Daily Anesthesiology Research Analysis
Analyzed 179 papers and selected 3 impactful papers.
Summary
Analyzed 179 papers and selected 3 impactful articles.
Selected Articles
1. Once-weekly semaglutide versus placebo in patients with alcohol use disorder and comorbid obesity: a randomised, double-blind, placebo-controlled trial.
In a 26-week, single-centre, double-blind RCT (n=108), once-weekly semaglutide 2.4 mg significantly reduced heavy drinking days versus placebo (estimated treatment difference −13.7 percentage points; 95% CI −22.0 to −5.4; p=0.0015). Benefits extended to multiple secondary alcohol-related and somatic outcomes, with mostly mild-to-moderate transient gastrointestinal adverse events occurring more often with semaglutide.
Impact: This well-conducted RCT provides compelling evidence that GLP-1 receptor agonism can reduce heavy drinking in patients with alcohol use disorder and obesity, representing a promising therapeutic avenue beyond weight and glycemic control.
Clinical Implications: Semaglutide may be considered as an adjunct to behavioral therapy for alcohol use disorder in patients with comorbid obesity, pending confirmation in multicentre trials and across BMI strata. Monitoring for gastrointestinal adverse events is warranted.
Key Findings
- Once-weekly semaglutide reduced heavy drinking days more than placebo (−41.1 vs −26.4 percentage points from baseline; treatment difference −13.7; 95% CI −22.0 to −5.4; p=0.0015).
- Improvements were observed across multiple secondary alcohol-related and somatic outcomes.
- Adverse events were mostly mild-to-moderate gastrointestinal events and more frequent with semaglutide; 81% of participants completed the intervention.
Methodological Strengths
- Randomised, double-blind, placebo-controlled design with intention-to-treat analysis and multiple imputation for missing data
- Prospectively registered trial with prespecified primary endpoint
Limitations
- Single-centre study with a modest sample size (n=108), potentially limiting generalisability
- Restricted to patients with comorbid obesity and 26-week follow-up; longer-term efficacy and broader applicability remain to be established
Future Directions: Conduct multicentre, larger RCTs across BMI ranges; compare with current pharmacotherapies (e.g., naltrexone, acamprosate); evaluate long-term relapse, quality of life, and mechanistic biomarkers.
BACKGROUND: Alcohol use disorder accounts for 5% of deaths worldwide annually, and there is an urgent need for new therapeutic interventions. Preclinical and initial human studies indicate that the GLP-1 receptor agonist semaglutide might reduce alcohol drinking. This study evaluated the efficacy of semaglutide once-weekly in treatment-seeking patients with alcohol use disorder and comorbid obesity. METHODS: In a 26-week, single-centre, randomised, double-blinded, placebo-controlled trial, t
2. Continuous Erector Spinae Plane Blocks to Treat Pain Following Percutaneous Nephrolithotomy: A Randomized, Triple-Masked, Placebo-Controlled Clinical Trial.
In a triple-masked RCT of 50 outpatients undergoing PCNL, adding a 57-hour continuous ESPB infusion to a standardized single-injection ESPB did not reduce average pain scores or opioid consumption over the first 48 hours. Secondary outcomes, including maximum pain, sleep disturbance, and pain interference, were also similar between active local anesthetic and saline infusion groups.
Impact: High-quality negative evidence challenges routine use of continuous ESPB catheters after PCNL, informing resource allocation and reducing unnecessary catheterization risks.
Clinical Implications: For outpatient PCNL, a single-injection ESPB appears sufficient; routine addition of continuous perineural infusion is unlikely to improve analgesia or reduce opioids and may be omitted to streamline care and reduce catheter-related risks.
Key Findings
- No difference in average daily pain over postoperative days 1–2 between active bupivacaine infusion and saline (estimated difference 0.25; 95% CI −1.0 to 1.5; p=0.538).
- No reduction in cumulative oxycodone consumption (ACTIVE 10 [0,25] mg vs PLACEBO 15 [0,30] mg; estimated difference 0; 95% CI −15 to 5; p=0.358).
- Secondary outcomes (maximum pain, sleep disturbance, Brief Pain Inventory interference scores) showed no significant between-group differences.
Methodological Strengths
- Randomized, triple-masked, placebo-controlled design with standardized single-injection ESPB across groups.
- Objective, patient-centered outcomes (pain NRS, opioid consumption) over the clinically relevant first 48 hours.
Limitations
- Single-center sample of 50 limits precision and generalizability.
- Follow-up limited to first 2 postoperative days; longer-term analgesic outcomes not assessed.
Future Directions: Multicenter trials powered for subgroups (e.g., bilateral stones, high baseline pain) and cost-effectiveness analyses are needed to determine if any patients benefit from continuous ESPB.
BACKGROUND: Single-injection erector spinae plane blocks (ESPB) provide analgesia following percutaneous nephrolithotomy (PCNL) but are limited in their duration. A continuous ESPB involving local anesthetic administered via a perineural catheter may extend analgesia duration. We hypothesized that adding a continuous ESPB to a single-injection ESPB following outpatient PCNL would decrease pain severity and/or opioid consumption over the first 2 postoperative days (dual primary outcomes). METHODS: Preoperatively, adults undergoing PCNL had an ultrasound-guided perineural catheter inserted at the 8th transverse process following saline injection. Bupivacaine 0.25% with epinephrine (20 mL) was manually injected via the catheter for all participants who were subsequently randomly allocated to one of two postoperative treatments: ACTIVE with bupivacaine 0.25% or PLACEBO with normal saline. An automatic intermittent bolus of 21 mL was delivered every 4 hours using a portable infusion pump for approximately 57 h. RESULTS: During the first 2 postoperative days, the median [interquartile range] average daily pain intensity as measured with the numeric rating scale for ACTIVE (n=25) was 3.5 [2.0, 4.5] compared with 3.0 [1.3, 4.5] for PLACEBO (n=25; estimated difference 0.25, 95% CI -1.0 to 1.5; p=0.538). Cumulative oxycodone consumption during this same period was 10 [0, 25] mg for ACTIVE versus 15 [0, 30] mg for PLACEBO (estimated difference 0, 95% CI -15 to 5; p=0.358). During this period, the maximum daily pain for ACTIVE was 7.0 [4.3, 8.0] compared with 6.5 [5.5, 8.0] for PLACEBO (p=0.754). Sleep disturbances the second night were 0 [0, 1] for both groups (p=0.423). During the day after surgery, pain's interference with physical and emotional functioning was 10 [0, 33] for ACTIVE and 8 [23, 48] for PLACEBO as measured with the Brief Pain Inventory (p=0.587). CONCLUSIONS: This investigation failed to identify benefits of adding a continuous ESPB to a single-injection ESPB following PCNL.
3. Evaluating three routes of tranexamic acid administration in total hip and knee arthroplasty: A nationwide database analysis in Taiwan.
Across Taiwan’s national database, topical, IV, and oral TXA all reduced transfusion risk versus no TXA, with no superior route or benefit from combining routes. Safety was broadly acceptable, though high-dose IV (>3 g) or oral (>8 g) TXA increased predicted renal injury risk in patients with preexisting renal disease; a signal for VTE with topical TXA in high-risk patients disappeared after adjustment.
Impact: Provides comparative effectiveness and safety evidence across common TXA routes at scale, supporting flexible, patient-tailored perioperative antifibrinolytic strategies.
Clinical Implications: Choose TXA route based on logistics and patient factors rather than efficacy differences; avoid high-dose IV/oral in renal disease and ensure VTE prophylaxis in vascular disease. Routine combination of routes is unlikely to confer additional benefit.
Key Findings
- All routes reduced transfusion versus no TXA: topical RR 0.45 (95% CI 0.41–0.48), IV RR 0.80 (0.79–0.84), oral RR 0.82 (0.73–0.92).
- Topical and IV TXA showed similar transfusion risk (RR 1.09; 95% CI 0.96–1.24); combining routes provided no additional benefit.
- No overall increase in VTE, infection, or wound complications; in renal disease, high-dose IV (>3 g) or oral (>8 g) TXA increased predicted renal injury risk (~10%).
Methodological Strengths
- Nationwide claims database with propensity score matching and multiple head-to-head route comparisons.
- Dose–response modeling identifying thresholds for renal risk and transfusion benefit.
Limitations
- Observational design susceptible to residual confounding and coding bias.
- Exact dosing regimens and perioperative co-interventions may be incompletely captured.
Future Directions: Pragmatic randomized trials comparing routes, and trials stratified by renal function, are warranted; further study of topical TXA and VTE risk in high-risk populations is needed.
BACKGROUND: Tranexamic acid (TXA) reduces perioperative blood loss, but comparative effectiveness and safety across administration routes remain uncertain. We evaluated topical, intravenous [IV], and oral TXA in unilateral total hip and knee arthroplasty. METHODS: Using Taiwan's national health insurance database (2012-2021), we identified patients undergoing unilateral arthroplasty and evaluated perioperative TXA use, red blood cell transfusion, and adverse events within 60 days after discharge. Conditional logistic regression and six propensity-score-matched comparisons were conducted: topical vs none, IV vs none, oral vs none, topical vs IV, topical+ 1.0g IV vs topical alone, and IV+ 1.0g topical vs IV alone. RESULTS: Compared with no TXA, all routes were associated with lower transfusion risk (topical: RR 0.45, 95%CI 0.41-0.48, p <0.001; IV: RR 0.80, 95%CI 0.79-0.84, p <0.001; oral: RR 0.82, 95%CI0.73-0.92, p=0.007). Topical and IV TXA were associated with similar risk (RR 1.09, 95%CI:0.96-1.24, p>0.999), and the combined use was not associated with a different risk compared with either route alone. Topical TXA was associated with the greatest reduction in predicted transfusion risk at low dose (- 3,087 per 10,000 [-2,886, -3,276], 0→3.0g). Overall, TXA use was not associated with increased venous thromboembolism (VTE), infections, or wound complications. A higher VTE incidence was observed with topical TXA in patients with prior vascular disease without pharmacological prophylaxis, but this was not significant after adjustment for confounders. TXA was not associated with renal injury overall, but high-dose IV (>3.0 g) or oral (>8.0 g) TXA increased predicted risk (~10%) in patients with preexisting renal disease. CONCLUSION: TXA use was associated with substantial transfusion reduction without an overall increase in adverse events. No administration route or combination proved superior. Caution is warranted with higher-dose IV or oral TXA in patients with renal disease, and the association between topical TXA and VTE in high-risk patients merits further investigation.