Daily Anesthesiology Research Analysis
Analyzed 97 papers and selected 3 impactful papers.
Summary
A multicenter randomized trial shows that superficial parasternal intercostal plane block with ropivacaine reduces opioid consumption after median sternotomy without affecting pain scores. A large multicenter cohort demonstrates that rocuronium has overtaken succinylcholine for rapid sequence induction with no detectable differences in key outcomes. A meta-analysis of randomized trials suggests video double-lumen tubes may modestly improve intubation efficiency and reduce sore throat versus traditional tubes, although heterogeneity limits certainty.
Research Themes
- Opioid-sparing regional anesthesia in cardiac surgery
- Evolution of neuromuscular blocker choice for rapid sequence induction
- Device innovation for one-lung ventilation and airway management
Selected Articles
1. Superficial parasternal intercostal plane block with ropivacaine versus placebo for opioid exposure after cardiac surgery (EPOCH CardioLink-10): a multicentre, double-blind, randomised trial.
In a multicenter, double-blind RCT of 318 patients undergoing sternotomy, continuous bilateral SPIP block with ropivacaine reduced 72-hour opioid consumption versus placebo without differences in pain scores or recovery measures. No serious block-related complications were reported, supporting SPIP as a pragmatic opioid-sparing strategy in cardiac surgery.
Impact: Provides high-quality randomized evidence for a specific regional anesthesia technique that reduces opioid use after cardiac surgery, a priority area for enhanced recovery pathways.
Clinical Implications: Consider bilateral SPIP catheter techniques as part of multimodal analgesia after sternotomy to reduce opioid exposure. Implement dosing protocols and monitoring for local anesthetic safety within cardiac ERAS pathways.
Key Findings
- Ropivacaine SPIP block reduced 72-hour opioid consumption versus placebo (least-squares mean difference −20.7 MMEs; 95% CI −39.0 to −2.3; p=0.027).
- Pain scores, delirium rates, and Quality of Recovery-15 were similar between groups.
- No serious block-related complications occurred; maximum total ropivacaine dose was 592 mg over 48 hours.
Methodological Strengths
- Multicenter, double-blind, randomized, placebo-controlled design with modified intention-to-treat analysis
- Standardized catheter-based dosing protocol with predefined primary endpoint (72-hour MME)
Limitations
- No prespecified comprehensive adverse event analysis; safety conclusions are limited
- Secondary outcomes (pain scores, recovery indices) did not differ, which may temper perceived clinical impact
Future Directions: Confirm effectiveness and safety across diverse centers with detailed safety monitoring, evaluate cost-effectiveness, and compare SPIP with alternative regional techniques (e.g., parasternal/intercostal variants, erector spinae plane) in cardiac ERAS bundles.
BACKGROUND: Cardiac surgery performed through a midline chest incision (median sternotomy) is associated with substantial postoperative pain and opioid use, the latter of which remains the dominant modality of analgesia. Contemporary international guidelines prioritise opioid-sparing, multimodal strategies; however, robust randomised evidence to support specific opioid-sparing analgesic approaches in cardiac surgery is lacking. METHODS: EPOCH CardioLink-10 was a pan-Canadian, multicentre, randomised, double-blind, placebo-controlled trial in adults undergoing cardiac surgery via median sternotomy. Participants were assigned to receive bilateral superficial parasternal intercostal plane (SPIP) blocks with either 0.2% ropivacaine or placebo (0.9% sodium chloride), delivered via indwelling catheters. Study interventions were delivered at a basal infusion rate (0.1-1 mL/h) after a 20 mL bolus post-insertion. Bolus dosing of 5 mL every 3-4 h was continued for 48 h. In the ropivacaine arm, this resulted in a maximum total ropivacaine dose of 592 mg over the infusion period. The primary outcome was cumulative opioid consumption over 72 h following catheter insertion, expressed in morphine milligram equivalents (MMEs). Secondary outcomes included subjective pain scores, cumulative use of opioid to discharge, rates of delirium, and participant-reported Quality of Recovery-15 score (ClinicalTrials.govNCT06028126). FINDINGS: Between Aug 16, 2023, and Dec 22, 2025, 650 patients were screened, and 318 included in the modified intention-to-treat population (164 in the ropivacaine group, 154 in the placebo group). Median age was 67 years (IQR 61-72), 72 (23%) participants were female, 178 (56%) were White, and 69 (22%) were South Asian. Over 72 h, ropivacaine reduced opioid consumption compared with placebo (least-squares mean difference -20.7 MMEs [95% CI -39.0 to -2.3]; p = 0.027). Pain scores and other secondary outcomes were similar between groups. There were no serious block-related complications and there was no pre-specified analysis of adverse events. INTERPRETATION: The findings of this multicentre, randomised trial suggest that bilateral SPIP blockade with ropivacaine may be a pragmatic option to manage sternotomy pain with lower opioid consumption post-cardiac surgery. FUNDING: Grants from the Canadian Institutes of Health Research (CIHR) [Principal Applicant: C D Mazer], the Dr. Timothy & Mrs. Linda Tang Anesthesia Research Fund at the University of Calgary, Calgary, AB [A J Gregory and C D Noss], and the CardioLink Research Trial Platform at St. Michael's Hospital, Toronto, ON. In-kind support from the Department of Anesthesia, Pain Management & Perioperative Medicine, Dalhousie University, Halifax, NS [P de Jager and J L Dougherty].
2. Rapid Sequence Induction Practices and Outcomes in Abdominal Surgery Patients: A Multicenter Observational Cohort Study.
Using MPOG data across 13 institutions, rocuronium use rose while succinylcholine use declined for RSI in abdominal surgery, with video laryngoscopy more common in RSI cases. Adjusted analyses found no significant differences in 30-day mortality, hypoxia, pulmonary complications, or AKI between rocuronium and succinylcholine.
Impact: Defines contemporary RSI practice patterns and provides comparative effectiveness data on neuromuscular blocker choice at scale, informing airway management decisions.
Clinical Implications: Both rocuronium and succinylcholine appear reasonable for RSI absent contraindications; selection can be tailored based on patient factors, contraindications, and availability of reversal (e.g., sugammadex) without expected impact on major outcomes.
Key Findings
- Succinycholine use declined from 85.4% (2015) to 37.3% (2022) of RSI cases, with rocuronium overtaking as the predominant agent.
- No significant differences between rocuronium and succinylcholine in 30-day mortality (RR 0.85; 95% CI 0.67–1.09), hypoxia (RR 1.04), pulmonary complications (RR 0.93), or AKI (RR 1.05).
- Video laryngoscopy was more commonly used in RSI cases (16.2% vs 8.0%; p<0.0001).
Methodological Strengths
- Large multicenter real-world dataset with mixed-effects modeling and targeted maximum likelihood estimation
- Temporal trend analysis across seven years and multiple institutions
Limitations
- Observational design with potential residual confounding and documentation bias in classifying RSI and agent choice
- Indication bias and unmeasured confounders (e.g., specific aspiration risk, provider preference) cannot be excluded
Future Directions: Prospective comparative effectiveness studies or pragmatic trials evaluating RSI drug choice with standardized co-interventions and patient-centered outcomes; explore interactions with reversal strategies and airway device use.
BACKGROUND: Rapid Sequence Induction (RSI) is commonly performed in the operating room to quickly secure the airway and minimize aspiration risk, especially in patients undergoing abdominal surgery. Current practice patterns of medications and RSI techniques used by anesthesiologists are not well-described. METHODS: This observational cohort study utilized the Multicenter Perioperative Outcomes Group database to evaluate RSI practices on adult patients undergoing abdominal surgery from 2015 to 2022. The primary aim was to describe modern RSI practices. We evaluated peri-induction medication use and intubation techniques. We hypothesized that over time, rocuronium would become the most utilized agent. Additionally, we investigated how the choice of neuromuscular blocking agent (NMB) affected outcomes using mixed-effects models and targeted maximum likelihood estimation. The primary endpoint was 30-day mortality. Secondary endpoints included post-induction hypoxia, pulmonary complications, and acute kidney injury (AKI). RESULTS: Across 13 institutions and 82,772 cases, 9,352 (11.3%) had a documented RSI. The most common NMB was succinylcholine (70.5%). However, the use of succinylcholine significantly decreased over the study period (85.4% of RSI cases in 2015; 37.3% in 2022, p < 0.0001), replaced by rocuronium. Patients usually received coadministration of multiple sedatives. Video laryngoscopy was more frequently used (16.2% of RSI vs 8.0% of non-RSI cases, p<0.0001). Rocuronium was not associated with a different risk of mortality (relative risk 0.85; 95% confidence interval 0.67 - 1.09), hypoxia (1.04; 0.61-1.77), pulmonary complications (0.93; 0.81-1.06), or AKI (1.05; 0.84-1.31) as compared to succinylcholine. CONCLUSION: Across institutions in the United States, rocuronium has been increasingly used for RSI, eventually overtaking succinylcholine. Rocuronium use was not associated with a different risk of mortality, hypoxia, pulmonary complications, or AKI.
3. Clinical efficacy of video double-lumen tube for one-lung ventilation in thoracic surgery: a meta-analysis of randomized controlled trials.
Across 18 randomized trials (n=1,332), video double-lumen tubes were associated with shorter intubation times, higher first-attempt success, lower MAP/HR after intubation, shorter repositioning time after dislodgement, and less sore throat than standard DLTs. However, extreme unexplained heterogeneity for intubation time limits confidence in that primary outcome.
Impact: Synthesizes randomized evidence on a widely used airway device innovation, informing equipment selection and training priorities in thoracic anesthesia.
Clinical Implications: VDLT may improve intubation efficiency and patient comfort (less sore throat) and facilitate rapid repositioning when displacement occurs. Adoption should consider operator training, device availability, and the current uncertainty from heterogeneous evidence.
Key Findings
- VDLT associated with shorter intubation time versus DLT, though with extreme, unexplained heterogeneity in pooled analyses.
- Higher first-attempt intubation success and reduced sore throat incidence with VDLT.
- Lower mean arterial pressure and heart rate after intubation, and shorter repositioning time after dislodgement with VDLT.
Methodological Strengths
- Meta-analysis restricted to randomized controlled trials with comprehensive database search and preregistration (PROSPERO)
- Sensitivity analyses and Egger’s test performed to assess robustness and publication bias
Limitations
- Extreme and unexplained heterogeneity for the primary outcome (intubation time) limits certainty
- Potential variability in operator experience, devices, and peri-intubation protocols across trials
Future Directions: Conduct standardized, multicenter international RCTs comparing VDLT and DLT with uniform operator training, protocols, and core outcome sets, including safety endpoints and cost-effectiveness.
BACKGROUND: Double-lumen tube (DLT) is generally regarded as the gold standard for one-lung ventilation during thoracic surgery. Compared with DLT, video double-lumen tube (VDLT) has an integrated camera, allowing continuous visualization of its position in the trachea. However, the clinical efficacy of VDLT for one-lung ventilation in thoracic surgery is unclear. This meta-analysis aims to evaluate the clinical efficacy of VDLT for one-lung ventilation in thoracic surgery. METHODS: The PubMed, EMBASE, Web of Science, the Cochrane Library, CNKI, WanFang, and CBM databases were searched for relevant studies from inception to July 2025. This meta-analysis used RevMan and Stata software to implement statistical analysis. The primary outcome was the intubation time. Sensitivity analysis and Egger's test were performed to evaluate the stability of the results and the publication bias. RESULTS: Eighteen studies involving 1,332 patients were included. For the primary outcome intubation time, extreme and unexplained between-study heterogeneity was observed (I CONCLUSION: Compared with the DLT, VDLT may provide modest clinical advantages of a shorter intubation time, higher first-attempt success rate, lower mean arterial pressure and heart rate after intubation, shorter repositioning time after dislodgement, and lower incidence of sore throat. However, the primary outcome of intubation time is limited by extreme between-study heterogeneity that could not be explained. Standardized multicenter international randomized trials are warranted to confirm the clinical efficacy of VDLT. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251138139, Identifier: CRD420251138139.