Daily Anesthesiology Research Analysis

OBJECTIVE: This study compared the Pericapsular Nerve Group (PENG) block combined with the Lateral Femoral Cutaneous Nerve (LFCN) block to the anterior Quadratus Lumborum Block (QLB) in patients undergoing Total Hip Arthroplasty (THA). METHODS: In this prospective, double-blind trial, 80 adults scheduled for THA under spinal anesthesia were randomized to receive either an anterior QLB (n = 40) with 30 mL of 0.25% bupivacaine or a combined PENG + LFCN block (n = 40) using 25 mL of 0.25% bupivacaine for PENG and 5 mL for LFCN. The primary outcome was cumulative 24 hour postoperative intravenous morphine consumption. Secondary outcomes included pain scores, quadriceps strength, patient satisfaction and side effects. RESULTS: No significant differences were observed between the groups in morphine consumption or pain scores during the first 12 hours (p > 0.05). At 24 hours, the PENG + LFCN group demonstrated significantly lower morphine consumption (p = 0.027) and resting VAS scores (p < 0.001). Quadriceps weakness occurred in 15% (6/40) of anterior QLB patients at 6 hours (p = 0.026), whereas no weakness was observed in the PENG + LFCN group within 24 hours. Patient satisfaction and the incidence of complications were comparable between the groups. CONCLUSION: Both anterior QLB and PENG + LFCN blocks provide effective analgesia for up to 12 hours post-THA. However, the PENG + LFCN combination offers prolonged analgesia, reduced opioid requirements and better preservation of quadriceps strength.

INTRODUCTION: Multiple trials have shown the advantages of videolaryngoscopy over direct laryngoscopy for tracheal intubation in the operating theatre. However, the effectiveness of universal videolaryngoscopy in real-world operating theatre settings remains uncertain. METHODS: We conducted a prospective, multicentre, quasi-experimental study, to evaluate the effectiveness of universal videolaryngoscopy compared with direct laryngoscopy for tracheal intubation in a real-world operating theatre setting. During the non-interventional phase, anaesthetists performed tracheal intubation using the Macintosh laryngoscope as their primary tool. In the interventional phase, the same anaesthetists employed a videolaryngoscope as the first-choice device. The primary outcome was 'easy tracheal intubation', defined as a composite of successful tracheal intubation on the first attempt; easy laryngoscopic view; and absence of the need for adjunct airway devices. RESULTS: Of the 5135 patients included in the study, easy tracheal intubation occurred in 1909/2568 patients (74.3%) during the non-interventional phase compared with 2216/2567 patients (86.3%) during the interventional phase (absolute difference 12%, 95%CI 9.8-14.1, p < 0.001). The interventional phase showed higher rates of successful first-attempt tracheal intubation (absolute risk difference 5.8%, 95%CI 4.1-7.5, p < 0.001); easy laryngoscopy (absolute risk difference 9.9%, 95%CI 8.2-11.7, p < 0.001); and a lower need for adjunct airway devices (absolute risk difference -5.2%, 95%CI -6.7 to -3.7, p < 0.001). Additionally, complications related to tracheal intubation were reduced significantly in the interventional phase (absolute risk difference -4.3%, 95%CI -5.7 to -2.8, p < 0.001). DISCUSSION: In a real-world operating theatre setting, universal videolaryngoscopy was effective at increasing the rate of easy tracheal intubation and successful first-attempt tracheal intubation, while reducing the incidence of difficult laryngoscopy and complications related to tracheal intubation.

PURPOSE: The anesthetic management combining remimazolam and neuromuscular blocking agents with sugammadex is expected to enhance the speed and safety of recovery from anesthesia. However, the effect of remimazolam on reversal of neuromuscular blockade with sugammadex remains unclear. We hypothesized that sugammadex could reverse rocuronium-induced neuromuscular blockade even under remimazolam anesthesia, although the recovery might be delayed. In the present study, the recovery time from rocuronium-induced neuromuscular blockade after administration of sugammadex under remimazolam anesthesia was compared with that under propofol anesthesia. METHODS: Twenty-six patients over 18 years old scheduled for elective gynecological laparotomy under general anesthesia combined with epidural anesthesia were prospectively randomly assigned to remimazolam and propofol groups. After induction of general anesthesia with remifentanil and remimazolam or remifentanil and propofol, followed by their continuous infusion for anesthesia maintenance, train-of-four (TOF) responses were monitored following 0.9 mg/kg rocuronium administration. During surgery, rocuronium was infused continuously to maintain a TOF count of 1. At the end of surgery, when TOF counts of 2 were confirmed, sugammadex 2 mg/kg was administered and time to recovery of the TOF ratio to ≥ 90% of the baseline TOF ratio was compared between the two groups. RESULTS: Median (interquartile range) recovery times in the remimazolam and propofol groups were 3.0 (2.3 to 3.8) and 2.5 (2.0 to 3.3) min, respectively (P = 0.62). CONCLUSION: Remimazolam anesthesia may not delay the efficacy of sugammadex in reversing rocuronium-induced neuromuscular blockade compared with propofol anesthesia. CLINICAL TRIAL NUMBER AND REGISTRY URL: The Japan Registry of Clinical trials (jRCT1071230073). URL: https://jrct.niph.go.jp/latest-detail/jRCT1071230073 .