Daily Anesthesiology Research Analysis
Three anesthesia-focused studies stand out today: a multicenter double-blind RCT shows surgeon-delivered intercostal nerve blocks outperform erector spinae plane blocks for uniportal thoracic surgery analgesia; a two-center RCT demonstrates opioid-free anesthesia built on thoracic paravertebral block improves early recovery after breast cancer surgery; and a preregistered meta-analysis links preoperative depression to longer postoperative hospitalization across 27 million surgical patients.
Summary
Three anesthesia-focused studies stand out today: a multicenter double-blind RCT shows surgeon-delivered intercostal nerve blocks outperform erector spinae plane blocks for uniportal thoracic surgery analgesia; a two-center RCT demonstrates opioid-free anesthesia built on thoracic paravertebral block improves early recovery after breast cancer surgery; and a preregistered meta-analysis links preoperative depression to longer postoperative hospitalization across 27 million surgical patients.
Research Themes
- Regional anesthesia optimization for thoracic and breast surgery
- Opioid-sparing and opioid-free perioperative strategies
- Perioperative mental health and surgical recovery
Selected Articles
1. Erector Spinae Plane Block versus Intercostal Nerve Blocks in Uniportal Videoscopic-assisted Thoracic Surgery: A Multicenter, Double-blind, Prospective Randomized Placebo-controlled Trial.
In 100 uniportal VATS patients, intercostal nerve block significantly reduced 12-h (10.9 vs 17.6 mg) and 24-h (18.7 vs 26.7 mg) morphine consumption compared with erector spinae plane block, lowered early pain scores, and required fewer rescue analgesics. Safety and length of stay were similar, and ESPB showed higher systemic local anesthetic absorption.
Impact: This high-quality, double-blind RCT provides definitive head-to-head evidence on two widely used thoracic wall blocks, challenging current preference for ESPB in uniportal VATS analgesia.
Clinical Implications: For uniportal VATS, surgeon-performed intercostal nerve blocks under direct vision should be considered first-line to optimize opioid-sparing analgesia and minimize systemic local anesthetic exposure.
Key Findings
- 12-h morphine consumption: 10.9 mg (ICNB) vs 17.6 mg (ESPB), P=0.0015
- 24-h morphine consumption: 18.7 mg (ICNB) vs 26.7 mg (ESPB), P=0.018
- Lower pain scores in first 2 h and fewer rescue analgesia needs (16% vs 40%, P=0.0033) with ICNB
- No differences in satisfaction, complications, or length of stay; higher systemic local anesthetic absorption with ESPB
Methodological Strengths
- Multicenter, double-blind, placebo-controlled randomized design
- Objective primary endpoint (morphine consumption) and pharmacokinetic assessment of local anesthetic levels
Limitations
- Sample size of 100 limits detection of rare adverse events
- Generalizability limited to uniportal VATS within ERAS protocols; no long-term pain outcomes
Future Directions: Evaluate long-term pain, chronic post-thoracotomy pain incidence, and cost-effectiveness across different thoracic approaches and patient risk strata.
2. Opioid-free anaesthesia protocol based on thoracic paravertebral block enhances postoperative recovery after breast cancer surgery: A two-center, prospective, randomized, controlled trial.
Among 252 breast surgery patients, OFA+TPVB improved QoR-15 at 24 h (139.1 vs 132.5; difference 6.6, 95% CI 4.87–8.40) and 48 h, reduced early pain scores, and decreased postoperative nausea/retching versus opioid-based anesthesia. Time to first urination and length of stay were similar between groups.
Impact: Provides randomized evidence that structured OFA with paravertebral regional anesthesia improves patient-centered recovery while reducing PONV in breast surgery.
Clinical Implications: OFA protocols anchored by TPVB can be adopted to enhance recovery and reduce PONV in breast surgery, with monitoring for analgesic adequacy and standardized ERAS pathways.
Key Findings
- QoR-15 at 24 h: 139.12 (OFA) vs 132.48 (OA); mean difference 6.6 (95% CI 4.87–8.40), P<0.001
- QoR-15 at 48 h higher with OFA (145.31 vs 142.18)
- Lower NRS pain at rest (6 h) and with activity (≤12 h) in OFA group
- Fewer postoperative nausea/retching events in OFA group; no difference in first urination time or length of stay
Methodological Strengths
- Prospective randomized controlled design across two centers
- Use of validated patient-reported outcome (QoR-15) with predefined MCID
Limitations
- Blinding not specified; potential performance bias in anesthetic management
- Single surgical domain (breast surgery); no long-term outcomes
Future Directions: Assess generalizability to broader surgeries, refine OFA components and dosing, and test long-term functional and opioid use outcomes.
3. Association between Preoperative Depression and Length of Stay after Major Surgery: A Systematic Review and Meta-analysis.
Across 57 studies encompassing 27,708,719 participants, preoperative depression was associated with a 0.98-day longer hospital stay (95% CI 0.35–1.62). Adjusted odds of extended length of stay were increased (OR 1.27, 95% CI 1.11–1.46). Certainty was limited by risk of bias and publication bias.
Impact: This preregistered meta-analysis quantifies the magnitude of depression’s impact on hospitalization length across diverse surgeries, highlighting perioperative mental health as a modifiable target.
Clinical Implications: Routine preoperative depression screening and targeted interventions may reduce prolonged hospitalization; prospective interventional trials are needed to test LOS reduction.
Key Findings
- 57 studies; total n=27,708,719 participants
- Mean postoperative LOS was 0.98 days longer with preoperative depression (95% CI 0.35–1.62)
- Adjusted odds of extended LOS increased: OR 1.27 (95% CI 1.11–1.46)
- ROBINS-E used for bias assessment; GRADE indicated limited certainty due to bias and publication bias
Methodological Strengths
- PROSPERO preregistration and comprehensive database search (Medline, Embase, Cochrane, PsycINFO)
- Use of GRADE and ROBINS-E; pooled adjusted and unadjusted estimates
Limitations
- Predominantly observational data with residual confounding and heterogeneity
- Evidence of publication bias reduces certainty of effect estimates
Future Directions: Conduct pragmatic trials testing perioperative depression interventions on LOS, and refine risk adjustment and subgroup analyses by surgery type and severity.