This review aims to characterize the current landscape of exoskeletons designed to promote medical care and occupational safety in industrial settings. Extensive exploration of scientific databases spanning industries, health, and medicine informs the classification of exoskeletons according to their distinctive attributes and specific footholds on the human physique. Within the scope of this review, a comprehensive analysis is presented, contextualizing the integration of exoskeletons based on different work activities. The reviewers extracted the most relevant articles published between 2008 and 2023 from IEEE, Proquest, PubMed, Science Direct, Scopus, Web of Science, and other databases. In this review, the PRISMA-ScR checklist was used, and a Cohen’s kappa coefficient of 0.642 was applied, implying moderate agreement among the reviewers; 75 primary studies were extracted from a total of 344. The future of exoskeletons in contributing to occupational health and safety will depend on continued collaboration between researchers, designers, healthcare professionals, and industries. With the continued development of technologies and an increasing understanding of how these devices interact with the human body, exoskeletons will likely remain valuable for improving working conditions and safety in various work environments. The work activities of an industry require that, on several occasions, workers perform tasks related to the strain of the body. These activities mainly regard handling loads on the head , forced Implementing exoskeletons has provided workers with more significant benefits and physical advantages. These benefits allow them to maintain specific positions without requiring great muscular efforts and reduce the risk of injuries or musculoskeletal affectations . OccupatThe main objective of this research is to provide a comprehensive and up-to-date view of how exoskeletons contribute to occupational health and safety in various industries, examining their current applications, limitations, and the path toward continuous improvement for the benefit of workers. This research answers research questions related to the objectives of occupational safety and health (OSH), which involve (1) maintenance of workers’ health; (2) improvement of the working environment and safety; and (3) promotion of a work culture that supports health and safety . ExoskelExoskeleton developers have generated devices that have the potential to significantly take care of the health of the worker . In partTo assist in reducing lower back disorders (LBD), portable back exoskeletons (or “exos”) have been developed to provide ergonomic support, effectively reducing musculoskeletal overexertion . These dDue to the frequency of injuries and risks of musculoskeletal affectations, the construction industry has implemented the use of exoskeletons to mitigate the effects generated by musculoskeletal disorders by reducing physical demand and increasing the capacity of users of these devices ,10,11. A second primary function of exoskeletons is to provide a means for workers to maintain their non-neutral working postures, limit muscle movement, and reduce human body members’ effort in performing tasks ,13. There are specific areas of the human body where muscular effort is more remarkable, as in the case of the shoulder, which is subjected to muscle and joint contact forces. Because of this, some developments in passive exoskeletons have focused on assisting while the worker performs quasi-static tasks . Another area in which physical effort is concentrated is the lower back. This fact is why sectors of an industry in which load-handling tasks are frequent have implemented the use of exoskeletons to amplify performance and have less impact on the lumbar area of workers . The tremendous physical demands due to the use of tools and machine tools by workers is another factor that has driven the development and use of exoskeletons to provide the worker with resistance and physical capacity, reducing the impact of disorders derived from the handling of these tools, including situations of work carried out at height ,17.The use and implementation of exoskeletons in workers’ activities should be studied and approached from the point of view of occupational physicians, ergonomists, and occupational health and safety specialists . The expDespite the wide variety of technologies and complexity of developments, the use of single-joint occupational exoskeletons that are portable and that use springs to support the user when handling loads at a considerable height concerning the height of their head is common in several productive sectors .The use of exoskeletons by workers has been well received in activities that correspond to manufacturing environments. According to previous studies, comfort is perceived, and a good adaptation of exoskeletons to the tasks performed provides safety in their use .The structure of the review article is organized as follows: One factor that influences the generation of musculoskeletal disorders in workers is poor control of activities that require a physical load. The assignment of physical load tasks must consider each job’s morphofunctional level and biomechanical demands . Exoskeletons have significantly improved occupational health and safety, improved worker productivity, and assisted aging workers by reducing their risk of musculoskeletal disorders . In addiThe disturbances generated by construction industry workers are the most representative of extraction and mining industries . StudiesAccording to It is known that greater force or torque is required to support the movement of some body regions. Electromechanical systems allow driving movements that help mobility in some parts of the body, and some of these systems are used in the development of exoskeletons and prostheses .Exoskeletons have been used and implemented in multiple industries as a preventive measure to reduce work-related musculoskeletal stress. The main functional principle of these assistive systems is to transfer mechanical energy to the human body, thereby reducing physical stress on specific body parts. However, there is a controversial debate on whether using exoskeletons prevents work-related musculoskeletal disorders . ImplemeNowadays, companies are implementing exoskeletons as solutions to reduce musculoskeletal disorders in the workplace. According to the European Agency for Safety and Health at Work , a perceWhile it is true that exoskeletons can be a tool for improvement, their implementation should not be an isolated action. Still, it should follow the principles and the hierarchy of preventive measures, ensuring that their use firstly helps to eliminate or control the risk factor detected and, secondly, that their introduction in the workplace does not generate new risks to users or third parties, or provoke a response of rejection by those who must use them. In this sense, we recommend reviewing NTP 1163: Exoskeletons II: Criteria for Selection and Integration in the company .As an essential parameter in implementing exoskeletons to support worker safety and health, the time employees spend handling or lifting heavy loads should be considered. Introducing new technologies in the work environment entails a thorough assessment of Occupational Safety and Health (OSH) for all parties involved. It is essential to have a design that prioritizes human comfort and well-being, as stipulated in the Framework Directive (89/391/EEC) . Due to Exoskeletons can be considered a technical, medical solution and can also be considered as protective equipment. The categorization of exoskeletons depends mainly on their application, design, and purpose of use. Consequently, exoskeletons are only evaluated through a case-by-case analysis. In practice, it is feasible for exoskeletons to be used as technical tools to streamline work processes. However, if their implementation aims to improve the design of a workspace where ergonomic measures are required to prevent injuries due to overloading, they will be considered personal protective equipment. In the future, it will be essential to integrate the evaluation of exoskeletons into the traditional ergonomic approach, focusing on human well-being as they influence work dynamics and organizational aspects.This section presents multiple advances in exoskeletons designed and built for worker health care and safety. Regarding health, using exoskeletons reduces the overload of effort the muscles are subjected to during the worker’s tasks . In termThe scientific literature reviewed was categorized in According to the action, the developments have three subcategories: passive , semi-acIn the case of semi-active and active exoskeletons, the actuators used to drive the joints often require electrical energy. The classification-powered technology includes four subcategories: exoskeletons have sets of mechanisms driven by human strength that increase the strength of the arms and legs. A second type is systems that employ hydraulic actuators. A third subcategory employs pneumatic actuators. A fourth category of those that have presented more current developments corresponds to actuators based on muscles formed by multifilaments driven by electrical energy, allowing muscle traction and compression according to the temperature in these polymers. Regarding occupational health and safety, developments of exoskeletons have been identified that obey two types of applications: assistance in loading tasks and rehabilitation for the recovery of mobility when workers have suffered disorders and/or injuries. In addition, there are exoskeletons for training that include using haptic devices to provide feedback to the user to correct their postures and train for the tasks to be performed.According to multiple studies of the most frequent disorders in construction activities, the symptoms and musculoskeletal disorders that present the most recurrence are neck pain; shoulder, upper back, and lower back pain; leg pain; foot pain; general fatigue of the whole body; and hand pain ,50,51,52In order to control and activate the degree of rotational freedom of the knee, developments have been presented that use an elastic actuator operated with a cable. This mechanism allows for the regulation of translation movements with a parallel mechanism of three degrees of freedom, whose movement can be guided by presenting a low inertial resistance for the user , guarantExoskeletons have been designed to provide knee assistance using multimodal actuators. These exoskeletons allow the activation of various modes of operation during movement cycles. In addition, elastic behavior, rigid position, and energy storage and release are controlled . Using a mechanical model, an eccentric pulley has been used to achieve multistage nonlinear assistance at different knee flexion angles. The assistance is lower during walking on flat terrain but increases markedly during ascent or climbing by the user .Studies on shape synthesis for exoskeletons that assist the knee have been presented; clinical biomechanical data have been considered to achieve gait cycles, achieving a 45% reduction in maximum actuation force. A four-bar link is used and is intended for use by people with injured knees to support ligaments, tendons, and muscles . Knee assistance solutions have been developed that also consider the hip and ankle in multiple gait ranges, and a solution has been proposed for the variable moments that increase with speed. In addition, these developments handle variable torques, which allows for optimizing the assistance benefiting the metabolic energy cost used according to a higher walking speed of up to 1.5 m/s .Subactuated soft exoskeletons have been designed to assist knee extension and plantar ankle flexion for each leg using a single actuator. These developments have made it possible to reduce knee activity by 6.40%. There was evidence of a significant reduction in ankle timing and power . To reduce the risk and pain of the knee due to the handling of loads while climbing stairs, an active knee exoskeleton has been proposed that assists in lifting the load by providing an extra pair in the user’s knee joint, which allows for reducing the load of the tendon of the kneecap and the quadriceps in their movement. Using integrated sensors, the force of human–robot interaction is used as a signal to control the device .The structure and technologies used by exoskeletons for walking assistance have been developed with the support of multiple technologies and types of kinematic joints with good results in the mobile structure . HoweverA technique involving central pattern generators (CPG) has been proposed to enhance the natural movement provided by exoskeletons. This approach enables the application of an adaptable method for modeling the gait trajectory, effectively controlling the movement of lower limb exoskeletons. Using CPG, exoskeletons can provide users with a more natural and intuitive walking experience. These CPGs are synchronized at different joints and updated online in response to the physical behavior of human users to improve their safety and comfort when walking . They alExoskeletons for lower extremities have been developed and evaluated to decrease metabolic cost, movement strategy, and muscle activation under repetitive load lifting and gait conditions. From measurements of energy expenditure, kinematic factors, and muscle activity in 11 healthy men in periods of 5 min for repetitive loading and walking, it was concluded that metabolic costs were reduced by 17%, which required less generation of physical work by the worker .Military workers who frequently walk and handle loads are prone to musculoskeletal injuries and disorders . These aTwo types of exoskeletons differ in their application field: assistance and augmentation exoskeletons. Assistive exoskeletons are commonly used to assist or replace affected limbs or joints of users in order for them to restore their movements, increasing their independence and improving their quality of life. Augmentation exoskeletons are used in industries to improve ergonomics, reduce risks of exposure to demanding working conditions, prevent work accidents, and reduce workers’ acute physical stress and stress by increasing their physical efficiency .Exoskeleton walking assistance also incorporates chair support to avoid risks of muscle fatigue in the lower extremities caused by standing for prolonged periods. According to studies, prolonged standing has been associated with an increased likelihood of heart disease . An alteFor assistance during level walking, climbing, descending stairs, and up and down ramps, portable exoskeletons have been developed that provide adequate electrical assistance . A rapidIn construction, musculoskeletal disorders represent one of the biggest problems for workers. The way and frequency with which loads are handled without adequate control often cause affectations in the lower back. It has been shown that using exoskeletons reduces flexion in the back, increasing flexion in the hip.Although there are developments implemented in industries to assist the posture of workers, it is considered that the deployment, widespread adoption, and potential of these alternatives are still limited and depend on multiple factors such as effectiveness, the type of task to be performed, and the body postures that require support .Another aspect to be solved with the use of exoskeletons is the control of the balance of workers while they handle loads. Solutions have been proposed to achieve equilibrium according to the exoskeleton type, and loads handled . Exoskeletons have been studied that assist workers whose task is to decontaminate nuclear power plants after disasters, for which force sensors have been implemented in the foot area so that the control system can determine the angles with which they move the user’s limbs and activate the motorized exoskeleton to assist the movement of the joints in a smoother and controlled way ,72. For More effective control has been achieved to provide electrical assistance to the exoskeleton actuators depending on the intention of movement of the users; this control method is based on the use of electromyography (EMG), with which the performance of the exoskeleton used for upper extremities has been evaluated, whose data for control have been obtained from the position of the user’s wrist and the extreme tip of the exoskeleton . Some deAs a contribution to preventive measures in tasks that require body movement with an inclination of the trunk, hip exoskeletons have been designed to allow for stabilizing the position under conditions of external disturbances, which has corroborated that the use of the exoskeleton reduces, by 40%, the forward inclination of the trunk, reducing the risk of muscle injuries .For people with disabilities in their lower extremities, exoskeletons on wheels have been developed whose novel design supports the postural transition in the change of movement from sitting to standing and vice versa, providing a greater degree of user independence .In order to reduce fatigue and muscle pain in the legs due to prolonged work in standing and squatting positions, an exoskeleton with a multilink mechanism based on redundant rods has been designed that avoids interference between the exoskeleton and the leg when walking. Based on the behavior of the crank–crank mechanism, the exoskeleton design has been given viability, managing to transmit body weight to the ground when the user feels supported by the exoskeleton . The injuries that influence the most in quality of life and reduce life expectancy in workers correspond to spinal cord injuries and disorders . Developments in the field of lumbar activity assistance exoskeletons include the participation of multiple disciplines such as robotics, mechanisms, bionics, control theory, communication technology, and information processing technology, which allows for integrating solutions to improve the control of the exoskeleton response to facilitate user activities .Assisting augmentation exoskeletons for people with spinal cord disorders or sequelae can get the worker to handle greater loads and achieve the activities that a person would normally do without any considerable affectation; however, the continued use of an exoskeleton for this purpose can promote bone loss and risk of fragility fracture, as is the case with people who constantly use wheelchairs. In order to provide a complete solution, an exoskeleton must allow adequate and necessary mobility so that the person is not affected by downstream effects arising from the use of exoskeletons . For adequate handling of loads at considerable heights, the Aerial Porter (APEx) exoskeleton has been created, which consists of a motorized system mounted on the hip and attached to an adjustable vest, according to the behavior of the user; this system activates the motors, which provide a torque of 30 Nm . With thWith the use of whole-body powered exoskeletons (WB-PEXO) and during the performance of static load loading and transfer tasks with and without an exoskeleton, a reduction in reduced average levels of muscle activity in the back (42–53% in thoracic and 24–43% in lumbar regions) and legs (41–63% in knee flexors and extensors) has been verified when handling loads of 10 to 15 kg . The evaluation of passive exoskeletons during the repetitive lifting of loads in squat positions, crouching, and in orientations such as frontal/symmetrical and lateral/asymmetric orientations has allowed us to measure the extensor muscle activity of the trunk and hip. Exoskeletons were determined to have limited influence on muscle responses; the device supports the hip extension and requires tight body posture during lifting . In addiWork performed on the worker’s head (OHW) poses significant risks that can lead to musculoskeletal disorders in the shoulder area. Upper extremity exoskeletons (EXOULs) have been developed to reduce these risks. This type of development seeks to control muscle activity in the postural muscles and upper extremities and balance control during the performance of OHW. Exoskeleton designs must adapt their mass in implementation, balance, and support torque to optimize the use of these devices .With the passive shoulder exoskeleton called Exo4Work, activity, muscle fatigue, and subjective experience during simulated work on the head without overload have been evaluated. Reduced muscle activity and delayed development of muscle fatigue have been shown during OHW .The excessive muscle and joint contact forces generated in the shoulder area that can cause musculoskeletal disorders have been effectively reduced using passive shoulder exoskeletons when performing quasi-static tasks. The evaluation of these advantages has not contemplated sequelae in joints and neighboring areas such as the elbow, lower back, hip, and knee. Further study is required around the assistance versus adaptation of the exoskeleton to the user and its effects on musculoskeletal loads . InsuffiWith torsion springs, passive arm exoskeletons have been developed to help workers lift loads or transport at height. The assistance generated with the springs provides a pair of assistance to the elbow and wrist joints that allow us to work with loads of up to 8 kg effectively. An advantage of this exoskeleton design is its low weight, low cost, and ease of use, as it is easy for workers to activate and deactivate the action of the springs at any time .A two-degree-of-freedom exoskeleton incorporating a dual motor–tendon actuator has been designed and tested to assist elbow and wrist movement. A rack gear joint is used to convert the rotational motion of the motor into linear motion, which allows for two types of flexion/extension and pronation/supination movement . Exoskeletons are often studied based on their collective impact rather than individual components in the context of their contributions to occupational health and safety. Therefore, various commercial, experimental, and prototype developments are outlined in A systematic review was conducted to compile this document by thoroughly examining the scholarly literature, including journal articles and conference papers from reputable scientific databases and repositories . The mosFive research questions were posed for extracting information in the selected documents and from which reference information could be extracted. The research questions posed were RQ1. What types of exoskeletons have been addressed in the studies?; RQ2. What are the applications of exoskeletons for occupational health and safety?; RQ3. How do occupational tasks influence the musculoskeletal affections of the worker?; RQ4. What are the contributions of exoskeletons to occupational health and safety?; and RQ5. What are the limitations that arise in the use of exoskeletons for occupational health and safety?The quality of the articles considered was evaluated considering the criteria shown in ® methodology is shown in For the search carried out, the following keywords were used: exoskeletal, safety, health, and occupational workers. A related scientific literature search was conducted using Web Of Sciences, ProQuest, ScienceDirect, SCOPUS, PubMed, and IEEE Xplore databases. From the identification of 344 articles, 75 works were obtained that provided relevant information to carry out this review article; the workflow carried out using the PRISMAIn the last 10 years, there have been more frequent developments in the field of exoskeletons for use in industries. Robotic exoskeletons have become more available and of interest for implementation in industrial processes, especially construction. The variety of exoskeletons also now has the potential to be successfully used for personal use at home and in the community .Concerning RQ1, various models, technologies, and types of exoskeletons have been identified that have been categorized by their type of assistance in exoskeletons for the knee, walking, posture, the lumbar area, and the arms ,34,35,36Articles have been found with information responding to RQ2 that describes applications of exoskeletons in the field of occupational safety in the performance of tasks related to the handling of moderate loads, which allows for maintaining posture in uncomfortable positions and mutual assistance devices that reduce the force they perform during tasks ,5,15,20.The tasks that generate the most impact on the development of musculoskeletal affectations correspond to the performance of construction tasks responding to RQ3. The construction field ,31,32,33About RQ4, knowledge gaps are glimpsed in studies carried out with sufficient time for the use of exoskeletons by workers. Although significant advantages have been identified in repetitive and loading tasks, no literature analyzes the muscle areas close to those that interact with the fastening elements of the devices. Exoskeletons and exosuits (EXOs) are designed to protect workers by reducing the risk of exertion injuries and muscle fatigue during work. Little of the scientific literature studies the effects in neighboring areas of the human body that exoskeletons have served; by modifying their activity and energy consumption, some muscles will have a greater or lesser effect on the other muscles or structures with which they interact ,16. The The limitations to which RQ5 refers have been identified in evaluations of the implementation of exoskeletons for workers of industries manifested with discomfort and movement restrictions, which have been the reason for new studies that propose alternatives to provide improvements in assistance, a torque increase automatically according to the intention of movement, user behaviors, or movement patterns. No studies address, in sufficient depth, aspects such as the optimal use of exoskeletons to perform work tasks .With the implementation of exoskeletons in fundamental tasks within an industry, user perception and usability have been evaluated several times . AlthougContinued use of exoskeletons can result in bone fragility due to a lack of limb activity . The assA word cloud has been made with the keywords from the reference documentation. The image in The limited sample size and the selection of participants from a specific geographic and work environment may affect the generalizability of the results to different contexts. In addition, socioeconomic heterogeneity may influence the acceptance of new technologies, such as exoskeletons .A lack of practical experience with exoskeletons may make assessing their impact on workers difficult. Participants may struggle to address the expected impact on surgical workers without directly experiencing exoskeletons .Many investigations show clear limitations in methodological quality, as they selectively select certain work activities for an analysis and do not comprehensively address work demands in various fields .Exoskeletons may limit functional performance in tasks that do not involve load manipulation. The exoskeleton may hinder tasks such as walking that require hip flexion, which may also increase metabolic costs .The effects of exoskeletons may depend on the specific task demands and working conditions. The effectiveness of an exoskeleton may vary depending on the task being performed .Most evaluations of exoskeletons focus on short-term effects, especially in laboratory settings. This case may be due to resource and feasibility constraints, which may not fully capture long-term impacts .Results obtained in studies limited to certain types of agricultural workers may not be generalizable to other forms of agriculture or agricultural workers with different working conditions and demands .Measurements based on recognized standards may have limitations, such as assessor-dependent results and poor correlations with direct physiological measurements .Discomfort and a lack of standards and novelty are challenges in exoskeleton design. Discomfort may hinder their acceptance and use in industrial settings, limiting their applicability . The lacExoskeletons can be expensive, which may restrict their adoption in industries with limited budgets . In addiProlonged use of exoskeletons can be uncomfortable for workers, especially if they are ill-fitting or interfere with natural movements . The intWorkers must be adequately trained to use exoskeletons effectively and safely. This training can take time and resources. Exoskeletons require regular maintenance to ensure that they function correctly . This siUser acceptance of the device is critical to its success . The intExoskeletons may be more effective in specific tasks and less effective in others. For example, it has been observed that exoskeletons may limit functional performance in tasks that require hip flexion, such as walking . ExoskelThere is a risk that exoskeletons may cause discomfort, pressure on unwanted parts of the body, changes in the center of gravity, and other health problems, such as skin irritation and allergic reactions .Although exoskeletons show advantages in improving occupational health and safety, the limitations mentioned above should be carefully evaluated by employers before implementing these devices in the workplace. Each exoskeleton has unique characteristics and considerations, so a comprehensive evaluation of its fit, usability, and effectiveness in specific work contexts is needed.The future of exoskeletons holds promising prospects, marked by ongoing research and development endeavors aimed at enhancing their functionality, comfort, and efficacy across diverse occupational domains . Expert Efforts are being directed toward implementing exoskeletons in surgical settings to mitigate musculoskeletal discomfort among surgical teams . ComparaA prudent approach involves delving deeper into using exoskeletons to prevent musculoskeletal injuries through randomized controlled trials. This approach would furnish robust data regarding exoskeletons’ efficacy in mitigating occupational hazards .To comprehensively understand exoskeleton applicability, we advocate for research encompassing diverse samples based on age, gender, health status, and occupational tasks . This apAnticipated advances in lightweight materials, sensors, and actuators are poised to facilitate the creation of more sophisticated and comfortable exoskeletons. This progress may usher in the next generation of devices featuring enhanced natural movements and superior adaptability to the human body .Incorporating artificial intelligence and augmented reality technologies can potentially elevate exoskeleton functionality and efficacy. This integration allows for improved interaction and intuitive interfaces between exoskeletons and users.The future envisions exoskeletons incorporating predictive algorithms for optimizing assistance control . Such inAdvancements in technology are expected to render exoskeletons lighter, more user-friendly, and affordable. Robust, ergonomic design and heightened usability are pivotal for seamless integration into work environments.Seamless integration into work processes is on the horizon, aligning exoskeletons more closely with workers’ needs. This alignment promises enhanced synergy between exoskeletons and occupational tasks.A future characterized by continual enhancements in design, functionality, comfort, and efficiency lies ahead for exoskeletons. As technology, materials, and scientific knowledge advance, these devices are poised to remain indispensable tools for curbing musculoskeletal risks and elevating occupational health and safety standards across diverse workplaces.The manufacturing and development of robotic exoskeletons have generated a paradigm shift in various sectors, encompassing healthcare, military, and industrial applications. As these technological advances continue to proliferate, it becomes crucial to consider their impact on the environment to know whether the production of these solutions will contribute to current environmental challenges .In the design process of exoskeletons, a fundamental part is the selection of the energy source, an aspect of notable influence on the environmental footprint of these devices. Electric exoskeletons exhibit a relatively low environmental impact, primarily when powered by renewable energy sources. They do not emit directly and are highly energy efficient. However, the production and disposal of their batteries can have environmental implications. Battery manufacturing often involves the extraction of rare earth metals, which can lead to habitat damage and water pollution. In addition, improper disposal of used batteries can release hazardous materials into the environment.Hydraulic and pneumatic exoskeletons could have a higher environmental impact. These systems often require fossil fuels to generate the necessary pressure, leading to carbon emissions. In addition, the production of hydraulic fluids and compressed gases can contribute to environmental pollution.For example, the use of exoskeletons could reduce the need for heavy machinery in the industrial field, resulting in lower energy consumption and emissions. They could also improve occupational safety and productivity, reducing injuries and their associated environmental impact. In health, exoskeletons could provide mobility for people with physical disabilities, reducing dependence on motorized wheelchairs and other devices. This situation could result in significant energy savings and reduced carbon emissions. In addition, promoting independence could reduce the demand for resource-intensive care facilities.Several strategies are feasible to maximize the environmental benefits of robotic exoskeletons. First, using renewable energy sources to power these devices should be prioritized. This instance could include integrating solar panels into the design or developing more efficient batteries. Second, the lifespan of exoskeleton components should be extended through more efficient design and maintenance. Finally, end-of-life management strategies should ensure environmentally friendly recycling or proper disposal of exoskeleton components .The potential of exoskeletons to promote sustainability is significant. Through the careful choice of energy sources and implementation of strategies to reduce waste and emissions, it is feasible to harness the benefits of this technology in a manner aligned with our environmental goals. As we continue to innovate and refine these devices, the potential for a more sustainable future is increasingly within our reach.Multiple designs and developments of exoskeletons have been implemented for commercial and academic purposes worldwide. The morphology of these devices and their functions provide real advantages. They contribute to fulfilling industry workers’ occupational health and safety objectives, emphasizing the construction and manufacturing area where heavier loads and conditions of high physical demand are handled. However, these conditions have not been thoroughly studied.Most studies and advancements in exoskeletons for occupational tasks have focused on providing shoulder and arms, full-body, leg, and back assistance. These systems are implemented in industrial sectors where some studies have gathered information on usability and user perception. On the other hand, academic studies and developments utilize test benches that enable the independent evaluation of muscular activity and interaction forces. Therefore, to more accurately evaluate the interaction between the worker and the exoskeleton, it is necessary to consider natural and task-specific situations in the workers’ daily routines. Additionally, it is crucial to consider the implications of prolonged usage of these devices to generate more comprehensive and significant studies.Uncertainties exist regarding the consequences of prolonged exoskeleton use in areas near the joints they support, including the effects of interaction, adaptability, optimization, and impact. It is essential to thoroughly study these factors to enhance the utilization of exoskeletons in work environments, mitigating potential health consequences for workers that may not be readily apparent.The design and evaluation of exoskeletons require the multidisciplinary participation of doctors, biomedical experts, physiotherapists, mechanics, electronics, and control specialists. The physical aspect of these exoskeletons, in terms of their movement, has undergone significant development and applied technologies. Optimization and improvements have been achieved by implementing automatic control strategies determining the user’s movement intention, behavior, and repetitive movement patterns. This analysis allows for activating and deactivating the exoskeleton’s actuators, initiating movement at the appropriate time, and achieving a more natural motion for the device user.


The results support a 6-factor model (21 items) that is statistically valid and reliable for use in universities (of applied sciences). The model includes the following factors, referring to types of support and their features: trust and availability, emotional support, networking support, autonomy support, similarity, and empathy. This questionnaire makes an original contribution insofar as (1) it is based on a sound, theoretical framework, and (2) it was demonstrated to be valid and reliable across different sub-populations in higher education. The questionnaire provides educational practitioners with a sound and valid tool to evaluate the quality of their mentoring program. It can also be used to assess what types of support could be offered to a greater extent.To keep up with technological advances and macro-economic trends, higher education has increasingly focused on developing students’ employability competences through mentoring programs. However, measuring the effectiveness of such mentoring programs has remained difficult, because many mentoring measurements are not validated or grounded in theory. Furthermore, existing questionnaires have mostly focused on one or two types of support, ignoring the wide variety of support types offered by a mentor. Therefore, the current study’s aim was to develop and validate a new questionnaire measuring various types of mentoring support. Based on a systematic literature review, a 35-item questionnaire was developed and data were collected from mentoring programs at four higher education institutions. Data were analyzed through exploratory factor analysis ( Today, business environments and labor markets are rapidly changing due to technological advances, macro-economic trends, and the evolving knowledge-based economy Tynjälä, . This isEmployability refers to “a set of achievements – skills, understandings and personal attributes – that makes graduates more likely to gain employment and be successful in their chosen occupations, which benefits themselves, the workforce, the community and the economy” Yorke, , p. 8. DHowever, these employability competences are neither innate nor easy to acquire. Hence, higher education curricula need to adopt specific instructional approaches to develop students’ employability competences. Dacre Pool and Sewell  argued tFor these reasons, mentoring has become an integral part of many higher educational curricula, and a wide variety of mentoring programs are currently in use , interviews (n = 29), on-site measurements (n = 13), or reflection journals (n = 11) , Academic Mentoring Behaviour Scale , Noe’s (n = 3), the Mentor Relationship Assessment Scale , and the questionnaire by Tenenbaum et al., (n = 2).Our systematic literature review also demonstrated that mentoring is measured in different ways, for instance through questionnaires , Noe’s  Mentor F et al., ; n = 2.n = 5) were used to assess the extent to which the mentees felt that support was offered to them, such as psychological and emotional support, academic subject knowledge support, psychosocial support, and career support  to strongly agree (5). Lastly, the questionnaire included four items asking about demographic information, such as gender, age, nationality, and program of study.The process of scale construction eventually led to the development of the Mentoring Support Scale. This questionnaire contained 35 items, divided over 5 subscales: 20 original items and 15 new items (11 based on previous items and four completely new items). For the final questionnaire, all scales were introduced by the following sentence: “To what extent do you agree with the following statements?” Additionally, the statements were evaluated using a 5-point Likert scale ranging from Data were collected using the newly developed measure  from undergraduate students at two universities of applied sciences in the Netherlands and one university of applied sciences in Belgium. Additional data for cross-validation were collected from graduate students at one university in the Netherlands, to make sure the questionnaire would fit a university context as well as a university of applied sciences context. All educational institutions offered academic mentoring programs to their students. These mentoring programs consisted of several similar features: (1) mentoring provided individually during one academic year, (2) a focus on the development of students’ (employability) competences, such as working in teams, written and verbal communication, and self-efficacy, and (3) the exclusion of guidance on academic matters . Because of this context, the Mentoring Support Scale is validated taking an employability perspective, even though its initial development took a broader view on potential mentoring outcomes. Most students in these mentoring programs were either in teacher training or studied hotel management.Program leaders of these mentoring programs were contacted and a meeting between the executive researcher and each program leader took place. During these meetings, the program leaders were informed of the subject of the study and were invited to participate. All program leaders decided to participate, and therefore they became the first point of contact. All students who participated in the mentoring programs were informed about the research study by their program leaders and were asked to participate in the study voluntarily. They were invited to fill out an online questionnaire along with an informed consent form. The questionnaire was presented in English and data collection took place in June 2020 and June 2021, as one round of data collection did not yield enough data to conduct the necessary analyses. In total, 281 students completed the survey in June 2020 and 253 students in June 2021. Most of the sample (79.8%) was female, which is in line with the percentage of female employees working in the respective disciplines  in June 2020 were used to conduct an exploratory factor analysis (EFA) in SPSS 26.0. An EFA is “an exploratory method used to generate theory; researchers use EFA to search for the smaller set of k latent factors to represent the larger set of j variables” .While EFA is used to generate theory, confirmatory factor analysis (CFA) is based on pre-existing theory  was calculated to provide information on model parsimony. According to Tabachnick et al.  was examined to compare the specified model with the base model. The cut-off value for the CFI is > 0.9 . Three tests of measurement invariance were conducted to assess the psychometric equivalence of the latent construct across different groups  was large enough. A traditional rule of thumb is to have at least 5–10 respondents per item . The results are presented in Fig. 2/df = 2.302). Second, the CFI was above 0.9 (0.926). Third, the RMSEA was below 0.08  and the SRMR was between 0 and 0.08 (0.0514). Therefore, all fit indices demonstrated a good model fit. The reliability of the scales was calculated on this subsample as well, and all Cronbach’s alphas were higher than 0.70 . The results are presented in Fig. 2/df = 1.680). Second, the CFI was above 0.9 (0.923). Third, the RMSEA was 0.08 (CI: 0.065–0.099) and the SRMR was between 0 and 0.08 (0.0623). The reliability of the scales was calculated on this subsample as well, and all Cronbach’s alphas were higher than 0.70 . Furthermore, the difference in CFI between model 1 (0.914) and model 2 (0.912) was 0.002 (ΔCFI ≤ 0.01) and the difference in Mc NCI between model 1 (0.541) and model 2 (0.522) was 0.009 (ΔMc NCI ≤ 0.02). Therefore, the results indicate that the model reached metric invariance, that is, equivalence of item loadings on factors . As a result, the core features of psychosocial support were identified as separate factors. More specifically, the psychosocial support construct resolved into three subscales. Trust and availability refers to a mentoring relationship in which the mentor and mentee achieve a high level of mutual trust, and in which the mentor is easy to talk to and makes time for the mentee. Similarity refers to the idea that the mentor and mentee display similar values and that the mentee can identify with the mentor as if they were friends. Empathy refers to the mutual respect the mentor and mentee show towards each other, and the fact that the mentor respects the feelings of the mentee.Third, and in contrast to what was expected, career support was not recognized as a separate type of support by the students. Career support refers to mentoring behaviors that prepare mentees for career advancement Noe, , help thThis study’s limitations and avenues for future research are as follows. First, the Mentoring Support Scale has been validated in one particular context, being a Western-European country adopting a mentoring program aimed at increasing students’ employability competences. Therefore, future research is needed to perform various cross-validations to be able to better generalize the results to other cultures or mentoring outcomes. Second, adaptations needed to be made regarding the relations between error terms when performing the cross-validation. This indicates that the measurement model was not fully identical across the two different groups of students, namely, applied sciences versus a university context. Future research might look into potential reasons why these error terms needed to be adapted to better suit the academic context. Second, when performing the cross-validation, the model did not reach scalar invariance. It is important to test for scalar invariance to assess if the mean differences in the latent construct capture all mean differences in the shared variance of the items . Lastly, and in contrast to what was expected, career support was not recognized as a separate type of support by the students. However, this finding could imply that students do not perceive career support to be a substantial mentoring function of mentoring programs in higher education.


Different modulators of Ca2+ signaling have been implied, such as STIM1, Orai1, CyPA, SGK1, etc. Also, the N-methyl-D-aspartate receptor (NMDAR) was identified to contribute to Ca2+ signaling in platelets. However, the role of the NMDAR in thrombus formation is not well defined.Platelet activation and thrombus formation is crucial for hemostasis, but also trigger arterial thrombosis. Calcium mobilization plays an important role in platelet activation, because many cellular processes depend on the level of intracellular CaIn vitro and in vivo analysis of platelet-specific NMDAR knock-out mice.Grin1fl/fl-Pf4-Cre+ mice with a platelet-specific knock-out of the essential GluN1 subunit of the NMDAR. We found reduced store-operated Ca2+ entry (SOCE), but unaltered store release in GluN1-deficient platelets. Defective SOCE resulted in reduced Src and PKC substrate phosphorylation following stimulation of glycoprotein (GP)VI or the thrombin receptor PAR4 followed by decreased integrin activation but unaltered degranulation. Consequently, thrombus formation on collagen under flow conditions was reduced ex vivo, and Grin1fl/fl-Pf4-Cre+ mice were protected against arterial thrombosis. Results from human platelets treated with the NMDAR antagonist MK-801 revealed a crucial role of the NMDAR in integrin activation and Ca2+ homeostasis in human platelets as well.In this study, we analyzed NMDAR signaling is important for SOCE in platelets and contributes to platelet activation and arterial thrombosis. Thus, the NMDAR represents a novel target for anti-platelet therapy in cardiovascular disease (CVD). This induces STIM1 oligomer aggregation and its translocation to the plasma membrane  and increases the intracellular Ca2+ level ([Ca2+](i)) in platelets. The increase activates multiple Ca2+-dependent targets. The increased Ca2+ level in the cell is also used as a Ca2+ source to replenish the intraluminal Ca2+ level in the DTS, for which the sarco (endo) plasmic reticulum calcium-ATPase 2 (SERCA2) is responsible (2+ entry and [Ca2+](i) dynamics through different mechanisms including membrane depolarization or store- and receptor-operated mechanisms . They assemble from tetrameric combinations of GluN1, GluN2, and GluN3 subunits, with GluN1 being obligatory for channel function. Distinct from other iGluR subfamilies, most NMDARs show relevant Ca2+ permeability and exhibit a voltage-dependent block by extracellular Mg2+ ions. Activation of most NMDAR subunit combinations requires binding of the agonist glutamate to GluN2 and the co-agonists glycine or D-serine to GluN1 subunits. An exception form complexes from GluN1 and GluN3, lacking a glutamate-binding site, which serve as glycine-activated cation channels (fl/fl-Pf4-Cre+Grin1) to identify NMDAR mediated activation and Ca2+ signaling in platelets important for hemostasis and thrombosis in vitro and in vivo.In recent years, N-methyl-D-aspartate receptors (NMDARs) were identified to contribute to Cachannels –20. NMDAchannels  playing channels , actin rchannels  cell adhchannels  as well channels . Moreovechannels . NMDARs channels , 28. How2.2.1.198, #ABN1681, Merck, 1:1,000), total Akt  and phosphorylated Akt , β-Actin , glyceraldehyde 3-phosphate dehydrogenase , phospho-PKC substrate motif [(R/K)XpSX(R/K)] , and horseradish peroxidase (HRP)-linked anti-rabbit secondary antibodies  were used. Additionally and anti GLUN1-Antibody  was used for detection of Grin1 expression in platelets. For flow cytometric analysis fluorophore conjugated antibodies labelling P-selectin , active integrin αIIbβ3 , GPIbα , GPVI , integrin α5  and integrin β3  were used. For inhibition experiments with human platelets, the inhibitor MK-801  was used in indicated concentrations.For platelet isolation apyrase  and prostacyclin  were used. Platelets were activated with collagen-related peptide , adenosine diphosphate , the thromboxane A2 analogue U46619 , PAR4 peptide , thrombin , lipopolysaccharide  or convulxin . For immunoblotting antibodies targeting total Src  and phosphorylated Src , total Syk , and phosphorylated Syk , total Pannexin-1  and phosphorylated Panx1  was collected from healthy volunteers. All healthy volunteers provided their written informed consent to participate in this study according to the Ethics Committee of the University Clinic of Duesseldorf, Germany . This study was conducted according to the Declaration of Helsinki and the International Council for Harmonization Guidelines on Good Clinical Practice.2.3.2, 2.8 mM KCl, 12 mM NaHCO3, 0.5 mM Na2HPO4, 5.5 mM glucose). For cell count determination, a 1:10 dilution in Tyrode's buffer was measured using a hematology analyzer . Cell count was set according to the experimental design by diluting with human Tyrode's buffer. MK-801 was preincubated for 15 min at 37°C for determination of altered platelet activation.For human platelet isolation, citrate-anticoagulated whole blood was centrifuged at 200×g for 10 min at RT and slowly decelerated. Subsequently, the upper phase, platelet-rich plasma (PRP) was collected and transferred into 1 ml PBS (pH 6.5). Platelet activation was inhibited by the addition of 2.5 U/ml apyrase and 1 µM prostaglandin E1 (PGE1). After centrifugation at 1,000×g for 6 min the supernatant was discarded and the platelet pellet was dissolved in human Tyrode's buffer  mice were provided by Dr. Eckhardt Lammert and cross-bread with PF4-Cre mice that were purchased from the Jackson Laboratory [C57BL/6-Tg (Pf4-cre) Q3Rsko/J], to generate megakaryocyte/platelet specific deletion of Grin1. The fl/fl-Pf4-Cre+Grin1 and fl/fl-Pf4-Cre−Grin1 mice were already described and characterized by Hearn and colleagues . All other experiments were conducted with male and female mice with an age of 2–4 months. Mice were maintained in an environmentally controlled room at 22 ± 1°C with a 12 h day-night cycle. Mice were housed in Macrolon cages type III with ad libitum access to food (standard chow diet) and water. All animal procedures were conducted according to the Declaration of Helsinki and are conform to the guidelines from Directive 2010/63/EU of the European Parliament on the protection of animals used for scientific purposes. All animal experiments were approved by the Ethics Committee of the State Ministry of Agriculture, Nutrition and Forestry State of North Rhine-Westphalia, Germany .2.5.10 to 12-week-old mice were anesthetized by a singular intraperitoneal (i.p.) injection of Ketamine  and Xylazine . After progressing successfully anesthesia, the tail tip was cut with a scalpel at a position where the diameter of the tail is 2.25 – 2.5 mm using a gauge. The tail was immersed in normal saline (37°C). The time from the incision to the cessation of bleeding was recorded (no blood flow for 1 min) as described previously . Euthana2.6.3 for 20 s. Thrombus formation was observed with a fluorescence microscope . Time until full occlusion of the vessel (when blood flow had stopped for more than 60 s) was measured. After 40 min without vessel occlusion, experiments were terminated. Euthanasia was performed by cervical dislocation.Mice (3–4 weeks of age) were anesthetized by a singular intraperitoneal (i.p.) injection of Ketamine  and Xylazine . After progressing successfully anesthesia, a midline abdominal incision was done, the mesentery was exteriorized and arterioles free of fat tissue were injured by topical application of a filter paper saturated with 20% FeCl2.7.2 and blood flow was measured in ml/min. Then a small pad was placed under the artery below the measuring head and the environment of the artery was dried. A 0.5 × 1 mm filter paper (Whatmann No.1) saturated with 10% FeCl3 (Sigma-Aldrich) was placed at the area of the carotid artery below the measuring head for 3 min. After removing the filter paper, the environment of the artery was moisturized with 0.9% NaCl2 again. The formation of the thrombus and or occlusion of the artery was recorded by the software until 5 min after a firm occlusion (stopped blood flow) or if there is no occlusion until the measurement reached a duration of 30 min. Euthanasia was performed by cervical dislocation.10 to 12-week-old mice were anesthetized by intraperitoneal administration of Ketamine and Xylazine as described above and the right A. carotis communis was prepared and placed into a flow probe . Before starting the measurement, the artery and the surrounding area were moisturized with 0.9% NaCl2.8.2HPO4, 2.7 mM KCl, 12 mM NaHCO3, 0.1% glucose, 0.35% bovine serum albumin (BSA)], containing apyrase and PGI2. Cell count was determined in a 1:10 dilution at using a hematology analyzer. For experimental use, the isolated platelets were resuspended in Tyrode's buffer supplemented with 1 mM CaCl2 .Mice were placed for anesthesia with controlled supply of isoflurane (2%) and oxygen (1 L/min). The blood was collected by using glass capillaries covered with sodium heparin by puncturing the retrobulbar venous plexus. Murine platelet isolation was conducted as described elsewhere . Briefly2.9.6) were stimulated with CRP or thrombin for indicated time-points at 37°C for time dependent analysis. For concentration dependent analysis, CRP stimulation was terminated after 2 min, and PAR4 stimulation after 5 min. Platelet stimulation was terminated by adding 1× human lysis buffer . Lysis was performed for 15 min at 4°C. Afterwards, 6× Laemmli buffer was added to the platelet lysates, followed by a denaturation step at 95°C for 5 min. The platelet lysates were stored at −70°C until use. For immunoblotting platelet lysates were separated by sodium dodecyl sulfate polyacrylamide gel electrophoresis . After gel separation using SDS-PAGE running buffer  for 2.5 h (25 mA), the gels were blotted to a nitrocellulose membrane for 1 h (70 mA). Unspecific antibody binding was prevented by blocking the membranes in 5% non-fat dry milk in TBST  for 1 h at RT. After 3× times washing n TBST the membrane was probed with specific antibody's listed under 2.1 at 4°C overnight. After washing, the membranes were probed with HRP-conjugated secondary antibody  for 1 h at RT. GAPDH  served as loading control. Bands were visualized by chemiluminescence detection reagents  and imaged using a FusionFX Chemiluminescence Imager System (Vilber). Quantification of immune-reactive band intensities was performed by using Image J sofware.Murine platelets were isolated as described in 2.8. Isolated platelets  in a ratio of 1:10 for 15 min at 37°C. Reaction was stopped by adding 300 µl of PBS to all samples. To analyze glycoprotein (GP) expression, washed whole blood was labeled for GPIbα, GPVI, integrin α5, or integrin β3 in a ratio of 1:10 for 15 min at RT. In All samples the MFI (mean fluorescence intensity) of the platelet specific FSC/SSC population was analyzed using a FACSCalibur flow cytometer (BD Biosciences).Flow cytometry was performed as described elsewhere . Briefly2.12.2+ and loaded with 5 µM Fura-2 acetoxymethyl ester  and 0.2 µg/ml of Pluronic F-127  at 37°C for 20 min. Platelets were washed once and resuspended in Tyrode's buffer containing 0.5 mM EGTA  for determination of store release measurements. For detection of store operated calcium entry (SOCE) buffer containing 1 mM Ca2+ was used. After platelet activation with different agonists and co-incubation with MK-801 for human platelets, the Ca2+ response was measured under stirring conditions. A spectrofluorometer  at alternate excitation wavelengths of 340 and 380 nm was used. The ratio values of 340/380 nm were converted into Ca2+ concentrations (Ca2+) by lysis of platelets with Triton X-100  for detection of the maximum ratio value. Followed by adding of EGTA to determine a minimum ratio value. Measurements with thapsigargin  were performed in Ca2+-free Tyrode's buffer. Incubation of platelets with 5 µM TG was followed by the addition of 1 mM Ca2+ to measure Ca2+ influx in murine and human platelets.Murine and human platelets were isolated as described above and resuspended in respective Tyrode's buffer without Ca2.13.Freshly isolated platelets from healthy volunteers were measured as percentage light transmission compared to human Tyrode's buffer (as = 100%) using Chrono-Log dual channel lumi-aggregometer (model 700) at 37°C stirring at 1,000 rpm. Agonists were used as indicated and human platelets were pre-incubated with MK-801 for 15 min at 37°C before measurement.ATP release from human platelets was assessed applying a luciferin/luciferase bioluminescent assay and calculated using a provided ATP standard protocol .2.14.−1 and platelet adhesion and aggregate formation was evaluated from five different microscopic areas  using Image J Software.Cover slips (24 × 60 mm) were coated with 200 µg/ml fibrillary type I collagen (Nycomed) and blocked with 1% BSA. Subsequently, heparinized murine or citrate-anticoagulated human whole blood was filled in a 1 ml syringe and perfused over a collagen-coated surface at shear rate of 450, 700, 1,000 and 1,700 s2.15.t-test or an unpaired student's t-test. Significant differences are indicated by asterisks .Data are presented as arithmetic means ± SEM (Standard error of mean), statistical analysis was performed using GraphPad Prism 8 (version 8.4.3). Statistical differences were determined using a two-way or one-way ANOVA with a Sidak's multiple comparison post-hoc test, an unpaired multiple 3.3.1.fl/fl-Pf4-Cre+Grin1 mice was confirmed (fl/fl-Pf4-Cre+Grin1 mice compared to controls (fl/fl-Pf4-Cre−Grin1 mice). In contrast to Hearn et al., we detected reduced platelet counts only by trend (fl/fl-Pf4-Cre+Grin1 mice compared to controls (fl/fl-Pf4-Cre−Grin1 mice)  .2+ mobilization upon platelet activation using platelets from fl/fl-Pf4-Cre+Grin1 and fl/fl-Pf4-Cre−Grin1 mice because the NMDAR forms an ion channel pore that is selective for cations, in particular for Ca2+ and channel opening is induced by NMDAR activation. Baseline levels of [Ca2+](i) were unaltered in fl/fl-Pf4-Cre+Grin1compared to controls (fl/fl-Pf4-Cre−)Grin1 i] was significantly reduced after stimulation of platelets with high doses of thrombin while no alterations have been detected in the absence of extracellular Ca2+  (2+](i) in both, platelets from fl/fl-Pf4-Cre+Grin1 and fl/fl-Pf4-Cre−Grin1mice. However, the increase of [Ca2+](i) was significantly reduced after stimulation of platelets with high doses of CRP in the presence of extracellular Ca2+ while no differences were detected in the absence of extracellular Ca2+   but not of store release. These defects in extracellular Ca2+ mobilization in NMDAR deficient platelets suggested a general defect in Ca2+ homeostasis induced by NMDAR deficiency.In a first step, we analyzed Caf4-Cre−) . Subsequof EDTA) . Stimulaof EDTA) . Measure2+]i were detected at baseline  triggered a Ca2+ release from intracellular stores that was unaltered between platelets of both groups. However, the addition of extracellular Ca2+ induced SOCE that was significantly reduced in platelets from fl/fl-Pf4-Cre+Grin1 compared to controls (fl/fl-Pf4-Cre−)Grin1 . Again, no differences in (i) was significantly reduced after stimulation of human platelets with high concentration of thrombin when pre-treated with MK-801  we did not detect any alterations in Ca2+ mobilization when platelet were activated with thrombin  using the well-known flow chamber  mice.This study reveals that the NMDAR is important for SOCE in platelets but not for store release. Thus, deficiency of GluN1 in mice resulted in reduced Ca+ influx, NMDARs yield additional influx of Ca2+ upon activation (3 induced injury of mesenteric arterioles and impaired hemostasis as reflected by prolonged bleeding times (Platelets express different iGluRs including kainate receptors (KARs), a-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptors (AMPARs), and NMDARs , 35. Whitivation , 37. Sevtivation  and KAR tivation . Treatmeng times . The samng times . Here, wng times . Large ang times , 41, 42 ng times , neutropng times , monocytng times , and lymng times . It is t2+ levels in washed platelets in the presence of 1 mM Ca2+. Here, we provided strong evidence that glutamate-induced activation of the NMDAR is sufficient to induce Ca2+ mobilization and SOCE because in this study, we only stimulated platelets with standard agonists such as thrombin, PAR4 peptide or collagen/CRP that are known for their ability to induce glutamate release from platelets  was identified as Ca2+ sensor in platelets that is located at the endoplasmic reticulum and relocates to the plasma membrane upon store release. In contrast to Orai1 and NMDAR, STIM1 is important for both, store release and SOCE . The deand SOCE , 48, STIor STIM1 , 48 and 2+ release from intracellular stores. To date, the regulation of NMDAR activation is not well understood, although Hearn and colleagues provided direct evidence that glutamate is important for platelet Ca2+ influx from the extracellular space because glutamate binding to the GluN2 subunit plays a key role in the activation of the NMDAR besides glycine or D-serine that bind to the GluN1 and GluN3 subunits  signaling that has been associated with NMDAR activation in the central nervous system   that leaEC-2 etc . Thus, ilization  as well lization  after bos system . The auts system . Thus, is system .2± mobilization via SOCE but also a result of reduced PKC activity. In parallel with Src activation, PKC might not only be a potential activator of the NMDAR but also be activated by the NMDAR via enhanced Ca2± mobilization in platelets as already suggested by Lutzu and Castillo (Furthermore, we detected differences in the phosphorylation of PKC substrates. PKC is a major regulator of platelet granule secretion, integrin activation, aggregation and spreading . FollowiCastillo . This agfl/fl-Pf4-Cre+Grin1 mice suggests that the NMDAR is a potent therapeutic target for the prevention of arterial thrombosis in cardiovascular diseases such as acute myocardial infarction or abdominal aortic aneurysm.Taken together, we identified the NMDAR as important regulator of SOCE that plays a crucial role in Src and PKC substrate phosphorylation, αIIbβ3 integrin activation, the release of ATP and thrombus formation. Protection against arterial thrombosis in


The popularity of rabbits as pets has grown substantially in the UK. However, despite progress, this species still has a much higher anesthesia-related mortality than dogs and cats. Rabbits are prey animals that tend to hide signs of pain, which makes it particularly difficult to assess and to treat it adequately. Perioperative systemic opioid administration is a cofactor in the high perioperative mortality and morbidity rates recorded in rabbits. To reduce post-surgical opioid requirements, a multimodal analgesia regimen is advisable. In such a context, loco-regional anesthesia has gained a central role in daily anesthesia practice as it effectively and significantly reduces the doses of perioperative systemic analgesic drug requirements. The quadratus lumborum block (QLB) is an ultrasound-guided loco-regional anesthesia technique developed in human medicine consisting of the injection of local anesthetic within the quadratus lumborum (QL) fascia that provides analgesia to the abdominal wall and viscera by blocking the ventral branches of the thoraco-lumbar spinal nerves and sympathetic trunk. The efficacy of the QLB in human medicine has driven veterinary research to investigate this block in companion and farm animals. To date, no study has investigated the QLB in rabbits. With the present cadaveric study, these authors aimed to carry out the following: firstly, to investigate the anatomical layout of the thoraco-lumbar area in rabbits; secondly, to design a feasible ultrasound-guided QLB for rabbits; and thirdly, after comparing different volumes of injectate and analyzing the spread obtained, to propose the most suitable volume of injectate to administer. This research was conducted by performing anatomical dissections and computed tomographic studies in rabbit cadavers.Ultrasound-guided (US-guided) loco-regional anesthesia can provide significant analgesia and anesthetic-sparing effects when used in rabbits. The aims of this study were to investigate the thoraco-lumbar anatomy of the rabbits, particularly the quadratus lumborum (QL) muscle, to design an appropriate US-guided quadratus lumborum block (QLB) specific for rabbits, and to define the most adequate volume of injectate required to consistently cover the ventral branches of T11 to L3 without affecting the pelvic limb innervation . Sixteen adult rabbit cadavers were included in the study. After randomization, four different volumes of injectate  were tested, with these volumes additionally randomized to two sites of injection (right or left QL fascia). An ultrasound-guided QLB was performed with a solution of lidocaine, iodinated contrast and tissue dye , with subsequent computed tomography (CT) and anatomical dissection, to evaluate the spread of the injectate. In all but one case, the US-guided QLB performed with a dorsolateral approach using 0.3 mL/kg was adequate, while a dose of 0.4 mL/kg consistently reached the targeted nerves but also extended to L4 and caudally. This may suggest that an injectate volume of 0.3 mL/kg may be the most appropriate to produce adequate spread while not affecting pelvic limb innervation.  Oryctolagus cuniculus) are the third most common pet in the UK, with an estimated population of 1.5 million [Rabbits  quadratus lumborum block (QLB) is an interfascial plane block developed to promote abdominal wall and visceral analgesia. The QLB consists of an injection of local anesthetic within the quadratus lumborum fascia, between the quadratus lumborum (QL) and the psoas major muscle (PM), with the aim to desensitize the ventral roots of the thoraco-lumbar spinal nerves and the sympathetic trunk to produce somatic and visceral analgesia of the abdomen. The QLB has gained a high acceptance in humans  and in vWhile anatomical studies in dogs and cats are available, no study has investigated the anatomy of the thoraco-lumbar area and, particularly, the quadratus lumborum muscle and fascia in rabbits, which is an essential step in order to use the QLB technique safely in clinical cases.According to the literature, the QL muscle in dogs is located directly ventral to the bodies of the thoracic vertebrae (T) T11, T12 and T13, and ventral to all of the lumbar vertebrae (L) . The limIn fact, despite the positive outcomes reported in the literature, the ultrasound-guided QLB has been associated with the desensitization of the femoral nerve in humans with temporary hindlimb motor function impairment . In rabbIn rabbits , the sciatic and the femoral nerves contribute to pelvic-limb motor function ,26,27. IThe aims of this study were(1)To investigate the thoraco-lumbar anatomy of rabbits, particularly the QL muscle and fascia.(2)To design an appropriate US-guided needling technique specific for rabbits.(3)To ascertain the volume of injectate required to consistently cover the ventral branches of T11 to L3 without affecting those nerve branches responsible for innervation of the pelvic limb.(1)Anatomical dissections focusing on the QL and psoas muscles, thoraco-lumbar fascia, quadratus lumborum fascia and ventral branches of the associated spinal nerves.(2)Sono-anatomical study and design of an ultrasound-guided QLB approach appropriate for this species.(3)Comparison of the spread obtained using four different volumes of injectate via anatomical dissections and computed tomography (CT) scans.For these reasons, a cadaveric study in rabbits was conducted using the following steps:We hypothesize that the US-guided QLB performed with the approach designed, using one of the volumes of injectate under investigation, will adequately and consistently stain the ventral branches of the spinal nerves from T11 to L3 without staining L4-L5-L6-L7-S1-S2-S3 .www.kiezebrink.co.uk (1 November 2022)). Sixteen adult rabbits , of varying body conditions, gender and breed, were obtained. No animals were euthanized for the purpose of this study and no ethical committee approval was needed, as this was only a cadaveric study.This study was performed in a UK-based Veterinary Referral Hospital  between November 2022 and January 2023. For the study purposes, intact adult rabbit carcasses were obtained from a commercial UK-based distributor of frozen food for falconer, zoo and exotic purposes  . All carcasses’ intramuscular temperatures were at least 18 degrees Celsius before any procedure was performed. For the rabbits undergoing US-guided QLB, both the thorax and abdomen were clipped.The first two carcasses were used for gross anatomical dissection to evaluate the quadratus lumborum muscle localization, its insertion sites and its relationship with the surrounding muscles, vertebrae and ribs.The rabbits were placed in dorsal recumbency, and a ventral midline incision was performed to gain access to the peritoneal cavity. The abdominal viscera were all intact and were carefully removed to expose the retroperitoneal space and sub-lumbar muscles without damaging the psoas compartment muscles. To improve the visualization of the most cranial quadratus lumborum muscle insertion, both the diaphragm and ribs were dissected, and all thoracic viscera were also removed .The first two out of four rabbit cadavers were used to understand the sono-anatomy and the relationship of the quadratus lumborum muscle and the thoraco-lumbar fascia surrounding the quadratus lumborum muscle and psoas muscles, and to design an ultrasound-guided quadratus lumborum muscle block approach specific for rabbits. For the needling, a ventral approach as reported in dogs and cats was first used ,17 with To overcome this complication, on the other two of four rabbits scheduled for the sono-anatomy and quadratus lumborum block design phase, the needling was performed using a modified dorsolateral approach as reported recently in dogs by Viscasillas and colleagues (2021), in which the needle passed through the epaxial muscles and a medial injection site was performed in the quadratus lumborum fascia, between the QL and PM muscles. This avoided visceral contamination with dye solution in these remaining two rabbits. For this reason, in the present study, only the dorsal approach was subsequently used .www.randomize.org (13 November 2022)) into four different volume groups . Those volumes were also randomized to the two sites of injection (right or left quadratus lumborum muscle) using a simple lottery system. These volumes were chosen based on previous studies performed in dogs and cats [After the investigation of the QLB sono-anatomy, needling and approach, the ten remaining rabbits  were randomized using a randomizer free-access online software  using a linear probe  and a 21-gauge, 50 mm echogenic insulated peripheral nerve block needles  attached to an extension line set, and a syringe containing the injectate mixture.The injectate solution consisted of a mixture of lidocaine 2% , radiographic contrast medium  and tissue marking dye  in a volume proportion of 3:1:1, respectively.All ultrasound-guided QLBs were performed randomly by the same investigator, starting from the rabbit positioned in right lateral recumbency to perform the left QLB followed by left lateral recumbency to perform the right QLB. The ultrasound probe was placed transversely over the hypaxial musculature, caudal and parallel to the last rib, with the cranial marker pointed dorsally. The probe was then slid dorsally to visualize the transverse process of the L1 vertebra and its acoustic shadow, and this was used as a first reference point. As a second reference, the thoraco-lumbar fascia was identified and the aponeurosis followed up to the hyperechoic line between the QL and PM muscle, to identify the so-called quadratus lumborum fascia. Once the quadratus lumborum fascia (selected as the injection point) was identified, the needle was inserted using an in-plane technique with a dorsolateral to ventromedial direction, passing through the epaxial muscles and advancing the needle tip until it reached the thoraco-lumbar fascia first and then the quadratus lumborum fascia, between the PM and the QL muscles. To confirm the correct needle placement, a fraction of the dye solution (approximately 0.05 mL) was injected and, if hydrorelease of the tissues was observed, this was considered correctly positioned in the targeted area. If hydrorelease was not seen to separate the correct structures (QL from PM), the needle was repositioned backward or forward within the fascia until hydrorelease was achieved.Within 10 min from the first ultrasound-guided QLB injection, each rabbit was positioned on the computed tomography (CT) table to perform the imaging studies to identify the injection site and the length of the contrast spread obtained. All CT studies were performed using a 64-slide Siemens SOMATOM Perspective .To acquire the images, all rabbits were positioned in sternal recumbency with the pelvic and thoracic limbs extended; in all carcasses, the images obtained included the cranial thoracic spine to sacrum. The CT scan parameters included the following: helical acquisition; a slice thickness of 1 mm; a slice increment of 0.6 mm; a collimator pitch factor of 0.8 kVp140, 110 mA; a rotation time of 1.5 s; and a matrix size of 512 × 512. CT data were reconstructed to images with a 1 mm slice thickness using a medium-frequency ) and a high-frequency  1500 HU, window level (WL) 300 HU) algorithm.In the CT images obtained, the pattern of distribution of the contrast and the extension of distribution through the vertebrae were evaluated and recorded by the same investigators unaware of the volume used. All images were then interpreted by a European College of Veterinary Diagnostic Imaging board-certified clinician, who recorded the presence of the contrast in the interfascial plane between the quadratus lumborum and psoas muscles (yes/no), sympathetic trunk , in the epidural space (yes/no), and abdominal cavity (yes/no). All rabbits underwent anatomical dissection after CT.After obtaining the CT images, the carcasses were dissected to investigate the spread of the injectate mixture within the fascia. All dissections were performed by the same investigator, unaware of the injectate volume used. For the dissection, all rabbits were placed in dorsal recumbency and a ventral midline incision exposing the abdominal contents was performed. All abdominal viscera were carefully removed to expose the psoas compartment muscles. Blunt dissection of the PM muscle was performed to separate it from the QL muscle and expose the dye solution within the quadratus lumborum fascia. At this point, the spread of dye solution was evaluated by counting the number of stained ventral branches of spinal nerves and the correspondent number of vertebral bodies .Staining of the nerves arising from T10, T11, T12, L1, L2, L3, L4, L5 and L6 were evaluated. The technique was deemed successful if all the ventral branches of the spinal nerves of T11 to L3 were stained and the dye solution was distributed around their circumference to a length greater than 0.6 cm , withoutIn addition, complications such as intra-abdominal dye solution injection, spread to the spinal cord and injection in any of the surrounding organs were also recorded.https://cran.r-project.org/bin/macosx/ (2 February 2023)). The parametric data were tested for normal distribution using the Shapiro–Wilk test and are presented as mean ± standard deviation (SD) and range. The Fisher’s exact test was performed to determine statistical significance using two categories: category-1 adequate staining of the ventral nerve branches  and category-2 inadequate staining of the ventral nerve branches . The data were analyzed using the R-programming language  and category-2 inadequate sympathetic block . Adequacy was based on the veterinary literature [p value < 0.05 was used to consider that the difference between groups was statistically significant.A second Fisher’s exact test was performed to determine statistical significance using two other categories: cterature  and withterature . A p valAll cadavers were in satisfactory condition after thawing, and no significant damage was observed; therefore, they were all included in the study . The mean internal temperature of the cadavers was 20.0 degrees Celsius (°C) (range of 18 to 22 °C) and the mean carcass weight was 1.90 kg (range of 1.0 to 2.8 kg).Dissection was performed by separating the PM muscle from the quadratus lumborum muscle A. In allThe QL muscle was localized dorsally to the psoas major muscle, laterally to the psoas minor muscle (Pm) and ventrally to the transverse processes of thoracic and lumbar vertebrae. It originated from the body of T7 and extended to insert in the transverse process of the lumbar vertebra L6 and the ventral angle of the iliac wing. The ventral branches of the spinal nerves were located and recorded as emerging from the intervertebral foraminae and running within a fascial plane surrounding the quadratus lumborum muscle between the QL and the PM muscles. Despite careful removal of the abdominal and thoracic viscera, the sympathetic trunk was not always left intact for its entire pathway in all cadavers, due to its very fragile nature. Using the computed tomography study, the spread of the contrast and the consequent staining of the sympathetic trunk were assessed.Once the approach and needling technique were designed, the ultrasound-guided QLB was performed at the first attempt within approximately 5 min per side in all 10 rabbits (20 sides). The ultrasound probe was initially positioned at the level of the thoraco-lumbar area (T12-L1) as reported in the literature , althougIn order to overcome this issue, the probe was slid caudally toward the level of L1. Despite this adjustment, in some rabbits (2/10), the shadow of the T12 transverse process was still interfering with the sonographic image . In these two rabbits, the ultrasound-shadow produced by the T12 transverse process at the level of T12-L1 space did not allow the visualization of the entire shaft of the needle during the approach; however, the tip was always visible. In relation to the surrounding structures, the erector spinae muscles (particularly developed in rabbits) were located dorsally to the thoraco-lumbar fascia and the quadratus lumborum muscle, which was located dorsally and medially in relation to the psoas major muscle within the same acoustic window (range of depths between 1 and 2 cm). During the insertion of the needle, the tip and shaft were always visible in 8/10 rabbits (16/20 QLBs). In order to reach the targeted fascia, the needle was passed through the erector spinae muscles, pierced the thoraco-lumbar fascia, passed through the QL muscle and finally reached the target, the quadratus lumborum fascia. This fascia surrounds the QL muscle and separates it from the PM muscle. The mean depth of the targeted area of injection (QL fascia) was recorded as 1.5 ± 0.09 cm amongst all cadavers A,B.The CT study revealed that in all cadavers at both sites, the contrast medium was detected in the interfascial plane between QL and PM muscles, surrounding the QL muscle in its ventral, lateral and medial aspects proportional to the volume of injectate used. The path of the injectate allowed in all the cases the separation of these two sub-lumbar muscles (QL muscle from PM muscle) in all rabbit cadavers. The dye distribution observed along the sympathetic trunk was statistically significant in the 0.3 mL/kg group compared with rabbits in the 0.1 mL/kg, 0.2 mL/kg and 0.4 mL/kg groups .Based on the CT images, the injection site occurred between T12 and L1 vertebrae, particularly at L1 (16/20), and at the level of T12-L1 (4/20).adequate when the injectate covered the cranial mesenteric ganglion, the celiac ganglion and sympathetic trunk from T10 to L3 vertebrae without further caudal or cranial distribution. The adequacy of the injectate spread to achieve a sympathetic trunk block evaluated by the CT study revealed that this was successfully achieved in 0/5 (0%) of the hemi-rabbits in the 0.1 mL/kg group; 0/5 (0%) of the hemi-rabbits in the 0.2 mL/kg group; 5/5 (100%) of the hemi-rabbits in the 0.3 mL/kg group; and 0/5 (0%) of the hemi-rabbits in the 0.4 mL/kg group. The spread of the contrast was not sufficient to cover the target area in rabbits in the 0.1 and 0.2 mL/kg groups, and a spread caudal to L3 occurred in rabbits in the 0.4 mL/kg group.According to the CT study, the distribution of the injectate was considered Overall, CT images showed that zero (0)/20 injections were in unwanted locations such as the abdominal cavities, surrounding organs, epidural canal or other muscle structures A–C.In all cadavers, the injectate solution mix was injected between caudal T12 and L1 vertebral spaces, with the majority performed at L1 (16/20) (80%).Based on the anatomical dissections of the carcasses, the aimed spread of the injectate  was only obtained using 0.3 and/or 0.4 mL/kg of injectate. However, in 100% of the hemi-rabbits where 0.4 mL/kg was administered, the spread of the injectate also stained L4 ventral spinal branches and, in 60% of these carcasses, a caudal L4 spread, up to L6, was also found.In regard to the 0.3 mL/kg group, 80% of the hemi-rabbits had a spread of the injectate at the level of cranial L3 vertebrae (4/5) and one at the L2-L3 intervertebral space area.Regarding the lower volume of injectate groups (0.1 mL/kg and 0.2 mL/kg), the spread was inadequate: in the 0.2 mL/kg group, the spread of injectate missed the T12 ventral spinal branch in 20% of the hemi-rabbits, while in the 0.1 mL/kg group, the spread of injectate missed the T12 ventral branch in 40% of the hemi-rabbits, while the L3 ventral branches was never stained.In terms of adequacy, the majority of rabbits  had the ventral branches of the spinal nerves from T11 to L3 stained with the injectate in rabbits in the 0.3 mL/kg group, whereas the results for the other volumes were more variable .The adequacy of spread of the dye/lidocaine/contrast mixture in rabbits in the 0.3 mL/kg group was statistically significant compared with rabbits in the 0.1 mL/kg, 0.2 mL/kg and 0.4 mL/kg groups .This is the first anatomical ex vivo study investigating the anatomy and sono-anatomy of the quadratus lumborum muscle layout in rabbits and the first study describing an ultrasound-guided QLB for this species.The findings of the present study showed that the QLB performed using a dorsolateral approach in rabbits was feasible and appeared safer compared to the ventrolateral approach described in other species , with thIn regard to the adequacy of spread through the quadratus lumborum fascia obtained by injecting the mixture of local anesthetic, tissue dye and contrast while performing the QLB technique described here, the use of an injectate volume of 0.3 mL/kg resulted in staining of the ventral branches of the thoraco-lumbar spinal nerves from T11 to L3 in the majority of the cases (80%), as demonstrated by anatomical dissections.In addition, CT images demonstrated that the sympathetic trunk and, in particular, the celiac ganglia were covered in 100% of the rabbits receiving 0.3 mL/kg of injectate. Furthermore, the volume of 0.3 mL/kg resulted in a sparing of the pelvic limb innervation in all cases.The results of this ex vivo study produced a QLB approach specifically designed for rabbits that, using an adequate volume of local anesthetic, has the potential to provide visceral and abdominal wall analgesia without affecting the pelvic-limb motor function. The QLB designed here may potentially reduce the systemic opioid requirement and their attendant adverse effects in rabbits undergoing abdominal surgery; however, these findings need to be confirmed with a future in vivo study.Besides the ability to desensitize the ventral roots of the thoraco-lumbar nerves, from T11 to L3, the ability to produce a sympathetic block is pivotal. In fact, although the true mechanism of the visceral analgesia provided by QLB has not yet been fully clarified, the current assumption is that the visceral analgesia results from the spread of anesthetics to the celiac ganglion/sympathetic trunk . In the In prey species such as rabbits, the visceral analgesia should be obtained, where possible, with a motor-sparing effect of the pelvic limbs. This is because the inability to move in conscious rabbits can be a cause of severe distress and even self-mutilation during the recovery period . Future Regarding the anatomy of the quadratus lumborum region, in rabbits, the QL muscle runs from the body of T7 and extends to insert in the transverse processes of the lumbar vertebrae and to then insert on the ventral angle of the iliac wing, as has been previously reported . This isDuring the design of the needling technique, the authors began by using the ventrolateral approach, which was soon abandoned for the following reasons: 1. the transverse process of T12 vertebra in rabbits creates an intense ultrasound-acoustic shadow that does not allow the visualization of the entire shaft of the needle during advancement; 2. at this site, in order to be able to target the fascia, a degree of pressure needs to be applied with the probe to obtain a suitable image, which may cause ventilatory impairment in a live animal; and 3. the proximity of the abdominal viscera to the injection site  could poFor this reason, in all the subsequent QLBs performed in all other rabbits’ carcasses, a dorsolateral approach with middle-point injection between the QL and PM muscles within the quadratus lumborum fascia was used.The dorsolateral approach resulted, in this study, in a feasible technique that allowed clear visualization of the shaft and tip of the needle, and no injection outside the targeted site was recorded on computed tomography or anatomical dissection. These results agree with the human literature where the incidence of complications is significantly lessened using the dorsolateral approach .The QLB designed in this study showed a consistent spread of the injectate within the quadratus lumborum fascia in all cadavers, regardless of the volume of injectate used, as evaluated by computed tomography and subsequent anatomical dissection.To perform the QLB reported here, the ultrasound probe was positioned at the level of the last thoracic vertebra as previously described , which, Another interesting finding of the present study was the difference in terms of the injectate spread detected with CT images versus the anatomical dissection, with a positive correlation between the volume of injectate and the degree of discrepancy: for the lower volumes (0.1–0.2 mL/kg), the discrepancy between CT and anatomical dissection spread was negligible, while, with higher volumes (0.3–0.4 mL/kg), this was more relevant . Similarly, a QLB study in dogs using a volume of 0.2 mL/kg  also repThese authors used the two techniques  as each one provides different information: while the CT scan evaluates the spread of the injectate within the fascial planes, using the thoraco-lumbar vertebrae as a reference point and allowing sympathetic trunk and ganglions stain evaluation, the anatomical dissection, on the other hand, helps identify which ventral nerve branches are actually stained. The different reference point  might have contributed to the discrepancy in the detected injectate spread between the two techniques in the present study.The volumes of the dye solution used in this study were decided according to similar studies performed in dogs ,16,17 anIn the present study, a volume of 0.3 mL/kg resulted in an adequate spread, allowing consistent staining, in all but one case, of the ventral branches of the thoraco-lumbar spinal nerves from T11 to L3 without further spread to the L4 level; however, a volume of 0.4 mL/kg consistently stained L4 and more caudally. Moreover, a volume of 0.3 mL/kg consistently stained, in all cases, the sympathetic trunk and the cranial mesenteric and celiac ganglions. It is not possible to exclude that a volume between 0.3 mL/kg and 0.4 mL/kg would result in 100% of adequate staining of ventral nerve branches, and concurrently sparing the pelvic limb innervation, while producing an adequate sympathetic block. Further studies are needed in alive rabbits to determine the minimal volume and concentration of local anesthetic needed to obtain the desired analgesic effect without causing any side-effects due to local anesthetic absorption.This ex vivo study has some limitations mainly related to the cadaveric nature of the investigation. Firstly, the population of rabbits used in this study was heterogeneous and not standardized for breed, size, gender or age, as they were obtained from a commercial distributor of frozen food for falconer, zoo and exotic animals. It is not possible to exclude that different results would be obtained if the same QLB is performed in a more homogeneous population such as New Zealand rabbits used for experimental studies.There is also evidence that the distribution of the contrast and the local anesthetic may be different between cadavers and in vivo . FreezinLastly, the number of cadavers used in our study was relatively small and further investigations with larger samples are warranted.The ultrasound-guided quadratus lumborum block in rabbits, performed with a dorsolateral approach and middle injection site within the quadratus lumborum and psoas major muscles as described in this study, resulted in adequate spread of the injectate within the quadratus lumborum fascia and staining of the ventral branches of the spinal nerves responsible for innervation of the abdominal wall and viscera. Furthermore, the staining of the sympathetic trunk and celiac and mesenteric ganglions obtained by performing the QLB described in the present study has the potential to produce an effective abdominal wall and visceral analgesia. Besides the analgesic effect that could be obtained by performing the QLB described here, using a dorsal approach, with 0.3 mL/kg as the injectate volume, in rabbits may spare their hindlimbs’ motor function in the post-operative period, allowing the expression of their natural behavior while reducing the risk of complications and the hospitalization.Despite, among the volumes tested, the 0.3 mL/kg volume of injectate producing an adequate spread, in the majority of the cases , it is not possible to exclude that an injectate volume between 0.3 and 0.4 mL/kg would be able to produce adequate spread in 100% of the cases.The QLB performed with the dorsolateral approach described here may also carry a lower risk of complications in live rabbits as the needling technique is performed away from major structures such as thoracic and abdominal organs. However, further in vivo studies are required to corroborate these results, and to evaluate if the use of this technique as part of a multimodal analgesia approach in rabbits undergoing abdominal surgery would facilitate post-operative recovery.