Preterm parents face higher risks of postpartum depression and anxiety, affecting bonding and infant development. Sensory stimulation shows promise, but its long-term impact on parental mental health needs further study.

This study aimed to evaluate whether a home-based integrated sensory stimulation program, administered to preterm infants by their parents, could alleviate parental mental health issues and enhance maternal bonding and parenting competence.

The program, including tactile, auditory, visual, gustatory, and olfactory stimuli, was assessed in a block-randomized controlled trial from November 2018 to January 2020. A total of 200 parents of preterm infants were recruited, and the intervention continued at home until the infants reached six months corrected age. Parents' depression and anxiety were assessed using validated scales at baseline, and at first, third, and sixth month follow-ups.

The intervention group included 98 parents, and the control group comprised 102 parents. At the six-month follow-up, the intervention group demonstrated significant improvements in maternal depression, state anxiety, and trait anxiety compared to the control group. In the mixed linear model, the intervention was associated with reductions in maternal trait anxiety (d =-2.18; 95% CI: -4.30, -0.06), paternal trait anxiety (d =-3.37; 95% CI: -5.62, -1.11) and state anxiety (d =-4.63; 95% CI: -7.00, -2.26).

The home-based integrated sensory stimulation program, when provided by parents to preterm infants, was effective in improving parents' mental health and can serve as an alternative treatment for postpartum depression and anxiety in parents of preterm infants at home.

Initially, molecular hydrogen was considered a physiologically inert and non-functional gas. However, experimental and clinical studies have shown that molecular hydrogen has anti-inflammatory, anti-apoptotic, and strong selective antioxidant effects. This study aimed to evaluate the effects of 60 minutes of molecular hydrogen inhalation on respiratory gas analysis parameters using a randomized, double-blind, placebo-controlled, crossover design. The study was conducted at Faculty of Physical Culture, Palacký University Olomouc from September 2022 to March 2023. Twenty, physically active female participants aged 22.1 ± 1.6 years who inhaled either molecular hydrogen or ambient air through a nasal cannula (300 mL/min) for 60 minutes while resting were included in this study. Metabolic response was measured using indirect calorimetry. Breath-by-breath data were averaged over four 15-minute intervals. Compared with placebo (ambient air), molecular hydrogen inhalation significantly decreased respiratory exchange ratio and ventilation across all intervals. Furthermore, the change in respiratory exchange ratio was negatively correlated with body fat percentage from 30 minutes onwards. In conclusion, 60 minutes of resting molecular hydrogen inhalation significantly increased resting fat oxidation, as evidenced by decreased respiratory exchange ratio, particularly in individuals with higher body fat percentages.

Children in clinical settings are prone to anxiety due to developmental limitations, which hinders treatment progress. This systematic review and meta-analysis aimed to evaluate the efficacy of social robot interventions compared to routine care or alternative non-pharmacological strategies in reducing anxiety among children aged 4-12 years undergoing medical procedures in clinical settings, based on evidence from randomized controlled trials.

The review protocol was prospectively registered in PROSPERO. Five electronic databases PubMed, Web of Science, Embase, Cochrane Library and PsycINFO were searched for randomized controlled trials (RCTs) examining the effects of SRs on children's anxiety. The search ends on 1 December 2024. A total of 10 RCTs meeting the inclusion criteria were identified, involving 877 children aged 4-12 years.

The meta-analysis reveals a significant reduction in anxiety levels among children who interacted with social robots in clinical settings. Subgroup analyses showed that 1) Both inpatient and outpatient children exhibited reduced anxiety levels. 2) School-age children experienced a decrease in anxiety following interventions with social robots. 3) The social robots were effective in alleviating children's anxiety using distraction techniques and psycho-educational interventions.

This meta-analysis is the first to summarize the effects of social robots on anxiety in children and finds an overall positive trend. It's more effective than traditional psychotherapy and has no adverse effects due to drug use. In the context of care shortages, social robots represent a significant tool for reducing anxiety among children in clinical settings and demonstrate promising potential.

Angina with nonobstructive coronary arteries (ANOCA) is a major cause of chronic coronary syndromes, affecting nearly half of patients with anginal symptoms who undergo invasive coronary angiography. ANOCA may lead to substantial symptom burden, increased risk of adverse cardiac events, increased healthcare utilization due to ongoing symptoms, repeat hospitalizations, and invasive testing. The pathophysiology of ANOCA often involves a variety of coronary disorders, such as coronary microvascular dysfunction, epicardial or microvascular vasospasm and endothelial dysfunction. While coronary function testing (CFT) can identify each of these specific endotypes, in current practice it is used as a second- or third-line diagnostic tool, delaying diagnosis which contributes to persistent symptoms and diminished quality of life. The ILIAS ANOCA clinical trial aims to enhance understanding and management of ANOCA through early routine CFT-guided management.

After exclusion of obstructive coronary artery disease, eligible patients undergo comprehensive CFT, and will be randomized to blinding of the CFT results (control group) or disclosure of the CFT results combined with a tailored medical therapy escalation plan (intervention group). The control group will be unblinded after 1 year. The primary outcome is the mean difference in the within-subject change in Seattle Angina Questionnaire (SAQ) summary score between the groups at 6 months from baseline. Secondary outcomes include differences in SAQ-summary score and additional health-status and quality of life questionnaires at 12 and 24 months from baseline.

International Clinical Trials Registry Platform identifier NL-OMON20739.

In patients resuscitated after cardiac arrest, a higher mean arterial pressure (MAP) may increase cerebral perfusion and attenuate hypoxic brain injury. Here we present the protocol of the mean arterial pressure after cardiac arrest and resuscitation (MAP-CARE) trial aiming to investigate the influence of MAP targets on patient outcomes.

MAP-CARE is one component of the Sedation, Temperature and Pressure after Cardiac Arrest and Resuscitation (STEPCARE) 2 x 2 x 2 factorial randomized trial. The MAP-CARE trial is an international, multicenter, parallel-group, investigator-initiated, superiority trial designed to test the hypothesis that targeting a higher (>85 mmHg) (intervention) versus a lower (>65 mmHg) (comparator) MAP after resuscitation from cardiac arrest reduces 6-month mortality (primary outcome). Trial participants are adults with sustained return of spontaneous circulation who are comatose following resuscitation from out-of-hospital cardiac arrest. The two other components of the STEPCARE trial evaluate sedation and temperature control strategies. Apart from the STEPCARE trial interventions, all other aspects of general intensive care will be according to the local practices of the participating site. Neurological prognostication will be performed according to European Resuscitation Council and European Society of Intensive Care Medicine guidelines by a physician blinded to allocation group. The sample size of 3500 participants provides 90% power with an alpha of 0.05 to detect a 5.6 absolute risk reduction in 6-month mortality, assuming a mortality of 60% in the control group. Secondary outcomes will be poor functional outcome 6 months after randomization, patient-reported overall health 6 months after randomization, and the proportion of participants with predefined severe adverse events.

The MAP-CARE trial will investigate if targeting a higher MAP compared to a lower MAP during intensive care of adults who are comatose following resuscitation from out-of-hospital cardiac arrest reduces 6-month mortality.

Bladder cancer (BC) is a significant global health concern and includes non-muscle-invasive BC (NMIBC), which poses challenges due to recurrence and progression. Immunotherapy, such as immune checkpoint inhibitors (ICIs) and Bacillus Calmette-Guérin (BCG), shows promise particularly in cases of BCG failure or BCG-unresponsive NMIBC, with ICIs emerging as a potential treatment option for these challenging cases. To the best of our knowledge, the present study is the first to systematically compare the efficacy and safety of BCG with ICIs in NMIBC. The present meta-analysis identifies response predictors and treatment outcomes, which can help in recognizing potential biomarkers such as tumor characteristics, hemoglobin levels and baseline performance status, associated with therapy response. These insights may guide future research in developing personalized treatment strategies for BCG non-responsive NMIBC cases. Following the Preferred Reporting Standards for Systematic Reviews and Meta-Analyses guidelines, a systematic literature search identified relevant studies published between January 2015 and April 2024. Randomized controlled trials and clinical trials involving patients with BCG-refractory NMIBC were included in the primary analysis. Data extraction and analysis were conducted using Review Manager version 5.4, employing a random effects model. The risk of bias assessment followed the Cochrane guidelines. The present study included 2,154 participants across 10 studies evaluating treatments for NMIBC. Primary comparisons focused on BCG vs. ICIs: Pembrolizumab significantly improved tumor control (OR, 4.67; 95% CI, 1.43-15.25; P=0.01), progression-free survival (PFS; OR, 4.85; CI, 1.58-14.85; P=0.006), and overall survival (OS; OR, 3.61; CI, 1.28-10.19; P=0.02). Atezolizumab similarly outperformed BCG in metastatic disease (OR, 0.19; CI, 0.06-0.59; P=0.004) and lymph node involvement (OR, 0.43; CI, 0.20-0.93; P=0.03). ICIs exhibited a favorable safety profile vs. BCG, with fewer incidents of anemia (OR, 2.87; P=0.001) and diarrhea (OR, 1.79; P=0.03), despite higher rates of asthenia (OR, 7.33; P<0.00001) and pyrexia (OR, 3.26; P<0.00001). Exploratory comparisons with chemotherapy revealed pembrolizumab's advantages in terms of PFS (OR, 1.36; P=0.02) and OS (OR, 1.31; P=0.005), while atezolizumab improved metastatic control (OR, 0.54; P=0.0008). Heterogeneity was low for BCG comparisons (I2=0%) but high for chemotherapy (I2=81-95%). In conclusion, ICIs, particularly pembrolizumab and atezolizumab, demonstrate superior efficacy and safety over BCG in BCG-refractory NMIBC, supporting their use as first-line alternatives. These findings advocate for a paradigm shift in managing BCG-unresponsive disease, emphasizing personalized immunotherapy.

Adjunct treatment with a popliteal plexus block (PPB) provides moderate enhancement to multimodal analgesic regimens following total knee arthroplasty while maintaining motor function. However, the optimal anesthetic volume of local anesthetic for PPB remains unknown.

To compare the analgesic effects of PPB with 10 versus 20 mL of local anesthetics as an adjunct to a femoral triangle block after total knee arthroplasty.

This blinded, controlled, randomized clinical trial will include 120 patients, randomly assigned to receive PPB with either 10 or 20 mL of bupivacaine 5 mg/mL. All patients undergo primary total knee arthroplasty under spinal anesthesia and receive a multimodal analgesia regimen, including paracetamol, ibuprofen, opioids, dexamethasone, and a femoral triangle block.

Primary outcome is 24-h postoperative opioid consumption. Secondary outcomes include the frequency of patients with opioid-free analgesia in the first 24 h after surgery, postoperative pain intensity at rest and during mobilization, postoperative muscle function of the leg, ability to mobilize with crutches 6 h after surgery, and Quality of Recovery-15 survey at 24 h after surgery.

This trial hopes to optimize postoperative pain management after total knee arthroplasty by providing valuable insights into the optimal analgesic volume for PPB.

Danish Data Protection Agency: 693807, clinicaltrials.gov: NCT06908837, CTIS: 2024-520204-26-00.

Clinical work-up for suspected cardiac chest pain is resource intensive. Despite expectations, high-sensitivity cardiac troponin assays have not made decision making easier. The impact of recently validated rapid triage protocols including the 0-hour/1-hour hs-cTn protocols on care and outcomes may be limited by the heterogeneity in interpretation of troponin profiles by clinicians. We have developed machine learning (ML) models which digitally phenotype myocardial injury and infarction with a high predictive performance and provide accurate risk assessment among patients presenting to EDs with suspected cardiac symptoms. The use of these models may support clinical decision-making and allow the synthesis of an evidence base particularly in non-T1MI patients however prospective validation is required.

We propose that integrating validated real-time artificial intelligence (AI) methods into clinical care may better support clinical decision-making and establish the foundation for a self-learning health system.

This prospective, multicenter, open-label, cluster-randomized clinical trial within blinded endpoint adjudication across 12 hospitals (n = 20,000) will randomize sites to the clinical decision-support tool or continue current standard of care. The clinical decision support tool will utilize ML models to provide objective patient-specific diagnostic probabilities (ie, likelihood for Type 1 myocardial infarction [MI] versus Type 2 MI/Acute Myocardial Injury versus Chronic Myocardial Injury etc.) and prognostic assessments. The primary outcome is the composite of cardiovascular mortality, new or recurrent MI and unplanned hospital re-admission at 12 months post index presentation.

Supporting clinicians with a decision support tool that utilizes AI has the potential to provide better diagnostic and prognostic assessment thereby improving clinical efficiency and establish a self-learning health system continually improving risk assessment, quality and safety.

ANZCTR, Registration Number: ACTRN12620001319965, https://www.anzctr.org.au/.

Peri-operative glucocorticoids reduce pain after total knee arthroplasty, with evidence suggesting potential benefits of increased dosing in specific patient groups. However, the impact of repeat-dose glucocorticoids has not been studied in high-pain-response patients receiving pre-operative high-dose glucocorticoids.

To investigate the effect on pain of an oral dose of dexamethasone after total knee arthroplasty in selected high-pain-response patients who had received a pre-operative high dose of intravenous dexamethasone (1 mg kg -1 ).

Randomised, double-blind, placebo-controlled superiority study.

A multicentre study conducted at two major arthroplasty centres in Denmark from November 2021 to March 2024.

One hundred and ten patients undergoing total knee arthroplasty who had received multimodal analgesia including pre-operative intravenous dexamethasone 1 mg kg -1 . Selection criteria included a Pain Catastrophising Scale score greater than 20 and moderate-to-severe pain (VAS >30) during walking 24 h postoperatively.

Patients were randomised to either oral dexamethasone 24 mg or placebo on postoperative day 1.

The primary outcome was the proportion of patients experiencing moderate-to-severe pain during walking at 48 h postoperatively. Secondary outcomes included pain scores at various time points within 1 week postoperatively, rescue analgesics, quality of sleep, length of hospital stay and morbidity with follow-up at 30 days.

At 48 h postoperatively, 65% of patients in the dexamethasone group and 79% in the placebo group reported moderate-to-severe pain during walking: odds ratio 0.48 [95% confidence interval (CI), 0.20 to 1.16]; P  = 0.100. The mean ± SD Visual Analogue Scale (VAS) at 48 h during walking was 43 ± 21 in the dexamethasone group and 51 ± 22 in the placebo group ( P  = 0.051). There were no differences between the groups regarding secondary pain outcomes or the use of rescue analgesics.

The administration of a high oral dose of dexamethasone following an initial pre-operative dose of 1 mg kg -1 intravenously in selected high-pain-response patients had no effect on postoperative pain following total knee arthroplasty.

ClinicalTrials.gov identifier NCT05563155.

This study aimed to evaluate intergenerational differences in miniscrew placement accuracy in the palatine vault using dynamic computer-assisted surgery (d-CAS), and to assess the correlation between the number of surgeries, and both accuracy variables and procedure duration.

72 subjects were enrolled and for each two miniscrews were inserted in the paramedian region via d-CAS (144 overall). Subjects were randomly allocated into three groups according to the operator's generation: Group A (Generation X), Group B (Generation Y), and Group C (Generation Z). CBCT scans were superimposed to evaluate five variables: Entry-3D, Entry-2D, Apex-3D, Apex-Vertical, and angular deviation. Procedure duration was calculated. Statistical analyses included descriptive statistics, Shapiro-Wilk, ANOVA, Kruskal-Wallis, Tukey and Dunn's tests and Pearson Correlation. P-value was set at ≤ 0.05.

ANOVA test demonstrated significant differences between the three groups in Entry-3D (P < 0.001), Entry-2D (P < 0.001), and Apex-3D (P = < 0.001) parameters, while Kruskal-Wallis test found a significant difference in angular deviation (P = 0.003). Post-hoc comparison revealed significant differences between groups A and C, and groups B and C. Pearson correlation indicated a negative correlation between intervention time and number of surgeries.

Miniscrew insertion using d-CAS is operator-dependent, and the generational cohort of the operator is a factor that influences certain accuracy parameters. There is a correlation between the progression of surgeries and a reduction in the time employed. Understanding the impact of generational differences can encourage the use of digital technologies for novices in clinical practice.

NCT06661551 (clinicaltrials.gov; 10/25/2024).

Survival of in-hospital-cardiac-arrests is lower when they occur at night and at weekends than when they occur during the day. Despite numerous studies, there is little evidence regarding the cardiopulmonary resuscitation quality at night and the influence of a feedback device depending on time of day. The present study investigates the differences between chest compressions at night and during the day, with and without the use of a feedback device.

The study was approved by the local Ethics Committee and registered in the German Clinical Trials Register on 22nd of February 2022 (DRKS00027309) prior to inclusion of the first participant. 158 medical professionals were randomized into one of two groups: "no feedback" and "feedback"-group. In both groups, participants carried out three two-minute intervals of cardiopulmonary resuscitation on a manikin at day and at night. Members of the "feedback"-group received guidance by a feedback device. Primary endpoint was the mean compression depth at two time-intervals at the beginning (t1 = 30-60 s) and the end (t2 = 480-540 s) of the experience at night. Secondary endpoints included mean compression depth, adequate compression depth (%), compression rate and effective compressions (%).

At night, mean compression depth was significantly higher in the "feedback"-group at t1 (47.7 ± 7.9 mm, 95% CI [45.6-49.8] vs 42.9 ± 11.0 mm, 95% CI [40.8-45.0]) and t2 (46.2 ± 7.9 mm, 95% CI [44.0-48.4] vs 39.6 ± 11.6 mm, 95% CI [37.3-41.8]). There was no significant difference in mean compression depth between day and night in the "no feedback"-group (41.4 ± 10.8 mm, 95% CI [39.3-43.5] vs 42.2 ± 10.8 mm, 95% CI [40.1-44.3]) nor in the "feedback-group" (47.4 ± 7.6 mm, 95% CI [45.3-49.4] vs 47.4 ± 7.5 mm; 95% CI [45.4-49.5]).

The use of a real-time audiovisual feedback significantly improved compression depth during the day and night in a manikin-based simulation study with medical professionals.

High stress may diminish a surgeon's performance in the operating room. Music is perceived to reduce stress in this setting, however the psycho-physiological effects of music on intra-operative stress in inexperienced and experienced operators is incompletely understood. The effect of music on the psychological (Six-Item State-Trait Anxiety Inventory [STAI-6] and Surgical Taskload Index [SURG-TLX]) and physiological responses (e.g., heart rate variability) was determined to a simulated surgical task (carotid patch-angioplasty) in 15 medical students and 12 vascular surgeons under stressing conditions in a randomised crossover design. Music did not affect the speed or accuracy of the simulated surgical stress task performance. While the surgical task increased SURG-TLX scores from baseline to control (Δ32 [22-42]; mean difference [95% confidence interval]) and to music (Δ30 [20-40]), and increased STAI-6 scores in both conditions, there was no difference between music and control. The surgical task also increased heart rate (peak Δ5.1 bpm [3.0-7.1] vs. baseline p < 0.0001) and an index of cardiac sympathetic nervous system activity, and reduced an index of parasympathetic nervous system activity, with the latter two exacerbated by music (SNS index: 0.14 [0.004-0.27], p = 0.042; PNS index: - 0.11 [- 0.22 to - 0.008], p = 0.032). The more experienced group performed faster and more accurately than the inexperienced group, but there were no psychological or physiological differences in their responses to music. Despite previous research identifying generally positive surgeon perceptions of music on the intra-operative experience of stress, herein, background music failed to improve surgical task performance or attenuate subjective ratings of task load and anxiety, and physiological arousal.

A growing body of evidence supports short-term DAPT as safe and efficacious following PCI with DES. However, methodological criticism of RCTs has led to caution when translating results into clinical practice. This study aimed to critically appraise the methodological rigour of included studies and consolidate the evidence on the safety and efficacy of short-term DAPT.

Medline, Cochrane Library and Embase were searched from inception until August 2022. The primary outcome was the methodological quality of published primary studies. Risk of bias was assessed using RoB 2.0 and the CASP tool. Evidence was rated for quality using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) score approach. Other endpoints were all-cause mortality and major bleeding.

Eighteen RCTs were included. Based on GRADE score, there was a moderate level of certainty that the reported results for both outcomes are probably close to the true effect. A total of 78% (14/18) of RCTs had a low risk of bias when assessing all-cause mortality and 61% (11/18) when assessing major bleeding. The CASP tool confirmed methodological rigour; however, only 33% (6/18) of studies were applicable beyond the studied populations. Compared with 12 months of DAPT, short-term DAPT was associated with a reduced risk of major bleeding [relative risk (RR): 0.69, 95% CI: 0.54-0.88, P = 0.003, I2 = 45%] and trended towards a reduced risk in all-cause mortality (RR: 0.90, 95% CI: 0.79-1.01, P = 0.08, I2 = 0%).

With moderate certainty evidence, short-term DAPT appears safe and efficacious post-PCI with DES in the studied populations.

Limited systematic reviews have explored the impact of acupoint embedding (AE) therapy on intractable facial paralysis (IFP). This review presents the current evidence on the efficacy and safety of AE therapy in the treatment of IFP.

PubMed, Embase, Cochrane Library, Web of Science, Chinese Biomedical Literature Database, VIP Database for Chinese Technical Periodicals, China National Knowledge Infrastructure, and Wanfang databases were systematically searched from inception to February 2024 to identify randomized controlled trials (RCTs) without language restrictions. Data extraction and analysis were independently conducted by two reviewers. The Risk of Bias was assessed using the Risk of Bias tool (version 2.0), and a meta-analysis was performed using the RevMan software (V5.4).

Eighteen RCTs involving 1881 patients were included in the analysis.

AE therapy demonstrated a higher total effective rate (relative risk [RR]: 1.28; 95 % confidence interval [CI]: 1.13-1.44; P < 0.0001), cure rate (RR: 1.81; 95 % CI: 1.05-3.12; P = 0.03), and facial nerve function score (standardized mean differences [SMD]: 1.57; 95 % CI: 1.16-1.99; P < 0.00001) compared to that of manual acupuncture. Additionally, AE therapy showed a higher total effective rate (RR: 1.16; 95 % CI: 1.10-1.22; P < 0.00001) and cure rate (RR: 1.70; 95 % CI: 1.46-1.98; P < 0.00001) in comparison to that of electroacupuncture. However, there were no significant differences in facial nerve function scores(SMD:2.04; 95 % CI: -1.25-5.32; P = 0.22) or adverse reactions(RR: 1.16; 95 % CI: 0.35-3.78; P = 0.81) between AE therapy and electroacupuncture therapy. Evidence supporting the efficacy and safety of AE treatment is also insufficient.

Most of the included studies indicated that AE therapy was more effective than MA/EA therapy for IFP. However, the quality of evidence for the majority of these studies was low, and all were conducted in China, where limited information has been reported regarding the safety of AE therapy.

Blood loss is a common side-effect in orthognathic surgery. Deliberated hypotensive anaesthesia can reduce blood loss. The purpose was to evaluate the effect of add-on dexmedetomidine compared with the usual hypotensive drug bolus on blood loss and patient outcomes in orthognathic surgery.

This double-blinded randomised controlled trial study was conducted on patients with American Society of Anaesthesiology class I or II, and 18 to 45 years-old, scheduled for bimaxillary orthognathic surgery. Patients were randomly divided into 2 groups: study (add-on dexmedetomidine; D group) and control (usual bolus of the hypotensive drug; C group) by block randomisation. The primary outcome variables were blood loss, postoperative haemoglobin, and incidence of intraoperative blood transfusion. The secondary outcome variables were the stability of the vital signs, overall pain score and opioid requirement, anaesthetic time, quality of the operative visual field, surgeons' satisfaction, hospital stay length and side effects. Statistical significance was defined as P-value <.05.

The sample was composed of 60 patients with a mean age of 25.93 (4.66) years and 26 (43.30%) were male. The blood loss for D and C groups was 401.67 (131.62) and 898.33 (548.58) mL, respectively (P < .001). The D group demonstrated a significantly lower overall pain score 2.43 (1.36) versus 4.10 (1.19) for C group. The quality of the surgical field using Fromme's scale was significantly higher in D group 0.93 (0.83) versus 2.53 (0.94). Nausea/vomiting was also significantly lower in D group.

Adding-on dexmedetomidine in orthognathic surgery decreases blood loss and improves patient outcomes, especially in overall pain score, quality of the surgical field, and incidence of nausea/vomiting.

Dexmedetomidine can be considered a safe and effective medication for performing DHA in orthognathic surgery. Adding-on dexmedetomidine significantly reduced estimated blood loss by over 50% and improves patient outcomes.

Chronic neck pain is an important public health problem. Telerehabilitation has emerged as an important tool for individuals with musculoskeletal conditions.

The study aims to identify the effectiveness of a telerehabilitation exercise programme compared with a digital self-care booklet on non-specific neck pain.

A randomised controlled trial assessor-blinded, 3 months follow-up. 70 patients were randomised into two groups of 35. The telerehabilitation group received 6 weeks of individualised training through vídeo calls and an online booklet. The control group received an online booklet. The primary outcome was functional disability. Secondary outcomes included pain intensity, global perceived effect, self-efficacy, quality of life, and kinesiophobia. All outcomes were assessed at baseline, 6 weeks, and a 3-month follow-up.

There was a significant difference between groups for functional disability (Mean 10.3, CI 95% 4.8-15.7), pain intensity (Mean 2.8, CI 95% 1.4-4.1), global perceived effect (Mean -2.3, CI 95% -3.7 to -0.9), and self-efficacy (Mean -24.7, CI 95% -41.0 to -8.4) at the 6-week. At the 3-month follow-up, statistically significant differences were observed for perceived overall effect (Mean -2.0, CI 95% -3.4 to -0.6) and self-efficacy (Mean -26.3, CI 95% -42.8 to -9.8).

Telerehabilitation is effective in improving disability and pain intensity compared with self-care booklets only in individuals with non-specific chronic neck pain.

This trial is registered at https://ensaiosclinicos.gov.br/rg/RBR-10h7khvk under the registration number RBR10h7khvk at 09/16/2022.

Patient education, physical activity, and exercise are recommended as first-line treatments for mild to moderate hip and knee osteoarthritis (OA). We developed two novel healthcare interventions: an electronic medical record-embedded physical activity prescription tool (PARx) for physicians, and a free, online educational platform (Joint Management (JM)) with exercise programming and optional telerehabilitation with a physiotherapist for patients. Objectives: 1) Determine the effectiveness of PARx ​± ​JM on patient-reported outcomes, physical activity levels, and performance-based functional outcomes in individuals with mild to moderate hip or knee OA, versus usual care; 2) evaluate engagement and adherence to PARx ​+ ​JM; and 3) explore the feasibility of PARx and PARx ​+ ​JM.

NCT04544904.

Randomized controlled trial (type 1 hybrid implementation effectiveness). We will recruit 339 (113/group) participants ≥40 years old with mild to moderate hip or knee OA and randomize them into three groups: PARx, PARx ​+ ​JM, or control (usual care). Follow-up appointments will be completed at 2-, 6-, and 12-months. Primary outcome: Knee Injury/Hip Disability and OA Outcome Score. Secondary outcomes: physical activity levels, anthropometric measurements, physical function, and other patient-reported outcomes. We will assess intervention feasibility and hold focus groups with patients and providers to explore perceptions of the interventions.

Two novel healthcare interventions will be used to provide physical activity and exercise programming for individuals with mild-moderate knee and hip OA. This study will allow us to determine the effectiveness of these interventions on patient-reported outcomes, physical activity levels, and performance-based functional outcomes.

High-concentration oxygen inhalation is the primary intervention to prevent perioperative hypoxemia. However, there are concerns that this may induce an imbalance in oxidation‒reduction processes, particularly in pediatric patients with compromised antioxidant defenses. This study aimed to evaluate the impact of varying intraoperative concentrations of oxygen inhalation on oxidative stress in children by analyzing plasma biomarkers, oxygenation indices, and the duration of surgery and oxygen inhalation. Forty-five children scheduled for laparoscopic pyeloplasty under general anesthesia were randomly assigned to three groups, each receiving different fractions of inspired oxygen during surgery: 30%, 50%, or 80%. The primary outcome was the plasma concentration of oxidative stress markers, and the other measurements included the surgical duration and duration of oxygen exposure. Thirty-five children completed the study, with 11 in the low group, 12 in the medium group and 12 in the high group. The levels of superoxide dismutase at immediately post-tracheal intubation, hydrogen peroxide at 1 hour post-intubation, and 8-isoprostane at immediately post-surgical procedure were significantly higher in the high group than in the low group. The S100B levels at immediately post-surgical procedure were higher than those at immediately post-tracheal intubation and 1 hour post-intubation within the low group. Therefore, we conclude that inhaling a high concentration of oxygen during laparoscopic pyeloplasty under general anesthesia, for a duration of less than 3 hours, does not significantly increase oxidative stress in pediatric patients. This study was registered at the Chinese Clinical Trial Registry (registration No. ChiCTR2400083143).

The demand for high-quality clinical evidence supporting acupuncture remains urgent, necessitating the establishment of a suitable methodological framework to promote its generation.

Following internal deliberations and extensive online discussions with experts in the IDEAL Collaboration, we proposed the IDEAL-Acu framework specifically for acupuncture, based on the surgery-focused IDEAL model with necessary modifications to accommodate the characteristics of acupuncture. To ensure consensus on recommendations, a panel of external experts and internal research team members was convened, and any disagreements were iteratively resolved through expert review.

This article introduces an IDEAL-Acu framework with five stages for evaluating acupuncture outcome and improving practice to optimize treatment. The framework includes Idea (proposal of an acupuncture regime), Development (optimization or standardization of the acupuncture regime), Exploration (feasibility assessment for conducting a definitive RCT), Assessment (evaluation of effects through comparison with standard therapy or sham acupuncture), and Long-term monitoring (examination of long-term efficacy and safety) stages. We provide clear recommendations for each stage along with specific examples.

The framework highlights the importance of conducting studies at each stage in acupuncture evaluation process and can serve as a helpful guide for assessing its effects and promoting evidence-based practice in acupuncture.

The Common Terminology Criteria for Adverse Events (CTCAE) is the established toxicity scoring system that assigns severity grades (G1 = mild to G5 = death) to Adverse Events (AEs). Compared to CTCAE v3.0 (2006), updated versions introduced changes in severity grade definitions. This study evaluated changes between v3.0 and v5.0 (2017) for AEs in gynaecological radiotherapy.

After selecting AEs relevant for gynaecological radiotherapy in v3.0, changes in severity grades were identified using CTCAE v3.0-to-v5.0 mapping tables. Six radiation oncologists (ROs) evaluated severity grade definitions for changes in: clinical interpretation, subjective (patient-reported symptoms) and objective (details on medication/intervention) information, and expected severe (≥G3) events. Agreement was based on at least five (≥5)ROs.

Gastrointestinal, urinary, reproductive, general and injury/musculoskeletal AEs were selected (n = 118). G4 definitions in v5.0 were removed in 22 % of AEs. ≥5ROs agreed on changes affecting clinical interpretation especially for G2 (31 %) and G3 (30 %). For subjective information, 18 % of G2 and 15 % of G3 were judged relying more on patient-reported symptoms. Less objective information was found in 51 % of G3 definitions. Variability in agreement was observed especially for subjective information in G3 and expected ≥G3 events.

This analysis revealed that severity grade definitions in v3.0 and v5.0 for AEs in gynaecological radiotherapy present changes with potential impact on scoring in clinical studies. Notably, 22 % of AEs in v5.0 no longer have G4 defined, and G3 definitions often include fewer details on medication/intervention. Variability in ROs' interpretations is frequently observed, highlighting the need for education to standardise toxicity scoring.

Enteral nutrition (EN) is key to reducing malnutrition risk in critically ill children, with timing of EN initiation being an important consideration. This systematic review aimed to assess the effects of early enteral nutrition (EEN) compared to delayed enteral nutrition (DEN) in critically ill children as part of the Global Evidence, Local Adaptation (GELA) project.

We searched PubMed, Embase and two trial registries (January 2000-November 2023) and included randomised controlled trials (RCTs) comparing EEN (typically within 24-48 hours of admission) to DEN (typically >48 hours of admission) in children aged one month to 12 years, and excluding studies in children with severe acute malnutrition, or conditions requiring long-term EN. Guided by Cochrane methods, we conducted random-effects meta-analyses to obtain pooled effect estimates for outcomes selected by the guideline development group, assessed risk of bias using Cochrane's Risk-of-Bias-2 tool and assessed certainty of the evidence using Grading of Recommendations, Assessment, Development and Evaluation (GRADE).

Four RCTs randomising 899 children in critical care settings in India, Iran and USA were included. Overall risk of bias was assessed as 'high risk' or 'some concerns' for all outcomes. Low-certainty evidence suggests that EEN may reduce in-hospital mortality (absolute effect (AE) 53 fewer deaths per 1000, 95% CI -85 to -12, I2=0%, 3 RCTs, n=869) and length of hospital stay on average (mean difference (MD) -2.98 days, 95% CI -9.79 to 3.83, I2=0%, 2 RCTs, n=760) compared to DEN, and may result in little to no difference in nosocomial infections (wound and blood stream infections) (AE 5 fewer cases per 1000, 95% CI -52 to 52, I2=0%, 3 RCTs, n=869). Evidence is very uncertain about effects on length of paediatric intensive care unit stay, number of days on the ventilator, sepsis, ventilator-associated pneumonia, and time to wound healing.

EEN may reduce in-hospital mortality and length of hospital stay in critically ill children, but our confidence in the effect estimates is limited. More high-quality studies comparing EEN to DEN in relation to patient-relevant and clinically important outcomes in paediatric critical illness are needed.

PROSPERO CRD42023487325.

Assess whether manual therapy combined with the ischemic compression (IC) technique on myofascial trigger points (MTrPs) in the upper trapezius has the potential to affect shoulder pain and the quantity of MTrPs in the middle and lower trapezius muscles in individuals experiencing shoulder pain.

Sixty individuals with shoulder pain were randomly assigned to three groups: Mobilization Group (MG, n = 20), underwent joint mobilizations of the shoulder complex; Compression Group (CG, n = 20), received mobilizations combined with IC on the myofascial trigger points (MTrPs) in the upper trapezius; and Placebo Group (PG, n = 20), underwent mobilizations combined with placebo IC. The interventions were administered twice a week for a duration of six weeks. Assessments were conducted at three time points: pre-treatment (week-0), post-treatment (week-6), and after a 1-month follow-up (week-10). Pain levels were evaluated using the Visual Analogue Scale and the number of MTrPs was counted by manual palpation for each muscle portion.

Assessments in week 6 showed decreased pain for all groups (p < 0.05). Moreover, the number of MTrPs of the upper trapezius decreased in the CG and MG (p = 0.05); for the middle trapezius decreases were observed only in the MG and for the lower trapezius decreases only in the CG. At week 10, all groups maintained the post-intervention effects, without differences between groups.

The addition of the IC technique on the upper trapezius MTrPs was able to influence the number of MTrPs of the three portions of the trapezius muscle. The pain decreased in all individuals.

Explicit education about exercise-induced hypoalgesia (EIH) reduces experimental pain after a single exercise session in pain-free individuals. However, the effect in people with chronic pain is unclear. This study aimed to determine the effect of EIH education on pain during and following exercise in people with knee osteoarthritis (OA).

All procedures were administered online. Participants were randomised to receive 15-min of explicit EIH education or 15-min of general education about knee OA. Participants then completed a questionnaire on their beliefs about exercise and pain, followed by a bout of home-based lower limb resistance exercise. Pain intensity (0-10) was assessed before, during and immediately after exercise.

40 participants completed the study (67.3 ± 10.8 years old, 73 % female). Participants only somewhat agreed pain could be reduced following a single session of exercise and that the education changed what they thought about exercise and pain, but these beliefs were not significantly different between groups (p = 0.053 and p = 0.104, respectively). Pain was similar between groups (adjusted mean difference [95 % CI]) during exercise (0.51 [-0.72 to 1.74], p = 0.410) and following exercise (-0.75 [-1.62 to 1.11], p = 0.087. Compared to baseline, pain (mean difference [95 % CI]) was lower during exercise (-1.01 [-1.66 to -0.36], p = 0.003) and following exercise (-0.96 [-1.5 to -0.42], p < 0.001).

A single exercise session reduces pain in people with knee OA, but this was not influenced by pre-exercise education about EIH. Further research is needed to understand if and how EIH can be modulated in people with knee OA.

To assess the efficacy of citric acid passivation on implant abutments by evaluating their impact on bacterial load, microbiome composition, inflammatory response, and clinical and radiographic outcomes compared with control abutments over a 12-month follow-up period.

Implants were placed subcrestally in the posterior sextants and randomly assigned to receive a 2-mm high definitive abutment, either with citric acid passivation (CA group) or without (CTR group). Final restorations were delivered after 12 weeks. Samples of the peri-implant crevicular fluid were collected at 3, 6 and 12 months for microbiological and inflammatory analysis. Clinical and radiographic measurements were also performed at these intervals. The primary outcome was total bacterial quantification (log CFU/mL).

Data from 17 patients in the CA group and 16 in the CTR group were analysed. At 12 months, there were no significant differences in total bacterial load between groups (p = 0.689). The biofilm was predominantly composed of commensal bacterial genera in both groups throughout the study period. Although no significant differences were observed in the microbiome alpha- and beta-diversity (p > 0.05), the microbiome within study time points showed an increased beta-diversity in the CA group at 12 months (p = 0.019). CA abutments also showed a higher differential abundance of peri-implant pathogenic bacterial genera at 12 months. At the 6-month mark, the CA group exhibited a trend toward lower IL-1β levels compared with the CTR group (p = 0.072). No significant differences were noted in other clinical or radiographic parameters.

Citric acid passivation of definitive abutments does not enhance the microbiological or inflammatory profiles in the short term. Further studies are needed to explore the potential benefits of citric acid passivation on implant abutments.

Initially registered on clinicatrials.gov (NCT05592327).

To analyze the effect of two 12-week interventions with free dance and dance therapy compared to the control group on self-esteem, body image anxiety and depressive symptoms in women undergoing breast cancer surgery.

Randomized clinical trial, with two different interventions (free dance and dance therapy) carried out at different periods, consisting of 23 female breast cancer survivors (58.7 ± 9.9 years), divided into two groups, the intervention group (IG - n = 11) who received different interventions at different times and the control group (CG -n = 12) who maintained their routine activities. The interventions lasted 12 weeks, with 60-min sessions, held twice a week and with a washout period of 35 days between them. The outcomes assessed were self-esteem (Self-Esteem Scale), anxiety (Beck Anxiety Inventory), body image (Body Image after Breast Cancer), and depressive symptoms (Beck Depression Inventory).

There was an improvement within the free dance group in depressive symptoms (p = 0.013) and within the dance therapy group in anxiety (p ≤ 0.001). Difference between the free dance group in the variable depressive symptoms (p ≤ 0.001) and difference between the dance therapy group in anxiety (p ≤ 0.001). In body image, the limitations domain showed an intragroup difference (p = 0.039) due to a worsening post-intervention in the CG compared to the dance therapy group.

Women survivors of breast cancer showed improvement in anxiety and depressive symptoms after performing 12 weeks of free dance and dance therapy.

Clinical registry: Brazilian Clinical Trials Registry (ReBEC) (nº 0RBR-772ktp).

To investigate the efficacy and safety of manipulative osteopathic techniques in persons of all ages with various medical indications.

Overview of systematic reviews and meta-analyses.

We conducted a systematic literature search for systematic reviews of randomized controlled trials in English or German that compared osteopathic interventions to no treatment, sham treatment or any other non-osteopathic treatment, in bibliographic databases and other sources.

We included 27 systematic reviews covering nine therapeutic indications. Based on moderate quality of evidence, osteopathic treatment was an effective means of reducing pain and partially improving physical function in adults with acute neck pain, chronic non-specific low back pain, low back pain in pregnancy, and chronic non-oncologic pain. It can also shorten the length of hospital stays in premature infants. Furthermore, osteopathic treatment may relieve symptoms in adults with chronic neck pain, postpartum low back pain, migraine, and irritable bowel syndrome, and it may help children with otitis media. It did not appear to provide relief to adults with acute non-specific low back pain, fibromyalgia, headaches of various causes, women with lower urinary tract symptoms, and children with cerebral palsy. Evidence for other indications like vertigo, chronic obstructive pulmonary disease, hypertension, gynecological or birth-related complaints, and a number of pediatric indications was insufficient to draw firm conclusions.

Manipulative osteopathic techniques appears to be particularly effective in musculoskeletal conditions. Overall, the evidence base for the outcomes of manual osteopathic treatment has improved, despite heterogeneous studies that are partly of poor methodological quality.

This study was to investigate the efficacy of ultrasound-guided genicular nerve block for patients who underwent knee arthroscopy. Patients were randomized into 2 groups: (1) nerve block group: ultrasound-guided genicular nerve block (superomedial, superolateral, and inferomedial genicular nerve, 2 ml 0.5% ropivacaine each nerve.) before the general anesthesia, (2) control group: no intervention before the general anesthesia. The measurements were pain severity at 3,6, 12, 24, 48, and 72 hours after surgery at rest and at activity (Pain severity was primary outcome at 3 hours after surgery at rest); the time for first ambulation; straight leg raise; mechanical pain threshold of the block areas; time of the surgery, anesthesia and extubation; the use of analgesics in the perioperative period and 72 hours after the surgery; the number of patients awakening from pain on the first 2 nights after the surgery; the length of hospital stay; postoperative adverse effects. The pain severity was measured by visual analogue scale (VAS) (A 10-point VAS, 0 points painless, 10 points severe pain) and median (interquartile range). A total of 70 patients (median age: 53 y, 32 men; 35 per group) were included. Compared with the control group, the nerve block group had a lower pain VAS score at rest [2 (2-2) vs. 3 (2-4), P <0.01] at 3 hours, and lower pain VAS score at rest persisted for 24 hours and activity persisted for 12 hours after the surgery, also had a lower intraoperative dosage of sufentanil (20±4.8 vs. 28.5±5.1 mg; P <0.001), lower requirement for analgesics for pain and lower postoperative nausea and vomiting throughout the 72-hour observation period. There were no significant differences in the incidence of postoperative adverse effects and straight leg raise. In conclusion, ultrasound-guided genicular nerve block could reduce the pain severity after knee arthroscopy and decrease the use of intraoperative sufentanil without affecting motor function.

The high-power pain threshold ultrasound (HPPTUS) technique is one of the ultrasound modifications used to treat trigger points and is strongly recommended for patients with mechanical neck pain because this method has excellent benefits but the clinical significance of this method is unclear.

To investigate the influence of adding High power pain threshold ultrasound technique to traditional therapy on axioappendicular muscles amplitude and fatigue of patients with mechanical neck pain.

Single-blind, Randomized clinical trial.

Outpatient clinic.

Sixty patients (19-38 years old) with mechanical neck pain participated in this study and were recruited from the outpatient clinic at the faculty of physical therapy after a referral from an orthopedist.

Patients were randomly assigned by the opaque sealed envelope to two treatment groups: Group A Received High power pain threshold ultrasound (HPPTUS), traditional therapy in form of (active range of motion, stretching exercises, and postural correction exercises (PCES), whereas Group B Received traditional therapy only; therapeutic sessions were performed Twice/week for 4 weeks. The visual analog scale, pressure pain threshold, neck disability index, upper trapezius and Levator scapulae median frequency, and root mean square were used to evaluate the patients' pre-treatment and post-treatment status.

Multiple pairwise comparisons within each group revealed statistically significant differences in all outcome variables in both groups with favor to the HPPTUS group as p = 0.0001. Between group analysis at post treatment revealed statistical significant difference between both groups in all outcome variables as p = 0.0001.

The High-power Pain Threshold Ultrasound technique combined with traditional therapy is an effective method more than traditional therapy alone for management the patients with MNP.

The present study has implications, especially for clinical decision-making with regard to the therapy of choice in MNP to reduce pain, improve function and muscle activity through HPPTUS technique, and its impact on normal lifestyle and highlight the need for active intervention.

High levels of sedentary behaviour are associated with poor child health outcomes such as obesity. Early childhood education and care (ECEC) services are a key intervention setting. Most ECEC policy-based interventions focus on children's nutrition and physical activity with few aimed at children's sedentary behaviour.

To evaluate the effect of the Play Active ECEC policy intervention on educator adherence to sedentary behaviour policy recommendations, educator's practices and educator psychosocial influences related to children's sedentary behaviour.

Pragmatic cluster randomized trial in 81 ECEC services in Perth, Western Australia. Services implemented the Play Active policy over three months. Outcomes were educator-reported changes in adherence to sedentary behaviour policy recommendations, practices and psychosocial influences related to children's sedentary behaviour. Analysis involved descriptive statistics and generalized linear mixed-effects models.

Adherence to sedentary behaviour policy recommendations and educator's practices and psychosocial influences related to children's sedentary behaviour was high at baseline and did not significantly change in response to the Play Active policy intervention.

Educators appeared to adhere to best-practice guidelines for children's sedentary behaviour in ECEC. Clear evidence informed policy, standards and legislation to maintain children's low levels of sedentary behaviours in ECEC is warranted.

The diagnostic accuracy of gastric ultrasound in children has not been assessed thoroughly. We aimed to determine the sensitivity and specificity in children of a qualitative ultrasound examination of the gastric antrum in the supine 45° semi-recumbent position and a clinical algorithm for detecting a gastric fluid volume > 1.25 ml.kg-1, reported to represent an 'at-risk stomach' for pulmonary aspiration.

We conducted a prospective, observer-blinded, randomised trial in healthy children fasted according to current pre-operative guidelines. An initial ultrasound assessment of gastric contents ensured that the stomach was empty. Children then drank a specific volume of water (0; 0.6; 1; 1.25; 1.5; or 2 ml.kg-1). Gastric ultrasound was performed after 3 min of fluid ingestion, in children lying supine and then in the right lateral decubitus position, with the head of the bed elevated to 45° (semi-recumbent). A clinical algorithm combining the qualitative assessment with calculation of gastric fluid volume was also completed. The sensitivity and specificity of the qualitative assessment in the supine semi-recumbent position and the clinical algorithm for the diagnosis of gastric fluid volume > 1.25 ml.kg-1 were estimated.

Ninety children, median (IQR [range]) age 7 (4.5-9 [1-10]) y, were studied. The sensitivity and specificity of the qualitative assessment for detecting gastric fluid volume > 1.25 ml.kg-1 were 75% (95%CI 58-88%) and 85% (95%CI 73-93%), respectively. The sensitivity and specificity of the clinical algorithm were 86% (95%CI 71-95%) and 78% (95%CI 64-88%), respectively.

In order to achieve high sensitivity of gastric ultrasound for the diagnosis of fluid volume > 1.25 ml.kg-1 in children, qualitative ultrasound assessment of gastric antrum contents should be combined with calculation of gastric fluid volume when fluid contents are seen in the gastric antrum.

The intravenous cannulation of children in emergency can be extremely challenging. This study was aimed at investigating the effect of the vein-imaging device used in peripheral intravenous catheterization on the success of the procedure in patients who presented to the children's emergency department.

In this randomized controlled study, 70 6- to 12-year-old children who presented to the emergency department were enrolled in the study. Then, they were randomly assigned to the vein imaging group (experimental group, n = 35) and to the standard group (control group, n = 35). The primary outcome measure was the success of the first attempt. Secondary outcome measures were the number of intravenous attempts and time allocated to the peripheral intravenous catheter placement.

Seventy children completed the study. Of them, 35 were girls and 35 were boys. The total time for the attempts per patient were shorter in the vein imaging group than it was in the standard group (29.48 ± 10.21 vs 35.00 ± 24.65). There was a significant difference between the children in the vein imaging device and standard groups in terms of the mean difficult intravenous access scores during the procedure (p < 0.05). The children in the vein imaging device group obtained higher mean scores than did the children in the standard group.

The use of new AccuVein AV500 technology assisted with peripheral intravenous catheterization access in children improves the first time success rate. Improved visualization of veins also reduced the number of attempts and the time required for the placement.

Both perineural and intravenous dexamethasone have been proposed as effective adjuncts that prolong the duration of peripheral nerve blocks. The authors sought to explore whether combining systemic with perineural dexamethasone yields any additive or synergistic effect on the characteristics and analgesic effects of peripheral nerve blocks.

Adult patients having distal radius open reduction and internal fixation and/or carpometacarpal arthroplasty under supraclavicular block were randomized to intravenous dexamethasone, a combination of perineural plus intravenous dexamethasone, or no dexamethasone (control). Sensory block duration was set as the primary outcome. Secondary outcomes included motor block duration; postoperative rebound pain scores as well as worst pain at 8, 16, 24, 32, 40, and 48 h; opioid consumption at 0 to 24 and 25 to 48 h; incidence of nausea/vomiting; and presence of burning sensation in the blocked limb at 24 and 48 h. The null hypothesis was lack of difference in sensory block duration between the three groups.

A total of 104 patients were included in the analysis (intravenous dexamethasone, 37; intravenous plus perineural dexamethasone, 34; control, 33). Compared to intravenous dexamethasone alone, adding perineural dexamethasone did not yield any incremental benefits in any of the outcomes examined. The mean ± SD of sensory block duration was 21.3 ± 7.3 h in the intravenous dexamethasone group, 20.6 ± 6.1 h in the perineural plus intravenous group, and 16.8 ± 6.8 h in the control group. The mean difference (95% CI) of sensory block duration was significantly prolonged by 4.5 h (95% CI, 1.3 to 7.7; P = 0.006) in the intravenous dexamethasone group and 3.8 h (95% CI, 0.8 to 6.8; P = 0.015) in the perineural plus intravenous dexamethasone group compared to control; however, no difference was observed when the two dexamethasone groups were compared to each other (0.7 h [95% CI, -2.5 to 3.9]; P = 0.670). Compared to control, both intravenous and intravenous plus perineural dexamethasone similarly reduced 24-h pain scores and opioid consumption and decreased incidence of rebound pain.

The authors' findings suggest that intravenous dexamethasone alone is sufficient to improve analgesic outcomes for patients receiving supraclavicular block for upper extremity surgery. Combining the intravenous and perineural dexamethasone routes does not yield an additive or synergistic effect on the characteristics and analgesic effects of supraclavicular block.