Daily Anesthesiology Research Analysis
Analyzed 61 papers and selected 3 impactful papers.
Summary
Analyzed 61 papers and selected 3 impactful articles.
Selected Articles
1. Phase 1 single-centre, placebo and levobupivacaine controlled study in healthy volunteers to assess the safety, tolerability, efficacy, and pharmacokinetics of LL10, a novel long-acting local anaesthetic.
In this first-in-human, controlled, dose-escalation study across three block types, LL10 significantly prolonged femoral nerve block duration versus levobupivacaine with no severe adverse events and linear pharmacokinetics. Dose-dependent, self-limited systemic symptoms occurred after TAP block at higher doses/volumes.
Impact: This introduces a novel long-acting local anesthetic that extends single-injection peripheral nerve block duration, potentially reducing catheters and opioid use. Published in a leading anesthesiology journal, it provides foundational human safety/PK data for subsequent clinical trials.
Clinical Implications: If efficacy and safety are confirmed in surgical patients, LL10 could enable longer-lasting single-shot blocks, reducing the need for catheters and postoperative opioids. Careful dose selection is warranted for TAP blocks where dose-dependent systemic symptoms were observed.
Key Findings
- LL10 (QX-OH 1.26% + levobupivacaine 0.325%) prolonged femoral nerve block duration versus levobupivacaine alone (median 25.0 h vs 15.5 h; P=0.021).
- No severe adverse events among 137 healthy volunteers; dose-dependent transient systemic symptoms occurred after TAP block at higher doses/volumes.
- LL10 demonstrated linear pharmacokinetics across cohorts and was tolerated up to 40 mL.
Methodological Strengths
- First-in-human, controlled, dose-escalation design across multiple block types with active and placebo controls
- Comprehensive safety, efficacy (sensory/motor testing), and pharmacokinetic assessments
Limitations
- Healthy volunteer setting limits generalizability to surgical patients and real-world analgesic outcomes
- Not designed or powered to detect rare adverse events; randomization and blinding procedures are not detailed
Future Directions: Conduct randomized surgical trials comparing LL10 to standard long-acting local anesthetics on pain, opioid use, and functional recovery; further characterize dose–response and safety in different fascial plane blocks.
2. The effect of remimazolam versus conventional anesthesia on postoperative delirium in frail patients: a prospective, controlled cohort study.
In 606 frail elderly undergoing non-cardiac surgery, remimazolam-based anesthesia was associated with a lower incidence of postoperative delirium compared with conventional general anesthesia. Anesthetic choice emerges as a modifiable strategy for neuroprotection in high-risk older adults.
Impact: Addresses a major geriatric complication with limited preventive options by testing a widely deployable anesthetic intervention. Findings could inform anesthetic protocols for frail patients.
Clinical Implications: Consider remimazolam as part of general anesthesia for frail older adults to reduce postoperative delirium risk, coupled with standard delirium prevention bundles. Confirmation via randomized trials is warranted.
Key Findings
- Prospective controlled cohort of 606 frail elderly (Clinical Frailty Scale ≥5) undergoing elective non-cardiac surgery.
- Remimazolam-based anesthesia was associated with a lower incidence of postoperative delirium than conventional anesthesia.
- Identifies anesthetic selection as a modifiable factor for delirium mitigation in high-risk patients.
Methodological Strengths
- Prospective design with a clearly defined frail population (CFS ≥5)
- Real-world comparison of anesthetic strategies in a sizable cohort
Limitations
- Nonrandomized design susceptible to residual confounding and selection bias
- Abstract lacks detailed group allocation and effect size estimates
Future Directions: Randomized controlled trials comparing remimazolam with standard agents on delirium incidence, cognitive recovery, and safety in frail older adults; mechanistic studies on GABAergic profiles and neuroinflammation.
3. Utilization and opioid outcomes of a transitional pain service in high-risk surgical veterans: a cohort study.
In a VA TPS cohort (n=345), only 3.2% were discharged on higher opioid doses, and 68% of preoperative opioid users reduced their dose. Pain catastrophizing was the strongest predictor of higher postoperative opioid use and TPS utilization, with nicotine use and high preoperative opioid doses also contributing.
Impact: Demonstrates that a structured transitional pain service can curb postoperative opioid escalation in a high-risk population while identifying actionable psychosocial predictors to target resources.
Clinical Implications: Preoperative psychosocial screening (e.g., catastrophizing, nicotine use) should inform risk stratification and TPS resource allocation. Implementing TPS can achieve opioid dose reductions even in complex surgical patients.
Key Findings
- Among 345 TPS-managed surgical patients, only 3.2% were discharged on higher opioid doses; 68% of preoperative opioid users reduced their dose.
- Pain catastrophizing independently predicted higher postoperative opioid use (+31 MME per point), longer TPS duration (+3.9 days per point), and more provider contacts.
- Active nicotine use and preoperative opioid ≥50 MME/day predicted higher postoperative opioid consumption.
Methodological Strengths
- Well-characterized cohort with multivariable analysis controlling for key psychosocial and clinical predictors
- Clinically meaningful outcomes (dose reduction, discharge dosing) with operational metrics (TPS duration, contacts)
Limitations
- Single-center retrospective design with potential residual confounding
- Generalizability may be limited to VA/high-risk populations
Future Directions: Prospective, multi-center evaluations of TPS effectiveness and cost-effectiveness; trials integrating targeted psychological interventions for high-catastrophizing patients.