Daily Anesthesiology Research Analysis
Analyzed 60 papers and selected 3 impactful papers.
Summary
Three studies reshape perioperative thinking across safety, analgesia, and critical care ventilation. A population-scale cohort links surgery to higher nonfatal self-injury risk within one year, a randomized trial shows costotransverse foramen block provides analgesia equivalent to erector spinae plane block in chest trauma, and a post-hoc analysis of an international RCT finds targeted mild hypercapnia does not reduce myocardial injury after OHCA with STEMI.
Research Themes
- Postoperative mental health risk and self-harm after surgery
- Regional anesthesia optimization for chest trauma analgesia
- Ventilation CO2 targets after out-of-hospital cardiac arrest with STEMI
Selected Articles
1. Analgesic efficacy of ultrasound-guided erector spinae plane block versus costotransverse foramen block in patients with chest trauma: A randomized controlled study.
In a double-blind RCT of 58 chest trauma patients, costotransverse foramen block achieved analgesia equivalent to erector spinae plane block for acute and longer-term pain control, with similar onset, duration, rescue analgesia needs, and no complications. Although CTFB may achieve slightly lower NRS over time, differences were not statistically significant.
Impact: Provides randomized evidence for a novel fascial plane block (CTFB) versus an established technique (ESPB) in a common, high-risk cohort. Results support ESPB as a simpler, equally effective option while characterizing CTFB performance.
Clinical Implications: For chest trauma analgesia, ESPB remains a practical first-line regional technique due to equivalent efficacy and user-friendliness; CTFB can be considered in expert hands but may not offer superior analgesia.
Key Findings
- Primary outcome: 20-minute NRS pain scores were similar between CTFB and ESPB at rest and with movement (no significant differences).
- Analgesia onset, duration, rescue analgesia requirements, and block failure rates were comparable between groups.
- No complications occurred; 1- and 3-month follow-ups showed equivalent pain control with both techniques.
Methodological Strengths
- Double-blinded, prospective, randomized controlled design in an emergency setting.
- Standardized ultrasound-guided techniques with predefined time-point assessments and longer-term follow-up.
Limitations
- Single-center study with a modest sample size (n=58) limits power to detect small differences.
- Findings may not generalize to polytrauma patients with hemodynamic instability or anticoagulated patients.
Future Directions: Larger multicenter RCTs comparing CTFB, ESPB, and paravertebral/epidural techniques including opioid consumption, functional recovery, and safety in high-risk subgroups.
BACKGROUND: Thoracic epidural anesthesia and paravertebral blocks (PVBs) are the gold standard techniques for pain relief of chest trauma, but they are technically challenging and have failure rates. The Erector Spinae Plane block (ESPB) is a PVB surrogate that provides effective hemi-thoracic analgesia. The costotransverse foramen block (CTFB) is a novel block that deposits local anaesthetic adjacent to the costotransverse foramen. We hypothesized that CFTB might offer superior analgesia compared to ESPB. METHODS: This double-blinded, prospective, randomized controlled trial was conducted in the emergency department (ED) of a tertiary care institution. Fifty-eight patients with chest trauma were randomized into two groups, Group-1 (USG-ESPB; n = 29) or Group-2 (USG-CTFB; n = 29). The primary outcome was to compare pain scores in the Numeric Rating Scale (NRS) at 20 min. The secondary outcomes were onset and duration of analgesia, pain score at fixed time intervals, block failure rates, need for rescue analgesia, assessment of pain score at one and three months, and adverse events. RESULTS: Demographic and vital parameters were similar between the two groups. Baseline pain scores recorded at rest [9.6(0.8) vs 9.5(0.9)] and on movement [9.8(0.6) vs 9.8(0.6)] did not differ. At 20 min following intervention, mean pain scores at rest were very similar in both groups [5.2 (1.7) vs. 5.3 (1.5)] (mean difference: 0.1; 95% CI: -0.55 to 0.50; P = 0.94). Pain scores during movement were also very similar in both groups [6.4 (1.7) vs. 6.3 (1.4)] (mean difference: 0.1; 95% CI: -0.43 to 0.62; P = 0.76). The NRS score was persistently lower in the CTFB group at all other designated time points, though the difference was not statistically significant. The onset, duration, requirement of rescue analgesia, and block failure were similar. There were no complications in any group. During assessments at one and three months, both techniques yielded equivalent pain control. CONCLUSION: CTFB provides analgesia equivalent to ESPB in terms of acute and long-term pain relief, onset, duration, and opioid consumption for chest trauma patients. CTFB, however, is technically more challenging, and ESPB is a safer and more user-friendly option.
2. Nonfatal self-injury in the first year after surgery: a population-based epidemiologic study.
In over 1.16 million surgical patients, nonfatal self-injury occurred at 7.07 per 10,000 within one year—significantly higher than in percutaneous coronary intervention and cataract cohorts. Younger age, White race, lower income, rural residence, prior psychiatric history, and nonelective surgery were associated with greater risk.
Impact: Defines the incidence and determinants of postoperative self-harm at population scale, strengthening the case for perioperative mental health screening and targeted prevention.
Clinical Implications: Incorporate routine psychosocial risk screening preoperatively and during recovery, particularly for identified high-risk groups; establish referral pathways to mental health services and consider tailored follow-up.
Key Findings
- Incidence of nonfatal self-injury within 365 days post-surgery was 7.07 per 10,000 (n=824/1,165,881).
- Risk was higher than in PCI and cataract cohorts (adjusted HR ~1.5 for both comparisons).
- Risk factors included younger age, White race, lower income, rural residence, prior psychiatric history, and nonelective surgery.
Methodological Strengths
- Population-based cohort with over 1.16 million patients and doubly robust estimation against two comparators.
- Comprehensive adjustment using Cox models across patient- and surgery-level covariates.
Limitations
- Administrative data may undercapture self-injury events managed outside hospitals and lacks granular psychosocial measures.
- Observational design limits causal inference; residual confounding is possible.
Future Directions: Prospective studies using validated mental health instruments and interventions to test perioperative screening and prevention pathways for self-harm.
BACKGROUND: Recovery after surgery can be psychologically distressing, putting patients at risk of suicidal behaviours such as nonfatal self-injury (NFSI). We evaluated the incidence and identified factors associated with NFSI after surgery. METHODS: Linked administrative databases from New York state were used to identify adults (≥18 yr) undergoing a broad range of surgical procedures between 2016 and 2018. The primary outcome was presentation to an emergency department or hospitalisation for NFSI within 365 days of discharge from the index surgical admission. The incidence was compared with two comparator groups using doubly robust estimation: percutaneous coronary interventions and cataract procedures. Patient- and surgery-related factors associated with NFSI after surgery were determined using Cox models. RESULTS: Among 1 165 881 patients, 824 presented with NFSI within the year after surgery (incidence 7.07 per 10 000 patients). This was higher than the incidence in the percutaneous coronary interventions group (4.88 per 10 000; adjusted hazard ratio, 1.55; 95% confidence interval, 1.06-2.27) and the cataract group (1.52 per 10 000; adjusted hazard ratio, 1.48; 95% confidence interval, 1.04-2.09). Risk factors for NFSI were younger age, White race, lower income, rural residence, previous psychiatric history, and nonelective surgery. CONCLUSIONS: Select patient groups were more susceptible to NFSI after surgery. The true burden of suicidal behaviours and severe psychological distress after surgery is likely underestimated by analyses of administrative data. Future studies should investigate psychological distress after surgery using validated instruments.
3. Effects of mild hypercapnia on myocardial injury among ST-elevation myocardial infarction patients after out-of-hospital cardiac arrest: A exploratory post-hoc study of the TAME trial.
In a post-hoc analysis of the multinational TAME trial, targeted mild hypercapnia after OHCA did not reduce myocardial injury (peak troponin) in STEMI patients, nor did it improve lactate clearance, in-hospital mortality, or six-month neurological outcomes. Findings held in successfully revascularized STEMI.
Impact: Refutes a plausible ventilatory strategy for myocardial protection post-resuscitation, guiding clinicians away from targeting mild hypercapnia in STEMI after OHCA.
Clinical Implications: Routine targeting of mild hypercapnia for myocardial protection after OHCA with STEMI is not supported; focus should remain on guideline-based ventilation, revascularization, and individualized CO2 management.
Key Findings
- No difference in peak hs-cTnT or cTnI between mild hypercapnia and normocapnia groups among STEMI patients.
- Lactate clearance, in-hospital mortality (~39–41%), and 6-month neurological outcomes did not differ by CO2 target.
- Results were consistent in successfully PCI-treated STEMI patients.
Methodological Strengths
- Analysis embedded within a large, international randomized trial with prespecified ventilation targets.
- Multiple clinically relevant outcomes including biomarkers, mortality, and neurological status.
Limitations
- Post-hoc exploratory design and subgroup (STEMI) focus may limit power and introduce multiplicity concerns.
- Troponin assays and clinical care variability across sites could confound small effect detection.
Future Directions: Prospective trials to test individualized PaCO2 targets by phenotype (e.g., coronary lesion burden, microcirculation) and to assess myocardial perfusion surrogates alongside troponin.
BACKGROUND: Targeting mild hypercapnia reduced myocardial injury in a single-centre cohort of STelevation myocardial infarction (STEMI) patients from the multinational Targeted Therapeutic Mild Hypercapnia after Resuscitated Cardiac Arrest (TAME) trial. We examined the effect of mild hypercapnia on myocardial injury and outcomes in all acute myocardial infarction (AMI) patients of the TAME trial. METHODS: Post-hoc exploratory study of the TAME trial that compared the effect of targeted mild hypercapnia or normocapnia in comatose adults after out-of-hospital cardiac arrest (OHCA). The primary outcome was myocardial injury assessed by peak high-sensitivity cardiac troponin T (hs-cTnT) or troponin I (cTnI) levels during hospitalisation in STEMI and successfully percutaneous coronary intervention (PCI) treated STEMI patients. Secondary outcomes included lactate clearance, in-hospital mortality, and neurological outcome at six months. RESULTS: We studied 810 of 1700 TAME patients (49%) that were diagnosed with AMI. Of these, 593 had STEMI (73%), with 287 patients (48%) in the mild hypercapnia group and 306 (52%) in the normocapnia group. Troponin levels were available for 562 STEMI patients (95%). There was no difference in troponin level (ratio of geometric means (95% (CI) (mild hypercapnia / normocapnia) cTnI 1.18 (0.79 to 1.77), hs-cTnT 1.20 (0.88 to 1.63)) or lactate clearance over the first 24 hours according to treatment allocation. In-hospital mortality in STEMI patients was 112 of 287 (39%) vs. 124 of 306 (40.5%) patients in the mild hypercapnia group vs. normocapnia group, respectively (Relative Risk 0.97, 95% CI, 0.82 to 1.14). At six months, 129 of 267 (44.3%) vs. 125 of 282 (48.5%) patients in the mild hypercapnia group vs normocapnia group had a favourable neurological outcome (Relative Risk 1.09, 95% CI, 0.92 to 1.29). For successful PCI STEMI patients there were no significant differences in any outcomes according to treatment allocation. CONCLUSION: Among STEMI patients of the TAME trial, myocardial injury, in-hospital mortality, and neurological outcome at six months were not modified by allocation to targeted mild hypercapnia.