Daily Anesthesiology Research Analysis
A network meta-analysis of 40 randomized trials identifies amethocaine, Buzzy, and lidocaine iontophoresis as top options for reducing needle pain in children, while vapocoolant spray is no better than placebo. A randomized crossover simulation shows real-time ultrasound guidance improves success, accuracy, and speed of needle cricothyroidotomy in difficult-airway models. A four-arm RCT finds bilateral superficial cervical plexus blocks with ropivacaine plus adjuvants enhance analgesia and recov
Summary
A network meta-analysis of 40 randomized trials identifies amethocaine, Buzzy, and lidocaine iontophoresis as top options for reducing needle pain in children, while vapocoolant spray is no better than placebo. A randomized crossover simulation shows real-time ultrasound guidance improves success, accuracy, and speed of needle cricothyroidotomy in difficult-airway models. A four-arm RCT finds bilateral superficial cervical plexus blocks with ropivacaine plus adjuvants enhance analgesia and recovery after thyroid cancer surgery, with dexmedetomidine causing more sedation than dexamethasone.
Research Themes
- Pediatric procedural analgesia and needle pain management
- Ultrasound-guided airway rescue techniques and training
- Regional anesthesia optimization and multimodal recovery
Selected Articles
1. Local analgesia for the relief of pain in children undergoing venipuncture and intravenous cannulation: a systematic review and network meta-analysis.
Across 40 RCTs involving 4,481 children, most local analgesia methods reduced venipuncture pain, but vapocoolant spray did not outperform placebo or routine care. Amethocaine ranked most effective, followed by Buzzy and lidocaine iontophoresis. Results guide evidence-based selection of topical and device-based analgesia in pediatric procedures.
Impact: This network meta-analysis synthesizes high-level evidence to rank pediatric needle pain interventions, directly informing practice and guidelines. It challenges common use of vapocoolant spray by showing no added benefit.
Clinical Implications: Prefer amethocaine where available; Buzzy and lidocaine iontophoresis are strong alternatives. Avoid relying on vapocoolant spray as sole analgesia. Integrate effective modalities into pediatric cannulation protocols and training.
Key Findings
- Vapocoolant spray did not reduce pain beyond placebo or routine care in children.
- Amethocaine had the highest probability (57.6%) of being the most effective analgesic.
- Buzzy (17.0%) and lidocaine iontophoresis (8.4%) ranked next in effectiveness.
- Multiple other methods (EMLA, lidocaine cream, needle-free delivery, heating patches) outperformed placebo.
- Limited direct head-to-head comparisons warrant cautious interpretation.
Methodological Strengths
- Comprehensive network meta-analysis of 40 RCTs with 4,481 children
- Use of CINeMA to assess certainty of evidence across comparisons
Limitations
- Limited number of direct head-to-head comparisons between interventions
- Potential heterogeneity in pain scales, dosing, application timing and settings across trials
Future Directions: Conduct head-to-head randomized trials comparing top-ranked interventions, evaluate combination strategies (e.g., topical plus device), and assess implementation outcomes in diverse clinical settings.
BACKGROUND: Venipuncture and intravenous cannulation are common procedures in hospitals that often cause pain, particularly in children. Despite the availability of various local analgesia methods to alleviate needle-associated pain, the most effective approach remains unknown. The objective of this study is to compare and rank the efficacy of different local analgesia methods in reducing pain in children undergoing venipuncture and intravenous cannulation. METHOD: Six databases including PubMed, Embase, CINAHL, Scopus, Web of Science, and the Cochrane Library were searched from January 1,1990 to December 1,2024. The primary outcome is the self-reported pain. We assessed the certainty of the body of evidence from the NMA for the primary outcome based on CINeMA. RESULT: 40 RCTs consisting of 4481 children and 9 local analgesia methods were included in the analysis. Results showed that vapocoolant spray was no more effective than placebo or routine care in reducing needle-associated pain in children. Other interventions including EMLA cream, lidocaine cream, lidocaine iontophoresis, amethocaine, needle-free lidocaine injection system, EMLA patch, lidocaine/tetracaine heating patch and Buzzy produced greater pain reduction in children compared to placebo and routine care. Amethocaine was the most effective local analgesia method with the probability of 57.6% being the best, followed by Buzzy and lidocaine iontophoresis with the probability of 17.0% and 8.4%, respectively. CONCLUSION: Most local analgesia methods were effective in relieving pain in children undergoing venipuncture and intravenous cannulation except vapocoolant spray which did not show greater pain reduction than placebo or routine care. Amethocaine, Buzzy and lidocaine iontophoresis are the top 3 local analgesia methods to relieve pain in children undergoing venipuncture and intravenous cannulation. However, due to the limited number of direct comparisons, interpretation of some results should be made with caution.
2. Real-time vs. static ultrasound-guided needle cricothyroidotomy: a randomized crossover simulation trial.
In a randomized crossover simulation with 48 clinicians, real-time ultrasound guidance outperformed static ultrasound for needle cricothyroidotomy in simulated difficult anatomy—achieving higher success, greater puncture accuracy, and shorter procedure time. Findings support training and protocol emphasis on real-time imaging.
Impact: Airway rescue proficiency is critical; this study provides comparative evidence to optimize ultrasound guidance strategy, likely influencing training curricula and emergency algorithms.
Clinical Implications: In airway training and checklists, prioritize real-time ultrasound guidance for needle cricothyroidotomy, particularly in anticipated difficult neck anatomy. Invest in hands-on ultrasound skill acquisition.
Key Findings
- Real-time ultrasound guidance had a significantly higher puncture success rate than static ultrasound.
- Real-time technique improved puncture accuracy compared with static mapping.
- Procedure time was shorter with real-time ultrasound.
- Findings were consistent across participants with varying experience levels (junior residents, anesthesia residents, anesthesiologists).
Methodological Strengths
- Randomized crossover design minimizing between-subject variability
- Standardized anatomically abnormal simulators and structured training before testing
Limitations
- Simulation study; clinical performance and patient outcomes were not assessed
- Single-session evaluation without assessment of skill retention or transfer
Future Directions: Validate in clinical settings (obese, neck pathology), assess learning curves and retention, and quantify complications and time-to-oxygenation in real patients.
Cricothyroidotomy is a key technique for securing airways when tracheal intubation and oxygenation are difficult to achieve. In recent years, it has become clear that ultrasonography is more accurate than palpation for identifying the cricothyroid membrane. However, it is unclear how ultrasound should be administered. We investigated whether real-time or static ultrasound techniques were more useful for needle cricothyrotomy in patients with simulated anatomical abnormalities of the neck. Three cervical simulators with anatomical abnormalities were created. After education and hands-on training in needle cricothyroidotomy, 48 participants (27 junior residents, 12 anesthesia residents, and nine anesthesiologists) performed needle cricothyroidotomy using either a real-time or static ultrasound technique (crossover study). Fisher's exact test was used to assess the success rate and accuracy of the puncture (p < 0.05 was considered statistically significant). The success rate of cricothyrotomy puncture was significantly higher with the real-time ultrasound technique than with the static ultrasound technique. The real-time ultrasound technique led to significantly higher puncture accuracy and shorter procedure time than the static ultrasound technique. Needle cricothyroidotomy using real-time ultrasonography may be more useful than that using static ultrasonography.
3. Effect of superficial cervical plexus nerve block with Ropivacaine or a combination of different adjuvants on perioperative analgesia and quality of postoperative recovery in patients undergoing radical thyroid cancer surgery under general anesthesia: a prospective randomized controlled trial.
In 140 patients undergoing thyroid cancer surgery, bilateral superficial cervical plexus blocks improved postoperative pain versus general anesthesia alone. Adding dexmedetomidine or dexamethasone to ropivacaine extended analgesic benefits through 24 hours, with dexmedetomidine causing higher post-extubation sedation than dexamethasone.
Impact: Provides randomized evidence supporting routine use and optimization of superficial cervical plexus blocks in thyroid surgery, clarifying benefits of commonly used adjuvants.
Clinical Implications: In thyroid surgery with nerve monitoring, incorporate bilateral superficial cervical plexus blocks to reduce pain and sedative/analgesic needs. When using adjuvants, weigh longer analgesia against higher sedation with dexmedetomidine; dexamethasone offers analgesic benefit with less sedation.
Key Findings
- Ropivacaine blocks reduced resting and active VAS within 12 hours versus general anesthesia alone.
- Combining dexmedetomidine or dexamethasone with ropivacaine further reduced VAS up to 24 hours postoperatively.
- Dexmedetomidine increased post-extubation sedation compared with dexamethasone, with no other significant differences.
- Blocks improved intraoperative hemodynamics and reduced intraoperative sedative/analgesic requirements.
Methodological Strengths
- Prospective randomized four-arm design with adequate sample size (n=140)
- Ultrasound-guided standardized block technique and multiple patient-centered outcomes
Limitations
- Single-center study; blinding of patients and assessors not clearly reported
- Short follow-up (primarily within 24 hours); limited safety data on rare adverse events
Future Directions: Multicenter, blinded RCTs comparing adjuvants head-to-head with longer follow-up, including functional recovery, opioid-sparing effects, and safety endpoints.
OBJECTIVE: To investigate the effect of ultrasound-guided bilateral superficial cervical plexus nerve blocks with Ropivacaine or a combination of different adjuvants on perioperative analgesia and quality of postoperative recovery in patients undergoing radical thyroid cancer surgery under general anesthesia with nerve monitoring without muscarinic maintenance. METHODS: A total of 140 patients undergoing elective radical thyroid cancer surgery were randomly divided into four groups, with 35 cases in each group: general anesthesia alone group (Group C), general anesthesia + Ropivacaine group (Group R), general anesthesia + Ropivacaine combined with dexmedetomidine group (Group R1), and general anesthesia + Ropivacaine combined with dexamethasone group (Group R2). The primary observation index were postoperative resting and active Visual Analogue Score. The secondary observation index were hemodynamics, intraoperative sedative and analgesic medication use, postoperative analgesic requirements, postoperative recovery indicators, Richards-Campbell Sleep Questionnaire scores, Quality of Postoperative Recovery-15 scores, and adverse reactions. RESULTS: Compared with group C, the resting and active VAS scores in group R were lower within 12 h after surgery (P < 0.05), the resting and active VAS scores in groups R1 and R2 were lower within 24 h after surgery (P < 0.05). Compared with group R, the VAS scores of patients in groups R1 and R2 were lower within 6 to 24 h after operation (P < 0.05). Compared with group R2, only the sedation score after extubation was higher in R1 group (P < 0.05), and there was no statistical difference in any other aspects (P < 0.05). CONCLUSION: Bilateral superficial cervical plexus nerve blocks with Ropivacaine or a combination of different adjuvants are superior to general anesthesia alone in terms of intraoperative hemodynamics, the amount of sedative and analgesic drugs, and analgesic efficacy and quality of recovery in patients undergoing radical thyroid cancer surgery with nerve monitoring without muscarinic maintenance. Ropivacaine combined with an adjuvant has better analgesic effectiveness and quality of recovery than without an adjuvant, and Ropivacaine combined with dexmedetomidine has a better sedation level than dexamethasone.