Daily Anesthesiology Research Analysis
Three randomized trials in anesthesiology advance perioperative care: continuous erector spinae plane block matched opioid-based analgesia yet improved recovery and safety after VATS; ciprofol alone proved non-inferior to ciprofol–fentanyl with better respiratory/hemodynamic stability but more coughing; and oliceridine reduced respiratory depression versus sufentanil during GI endoscopy sedation with remimazolam–etomidate.
Summary
Three randomized trials in anesthesiology advance perioperative care: continuous erector spinae plane block matched opioid-based analgesia yet improved recovery and safety after VATS; ciprofol alone proved non-inferior to ciprofol–fentanyl with better respiratory/hemodynamic stability but more coughing; and oliceridine reduced respiratory depression versus sufentanil during GI endoscopy sedation with remimazolam–etomidate.
Research Themes
- Opioid-sparing and opioid-optimizing sedation strategies
- Regional anesthesia to enhance recovery and reduce complications
- Safety optimization in ambulatory endoscopy sedation
Selected Articles
1. Analgesic efficacy of continuous erector spinae plane block vs. opioid-based regimen for postoperative pain management following video-assisted thoracoscopic lung resection: a prospective, randomised, open-label, non-inferiority trial.
In a randomized, open-label non-inferiority trial after VATS lung resection, continuous erector spinae plane block achieved non-inferior analgesia versus an opioid-based regimen. It significantly improved QoR-15 at 24 and 48 hours and reduced postoperative pulmonary complications and PONV-related symptoms.
Impact: Demonstrates an opioid-sparing regional technique that not only matches analgesia but enhances recovery and safety in thoracic surgery, with implications for ERAS pathways.
Clinical Implications: Continuous ESPB can be considered a first-line postoperative analgesic strategy after VATS to improve recovery quality and reduce pulmonary and PONV complications while minimizing opioid exposure.
Key Findings
- Non-inferior pain control vs. opioid regimen (pain NRS AUC; p=0.011 for non-inferiority).
- Higher QoR-15 at 24 h (median difference 11) and 48 h (median difference 10), both p<0.001.
- Lower postoperative pulmonary complications (RR 0.45; 95% CI 0.21–0.96; p=0.031).
- Fewer postoperative nausea, retching, and dizziness events (all statistically significant).
Methodological Strengths
- Prospective randomized non-inferiority design with clinically meaningful endpoints (QoR-15, complications).
- Comprehensive safety assessment including PONV and pulmonary complications.
Limitations
- Open-label design may introduce performance/assessment bias.
- Single-procedure context (VATS) may limit generalizability; sample size not reported in abstract.
Future Directions: Multicenter, blinded trials comparing continuous ESPB to other regional techniques and opioid-sparing multimodal regimens with longer-term outcomes (e.g., chronic pain, functional recovery).
INTRODUCTION: Video-assisted thoracoscopic lung resection causes significant postoperative pain. We hypothesised that continuous erector spinae plane block would provide non-inferior analgesia compared with a conventional opioid-based regimen for this procedure. METHODS: Patients were allocated randomly to continuous erector spinae plane block (continuous infusion of 0.25% ropivacaine via perineural catheters (5 ml.h RESULTS: The cumulative area under curve for the pain numeric rating scale score in patients allocated to the continuous erector spinae plane block group was non-inferior to those allocated to the conventional group (mean difference - 0.99, 95%CI -11.97-9.98, p = 0.011). Patients allocated to the continuous erector spinae plane block group showed superior quality of recovery-15 scores at 24 h (median difference 11, 95%CI 6-16, p < 0.001) and 48 h postoperatively (median difference 10, 95%CI 7-15, p < 0.001), alongside reduced postoperative pulmonary complications (relative risk 0.45, 95%CI 0.21-0.96, p = 0.031). Safety outcomes favoured continuous erector spinae plane block, with lower incidences of postoperative nausea (relative risk 0.17, 95%CI 0.04-0.73, p = 0.005); retching (relative risk 0.11, 95%CI 0.02-0.89, p = 0.023); and dizziness (relative risk 0.22, 95%CI 0.07-0.72, p = 0.005). DISCUSSION: Following video-assisted thoracoscopic lung resection, continuous erector spinae plane block provides non-inferior postoperative analgesia compared with conventional opioid-based regimen whilst enhancing recovery quality significantly and reducing complications. After a certain type of lung surgery done with a camera (called video‐assisted thoracoscopic surgery), patients often have a lot of pain. We wanted to see if using a special type of pain relief, called a ‘continuous erector spinae plane nerve block,’ worked just as well as regular strong oral pain medicine. We split the patients into two groups. One group got the special block, which slowly sent pain medicine (a numbing drug called ropivacaine) through a small tube into their back, with extra doses every few hours for one day. The other group got regular strong pain medicine (sufentanil, an opioid) through a drip for two days. We measured how much pain they felt when they coughed and how well the pain medicine worked over the first two days. The new pain relief method (the block) worked just as well as the regular pain medicine for helping with pain. But the patients who got the block felt better overall: they recovered better; had fewer problems after surgery; and felt less sick. They also had less nausea; less vomiting; and less dizziness. The special pain block helped patients just as much with pain as regular opioids did, but also helped them feel better, heal faster, and have fewer side effects. It may be a better choice for people having this type of lung surgery.
2. Efficacy and Safety of Ciprofol Alone versus Ciprofol with Fentanyl for Upper Gastrointestinal Endoscopy: A Randomized, Double-Blind, Controlled Trial.
In a double-blind RCT of 344 adults undergoing upper GI endoscopy, ciprofol alone was non-inferior to ciprofol plus fentanyl for sedation success. Ciprofol alone reduced respiratory depression and improved hemodynamic stability but increased intraoperative coughing, slightly prolonged induction/recovery, and raised postoperative dizziness.
Impact: Supports an opioid-free sedation strategy with ciprofol, potentially reducing opioid-related adverse events while maintaining procedural success.
Clinical Implications: For low-risk upper GI endoscopy, ciprofol without opioids may be preferred to improve respiratory and hemodynamic safety, with preparedness to manage increased coughing and mild dizziness.
Key Findings
- Sedation success: 99.4% (ciprofol-alone) vs 100% (ciprofol+fentanyl); met non-inferiority.
- Lower respiratory depression and better hemodynamic stability with ciprofol alone.
- Trade-offs: higher intraoperative coughing (18.1% vs 2.9%, P=0.01), slightly longer induction/recovery, more postoperative dizziness (15.2% vs 7%, P=0.03).
Methodological Strengths
- Randomized double-blind design with clear non-inferiority framework.
- Adequate sample size and standardized dosing with objective primary endpoint.
Limitations
- Single-center setting may limit generalizability to higher-risk populations or different endoscopy practices.
- ASA I–II only; outcomes beyond immediate peri-procedural period not assessed.
Future Directions: Evaluate ciprofol-only protocols in higher-risk cohorts, different procedural types, and with airway reflex management strategies to mitigate coughing.
BACKGROUND: Ciprofol is increasingly used in surgical procedures, and anesthesiologists have observed that it provides deeper sedation compared to propofol. However, it remains unclear whether the use of ciprofol alone, without combining opioids, is sufficient for upper gastrointestinal endoscopy. This study aims to address this question. OBJECTIVE: To determine whether ciprofol alone is non-inferior to ciprofol combined with fentanyl regarding sedation success and safety. METHODS: In this randomized, double-blind trial, 344 adult patients (ASA I-II, aged 18-70 years) undergoing elective upper gastrointestinal endoscopy were randomized to receive either ciprofol with saline (CS group) or ciprofol with fentanyl (CF group). Participants in both groups received an initial ciprofol dose of (0.4 mg/kg). The CF group received (1 µg/kg) intravenously before ciprofol administration, while the CS group received an equivalent volume of saline. Additional ciprofol doses (0.15-0.30 mg/kg) were administered as needed. The primary outcome was sedation success, defined as procedure completion with no more than two additional ciprofol doses within any 5-minute interval. Secondary outcomes included the incidence of hypotension and hypoxemia, as well as adverse events. RESULTS: Sedation success rates were 99.4% for CS and 100% for CF, demonstrating non-inferiority (difference: -0.6%, 95% CI: -0.02, 0.01). The CS group had lower respiratory depression rates and better hemodynamic stability but higher intraoperative coughing (18.1% vs 2.9%, P=0.01). Induction and recovery times were slightly longer in the CS group, and postoperative dizziness was more common (15.2% vs 7%, P=0.03). CONCLUSION: Ciprofol alone is non-inferior to ciprofol with fentanyl for sedation in upper gastrointestinal endoscopy and offers advantages in respiratory and hemodynamic stability. However, it is associated with increased coughing, minor delays in induction and recovery, and more postoperative dizziness.
3. A Comparative Evaluation of the Safety and Efficacy of Oliceridine and Sufentanil in Gastrointestinal Endoscopy: A Single-Center, Randomized Controlled Trial.
In a single-center RCT (n≈612 analyzed) of GI endoscopy sedation with remimazolam–etomidate, oliceridine reduced respiratory depression versus sufentanil (14.1% vs 21.8%; OR 0.59, 95% CI 0.39–0.90), with near-100% sedation success in both arms. Safety and patient satisfaction favored oliceridine.
Impact: Demonstrates a safety advantage of a biased μ-opioid agonist over a traditional opioid within a commonly used sedative backbone, addressing a key risk (respiratory depression) in endoscopy sedation.
Clinical Implications: When using remimazolam–etomidate for GI endoscopy, oliceridine may be preferred over sufentanil to mitigate respiratory depression without sacrificing sedation success.
Key Findings
- Lower respiratory depression with oliceridine vs sufentanil: 14.1% vs 21.8% (OR 0.59; 95% CI 0.39–0.90).
- Sedation success approached 100% in both groups.
- Secondary outcomes (hypoxemia, airway intervention, satisfaction) favored oliceridine per authors’ conclusion.
Methodological Strengths
- Randomized controlled design with a prespecified safety primary endpoint.
- Large sample size for a single-center procedural sedation study.
Limitations
- Blinding status not reported; single-center limits external validity.
- Combination with remimazolam–etomidate may limit generalizability to other sedation backbones.
Future Directions: Confirm findings in multicenter, blinded RCTs and evaluate dosing strategies across diverse patient risk profiles and alternative sedative combinations.
PURPOSE: Gastrointestinal (GI) endoscopic sedation employs a range of medication regimens; however, safer and more effective sedation protocols must be identified. Oliceridine, a novel biased µ-opioid receptor agonist, can reduce opioid-related adverse events. However, compared to traditional opioids, data on its use in GI endoscopic sedation remain limited. PATIENTS AND METHODS: This single-center, randomized controlled clinical trial was conducted between April and July 2024. In total, 628 patients scheduled for GI endoscopy were randomly assigned to receive either remimazolam-etomidate-oliceridine or remimazolam-etomidate-sufentanil for sedation. The primary outcome was the incidence of respiratory depression, and the secondary outcomes included the incidence of hypoxemia, need for airway intervention, procedure- and sedation-related metrics, sedation success rate, and adverse events. RESULTS: Among the 628 patients, 305 and 307 were randomized in the oliceridine and sufentanil groups, respectively, and completed the trial. Respiratory depression occurred in 43 patients (14.1%) in the oliceridine group compared to 67 patients (21.8%) in the sufentanil group (odds ratio, 0.59; 95% CI, 0.39-0.90; CONCLUSION: The sedation success rate for GI endoscopy using remimazolam and etomidate in combination with either oliceridine or sufentanil approaches 100%, with oliceridine demonstrating superior safety and enhanced patient satisfaction.