My bookmarks / My personal programme Log in to my myCO account

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.
08:50
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 (chair) (Chairperson, Vinnitsa, Ukraine) 09:00 - 09:05 Introduction. Dmytro DMYTRIIEV (chair) (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, Cuyahoga Falls, 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)
09:30
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.
09:50

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, Adana, 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)
11:00
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 (Associate 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.
11:20
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 (head of department, 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)
11:40
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.
12:20

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 (head of department, 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, Genk, Belgium) 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)
14:50
14:55

15:00 - 15:30	COFFEE BREAK

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 defi


	Email:

	Password:

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 (head of department, 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 (head of department, 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)

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 (head of department, 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 (head of department, 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)