Daily Anesthesiology Research Analysis
Three perioperative studies stand out today: a rigorous BJA systematic review/meta-analysis standardizes how to measure and report adherence to prehabilitation, a comprehensive BJA systematic review links perioperative autonomic imbalance to major postoperative complications and potential modulatory strategies, and a mixed retrospective–prospective study shows afternoon cesarean sections are associated with higher postoperative pain and analgesic requirements with biomarker correlates.
Summary
Three perioperative studies stand out today: a rigorous BJA systematic review/meta-analysis standardizes how to measure and report adherence to prehabilitation, a comprehensive BJA systematic review links perioperative autonomic imbalance to major postoperative complications and potential modulatory strategies, and a mixed retrospective–prospective study shows afternoon cesarean sections are associated with higher postoperative pain and analgesic requirements with biomarker correlates.
Research Themes
- Standardizing adherence metrics in perioperative prehabilitation
- Autonomic nervous system modulation to reduce postoperative complications
- Chronobiology influences on postoperative pain after cesarean section
Selected Articles
1. Adherence to prehabilitation in adult surgical patients: a systematic review, meta-analysis, meta-regression, and qualitative synthesis.
Across 105 randomized trials (n=4941), pooled adherence to prehabilitation was 79%, but adherence metrics varied widely. Meta-regression found little credible evidence for predictors of adherence, while qualitative synthesis identified practical barriers and facilitators. The authors call for standardization of adherence definitions and reporting to strengthen evidence synthesis and implementation.
Impact: This work provides the most comprehensive synthesis to date of prehabilitation adherence, quantifying performance and exposing critical measurement heterogeneity that limits translation.
Clinical Implications: Use standardized, transparent adherence metrics in prehabilitation programs; address identified barriers (e.g., access, motivation, complexity) and leverage facilitators to improve uptake. Reporting adherence consistently will enable benchmarking and more reliable effectiveness estimates.
Key Findings
- Pooled prehabilitation adherence across 105 trials (n=4941) was 79% (95% CI 70–88).
- Adherence measurement and reporting were highly variable across studies, limiting comparability.
- Meta-regression found little credible evidence for predictors of adherence; qualitative synthesis mapped barriers and facilitators using the Theoretical Domains Framework.
Methodological Strengths
- Comprehensive multi-database search with predefined protocol (PROSPERO CRD42024518851).
- Random-effects meta-analysis, meta-regression, and qualitative synthesis using a theoretical framework.
Limitations
- Heterogeneity in adherence definitions and metrics across trials.
- Potential reporting biases and limited ability to identify robust predictors of adherence.
Future Directions: Develop consensus adherence definitions and core outcome sets; incorporate implementation science endpoints; evaluate digital/telehealth strategies to enhance adherence.
2. Effect of perioperative autonomic nervous system imbalance on surgical outcomes: a systematic review.
This systematic review synthesizes mechanistic and clinical evidence that perioperative sympathetic–parasympathetic imbalance contributes to inflammation, cardiovascular instability, immunosuppression, neurocognitive decline, and possibly cancer recurrence. It outlines pharmacologic (e.g., dexmedetomidine, beta-blockers) and non-pharmacologic (e.g., temperature control, electroacupuncture) strategies that may restore autonomic balance.
Impact: It reframes perioperative risk through the lens of autonomic dysregulation and maps actionable targets for modulation, with potential to reduce common and serious postoperative complications.
Clinical Implications: Consider integrating ANS-aware strategies (dexmedetomidine, judicious β-blockade, normothermia, analgesia minimizing sympathetic surges, and selected non-pharmacologic approaches) into ERAS pathways; monitor for dysautonomia in high-risk patients.
Key Findings
- Perioperative ANS imbalance drives stress responses, cardiovascular instability, impaired repair, and immunosuppression, increasing infection, neurocognitive decline, and organ dysfunction.
- Low parasympathetic tone weakens the cholinergic anti-inflammatory pathway; sympathetic hyperactivity elevates catecholamines and pro-inflammatory cytokines.
- Multiple pharmacologic (dexmedetomidine, β-blockers) and non-pharmacologic (electroacupuncture, temperature management) strategies may help restore autonomic balance.
Methodological Strengths
- Comprehensive synthesis across basic and clinical studies.
- Actionable mapping of therapeutic strategies linked to mechanistic pathways.
Limitations
- Heterogeneous evidence base without unified quantitative effect estimates.
- Potential publication bias and limited RCT data for some proposed interventions.
Future Directions: Prospective trials testing ANS-modulating bundles within ERAS; standardized perioperative dysautonomia metrics; integration of autonomic monitoring into risk stratification.
3. Effects of daytime variation on pain intensity and analgesic requirement after cesarean section: a retrospective and prospective study.
Afternoon cesarean sections were associated with higher 24-hour postoperative pain (NRS AUC) and analgesic consumption than morning procedures. Prospective biomarker and psychophysical testing suggested lower postoperative pressure pain tolerance and increased endorphin and IL-6 responses after afternoon CS.
Impact: Identifying a circadian effect on post-cesarean pain with biologic correlates provides a rationale for time-tailored analgesia and staffing in obstetric anesthesia.
Clinical Implications: Consider proactive multimodal analgesia (e.g., neuraxial adjuncts, scheduled non-opioids, regional blocks) and monitoring for patients undergoing afternoon CS; incorporate chronobiology into obstetric anesthesia planning.
Key Findings
- Afternoon CS was associated with higher 24-hour analgesic requirements compared to morning CS.
- Pain NRS AUC and total analgesic consumption over 24 hours were higher after afternoon CS.
- Postoperative pressure pain tolerance decreased and serum endorphin and IL-6 increased after afternoon CS, but not after morning CS.
Methodological Strengths
- Combined retrospective cohort with prospective psychophysical and biomarker assessments.
- Registered protocol (ChiCTR2000039720) and objective endpoints (IL-6, endorphin, pain tolerance).
Limitations
- Single-center study with potential confounding by case-mix and workflow.
- Details on sample size and analgesic protocols are limited in the abstract; not randomized.
Future Directions: Conduct multicenter randomized or time-blocked trials testing time-tailored analgesic strategies and exploring mechanistic circadian pathways.