Daily Anesthesiology Research Analysis

BACKGROUND: There remains a substantial unmet need for effective and safe treatments for neuropathic pain. The Neuropathic Pain Special Interest Group aimed to update treatment recommendations, published in 2015, on the basis of new evidence from randomised controlled trials, emerging neuromodulation techniques, and advances in evidence synthesis. METHODS: For this systematic review and meta-analysis, we searched Embase, PubMed, the International Clinical Trials Registry, and ClinicalTrials.gov from data inception for neuromodulation trials and from Jan 1, 2013, for pharmacological interventions until Feb 12, 2024. We included double-blind, randomised, placebo-controlled trials that evaluated pharmacological and neuromodulation treatments administered for at least 3 weeks, or if there was at least 3 weeks of follow-up, and which included at least ten participants per group. Trials included participants of any age with neuropathic pain, defined by the International Association for the Study of Pain. We excluded trials with enriched enrolment randomised withdrawal designs and those with participants with mixed aetiologies (ie, neuropathic and non-neuropathic pain) and conditions such as complex regional pain syndrome, low back pain without radicular pain, fibromyalgia, and idiopathic orofacial pain. We extracted summary data in duplicate from published reports, with discrepancies reconciled by a third independent reviewer on the platform Covidence. The primary efficacy outcome was the proportion of responders (50% or 30% reduction in baseline pain intensity or moderate pain relief). The primary safety outcome was the number of participants who withdrew from the treatment owing to adverse events. We calculated a risk difference for each comparison and did a random-effects meta-analysis. Risk differences were used to calculate the number needed to treat (NNT) and the number needed to harm (NNH) for each treatment. Risk of bias was assessed by use of the Cochrane risk of bias tool 2 and certainty of evidence assessed by use of GRADE. Recommendations were based on evidence of efficacy, adverse events, accessibility, and cost, and feedback from engaged lived experience partners. This study is registered on PROSPERO, CRD42023389375.

OBJECTIVE: To characterize the association between preoperative psychological distress and postoperative complications at 30 days and mortality at 1 year in a non-cardiac surgery sample. METHOD: Data were taken from a subsample of the VISION cohort study (n = 997; 2011-2012). Participants were scheduled to undergo major non-cardiac surgery under general or regional anesthesia. Participants self-reported past 30-day psychological distress on the day of surgery using the Kessler-6 (K6) Scale. Complications were assessed via interviews and/or chart reviews. Multivariable logistic regressions characterized the relationship between preoperative psychological distress and postoperative complications. Models were fitted for sociodemographics, surgery type, preoperative medical morbidity, and smoking. RESULTS: Among participants with a completed K6 (n = 938), 7.9 % experienced mortality within 1 year. After controlling for age, ethnicity, sex, surgery type, preoperative medical morbidity, and smoking, higher levels of preoperative psychological distress were associated with 30 day complications such as myocardial infarction, non-fatal cardiac arrest, leg/arm deep vein thrombosis/ pulmonary embolism, new acute renal failure, pneumonia, and congestive heart failure (AOR3 (3rd model), 1.12, [95 % CI, 1.02-1.22, p < 0.05]) and 1-year mortality (AOR3, 1.09, [95 % CI, 1.02-1.18, p < 0.05]). Sensitivity analyses demonstrate that the latter association was being driven by symptoms of depression (AOR3, 1.17 [95 % CI 1.04-1.33, p < 0.05]) but not anxiety (AOR2, 0.94 [95 % CI, 0.61-1.62, p > 0.05]). CONCLUSION: Elevated preoperative distress increased the risk of 30-day complications and mortality at 1 year. These results underscore the need for future research to examine if supporting patients' mental health during the perioperative period can mitigate risk. CLINICAL TRIAL REGISTRATION: clinicaltrials.gov, no. NCT00512109 (main VISION study).

BACKGROUND: This study aimed to explore the risk of stroke death (SD) in cancer patients, estimate rates, and identify risk factors associated with SD. METHODS: In this retrospective study, we used the 17 National Cancer Institute Surveillance, Epidemiology, and End Results registries (2000-2020). A total of 5,922,533 patients diagnosed with their first primary cancer were included. The primary outcome was the standardized mortality ratio (SMR) of SD in cancer patients. Secondary outcomes included SD incidence rates and risk factors. Rates were calculated per 100,000 persons with the annual percentage change (APC). RESULTS: Among included patients, 56,686 (2.0 %) died due to stroke. Compared to the general population, younger patients (≤39 years) (SMR: 2.31) and patients receiving no treatment (SMR: 1.36) had the highest risk. Cancer types with the fastest-declining SD rates were in the male genital (APC: -13.9 %) and breast (APC: -11.8 %). Older age (hazard ratio [HR]: 1.11, p < 0.001), male sex (HR: 1.06, p < 0.001), and non-white race (HR: 1.13, p < 0.001) were associated with increased risk of SD. Cancers of the nervous system (HR: 3.42, p < 0.001), respiratory (HR: 1.38, p < 0.001), and head and neck (HR: 1.37, p < 0.001) had higher risk of SD vs. breast cancer. Patients with primary chemotherapy (HR: 0.69, p < 0.001) and radiotherapy (HR: 0.69, p < 0.001) demonstrated less risk vs. those without treatment. CONCLUSION: SD has declined over the years for both sexes and all cancer types. Older age, non-white race, and certain cancers (nervous system, respiratory system, and head and neck) pose significant risks for SD.