BackgroundPectoral (PECs) block was first described by Blanco et al for postoperative analgesia in breast surgery. It was proposed to be an easier and safer alternative to thoracic epidural or paravertebral block (PVB). In this systematic review and meta-analysis, we compare the perioperative analgesic efficacy and adverse events of PECs block and PVB.MethodsWe systematically searched PubMed, Central, EMBASE, CINAHL, Google Scholar, Web of Science citation index, US clinical trials register, Wanfang database, as well as recent conference abstracts, for clinical studies comparing the two techniques. Analgesic efficacy was assessed according to the time to first rescue analgesia and 24 hours opioid consumption. Adverse events from the trials were recorded and reported descriptively.ResultsThe literature search was last updated on 20 February 2020. We identified a total of 10 randomized controlled trials (RCTs) comparing PECs to PVB with 252 and 250 patients, respectively. There was no difference in 24 hours opioid consumption between PECs and PVB. There was no significant difference in the time to rescue analgesia between the two cohorts. The most common adverse event noted was postoperative nausea and vomiting). Trial sequence analysis indicate that further studies are unlikely to alter the conclusion regarding opioid requirement.ConclusionOur systematic review suggests that PECs and PVB are comparable in postoperative analgesia efficacy for mastectomy, and further studies are unlikely to alter the conclusion. The choice of technique should, therefore, be based on practitioner skill and institutional guidelines.PROSPERO registration numberCRD42020165137.
Introduction: Point-of-care ultrasound has seen an increase in its use in pre-hospital emergency care. There is lack of literature around the training requirement for point-of-care ultrasound of pre-hospital clinicians. This service evaluation assesses the effectiveness of a bespoke hybrid teaching programme. Methods: This is a service evaluation of the point-of-care ultrasound teaching programme at London’s Air Ambulance from 1 April to 28 May 2021. Subjects’ knowledge, image interpretation and confidence were assessed at two different points. Data were gathered using REDCap and exported to Excel for analysis. Mean values and delta were calculated, and t-test was applied for statistical significance. Results: In total, 57 participants were included; out of which 11 were excluded, as they did not complete a post-course survey. Of these, 41.3% participants were point-of-care ultrasound naïve. Mean pre- and post-course scores were 76.5% and 81.7%, respectively, with an average delta improvement of 5.2% (95% confidence interval = 4.70%–5.68%) which was statistically significant ( p < 0.002). There was a statistically significant mean improvement of pre- and post-course scores between point-of-care ultrasound naïve and point-of-care ultrasound experienced groups ( p = 0.014). Confidence in using point-of-care ultrasound showed mean overall improvement from 2.36/4 to 3.34/4, a mean difference of 0.98 (95% confidence interval = 0.61–1.34), which was statistically significant ( p = 0.0039). Conclusion: Our service evaluation highlighted that a hybrid teaching model used by London’s Air Ambulance was feasible and had shown significant improvement in the knowledge, image interpretation and confidence of both the point-of-care ultrasound naïve and the PoCUS experienced cohort of clinicians.
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