{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T17:37:13Z","timestamp":1780681033679,"version":"3.54.1"},"reference-count":30,"publisher":"Springer Science and Business Media LLC","issue":"15","license":[{"start":{"date-parts":[[2025,4,23]],"date-time":"2025-04-23T00:00:00Z","timestamp":1745366400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,4,23]],"date-time":"2025-04-23T00:00:00Z","timestamp":1745366400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100011644","name":"Kahramanmaras Sutcu Imam University","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100011644","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Aesth Plast Surg"],"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Background<\/jats:title>\n            <jats:p>Gynecomastia surgeries are frequently performed due to esthetic concerns. There is lack of data regarding postoperative pain control for these patients. The aim of this study was to compare the pectoral nerve (PECS) block type I and type II with respect to postoperative analgesic consumption, pain scores in these patients.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>The prospective randomized study was conducted with 30 patients, with American Society of Anesthesiologists I\u2013II, between the ages of 18 and 50, and undergoing bilateral gynecomastia surgery. The patients were divided into two groups: PECS I block with general anesthesia (<jats:italic>n<\/jats:italic> = 15) and PECS II block with general anesthesia (<jats:italic>n<\/jats:italic> = 15). The demographic data, hemodynamic parameters, postoperative numeric rating scale (NRS) scores (at 0, 1, 2, 6, 12, 24 h postoperative), the number of patients who needed rescue analgesia, and block-related adverse events were recorded.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>NRS scores at 30 min, 1 and 2 h postoperatively were similar in the two groups, whereas the scores at 6, 12 and 24 h were significantly lower in the PECS II group (<jats:italic>p<\/jats:italic> = 0.005, <jats:italic>p<\/jats:italic> = 0.007, <jats:italic>p<\/jats:italic> = 0.002, respectively). It was determined that the postoperative 24-h tramadol consumption was statistically significantly lower in the PECS II group (<jats:italic>p<\/jats:italic> = 0.005). Additional analgesic was required in two patients in the PECS I group, but none in the PECS II group.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion<\/jats:title>\n            <jats:p>PECS blocks could effectively reduce postoperative pain level in gynecomastia operations; however, PECS II block was superior to PECS I block in terms of both analgesic consumption and pain scores.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Level of Evidence II<\/jats:title>\n            <jats:p>This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"http:\/\/www.springer.com\/00266\" ext-link-type=\"uri\">www.springer.com\/00266<\/jats:ext-link>.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1007\/s00266-025-04865-1","type":"journal-article","created":{"date-parts":[[2025,4,23]],"date-time":"2025-04-23T12:39:40Z","timestamp":1745411980000},"page":"4304-4313","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["The Comparison of Efficacy of Bilateral Type I Versus Type II Pectoral Nerve Block Applied with Ultrasound-Guided for Postoperative Analgesia in Gynecomastia Surgeries"],"prefix":"10.1007","volume":"49","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0657-7578","authenticated-orcid":false,"given":"Aykut","family":"Urfal\u0131oglu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2422-7272","authenticated-orcid":false,"given":"Mehmet","family":"Bekerecioglu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0270-9350","authenticated-orcid":false,"given":"Adem","family":"Doganer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2696-7255","authenticated-orcid":false,"given":"Harun","family":"Karaduman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-1943-2455","authenticated-orcid":false,"given":"Gizem Ezgi","family":"Sat\u0131c\u0131","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8785-8186","authenticated-orcid":false,"given":"Abdullah","family":"Dincg\u00f6zoglu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,4,23]]},"reference":[{"issue":"4","key":"4865_CR1","doi-asserted-by":"publisher","first-page":"573","DOI":"10.1016\/j.bpa.2019.07.003","volume":"33","author":"EM Helander","year":"2019","unstructured":"Helander EM, Webb MP, Kendrick J, Montet T, Kaye AJ, Cornett EM, Kaye AD. PECS, serratus plane, erector spinae, and paravertebral blocks: a comprehensive review. Best Pract Res Clin Anaesthesiol. 2019;33(4):573\u201381. https:\/\/doi.org\/10.1016\/j.bpa.2019.07.003.","journal-title":"Best Pract Res Clin Anaesthesiol"},{"issue":"1","key":"4865_CR2","doi-asserted-by":"publisher","first-page":"20e","DOI":"10.1097\/PRS.0000000000002842","volume":"139","author":"EA Salviz","year":"2017","unstructured":"Salviz EA, Sivrikoz N, Ozonur A, Orhan-Sungur M, Savran-Karadeniz M, Altun D, Hocaoglu E, Celet-Ozden B, Tugrul KM. Ultrasound-guided bilateral thoracic paravertebral blocks as an adjunct to general anaesthesia in patients undergoing reduction mammaplasty: a historical cohort study. Plast Reconstr Surg. 2017;139(1):20e\u20138e. https:\/\/doi.org\/10.1097\/PRS.0000000000002842.","journal-title":"Plast Reconstr Surg"},{"issue":"3","key":"4865_CR3","doi-asserted-by":"publisher","first-page":"307","DOI":"10.1016\/j.bjan.2018.11.009","volume":"69","author":"B Alt\u0131parmak","year":"2019","unstructured":"Alt\u0131parmak B, Korkmaz Toker M, Uysal AI, G\u00fcm\u00fc\u015f Demirbilek S. Ultrasound guided erector spinae plane block for postoperative analgesia after augmentation mammoplasty: case series. Braz J Anesthesiol. 2019;69(3):307\u201310. https:\/\/doi.org\/10.1016\/j.bjan.2018.11.009.","journal-title":"Braz J Anesthesiol"},{"issue":"9","key":"4865_CR4","first-page":"280","volume":"6","author":"R Khemka","year":"2016","unstructured":"Khemka R, Chakraborty A, Ahmed R, Datta T, Agarwal S. Ultrasound-guided serratus anterior plane block in breast reconstruction surgery. A case report. A&A Practice. 2016;6(9):280\u20132.","journal-title":"A&A Practice"},{"issue":"1","key":"4865_CR5","doi-asserted-by":"publisher","first-page":"47","DOI":"10.1016\/j.accpm.2018.03.009","volume":"38","author":"O Karaca","year":"2019","unstructured":"Karaca O, Pinar HU, Arpaci E, Dogan R, Cok OY, Ahiskalioglu A. The efficacy of ultrasound-guided type-I and type-II pectoral nerve blocks for postoperative analgesia after breast augmentation: a prospective, randomised study. Anaesth Crit Care Pain Med. 2019;38(1):47\u201352. https:\/\/doi.org\/10.1016\/j.accpm.2018.03.009.","journal-title":"Anaesth Crit Care Pain Med"},{"issue":"20","key":"4865_CR6","doi-asserted-by":"publisher","first-page":"4137","DOI":"10.1007\/s00266-024-03856-y","volume":"48","author":"X You","year":"2024","unstructured":"You X, Jiang G. Effect of ropivacaine intercostal nerve block combined with patient controlled intravenous analgesia on postoperative analgesia after breast augmentation. Aesthet Plast Surg. 2024;48(20):4137\u201341.","journal-title":"Aesthet Plast Surg"},{"issue":"9","key":"4865_CR7","doi-asserted-by":"publisher","first-page":"847","DOI":"10.1111\/j.1365-2044.2011.06838.x","volume":"66","author":"R Blanco","year":"2011","unstructured":"Blanco R. The \u2018pecs block\u2019: a novel technique for providing analgesia after breast surgery. Anaesthesia. 2011;66(9):847\u20138.","journal-title":"Anaesthesia"},{"issue":"9","key":"4865_CR8","doi-asserted-by":"publisher","first-page":"470","DOI":"10.1016\/j.redar.2012.07.003","volume":"59","author":"R Blanco","year":"2012","unstructured":"Blanco R, Fajardo M, Parras Maldonado T. Ultrasound description of Pecs II (modified Pecs I): a novel approach to breast surgery. Rev Esp Anestesiol Reanim. 2012;59(9):470\u20135.","journal-title":"Rev Esp Anestesiol Reanim"},{"issue":"3","key":"4865_CR9","doi-asserted-by":"publisher","first-page":"231","DOI":"10.1097\/AJP.0000000000000529","volume":"34","author":"K Wang","year":"2018","unstructured":"Wang K, Zhang X, Zhang T, Yue H, Sun S, Zhao H, Zhou P. The efficacy of ultrasound-guided Type II pectoral nerve blocks in perioperative pain management for immediate reconstruction after modified radical mastectomy: a prospective, randomised study. Clin J Pain. 2018;34(3):231\u20136. https:\/\/doi.org\/10.1097\/AJP.0000000000000529.","journal-title":"Clin J Pain"},{"issue":"4","key":"4865_CR10","doi-asserted-by":"publisher","first-page":"846","DOI":"10.1016\/j.bja.2017.11.112","volume":"120","author":"P O'Scanaill","year":"2018","unstructured":"O\u2019Scanaill P, Keane S, Wall V, Flood G, Buggy DJ. Single-shot pectoral plane (PECs I and PECs II) blocks versus continuous local anaesthetic infusion analgesia or both after non-ambulatory breast-cancer surgery: a prospective, randomised, double-blind trial. Br J Anaesth. 2018;120(4):846\u201353. https:\/\/doi.org\/10.1016\/j.bja.2017.11.112.","journal-title":"Br J Anaesth"},{"issue":"2","key":"4865_CR11","first-page":"102","volume":"53","author":"O Sercan","year":"2021","unstructured":"Sercan O, Karaveli A, Ozmen S, Uslu A. Comparison of the effects of pectoral nerve block and local infiltration anaesthesia on postoperative pain for breast reduction surgery: a prospective observational study. Eur J Med. 2021;53(2):102\u20137.","journal-title":"Eur J Med"},{"issue":"4","key":"4865_CR12","doi-asserted-by":"publisher","first-page":"333","DOI":"10.1016\/j.bjan.2020.04.013","volume":"70","author":"J Desroches","year":"2020","unstructured":"Desroches J, Roy M, Belliveau M, Leblanc B, Beaulieu P. Bloqueio PECS I para analgesia p\u00f3s-operat\u00f3ria em pacientes submetidos a mamoplastia de aumento: estudo randomizado, duplo-cego, controlado por placebo [PECS I block for postoperative analgesia in patients undergoing breast augmentation surgery: a randomised double-blind placebo-controlled study]. Braz J Anesthesiol. 2020;70(4):333\u201342. https:\/\/doi.org\/10.1016\/j.bjan.2020.04.013.","journal-title":"Braz J Anesthesiol"},{"issue":"2","key":"4865_CR13","doi-asserted-by":"publisher","first-page":"297","DOI":"10.1007\/s00266-019-01322-8","volume":"43","author":"M Ekinci","year":"2019","unstructured":"Ekinci M, Ciftci B, Celik EC, Karakaya MA, Demiraran Y. The efficacy of different volumes on ultrasound-guided type-I pectoral nerve block for postoperative analgesia after subpectoral breast augmentation: a prospective, randomised, controlled study. Aesthet Plast Surg. 2019;43(2):297\u2013304.","journal-title":"Aesthet Plast Surg"},{"issue":"1","key":"4865_CR14","doi-asserted-by":"publisher","first-page":"44","DOI":"10.1016\/j.bjane.2020.12.004","volume":"71","author":"B Ciftci","year":"2021","unstructured":"Ciftci B, Ekinci M, Celik EC, Karaaslan P, Tukac IC. Ultrasound-guided pectoral nerve block for pain control after breast augmentation: a randomised clinical study. Braz J Anesthesiol. 2021;71(1):44\u20139. https:\/\/doi.org\/10.1016\/j.bjane.2020.12.004.","journal-title":"Braz J Anesthesiol"},{"issue":"5","key":"4865_CR15","doi-asserted-by":"publisher","first-page":"1072","DOI":"10.1097\/PRS.0000000000007901","volume":"147","author":"AE Hoyos","year":"2021","unstructured":"Hoyos AE, Perez ME, Dom\u00ednguez-Mill\u00e1n R. Gynecomastia treatment through open resection and pectoral high-definition liposculpture. Plast Reconstr Surg. 2021;147(5):1072\u201383. https:\/\/doi.org\/10.1097\/PRS.0000000000007901.","journal-title":"Plast Reconstr Surg"},{"issue":"3","key":"4865_CR16","doi-asserted-by":"publisher","first-page":"557","DOI":"10.1097\/00000658-194609000-00011","volume":"124","author":"JP Webster","year":"1946","unstructured":"Webster JP. Mastectomy for gynecomastia through a semicircular intra-areolar incision. Ann Surg. 1946;124(3):557\u201375.","journal-title":"Ann Surg"},{"issue":"1","key":"4865_CR17","doi-asserted-by":"publisher","first-page":"48","DOI":"10.1097\/00006534-197301000-00009","volume":"51","author":"BE Simon","year":"1973","unstructured":"Simon BE, Hoffman S, Kahn S. Classification and surgical correction of gynecomastia. Plast Reconstr Surg. 1973;51(1):48\u201352. https:\/\/doi.org\/10.1097\/00006534-197301000-00009.","journal-title":"Plast Reconstr Surg"},{"key":"4865_CR18","first-page":"69","volume-title":"Operative techniques in plastic surgery, trunk reconstruction and body contouring","author":"JT Stranix","year":"2020","unstructured":"Stranix JT, Hazen A. Gynecomastia. In: Disa JJ, Chung KC, editors. Operative techniques in plastic surgery, trunk reconstruction and body contouring. Philadelphia: Wolters Kluwer; 2020. p. 69\u201372."},{"issue":"1","key":"4865_CR19","doi-asserted-by":"publisher","first-page":"106","DOI":"10.1007\/s00266-022-03135-8","volume":"47","author":"Z Zhang","year":"2023","unstructured":"Zhang Z, Li Z, Zhang Z, Guan X, Xin M. Analgesic efficacy of pectoral nerve blocks in implant-based mammoplasty: a systematic review and meta-analysis. Aesthetic Plast Surg. 2023;47(1):106\u201315.","journal-title":"Aesthetic Plast Surg"},{"key":"4865_CR20","doi-asserted-by":"publisher","first-page":"142","DOI":"10.2340\/jphs.v58.9395","volume":"58","author":"H Yang","year":"2023","unstructured":"Yang H, Wang H, Wang Q. The analgesic efficacy of pectoral nerve block for breast augmentation: a meta-analysis of randomised controlled studies. J Plast Surg Hand Surg. 2023;58:142\u20138. https:\/\/doi.org\/10.2340\/jphs.v58.9395.","journal-title":"J Plast Surg Hand Surg"},{"issue":"1","key":"4865_CR21","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1016\/j.redar.2017.04.005","volume":"65","author":"RJB Schuitemaker","year":"2018","unstructured":"Schuitemaker RJB, Sala-Blanch X, Rodriguez-P\u00e9rez CL, Mayoral RJT, L\u00f3pez-Pantaleon LA, S\u00e1nchez-Cohen AP. The PECS II block as a major analgesic component for clavicle operations: a description of 7 case reports. Rev Esp Anestesiol Reanim (Engl Ed). 2018;65(1):53\u20138.","journal-title":"Rev Esp Anestesiol Reanim (Engl Ed)"},{"issue":"6","key":"4865_CR22","doi-asserted-by":"publisher","first-page":"666","DOI":"10.1007\/s00266-006-0230-5","volume":"31","author":"RD Cooter","year":"2007","unstructured":"Cooter RD, Rudkin GE, Gardiner SE. Day case breast augmentation under paravertebral blockade: a prospective study of 100 consecutive patients. Aesthetic Plast Surg. 2007;31(6):666\u201373. https:\/\/doi.org\/10.1007\/s00266-006-0230-5.","journal-title":"Aesthetic Plast Surg"},{"issue":"8","key":"4865_CR23","doi-asserted-by":"publisher","first-page":"617","DOI":"10.4103\/ija.IJA_163_19","volume":"63","author":"C Sinha","year":"2019","unstructured":"Sinha C, Kumar A, Kumar A, Prasad C, Singh PK, Priya D. Pectoral nerve versus erector spinae block for breast surgeries: a randomised controlled trial. Indian J Anaesth. 2019;63(8):617\u201322.","journal-title":"Indian J Anaesth"},{"key":"4865_CR24","doi-asserted-by":"publisher","first-page":"61","DOI":"10.1016\/j.jclinane.2018.10.040","volume":"54","author":"B Alt\u0131parmak","year":"2019","unstructured":"Alt\u0131parmak B, Korkmaz Toker M, Uysal AI, Turan M, G\u00fcm\u00fc\u015f Demirbilek S. Comparison of the effects of modified pectoral nerve block and erector spinae plane block on postoperative opioid consumption and pain scores of patients after radical mastectomy surgery: a prospective, randomised, controlled trial. J Clin Anaesth. 2019;54:61\u20135.","journal-title":"J Clin Anaesth"},{"issue":"2","key":"4865_CR25","volume":"12","author":"A Bakeer","year":"2022","unstructured":"Bakeer A, Abdallah NM. Erector spinae plane block versus PECS block type II for breast surgery: a randomised controlled trial. Anaesth Pain Med. 2022;12(2): e122917.","journal-title":"Anaesth Pain Med"},{"issue":"2","key":"4865_CR26","doi-asserted-by":"publisher","DOI":"10.1097\/PR9.0000000000001244","volume":"10","author":"AM Soliman","year":"2025","unstructured":"Soliman AM, Kamel MA, Khalil AE, Kotb TA, Abed SM, Abdelmoneim NM. Ultrasound-guided rhomboid intercostal block combined with subserratus plane block vs pectoral nerve block type-2 in analgesia for breast-conserving surgery (randomized, controlled study). Pain Rep. 2025;10(2): e1244. https:\/\/doi.org\/10.1097\/PR9.0000000000001244.","journal-title":"Pain Rep"},{"key":"4865_CR27","doi-asserted-by":"publisher","first-page":"4315931","DOI":"10.1155\/2018\/431593","volume":"2018","author":"DH Kim","year":"2018","unstructured":"Kim DH, Kim S, Kim CS, Lee S, Lee IG, Kim HJ, Lee JH, Jeong SM, Choi KT. Efficacy of pectoral nerve block type II for breast-conserving surgery and sentinel lymph node biopsy: a prospective randomised controlled study. Pain Res Manag. 2018;2018:4315931. https:\/\/doi.org\/10.1155\/2018\/431593.","journal-title":"Pain Res Manag"},{"issue":"6","key":"4865_CR28","doi-asserted-by":"publisher","first-page":"367","DOI":"10.1097\/AJP.0000000000001208","volume":"40","author":"AE Ardon","year":"2024","unstructured":"Ardon AE, Curley E, Greengrass R. Safety and complications of landmark-based paravertebral blocks: a retrospective analysis of 979 patients and 4983 injections. Clin J Pain. 2024;40(6):367\u201372.","journal-title":"Clin J Pain"},{"issue":"1","key":"4865_CR29","doi-asserted-by":"publisher","first-page":"1e","DOI":"10.1097\/PRS.0000000000009253","volume":"150","author":"J Abi-Rafeh","year":"2022","unstructured":"Abi-Rafeh J, Safran T, Abi-Jaoude J, Kazan R, Alabdulkarim A, Davison PG. Nerve blocks in breast plastic surgery: outcomes, complications, and comparative efficacy. Plast Reconstr Surg. 2022;150(1):1e\u201312e. https:\/\/doi.org\/10.1097\/PRS.0000000000009253.","journal-title":"Plast Reconstr Surg"},{"issue":"3","key":"4865_CR30","doi-asserted-by":"publisher","first-page":"442","DOI":"10.1097\/ALN.0000000000003855","volume":"135","author":"Y Aarab","year":"2021","unstructured":"Aarab Y, Ramin S, Odonnat T, Garnier O, Boissin A, Molinari N, Marin G, Perrigault PF, Cuvillon P, Chanques G. Pectoral nerve blocks for breast augmentation surgery: a randomised, double-blind. Dual-centred controlled trial. Anesthesiology. 2021;135(3):442\u201353. https:\/\/doi.org\/10.1097\/ALN.0000000000003855.","journal-title":"Anesthesiology"}],"container-title":["Aesthetic Plastic Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00266-025-04865-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00266-025-04865-1\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00266-025-04865-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,10]],"date-time":"2025-09-10T20:06:52Z","timestamp":1757534812000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00266-025-04865-1"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,23]]},"references-count":30,"journal-issue":{"issue":"15","published-print":{"date-parts":[[2025,8]]}},"alternative-id":["4865"],"URL":"https:\/\/doi.org\/10.1007\/s00266-025-04865-1","relation":{},"ISSN":["0364-216X","1432-5241"],"issn-type":[{"value":"0364-216X","type":"print"},{"value":"1432-5241","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,4,23]]},"assertion":[{"value":"3 January 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"22 March 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"23 April 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare that they have no conflict of interest to disclose.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"This study was approved by our institution's research ethics board. This article conforms to the guidelines set forth by the Helsinki Declaration in 1975.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics Approval"}},{"value":"Informed consent of the patients was obtained for this study.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed Consent"}}]}}