Abstract In recent years, there has been a growing awareness of the limitations and risks associated with the overreliance on opioids in various surgical procedures, including cardiothoracic surgery. This shift on pain management toward reducing reliance on opioids, together with need to improve patient outcomes, alleviate suffering, gain early mobilization after surgery, reduce hospital stay, and improve patient satisfaction and functional recovery, has led to the development and widespread implementation of enhanced recovery after surgery (ERAS) protocols. In this context, fascial plane blocks are emerging as part of a multimodal analgesic in cardiac surgery and as alternatives to conventional neuraxial blocks for thoracic surgery, and there is a growing body of evidence suggesting their effectiveness and safety in providing pain relief for these procedures. In this review, we discuss the most common fascial plane block techniques used in the field of cardiothoracic surgery, offering a comprehensive overview of regional anesthesia techniques and presenting the latest evidence on the use of chest wall plane blocks specifically in this surgical setting. 

Fascial plane blocks for cardiothoracic surgery: a narrative review

Sex estimation is one of the crucial trends in cases of findings of unknown skeletal remains in forensics and bioarchaeology. The changing nature of sexual dimorphism (population specificity, secular trend, other external and internal factors influence) brings challenges to developing new methods; and there are new aims to be independent of these changes such, as the method by Musilová et al. (2016). These methods need to be evaluated on different datasets to determine if they are truly reliable among populations from different places and times, in the case of bioarchaeology. This study assessed the application of the aforementioned method on non-European contemporary and ancient populations to identify the reliability of the method on this separate dataset. The study sample consisted of 96 CT scans of skulls from contemporary Egyptians and 54 3D models of skulls from the Egyptian Old Kingdom Period (2700-2180 BC). The classifier method, previously tested on both Czech and French populations, yielded high accuracies (over 90 %) for sex estimation. For the contemporary Egyptian skull sample, the classifier was able to determine males versus females with an 89.59 % accuracy rate and an AUC value (area under the curve - a measure of the combined specificity and sensitivity of the test) of 0.99; this proves that the classifier is reliable even with a lower degree of accuracy. Conversely, the Old Kingdom Period sample yielded a lower level of accuracy at around 70 % (61.11 %, precisely), although with an AUC value of 0.92, the result is not considered reliable. 

How reliable is the application of the sex classifier based on exocranial surface (Musilová et al., 2016) for geographically and temporally distant skull series.

The estimation of biological sex is a critical step in the assessment of the biological profile of an anonymous skeletonized individual. In certain recovery circumstances, the most dimorphic skeletal areas, such as the pelvis, are absent or fragmented; in that case, other bones of the skeleton, including the clavicle and scapula, can be used to predict sex. The purpose of this research is to generate new models for the estimation of sex with clavicular and scapular measurements using a study-sample of 129 individuals with clavicle (65 males and 64 females) and 112 individuals with scapula (50 males and 62 females) from the Lisbon Identified Skeletal Collection (Portugal). A decision tree classifier (C4.5) and logistic regression (LR) were employed to create univariable and multivariable sex prediction models. Accuracy under cross-validation of the classification models is high (up to 93.8%), with minimal bias (<5%), particularly in the multivariable models. The proposed LR models facilitate the probabilistic estimation of biological sex, accounting for the significant overlap in the expression of sexual dimorphism.

Assigned sex estimation with the clavicle and scapula: A study in a Portuguese reference sample.

Background Current understanding of the mechanism of action of the pericapsular nerve group (PENG) block is primarily based on cadaver studies. We performed an imaging study in patients undergoing hip surgery to enhance the understanding of the analgesic mechanisms following a PENG block. Materials and methods 10 patients scheduled for hip surgery received an ultrasound-guided PENG block with 18 mL of 0.5% ropivacaine mixed with 2 mL of a contrast agent. After completion of the block, a high-resolution CT scan was performed to obtain a three-dimensional reconstruction of the injectate’s dispersion. Results The CT imaging revealed that injectate was mainly confined to the epimysium of the iliacus and the psoas muscle, with a minor spread to the hip capsule. Contrast dye was detected within the iliacus and/or the psoas muscle in all patients. No observed spread to either the subpectineal plane or the obturator foramen was detected. Conclusion Our study suggests that the analgesic effect of the PENG block may be related to the block of the branches of the femoral nerve traveling within the iliopsoas muscle without a spread pattern commensurate with the block of the obturator nerve. Trial registration number ClinicalTrials.gov Registry ( NCT06062134 ). 

Pericapsular nerve group block: a 3D CT scan imaging study to determine the spread of injectate

Purpose The pericapsular nerve group (PENG) block provides satisfactory postoperative analgesia without hampering motor function for total hip arthroplasty (THA); however, unexpected motor block has been observed clinically. It is unknown whether this motor block is related to the dose of ropivacaine. We aimed to conduct a prospective randomized trial to test whether reducing the volume or concentration of ropivacaine was better for less motor block after PENG block. Patients and Methods Ninety-nine patients with fracture or femoral head necrosis scheduled for THA were randomly allocated to receive 20 mL 0.5% ropivacaine (Group A), 20 mL 0.25% ropivacaine (Group B), and 10 mL 0.5% ropivacaine (Group C). The primary outcome was the incidence of postoperative quadriceps motor block at 6 hours. Secondary outcomes were the incidence of postoperative quadriceps motor block at 0, 12, 24 and 48 hours; pain scores on the numeric rating scale (NRS) at all postoperative time points (0, 6, 12, 24, and 48 hours); the time to first walk; the incidence of rescue analgesia; side effects such as dizziness, ache, nausea, and vomiting; and patient satisfaction. Results Compared with Group A, Group C resulted in a lower incidence of quadriceps motor block at 0 hours, 6 hours and 12 hours postoperatively (P < 0.05), while Group B only resulted in a lower incidence of motor block at 12 hours postoperatively (P < 0.05). No intergroup differences were found in terms of postoperative pain scores, the incidence of rescue analgesia, adverse events or patient satisfaction (P > 0.05). Conclusion A higher incidence of motor blockade was observed when 20 mL of 0.5% ropivacaine was administered, which was mainly caused by the excessive volume. Therefore, we recommend performing PENG block with 10 mL 0.5% ropivacaine.

Effect of Pericapsular Nerve Group Block with Different Concentrations and Volumes of Ropivacaine on Functional Recovery in Total Hip Arthroplasty: A Randomized, Observer-Masked, Controlled Trial

Optimal techniques of ultrasound-guided superficial and deep parasternal intercostal plane blocks: a cadaveric study

Facial reconstruction using 3-D computerized method: A scoping review of Methods, current Status, and future developments.

SUMMARY: As natural disasters or crimes, precise postmortem identification is needed especially in case of unknown human remains. The aim of the study is to assess sexual dimorphism by formulating new multivariate equations based on scapular and clavicular parameters for a modern Thai population. Eight left scapular and six left clavicular parameters were measured from 278 individuals (124 males and 124 females for training group; and 15 males and 15 females for test group) of a modern Thai population with age ranges from 19 to 101 years. All scapular and clavicular parameters were sexually dimorphic. Direct and stepwise multivariate discriminant function analysis was performed to generate models. Three direct multivariate discriminant functions showed accuracy rates from 91.1c to 92.3 % (cross-validated range from 90.3 % to 91.5 %). Similarly, three stepwise multivariate discriminant functions showed accuracy rates from 90.7 % to 92.7 % (cross-validated range from 90.7 % to 92.7 %). Moreover, the test group showed 86.67 % to 100 % of sex determination accuracy in six discriminant functions. As recommendation for sex determination by using combination of the scapular and clavicular parameters yields statistically high accuracy for sex determination. Therefore, the accuracies of these multivariate discriminant function equations obtained from scapula and clavicle can be applied for forensic sex determination, especially in modern Thais.

Sex Determination Using Scapular and Clavicular Parameters in Modern Thai Population

Estimation of Stature Based on Metatarsal Bones in a Thai Population

<h3>Background and Aims</h3> Parasternal intercostal plane (PIP) block provides effective analgesia for the anteromedial thorax; however, the optimal technique has not been elucidated. This cadaveric study aims to describe the anatomy of the transversus thoracis muscle (TTM) and internal mamillary artery (IMA), and to investigate dye spread after superficial and deep approaches of PIP block. <h3>Methods</h3> The study was approved by the hospital ethics committee (ANE-256307685). After sonographic examination, superficial or deep PIP blocks with single or multiple injections were randomly applied in 24 hemithoraces. Twenty mL of dye was injected for each block. On dissection, dye distribution over the intercostal spaces (ICS) was recorded. <h3>Results</h3> The TTM was consistently found at the 2nd-6thICS on both sides of the thorax. Agreement between the sonographic identification and presence of the TTM was higher than 80% at the 2nd-5thICS. Along the 2nd-6thICS, the IMA located medial to the halfway between lateral border of the sternum and the costochondral junction, and the mean distance from the sternal border was 9.3 (4.8) mm. For both superficial and deep approaches of PIP block, the more numbers of injections rendered the wider dye distribution. The numbers of stained ICS after superficial PIP block at 2nd, 4th, and 5thICS, and deep PIP block at 3rd and 5thICS were 5.3 (1.2) and 5.7 (0.6), respectively. <h3>Conclusions</h3> Triple injections at the 2nd, 4th, and 5thICS for superficial approach and double injections at the 3rdand 5thICS for deep approach were optimal techniques of PIP block. 

/pdf/b87-a-cadaveric-study-determining-optimal-techniques-for-lwjatkss.pdf

B87 A cadaveric study determining optimal techniques for ultrasound-guided parasternal intercostal plane block

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Optimal techniques of ultrasound-guided superficial and deep parasternal intercostal plane blocks: a cadaveric study

Facial reconstruction using 3-D computerized method: A scoping review of Methods, current Status, and future developments.

Sex Determination Using Scapular and Clavicular Parameters in Modern Thai Population

Estimation of Stature Based on Metatarsal Bones in a Thai Population

B87 A cadaveric study determining optimal techniques for ultrasound-guided parasternal intercostal plane block