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Sleeve gastrectomy is a leading technique in metabolic \& bariatric surgery. It gained ever-increasing popularity among laparoscopic bariatric surgeries and has proved to be a successful method in achieving considerable weight loss in a short time . Postoperative pain management can be obtained by opioids, opioid free analgesics and/or regional blocks. Regional techniques, like Transverse abdominis plane block (TAP) blocks or Modified Thoracoabdominal Nerve Block through perichondrial approach (M-TAPA), offer targeted pain relief, reduce the need for opioids, and promote faster recovery. Compared to systemic opioids, regional blocks are more effective in managing postoperative pain while minimizing complications and enhancing recovery after surgery . M-TAPA was developed by Tulgar et al. as a targeted method for managing postoperative pain in patients undergoing abdominal surgeries. This innovative technique utilizes a perichondrial approach, where a local anesthetic is administered to the lower surface of the chondrium . This method is particularly beneficial because it allows the anesthetic to spread widely, effectively covering multiple dermatomal levels, specifically T5 and T11-12. The diffusion of the local anesthetic across the linea semilunaris contributes to a broader analgesic effect, which is crucial for comprehensive pain management in this surgical context . The feasibility of doing the block in a supine position is making it a practical option for both patients and surgeons during procedures. This accessibility can streamline the surgical workflow and enhance patient comfort . Moreover, it plays a great role in Enhanced Recovery After Bariatric Surgery (ERABS) protocols . Twenty, 25, and 30-mL volumes of 0.25% bupivacaine per side were used in case reports and single-group studies . However, so far no available studies compared different volumes of M-TAPA block abdominal surgeries. The aim of this study is to assess the perioperative analgesic efficacy of different volumes of Modified Thoracoabdominal Perichondrial Approach (M-TAPA) in patients undergoing laparoscopic sleeve gastrectomy to determine the optimal volume for effective pain control and reduced opioid use.

This study aims to evaluate the effect of increasing preoperative timing of single dexmedetomidine on the stress response of laryngoscopy and intubation.

BACKGROUND: Alginate impressions have long been a staple in orthodontics, but with recent technological advancements, digital impressions via intraoral scans are gaining increasing popularity. While much research has focused on patient preference and the accuracy of these techniques, there is a notable gap in the literature regarding chair side time and associated costs. Existing studies on chair side time comparisons between alginate impressions and intraoral scanning yield inconsistent results, underscoring the need for further investigation. This study aimed to evaluate the chair side time and cost implications of intraoral scanning and alginate impressions. OBJECTIVES: The primary objective is to compare the chair side time taken for alginate impressions and intraoral scanning of orthodontic patients aged 9 years and over in an orthodontic department at a district general hospital. The secondary objective is to evaluate the costs associated with alginate impressions and intraoral scanning of orthodontic patients described above. DESIGN, SETTING AND PARTICIPANTS: A prospective, single-centre, parallel-arm randomised controlled trial (1:1 allocation) to be undertaken in a district general hospital. Sixty-eight orthodontic patients aged nine and above, requiring study models, will be recruited during new patient appointments at the Orthodontic Department at Queen's Medical Centre, Nottingham. Patients will be randomly assigned to either the intraoral scan or alginate impression group, with chair side time recorded for each procedure, including retakes. The IOS group will use the 3Shape TRIOS scanner, while the alginate group will follow standard procedures. The costs of each technique will be calculated following the procedure. Ethical approval was obtained from a Health Research Authority Research Ethics Committee. OUTCOMES: N/A CONCLUSIONS: N/A