Introduction Traumatic rib fractures remain a significant cause of morbidity and mortality, particularly in older adults and polytrauma patients. Pain from rib fractures leads to impaired respiratory mechanics, reduced tidal volumes, and ineffective coughing, all of which predispose patients to complications such as atelectasis, pneumonia, and respiratory failure. Importantly, the use of systemic opioids—long considered the mainstay of analgesia—can further exacerbate respiratory depression, creating a challenging clinical paradox. Thoracic epidural analgesia (TEA) has traditionally been regarded as the gold standard for pain control in patients with multiple rib fractures. However, TEA is not feasible in many trauma patients due to contraindications such as coagulopathy, spinal injuries, altered mental status, or hemodynamic instability. This gap in care has driven interest in alternative regional anesthesia techniques. In recent years, thoracic fascial plane blocks—including erector spinae plane (ESP) block and serratus anterior plane block (SAPB)—have emerged as promising options. These techniques are technically simpler, safer in anticoagulated patients, and can be performed in a wider range of clinical settings. The scoping review by Niazi et al. provides a comprehensive evaluation of the current evidence supporting the use of these blocks in traumatic rib fractures. Study objective and methods The primary aim of this scoping review was to evaluate the effectiveness of thoracic fascial plane blocks in patients with multiple rib fractures, focusing on: Pain control Opioid consumption Respiratory function Secondary objectives included assessing safety and comparing these techniques with traditional modalities such as TEA and paravertebral blocks (PVB). Key methodological features Comprehensive database search: PubMed Embase Cochrane databases Web of Science Scopus Google Scholar ClinicalTrials.gov Timeframe: From database inception to October 2023 Inclusion criteria: Patients with unilateral or bilateral rib fractures Use of fascial plane blocks (ESP, SAPB, PEC, etc.) Reporting of pain or opioid outcomes Study types included: Randomized controlled trials (RCTs) […]

Total knee arthroplasty (TKA) is one of the most commonly performed orthopedic procedures worldwide, with increasing emphasis on enhanced recovery after surgery (ERAS) protocols. Effective postoperative analgesia is crucial to support early mobilization, reduce opioid consumption, and improve patient satisfaction. The adductor canal block (ACB) has become a cornerstone of regional anesthesia in TKA due to its motor-sparing profile and targeted analgesia of the anteromedial knee. In continuous ACB, boluses of local anesthetic are often administered via catheter to extend pain relief. However, there is little consensus on the optimal concentration and volume of local anesthetic for these boluses. This randomized non-inferiority trial, led by Kampitak et al., aimed to determine whether a low-volume, low-concentration bupivacaine bolus could provide pain relief comparable to a higher-volume, higher-concentration alternative. The results carry important implications for minimizing local anesthetic use while maintaining analgesic efficacy in TKA patients. Study objective and methods The study’s primary objective was to assess whether a 10 mL bolus of 0.15% bupivacaine is non-inferior to a 20 mL bolus of 0.25% bupivacaine in managing postoperative pain via continuous adductor canal block in patients undergoing total knee arthroplasty. This was a prospective, randomized, non-inferiority trial conducted at King Chulalongkorn Memorial Hospital in Bangkok, Thailand. The study enrolled 140 adult patients scheduled for primary unilateral TKA under spinal anesthesia, all of whom received multimodal analgesia including: Continuous adductor canal block with 0.15% bupivacaine at 5 mL/hour. Intraoperative local infiltration analgesia. A single-shot iPACK (interspace between the popliteal artery and capsule of the knee) block. Participants were randomized into two groups: 20/0.25 group: Received a 20 mL bolus of 0.25% bupivacaine. 10/0.15 group: Received a 10 mL bolus of 0.15% bupivacaine. The bolus was administered at the end of surgery through the catheter. Pain scores were assessed using an 11-point numeric rating […]