Daily Anesthesiology Research Analysis
Three studies stand out today for anesthesiology and perioperative care: a randomized trial showed that nociception-guided intraoperative analgesia (NOX) reduced early postoperative delirium in elderly total knee arthroplasty patients; a large GWAS identified genomic loci associated with postoperative sepsis and surgical site infection; and a 5-year pooled analysis demonstrated durable pain, function, and opioid-sparing benefits after basivertebral nerve ablation for vertebrogenic low back pain.
Summary
Three studies stand out today for anesthesiology and perioperative care: a randomized trial showed that nociception-guided intraoperative analgesia (NOX) reduced early postoperative delirium in elderly total knee arthroplasty patients; a large GWAS identified genomic loci associated with postoperative sepsis and surgical site infection; and a 5-year pooled analysis demonstrated durable pain, function, and opioid-sparing benefits after basivertebral nerve ablation for vertebrogenic low back pain.
Research Themes
- Perioperative brain health and delirium prevention via nociception-guided analgesia
- Precision perioperative risk stratification using genomics for sepsis/SSI
- Durable interventional pain therapies with opioid-sparing outcomes
Selected Articles
1. Influence of Intraoperative Pain Management on Postoperative Delirium in Elderly Patients: A Prospective Single-Center Randomized Controlled Trial.
In elderly TKA patients with sedation guided by BIS in both groups, NOX-guided intraoperative analgesia reduced day-1 postoperative delirium (7% vs 16%) and required higher remifentanil dosing. This supports nociception-index guidance as a modifiable intraoperative factor for delirium prevention.
Impact: This RCT identifies intraoperative nociception-guided analgesia as a practical strategy to lower postoperative delirium, a major driver of morbidity in older surgical patients.
Clinical Implications: Incorporating nociception monitoring (e.g., NOX) to titrate intraoperative opioids while keeping sedation depth constant may reduce early postoperative delirium in older adults undergoing TKA.
Key Findings
- NOX-guided analgesia reduced day-1 postoperative delirium (7% vs 16%; P=0.041).
- Remifentanil dose was higher with NOX guidance (mean 927 vs 882 mg; P=0.002).
- Sedation depth was standardized with BIS in both groups, isolating the analgesia effect.
Methodological Strengths
- Prospective randomized controlled design with standardized sedation using BIS
- Clinically relevant outcome assessed with CAM over 3 postoperative days
Limitations
- Single-center study may limit generalizability
- Delirium reduction demonstrated on postoperative day 1; longer-term cognitive outcomes not reported
Future Directions: Multicenter trials testing NOX-guided analgesia across procedures and exploring optimal opioid titration to balance pain control and delirium risk are warranted.
2. Genomic analysis of surgical patients to identify patients at risk for postoperative sepsis and surgical site infection.
A large EMR-linked GWAS (n=59,755) identified significant loci on chromosomes 9 (rs9413988) and 14 (rs35407594) associated with postoperative sepsis, with similar variants linked to SSIs. These findings suggest genetic predisposition contributes to postoperative infection risk and could inform precision perioperative risk stratification.
Impact: This study opens a genomics-based pathway for identifying surgical patients at elevated infection risk, potentially enabling targeted prophylaxis and monitoring.
Clinical Implications: Perioperative teams could integrate genetic risk markers, once validated, into preoperative assessment to tailor infection prevention strategies and surveillance.
Key Findings
- GWAS in 59,755 surgical patients identified rs9413988 (chr9) and rs35407594 (chr14) associated with postoperative sepsis at genome-wide significance.
- Similar SNPs were associated with surgical site infections, suggesting shared genetic risk.
- Lead loci map near PGM5P2/ZNGF1 (transcriptional regulation) and OR11 family, warranting functional studies.
Methodological Strengths
- Large-scale GWAS with stringent genome-wide significance threshold
- Use of EMR-linked biobank enabling precise case-control phenotyping
Limitations
- Findings require replication in independent, diverse cohorts and functional validation
- Potential residual confounding from population stratification or phenotype misclassification
Future Directions: Replication across ancestries, fine-mapping, and mechanistic studies, followed by integration of polygenic risk into perioperative risk models.
3. Intraosseous basivertebral nerve ablation: A 5-year pooled analysis from three prospective clinical trials.
Across three prospective trials, 249 BVNA-treated patients with vertebrogenic CLBP completing 5-year follow-up showed sustained improvements in pain (mean NPS −4.32) and disability (ODI −28), with 32% pain-free, 65% discontinuing opioids, 58% fewer spinal injections, and no serious device-related adverse events.
Impact: Provides durable, 5-year evidence that BVNA yields substantial and sustained clinical benefit with opioid-sparing, informing long-term expectations and payer decisions for vertebrogenic low back pain.
Clinical Implications: For MRI-confirmed vertebrogenic CLBP (Modic 1/2), BVNA offers durable pain and functional improvements and may reduce opioid use and interventional healthcare utilization.
Key Findings
- Mean NPS improved by 4.32 points and ODI by 28 points over a mean 5.6-year follow-up.
- 32.1% of patients were pain-free at 5 years; 65.2% discontinued opioids.
- Healthcare utilization decreased: spinal injections down 58.1%; same-level reintervention 13.2% (fusion 6.0%); no serious device-related AEs.
Methodological Strengths
- Prospective trials with harmonized eligibility and outcomes enabling pooled long-term analysis
- High follow-up participation (78%) and multiple clinically meaningful endpoints
Limitations
- Five-year analyses are single-arm follow-ups of treated cohorts without concurrent controls
- Potential attrition and selection bias; heterogeneity across original trials
Future Directions: Comparative effectiveness and cost-effectiveness versus other spine interventions, identification of predictors of long-term response, and broader real-world registries.