PurposeChronic postsurgical pain is a challenging problem after breast cancer surgery. This prospective, randomized, double-blinded, parallel-group, placebo-controlled trial was conducted to evaluate the influence of preoperative ultrasound-guided multilevel paravertebral blocks (PVBs) on chronic pain following mastectomy.Patients and methodsOne hundred eighty-four women were randomized to receive ultrasound-guided multilevel (T1–T5) PVBs with 5 mL of ropivacaine 0.5% or normal saline per level. The primary end point was the incidence of chronic pain at 3 months following mastectomy assessed by the brief pain inventory (BPI), while the secondary end points were the acute postoperative pain, the number of patients requiring rescue analgesia, postoperative nausea and vomiting (PONV), side effects, and chronic pain at 6 months after surgery assessed by the BPI.ResultsA total of 172 patients completed the study. Ultrasound-guided multilevel PVBs significantly decreased immediate postoperative pain for the first 12 hours (P<0.001). Additionally, fewer patients in the PVB group required rescue analgesia in the first 48 hours post-operatively compared to the control group (5/86 vs 28/86, OR =0.128, 95% CI: 0.047–0.351, P<0.001). No statistically significant difference was tested between the two groups (9.3% vs 17.4%, OR =0.419, 95% CI: 0.162–1.087, P=0.068) in the incidence of PONV. At 3 months, the incidence of chronic pain (BPI average pain score ≥3) was 34.5% and 51.2% (OR =0.511, 95% CI: 0.277–0.944, P=0.031) in the PVB and control groups, respectively, and at 6 months, the incidence was 22.1% and 37.2% (OR =0.479, 95% CI: 0.245–0.936, P=0.03), respectively. No complications occurred during the study.ConclusionThis study indicated that perioperative ultrasound-guided multilevel PVBs with ropivacaine improved acute postoperative pain and decreased postmastectomy chronic pain at 3 and 6 months postoperatively.

Fluid performances of gender online by gender-diverse individuals facing discrimination and fetishization raises questions about whether these acts are a source of empowerment or reinforce prevailing prejudice. We combine virtual ethnography and interviews with transwomen sex workers in Singapore (n = 14) to explore the dynamic between sociostructural oppression and agentic resistance. First, heterosexual power relations manifest online via digital practices of access, surveillance, and intervention to discriminate against and objectify respondents’ identities and bodies. Second, the online response can be categorized into specific digital practices of avoidance involving privacy and anonymity, accommodation via subtle practices of submission, and collaboration via community mobilization. Finally, gender performativity on sites for sex solicitation manifests in the presentation of both essentialist (submissive femininity) and provocative (hyper-sexual) embodiments, defying simplistic characterization into the structure-agency dynamic. We discuss the co-constructive nature of socially situated gender performances and the potential for challenging normative regimes of gender. Online spaces allow people to perform their gender more fluidly. We studied how gender-diverse people’s online media use can lead to both personal empowerment and social oppression. Social forces oppress gender-diverse people through online harassment and abuse. We classify these progressively intrusive digital practices as access, surveillance, and intervention. However, gender-diverse people also respond to such oppression through digital strategies such as avoidance, accommodation, and collaboration. Transwomen sex workers in Singapore perform femininity online in submissive and hyper-sexual ways. Our material suggests that they do this to both affirm their transgender identities and also to attract customers. These nuances blur the line between individual choice and compliance with social demands. Indeed, the informants’ quotes suggest that the digital strategies that seem to accommodate client desires may in fact empower these transwomen sex workers. Yet, it is uncertain if this individual empowerment leads to broader social change for gender-diverse communities.

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BACKGROUND: Patients with hemorrhagic shock may develop emerging enterogenic sepsis due to damage to the intestinal mucosal barrier and translocation of intestinal bacteria and endotoxins caused by ischemic injury. Because of the dual effects of anesthesia state and hemorrhagic shock, perioperative emerging enterogenic sepsis is even more rare and insidious. Case presentation: We reported a case of 56-year-old man who underwent right hepatectomy for intrahepatic bile duct stones. Severe hemorrhage occurred during the procedure and the hemodynamics neither improved nor worsened after rehydration therapy and vasoactive drug administration. Based on the patient's history and clinical presentation, a possible enterogenic sepsis was considered. After anti-infective treatment and hormone supplementation, the patient's circulation improved significantly and he had an uneventful recovery. Conclusion: The possibility of emerging enterogenic sepsis in hemorrhagic shock must always be taken into consideration. Familiarity with the risk factors and pathophysiological alterations of enterogenic sepsis is a prerequisite for early recognition and sound clinical decision making.