Daily Anesthesiology Research Analysis
Analyzed 95 papers and selected 3 impactful papers.
Summary
Three high-impact anesthesiology papers stood out today: a BMJ systematic review establishes an evidence hierarchy for non-drug strategies to prevent postoperative pulmonary complications after abdominal surgery; a large nationwide cohort study identifies strong predictors of unsafe concurrent benzodiazepine–opioid use after joint arthroplasty; and a preregistered systematic review with trial sequential analysis clarifies effective opioid-sparing analgesic options after lumbar discectomy despite low overall certainty.
Research Themes
- Prevention of postoperative pulmonary complications via perioperative systems and respiratory strategies
- Safe postoperative prescribing: avoiding concurrent benzodiazepine–opioid use after arthroplasty
- Opioid-sparing multimodal analgesia after spine surgery with evidence synthesis and TSA
Selected Articles
1. Non-drug perioperative interventions to reduce postoperative pulmonary complications after abdominal surgery: systematic review and meta-analysis.
This comprehensive meta-analysis of 255 RCTs (55,260 participants) synthesizes 10 classes (39 subtypes) of non-drug perioperative interventions to prevent postoperative pulmonary complications after abdominal surgery. PPCs occurred in 11.7% overall, and the authors used trial sequential analysis and GRADE to prioritize strategies and establish an evidence hierarchy, including oxygen fraction strategies among high-certainty domains.
Impact: Defines an evidence-based hierarchy for non-pharmacologic perioperative strategies to reduce PPCs, directly informing anesthesia-led ERAS pathways and ventilatory care bundles.
Clinical Implications: Supports prioritization of selected perioperative systems and respiratory care strategies to reduce PPC risk after abdominal surgery and guides protocol standardization with GRADE-based certainty.
Key Findings
- Synthesized 255 RCTs (55,260 participants) evaluating 10 intervention types and 39 subtypes for PPC prevention in abdominal surgery.
- Overall PPC incidence across trials was 11.7%, enabling benchmarking for future studies and quality initiatives.
- Used trial sequential analysis and GRADE to establish an evidence hierarchy; oxygen fraction strategies were among high-certainty domains.
Methodological Strengths
- Comprehensive search across major databases with no language restrictions
- Use of trial sequential analysis and GRADE for error control and certainty assessment
Limitations
- Heterogeneity in PPC definitions and timepoints across RCTs
- Intervention diversity may limit direct comparability and meta-analytic precision for some subgroups
Future Directions: Head-to-head pragmatic trials and implementation studies are needed to operationalize top-ranked strategies within ERAS bundles and validate impact on PPCs, LOS, and cost.
OBJECTIVE: To evaluate the effectiveness of perioperative non-drug interventions in reducing postoperative pulmonary complications (PPCs) in adults undergoing abdominal surgery. DESIGN: Systematic review and meta-analysis. DATA SOURCES: Ovid MEDLINE, Embase, and Web of Science from database inception to January 2025 and updated in January 2026, with no language restrictions. STUDY SELECTION: Randomised controlled trials assessing the effectiveness of perioperative non-drug interventions for the prevention of PPCs in adults undergoing elective abdominal surgery under general anaesthesia, with clearly defined PPCs. MAIN OUTCOME MEASURES: The primary outcome w
2. Postoperative Pain Management After Lumbar Discectomy. A Systematic Review With Meta-Analyses and Trial Sequential Analyses.
Across 76 RCTs (n=5617), multiple modalities—paracetamol, NSAIDs, neuraxial/local techniques, and gabapentinoids—significantly reduced 24-hour opioid consumption and early pain after lumbar discectomy. Despite positive signals, overall certainty was low to very low due to risk of bias, small samples, heterogeneity, and inconsistent baseline analgesia, underscoring the need for standardized, higher-quality trials.
Impact: Provides the most comprehensive, preregistered synthesis with TSA for postoperative analgesia after lumbar discectomy, clarifying opioid-sparing options despite low certainty.
Clinical Implications: Supports multimodal, opioid-sparing regimens (e.g., paracetamol, NSAIDs, regional/local techniques, gabapentinoids) after lumbar discectomy, while emphasizing careful appraisal of low-certainty evidence and the need for institutional standardization.
Key Findings
- Included 76 RCTs (n=5617) and preregistered in PROSPERO with PRISMA adherence, ROB2 risk-of-bias, and GRADE certainty.
- Paracetamol, NSAIDs, neuraxial/local anesthetics, nerve blocks, gabapentin, and pregabalin significantly reduced 24-hour opioid consumption; several also lowered 6–24 h pain scores.
- Overall certainty of evidence ranged from low to very low due to heterogeneity, small samples, and baseline analgesia inconsistency.
Methodological Strengths
- PROSPERO preregistration and PRISMA-compliant methods
- Use of Trial Sequential Analysis to control random errors and GRADE for certainty
Limitations
- Low-to-very-low certainty due to heterogeneity and small sample sizes
- Inconsistent baseline analgesic regimens across trials
Future Directions: Conduct large, standardized, pragmatic RCTs comparing prioritized multimodal bundles with harmonized baseline analgesia and patient-centered outcomes.
BACKGROUND: Inadequate postoperative pain management after lumbar discectomy may delay recovery, increase the risk of chronic pain, and prolong hospitalization. Effective analgesic strategies must balance pain control with minimal adverse effects. OBJECTIVE: To identify the most effective postoperative analgesic interventions for patients undergoing lumbar discectomy. DATABASES AND DATA TREATMENT: This systematic review was preregistered in PROSPERO and conducted in accordance with PRISMA guidelines. Randomized controlled trials were identified through systematic searches in Medline, Embase, and the Cochrane Library. The primary outcome was opioid consumption within 24 h postoperatively. Meta-analyses were conducted using RevMan, with Trial Sequential Analysis (TSA) to adjust for random errors. Risk of bias was assessed using ROB2, and certainty of evidence was evaluated with GRADE. RESULTS: A total of 76 RCTs comprising 5617 participants were included, covering 11 analgesic strategies. Paracetamol, NSAIDs, epidural and intrathecal anaesthetics, local infiltration, nerve blocks, gabapentin, and pregabalin significantly reduced 24-h opioid consumption. Several interventions-including paracetamol, NSAIDs, glucocorticoids, ketamine, epidural and intrathecal anaesthetics, local anaesthetics, nerve blocks, gabapentin, and pregabalin-were also associated with lower pain scores at 6 and 24 h. However, evidence certainty ranged from low to very low due to methodological limitations, small sample sizes, heterogeneity, and inconsistent baseline analgesia. CONCLUSIONS: Multiple analgesic strategies show potential for reducing opioid use and improving early postoperative pain control after lumbar discectomy. Nevertheless, the low certainty of evidence highlights the urgent need for high-quality, standardized trials to inform clinical practice. SIGNIFICANCE: The findings demonstrate that the following analgesics significantly reduce supplemental opioid consumption and pain levels in the immediate postoperative period: PCM, NSAIDs, intrathecal anaesthetics, epidural anaesthetics, LIA/wound infiltration, nerve blockade, gabapentin, and pregabalin. However, the high risk of bias and low quality of evidence in many of the included trials necessitate cautious interpretation of the findings.
3. Factors Associated With Concurrent Benzodiazepine and Opioid Use Following Total Hip and Knee Arthroplasty: A Nationwide Cohort Study.
Linkage of national arthroplasty and pharmacy databases showed 4% (THA) and 7% (TKA) received ≥7 days of concurrent benzodiazepine–opioid dispensation within 90 days. Preoperative benzodiazepine use was the dominant predictor (OR ~23), with additional risk from antidepressant/anxiolytic use, female sex, smoking, and ASA III–IV, while preoperative pain, preoperative opioids, and implant features were not associated.
Impact: Identifies modifiable, preoperative medication-related risk factors for unsafe benzo–opioid co-prescription at scale, directly informing perioperative prescribing safety protocols.
Clinical Implications: Implement medication history checks and prescribing safeguards for patients with preoperative benzodiazepine or psychotropic use, and tailor non-opioid multimodal regimens to avoid early postoperative co-prescription.
Key Findings
- Among 89,139 THA and 76,710 TKA patients, 4% and 7% respectively received ≥7 days of concurrent benzo–opioid dispensation within 90 days postoperatively.
- Preoperative benzodiazepine use was the strongest predictor (THA OR 23.5; TKA OR 22.8); preoperative antidepressant/anxiolytic use also increased risk.
- Female sex, current smoking, and ASA III–IV were associated with concurrent use, whereas preoperative pain, preoperative opioids, and implant characteristics showed little to no association.
Methodological Strengths
- Nationwide registry linkage with large sample and objective dispensing data
- Adjusted multivariable logistic models with clinically relevant covariates
Limitations
- Dispensation does not ensure concomitant ingestion; clinical indications not fully captured
- Residual confounding possible in observational design
Future Directions: Test targeted stewardship interventions (e.g., prescribing alerts, pharmacist-led reviews) in high-risk groups to reduce unsafe co-dispensation and evaluate patient outcomes.
PURPOSE: Concurrent use of benzodiazepines and opioids is discouraged due to synergistic adverse effects. However, patients undergoing total hip or knee arthroplasty (THA/TKA) often receive them, particularly in the first 3 postoperative months. We identified factors associated with new outpatient concurrent benzodiazepine-opioid dispensation following THA/TKA. METHODS: In this nationwide cohort study, we linked the Dutch Arthroplasty Register with the Dutch Foundation for Pharmaceutical Statistics, which provided medication dispensation data. We included all patients undergoing primary elective THA/TKA (2013-2022) who had no preoperative concurrent use in the 6 months pre-procedure. The primary outcome was ≥ 7 days of a new concurrent benzodiazepine-opioid dispensation within 90-day postoperative. Determinants included patient and implant characteristics, and preoperative medication use. Multivariable logistic regression analyses were performed, adjusted for age, sex, and comorbidity. RESULTS: Among 89 139 THA and 76 710 TKA patients, 3756 (4%) and 5571 (7%), respectively, received new postoperative concurrent benzodiazepine-opioid dispensation within 90-days postoperative. The main factor associated with such dispensation was preoperative benzodiazepine use (THA: OR 23.5 [95% CI: 21.8-25.3], TKA: OR 22.8 [95% CI: 21.3-24.3]), followed by preoperative antidepressant/anxiolytic use (THA: OR 2.9 [95% CI: 2.6-3.1], TKA: OR 2.5 [95% CI: 2.3-2.7]). Other factors included female sex, current smoking, and American Society of Anesthesiologists (ASA) scale III-IV. Preoperative pain scores, preoperative opioid use, and implant characteristics showed little to no association with the outcome. CONCLUSIONS: Preoperative benzodiazepine use was the main factor associated with new outpatient concurrent benzodiazepine-opioid dispensation after THA/TKA, followed by preoperative antidepressant/anxiolytic use. These results highlighted that careful review of the patient's medication history when planning postoperative pain management could help prevent unsafe co-prescription. Using benzodiazepines and opioids together is usually discouraged because their combined effects can be harmful. However, patients who have hip or knee replacement surgery often receive both drugs, especially during the first three months after surgery. This study, based on data from the Netherlands between 2013 and 2022, examined how often patients started using both medications together after surgery and what factors increased this risk. We found that 4% of hip and 7% of knee replacement patients received these medications together for at least a week. The strongest factor linked to this was if patients had already been using benzodiazepines before surgery. Using antidepressants or anxiety medications before surgery also increased the risk. Other factors included being female, smoking, and having certain health issues. Pain levels before surgery and previous opioid use were not linked to using both drugs after surgery. These findings show how important it is for doctors to carefully review a patient's medication history before planning pain treatment after surgery to avoid unsafe drug combinations.