Daily Anesthesiology Research Analysis

BACKGROUND: Perioperative death globally has been described as the third leading cause of death behind heart disease and malignant neoplasm and ahead of cerebrovascular disease. However, studies of all-cause perioperative mortality have not distinguished patients who were outpatients preoperatively ("elective") from patients having urgent surgery or having surgery on a day after their date of admission ("nonelective"). Strategies for reducing overall perioperative mortality are affected by whether most deaths occur after elective or nonelective surgery. METHODS: The authors studied all adult patients undergoing major diagnostic or therapeutic surgery in Florida in 2021 and 2022 hospitalized 2 or more midnights. They compared those who survived to discharge or died between the elective and nonelective groups. Major hospital-acquired complications were considered as sensitivity analyses. The diversity of procedures (International Classification of Diseases, Tenth Revision-Procedure Coding System [ICD-10-PCS] codes) was quantified using the inverse of the internal Herfindahl. RESULTS: Among the 1,245,537 hospitalizations studied, the nonelective group accounted for 94.5% (95% CI, 94.0 to 95.1%) of the 20,874 in-hospital deaths ( P < 0.0001 vs. 50% ["most"]). The nonelective group also accounted for most (70.0%) hospitalizations studied. The relative risk of death in the elective versus nonelective group was 0.13 (95% CI, 0.12 to 0.14; P < 0.0001 vs . 1.0). The relative risks of acute kidney injury, hospital-acquired pneumonia, a major adverse cardiovascular event, and infection were all less than 1.0 in the elective group. Hundreds of different ICD-10-PCS codes occurred commonly among patients who died, in both groups. CONCLUSIONS: Results of previous studies of all-cause perioperative mortality should not be applied to patients having elective major surgery because most deaths (approximately 95%) and most cases (70%) are in patients having nonelective major surgery ( i.e. , already admitted to the hospital or undergoing trauma-related surgery). From a public health perspective, interventions to reduce postoperative mortality should be primarily focused on patients who are inpatients before their first major surgical procedure.

BACKGROUND: Cesarean section is one of the most common surgical procedures. Currently, there are many analgesic methods available after cesarean section, but the optimal analgesic method after cesarean section is not clear. METHODS: A network meta-analysis of randomized controlled trials was used to search Embase, PubMed, Web of Science, and Cochrane databases. Outcomes included time to first postoperative request for analgesia, postoperative medication-supplemented analgesia, pain scores at four postoperative time points, postoperative complications (nausea and vomiting, itching, and level of sedation), and patient satisfaction. RESULT: A total of 110 randomized controlled trials involving 8871 pregnant women were finally included. A total of 17 postoperative analgesic techniques for cesarean delivery were included. Compared with the control group, all modalities except wound infiltration prolonged the time to the first request for analgesia. Transversal abdominal block-type and lumbar quadratus block-type analgesia were effective in decreasing the need for opioids in postoperative patients. Wound infiltration and transversalis fascia plane decreased the need for nonopioid medications in postoperative patients. The traditional analgesic modalities of intrathecal morphine (IM) and epidural morphine have the best analgesic effect, and the analgesic effect of the type of transversal abdominal block and the type of lumbar square muscle block in local anesthesia is better than that of other local anesthesia modalities. The lateral transversus abdominis block and posterior and anterior lumbar square muscle block can effectively reduce postoperative complications with the best effect. In terms of patient satisfaction, IM with conventional Petit transverse abdominal block was the best. CONCLUSIONS: Regional nerve block is a safe and effective postoperative analgesic modality; QLB III, which is used to use opioids as postoperative supplemental analgesia, is the safest and most effective analgesic modality, and those who are used to use non-opioids as postoperative supplemental analgesia can choose transversalis fascia plane as a postoperative analgesic modality.

BACKGROUND: Postoperative fatigue syndrome (POFS) is a common yet often under-recognized consequence of surgical interventions, particularly in cardiac surgery. POFS is associated with prolonged recovery times, extended hospital stays, and increased healthcare costs. Current strategies for preventing POFS have demonstrated limited success. This study aims to evaluate the impact of pecto-intercostal fascial block (PIFB) on the incidence of POFS in elderly patients undergoing off-pump coronary artery bypass graft (CABG) surgery. METHODS: In this randomized controlled trial, 110 elderly patients scheduled for off-pump CABG surgery were randomly assigned to either the PIFB group ( n = 55; 0.4% ropivacaine) or the control group ( n = 55; normal saline). The primary outcome was the incidence of POFS, which was assessed using the ICFS-10 scale. Secondary outcomes included postoperative pain scores, opioid consumption, extubation time, duration of ICU and hospital stay, and Quality of Recovery (QoR-15) scores. RESULTS: The incidence of POFS was significantly lower in the PIFB group compared to the control group on postoperative days 1 (69.0% vs. 92.7%, P = 0.004), 3 (63.6% vs. 83.6%, P = 0.030), and 5 (52.7% vs. 72.7%, P = 0.048), with no significant differences observed by day 7 and 8 weeks. Pain scores were also markedly lower in the PIFB group at three time points: immediately after extubation, 12 hours post-surgery, and 24 hours post-surgery ( P < 0.001, P < 0.001, and P = 0.002, respectively). Furthermore, opioid consumption was reduced by an average of 11.1 mg ( P < 0.001). Patients in the PIFB group experienced significantly shorter extubation times (5.5 ± 1.8 hours vs. 8.6 ± 2.1 hours, P < 0.001), ICU stays (31.8 ± 7.3 hours vs. 39.4 ± 7.5 hours, P < 0.001), and hospital stays (8.2 ± 1.1 days vs. 8.8 ± 1.2 days, P = 0.007). QoR-15 scores were significantly higher in the PIFB group on postoperative days 1, 3, and 5 ( P < 0.001, P = 0.003, and P = 0.037, respectively). Notably, no PIFB-related adverse events were reported in either group. CONCLUSIONS: PIFB significantly alleviated early POFS, enhanced pain management, reduced opioid consumption, and accelerated recovery, thereby improving the overall quality of recovery in elderly patients undergoing off-pump CABG.