Daily Anesthesiology Research Analysis
Analyzed 86 papers and selected 3 impactful papers.
Summary
Analyzed 86 papers and selected 3 impactful articles.
Selected Articles
1. Comparison of intrathecal morphine, lateral quadratus lumborum block, and their combination for analgesia and quality of recovery after Caesarean delivery: a randomised, double-blind, two-centre clinical trial.
In a two-centre, double-blind RCT, lateral QLB did not demonstrate noninferiority to ITM for 24-hour QoR-40, but it lowered early resting pain versus ITM. Combining QLB with ITM further reduced early resting and coughing pain and worst pain at 24 hours without reducing opioid use; pruritus was more frequent but mild.
Impact: This trial directly informs obstetric anesthesia by quantifying the incremental benefit of adding a trunk block to intrathecal morphine. It highlights technique-specific trade-offs, guiding personalized multimodal analgesia after Caesarean delivery.
Clinical Implications: ITM remains a robust standard for Caesarean analgesia. Adding lateral QLB can improve early pain metrics, especially when minimizing early breakthrough pain is prioritized or when ITM dose must be limited; however, routine addition may not improve global recovery or reduce opioids.
Key Findings
- Noninferiority of QLB vs ITM for 24-hour QoR-40 was inconclusive.
- QLB lowered 6-hour resting pain vs ITM; ITM+QLB further reduced 6-hour resting and coughing pain and worst pain at 24 hours vs ITM alone.
- Opioid consumption and nausea/vomiting were similar across groups; pruritus was more frequent with QLB-containing regimens but was mild.
Methodological Strengths
- Randomized, double-blind, placebo-controlled design across two centers
- Pre-registered trial with prespecified primary endpoint (QoR-40) and adjusted alpha for three-group comparisons
Limitations
- Modest sample size (n=58) may limit power for patient-centered outcomes and safety events
- Short follow-up focused on 24-hour outcomes; generalizability beyond included regimens/doses is uncertain
Future Directions: Larger multicenter RCTs should assess longer-term recovery trajectories, functional outcomes, breastfeeding/newborn endpoints, and cost-effectiveness of adding QLB to ITM.
BACKGROUND: Lateral quadratus lumborum block (QLB) is a potential alternative to intrathecal morphine (ITM) for analgesia after Caesarean delivery. We compared quality of recovery (QoR) and analgesia with lateral QLB, ITM, or ITM+QLB. METHODS: In this randomised, double-blind, placebo-controlled trial, women undergoing Caesarean delivery under spinal anaesthesia were allocated to (1) bilateral lateral QLB with 20 ml 0.5% ropivacaine; (2) 100 μg preservative-free ITM with sham QLB; or (3) ITM+QLB. The primary outcome was the QoR-40 score at 24 h. Secondary outcomes included pain scores, opioid consumption, and adverse effects. Given three-group comparisons, statistical significance was set at P<0.017. RESULTS: Fifty-eight women were analysed. Noninferiority testing for QoR-40 at 24 h between ITM and QLB was inconclusive (mean difference -0.9; 90% confidence interval [CI] -0.9 to 13.5). QLB reduced the resting pain score at 6 h compared with ITM (mean difference 2.9 [95% CI 1.3, 4.5]; P<0.001). Compared with ITM alone, ITM+QLB reduced the resting pain at 6 h (mean difference 3.3 [1.9, 4.8]; P<0.001), coughing pain at 6 h (3.0 [1.4, 4.7]; P<0.001), and worst pain at 24 h (1.8 [0.6, 3.1]; P=0.006). Oxycodone consumption and nausea or vomiting did not differ between groups. Pruritus was more frequent with QLB and ITM+QLB compared with ITM alone but was predominantly mild. CONCLUSIONS: Noninferiority of QLB vs ITM for QoR-40 at 24 h was inconclusive. However, QLB reduced early resting pain vs ITM, whereas ITM+QLB further reduced early resting and coughing pain and worst pain at 24 h vs ITM alone. Larger trials are needed to confirm these findings. CLINICAL TRIAL REGISTRATION: NCT02871713 (https://clinicaltrials.gov/study/NCT02871713).
2. Evaluating the effectiveness of bilateral erector spinae plane blocks in addition to standard multimodal analgesia at reducing opioid consumption in patients undergoing elective mammoplasty in an ambulatory surgical center: a randomized clinical trial.
In ambulatory mammoplasty, adding bilateral ESP blocks reduced PACU opioid use and shortened discharge time but did not achieve a clinically meaningful reduction in 24-hour opioid consumption or pain scores. Safety-related advantages may support selective use.
Impact: This negative-yet-informative RCT challenges assumptions about routine ESP block use for opioid sparing in ambulatory breast surgery, emphasizing the importance of meaningful clinical endpoints beyond statistical significance.
Clinical Implications: ESP blocks may be reserved for patients in whom reduced PACU opioid exposure or faster discharge is prioritized, rather than for broad opioid-sparing in the first 24 hours. Shared decision-making should weigh workflow benefits against procedural time and resources.
Key Findings
- 24-hour oral morphine equivalent consumption was statistically lower with ESP but not clinically meaningful (10.6 vs 17.5 MME).
- ESP reduced PACU opioid administration (59% vs 86.8% requiring opioids) and shortened time from PACU admission to discharge (170 vs 213 minutes).
- No significant differences in pain at discharge, 24-hour pain scores, PONV in PACU, or overall anesthesia satisfaction.
Methodological Strengths
- Randomized clinical trial design with standardized bilateral ultrasound-guided ESP technique at T4
- Relevant pragmatic endpoints including PACU opioid use and time to discharge
Limitations
- Blinding not specified; potential performance/detection bias
- Single procedure type (reduction mammoplasty) and short follow-up limit generalizability
Future Directions: Evaluate patient subgroups (e.g., high PONV risk, opioid-intolerant) and combinations with other blocks; assess cost-effectiveness and recovery milestones beyond 24 hours.
BACKGROUND: The paravertebral block is considered the gold standard for regional anesthesia in breast surgery; however, it carries an elevated risk of pneumothorax. The erector spinae plane (ESP) block is thought to be safer. We sought to evaluate outcomes following breast reduction mammoplasty in patients treated with ESP block plus standard analgesia versus standard analgesia alone. METHODS: 78 patients were randomized to either the ESP block group or the standard analgesia group. Participants in the block group received bilateral ultrasound-guided ESP blocks with 30 mL of 0.25% ropivacaine per side at the T4 level. RESULTS: The block group reported a clinically insignificant reduction in the mean cumulative dose of oral morphine milligram equivalents used in the 24 hours postsurgery when compared with the no-block group (10.6 vs 17.5; p=0.014). Patients who received a block were discharged a mean of 170 min after post-anesthesia care unit (PACU) admission compared with the no-block group of 213 min (p=0.012). Nausea and vomiting in PACU, pain at discharge, 24-hour pain scores, and overall anesthesia satisfaction scores were not significantly different between the groups. Any opioid use during the PACU stay was significantly less in the block group, with only 59% of patients in the block group requiring opioids versus 86.8% in the no-block group (p=0.006). CONCLUSION: An ESP block prior to breast reduction mammoplasty did not translate to a clinically meaningful reduction in opioid usage in the immediate postoperative period. TRIAL REGISTRATION NUMBER: NCT03954249.
3. Pericapsular Nerve Group Block Versus Femoral Nerve Block for Analgesia in Newly Admitted Patients With Hip Fractures: A Randomized Controlled Trial.
Among hip-fracture patients, PENG block provided superior early analgesia and faster sonographic targeting than FNB but had a shorter duration, resulting in earlier and greater rescue analgesic use over 24 hours. Procedural time, vital signs, and recovery quality were similar.
Impact: This pragmatic RCT clarifies the time-profile trade-off between PENG and FNB, informing block selection that balances rapid preoperative pain relief against duration needs in frail, often delirium-prone patients.
Clinical Implications: Select PENG when rapid early analgesia and expedited imaging are priorities (e.g., transfers, positioning), but plan supplemental analgesia or transition strategies due to shorter duration. FNB may be preferable when longer-lasting analgesia is needed before surgery.
Key Findings
- At 30 minutes post-block, PENG achieved lower resting and passive movement VAS than FNB.
- At 12 hours, PENG had higher resting and movement VAS than FNB, indicating shorter duration.
- PENG enabled faster optimal ultrasound imaging but required earlier and greater 24-hour rescue analgesia; procedural time and recovery quality did not differ.
Methodological Strengths
- Randomized controlled design with clearly defined primary and secondary endpoints
- Standardized ultrasound-guided techniques and consistent perioperative assessments
Limitations
- Single-center, modest sample size limits precision and external validity
- Blinding not reported; analgesic consumption assessed over only 24 hours
Future Directions: Head-to-head trials incorporating functional outcomes (mobility, delirium), motor-sparing assessments, and multimodal pathways could refine block choice across hip-fracture phenotypes.
OBJECTIVES: To compare the effects of preoperative pericapsular nerve group (PENG) block versus femoral nerve block (FNB) on pain in patients with hip fractures. METHODS: Sixty eligible patients were randomized (1:1) to receive PENG block or FNB. The primary endpoint was post-block pain assessed via Visual Analogue Scale (VAS). Secondary endpoints included time to optimal ultrasound imaging, procedure duration, time to first rescue analgesic, 24-hour rescue analgesic consumption, postoperative recovery quality, vital signs, and adverse events. RESULTS: At 30 minutes post-block, both resting VAS scores (0.0 [0.0, 1.2] vs. 1.1 [0.6, 1.8], P=0.020) and passive movement VAS scores (2.9 [1.7, 3.6] vs. 3.4 [2.7, 4.7], P=0.027) were significantly lower in the PENG group compared with the FNB group. At 12 hours post-block, resting VAS (3.0 [2.1, 4.0] vs. 2.3 [1.7, 2.6], P=0.006) and passive movement VAS (6.8 [5.1, 7.3] vs. 4.9 [4.1, 5.8], P=0.002) were higher in the PENG group. The PENG group achieved optimal ultrasound imaging faster, had an earlier time to first rescue analgesic, and required a greater total dose of rescue analgesics within 24 hours (all P <0.001). Procedure duration, vital signs, and recovery quality did not differ significantly. DISCUSSION: PENG blocks outperform FNB in imaging speed and early pain control but yield a shorter block duration, thereby increasing 24-hour rescue analgesic demands.