Comparing ultrasound-guided modified thoracoabdominal nerves block through perichondrial approach with oblique subcostal transversus abdominis plane block for patients undergoing laparoscopic cholecystectomy: a randomized, controlled trial

Abstract Background Laparoscopic cholecystectomy(LC) causes significant postoperative pain. Oblique subcostal transversus abdominis plane(OSTAP) block was described for postoperative analgesia, especially for upper abdominal surgeries. Modified thoracoabdominal nerves block through perichondrial approach(M-TAPA) block is a new technique defined by the modification of the thoracoabdominal nerves through perichondrial approach (TAPA) block, in which local anesthetics are delivered only to the underside of the perichondral surface. The primary aim of this study was to evaluate the effect of M-TAPA and OSTAP blocks as part of multimodal analgesia on postoperative opioid consumption in patients undergoing LC. Method The present study was designed as a randomized, controlled, prospective study. Seventy-six adult patients undergoing LC were randomly assigned to receive either bilaterally M-TAPA or OSTAP block after the induction of anesthesia and before surgery using bupivacaine 0.25%, 25 ml. The primary outcome was assessed as postoperative 24 h opioid consumption, between groups were compared. Secondary outcomes were Numerical Rational scale(NRS) scores, time to first opioid analgesia, patient recovery, using the Quality of Recovery-15 (QoR-15) scale, nausea and vomiting, sedation score, metoclopramide consumption, and evaluating the analgesic range of dermatome. Results The mean tramadol consumption at the postoperative 24th hour was higher in the group OSTAP than in group M-TAPA (P = 0.047). NRS movement score at 12th hour was statistically significantly lower in group M-TAPA than in group OSTAP (P = 0.044). Dermatomes showed intense sensory analgesia between T7-11 in both groups, and it was determined that there was proportionally more involvement in the group M-TAPA. There were no differences between the groups in terms of other results. Conclusions After the LC surgery, ultrasound-guided M-TAPA block effectively reduced opioid consumption, postoperative pain, and QoR-15 scores similar to OSTAP block. Clinical trial registration The study was registered prospectively at clinicaltrials.gov (trial ID: NCT05108129 on 4/11/2021)

Determination of anticancer activity and biosynthesis of Cu, Zn, and Co hybrid nanoflowers with Tribulus terrestris L. extract

In this work, a green process for the synthesis and characterization of hybrid nanoflowers was proposed, wherein&nbsp;Tribulus terrestris&nbsp;L. extract functioned as the organic component and Cu (II), Zn (II) and Co (II) metal ions as the inorganic element during the formation of the nanoflowers. To characterize the synthesized hybrid nanoflowers (hNFs), the morphologies were investigated using SEM, EDX, FT-IR analysis, elemental mapping, and XRD spectroscopy. The cytotoxic effect of hNFs was investigated to test biological activity. A549 cell lines and the MTT staining method were used for the anticancer activity of&nbsp;T. terrestris&nbsp;L. extract and hNFs. Differences in SEM images were observed as the metal content changed. Cytotoxic evaluations have shown that Co nanoflower may be a safer therapeutic alternative than plant extracts and other nanoflowers. It was observed that Zn and Cu hybrid nanoflowers were influential on the cell line up to a specific concentration, but as the concentration increased, they increased cell viability. It was observed that metal hybrid nanoflowers increased the anticancer activity compared to&nbsp;T. terrestris&nbsp;L. extract. These results can contribute to developing adequate new-generation preparations for A549 (lung cancer) problems of nanoflowers synthesized using&nbsp;T. terrestris&nbsp;L. extract. In summary, this study has been conducted for the first time.</p