Bibliometrics and knowledge map analysis of ultrasound-guided regional anesthesia

ObjectiveWe examined the pain-relieving effect of ultrasound-guided regional anesthesia performed by emergency physicians on elderly hip fracture patients.MethodsThis study is a prospective, non-randomized, case-control study. The subjects were patients older than 65 years who visited the emergency department with a hip fracture. After we obtained informed consent, two emergency physicians performed an ultrasound-guided three-in-one femoral block using 20 mL of 0.5% bupivacaine. The pain score was measured just before regional anesthesia, and 0.25, 0.5, 1, 2, 3, and 4 hours after the procedure. Another group of patients was given multiple doses of morphine to control the pain. We compared the change in pain score and the development of adverse reactions between the two groups.ResultsA total of 47 patients were enrolled in this study, of which 25 were given regional anesthesia. Successful pain control (pain score<4) was significantly higher in the regional anesthesia group (96.0% vs. 40.9%; P<0.001). The decrease in pain score was significantly higher in the regional anesthesia group (7 [interquartile range, 6 to 7] vs. 4 [interquartile range, 3 to 5]; P< 0.001). The only adverse reaction observed was mild nausea in 4 patients (1 out of 25 from the regional anesthesia group and 3 out of 22 from the morphine group).ConclusionUltrasound-guided regional anesthesia administered by emergency physicians treating elderly hip fracture patients provided faster pain relief and a larger decrease in pain than conventional intravenous injections of morphine.

Effective plexus anaesthesia in a patient with Ehlers–Danlos syndrome type III

Real-time two-dimensional ultrasound guidance is undoubtedly one of the most important evolutions in the field of regional anesthesia techniques, for peripheral nerve blocks and neuraxial anesthesia. The recent literature has been analyzed for studies concerning new technological trends in ultrasound-guided regional anesthesia. This review focuses on electromagnetic tracking systems for ultrasound guidance and three/four-dimensional ultrasound imaging in regional anesthesia. Electromagnetic tracking can facilitate needle-beam alignment for in-plane approaches and indicates where the needle crosses the beam during out-of-plane ultrasound-guided procedures. Three-dimensional ultrasound imaging can provide more detailed anatomical information and better spatial orientation than two-dimensional imaging. Four-dimensional ultrasound imaging enhances the visualization of a particular anatomy and offers real-time assessment of local anesthetic spread during ultrasound-guided regional anesthesia. These techniques have some limitations and drawbacks limiting their expansion. This article describes the principles, technology and development of electromagnetic tracking system for ultrasound guidance and three/four-dimensional ultrasound imaging in regional anesthesia, considering whether these new technologies will have impending applications in clinical practice.

Recent advancements in perioperative pain management have been transformative, particularly the application of ultrasound-guided (USG) regional anesthesia techniques and multimodal analgesia. Ultrasound-guided regional anesthesia allows for real-time visualization of nerves, muscles, and vascular structures, enabling precise needle placement and local anesthetic delivery. This precision significantly enhances block success rates and reduces the risk of complications such as inadvertent nerve injury, vascular puncture, and local anesthetic systemic toxicity (LAST). For example, USG-guided nerve blocks like erector spinae plane block, brachial plexus block, IPACK, and genicular nerve blocks have substantially improved perioperative outcomes by providing superior analgesia, reduced opioid requirements, and faster mobilization, thereby shortening hospital stays and accelerating recovery.

Ultrasound guided regional anesthesia (UGRA) for peripheral nerve blockade is becoming increasingly popular. The advantage of ultrasound technology is that it affords the anesthesiologist the real time ability to visualize neural structures, needle advancement, and local anesthetic spread. Recent data suggest that UGRA generates improved success rates and reductions in performance times in comparison to traditional approaches. Further, the use of ultrasound technology in peripheral nerve blocks has provided insight into needle–nerve interactions, revealing distinct limitations of nerve stimulator techniques. Given that UGRA requires a unique set of skills, formal standards and guidelines are currently being developed by leadership societies in order to foster education and training. This review article, in a case vignette format, highlights important techniques, concepts, and limitations regarding the use of ultrasound to facilitate regional anesthesia. Clinically relevant aspects of ultrasound physics are also discussed.

Inguinal hernia repair is one of the most common operations performed in General Surgery accounting for about 10-15% of all surgeries. Inguinal hernia repair can be done under local, spinal or general anaesthesia. Although specialized hernia centres routinely use local anaesthesia for uncomplicated open inguinal hernia repair, very few surgeons adopt this technique, and prefer performing surgery under spinal or general anaesthesia. We compared the short-term outcomes following open inguinal hernia mesh repair under local, spinal and general anaesthesia in our hospital. (1) To compare the post-operative pain scores among the three groups. (2) To compare the duration of surgery in minutes, the duration of analgesia, analgesic requirement, the time of return to normal activity such as walking, the time of initiation of diet, and the time of voiding after the surgery. Also to compare any complications, such as urinary retention, need for catheterization, nausea and/or emesis, and the length of hospital stay. (3) To observe the impact on health-related quality of life according to EuroQol and patient satisfaction and acceptance of the type of anaesthesia for the procedure. A single centre non-randomised, prospective, observational study was performed in 135 patients undergoing inguinal hernia repair under local (LA), spinal (SA) or general anaesthesia (GA), with 45 patients in each arm, over the span of one year. After approval from the Ethical Committee, and proper informed consent, patients above 18years of age who were to undergo uncomplicated open inguinal hernioplasty were recruited for the study. Lichtensteins tension-free hernioplasty was performed in all cases. The duration of the procedure was calculated from the time of induction or infiltration of local or spinal anaesthesia, till the end of dressing, or extubation in case of general anaesthesia. The duration of analgesia was calculated from the end of the procedure to the feeling of first pain as recorded in the questionnaire. A standard postoperative protocol was employed to determine the pain scores for the first 7days and also to compare the short-term outcomes i.e., duration of analgesia, return to normal activity, complications, post-operative nausea and emesis, analgesic requirement, urinary retention, length of hospital stay, health-related quality of life and patient satisfaction and acceptance were recorded according to standard proforma and EuroQol questionnaire. All the statistical analysis was carried out by SPSS version 16.0. The mean pain scores were lower in the LA group as compared to SA and GA groups from POD-1 to POD-6 (p < 0.001). However, the values from the 7th post-operative days were similar in all three groups and statistically insignificant (p = 0.09). The outcomes such as duration of analgesia, return to activity such as walking, time of first meal and time of discharge from the hospital were all better in the LA group (p < 0.001). The results concerning nausea, vomiting, analgesic use and urinary retention all favour LA. No difference was found among the three groups concerning overall satisfaction and quality of life. In a general surgical setting, we found that local anaesthesia is well tolerated and associated with significantly lower pain scores in the immediate post-operative period and also requires less analgesic use when compared with general and spinal anaesthesia. Patients in the LA group can resume basic activities such as walking, voiding, and initiating diet almost immediately after the procedure and there were no incidences of retention of urine, which was a significant advantage over the other two types of anaesthesia. Patients who were graded as ASA 4 and 5, who were unfit for general anaesthesia, were able to undergo the surgery under local anaesthesia with no postoperative complications. Moreover, the complications and risks of spinal and general anaesthesia are avoided without compromising the quality of surgery and its outcomes. The duration of the surgery as well as hospital stay is significantly less in patients undergoing surgery under local anaesthesia and most cases can be done as a daycare procedure, which is significantly advantageous, especially in low-income settings, with no difference in the health-related quality of life or patient satisfaction and acceptance.

To evaluate the global trends in and explore hotspots of high myopia (HM) research. This bibliometric analysis was used to reveal the publication trends in HM research field based on the Web of Science Core Collection (WoSCC). VOSviewer version 1.6.13 software was used to analyze the data and construct a knowledge map including the yearly publication number, journals, countries, international collaborations, authors, research hotspots, and intellectual base in HM. The search engine found 3544 peer-reviewed publications on HM between 2010 and 2019, and the yearly research output substantially elevated over the past decade. China is the top publishing country, and Sun Yat-sen University was the most active academic institution. Jonas JB is the top publishing scientist, and Investigative Ophthalmology and Visual Science (IOVS) was the most productive journal. The highest cited references mainly focused on epidemiology and management. The keywords formed 6 clusters: 1) refractive surgery; 2) etiology and clinical characteristics; 3) the mechanism of eye growth; 4) management for myopic maculopathy; 5) vitrectomy surgical treatment; 6) myopia-associated glaucoma-like optic neuropathy. The evaluation of development trends based on the data extracted from WoSCC can provide valuable information and guidance for ophthalmologists and public health researchers to improve management procedures in HM field.

The transversus abdominis plane block (TAP-B) has emerged as a key component of multimodal analgesic regimens aimed at mitigating perioperative pain in diverse abdominal surgeries. Despite its widespread clinical adoption, the precise analgesic efficacy of TAP-B remains a subject of ongoing debate and active scientific inquiry. Therefore, a systematic evaluation of TAP-B publication trends and emerging research directions is essential to guide future investigation and advance evidence-based practice. A comprehensive bibliometric analysis was conducted using the Web of Science Core Collection (WoSCC) database, covering TAP-B-related publications from January 2007 to May 2024. Extracted bibliographic data included authorship, institutional affiliation, country of origin, journal, funding source, research discipline, and research focus. Only original research articles were included, resulting in 702 publications for final analysis. Among the 702 eligible articles, the United States contributed the highest number of publications, followed by China and India. At the institutional level, the University of Copenhagen emerged as the most productive institution. Laffey JG and McDonnell JG were identified as the most prolific authors, while Surgical Endoscopy and Other Interventional Techniques published the highest number of TAP-B-related articles. Key research themes centered on perioperative analgesia, ultrasound-guided regional anesthesia, and laparoscopy. Emerging trends indicated growing interest in the analgesic mechanisms of TAP-B and its comparative efficacy with other novel truncal blocks, such as quadratus lumborum and erector spinae plane blocks. This bibliometric analysis provides a comprehensive overview of global research activity in TAP-B, identifying dominant themes, influential contributors, and evolving research frontiers. The findings underscore the significant role of TAP-B in modern regional anesthesia and multimodal analgesic regimens. Furthermore, this study highlights key research areas for future investigation aimed at optimizing the clinical application of TAP-B and its integration into evolving multimodal analgesia strategies.

Characterizing Novice Behavior Associated With Learning Ultrasound-Guided Peripheral Regional Anesthesia

The article by Chuan et al. 1 on meat-based vs. human cadaveric models for teaching ultrasound-guided regional anaesthesia does not provide much additional clarity about the novice's acquisition of keys skills because it compares two models that are rarely used in the UK 2. Many of the regional anaesthesia courses for true novices in the UK, such as the Royal College of Anaesthetists regional anaesthesia ultrasound workshop course 3, use low fidelity phantoms for needling and live models for the majority of their sono-anatomy skills acquisition. When cadavers or porcine models are used, for example in the Sonosite ‘Ultrasound guided regional anaesthesia – beyond introductory’ courses 4, there is a stipulation that ‘previous experience in regional anaesthesia is essential’. When confronted with a cadaver model, therefore, most operators will already be beyond the novice stage of skills acquisition described in the paper. As the editorial rightly points out, the use of cadaver models comes into its own once these initial skills have been acquired, and where high fidelity cadavers such as the Thiel embalmed cadaver can reproduce anatomy, needling, fascial feedback, injection and spread in a model that can be used over prolonged time periods 5. The translation of advanced skills from cadaver models into patient-centered practice would provide a much more useful analysis and could form the bedrock of any future tiered training in regional anaesthesia, as postulated by Gupta and Morton 6.

BackgroundIL-33 has been studied widely but its comprehensive and systematic bibliometric analysis is yet available. The present study is to summarize the research progress of IL-33 through bibliometric analysis.MethodsThe publications related to IL-33 were identified and selected from the Web of Science Core Collection (WoSCC) database on 7 December 2022. The downloaded data was analyzed with bibliometric package in R software. CiteSpace and VOSviewer were used to conduct IL-33 bibliometric and knowledge mapping analysis.ResultsFrom 1 January 2004 to 7 December 2022, 4711 articles on IL-33 research published in 1009 academic journals by 24652 authors in 483 institutions from 89 countries were identified. The number of articles had grown steadily over this period. The United States of America(USA) and China are the major contributors in the field of research while University of Tokyo and University of Glasgow are the most active institutions. The most prolific journal is Frontiers in Immunology, while the Journal of Immunity is the top 1 co-cited journal. Andrew N. J. Mckenzie published the most significant number of articles and Jochen Schmitz was co-cited most. The major fields of these publications are immunology, cell biology, and biochemistry & molecular biology. After analysis, the high-frequency keywords of IL-33 research related to molecular biology (sST2, IL-1), immunological effects (type 2 immunity, Th2 cells), and diseases (asthma, cancer, cardiovascular diseases). Among these, the involvement of IL-33 in the regulation of type 2 inflammation has strong research potential and is a current research hotspot.ConclusionThe present study quantifies and identifies the current research status and trends of IL-33 using bibliometric and knowledge mapping analysis. This study may offer the direction of IL-33-related research for scholars.

Introduction Ultrasound-guided regional anaesthesia (UGRA) is being used increasingly in patients but varying patient characteristics make it difficult to visualize needles and spread of local anaesthetic fluid. Methods To evaluate the use of elastography for UGRA by performing ultrasound-guided nerve blocks in Thiel embalmed cadavers. Both upper limb and lower limb blocks were performed on cadavers with ultrasound guidance. B-mode and elastography images obtained on split screen were analysed. Results The B-mode images were superior compared with the ultrasound elastography images with respect to the anatomical details; however, dynamic changes such as fluid spread were visualized better with elastography. Conclusion The elastography images also had good dose response to the volume of the injectate implying its usefulness in detecting local anaesthetic spread when low volumes are used as test doses.

Objective: This study aims to explore the application of neural stem cells (NSCs) in the treatment of spinal cord injury (SCI) through a bibliometric analysis, identifying global research trends and hotspots in this field to further promote research progress. Methods: The bibliometric analysis was conducted using data from the Web of Science (WOS) database, focusing on literature published between 2000 and 2024. A total of 7010 related documents were retrieved, with 4531 specifically addressing NSCs and SCI. The analysis utilized the VOSviewer data analysis platform and the bibliometric online analysis platform to visualize publication and citation trends, keyword frequencies, and the contributions of various countries, authors and journals to the field. Results: The analysis revealed that the United States leads in SCI research, producing the most related articles, followed by China. Key research themes identified include “central nervous system”, “transplantation”, and “differentiation”. The most prolific journals in this field are the Cell Transplantation and Experimental Neurology, with the highest average citation rates observed in Nature Medicine. Okano H and Univ Toronto are the most influential author and institution, respectively. Conclusion: The bibliometric analysis underscores the growing global attention to SCI research and the importance of NSCs as a promising treatment avenue. Despite the challenges in understanding the SCI microenvironment and achieving clinical translation, significant progress has been made in stem cell preparation, in vitro culture, and differentiation methods. The study suggests that ongoing research and the development of comprehensive treatment strategies will enhance the clinical application of NSCs, offering hope for improved outcomes in SCI patients.

The banking sector plays an indispensable role in the global economy by facilitating economic growth, providing financial services, and ensuring the stability of the financial system. The banking industry is one of the most dynamic sectors, where financial institutions are constantly striving to achieve a strategic advantage over their peers. One such effective strategy is mergers and acquisitions (M&amp;A), where banks consolidate their operations through either a merger or an acquisition to achieve strategic objectives. The purpose of this paper is to undertake a review of mergers and acquisitions in the banking industry using bibliometric analysis to identify their technical reasons, significance, and effects and to offer thematic and methodological directions for further studies to move forward on the topic. Bibliometric analysis, including citation, bibliographic coupling, coauthorship, and co-occurrence analysis, was utilized to discover trends in and conduct descriptive analysis of articles. The study used keyword and reference search methods to discover 616 research articles from the Scopus database between 1994 and 2022. Publication trends, highly influential authors, leading nations, and top journals are addressed. Hence, the systematic review of the most cited articles has been performed significantly. The study summarizes the significance, effects, and performance evaluation of mergers and acquisitions in the banking sector using both bibliometric and systematic analysis, which will enable academicians and researchers to make significant contributions to future research directions on mergers and acquisitions in the banking sector.

St. James Healthcare, Butte, Montana. pcory@littleappletech.comI would like to thank Dr. Shankar for his response regarding my concerns about ultrasound-guided regional anesthesia and for clarifying some of the ultrasound parameters. However, my main reason for writing was that we do not understand the interaction of ultrasound and local anesthetics. No literature exists, that I could locate, addressing the combination effects that have the potential to be significant. The literature also does not support a reduced nerve injury rate when ultrasound guidance is used. In the cases of nerve injury unrelated to positioning, especially pan-plexopathies, when the needle tip was visualized away from the nerve during injection, something other than direct trauma must be playing a role, and assumptions that direct trauma, nerve ischemia, or injection trauma were primarily responsible may be too simplistic.As I pointed out in my original letter, ultrasound is demonstratively cytotoxic in vitro at intensities used for regional anesthesia, and comparison dosimetry with ionizing radiation has been performed.1,2Also, local anesthetics have long been known to be neurotoxic above critical concentrations. Furthermore, the mechanisms of toxicity are different for the two agents. Although both ultrasound and ionizing radiation work primarily by free radical formation, activation of the mitogen-induced protein kinase system is likely responsible for local anesthetic neurotoxicity.3The mechanism for an ultrasound-related nerve injury may be the formation of hydrogen peroxide from hydroxyl ion and subsequent membrane lipid peroxidation.4This may be offset by the observation that local anesthetics have been shown capable of free radical scavenging, especially hydroxyl ions.5The observations suggest that the combination may actually protect from any ultrasound-related toxicity. If another ultrasound neurotoxic effect is at play, the combination of the two agents may have additive or even synergistic effects. We simply do not know. When a chemotherapeutic agent, that is, cisplatin or methotrexate, is added to the mix, the effects on neurotoxicity may be dramatic.6,7Regarding the references given by Dr. Shankar and myself to other neurologic effects in animals and humans, I do not read the literature as showing decades of animal research demonstrating clear safety. Rather, there seems to be a fair amount of noise in the literature with some compelling data showing adverse effects on fetal neuronal migration, opening of the blood brain barrier, and adult locomotor abnormalities in mice exposed in utero to diagnostic ultrasound levels.8–10The study he quotes in humans has a problem in that the control group also received antenatal ultrasound.11The mouse locomotor study indicates that any exposure in utero may be significant, suggesting that only a control group with no history of ultrasound exposure would be suitable—a very difficult study to arrange today.I appreciate the observations of Drs. Gray and Drasner regarding the bioeffects of ultrasound, including the ability of high-intensity ultrasound to promote nerve regeneration. I remain unsure how to relate the Food and Drug Administration imposed limit of 720 mW/cm2for diagnostic imaging to the Ipa.3@MImaxratings listed in the M-Turbo manual that are well into the hundreds of Watts per square centimeters range.12I am pleased that Drs. Gray and Drasner agree that more work is needed to address the interactions between ultrasound and local anesthetics. In referencing Orebaugh et al. 13regarding complication rates, I am reminded of the question of who was performing the block. I suspect these data come from resident-performed regional anesthesia, and if so, likely reflect the steep learning curve for safely performing blocks with anatomic landmarks and nerve stimulation as the only guide. It is very clear that ultrasound shortens the steep learning curve substantially but at the steep price of making practitioners ultrasound dependent.St. James Healthcare, Butte, Montana. pcory@littleappletech.com