Daily Anesthesiology Research Analysis

BACKGROUND: Clinical evidence on the analgesic efficacy of the subtransverse process interligamentary plane (STIL) block after thoracic surgery remains limited. This study aimed to compare the postoperative analgesic efficacy of the STIL block versus the thoracic paravertebral block (TPVB) in thoracic surgery. METHODS: This randomized, non-inferiority trial enrolled patients undergoing video-assisted thoracoscopic surgery at a large academic medical center in China. Patients were randomly assigned (1:1) to receive either the STIL block or TPVB. Both groups received a single-shot injection of 15 mL of 1% ropivacaine mixed with 2% lidocaine. The primary outcome was pain intensity during deep inspiration within 48 h postoperatively, assessed by the area under the curve (AUC) of the numeric rating scale. A non-inferiority margin of 34 was predefined, and analyses were performed in both intention-to-treat and per-protocol populations. RESULTS: From February 1, 2023, to December 30, 2024, 114 eligible patients (median age 58 years [IQR 49-61]; 54.0% female) were enrolled and randomly assigned to receive either the STIL block (n = 57) or the TPVB (n = 57). Nine patients were excluded after randomisation, resulting in 105 patients included in the per-protocol analysis. In the per-protocol population, the 48-h postoperative pain AUC during deep inspiration was 196.04 ± 2.50 for the STIL group and 187.49 ± 4.13 for the TPVB group (mean difference = 8.59; 95% CI, -0.94 to 18.14). In the intention-to-treat population, the values were 195.24 ± 2.49 and 186.44 ± 4.03, respectively (mean difference = 9.12; 95% CI, -0.39 to 18.63), both within the predefined noninferiority margin. No serious adverse events were observed in either group. CONCLUSIONS: This randomized clinical trial demonstrates that, in the studied population, the subtransverse process interligamentary plane block was non-inferior to the thoracic paravertebral block for postoperative pain control after thoracic surgery, providing an effective alternative for analgesia.

BACKGROUND: Postoperative cognitive dysfunction (POCD) is a detrimental complication after surgery with lasting impact on patients' daily lives. It is most common after postoperative delirium. While dopaminergic dysfunction has been suggested to play a role in delirium, little knowledge exists regarding its relevance for POCD. OBJECTIVE: We hypothesised that POCD is associated with altered resting-state functional connectivity (FC) of the ventral tegmental area (VTA) and the substantia nigra pars compacta (SNc) in functional magnetic resonance imaging (fMRI). SETTING: Tertiary care centre, Germany. PATIENTS: Patients aged at least 65 years with a Mini-Mental Status Examination (MMSE) at least 24 points presenting for elective major surgery were eligible for this study. Of 747 included patients, 214 patients with POCD assessment and at least one preoperative fMRI dataset were analysed. INVESTIGATIONS: Resting-state fMRI and neuropsychological assessment before surgery and at follow-up 3 months later. MAIN OUTCOME: POCD after 3 months after surgery was determined as the Reliable Change Index (RCI). Connectivity between VTA or SNc and 132 regions was calculated. RESULTS: Twenty-six patients (12%) developed POCD. Four components for VTA-FC and SNc-FC were selected for further analysis with principal component analysis. For both VTA and SNc connectivity, one component was significantly associated with POCD. Postoperative alterations of dopaminergic networks were observed in an exploratory voxelwise analysis in a left temporal cluster. CONCLUSION: Higher dopaminergic connectivity to regions associated with spatial perceptive processes and lower connectivity to cognitive control-related areas may predispose to POCD. TRIAL REGISTRATION: clinicaltrials.gov, NCT02265263.

BACKGROUND: Transversus abdominis plane (TAP) blocks reduce opioid use and improve outcomes in elective surgeries, but their benefit in acute care surgery has not been demonstrated. Our program recently developed a quality improvement project to implement a pain management protocol including TAP blocks for emergency laparotomy. The purpose of this study is to evaluate the impact of TAP blocks on opioid use and hospital outcomes. METHODS: As part of a hospital quality improvement initiative, we conducted a retrospective cohort study (2022-2024) including patients (18 years or older) who underwent an emergency laparotomy. Patients were divided into TAP block and no TAP block cohorts. Univariate and multivariate analyses were performed to assess the association between the use of TAP blocks and study outcomes including postoperative morphine milligram equivalents (MME), hospital length of stay, and postoperative complications. RESULTS: Among 219 patients (TAP block, 110; no TAP block, 109), those receiving TAP blocks required significantly less total MME (64 vs. 118, p = 0.009) and daily MME (9 vs. 15, p < 0.001) and were less likely to require ≥20 MME/day (22.7% vs. 45.9%, p < 0.001). No significant differences were observed in postoperative complications or hospital length of stay. Multivariate analysis showed the use of TAP blocks was associated with decreased odds of requiring ≥20 MME/day (adjusted odds ratio, 0.363; 95% confidence interval, 0.195-0.675; p = 0.001), and less MME per day (β = -14.52; 95% confidence interval, -27.50 to -1.53; p = 0.029). CONCLUSION: Our results suggest that the use of TAP blocks was significantly associated with reduced opioid use in trauma and emergency general surgery patients. While further research is warranted, TAP blocks should be considered for postoperative pain management in acute care surgery patients undergoing emergency laparotomy. LEVEL OF EVIDENCE: Therapeutic/Care Management Study; Level III.