Daily Anesthesiology Research Analysis

BACKGROUND CONTEXT: Posterior spinal fusion for idiopathic scoliosis in children and adolescents is associated with severe postoperative pain and high opioid requirements. The erector spinae plane block (ESPB) provides effective analgesia, but its duration is limited. Dexamethasone prolongs peripheral nerve blocks in adults; however, its effects on analgesia and neurophysiological parameters in pediatric spine surgery remain unclear. PURPOSE: To evaluate whether dexamethasone administered within the fascial plane as an adjuvant to ESPB is associated with prolonged analgesia, reduced opioid consumption, and changes in motor neurophysiological parameters in pediatric scoliosis surgery. STUDY DESIGN/SETTING: Prospective, randomized, double-blind, controlled clinical trial conducted at a tertiary university hospital. PATIENT SAMPLE: Sixty children and adolescents aged 10-18 years with Lenke type 3 scoliosis undergoing posterior spinal fusion were randomized to receive ESPB with ropivacaine 0.2% plus dexamethasone (0.1 mg/kg; DEX group, n=30) or ropivacaine 0.2% alone (NO DEX group, n=30). OUTCOME MEASURES: Primary outcome was time to first rescue opioid analgesia within 48 hours postoperatively. Secondary outcomes included total opioid consumption, postoperative pain scores (Numerical Rating Scale, NRS), perioperative blood glucose levels, neurological complications, intraoperative motor evoked potentials (MEPs), and postoperative electroneurography (ENG) parameters. METHODS: Bilateral ultrasound-guided ESPBs were performed at T4 and T10 after anesthesia induction. Neuromonitoring included intraoperative transcranial electrical stimulation-elicited MEPs and postoperative transcranial magnetic stimulation-elicited MEPs, as well as postoperative motor ENG of the peroneal nerves. Pain scores and opioid consumption were recorded by blinded assessors. Appropriate parametric and non-parametric tests, including repeated-measures analyses, were applied. RESULTS: Time to first opioid administration was longer in the DEX group than in the NO DEX group (13.0 ± 2.1 h vs. 5.2 ± 1.6 h; p<0.0001). Total opioid consumption during the first 48 hours was lower in the DEX group (18.1 ± 3.8 mg vs. 27.3 ± 4.4 mg morphine equivalents; p<0.0001). NRS pain scores were lower at 8, 12, and 24 hours postoperatively (p<0.05). Neurophysiological assessments showed higher postoperative MEP amplitudes and more favorable ENG parameters in the DEX group compared with the NO DEX group; overall postoperative improvement in neurophysiological measures was observed in both groups. No differences in perioperative blood glucose levels or neurological complications were detected. CONCLUSIONS: In pediatric scoliosis surgery, dexamethasone administered within the fascial plane as an adjuvant to ESPB is associated with prolonged analgesia and reduced opioid requirements without increasing adverse effects. Differences in neurophysiological parameters between groups should be interpreted as associations and may reflect modulation of perioperative conditions rather than a direct neuroprotective effect. Overall postoperative neurophysiological improvement is likely related to surgical scoliosis correction.

Patients often need to interrupt anticoagulation for invasive procedures or surgery. Periprocedural bleeding can contribute to substantial morbidity and mortality. Procedural bleed risk stratification informs whether anticoagulation needs to be interrupted, for how long, and when to restart anticoagulation post-procedure. Guidance on procedure-specific bleed risk varies and contributes to discordant perioperative anticoagulation management. To address this important knowledge gap, the Perioperative and Critical Care Thrombosis and Hemostasis Subcommittee of the International Society on Thrombosis and Haemostasis undertook a review of contemporary procedural bleed risk stratification schemas and developed a practical bleed risk stratification approach for use in anticoagulated adult patients having a planned elective surgery or procedure.

BackgroundPostoperative pain following liver resection remains a clinical challenge, and the optimal analgesic strategy is still debated.ObjectiveTo determine whether a single intrathecal morphine injection provides superior analgesia and opioid-sparing effects compared with conventional systemic or regional techniques in adult patients undergoing liver surgery.MethodsPubMed, Embase, Web of Science citation index, and the Cochrane Library were searched from inception to August 2025 for randomized controlled trials comparing intrathecal morphine with alternative analgesic regimens in liver resection. The primary outcome was pain intensity at rest 24 h after surgery (standardized mean difference). Secondary outcomes included pain intensity at 48 and 72 h and cumulative opioid consumption within 24 h postoperatively. Random-effects meta-analyses and I² statistics were used to assess pooled effects and heterogeneity.ResultsEleven randomized controlled trials (n = 535) met the inclusion criteria. Intrathecal morphine reduced 24-h postoperative pain scores with a moderate effect (standardized mean difference = -0.64; 95% confidence interval: -0.84 to -0.44;