Daily Anesthesiology Research Analysis

BACKGROUND: Transcranial electrical stimulation has yielded positive results for relieving pain in patients with chronic pain (CP), but the existing evidence is insufficient. In order to address some gaps in the literature, we conducted a randomized, double blind, sham-controlled clinical trial aimed at evaluating the feasibility and efficacy of home-based neurostimulation in a sample of 120 patients. METHODS: The patients completed 15 self-administered home-based sessions of either transcranial direct current stimulation (tDCS, n = 48), transcranial alternate current stimulation (tACS, n = 48), or sham stimulation (n = 24). The primary outcome variable, i.e., pain intensity, and related variables were assessed online (using numerical rating scales from 0 to 10) throughout 45 days (pre-treatment, treatment, and post-treatment periods each of 15 days). RESULTS: ANOVA (classical and Bayesian frameworks) and time series analysis consistently showed that both tDCS and tACS decreased the patients' daily reported pain intensity (tDCS: tau = -0.553; p < 0.001; tACS: tau = -0.563; p < 0.001), pain unpleasantness (tDCS: tau = -0.489; p < 0.001; tACS: tau = -0.537; p < 0.001), interference due to pain (tDCS: tau = -0.368; p < 0.001; tACS: tau = -0.424; p < 0.001), and other symptoms such as fatigue (tDCS: tau = -0.255; p = 0.02; tACS: tau = -0.556; p < 0.001) and stress/anxiety (tDCS: tau = -0.245; p = 0.02; tACS: tau = -0.685; p < 0.001). No such improvement was observed in the group receiving the sham stimulation. The home-based treatment was associated with low drop-out rates (6.66%) and moderate satisfaction with the procedure (around 5 out of 10 in all groups), and minimal adverse effects of transcranial electrical stimulation were reported. CONCLUSIONS: tDCS and tACS significantly reduced daily-reported pain in chronic pain patients. Home-based intervention could significantly reduce the high economic burden associated with chronic pain management in healthcare systems. Inclusion of daily reports assessed by time series analysis can improve clinical trials in the field of chronic pain. STUDY REGISTRATION: ClinicalTrials.gov ID number: NCT05099406 (https://clinicaltrials.gov/study/NCT05099406?term=NCT05099406%20&rank=1).

BACKGROUND: Chronic postsurgical pain (CPSP) is one of the most common surgery-related complications and significantly impacts patient' quality of life. However, studies exploring the underlying genetics of postsurgical pain remain limited. METHODS: This study was based on 17 025 individuals from the China Surgery and Anaesthesia Cohort. We used the Brief Pain Inventory to measure pain intensity prospectively after surgery. CPSP was defined as a dichotomous (yes, no) or continuous (based on pain intensity) variable across surgeries (abdomen, thorax, head and neck, limbs and superficial body regions and other body areas) at 3 months, and persistent pain at various postsurgical follow-up assessments. Genome-wide association analyses were conducted in 9022 individuals with genotyping data. RESULTS: We identified 16 independent genome-wide significant loci associated with CPSP. Multiple approaches, including gene mapping, annotation, and multiomics colocalisation, prioritised several potential risk genes, such as ASTN1, RSU1, and C1QL3, involved in neuronal migration, extracellular signal-regulated kinase/mitogen-activated protein kinase signalling, and synaptic function. The single nucleotide polymorphism-based narrow-sense heritability was estimated to be 13.7% (5.1-22.4%) for CPSP defined as a continuous variable. The polygenic risk scores of post-traumatic stress disorder, pain all over the body, multisite chronic pain, and opioid dependence were associated with CPSP at a nominal significance level. CONCLUSIONS: This study enhances our understanding of the genetic predisposition to chronic postsurgical pain. CLINICAL TRIAL REGISTRATION: Chinese Clinical Trial Registry (ChiCTR2000034039).

BACKGROUND: The relationship between myocardial injury after cardiac surgery (MICS), ischemia on electrocardiogram (ECG), and mortality is uncertain. In this study we aimed to determine whether potential ischemic ECG changes after cardiac surgery are associated with 30-day mortality. METHODS: In a cohort of adults who underwent cardiac surgery, experts interpreted ECGs preoperatively; on postoperative days 0, 1, 2, and 3; and on the last day before discharge (59,539 total ECGs reviewed) for new potential ischemic ECG changes. RESULTS: Among 12,594 patients, 9097 (72.2%) had potential ischemic ECG changes; 259 (2.1%) died within 30 days after surgery. Among patients with troponin elevation meeting MICS criteria, in models adjusting for EuroSCORE II, the hazard ratio (HR) for 30-day mortality was 0.57 (95% confidence interval [CI] 0.35-0.94, P = 0.03) for new Q waves, 2.17 (95% CI 1.14-4.13, P = 0.02) for ST depression ≥ 2 mm, and 0.58 (95% CI 0.39-0.87, P = 0.007) for T-wave inversion 1-1.9 mm. ST elevation was not significantly associated with 30-day mortality. The only ECG change for which coronary artery bypass grafting (CABG) was an effect modifier was new left bundle branch block (LBBB), with an HR of 2.78 (95% CI 1.69-4.60, P = 0.0001) with CABG and an HR of 1.10 (95% CI 0.54-2.21, P = 0.27) without CABG (P value for interaction = 0.03). CONCLUSIONS: After cardiac surgery, potential ischemic ECG changes are common and have divergent associations with mortality. ST depression was associated with a higher risk of death, whereas new Q waves and T-wave inversions were associated with a lower risk of death. A new LBBB was associated with a higher risk of death only among patients who underwent CABG. Potential ischemic ECG changes are common after cardiac surgery and lack specificity for the diagnosis of myocardial infarction.