Background and aims: The supraumbilical region of the abdominal wall has a complex nerve supply with overlapping innervation of multiple intercostal nerves and their branches. Effective analgesia for surgical incision sites in this region can be challenging. Using ultrasound guidance, it is possible to block the anterior and lateral cutaneous branches of intercostal nerves, T6-T10, in the external oblique intercostal fascial plane. In this study, we compared the analgesic efficacy of the External Oblique Intercostal (EOI) fascial plane block with port-site infiltration in the post-operative period following laparoscopic cholecystectomy. Methods: Fifty ASA I and II patients posted for laparoscopic cholecystectomy were randomly assigned to receive ultrasound-guided EOI block (Group E) or Port-site infiltration of skin (Group P) with local anaesthetic solution. The primary outcome was the postoperative pain score, measured using the Visual Analog Scale (VAS). Secondary outcomes included the time to first analgesic requirement and the total requirement of opioids administered to provide pain relief in the first 24 hours post-operatively.Results: Patients in Group E had significantly lower VAS scores at 2, 4, 8 and 24 hours post-operatively (p<0.001). The mean time to first rescue analgesic was significantly later in Group E (484.8 ± 170.51 min) than in Group P (340.8 ± 96 min), with p=0.0006. Total intravenous Tramadol (mg) consumption in 24 hours was also lower (152±71.41 versus 260±50, p<0.0001) in Group E than in Group P, respectively.Conclusion: EOI block provides effective analgesia in laparoscopic cholecystectomy as observed by the reduced pain scores and reduced opioid analgesic consumption in the post-operative period.
Anaesthetic management of breast cancer in elderly patients with significant comorbidities is chal-lenging due to the associated perioperative risks. Regional anesthesia offers a safe alternative to general anesthesia by reducing systemic side effects, providing effective analgesia, and decreasing opioid consumption.We report an 80-year-old female with coronary artery disease, hypertension, and hypothyroidism with evidence of poor disease control, successfully undergoing modified radical mastectomy with axillary lymph node resection under ultrasound-guided Erector Spinae Plane block (ESPB) com-bined with Interscalene Brachial Plexus block (IBPB) as the sole anaesthetic technique without any untoward complications.
The rapid advancement of artificial intelligence (AI), particularly generative large language models (LLMs), has significantly transformed scientific publishing and the editorial process. AI tools are increasingly used by authors, reviewers, and editors for manuscript preparation, peer review, plagiarism detection, language editing, and preliminary screening, offering notable gains in efficiency and clarity. However, their use also raises critical ethical concerns related to authorship attribution, originality, transparency, accountability, data integrity, and editorial responsibility. This editorial examines the implications of AI in scientific publishing, highlighting its strengths in enhancing writing quality and streamlining editorial workflows, while also addressing its limitations, including the risk of fabricated content, bias, automation-dependency, and loss of critical scholarly skills. The challenges faced by editors in defining acceptable AI use, ensuring disclosure, safeguarding confidentiality, and maintaining human oversight are discussed in the context of existing ethical guidance. The editorial emphasizes that AI should function as a supportive tool rather than a substitute for human intelligence and judgment. Responsible integration of AI, guided by clear editorial policies, transparency, and ethical vigilance, is essential to preserve the integrity, credibility, and quality of scholarly publishing.
Acute respiratory distress syndrome (ARDS) is a potentially fatal condition associated with significant mortality rates. It is an infrequent complication of anaphylaxis. Despite its recognition as a sequela, no comprehensive reviews have yet been conducted on this topic. Particularly in the current context, where proposed revisions to ARDS diagnostic criteria are anticipated to increase the number of patients classified with ARDS, it is both timely and necessary to undertake an extensive review. Such an analysis aims to elucidate key aspects, including the identification of offending agents, clinical progression, outcomes, and patient demographics. Additionally, the review will evaluate the limitations inherent in the current body of evidence.
