Ultrasound-Guided Erector Spinae Plane Block: A Comparative Study to Assess its Analgesic Efficacy in Pediatric Patients Undergoing Aortic Coarctation Repair

Background: Effective postoperative analgesia is an important aspect of both anesthetic practice and postoperative outcomes. Thoracotomy for the repair of coarctation of the aorta is a painful surgical procedure; inadequate postoperative analgesia may result in postoperative respiratory complications with the possible prolonged need for oxygen therapy. In addition, paradoxical hypertension is a well-recognized complication of repair. We hypothesize that erector spinae plane block (ESPB) by providing adequate analgesia and blocking sympathetic stimulation may reduce opioid consumption, accelerate weaning of oxygen therapy, and reduce the incidence of early postoperative paradoxical hypertension. Material and methods: Open-labeled randomized controlled trial carried out on 40 patients divided into two groups. Group (B) received ESPB before the skin incision and group (C), the control group received no block. Results: Patients who received ESPB had significantly less intraoperative fentanyl consumption than the control group (P-value<0.001), and significantly less postoperative fentanyl consumption by 50% than the control group in the first 12 hours 2.025 ±0.273 μg/kg and 4.05 ±0.527 μg/kg respectively (P-value<0.001). while there was no statistically significant difference between both groups regarding the incidence of postoperative vasodilator infusion for paradoxical hypertension (P-value=0.054), the pediatric anesthesia emergence delirium (PAED) (P-value=0.06) nor the time to wean oxygen supply (P-value=0.49).  Conclusion: Erector spinae plane block effectively reduces postoperative pain in pediatric patients undergoing repair of coarctation of the aorta. However, it did not significantly accelerate weaning from oxygen therapy nor reduce the incidence of vasodilator use for postprocedural hypertension

Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10 years; 78.2% included were male with a median age of 37 years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020