{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T20:05:45Z","timestamp":1785787545895,"version":"3.56.0"},"reference-count":33,"publisher":"Springer Science and Business Media LLC","issue":"13","license":[{"start":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T00:00:00Z","timestamp":1780444800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T00:00:00Z","timestamp":1780444800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100004913","name":"Universit\u00e0 degli Studi di Palermo","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100004913","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":[[2026,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Post-operative pain after breast augmentation remains unpredictable, and regional anesthesia alone is seldom described. We evaluated an opioid-free protocol combining pectoral nerves (PECS I\u2013II) and parasternal blocks with intravenous sedation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Between January 2020 and December 2024, 627 women (mean age 35\u00a0y) underwent bilateral primary augmentation under ultrasound-guided fascial-plane blocks plus sedation. VAS pain scores were recorded at predefined intervals up to 72\u00a0h. Descriptive statistics, cubic modelling of pain trajectories and Kruskal\u2013Wallis tests compared implant planes; cumulative pain was expressed as the 0\u201372\u00a0h area under the curve (AUC).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Mean VAS was &lt;\u20092 in all groups by 72\u00a0h. Pain peaked at 16\u00a0h, highest with dual-plane placement (mean 7.0) and lower with submuscular and pre-pectoral placements (both \u2248\u20095.5;\n                      <jats:italic>p\u2009<\/jats:italic>\n                      &lt;\u20090.001). Inter-group differences persisted to 48\u00a0h but disappeared by 72\u00a0h (\n                      <jats:italic>p\u2009<\/jats:italic>\n                      =\u20090.115). AUC confirmed the greatest pain burden for dual-plane (292 VAS\u00b7h) versus submuscular (238) and pre-pectoral (200). Implant volume showed only a weak overall correlation with pain (\u03c1\u2009=\u20090.20) and none within individual planes. No patient required rescue opioids; most resumed normal activities within four days, and no major complications occurred.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Ultrasound-guided PECS I\u2013II and parasternal blocks with sedation provide safe, effective, opioid-free analgesia for aesthetic breast augmentation. Early pain is determined mainly by the implant plane, not by implant size, and should be considered in surgical planning and postoperative care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence III<\/jats:title>\n                    <jats:p>\n                      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\n                      <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>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00266-026-05966-1","type":"journal-article","created":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T19:30:27Z","timestamp":1780515027000},"page":"5127-5134","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Regional Anesthesia as Primary Strategy in Aesthetic Breast Augmentation Surgery: Clinical Outcomes in 627 Sedated Patients Undergoing Pectoral Nerves (PECS I\u2013II) and Parasternal Blocks"],"prefix":"10.1007","volume":"50","author":[{"given":"Di Lorenzo","family":"Sara","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea Pio","family":"Cascino","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scalisi","family":"Alfio","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pulvirenti","family":"Giuseppe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1830-0530","authenticated-orcid":false,"given":"Corradino","family":"Bartolo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,6,3]]},"reference":[{"issue":"20","key":"5966_CR1","doi-asserted-by":"publisher","first-page":"4217","DOI":"10.1007\/s00266-024-04260-2","volume":"48","author":"L Triana","year":"2024","unstructured":"Triana L, Palacios Huatuco RM, Campilgio G, Liscano E. Trends in surgical and nonsurgical aesthetic procedures: a 14-year analysis of the International Society of Aesthetic Plastic Surgery\u2014ISAPS. Aesth Plast Surg. 2024;48(20):4217\u201327. https:\/\/doi.org\/10.1007\/s00266-024-04260-2.","journal-title":"Aesth Plast Surg"},{"issue":"2","key":"5966_CR2","doi-asserted-by":"publisher","first-page":"195","DOI":"10.1016\/0304-3959(96)03064-3","volume":"66","author":"MS Wallace","year":"1996","unstructured":"Wallace MS, Wallace AM, Lee J, Dobke MK. Pain after breast surgery: a survey of 282 women. Pain. 1996;66(2):195\u2013205. https:\/\/doi.org\/10.1016\/0304-3959(96)03064-3.","journal-title":"Pain"},{"issue":"Suppl 1","key":"5966_CR3","doi-asserted-by":"publisher","first-page":"S40","DOI":"10.4103\/joacp.JOACP_51_18","volume":"35","author":"AD Kaye","year":"2019","unstructured":"Kaye AD, Urman RD, Rappaport Y, Siddaiah H, Cornett EM, Belani K, et al. Multimodal analgesia as an essential part of enhanced recovery protocols in the ambulatory settings. J Anaesthesiol Clin Pharmacol. 2019;35(Suppl 1):S40\u20135. https:\/\/doi.org\/10.4103\/joacp.JOACP_51_18.","journal-title":"J Anaesthesiol Clin Pharmacol"},{"issue":"3","key":"5966_CR4","doi-asserted-by":"publisher","first-page":"979","DOI":"10.1007\/s00266-022-03214-w","volume":"47","author":"S Stahl","year":"2023","unstructured":"Stahl S, Santos Stahl A, Feng YS, Estler A, Swoboda K, Buiculescu F, et al. Enhanced recovery after aesthetic breast surgery under sedation, intercostal block and tumescent anaesthesia: a prospective cohort study of the early postoperative phase. Aesth Plast Surg. 2023;47(3):979\u201397. https:\/\/doi.org\/10.1007\/s00266-022-03214-w.","journal-title":"Aesth Plast Surg"},{"issue":"8","key":"5966_CR5","doi-asserted-by":"publisher","first-page":"964","DOI":"10.1177\/1090820x12457014","volume":"32","author":"SS Stanley","year":"2012","unstructured":"Stanley SS, Hoppe IC, Ciminello FS. Pain control following breast augmentation: a qualitative systematic review. Aesthet Surg J. 2012;32(8):964\u201372. https:\/\/doi.org\/10.1177\/1090820x12457014.","journal-title":"Aesthet Surg J"},{"issue":"2 Suppl","key":"5966_CR6","doi-asserted-by":"publisher","first-page":"S105","DOI":"10.36076\/ppj.2008\/11\/S105","volume":"11","author":"R Benyamin","year":"2008","unstructured":"Benyamin R, Trescot AM, Datta S, Buenaventura R, Adlaka R, Sehgal N. Opioid complications and side effects. Pain Physician. 2008;11(2 Suppl):S105-120.","journal-title":"Pain Physician"},{"issue":"2","key":"5966_CR7","doi-asserted-by":"publisher","first-page":"534","DOI":"10.1213\/01.ane.0000068822.10113.9e","volume":"97","author":"JL Apfelbaum","year":"2003","unstructured":"Apfelbaum JL, Chen C, Mehta SS, Gan ATJ. Postoperative pain experience: results from a national survey suggest postoperative pain continues to be undermanaged. Anesth Analg. 2003;97(2):534\u201340. https:\/\/doi.org\/10.1213\/01.ane.0000068822.10113.9e.","journal-title":"Anesth Analg"},{"issue":"9","key":"5966_CR8","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. https:\/\/doi.org\/10.1111\/j.1365-2044.2011.06838.x.","journal-title":"Anaesthesia"},{"issue":"9","key":"5966_CR9","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. https:\/\/doi.org\/10.1016\/j.redar.2012.07.003.","journal-title":"Rev Esp Anestesiol Reanim"},{"issue":"4","key":"5966_CR10","doi-asserted-by":"publisher","first-page":"254","DOI":"10.4103\/ija.ija_46_18","volume":"62","author":"R Garg","year":"2018","unstructured":"Garg R, Bhan S, Vig S. Newer regional analgesia interventions (fascial plane blocks) for breast surgeries: review of literature. Indian J Anaesth. 2018;62(4):254. https:\/\/doi.org\/10.4103\/ija.ija_46_18.","journal-title":"Indian J Anaesth"},{"issue":"1","key":"5966_CR11","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, P\u0131nar HU, Arpac\u0131 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"},{"key":"5966_CR12","doi-asserted-by":"publisher","DOI":"10.1186\/s42077-019-0033-y","author":"KYK Hakim","year":"2019","unstructured":"Hakim KYK, Wahba WZ. Single injection pectoral nerve block (Pecs I and Pecs II) versus local anesthetic infiltration for ambulatory breast augmentation combined with monitored anesthesia care. Ain-Shams J Anesthesiol. 2019. https:\/\/doi.org\/10.1186\/s42077-019-0033-y.","journal-title":"Ain-Shams J Anesthesiol"},{"issue":"4","key":"5966_CR13","doi-asserted-by":"publisher","first-page":"333","DOI":"10.1016\/j.bjane.2020.07.004","volume":"70","author":"J Desroches","year":"2020","unstructured":"Desroches J, Roy M, Belliveau M, Leblanc B, Beaulieu P. PECS I block for postoperative analgesia in patients undergoing breast augmentation surgery: a randomized double-blind placebo-controlled study. Braz J Anesthesiol (Engl Ed). 2020;70(4):333\u201342. https:\/\/doi.org\/10.1016\/j.bjane.2020.07.004.","journal-title":"Braz J Anesthesiol (Engl Ed)"},{"issue":"17","key":"5966_CR14","doi-asserted-by":"publisher","DOI":"10.3390\/cancers14174223","volume":"14","author":"V M\u00e9gevand","year":"2022","unstructured":"M\u00e9gevand V, Scampa M, McEvoy H, Kalbermatten DF, Oranges CM. Comparison of outcomes following prepectoral and subpectoral implants for breast reconstruction: systematic review and meta-analysis. Cancers. 2022;14(17):4223. https:\/\/doi.org\/10.3390\/cancers14174223.","journal-title":"Cancers"},{"key":"5966_CR15","doi-asserted-by":"publisher","first-page":"11","DOI":"10.21037\/abs-24-48","volume":"9","author":"A Pumilia","year":"2025","unstructured":"Pumilia A, Le PB, Bian J, Becker ME, Friedman HI. Implant-based breast reconstruction\u2014a systematic review and meta-analysis of prepectoral versus submuscular implant placement. Ann Breast Surg. 2025;9:11\u201311. https:\/\/doi.org\/10.21037\/abs-24-48.","journal-title":"Ann Breast Surg"},{"issue":"3","key":"5966_CR16","doi-asserted-by":"publisher","DOI":"10.1097\/gox.0000000000004843","volume":"11","author":"MC Medor","year":"2023","unstructured":"Medor MC, Bouhadana G, Churchill IF, Hemmerling T, Bonapace-Potvin M, Papanastasiou C, et al. How big is too big? Exploring the relationship between breast implant volume and postoperative complication rates in primary breast augmentations. Plast Reconstr Surg Glob Open. 2023;11(3):e4843. https:\/\/doi.org\/10.1097\/gox.0000000000004843.","journal-title":"Plast Reconstr Surg Glob Open"},{"issue":"7","key":"5966_CR17","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000006107","volume":"96","author":"MH Kim","year":"2017","unstructured":"Kim MH, Kim MS, Lee JH, Seo JH, Lee JR. Can quality of recovery be enhanced by premedication with midazolam?: A prospective, randomized, double-blind study in females undergoing breast surgery. Medicine (Baltimore). 2017;96(7):e6107. https:\/\/doi.org\/10.1097\/MD.0000000000006107.","journal-title":"Medicine (Baltimore)"},{"issue":"14","key":"5966_CR18","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph19148696","volume":"19","author":"M Szamborski","year":"2022","unstructured":"Szamborski M, Janc J, Rosi\u0144czuk J, Janc JJ, Le\u015bnik P, \u0141ysenko L. Use of ultrasound-guided interfascial plane blocks in anterior and lateral thoracic wall region as safe method for patient anesthesia and analgesia: review of techniques and approaches during COVID-19 pandemic. Int J Environ Res Public Health. 2022;19(14):8696. https:\/\/doi.org\/10.3390\/ijerph19148696.","journal-title":"Int J Environ Res Public Health"},{"issue":"4","key":"5966_CR19","doi-asserted-by":"publisher","first-page":"104","DOI":"10.1097\/AIA.0b013e31820e4a49","volume":"49","author":"CM Brummett","year":"2011","unstructured":"Brummett CM, Williams BA. Additives to local anesthetics for peripheral nerve blockade. Int Anesthesiol Clin. 2011;49(4):104\u201316. https:\/\/doi.org\/10.1097\/AIA.0b013e31820e4a49.","journal-title":"Int Anesthesiol Clin"},{"issue":"2","key":"5966_CR20","doi-asserted-by":"publisher","first-page":"113","DOI":"10.1097\/AAP.0000000000000720","volume":"43","author":"JM Neal","year":"2018","unstructured":"Neal JM, Barrington MJ, Fettiplace MR, Gitman M, Memtsoudis SG, M\u00f6rwald EE, et al. The third American society of regional anesthesia and pain medicine practice advisory on local anesthetic systemic toxicity: executive summary 2017. Reg Anesth Pain Med. 2018;43(2):113\u201323. https:\/\/doi.org\/10.1097\/AAP.0000000000000720.","journal-title":"Reg Anesth Pain Med"},{"issue":"6","key":"5966_CR21","doi-asserted-by":"publisher","first-page":"596","DOI":"10.1097\/aap.0000000000000779","volume":"43","author":"J Cros","year":"2018","unstructured":"Cros J, Seng\u00e8s P, Kaprelian S, Desroches J, Gagnon C, Labrunie A, et al. Pectoral I block does not improve postoperative analgesia after breast cancer surgery: a randomized, double-blind, dual-centered controlled trial. Reg Anesth Pain Med. 2018;43(6):596\u2013604. https:\/\/doi.org\/10.1097\/aap.0000000000000779.","journal-title":"Reg Anesth Pain Med"},{"key":"5966_CR22","doi-asserted-by":"publisher","DOI":"10.1186\/s40981-015-0018-1","author":"H Morioka","year":"2015","unstructured":"Morioka H, Kamiya Y, Yoshida T, Baba H. Pectoral nerve block combined with general anesthesia for breast cancer surgery: a retrospective comparison. JA Clin Rep. 2015. https:\/\/doi.org\/10.1186\/s40981-015-0018-1.","journal-title":"JA Clin Rep"},{"issue":"1","key":"5966_CR23","doi-asserted-by":"publisher","first-page":"68","DOI":"10.1097\/aap.0000000000000163","volume":"40","author":"GMN Bashandy","year":"2015","unstructured":"Bashandy GMN, Abbas DN. Pectoral nerves I and II blocks in multimodal analgesia for breast cancer surgery: a randomized clinical trial. Reg Anesth Pain Med. 2015;40(1):68\u201374. https:\/\/doi.org\/10.1097\/aap.0000000000000163.","journal-title":"Reg Anesth Pain Med"},{"issue":"4","key":"5966_CR24","doi-asserted-by":"publisher","first-page":"254","DOI":"10.4103\/ija.ija_46_18","volume":"62","author":"R Garg","year":"2018","unstructured":"Garg R, Bhan S, Vig S. Newer regional analgesia interventions (fascial plane blocks) for breast surgeries: review of literature. Indian J Anaesth. 2018;62(4):254. https:\/\/doi.org\/10.4103\/ija.ija_46_18.","journal-title":"Indian J Anaesth"},{"issue":"3","key":"5966_CR25","doi-asserted-by":"publisher","first-page":"328","DOI":"10.1016\/j.ejpain.2010.07.004","volume":"15","author":"ML Von Sperlingl","year":"2011","unstructured":"Von Sperlingl ML, H\u00f8imyrl H, Finnerupl K, Jensenl TS, Finnerupl NB. Persistent pain and sensory changes following cosmetic breast augmentation. Eur J Pain. 2011;15(3):328\u201332. https:\/\/doi.org\/10.1016\/j.ejpain.2010.07.004.","journal-title":"Eur J Pain"},{"issue":"5","key":"5966_CR26","doi-asserted-by":"publisher","first-page":"1053","DOI":"10.1213\/ane.0b013e318264ba33","volume":"115","author":"S Gardiner","year":"2012","unstructured":"Gardiner S, Rudkin G, Cooter R, Field J, Bond M. Paravertebral blockade for day-case breast augmentation: a randomized clinical trial. Anesth Analg. 2012;115(5):1053\u20139. https:\/\/doi.org\/10.1213\/ane.0b013e318264ba33.","journal-title":"Anesth Analg"},{"issue":"1","key":"5966_CR27","doi-asserted-by":"publisher","first-page":"55","DOI":"10.1097\/00000542-199701000-00009","volume":"86","author":"RM Giebler","year":"1997","unstructured":"Giebler RM, Scherer RU, Peters J. Incidence of neurologic complications related to thoracic epidural catheterization. Anesthesiology. 1997;86(1):55\u201363. https:\/\/doi.org\/10.1097\/00000542-199701000-00009.","journal-title":"Anesthesiology"},{"issue":"6","key":"5966_CR28","doi-asserted-by":"publisher","first-page":"697.e1","DOI":"10.1016\/j.ajem.2010.06.014","volume":"29","author":"MB Stone","year":"2011","unstructured":"Stone MB, Carnell J, Fischer JWJ, Herring AA, Nagdev A. Ultrasound-guided intercostal nerve block for traumatic pneumothorax requiring tube thoracostomy. Am J Emerg Med. 2011;29(6):697.e1-697.e2. https:\/\/doi.org\/10.1016\/j.ajem.2010.06.014.","journal-title":"Am J Emerg Med"},{"issue":"1","key":"5966_CR29","doi-asserted-by":"publisher","first-page":"51","DOI":"10.1007\/s00266-020-01892-y","volume":"45","author":"D Ribuffo","year":"2021","unstructured":"Ribuffo D, Berna G, De Vita R, Di Benedetto G, Cigna E, Greco M, et al. Dual-plane retro-pectoral versus pre-pectoral DTI breast reconstruction: an Italian multicenter experience. Aesthet Plast Surg. 2021;45(1):51\u201360. https:\/\/doi.org\/10.1007\/s00266-020-01892-y.","journal-title":"Aesthet Plast Surg"},{"issue":"10","key":"5966_CR30","doi-asserted-by":"publisher","first-page":"1092","DOI":"10.1093\/asj\/sjy071","volume":"38","author":"O Govrin-Yehudain","year":"2018","unstructured":"Govrin-Yehudain O, Matanis Y, Govrin-Yehudain J. Reduced pain and accelerated recovery following primary breast augmentation with lightweight breast implants. Aesthet Surg J. 2018;38(10):1092\u20136. https:\/\/doi.org\/10.1093\/asj\/sjy071.","journal-title":"Aesthet Surg J"},{"issue":"6S Suppl 5","key":"5966_CR31","doi-asserted-by":"publisher","first-page":"S299","DOI":"10.1097\/SAP.0000000000001132","volume":"78","author":"P Tan","year":"2017","unstructured":"Tan P, Martin MS, Shank N, Myers L, Wolfe E, Lindsey J, et al. A comparison of 4 analgesic regimens for acute postoperative pain control in breast augmentation patients. Ann Plast Surg. 2017;78(6S Suppl 5):S299-304. https:\/\/doi.org\/10.1097\/SAP.0000000000001132.","journal-title":"Ann Plast Surg"},{"issue":"3","key":"5966_CR32","doi-asserted-by":"publisher","first-page":"743","DOI":"10.31557\/apjcp.2019.20.3.743","volume":"20","author":"M Bourazani","year":"2019","unstructured":"Bourazani M, Papageorgiou E, Zarkadas G, Petrakopoulou T, Kaba E, Fasoi G, et al. The role of muscle relaxants\u2014spasmolytic (Thiocochlicoside) in postoperative pain management after mastectomy and breast reconstruction. Asian Pac J Cancer Prev. 2019;20(3):743\u20139. https:\/\/doi.org\/10.31557\/apjcp.2019.20.3.743.","journal-title":"Asian Pac J Cancer Prev"},{"issue":"20","key":"5966_CR33","doi-asserted-by":"publisher","DOI":"10.3390\/jcm13206133","volume":"13","author":"A Bianconi","year":"2024","unstructured":"Bianconi A, Fiore M, Rosso A, Acuti Martellucci C, Cal\u00f2 GL, Cioni G, et al. Efficacy of Thiocolchicoside for musculoskeletal pain management: a systematic review and meta-analysis of randomized controlled trials. JCM. 2024;13(20):6133. https:\/\/doi.org\/10.3390\/jcm13206133.","journal-title":"JCM"}],"container-title":["Aesthetic Plastic Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00266-026-05966-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00266-026-05966-1","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00266-026-05966-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T19:11:16Z","timestamp":1785784276000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00266-026-05966-1"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,3]]},"references-count":33,"journal-issue":{"issue":"13","published-print":{"date-parts":[[2026,7]]}},"alternative-id":["5966"],"URL":"https:\/\/doi.org\/10.1007\/s00266-026-05966-1","relation":{},"ISSN":["0364-216X","1432-5241"],"issn-type":[{"value":"0364-216X","type":"print"},{"value":"1432-5241","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,3]]},"assertion":[{"value":"13 August 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"22 April 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"3 June 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare no commercial or financial conflicts of interest related to the subject of this study. No external funding was received for this study.","order":1,"name":"Ethics","label":"Conflict of interest","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare that they have no conflicts of interest to disclose. The study was conducted in accordance with the Declaration of Helsinki. Written informed consent for the surgical and anesthetic procedures, including permission for the anonymized use of clinical data for research purposed was obtained from all patients.","order":2,"name":"Ethics","label":"Ethical Approval","group":{"name":"EthicsHeading","label":"Declarations"}}]}}