Background: Thoracic retrolaminar block (TRLB) is a relatively new regional analgesic technique that can be used as an alternative to thoracic paravertebral block. This study aimed to evaluate the postoperative analgesic effects of ultrasound-guided TRLB in children undergoing open cardiac surgery via median sternotomy incision.Methods: Sixty-six patients aged 2 to 8 years undergoing cardiac open cardiac surgery via median sternotomy incision were recruited. In the TRLB group, 0.25% bupivacaine 0.4mL/kg was injected into the retrolaminar space on each side at the level of T4 lamina. Patients in the control group were injected with 0.9% saline. The primary outcome measure was the 24h post-extubation fentanyl consumption. The secondary outcome measures were total intraoperative fentanyl consumption, postoperative modified objective pain score (MOPS) and time to extubation. Results:The mean±SD total intraoperative fentanyl requirements (μg/kg) and the 24h postextubation fentanyl consumption (μg/kg) were significantly lower (P<0.001) in the TRLB group (9.3±1.2&6.9±2.1 respectively) than the control group (12.5±1.4&16.6±2.8 respectively). The median (Q1, Q3) time (h) of extubation and the mean±SD time (h) of ICU length of stay were significantly shorter (P<0.001) in the TRLB group (2 [1-3] &23.8±3.2 respectively) in comparison with the control group (6 [4.5-6] & 30.3±3.2 respectively). MOPS was significantly lower (P<0.05) in the TRLB group than the control group at the following time points, 0, 2, 4, 8, 12 and16 hours after extubation. Conclusions: Bilateral ultrasound-guided TRLB is effective in providing postoperative analgesia in children undergoing open cardiac surgery via median sternotomy incision.

Background: Surgical repair of congenital inguinal hernia results in significant postoperative discomfort and pain. The aim of the current study was to evaluate the pre-emptive analgesic efficacy of a transversalis fascia plane (TFP) block after pediatric inguinal herniorrhaphy.Methods: Forty-four patients aged 12 to 60 months who underwent unilateral inguinal herniorrhaphy were enrolled. Four patients were excluded, and the remaining were allocated to the control group and the TFP block group. In the TFP block group, 0.4 mL/kg bupivacaine 0.25% was instilled in the plane between the transversus abdominis and transversalis fascia, while in the control group 0.9% saline was used instead of bupivacaine. The collected data were the total dose of paracetamol consumed during the first 12 h postoperatively, the postoperative Face, Leg, Activity, Cry, Consolability (FLACC) pain score, time to first use of rescue analgesia, number of patients required additional postoperative analgesics, and parents' satisfaction.Results: The median paracetamol consumption was significantly lower in the TFP block group than in the control group, and FLACC pain scores were significantly lower for all study times in the TFP block group with higher parental satisfaction scores than those for the control group. The number of patients who required additional analgesics was significantly lower in the TFP block group than in the control group. Conclusions: The use of a TFP block decreases postoperative analgesic consumption and postoperative pain intensity after pediatric inguinal herniorrhaphy. Future studies with larger sample size are required to evaluate the actual complications rate of TFP block.

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Background Heart rate variability (HRV) is a valuable indicator of autonomic nervous system integrity and can be a prognostic tool of COVID-19 induced myocardial affection. This study aimed to compare HRV indices between patients who developed myocardial injury and those without myocardial injury in COVID-19 patients who were admitted to intensive care unit (ICU). Methods In this retrospective study, the data from 238 COVID-19 adult patients who were admitted to ICU from April 2020 to June 2021 were collected. The patients were assigned to myocardial injury and non-myocardial injury groups. The main collected data were R-R intervals, standard deviation of NN intervals (SDANN) and the root mean square of successive differences between normal heartbeats (RMSSD) that were measured daily during the first five days of ICU admission. Results The R-R intervals, the SDANN and the RMSSD were significantly shorter in the myocardial injury group than the non-myocardial group at the first, t second, third, fourth and the fifth days of ICU admission. There were no significant differences between the myocardial injury and the non-myocardial injury groups with regard the number of patients who needed mechanical ventilation, ICU length of stay and the number of ICU deaths. Conclusions From the results of this retrospective study, we concluded that the indices of HRV were greatly affected in COVID-19 patients who developed myocardial injury.