Daily Anesthesiology Research Analysis
Top anesthesiology-relevant papers today include: a double-blind RCT showing oliceridine improves 24-hour recovery and reduces respiratory depression and PONV versus sufentanil in hysteroscopic surgery; a PROSPERO-registered meta-analysis suggesting prothrombin complex concentrate (PCC), especially within viscoelastic testing algorithms, can reduce red cell transfusion without clear safety signals versus plasma in liver transplantation; and a pediatric RCT indicating the anterior quadratus lumbo
Summary
Top anesthesiology-relevant papers today include: a double-blind RCT showing oliceridine improves 24-hour recovery and reduces respiratory depression and PONV versus sufentanil in hysteroscopic surgery; a PROSPERO-registered meta-analysis suggesting prothrombin complex concentrate (PCC), especially within viscoelastic testing algorithms, can reduce red cell transfusion without clear safety signals versus plasma in liver transplantation; and a pediatric RCT indicating the anterior quadratus lumborum block yields superior analgesia versus lateral/posterior approaches.
Research Themes
- Opioid-sparing and recovery-focused perioperative analgesia
- Coagulation management and viscoelastic-guided transfusion in transplantation
- Optimization of pediatric regional anesthesia techniques
Selected Articles
1. A comparison of the effects of oliceridine and sufentanil on the quality of recovery after hysteroscopic surgery: a prospective double-blind randomized controlled trial.
In a double-blind RCT of hysteroscopic surgery, oliceridine improved 24-hour QoR-15 scores by 6.5 points versus sufentanil and reduced respiratory depression and nausea/vomiting. Hemodynamic and respiratory fluctuations were attenuated with oliceridine, without differences in sedation onset, propofol dose, or emergence time.
Impact: Demonstrates a clinically meaningful improvement in patient-centered recovery and safety with a G protein–biased opioid, potentially informing perioperative opioid selection.
Clinical Implications: Oliceridine may be preferred over sufentanil for short gynecologic procedures to enhance early recovery and reduce respiratory and emetic adverse events.
Key Findings
- QoR-15 at 24 h was higher with oliceridine vs sufentanil (123 vs 116.5; difference 6.5; P<0.001).
- Lower incidence of respiratory depression and nausea/vomiting with oliceridine.
- Less intraoperative heart/respiratory rate impact; no differences in sedation onset, total propofol dose, or emergence.
Methodological Strengths
- Prospective, double-blind, randomized controlled design with active comparator.
- Use of validated patient-centered primary endpoint (QoR-15) at a predefined time point.
Limitations
- Single procedure type and modest sample size may limit generalizability.
- Short-term follow-up focused on early recovery without longer-term outcomes.
Future Directions: Evaluate oliceridine across diverse surgeries, higher-risk populations, and include longer-term outcomes and cost-effectiveness.
PURPOSE: Oliceridine is a G protein-biased μ-opioid receptor agonist that selectively activates G protein signaling while significantly reducing β-arrestin pathway recruitment. Clinical data indicate that this unique signaling bias may help mitigate common adverse effects associated with traditional opioids. The objective of this study was to compare the effects of oliceridine and sufentanil on postoperative recovery quality in patients undergoing hysteroscopic surgery. METHODS: In this prospective, double-blind, randomized controlled trial, 108 patients undergoing hysteroscopic surgery were enrolled and randomly assigned to either the oliceridine group (Group O) or the sufentanil group (Group S). The primary outcome was the 15-item Quality of Recovery Scale (QoR-15) score assessed at 24 h post-operatively. RESULTS: One hundred one patients were included in the analysis (Group O: n = 51; Group S: n = 50). At 24 h post-operatively, Group O had significantly higher total QoR-15 scores than Group S did (123 [IQR 120-125] vs. 116.5 [IQR 114-118]; difference = 6.5, P < 0.001). Group O also scored higher on specific QoR-15 domains: enjoyment of food, general well-being, and nausea or vomiting. Adverse events were less common in Group O, which had significantly lower rates of respiratory depression and nausea/vomiting. Intraoperative monitoring revealed less pronounced effects on heart and respiratory rates in Group O vs. Group S. No statistically significant differences were observed in sedation onset time, total propofol dose, or emergence time. CONCLUSION: When compared with sufentanil, oliceridine significantly enhanced early postoperative recovery quality in patients undergoing hysteroscopic surgery while reducing the incidence of respiratory depression and nausea/vomiting.
2. Use of prothrombin complex concentrates in liver transplantation: a systematic review and meta-analysis.
Across retrospective cohorts in liver transplantation, PCC use showed similar efficacy and safety to plasma. When embedded in viscoelastic testing–guided algorithms, PCC was associated with lower odds of any RBC transfusion versus usual care (OR 0.53, 95% CI 0.32–0.86).
Impact: Synthesizes current PCC evidence in liver transplantation and highlights the potential of viscoelastic-guided PCC strategies to reduce transfusion exposure.
Clinical Implications: Centers may consider viscoelastic-guided coagulation algorithms incorporating PCC to minimize RBC transfusion, while awaiting RCTs directly comparing PCC with plasma.
Key Findings
- All included studies were retrospective; patients receiving PCC often had worse preoperative coagulopathy and comorbidities.
- Mean units of RBCs, plasma, and platelets transfused were comparable between PCC-exposed and controls.
- Viscoelastic testing–based algorithms using PCC reduced odds of RBC transfusion versus usual care (OR 0.53, 95% CI 0.32–0.86).
Methodological Strengths
- PROSPERO-registered systematic review with comprehensive multi-database search.
- Use of random-effects meta-analytic models and reporting of pooled effect sizes.
Limitations
- All included studies were retrospective with risk of confounding by indication.
- Heterogeneity in PCC dosing, algorithms, and outcome reporting; no RCTs comparing PCC vs plasma.
Future Directions: Conduct adequately powered RCTs comparing PCC versus plasma within standardized viscoelastic-guided algorithms, including thrombotic safety and cost-effectiveness.
BACKGROUND: Liver transplantation (LT) can be a high transfusion procedure. Frozen plasma (FP) is widely used despite mixed efficacy and safety data. Several centres perform LT with no or low volume of FP by using prothrombin complex concentrate (PCC). This systematic review and meta-analysis characterises the existing efficacy and safety data of PCC use in LT. METHODS: This review was registered (PROSPERO CRD#42024561866). MEDLINE, Embase, Cochrane, and ClinicalTrials.gov were searched from inception to 30 May 2024. Studies in adults undergoing LT where PCC exposure was reported in relation to clinical outcomes were included. Random effects models were used to obtain pooled effect estimates. RESULTS: All studies were retrospective, with seven reporting the number of patients receiving PCC [392/1901 (21%)], and one grouping patients receiving different factor concentrates together [576/939 (61%)]. Patients receiving PCC had worse preoperative coagulopathy, model for end-stage liver disease scores, and comorbidities. Patients exposed to PCC had a comparable mean number of red blood cell (RBC), plasma, or platelet units transfused. Use of viscoelastic testing-based algorithms incorporating PCC compared with usual care was associated with reduced odds of RBC exposure (odds ratio [OR]: 0.53, 95% confidence interval [CI]: 0.32-0.86, I CONCLUSIONS: Although there are no randomised trials comparing use of PCC vs FP in LT, their efficacy and safety appear comparable. Higher-quality studies are needed to assess PCC use for coagulopathic bleeding in LT.
3. Comparison of three quadratus lumborum block approaches for pediatric lower abdominal surgeries: a randomized controlled trial.
In 120 children undergoing lower abdominal surgery, the anterior QL block resulted in lower postoperative fentanyl consumption and lower early FLACC pain scores compared with lateral and posterior approaches, with higher parent satisfaction.
Impact: Head-to-head randomized evidence clarifies the optimal QL block approach in children, directly informing technique selection in pediatric regional anesthesia.
Clinical Implications: For pediatric lower abdominal surgery, the anterior QL approach may be preferred to reduce opioid requirements and improve early pain control and caregiver satisfaction.
Key Findings
- Anterior QL block reduced postoperative fentanyl consumption versus lateral (p<0.001) and posterior (p<0.011) approaches.
- Early postoperative FLACC pain scores were significantly lower with the anterior approach.
- Parent satisfaction scores were significantly higher with the anterior approach.
Methodological Strengths
- Randomized, parallel-group design comparing three active techniques.
- Clinically relevant outcomes including opioid consumption, validated pain scores, and satisfaction.
Limitations
- Details on dosing completion and blinding are truncated; assessor blinding is unclear.
- Follow-up limited to early postoperative period; no adverse event profile reported in detail.
Future Directions: Replicate findings with blinded assessors, standardized dosing, and extended safety monitoring, including dermatomal spread and motor block.
BACKGROUND: Lower abdominal surgeries in the pediatric population are associated with significant post-operative pain. Regional anesthesia techniques including ilioinguinal nerve block, Transversus Abdominis Plane (TAP) block, and Quadratus Lumborum (QL) block have been explored for lower abdominal surgeries. This study compares the analgesic effect of three different approaches to quadratus lumborum block in pediatric patients undergoing lower abdominal surgeries. METHODS: This randomized controlled trial included 120 pediatric patients aged between 1 and 7 years, scheduled for lower abdominal surgery under general anesthesia. Patients were randomized into 3 groups. Patients of Group A received QL block via anterior approach, Group L received QL block via lateral approach, and Group P received QL block via posterior approach. A volume of 0.5 mL.kg RESULTS: Postoperative mean fentanyl consumption was significantly lower in Group A as compared to Group L (p < 0.001) and Group P (p < 0.011). Postoperative median FLACC scores were significantly lower (p < 0.05) in Group A in comparison to Group L and Group P in the early postoperative period. The parent satisfaction score was significantly higher (p < 0.05) in Group A. CONCLUSION: Anterior approach to QL block reduces postoperative analgesic consumption and provides longer duration analgesia with better parental satisfaction scores in comparison to lateral and posterior approaches in pediatric patients undergoing lower abdominal surgeries.