Daily Anesthesiology Research Analysis

BACKGROUND: Postoperative neurocognitive disorder and delayed neurocognitive recovery (pNCD/dNCR) are common yet unresolved complications after surgery. METHODS: We conducted a systematic literature search in resources of Ovid MEDLINE, EMBASE, Web of Science, and ClinicalTrials.gov and multivariable meta-regression analyses of RCTs to identify trial-level characteristics associated with prevention effectiveness in pNCD/dNCR research. Trials investigating pNCD/dNCR prevention in adult surgical patients were eligible. Trials performed in paediatric patients or assessing cognitive changes on the same day of surgery were excluded. Effectiveness associated with trial-level characteristics was assessed using ratio of odds ratio (OR) and 95% confidence interval (CI). RESULTS: We analysed 187 eligible trials. Trials originating from the USA/Canada (ratio of OR, 3.04; 95% CI, 1.62-5.73; P=0.001), Europe/Australia/New Zealand (1.58; 1.04-2.40; P=0.033), and other regions (2.0; 1.19-3.36; P=0.009) were associated with reduced effectiveness compared with trials from China. Higher pNCD/dNCR incidence in control groups was associated with greater effectiveness (0.98; 0.97-0.99; P<0.001). Trials involving volatile anaesthetics (2.12; 1.16-3.86; P=0.014) were associated with reduced effectiveness compared with dexmedetomidine and abdominal surgery, respectively. Registered trials exhibited enhanced effectiveness (0.69; 0.50-0.95; P=0.022), whereas those with power analyses reported reduced effectiveness (1.43; 1.06-1.94; P=0.021). Trials with a high risk of bias in the selection of the reported result were associated with reduced effectiveness (2.99; 1.04-8.59; P=0.041). Dexmedetomidine was the most studied intervention, showing potential benefits, though evidence certainty was very low. CONCLUSIONS: Trial-level characteristics were significantly associated with prevention effectiveness in pNCD/dNCR research. Identifying and addressing the underlying causes of regional differences might enhance the quality and consistency of future trials on a global level. SYSTEMATIC REVIEW PROTOCOL: PROSPERO (CRD42024543584).

Total hip arthroplasty can cause moderate and severe pain that can have a profound impact during postoperative rehabilitation. Regional nerve block is recommended for anesthesia and analgesia during hip surgery. In particular, the iliac fascia space block of the inguinal ligament is a widely used technique in clinical practice that can block the femoral nerve trunk, obturator nerve trunk, and lateral femoral cutaneous nerve simultaneously. This study aimed to compare the effect of supra-inguinal fascia iliaca compartment block (S-FICB) to a combination of pericapsular nerve group block (PNGB) and lateral femoral cutaneous nerve block (LFCNB) on block range and analgesia as well as motor function of patients with total hip arthroplasty. Sixty patients undergoing total hip arthroplasty through posterolateral approach were randomly divided into two groups with 30 patients each. After complete awakening from general anesthesia, patients received ultrasound-guided S-FICB with 40 mL 0.4% ropivacaine (group S) or 20 mL 0.4% ropivacaine PNGB combined with 3 mL 0.4% ropivacaine LFCNB (PH group). We used the Numerical Rating Scale and cumulative dosage of sufentanil to grade pain during the first 48 h. Quadriceps femoris muscle and adductor muscle strength, range of sensory block, length of stay, and complications were also recorded. No significant differences were found in analgesic indicators of both groups (P>0.05). The Numerical Rating Scale scores of resting pain at each time point after the blockage were significantly lower than those before the blockage (P<0.05). However, the PH group had significantly less incidence of analgesia sensation in the anterior and medial side of the thigh (P < 0.05), and less incidence of quadriceps and adductor weakness (P<0.05) at 1 h and 6 h after the blockage compared to that in group S. Compared to S-FICB, the combination of PNGB and LFCNB provided equivalent analgesic effect and significantly lowered the risk of numbness and muscle weakness of the thigh, which is more conducive to early postoperative exercise and rehabilitation .This combination can be used as a new option in multimodal analgesia after total hip arthroplasty.Trial registration: Chinese Clinical Trial Registry (no. ChiCTR2200055963, date of registration 29/01/2022).

BACKGROUND: The aim of this study was to evaluate the risk of bradycardia after sugammadex administration for reversal of neuromuscular block compared with neostigmine and pyridostigmine. METHODS: This multicentre retrospective observational study included adult patients who underwent surgery under general anaesthesia between 2011 and 2021 in three university hospitals in Korea. The risk of bradycardia, defined as relative (≥10%, ≥20%, ≥30%, or ≥40%) or absolute (≥5, ≥10, ≥15, or ≥20 beats min RESULTS: A total of 359 414 patients were analysed; sugammadex, neostigmine, and pyridostigmine were administered in 107 018, 97 754, and 154 642 patients, respectively. The overall incidence of bradycardia in the sugammadex group was similar to that of the neostigmine group. Specifically, the risk of a ≥20% decrease in HR was not significantly different between the sugammadex and neostigmine groups (9.8% vs 10.2%; odds ratio [95% confidence interval]: 1.00 [0.97-1.03]), though it was significantly higher in the sugammadex group than in the pyridostigmine group (9.8% vs 5.8%; 1.93 [1.87-1.98]). Restricted cubic spline curves suggested a linear increase in the risk of a ≥20% decrease in HR as the dose of sugammadex increased. CONCLUSIONS: The incidence of bradycardia after sugammadex administration was low, and its adjusted risk was not significantly different from that of neostigmine, the most commonly used acetylcholinesterase inhibitor for reversal of neuromuscular block.