Daily Anesthesiology Research Analysis
Analyzed 89 papers and selected 3 impactful papers.
Summary
Analyzed 89 papers and selected 3 impactful articles.
Selected Articles
1. Clinical effectiveness of transversus abdominis plane block versus local anaesthesia wound infiltration for postoperative pain relief after laparoscopic appendicectomy in children: A multicentre, double-blind, randomised, controlled phase III trial.
In this multicenter double-blind RCT of children undergoing laparoscopic appendectomy with standardized multimodal analgesia, TAP block did not reduce 24-hour nalbuphine use versus local wound infiltration. Pain behavior scores and times to rescue analgesia or first mobilization were also similar.
Impact: This high-quality RCT directly challenges the routine use of TAP block for pediatric appendectomy when multimodal analgesia is employed, supporting simpler, faster, and potentially safer local infiltration strategies.
Clinical Implications: When using standardized multimodal analgesia for pediatric laparoscopic appendectomy, local wound infiltration can be favored over TAP block to streamline workflow, reduce procedural risks, and conserve resources without sacrificing analgesic efficacy.
Key Findings
- Total 24-hour nalbuphine dose was identical between TAP and local infiltration groups (median 0.2 mg/kg each; P=0.95).
- FLACC pain behavior scores did not differ at 1–24 hours postoperatively (P=0.78).
- Times to first nalbuphine dose and first mobilization showed no significant differences between groups.
Methodological Strengths
- Multicenter, double-blind, randomized phase III design
- Standardized multimodal analgesia and equal local anesthetic dosing across arms
Limitations
- Sample size may be underpowered to detect small differences
- Conducted in two centers with a specific multimodal regimen, potentially limiting generalizability
Future Directions: Evaluate effectiveness across different multimodal regimens and surgical procedures, and assess cost, workflow, and block-related complication profiles.
BACKGROUND: Postoperative pain relief after laparoscopic appendicectomy in children provided by transversus abdominis plane (TAP) block and local anaesthesia wound infiltration (LAWI) of trocar insertion sites has never been compared. OBJECTIVE: To investigate whether TAP block could decrease postoperative opioid requirements after laparoscopic appendicectomy in children compared with LAWI. DESIGN: Multicentre, double-blind, phase III randomised trial. SETTING: Two tertiary paediatric surgery centres. PATIENTS: Children aged 3 to 15 years admitted for laparoscopic appendicectomy. MAIN OUTCOME MEASURES: The primary outcome was the total dose of nalbuphine delivered within 24 h after surgery. Secondary outcomes were the Face Legs Activity Cry Consolability (FLACC) scale values at 1, 2, 6, 12 and 24 h, the time from levobupivacaine injection to the first dose of nalbuphine, and the time from the end of surgery to the first mobilisation. Patients received either ultrasound-guided TAP block (TAP group) or LAWI of trocar insertion sites (infiltration group) with 0.6 ml kg-1 of levobupivacaine 2.5 mg ml-1, combined with standardised systemic multimodal analgesia including paracetamol, ketoprofen, phloroglucinol and nalbuphine. RESULTS: Forty-six and 50 patients were analysed in the TAP and infiltration groups, respectively [age: 10 [7 to 12] versus 10 [8 to 12] years; females: 16 (35%) versus 25 (50%); duration of surgery: 71 [64 to 90] versus 69 [56 to 89] min]. The primary outcome (total nalbuphine dose) was 0.2 [0.0 to 0.2] and 0.2 [0.0 to 0.2] mg kg-1 in the TAP and infiltration groups, respectively (P = 0.95). FLACC scale values did not significantly differ between the two groups (P = 0.78). Time to the first dose of nalbuphine or to first mobilisation was not significantly different between groups (P value for log-rank test = 0.095 and 0.18, respectively). CONCLUSION: TAP block does not appear to provide a greater opioid-sparing effect than LAWI of trocar insertion sites after laparoscopic appendicectomy in children, when combined with systemic multimodal analgesia including nonsteroidal anti-inflammatory drugs. TRIAL REGISTRATION: ClinicalTrials.gov NCT04969133.
2. Dexmedetomidine for Adult Patients Undergoing Electroconvulsive Therapy: A Systematic Review and Meta-Analysis.
Across 20 double-blind RCTs (n=1526), dexmedetomidine significantly reduced ECT-induced HR and MAP surges, with peak effects 0–4 minutes post-stimulus and persistence up to 30 minutes. Seizure duration, recovery milestones, and adverse event rates were unchanged, and intermediate dosing (0.25–0.5 µg/kg) yielded the most consistent benefit.
Impact: This synthesis provides robust, practice-informing evidence that dexmedetomidine safely blunts autonomic surges during ECT without compromising seizure quality, and it clarifies an optimal dosing window.
Clinical Implications: Consider pre-induction dexmedetomidine at 0.25–0.5 µg/kg for adult ECT to attenuate hemodynamic surges, particularly in cardiovascularly vulnerable patients, while maintaining seizure duration and timely recovery.
Key Findings
- Dexmedetomidine reduced HR (MD −17.28 bpm) and MAP (MD −19.44 mmHg) 0–4 minutes after stimulus, with effects lasting up to 30 minutes.
- No reduction in seizure duration or delays in recovery milestones (spontaneous breathing, eye opening, following commands).
- No increased incidence of hypotension or bradycardia; intermediate dosing (0.25–0.5 µg/kg) was most consistently beneficial.
Methodological Strengths
- Included only double-blind randomized controlled trials
- Random-effects meta-analysis with prespecified subgroup analyses by dose and anesthetic regimen
Limitations
- Heterogeneity in dosing strategies and anesthetic protocols across trials
- Focus on short-term peri-procedural hemodynamics without hard cardiovascular outcomes
Future Directions: Standardize dosing protocols and evaluate outcomes in high-risk cardiovascular subgroups, including prospective RCTs assessing hard outcomes and cost-effectiveness.
INTRODUCTION: Electroconvulsive therapy (ECT) triggers a pronounced sympathetic surge that may increase cardiovascular risk, especially in susceptible patients. Dexmedetomidine, an α2-adrenergic agonist with sympatholytic properties, has been proposed to blunt this response, but its overall clinical impact and optimal dosing remain unclear. METHODS: We conducted a systematic review and meta-analysis of double-blind randomized controlled trials evaluating dexmedetomidine administered before anesthesia induction in adult ECT. Primary outcomes were heart rate (HR) and mean arterial pressure (MAP). Secondary outcomes included seizure duration, recovery parameters, and adverse events. Random-effects models were applied, with prespecified subgroup analyses by dosage and anesthetic regimen. RESULTS: Twenty trials involving 1526 participants met eligibility criteria. Dexmedetomidine significantly attenuated the sympathetic response to ECT, reducing HR and MAP at most peri-procedure time points. The largest effects occurred 0 to 4 minutes after the electrical stimulus (mean difference for HR: -17.28 bpm; mean difference for MAP: -19.44 mmHg). Hemodynamic attenuation persisted for up to 30 minutes. Dexmedetomidine did not reduce seizure duration, prolong recovery milestones (spontaneous breathing, eye opening, following commands), or increase the incidence of hypotension or bradycardia. Subgroup analyses indicated that intermediate doses (0.25 to 0.5 µg/kg) provided the most consistent benefit, with no additional advantage at doses >0.5 µg/kg and stable effects across propofol-based induction regimens. DISCUSSION: Dexmedetomidine seems to be a safe and effective adjunct for mitigating the autonomic surge associated with ECT without compromising seizure quality or delaying recovery. Variability in dosing strategies and anesthetic protocols highlights the need for standardized approaches and further high-quality trials.
3. Effect of Perineural Dexamethasone on the Duration of Analgesia in Paravertebral Block: A Meta-Analysis.
Pooling 10 RCTs (n=731), perineural dexamethasone extended paravertebral block analgesia by about 350 minutes, reduced early postoperative pain scores, lowered PONV risk (RR 0.41), and decreased cumulative opioid consumption. Trial sequential analysis indicated that the evidence threshold for benefit has been met.
Impact: Provides decisive, synthesis-level evidence supporting a practical adjuvant that enhances block duration and improves recovery-relevant outcomes, informing routine perioperative analgesia strategies.
Clinical Implications: Adding perineural dexamethasone to paravertebral blocks can meaningfully prolong analgesia and reduce PONV and opioid needs; clinicians should weigh benefits against off-label use considerations and monitor for potential steroid-related risks.
Key Findings
- Analgesia duration increased by approximately 350 minutes versus placebo across 10 RCTs (n=731).
- Lower postoperative VAS scores at 2, 6, 12, and 24 hours with dexamethasone.
- Reduced PONV risk (RR 0.41; 95% CI 0.25–0.69) and decreased cumulative opioid consumption (MD −8.85).
- Trial sequential analysis crossed monitoring boundaries and reached required information size.
Methodological Strengths
- Randomized controlled trials only with consistent effect directions
- Trial sequential analysis demonstrating sufficiency of cumulative evidence
Limitations
- Heterogeneity in surgical procedures, local anesthetic regimens, and dexamethasone dosing
- Safety outcomes for perineural steroid use were not uniformly reported across trials
Future Directions: Standardize dosing and formulations, assess long-term safety including neurotoxicity, and evaluate cost-effectiveness and patient-centered outcomes.
OBJECTIVE: The aim of this meta-analysis was to evaluate the effect of perineural (PN) dexamethasone on the duration of analgesia in paravertebral block (PVB). METHODS: We systematically searched PubMed, Embase, Web of Science, The Cochrane Library, and CNKI up to October 2025 for relevant randomized controlled trials (RCTs) comparing PN dexamethasone to a placebo in PVB. The primary outcome was the duration of analgesia. The mean difference (MD) and the risk ratio (RR) were calculated for continuous and dichotomous outcomes, respectively. Trial sequential analysis (TSA) was also carried out to calculate the required information size (RIS). RESULTS: Ten trials with 731 participants were included. PN dexamethasone prolonged the duration of analgesia by approximately 350 minutes compared with placebo. In the trial sequential analysis, the cumulative Z-curve crossed both the conventional boundary and the trial sequential monitoring boundary for benefit, and reached RIS. In addition, PN dexamethasone decreased Visual analogue scale (VAS) scores at 2 hours, 6 hours, 12 hours and 24 hours after surgery with lower incidence of postoperative nausea and vomiting (PONV, risk ratio [RR] 0.41; 95% CI 0.25 to 0.69) and less cumulative opioid consumption (MD = -8.85; 95% CI: -13.39 to -4.32). CONCLUSION: This study suggested PN dexamethasone effectively prolongs the duration of analgesia in PVB and reduces the cumulative opioid consumption. TSA suggested that no more trials are required to confirm that PN dexamethasone effectively prolongs the duration of analgesia in PVB.