Background To evaluate the analgesic efficacy and spread of variable volumes of local anesthetics (LA) in Erector spinae plane block (ESPB). Methods Sixty patients aged between 18 and 50 years with an ASA I-II and scheduled for breast cancer surgery were randomized to receive either ESPB with 20 ml 0.25% bupivacaine (Standard volume ESPB), or with 40 ml 0.125% bupivacaine (High volume ESPB), or no ESPB (GA only group). The primary outcome was pain intensity evaluated by the visual analogue scale (VAS), 12 hours after surgery. P-values < 0.05 were considered the cutoff point for statistical significance. The secondary outcomes were pain at rest and pain on movement evaluated by the VAS, craniocaudal injectate spread, to paravertebral (PV) and epidural spaces assessed by CT, clinical dermatomal spread, level of sedation or agitation, and patient satisfaction with anesthesia and analgesia. Results VAS at rest 12 h after surgery was less in both intervention groups compared to the control (1.75 ± 0.79 vs. 1.6 ± 0.88 vs. 3.4 ± 1.96, p = 0.001). The LA had extended further in the high volume group than the standard volume group (11.20 ± 3.07 vs. 9.15 ± 2.54 vertebral levels, p = 0.027). No difference of the spread to PV or epidural spaces between the 2 intervention groups. More dermatomes were covered in the high volume group (7.20 ± 2.12 vs. 5.75 ± 1.37 dermatomes, p = 0.014). Agitation was higher in the GA only group than both ESPB groups in the first 8 postoperative hours. Patients were more satisfied in both ESPB groups than the GA only group. Conclusions Preoperative ESPB is an excellent analgesic modality and it can also attenuate both postoperative agitation and sedation. Doubling the injectate volume enhances the craniocaudal spreading and may be useful for surgeries requiring multiple dermatomes. However, larger volume has no effect on analgesic efficacy or patient satisfaction as there is no further spread to the PV, epidural spaces or spinal nerve rami. Trial registration NCT04796363 (12/3/2021).

Background: The goal of this study was to evaluate varying volumes of ESPB on analgesia, LA spread, sedation, and patient satisfaction.Methods: 60 patients aged between 18 and 50 years with an ASA I-II and scheduled for breast cancer surgery were randomized to receive either ESPB with 20 ml 0.25% bupivacaine (Standard volume ESPB), or with 40 ml 0.125% bupivacaine (High volume ESPB), or no ESPB (GA only group). The primary outcome was pain intensity evaluated by the VAS, 12 hours after surgery. P-values < 0.05 were considered the cutoff point for statistical significance. The secondary outcomes were pain at rest and pain on movement evaluated by the VAS, craniocaudal injectate spread, to PV space and epidural space assessed by CT, clinical dermatomal spread, level of sedation assessed by RASS, and patient satisfaction with anaesthesia and analgesia.Results: VAS at rest 12 h after surgery was less in both intervention groups compared with the control (1.75 ± 0.79 vs. 1.6 ± 0.88 vs. 3.4 ± 1.96, p = 0.001). In other time points, VAS was less in each ESPB group compared to GA only during rest and movement and the volume injected made no difference. The LA had extended further in the high volume group than the standard volume group (11.20 ± 3.07 vs. 9.15 ± 2.54 vertebral levels, p = 0.027). No difference of the spread to PV space or epidural space between the 2 intervention groups. More dermatomes were covered in the high volume group (7.20 ± 2.12 vs. 5.75 ± 1.37 dermatomes, p = 0.014). Agitation was higher in GA only group than both ESPB groups in the first 8 postoperative hours. Patient satisfaction was higher in both ESPB groups compared to GA only group.Conclusions: Preoperative ESPB is an excellent analgesic modality that should be considered in breast cancer surgeries. Apart from analgesia it attenuates postoperative agitation and enhances patient satisfaction. Volume injected has no effect on analgesia or patient satisfaction but it results in more LA spread.Trial registration: NCT04796363 (12/3/2021)

Objective: To assess the efficacy of therapeutic ear plugs in the treatment of myogenous TMD compared to stabilization splints. Materials and Methods: 60 patients suffering from myogenous TMD according to DC/TMD criteria where divided into 2 group, stabilization splint group, and a group treated with therapeutic ear plugs. Pain was evaluated using visual analog scale VAS, and mouth opening was evaluated using a mouth opening index OI, after 1 and 3 months. Results: Pain was reduced significantly in the ear plug group, dropping from 7.18 to 3.82 after 1 month and to 2.41 after 3 months. For the splint group there was significant drop in pain after 3 months where it decreased from 7.34 to 2.63, while it showed a nonsignificant decrease after 1 month (6.16). OI showed significant improvement in mouth opening in the ear plug group decreasing from 10.34 to 6.14 after 1 month and to 5.13 after 3 months. In the splint group the OI improved significantly from 11.06 to 4.87 after 3 months, while the improvement wasn't significant after 1 month (9.85). Conclusions: Therapeutic ear plugs are a discrete, small, and effective alternative to stabilization splint in the treatment of myogenous TMD, and its full-time wear advantage over the splint makes its action more rapid.

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