Daily Anesthesiology Research Analysis
Top perioperative anesthesia research today centers on optimizing regional blocks, pediatric premedication, and local anesthetic formulation choices. A large meta-analysis finds erector spinae plane block (ESPB) outperforms quadratus lumborum block (QLB), a pediatric RCT shows intranasal esketamine reduces sevoflurane needs and emergence delirium, and a thoracic surgery RCT reports only limited benefits of liposomal bupivacaine over plain bupivacaine for paravertebral blockade.
Summary
Top perioperative anesthesia research today centers on optimizing regional blocks, pediatric premedication, and local anesthetic formulation choices. A large meta-analysis finds erector spinae plane block (ESPB) outperforms quadratus lumborum block (QLB), a pediatric RCT shows intranasal esketamine reduces sevoflurane needs and emergence delirium, and a thoracic surgery RCT reports only limited benefits of liposomal bupivacaine over plain bupivacaine for paravertebral blockade.
Research Themes
- Regional anesthesia block selection (ESPB vs QLB)
- Pediatric premedication with intranasal esketamine
- Value of liposomal bupivacaine in paravertebral block
Selected Articles
1. Comparison of the analgesic effects of ultrasound-guided erector spinae plane block and quadratus lumborum block: a systematic review and meta-analysis.
This PROSPERO-registered meta-analysis of 27 RCTs (n=1,942) found ESPB provides superior postoperative analgesia to QLB across surgeries, with lower 24-hour analgesic consumption, faster block performance, and reduced PONV. Evidence quality was appraised with GRADE and supported by subgroup and sensitivity analyses.
Impact: Directly informs block selection for perioperative analgesia by synthesizing randomized evidence with GRADE appraisal. Likely to influence ERAS pathways and regional anesthesia practice.
Clinical Implications: Consider ESPB as the preferred truncal block over QLB for postoperative analgesia, anticipating less opioid use, faster placement, and lower PONV. Tailor by surgery type and patient factors while maintaining ultrasound-guided best practices.
Key Findings
- Across 27 RCTs (n=1,942), ESPB reduced 24-hour postoperative analgesic consumption versus QLB (WMD −4.03; 95% CI −6.25 to −1.82).
- ESPB had faster block performance times than QLB.
- ESPB was associated with a lower incidence of postoperative nausea and vomiting compared with QLB.
- GRADE assessment indicated moderate-to-high quality evidence; subgroup and sensitivity analyses supported robustness.
Methodological Strengths
- PROSPERO-registered protocol and comprehensive multi-database search
- Use of GRADE with subgroup and sensitivity analyses to assess robustness
Limitations
- Heterogeneity across surgical procedures and analgesic regimens
- Potential publication bias and variability in opioid conversion metrics
Future Directions: Head-to-head, surgery-specific RCTs with standardized outcome definitions and cost-effectiveness analyses to refine block selection algorithms.
2. Intranasal Esketamine Premedication Reduces Sevoflurane Requirements During Laryngeal Mask Airway Insertion in Pediatric Patients: A Randomized Controlled Trial.
In a double-blind RCT of 90 children (2–5 years), intranasal esketamine reduced sevoflurane MAC for LMA insertion in a dose-dependent manner (−13.4% with 0.5 mg/kg; −30.6% with 1.0 mg/kg). The 1.0 mg/kg dose improved induction quality, reduced emergence delirium and negative postoperative behaviors, without prolonging emergence or increasing adverse events.
Impact: Provides high-quality pediatric evidence supporting a practical premedication that reduces volatile exposure and perioperative neurobehavioral complications.
Clinical Implications: Intranasal esketamine 1.0 mg/kg can be considered for premedication to facilitate LMA insertion, reduce volatile anesthetic requirements, and lower emergence delirium risk in preschool children undergoing brief procedures.
Key Findings
- Sevoflurane MAC for LMA insertion decreased from 2.16% (control) to 1.87% (0.5 mg/kg) and 1.50% (1.0 mg/kg), indicating a dose-dependent effect.
- Esketamine 1.0 mg/kg improved induction quality and reduced emergence delirium (13.8% vs 46.4%) and negative behavioral changes at day 3.
- Emergence time and adverse events were similar across groups, suggesting maintained safety.
Methodological Strengths
- Randomized, double-blind, placebo-controlled design with three arms
- Use of Dixon’s up-and-down method to estimate MAC and assessment of neurobehavioral outcomes
Limitations
- Single-center study focused on strabismus surgery; generalizability to other procedures is uncertain
- Short follow-up limited to early postoperative period and day-3 behavior
Future Directions: Multicenter trials across varied pediatric surgeries, comparisons with alternative premedications, and longer-term neurodevelopmental follow-up.
3. Thoracic Paravertebral Block with Liposomal Bupivacaine Versus Plain Bupivacaine in Patients Undergoing Thoracoscopic Lung Resection: A Randomized Controlled Study.
In 114 VATS patients randomized to thoracic paravertebral block with liposomal versus plain bupivacaine, 48-hour opioid consumption (primary endpoint) was unchanged. Liposomal bupivacaine modestly improved 24-hour QoR-15, prolonged time to first analgesia, and reduced cumulative rest pain, without differences in cough pain or 3-month CPSP.
Impact: Provides comparative RCT evidence questioning routine use of costly liposomal bupivacaine for paravertebral block in thoracic surgery by showing limited clinical gains without opioid-sparing.
Clinical Implications: Routine substitution of plain bupivacaine with liposomal bupivacaine for TPVB in VATS may not be justified solely for opioid reduction. Consider LB selectively for early recovery metrics if cost and availability permit.
Key Findings
- 48-hour postoperative opioid consumption did not differ between liposomal and plain bupivacaine groups (primary endpoint).
- LB increased QoR-15 at 24 hours (120.2 vs 116.5) and prolonged time to first analgesia (≈586 vs 315 minutes).
- LB reduced the AUC of rest NRS pain; cough pain and 3-month CPSP rates were similar between groups.
Methodological Strengths
- Randomized controlled design with clearly defined primary and secondary endpoints
- Standardized TPVB levels and comprehensive pain/recovery assessments including QoR-15
Limitations
- Single-trial context without explicit cost-effectiveness analysis
- Potential differences in pharmacokinetics and dosing equivalence between formulations
Future Directions: Cost-effectiveness trials and head-to-head comparisons within multimodal ERAS pathways to identify subgroups benefitting from liposomal formulations.