Background: Adequate control of acute postoperative pain is crucial in breast surgeries, as it is a significant factor in the development of persistent chronic pain. Inadequate postoperative pain control increases length of hospital stays and risk of severe complications. Erector spinae plane block (ESPB) is a novel regional block that has the ability to sufficiently block unilateral multidermatomal sensation from T1 to L3. By reviewing the literature on ESPB, this paper aimed to elucidate its efficacy in breast surgery analgesia and its role in addressing the opioid crisis in North America. Methods: PUBMED, EMBASE, and Cochrane databases were systematically searched for relevant articles according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Inclusion criteria included any articles that described ESPB in breast surgery. Exclusion criteria composed of articles that exclusively discussed other kinds of regional blocks. Results: Thirty-two articles including 6 randomized controlled trials were included in this review. ESPB demonstrated superior pain control and less opioid consumption compared with tumescent anesthesia or using no block. However, ESPB showed lower efficacy in pain control compared with pectoral nerve block. Patients experienced less nausea and vomiting and were overall more satisfied with ESPB compared with other pain control modalities. The vast majority of the studies reported the ease of ESPB administration, and only 1 case presented with a complication. Conclusions: ESPB is a promising form of regional anesthesia that can decrease postoperative pain and opioid consumption when used as part of multimodal pain analgesia for patients undergoing breast surgery.

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Background: Rectus diastasis is a common condition that can result in a protruding abdomen, causing cosmetic and functional disability. Although it is usually repaired during abdominoplasty or herniorrhaphy, there is a lack of consensus with regard to the repair indications and optimal surgical techniques. The goal of this study is to provide an updated review of the surgical techniques used for rectus diastasis repair and their comparative efficacy. Methods: In accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, the PubMed, Embase, and Cochrane databases were searched for articles that discussed the surgical management of rectus diastasis and reported on either outcomes, complications, or recurrence rates. Data detailing surgical techniques were extracted, and pooled analyses of complication and recurrence rates were performed, controlling for surgical approach, common variations in technique, and an associated herniorrhaphy. Results: Thirty-seven studies describing 45 techniques were included. An open rectus diastasis repair was performed in 24 of the studies. After controlling for an associated herniorrhaphy, there was no statistically significant difference in surgical complication and recurrence rates between open and laparoscopic approaches (p = 0.165 and p = 0.133, respectively). Although a double-layer suture closure was associated with a significantly lower rate of complications (p = 0.002), no significant difference was found for suture type absorbability. Conclusions: Surgical repair of rectus diastasis is safe and effective through both open and laparoscopic approaches. Although suture type absorbability does not affect complication or recurrence rates, a double-layer suture closure can decrease surgical complications. The pooled analysis of complication and recurrence rates can help improve informed consent and patient education.

In the current ever‐changing state of the COVID‐19 pandemic, it is clear that one of the casualties has been medical education across all academic levels. While clinical teaching has either been suspended or significantly modified, academic teaching is slowly recovering with the aid of online platforms. Though faculty and educators are working tirelessly to adapt curricula and ensure that students meet requirements to graduate without delay, there is still incredible uncertainty as to how medical training will coexist and evolve within the pandemic.

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Historically, medical trainees were surgically trained using Halsted's principles of training, which emphasize learning through direct exposure to surgical procedures, followed by hands-on practice on real patients. 1 Although this apprenticeship model of surgical training has been successful for centuries, recent changes in medical education, coupled with patient safety concerns left medical students with less opportunity to practice their surgical skills. 2 Furthermore, although the implementation of competency-based education throughout surgical residency programs has many well-cited merits, [3][4][5][6] it is forecasted to increase workload on attending surgeons for residents' assessment and evaluation, potentially leading to less direct supervision and surgical training of medical students. 7 Surgery as a career has been declining in popularity among medical students in the last several years. 8,9 Plastic surgery, in particular, witnessed a significant decrease in interest among Canadian medical students. A recent study showed that although the number of Canadian plastic surgery residency positions nearly doubled, first choice applicants decreased by over 15% within 6 years. 10 Another study confirmed that over the past decade, although American plastic surgery residency programs have Related Digital Media are available in the full-text version of the article on www.PRSGlobalOpen.com.

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