Daily Anesthesiology Research Analysis
An international Delphi consensus refined how ARDS should be conceptually defined and highlighted priorities for subphenotyping, with implications for diagnosis and research. A randomized trial in total knee arthroplasty found spinal mepivacaine modestly hastened motor recovery versus bupivacaine without improving ambulation or discharge. A meta-analysis of 12 RCTs showed transversus abdominis plane blocks reduce pain and opioid use after gastric surgery and modestly speed gastrointestinal recov
Summary
An international Delphi consensus refined how ARDS should be conceptually defined and highlighted priorities for subphenotyping, with implications for diagnosis and research. A randomized trial in total knee arthroplasty found spinal mepivacaine modestly hastened motor recovery versus bupivacaine without improving ambulation or discharge. A meta-analysis of 12 RCTs showed transversus abdominis plane blocks reduce pain and opioid use after gastric surgery and modestly speed gastrointestinal recovery.
Research Themes
- Refining ARDS definition and advancing subphenotyping for precision critical care
- Optimizing neuraxial anesthesia agents for rapid functional recovery
- Regional anesthesia in ERAS pathways for upper gastrointestinal surgery
Selected Articles
1. Defining and subphenotyping ARDS: insights from an international Delphi expert panel.
A four-round Delphi process involving diverse ARDS experts achieved consensus on a conceptual model and key definition components across clinical, research, and educational contexts, and endorsed advancing subphenotyping. The panel identified knowledge gaps and research priorities to refine diagnostic precision and account for ARDS heterogeneity.
Impact: This consensus clarifies what should constitute an ARDS definition and prioritizes subphenotyping, guiding future trials and diagnostic strategies in critical care.
Clinical Implications: Refined ARDS components and emphasis on subphenotyping can improve patient selection, stratification in trials, and potentially personalize ventilatory and adjunctive therapies.
Key Findings
- Consensus on a conceptual model and defining components for ARDS across clinical, research, and educational use cases.
- Endorsement of further research into ARDS subphenotyping to address heterogeneity.
- Use of a rigorous, anonymous multi-round Delphi method with diverse international experts and predefined quantitative criteria.
Methodological Strengths
- Structured four-round Delphi with anonymity, minimizing groupthink and bias.
- Global, multidisciplinary expert participation ensuring broad applicability.
Limitations
- Consensus does not equate to empirical validation; proposed components were not prospectively tested.
- Operational thresholds and diagnostic performance metrics were not established.
Future Directions: Prospective validation of proposed components and subphenotypes, integration with biomarkers and imaging, and evaluation of phenotype-guided treatment strategies.
2. Mepivacaine versus bupivacaine spinal anesthesia for return of motor function following total knee arthroplasty: a randomized controlled trial.
In 163 TKA patients, spinal mepivacaine shortened time to motor recovery by about 19 minutes and reduced urinary retention versus bupivacaine, but did not improve time to ambulation, ambulation distance, same-day discharge, length of stay, or opioid use. PACU pain scores were higher with mepivacaine but equalized by 6–48 hours.
Impact: This well-powered RCT provides high-quality comparative data for selecting intrathecal local anesthetics in fast-track arthroplasty pathways.
Clinical Implications: Mepivacaine may be preferred when modestly faster motor recovery and lower urinary retention are priorities, but expectations for earlier ambulation or discharge should be tempered.
Key Findings
- Time to return of motor function was shorter with mepivacaine (median 210 vs 229 minutes; p<0.001).
- Urinary retention was less frequent with mepivacaine (36% vs 57%; p=0.007).
- No differences in time to first ambulation, ambulation distance, same-day discharge, length of stay, or opioid consumption.
- Higher PACU pain with mepivacaine, with no differences by 6–48 hours.
Methodological Strengths
- Randomized controlled design with trial registration.
- Clinically relevant outcomes including ambulation and discharge metrics.
Limitations
- Single procedure type limits generalizability beyond TKA.
- No blinding details provided; modest absolute difference in motor recovery.
Future Directions: Evaluate dosing strategies and adjuncts to balance faster motor recovery with early analgesia; assess cost-effectiveness and patient-centered outcomes in fast-track programs.
3. Efficacy of transversus abdominis plane block for gastric surgery: a meta-analysis.
Across 12 RCTs (n=841), TAP blocks after gastric surgery lowered pain scores through 48 hours, reduced opioid consumption, and modestly accelerated first ambulation and flatus, without shortening hospital stay. Findings support TAP as part of multimodal ERAS analgesia for gastric procedures.
Impact: Synthesizes randomized evidence specific to gastric surgery, informing ERAS analgesic strategies with consistent benefits in pain and opioid reduction.
Clinical Implications: Consider incorporating TAP blocks into standard gastric surgery ERAS pathways to reduce pain and opioids and facilitate early GI recovery, while recognizing limited impact on length of stay.
Key Findings
- TAP reduced postoperative VAS pain scores at 1–48 hours (WMD ~ -0.62 to -0.97).
- Postoperative opioid consumption decreased with TAP (WMD -1.89).
- Earlier first flatus (WMD -5.17 hours) and a borderline improvement in time to ambulation (SMD -0.46).
- No significant difference in hospital length of stay.
Methodological Strengths
- Exclusive inclusion of RCTs with multi-database search and dual-reviewer screening.
- Consistent effects across multiple time points and outcomes.
Limitations
- Potential heterogeneity in TAP techniques, surgical approaches, and perioperative care.
- Unclear assessment of publication bias and variable reporting quality across trials.
Future Directions: Head-to-head comparisons of TAP variants (e.g., subcostal vs lateral), local anesthetic dosing strategies, and integration with adjunct blocks in specific gastric procedures.