Daily Anesthesiology Research Analysis

STUDY OBJECTIVE: To compare recovery quality after PCNL using ESPB, TPVB, and placebo. DESIGN: Randomized, double-blind, placebo-controlled trial. SETTING: Sanming First Hospital affiliated to Fujian Medical University in China. PATIENTS: 120 adults with American Society of Anesthesiologists physical status I-II scheduled for elective unilateral PCNL. INTERVENTIONS: Patients were randomized 1:1:1 to receive ESPB, TPVB, or placebo to test ESPB superiority over placebo and non-inferiority to TPVB. MEASUREMENTS: The primary outcome was Quality of Recovery-15 (QoR-15) score at 24 h. We tested ESPB superiority over placebo (8-point clinically important difference) and non-inferiority to TPVB (6-point margin). Secondary outcomes included pain scores, morphine consumption, time to first rescue analgesia, patient satisfaction, and adverse events. MAIN RESULTS: ESPB demonstrated significantly higher QoR-15 scores than placebo (median difference 11.0 points, 95% CI 7.0-14.0, P < 0.001) and met non-inferiority criteria versus TPVB (median difference 1.0 point, 95% CI -5.0 to 2.0). Both blocks reduced pain scores and morphine consumption by approximately 40% compared with placebo (P < 0.001), with no differences between techniques. Time to first rescue analgesia was prolonged with both blocks compared with placebo (P < 0.001). Patient satisfaction was higher with both blocks than with placebo (P < 0.001). No block-related complications occurred; postoperative adverse events were similar across groups. CONCLUSIONS: ESPB significantly improved recovery quality after PCNL, demonstrating superiority to placebo and non-inferiority to TPVB. ESPB represents an effective alternative to TPVB for PCNL analgesia, with comparable efficacy and safety.

BACKGROUND: Peripheral nerve stimulation (PNS) has emerged as a promising neurostimulation modality, yet its effectiveness and durability for chronic pain remain uncertain. We conducted a systematic review and meta-analysis to evaluate changes in pain intensity following implantable PNS therapy. METHODS: Eligible studies included adults (≥18 years) with chronic pain treated with an implantable PNS system, and pain intensity was assessed at baseline and follow-up time points. The primary outcome was change in pain intensity from baseline to 6 months after PNS implantation. Secondary outcomes included changes in pain intensity at 3, 12 and 24 months after PNS implantation. Standardized mean differences (Hedges' RESULTS: A total of 106 studies comprising 9272 patients were included. PNS was associated with large, statistically significant reductions in pain intensity from baseline to all time points: 3 months (Hedges' CONCLUSION: Implantable PNS provides persistent and clinically meaningful analgesia for chronic pain, with benefits sustained up to 24 months. These findings support broader clinical adoption and provide evidence to inform pay0r coverage and policy decisions.

BACKGROUND: Single-injection superficial parasternal intercostal plane (SPIP) blockade provides an effective and low-risk analgesic option for patients undergoing cardiac surgery with sternotomy, but their duration is limited. We sought to evaluate whether continuous SPIP blockade, compared with single-injection SPIP blockade, reduces acute sternal pain on coughing at 24 hours after cardiac surgery. METHODS: We conducted a randomized controlled parallel-arm superiority trial at a tertiary care center in Vancouver, BC, Canada. We included English-speaking adult patients undergoing scheduled cardiac surgery with full median sternotomy. We randomized participants in a 1:1 ratio to intervention or control groups, stratified by sex, using permuted block randomization with variable block sizes of 4 or 6. Patients in both study groups received bilateral SPIP catheters, with a 20 mL bolus of ropivacaine 0.2% through each catheter followed by a 3 mL/hour infusion of study solution (ropivacaine 0.2% in the intervention group and normal saline in the control group) for 48 hours. All patients received standardized multimodal analgesia. The primary outcome was the numeric rating scale (NRS) sternal pain score on standardized coughing at 24 hours. Secondary outcomes included sternal pain within 48 hours, opioid use, quality of recovery, postoperative nausea or vomiting and chronic sternal pain. Patients, healthcare providers, outcome collectors and data analysts were blinded to group allocation. RESULTS: Eighty patients were randomized (n=40 per group). Mean (SD) sternal pain (NRS) scores on coughing at 24 hours were 4.0 (2.2) in the intervention group versus 3.9 (2.2) in the control group. The adjusted mean difference was -0.2 (95% CI -1.7 to 1.3; p=0.79). There were no differences between the groups in secondary outcomes. One patient in the intervention group experienced suspected local anesthetic systemic toxicity requiring unblinding. No other major complications were noted. CONCLUSIONS: Continuous SPIP blockade did not demonstrate superiority over single-injection SPIP blockade in reducing acute sternal pain on coughing at 24 hours after cardiac surgery. TRIAL REGISTRATION NUMBER: NCT05054179.