nerve supply to the presents opportunities to identify areas to avoid nerves, such as the proximal-lateral hip capsule [1]. However, potential proprioceptive deficits may be minimal in all cases due to the significance of active and passive tissues in contributing to stability [1]. These deficits equally may be mitigated by repair of the hip capsule, which is shown to have favourable outcomes, including lower revision rates [31]. Future Directions in Hip Joint Innervation Research To date, little is known about the innervation patterns of some associated joint tissues, and the specific distribution of free nerve endings within the hip capsule, which is important to develop recommendations for THA and RA. Given the anatomical variation of smaller capsular branches, that numerous nerves that supply the whole joint, and that the success rates of RA is variable, associated work should also determine appropriate sites for RA, lesion sizes, and necessity for multiple lesions to take into account the range of nerve variations surrounding the hip. Whereas, to enable developing anatomical informed THA approaches, future work should explore the physiological role of hip joint nerves to determine their relative contribution to joint stability and therefore the necessity for exploring this topic further to develop individualised pre-operative planning. References 1. Tomlinson, J.C.L., et al., Microstructural analysis on the innervation of the anterior, medial, and lateral human hip capsule: Preliminary evidence on its neuromechanical contribution. Osteoarthritis Cartilage, 2023. 31(11): p. 1469-1480. 2. Murphy, N.J., J.P. Eyles, and D.J. Hunter, Hip Osteoarthritis: Etiopathogenesis and Implications for Management. Adv Ther, 2016. 33(11): p. 1921-1946. 3. Dargel, J., et al., Dislocation following total hip replacement. Dtsch Arztebl Int, 2014. 111(51-52): p. 884-90. 4. Pressler, M.P., et al., Radiofrequency ablation of the hip: review. Ann Palliat Med, 2024. 5. Hilton, J., On the influence of mechanical and physiological rest in the the treatment of accidents and surgical diseases and the diagnositic value of pain. A course of lectures delivered at the Royal College of Surgeons of England in the years 1860, 1861 and 1862. , ed. B.a. Daldy. 1863. 6. Iwanaga, J., et al., Revisiting the muscular innervation of the obturator nerve: application to neurotization procedures. Kurume Medical Journal, 2021. 68: p. 75-80. 7. Choi, S., et al., Intramuscular innervation of the tensor fasciae latae: Application to total hip arthroplasty. Clin Anat, 2023. 36(8): p. 1089-1094. 8. Flack, N.A., H.D. Nicholson, and S.J. Woodley, The anatomy of the hip abductor muscles. Clin Anat, 2014. 27(2): p. 241-53. 9. Tomlinson, J., et al., A systematic review and meta-analysis of the hip capsule innervation and its clinical implications. Sci Rep, 2021. 11(1): p. 5299. 10. Perumal, V., S.J. Woodley, and H.D. Nicholson, Neurovascular structures of the ligament of the head of femur. J Anat, 2019. 234(6): p. 778-786. 11. Gerhardt, M., et al., Characterisation and classification of the neural anatomy in the human hip joint. Hip Int, 2012. 22(1): p. 75-81. 12. Fede, C., et al., Fascia and soft tissues innervation in the human hip and theirpossible role in post‐surgical pain. J Orthopaedic Res, 2020. 38: p. 1646-1654. 13. Alzaharani, A., et al., The innervation of the human acetabular labrum and hip joint: an anatomic study. BMC Musculoskelet Disord, 2014. 15: p. 41. 14. Tomlinson, J., et al., Innervation of the hip joint capsular complex: a systematic review of histological and immunohistochemical studies and their clinical implications for contemporary treatment strategies in total hip arthroplasty. Plos One, 2020. 15(2): p. 1-27. 15. Zaghloul, A., Hip Joint: Embryology, Anatomy and Biomechanics. Biomedical Journal of Scientific & Technical Research, 2018. 12(3). 16. Kim, H., et al., Morphologic classification and innervation patterns of the pectineus muscle. Anat Sci Int, 2021. 96(4): p. 524-530. 17. Woodburne, R.T., The accessory obturator nerve and the innervation of the pectineus muscle. Anat Rec, 1960. 136: p. 367-9. 18. Iwanaga, J., et al., The majority of piriformis muscles are innervated by the superior gluteal nerve. Clin Anat, 2019. 32(2): p. 282-286. 19. Feigl, G.C., et al., The posterior femoral cutaneous nerve contributes significantly to sensory innervation of the lower leg: an anatomical investigation. Br J Anaesth, 2020. 124(3): p. 308-313. 20. Tomlinson, J., et al., How complex is the complex innervation of the hip joint capsular complex? Arthroscopy, 2021. 37(7). 21. Stofferin, H., et al., The Anatomical Course of the Femoral Nerve with Regard to the Direct Anterior Approach for Total Hip Arthroplasty. J Arthroplasty, 2024. 39(5): p. 1341-1347. 22. Ukai, T., et al., The anatomical features of the lateral femoral cutaneous nerve with total hip arthroplasty: a comparative study of direct anterior and anterolateral supine approaches. BMC Musculoskelet Disord, 2022. 23(1): p. 267. 23. Hanna, A.S., et al., Anatomical Relationships of the Sciatic Nerve and Pudendal Nerve to the Ischial Spine as They Exit the Greater Sciatic Foramen. World Neurosurg, 2024. 183: p. e564-e570. 24. Starke, V., et al., The Anatomical Course of the Superior Gluteal Nerve With Regard to the Direct Anterior Approach for Primary and Revision Total Hip Arthroplasty. J Arthroplasty, 2021. 36(3): p. 1138-1142. 25. Byun, S., S. Morris, and N. Pather, Magnetic resonance imaging study of the sciatic nerve variation in the pediatric gluteal region: Implications for the posterior approach of the sciatic nerve blockade. Paediatr Anaesth, 2022. 32(12): p. 1355-1364. 26. Vermeylen, K., et al., Deep posterior gluteal compartment block for regional anaesthesia of the posterior hip: a proof-of-concept pilot study. BJA Open, 2023. 5: p. 100127. 27. Fan, X., F. Cao, and A. Luo, Femoral nerve block versus fascia iliaca block for pain control in knee and hip arthroplasties: A meta-analysis. Medicine (Baltimore), 2021. 100(14): p. e25450. 28. Kim, J.Y., et al., Anatomical and Radiological Assessments of Injectate Spread Stratified by the Volume of the Pericapsular Nerve Group Block. Anesth Analg, 2023. 136(3): p. 597-604. 29. Yeoh, S.R., et al., Pericapsular Nerve Group Block and Iliopsoas Plane Block: A Scoping Review of Quadriceps Weakness after Two Proclaimed Motor-Sparing Hip Blocks. Healthcare (Basel), 2022. 10(8). 30. Abd-Elsayed, A., et al., Radiofrequency Ablation of the Trochanteric Branches of the Femoral Nerve for the Treatment of Greater Trochanteric Syndrome. J Pain Res, 2022. 15: p. 115-122. 31. Kunutsor, S.K., et al., Risk factors for dislocation after primary total hip replacement: a systematic review and meta-analysis of 125 studies involving approximately five million hip replacements. The Lancet Rheumatology, 2019. 1(2): p. e111-e121. Joanna TOMLINSON (Bristol, United Kingdom) 15:50 - 16:05 Shoulder. Matthew SZARKO (Anatomist) (Keynote Speaker, Malaga, Spain) 16:05 - 16:20 Adipose tissue and fasciae around the nerve, the secret of the success of anesthetic blocks. Miguel Angel REINA (Professor) (Keynote Speaker, Madrid, Spain) 16:20 - 16:30 Q&A.	15:30-16:20 Added to your list of favorites Deleted from your list of favorites C16 LIVE DEMONSTRATION Abdominal wall blocks LIVE DEMONSTRATION Abdominal wall blocks Demonstrators: Mario FAJARDO PEREZ (Anesthesia) (Demonstrator, Madrid, Spain), Athmaja THOTTUNGAL (yes) (Demonstrator, Canterbury, United Kingdom)	15:30-17:20 Added to your list of favorites Deleted from your list of favorites D17 NETWORKING SESSION Chronic postsurgical pain - closing gaps NETWORKING SESSION Chronic postsurgical pain - closing gaps Chairperson: Narinder RAWAL (Mentor PhD students, research collaboration) (Chairperson, Stockholm, Sweden) 15:30 - 15:35 Introduction. Narinder RAWAL (Mentor PhD students, research collaboration) (Keynote Speaker, Stockholm, Sweden) 15:35 - 15:57 Risk factors and prognostic models for acute and Chronic pain after surgery. Nicholas PAPADOMANOLAKIS-PAKIS (Research) (Keynote Speaker, Aarhus, Denmark) 15:57 - 16:19 #43404 - D17 Regional Anesthesia and the prevention of Chronic Post-Surgical Pain. Regional Anesthesia and the prevention of Chronic Post-Surgical Pain. The prevention of chronic pain after surgery remains an actual challenge in perioperative medicine. The identification of high risk patients and the implementation of effective preventive strategies are mandatory to solve the problem. While RA participates to the success of multimodal analgesia protocols for acute pain control, its protective effect on CPSP has brought deceiving results so far. However some observations regarding the failures and also the success of RA deserve to be questioned as they could help us to refine the perioperative utilization of RA in the aim to improve patients outcomes. Patricia LAVAND'HOMME (Brussels, Belgium) 16:19 - 16:41 #43496 - D17 Pharmacological Effectivity to Prevent Postsurgical Pain. Pharmacological Effectivity to Prevent Postsurgical Pain. Eleni Moka (1), Martina Rekatsina (2), Kassiani Theodoraki (3), Evmorfia Stavropoulou (4), Alexandros Makris (5), Ioanna Siafaka (2), Athina Vadalouka (2) 1. Anaesthesiology Department, Creta InterClinic Hospital - Hellenic HealthCare Group (HHG), Heraklion, Greece 2. A' Anaesthesiology Clinic, Pain Therapy and Palliative Care Centre , Aretaieion University Hospital, Athens, Greece 3. A’ Anaesthesiology Clinic, Aretaieion University Hospital, Athens, Greece 4. Anaesthesiology Department, KAT General Hospital of Attiki, Athens, Greece 5. Anaesthesiology Department, Asklepeiion General Hospital of Voula, Athens, Greece Introduction Chronic Post-Surgical Pain (CPSP) is a significant complication that can arise after various surgical procedures, having an adverse impact on patients' quality of life and potentially leading to disability, prolonged suffering and increased healthcare use. It could be characterized a silent epidemic in the surgical population, as it may affect between 5 and 75% of patients. When the pain is neuropathic—between 6 and 68%, depending on the type of surgery— the impact in terms of quality of life and costs is even higher. Mean annualized adjusted direct and indirect costs per patient were recently estimated at US$11,846 and US$29,617, respectively. The prevention of CPSP is a critical aspect of perioperative care, necessitating a comprehensive approach that among other modalities includes a variety of pharmacological strategies. Effective prevention involves addressing multiple pain pathways and mechanisms, to reduce the risk of persistent pain after an operative procedure. While the transition of acute to chronic pain is a complex process —involving multiple mechanisms at different levels— the current strategies for prevention have primarily been restricted to perioperative pharmacological interventions. The results of the available randomized trials on CPSP pharmacological prevention are not encouraging and remain with inconclusive results. High-quality trials of multimodal interventions, matched to pain characteristics are needed to improve the effectiveness of applied preventive strategies. The medications that have been most studied for the prevention of CPSP include: (a) N-methyl-D-aspartate (NMDA) receptor antagonists, mainly ketamine and memantine, (b) Gabapentinoids, (c) Corticosteroids, (d) iv Lidocaine, (e) Antidepressants, (f) Other drugs, such as Non-Steroidal Anti-inflammatory Drugs (NSAIDs), Nefopam, Clonidine, Dexmedetomidine and Anaesthetic Maintenance Agents. In this review, the current existing evidence for the agents listed will be presented. NMDA Receptor Antagonists Ketamine Ketamine is a broadly used NMDA receptor antagonist, possessing anaesthetic, analgesic, antihyperalgesic, and anti-inflammatory properties. NMDA receptors are a key player in the pathophysiological pathway of central sensitization post-surgery. Perioperative ketamine is one of the most promising drugs available, that might decrease not only acute postoperative pain intensity and opioid consumption, but also CPSP prevalence and development. Several publications have examined the effect of iv ketamine on CPSP prevention, concluding that there is a modest but significant decrease in the CPSP incidence at 3 and 6 months after surgery. However, other studies have shown contradictory results, indicating an uncertain effect of ketamine on the prevalence of CPSP at 3-, 6- and 12-months post-surgery. Literature reports suggest that the effects of ketamine might be most marked after joint arthroplasties, whereas, in thoracotomy patients, although ketamine may significantly reduce acute pain intensity, there is little evidence supporting its preventive effect on CPSP. The available evidence appears to be inconclusive, which could be attributed, at least in part, to the heterogeneity and small size of the studies, potentially leading to an overestimation of the effect. Additionally, variations in dosage, timing and duration of treatment, as well as lack of patient and type of surgery stratification and the variations in outcome measures might contribute to the inconsistency. Interestingly, these potentially beneficial effects of ketamine might be more apparent in patients receiving opioids before surgery. Importantly, post hoc analysis have shown that only patients consuming over 36 mg of morphine equivalents a day preoperatively benefited from the addition of ketamine. Therefore, ketamine can be considered for perioperative use, particularly in subgroups of patients such as those with chronic pain, those on high-dose opioids prior to surgery, or those who are opioid-dependent, as these patients appear to be the primary beneficiaries of ketamine use. Memantine The role of memantine (an oral NMDA receptor antagonist) has also been examined in the perioperative setting, although scarce reports exist in literature. According to some researchers the association of memantine, as an adjuvant in patients receiving a continuous brachial plexus block, reduced both the incidence and the intensity of upper limb phantom limb pain. In another trial, women undergoing mastectomy and receiving memantine for 4 weeks (2 weeks before, 2 weeks after surgery) reported significantly lower mean pain scores, as well as reduced need for analgesics 3 (but not 6) months after surgery. While these results can be considered promising, larger trials, involving different surgical procedures are still needed prior to recommending memantine as an effective pharmacological intervention for the prevention of CPSP. Gabapentinoids Gabapentin and pregabalin, though primarily antiepileptics, reduce nociceptive neurotransmission, by blocking the a2d subunits of voltage-gated calcium channels, with their main differences lying in their bioavailability. Both are recommended as a first-line treatment for managing chronic neuropathic pain. Numerous studies and reviews have also demonstrated that these medications reduce acute postoperative pain intensity and opioid consumption, making them valuable components of a multimodal analgesic plan as adjuvants. Proponents of gabapentinoids initially advocated for their utilization in the prevention of CPSP. However, recently, their widespread use in this context has come under scrutiny due to concerns over their efficacy and safety. The potential benefits of gabapentin on CPSP prevalence have been extensively investigated. Some studies reported no significant impact on CPSP prevention at the 3-month mark, when gabapentin was included in the perioperative analgesic regimen.Other double-blinded, placebo-controlled RCTs highlighted that gabapentin does not offer protective effects against CPSP in knee arthroplasty and thoracotomy patients. Systematic reviews and meta-analyses of trials investigating the role of perioperative pregabalin on the incidence of CPSP have yielded conflicting results as well. According to those, perioperative pregabalin administration does not affect CPSP prevalence at 3-, 6-, and 12-months post-surgery. Not surprisingly, discrepancies between the latest and earlier evidence can be explained by the inclusion of previously unpublished data in the latest systematic reviews and metanalysis. Interestingly, trials focusing exclusively on CPSP with neuropathic characteristics have reported a preventive effect of pregabalin. However, these findings should be interpreted with caution, as the authors acknowledge that both the number of studies included, and the quality of evidence are low. In conclusion, the current evidence does not support the use of either gabapentin or pregabalin for the prevention of CPSP. Some researchers have raised safety and security concerns, particularly an increased risk of respiratory depression when gabapentinoids are combined with opioids. Nevertheless, gabapentinoids may be appropriate for certain patients undergoing procedures likely to result in nerve damage, such as complex spinal surgery, total knee arthroplasty, or cardiac surgery, due to their ability to reduce neuropathic pain. In these cases, pregabalin could reduce the risk of neuropathic CPSP, although further large-scale, well-designed studies are needed to clarify this potential benefit and provide firm conclusions. Corticosteroids Corticosteroids have also been used as adjuvants for the prevention or minimization of CPSP. They block the expression of pro-inflammatory cytokines, that when secreted at or near the site of a nerve injury are involved in the development and maintenance of central sensitization. Corticosteroids also induce expression of anti-inflammatory cytokines, reduce prostaglandin synthesis, inhibit glial activation and have a direct effect on voltage-dependent calcium currents in dorsal root ganglion neurons. RCTs examining the role of dexamethasone, methylprednisolone, and hydrocortisone in decreasing the incidence and intensity of CPSP leaded to inconclusive results, and heterogeneity precluded any meta-analysis. Also systematic reviews and metanalysis of the available studies conclude in negative results. Perioperative administration of dexamethasone is not associated with any impact on the incidence of chronic pain after mastectomy, whereas, similarly, a 500-mg bolus of methylprednisolone couldn’t demonstrate a benefit of on CPSP occurrence, 6 months after cardiac surgery. There were also no significant differences in pain intensity, impact on daily life or use of analgesics. Finally, 16 mg of dexamethasone, administered in patients scheduled for lumbar disk surgery resulted in no effect on CPSP at 3 months and 1 year after surgery. In conclusion, the available literature shows conclusively that perioperative glucocorticoids do not reduce CPSP incidence and intensity, after a variety of surgical procedures. iv Lidocaine Lidocaine is an amide local anesthetic with analgesic, antihyperalgesic, and anti-inflammatory properties. Lidocaine administered intravenously, has been studied extensively, as a part of a multimodal analgesic regimen. There is sound evidence of the benefits of iv lidocaine in terms of reduction of acute postoperative pain intensity, opioid requirements, length of hospital stay, and postoperative nausea. However, fewer studies have evaluated its impact on CPSP prevalence. Administration of iv Lidocaine for 24 h or less potentially helps to reduce CPSP in patients undergoing breast surgery. While encouraging, the small number of patients included in such studies preclude from making definitive conclusions. Intravenous lidocaine could also be beneficial for other types of surgery, as literature reports provide promising results on the incidence of CPSP after robot-assisted thyroidectomy and nephrectomy. In conclusion, the available literature suggests that intravenous lidocaine could help prevent CPSP after specific surgical procedures. However, no clear recommendation can be made, possible beneficial effects have to be confirmed, and an adequate dose and duration must be found. Antidepressants Antidepressants are known modulators of the serotonin or noradrenaline signaling and represent the first recommended line of treatment for chronic neuropathic pain. Serotonin and noradrenaline are important neurotransmitters that regulate the nociceptive transmission in the spinal cord. The most important antidepressants are (a) the selective serotonin reuptake inhibitors (e.g., escitalopram), (b) the serotonin-norepinephrine reuptake inhibitors (e.g., duloxetine and venlafaxine), and (c) the tricyclic antidepressants (e.g., amitriptyline). Their role in the decreasing or preventing acute or/and CPSP has been examined in literature. Despite some positive results in reference to acute pain outcomes, unfortunately, the clinical heterogeneity between the studies in relation to the type of drug, dosing regimen, and outcome measures precludes any firm conclusion. The potential for duloxetine, venlafaxine and escitalopram to reduce pain up to 6 months, after knee arthroplasty, breast cancer surgery, and coronary heart bypass respectively, has been examined, with only venlafaxine showing a promising effect, that is a reduction in movement-evoked pain intensity after breast cancer surgery. Other studies focusing on duloxetine, in addition to a multimodal analgesic regimen, showed that this antidepressant had no effect on subacute or chronic pain levels after knee arthroplasty. However, duloxetine was beneficial in patients with diabetic polyneuropathy, indicating an impact on descending pain modulation. In patients with an enhanced pain sensitivity, it could reduce postoperative pain 12 weeks after surgery. In conclusion, most of the available literature does not support firmly the clinical use of antidepressants for CPSP prevention. Other Drugs The effects of drugs such as clonidine, dexmedetomidine, NSAID, nefopam and anaesthetic maintenance agents have not yet been studied adequately. As such, no recommendation for the prevention of CPCP for any of these drugs is currently possible. Conclusion Chronic postsurgical pain is common after surgery, so identification of non-opioid analgesics with potential for preventing CPSP is important. The evidence for most pharmacological interventions targeting the prevention of CPSP is limited. Indeed, the currently applied strategies have not enabled us to reduce the incidence of CPSP, which unfortunately still affects 5 to 75% of patients, depending on the surgical procedure. Ketamine probably represents the most studied drug of the pharmacological modalities available in our armamentarium and can possibly have a preventive effect, at least in specific subgroups of patients. The role of gabapentinoids and antidepressants has been criticized lately, due to non – proven efficacy and potential safety concerns in some cases. Small trials with, memantine, intravenous lidocaine, dexamethasone, and nefopam have shown promising but limited results. According to more recent data of networking meta-analysis, a possible reduction in CPSP only up to 6 months has been exerted by lidocaine (most effective), gabapentinoids, ketamine, and possibly dexmedetomidine. The evidence is insufficient for longer-term outcomes, opioid use, or serious adverse events. Researchers should continue to investigate the topic focusing on the ability of opioid-free anaesthesia to reduce the incidence of CPSP. For a better efficacy and more chances for a pharmacological CPSP prevention it is probably of paramount importance to better identify the patients at risk, personalize the management and tailor interventions to their risk factors and improve the approach of their transitional pain, including a follow up after discharge from hospital and beyond the immediate postoperative period. Also, high-quality trials of multimodal interventions matched to pain characteristics are still warrantied, to enrich. the evidence for treatment options that could minimize the incidence of CPSP. Indeed, it makes intuitive sense to reduce the intensity of acute pain by adopting multimodal strategies including the adjuvants with the firmest evidence and by limiting the use of pre- and perioperative opioids. Multidisciplinary concepts targeting the biopsychosocial aspects of the pain chronification process are promising but warrant further evaluation before integrating them routinely into clinical practice. Literature 1. Chaparro LE, Smith SA, Moore RA, Wiffen PJ, Gilron I. Pharmacotherapy for the prevention of chronic pain after surgery in adults. Cochrane Database Syst Rev. 2013; 26:CD00 8307. 23. 2. Clarke H, Poon M, Weinrib A, Katznelson R, Wentlandt K, Katz J. Preventive analgesia and novel strategies for the prevention of chronic post-surgical pain. Drugs. 2015; 75: 339–351. 3. Steyaert A, Lavand’homme P. Prevention and Treatment of Chronic Postsurgical Pain: A Narrative Review. Drugs. 2018; 78, 339–354. 4. Carley ME, Chaparro LE, Choiniere M, Kehlet H, Andrew Moore R, Van Den Kerkhof E, Gilron I. Pharmacotherapy for the Prevention of Chronic Pain after Surgery in Adults: An Updated Systematic Review and Meta-analysis. Anesthesiology. 2021; 135: 304–325. 5. Rosenberger DC, Pogatzki-Zahn EM. Chronic post-surgical pain e update on incidence, risk factors and preventive treatment options. BJA Education. 2022; 22: 190–196. 6. Doleman B, Mathiesen O, Sutton AJ, Cooper NJ, Lund JN, Williams JP. Non-opioid analgesics for the prevention of chronic postsurgical pain: A systematic review and network meta-analysis. Br J Anaest. 2023; 30: 719–728. Eleni MOKA (Heraklion, Crete, Greece) 16:41 - 17:03 Effectiveness of a transitional pain service for the prevention of chronic post-surgical pain. Esther POGATZKI ZAHN (Full Professor) (Keynote Speaker, Muenster, Germany) 17:03 - 17:20 Q&A.	15:30-16:20 Added to your list of favorites Deleted from your list of favorites E17 ASK THE EXPERT RA for airway management ASK THE EXPERT RA for airway management Chairperson: Ana LOPEZ (Consultant) (Chairperson, Barcelona, Spain) 15:30 - 15:35 Introduction. Ana LOPEZ (Consultant) (Keynote Speaker, Barcelona, Spain) 15:35 - 16:05 PNB for airway management. Kamen VLASSAKOV (Chief,Division of Regional&Orthopedic Anesthesiology;Director,Regional Anesthesiology Fellowship) (Keynote Speaker, Boston, USA) 16:05 - 16:20 Q&A.	15:30-16:20 Added to your list of favorites Deleted from your list of favorites F17 ASK THE EXPERT Blocks for foot surgery ASK THE EXPERT Blocks for foot surgery Chairperson: Slobodan GLIGORIJEVIC (senior consultant) (Chairperson, Zürich, Switzerland) 15:30 - 15:35 Introduction. Slobodan GLIGORIJEVIC (senior consultant) (Keynote Speaker, Zürich, Switzerland) 15:35 - 16:05 Lecture. Peter MERJAVY (Consultant Anaesthetist & Acute Pain Lead) (Keynote Speaker, Craigavon, United Kingdom) 16:05 - 16:20 Q&A.	15:30-16:00 Added to your list of favorites Deleted from your list of favorites G17 REFRESHING YOUR KNOWLEDGE Acute postoperative Pain REFRESHING YOUR KNOWLEDGE Acute postoperative Pain Chairperson: Giustino VARRASSI (President) (Chairperson, Roma, Italy) 15:30 - 15:35 Introduction. Giustino VARRASSI (President) (Keynote Speaker, Roma, Italy) 15:35 - 15:55 The role of Ketamine for acute and chronic pain after surgery? Massimo ALLEGRI (Médecin chef) (Keynote Speaker, morges, Switzerland) 15:55 - 16:00 Q&A.	14:00-16:00 Added to your list of favorites Deleted from your list of favorites H16 SIMULATION TRAININGS SIMULATION TRAININGS Demonstrators: Josip AZMAN (Consultant) (Demonstrator, Linkoping, Sweden), Clara LOBO (Medical director) (Demonstrator, Abu Dhabi, United Arab Emirates), Kassiani THEODORAKI (Anesthesiologist) (Demonstrator, Athens, Greece), Roman ZUERCHER (Senior Consultant) (Demonstrator, Basel, Switzerland)	15:30-16:25 Added to your list of favorites Deleted from your list of favorites FP15 PERIPHERAL NERVE BLOCKS Free Papers 4 PERIPHERAL NERVE BLOCKS Free Papers 4 Chairperson: Hosim PRASAI THAPA (Consultant Anaesthetist) (Chairperson, Melbourne, Australia, Australia) 15:30 - 15:37 #42511 - OP040 Analgesic efficacy of perineural ketamine as an adjuvant to local anesthetic solution for peripheral nerve blocks: A systematic review and meta analysis. OP040 Analgesic efficacy of perineural ketamine as an adjuvant to local anesthetic solution for peripheral nerve blocks: A systematic review and meta analysis. Peripheral nerve blocks are commonly practiced in anesthesia practice to provide post operative analgesia. Ketamine is a NMDA antagonist which possesses anti-nociceptive and local anesthetic properties. The aim of the meta-analysis is to assess the analgesic efficacy of perineural ketamine as an adjuvant to local anesthetic solution compared to local anesthetics alone for peripheral nerve blocks during surgical procedures Randomized controlled trials (RCT) comparing ketamine as adjuvant to local anesthetic solution in peripheral nerve blocks in adult patients undergoing elective surgeries were systematically searched from databases – Pubmed, Embase, CENTRAL from inception till May 2023. The primary objective was analgesic efficacy in terms of duration of analgesia and opioid requirement. Secondary objectives included onset and duration of nerve block A total of 12 RCT (539 patients) were included. Duration of analgesia was significantly longer when ketamine was used as adjuvant for peripheral nerve block [SMD – 1.88; 95% CI (1.01-2.76); P < 0.0001]. Opioid requirement was also lower when ketamine was used [SMD – 1.4; 95% CI (2.00-0.80); P <0.0001]. The duration of sensory and motor block were similar in both the groups. The onset of sensory block was similar while onset of motor block was slightly delayed with use of ketamine. The use of ketamine as an adjuvant to local anesthetics in peripheral nerve blocks for surgeries leads to longer duration of analgesia and lower opioid requirement. The duration of sensory and motor block remains similar compared to use of local anesthetics alone. Sana Yasmin HUSSAIN (New Delhi, India), Dhruv JAIN, Shailendra KUMAR 15:37 - 15:44 #42651 - OP041 Liposomal Bupivacaine versus Bupivacaine in Adductor Canal catheter After Total Knee Arthroplasty with different Postoperative Outcomes: A Randomized Controlled Trial. OP041 Liposomal Bupivacaine versus Bupivacaine in Adductor Canal catheter After Total Knee Arthroplasty with different Postoperative Outcomes: A Randomized Controlled Trial. This study compares the use of liposomal bupivacaine (Exparel) versus Bupivacaine in adductor canal catheter after total knee arthroplasties (TKAs). From the months of October 2023to March 2024, 70 patients undergoing unilateral primary TKA were asked to participate in this prospective, double-blinded randomized controlled trial. Each patient received an Adductor canal catheter and iPACK block utilizing Bupivacaine 0.25% (10 ml). Then patients were additionally randomized to receive an injection in the adductor catheter with Exparel or Bupivacaine 0.5% (10 ml) as pain management postoperatively. For each patient, demographic information, inpatient hospital information, postoperative opioid use, and numerical Pain Score were registered. Overall, 70 patients were included (35 in each group). The Exparel group had the same hospital length of stay compared to the Control group (4 nights). Patients in the Exparel group reported an increased amount of Numerical Rating Scale pain score at postoperative timepoints. These patients also used a higher consumption of inpatient opioids (40.9 vs 47.3, P = .04) Exparel injection in adductor canal catheter led to increase in pain levels, same hospital lengths of stay and increase inpatient opioid consumption. Exparel used in adductor catheter after TKA showed diverse and unexpected results in controlling postoperative pain and decrease length of stay. Aboud ALJABARI (Riyadh, Saudi Arabia) 15:44 - 15:51 #41472 - OP042 The effects of Popliteal Plexus Block after Total Knee Arthroplasty – a randomized clinical trial. OP042 The effects of Popliteal Plexus Block after Total Knee Arthroplasty – a randomized clinical trial. Motor-sparing peripheral nerve blocks, like Adductor Canal Block (ACB) and Femoral Triangle Block (FTB), enhance multimodal opioid-sparing strategies after total knee arthroplasty. Incorporating a Popliteal Plexus Block (PPB), targeting genicular nerves from the tibial and obturator nerve, may further optimize these strategies. We hypothesized that a combination of PPB+FTB could reduce 24-hour opioid consumption(=primary outcome) after total knee arthroplasty in comparison to standalone FTB and standalone ACB. In this patient- and assessor blinded study, 165 patients were randomized into three parallel intervention groups, receiving either 1)PPB+FTB, 2)FTB or 3)ACB. Preoperatively, maximum voluntary isometric contraction and manual muscle test of knee and ankle movement were assessed before and after nerve block procedure. Postoperatively, opioid consumption and pain scores were obtained for 24 hours, and mobilization assessed at 5 hours. Intravenous oxycodone was administered via patient-controlled analgesia pumps. At 24 hours postoperatively, consumed intravenous oxycodone varied significantly between groups(P<0.009), with medians(IQR) of 6 mg(2-12) in the PPB+FTB group, 10 mg(8-16) in the FTB group, and 12 mg(6-18) the ACB group. Median consumption in the PPB+FTB group was reduced by -4 mg(95%CI[-7.4, -1.0],P<0.005) and -6 mg(95%CI[-8.3, -1.3],P<0.012) compared to groups of FTB and ACB, respectively. No differences were found in pain scores, mobilization, or muscle strength. Post-hoc analysis revealed 12 PPB+FTB patients not requiring opioids at 24 hours postoperatively, compared to only 2 FTB and 6 ACB patients. Adding PPB reduced 24-hour postoperative opioid consumption but not pain scores. PPB did not hinder mobilization or increase the risks of motor impairment. Johan Kløvgaard SØRENSEN (Aarhus, Denmark), Ulrik GREVSTAD, Pia JÆGER, Lone NIKOLAJSEN, Charlotte RUNGE 15:51 - 15:58 #42816 - OP043 Comparison of local anaesthetic dose in iPACK block for total knee arthroplasty: A prospective randomized controlled trial. OP043 Comparison of local anaesthetic dose in iPACK block for total knee arthroplasty: A prospective randomized controlled trial. iPACK block is a novel regional method providing analgesia to the posterior part of the knee without causing motor block in knee surgeries. In this study, we aimed to compare the postoperative analgesic efficacy of iPACK block using different doses of local anaesthetics. 119 patients aged 18-80 years, ASA I-III, undergoing total knee arthroplasty(TKA) surgery under spinal anaesthesia were included in this prospective randomized controlled study registered with the Clinical Trials(NCT05963139). The patients were divided into 4 groups using a computer software. All groups received an adductor canal block(ACB) with 15ml of 0.25%bupivacaine. iPACK block; 10ml of 0.25%bupivacaine in Group-1, 15ml of 0.25%bupivacaine in Group-2, 20ml of 0.25%bupivacaine in Group-3 and no iPACK block in Group-4 as control group. NRS score, morphine consumption, and nausea-vomiting were evaluated at 1,4,8,12,24 and 48hours postoperatively. Time to first mobilization, length of hospital stay, breakthrough opioid need, patient and surgeon satisfaction, muscle strength measured preoperatively and at discharge, WOMAC Osteoarthritis index, ROM, and complications were recorded. In Groups-2&3, the NRS scores at the 4th&8th hours were significantly lower than in Group-4(p=0.026,p=0.009,respectively). In Group-3, morphine consumption at the 8th&12th hours was significantly lower than in Groups-1&2&4(p=0.018,p=0.004,respectively). The presence of nausea-vomiting at the 12th&24th&48th hours was significantly higher in Group-4 compared to Groups-2&3(p=0.026,p=0.026,p=0.032,respectively). Patient and surgeon satisfaction were significantly lower in Group-4 compared to the other groups(p=0.001,p=0.001,respectively). We believe that iPACK block with 20ml of 0.25%bupivacaine provides more ideal postoperative analgesia with lower pain scores, thereby reducing opioid side effects without causing complications in knee arthroplasties. Gülberk KILIÇ (Istanbul, Turkey), Nur CANBOLAT, Mehmet I. BUGET, Nükhet SIVRIKOZ, Cengiz ŞEN, Kemalettin KOLTKA 15:58 - 16:05 #42634 - OP044 A randomised, controlled, double blind, non-inferiority study comparing periarticular block vs. adductor canal block on postoperative analgesia in patients post primary total knee arthroplasty. OP044 A randomised, controlled, double blind, non-inferiority study comparing periarticular block vs. adductor canal block on postoperative analgesia in patients post primary total knee arthroplasty. Postoperative pain management after primary total knee arthroplasty remains the main challenge for orthopaedic anaesthesiologists. Single shot adductor canal block is widely accepted as part of multimodal analgesia reducing postoperative opiate consumption and promotes early mobilization. Ethics approval was gained from the study centre. Patients scheduled for primary knee arthroplasty in a tertiary referral centre for elective orthopaedic surgery were identified and randomised into 2 groups. Group A received ultrasound guided(USG) adductor canal block(ACB) with 20mls of 0.25% levobupivacaine. Group B received a periarticular block by surgeon as per protocol plus sham USG ACB. A non-blinded anaesthesiologist, prepared the solution for adductor canal block, performed the spinal anaesthesia and looked after the patient in the operating theatre. A separate, blinded anaesthesiologist performed the USG ACB. Both groups received the same dose of spinal anaesthesia. The same intraoperative and postoperative analgesia and antiemetics were administered, with other medications at the discretion of the non-blinded anaesthesiologist. Primary outcome measures were morphine milligram equivalent(MME) at 24 and 48 hours. Secondary outcomes were time to first opiate(mins) and visual analogue pain score(VAS) at 24 and 48 hours. 22 suitable patients were recruited and randomised into groups A and B. Mean +/- standard error 24-hour MME for test group (A) was 70+/-10.8 and for sham group (B) was 59.6+/-7.64, p=0.47. 48-hour MME for group A 72.23 +/- 22.4 and group B was 84.45+/-15.4, p=0.71. There was no significant difference in primary outcomes between groups. Secondary outcomes similarly had no significant difference between groups. Jenny FITZGIBBON (Dublin, Ireland), Viera HUSAROVA 16:05 - 16:12 #42720 - OP045 Comparative efficacy of thoracic paravertebral block and serratus posterior superior intercostal plane block for postoperative pain management in VATS lung resections: A randomized controlled trial. OP045 Comparative efficacy of thoracic paravertebral block and serratus posterior superior intercostal plane block for postoperative pain management in VATS lung resections: A randomized controlled trial. Video-assisted thoracoscopic surgery (VATS) is increasingly preferred for lung resections due to its reduced postoperative pain and faster recovery compared to traditional thoracotomy. However, effective pain management remains a challenge. This study aimed to compare the analgesic efficacy of Thoracic Paravertebral Block (TPVB) and Serratus Posterior Superior Intercostal Plane Block (SPSIP) in patients undergoing VATS. In this prospective, randomized controlled trial conducted at Koç University Hospital,Istanbul,Turkey, 34 patients scheduled for VATS lung resection were randomly assigned to receive either TPVB or SPSIP in addition to standard general anesthesia. Numeric Rating Scale (NRS) scores for pain were recorded at 0, 6, 12, 24, and 48 hours postoperatively. Intravenous patient-controlled analgesia (PCA) morphine consumption was also measured over the same period.Non-parametric tests were used due to small sample size and data distribution. The median NRS scores were higher initially for the Paravertebral Block group (5.00) compared to the SPISP group (3.00). The Friedman test showed significant differences in pain scores over time within both groups (Paravertebral Block: p < .001, SPISP: p = .002). The Mann-Whitney U test indicated that while the NRS scores were lower in the SPISP group at all time points, the differences were not statistically significant.Morphine consumption was significantly lower in the SPISP group (median 21.00 mg) compared to the Paravertebral Block group (median 45.50 mg, p = .012). SPSIP is associated with lower morphine requirements, suggesting it may provide superior pain management.Further studies are warranted to confirm these findings and to optimize postoperative analgesia in thoracic surgery. Mete MANICI, Ilayda KALYONCU (Istanbul, Turkey), Yasemin SINCER, Serhan TANJU, Yavuz GURKAN 16:12 - 16:19 #42814 - OP046 The contribution of anterior femoral cutaneous nerve block to postoperative analgesia in total knee arthroplasty surgery. OP046 The contribution of anterior femoral cutaneous nerve block to postoperative analgesia in total knee arthroplasty surgery. Total knee arthroplasty (TKA) surgery induces severe pain during the postoperative period. The aim of this study is to investigate the contribution of combining anterior femoral cutaneous nerve block with distal adductor canal block to postoperative analgesia in TKA. Fifty-eight patients undergoing TKA with spinal anesthesia were divided into two groups. Group1 received adductor canal block(20ml), Group2 received anterior femoral cutaneous nerve block(10ml) in addition to distal adductor canal block(20ml). 0.25%bupivacaine was used for all blocks performed in the study. Postoperative pain was assessed using the visual analogue scale(VAS) at 3,10, and 24 hours postoperatively. Pain at the site of drain placement in the upper lateral quadrant of the knee was queried. The location of incisional pain, whether proximal or distal to the patella, was investigated. Time to first analgesic, total postoperative analgesic and opioid consumption recorded. Postoperative VAS values were lower in Group2, although there was no significant difference between the groups (respectively, postoperative 3, 10, 24 hours; Group1: 2.03,2.69,3.28; Group 2:1.69,2.34,2.62). Group1; 23/29 patients reported drain site pain, Group 2, 6/29(p<0.05). Group1 and Group2 incisional pain proximal and distal to the patella numbers of patients 25 and 9; 10 and 17. Time to first analgesic consumption, the total postoperative analgesic consumption and opioid content were no statistical difference (respectively,Group1:97.59,4.79,1.69; Group2:112.24,4.66,1.59). That block combination did not show superiority over adductor canal block. However, the anterior femoral cutaneous nerve block reduced drain site pain and incisional pain proximal to the patella. Müge ÇAKIRCA, Müge ÇAKIRCA (yes, Turkey), Funda ATAR, Serhan ÜNLÜ, Derya ÖZKAN
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16:10							16:10-16:40 Added to your list of favorites Deleted from your list of favorites G18 REFRESHING YOUR KNOWLEDGE Rebound pain REFRESHING YOUR KNOWLEDGE Rebound pain Chairperson: Thomas VOLK (Chair) (Chairperson, Homburg, Germany) 16:10 - 16:15 Introduction. Thomas VOLK (Chair) (Keynote Speaker, Homburg, Germany) 16:15 - 16:35 #43463 - G18 How can we manage the rebound pain. How can we manage the rebound pain. There are many definitions of rebound pain (RP). All of them have in common the same characteristics: the pain is a severe pain related to regional anesthesia, which occurs after the resolution of the sensory peripheral nerve block (PNB) in the first 12-24 hours after the performing of the PBN, with a duration around 2 hours and does not respond to intravenous opioid administration (Henningsen et al., 2018). The patients describe RP mainly as an intense burning or aching pain (Williams et al., 2007). Although some authors described RP after regional anesthesia as an adverse effect when the block wore off, which impacts the postoperative analgesic benefit by diminishing the overall benefit (Dada et al., 2019), other researchers acknowledged that RP correlates more evident with regional anesthesia for surgical procedures performed under regional anesthesia and more frequently after a single-injection peripheral nerve block (Abdallah et al., 2015; Munoz-Leyva et al., 2020). This lecture approaches RP from the perspective of the following questions: 1. What are the risk factors for RP? 2. How intense or severe is the RP? 3. When occurs the RP, and what is the mechanism involved? 4. What do we know about the epidemiology of the RP? 5. How can we manage RP? Regarding the first question, independent study groups identified risk factors as younger age, female gender (Lautenbacher et al., 2005; Li et al., 2022), bone surgery, and the absence of intraoperative intravenous dexamethasone (Barry et al., 2021). For other researchers, the most important risk factor and predictor of rebound pain was preoperative pain (Gramke et al., 2009). The type of surgery is also a significant risk factor for RP, mainly upper and lower limb surgery, such as shoulder surgery performed under brachial plexus block (Hadzic et al., 2005; Kim et al., 2018), ankle fracture surgery under popliteal sciatic nerve block (Henningsen et al., 2018). When the sensory block revolves in the case of RP, there is a dramatic increase in pain score and opioid consumption, which is not the case for fascial blocks such as tranversus abdominis plane block, pectoral nerves, erector spinae or quadratus lumborum blocks. 2. The intensity of RP appears to be higher after shoulder surgery than complex knee surgery (Williams et al., 2007). Both RP intensity and incidence are reduced in patients older than 60 years old after primary ankle fracture surgery (Sort et al., 2017). The site of surgery might influence the intensity of RP. In another study, the intensity of RP was reported as excruciating pain at night, with a duration of around two hours and a burning characteristic (Henningsen et al., 2018). One important concern regarding orthopaedic surgery is an almost three-fold increased risk of developing moderate to severe chronic pain compared with all other types of surgery at one year. Besides the existence of preoperative pain, type of surgery, and percentage of time in severe pain as risk factors of chronic postsurgical pain, there is another important newly identified risk factor, which is a high percentage of time in severe pain in the first 24 h postoperatively (Fletcher et al., 2015)). Therefore, controlling the pain in the first 24 h postoperatively offers a better outcome for longue term and targets a new management goal in prevention of the chronic pain. 3. PNB and regional anesthesia are preferred techniques for ambulatory surgery because of the advantages offered: decreased postanesthesia care unit need and low incidence of nausea, decreased postoperative pain, and lower opioid consumption(Liu et al., 2005). Therefore, RP could be unpleasant and challenging to treat patients in the ambulatory surgery setting when it occurs at home, mostly at night. If pain occurs during sleep, it is intense and wakes the patient, making it difficult for them to go back to sleep (Stone et al., 2022)). The mechanism of RP is described as an intense burning pain more a neuropathic mechanism than a nociceptive component after nerve block (Williams et al., 2007). In neuropathic pain, ongoing burning pain is caused by abnormal spontaneous C-fibers activity and hyperexcitability of nociceptors (Truini, 2017)). As I mentioned before, RP occurs frequently and is more severe in patients younger than 60. Although the mechanism is not understood, there are age-related differences in muscle as deep tissue and skin as superficial tissue, nociception increases in peripheral nerve sensitivity to local anesthetics, and peripheral nerve conduction velocity is lower in the elderly. (Verdu et al., 2000)). However, the later outcomes of the patients are not influenced by the intensity of the RP. From the patient side, RP does not outweigh the early postoperative benefits of a pain-free interval(Liu et al., 2005). 4. The incidence of RP could reach around 40% of patients for ambulatory surgery and may be due to abnormal spontaneous C-fiber hyperactivity and nociceptor hyper-excitability without mechanical nerve lesions. The incidence of RP is unknown but could reach 40% of patients at PNB resolution (Lavand'homme, 2018). The incidence differs after discharge following inpatient care, and it is 12-13% for severe-to-extreme pain. Another study for ambulatory surgery finds an incidence of 30% of severe pain after 24 hours (McGrath et al., 2004)). 5. Strategies used to manage RP are multiple and involve different approaches. One of the most important and easy to perform is preoperative education of the patient. The patient should be informed about the limits of regional anesthesia and warned about the possibility of severe but transient pain at the resolution of PNB. Also, they should be instructed to take the rescue analgesic medication prescribed before discharge rather earlier than later. "Acknowledging "rebound pain" after the use of regional anesthesia associated with patient counseling regarding early narcotic administration may allow patients to have more effective postoperative pain control (Galos et al., 2016)). Also important is the preoperative evaluation of the anxiety score and catastrophizing tendencies because both scores significantly correlate with postoperative pain scores (Granot & Ferber, 2005). Another strategy is using continuous catheter PNB techniques. Increasing the sensory block allows more time for healing, decreases the inflammatory process, and impacts the incidence of RP. Although this strategy has advantages, it remains not the first option for the patient in ambulatory surgery. The main limitations are that the technique is time-consuming, can be performed by highly skilled personnel, and has a failure rate. The third strategy is using local anesthetic adjuvants in single-injection PNB to prolong the duration of the sensory block. Many experimental and clinical studies study different combinations of local anesthetics with clonidine, dexamethasone, buprenorphine, and dexmedetomidine. So far, the most challenging adjuvant is dexamethasone because it is cheap and easy to find, but the perineural use is off-label. Although dexamethasone (perineural more so than intravenous) can prolong the analgesic benefit of PNB (Heesen et al., 2018), the authors of a recent review prefer systemic administration intravenously of dexamethasone over a perineural route because of a better understanding of potential side effects during intravenously application mode (Streb et al., 2022)). The duration of the PNB can be achieved with liposomal bupivacaine as an effective strategy to prolong the duration of analgesia (up to 72 h) with single-injection PNB. Still, current evidence fails to support its routine use. Multimodal analgesia is another strategy recommended, which combines PNB with systemic multimodal analgesia for improving postoperative pain and related outcomes. Multimodal analgesia addresses peripheral sensitization and other physiological responses mediated by the humoral inflammatory response to surgery. These mechanisms are unaffected by the PNB. Different classes of analgesic could be combined: acetaminophen, non-steroidal anti-infammatory drugs/COX-2 inhibitors, oral opioids. As mentioned previously, the administration of the multimodal analgesia before the sensory block resolution could lower the intensity and severity of RP. Conclusion. RP is a transient acute severe pain that appears when the sensory block of regional anesthesia resolves. Although the intensity of pain, RP does not impact significantly the opioid consumption at 24 h, quality of recovery, or patient satisfaction. There is no evidence of an association between RP and chronic postoperative pain. It is important to inform the patient preoperatively about this phenomenon and the patients in ambulatory surgery to recognize RP and to have a perioperative management plan. Preoperative patient education and counseling, the preemptive starting of the multimodal analgesia, using of continuous catheter techniques, or prolonging the duration of PNB with adjuvants are all effective strategies for better care of postoperative pain with a favorable benefit-risk ratio for the patient. References Abdallah, F. W., Halpern, S. H., Aoyama, K., & Brull, R. (2015). Will the Real Benefits of Single-Shot Interscalene Block Please Stand Up? A Systematic Review and Meta-Analysis. Anesth Analg, 120(5), 1114-1129. https://doi.org/10.1213/ANE.0000000000000688 Barry, G. S., Bailey, J. G., Sardinha, J., Brousseau, P., & Uppal, V. (2021). Factors associated with rebound pain after peripheral nerve block for ambulatory surgery. Br J Anaesth, 126(4), 862-871. https://doi.org/10.1016/j.bja.2020.10.035 Fletcher, D., Stamer, U. M., Pogatzki-Zahn, E., Zaslansky, R., Tanase, N. V., Perruchoud, C., Kranke, P., Komann, M., Lehman, T., Meissner, W., & eu, C. g. f. t. C. T. N. g. o. t. E. S. o. A. (2015). Chronic postsurgical pain in Europe: An observational study. Eur J Anaesthesiol, 32(10), 725-734. https://doi.org/10.1097/EJA.0000000000000319 Galos, D. K., Taormina, D. P., Crespo, A., Ding, D. Y., Sapienza, A., Jain, S., & Tejwani, N. C. (2016). Does Brachial Plexus Blockade Result in Improved Pain Scores After Distal Radius Fracture Fixation? A Randomized Trial. Clin Orthop Relat Res, 474(5), 1247-1254. https://doi.org/10.1007/s11999-016-4735-1 Gramke, H. F., de Rijke, J. M., van Kleef, M., Kessels, A. G., Peters, M. L., Sommer, M., & Marcus, M. A. (2009). Predictive factors of postoperative pain after day-case surgery. Clin J Pain, 25(6), 455-460. https://doi.org/10.1097/AJP.0b013e31819a6e34 Hadzic, A., Williams, B. A., Karaca, P. E., Hobeika, P., Unis, G., Dermksian, J., Yufa, M., Thys, D. M., & Santos, A. C. (2005). For outpatient rotator cuff surgery, nerve block anesthesia provides superior same-day recovery over general anesthesia. Anesthesiology, 102(5), 1001-1007. https://doi.org/10.1097/00000542-200505000-00020 Heesen, M., Klimek, M., Imberger, G., Hoeks, S. E., Rossaint, R., & Straube, S. (2018). Co-administration of dexamethasone with peripheral nerve block: intravenous vs perineural application: systematic review, meta-analysis, meta-regression and trial-sequential analysis. Br J Anaesth, 120(2), 212-227. https://doi.org/10.1016/j.bja.2017.11.062 Henningsen, M. J., Sort, R., Moller, A. M., & Herling, S. F. (2018). Peripheral nerve block in ankle fracture surgery: a qualitative study of patients' experiences. Anaesthesia, 73(1), 49-58. https://doi.org/10.1111/anae.14088 Kim, J. H., Koh, H. J., Kim, D. K., Lee, H. J., Kwon, K. H., Lee, K. Y., & Kim, Y. S. (2018). Interscalene brachial plexus bolus block versus patient-controlled interscalene indwelling catheter analgesia for the first 48 hours after arthroscopic rotator cuff repair. J Shoulder Elbow Surg, 27(7), 1243-1250. https://doi.org/10.1016/j.jse.2018.02.048 Lautenbacher, S., Kunz, M., Strate, P., Nielsen, J., & Arendt-Nielsen, L. (2005). Age effects on pain thresholds, temporal summation and spatial summation of heat and pressure pain. Pain, 115(3), 410-418. https://doi.org/10.1016/j.pain.2005.03.025 Lavand'homme, P. (2018). Rebound pain after regional anesthesia in the ambulatory patient. Curr Opin Anaesthesiol, 31(6), 679-684. https://doi.org/10.1097/ACO.0000000000000651 Li, Y. S., Chang, K. Y., Lin, S. P., Chang, M. C., & Chang, W. K. (2022). Group-based trajectory analysis of acute pain after spine surgery and risk factors for rebound pain. Front Med (Lausanne), 9, 907126. https://doi.org/10.3389/fmed.2022.907126 Liu, S. S., Strodtbeck, W. M., Richman, J. M., & Wu, C. L. (2005). A comparison of regional versus general anesthesia for ambulatory anesthesia: a meta-analysis of randomized controlled trials. Anesth Analg, 101(6), 1634-1642. https://doi.org/10.1213/01.ANE.0000180829.70036.4F McGrath, B., Elgendy, H., Chung, F., Kamming, D., Curti, B., & King, S. (2004). Thirty percent of patients have moderate to severe pain 24 hr after ambulatory surgery: a survey of 5,703 patients. Can J Anaesth, 51(9), 886-891. https://doi.org/10.1007/BF03018885 Munoz-Leyva, F., Cubillos, J., & Chin, K. J. (2020). Managing rebound pain after regional anesthesia. Korean J Anesthesiol, 73(5), 372-383. https://doi.org/10.4097/kja.20436 Stone, A., Lirk, P., & Vlassakov, K. (2022). Rebound Pain After Peripheral Nerve Blockade-Bad Timing or Rude Awakening? Anesthesiol Clin, 40(3), 445-454. https://doi.org/10.1016/j.anclin.2022.03.002 Streb, T., Schneider, A., Wiesmann, T., Riecke, J., Schubert, A. K., Dinges, H. C., & Volberg, C. (2022). [Rebound pain-From definition to treatment]. Anaesthesiologie, 71(8), 638-645. https://doi.org/10.1007/s00101-022-01120-z ("Rebound pain" - von der Definition bis zur Therapie.) Truini, A. (2017). A Review of Neuropathic Pain: From Diagnostic Tests to Mechanisms. Pain Ther, 6(Suppl 1), 5-9. https://doi.org/10.1007/s40122-017-0085-2 Verdu, E., Ceballos, D., Vilches, J. J., & Navarro, X. (2000). Influence of aging on peripheral nerve function and regeneration. J Peripher Nerv Syst, 5(4), 191-208. https://doi.org/10.1046/j.1529-8027.2000.00026.x Williams, B. A., Bottegal, M. T., Kentor, M. L., Irrgang, J. J., & Williams, J. P. (2007). Rebound pain scores as a function of femoral nerve block duration after anterior cruciate ligament reconstruction: retrospective analysis of a prospective, randomized clinical trial. Reg Anesth Pain Med, 32(3), 186-192. https://doi.org/10.1016/j.rapm.2006.10.011 Denisa ANASTASE (Bucharest, Romania) 16:35 - 16:40 Q&A.	16:10-18:00 Added to your list of favorites Deleted from your list of favorites H18 BEST FREE PAPER SESSION - CHRONIC PAIN BEST FREE PAPER SESSION - CHRONIC PAIN Chairperson: Dan Sebastian DIRZU (consultant, head of department) (Chairperson, Cluj-Napoca, Romania) Jurys: Sarah LOVE-JONES (Anaesthesiology) (Jury, Bristol, United Kingdom), Reda TOLBA (Department Chair and Professor) (Jury, Abu Dhabi, United Arab Emirates), Giustino VARRASSI (President) (Jury, Roma, Italy), Efrossini (Gina) VOTTA-VELIS (speaker) (Jury, Chicago, USA) 16:10 - 16:21 #41293 - OP010 Development of a novel virtual reality-based application as an adjunctive modality in chronic non-cancer pain management. OP010 Development of a novel virtual reality-based application as an adjunctive modality in chronic non-cancer pain management. Chronic Non-Cancer Pain (CNCP) is a highly prevalent condition with debilitating psychosocial effects. Despite this, CNCP remains poorly managed. With increasing interest in the use of Virtual Reality (VR) in chronic pain management, our study team developed a patient-centric VR prototype as an adjuvant pain management tool. We conducted a multi-phase prospective qualitative study using purposive criterion sampling. Phases 1 (n=16) and 3 (n=14) included patients suffering from non-cancer chronic pain for more than three months, while phase 2 (n=8) involved healthcare professionals with more than six months experience in pain medicine. All participants were recruited from our institution’s Chronic Pain Clinic, with the study conducted through semi-structured interviews. Thematic analyses of the participants interviewed in Phases 1 and 2, detailed in Figure 1, revealed barriers relating to affordability and accessing multidisciplinary treatment for CNCP patients. Seven educational VR modules were designed, applying mindfulness-based stress reduction and diaphragmatic breathing and relaxation as modes of pain distraction. Phase 3 participants partook in two 20-minute VR sessions and post-intervention interviews showed that participants generally perceived the VR modules to be easy to use and beneficial for pain management, as seen in Figure 2 and 3. This study aimed to understand participants’ perceptions toward a VR prototype as an adjuvant pain management tool. Although further assessments are needed to assess its effectiveness, our results validate the prototype as a promising adjunct in the multimodal management of CNCP, and its potential to increase accessibility to, and reduce the perceived stigma associated with psychotherapy. Amanda LEE (Singapore, Singapore), Lydia LI, Jane LIM 16:21 - 16:32 #42499 - OP011 Efficacy of epidural verapamil injection for chronic lumbar radicular pain: A randomized, double blind study. OP011 Efficacy of epidural verapamil injection for chronic lumbar radicular pain: A randomized, double blind study. Lumbar radiculopathy is a common source of chronic low back and leg pain Pain processing involves calcium channels found on dorsal horn and causes release of substance P, glutamate resulting in nociception. Verapamil is a calcium channel blocker and has been used via neuraxial route to potentiate the effects of local anesthetic/opioids for peri operative analgesia. The aim of the study was to compare verapamil as an adjuvant to epidural steroid in patients with radiculopathy due to lumbar disc herniation This randomized controlled trial was conducted in 71 patients with unilateral lumbar radicular pain undergoing epidural injections. Patients were randomized into 2 groups – Group C (Epidural injection - 80 mg triamcinolone) and Group V (Epidural injection of 80 mg triamcinolone + 5 mg verapamil). Patients were followed for 6 months. The outcomes were comparison of numerical rating scale (NRS) for pain, Oswestry disability index (ODI) scores and successful outcome at follow up between the two groups The NRS and ODI scores are shown in Table 1 and were not statistically significant between the groups. Successful outcome was defined as > 50% reduction in NRS and 10 point decrease in ODI. Successful outcome was better in verapamil group at 3 months. No complications were seen in any group The addition of verapamil as an adjuvant to steroid did not result in significant improvement when added to epidural injection in patients with lumbar radicular pain. However, Successful outcome was better in verapamil group at 3 months. Dhruv JAIN (New Delhi, India), Virender Kumar MOHAN, Sana Yasmin HUSSAIN, Debesh BHOI 16:32 - 16:43 #42446 - OP012 The Effect of Ultrasound Guidance on Radiation Dose and Procedure Time in Lumbar Transforaminal Epidural Injection. OP012 The Effect of Ultrasound Guidance on Radiation Dose and Procedure Time in Lumbar Transforaminal Epidural Injection. Epidural injection of corticosteroids and local anesthetics is an important therapeutic option for managing lumbar radicular pain. Ultrasound alone isn't suitable for transforaminal epidural injections (TFESIs) due to limited visualization of structures beneath the bone. Integrating ultrasound and fluoroscopy offers advantages like reduced radiation exposure, soft tissue visualization. This study aims to determine the impact of integrating ultrasound guidance into TFESIs on radiation dose and procedure time. This prospective randomized study included 55 patients aged 18-70 with lumbar radiculopathy due to disc herniation and unresponsive to conservative treatment, planned for single-level TFESIs. Group F received fluoroscopy-guided TFESIs, while Group H received ultrasound-fluoroscopy integration. In Group H, after advancing the needle under ultrasound guidance to the lateral edge of the target vertebra, the procedure proceeded with fluoroscopic imaging. In both groups, the same solutions were administered into the epidural space. Demographic data, radiation dose, radiation duration, procedure duration, number of fluoroscopy shots, complications, contrast spread pattern, and Numeric Rating Scale (NRS) scores were recorded and compared. Statistical analysis was completed with 50 patients after excluding 5 patients who started with ultrasound guidance. Group F (n=25) showed statistically significantly higher radiation dose (p=0.001; p < 0.01), radiation duration (p < 0.01), fluoroscopy shots (p < 0.01), and supranuclear rate (p < 0.01) than Group H (n=25). No significant differences were found in procedure duration, complication rate (p>0.05), or NRS scores before and after the procedure (p>0.05). Integrating ultrasound guidance into TFESIs as a hybrid method reduces both radiation exposure and duration. Sinem OZLER (Istanbul, Turkey), Serdar KOKAR, Yucel OLGUN, Savas SENCAN, Osman Hakan GUNDUZ 16:43 - 16:54 #42793 - OP013 Effectiveness of Conventional and Cooled RF in Treating Chronic Knee Pain: Initial Findings from the COGENIUS Trial: Interim report. OP013 Effectiveness of Conventional and Cooled RF in Treating Chronic Knee Pain: Initial Findings from the COGENIUS Trial: Interim report. The COGENIUS trial aims to evaluate the cost-effectiveness and efficacy of conventional and cooled RF treatments in patients with therapy-resistant chronic knee pain due to osteoarthritis (OA) and persistent post-surgical pain (PPSP) after a total knee prosthesis. The COGENIUS trial is a multicenter double-blinded, randomized controlled trial of 2-year follow-up. After an initial run-in period, 200 patients per subgroup will be randomized to receive either conventional RF, cooled RF, or a sham procedure in a 2:2:1 ratio (Fig. 1,2). The analysis includes a comparison of the effectiveness of each RF treatment with the sham procedure and between conventional and cooled RF. The primary outcome is the Western Ontario and McMaster Universities Osteoarthritis Index score at 6 months. Knee pain, functionality, quality of life, emotional health, medication use and cost constitute secondary endpoints. To date, 822 patients have been screened, of which were 220 eligible for the trial and 164 randomized across 14 centers. Of these, 63 participants belong to the OA subgroup and 101 to the PPSP subgroup. The enrollment began on 7 July 2022, with the trial projected to conclude in March 2028. Most exclusions occurred due to bilateral knee pain (128/822), refusal to participate (85/822), and chronic widespread pain (49/822). Until present 12 of the 220 patients experienced adequate improvement in pain after the run-in period. This ongoing study aims to delineate the relative effectiveness of cooled and conventional RF treatments compared to a sham procedure in patients with chronic knee pain. Amy BELBA, Thibaut VANNESTE, William AERTS, Leander MANCEL, Sarah SHIBA, Walter STAELENS, Jan VAN ZUNDERT (Genk, Belgium) 16:54 - 17:05 #41298 - OP014 Does iPACK a punch? A prospective observational study on the efficacy of pain relief and functional improvement of an iPACK block for chronic knee osteoarthritis. OP014 Does iPACK a punch? A prospective observational study on the efficacy of pain relief and functional improvement of an iPACK block for chronic knee osteoarthritis. Knee osteoarthritis (KOA) causes chronic pain, which impairs mobility. Access to total knee replacement surgery is limited in lower- and middle-income countries, with waiting times often extending to many years. Prolonged immobility is associated with increased perioperative complications. Reducing patients’ chronic knee pain whilst awaiting surgery may therefore improve their mobility and surgical outcomes. This study investigated if pain and physical function were improved in patients with KOA, awaiting knee arthroplasty, using an iPACK (infiltration between the Popliteal Artery and the posterior Capsule of the Knee) block. Nineteen patients with KOA attending a specialist Pain Unit in South Africa were included in the study. Baseline measurements of pain and physical function were performed using the numerical rating scale (NRS) and Knee Injury and Osteoarthritis Outcome Score short form (KOOS-PS). An ultrasound-guided iPACK block was performed, using 20ml 0.25% bupivacaine and 80mg methylprednisolone. Repeat NRS and KOOS-PS measurements were obtained telephonically after one and two months, and in-person at three months. Pain scores were significantly reduced at one month (NRS -2, p=0.044) and two months (NRS -2, p=0.021) but not month three. Similarly, physical function was significantly improved at month one (KOOS-PS -7.6, p=0.016), and month two (KOOS-PS -10.2, p=0.026) but not month three. Most participants (78.9%) reported satisfaction with the block. An iPACK block reduces chronic pain and improves physical function in patients awaiting knee arthroplasty, for about two months. Larger studies are required to confirm these findings and if these translate to reduced perioperative complications. Bernard EDWARDS (Bloemfontein, South Africa), Gillian LAMACRAFT 17:05 - 17:16 #42416 - OP015 Evaluation of the Efficacy and Safety of Combined Pulsed Radiofrequency and Epidural Steroid Injection in Herpes Zoster-Related Pain. OP015 Evaluation of the Efficacy and Safety of Combined Pulsed Radiofrequency and Epidural Steroid Injection in Herpes Zoster-Related Pain. In this study, we aimed to evaluate the effectiveness of Pulsed Radiofrequency (PRF) and Transforaminal anterior epidural steroid injection (TFAESI) applied to the dorsal root ganglion (DRG) in herpes zoster pain. The results of patients who underwent DRG PRF and TFAESI for herpes zoster-related pain in the Algology clinic between June 2026 and March 2023 were evaluated retrospectively. Demographic and clinical examination findings (gender, age, involved dermatome, side, neurologic examination, medications used) and VAS scores were recorded. VAS pain scores and complication findings were recorded at 1 month, 6 months and 12 months after the procedure. Datas of 93 patients were evaluated. 66 patients were in acute/subacute pain while 27 patients had postherpetic neuralgia (PHN) at presentation. 11 patients had cervical, 75 patients had thoracic segment involvement, and 7 patients had lumbar segment involvement. Cervical, thoracic and lumbar DRG and TFAESI were performed according to the segment involved. VAS scores for all three regions were significantly lower than pre-procedure at 1 month, 6 months and 12 months after the procedure (p<0.001, p<0.001nvolved DRG, p=0.008, respectively). There was no significant difference for PHN at 6 months and 12 months follow-up (p=0.3, p=0.6). While 2 patients developed nausea and dizziness due to subdural and intravenous leakage after the procedure, no fatal complications were recorded in any patient. In herpes zoster-associated refractory neuropathic pain, fluoroscopy-guided combined DRG and TFEASI application methods provide long-term effective pain control and are safe both in the acute/subacute phase and in patients who develop PHN. Esra ERTILAV (Aydin, Turkey), Oznur YILDIRIM 17:27 - 17:38 #42431 - OP017 Rib fractures: are we doing enough? OP017 Rib fractures: are we doing enough? Beaumont Hospital, one of Ireland's premier acute care facilities, routinely confronts the challenges associated with traumatic rib fractures, which significantly impact patient outcomes due to complications such as atelectasis and pneumonia. Despite existing guidelines, notable variations in pain management practices persist. This study aims to critically assess and refine existing pain management protocols by benchmarking them against best practices, ensuring consistent and effective care. A comprehensive retrospective analysis was conducted on 3,000 CT scans (including CT TAPs and CT thoraxes) from 2023, performed at Beaumont Hospital. The review focused on identifying cases with rib fractures and analysing the type and timing of analgesia administered within the first 24 hours post-diagnosis. This assessment was compared with established pain management guidelines to evaluate adherence and effectiveness. Initial findings from the study reveal significant inconsistencies in the application of pain management protocols among patients with rib fractures. These preliminary results have propelled the research into its next phase, which involves a more thorough investigation into the correlation between the timeliness and adequacy of pain management and key patient outcomes, including recovery speed, overall satisfaction, and long-term health implications. There is a critical need to optimise pain management services for patients presenting with rib fractures at Beaumont Hospital. This study is essential in providing detailed insights into current practices and will form the basis of targeted recommendations aimed at enhancing pain management strategies, ultimately ensuring that all patients receive optimal and equitable care. Caitriona RYAN (Dublin, Ireland), Mujeeb SHAIKH, David MOORE, John BOURKE 17:38 - 17:49 #42518 - OP018 Spinal cord stimulation in a patient with an implantable cardioverter defibrillator for the management of chronic ischemic and neuropathic chest pain: A Case Report and Focused Review of the Current Literature. OP018 Spinal cord stimulation in a patient with an implantable cardioverter defibrillator for the management of chronic ischemic and neuropathic chest pain: A Case Report and Focused Review of the Current Literature. To present a successful case of pain relief using simultaneous use of spinal cord stimulation (SCS) and implantable cardioverter defibrillator (ICD) without interaction in a patient with refractory chest pain. A 64-year-old man with a medical history of arterial hypertension, and multivessel coronary artery disease, previously underwent percutaneous coronary intervention and stent insertion and a severe ventricular dysfunction with an LVEF of 21% which is why the implantation of a dual chamber ICD was indicated. Later presented mixed etiology refractory chronic chest pain (ischemic and neuropathic), without response to multimodal pharmacological treatment, including high doses of opioids, among others, this being a limitation for the patient daily activities, so taking into account the previous treatments, he was taken to implant a spinal stimulator with two eight-contact electrodes at levels T6 and T7 and T3-T4. Pain perception before the procedure was 10/10 according to the visual analog pain scale, which presented a significant improvement in the postoperative period with a new value of 3/10 at 48 hours, 3/10 at 7 days and 2/10 at follow-up at 6 months with a 50% decrease in the opioid dose previously used by the patient. During follow-up, there were no alterations in ICD functioning after one year of the procedure. For patients with cardiac implantable electronic devices such as pacemaker and ICD, spinal cord stimulation is a safe and effective treatment for chronic refractory pain. Anamaria CAMARGO (Bucaramanga, Colombia), German William RANGEL, Ximena CEDIEL, Cristian PORRAS, Eliana BERDUGO
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16:30			16:30-17:20 Added to your list of favorites Deleted from your list of favorites C17 LIVE DEMONSTRATION Ankle block LIVE DEMONSTRATION Ankle block Demonstrators: Corey KULL (Junior Consultant) (Demonstrator, Lausanne, Switzerland), Peter MERJAVY (Consultant Anaesthetist & Acute Pain Lead) (Demonstrator, Craigavon, United Kingdom)		16:30-17:20 Added to your list of favorites Deleted from your list of favorites E18 ASK THE EXPERT Blocks for breast surgery ASK THE EXPERT Blocks for breast surgery 16:30 - 16:35 Introduction. Marcus NEUMUELLER (Senior Consultant) (Chairperson, Steyr, Austria) 16:35 - 17:05 Blocks for breast surgery. Barbara VERSYCK (Anesthesiologist) (Keynote Speaker, Turnhout, Belgium) 17:05 - 17:20 Q&A.	16:30-17:20 Added to your list of favorites Deleted from your list of favorites F18 ASK THE EXPERT Defining quality in obstetric anaesthesia ASK THE EXPERT Defining quality in obstetric anaesthesia Chairperson: Tatjana STOPAR PINTARIC (Head of Obstetric Anaesthesia Division) (Chairperson, Ljubljana, Slovenia) 16:30 - 16:35 Introduction. Tatjana STOPAR PINTARIC (Head of Obstetric Anaesthesia Division) (Keynote Speaker, Ljubljana, Slovenia) 16:35 - 17:05 Defining quality in obstetric anaesthesia. Alex SIA (CEO) (Keynote Speaker, Singapore, Singapore) 17:05 - 17:20 Q&A.
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16:50		16:50-17:25 Added to your list of favorites Deleted from your list of favorites B16 PROBLEM BASED LEARNING DISCUSSION Grey zones PROBLEM BASED LEARNING DISCUSSION Grey zones Chairperson: Thomas Fichtner BENDTSEN (Professor, consultant anaesthetist) (Chairperson, Aarhus, Denmark) 16:50 - 16:55 Introduction. Thomas Fichtner BENDTSEN (Professor, consultant anaesthetist) (Keynote Speaker, Aarhus, Denmark) 16:55 - 17:15 To manage grey zones for neuraxial blocks. Michael HERRICK (Faculty Member) (Keynote Speaker, Hanover, NH, USA) 17:15 - 17:25 Q&A.					16:50-17:20 Added to your list of favorites Deleted from your list of favorites G19 REFRESHING YOUR KNOWLEDGE Nerve injury REFRESHING YOUR KNOWLEDGE Nerve injury Chairperson: Urs EICHENBERGER (Head of Department) (Chairperson, Zürich, Switzerland) 16:50 - 16:55 Introduction. Urs EICHENBERGER (Head of Department) (Keynote Speaker, Zürich, Switzerland) 16:55 - 17:15 Nerve injuries after regional anesthesia - Diagnosis and treatment. David LORENZANA (Head Pain Therapy) (Keynote Speaker, Zürich, Switzerland) 17:15 - 17:20 Q&A.
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17:30		17:30-18:00 Added to your list of favorites Deleted from your list of favorites B17 TIPS & TRICKS How to observe and learn TIPS & TRICKS How to observe and learn 17:30 - 17:35 Introduction. Thomas VOLK (Chair) (Keynote Speaker, Homburg, Germany) 17:35 - 17:55 Standards for observational trials. Vishal UPPAL (Professor) (Keynote Speaker, Halifax, Canada, Canada) 17:55 - 18:00 Q&A.

18:15	18:15-19:15 Added to your list of favorites Deleted from your list of favorites A17 OPENING CEREMONY OPENING CEREMONY ESRA SESSION 18:15 - 19:15 Carl Koller Award Lecture. Admir HADZIC (Director) (Keynote Speaker, New York, USA) 18:15 - 19:15 Recognition of Education in Pain Medicine Award. Athmaja THOTTUNGAL (yes) (Keynote Speaker, Canterbury, United Kingdom) 18:15 - 19:15 Recognition of Education in Regional Anaesthesia Award Lecture. Vincent CHAN (Keynote Speaker, Toronto, Canada)


18:45 - 19:45	WELCOME RECEPTION IN THE EXHIBITION HALL
Thursday 05 September
Time	CONGRESS HALL	PANORAMA HALL	South Hall 1A	South Hall 1B	South Hall 2A	South Hall 2B	Small Hall	NORTH HALL	CHAMBER HALL	CLUB B

08:00	08:00-09:55 Added to your list of favorites Deleted from your list of favorites A20 SPECIAL SESSION Nerve injury after regional anesthesia, trauma or surgery - what to do? 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.	08:00-09:50 Added to your list of favorites Deleted from your list of favorites B20 NETWORKING SESSION State of the art labour analgesia 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.	08:00-08:50 Added to your list of favorites Deleted from your list of favorites C20 LIVE DEMONSTRATION QLB blocks LIVE DEMONSTRATION QLB blocks Demonstrator: Rafael BLANCO (Pain medicine) (Demonstrator, Abu Dhabi, United Arab Emirates)	08:00-09:50 Added to your list of favorites Deleted from your list of favorites D20 NETWORKING SESSION Pain assessment beyond pain intensity scales 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.	08:00-08:50 Added to your list of favorites Deleted from your list of favorites E20 PRO CON DEBATE Meta-Analyses: Still the ‘Gold Standard’ For Guideline Development? 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.	08:00-09:05 Added to your list of favorites Deleted from your list of favorites F20 EXPERT OPINION DISCUSSION Lumbar facet denervation - controversies 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.	08:00-08:30 Added to your list of favorites Deleted from your list of favorites G20a REFRESHING YOUR KNOWLEDGE Efficacy of LIA in various surgical procedures 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.	08:00-10:00 Added to your list of favorites Deleted from your list of favorites H20 SIMULATION TRAININGS SIMULATION TRAININGS Demonstrators: Josip AZMAN (Consultant) (Demonstrator, Linkoping, Sweden), Kassiani THEODORAKI (Anesthesiologist) (Demonstrator, Athens, Greece), Roman ZUERCHER (Senior Consultant) (Demonstrator, Basel, Switzerland)
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08:40							08:40-09:10 Added to your list of favorites Deleted from your list of favorites G20b REFRESHING YOUR KNOWLEDGE Cannabinoids 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.
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09:00			09:00-09:50 Added to your list of favorites Deleted from your list of favorites C21 LIVE DEMONSTRATION Rheumatoid Arthritis: The Role of US in Diagnosis and Treatment LIVE DEMONSTRATION Rheumatoid Arthritis: The Role of US in Diagnosis and Treatment Demonstrator: Ismael ATCHIA (Consultant Rheumatologist) (Demonstrator, Newcastle, United Kingdom)							09:00-12:30 Added to your list of favorites Deleted from your list of favorites TARA TARA SESSION Exploring Innovations in Migraine and Headache Treatments 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)
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09:20					09:20-09:50 Added to your list of favorites Deleted from your list of favorites E21b TIPS & TRICKS Protocols for critical Patients 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.	09:20-09:50 Added to your list of favorites Deleted from your list of favorites F21 TIPS & TRICKS Clavicle Fracture 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.	09:20-09:50 Added to your list of favorites Deleted from your list of favorites G21 TIPS & TRICKS For Needle Navigation 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.
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10:00 - 10:30	COFFEE BREAK

10:30	10:30-12:20 Added to your list of favorites Deleted from your list of favorites A21 NETWORKING SESSION Paediatric Anaesthesia 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 (medical director) (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.	10:30-11:30 Added to your list of favorites Deleted from your list of favorites B21 Special session The right imaging modality for the right intervention in interventional pain therapy 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 (Chairman. 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)	10:30-11:50 Added to your list of favorites Deleted from your list of favorites C22 LIVE DEMONSTRATION Ultrasound-Guided invasive treatments for joint pain: Shoulder - Hip - Knee LIVE DEMONSTRATION Ultrasound-Guided invasive treatments for joint pain: Shoulder - Hip - Knee Demonstrators: Thomas HAAG (Consultant) (Demonstrator, Wrexham, 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)	10:30-11:20 Added to your list of favorites Deleted from your list of favorites D22 ASK THE EXPERT POCUS on Diaphragm 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.	10:30-11:20 Added to your list of favorites Deleted from your list of favorites E22 ASK THE EXPERT ESP myths and facts 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 (staff anesthesiologist) (Keynote Speaker, Bergamo, Italy) 11:05 - 11:20 Q&A.	10:30-11:20 Added to your list of favorites Deleted from your list of favorites F22 EXPERT OPINION DISCUSSION Setting up a block room EXPERT OPINION DISCUSSION Setting up a block room Chairperson: Siska BJORN (Resident) (Chairperson, Aarhus, Denmark) 10:30 - 10:35 Introduction. Siska BJORN (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.	10:30-11:00 Added to your list of favorites Deleted from your list of favorites G22 TIPS & TRICKS To presonalized treatments 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.	10:30-11:20 Added to your list of favorites Deleted from your list of favorites H22 EXPERT OPINION DISCUSSION How to teach ultrasound-guided peripheral nerve blocks to residents 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.	10:30-11:25 Added to your list of favorites Deleted from your list of favorites FP30 ULTRASOUND GUIDED RA (UGRA) Free Papers 5 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)	09:00-12:30 Added to your list of favorites Deleted from your list of favorites TARA TARA SESSION Exploring Innovations in Migraine and Headache Treatments 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)
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11:10							11:10-11:40 Added to your list of favorites Deleted from your list of favorites G22b TIPS & TRICKS Silver Trauma 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.
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11:30				11:30-12:20 Added to your list of favorites Deleted from your list of favorites D23 ASK THE EXPERT Challenges in Implementing Regional Anesthesia in Different Settings 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.	11:30-12:20 Added to your list of favorites Deleted from your list of favorites E23 ASK THE EXPERT Lumbar Neuraxial approaches 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.	11:30-12:20 Added to your list of favorites Deleted from your list of favorites F23 EXPERT OPINION DISCUSSION Rethinking Relief: A Second Opinion on Multimodal Approaches to Acute Pain Management 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.		11:30-12:25 Added to your list of favorites Deleted from your list of favorites H23 ESRA-ASRA SESSION Current and future developments 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, Heraklion, Crete, Greece) 11:55 - 12:15 ASRA. David PROVENZANO (Faculty) (Keynote Speaker, Bridgeville, USA) 12:15 - 12:25 Q&A.	11:30-12:25 Added to your list of favorites Deleted from your list of favorites FP31 CHRONIC PAIN MANAGEMENT Free Papers 6 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
11:35		11:35-12:25 Added to your list of favorites Deleted from your list of favorites B22 PRO CON DEBATE Do we still need cadaver lab to teach regional anaesthesia and pain procedures? 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.
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11:50							11:50-12:20 Added to your list of favorites Deleted from your list of favorites G23 REFRESHING YOUR KNOWLEDGE Pharmacology 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.
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13:15								13:15-13:45 Added to your list of favorites Deleted from your list of favorites H24 MANAGING CHRONIC PAIN:HANDS-ON WITH COOLED RADIOFREQUENCY AB MANAGING CHRONIC PAIN:HANDS-ON WITH COOLED RADIOFREQUENCY AB Keynote Speaker: Thomas HAAG (Consultant) (Keynote Speaker, Wrexham, United Kingdom)

14:00	14:00-14:50 Added to your list of favorites Deleted from your list of favorites A23 ASK THE EXPERT Awake Hip Surgery 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.	14:00-14:50 Added to your list of favorites Deleted from your list of favorites B23 PRO CON DEBATE Spinal injections in the treatment of spinal canal stenosis 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.	14:00-14:50 Added to your list of favorites Deleted from your list of favorites C24 LIVE DEMONSTRATION Spinal Pain Ultrasound Guided Targets 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)	14:00-14:50 Added to your list of favorites Deleted from your list of favorites D24 ASK THE EXPERT Fascial plane blocks 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.	14:00-14:50 Added to your list of favorites Deleted from your list of favorites E24 ASK THE EXPERT AI our future for good 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.	14:00-14:25 Added to your list of favorites Deleted from your list of favorites F25 REFRESHING YOUR KNOWLEDGE Spinal MRI 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.	14:00-14:25 Added to your list of favorites Deleted from your list of favorites G25 TIPS & TRICKS Cervical Blocks 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.	14:00-16:00 Added to your list of favorites Deleted from your list of favorites H25 SIMULATION TRAININGS SIMULATION TRAININGS Demonstrators: Clara LOBO (Medical director) (Demonstrator, Abu Dhabi, United Arab Emirates), Roman ZUERCHER (Senior Consultant) (Demonstrator, Basel, Switzerland)	14:00-14:55 Added to your list of favorites Deleted from your list of favorites FP32 POSTOPERATIVE PAIN MANAGEMENT Free Papers 7 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
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14:30						14:30-15:00 Added to your list of favorites Deleted from your list of favorites F26 REFRESHING YOUR KNOWLEDGE Neurophysiology 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.	14:30-15:00 Added to your list of favorites Deleted from your list of favorites G26 TIPS & TRICKS Central Block 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.
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15:30	15:30-16:20 Added to your list of favorites Deleted from your list of favorites A25 ASK THE EXPERT High Precision Blocks are preferred to low precision fascial plane 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.	15:30-16:20 Added to your list of favorites Deleted from your list of favorites B25 PRO CON DEBATE Lidocaine and ketamine infusion for chronic pain are effective PRO CON DEBATE Lidocaine and ketamine infusion for chronic pain are effective Chairperson: Maria Luz PADILLA DEL REY (Anesthesiologist and Pain Physician) (Chairperson, MURCIA, Spain) 15:30 - 15:35 Introduction. Maria Luz PADILLA DEL REY (Anesthesiologist and Pain Physician) (Keynote Speaker, MURCIA, Spain) 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.	15:30-16:20 Added to your list of favorites Deleted from your list of favorites C25 LIVE DEMONSTRATION Physical examination of spinal pain syndromes 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)	15:30-16:20 Added to your list of favorites Deleted from your list of favorites D25 ASK THE EXPERT Green RA 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.	15:30-16:20 Added to your list of favorites Deleted from your list of favorites E25 ASK THE EXPERT Hygienic standards for RA 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.	15:30-16:20 Added to your list of favorites Deleted from your list of favorites F27 EXPERT OPINION DISCUSSION How I do it: Awake Major Breast Surgery 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.	15:30-17:00 Added to your list of favorites Deleted from your list of favorites G27 TRAINEES SESSION Tables are turned! What can be learned from trainees 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 (Belgian Trainee Representative - Resident) (Keynote Speaker, Antwerp (Belgium), Belgium) 15:30 - 17:00 Case 3. Katharina POLITT (Physician) (Keynote Speaker, Marburg, Germany) 15:30 - 17:00 Case 4. Lua RAHMANI (Anaesthetist) (Keynote Speaker, Dublin, Ireland)	14:00-16:00 Added to your list of favorites Deleted from your list of favorites H25 SIMULATION TRAININGS SIMULATION TRAININGS Demonstrators: Clara LOBO (Medical director) (Demonstrator, Abu Dhabi, United Arab Emirates), Roman ZUERCHER (Senior Consultant) (Demonstrator, Basel, Switzerland)	15:30-16:25 Added to your list of favorites Deleted from your list of favorites FP32bis MISCELLANEOUS Free Papers 8 MISCELLANEOUS Free Papers 8 Chairperson: Dmytro DMYTRIIEV (medical director) (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)
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16:10								16:10-18:00 Added to your list of favorites Deleted from your list of favorites H28 BEST FREE PAPER SESSION - RA BEST FREE PAPER SESSION - RA Chairperson: Thomas VOLK (Chair) (Chairperson, Homburg, Germany) Jurys: Christian BERGEK (Anaesthetist) (Jury, Gothenburg, Sweden), Dario BUGADA (staff 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
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16:30	16:30-17:40 Added to your list of favorites Deleted from your list of favorites A26 PANEL DISCUSSION Injectable Pharmacology for the Interventional Pain Physician 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.	16:30-17:20 Added to your list of favorites Deleted from your list of favorites B26 PRO CON DEBATE Neurolytic blocks for CNMP PRO CON DEBATE Neurolytic blocks for CNMP Chairperson: Andrzej DASZKIEWICZ (consultant) (Chairperson, Ustroń, Poland) 16:30 - 16:35 Introduction. Andrzej DASZKIEWICZ (consultant) (Keynote Speaker, Ustroń, 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.	16:30-17:40 Added to your list of favorites Deleted from your list of favorites C26 EXPERT OPINION DISCUSSION Abdominal blocks 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.	16:30-17:20 Added to your list of favorites Deleted from your list of favorites D29 PRO CON DEBATE Sedation and Regional Anesthesia: Yes or No? 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.	16:30-17:20 Added to your list of favorites Deleted from your list of favorites E29 PRO CON DEBATE PNB in patients at risk for compartment 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.	16:30-17:20 Added to your list of favorites Deleted from your list of favorites F28 EXPERT OPINION DISCUSSION Research Priorities in RA 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.
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18:00		18:00-19:00 Added to your list of favorites Deleted from your list of favorites FP33 HONOURS & DIPLOMATES CEREMONY HONOURS & DIPLOMATES CEREMONY 18:00 - 18:03 Introduction. Eleni MOKA (faculty) (ESRA President, Heraklion, Crete, 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)

19:30 - 21:00	DIPLOMATES & TRAINEES RECEPTION
Friday 06 September
Time	CONGRESS HALL	PANORAMA HALL	South Hall 1A	South Hall 1B	South Hall 2A	South Hall 2B	Small Hall	NORTH HALL	CHAMBER HALL	CLUB B

08:00	08:00-09:50 Added to your list of favorites Deleted from your list of favorites A30 NETWORKING SESSION Paediatric RA NETWORKING SESSION Paediatric RA PAEDIATRIC Chairperson: Kris VERMEYLEN (Md, PhD) (Chairperson, ZAS ANTWERP, Belgium) 08:00 - 08:05 Introduction. Kris VERMEYLEN (Md, PhD) (Keynote Speaker, ZAS ANTWERP, Belgium) 08:05 - 08:27 Chloroprocaine in pediatric regional anesthesia? Karen BORETSKY (Senior Associate in Perioperative Anesthesia, Department of Anesthesiology, Critical Care and Pain Medicine) (Keynote Speaker, Boston, USA) 08:27 - 08:49 When to choose Caudal or Ilio-Inguinal block in children undergoing Inguinal Herniotomy. Luc TIELENS (pediatric anesthesiology staff member) (Keynote Speaker, Nijmegen, The Netherlands) 08:49 - 09:11 Is there still a place for epidural anesthesia in infants? Markus STEVENS (anesthesiologist) (Keynote Speaker, Amsterdam, The Netherlands) 09:11 - 09:33 Regional anesthesia and ambulatory procedures. An TEUNKENS (Clinical Head, associate professor KU Leuven) (Keynote Speaker, Leuven, Belgium) 09:33 - 09:50 Q&A.	08:00-08:50 Added to your list of favorites Deleted from your list of favorites D30 ASK THE EXPERT AI FOR GOOD ASK THE EXPERT AI FOR GOOD Chairperson: Philippe GAUTIER (MD) (Chairperson, BRUSSELS, Belgium) 08:00 - 08:05 Introduction. Philippe GAUTIER (MD) (Keynote Speaker, BRUSSELS, Belgium) 08:05 - 08:35 HOW I use AI. Rajnish GUPTA (Professor of Anesthesiology) (Keynote Speaker, Nashville, USA) 08:35 - 08:50 Q&A.	08:00-08:50 Added to your list of favorites Deleted from your list of favorites C30 PRO CON DEBATE Rebound pain has a biological basis PRO CON DEBATE Rebound pain has a biological basis Chairperson: Hari KALAGARA (Assistant Professor) (Chairperson, Florida, USA) 08:00 - 08:05 Introduction. Hari KALAGARA (Assistant Professor) (Keynote Speaker, Florida, USA) 08:05 - 08:20 For the PROs. Sina GRAPE (Head of Department) (Keynote Speaker, Sion, Switzerland) 08:20 - 08:35 For the CONs. Thomas WIESMANN (Head of the Dept.) (Keynote Speaker, Schwäbisch Hall, Germany) 08:35 - 08:50 Q&A.	08:00-09:50 Added to your list of favorites Deleted from your list of favorites B30 SPECIAL SESSION RA History: What have we learned in the last 5 decades? SPECIAL SESSION RA History: What have we learned in the last 5 decades? Chairpersons: Eleni MOKA (faculty) (Chairperson, Heraklion, Crete, Greece), Brian SITES (Faculty) (Chairperson, Plainfield, USA) 08:00 - 08:05 Introduction. Eleni MOKA (faculty) (Keynote Speaker, Heraklion, Crete, Greece), Brian SITES (Faculty) (Keynote Speaker, Plainfield, USA) 08:05 - 08:23 #43486 - B30 ESRA History: Important Milestones. ESRA History: Important Milestones. ESRA History: Important Milestones Athina Vadalouca,¹ Eleni Moka,² 1. Pain & Palliative Care Centre, Athens Medical Centre, Athens, Greece 2. Anaesthesiology Department, Creta Interclinic Hospital, Hellenic Healthcare Group (HHG), Heraklion – Crete, Greece To effectively unfold a history, one needs to: know those inspired people, that paved the pathway and «wrote» the history, comprehend their backgrounds and motivations, delve into and understand their scientific or/and intellectual journeys, be one of them to identify and trace the history, or develop a deep connection with the history pioneers, aligning with their objectives and sharing their goals and vision, to authentically convey their perspectives. Since these criteria are met, the up to now history of the European Society of Regional Anaesthesia and Pain Therapy (ESRA) will be elaborated upon the lecture of Athina Vadalouca, during the 41^st ESRA Annual Congress, held in Prague in September 2024, and will further be summarized in the following pages. ESRA was founded 44 years ago. Honouring its history and cherishing its heritage, nowadays, the society represents a dynamic organization that continues to share the passion for advancing education, scientific research and training in Regional Anaesthesia (RA), Perioperative Care and Pain Medicine. While its origins are rooted in Europe, ESRA has evolved into a global network, currently embracing more than 8.000 active voting members and an audience of more than 30.000 trainees, specialists, and nurses across the globe. As an international community, with a reputation for innovation, diversity and inclusion, its mission transcends geographical boundaries, offering invaluable opportunities to medical professionals worldwide, with the promise to support them during the transform of their professional journey. ESRA was founded by individuals, who shared the same mission, vision and talent to create the society. The idea originated from the first officers of ASRA Pain Medicine and from some brilliant minds who were well acquainted with many people in Europe, both professionally and personally. For instance, Ben Covino worked with Bruce Scott, the first President of ESRA, in Edinburg in 1976, and encouraged him to start establishing a European Society of Regional Anaesthesia. ESRA was officially founded by a Belgian Royal Decree on January 31, 1980, following intensive efforts and a pivotal meeting in Heidelberg, on September 24-25, 1979. The organization's «Founding Fathers» were Albert Van Steenberge (Belgium), Hans Nolte (Germany), Arno Hollmén (Finland), Bruce Scott (UK), and Françoise Van Steenberge (Albert’s wife), who served as the group’s secretary. They established an administrative and scientific structure, accommodating Europe’s diverse countries, languages, and currencies. Under Bruce Scott’s leadership, two committees were created from the very first beginning: one to establish and set up the society across Europe and another to plan the first scientific meeting. This inaugural meeting was held in Edinburgh on September 16–18, 1982. ASRA Pain Medicine provided funding, and several UK companies (Astra Pharmaceuticals Ltd, Duncan Flockhart & Co Ltd, Dupont UK Ltd, and Roche Products Ltd) offered substantial sponsorship. The Edinburgh meeting marked the emergence of ESRA as a separate and distinct entity. The meeting lasted two days, with its scientific activities taking place in only one plenary hall, hosting one session at a time. Over the years, the ESRA scientific meetings grew and flourished, now expanding to four days and featuring multiple concurrent sessions, such as networking symposia, plenary experts’ panel discussions, instructional refresher course lectures, PRO–CON debates, «ask the expert» interactive sessions, «second opinion» discussions, «tips & tricks» sessions, problem based learning discussions (PBLD), free papers and video contests, electronic poster presentations with a poster competition, various hands–on clinical workshops on Ultrasound Guided Regional Anaesthesia (UGRA) and Pain Management, cadaver workshops, and exams for the acquisition of the ESRA Diplomas (ESRA–DRA and ESRA–DPM). Many other innovative sessions are introduced on an annual basis, including complex case discussions with audience–submitted content, trainees sessions, LIVE demonstrations on models and the 360 open space simulation courses. The annual congresses are pre–planned well in advance and take place in major European cities, each with unique social programs. ESRA's first President was Bruce Scott, Albert Van Steenberge held the position of General Secretary, and Otto Schulte–Steinberg took charge of the finances as Treasurer. The initial zones created in 1980 were Benelux, France, Germany, Italy, Scandinavia, Spain, and the UK. Greece became a member in 1988, followed by Austria, Switzerland, and Portugal in 1990. The aim of ESRA was to attract all European countries, by offering educational, training and research opportunities, adhering to a philosophy of inclusivity and knowledge advancement beyond barriers. ESRA actively supported the establishment of national or regional groups or organisations of RA throughout Europe, inviting and encouraging them to join the society under its rules and regulations. ESRA Ambassadors such as Albert Van Steenberge (Belgium), Slobodan Gligorijevic (Switzerland), Marc Van De Velde (Belgium) and Patrick Narchi (France) have supported and represented Eastern European countries throughout these efforts. ESRA continuously updated its administrative structures with the primary goal of enhancing the dissemination of knowledge in RA and, more recently in Pain Management. We can trace the ESRA history step by step, throughout its significant milestones, that are presented below. · In 1984, during the Vienna meeting, ESRA established the Carl Koller Award, recognizing Dr John Alfred Lee (UK) as its first recipient. This award, originally sponsored by ASTRA, continues until today to honour, recognize and acknowledge scientific achievements and an outstanding lifetime contribution in the field of RA and/or Pain Medicine. · In 1989, ESRA launched its official publication, «The International Monitor of Regional Anaesthesia and Pain Therapy (IMRAPT)», with Mathieu Gielen (The Netherlands) serving as Editor–in–Chief. IMRAPT was initially supported by ASTRA, and later on by ASTRA/ZENECA, with its issues being published on a quarterly basis. Narinder Rawal (Sweden) succeeded Mathieu Gielen, and took over as Editor–in–Chief, holding the position from 1995 to 2005. · In 1992, André Van Zundert (Belgium) initiated the publication of the «Highlights» of Regional Anaesthesia and Pain Therapy, serving as Editor–in–Chief until 1999. From 2000 to 2003, he co–edited this edition with Narinder Rawal (Sweden), who then continued as Co–Editor alongside with the society Presidents, Slobodan Gligorijevic (Switzerland) and Giorgio Ivani (Italy), until 2009. In 2010, José de Andres (Spain) and Marc Van De Velde (Belgium) took over as Editors–in–Chief. The Highlights continue to be released as an online RAPM supplement every September. · On October 27, 1993, the ESRA Foundation was established, with its statutes being published on December 16, 1993. The foundation's mission was to organize educational activities in RA and Pain Therapy for anaesthetists. Additionally, it was authorized and empowered to grant awards and prizes, to recognize excellence in the fields. · In 1995, the ESRA lecture was introduced, being delivered by JAW Wildsmith (UK), and becoming a prominent feature of the Annual Congresses. · The following year, in 1996, the ASRA lecture was added to the Annual Congress program, with the inaugural lecture being delivered by John Rowlingson (USA). · In order to showcase the diverse applications of RA, enhance the understanding and improve the knowledge in the field, as well as to attract new members to join the society, the ESRA Board of Directors planned an International Symposium on RA (ISRA). The inaugural ISRA congress took place in New Zealand from April 9–11, 1996, was supported by ESRA, ASRA, AOSRA, and LASRA, with JFW Wildsmith (UK) being at the helm of its scientific committee. · In 1998, during the Annual Congress in Geneva, from September 16–19, the ESRA Board of Directors approved and sanctioned the formation of several new committees. These were: ·a. Newsletter and Promotions Committee (Chair: A. Vadalouca, Greece) b. Research Grant Committee (Chair: A. Vadalouca, Greece) c. Education and Website Committee (Chair: B. Fischer, UK) d. Best Presentation Committee (Chair: M. Gielen, The Netherlands) e. Guidelines on Acute and Chronic Pain Committee (Chair: N. Rawal, Sweden) Three prizes for the best free papers and three for the best posters, sponsored by Becton–Dickinson, were awarded for the first time at this meeting. This event also marked the ESRA and EuroPain inaugural joint meeting, followed by another one in Istanbul in 1999. Concurrently, the first ESRA Cadaver Workshop in Innsbruck also started that year, with Slobodan Gligorijevic (Switzerland) serving as the chair of this event. This was a significant educational initiative, which was further improved and fine–tuned over the years, remaining one of the most popular ESRA activities until today. ESRA expanded its global presence and footprint by holding a fruitful international meeting in Jaipur, India, from February 9–13, 1998, with Narinder Rawal (Sweden) being the chair of the event. The society further engaged with and reached out to the Balkan countries, by organizing the 1st Mediterranean and Balkan Congress in Athens, Greece, from June 19-21, 1998, chaired by Athina Vadalouca (Greece), and attracting over 550 participants. At the Rome ESRA Annual Congress, in 2000, ESRA awarded its first Research Grant, being split between Spanish and Greek recipients. That year, meetings were also held in Quebec and Athens. In 2002, Barcelona hosted the 1st World Congress of Regional Anaesthesia, providing a global perspective on RA and Pain Therapy. The first Eastern European anatomy workshop on RA took place in Ljubljana also in 2002, whereas ESRA launched its first Winter Week course on RA in 2003. Both events were leaded by Slobodan Gligorijevic (Switzerland) and were welcome warmly by their audiences. The Eastern European Cadaver workshops keep being organized, with Paul Kessler (Germany) and Peter Merjavy (UK) serving as event chairs and following a venue rotation between Ljubljana, Prague, and Budapest. Additionally, Winter Week has evolved into an extremely successful activity over the years, being continued until today, under the leadership of Geert Jan Van Geffen (The Netherlands). The BBraun Award was established in 2005 and was presented to Alain Delbos (France), for his outstanding contribution in UGRA, via the introduction of a 3–D simulation training tool in the format of a DVD. The award kept being sponsored by BBraun until 2010. Afterwards, it was renamed «Recognition of Education in Regional Anaesthesia» Award, and is offered annually to support outstanding innovative activities or developments in the field of RA, as a reflection of excellence in teaching & clinical education. Similarly, the «Recognition of Education in Pain Medicine» Award was introduced in 2023, with Philip Peng (Canada) being its first recipient. In 2005, the ESRA Diploma of Regional Anaesthesia (EDRA) was launched, a project driven and spearheaded by André Van Zundert (Belgium), Giorgio Ivani (Italy), Narinder Rawal (Sweden), and Alain Borgeat (Switzerland), with the valuable assistance and substantial contribution from Chandra Kumar (UK). The first EDRA Diploma exams took place, in 2006, during the ESRA Annual Congress in Monte Carlo, Monaco. There were only a few candidates at first (4 in total), but the number has increased considerably since then, with ESRA nowadays counting more than 1000 diplomates. Recently this popular diploma has been renamed to ESRA–DRA (ESRA European Diploma of Regional Anaesthesia). Education and Excellence in the Provision of Care in Europe and beyond represent an integral part of the ESRA mission. The society is proud of the two jewels on its crown: Not only the ESRA–DRA, but also the ESRA–DPM (ESRA European Diploma of Pain Medicine), which was established in 2017, as an idea of Jose De Andres (Spain). Both aim to harmonize and improve quality standards for safe, independent practice in our fields, in Europe and elsewhere. The Diplomas assess the competencies of anaesthesiologists and pain physicians, acting within a multidisciplinary team and practicing as specialists. They also intend to complement national standards and enhance the competent, ethical, and professional care of RA and Pain Medicine. The ESRA Diplomas Exams, which are quite popular, are organized regularly on an annual basis, remotely and in person, within but also outside the European territory. Both of them, in 2023, during the 6^th World Congress of Regional Anaesthesia and Pain Medicine, have been evaluated and received official accreditation by the Council for European Medical Specialists Assessment (CESMA), an advisory body of the European Union of Medical Specialists (UEMS). Pioneers in this endeavor were Morne Wolmarans (UK) and Sam Eldabe (UK), for the ESRA–DRA and ESRA–DPM respectively. The ESRA Academy was founded in 2010, was presented at the annual congress in Porto, and was further reformed from scratches in the coming years, being re–launched and presented in 2015 by Paolo Grossi (Italy). The Academy continues to be a valuable tool for all ESRA members, by hosting a variety of online educational content, including but not limited to recorded lectures, videos, and live demonstrations of RA/Pain techniques. The updated ESRA bylaws were also presented in 2010, and were approved by the Annual General Assembly, in addition to the «Albert Van Steenberge» Award, which was also launched that year. ESRA kept growing its membership and impact in RA and Pain Therapy in 2013. That year, the first publication on ESRA history by André Van Zundert (Belgium) and JAW Wildsmith (UK) was released and published in the journal RAPM. In 2014, PROSPECT (Procedure Specific Postoperative Pain Management) and ESRA formalized an agreement to strategize and plan their future partnership and to expand the group membership. PROSPECT, although an ESRA working group, still remains an independent academic body within the society academic umbrella. Currently, under the leadership of Marc Van De Velde (Belgium), continues to benefit from the academic endorsement and support of ESRA and develops some of the best available Consensus Recommendations in a clinically useful format. These are readily transferable in daily practice, serve as a clinical decision support service, and are designed to improve postoperative pain management on a procedure–specific basis. As such, they are translated into multiple languages to be readily available for clinicians across all corners of the world. In 2014, the 4th World Congress on RA and Pain Therapy (WCRAPT) took place in Cape Town, South Africa, from November 24–28, being jointly organized by ESRA, ASRA, LASRA, and AFSRA. In 2015, 2016 and onwards, under the leadership of Paul Kessler (Germany), ESRA significantly expanded its accredited workshops, featuring cadaver sessions and practical hands–on training across multiple European cities, mainly Innsbruck and Witten. The cadaver workshops have also expanded in the field of pain and under the guidance of Andrzej Krol (UK), ultrasound and C–Arm facilitated interventional chronic pain techniques are regularly demonstrated and taught. In the era of rapid E–Learning transformation, ESRA was a pioneer. It keeps staying in tune with the latest trends and technologies and has adapted the provision of its educational content to the new digitally driven world. Since 2017, it offers its audience access and navigation into the USabcd platform, a unique E–Learning concept, which provides the empowerment one needs with the knowledge of RA and Point–of–Care Ultrasound in clinical practice. Clinicians who utilize the USabcd tool may take advantage of its focused, structured and comprehensive format to improve their diagnosis capabilities and optimize patients’ care in the perioperative, ICU and emergency medicine setting. At the end of the previous decade, ESRA introduced innovative online educational initiatives, and is proud of its interactive e–Congress (e–ESRA), which was first launched in 2018, by Alain Delbos (France) and Luc Mercadal (France). This internet–based activity, a unique educational concept, brought a new dimension of online education, for a maximum learning outcome. With an extended 24–hour program, broadcasted live all over the world in parallel streams, and the enthusiastic interaction of participants, via live chats, polls & quizzes with instant results, a virtual experience of a full congress, dedicated to RA, Perioperative Care & Pain Medicine, has been accomplished. Its 6^th edition took place in April 2024, under the leadership of Jose Aguirre (Switzerland), with the active involvement of not only ESRA, but also ASRA Pain Medicine, LASRA, AFSRA and AOSRA–PM. It attracted more than 1.200 delegates connected online in one single day, across all continents. Interesting lectures of short duration, podcasts, videos, and Live Demonstration Sessions were presented, and are available for replay, via the ESRA Academy. The e–ESRA represents a hub for elevating education standards and for promoting international collaboration and networking. It opens the doors to knowledge for physicians from Europe and beyond, in a flexible and affordable way, and fosters a diverse and enriching exchange of ideas, transcending any geographical boundaries. In 2018 and 2019, ESRA was phenomenal in expanding its social media presence and outreach, attracting thousands of followers on platforms like Facebook, Instagram, LinkedIn and Twitter. Traditionally, ESRA participated in the development of comprehensive Guidelines or Recommendations on RA and PM practices, in close collaboration with other organizations. The latest ones include, but are not limited to (a) the Joint Guidelines with the European Society of Anaesthesiology and Intensive Care (ESAIC) on how to manage patients on antithrombotic drugs who need RA, published in European Journal of Anaesthesiology in 2022, (b) the International Consensus Meeting (ICM) Recommendations on Venous Thromboembolism (VTE), published in The Journal of Bone and Joint Surgery in 2022, (c) the International Consensus on anatomical structures to identify on ultrasound for the performance of basic blocks in UGRA, published in RAPM in 2022, and (d) the Evidence–Based Clinical Practice Guidelines on Postdural Puncture Headache, as a Consensus Report from a Multisociety International Working Group, published in RAPM and JAMA Open in 2024. ESRA prioritized education for anaesthetists in training and young specialists across Europe and devotes much of its efforts to the residents, the lifeblood of our profession and the promising future of medical care. Their enthusiasm, fresh perspectives, and unwavering commitment to patient well–being pave the way for innovation and excellence in our fields. Alongside experts’ guidance, ESRA fully supports the ESRA Trainees Group that was created in 2016, and their annual course, whereas a part of the ESRA website educational content is fully dedicated to them. Research and Education grants of up to 10.000 and 4.000 EUR each respectively are awarded regularly to young researchers worldwide, who are strongly encouraged to apply. Approved Training Centres of Excellence on RA or/and Pain Medicine in Europe are available to the new generation of physicians, with specific emphasis given to applications from anaesthesiologists from countries lacking the financial infrastructures needed to achieve education in RA and Pain Medicine. The ESRA Updates, the new format of the ESRA Newsletter, initiated by Clara Lobo (Portugal), serves the society by offering content that is not only informative but also engaging for the members. Its main goal and objectives are to spread information on ESRA events and training opportunities and disseminate the spirit of enthusiasm among our younger colleagues. Since May 2016, ESRA, also started offering a Master Diploma (MSc) to its members in partnership with the University of East Anglia. In 2020 and 2021, ESRA responded to the COVID–19 pandemic by moving many educational events to online formats. Innovative web–based training activities, including free webinars, virtual or hybrid meetings and the well–established e-Congresses (e-ESRA) maintained the society at the knowledge forefront, and finally became tradition. Currently, these tools continue to thrive on an annual basis, showcasing the ESRA dedication to improving RA and Pain Medicine through education, research, and international cooperation. In 2022, ESRA marked its 40th anniversary since the organization of its first meeting, looking back on its development and achievements in the field. The first annual congress after the pandemic took place in Thessaloniki, Greece, with over 1.750 attendees and more than 500 abstracts, under the leadership of Alain Delbos (France) and Eleni Moka (Greece). The event was both scientifically and socially rewarding. In 2023, ESRA hosted its biggest scientific event ever, the 6^th World Congress of RA and PM, in Paris, as a joint event with its 40^th Annual Congress. Joining collaborative efforts with all sister societies (ASRA Pain Medicine, AFSRA, LASRA, AFSRA and AORAPM), the impressive numbers of more than 3.300 Delegates, more than 300 Faculty Members & Key Opinion Leaders from all continents, and more than 750 abstracts were achieved. Alain Delbos (France) and Eleni Moka (Greece) led the scientific committee and supervised the whole organization. An expanded, high–quality scientific content was offered to all participants, in parallel with a great family atmosphere, combined with networking, interactivity, knowledge sharing and exchange of new ideas. This congress was not just another ESRA event; it showcased that, in the rapidly evolving landscape of healthcare, deepening partnerships is the cornerstone, upon which we can build bridges, learn from each other, support fundamental changes and establish progress. ESRA embraces diversity within its community and offers unparalleled networking opportunities and friendships that span the globe. Collective efforts with partners that share similar values and principles are more than welcome, as they enhance the richness of discussions and perspectives, providing a global outlook on our fields. A great example inside ESRA is its International Committee, established in 2021, to give a sound voice to physicians from all continents involved in RA and Pain Medicine. The unique experiences and insights of all ESRA followers are not just valued but celebrated! In the past, the highlighting event of such celebration was the European Day of RA, that was first organized in 2018, as an initiative of Alain Delbos (France) and Sebastien Bloc (France) and which continued to take place at the beginning of each year in January, until 2023. Together with the National Societies of RA and Pain Therapy, multiple cities in different European countries every year participated simultaneously, with a common scientific program, aiming at interactivity and exchange of scientific opinions between trainees and experts on hot topics related to RA and Perioperative Care. The primary goal was discussing innovations and combining theory with clinical methodology and Hands–On Practice. With this event, ESRA kept promoting signaling the encouragement of training, education and research in the context of improved quality of continuing medical education among European Anaesthesiologists. Following the footsteps of such meetings, and in the same spirit of enthusiasm, ESRA aspired to expand this activity worldwide to contribute to its mission fulfilment. Under the presidency of Eleni Moka (Greece), ESRA, together with its Sister Societies AFSRA, ASRA Pain Medicine, AOSRA and LASRA, launched the 1^st World Week and the 1^st World Day of RA and Pain Medicine in January 2024, drawing more than 14.000 participants from more than 140 cities across all continents. During this week, in the concept of a strengthened alliance, RA and Chronic Pain physicians around the globe were connected together, to shine a spotlight on the critical fields of RA and Pain Medicine, under the inspiring theme “Joining Hands for a Pain Free Future Worldwide”. Recognizing that progress transcends individual achievements, leaders of all RA and PM Sister Societies acknowledged the power of unity, identified shared visions and missions, and recognized the potential for our patients’ benefit. All ESRA milestones that have been described, allow us to reflect on the progress that has been made and the work that lies ahead. Throughout its remarkable journey, ESRA expanded its horizons and pushed the boundaries to become an international community for everyone who aspires to high standards and professionalism in RA, Perioperative Care and Pain Medicine. Despite challenges, ESRA is a testament to the power of inclusivity and collaboration in our ever–evolving fields of interest. A vibrant tapestry of ideas and shared values were and continue to be created by joining efforts. As we embark on this journey together, let us remember that in unity, we may find strength, and in inclusion, we can discover the boundless potential for growth and innovation. When combined, our individual strengths have the power to collectively achieve remarkable advancements in the pursuit of knowledge, scientific research and patient care. ESRA continues to extend the hand of partnership to everyone that shares its vision, ensuring a brighter future to reach global excellence. References 1. André AJ Van Zundert, John AW Wildsmith. The European Society of Regional Anaesthesia and Pain Therapy (1982–2012): 30 Years Strong. Reg Anesth Pain Med, 2013; 38(5): 436 – 441. (The following individuals contributed to this article on behalf of the Heritage Group of the European Society of Regional Anaesthesia and Pain Therapy: Alain Borgeat, MD, PhD, EDRA; José De Andres, MD, PhD, EDRA; Slobodan Gligorijevic, MD, EDRA; Giorgio Ivani, MD, PhD, EDRA; Narinder Rawal, MD, PhD, EDRA, FRCA; Harald Rettig, MD, PhD, EDRA; Athina Vadalouca, MD, PhD; Marc Van De Velde, MD, PhD, EDRA) 2. ESRA Newsletter, No 1, September 1998. 3. ESRA Newsletter, No 2, Spring 1999. 4. The International monitor of Regional Anaesthesia and Pain Therapy, 1992 – 2004. 5. Highlights in Regional Anaesthesia and Pain Therapy, 1992 – 2010. 6. Kietaibl S, Ferrandis R, Godier A, Llau J, Lobo C, Macfarlane AJ, Schlimp CJ, Vandermeulen E, Volk T, Von Heymann C, Wolmarans M, Afshari A. Regional anaesthesia in patients on antithrombotic drugs: Joint ESAIC/ESRA guidelines. Eur J Anaesthesiol, 2022; 39(2): 100 – 132. 7. ICM – VTE General Delegates. Recommendations from the ICM – VTE (Recommendations of the International Consensus Group on Venous Thromboembolism after Orthopaedic Procedures). J Bone Joint Surg Am, 2022; 104(Suppl 1): 4 – 162. 8. Bowness JS, Pawa A, Turbitt L, Bellew B, Bedforth N, Burckett-St Laurent D, Delbos A, Elkassabany N, Ferry J, Fox B, French JLH, Grant C, Gupta A, Harrop-Griffiths W, Haslam N, Higham H, Hogg R, Johnston DF, Kearns RJ, Kopp S, Lobo C, McKinlay S, Memtsoudis S, Merjavy P, Moka E, Narayanan M, Narouze S, Noble JA, Phillips D, Rosenblatt M, Sadler A, Sebastian MP, Taylor A, Thottungal A, Valdés-Vilches LF, Volk T, West S, Wolmarans M, Womack J, Macfarlane AJR. International consensus on anatomical structures to identify on ultrasound for the performance of basic blocks in ultrasound-guided regional anesthesia. Reg Anesth Pain Med, 2022; 47(2): 106 – 112. 9. Uppal V, Russell R, Sondekoppam RV, Ansari J, Baber Z, Chen Y, DelPizzo K, Dirzu DS, Kalagara H, Kissoon NR, Kranz PG, Leffert L, Lim G, Lobo C, Lucas ND, Moka E, Rodriguez SE, Sehmbi H, Vallejo MC, Volk T, Narouze S. Evidence–based clinical practice guidelines on postdural puncture headache: A consensus report from a multisociety international working group. Reg Anesth Pain Med, 2023; Epub online ahead of print – Article in press. 10. Uppal V, Russell R, Sondekoppam R, Ansari J, Baber Z, Chen Y, DelPizzo K, Dirzu DS, Kalagara H, Kissoon NR, Kranz PG, Leffert L, Lim G, Lobo CA, Lucas ND, Moka E, Rodriguez SE, Sehmbi H, Vallejo MC, Volk T, Narouze S. Consensus Practice Guidelines on Postdural Puncture Headache from a Multisociety, International Working Group: A Summary Report. JAMA Netw Open, 2023; 6(8): e2325387. 11. ESRA Official Website: www.esraeurope.org [assessed 30^th June 2024]. Athina VADALOUCA (Athens, Greece) 08:23 - 08:41 Spinal Opioids: Evolution during 5 Decades and New Postoperative Monitoring Recommendations. Narinder RAWAL (Mentor PhD students, research collaboration) (Keynote Speaker, Stockholm, Sweden) 08:41 - 08:59 #43240 - B30 Adjuvants in Regional Anesthesia: Lessons Learned. Adjuvants in Regional Anesthesia: Lessons Learned.* Andre Van Zundert (1), Kai Woodfall (2), Ekladious Shady (3), Nikolae Robert (3) 1. Department of Anaesthesia & Perioperative Medicine, Royal Brisbane and Women's Hospital & The University of Queensland, Herston-Brisbane, Australia 2. Department of Anaesthesia & Perioperative Medicine, Royal Brisbane & Women's Hospital & The University of Queensland, Brisbane, Australia, none, Brisbane, Australia 3. Department of Anaesthesia & Perioperative Medicine, Royal Brisbane & Women's Hospital & The University of Queensland, Brisbane, Australia, none, Brisbane, QLD, Australia Key Reasons why Regional Anesthesia is Preferred by Patients, Surgeons and Anesthesiologists The choice of anesthesia must be tailored to each patient’s specific circumstances and the type of surgery. However, regional anesthesia (RA) offers numerous benefits over general anesthesia (GA) for many surgical patients and has been advocated as a valuable adjunct to a multimodal analgesic regimen. These benefits span across overall experience and patient safety, i.e., improved pain management, higher patient comfort and satisfaction, faster recovery, reduced systemic side effects, and fewer respiratory and cardiovascular complications. In terms of environmental impact, RA has several benefits compared to GA: a) complete avoidance of potent anesthetic greenhouse gases results in a decreased atmospheric pollution, a smaller carbon footprint, and reduced long-term pollution; b) lower energy consumption as the patient is in the operating room for a shorter time, requires less monitoring and less electrically-operated medical equipment, and reduces the need for intense ventilation to clear anesthetic gases, which itself engenders significant energy use; c) RA generates less disposable consumption, leading to less medical waste; d) localized delivery of anesthetic agents reduces the overall quantity of pharmaceuticals entering the environment through patient excretion and drug wastage; e) some equipment used in RA, i.e., nerve stimulators, ultrasound devices, is reusable and has a longer lifespan compared to the single use items often used for GA. One potential environmental downside for RA compared to GA is an increased burden of sterilization and thus electrical consumption. However, this is unlikely to offset the overall environmental benefit of RA. Some of the key reasons why RA is often preferred include: a) improved pain management: RA provides targeted pain relief at the surgical site, leaving the areas above and below surgery unaffected. Perioperative pain relief is often superior by effectively controlling pain with local anesthetics (LAs), decreasing the need for systemic opioids, thereby lowering the risk of opioid-related side effects and dependency; b) enhanced recovery and mobility: Patients often recover more quickly from RA, experiencing less grogginess and confusion compared to those recovering from GA. This facilitates earlier postoperative mobilization, which is crucial for reducing risks of complications (e.g., deep vein thrombosis) and promoting faster overall recovery; c) fewer respiratory complications due to the avoidance of airway manipulation and preservation of respiratory function: GA requires airway management with its inherent complications (sore throat, hoarseness, and in severe cases, aspiration or respiratory distress). RA avoids these risks by eliminating the need for intubation, preserving the patient’s respiratory function, allowing spontaneous breathing. RA is particularly beneficial for those with existing respiratory conditions; d) cardiovascular stability due to reduced hemodynamic fluctuation: RA typically results in more stable blood pressure and heart rate compared to the hemodynamic changes that can occur with the induction and emergence phases of GA. For patients with cardiovascular conditions, the reduced stress on the heart makes RA a safer option; e) reduced systematic side effects due to the minimized drug exposure and lowered risk of cognitive dysfunction: RA involves less exposure to systemic medications, reducing the risk of drug-related side effects, i.e., nausea and vomiting, and respiratory depression. GA can lead to postoperative cognitive delirium and dysfunction, particularly in the elderly population. RA reduces this risk by avoiding systemic sedatives and anesthetics that affect the brain; f) higher overall patient satisfaction and comfort: RA allows the patients to remain awake or lightly sedated during surgery, allowing them to avoid the disorienting effects of GA; g) RA may not be suitable for all types of surgeries or all types of patients. However, for many complex surgeries that typically require GA, RA can complement by providing excellent pain relief; and h) RA is cost-effective: RA allows faster recovery times which can lead to shorter hospital stays, which is cost-effective for healthcare and the patient. The decreased use of systemic anesthetics and opioids may lower the overall cost of medications. Whether LAs provide the best perioperative analgesia depends on various factors, including the type of surgery, patient characteristics, and the desired outcomes. LAs provide targeted pain relief by blocking nerve signals in the area of administration, which can be very effective for many surgical procedures using central neuraxial and peripheral nerve blockade, with long-lasting pain relief if catheters are used, often combined with continuous infusion pumps. LAs can be used in various forms, including topical applications, infiltration blockade, nerve blocks, and spinal, epidural or combined anesthesia techniques, making them versatile for different surgical needs. Limitations of LAs LAs are highly effective for perioperative pain management, providing targeted analgesia with minimal systemic side effects. However, there are limitations using solely LAs: a) insufficient duration of action: the analgesic effect of LAs is limited to the duration of the block, which may not cover the entire perioperative period. Longer-acting agents, continuous infusion techniques and the use of adjuvants can mitigate these limitations but will add to the complexity of blocks; b) incomplete RA blockade requires supplemental pain management strategies; c) LAs are generally safe but still can cause complications such as LA systemic toxicity (LAST) due to massive resorption or intravascular injections, allergic reactions, or damage to muscles (LA-induced myotoxicity and myo-degeneration), nerves, or spinal cord if improperly administered or when high doses are used.¹ However, their limitations in duration and potential for incomplete pain relief make them most effective when used as part of a multimodal pain management strategy. By combining LAs with other analgesics, adjuvants, and techniques, anesthesiologists can achieve optimal pain control tailored to individual patient needs and surgical contexts. Adjuvants to LAs As the indications for RA have gradually expanded, adjuvants are frequently incorporated to enhance patient safety and comfort, improve efficacy, onset, quality and duration of analgesia, reduce the required dose of LAs and minimize potential side effects.^2-6 The benefits of these adjuvants include a faster onset of block, improved hemodynamic stability, reduced postoperative opioid requirements, anti-inflammatory effects, and additional anxiolysis and sedation. These advantages contribute to better pain management, increased patient satisfaction, enhanced clinical outcomes, and improved overall perioperative results. These substances can be added to LAs for various types of regional blocks, including peripheral nerve blocks, fascia blocks, central neuraxial blocks, ophthalmic blocks, and intravenous RA blocks, with the intention of blocking transmission to avoid or relieve pain. Anesthesiologists select these adjuvants based on specific clinical scenarios and surgical interventions, patient-specific factors, type of RA, desired effects, and a balance of their benefits against potential side effects. Table 1 provides an unrestricted list of potential useful adjuvants to LAs for a variety of RA blocks, including central neuraxial and peripheral nerve blocks. Suggested doses are provided, though clinicians need to verify each dosage according to their local circumstances, the surgical intervention, and the individual patient. LAs and adjuvants are used in a large range of medication types, volumes, doses, and concentrations. It is crucial to consider the appropriate drug in the right volume/concentration/dose for each specific RA technique. Clinicians should evaluate all substances in the correct LA solution for the right indication before any injection. Not all RA adjuvants have been approved by the regulators or licensed for neuraxial administration in all countries, and some preparations may contain additives, such as preservatives that are potentially neurotoxic. In specific clinical circumstances (e.g., existing diabetic neuropathy) some practice modifications may be considered to reduce the risk of overdose, side effects and complications.⁷ Clinicians need to be diligent about monitoring for the development of adverse side effects and complications from LAs and RA adjuvants and their immediate appropriate management. These common side effects limit their clinical use and may pose an even greater threat in certain procedures, including organ damage. Opioids act as agonists at G-protein coupled inhibitory receptors, i.e., mu, kappa, delta, and nociceptin. These opioid receptors are widespread throughout the brain (cerebrum, thalamus, hypothalamus, amygdalae, basal ganglia, brainstem, reticular activating system), spinal cord, and non-neural tissues (gastrointestinal tract). Side effects often seen following neuraxial administration of opioids due to their cephalad spread in the CSF or systemic absorption from the epidural space, include pruritus, PONV, urinary retention, and respiratory depression. Minute doses of fentanyl or sufentanil are useful adjuvants to low-dose LAs.^8,9 Adverse effects following the administration of LA mixtures are a concern, including cardiopulmonary, neurological, and renal complications, as well as uncommon reactions such as allergy and rarely malignant hyperthermia. Adjuvants to LAs have their own side effects (see Table 1). Therefore, further research on the development of novel LA adjuvants is necessary. Liposomal bupivacaine is an example of an extended-release formulation that allows for a slow release of bupivacaine HCl from its liposomes. Another promising avenue is the use of exosomes, a class of new bioactive substances released from specific cells, which show unique effects in repairing damaged tissues and organs.¹⁰Exosomes released from cardiomyocytes after exercise have powerful cardioprotective effects, while those released from mesenchymal stem cells can improve neural cell damage. Exosomes originating from the cerebrospinal fluid can promote neuronal repair processes. Exosomes may help to overcome the hazards of LA adjuvants, such as cardiovascular, neurotoxic and gastrointestinal risks. Animal research has demonstrated that exosomes derived from different tissue cell sources exhibit repair functions after ischemia-reperfusion injuries, causing cellular metabolic acidosis and short-term organ damage. Exosomes released by specific cell types have been found to exert similar effects as many LA adjuvants. Therefore, these exosomal anesthetic adjuvants can be considered as novel LA adjuvant drugs with additional organ repair functions due to their reduction of the inflammatory response and pain relief. Exosomes exhibit reno-, neuro- and cardioprotective effects and immunosuppressive effects similar to those of stem cells. Reduction of postoperative pain is associated with exosomes of macrophage origin. There are numerous aspects of RA adjuvants that were not addressed in this manuscript: a) all adjuvants available for use during RA, i.e., neostigmine and non-steroid anti-inflammatory drugs; b) alternative locally administered analgesic agents that have local anesthetic properties, e.g., tramadol; c) the efficacy of perioperative gabapentin in the treatment of postoperative pain; d) which adjuvants are preferred for specific circumstances e.g., which opioid is superior for a specific RA block; e) adjuvants that are better avoided due to their potential for adverse effects, limited efficacy, or safety concerns, e.g., vasopressin; f) the maximum dosage used in the different blocks; g) the potential of novel local anesthetics with protracted analgesic effect and minimal toxicity, which are neurotoxins isolated from animals, plants, and marine organisms, e.g., α-cobratoxin (α-CTx). The latter is isolated from the Thailand Cobra, which has strong affinity for the α7 subunit of the nAChR (α7nAChR) neuronal receptor of the peripheral nervous system. This neurotoxin leads to the depolarization of postsynaptic membranes and the prevention of neurotransmitter release, hence causing pain relief. Conclusion Medications used in anesthesia represent one of the greatest discoveries in medical history, revolutionizing pain management and patient care. The indications for LAs and RA blocks have gradually expanded, often in combination with general anesthesia. When used appropriately, adjuvants can significantly enhance the efficacy of RA, though potential adverse reactions must be carefully managed. These additives may improve the RA block’s quality, onset time, duration, or performance (such as motor blockade). Drugs utilized during RA procedures play a crucial role in perioperative pain prevention and relief. The growing interest in RA techniques has spurred efforts to extend the duration of LAs. The development of LA adjuvants has been instrumental in mitigating the side effects and complications associated with large doses of LAs, including systemic and neurotoxicity risks. These adjuvants have effectively reduced LA toxicity, improved patient satisfaction, and decreased pain experiences. Adjuvants have also enhanced the speed of recovery, facilitated operator convenience, reduced postoperative delirium and increased the efficiency and safety of RA procedures. Continued research and innovation in new LA adjuvants will further advance the field of anesthesia, offering safer and more effective pain management solutions. References 1. Hussain N, McCartney CJL, Neal JM, Chippor J, Banfield L, Abdallah FW. Local anaesthetic-induced myotoxicity in regional anaesthesia: a systematic review and empirical analysis. Br J Anaesth. 2018 Oct;121(4):822-841. doi: 10.1016/j.bja.2018.05.076. PMID: 30236244. 2. Bao N, Shi K, Wu Y, He Y, Chen Z, Gao Y, Xia Y, Papadimos TJ, Wang Q, Zhou R. Dexmedetomidine prolongs the duration of local anesthetics when used as an adjuvant through both perineural and systemic mechanisms: a prospective randomized double-blinded trial. BMC Anesthesiol. 2022 Jun 7;22(1):176. doi: 10.1186/s12871-022-01716-3. PMID: 35672660; PMCID: PMC9172023. 3. Martin MTF, Alvarez Lopez S, Aldecoa Alvarez-Santullano C. Role of adjuvants in regional anesthesia: A systematic review. Rev Esp Anestesiol Reanim (Engl Ed). 2023 Feb;70(2):97-107. doi: 10.1016/j.redare.2021.06.006. PMID: 36813032. 4. Coppens SJR, Zawodny Z, Dewinter G, Neyrinck A, Balocco AL, Rex S. In search of the Holy Grail: Poisons and extended release local anesthetics. Best Pract Res Clin Anaesthesiol. 2019 Mar;33(1):3-21. doi: 10.1016/j.bpa.2019.03.002. PMID: 31272651. 5. Prabhakar A, Lambert T, Kaye RJ, Gaignard SM, Ragusa J, Wheat S, Moll V, Cornett EM, Urman RD, Kaye AD. Adjuvants in clinical regional anesthesia practice: A comprehensive review. Best Pract Res Clin Anaesthesiol. 2019 Dec;33(4):415-423. doi: 10.1016/j.bpa.2019.06.001. Erratum in: Best Pract Res Clin Anaesthesiol. 2021 Dec;35(4):E3-E4. doi: 10.1016/j.bpa.2020.09.002. PMID: 31791560. 6. Tresierra S, Gilron I, Mizubuti GB. Adjuvant Medications for Peripheral Nerve Blocks. ATOTW 489, 2023. https://resources.wfsahq.org/anaesthesia-tutorial-of-the-week/ 7. Lirk P, Brummett CM. Regional anaesthesia, diabetic neuropathy, and dexmedetomidine: a neurotoxic combination? Br J Anaesth. 2019 Jan;122(1):16-18. doi: 10.1016/j.bja.2018.09.017. PMID: 30579401. 8. Dong J, Jin Z, Chen H, Bao N, Xia F. Sufentanil Improves the Analgesia Effect of Continuous Femoral Nerve Block After Total Knee Arthroplasty. J Pain Res. 2023 Dec 7;16:4209-4216. doi: 10.2147/JPR.S409668. PMID: 38090025; PMCID: PMC10712246. 9. Kim SY, Cho JE, Hong JY, Koo BN, Kim JM, Kil HK. Comparison of intrathecal fentanyl and sufentanil in low-dose dilute bupivacaine spinal anaesthesia for transurethral prostatectomy. Br J Anaesth. 2009 Nov;103(5):750-4. doi: 10.1093/bja/aep263. PMID: 19797249. 10. Zhang Y, Feng S, Cheng X, Lou K, Liu X, Zhuo M, Chen L, Ye J. The potential value of exosomes as adjuvants for novel biologic local anesthetics. Front Pharmacol. 2023 Jan 26;14:1112743. doi: 10.3389/fphar.2023.1112743. PMID: 36778004; PMCID: PMC9909291. Andre VAN ZUNDERT (Brisbane Australia, Australia) 08:59 - 09:17 PNBs: From paraesthesia techniques to advanced US-guided blocks. Balavenkat SUBRAMANIAN (Faculty) (Keynote Speaker, Coimbatore, India) 09:17 - 09:35 RA in obstetrics: More than a century of advances. Nuala LUCAS (Speaker) (Keynote Speaker, London, United Kingdom) 09:35 - 09:50 Q&A.	08:00-08:35 Added to your list of favorites Deleted from your list of favorites E30 TIPS & TRICKS LAST TIPS & TRICKS LAST Chairperson: Manoj KARMAKAR (Professor, Consultant, Director of Pediatric Anesthesia) (Chairperson, Shatin, Hong Kong) 08:00 - 08:05 Introduction. Manoj KARMAKAR (Professor, Consultant, Director of Pediatric Anesthesia) (Keynote Speaker, Shatin, Hong Kong) 08:05 - 08:25 Updates in our understanding of local anaesthetic systemic. Alan MACFARLANE (Consultant Anaesthetist) (Keynote Speaker, Glasgow, United Kingdom) 08:25 - 08:30 Q&A.	08:00-08:50 Added to your list of favorites Deleted from your list of favorites F30 ASK THE EXPERT Needle tracking technology ASK THE EXPERT Needle tracking technology Chairperson: Ivan KOSTADINOV (ESRA Council Representative) (Chairperson, Ljubljana, Slovenia) 08:00 - 08:05 Introduction. Ivan KOSTADINOV (ESRA Council Representative) (Keynote Speaker, Ljubljana, Slovenia) 08:05 - 08:35 Practice of needle tracking. Graeme MCLEOD (Professor) (Keynote Speaker, Dundee, United Kingdom) 08:35 - 08:50 Q&A.	08:00-09:50 Added to your list of favorites Deleted from your list of favorites G30 NETWORKING SESSION Complications in obstetric anaesthesia NETWORKING SESSION Complications in obstetric anaesthesia Chairperson: Eva ROOFTHOOFT (Anesthesiologist) (Chairperson, Haacht, Belgium) 08:00 - 08:05 Introduction. Eva ROOFTHOOFT (Anesthesiologist) (Keynote Speaker, Haacht, Belgium) 08:05 - 08:27 High neuraxial block. Kassiani THEODORAKI (Anesthesiologist) (Keynote Speaker, Athens, Greece) 08:27 - 08:49 The inadvertent intrathecal catheter. Sarah DEVROE (Head of clinic) (Keynote Speaker, Leuven, Belgium) 08:49 - 09:11 #43394 - G30 Amniotic fluid embolism. Amniotic fluid embolism. Tatjana Stopar Pintaric (1), Andrej Hostnik (1) 1. Clinical Department of Anaesthesiology and Intensive Therapy, University Medical Centre Ljubljana, Slovenia, Ljubljana, Slovenia 1. Introduction Amniotic fluid embolism (AFE) is a rare but often lethal condition typically observed during labor or within 30 minutes postpartum, with an estimated incidence ranging from 1 in 8000 to 1 in 80000 deliveries. Specific risk factors for AFE might include advanced maternal age, placenta praevia, IVF pregnancies, fetal demise, preterm delivery and cesarean sections. Its pathophysiology, while not fully understood, is believed to involve vasospastic, inflammatory and immune reactions triggered by the presence of amniotic debris or other antigens in the maternal circulation. Young et al. recently proposed a new theory of pathophysiology with initial intravascular coagulation in the pulmonary circulation due to procoagulant surface antigen CD142 present in amniotic fluid, followed by derangements similar to any pulmonary embolism. 2. Clinical Presentation and Diagnosis AFE should be suspected intrapartum or in the immediate postpartum period in women experiencing sudden cardiovascular collapse, sudden respiratory distress and subsequent coagulopathy, particularly when no other explanations (such as postpartum haemmorhage, sepsis, pulmonary thromboembolism) are apparent. Clinical manifestations may include hypotension, arrhythmia, heart failure, shock, pulmonary edema, hypoxaemia, hemorrhagic coagulopathy, disseminated intravascular coagulopathy (DIC) and neurologic symptoms such as seizures or altered mental status. Identification of amniotic fluid debris in blood or lung tissue samples is not diagnostically useful. 3. Management Early recognition and prompt multidisciplinary care involving anaesthesiologists, obstetricians, neonatologists, critical care specialists and nurses is crucial for stabilizing patients and preventing further deterioration. Resuscitative efforts should be initiated concurrently with diagnostic evaluation to address cardiorespiratory compromise. Standard cardiac and respiratory life support measures, along with fluid resuscitation, vasopressor therapy, and transfusion of blood products, are essential components of initial management. Point-of-care testing, such as rotational thromboelastometry can be useful in diagnosing coagulopathy and guiding treatment, which might neccessitate use of fibrinogen and/or prothrombin complex. ECMO and cardipulmonary bypass should be considered when appropriate. The decision for immediate delivery should be made based on individual circumstances, with consideration given to fetal viability and maternal condition. For patients who stabilize following initial resuscitation or who present hemodynamically stable, supportive care focusing on airway management, hemodynamic stability, oxygenation, and prevention of bleeding is paramount. Further investigation should be performed to rule out alternative aetiologies. 4. Prognosis Despite improvements in management, AFE continues to carry significant maternal mortality and morbidity, with approximately 20% mortality rate and potential for neurologic sequelae in survivors due to cerebral hypoxia. Neonatal mortality rate is 20-25% and only 50% of the survivors may be neurologically intact. 5. Literature 1. Young BK, Florine Magdelijns P, Chervenak JL, Chan M. Amniotic fluid embolism: A reappraisal. Journal of Perinatal Medicine. 2023;52(2):126-135. doi:10.1515/jpm-2023-0365 2. Gist RS, Stafford IP, Leibowitz AB, Beilin Y. Amniotic fluid embolism. Anesthesia & Analgesia. 2009;108(5):1599-1602. doi:10.1213/ane.0b013e31819e43a4 3. Benson MD. Amniotic fluid embolism mortality rate. Journal of Obstetrics and Gynaecology Research. 2017;43(11):1714-1718. doi:10.1111/jog.13445 4. Loughran JA, Kitchen TL, Sindhakar S, Ashraf M, Awad M, Kealaher EJ. Rotational thromboelastometry (Rotem®)-guided diagnosis and management of amniotic fluid embolism. International Journal of Obstetric Anesthesia. 2019;38:127-130. doi:10.1016/j.ijoa.2018.09.001 5. Clark SL. Amniotic fluid embolism. Obstetrics & Gynecology. 2014;123(2):337-348. doi:10.1097/aog.0000000000000107 6. Clark SL, Romero R, Dildy GA, et al. Proposed diagnostic criteria for the case definition of amniotic fluid embolism in research studies. American Journal of Obstetrics and Gynecology. 2016;215(4):408-412. doi:10.1016/j.ajog.2016.06.037 Tatjana STOPAR PINTARIC (Ljubljana, Slovenia) 09:11 - 09:33 Cardiac arrest in obstetrics. Alexandra SCHYNS-VAN DEN BERG (Consultant anesthesiology) (Keynote Speaker, Dordrecht, The Netherlands) 09:33 - 09:50 Q&A.	08:00-10:00 Added to your list of favorites Deleted from your list of favorites H30 SIMULATION TRAININGS SIMULATION TRAININGS Demonstrators: Clara LOBO (Medical director) (Demonstrator, Abu Dhabi, United Arab Emirates), Roman ZUERCHER (Senior Consultant) (Demonstrator, Basel, Switzerland)
08:35
08:40					08:40-09:50 Added to your list of favorites Deleted from your list of favorites E31 PANEL DISCUSSION PEDIATRIC RA training - Workforce PANEL DISCUSSION PEDIATRIC RA training - Workforce Chairperson: Nat HASLAM (Consultant Anaesthetist) (Chairperson, Sunderland, United Kingdom) 08:40 - 08:45 Introduction. Nat HASLAM (Consultant Anaesthetist) (Keynote Speaker, Sunderland, United Kingdom) 08:45 - 09:05 Training standards for Pediatric RA in Sweden. Per-Arne LONNQVIST (Professor) (Keynote Speaker, Stockholm, Sweden) 09:05 - 09:25 Assuring Training in Pediatric RA in Greece. Eleana GARINI (Consultant) (Keynote Speaker, Athens, Greece) 09:25 - 09:45 Matching RA to Specific Pediatric Procedures. Peter KENDERESSY (Senior Consultant and Lecturer in Paediatric Anaesthesia) (Keynote Speaker, Banska Bystrica, Slovakia) 09:45 - 09:50 Q&A.
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09:00		09:00-09:50 Added to your list of favorites Deleted from your list of favorites D31 PRO CON DEBATE Liposomal Bupivacaine PRO CON DEBATE Liposomal Bupivacaine Chairperson: Margaretha (Barbara) BREEBAART (anaesthestist) (Chairperson, Antwerp, Belgium) 09:00 - 09:05 Introduction. Margaretha (Barbara) BREEBAART (anaesthestist) (Keynote Speaker, Antwerp, Belgium) 09:05 - 09:20 For the PROs. Admir HADZIC (Director) (Keynote Speaker, New York, USA) 09:20 - 09:35 For the CONs. Eric ALBRECHT (Program director of regional anaesthesia) (Keynote Speaker, Lausanne, Switzerland) 09:35 - 09:50 Q&A.	09:00-09:50 Added to your list of favorites Deleted from your list of favorites C31 ASK THE EXPERT Conflicts in the OR and avoiding nerve injury ASK THE EXPERT Conflicts in the OR and avoiding nerve injury Chairperson: Maria Paz SEBASTIAN (Anaestheics and Acute Pain) (Chairperson, London, United Kingdom) 09:00 - 09:05 Introduction. Maria Paz SEBASTIAN (Anaestheics and Acute Pain) (Keynote Speaker, London, United Kingdom) 09:05 - 09:25 How to deal with conflict in operating theatre. Geert-Jan VAN GEFFEN (Anesthesiologist) (Keynote Speaker, NIjmegen, The Netherlands) 09:25 - 09:30 Q&A.			09:00-09:50 Added to your list of favorites Deleted from your list of favorites F31 EXPERT OPINION DISCUSSION Chronic pain in specific cases EXPERT OPINION DISCUSSION Chronic pain in specific cases Chairperson: Dmytro DMYTRIIEV (medical director) (Chairperson, Vinnitsa, Ukraine) 09:00 - 09:05 Introduction. Dmytro DMYTRIIEV (medical director) (Keynote Speaker, Vinnitsa, Ukraine) 09:05 - 09:20 Chronic pain after eye surgery. Friedrich LERSCH (senior consultant) (Keynote Speaker, Berne, Switzerland) 09:20 - 09:35 CRPS in a toddler. Amany EZZAT AYAD (Professor) (Keynote Speaker, Cairo, Egypt) 09:35 - 09:50 Q&A.
09:50

10:00 - 10:30	COFFEE BREAK

10:30	10:30-11:20 Added to your list of favorites Deleted from your list of favorites A31 WORLD SISTER SOCIETIES MEETING WORLD SISTER SOCIETIES MEETING Keynote Speakers: Thang CONG QUYET (Senior lecturer) (Keynote Speaker, Hanoi, Vietnam), Juan Carlos DE LA CUADRA FONTAINE (Associate Clinical Professor/ Anesthesiologist/ LASRA President) (Keynote Speaker, Santiago, Chile), Ezzat SAMY AZIZ (Professor of Anesthesia) (Keynote Speaker, Cairo, Egypt) Chairperson: Eleni MOKA (faculty) (Chairperson, Heraklion, Crete, Greece)	10:30-11:20 Added to your list of favorites Deleted from your list of favorites B41 ASK THE EXPERT SCS for sicle cell disease and other rare indications ASK THE EXPERT SCS for sicle cell disease and other rare indications Chairperson: Steven COHEN (Professor) (Chairperson, Chicago, USA) 10:30 - 10:35 Introduction. Steven COHEN (Professor) (Keynote Speaker, Chicago, USA) 10:35 - 11:05 SCS for sickle cell disease. Magdalena ANITESCU (Professor of Anesthesia and Pain Medicine) (Keynote Speaker, Chicago, USA) 11:05 - 11:20 Q&A.	10:30-11:20 Added to your list of favorites Deleted from your list of favorites C33 EXPERT OPINION DISCUSSION Role of predictive testing in pain interventions EXPERT OPINION DISCUSSION Role of predictive testing in pain interventions Chairperson: Jan BLAHA (Head of the Department) (Chairperson, Praha 2, Czech Republic) 10:30 - 10:35 Introduction. Jan BLAHA (Head of the Department) (Keynote Speaker, Praha 2, Czech Republic) 10:35 - 10:48 Diagnostic Medial Branch Block. David PROVENZANO (Faculty) (Keynote Speaker, Bridgeville, USA) 10:48 - 11:01 Trials of SCS. Maria Luz PADILLA DEL REY (Anesthesiologist and Pain Physician) (Keynote Speaker, MURCIA, Spain) 11:01 - 11:14 Intrathecal Drug Delivery. Denis DUPOIRON (Head of Department) (Keynote Speaker, Angers, France) 11:14 - 11:20 Q&A.	10:30-11:20 Added to your list of favorites Deleted from your list of favorites D33 ASK THE EXPERT Human factors ASK THE EXPERT Human factors Chairperson: Geert-Jan VAN GEFFEN (Anesthesiologist) (Chairperson, NIjmegen, The Netherlands) 10:30 - 10:35 Introduction. Geert-Jan VAN GEFFEN (Anesthesiologist) (Keynote Speaker, NIjmegen, The Netherlands) 10:35 - 11:05 Human factors in PNB (stop before you block, wrong drugs, wrong route). Morne WOLMARANS (Consultant Anaesthesiologist) (Keynote Speaker, Norwich, United Kingdom) 11:05 - 11:20 Q&A.	10:30-11:20 Added to your list of favorites Deleted from your list of favorites E33 ASK THE EXPERT Best options for minimal invasive thoracic surgery ASK THE EXPERT Best options for minimal invasive thoracic surgery Chairperson: Manoj KARMAKAR (Professor, Consultant, Director of Pediatric Anesthesia) (Chairperson, Shatin, Hong Kong) 10:30 - 10:35 Introduction. Manoj KARMAKAR (Professor, Consultant, Director of Pediatric Anesthesia) (Keynote Speaker, Shatin, Hong Kong) 10:35 - 11:05 Best options for minimal invasive thoracic surgery. Michael HERRICK (Faculty Member) (Keynote Speaker, Hanover, NH, USA) 11:05 - 11:20 Q&A.	10:30-11:20 Added to your list of favorites Deleted from your list of favorites F33 EXPERT OPINION DISCUSSION PNB for Cardiac Surgery EXPERT OPINION DISCUSSION PNB for Cardiac Surgery Chairperson: Marcus THUDIUM (Consultant anesthesiologist) (Chairperson, Bonn, Germany) 10:30 - 10:35 Introduction. Marcus THUDIUM (Consultant anesthesiologist) (Keynote Speaker, Bonn, Germany) 10:35 - 10:50 For cardiac surgery. Sina GRAPE (Head of Department) (Keynote Speaker, Sion, Switzerland) 10:50 - 11:05 #43421 - F33 For thoracic surgery. For thoracic surgery. Introduction Pain after thoracic surgery is of moderate-to-severe intensity and can cause increased postoperative distress and impair functional recovery. Peripheral nerve blocks (PNBs) have gained considerable attention in perioperative pain management as a method to reduce systemic opioid consumption and improve pain control. This narrative review aims to describe the different peripheral regional blocks in the context of thoracic surgery. PubMed and Embase were searched for all RCTs and reviews involving adult participants undergoing thoracic surgery with PNB as analgesia. A total of 157 articles were retrieved according to the search strategy in Pubmed and 234 in Embase. After screening of the title and abstract,92 articles (68 RCT,24 reviews) were selected finally. Regional anaesthesia is a useful choice in thoracic surgery and peripheral nerve block can improve patient outcomes. Due to the lack of RCTs, it is still not possible to determine the most appropriate block in individual surgical situations, although we have the PROSPECT recommendations. Discussion Intercostal nerve blocks are a relatively easy procedure to perform and can provide potent analgesia in a fast and reliable manner48. One advantage of intercostal blocks is that they can be performed under direct visualisation in the pleural cavity by the surgeon in the field or percutaneously by the anaesthetist. Due to the circumscribed nature of the intercostal nerves innervating the chest wall, multiple levels of injection are required to ensure adequate analgesia. A systematic review and meta-analysis revealed that the administration of a single-injection ICNB among adults undergoing thoracic surgery was associated with a modest reduction in pain scores during the initial 24-hour postoperative period. Intercostal nerve block analgesia was superior to systemic opioid-based analgesia, noninferior to TEA, and marginally inferior to PVB. Because ICNB analgesia was also associated with better pulmonary function and a reduction in the risk of pulmonary complications, these findings were clinically relevant. The data suggested that the benefit of ICNB analgesia decreases progressively and disappears at 24 to 48 hours after surgery. Reliance on ICNB after this period may result in an abrupt lack of analgesia or rebound pain, represented by higher pain scores at 24 hours after surgery for dynamic pain and 48 hours after surgery for static pain. These factors have motivated further research with the objective of developing a more efficient technique. The anterior serratus plane block was the first describen. It is a type of regional anaesthetic that is simple to perform and highly effective in providing analgesia. It has no adverse effects, such as respiratory or circulatory depression. In comparison to traditional local infiltration anaesthesia, SAPB necessitates a reduced quantity of local anaesthetics, is devoid of the potential for local anaesthetic poisoning, and extends the duration of analgesia through catheterisation. In comparison to a thoracic epidural block, SAPB does not result in spinal cord injury, epidural haematoma, respiratory depression, or fluctuations50. In comparison to an intercostal nerve block, a SAPB is a relatively simple procedure, necessitating fewer injections and presenting a lower incidence of complications such as pneumothorax. In comparison to a thoracic paravertebral nerve block, a SAPB is a less challenging procedure with no risk of orthostatic hypotension or urinary retention51. In comparison with total intravenous analgesia, SAPB has the advantage of not causing adverse reactions such as nausea and vomiting, excessive sedation, or respiratory depression caused by opioids. Furthermore, opioids are a more expensive option. Consequently, future research on SAPB may be conducted in an ambulatory setting, such as during breast nodule resection, breast prosthesis implantation, invasive procedures, such as breast tissue pathological biopsy and treatment of intercostal neuralgia. A relatively recent regional anaesthetic technique that offers significant advantages and has been gaining popularity in the context of thoracic surgery is the erector spinae block. As with numerous other regional techniques, this block can be performed as a single-shot procedure with an appropriate volume of local anaesthetic, or alternatively, by placing a catheter for continuous infusion. Furthermore, this technique is demonstrating encouraging results in the treatment of trauma patients with rib fractures. The existing literature on the use of ESPB in thoracic surgery is limited to case reports, editorials, and a few clinical trials. The ESPB has been demonstrated to be an efficacious peripheral technique for postoperative pain management in this cohort of patients. These findings are in accordance with the results of the present study, which demonstrated that ESPB provided adequate analgesia following minithoracotomy. The average static and dynamic NRS scores remained below 3 throughout the follow-up period, and the number of requests for additional analgesic drugs was low. In comparison to TEA and TPVB, ESPB appears to be a safer option, with a minimal risk of pleural puncture and epidural spread. Furthermore, the risk of coagulopathy should be minimal, given that the procedure is performed at a distance from the spinal cord or the epidural venous plexus, thereby avoiding the risk of epidural haematoma. In the initial 48 hours following surgery, patients undergoing continuous ESPB exhibited reduced opioid requirements and reported diminished pain compared to those undergoing ICNB55. There were no differences in respiratory muscle strength, postoperative complications, or time to hospital discharge. However, TPVB appeared to be the preferable method compared with ESPB and ICNB, with a more successful analgesia and less morphine consumption. In comparison with other regional anaesthetic techniques, a variety of outcomes have been documented. Although statistical analysis indicated that ESPB was less effective than thoracic paravertebral block and intercostal nerve block and more effective than serratus anterior plane block in postoperative analgesia, the clinical differences remain unclear. The incidence of haematoma was found to be lower in the ESPB group than in the other groups (odds ratio 0.19, 95% CI 0.05-0.73)20. Erector spinae plane (ESP) block and serratus anterior plane (SAP) block promise effective thoracic analgesia compared with systemically administered opioids. Compared with SAP, ESP provides superior quality of recovery at 24 h, lower morbidity, and better analgesia after minimally invasive thoracic surgery. However, the SAP block can play an important role in the management of pain after thoracic surgery by reducing both pain scores and 24-h postoperative opioids consumption. In addition, there is fewer incidence of PONV in the SAP block group. Regarding the pain control in emergency department Dr Armin recommends ESPB in blunt or penetrating thoracic trauma27. Analgesia in breast surgery has different connotations, as it involves both intercostal and pectoral nerves. The results of some meta-analysis demonstrate that the Pecs II block is a valuable adjunct for postoperative analgesia in patients undergoing breast cancer surgery. Compared with patients who received only systemic analgesia, patients who received a Pecs II block not only had significantly less pain at all measured postoperative time-points up to 24 h but also a time to first analgesia request that was prolonged by 5 h on average. Although some might question the clinical significance of a 1–2-point reduction in pain scores on a 0–10 scale, it is worth noting that this represents a reduction of 39–55% from the average pain scores of 2.4–3.5 reported in the control groups. Furthermore, this was achieved with a simultaneous 59% reduction in 24-h opioid consumption. Although the role of peri-operative opioids in tumour metastasis remains uncertain, the importance of fully attenuating the peri-operative stress response possible is unquestioned56 One reason for the popularity of the Pecs II block is that it is a simpler and safer alternative to a thoracic paravertebral block, which many find a challenging technique to perform. Conclusions With the development of ERAS protocols, the classical approach to post-operative pain control has changed; narcotics are no longer enough. In this area, peripheral nerve blocks have shown good results. Nowadays, peripheral nerve blocks and their different approaches have shown to be an alternative to central blocks (paravertebral and epidural). ICNB, SAPB, ESPB and PECS are associated with a reduction in pain during the first 24 hours after thoracic surgery and reduce the amount of opioids during the postoperative period. Furthermore, the current literature supports that some of them offer non-inferior or comparable analgesic efficacy to a TPVB, suggesting that they may also be beneficial in cases where TEA and PVB are not indicated, and even the Pecs II block warrants consideration as a first-line option for regional analgesia in breast surgery. María Teresa FERNÁNDEZ (Valladolid, Spain) 11:05 - 11:20 Q&A.	10:30-11:20 Added to your list of favorites Deleted from your list of favorites G33 ASK THE EXPERT Psychedelic substances ASK THE EXPERT Psychedelic substances Chairperson: Brian KINIRONS (Consultant Anaesthetist) (Chairperson, Galway, Ireland, Ireland) 10:30 - 10:35 Introduction. Brian KINIRONS (Consultant Anaesthetist) (Keynote Speaker, Galway, Ireland, Ireland) 10:35 - 11:05 #43451 - G33 Psychedelic Drugs for the Treatment of Chronic Pain: Is Ketamine Included? Psychedelic Drugs for the Treatment of Chronic Pain: Is Ketamine Included? Psychedelic Drugs for the Treatment of Chronic Pain: Is Ketamine Included? By; Amany E. Ayad, MD, FIPP Professor of Anesthesia, ICU and Pain, Cairo University One of the main causes of misery and incapacity is chronic pain, which is frequently linked to psychological issues. Psychedelic substances are drugs that can exert a psychological effect on patients. Psychedelic drugs like lysergic acid diethylamide (LSD) and psilocybin, exert their action mainly via activation of the serotonin-2A (5-HT2A). (1) In a trial to understand the actual mode of action of psychedelics in chronic pain setting; Joel Castellanos et al (2) elaborated that, given the complexity of chronic pain, which is still not fully understood, a multitude of somatic and visceral afferent pain signals may strengthen specific neural circuits through peripheral and central sensitization, leading to the perception of both physical and emotional chronic pain experience. Consequently, psychedelics exert their influence on human nociceptive system modulation and serotonin pathway activation. Additionally, the alterations in functional connections (FC ) seen with psychedelic drugs use suggested a way that these agents could help reverse the changes in neural connections seen in chronic pain states. (2) Psychedelics may have potential to alleviate pain secondary to a multitude of chronic painful conditions as concluded in an article that was published by Christopher L Robinson et al in March 2024. (3) Mauro Cavarra et al. reported in a different survey conducted that same year, that individuals with fibromyalgia, sciatica, migraine, arthritis, and tension-type headaches can experience analgesic effects from psychedelics. (4) Psychedelic substances have a generally favorable safety profile, particularly when contrasted with opioid analgesics. However, clinical evidence to date for their use in chronic pain management is limited and of low quality. (2) Several studies and reports over the past 50 years have shown potential analgesic benefit in cancer pain, phantom limb pain and cluster headache as well (2). Given the current state of the opioid epidemics and limited efficacy of non-opioid analgesics, research on psychedelics as analgesics is gaining popularity in order to improve the lives of chronic pain patients. Based on the previously provided information, can we add ketamine to the list of psychedelic drugs utilized for chronic pain management!!!! The answer is YES! Yes, ketamine is indeed considered a psychedelic drug. It was initially developed as a dissociative anesthetic drug, but has gained attention for its unique effects on perception, consciousness, and mood. When used in controlled settings, ketamine can induce hallucinations, dissociation, and altered states of consciousness. In clinical contexts, it’s also being explored for its potential in treating chronic pain, depression and and post traumatic stress disorder (PTSD). (5) In the context of resistant depression cases in the west, ketamine clinics all of a sudden began to exhibit a "Trending" attitude. Since it first entered the pharmaceutical industry more than 50 years ago, ketamine has been used by pain specialists for more than 20 years to treat patients with chronic pain who are refractory, all without the benefit of strict guidelines. We are grateful to the American Society of Regional Anesthesia and Pain Medicine (ASRA), which brought up this matter and began drawing attention to the need for recommendations, as originally mentioned by Brian J. Marascalchi and Steve Cohen in their November 2018 newsletter. (6) Shortly after, in collaboration with the American Society of Anesthesiologists, the American Academy of Pain Medicine, and the ASRA, Cohen and his colleagues released the first organized guidelines regarding the use of intravenous ketamine for chronic pain. (7) Among a limited number of adequately structured systematic reviews we would mention a meta-analysis by Orhurhu V and his colleagues (8), another review by JE Israel et al.(9), and a good review by Riccardi A (10). However we find all these are still not adequate. NMDA receptor/ion channel complexes are sited peripherally and centrally within the nervous system. Ketamine is a phenylcyclidine derivative that acts primarily as a non-competitive antagonist of the NMDA receptor, although it also binds to many other sites in the peripheral and central nervous systems (11). Primarily, ketamine exhibits its analgesic, antidepressant, and cognitive effects via the NMDA receptors situated in the central nervous system. Ketamine has also been found to act on the; opioid receptors, γ-aminobutyric acid A (GABA-A) receptors, dopamine D2 receptors, nicotinic receptors, muscarinic cholinergic receptors, and a ligand of the serotonin 5-HT2A receptor. (11) We highlight that ketamine acquires almost the same mode of action (serotonin receptors activation) like other psychedelic drugs. In the chronic pain setting, ketamine was found to exert a good therapeutic effect in cases of Complex regional pain syndrome, fibromyalgia, chronic neuropathic pain, cancer pain and phantom limb pain.(9) Given that ketamine is widely accessible and reasonably priced, physicians in countries with limited resources find it especially appealing for treating refractory patients because they are unable to pay for more expensive and advanced treatments like neuromodulation. More structured guidelines are still required. But as Carl Sagan eloquently said, “Absence of Evidence is not Evidence of Absence." References; 1-Kooijman NI, Willegers T, Reuser A, Mulleners WM, Kramers C, Vissers KCP, van der Wal SEI. Are psychedelics the answer to chronic pain: A review of current literature. Pain Pract. 2023 Apr;23(4):447-458. doi: 10.1111/papr.13203. Epub 2023 Jan 11. PMID: 36597700. 2- Castellanos JP, Woolley C, Bruno KA, et al Chronic pain and psychedelics: a review and proposed mechanism of action Regional Anesthesia & Pain Medicine 2020;45:486-494. doi: 10.1136/rapm-2020-101273. 3-Robinson CL, Fonseca ACG, Diejomaoh EM, D'Souza RS, Schatman ME, Orhurhu V, Emerick T. Scoping Review: The Role of Psychedelics in the Management of Chronic Pain. J Pain Res. 2024 Mar 11;17:965-973. doi: 10.2147/JPR.S439348. PMID: 38496341; PMCID: PMC10941794. 4-Cavarra M, Mason NL, Kuypers KPC, Bonnelle V, Smith WJ, Feilding A, Kryskow P, Ramaekers JG. Potential analgesic effects of psychedelics on select chronic pain conditions: A survey study. Eur J Pain. 2024 Jan;28(1):153-165. doi: 10.1002/ejp.2171. Epub 2023 Aug 20. PMID: 37599279. 5-Jonkman K, Dahan A, van de Donk T, Aarts L, Niesters M, van Velzen M. Ketamine for pain. F1000Res. 2017 Sep 20;6:F1000 Faculty Rev-1711. doi: 10.12688/f1000research.11372.1. PMID: 28979762; PMCID: PMC5609085. 6-Cohen SP, Bhatia A, Buvanendran A, et al Consensus Guidelines on the Use of Intravenous Ketamine Infusions for Chronic Pain From the American Society of Regional Anesthesia and Pain Medicine, the American Academy of Pain Medicine, and the American Society of Anesthesiologists Regional Anesthesia & Pain Medicine 2018;43:521-546. doi: 10.1097/AAP.0000000000000808. 7-Intravenous Ketamine Guidelines for Pain Management; ASRA newsletter,November2018 8-Orhurhu V, Orhurhu MS, Bhatia A, Cohen SP. Ketamine Infusions for Chronic Pain: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Anesth Analg. 2019 Jul;129(1):241-254. doi: 10.1213/ANE.0000000000004185. PMID: 31082965. 9-Israel JE, St Pierre S, Ellis E, Hanukaai JS, Noor N, Varrassi G, Wells M, Kaye AD. Ketamine for the Treatment of Chronic Pain: A Comprehensive Review. Health Psychol Res. 2021 Jul 10;9(1):25535. doi: 10.52965/001c.25535. PMID: 34746491; PMCID: PMC8567802. 10-Riccardi A, Guarino M, Serra S, Spampinato MD, Vanni S, Shiffer D, Voza A, Fabbri A, De Iaco F; Study and Research Center of the Italian Society of Emergency Medicine. Narrative Review: Low-Dose Ketamine for Pain Management. J Clin Med. 2023 May 2;12(9):3256. doi: 10.3390/jcm12093256. PMID: 37176696; PMCID: PMC10179418. 11-Niesters M, Aarts L, Sarton E, Dahan A. Influence of ketamine and morphine on descending pain modulation in chronic pain patients: a randomized placebo-controlled cross-over proof-of-concept study. Br J Anaesth. 2013 Jun;110(6):1010-6. doi: 10.1093/bja/aes578. Epub 2013 Feb 5. PMID: 23384733. Amany E. AYAD (Cairo, Egypt) 11:05 - 11:20 Q&A.	10:30-11:20 Added to your list of favorites Deleted from your list of favorites H33 PRO CON DEBATE Peripheral nerve catheters are still a valid option PRO CON DEBATE Peripheral nerve catheters are still a valid option Chairperson: Michal VENGLARCIK (Head of anesthesia) (Chairperson, Banska Bystrica, Slovakia) 10:30 - 10:35 Introduction. Michal VENGLARCIK (Head of anesthesia) (Keynote Speaker, Banska Bystrica, Slovakia) 10:35 - 10:50 For the PROs. Roman ZUERCHER (Senior Consultant) (Keynote Speaker, Basel, Switzerland) 10:50 - 11:05 For the CONs. Eric ALBRECHT (Program director of regional anaesthesia) (Keynote Speaker, Lausanne, Switzerland) 11:05 - 11:20 Q&A.

11:30	11:30-12:35 Added to your list of favorites Deleted from your list of favorites A31b AWARDS CEREMONY AWARDS CEREMONY 11:30 - 11:50 Carl Koller Award Lecture. Admir HADZIC (Director) (Keynote Speaker, New York, USA) 11:50 - 12:00 Summary of the Albert Van Steenbergue Award Article. Kariem EL BOGHDADLY (Consultant) (Keynote Speaker, London, United Kingdom) 12:00 - 12:10 Summary of the Chronic pain Award Article. K Harbinder SANDHU (Keynote Speaker, United Kingdom) 12:10 - 12:20 Announcement of the Best free Paper and E-Poster Winners 2024. Luis Fernando VALDES VILCHES (Clinical head) (Keynote Speaker, Marbella, Spain) 12:20 - 12:25 Educational Grants. Axel SAUTER (consultant anaesthesiologist) (Keynote Speaker, Oslo, Norway) 12:25 - 12:30 Research Grants. Axel SAUTER (consultant anaesthesiologist) (Keynote Speaker, Oslo, Norway)
12:30							12:30-13:30 Added to your list of favorites Deleted from your list of favorites G35 AGA SESSION AGA SESSION
12:35

12:30 - 13:30	LUNCH BREAK

13:30		13:30-14:50 Added to your list of favorites Deleted from your list of favorites B34 ESRA Educational Video Competition ESRA Educational Video Competition Chairperson: Paolo GROSSI (Consultant) (Chairperson, milano, Italy) Jurys: Oya Yalcin COK (EDRA Part I Vice Chair, EDRA Examiner, lecturer, instructor) (Jury, Türkiye, Turkey), Steve COPPENS (Head of Clinic) (Jury, Leuven, Belgium), Brian KINIRONS (Consultant Anaesthetist) (Jury, Galway, Ireland, Ireland), Ana Patrícia MARTINS PEREIRA (Resident Doctor) (Jury, Braga, Portugal), Athmaja THOTTUNGAL (yes) (Jury, Canterbury, United Kingdom) 13:30 - 14:50 Is That A Pneumothorax? International Evidence-Based Recommendations for Lung POCUS. Melody HERMAN (Director of Regional Anesthesiology) (Poster Presenter, Charlotte, USA) 13:30 - 14:50 Parasternal Blocks. Burhan DOST (Anesthesiologist) (Poster Presenter, Samsun, Turkey) 13:30 - 14:50 Video on Sonoanatomy of the Lumbar Spine. Hemangini BAROT (-) (Poster Presenter, Coventry, United Kingdom) 13:30 - 14:50 Scalp Block as the key to comfortably managing awake craniotomy patient. QR virtual tour at the end. Ana SUAREZ (Anesthesiologist) (Poster Presenter, Bogotá, Colombia) 13:30 - 14:50 Neuronavigation -Guided Scalp Block. Ergun MENDES (Poster Presenter, İstanbul, Turkey) 13:30 - 14:50 ULTRA SOUND ASSISTED SPINE SCANNING. Azaresh RAMINEEDI (Specialty Doctor) (Poster Presenter, Prescot, United Kingdom) 13:30 - 14:50 3 best Educational Video Presentations. Clara LOBO (Medical director) (Jury, Abu Dhabi, United Arab Emirates)
14:00	14:00-14:50 Added to your list of favorites Deleted from your list of favorites A33 ASK THE EXPERT Chronic pain in pediatrics ASK THE EXPERT Chronic pain in pediatrics Chairperson: Barbara RUPNIK (Consultant anesthetist) (Chairperson, Zurich, Switzerland) 14:00 - 14:05 Introduction. Barbara RUPNIK (Consultant anesthetist) (Keynote Speaker, Zurich, Switzerland) 14:05 - 14:35 #43306 - A33 Chronic pain in children. Chronic pain in children. Chronic pain in children and adolescents, more than just a pill. Introduction and epidemiology It was in 2022 that well-known researchers involved in pediatric pain made a statement for more attention for pediatric pain in general, and where more research concerning pediatric pain was needed, using the motto: make pain matter, make pain understood, make pain visible and make pain better (Eccleston et al., 2021). Currently there are gaps in knowledge of validated criteria for certain pediatric pain conditions, adequate treatment protocols, adequate dosing of medication for all age groups and an absolute lack of evidence for invasive interventions (Boulkedid et al., 2018; Shah et al., 2016). And despite things are improving the amount of publications related to pain in children was in 2023 around one tenth of the amount related to pain adults (Krane 2023). Chronic pain in children and adolescents is a common problem with a prevalence cited between 11% and 38% of the general population (King et al., 2011). Between 2004 and 2010 an increase was observed of 831% in the amount of pediatric pain patients presenting with chronic pain in 43 tertiary centers in the United States (Coffelt et al., 2013). This may be caused by an enhanced detection and awareness but an increase in prevalence of chronic pain cannot be excluded. Risk factors As risk factors for chronic pain are considered: female sex, age around 12-14 years, children with anxiety or depression, other chronic health conditions, low socio-economic status but also additional neurodevelopment disorders like autism or attention deficit hyperactivity disorder (ADHD) (King et al., 2011; Lipsker et al., 2018). Furthermore adverse child experiences like child abuse or bullying at school are considered as risk factors as well as an immigration background, the last especially in younger children (Abrahamyan et al., 2024; Roman-Juan et al., 2024; Solé et al., 2024). Consequences of chronic pain in childhood Consequences of pain in childhood or adolescence can be more anxiety and depression with sometimes suicidal ideation, sleep disturbances, social isolation, school absence and therefore a lower school achievement, an impaired athletic performance and generally a lower quality of life. In addition, there is the burden through involvement of parents and siblings. So adequate treatment of these chronic pain disorders in childhood or adolescence is eminent. Not just because of the actual burden but also because around two third of children with chronic pain in childhood or adolescence might present themselves in an adult pain center in adulthood (Kashikar-Zuck et al., 2014; Walker et al., 2010). Presentations of pediatric pain Now what kind or pain conditions are generally seen in a pediatric pain center ? This may vary from one pediatric pain center to another, by country and how care is arranged. Generally it concerns musculoskeletal and limb pain (e.g. complex regional pain syndrome), headache, abdominal pain, back pain, chronic postsurgical pain, pain that comes with chronic diseases like sickle cell anemia or neurofibromatosis and more general; pain like functional pain. Furthermore there is pain in palliative care situations. Overlooking the different types of pain, next to nociceptive pain which is most of the time acute pain, chronic pain contains often neuropathic pain, a pain type that is often overlooked and for which specific diagnostic questionnaires are not validated for children. Also the causes of neuropathic pain in children are often different from those in adults (Howard et al., 2014; Kachko et al., 2014). Since a few years there is a new descriptor, that involves pain not caused through tissue damage or disease or damage of the somatosensory system but through altered pain processing: nociplastic pain. This new descriptor can help us to elucidate the often used explanation for their pain complaints to patients an parents: Functional pain, or better dysfunctional pain (Schechter 2014). Assessment and treatment Chronic pediatric pain assessment and treatment according a bio-psycho-social model by a multi- or interdisciplinary team is generally considered state of the art nowadays. Again, depending on how care is organized by center, regionally or nationally (Liossi et al., 2019; Miró et al., 2017). Generally such interdisciplinary team consists of a pediatric pain specialist, psychologist and physiotherapist (3 P’s) with eventually complementary therapists like occupational or music therapists. This way each team member has treatment modalities from their own professional background (Rolfe 2016). First step, and crucial in assessment and treatment should be connection with and feedback to the patient and parents in the so called “Golden Half Hour” (Schechter et al., 2021). One should validate symptoms, emphasize a multi- or interdisciplinary treatment plan and give education. Diagnostic uncertainty in patients or parents might otherwise lead to more catastrophizing and higher pain scores (Neville et al., 2020). Furthermore the target in treatment is in the first place; recovery of function with the restoration of daily activities and sleep rhythm, next to reduction of pain. In such a treatment program physiotherapy has proven it’s benefit, for example through a graded exposure or graded activity plan, not only in the treatment of musculoskeletal pain but also in abdominal pain or tension headache. Psychologic therapies, like cognitive behavioral therapy (CBT) or acceptance and commitment therapy (ACT), have proven to be efficient, also to elucidate pain-maintaining factors (Fisher et al., 2018). Additionally, for the treatment of chronic pain after a traumatic injury, trauma therapy like eye movement desensitization an reprocessing (EMDR) and hypnosis techniques can be incorporated in the armament of the psychologist. Pending assessment in the clinic, some types of therapy may already be offered via the internet but the evidence up till now is low (Fisher et al., 2019; Murray et al., 2020). Furthermore, pain medication can be offered by the physician of the interdisciplinary team as treatment by itself but also to make physiotherapy more feasible. Most used medications for the treatment of chronic pain are non-steroid anti-inflammatory drugs (NSAID’s), Cox-2-inhibitors, gabapentinoids, tricyclic antidepressants (TCA’s), and selective serotonin reuptake inhibitors (SSRI’s). For the use of opioids there is only place in special pain conditions and palliative care (Cooper et al., 2017). Most evidence for the use of medication as well as doses advices are abstracted from literature in adults. In daily practice hardly treatment protocols are used and one must keep in mind that generally the evidence for the use of medication in chronic pediatric pain is very low (de Leeuw et al., 2020; Eccleston et al., 2019). As an extra tool transcutaneous electric nerve stimulation (TENS) could be used. It hardly has any side effects and has the advantage that it gives patients a way of self-control in their pain treatment. On the contrary there is no robust evidence for invasive interventions in the treatment of chronic pediatric pain (Shah et al., 2016; Zernikow et al., 2012). A drawback is further that these interventions in children have to be performed under sedation or general anesthesia. The format of interdisciplinary treatment programs varies from clinic to clinic, as does the way of reimbursement for such treatments, which is regulated differently from country to country. Often it is provided by means of an outward patient program but clinics can also offer an internal intensive rehabilitation program. Such an intensive rehabilitation program may offer better results than a program in an outward patient setting (Claus et al., 2022; Dekker et al., 2020; Hechler et al., 2015; Simons et al., 2013; Wager et al., 2021) A list of clinics with a pediatric pain program worldwide can be found under: http://childpain.org/index.php/resources/ Conclusion Chronic pain in children and adolescents is an increasing problem in Western Europe and North America, but an increased prevalence cannot be excluded in the Non-Western world (Coffelt et al., 2013; McCarthy and de Leeuw 2019). Assessment of chronic pain and treatment of chronic pain in children and adolescents is time consuming and needs great commitment from the treatment team. Trust and bonding of the patient and parents with the treatment team are essential and since often these patients are frequently referred from one professional to another without satisfying result, this might be difficult to achieve and should be priority during the first assessment (Schechter et al., 2021). The recently published study of Pico showed that chronic pain in children is still underdiagnosed and undertreated mainly due to a lack of knowledge of health care professionals (mainly pediatricians in this study) of mechanisms contributing to persistence of chronic and adequate management of chronic pain (Pico et al., 2023). Education, treatment protocols and up to date guidelines and programs are mandatory, just as adequate guidelines where and by whom (preferably pediatric pain specialists) these children should be treated (McCarthy and de Leeuw 2019; Miró et al., 2017). Abrahamyan A, Lucas R, Severo M, Talih M, Fraga S. Association between adverse childhood experiences and bodily pain in early adolescence. Stress Health 2024: e3383. Boulkedid R, Abdou AY, Desselas E, Monégat M, de Leeuw TG, Avez-Couturier J, Dugue S, Mareau C, Charron B, Alberti C, Kaguelidou F. The research gap in chronic paediatric pain: A systematic review of randomised controlled trials. Eur J Pain 2018;22: 261-271. Claus BB, Stahlschmidt L, Dunford E, Major J, Harbeck-Weber C, Bhandari RP, Baerveldt A, Neß V, Grochowska K, Hübner-Möhler B, Zernikow B, Wager J. Intensive interdisciplinary pain treatment for children and adolescents with chronic noncancer pain: a preregistered systematic review and individual patient data meta-analysis. Pain 2022;163: 2281-2301. Coffelt TA, Bauer BD, Carroll AE. Inpatient characteristics of the child admitted with chronic pain. Pediatrics 2013;132: e422-429. Cooper TE, Fisher E, Gray AL, Krane E, Sethna N, van Tilburg MA, Zernikow B, Wiffen PJ. Opioids for chronic non-cancer pain in children and adolescents. Cochrane Database Syst Rev 2017;7: Cd012538. de Leeuw TG, der Zanden TV, Ravera S, Felisi M, Bonifazi D, Tibboel D, Ceci A, Kaguelidou F, de Wildt SN, On Behalf Of The Gapp C. Diagnosis and Treatment of Chronic Neuropathic and Mixed Pain in Children and Adolescents: Results of a Survey Study amongst Practitioners. Children (Basel) 2020;7. Dekker C, Goossens M, Winkens B, Remerie S, Bastiaenen C, Verbunt J. Functional Disability in Adolescents with Chronic Pain: Comparing an Interdisciplinary Exposure Program to Usual Care. Children (Basel) 2020;7. Eccleston C, Fisher E, Cooper TE, Grégoire MC, Heathcote LC, Krane E, Lord SM, Sethna NF, Anderson AK, Anderson B, Clinch J, Gray AL, Gold JI, Howard RF, Ljungman G, Moore RA, Schechter N, Wiffen PJ, Wilkinson NMR, Williams DG, Wood C, van Tilburg MAL, Zernikow B. Pharmacological interventions for chronic pain in children: an overview of systematic reviews. Pain 2019;160: 1698-1707. Eccleston C, Fisher E, Howard RF, Slater R, Forgeron P, Palermo TM, Birnie KA, Anderson BJ, Chambers CT, Crombez G, Ljungman G, Jordan I, Jordan Z, Roberts C, Schechter N, Sieberg CB, Tibboel D, Walker SM, Wilkinson D, Wood C. Delivering transformative action in paediatric pain: a Lancet Child & Adolescent Health Commission. Lancet Child Adolesc Health 2021;5: 47-87. Fisher E, Law E, Dudeney J, Eccleston C, Palermo TM. Psychological therapies (remotely delivered) for the management of chronic and recurrent pain in children and adolescents. Cochrane Database Syst Rev 2019;4: Cd011118. Fisher E, Law E, Dudeney J, Palermo TM, Stewart G, Eccleston C. Psychological therapies for the management of chronic and recurrent pain in children and adolescents. Cochrane Database Syst Rev 2018;9: Cd003968. Hechler T, Kanstrup M, Holley AL, Simons LE, Wicksell R, Hirschfeld G, Zernikow B. Systematic Review on Intensive Interdisciplinary Pain Treatment of Children With Chronic Pain. Pediatrics 2015;136: 115-127. Howard RF, Wiener S, Walker SM. Neuropathic pain in children. Arch Dis Child 2014;99: 84-89. Kachko L, Ben Ami S, Lieberman A, Shor R, Tzeitlin E, Efrat R. Neuropathic pain other than CRPS in children and adolescents: incidence, referral, clinical characteristics, management, and clinical outcomes. Paediatr Anaesth 2014;24: 608-613. Kashikar-Zuck S, Cunningham N, Sil S, Bromberg MH, Lynch-Jordan AM, Strotman D, Peugh J, Noll J, Ting TV, Powers SW, Lovell DJ, Arnold LM. Long-term outcomes of adolescents with juvenile-onset fibromyalgia in early adulthood. Pediatrics 2014;133: e592-600. King S, Chambers CT, Huguet A, MacNevin RC, McGrath PJ, Parker L, MacDonald AJ. The epidemiology of chronic pain in children and adolescents revisited: a systematic review. Pain 2011;152: 2729-2738. Krane EJ. Some innovations in pediatric pain management. 2023. Liossi C, Johnstone L, Lilley S, Caes L, Williams G, Schoth DE. Effectiveness of interdisciplinary interventions in paediatric chronic pain management: a systematic review and subset meta-analysis. Br J Anaesth 2019;123: e359-e371. Lipsker CW, Bölte S, Hirvikoski T, Lekander M, Holmström L, Wicksell RK. Prevalence of autism traits and attention-deficit hyperactivity disorder symptoms in a clinical sample of children and adolescents with chronic pain. J Pain Res 2018;11: 2827-2836. McCarthy KF and de Leeuw TG. Trickle-down healthcare in paediatric chronic pain. Br J Anaesth 2019;123: e188-e190. Miró J, McGrath PJ, Finley GA, Walco GA. Pediatric chronic pain programs: current and ideal practice. Pain Rep 2017;2: e613. Murray CB, de la Vega R, Loren DM, Palermo TM. Moderators of Internet-Delivered Cognitive-Behavioral Therapy for Adolescents With Chronic Pain: Who Benefits From Treatment at Long-Term Follow-Up? J Pain 2020;21: 603-615. Neville A, Jordan A, Pincus T, Nania C, Schulte F, Yeates KO, Noel M. Diagnostic uncertainty in pediatric chronic pain: nature, prevalence, and consequences. Pain Rep 2020;5: e871. Pico M, Matey-Rodríguez C, Domínguez-García A, Menéndez H, Lista S, Santos-Lozano A. Healthcare Professionals' Knowledge about Pediatric Chronic Pain: A Systematic Review. Children (Basel) 2023;10. Rolfe P. Paediatric chronic pain. Anaesth Int Care Med 2016;17: 531-535. Roman-Juan J, Sánchez-Rodríguez E, Solé E, Castarlenas E, Jensen MP, Miró J. Immigration background as a risk factor of chronic pain and high-impact chronic pain in children and adolescents living in Spain: differences as a function of age. Pain 2024;165: 1372-1379. Schechter NL. Functional pain: time for a new name. JAMA Pediatr 2014;168: 693-694. Schechter NL, Coakley R, Nurko S. The Golden Half Hour in Chronic Pediatric Pain-Feedback as the First Intervention. JAMA Pediatr 2021;175: 7-8. Shah RD, Cappiello D, Suresh S. Interventional Procedures for Chronic Pain in Children and Adolescents: A Review of the Current Evidence. Pain Pract 2016;16: 359-369. Simons LE, Sieberg CB, Pielech M, Conroy C, Logan DE. What does it take? Comparing intensive rehabilitation to outpatient treatment for children with significant pain-related disability. J Pediatr Psychol 2013;38: 213-223. Solé E, Roman-Juan J, Sánchez-Rodríguez E, Castarlenas E, Jensen MP, Miró J. School bullying and peer relationships in children with chronic pain. Pain 2024;165: 1169-1176. Wager J, Ruhe AK, Stahlschmidt L, Leitsch K, Claus BB, Häuser W, Brähler E, Dinkel A, Kocalevent R, Zernikow B. Long-term outcomes of children with severe chronic pain: Comparison of former patients with a community sample. Eur J Pain 2021;25: 1329-1341. Walker LS, Dengler-Crish CM, Rippel S, Bruehl S. Functional abdominal pain in childhood and adolescence increases risk for chronic pain in adulthood. Pain 2010;150: 568-572. Zernikow B, Dobe M, Hirschfeld G, Blankenburg M, Reuther M, Maier C. [Please don't hurt me!: a plea against invasive procedures in children and adolescents with complex regional pain syndrome (CRPS)]. Schmerz 2012;26: 389-395. Tom G. DE LEEUW (Rotterdam, The Netherlands) 14:35 - 14:50 Q&A.		14:00-15:00 Added to your list of favorites Deleted from your list of favorites C36 EXPERT OPINION DISCUSSION Peripheral Neuromodulation EXPERT OPINION DISCUSSION Peripheral Neuromodulation Chairperson: Jan BOUBLIK (Assistant Professor) (Chairperson, Stanford, USA) 14:00 - 14:05 Introduction. Jan BOUBLIK (Assistant Professor) (Keynote Speaker, Stanford, USA) 14:05 - 14:20 Targets for peripheral neuromodulation in chronic pain. Kenneth CANDIDO (Speaker/presenter) (Keynote Speaker, OAK BROOK, USA) 14:20 - 14:35 #43460 - C36 Peripheral Neurostimulation in Postoperative Pain and its role in preventing persistent post surgery chronic pain. Peripheral Neurostimulation in Postoperative Pain and its role in preventing persistent post surgery chronic pain. Electroanalgesia is based on “gate control Theory” (activation of large motor fibbers inhibits transmition of pain signals from small fibbers). New dispositives ultrasound guided, allow a lead to be inserted approximately 0.5 to 3.0 cm close to peripheral nerves.(1) In 2018, the US Food and Drug Administration (FDA) approved the first PNS device designed for percutaneous placement portability and short term use. The main question that evidence should answer is if perisferic stimulation could replace or potentiate the use of perisferic catheter and integrate this dispositive to multimodal perioperative analgesia.(2) The accessibility to ultrasound machines,the high prevalence of anaesthesiologists with skills in ultrasound-guided regional anaesthesia, the development of a small stimulator that can be stick into the skin, the development of an insulated electrical lead specifically designed for percutaneous, extended use (up to 60 days) in the periphery now allow the wide application of PNS to treat postoperative pain.(1) PNS use in the perioperative setting is still on its beginnings, and require high quality prospective clinical trials to definitively demonstrate efficacy and feasibility of this technology in the surgical environment. (2) The only device with FDA clearance and published cases for the treatment of acute pain is the SPRINT PNS system (SPR Therapeutics, LLC, OH, USA). For both acute and chronic pain in the back and/or extremities for up to 60 days. This device include two components: a percutaneous electrical lead to deliver the stimulation to the target nerve and a battery-powered external pulse generator. (3) One of the main reasons for the increased interest in PNS it is the potential to modulate pain signalling and decrease neuronal sensitization, with opioid sparing effect, reducing the incidence of hyperalgesia , allodynia and the neuropathic pain in the postoperative period reducing its persistence. It can be use alone or together with pharmacological approach performing also a nerve block. The option to switch between chemical or electric nerve stimulation in the postoperative period may have good results. (2) Stratifying the risk of develop of persistent postoperative pain is essential to allow to PNS to be a cost effective preventative measure. Early PNS may avoid priming/sensitizing nervous system providing enhanced analgesia for patients developing or with previous neuropathic pain. PNS has the potential more than control the pain, it can improve recovery recruiting and strengthening affected muscles groups and nerve regeneration. (2) Specific surgeries: In knee arthroplasty , neurostimulate sciatic and femoral nerve has allowed opioid sparring .No falls, motor blocks or infections. PNS seem to be a promising useful techniques in foot surgery, placing an electrode near the sciatic nerve in hallux valgus surgery. (5) In rotator cuff repair the use of neurostimulation in interscalene approach do not showed appreciable differences if the leads where placed in the suprascapular nerve.(6) In cruciate ligaments repair. A electrode could be placed at femoral nerve(5) A randomized placebo controlled trail of 60 days in postoperative patients after knee replacement showed relief or persistent postoperative pain and improved function. These results provide evidence from a multicentre, randomized, double-blind, placebo-controlled trial showing that percutaneous PNS is safe and can provide sustained benefits for patients with postoperative pain after TKA.(4) As benefits PNS avoid the challenges of management local anaesthetics infusion pumps, eliminate the risk of medication toxicity and obtain a longer length of analgesia compared with peripheral catheter. Combined, these characteristics permit a far longer duration of use for PNS compared with continuous peripheral nerve blocks, possibly providing both preoperative and subsequently postoperative analgesia that outlasts the pain resulting from nearly all surgical procedures Limitations of PNS: Sadly the costs and accessibility of these dispositives are still unaffordable in ordinary conditions. (2) The leads are fragile and can be damaged or be broken during its exit and some part or it may persist inside the patient .(1) There is no consensus on when and how much time PNS must be use in postoperative.(2) PNS use in managing acute pain and in the transitional period is promising. It must overcome many obstacles before it can be introduced into routine practice. We must determine which patients, which types of surgeries, and which nerves are the best candidates for this treatment. We need to determine if a PNS lead should be placed before surgery, immediately after surgery, during the subacute transitional pain period, or only after chronic pain develops. (2) Ultrasound-guided percutaneous PNS may serve as an alternative approach free of some of the limitations associated with peripheral nerve blocks for this patient population. However the evidence is currently limited to small-scale feasibility studies. Further large-scale prospective, studies are necessary. (5) Ana SCHWARTZMANN BRUNO (Montevideo, Uruguay) 14:35 - 14:50 No more implants! External neuromodulation high and low frequency. Teodor GOROSZENIUK (Consultant) (Keynote Speaker, London, United Kingdom) 14:50 - 15:00 Q&A.	14:00-14:50 Added to your list of favorites Deleted from your list of favorites D36 PRO CON DEBATE TEA is better than TAP for abdominal surgery PRO CON DEBATE TEA is better than TAP for abdominal surgery Chairperson: Mark CROWLEY (EDRA Faculty) (Chairperson, Oxford, United Kingdom) 14:00 - 14:05 Introduction. Mark CROWLEY (EDRA Faculty) (Keynote Speaker, Oxford, United Kingdom) 14:05 - 14:20 For the PROs. Marcus THUDIUM (Consultant anesthesiologist) (Keynote Speaker, Bonn, Germany) 14:20 - 14:35 For the CONs. Neel DESAI (Consultant in Anaesthetics) (Keynote Speaker, London, United Kingdom) 14:35 - 14:50 Q&A.	14:00-14:50 Added to your list of favorites Deleted from your list of favorites E36 PRO CON DEBATE Peripheral nerve blocks: Awake or asleep? PRO CON DEBATE Peripheral nerve blocks: Awake or asleep? Chairperson: Nabil ELKASSABANY (Professor) (Chairperson, Charlottesville, USA) 14:00 - 14:05 Introduction. Nabil ELKASSABANY (Professor) (Keynote Speaker, Charlottesville, USA) 14:05 - 14:20 #43264 - E36 AWAKE Should be preferred. AWAKE Should be preferred. During recent years, the once widely spread assumption that peripheral nerve blocks (PNB) shell only be performed in awake adult patients has been progressively questioned. The increasing evidences showing the rarity of catastrophic nerve lesions (1) and the example of paediatric anaesthesia, where PNB are regularly done under general anaesthesia, with extremely rare complications, have contributed to revive the debate on the opportunity to reconsider this dogma. However, some rational objections could be reasonably presented for consideration by Colleagues sustaining the idea that performing PNB in adult patients is a safe practice, which should become the new standard of care. 1. Catastrophic, permanent nerve injuries after PNB are rare, but they represent only the tip of a very big iceberg, made of a whole range of minor to moderate symptoms related to a nerve suffering. Those symptoms, even if transient, are far more frequent and their incidence after PNB might be as high as 10% (2). 2. Even if characterised by a favourable prognosis, those complications nevertheless often determine a loss of productivity and/or a tangible impairment of patients’ quality of life, consequently representing the main reason for litigations in non-obstetric anaesthesia cases (3). Those litigations outcome does not depend on the entity or duration of the actual damage (4). 3. In case of litigation, the Anaesthetist involved is asked to demonstrate that she has acted lege artis, i.e. doing whatever it takes in order to minimise the portion of controllable risk, beside the intrinsic procedural risk (alea terapeutica). In case she did not, according to the vast majority of European Countries legislations, she can be accused of imprudence in her clinical practice. According to the current level of knowledge, the only way we have to minimize this controllable risk during a PNB is by avoiding nerve puncturing and intraneural injection. Even if it has been shown that paraesthesia might not be elicited in more than a half of awake patients, even in case of needle to nerve contact (5), the concept of compound risk teaches us how even this per se unreliable method can contribute to significantly increase the probability of detecting a nerve puncture, when combined with one or –better- more other methods (ultrasound guidance, nerve stimulation, injection pressure monitoring). 4. Nerve lesions are not the most frequent and potentially catastrophic complications of PNB, nor are the only reason why an awake patients might help to increase the level of safety during these procedures. Local anaesthetic systemic toxicity (LAST) occurs in more than 8% of cases and its incidence is probably increasing, given the increasing popularity of high volume infiltrative blocks (6). In case of accidental intravascular injection, early neurologic symptoms are the only signs, which my guide to the correct diagnosis and induce the Anaesthetist to immediately stop the local anaesthetic injection and initiate appropriate treatment, thus avoiding a potentially fatal progression. This is precisely why current recommendations on acute LAST risk minimisation almost invariably recommend avoiding deep sedation and continuously interacting with patients throughout the procedure. References 1. Preliminary results of the Australasian regional anaesthesia collaboration. Barrington MJ et al. Reg Anesth Pain Med 2009; 34: 534-541. 2. Complications of peripheral nerve blocks. Jeng CL et al. Brit J Anaesth 2010; 105: 97-107. 3. Litigation related to regional anaesthesia: an analysis of claims against the NHS in England 1995-2007. Szypula K et al. Anaesthesia 2010: 65: 443-452. 4. Litigation in Canada against anesthesiolists practicing regional anesthesia. A review of closed claims. Peng PWH et al. Can J Anesth 2000; 47: 105-112. 5. The sensitivity of motor response to nerve stimulation and paresthesia for nerve localization as evaluated by ultrasound. Perlas et al. Reg Anesth Pain Med 2006; 31: 445-450. 6. Local anaestetic systemic toxicity. Linsey EC et al. Brit J Anaesth Education 2015: 15: 136-142. Andrea SAPORITO (Bellinzona, Switzerland) 14:20 - 14:35 ASLEEP is preferred. Peter MERJAVY (Consultant Anaesthetist & Acute Pain Lead) (Keynote Speaker, Craigavon, United Kingdom) 14:35 - 14:50 Q&A.	14:00-14:50 Added to your list of favorites Deleted from your list of favorites F36 PRO CON DEBATE Are abdominal wall blocks required for minor abdominal surgery? PRO CON DEBATE Are abdominal wall blocks required for minor abdominal surgery? Chairperson: Ismet TOPCU (Anesthesiologist) (Chairperson, İzmir, Turkey) 14:00 - 14:05 Introduction. Ismet TOPCU (Anesthesiologist) (Keynote Speaker, İzmir, Turkey) 14:05 - 14:20 For the PROs. Emine Aysu SALVIZ (Attending Anesthesiologist) (Keynote Speaker, St. Louis, USA) 14:20 - 14:35 For the CONs. Marc VAN DE VELDE (Professor of Anesthesia) (Keynote Speaker, Leuven, Belgium) 14:35 - 14:50 Q&A.	14:00-14:50 Added to your list of favorites Deleted from your list of favorites G36 PRO CON DEBATE Radiofrequency ablation as preventive treatment for development of postoperative and persistent pain after surgery PRO CON DEBATE Radiofrequency ablation as preventive treatment for development of postoperative and persistent pain after surgery Chairperson: Steven COHEN (Professor) (Chairperson, Chicago, USA) 14:00 - 14:05 Introduction. Steven COHEN (Professor) (Keynote Speaker, Chicago, USA) 14:05 - 14:20 For the PROs. Thomas HAAG (Consultant) (Keynote Speaker, Wrexham, United Kingdom) 14:20 - 14:35 For the CONs. Dan Sebastian DIRZU (consultant, head of department) (Keynote Speaker, Cluj-Napoca, Romania) 14:35 - 14:50 Q&A.	14:00-14:50 Added to your list of favorites Deleted from your list of favorites H36 PRO CON DEBATE AI will soon be routine part of regional anesthesia PRO CON DEBATE AI will soon be routine part of regional anesthesia Chairperson: James BOWNESS (Consultant Anaesthetist) (Chairperson, London, United Kingdom) 14:00 - 14:05 Introduction. James BOWNESS (Consultant Anaesthetist) (Keynote Speaker, London, United Kingdom) 14:05 - 14:20 For the PROs. Kariem EL BOGHDADLY (Consultant) (Keynote Speaker, London, United Kingdom) 14:20 - 14:35 For the CONs. Sandy KOPP (Professor of Anesthesiology and Perioperative Medicine) (Keynote Speaker, Rochester, USA) 14:35 - 14:50 Q&A.
14:50

15:00	COFFEE BREAK	15:00-15:30 Added to your list of favorites Deleted from your list of favorites B34b ESRA Infographics Competition ESRA Infographics Competition Chairperson: Paolo GROSSI (Consultant) (Chairperson, milano, Italy) Jurys: Oya Yalcin COK (EDRA Part I Vice Chair, EDRA Examiner, lecturer, instructor) (Jury, Türkiye, Turkey), Steve COPPENS (Head of Clinic) (Jury, Leuven, Belgium), Brian KINIRONS (Consultant Anaesthetist) (Jury, Galway, Ireland, Ireland), Clara LOBO (Medical director) (Jury, Abu Dhabi, United Arab Emirates), Ana Patrícia MARTINS PEREIRA (Resident Doctor) (Jury, Braga, Portugal), Athmaja THOTTUNGAL (yes) (Jury, Canterbury, United Kingdom) 15:00 - 15:04 #43500 - Regional Anesthesia in Patients with Antithrombotic Drugs. Regional Anesthesia in Patients with Antithrombotic Drugs. Regional anesthesia in patients undergoing treatment with antithrombotic drugs presents significant challenges due to the increased risk of bleeding. We describe a clinical scenario involving patients on antithrombotic treatment who require deep nerve and/or neuraxial blocks via single puncture without catheter insertion. This infographic is based on recommendations according to the Joint ESAIC/ESRA Guidelines on "Regional Anesthesia in Patients on Antithrombotic Drugs”. Hipolito LABANDEYRA (Barcelona, Spain), Xavier SALA-BLANCH 15:04 - 15:08 #43045 - Gastronomy Of Prandial Status With Gastric Ultrasound. Gastronomy Of Prandial Status With Gastric Ultrasound. Gastric ultrasound is an essential skill for anesthesiologists, enabling real-time assessment of gastric contents at the bedside and playing a crucial role in risk stratification for patients at risk of pulmonary aspiration. This infographic provides a comprehensive overview of clinical indications, acquisition of standard images, sonographic interpretation, and the application of informed decision-making through gastric ultrasound in the perioperative period. Jie Cong YEOH, Gee Ho SIEW (Klang, Malaysia), Shahridan MOHD FATHIL 15:08 - 15:12 #43540 - Point of care ultrasound for patients on GLP-1 receptor agonist. Point of care ultrasound for patients on GLP-1 receptor agonist. GLP-1 RAs delay gastric emptying and increase residual gastric content and aspiration risk during anesthesia. Gastric POCUS assesses the gastric content of preoperative patients with GLP-1 RAs. A curved probe was used in the epigastrium to evaluate the antral content in the supine and RLD positions. Calculate gastric volume (GV) using the antral CSA. Risk stratification: GV < 1.5 mL/kg (low) and GV > 1.5 mL/kg (high). Adjustment of surgical and anesthetic plans Ana Maria SUAREZ (Bogotá, Colombia), Maria Jose PELAEZ, William AMAYA, Andrés Felipe ZULUAGA, Andrea Carolina PEREZ-PRADILLA 15:12 - 15:16 #43482 - Points for Pain. Points for Pain. Approximately 3000 Years ago was the first recorded use of acupuncture in medicine. Its useful healing properties spread westward along trade routes originating in China Acupuncture in the Operating Room: Acupuncture can be implemented during surgery to help patients with: Pain Relief, Nausea, Vomiting, Anxiety, Post-procedure recovery. Timeline: Patient is induced for surgery, Acupuncture needles are placed, Needles are connected to 30Hz, Needles remain in the ear for 60 min. Marko POPOVIC (New York, USA), Stephanie CHENG 15:16 - 15:20 #43656 - Ultrasound-Guided Nerve Blocks for Craniotomy Analgesia. Ultrasound-Guided Nerve Blocks for Craniotomy Analgesia. See attached infographic : scalp blocks.pdf Hiram ABRAHAMS, Hiram ABRAHAMS (Cape Town, South Africa) 15:20 - 15:24 #43552 - What is blocking the block? Causes of fascial plane block failure. What is blocking the block? Causes of fascial plane block failure. With the plethora of Fascial Plane Blocks being described, questions regarding their effectiveness, cause and rate of failure still remain unanswered. With this infographic we are describing the various factors associated with failure of fascial plane blocks. Dr. Shruti SHREY (PATNA, India), Dr.chandni SINHA, Dr.amarjeet KUMAR, Dr.ajeet KUMAR 15:24 - 15:28 3 best Infographics winners.	COFFEE BREAK

15:30	15:30-17:20 Added to your list of favorites Deleted from your list of favorites A35 PROSPECT SESSION PROSPECT SESSION Chairperson: Marc VAN DE VELDE (Professor of Anesthesia) (Chairperson, Leuven, Belgium) 15:30 - 15:35 Introduction. Marc VAN DE VELDE (Professor of Anesthesia) (Keynote Speaker, Leuven, Belgium) 15:35 - 15:57 PROSPECT methodology update. Girish JOSHI (Professor) (Keynote Speaker, Dallas, Texas, USA, USA) 15:57 - 16:19 Laparoscopic and open colectomy. Marc VAN DE VELDE (Professor of Anesthesia) (Keynote Speaker, Leuven, Belgium) 16:19 - 16:41 Appendectomy. Dileep N. LOBO (Professor of Gastrointestinal Surgery) (Keynote Speaker, Nottingham, United Kingdom) 16:41 - 17:03 Sternotomy. Marc VAN DE VELDE (Professor of Anesthesia) (Keynote Speaker, Leuven, Belgium) 17:03 - 17:20 Q&A.	15:30-16:20 Added to your list of favorites Deleted from your list of favorites B36 PRO CON DEBATE Children at Risk for Compartment Syndrome should receive a block PRO CON DEBATE Children at Risk for Compartment Syndrome should receive a block Chairperson: Sandy KOPP (Professor of Anesthesiology and Perioperative Medicine) (Chairperson, Rochester, USA) 15:30 - 15:35 Introduction. Sandy KOPP (Professor of Anesthesiology and Perioperative Medicine) (Keynote Speaker, Rochester, USA) 15:35 - 15:50 For the PROs. Barbara VERSYCK (Anesthesiologist) (Keynote Speaker, Turnhout, Belgium) 15:50 - 16:05 For the CONs. Valeria MOSSETTI (Anesthesiologist) (Keynote Speaker, Torino, Italy) 16:05 - 16:20 Q&A.	15:30-17:20 Added to your list of favorites Deleted from your list of favorites C38 NETWORKING SESSION RAPM: Best current publications NETWORKING SESSION RAPM: Best current publications Chairperson: Brian SITES (Faculty) (Chairperson, Plainfield, USA) 15:30 - 15:35 Introduction. Brian SITES (Faculty) (Keynote Speaker, Plainfield, USA) 15:35 - 15:57 Top papers on acute pain. Michael HERRICK (Faculty Member) (Keynote Speaker, Hanover, NH, USA) 15:57 - 16:19 Top papers on chronic pain. Kenneth CANDIDO (Speaker/presenter) (Keynote Speaker, OAK BROOK, USA) 16:19 - 16:41 Future research. Alan MACFARLANE (Consultant Anaesthetist) (Keynote Speaker, Glasgow, United Kingdom) 16:41 - 17:03 Editor in chief perspective: Science vs. Advocacy. Brian SITES (Faculty) (Keynote Speaker, Plainfield, USA) 17:03 - 17:20 Q&A.	15:30-16:20 Added to your list of favorites Deleted from your list of favorites D38 EXPERT OPINION DISCUSSION Refractory Angina Pain EXPERT OPINION DISCUSSION Refractory Angina Pain Chairperson: Amy PEARSON (Interventional Pain Physician) (Chairperson, Milwaukee, WI, USA) 15:30 - 15:35 Introduction. Amy PEARSON (Interventional Pain Physician) (Keynote Speaker, Milwaukee, WI, USA) 15:35 - 15:50 #43470 - D38 Differential diagnosis. Differential diagnosis. Introduction: Not only acute but also chronic chest pain belongs to one complaint relatively commonly presented by patients to primary care physicians. Chronic chest pain is defined as pain within the thoracic region lasting more than 3 months [1]. Refractory chest pain is defined as chronic chest pain not reacting satisfactorily to routine pain medication and/or adjuvant chronic pain therapy. The main goal of any clinician is to distinguish between pain of cardiac and non-cardiac origin and also differentiate between potentially life-threatening conditions and relatively benign ones. While the incidence of chest pain compared with other complaints in primary medical care is estimated between 7-24%, and in other sources even between 20-40% [2], the incidence of chronic or refractory chest pain in the community is not well investigated. The approximate prevalence of chronic cardiac chest pain in a population older than 60 years is estimated between 10-15%. Refractory angina Patients with diagnosed cardiac chest pain who are not suitable for percutaneous coronary intervention (PCI) or open surgical revascularization (CABG), and those not responding to standard conservative medical treatment get allocated a diagnosis of refractory angina. Chronic refractory angina is defined as any pain of cardiac origin associated with coronary vessel disease lasting for more than three months [3]. Pathophysiologically, refractory angina can be described as reversible attacks of the cardiac muscle ischemia with concurrent anatomical changes of the coronary vasculature and with poor response to any conservative or interventional therapy. Refractory angina pain is present in approximately 5-10% of all subjects diagnosed with ischemic heart disease [4]. Refractory angina is statistically associated with reduced quality of life, increased rate of hospital admissions, and also with increased financial burden for the healthcare system. Refractory angina may be divided into four phenotypes [5]: A – microvascular angina with minimum changes on coronary arteries (syndrome X), B – patients with localized narrowing or obstruction of coronary vessels, C – patients with diffuse atherosclerotic changes to the coronary arteries often affecting side branches or distal parts of the coronary vasculature, D – end-stage coronary artery disease with refractory angina pain even post PCI or CABG. The incidence of refractory angina on the European continent is reported to be as high as 30-50.000 patients yearly [2,3] with 50.000 new patients diagnosed in the United States every year [3]. Differential diagnosis It is clinically extremely important to differentiate cardiac chronic chest pain from pain of non-cardiac origin and subsequently, if cardiac chronic pain is confirmed, make its differential diagnosis and set up an appropriate pathway of medical and non-medical treatment. During the differential diagnosis of chronic chest pain, the clinicians should start systematically with the detailed history obtained from the patient or his/her relatives, review of the previous medical charts, hospital admissions, and outpatient visits [2]. Subsequently, all methods of physical examination (inspection, palpation, percussion, auscultation) are used in the first instance. They should be followed by appropriate functional tests, laboratory methods, and evaluation using radiological examinations. The presence or probability of chronic cardiac pain can be confirmed or excluded from underlying symptoms, the patient´s age, sex, family history factors, and from the presence or absence of risk factors for the development of atherosclerosis. Family history of myocardial infarction, coronary artery disease, sudden cardiac death, the presence of diabetes, poorly controlled hypertension, hyperlipidemia, and abuse of smoking increase the probability of cardiac origin of chronic chest pain [6]. Essential information is also the identification of factors invoking, worsening, and alleviating chest pain. If provoking and worsening factors are associated with increased physical activity while reduction of intensity comes at rest, it is quite probable that the origin of pain is cardiac. Character and descriptors of pain can also help in the differential diagnosis of chronic chest pain. Sharp, exactly located pain is usually somatic in origin and may arise from subcutaneous tissue, muscles, ribs, or pleura. On the contrary, blunt, poorly located, or diffuse pain deep inside the chest is probably associated with myocardial ischemia or arises from the esophagus or stomach. Vital signs such as heart rate, non-invasive blood pressure values, the character of the peripheral pulse wave, capillary refill time, respiratory rate, peripheral oxygen saturation using a pulse oximeter, and body temperature should be evaluated and recorded in every patient suffering from chest pain [2]. Twelve-lead electrocardiogram (ECG) should be carried out in all patients where the cardiac cause of chest pain could not be safely excluded. It must be mentioned that ECG without ischemic changes cannot always exclude the cardiac origin of pain. Other cardiac examinations such as treadmill test, bicycle ergometry, dobutamine stress echocardiography, or even mini-invasive coronarography are indicated if the cardiac origin of the pain is probable. Other causes of chronic cardiac pain: Vasospastic angina (Prinzmetal´s angina) – this type of angina pain is induced mainly by the coronary artery vasospasm at the level of epicardium [4]. Concurrent obstructive coronary artery affliction may be either absent or present. Precipitating factors may be multifactorial and involve stress, cold, hyperinsulinemia, use of vasospasm-inducing drugs such as cocaine. This type of angina can present during exercise or as well at rest. Myocardial infarction may develop if the spasm is not terminated. Vasospastic angina is in most cases relieved by the sublingual use of glyceryl trinitrate and/or calcium channel blockers. Pericarditis – pain in pericarditis is usually quite sharp, some patients describe it even as stabbing or stinging but a minority of affected persons may describe its character as pressure-like, dull, or astringent [2]. Pain is located mostly behind the sternum or inside of the left side of the chest but it can irradiate into the left shoulder, left arm, or neck. Its intensity decreases in the sitting position and worsens when supine, during deep breathing or coughing. Chronic constrictive pericarditis develops gradually and persists for more than 3 months. Diagnosis is confirmed with echocardiography. Aortic stenosis – chest pain in aortic stenosis is similar to angina pain and is usually associated with physical activity. The presence of additional symptoms and findings such as shortness of breath, fatigue, palpitations, and long systolic murmur may help in differential diagnosis. Echocardiography confirms or excludes aortic stenosis. Mitral valve prolapse – the character of pain in this condition mostly differs from angina pain. It is more sharp often similar to myofascial pain but may be very intense and cause major anxiety. Other symptoms associated with mitral valve prolapse include palpitation, arrhythmias, dizziness, or dyspnea. Mitral valve prolapse is confirmed with echocardiography. Congenital heart defects and other anomalies – almost one-third of adult patients with congenital heart disease report chronic pain. The prevalence of pain increases with age and in individuals older than 65 years, the incidence of moderate or severe pain is reported at 47% [7]. The highest incidence of pain has been reported in cyanotic congenital heart anomalies, Eisenmeger´s syndrome, and in those patients with a history of previous open heart surgery. Pericardial effusion – chest pain is located directly behind the sternum or slightly on the left side from the sternal bone. Patients can also report the feeling of the full chest, tenderness, or pressure-like pain. Breathing difficulties and other symptoms usually improve when the affected persons sit up or stand up and worsen when lying flat. Transthoracic or transesophageal echocardiography is indicated if this diagnosis is suspected. Causes of non-cardiac chronic chest pain: Causes of non-cardiac (atypical) chronic chest pain include a relatively wide spectrum of diseases and conditions arising from pathologies or functional problems within the respiratory and gastrointestinal tracts, or from other organs of the thoracic cavity a chest wall [1]. The most important issue for the clinician is to distinguish between potentially life-threatening causes and relatively benign conditions. Any type of cancer should be always excluded. Other serious causes of chronic non-cardiac chest pain include almost all pulmonary diseases, GIT ulcers, and aneurysm/dissection of the intrathoracic aorta. Pulmonary origin: pneumonia, pneumonitis, pulmonary embolism, pulmonary infarction, intrapulmonary abscess, pleuritis, pneumothorax, hemothorax, asthma, chronic pulmonary obstructive disease. Pulmonary origin of chronic chest pain should be always confirmed or excluded using imaging methods (CT, MRI, ultrasound, bronchoscopy, EBUS) [6]. Pain in COPD is often related to mediastinal fascias [8]. Origin from the gastrointestinal tract: esophagus inflammation, gastroesophageal reflux disease, esophageal spasm, esophageal cancer, gastritis, gastric or duodenal ulcer, Boerhave´s syndrome, less often cholecystitis (location predominantly right upper quadrant) or pancreatitis (location predominantly epigastrium, middle back or the entire abdomen) [9]. Most similar pain to chronic angina is that associated with the involvement of the esophagus [1]. While esophagitis, gastroesophageal reflux disease, and esophageal cancer may be quite easily diagnosed using upper gastrointestinal endoscopy, CT, MRI, or ultrasound, the diagnosis of esophageal spasms is often very difficult [10]. Origin in mediastinum: dissection of the ascending aorta, aortic arch, descending aorta, aneurysms of the ascending aorta, aortic arch or thoraco-abdominal aorta, mediastinitis. These diseases are excluded or confirmed usually with an MRI or CT scan if an MRI is not feasible or available. Musculoskeletal origin: Costochondritis, trauma to the ribs, sternum, chest wall muscles, muscle spasms, fibromyalgia, post-procedural chronic pain (sternotomy, thoracotomy, breast surgery), referred pain from the thoracic spine (facet joint, nerve root compression, inflammation, discogenic pain), chest wall tumors (infiltration of the ribs, sternum, mesothelioma, sarcomas, lymphomas, thymoma). Pathologies of the musculosceletal system and chest wall are confirmed by imaging methods, functional conditions are often difficult to diagnose. Other origin: post-herpetic neuralgia, necrotizing fasciitis, panic attack disorders, psychiatric illness. Conclusions Differential diagnosis of chronic or refractory chest pain includes as a first step exclusion of the cardiac origin of pain. Comprehensive differential diagnosis is based on the patient´s history, physical examination, and the judicious use of laboratory tests, functional evaluations, and imaging methods. Appendix Suggested treatment algorithm for refractory angina pain Based on our more than 15-year experience with patients suffering from refractory angina pain in our center, we would like to suggest the following treatment algorithm: 1. 1. In the first step, we test the responsivity of the sympathetic nervous system in refractory angina pain. All patients undergo ultrasound-guided stellate ganglion block on the left side with 10 ml of 0.2% bupivacaine (levo-bupivacaine) twice in a two-week interval. The intensity of pain using a 0-10 visual analogue scale (VAS) of pain, the frequency of angina attacks, and the consumption of glyceryl trinitrate is evaluated and recorded daily for one month. All patients having at least a 50% reduction in two out of these three evaluated parameters are considered responders to sympathetic block and indicated for left-sided radiofrequency ablation of ympathetic chain at the level of T2 and T3. 2. 2. Patients not responding to sympathetic block are offered a trial of transcutaneous electrical nerve stimulation (TENS) and if they have a positive response, they receive implantation of a spinal cord stimulator. 3. 3. Patients in the terminal phase of their life may receive a tunneled high thoracic epidural catheter or systemic treatment with morphine. References: 1. 1. Görge G, Grandt D, Häuser W. Chronischer brustschmerz. Schmerz 2014;28:282-8. 2. 2. Fritz AK, Faber P. Chronic cardiac chest pain. Cont Ed Anaesth Crit Care Pain 2012;12:302-6. 3. 3. Dobias M, Michalek P, Neuzil P, Stritesky M, Johnston P. Interventional treatment of pain in refractory angina. A review. Biomed Pap 2014;158:518-27. 4. 4. Makowski M, Makowska JS, Zielinska M. Refractory angina – unsolved problem. Cardiol Clin 2020;38:629-37. 5. 5. Lantz R, Quesada O, Mattingly G, Henry TD. Contemporary management of refractory angina. Interv Cardiol Clin 2022;11:279-92. 6. 6. Saitta D, Hebbard G. Beyond the heart: noncardiac chest pain. Aus J Gen Pract 2022;51:849-54. 7. 7. Leibold A, Eichler E, Chung S, et al. Pain in adults with congenital heart disease – an international perspective. Int J Cardiol 2021;5:100200. 8. 8. Bordoni B, Marelli F, Morabito B, Castagna R. Chest pain in patients with COPD: the fascia´s subtle science. Int J Chron Obstruct Pulm Dis 2018;13:1157-65. 9. 9. Yamasaki T, Fass R. Noncardiac chest pain: diagnosis and management. Curr Opin Gastroenterol 2017;33:293-300. 10. 10. Zaher EA, Patel P, Atia G, Sigdel S. Distal esophageal spasm: an updated review. Cureus 2023;15:e41504. Pavel MICHALEK (Praha, Czech Republic) 15:50 - 16:05 Management and outcome measurement. Teodor GOROSZENIUK (Consultant) (Keynote Speaker, London, United Kingdom) 16:05 - 16:20 Q&A.	15:30-16:20 Added to your list of favorites Deleted from your list of favorites E38 PRO CON DEBATE We need PNB for THR under spinal anaesthesia PRO CON DEBATE We need PNB for THR under spinal anaesthesia Chairperson: Eric ALBRECHT (Program director of regional anaesthesia) (Chairperson, Lausanne, Switzerland) 15:30 - 15:35 Introduction. Eric ALBRECHT (Program director of regional anaesthesia) (Keynote Speaker, Lausanne, Switzerland) 15:35 - 15:50 For the PROs. Kris VERMEYLEN (Md, PhD) (Keynote Speaker, ZAS ANTWERP, Belgium) 15:50 - 16:05 For the CONs. Sina GRAPE (Head of Department) (Keynote Speaker, Sion, Switzerland) 16:05 - 16:20 Q&A.	15:30-16:20 Added to your list of favorites Deleted from your list of favorites F38 SECOND OPINION BASED DISCUSSION Confused about CRPS? SECOND OPINION BASED DISCUSSION Confused about CRPS? Chairperson: Andrea SAPORITO (Chair of Anesthesia) (Chairperson, Bellinzona, Switzerland) 15:30 - 15:35 Introduction. Andrea SAPORITO (Chair of Anesthesia) (Keynote Speaker, Bellinzona, Switzerland) 15:35 - 15:50 CRPS is a primary Chronic Pain Syndrome. Maria Luz PADILLA DEL REY (Anesthesiologist and Pain Physician) (Keynote Speaker, MURCIA, Spain) 15:50 - 16:05 Early interventions are effective in CRPS t 1 and 2. Urs EICHENBERGER (Head of Department) (Keynote Speaker, Zürich, Switzerland) 16:05 - 16:20 Q&A.	15:30-17:30 Added to your list of favorites Deleted from your list of favorites G38 RA Taboo & Pictionary Competition Competition reserved to Trainees only - Visitors are welcome! - Please go on the Trainees Corner to register your Trainee Team! RA Taboo & Pictionary Competition Competition reserved to Trainees only - Visitors are welcome! - Please go on the Trainees Corner to register your Trainee Team! Chairpersons: Can AKSU (Associate Professor) (Chairperson, Kocaeli, Turkey), Sari CASAER (Anesthesiologist) (Chairperson, Antwerp, Belgium), Ufuk YOROKOGLU (MD) (Chairperson, Kocaeli, Turkey) !Please see the Competition Rules here!	15:30-18:00 Added to your list of favorites Deleted from your list of favorites H38 UARA WORKSHOP RA and eFAST in the emergency setting UARA WORKSHOP RA and eFAST in the emergency setting Demonstrators: Wolf ARMBRUSTER (Head of Department, Clinical Director) (Demonstrator, Unna, Germany), Maksym BARSA (Anaesthesiologist) (Demonstrator, Rivne, Ukraine), Dmytro DMYTRIIEV (medical director) (Demonstrator, Vinnitsa, Ukraine), Ruediger EICHHOLZ (Owner, CEO) (Demonstrator, Stuttgart, Germany), Andrii KHOMENKO (Anesthesiologist, ICU physician, Pain Medicine physician) (Demonstrator, Київ, Ukraine), Andrii STROKAN (chief clinical medical officer) (Demonstrator, Kyiv, Ukraine) Free Workshop Limited to 36 first registrations Learning goals: • Apply all your ultrasound skills and knowledge under time pressure • Rapid bedside diagnostics • Rapid performance of blocks for instant pain relief and surgical procedures 15:30 - 15:35 Introduction. 15:35 - 15:50 How do we quickly identify the correct site of injection? Standardized scanning procedures are useful! Case presentations. 15:50 - 16:00 eFAST. 16:00 - 16:20 Hands-on - US STATION: RA upper limb. 16:20 - 16:40 Hands-on - US STATION: RA lower limb. 16:40 - 17:00 Hands on - US STATION: RA trunk. 17:00 - 17:20 Hands-on - US STATION: Pleura. 17:20 - 17:40 Hands-on - US STATION: eFAST. 17:40 - 18:00 Hands-on - US STATION: BLUE.
16:20
16:30		16:30-17:20 Added to your list of favorites Deleted from your list of favorites B37 SECOND OPINION BASED DISCUSSION Radiofrequency ablation Different techniques similar outcome? SECOND OPINION BASED DISCUSSION Radiofrequency ablation Different techniques similar outcome? Chairperson: Dan Sebastian DIRZU (consultant, head of department) (Chairperson, Cluj-Napoca, Romania) 16:30 - 16:32 Introduction. Dan Sebastian DIRZU (consultant, head of department) (Keynote Speaker, Cluj-Napoca, Romania) 16:32 - 16:42 Cervical Medial Branch. David PROVENZANO (Faculty) (Keynote Speaker, Bridgeville, USA) 16:42 - 16:52 Lumbar Medial Branch. Philip PENG (Office) (Keynote Speaker, Toronto, Canada) 16:52 - 17:02 Sacroilliac joint. Michele CURATOLO (Endowed Professor for Medical Education and Research) (Keynote Speaker, Seattle, USA) 17:02 - 17:12 Hip, Knee and Shoulder. Thomas HAAG (Consultant) (Keynote Speaker, Wrexham, United Kingdom) 17:12 - 17:20 Conclusion and Q&A.		16:30-17:30 Added to your list of favorites Deleted from your list of favorites D39 ESRA SESSION Safety standards vs. practicality/reality of RA in different settings ESRA SESSION Safety standards vs. practicality/reality of RA in different settings Chairperson: Andre VAN ZUNDERT (Professor and Chair Anaesthesiology) (Chairperson, Brisbane Australia, Australia) 16:30 - 16:35 Introduction. Patrick NARCHI (Anesthesia) (Keynote Speaker, SOYAUX, France) 16:35 - 16:45 #43171 - D39 Australian Perspective: Acute pain service with pain nurse practitioner performing blocks. Australian Perspective: Acute pain service with pain nurse practitioner performing blocks. With increasing elderly population globally, rib and hip fractures have become commonplace. Unfortunately, fractured neck of femur (NOF) has 1 year mortality rate as high as 18-25%^1-4. Surgery within 36 hours, involvement of an orthogeriatric team and regional anaesthesia techniques for pain management are interventions that can improve outcomes^5-7. In most Australian hospitals and globally, patients with fractured NOF receive a single shot femoral or fascia iliaca compartment block (FICB) on arrival in the Emergency Department (ED)^8-10. Systemic opioids then become the mainstay of analgesia which is often poorly tolerated by this frail, elderly cohort. Consultant anaesthetists’ unavailability to perform ultrasound guided regional anaesthesia (USGRA) outside theatre, hinders access to these much-needed blocks. Hence, most blocks are performed as a rescue analgesic technique when all else fails! Recognising this gap in the pain management, our pain nurse practitioner underwent rigorous training and assessment to upskill herself in specific USGRA techniques. Currently, at our institution, the acute pain service (APS) offers daily ward based US guided FICB to all our fractured NOF patients awaiting surgery. Similarly, high risk rib fracture patients receive erector spinae catheter as the main analgesic technique in combination with multimodal analgesia. Timely access to blocks led by nurse practitioner has not only resulted in exceptional pain management but also a steep increase in number of regional anaesthesia techniques at our institution which has created opportunities for anaesthesia trainees to get more hands-on experience. Results from a retrospective study conducted at our institution focusing on outcomes in these patients, safety of these blocks and a nursing staff survey on effect of these blocks on pressure care, pain management and their overall workload will be discussed. References: 1. Australian Institute of Health and Welfare (2023) Hip Fracture care pathways in Australia, Catalogue number PHE 336, AIHW, Australian Government. 2. Dimet-Wiley A, Golovko G, Watowich S. One-Year Postfracture Mortality Rate in Older Adults With Hip Fractures Relative to Other Lower Extremity Fractures: Retrospective Cohort Study JMIR Aging 2022;5(1): e32683 URL:https://aging.jmir.org/2022/1/e32683 DOI: 10.2196/32683 3. Mundi S, Pindiprolu B, Simunovic N, Bhandari M. Similar mortality rates in hip fracture patients over the past 31 years: a systematic review of RCTs. Acta Orthopaedica. 2014;85(1):54-9. doi:10.3109/17453674.2013.878831 4. Leung MTY, Marquina C, Turner JP, Ilomaki J, Tran T, Bell JS. Hip fracture incidence and post-fracture mortality in Victoria, Australia: a state-wide cohort study. Arch Osteoporos. 2023 Apr 29;18(1):56. doi: 10.1007/s11657-023-01254-6. Erratum in: Arch Osteoporos. 2023 May 22;18(1):74. doi: 10.1007/s11657-023-01286-y. PMID: 37119328; PMCID: PMC10148778 5. https://www.nice.org.uk/guidance/cg124 6. Griffiths R, Babu S, Dixon P, Freeman N, Hurford D, Kelleher E, Moppett I, Ray D, Sahota O, Shields M and White S. (2021), Guideline for the management of hip fractures 2020. Anaesthesia, 76: 225-237. https://doi.org/10.1111/anae.15291 7. Pissens S, Cavens L, Joshi G.P, Bonnet M.P, Sauter A, Raeder J, Van de Velde M, on behalf of the PROSPECT Working Group of the European Society of Regional Anaesthesia and Pain Therapy (esrA), Pain management after hip fracture repair surgery: a systematic review and procedure-specific postoperative pain management (PROSPECT) recommendations. Acta Anaesth.Bel. 2024;75(1):15-31 https://doi.org/10.56126/75.1.04 8. Australian and New Zealand Hip Fracture Registry Annual Report 2023. https://anzhfr.org/wp-content/uploads/sites/1164/2023/09/ANZHFR-2023-Annual-Report-%E2%80%93-eReport-%E2%80%93-FINAL.pdf 9. Steenberg J, Moller A. M. Systematic review of the effects of fascia iliaca compartment block on hip fracture patients before operation. British Journal of Anaesthesia, 2018;120(6):1368-1380 https://doi.org/10.1016/j.bja.2017.12.042 10. O’Reilly N, Desmet M, Kearns R. Fascia iliaca compartment block. BJA Education 2019;19(6):191-197 Hosim PRASAI THAPA (Melbourne, Australia, Australia) 16:45 - 16:55 South African perspective: Regional Anesthesia in the absence of ideal equipment/training/safety standards. Francois RETIEF (Head Clinical Unit) (Keynote Speaker, Cape Town, South Africa) 16:55 - 17:05 Asian perspective: “Targeted spinal anaesthesia and the need for laying down safety norms”. Anju GUPTA (Faculty) (Keynote Speaker, New Delhi, India) 17:05 - 17:15 American perspective: “From USRA to POCUS - an easy transition for the regional anaesthetist”. Melody HERMAN (Director of Regional Anesthesiology) (Keynote Speaker, Charlotte, USA) 17:15 - 17:30 Panel discussion.	16:30-17:20 Added to your list of favorites Deleted from your list of favorites E39 ASK THE EXPERT Tourniquet ASK THE EXPERT Tourniquet Chairperson: Matthieu CACHEMAILLE (Médecin chef) (Chairperson, Geneva, Switzerland) 16:30 - 16:35 Introduction. Matthieu CACHEMAILLE (Médecin chef) (Keynote Speaker, Geneva, Switzerland) 16:35 - 17:05 Tourniquet: Myths and facts; What we should teach the surgeons. Gernot GORSEWSKI (Bereichsleitender Oberarzt für Regionalanästhesie & Akutschmerztherapie) (Keynote Speaker, Feldkirch, Austria) 17:05 - 17:20 Q&A.	16:30-17:20 Added to your list of favorites Deleted from your list of favorites F39 ASK THE EXPERT CRPS in children ASK THE EXPERT CRPS in children Chairperson: Ovidiu PALEA (head of ICU and Pain Department) (Chairperson, Bucharest, Romania) 16:30 - 16:35 Introduction. Ovidiu PALEA (head of ICU and Pain Department) (Keynote Speaker, Bucharest, Romania) 16:35 - 17:05 #43310 - F39 Complex regional pain syndrome in children. Complex regional pain syndrome in children. CRPS in children, is it different from adults ?? Introduction Complex regional pain syndrome (CRPS) is a clinical disorder characterized by chronic pain, sometimes spontaneous, sometimes provoked by (minor) trauma or operation. The pain is disproportionate to the triggering event. It can be accompanied by sensory, vasomotor, sudomotor and trophic changes. The diagnosis CRPS is a clinical diagnosis based on the new IASP-criteria, also known as the Budapest Criteria. Generally two different types are distinguished CRPS type I where there is no demonstrable nerve lesion and CRPS type II which results of a nerve lesion. Distinction between type I and II is unclear since nerve deficits are not well described. Additionally CRPS I and II do not differ in clinical presentation and choice of treatment. In literature other subtypes are mentioned, as an adaptation of the Budapest criteria: CRPS “with remission of some features” and CRPS NOS i.e. “not otherwise specified and no other diagnosis better explains clinical features”, meaning that the patient has never been documented to fulfill the new IASP-criteria (Goebel et al., 2021). Important is that none of these criteria have ever been validated for diagnosing CRPS in children. Also other cut off points for children are suggested (Friedrich Y 2019). So overlooking these adjustments, one may wonder if CRPS in children should always be labelled as CRPS NOS. Figure 1 Now, is CRPS in children different from CRPS in adults ? Epidemiology studies show that the incidence in children is more rare, around 1.14-1.2/100.000/year whereas in adults there is a range from 5.5 to 26.2/100.000/year (Abu-Arafeh and Abu-Arafeh 2016; Baerg et al., 2022; de Mos et al., 2007). Just like in adults the incidence is three-to eightfold higher in women. In contrary to adults lower extremities are more involved than upper extremities. Children may present more often with “cold” CRPS, although swelling and sweating may be present. Skin discoloration and change in temperature are often present, but trophic changes to hair and nails are less often present than in adults. What is seen in almost every patient is severe pain (not dermatome determined, but more shaped like a sock or glove) with hyperalgesia and allodynia in such a way that gentle touch as from clothing or blankets cannot be tolerated. In more advanced cases decreased range of motion, muscular atrophy and dystonia can be seen. Prognostic, the syndrome may develop better than in adults but recurrence rates of 25-50% have been described. Pathophysiology In the past it has been discussed by pediatric pain specialists if the pathophysiology in children is different from adults but nowadays, although still not completely elucidated, the general consensus now that it is the same. The basis is probably a genetic determined susceptibility followed by an exaggerated inflammatory response after (sometimes minor) trauma or surgery. Peripheral and central sensitization, immune related factors and altered sympathetic nervous system functioning play a role next to psychologic factors. The incidence of psychologic factors is generally not higher than in other chronic pediatric chronic pain states (Lascombes and Mamie 2017; Logan et al., 2013; Stanton-Hicks 2010; Williams and Howard 2016). Furthermore the representation of the limbs on the somatosensory cortex changes which may reverse when the syndrome is cured. Diagnosis The diagnosis CRPS in children is, just as in adults, a clinical diagnosis based on the IASP “Budapest” diagnostic criteria although the criteria are not validated for children. Due to heterogeneity of the syndrome also experience of the clinician may be important in recognizing the symptoms. Until now, no screening tools, laboratory tests or imaging diagnostics are specific to come to the diagnosis (Greenough et al., 2022). Probably due to unfamiliarity with CRPS in children and a lower prevalence there is still a delay before the patient is referred to a pediatric pain center (Kachko et al., 2008; Lascombes and Mamie 2017; Williams and Howard 2016). Treatment Due to the lack of evidence-based data there is no standardized treatment for CRPS in children. Like most chronic pain conditions in children it needs an interdisciplinary approach according a biopsychosocial model. Physiotherapy by means of a graded exposure or graded activity plan next to desensitization is essential although there are no standard protocols on intensity or duration. Also transcutaneous nerve stimulation (TENS) can be used as supportive treatment. Furthermore psychologic interventions through cognitive behavioral therapy to improve pain coping are important to enhance the physiotherapy program and to avoid refusal of the patient to move, because hand or foot is too painful. Evidence for effective pharmacotherapeutic treatment options are limited. In literature concerning CRPS in adults a plea was made for a more mechanism based treatment where pharmacotherapy for CRPS in children is generally aiming on symptomatic relief (Mangnus et al., 2022; Williams and Howard 2016). In the Netherlands, free radical scavengers (dimethyl sulphoxide, vitamin C and acetylcysteine) are advised, but internationally they generally are not used. More commonly used drugs are paracetamol or non-steroid anti-inflammatory drugs (NSAID’s) but their efficacy is low. In case of neuropathic/nociplastic pain gabapentinoids or tricyclic antidepressants (TCA’s) can be used, the latter specially if there are also sleeping problems. Further agents that are used are lidocaine patch, in case the painful area is limited, or capsaicin crème, used for desensitization and baclofen for dystonia. There is limited evidence for the use of corticosteroids in the acute phase of CRPS. In refractory cases esketamine i.v. can be considered as well as bisphosphonates in case of bone demineralization (Sheehy et al., 2015). In the past different interventional techniques have been used but evidence is weak and therefore interventional techniques are generally discouraged (Zernikow et al., 2012) (Zernikow et al., 2015). Also the use of neuromodulation remains controversial although one review described good results in a limited amount of patients (Karri et al., 2021). On the contrary good results are achieved with intensive interdisciplinary rehabilitation thereapy (Simons et al., 2013). Conclusion Complex regional pain syndrome in children requires experienced assessment in a Pediatric Pain Center with an interdisciplinary approach. Education of patients, parents but also professionals about this rare condition is important. The outcome might be better if treatment is started without delay, although evidence for the different treatment modalities is limited and prognosis might be poorer than previously assumed (Tan et al., 2009; Wong et al., 2020). Abu-Arafeh H and Abu-Arafeh I. Complex regional pain syndrome in children: incidence and clinical characteristics. Arch Dis Child 2016;101: 719-723. Baerg K, Tupper SM, Chu LM, Cooke N, Dick BD, Doré-Bergeron MJ, Findlay S, Ingelmo PM, Lamontagne C, Mesaroli G, Oberlander TF, Poolacherla R, Spencer AO, Stinson J, Finley GA. Canadian surveillance study of complex regional pain syndrome in children. Pain 2022;163: 1060-1069. de Mos M, de Bruijn AG, Huygen FJ, Dieleman JP, Stricker BH, Sturkenboom MC. The incidence of complex regional pain syndrome: a population-based study. Pain 2007;129: 12-20. Friedrich Y ZD, Sieberg CB, et al.Evaluation of the Budapest Criteria. International Symposium on Pediatric PainBasel, Switzerland; 2019. Goebel A, Birklein F, Brunner F, Clark JD, Gierthmühlen J, Harden N, Huygen F, Knudsen L, McCabe C, Lewis J, Maihöfner C, Magerl W, Moseley GL, Terkelsen A, Thomassen I, Bruehl S. The Valencia consensus-based adaptation of the IASP complex regional pain syndrome diagnostic criteria. Pain 2021;162: 2346-2348. Greenough M, Bucknall T, Jibb L, Lewis K, Lamontagne C, Squires JE. Attaining expert consensus on diagnostic expectations of primary chronic pain diagnoses for patients referred to interdisciplinary pediatric chronic pain programs: A delphi study with pediatric chronic pain physicians and advanced practice nurses. Front Pain Res (Lausanne) 2022;3: 1001028. Kachko L, Efrat R, Ben Ami S, Mukamel M, Katz J. Complex regional pain syndromes in children and adolescents. Pediatr Int 2008;50: 523-527. Karri J, Palmer JS, Charnay A, Garcia C, Orhurhu V, Shah S, Abd-Elsayed A. Utility of Electrical Neuromodulation for Treating Chronic Pain Syndromes in the Pediatric Setting: A Systematic Review. Neuromodulation 2021. Lascombes P and Mamie C. Complex regional pain syndrome type I in children: What is new? Orthop Traumatol Surg Res 2017;103: S135-s142. Logan DE, Williams SE, Carullo VP, Claar RL, Bruehl S, Berde CB. Children and adolescents with complex regional pain syndrome: more psychologically distressed than other children in pain? Pain Res Manag 2013;18: 87-93. Mangnus TJP, Bharwani KD, Dirckx M, Huygen F. From a Symptom-Based to a Mechanism-Based Pharmacotherapeutic Treatment in Complex Regional Pain Syndrome. Drugs 2022;82: 511-531. Sheehy KA, Muller EA, Lippold C, Nouraie M, Finkel JC, Quezado ZM. Subanesthetic ketamine infusions for the treatment of children and adolescents with chronic pain: a longitudinal study. BMC Pediatr 2015;15: 198. Simons LE, Sieberg CB, Pielech M, Conroy C, Logan DE. What does it take? Comparing intensive rehabilitation to outpatient treatment for children with significant pain-related disability. J Pediatr Psychol 2013;38: 213-223. Stanton-Hicks M. Plasticity of complex regional pain syndrome (CRPS) in children. Pain Med 2010;11: 1216-1223. Tan EC, van de Sandt-Renkema N, Krabbe PF, Aronson DC, Severijnen RS. Quality of life in adults with childhood-onset of Complex Regional Pain Syndrome type I. Injury 2009;40: 901-904. Williams G and Howard R. The Pharmacological Management of Complex Regional Pain Syndrome in Pediatric Patients. Paediatr Drugs 2016;18: 243-250. Wong BJ, Yoon IA, Krane EJ. Outcome in young adults who were diagnosed with complex regional pain syndrome in childhood and adolescence. Pain Rep 2020;5: e860. Zernikow B, Dobe M, Hirschfeld G, Blankenburg M, Reuther M, Maier C. [Please don't hurt me!: a plea against invasive procedures in children and adolescents with complex regional pain syndrome (CRPS)]. Schmerz 2012;26: 389-395. Zernikow B, Wager J, Brehmer H, Hirschfeld G, Maier C. Invasive treatments for complex regional pain syndrome in children and adolescents: a scoping review. Anesthesiology 2015;122: 699-707. Tom G. DE LEEUW (Rotterdam, The Netherlands) 17:05 - 17:20 Q&A.
17:20
17:30

20:00 - 23:59	CONGRESS NETWORKING DINNER
Saturday 07 September
Time	CONGRESS HALL	PANORAMA HALL	South Hall 1A	South Hall 1B	South Hall 2A	South Hall 2B	Small Hall	NORTH HALL	CHAMBER HALL	CLUB B

09:30	09:30-10:45 Added to your list of favorites Deleted from your list of favorites A40 PANEL DISCUSSION AI in RA and Pain medicine PANEL DISCUSSION AI in RA and Pain medicine Chairperson: James BOWNESS (Consultant Anaesthetist) (Chairperson, London, United Kingdom) 09:30 - 09:35 Introduction. 09:35 - 09:55 AI in healthcare: shaping the future. Alex SIA (CEO) (Keynote Speaker, Singapore, Singapore) 09:55 - 10:15 Ethics and Regulation of AI: how do we make sure it’s fair. Xiao LIU (Clinician Scientist) (Keynote Speaker, Birmingham, United Kingdom) 10:15 - 10:35 Opportunities for AI in Regional Anaesthesia. Rajnish GUPTA (Professor of Anesthesiology) (Keynote Speaker, Nashville, USA) 10:35 - 10:40 Q&A Discussion.	09:30-10:45 Added to your list of favorites Deleted from your list of favorites B40 EXPERT OPINION DISCUSSION Music and sex EXPERT OPINION DISCUSSION Music and sex Chairperson: Geert-Jan VAN GEFFEN (Anesthesiologist) (Chairperson, NIjmegen, The Netherlands) 09:30 - 09:35 Introduction. Geert-Jan VAN GEFFEN (Anesthesiologist) (Keynote Speaker, NIjmegen, The Netherlands) 09:35 - 10:05 Music was my first love. Hans TIMMERMAN (Senior researcher) (Keynote Speaker, Groningen, The Netherlands) 10:05 - 10:35 A woman´s only transitional pain service. Rafael BLANCO (Pain medicine) (Keynote Speaker, Abu Dhabi, United Arab Emirates) 10:35 - 10:45 Q&A.

10:45 - 11:10	COFFEE BREAK

11:10	11:10-12:00 Added to your list of favorites Deleted from your list of favorites A42 PRO CON DEBATE Intrathecal catheters are protective after accidental dura punction PRO CON DEBATE Intrathecal catheters are protective after accidental dura punction Chairperson: Philippe GAUTIER (MD) (Chairperson, BRUSSELS, Belgium) 11:10 - 11:15 Introduction. Philippe GAUTIER (MD) (Keynote Speaker, BRUSSELS, Belgium) 11:15 - 11:30 For the PROs. Marc VAN DE VELDE (Professor of Anesthesia) (Keynote Speaker, Leuven, Belgium) 11:30 - 11:45 For the CONs. Nuala LUCAS (Speaker) (Keynote Speaker, London, United Kingdom) 11:45 - 12:00 Q&A.	11:10-12:00 Added to your list of favorites Deleted from your list of favorites B42 PRO CON DEBATE i.v. Lidocaine is to be preferred over epidural catheter management PRO CON DEBATE i.v. Lidocaine is to be preferred over epidural catheter management Chairperson: Alan MACFARLANE (Consultant Anaesthetist) (Chairperson, Glasgow, United Kingdom) 11:10 - 11:15 Introduction. Alan MACFARLANE (Consultant Anaesthetist) (Keynote Speaker, Glasgow, United Kingdom) 11:15 - 11:30 #43031 - B42 For the PROs. For the PROs. Introduction Enhanced recovery after surgery (ERAS) pathways have become standard of care, as they reduce perioperative complications and accelerate recovery. Optimal postoperative pain management is considered a prerequisite to enhancing recovery after surgery because it facilitates ambulation and rehabilitation [1]. However, postoperative pain continues to be inadequately managed. One of the major reasons for inadequate pain control includes inappropriate clinical application of current knowledge. Because pain is a complex phenomenon, a multimodal approach has been recommended [2]. Although optimal multimodal analgesic regimen remains controversial, it is well accepted that combination of paracetamol (acetaminophen) and non-steroidal anti-inflammatory drugs (NSAIDs) or cyclooxygenase (COX)-2 specific inhibitor should be administered unless there are contraindications. In addition, local and/or regional analgesia is recommended. The choice of the regional analgesia technique should be procedure specific. Furthermore, analgesic adjuncts such as ketamine, dexmedetomidine, and lidocaine infusions have been evaluated as components of multimodal analgesic regimen and/or opioid-free anesthesia [3]. The aim of this pro/con discussion is to present the current evidence on the role of epidural analgesia and intravenous lidocaine infusion as components of multimodal analgesia technique for enhanced recovery. Epidural Analgesia Epidural analgesia provides excellent dynamic pain relief and has been shown to reduce postoperative morbidity and mortality [4,5]. Advantages of epidural analgesia include reduced pulmonary, cardiovascular, gastrointestinal, and venous thromboembolic complications. Given these benefits thoracic epidural has been recommended in patients with significant comorbid conditions including cardiovascular disease and chronic obstructive pulmonary disease [6]. Therefore, epidural analgesia has been considered as a gold standard for patients undergoing major thoraco-abdominal surgery [7-9]. However, in recent years the clinical benefits of epidural analgesia have been questioned [10-13]. This probably is due to implementation of ERAS pathways, improved surgical techniques, improved postoperative care (e.g., avoidance of nasogastric tubes and drains), improved pulmonary physiotherapy, early oral intake and early mobilization. A systematic review of randomized trials in patients undergoing laparoscopic colonic surgery revealed that pain scores in patients receiving optimal multimodal analgesia were within an acceptable range, suggesting that epidural analgesia may not be necessary for laparoscopic procedures [14]. Also, there were no differences between the epidural analgesia and the non-epidural analgesia groups with respect to return of bowel function, pulmonary function, length of stay, and quality of life. Other studies in patients undergoing laparoscopic colorectal surgery also found that epidural analgesia increased the incidence of urinary infection and longer hospital length of stay [15-17] without providing any analgesic benefits over conventional analgesic regimen. Also, epidural analgesia did not reduce post-discharge opioid requirements [18] or postopeerative venous thromboembolism [19]. Epidural analgesia is limited by a significant failure rate for catheter placement and malfunction as well as adverse effects related to sympathetic and motor blockade. In addition, use of epidural opioids can increase postoperative pruritis, nausea, and urinary retention. Also, epidural analgesia can delay ambulation due to the presence of catheters/pumps and difficulties in catheter management due to routine use of VTE prophylaxis.Also, epidural analgesia is invasive, labor-intensive, and expensive [20,21]. Given the lack of clinical benefits and the potential for increased complications including delayed ambulation, epidural analgesia is being replaced with more distal regional analgesia techniques such as interfascial plane blocks and/or surgical site infiltration. Intravenous Lidocaine Infusion Lidocaine has analgesic, anti-hyperalgesic, and anti-inflammatory effects. It also has anti-neoplastic properties, and therefore may provide benefits in patients undergoing cancer surgery [22]. Lidocaine can reduce nociception and/or cardiovascular responses to surgical stress. Also, perioperative (intraoperative and immediate postoperative) intravenous lidocaine infusion has been found to reduce pain scores and opioid requirements. In addition to improved pain control, some studies have reported beneficial effects on the gastrointestinal tract (decrease in postoperative ileus, shortening of both the time to first flatus and the time to first bowel movement, decrease in postoperative nausea and vomiting) [23-26]. These benefits are observed only in patients undergoing abdominal surgery (laparoscopic and open approaches), but not for any other surgical procedures, although the reason for this specificity is poorly understood. Overall, intraopertive lidocaine infusion has been used widely as a component of multimodal analgesic technique, particularly in patients undergoing abdmonial surgery. Also, intravenous lidocaine infusion could be recommended in patients undergoing open abdominal surgery with contraindications to basic analgesics (e.g. paracetamol and NSAIDs). Furthermore, lidociane infusion may be suitable for patients at high risk of postoperative pain, however, the evidence for this is lacking. Although the exact mechanism of action of lidocaine infusion are not well understood [22], the plasma concentrations of lidocaine infusion are like those obtained during epidural administration, which may be its mechanism of action [27].Therefore, intravenous lidocaine infusion has been labelled as “the poor man's epidural.” A recent study found that lidocaine infusion provides clinically meaningful difference in postoperative pain [28]. However, almost 10% of patients experienced symptoms consistent with local anesthetic toxicity (LAST) including one patient having cardiac arrest who recovered after receiving intravenous lipid emulsion. The potential for LAST increases with the use of local/regional analgesia techniques, which are increasingly being used in current clinical practice. Therefore, some suggest that lidocaine infusion should be considered as a ‘high-risk’ approach for pain management [29,30]. Significant caution is advised to prevent LAST. It is recommended that the lidocaine infusion dose should be calculated based on Ideal body weight, not actual body weight. Lidocaine infusion should not be used in patients weighing <40 kg. The loading dose should be ≤1.5 mg/kg, given over 10 min followed by infusion rate of ≤1.5 mg/kg/h for maximum of 24 h. Total lidocaine dose infused should be <120 mg/h. Intravenous lidocaine should be avoided when regional analgesic blocks are used. If regional analgesia technique is planned, the choice of loco/regional blocks may become limited with the use of lidocaine infusion. It is recommended to avoid a regional analgesia technique with high risk of LAST based on local anesthetic absorption characteristics (e.g. intercostal, paravertebral, or fascial plane blocks, and midline surgeries needing bilateral blockade) or characteristics of surrounding structures. Choose techniques where the minimum effective dose is small, such as selective root blocks of the brachial plexus. Also, continuous catheter techniques should be avoided when using lidocaine infusion. Lidocaine metabolism can be affected by the duration and direct effects of GA and surgery on liver blood flow. Vigilance is needed in patients with existing comorbidity. When administered on the wards, patients should be managed in a monitored high dependency unit. Also, lidocaine infusion should be administered through a dedicated intravenous cannula using a suitable infusion device. There should be a separate lidocaine monitoring chart. Physician and staff should be educated regarding patient susceptibility and selection as well as infusion preparation and infusion pump programing. Conclusions In summary, the role of epidural analgesia in current clinical practice of enhanced recovery after surgery is diminishing. Peripheral regional blocks such as interfascial plane blocks and local infiltration analgesia. Intravenous lidocaine infusion has been shown to influence postoperative outcomes after abdominal surgery. However, the optimal duration of administration appears to be for 24 h. Also, there are concerns of LAST particularly with concomitant use of local/regional analgesia techniques. Therefore, it is imperative to follow rigorous precautions for prevention as well as early diagnosis and management of LAST. References 1. Joshi GP, Kehlet H: Postoperative pain management in the era of ERAS: an overview. Best Pract Res Anaestheisiol 2019; 33: 259-67. 2. Joshi GP. Rational Multimodal Analgesia for Perioperative Pain Management. Curr Pain Headache Rep. 2023; 27: 227-37. 3. Shanthanna H, Ladha KS, Kehlet H, Joshi GP. Perioperative opioid administration. Anesthesiology 2021; 134: 645-59. 4. Popping DM, Elia N, Marret E, et al. Protective effects of epidural analgesia on pulmonary complications after abdominal and thoracic surgery: a meta-analysis. Arch Surg 2008; 143: 990-9. 5. Rodgers A, Walker N, Schug S, et al. Reduction of postoperative mortality with epidural or spinal anaesthesia: results from overview of randomized trials. Br Med J 2000; 321: 1493-7. 6. van Lier F, van der Geest PJ, Hoeks SE, et al. Epidural analgesia is associated with improved health outcomes of surgical patients with chronic obstructive pulmonary disease. Anesthesiology 2011; 115: 315-21. 7. Joshi GP, Bonnet F, Shah R, et al: A systematic review of randomized trials evaluating regional techniques for postthoracotomy analgesia. Anesth Analg 2008; 107:1026-40. 8. Elsaharydah A, Zuo LW, Minhajuddin A, Joshi GP. Effects of epidural analgesia on the recovery after open colorectal surgery. Proc Bayl Univ Med Cent 2017; 30: 255-8. 9. Freise H, Van Aken HK: Risks and benefits of thoracic epidural anaesthesia. Br J Anaesth 2011; 107: 859-68. 10. Rigg JR, Jamrozik K, Myles PS, et al. Epidural anaesthesia and analgesia and outcome of major surgery: a randomized trial. Lancet 2002; 359: 1276-82. 11. Christie W, McCabe S. Major complications of epidural analgesia after surgery: results of a six-year survey. Anaesthesia 2007; 62: 335-41. 12. Low J, Johnston N, Morris C: Epidural analgesia: first do no harm. Anaesthesia 2008; 63: 1-3. 13. Kehlet H, Joshi GP. Systematic reviews and meta-analyses of randomized controlled trials on perioperative outcomes: an urgent need for critical reappraisal. Anesth Analg 2015; 121: 1104-7. 14. Joshi GP, Bonnet F, Kehlet H, et al. Evidence-based postoperative pain management after laparoscopic colorectal surgery. Colorectal Dis. 2013; 15: 146-55. 15. Halabi WJ, Jafari MD, Nguyen VQ, et al. A nationwide analysis of the use and outcomes of epidural analgesia in open colorectal surgery. J Gastrointest Surg 2013;17:1130-7. 16. Halabi WJ, et al: Epidural analgesia in laparoscopic colorectal surgery: a nationwide analysis of use and outcomes. JAMA Surg 2014;149:130-6. 17. ERAS Compliance Group. The impact of enhanced recovery protocol complicance on elective colorectal cancer resection: results from an international registry. Ann Surg 2015;261:1153-9. 18. Ladha KS, et al: Impact of perioperative epidural placement on postdischarge opioid use in patients undergoing abdominal surgery. Anesthesiology 2016; 124: 19. Turan A, et al: Association of neuraxial anesthesia with postoperative venous thromoboembolism after noncardiac surgery: a propensity-matched analysis of ACS-NSQIP database. Anesth Analg 2019; 128: 494-501. 20. Rawal N. Epidural technique for postoperative pain: gold standard no more? Reg Anesth Pain Med 2012; 37: 310-7. 21. Wildsmith JA. Continuous thoracic epidural block for surgery: gold standard or debased currency? Br J Anaesth 2012; 109: 9-12. 22. Hermanns H, Hollmann MW, Stevens MF, et al: Molecular mechanisms of action of systemic lidocaine in acute and chronic pain: a narrative review. Br J Anaesth 2019; 123: 335-49. 23. Dunn LK, Durieux ME. Perioperative use of intravenous lidocaine. Anesthesiology. 2017; 126: 729-37. 24. Sun Y, Li T, Wang N, Yun Y, Gan TJ. Perioperative systemic lidocaine for postoperative analgesia and recovery after abdominal surgery: a meta-analysis of randomized controlled trials. Dis Colon Rectum. 2012; 55: 1183-94. 25. Rollins KE, Javanmard-Emamghissi H, Scott MJ, Lobo DN. The impact of peri-operative intravenous lidocaine on postoperative outcome after elective colorectal surgery: A meta-analysis of randomised controlled trials. Eur J Anaesthesiol 2020; 37:1–12. 26. Yang W, Yan S, Yu F, Jiang C. Appropriate duration of perioperative intravenous administration of lidocaine to provide satisfactory analgesia for adult patients undergoing colorectal surgery: a meta-analysis of randomized controlled trials. Anesth Analg 2023; 136: 494-506. 27. Hollmann MW, Strümper D, Durieux ME. The poor man's epidural: systemic local anesthetics for improving postoperative outcomes. Med Hypotheses 2004; 63: 386-9. 28. De Oliveira K, Eipe N. Intravenous lidocaine for acute pain: a single-institution retrospective study. Drugs Real World Outcomes 2020; 7: 205-12. 29. Foo I, Macfarlane AJR, Srivastava D, et al. The use of intravenous lidocaine for postoperative pain and recovery: international consensus statement on efficacy and safety. Anaesthesia 2021; 76: 238-50. 30. Shanthanna H, Weinburg G. Intravenous lidocaine, regional blockade, or both: considerations for multiple interventions involving local anaesthetics. Br J Anaesth 2021; 127: 497-501. Girish JOSHI (Dallas, Texas, USA, USA) 11:30 - 11:45 For the CONs. Admir HADZIC (Director) (Keynote Speaker, New York, USA) 11:45 - 12:00 Q&A.

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NETWORKING SESSION Emerging Concepts CHRONIC PAIN MANAGEMENT

ROUND TABLE DISCUSSION Evolution and Current Trends in Regional Anesthesia

NETWORKING SESSION State of the art anaesthesia for CS

ASK THE EXPERT POCUS is ultrasound

TIPS & TRICKS Blocks in the ICU

ASK THE EXPERT World at war: benefits, advantages and pitfalls of early analgesic procedures

SECOND OPINION BASED DISCUSSION The best management of post amputation pain

REFRESHING YOUR KNOWLEDGE - TARA SESSION Headache

H11 SIMULATION TRAININGS SIMULATION TRAININGS Demonstrators: Josip AZMAN (Consultant) (Demonstrator, Linkoping, Sweden), Clara LOBO (Medical director) (Demonstrator, Abu Dhabi, United Arab Emirates), Roman ZUERCHER (Senior Consultant) (Demonstrator, Basel, Switzerland)

SIMULATION TRAININGS

TIPS & TRICKS In Obstetric Anesthesia

NETWORKING SESSION Recent papers that might change the clinical practice PERIPHERAL NERVE BLOCKS (PNBs)

ASK THE EXPERT POCUS in obstetric anesthesia

C12 LIVE DEMONSTRATION Blocks above the clavicle LIVE DEMONSTRATION Blocks above the clavicle Demonstrators: Eric ALBRECHT (Program director of regional anaesthesia) (Demonstrator, Lausanne, Switzerland), Sebastien BLOC (Anesthésiste Réanimateur) (Demonstrator, Paris, France)

LIVE DEMONSTRATION Blocks above the clavicle

REFRESHING YOUR KNOWLEDGE Pharmacology

REFRESHING YOUR KNOWLEDGE Complications

TIPS & TRICKS The difficult patient

REFRESHING YOUR KNOWLEDGE Caudals

H11 SIMULATION TRAININGS SIMULATION TRAININGS Demonstrators: Josip AZMAN (Consultant) (Demonstrator, Linkoping, Sweden), Clara LOBO (Medical director) (Demonstrator, Abu Dhabi, United Arab Emirates), Roman ZUERCHER (Senior Consultant) (Demonstrator, Basel, Switzerland)

SIMULATION TRAININGS

REFRESHING YOUR KNOWLEDGE Anatomy

TIPS & TRICKS Monitoring

TIPS & TRICKS Hip Fracture

REFRESHING YOUR KNOWLEDGE Platelet Rich Plasma

PANEL DISCUSSION Training RA for obstetric anesthesia

EXPERT OPINION DISCUSSION POCUS on abdomen

C13 LIVE DEMONSTRATION Blocks below the clavicle LIVE DEMONSTRATION Blocks below the clavicle Demonstrators: Agnese OZOLINA (faculty member) (Demonstrator, Riga, Latvia), Peter POREDOS (consultant) (Demonstrator, Ljubljana, Slovenia, Slovenia)

LIVE DEMONSTRATION Blocks below the clavicle

OBSTETRIC Free Papers 2

REFRESHING YOUR KNOWLEDGE Obstetric

TIPS & TRICKS Pediatric RA

TIPS & TRICKS Ambulatory Surgery

REFRESHING YOUR KNOWLEDGE Emerging techniques for acute pain

EXPERT OPINION DISCUSSION Intrathecal opioids CENTRAL NERVE BLOCKS (CNBs)

ASK THE EXPERT Blocks in challenging situations

C15 LIVE DEMONSTRATION Thoracic wall blocks LIVE DEMONSTRATION Thoracic wall blocks Demonstrators: Peter POREDOS (consultant) (Demonstrator, Ljubljana, Slovenia, Slovenia), Valentina RANCATI (Consultant) (Demonstrator, Lausanne, Switzerland)

LIVE DEMONSTRATION Thoracic wall blocks

EXPERT OPINION DISCUSSION Procedure specific vs. individualized pain management

PRO CON DEBATE RA is a MUST for every ERAS Protocol

ASK THE EXPERT Blocks for shoulder surgery

ASK THE EXPERT Conversion

SIMULATION TRAININGS

PAEDIATRIC Free Papers 3

EXPERT OPINION DISCUSSION Continuous Peripheral Nerve Blocks POSTOPERATIVE PAIN MANAGEMENT

EXPERT OPINION DISCUSSION Anatomy at it's finest PERIPHERAL NERVE BLOCKS (PNBs)

C16 LIVE DEMONSTRATION Abdominal wall blocks LIVE DEMONSTRATION Abdominal wall blocks Demonstrators: Mario FAJARDO PEREZ (Anesthesia) (Demonstrator, Madrid, Spain), Athmaja THOTTUNGAL (yes) (Demonstrator, Canterbury, United Kingdom)

LIVE DEMONSTRATION Abdominal wall blocks

NETWORKING SESSION Chronic postsurgical pain - closing gaps

ASK THE EXPERT RA for airway management

ASK THE EXPERT Blocks for foot surgery

REFRESHING YOUR KNOWLEDGE Acute postoperative Pain

SIMULATION TRAININGS

PERIPHERAL NERVE BLOCKS Free Papers 4

REFRESHING YOUR KNOWLEDGE Rebound pain

BEST FREE PAPER SESSION - CHRONIC PAIN

C17 LIVE DEMONSTRATION Ankle block LIVE DEMONSTRATION Ankle block Demonstrators: Corey KULL (Junior Consultant) (Demonstrator, Lausanne, Switzerland), Peter MERJAVY (Consultant Anaesthetist & Acute Pain Lead) (Demonstrator, Craigavon, United Kingdom)

LIVE DEMONSTRATION Ankle block

ASK THE EXPERT Blocks for breast surgery

ASK THE EXPERT Defining quality in obstetric anaesthesia

PROBLEM BASED LEARNING DISCUSSION Grey zones

REFRESHING YOUR KNOWLEDGE Nerve injury

TIPS & TRICKS How to observe and learn

OPENING CEREMONY ESRA SESSION

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

NETWORKING SESSION State of the art labour analgesia

C20 LIVE DEMONSTRATION QLB blocks LIVE DEMONSTRATION QLB blocks Demonstrator: Rafael BLANCO (Pain medicine) (Demonstrator, Abu Dhabi, United Arab Emirates)

LIVE DEMONSTRATION QLB blocks

NETWORKING SESSION Pain assessment beyond pain intensity scales

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

H20 SIMULATION TRAININGS SIMULATION TRAININGS Demonstrators: Josip AZMAN (Consultant) (Demonstrator, Linkoping, Sweden), Kassiani THEODORAKI (Anesthesiologist) (Demonstrator, Athens, Greece), Roman ZUERCHER (Senior Consultant) (Demonstrator, Basel, Switzerland)

SIMULATION TRAININGS

REFRESHING YOUR KNOWLEDGE Cannabinoids

C21 LIVE DEMONSTRATION Rheumatoid Arthritis: The Role of US in Diagnosis and Treatment LIVE DEMONSTRATION Rheumatoid Arthritis: The Role of US in Diagnosis and Treatment Demonstrator: Ismael ATCHIA (Consultant Rheumatologist) (Demonstrator, Newcastle, United Kingdom)

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

NETWORKING SESSION
Emerging Concepts
CHRONIC PAIN MANAGEMENT

ROUND TABLE DISCUSSION
Evolution and Current Trends in Regional Anesthesia

NETWORKING SESSION
State of the art anaesthesia for CS

ASK THE EXPERT
POCUS is ultrasound

TIPS & TRICKS
Blocks in the ICU

ASK THE EXPERT
World at war: benefits, advantages and pitfalls of early analgesic procedures

SECOND OPINION BASED DISCUSSION
The best management of post amputation pain

REFRESHING YOUR KNOWLEDGE - TARA SESSION
Headache

H11

SIMULATION TRAININGS

SIMULATION TRAININGS

Demonstrators: Josip AZMAN (Consultant) (Demonstrator, Linkoping, Sweden), Clara LOBO (Medical director) (Demonstrator, Abu Dhabi, United Arab Emirates), Roman ZUERCHER (Senior Consultant) (Demonstrator, Basel, Switzerland)

TIPS & TRICKS
In Obstetric Anesthesia

NETWORKING SESSION
Recent papers that might change the clinical practice
PERIPHERAL NERVE BLOCKS (PNBs)

ASK THE EXPERT
POCUS in obstetric anesthesia

C12

LIVE DEMONSTRATION
Blocks above the clavicle

LIVE DEMONSTRATION
Blocks above the clavicle

Demonstrators: Eric ALBRECHT (Program director of regional anaesthesia) (Demonstrator, Lausanne, Switzerland), Sebastien BLOC (Anesthésiste Réanimateur) (Demonstrator, Paris, France)

LIVE DEMONSTRATION
Blocks above the clavicle

REFRESHING YOUR KNOWLEDGE
Pharmacology

REFRESHING YOUR KNOWLEDGE
Complications

TIPS & TRICKS
The difficult patient

REFRESHING YOUR KNOWLEDGE
Caudals

H11

SIMULATION TRAININGS

SIMULATION TRAININGS

Demonstrators: Josip AZMAN (Consultant) (Demonstrator, Linkoping, Sweden), Clara LOBO (Medical director) (Demonstrator, Abu Dhabi, United Arab Emirates), Roman ZUERCHER (Senior Consultant) (Demonstrator, Basel, Switzerland)

REFRESHING YOUR KNOWLEDGE
Anatomy

TIPS & TRICKS
Monitoring

TIPS & TRICKS
Hip Fracture

REFRESHING YOUR KNOWLEDGE
Platelet Rich Plasma

PANEL DISCUSSION
Training RA for obstetric anesthesia

EXPERT OPINION DISCUSSION
POCUS on abdomen

C13

LIVE DEMONSTRATION
Blocks below the clavicle

LIVE DEMONSTRATION
Blocks below the clavicle

Demonstrators: Agnese OZOLINA (faculty member) (Demonstrator, Riga, Latvia), Peter POREDOS (consultant) (Demonstrator, Ljubljana, Slovenia, Slovenia)

LIVE DEMONSTRATION
Blocks below the clavicle

OBSTETRIC
Free Papers 2

REFRESHING YOUR KNOWLEDGE
Obstetric

TIPS & TRICKS
Pediatric RA

TIPS & TRICKS
Ambulatory Surgery

REFRESHING YOUR KNOWLEDGE
Emerging techniques for acute pain

EXPERT OPINION DISCUSSION
Intrathecal opioids
CENTRAL NERVE BLOCKS (CNBs)

ASK THE EXPERT
Blocks in challenging situations

C15

LIVE DEMONSTRATION
Thoracic wall blocks

LIVE DEMONSTRATION
Thoracic wall blocks

Demonstrators: Peter POREDOS (consultant) (Demonstrator, Ljubljana, Slovenia, Slovenia), Valentina RANCATI (Consultant) (Demonstrator, Lausanne, Switzerland)

LIVE DEMONSTRATION
Thoracic wall blocks

EXPERT OPINION DISCUSSION
Procedure specific vs. individualized pain management

PRO CON DEBATE
RA is a MUST for every ERAS Protocol

ASK THE EXPERT
Blocks for shoulder surgery

ASK THE EXPERT
Conversion

PAEDIATRIC
Free Papers 3

EXPERT OPINION DISCUSSION
Continuous Peripheral Nerve Blocks
POSTOPERATIVE PAIN MANAGEMENT

EXPERT OPINION DISCUSSION
Anatomy at it's finest
PERIPHERAL NERVE BLOCKS (PNBs)

C16

LIVE DEMONSTRATION
Abdominal wall blocks

LIVE DEMONSTRATION
Abdominal wall blocks

Demonstrators: Mario FAJARDO PEREZ (Anesthesia) (Demonstrator, Madrid, Spain), Athmaja THOTTUNGAL (yes) (Demonstrator, Canterbury, United Kingdom)

LIVE DEMONSTRATION
Abdominal wall blocks

NETWORKING SESSION
Chronic postsurgical pain - closing gaps

ASK THE EXPERT
RA for airway management

ASK THE EXPERT
Blocks for foot surgery

REFRESHING YOUR KNOWLEDGE
Acute postoperative Pain

PERIPHERAL NERVE BLOCKS
Free Papers 4

REFRESHING YOUR KNOWLEDGE
Rebound pain

C17

LIVE DEMONSTRATION
Ankle block

LIVE DEMONSTRATION
Ankle block

Demonstrators: Corey KULL (Junior Consultant) (Demonstrator, Lausanne, Switzerland), Peter MERJAVY (Consultant Anaesthetist & Acute Pain Lead) (Demonstrator, Craigavon, United Kingdom)

LIVE DEMONSTRATION
Ankle block

ASK THE EXPERT
Blocks for breast surgery

ASK THE EXPERT
Defining quality in obstetric anaesthesia

PROBLEM BASED LEARNING DISCUSSION
Grey zones

REFRESHING YOUR KNOWLEDGE
Nerve injury

TIPS & TRICKS
How to observe and learn

OPENING CEREMONY

ESRA SESSION

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

NETWORKING SESSION
State of the art labour analgesia

C20

LIVE DEMONSTRATION
QLB blocks

LIVE DEMONSTRATION
QLB blocks

Demonstrator: Rafael BLANCO (Pain medicine) (Demonstrator, Abu Dhabi, United Arab Emirates)

LIVE DEMONSTRATION
QLB blocks

NETWORKING SESSION
Pain assessment beyond pain intensity scales

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

H20

SIMULATION TRAININGS

SIMULATION TRAININGS

Demonstrators: Josip AZMAN (Consultant) (Demonstrator, Linkoping, Sweden), Kassiani THEODORAKI (Anesthesiologist) (Demonstrator, Athens, Greece), Roman ZUERCHER (Senior Consultant) (Demonstrator, Basel, Switzerland)

REFRESHING YOUR KNOWLEDGE
Cannabinoids

C21

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

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

Demonstrator: Ismael ATCHIA (Consultant Rheumatologist) (Demonstrator, Newcastle, United Kingdom)

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

NETWORKING SESSION
Paediatric Anaesthesia
PAEDIATRIC

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