Background Modified pectoral nerves (PECSII) and serratus blocks have been recently used for analgesia in breast surgery, but evidence comparing their analgesic benefits is limited. This prospective randomized, controlled study aims to examine the analgesic efficacy and safety profile of ultrasound-guided PECSII versus serratus blocks in patients undergoing modified radical mastectomy (MRM) for breast cancer. Patients and Methods One-hundred and eighty adult females scheduled for MRM were randomly allocated to three groups. PECS group patients received a PECSII block with 30mL of bupivacaine 0.25%, whereas SAPB group received a serratus anterior plane block (SAPB) using the same volume of bupivacaine 0.25% before induction of anesthesia. The control group received general anesthesia alone. Outcomes included 24 hours morphine consumption, intraoperative fentanyl requirements, visual analogue scale (VAS) scores for pain at rest and during movement, time to first rescue analgesia, postoperative nausea and vomiting (PONV), and sedation scores. Results Both PECSII and serratus blocks were associated with reduced postoperative morphine consumption compared to the control group (p<0.001). Both blocks were associated with reduced intraoperative fentanyl requirements, VAS scores, and PONV as compared with the control group. Also, they were associated with prolonged time to first rescue analgesia and better sedation scores in comparison with the control group. However, there were no differences between both blocks for all outcomes. Conclusion PECSII and serratus blocks provide similarly adequate analgesia following modified radical mastectomy. Clinical Trial Registration NCT02946294.

Background: Weaning failure is common in mechanically ventilated patients, and if ultrasound can predict weaning outcome remains controversial. The purpose of this study was to evaluate the diaphragmatic function (thickness and excursion) measured by ultrasound as a predictor of the extubation outcome. Methods: We included 62 mechanically ventilated patients from the chest intensive care unit in this study. Sixty-two patients who successfully passed the spontaneous breathing trial (SBT) were enrolled. The transthoracic ultrasound of the diaphragm was performed during an SBT to the assess diaphragmatic function (excursion and thickness), and they were classified into the successful extubation group and the failed extubation group. Results: There was a statistically significant increase in the successful extubation group in the diaphragmatic excursion and thickness fraction (p<0.001), a statistically significant negative correlation between the diaphragmatic function and the duration of the mechanical ventilation, and a statistically significant negative correlation between the diaphragmatic excursion and the Acute Physiology and Chronic Health Evaluation II. The diaphragmatic excursion cutoff value predictive of weaning was 1.25 cm, with a specificity of 82.1% and a sensitivity of 97.1% respectively, and the diaphragmatic thickness cutoff value predictive of weaning was 21.5%, with a specificity of 60.7% and a sensitivity of 91.2%, respectively. Conclusion: The diaphragmatic ultrasonography was found to be a promising tool for predicting the extubation outcome for mechanically ventilated patients.

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IntroductionForward head posture (FHP) is commonly seen in subjects with chronic neck pain (CNP) and is associated with respiratory function limitations. Therefore, the main aim of this study was to assess the effect of FHP compared with normal head posture (NHP) on diaphragmatic excursion in subjects with non-specific CNP.MethodsOverall, 30 subjects with CNP aged 35–45 years were recruited for this study and divided into 2 equal groups: the FHP group and the NHP group. The inclusion criteria were non-specific CNP duration of 3 months, presence or absence of FHP, FHP confirmed with a craniovertebral angle of < 50°, and male or female sex. The exclusion criteria involved cervical disc problems, cervical spondylosis, traumatic neck pain, chest disease or heart failure, neurological disorders affecting the diaphragm, obesity, and smoking. First, the craniovertebral angle was assessed for subject selection; then, the diaphragmatic excursion and the neck disability index (NDI) were established as the main clinical outcomes of the study. Unpaired t-test was used for statistical analysis.ResultsThe diaphragmatic excursion was lower in the FHP group than in the NHP group (57.00 ± 15.63 vs. 67.60 ± 15.18; p = 0.070), with no significant difference between the 2 groups. NDI did not differ significantly between the groups.ConclusionsWe suggest that FHP may be related to reduced diaphragmatic excursion in subjects with non-specific CNP. The multimodal approaches to physiotherapy management of non-specific CNP with FHP may consider our suggestion.

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