Daily Anesthesiology Research Analysis
Three high-impact studies in anesthesiology advanced perioperative analgesia and pain medicine. A rigorous RCT shows erector spinae plane block (ESPB) improves recovery versus placebo and is non-inferior to paravertebral block after percutaneous nephrolithotomy; a meta-analysis supports durable analgesia from implantable peripheral nerve stimulation (PNS) up to 24 months; and a placebo-controlled RCT finds continuous parasternal intercostal plane catheters do not outperform single-injection bloc
Summary
Three high-impact studies in anesthesiology advanced perioperative analgesia and pain medicine. A rigorous RCT shows erector spinae plane block (ESPB) improves recovery versus placebo and is non-inferior to paravertebral block after percutaneous nephrolithotomy; a meta-analysis supports durable analgesia from implantable peripheral nerve stimulation (PNS) up to 24 months; and a placebo-controlled RCT finds continuous parasternal intercostal plane catheters do not outperform single-injection blocks after cardiac surgery.
Research Themes
- Regional anesthesia optimization and comparative effectiveness
- Neuromodulation for chronic pain with long-term outcomes
- Value of negative trials in refining perioperative analgesic strategies
Selected Articles
1. Erector spinae plane block versus paravertebral block and placebo for recovery quality after percutaneous nephrolithotomy: A randomized controlled trial.
In 120 adults undergoing unilateral PCNL, ESPB improved 24-hour QoR-15 versus placebo and was non-inferior to thoracic paravertebral block. Both ESPB and TPVB reduced pain and morphine use by about 40% versus placebo without added complications.
Impact: Provides high-quality comparative effectiveness data supporting ESPB as a practical alternative to paravertebral block for PCNL analgesia with patient-centered outcomes.
Clinical Implications: ESPB can be adopted as an alternative to TPVB for PCNL to improve recovery quality and reduce opioid requirements, especially where TPVB expertise or feasibility is limited.
Key Findings
- ESPB improved 24-hour QoR-15 versus placebo (median difference 11 points; P < 0.001).
- ESPB met non-inferiority to TPVB for QoR-15 (median difference 1 point; 95% CI -5 to 2).
- Both ESPB and TPVB lowered pain scores and morphine use by ~40% vs placebo and extended time to first rescue analgesia without added adverse events.
Methodological Strengths
- Randomized, double-blind, placebo-controlled design with predefined superiority and non-inferiority margins
- Clinically meaningful primary outcome (QoR-15) and comprehensive secondary endpoints
Limitations
- Single-center study may limit generalizability
- ASA I–II population; external validity to higher-risk patients uncertain
Future Directions: Multicenter trials including higher-risk cohorts and cost-effectiveness analyses comparing ESPB and TPVB are warranted.
2. Implantable peripheral nerve stimulation for chronic pain: a systematic review and meta-analysis of analgesic outcomes up to 24 months.
Across 106 studies with 9,272 patients, implantable PNS produced large, statistically significant pain reductions sustained through 24 months. Findings support durable analgesia and can inform wider clinical adoption and coverage decisions.
Impact: Synthesizes a large and diverse evidence base showing durable analgesia from implantable PNS, addressing a key gap in long-term outcomes for neuromodulation.
Clinical Implications: Implantable PNS can be considered for refractory chronic pain with expectation of sustained benefit up to two years, supporting shared decision-making and payer policies.
Key Findings
- 106 studies (n=9,272) show significant pain reductions at 3, 6, 12, and 24 months after PNS implantation.
- Effect sizes were large and sustained, indicating durability of analgesia up to 24 months.
- Evidence supports broader clinical adoption and informs payer coverage and policy discussions.
Methodological Strengths
- Comprehensive systematic review and meta-analysis with large aggregated sample size
- Assessment of multiple clinically relevant time points up to 24 months
Limitations
- Heterogeneity in study designs, indications, and outcome measures likely present
- Risk of publication bias and variable quality among included studies
Future Directions: High-quality, condition-specific RCTs with standardized outcomes and head-to-head comparisons versus alternative therapies are needed to refine indications and cost-effectiveness.
3. Analgesic efficacy of continuous superficial parasternal intercostal plane blockade in patients undergoing cardiac surgery with median sternotomy: a randomized controlled trial.
In 80 sternotomy patients, continuous SPIP catheters with ropivacaine infusion did not reduce 24-hour coughing-related sternal pain compared with single-injection SPIP. Secondary outcomes, including opioid use and recovery, were also similar.
Impact: A well-controlled negative trial prevents overuse of catheters and resources when single-injection techniques suffice, refining enhanced recovery pathways.
Clinical Implications: Routine use of continuous SPIP catheters to reduce acute sternal pain after sternotomy is not supported; single-injection SPIP with multimodal analgesia remains appropriate.
Key Findings
- No superiority of continuous SPIP over single-injection SPIP for 24-hour sternal pain on coughing (adjusted mean difference -0.2; p=0.79).
- Secondary outcomes (opioid use, quality of recovery, PONV, chronic sternal pain) showed no significant differences.
- One suspected local anesthetic systemic toxicity occurred; otherwise no major complications.
Methodological Strengths
- Randomized, blinded, placebo-controlled infusion with standardized multimodal analgesia
- Clinically relevant primary endpoint and rigorous allocation concealment
Limitations
- Single-center with modest sample size may limit power for secondary outcomes
- Findings pertain to early postoperative period; long-term benefits not established
Future Directions: Future work should identify patient subgroups that might benefit from continuous techniques and evaluate resource utilization and cost-effectiveness.