Pub Date : 2025-03-29DOI: 10.1016/j.bjane.2025.844616
Gustavo R.M. Wegner , Bruno F.M. Wegner , Ramon Huntermann , Manoela L. Pinto , Júlia A.P. Vieira , Amanda P. de Souza , Francisco J.L. Bezerra
Background
Recent randomized clinical trials have compared the perioperative use of Intravenous (IV) lidocaine and Thoracic Epidural Analgesia (TEA) for postoperative analgesia in patients undergoing abdominal surgery.
Methods
A systematic search was conducted on Embase, Web of Science (all databases), Cochrane Library, and PubMed on March 25, 2024, adhering to the Cochrane Handbook and PRISMA guidelines.
Results
Out of 1261 screened studies, 6 were included. TEA provided superior pain relief on a 0 to 10 pain scale at rest compared to IV lidocaine at 2 (n = 335, MD = -0.72, 95% CI -0.19 to -1.25, p = 0.007423, I2 = 83%) and 24 hours postoperatively (n = 402; MD = -0.18, 95% CI -0.12 to -0.23; p < 0.000001, I2 = 18%). However, no statistically significant differences were observed on pain scores at rest at 48 and 72 hours. TEA provided superior pain relief on a 0 to 10 pain scale during coughing at 24 hours postoperatively (n = 360; MD = -0.36, 95% CI -0.19 to -0.52, p = 0.000019, I2 = 2%), but no statistically significant differences were observed in pain scores on coughing at 48 and 72 hours. There were no statistically significant differences in postoperative nausea and vomiting, time to first flatus, or length of hospital stay.
Conclusions
TEA provides more effective postoperative pain relief compared to IV lidocaine during the first postoperative day, as evidenced by analyses of pain both at rest and during coughing.
{"title":"Comparative efficacy of perioperative lidocaine infusion versus thoracic epidural analgesia for pain management in abdominal surgery: systematic review and meta-analysis","authors":"Gustavo R.M. Wegner , Bruno F.M. Wegner , Ramon Huntermann , Manoela L. Pinto , Júlia A.P. Vieira , Amanda P. de Souza , Francisco J.L. Bezerra","doi":"10.1016/j.bjane.2025.844616","DOIUrl":"10.1016/j.bjane.2025.844616","url":null,"abstract":"<div><h3>Background</h3><div>Recent randomized clinical trials have compared the perioperative use of Intravenous (IV) lidocaine and Thoracic Epidural Analgesia (TEA) for postoperative analgesia in patients undergoing abdominal surgery.</div></div><div><h3>Methods</h3><div>A systematic search was conducted on Embase, Web of Science (all databases), Cochrane Library, and PubMed on March 25, 2024, adhering to the Cochrane Handbook and PRISMA guidelines.</div></div><div><h3>Results</h3><div>Out of 1261 screened studies, 6 were included. TEA provided superior pain relief on a 0 to 10 pain scale at rest compared to IV lidocaine at 2 (n = 335, MD = -0.72, 95% CI -0.19 to -1.25, p = 0.007423, I<sup>2</sup> = 83%) and 24 hours postoperatively (n = 402; MD = -0.18, 95% CI -0.12 to -0.23; p < 0.000001, I<sup>2</sup> = 18%). However, no statistically significant differences were observed on pain scores at rest at 48 and 72 hours. TEA provided superior pain relief on a 0 to 10 pain scale during coughing at 24 hours postoperatively (n = 360; MD = -0.36, 95% CI -0.19 to -0.52, p = 0.000019, I<sup>2</sup> = 2%), but no statistically significant differences were observed in pain scores on coughing at 48 and 72 hours. There were no statistically significant differences in postoperative nausea and vomiting, time to first flatus, or length of hospital stay.</div></div><div><h3>Conclusions</h3><div>TEA provides more effective postoperative pain relief compared to IV lidocaine during the first postoperative day, as evidenced by analyses of pain both at rest and during coughing.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 3","pages":"Article 844616"},"PeriodicalIF":1.7,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143756146","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-28DOI: 10.1016/j.bjane.2025.844615
Mariana F.L. Neville , Victor Guimarães de Almeida , Pamela Vieira Andrade , Joilson Moura Santos , Masashi Munechika , David Ferez , Mary dos Santos Silva , Leonardo Ayres Canga , Ana Cristina Tripoloni , Thierry Girard , Helga Cristina Almeida da Silva
Introduction
Simulation-based training is particularly beneficial for rare and life-threatening diseases such as Malignant Hyperthermia (MH). In addition, cognitive aids, including flowcharts and checklists, can be used as guidance in crisis, reducing cognitive demand and simplifying patient care. We assessed the technical and non-technical performance of anesthesiology residents when diagnosing and treating a hypothetical case of MH in three different scenarios.
Methods
This was an observational, cross-sectional, and controlled study. Pairs of anesthesiology residents participated in a validated high-fidelity MH realistic simulation in one of three different scenarios: 1) Control (no access to cognitive aids), 2) Poster, or 3) Mobile application. Both poster and mobile application provided a flowchart and information related to MH diagnosis and treatment. Demographic data, perceived stress levels, and technical and non-technical skills were registered and compared among the groups.
Results
Thirty residents (5-pairs for each scenario) participated in the simulations. The mean score in the technical skill survey was significantly higher in the poster and mobile application groups compared with the control group (83 [4.4], 83 [3.8], and 74 [8.2], respectively, ANOVA, p = 0.047). A significantly higher score for non-technical skills was also found for the poster and mobile application groups compared with the control group (55 [2.5], 57 [0.8], 52 [2.1], respectively, ANOVA, p = 0.03).
Conclusion
In a realistic high-fidelity MH simulation, the participants had satisfactory performance regarding technical and non-technical skills. However, the groups with access to cognitive aids achieved better scores, with no difference between the groups with access to the MH poster and the MH mobile application.
{"title":"Evaluation of anesthesiology residents in the diagnosis and control of malignant hyperthermia: comparison of three scenarios of realistic simulation ‒ a cross-sectional controlled study","authors":"Mariana F.L. Neville , Victor Guimarães de Almeida , Pamela Vieira Andrade , Joilson Moura Santos , Masashi Munechika , David Ferez , Mary dos Santos Silva , Leonardo Ayres Canga , Ana Cristina Tripoloni , Thierry Girard , Helga Cristina Almeida da Silva","doi":"10.1016/j.bjane.2025.844615","DOIUrl":"10.1016/j.bjane.2025.844615","url":null,"abstract":"<div><h3>Introduction</h3><div>Simulation-based training is particularly beneficial for rare and life-threatening diseases such as Malignant Hyperthermia (MH). In addition, cognitive aids, including flowcharts and checklists, can be used as guidance in crisis, reducing cognitive demand and simplifying patient care. We assessed the technical and non-technical performance of anesthesiology residents when diagnosing and treating a hypothetical case of MH in three different scenarios.</div></div><div><h3>Methods</h3><div>This was an observational, cross-sectional, and controlled study. Pairs of anesthesiology residents participated in a validated high-fidelity MH realistic simulation in one of three different scenarios: 1) Control (no access to cognitive aids), 2) Poster, or 3) Mobile application. Both poster and mobile application provided a flowchart and information related to MH diagnosis and treatment. Demographic data, perceived stress levels, and technical and non-technical skills were registered and compared among the groups.</div></div><div><h3>Results</h3><div>Thirty residents (5-pairs for each scenario) participated in the simulations. The mean score in the technical skill survey was significantly higher in the poster and mobile application groups compared with the control group (83 [4.4], 83 [3.8], and 74 [8.2], respectively, ANOVA, p = 0.047). A significantly higher score for non-technical skills was also found for the poster and mobile application groups compared with the control group (55 [2.5], 57 [0.8], 52 [2.1], respectively, ANOVA, p = 0.03).</div></div><div><h3>Conclusion</h3><div>In a realistic high-fidelity MH simulation, the participants had satisfactory performance regarding technical and non-technical skills. However, the groups with access to cognitive aids achieved better scores, with no difference between the groups with access to the MH poster and the MH mobile application.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 4","pages":"Article 844615"},"PeriodicalIF":1.7,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143756125","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-28DOI: 10.1016/j.bjane.2025.844614
Flavio M. Ferreira, David D. Araujo, Gustavo M. Dantas, Ligia Cristina C. Cunha, Suely P. Zeferino, Filomena B. Galas
Introduction
Low Cardiac Output Syndrome (LCOS) remains a significant perioperative challenge in pediatric cardiac surgery. This study evaluated whether a hemodynamic protocol aimed at optimizing continuous central venous Oxygen Saturation (SvcO2) using the PediaSat catheter could reduce postoperative complications in pediatric patients undergoing congenital heart surgery.
Methods
Conducted at the Instituto do Coração in São Paulo, this randomized clinical trial compared a group receiving SvcO2-based goal-directed therapy via PediaSat (intervention) against conventional care (control). The main objective was assessing 24-hour lactate clearance post-surgery, with secondary outcomes including Vasoactive-Inotropic Score (VIS), Mechanical Ventilation (MV) duration, vasopressor use, and ICU/hospital stay lengths.
Results
From July 13, 2014, to March 17, 2016, 391 patients were evaluated for eligibility. After applying inclusion and exclusion criteria, 65 patients were included and randomized ‒ 33 to the control group and 32 to the PediaSat group. There were no losses to follow-up in either group. Lactate clearance did not significantly differ between the intervention and control groups. However, the PediaSat group showed significantly shorter mechanical ventilation times, reduced vasopressor use, and shorter ICU stays. No significant differences were observed in hospital stay length or incidence of postoperative complications between the group.
Conclusions
While optimizing SvcO2 did not affect overall lactate clearance, it was associated with shorter MV duration, decreased vasopressor need, and shorter ICU stays in pediatric cardiac surgery patients. These findings highlight the potential benefits of continuous SvcO2 monitoring in postoperative care.
{"title":"Goal-directed therapy with continuous SvcO2 monitoring in pediatric cardiac surgery: the PediaSat single-center randomized trial","authors":"Flavio M. Ferreira, David D. Araujo, Gustavo M. Dantas, Ligia Cristina C. Cunha, Suely P. Zeferino, Filomena B. Galas","doi":"10.1016/j.bjane.2025.844614","DOIUrl":"10.1016/j.bjane.2025.844614","url":null,"abstract":"<div><h3>Introduction</h3><div>Low Cardiac Output Syndrome (LCOS) remains a significant perioperative challenge in pediatric cardiac surgery. This study evaluated whether a hemodynamic protocol aimed at optimizing continuous central venous Oxygen Saturation (SvcO<sub>2</sub>) using the PediaSat catheter could reduce postoperative complications in pediatric patients undergoing congenital heart surgery.</div></div><div><h3>Methods</h3><div>Conducted at the Instituto do Coração in São Paulo, this randomized clinical trial compared a group receiving SvcO<sub>2</sub>-based goal-directed therapy via PediaSat (intervention) against conventional care (control). The main objective was assessing 24-hour lactate clearance post-surgery, with secondary outcomes including Vasoactive-Inotropic Score (VIS), Mechanical Ventilation (MV) duration, vasopressor use, and ICU/hospital stay lengths.</div></div><div><h3>Results</h3><div>From July 13, 2014, to March 17, 2016, 391 patients were evaluated for eligibility. After applying inclusion and exclusion criteria, 65 patients were included and randomized ‒ 33 to the control group and 32 to the PediaSat group. There were no losses to follow-up in either group. Lactate clearance did not significantly differ between the intervention and control groups. However, the PediaSat group showed significantly shorter mechanical ventilation times, reduced vasopressor use, and shorter ICU stays. No significant differences were observed in hospital stay length or incidence of postoperative complications between the group.</div></div><div><h3>Conclusions</h3><div>While optimizing SvcO<sub>2</sub> did not affect overall lactate clearance, it was associated with shorter MV duration, decreased vasopressor need, and shorter ICU stays in pediatric cardiac surgery patients. These findings highlight the potential benefits of continuous SvcO<sub>2</sub> monitoring in postoperative care.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 4","pages":"Article 844614"},"PeriodicalIF":1.7,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143756127","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-28DOI: 10.1016/j.bjane.2025.844617
Cheng Lin , Ana Larissa Guerrero , Joshua Jesin , Rohin Tangri , Nasong Anthony Luginaah , Kamal Kumar , Christopher Hansebout
Introduction
Results from Randomized Controlled Trials (RCTs) on mixed Local Anesthetics (LA) are conflicting. We conducted a systematic review and meta-analysis on whether using mixed LA leads to faster onset of surgical block.
Method
We conducted systemic review and meta-analysis of RCTs. Medline and Embase without language restriction from inception to June 15, 2024, were searched. Included RCTs had to compare mixed LA to long-acting LA in adult surgical patients for onset or duration of nerve blocks. Onset time to surgical block was the primary outcome. The Cochrane Risk of Bias Tool with GRADE methodology was utilized to assess evidence quality.
Results
Nineteen trials including 1060 participants met the inclusion criteria. Mixed LA modestly reduced time to surgical block (-8.4 minutes; 95% CI -12.0 to -4.8 minutes; p = 0.0001; I2 = 0.99), sensory block duration (-226.2 minutes; 95% CI -352.2 to -100.1 minutes; p = 0.002; I2 = 0.98) and motor block duration (-259.2 minutes; 95% CI -399.5 to -119.0 minutes; p = 0.003; I2 = 0.98) but not time to analgesic request duration (-130.5 minutes; 95% CI -265.9 to 4.9 minutes; p = 0.057; I2 = 0.98). GRADE scoring ranged from low to very low.
Conclusion
The existing evidence showed mixed LA led to a modest reduction in surgical block latency but also shortened block duration. Future studies should evaluate the role of mixed LA in lower limb blocks and optimal dosing of long-acting LA to balance onset latency and analgesic duration.
PROSPERO registration
CRD42024552801.
简介：混合局麻药（LA）的随机对照试验（RCTs）结果是相互矛盾的。我们进行了一项系统回顾和荟萃分析，研究使用混合物是否会导致手术阻滞更快发生。方法：对随机对照试验进行系统评价和荟萃分析。检索了从成立到2024年6月15日没有语言限制的Medline和Embase。纳入的随机对照试验必须比较混合LA和长效LA在成年外科患者神经阻滞的发作或持续时间。到手术阻滞的发病时间是主要观察指标。采用Cochrane偏倚风险工具和GRADE方法评估证据质量。结果：19项试验1060名受试者符合纳入标准。混合LA适度缩短了手术阻滞时间(-8.4分钟；95% CI -12.0 ~ -4.8分钟；p = 0.0001;I2 = 0.99)，感觉阻滞时间(-226.2分钟；95% CI -352.2 ~ -100.1分钟；p = 0.002;I2 = 0.98)和运动阻滞持续时间(-259.2分钟；95% CI -399.5 ~ -119.0分钟；p = 0.003;I2 = 0.98)，但没有时间到镇痛要求持续时间(-130.5分钟；95% CI -265.9 ~ 4.9分钟；p = 0.057;I2 = 0.98)。GRADE评分范围从低到非常低。结论：现有证据表明混合LA可适度减少手术阻滞潜伏期，但也缩短阻滞持续时间。未来的研究应评估混合LA在下肢阻滞中的作用，以及长效LA的最佳剂量，以平衡发病潜伏期和镇痛持续时间。普洛斯彼罗注册：CRD42024552801。
{"title":"Comparing block characteristics of mixtures of short/intermediate- and long-acting local anesthetics for peripheral nerve block: a systematic review and meta-analysis","authors":"Cheng Lin , Ana Larissa Guerrero , Joshua Jesin , Rohin Tangri , Nasong Anthony Luginaah , Kamal Kumar , Christopher Hansebout","doi":"10.1016/j.bjane.2025.844617","DOIUrl":"10.1016/j.bjane.2025.844617","url":null,"abstract":"<div><h3>Introduction</h3><div>Results from Randomized Controlled Trials (RCTs) on mixed Local Anesthetics (LA) are conflicting. We conducted a systematic review and meta-analysis on whether using mixed LA leads to faster onset of surgical block.</div></div><div><h3>Method</h3><div>We conducted systemic review and meta-analysis of RCTs. Medline and Embase without language restriction from inception to June 15, 2024, were searched. Included RCTs had to compare mixed LA to long-acting LA in adult surgical patients for onset or duration of nerve blocks. Onset time to surgical block was the primary outcome. The Cochrane Risk of Bias Tool with GRADE methodology was utilized to assess evidence quality.</div></div><div><h3>Results</h3><div>Nineteen trials including 1060 participants met the inclusion criteria. Mixed LA modestly reduced time to surgical block (-8.4 minutes; 95% CI -12.0 to -4.8 minutes; p = 0.0001; I<sup>2</sup> = 0.99), sensory block duration (-226.2 minutes; 95% CI -352.2 to -100.1 minutes; p = 0.002; I<sup>2</sup> = 0.98) and motor block duration (-259.2 minutes; 95% CI -399.5 to -119.0 minutes; p = 0.003; I<sup>2</sup> = 0.98) but not time to analgesic request duration (-130.5 minutes; 95% CI -265.9 to 4.9 minutes; p = 0.057; I<sup>2</sup> = 0.98). GRADE scoring ranged from low to very low.</div></div><div><h3>Conclusion</h3><div>The existing evidence showed mixed LA led to a modest reduction in surgical block latency but also shortened block duration. Future studies should evaluate the role of mixed LA in lower limb blocks and optimal dosing of long-acting LA to balance onset latency and analgesic duration.</div></div><div><h3>PROSPERO registration</h3><div>CRD42024552801.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 3","pages":"Article 844617"},"PeriodicalIF":1.7,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143755653","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-09DOI: 10.1016/j.bjane.2025.844606
Mariana AbdElSayed Mansour , Saeed Baradwan , Ahmed Abdelaziz Shama , Mohamed Ali Mahmoud , Ayman Salah Abouelnour , Ayman Mohamed AbdelWahed Mohamed , Ahmed Fathi Hassan Elkhouly , Abdelkarem Hussiny Ismail Elsayed , Zaky Ftouh Rashed , Ahmed Mohamed Abdelhakim , Mrooj Mabruk Almutairi , Mohamed A. Lotfy , Ahmed Goda Ahmed
Background
Peripheral abdominal nerve blocks are key components of multimodal analgesia, enhancing recovery after cesarean sections. This systematic review and meta-analysis aimed to assess analgesic efficacy of Erector Spinae Plane Block (ESPB) versus Transversus Abdominis Plane Block (TAPB) under ultrasound guidance following Cesarean Section (CS) under spinal anesthesia.
Methods
A comprehensive search was conducted across PubMed, Scopus, Cochrane Library, and ISI Web of Science to identify relevant trials. The inclusion criteria followed the PICOS framework: Population (women undergoing elective cesarean delivery), Intervention (ESPB), Comparator (TAPB), Outcomes (postoperative pain, opioid consumption, analgesic duration, and satisfaction), and Study Design (randomized controlled trials).
Results
Seven RCTs (380-patients) met the inclusion criteria. The ESPB group had significantly lower postoperative pain scores at rest and during movement, reduced 24-hour opioid consumption (MD = -2.62 MME; 95% CI -4.11 to -1.13; p = 0.006), and longer analgesic duration (SMD = 1.77; 95% CI 1.11 to 2.44; p < 0.001) than the TAPB group. Patient satisfaction was also significantly higher in the ESPB group (OR = 4.75; 95% CI 2.26 to 9.99; p < 0.001). While most outcomes demonstrated low heterogeneity, significant variability was observed in analgesic duration (I2 = 83%), requiring cautious interpretation.
Conclusions
The ESP block offers superior pain relief, reduces opioid use, and enhances satisfaction compared to the TAP block in cesarean sections. These findings suggest that the implementation of the ESP block in postoperative analgesia protocols could significantly improve patient outcomes, potentially leading to enhanced recovery and reduced reliance on opioids.
背景：腹外周神经阻滞是剖宫产术后多模式镇痛的关键组成部分。本系统综述和荟萃分析旨在评价超声引导下脊柱麻醉下剖宫产（CS）术后应用竖脊平面阻滞（ESPB）与腹横平面阻滞（TAPB）的镇痛效果。方法：通过PubMed、Scopus、Cochrane Library和ISI Web of Science进行综合检索，以确定相关试验。纳入标准遵循PICOS框架：人群（选择性剖宫产妇女）、干预（ESPB）、比较物（TAPB）、结局（术后疼痛、阿片类药物消耗、镇痛持续时间和满意度）和研究设计（随机对照试验）。结果：7项rct（380例患者）符合纳入标准。ESPB组术后休息和运动时疼痛评分明显降低，24小时阿片类药物消耗减少(MD = -2.62 MME；95% CI -4.11 ~ -1.13；p = 0.006)，且镇痛持续时间较长(SMD = 1.77；95% CI 1.11 ~ 2.44；p < 0.001)。ESPB组患者满意度也显著高于ESPB组(OR = 4.75；95% CI 2.26 ~ 9.99；P < 0.001)。虽然大多数结果显示低异质性，但在镇痛持续时间方面观察到显著的变异性（I2 = 83%），需要谨慎解释。结论：在剖宫产术中，与TAP阻滞相比，ESP阻滞能更好地缓解疼痛，减少阿片类药物的使用，并提高满意度。这些发现表明，在术后镇痛方案中实施ESP阻滞可以显著改善患者的预后，有可能促进恢复并减少对阿片类药物的依赖。
{"title":"Erector spinae plane block versus transversus abdominis plane block for analgesia after cesarean section: a systematic review and meta-analysis","authors":"Mariana AbdElSayed Mansour , Saeed Baradwan , Ahmed Abdelaziz Shama , Mohamed Ali Mahmoud , Ayman Salah Abouelnour , Ayman Mohamed AbdelWahed Mohamed , Ahmed Fathi Hassan Elkhouly , Abdelkarem Hussiny Ismail Elsayed , Zaky Ftouh Rashed , Ahmed Mohamed Abdelhakim , Mrooj Mabruk Almutairi , Mohamed A. Lotfy , Ahmed Goda Ahmed","doi":"10.1016/j.bjane.2025.844606","DOIUrl":"10.1016/j.bjane.2025.844606","url":null,"abstract":"<div><h3>Background</h3><div>Peripheral abdominal nerve blocks are key components of multimodal analgesia, enhancing recovery after cesarean sections. This systematic review and meta-analysis aimed to assess analgesic efficacy of Erector Spinae Plane Block (ESPB) versus Transversus Abdominis Plane Block (TAPB) under ultrasound guidance following Cesarean Section (CS) under spinal anesthesia.</div></div><div><h3>Methods</h3><div>A comprehensive search was conducted across PubMed, Scopus, Cochrane Library, and ISI Web of Science to identify relevant trials. The inclusion criteria followed the PICOS framework: Population (women undergoing elective cesarean delivery), Intervention (ESPB), Comparator (TAPB), Outcomes (postoperative pain, opioid consumption, analgesic duration, and satisfaction), and Study Design (randomized controlled trials).</div></div><div><h3>Results</h3><div>Seven RCTs (380-patients) met the inclusion criteria. The ESPB group had significantly lower postoperative pain scores at rest and during movement, reduced 24-hour opioid consumption (MD = -2.62 MME; 95% CI -4.11 to -1.13; p = 0.006), and longer analgesic duration (SMD = 1.77; 95% CI 1.11 to 2.44; p < 0.001) than the TAPB group. Patient satisfaction was also significantly higher in the ESPB group (OR = 4.75; 95% CI 2.26 to 9.99; p < 0.001). While most outcomes demonstrated low heterogeneity, significant variability was observed in analgesic duration (I<sup>2</sup> = 83%), requiring cautious interpretation.</div></div><div><h3>Conclusions</h3><div>The ESP block offers superior pain relief, reduces opioid use, and enhances satisfaction compared to the TAP block in cesarean sections. These findings suggest that the implementation of the ESP block in postoperative analgesia protocols could significantly improve patient outcomes, potentially leading to enhanced recovery and reduced reliance on opioids.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 4","pages":"Article 844606"},"PeriodicalIF":1.7,"publicationDate":"2025-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143607299","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-03DOI: 10.1016/j.bjane.2025.844605
Luigi Vetrugno
{"title":"Pulmonary arterial catheter vs. prediction index software in patients undergoing orthotopic liver transplantation: “We cannot lump together everything”","authors":"Luigi Vetrugno","doi":"10.1016/j.bjane.2025.844605","DOIUrl":"10.1016/j.bjane.2025.844605","url":null,"abstract":"","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 3","pages":"Article 844605"},"PeriodicalIF":1.7,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143569160","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01DOI: 10.1016/j.bjane.2025.844600
Luciana C. Stefani , Brasil Silva Neto , Débora Roberta de Avila Dornelles , Mariana Brandão , Marcio Rahel Guimarães , Pedro Knijnik , Jeruza N. Neyeloff , Stela M.J. Castro , Paulo Corrêa da Silva Neto , Gilberto Braulio
Background
Before the pandemic, healthcare systems in Low-Middle Income Countries (LMIC) experienced a limited capacity to treat postoperative complications. It is uncertain whether the interference of the Coronavirus (COVID-19) pandemic on surgical systems has increased postoperative mortality.
Methods
This before and after cohort study aimed to assess the pandemic's impact on in-hospital postoperative mortality in a university COVID-19 reference hospital in southern Brazil. Data from patients who underwent surgery before (January 2018 to December 2019) the pandemic were compared to data from patients who underwent surgery during the pandemic (February to December 2020). The primary outcome was in-hospital mortality. We developed Poisson regression models to examine the mortality risk of being operated on during the COVID-19 pandemic.
Results
We assessed 15156 surgical patients, 12207 of whom underwent surgery before the pandemic and 2949 during the first year of the pandemic. Mortality rates were 2.5% (309/12207) in the pre-pandemic versus 7.2% (212/2949) in the pandemic. Of these, 25.8% (32/124) of patients with COVID-19 and 6.4% (80/2816) of patients without COVID-19 died. The proportion of urgent surgeries and ASA-PS III was higher in the pandemic group. After adjusting for mortality-related variables, the Relative Risk (RR) associated with undergoing surgery during the pandemic was 1.51 (95% CI 1.27 to 1.79). We excluded COVID-19-positive to perform a sensitivity analysis that confirmed the increased risk of undergoing surgery during the pandemic RR = 1.50 (95% CI 1.27 to 1.78).
Conclusion
The substantial number of additional deaths, even amongst those without COVID-19 infection, suggests the pandemic disrupted the surgical service in an LMIC context. Fragile surgical systems may suffer more significant adverse impacts from external stressors such as a pandemic, and urging measures are needed to increase their performance and resilience.
背景：在大流行之前，中低收入国家（LMIC）的卫生保健系统治疗术后并发症的能力有限。目前尚不确定冠状病毒（COVID-19）大流行对手术系统的干扰是否增加了术后死亡率。方法：本队列研究旨在评估大流行对巴西南部一所大学COVID-19参考医院住院术后死亡率的影响。将大流行之前（2018年1月至2019年12月）接受手术的患者的数据与大流行期间（2020年2月至12月）接受手术的患者的数据进行比较。主要终点是住院死亡率。我们建立了泊松回归模型来检验COVID-19大流行期间接受手术的死亡率风险。结果：我们评估了15156例手术患者，其中12207例在大流行前接受了手术，2949例在大流行的第一年接受了手术。大流行前死亡率为2.5%(309/12207)，而大流行期间死亡率为7.2%（212/2949）。其中，25.8%（32/124）的新冠肺炎患者和6.4%（80/2816）的非新冠肺炎患者死亡。紧急手术和ASA-PS III的比例在大流行组较高。在调整了死亡率相关变量后，大流行期间与手术相关的相对风险（RR）为1.51 （95% CI 1.27 - 1.79）。我们排除了covid -19阳性患者进行敏感性分析，证实大流行期间接受手术的风险增加，RR=1.50 （95% CI 1.27至1.78）。结论：即使没有感染COVID-19的人也有大量额外死亡，这表明大流行扰乱了低收入和中等收入国家的外科服务。脆弱的外科系统可能会受到诸如流行病等外部压力因素的更严重的不利影响，因此需要采取紧急措施来提高其性能和恢复能力。
{"title":"The side effects of the pandemic on all-cause postoperative mortality in a COVID reference Hospital in Brazil: a before and after cohort study with 15156 patients","authors":"Luciana C. Stefani , Brasil Silva Neto , Débora Roberta de Avila Dornelles , Mariana Brandão , Marcio Rahel Guimarães , Pedro Knijnik , Jeruza N. Neyeloff , Stela M.J. Castro , Paulo Corrêa da Silva Neto , Gilberto Braulio","doi":"10.1016/j.bjane.2025.844600","DOIUrl":"10.1016/j.bjane.2025.844600","url":null,"abstract":"<div><h3>Background</h3><div>Before the pandemic, healthcare systems in Low-Middle Income Countries (LMIC) experienced a limited capacity to treat postoperative complications. It is uncertain whether the interference of the Coronavirus (COVID-19) pandemic on surgical systems has increased postoperative mortality.</div></div><div><h3>Methods</h3><div>This before and after cohort study aimed to assess the pandemic's impact on in-hospital postoperative mortality in a university COVID-19 reference hospital in southern Brazil. Data from patients who underwent surgery before (January 2018 to December 2019) the pandemic were compared to data from patients who underwent surgery during the pandemic (February to December 2020). The primary outcome was in-hospital mortality. We developed Poisson regression models to examine the mortality risk of being operated on during the COVID-19 pandemic.</div></div><div><h3>Results</h3><div>We assessed 15156 surgical patients, 12207 of whom underwent surgery before the pandemic and 2949 during the first year of the pandemic. Mortality rates were 2.5% (309/12207) in the pre-pandemic versus 7.2% (212/2949) in the pandemic. Of these, 25.8% (32/124) of patients with COVID-19 and 6.4% (80/2816) of patients without COVID-19 died. The proportion of urgent surgeries and ASA-PS III was higher in the pandemic group. After adjusting for mortality-related variables, the Relative Risk (RR) associated with undergoing surgery during the pandemic was 1.51 (95% CI 1.27 to 1.79). We excluded COVID-19-positive to perform a sensitivity analysis that confirmed the increased risk of undergoing surgery during the pandemic RR = 1.50 (95% CI 1.27 to 1.78).</div></div><div><h3>Conclusion</h3><div>The substantial number of additional deaths, even amongst those without COVID-19 infection, suggests the pandemic disrupted the surgical service in an LMIC context. Fragile surgical systems may suffer more significant adverse impacts from external stressors such as a pandemic, and urging measures are needed to increase their performance and resilience.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 2","pages":"Article 844600"},"PeriodicalIF":1.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143494902","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01DOI: 10.1016/j.bjane.2025.844601
Claudia M.R.P. Cavaliere , Lorena I.M. Carvalho , Liana M.T.A. Azi , Edgar Yugue , Renata de Paula Lian , Marcos A.C. Albuquerque
{"title":"Implementing a well-being curriculum in anesthesiology residency: insights from a teaching hospital in Brazil","authors":"Claudia M.R.P. Cavaliere , Lorena I.M. Carvalho , Liana M.T.A. Azi , Edgar Yugue , Renata de Paula Lian , Marcos A.C. Albuquerque","doi":"10.1016/j.bjane.2025.844601","DOIUrl":"10.1016/j.bjane.2025.844601","url":null,"abstract":"","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 2","pages":"Article 844601"},"PeriodicalIF":1.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143494894","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01DOI: 10.1016/j.bjane.2025.844597
Yoshio Tatsuoka , Zili He , Hung-Mo Lin , Andrew P. Notarianni , Zyad J. Carr
Background
Postoperative Pulmonary Complications (PPC) are a significant source of increased morbidity and mortality after surgical procedures. Measures to enhance 30-day PPC risk stratification are an area of significant clinical interest, and integrating common preoperative investigations, such as echocardiography, may enhance quantitative risk prediction when combined with clinical score-based systems, particularly for high-risk populations. The authors hypothesized that Right Ventricular Systolic Pressure (RVSP) would significantly enhance the predictive capabilities of the Assess Respiratory Risk in Surgical Patients in Catalonia (ARISCAT) score in the prediction of 30-day PPC in a Pulmonary Hypertension (PH) study cohort.
Methods
277 patients with the diagnosis of PH, ARISCAT score, and echocardiography-derived RVSP within 12-months of surgical procedure were analyzed. The primary endpoint was the 59-variable 30-day Agency for Healthcare Research and Quality PPC composite. Secondary endpoints included sub composites of Pneumonia (PNA), Respiratory Failure (RF), Pulmonary Aspiration (ASP) and thromboembolic Phenomenon (PE). Adjusted multivariable logistic regression models followed by Receiver Operating Characteristic Curves (ROC) and Area Under the Curve (AUC) analysis were employed to assess the prediction of 30-day PPC.
Results
Mean RVSP was 52.1 mmHg (±17.4). Overall PPC incidence was 29.9%, with RF (19.5%), PNA (12.3%), ASP (5.4%), and PE (3.6%) composites. Logistic regression showed no significant association between RVSP and PPC (Odds Ratio [OR = 1.01], p = 0.307). The ARISCAT score was associated with 30-day PPC risk (OR = 1.02, p = 0.037). Receiver Operating Characteristic (ROC) curve analysis revealed an Area Under the Curve (AUC) of 0.555 for RVSP alone, 0.575 for the ARISCAT score, and 0.591 for the combination of RVSP+ARISCAT for the primary endpoint.
Conclusion
RVSP demonstrated limited efficacy as a standalone predictor of 30-day PPC in patients with PH. Although integrating RVSP with ARISCAT scoring yielded marginal improvements in predictive accuracy, neither metric, independently or in combination, achieved adequate clinical significance for reliable risk stratification. These findings highlight a critical gap in the current preoperative risk assessment for PH-specific predictive tools. Future research should focus on alternative measures that better capture vulnerability to the hemodynamic complexities underscoring PPC in this high-risk population.
{"title":"The role of right ventricular systolic pressure and ARISCAT score in perioperative pulmonary risk assessment","authors":"Yoshio Tatsuoka , Zili He , Hung-Mo Lin , Andrew P. Notarianni , Zyad J. Carr","doi":"10.1016/j.bjane.2025.844597","DOIUrl":"10.1016/j.bjane.2025.844597","url":null,"abstract":"<div><h3>Background</h3><div>Postoperative Pulmonary Complications (PPC) are a significant source of increased morbidity and mortality after surgical procedures. Measures to enhance 30-day PPC risk stratification are an area of significant clinical interest, and integrating common preoperative investigations, such as echocardiography, may enhance quantitative risk prediction when combined with clinical score-based systems, particularly for high-risk populations. The authors hypothesized that Right Ventricular Systolic Pressure (RVSP) would significantly enhance the predictive capabilities of the Assess Respiratory Risk in Surgical Patients in Catalonia (ARISCAT) score in the prediction of 30-day PPC in a Pulmonary Hypertension (PH) study cohort.</div></div><div><h3>Methods</h3><div>277 patients with the diagnosis of PH, ARISCAT score, and echocardiography-derived RVSP within 12-months of surgical procedure were analyzed. The primary endpoint was the 59-variable 30-day Agency for Healthcare Research and Quality PPC composite. Secondary endpoints included sub composites of Pneumonia (PNA), Respiratory Failure (RF), Pulmonary Aspiration (ASP) and thromboembolic Phenomenon (PE). Adjusted multivariable logistic regression models followed by Receiver Operating Characteristic Curves (ROC) and Area Under the Curve (AUC) analysis were employed to assess the prediction of 30-day PPC.</div></div><div><h3>Results</h3><div>Mean RVSP was 52.1 mmHg (±17.4). Overall PPC incidence was 29.9%, with RF (19.5%), PNA (12.3%), ASP (5.4%), and PE (3.6%) composites. Logistic regression showed no significant association between RVSP and PPC (Odds Ratio [OR = 1.01], p = 0.307). The ARISCAT score was associated with 30-day PPC risk (OR = 1.02, p = 0.037). Receiver Operating Characteristic (ROC) curve analysis revealed an Area Under the Curve (AUC) of 0.555 for RVSP alone, 0.575 for the ARISCAT score, and 0.591 for the combination of RVSP+ARISCAT for the primary endpoint.</div></div><div><h3>Conclusion</h3><div>RVSP demonstrated limited efficacy as a standalone predictor of 30-day PPC in patients with PH. Although integrating RVSP with ARISCAT scoring yielded marginal improvements in predictive accuracy, neither metric, independently or in combination, achieved adequate clinical significance for reliable risk stratification. These findings highlight a critical gap in the current preoperative risk assessment for PH-specific predictive tools. Future research should focus on alternative measures that better capture vulnerability to the hemodynamic complexities underscoring PPC in this high-risk population.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 2","pages":"Article 844597"},"PeriodicalIF":1.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143460973","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Systematic review and meta-analysis to evaluate the efficacy of the Erector Spinae Plane Block (ESPB) in managing pain related to Herpes Zoster.
Methods
We systematically searched PubMed, Embase, Cochrane Library, and CNKI for randomized trials comparing ESPB plus standard clinical treatment with clinical treatment alone. The population included patients with acute infection and those with Postherpetic Neuralgia (PHN). The primary outcome was pain intensity, and secondary outcomes included analgesic consumption. Mean Difference (MD) was used for continuous outcomes, and Risk Ratio (RR) for binary outcomes.
Results
Seven trials with 362 patients were included. ESPB significantly reduced pain up to eight weeks (MD = -1.21; 95% CI -2.17 to -0.24; I2 = 89%). In the subgroup analysis of patients in the acute stage, the benefit seemed to extend with pain reduction lasting up to 12-weeks (MD = -1.49; 95% CI -2.61 to -0.37; I2 = 0%), and a reduction in the incidence of PHN (RR = 0.49; 95% CI 0.28 to 0.85; I2: 0%). In the PHN subgroup, pain reduction was notable only at four weeks (MD = -1.08; 95% CI -1.81 to -0.35; I2 = 86%). ESPB also reduced acetaminophen (MD = -0.6 g.day-1; 95% CI -1.05 to -0.14; I2 = 49%) and pregabalin consumption (-68.58 mg.day-1; 95% CI -127.18 to -9.97; I2 = 41%) over 12 weeks.
Conclusion
ESPB seems to provide pain relief in Herpes Zoster patients, with a prolonged benefit in the acute stage. Also, ESPB reduced the need for analgesics over 12 weeks. More research is needed to corroborate this practice.
Study Registration Number and Date
This article was prospectively registered in PROSPERO (www.crd.york.ac.uk/prospero, CRD42024566674).
目的：系统回顾和荟萃分析通过系统综述和荟萃分析评估脊柱后凸肌平面阻滞疗法（ESPB）治疗带状疱疹相关疼痛的疗效：我们系统地检索了 PubMed、Embase、Cochrane Library 和 CNKI 中比较 ESPB 加标准临床治疗与单纯临床治疗的随机试验。研究对象包括急性感染患者和带状疱疹后遗神经痛（PHN）患者。主要研究结果为疼痛强度，次要研究结果包括镇痛药消耗量。连续结果采用平均差（MD），二元结果采用风险比（RR）：结果：共纳入了 7 项试验，362 名患者接受了治疗。ESPB可明显减轻疼痛达8周（MD = -1.21; 95% CI -2.17 to -0.24；I2 = 89%）。在对急性期患者进行的亚组分析中，疼痛减轻的时间似乎延长至 12 周（MD = -1.49; 95% CI -2.61 to -0.37；I2 = 0%），PHN 的发生率也有所降低（RR = 0.49; 95% CI 0.28 to 0.85；I2：0%）。在PHN亚组中，只有在四周时疼痛才明显减轻（MD = -1.08; 95% CI -1.81 to -0.35；I2 = 86%）。在 12 周内，ESPB 还减少了对乙酰氨基酚的用量（MD = -0.6 克/天-1；95% CI -1.05 至 -0.14；I2 = 49%）和普瑞巴林的用量（-68.58 毫克/天-1；95% CI -127.18 至 -9.97；I2 = 41%）：ESPB似乎可以缓解带状疱疹患者的疼痛，并在急性期延长疗效。此外，ESPB还能在12周内减少镇痛剂的使用。需要更多的研究来证实这一做法。研究注册编号和日期：本文在 PROSPERO 上进行了前瞻性注册（www.crd.york.ac.uk/prospero，CRD42024566674）。
{"title":"Efficacy of erector spinae plane block in pain management for patients with herpes zoster: a systematic review and meta-analysis","authors":"Alexandre Yamada Fujimura Júnior , Carolina Braga Moura , Arnaldo Bastos dos Santos","doi":"10.1016/j.bjane.2025.844598","DOIUrl":"10.1016/j.bjane.2025.844598","url":null,"abstract":"<div><h3>Objectives</h3><div>Systematic review and meta-analysis to evaluate the efficacy of the Erector Spinae Plane Block (ESPB) in managing pain related to Herpes Zoster.</div></div><div><h3>Methods</h3><div>We systematically searched PubMed, Embase, Cochrane Library, and CNKI for randomized trials comparing ESPB plus standard clinical treatment with clinical treatment alone. The population included patients with acute infection and those with Postherpetic Neuralgia (PHN). The primary outcome was pain intensity, and secondary outcomes included analgesic consumption. Mean Difference (MD) was used for continuous outcomes, and Risk Ratio (RR) for binary outcomes.</div></div><div><h3>Results</h3><div>Seven trials with 362 patients were included. ESPB significantly reduced pain up to eight weeks (MD = -1.21; 95% CI -2.17 to -0.24; I<sup>2</sup> = 89%). In the subgroup analysis of patients in the acute stage, the benefit seemed to extend with pain reduction lasting up to 12-weeks (MD = -1.49; 95% CI -2.61 to -0.37; I<sup>2</sup> = 0%), and a reduction in the incidence of PHN (RR = 0.49; 95% CI 0.28 to 0.85; I<sup>2</sup>: 0%). In the PHN subgroup, pain reduction was notable only at four weeks (MD = -1.08; 95% CI -1.81 to -0.35; I<sup>2</sup> = 86%). ESPB also reduced acetaminophen (MD = -0.6 g.day<sup>-1</sup>; 95% CI -1.05 to -0.14; I<sup>2</sup> = 49%) and pregabalin consumption (-68.58 mg.day<sup>-1</sup>; 95% CI -127.18 to -9.97; I<sup>2</sup> = 41%) over 12 weeks.</div></div><div><h3>Conclusion</h3><div>ESPB seems to provide pain relief in Herpes Zoster patients, with a prolonged benefit in the acute stage. Also, ESPB reduced the need for analgesics over 12 weeks. More research is needed to corroborate this practice.</div></div><div><h3>Study Registration Number and Date</h3><div>This article was prospectively registered in PROSPERO (<span><span>www.crd.york.ac.uk/prospero</span><svg><path></path></svg></span>, CRD42024566674).</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 2","pages":"Article 844598"},"PeriodicalIF":1.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143460970","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号