Daily Anesthesiology Research Analysis
Analyzed 28 papers and selected 3 impactful papers.
Summary
Analyzed 28 papers and selected 3 impactful articles.
Selected Articles
1. Brain sensory network activity underlies reduced nociceptive initiated and nociplastic pain via acupuncture in fibromyalgia.
In a randomized, preregistered trial with neuroimaging, electroacupuncture reduced widespread pain in fibromyalgia via increased primary somatosensory activation and strengthened somatosensory–insula connectivity, consistent with a bottom-up mechanism. Sham reduced pain via decreased precuneus activity and precuneus–insula connectivity, indicating a distinct top-down pathway.
Impact: This trial provides mechanistic evidence differentiating bottom-up sensory modulation by electroacupuncture from top-down effects of sham, advancing understanding of how acupuncture may benefit mixed nociceptive/nociplastic pain.
Clinical Implications: Supports considering electroacupuncture for patients with both nociceptive-initiated and nociplastic pain, and suggests neurobiologically informed patient selection (e.g., sensory hypersensitivity) and outcome measures in future trials.
Key Findings
- Electroacupuncture increased pressure-pain tolerance and reduced widespread pain.
- Mechanistic mediation via increased primary somatosensory cortex activation and strengthened somatosensory–insula connectivity.
- Sham reduced widespread pain via decreased precuneus activity and precuneus–insula connectivity (top-down pathway).
Methodological Strengths
- Randomized controlled design with preregistration (NCT02064296).
- Multimodal assessment including fMRI and mediation analyses linking brain changes to clinical outcomes.
Limitations
- Secondary analysis with small sample size and female-only participants.
- Short intervention period and lack of long-term follow-up.
Future Directions: Larger, sex-inclusive RCTs with longer follow-up to validate brain-based mediators and to test biomarker-guided patient selection for acupuncture-based therapies.
BACKGROUND: Chronic pain may involve both nociceptive pain driven by peripheral tissue damage and nociplastic pain reflecting central nervous system dysregulation, as in fibromyalgia. Electroacupuncture has been shown to modulate these pathways, but the underlying brain mechanisms remain unclear. This study investigated how electroacupuncture influences nociceptive-initiated and centrally maintained pain via changes in brain activation and functional connectivity. METHODS: In this randomized controlled trial (NCT02064296), female adults with fibromyalgia received either electroacupuncture (n = 19) or sham treatment with inactive laser stimulation (n = 25) over four weeks. Changes in brain activation and connectivity during evoked pressure-pain stimulation were assessed using functional magnetic resonance imaging before and after treatment. Here, we present a secondary analysis of data from the trial. Clinical outcomes assessed include pressure-pain tolerance and widespread pain, and analyses tested whether brain measures mediated treatment-related effects. RESULTS: Here we show that in the electroacupuncture group, reductions in widespread pain are associated with increases in pressure-pain tolerance. This relationship is mediated by greater activation of the primary somatosensory cortex and stronger connectivity between somatosensory and insular regions, consistent with a bottom-up mechanism linking peripheral nociceptive-initiated input to central nociplastic pain modulation. In contrast, the sham group shows reductions in widespread pain linked to decreased precuneus activity and precuneus-insula connectivity, consistent with a top-down process. CONCLUSIONS: Electroacupuncture and sham treatments engage distinct neural pathways to influence pain perception. These findings highlight that electroacupuncture modulates nociceptive-initiated and nociplastic pain through a bottom-up sensory pathway, whereas sham treatment engages top-down control. This mechanistic dissociation may inform patient selection and optimization of acupuncture-based therapies for chronic pain. Fibromyalgia is a long-term condition that causes widespread pain, fatigue, and increased sensitivity. Pain in fibromyalgia can come from signals in the body (nociceptive pain) and from how the brain processes those signals (nociplastic pain). This study tested how electroacupuncture, a form of acupuncture that uses gentle electrical pulses, affects these pain pathways. Adults with fibromyalgia received either four weeks of electroacupuncture or a placebo-like treatment. Brain scans and pain tests were done before and after treatment. Electroacupuncture increased people’s tolerance to pressure pain and changed activity in sensory regions of the brain that detect and interpret pain. These brain changes were linked to reduced widespread pain, suggesting that pain relief after electroacupuncture begins in the body and then leads to changes in the brain. In contrast, the placebo treatment affected only brain pathways linked to nociplastic pain. Electroacupuncture may therefore benefit people with both nociceptive and nociplastic pain.
2. One year follow up of the TROPonin In CArotid Revascularisation (TROPICAR) study.
In a prospective multicenter cohort of 527 carotid revascularization patients with 95.8% 1-year follow-up, postoperative myocardial injury independently predicted 1-year MI (OR 6.54) and reduced MI-free survival. Preoperative malignancy also predicted MI, highlighting a high-risk subgroup for intensified secondary prevention.
Impact: Identifies postoperative myocardial injury as a powerful predictor of 1-year MI after carotid revascularization, enabling actionable perioperative risk stratification.
Clinical Implications: Routine postoperative high-sensitivity troponin monitoring after CEA/CAS may identify patients needing intensified cardioprotective therapy and follow-up (e.g., statin/antiplatelet optimization, cardiology co-management).
Key Findings
- 1-year MI incidence was 2.6% and stroke 3.8% after carotid revascularization.
- Postoperative myocardial injury independently predicted 1-year MI (OR 6.54; p = .003).
- MI-free survival was significantly lower with postoperative MIn (91.9% vs 98.2%; log-rank p = .003).
Methodological Strengths
- Prospective, multicenter cohort with high follow-up completeness (95.8%).
- Standardized hs-troponin measurements pre- and postoperatively with time-to-event analyses.
Limitations
- Observational design susceptible to residual confounding.
- Generalizability may be limited to tertiary centers; MIn definitions and thresholds may vary across settings.
Future Directions: Interventional studies testing troponin-guided optimization (e.g., beta-blockade, antithrombotic strategies) and external validation across diverse healthcare settings.
OBJECTIVE: The aim of this study was to examine the association between peri-operative myocardial injury (MIn) and the occurrence of adverse cardiovascular events and or death 1 year after carotid revascularisation. METHODS: In this prospective, multicentre cohort study, 527 consecutive patients undergoing elective carotid endarterectomy (CEA) or carotid artery stenting (CAS) (June - October 2023) were enrolled across five tertiary centres. High sensitivity cardiac troponin was measured pre- and post-operatively, and patients were followed for 1 year. The primary endpoint was myocardial infarction (MI). Secondary endpoints were stroke, cardiac related death, and all cause death 1 year following CEA or CAS. Survival analysis was used to assess the impact of MIn on time dependent outcomes of interest. RESULTS: One year follow up was completed in 505 patients (95.8%), predominantly males (n = 349, 69.1%), asymptomatic (n = 339, 67.3%), with a mean age of 71.6 ± 8.6 years (range 41 - 90 years). During follow up, eight lethal outcomes were documented, of which one patient (0.2%) died due to cardiac related cause. One year post-operatively, the incidence of MI was 2.6% (n = 13) and the incidence of stroke was 3.8% (n = 19). Post-operative MIn and pre-operative diagnosis of malignancy independently predicted MI within 1 year after CEA or CAS (odds ratio [OR] = 6.54, 95% confidence interval [CI] 1.91 - 22.22, p = .003; OR = 6.13, 95% CI 1.67 - 22.73, p = .006, respectively). MI free survival was statistically significantly lower in patients with post-operative MIn 1 year after CEA or CAS (91.9% vs. 98.2%, log rank p = .003). CONCLUSION: Post-operative MIn independently predicted 1 year MI following CEA or CAS. Patients with post-operative MIn after carotid revascularisation represent a high risk subgroup in whom targeted strategies should be considered to reduce the risk of subsequent cardiac adverse events.
3. Extended thromboprophylaxis in enhanced recovery after surgery for colorectal cancer: a multicentre retrospective cohort study.
In 2409 ERAS-era colorectal cancer surgeries across six centers, symptomatic VTE at 90 days was rare (0.2%) and not reduced by extended post-discharge thromboprophylaxis, which was independently associated with more major bleeding. Routine extended prophylaxis warrants reconsideration in modern practice.
Impact: Provides large-scale, multicenter data suggesting no VTE benefit and increased bleeding with extended prophylaxis in ERAS settings, challenging prevailing practices.
Clinical Implications: Favor individualized VTE risk assessment over routine extended prophylaxis after ERAS colorectal surgery; balance bleeding risk and consider early mobilization and in-hospital optimization.
Key Findings
- Symptomatic 90-day VTE incidence was 0.2% overall with no difference between until-discharge and extended groups (0.2% vs 0.2%; p = 0.925).
- Extended prophylaxis was independently associated with more major bleeding (2.0% vs 1.0%; multivariable OR 2.002, 95% CI 1.007–3.980).
- Median prophylaxis duration: 4 days (IQR 2–6) vs 28 days (IQR 18–28) for until-discharge vs extended regimens.
Methodological Strengths
- Large multicenter cohort with ERAS adherence and clear time-to-event analysis.
- Multivariable modeling to adjust for confounders.
Limitations
- Retrospective design with regimen allocation by institutional policy introduces potential confounding.
- Very low VTE event rate may limit power to detect small differences; asymptomatic VTE not captured.
Future Directions: Prospective pragmatic trials or registry-based randomized designs using risk-stratified strategies to balance VTE prevention and bleeding in ERAS pathways.
INTRODUCTION: The value of continuing thromboprophylaxis after hospital discharge (extended prophylaxis) following colorectal cancer surgery is uncertain in modern surgical practices. METHODS: A multicentre, retrospective cohort study was conducted across 6 ERAS-adherent centres in the Netherlands, including 2409 patients who underwent elective colorectal cancer surgery between January 2018 and August 2023. Patients were categorized based on their hospital's thromboprophylaxis regimen: thromboprophylaxis until discharge or extended prophylaxis continued after discharge. The primary outcome was 90-day cumulative incidence of symptomatic VTE, with log-rank tests for group comparisons. Secondary outcomes included major bleeding complications (Clavien-Dindo grade ≥ III), and factors associated with occurence of postoperative VTE or major bleeding complications. RESULTS: The median duration of thromboprophylaxis was 4 (IQR 2-6) days in the until-discharge group (n = 1260) and 28 (IQR 18-28) days in the extended-prophylaxis group (n = 1149). The overall incidence of symptomatic VTE was 0.2 %, with no significant difference observed between the two groups (0.2 % vs. 0.2 %; p = 0.925). Major bleeding complications occurred more frequently in the extended-prophylaxis group (1.0 % vs. 2.0 %; p = 0.049). Multivariate analysis demonstrated that extended thromboprophylaxis was independently associated with major bleeding complications (OR2.002, 95 %CI 1.007-3.980), but not with VTE incidence. CONCLUSION: The overall incidence of symptomatic VTE following elective colorectal cancer surgery within ERAS protocols was low. Thromboprophylaxis regimens continued after discharge were not associated with lower incidence of postoperative VTE, but were associated with a higher frequency of postoperative major bleeding complications. These findings suggest that routine extended thromboprophylaxis may be reconsidered in modern colorectal cancer surgery. CLINICAL TRIAL REGISTRATION: registration number W22.176.