Daily Anesthesiology Research Analysis

BACKGROUND: Although chronic pain is highly prevalent among individuals with diabetes, its relationship with the risk of developing chronic kidney disease (CKD) in this population remains poorly understood. The authors aimed to explore the associations between multisite chronic pain and analgesic use with CKD risk in people with diabetes, and to further characterize the underlying metabolic and proteomic signatures. METHODS: The authors analyzed data from 20,208 UK Biobank participants with diabetes and complete chronic pain site information (headache, facial, neck/shoulder, back, stomach/abdominal, hip, knee). Using multivariable Cox regression models, they evaluated the prospective associations between chronic pain (both site specific and multisite), analgesic use (ibuprofen, paracetamol, opioid), and incident CKD risk. Multiomics data (248 metabolites, 2,911 proteins) were integrated to explore biological pathways. RESULTS: During a median follow-up of 13.2 yr, 2,589 incident CKD cases were documented. Chronic pain was associated with an 18% higher CKD risk (adjusted hazard ratio [HR], 1.18; 95% CI, 1.08 to 1.28). Site-specific analysis identified significant associations between CKD risk and pain in neck/shoulder, back, hip, knee, and stomach/abdominal regions, while headache and facial pain showed no significant associations. Multisite pain exhibited a dose-dependent relationship with CKD risk (per additional site: adjusted HR, 1.08; 95% CI, 1.05 to 1.12). Among participants with chronic pain, opioid use showed significant positive associations with CKD risk (adjusted HR, 1.22; 95% CI, 1.06 to 1.40), whereas ibuprofen and paracetamol demonstrated no significant associations. Multiomics secondary analysis identified three consistently dysregulated biomarkers across all five significant pain sites: elevated chromogranin-A, increased glycoprotein acetyls, and reduced omega-3 to total fatty acids ratio. Protein network analysis revealed tumor necrosis factor (TNF) and epidermal growth factor receptor (EGFR) as central nodes in the observed chronic pain-CKD risk associations. CONCLUSIONS: Multisite chronic pain and opioid use are associated with elevated CKD risk in diabetes, supported by metabolomic/proteomic signatures. These findings highlight the need for renal-conscious pain management in diabetes care.

BACKGROUND: Comorbid depressive symptoms are prevalent in patients with breast cancer, which adversely impacts postoperative recovery outcomes. Esketamine has emerged as a promising intervention for perioperative depression due to its rapid and sustained effects. This study aims to investigate the impact of the continuous intravenous infusion of esketamine during the perioperative period on postoperative depressive symptoms in breast cancer patients. METHODS: In this randomized, double-blind, controlled trial, 96 female patients aged 18-65 years undergoing unilateral modified radical mastectomy were enrolled. Participants were randomly assigned to one of two groups. The esketamine group received 0.5 mg/kg and 0.25 mg/kg/h esketamine and the normal saline group received 5 mL and 0.25 mL/kg/h normal saline during anesthesia induction and maintenance, respectively. The primary outcome was the Hamilton Depression Rating Scale (HAMD-17) score on postoperative day 30 (POD-30). Secondary outcomes included HAMD-17 scores on POD 1 and 3; self-Rating Depression Scale (SDS) scores on POD 1, 3, and 30; serum levels of brain-derived neurotrophic factor (BDNF) and serotonin (5-hydroxytryptamine, 5-HT) after surgery; relative changes in heart rate (HR) and mean arterial pressure (MAP) before and after intubation; time to awakening; Visual Analog Scale (VAS) pain scores; and adverse events related to esketamine. RESULTS: The HAMD-17 score on POD-30 was significantly lower in the esketamine group [3.00 (2.08-4.10)] than in the normal saline group [5.00 (4.00-6.20)]. Regarding secondary outcomes, HAMD-17 scores on POD 1 and 3 were significantly lower in the esketamine group. SDS scores on POD 1, 3, and 30 were also significantly lower in the esketamine group. Compared with the saline group, the esketamine group exhibited significantly higher postoperative levels of BDNF and serotonin. Additionally, VAS scores at 30 minutes after extubation were significantly lower in the esketamine group. There was no significant difference in the incidence of adverse reactions between the two groups. CONCLUSION: Perioperative continuous administration of esketamine reduces postoperative depression scores in patients undergoing breast cancer surgery. TRIAL REGISTRATION: Chinese Clinical Trial Registry. Identifier: ChiCTR2200061575.

BACKGROUND: Long-term opioid dependence after critical illness is an emerging concern, yet the incidence and predictors of persistent opioid use among intensive care unit (ICU) survivors remain incompletely characterized. We aimed to estimate the six-month incidence of new persistent opioid use in opioid-naïve ICU survivors and to identify associated risk factors. METHODS: We conducted a retrospective, nationwide cohort study using South Korea's National Health Insurance Service database. Adults admitted to any ICU between January 1, 2020, and December 31, 2022, were included if they survived to hospital discharge and remained alive for at least six months, with no opioid prescription in the 12 months preceding admission. New persistent opioid use was defined as at least one outpatient opioid prescription within 90 days after discharge and at least one additional prescription between 91 and 180 days. We performed multivariable logistic regression to identify independent predictors. RESULTS: Among 567,260 opioid-naïve ICU survivors, 23,945 (4.2%) developed new persistent opioid use within six months. Across the cohort, 22,643 (4.0%) received less-potent opioids (tramadol, dihydrocodeine) and 1,643 (0.3%) received potent opioids (morphine, fentanyl, oxycodone, hydromorphone, methadone). Independent predictors included older age (odds ratio [OR] 1.01 per year; 95% confidence interval [CI], 1.01-1.02; P < 0.001), female sex (OR 1.13; 95% CI, 1.09-1.16; P < 0.001), socioeconomic disadvantage (Medical Aid, OR 1.30; 95% CI, 1.23-1.38; P < 0.001), malignancy (OR 1.05; 95% CI, 1.01-1.09; P = 0.017), metastatic tumor (OR 1.24; 95% CI, 1.15-1.35; P < 0.001), extracorporeal membrane oxygenation (OR 1.80; 95% CI, 1.75-1.89; P < 0.001), and continuous renal replacement therapy (OR 1.24; 95% CI, 1.11-1.37; P < 0.001). The strongest predictor was an early opioid prescription within 30 days of discharge (OR 19.7; 95% CI, 19.1-20.3; P < 0.001). Potency-specific analysis showed potent opioid persistence was largely driven by cancer, while less-potent use was shaped more by demographic and socioeconomic factors. CONCLUSIONS: Approximately one in 25 ICU survivors developed new persistent opioid use by six months. Early post-discharge opioid prescription was the dominant risk factor. Risk profiles differed by opioid potency, underscoring the need for early tapering strategies, multimodal non-opioid analgesia, and stewardship programs tailored to patient subgroups and opioid type.