Daily ReportOct 12, 2026
Anesthesiology, October 12 edition
We read 28 papers and selected 3.
Summary
Today’s strongest evidence supports erector spinae plane block as an opioid-sparing component of analgesia after coronary artery bypass grafting, with meta-analytic evidence of reduced opioid use, pain, extubation time, and intensive care unit stay. Two observational studies provide clinically relevant risk-stratification insights: a three-point venous congestion score plus TAPSE identified patients at increased risk after mitral valve surgery, while excessive intraoperative diastolic blood pressure reduction was associated with postoperative hematoma after anterior cervical discectomy and fusion.
Research Themes
- Opioid-sparing regional anesthesia and enhanced recovery after cardiac surgery
- Preoperative hemodynamic risk stratification
- Blood pressure management and prevention of postoperative complications
Selected Articles
1. Impact of Erector Spinae Block on Postoperative Analgesia and Hospital Recovery in Coronary Artery Bypass Surgery: A Systematic Review with Meta-analysis, Meta-Regression, and Sequential Trial Analysis.
This systematic review and meta-analysis included 12 studies involving 704 CABG patients. ESPB reduced 24-hour morphine milligram equivalent consumption by 19.05 mg and 48-hour consumption by 19.42 mg, while also reducing early pain, extubation time by 2.50 hours, and ICU stay by 12.55 hours. Trial sequential analysis supported the robustness of the opioid-sparing and early recovery findings.
Impact: The study provides an integrated assessment of analgesic efficacy and recovery outcomes using meta-regression, trial sequential analysis, and GRADE certainty ratings. Its findings support ESPB as a potentially important component of opioid-sparing enhanced recovery pathways after CABG.
Clinical Implications: ESPB may be considered as part of multimodal analgesia and enhanced recovery protocols after CABG, particularly when reducing perioperative opioid exposure and facilitating early extubation are priorities. Technique selection, continuous versus single-shot administration, and operator training still require standardization.
Key Findings
- Twelve studies involving 704 patients were included.
- ESPB reduced 24-hour morphine milligram equivalent consumption by 19.05 mg and 48-hour consumption by 19.42 mg.
- ESPB reduced pain scores, extubation time by 2.50 hours, and ICU stay by 12.55 hours.
Methodological Strengths
- Random-effects meta-analysis incorporated evidence from multiple comparative studies.
- Meta-regression, trial sequential analysis, and GRADE assessment evaluated heterogeneity, robustness, and certainty.
Limitations
- The analysis included only 12 studies and 704 patients, limiting precision for less frequently reported outcomes.
- The optimal block technique, local anesthetic regimen, and role of continuous catheter techniques remain uncertain.
Future Directions: Large, multicenter randomized trials should compare standardized single-shot and continuous ESPB protocols, evaluate adverse events and functional recovery, and determine whether opioid reduction translates into shorter hospitalization and improved patient-centered outcomes.
The erector spinae plane block (ESPB) is a promising regional technique for cardiac surgery. We evaluated the efficacy of ESPB regarding analgesia and in-hospital outcomes in patients undergoing coronary artery bypass grafting (CABG). We conducted a systematic review and meta-analysis comparing ESPB versus control in adults undergoing CABG (CRD42025645045). Primary outcomes were opioid consumption (24 h/48 h) and pain intensity. Secondary outcomes included extubation time and intensive care unit (ICU) length of stay. Data were pooled using random-effects models. Meta-regression and trial sequential analysis (TSA) were used to assess sources of heterogeneity and robustness, respectively, while the Grading of Recommendations, Assessment, Development, and Evaluations framework provided the certainty of the evidence for each outcome. Twelve studies (704 patients) were analyzed.
2. Three-Point Bedside Congestion Score (IJV Collapsibility + IVC Collapsibility + Central Venous Pressure) in Elective Mitral Valve Surgery: A Prospective Observational Study.
In this prospective single-center study of 100 adults undergoing elective mitral valve surgery, a three-point congestion score combined internal jugular vein collapsibility, inferior vena cava collapsibility, and central venous pressure. Patients with the maximum score had higher vasoactive-inotropic requirements, longer ventilation and ICU stays, and higher rates of acute kidney injury and mortality. Combining the score with TAPSE produced moderate discrimination for acute kidney injury and mortality, with AUCs of 0.77 and 0.782, respectively.
Impact: The paper proposes a simple, rapidly obtainable bedside tool that integrates venous congestion and right-ventricular function before mitral valve surgery. It offers a clinically practical hypothesis for perioperative risk stratification while appropriately emphasizing the need for external validation.
Clinical Implications: The score may help identify patients who need intensified hemodynamic monitoring, optimization of venous congestion, and renal-protective perioperative planning. It should not yet be used as a definitive decision rule because the study was single-center and lacked external validation.
Key Findings
- Patients with a congestion score of 3 had higher postoperative vasoactive-inotropic scores, longer ventilation, and longer ICU and hospital stays.
- Acute kidney injury occurred in 40% of high-score patients versus 20% of low-score patients; mortality was 10% versus 2%.
- The combined congestion score plus TAPSE model had an AUC of 0.77 for acute kidney injury and 0.782 for mortality.
Methodological Strengths
- The study prospectively enrolled consecutive patients and used predefined bedside ultrasound and hemodynamic thresholds.
- The analysis included cross-validated discrimination, calibration assessment, and decision curve analysis.
Limitations
- The sample size was 100 patients from a single center, and the score was not externally validated.
- Patients were dichotomized because the observed score distribution was concentrated at 0 to 2 and 3, which may reduce information contained in the original scale.
Future Directions: Multicenter prospective validation should assess calibration across different surgical populations and determine whether score-guided interventions, such as targeted decongestion or intensified renal protection, improve clinical outcomes.
Systemic venous congestion and right-ventricular (RV) dysfunction are key drivers of postoperative hemodynamic instability, prolonged ventilation, and acute kidney injury (AKI) after mitral valve surgery. Comprehensive echocardiography is informative but may be impractical in high-throughput pre-anesthesia workflows. We evaluated a pragmatic three-point bedside congestion score combining internal jugular vein (IJV) collapsibility, inferior vena cava (IVC) collapsibility, and invasively measured central venous pressure (CVP) for preoperative risk stratification. In this prospective, observational, single-center study, 100 consecutive adults undergoing elective mitral valve surgery for mitral stenosis were enrolled.
3. Excessive intraoperative diastolic blood pressure decrease during anesthesia lead to a higher risk of postoperative hematoma following anterior cervical discectomy and fusion (ACDF): a single-center study of 10,615 patients.
This single-center study examined 10,615 ACDF procedures and identified 26 postoperative hematomas. The hematoma group had higher preoperative diastolic blood pressure and a greater intraoperative diastolic blood pressure decrease; multivariable analysis identified the decrease as an independent risk factor. A decrease threshold of 19.5 mmHg yielded an area under the curve of 0.695, providing a clinically testable hypothesis for intraoperative blood pressure management.
Impact: The study challenges the assumption that lower intraoperative blood pressure is uniformly beneficial for reducing bleeding during ACDF. Its large surgical cohort and clinically interpretable threshold generate a practical hypothesis for avoiding excessive diastolic hypotension, although causality is not established.
Clinical Implications: Anesthesiologists and spine surgeons may consider avoiding excessive intraoperative diastolic blood pressure reduction, particularly in patients with elevated baseline blood pressure. The 19.5-mmHg threshold should be viewed as hypothesis-generating rather than a validated treatment target.
Key Findings
- Among 10,615 ACDF procedures, 26 patients developed postoperative hematoma, an incidence of 0.24%.
- Greater intraoperative diastolic blood pressure decrease was independently associated with postoperative hematoma.
- A diastolic blood pressure decrease cut-off of 19.5 mmHg had an area under the curve of 0.695.
Methodological Strengths
- The study used a large consecutive surgical cohort with three time-matched controls for each hematoma case.
- Multivariable analysis incorporated demographic, clinical, surgical, coagulation, and perioperative blood pressure variables.
Limitations
- The retrospective single-center design is vulnerable to residual confounding and selection bias.
- Postoperative hematoma was rare, with only 26 events, and the proposed blood pressure threshold was not externally validated.
Future Directions: Prospective multicenter studies should evaluate individualized diastolic blood pressure targets, account for baseline hypertension and surgical complexity, and test whether avoiding excessive diastolic hypotension reduces postoperative hematoma without increasing blood loss or other complications.
Postoperative hematoma (PH) after anterior cervical discectomy and fusion (ACDF) is a serious complication that requires urgent intervention. Many surgeons prefer maintaining relatively low blood pressure during surgery to minimize blood loss; however, the effect of this practice on the risk of PH remains unclear. This study aims to investigate how perioperative blood pressure management influences the risk of PH following ACDF. We reviewed consecutive patients who underwent ACDF at a single institution from January 2010 to December 2021. Patients who developed postoperative hematoma (PH) were classified as the hematoma group. For each PH patient, three control subjects who underwent same surgery within the adjacent month were randomly selected, forming a control group.