Daily Anesthesiology Research Analysis
Three impactful studies in anesthesiology and perioperative care stand out today: a phase III randomized trial shows adamgammadex is noninferior to sugammadex for rapid reversal of deep rocuronium block; a Cochrane network meta-analysis finds commonly used regional blocks for breast surgery offer broadly comparable analgesia and safety; and a randomized trial demonstrates propofol-based anesthesia improves first-night postoperative sleep in older adults, potentially via reduced orexin-A.
Summary
Three impactful studies in anesthesiology and perioperative care stand out today: a phase III randomized trial shows adamgammadex is noninferior to sugammadex for rapid reversal of deep rocuronium block; a Cochrane network meta-analysis finds commonly used regional blocks for breast surgery offer broadly comparable analgesia and safety; and a randomized trial demonstrates propofol-based anesthesia improves first-night postoperative sleep in older adults, potentially via reduced orexin-A.
Research Themes
- Neuromuscular blockade reversal and perioperative safety
- Regional anesthesia optimization for breast cancer surgery
- Anesthetic choice and postoperative sleep physiology in older adults
Selected Articles
1. Efficacy and safety of adamgammadex for reversing rocuronium-induced deep neuromuscular block: a multicentre, randomised, double-blind, positive-controlled phase III trial.
In a multicentre, double-blind phase III noninferiority RCT (n=321), adamgammadex 8 mg/kg rapidly reversed deep rocuronium-induced neuromuscular block with a 98.7% success rate to TOFR 0.9, noninferior to sugammadex (100%). Median time to TOFR 0.9 was 2.5 vs 2.2 minutes, and safety profiles were comparable.
Impact: Introduces a potential alternative to sugammadex for rapid reversal of deep neuromuscular block, with rigorous RCT evidence supporting efficacy and safety.
Clinical Implications: Adamgammadex could expand options for reliable reversal of deep rocuronium block, aiding throughput and safety in the OR/PACU. Adoption will depend on availability, cost, and postmarketing safety data.
Key Findings
- Noninferiority achieved for TOFR 0.9 recovery success: 98.7% (adamgammadex) vs 100% (sugammadex); difference -1.3% (95% CI -4.6 to 1.2).
- Median time to TOFR 0.9: 2.5 minutes (adamgammadex) vs 2.2 minutes (sugammadex); between-group difference 0.5 minutes (95% CI 0.3 to 0.7), within noninferiority margin.
- No significant differences in safety profile between groups.
Methodological Strengths
- Multicentre, randomized, double-blind, positive-controlled noninferiority design
- Prespecified noninferiority margins and adequate sample size with trial registration
Limitations
- Details of dosing strata and subgroup analyses are limited in the abstract
- Long-term safety and rare adverse events require postmarketing surveillance
Future Directions: Head-to-head cost-effectiveness studies versus sugammadex; evaluation in special populations (renal impairment, pediatrics) and across varying depths of block.
2. Propofol versus sevoflurane anesthesia on postoperative sleep quality in older patients after major abdominal surgery: A randomized clinical trial.
In older adults undergoing major abdominal surgery (n=144), propofol-based anesthesia increased first-night total sleep time by a median of 29 minutes versus sevoflurane and was associated with lower perioperative plasma orexin-A levels. Findings point to anesthetic-specific effects on postoperative sleep physiology.
Impact: Links anesthetic choice to objectively measured postoperative sleep outcomes and neuropeptide biology in an at-risk population, informing ERAS and geriatric anesthesia strategies.
Clinical Implications: Propofol may be preferred when postoperative sleep restoration is prioritized in older patients, while monitoring for other trade-offs. Integration with multimodal sleep-promoting strategies is warranted.
Key Findings
- First postoperative night total sleep time was longer with propofol: median 150 vs 111 minutes; median difference 29 minutes (95% CI 4 to 53), P=0.025.
- Propofol group had lower plasma orexin-A at 1 hour after induction and at 06:00 on postoperative day 1 (both P<0.05).
- Randomized design in 144 patients aged 65–90 supports internal validity for sleep outcome differences.
Methodological Strengths
- Randomized allocation between anesthetic strategies with objective actigraphy monitoring
- Biomarker assessment (orexin-A) supports mechanistic inference
Limitations
- Single-center setting may limit generalizability
- Effect size modest; blinding of clinicians/patients to anesthetic type is inherently difficult
Future Directions: Multicenter trials integrating sleep, delirium, and functional recovery endpoints; exploration of dosing and adjuncts that modulate orexin signaling.
3. Regional analgesia techniques for postoperative pain after breast cancer surgery: a network meta-analysis.
Across 39 RCTs (n=2348), network meta-analysis found broadly comparable postoperative pain relief and complication rates among paravertebral, erector spinae plane, pectoral, and serratus anterior plane blocks for breast surgery. PEC block showed a small advantage over PVB at 2 hours (MD -0.47 on a 0–10 scale), below the 1-point MCID.
Impact: Provides high-level comparative effectiveness evidence to guide selection among commonly used regional blocks in breast surgery, emphasizing flexibility and clinician expertise.
Clinical Implications: Block choice can prioritize provider expertise, patient-specific anatomy, and resource availability, as analgesic efficacy and safety are largely similar. Training and ultrasound guidance remain key.
Key Findings
- Included 39 RCTs (n=2348); primary NMA for pain included low risk-of-bias studies.
- At 2 hours post-op (rest), PEC slightly reduced pain versus PVB (MD -0.47; 95% CI -0.73 to -0.22), below the 1-point MCID.
- Overall, regional techniques (PVB, ESPB, PEC, SAPB) showed comparable analgesic efficacy and complication rates.
Methodological Strengths
- Cochrane-compliant systematic review with network meta-analysis and CINeMA certainty assessment
- Restriction to low risk-of-bias trials in primary analysis; comprehensive, multilingual search
Limitations
- Heterogeneity in block techniques, anesthetic dosing, and surgical procedures; some analyses truncated by available data
- Clinical significance of small MDs questionable; long-term outcomes variably reported
Future Directions: Head-to-head pragmatic RCTs incorporating patient-centered outcomes (quality of recovery, chronic pain) and cost; standardized protocols to reduce heterogeneity.