Regional anesthesia remains essential in lower limb orthopedic surgeries for providing effective intraoperative anesthetic control and post-operative analgesia with fewer systemic side effects. Therefore, it is of interest to evaluate the fifty patients undergoing elective lower limb orthopedic procedures to assess spinal versus epidural anesthesia in relation to hemodynamic stability and block duration. Twenty-five patients received hyperbaric bupivacaine via spinal route and twenty-five received bupivacaine through a lumbar epidural catheter. Spinal anesthesia demonstrated faster onset and denser surgical block but was associated with higher incidence of hypotension and bradycardia. Epidural anesthesia produced slower onset yet maintained better hemodynamic stability along with prolonged post-operative analgesia. Thus, data shows the both techniques are safe and effective, with choice guided by surgical duration, patient profile and post-operative pain management requirements.

Complex maxillofacial bone anatomy compromises the efficacy of local anesthetics. This study develops an ultrasound (US)/reactive oxygen species (ROS) cascade-responsive polylactic-coglycolic acid (PLGA) nanoparticle system for enhanced dental infiltration anesthesia and perioperative pain management. The nanoparticles, which were surface-modified with alendronate (ALN) via an ROS-cleavable thioketal (TK) linker and coloaded with bupivacaine (BUPI) and perfluorohexane (PFH), enabled enhanced bone targeting and penetration. Under US stimulation, PFH undergoes a liquid-gas phase transition, generating ROS that cleave TK linkers, switching the system from a "bone-targeting" to a "bone-penetration" state. This cascade mechanism facilitates deep tissue penetration of local anesthetics for enhanced anesthesia while enabling a dual-phase release profile: rapid US-triggered BUPI release for intraoperative analgesia and sustained diffusion for postoperative pain management. In rat models of tooth extraction and pulp injury, the system demonstrated superior efficacy over conventional BUPI, significantly increasing drug concentrations in the mandibular bone and improving pain-related outcomes. Biocompatibility was confirmed via histology and serum biomarkers. By overcoming maxillofacial bone barriers and enabling responsive, biphasic drug release, this platform represents a promising strategy to address the limitations of current local anesthetics in dentistry, reducing local anesthesia failure rates and improving perioperative pain control.

Background Effective postoperative pain management following midline laparotomy is critical to enhance recovery and minimize complications. The rectus sheath block (RSB) with bupivacaine has been proposed as a targeted, opioid-sparing regional analgesic technique. However, data from government hospital settings in India remain scarce. This study evaluated the efficacy of a single-dose RSB with 0.25% bupivacaine compared to standard postoperative analgesia using the Visual Analogue Scale (VAS). Methods A retrospective comparative study was conducted by reviewing records of patients who underwent midline laparotomy at Pandit Dindayal Upadhyay (PDU) Government Hospital, Rajkot, Gujarat, India, from January 2023 to June 2024 (1.5 years). Case records of 60 patients were reviewed and allocated to Group A (n = 30; RSB with 0.25% bupivacaine) or Group B (n = 30; standard care, no block) based on the analgesic technique documented in their operative and postoperative records. VAS pain scores, postoperative analgesia requirement, and rescue analgesia frequency, as recorded in nursing and anesthetic charts at 4, 8, 12, and 24 hours postoperatively, were extracted for analysis. Statistical analysis used the Mann-Whitney U test for VAS data and chi-square/Fisher exact tests for categorical outcomes. Results RSB significantly reduced VAS scores at all time points (median VAS: 3.00 vs. 5.00 at 4 hours; 4.00 vs. 6.50 at 8 hours; 4.00 vs. 7.00 at 12 hours; 5.00 vs. 7.00 at 24 hours; p < 0.001 at all time points). At four hours, none of the RSB patients required analgesia versus 25 (83.3%) in controls (χ[2] = 42.85, p < 0.001). Rescue analgesia was required four times by 25 (83.3%) controls versus none in the RSB group. Six (20.0%) RSB patients required no rescue analgesia over the 24-hour period. Conclusion Single-dose RSB with bupivacaine provides superior, prolonged postoperative analgesia in midline laparotomy patients, significantly reducing pain scores and analgesic requirements for up to 24 hours. RSB should be considered an integral component of multimodal postoperative pain management protocols, particularly where epidural analgesia is contraindicated or unavailable.

Background and aims The erector spinae plane (ESP) block is a popular technique for postoperative analgesia across various surgical procedures. This study aimed to compare two different approaches - the superficial ESP (SES) block and deep ESP (DES) block - for the duration and quality of analgesia in women undergoing modified radical mastectomy (MRM). Materials and methods This prospective, double-blind, randomized comparative study was conducted on 44 American Society of Anesthesiologists (ASA) physical status I/II patients aged 18-65 years and posted for MRM. Patients were randomly assigned to either Group DES or Group SES. Following induction of anesthesia, patients were turned lateral, and the ultrasound-guided blocks were performed at the level of the fourth thoracic vertebra (T4) with 20 mL of 0.25% bupivacaine and 6 mg dexamethasone, as per group allocation. Time to first request of supplemental analgesia, postoperative numeric rating scale (NRS) scores, and total analgesic consumption over 24 hours postoperatively were recorded. Results There was no significant difference in time to first request for supplemental analgesia between the two groups. Group DES demonstrated a lower percentage of patients requesting supplemental analgesia compared to Group SES (18.2% vs. 63.6%, p = 0.002). Additionally, Group DES had significantly lower total postoperative analgesic consumption (17.05 ± 39.63 mg vs. 51.14 ± 42.59 mg of diclofenac, p = 0.004) and reduced NRS scores at 12 hours (0.55 ± 1.224 vs. 1.86 ± 1.885, p = 0.01) as compared to Group SES. Conclusion The ESP block is an effective regional anesthetic technique for the provision of postoperative analgesia in patients undergoing MRM. The DES block provided better quality of analgesia compared with the SES block.

Dental opioid prescriptions remain one of the most common initial exposures to opioids worldwide. Although opioid prescribing in dentistry has declined, even limited exposure to opioids may be a significant risk factor for developing Opioid Use Disorder (OUD), particularly in younger populations. This review evaluates the existing literature on dental opioid prescriptions and the development of OUD, identifies procedural and patient-related risk factors, and assesses the effectiveness of existing intervention strategies. Following the PRISMA guidelines, a comprehensive literature search was conducted across MEDLINE, Embase, PsycINFO, Web of Science, and CENTRAL from January 2011 to July 2026. Eligible studies examined opioid prescribing in dental alveolar surgeries, related OUD/SUD outcomes, and preventative interventions. From an initial 1008 identified records, 12 studies met the final inclusion criteria for qualitative synthesis. Observational studies showed that factors significantly associated with persistent opioid use or adverse outcomes included higher prescribed opioid doses, prior substance use disorder, public or Medicaid insurance, younger age, female sex, and complex chronic medical conditions. Notably, patients undergoing low-pain dental procedures who received opioids demonstrated the highest relative risk for short-term persistent use. Five studies evaluated interventions, finding that short behavioral counseling and opioid-sparing pharmacologic strategies, specifically liposomal bupivacaine and preemptive intravenous paracetamol, effectively reduced postoperative opioid consumption. However, none of the included intervention studies had sufficient follow-up to evaluate the direct prevention of clinical OUD. Future research should prioritize prospective longitudinal studies and randomized controlled trials to evaluate interventions that safely reduce opioid exposure and definitively prevent OUD following dental procedures.