Daily ReportOct 24, 2026
Anesthesiology, October 24 edition
We read 5 papers and selected 3.
Summary
The strongest paper was a randomized, double-blind, placebo-controlled trial showing that repetitive perimenstrual greater occipital nerve blockade may reduce menstrual migraine severity, frequency, duration, and disability, although blinding and retrospective baseline assessment limit certainty. A large retrospective gynecologic cohort found shorter hospitalization and fewer transfusions after single-port robotic surgery, while two cases highlighted imaging-guided esophageal decompression to reduce regurgitation risk during anesthesia.
Research Themes
- Interventional regional anesthesia for menstrual migraine
- Comparative outcomes and resource utilization in robotic gynecologic surgery
- Perioperative aspiration-risk assessment in esophageal dilatation
Selected Articles
1. Perimenstrual repetitive greater occipital nerve blockade for menstrual migraine: a randomized, double-blind, placebo-controlled trial.
In 48 patients with menstrual migraine, repetitive perimenstrual greater occipital nerve blockade with 0.5% bupivacaine produced substantially greater improvement than saline in pain intensity at 3 months. Attack frequency, duration, headache days, analgesic use, and MIDAS disability scores also improved, with benefits reported at 6 months and only transient injection-site tenderness observed.
Impact: This is the only randomized controlled trial among the submissions and directly evaluates a procedure that could provide a non-systemic preventive option for menstrual migraine. Its findings are clinically promising, while the small sample and imperfect blinding require confirmation.
Clinical Implications: Repetitive perimenstrual greater occipital nerve blockade may be considered as an investigational short-term preventive strategy for patients with menstrual migraine, particularly when conventional preventive treatments are ineffective or poorly tolerated. It should not yet replace established therapies because the trial was small, retrospectively registered, and vulnerable to placebo and natural-history effects.
Key Findings
- The active group had a greater reduction in VAS pain score at month 3 than the placebo group, decreasing from 8.75 ± 0.67 to 3.80 ± 3.18 versus 8.71 ± 1.04 to 7.16 ± 1.31; p < 0.001.
- Monthly attack frequency, attack duration, headache days, MIDAS scores, and analgesic use were significantly reduced in the active group.
- Clinical improvements were maintained at month 6, and mild transient injection-site tenderness was the only reported adverse effect.
Methodological Strengths
- Randomized, double-blind, placebo-controlled design with prospectively collected post-treatment headache diaries.
- Assessment included clinically relevant primary and secondary outcomes, including disability and analgesic use.
Limitations
- Only 48 patients were enrolled, limiting statistical precision and generalizability.
- Baseline data were retrospectively recalled, the primary endpoint was subjective, and imperfect blinding or late placebo responses cannot be excluded.
- The trial was retrospectively registered, and secondary outcomes were exploratory.
Future Directions: Larger prospectively registered trials should use validated electronic headache diaries, objective blinding assessments, standardized injection protocols, and comparison with established preventive therapies. Studies should also determine the optimal timing, dose, duration, and cost-effectiveness of repeated blockade.
BACKGROUND: The main purpose of this study is to demonstrate the decrease in headache severity, pain duration and the number of painful days in a month after repetitive GON blockade applied with local anesthetic in menstrual migraine patients compared to the placebo group. METHODS: This randomized, double-blind, placebo-controlled study included 48 menstrual migraine patients. 24 patients received medication (0.5% bupivacaine) and 24 received placebo (saline) GON blockade twice a month for three months. Baseline data (month 0) relied on retrospective recall, whereas post-treatment data (months 3 and 6) were collected prospectively using a paper-based headache diary.
2. Clinical outcomes and hospital-based cost avoidance of single-port robotic surgery in gynecology: a large comparative cohort study.
In 8,243 consecutive gynecologic minimally invasive procedures, single-port robotic surgery was associated with shorter total and postoperative hospitalization and a lower transfusion rate than conventional laparoscopy. Operative and anesthesia times were approximately 8 minutes longer, while major complications, mortality, and 30-day readmission were similar; estimated hospital-based cost avoidance was US$171,469 across 2,134 robotic procedures.
Impact: The large real-world cohort evaluates both patient outcomes and hospital resource use, addressing an important gap in evidence for single-port robotic gynecologic surgery. The findings support prospective comparative studies but cannot establish causal superiority because treatment allocation was nonrandomized.
Clinical Implications: Single-port robotic surgery may be a reasonable option in selected gynecologic patients when shorter hospitalization and reduced transfusion risk are priorities. Decisions should also account for procedure-specific complexity, equipment costs, surgeon experience, and potential selection bias, because the observed cost avoidance was driven mainly by shorter length of stay rather than a reduction in major complications.
Key Findings
- Total hospitalization was shorter with robotic surgery than laparoscopy, 2.54 versus 3.18 days, p < 0.001.
- Postoperative hospitalization was shorter, 2.38 versus 2.90 days, p < 0.001, and transfusion was less frequent, 0.6% versus 2.5%, p < 0.001.
- Across 2,134 robotic procedures, estimated hospital-based cost avoidance was US$171,469, or US$80.4 per patient, with more than 84% attributable to reduced length of stay.
Methodological Strengths
- Large consecutive real-world cohort of 8,243 patients with direct comparison between conventional laparoscopy and robotic surgery.
- Evaluation included clinical outcomes, perioperative variables, readmission, and hospital-based economic consequences.
Limitations
- The retrospective, nonrandomized design permits confounding by indication and differences in patient selection, disease complexity, and surgeon expertise.
- Cost avoidance was hospital-based and may not represent total societal costs, acquisition costs, or patient-incurred expenses.
- The study was conducted at a single institution, limiting external generalizability.
Future Directions: Prospective multicenter comparative studies should adjust for procedure type, disease severity, patient risk, surgeon experience, and institutional learning curves. Full economic evaluations should include capital costs, maintenance, operating-room efficiency, patient costs, and quality-adjusted outcomes.
Single-port robotic surgery is increasingly used in gynecologic practice, yet large-scale comparative data describing both postoperative outcomes and the downstream use of hospital resources remain limited. In this study, we aimed to investigate postoperative outcomes and hospital-based economic analysis in single-port robotic surgery and laparoscopic surgery through a large-scale retrospective analysis. We retrospectively evaluated 8,243 consecutive patients who underwent minimally invasive surgery for benign or malignant gynecologic disease at Keimyung University Dongsan Hospital from April 2019 through December 2024. Conventional laparoscopy was performed in 6,109 patients and robotic-assisted surgery using the da Vinci Xi single-site or da Vinci SP platform in 2,134.
3. Case Report: Beyond the stomach: the role of preoperative imaging in assessing regurgitation risk in patients with esophageal dilatation: a report of two cases.
Two cases demonstrate that prolonged fasting and rapid sequence induction may not adequately protect patients with a dilated esophagus from regurgitation. Computed tomography and barium swallow imaging identified clinically relevant proximal esophageal pooling, and targeted conscious endoscopic evacuation enabled uneventful anesthesia and peroral endoscopic myotomy in a patient with achalasia.
Impact: The report identifies an underrecognized anatomical source of aspiration risk that is not reliably assessed by standard gastric ultrasound or fasting history. It proposes a practical, imaging-informed strategy for selected high-risk patients, although evidence remains limited to two cases.
Clinical Implications: In patients with achalasia, megaesophagus, esophageal obstruction, or marked esophageal dilatation, anesthesiologists should consider preoperative cross-sectional or contrast imaging when clinically indicated and plan airway protection accordingly. Targeted pre-induction endoscopic decompression may be useful in selected patients, but it requires multidisciplinary planning and cannot yet be considered routine care.
Key Findings
- A 68-year-old man with esophageal carcinoma had massive white-foam regurgitation during rapid sequence induction despite five days of preoperative fasting.
- A 42-year-old woman with achalasia and marked esophageal dilatation underwent pre-anesthetic conscious endoscopic suctioning guided by computed tomography and barium swallow findings.
- The targeted decompression strategy was followed by uneventful induction and peroral endoscopic myotomy, illustrating a potential approach for selected high-risk patients.
Methodological Strengths
- The cases contrast an unexpected regurgitation event with a proactively managed patient, clarifying the clinical decision point.
- Integration of computed tomography, barium swallow imaging, airway management, and endoscopic decompression provides a coherent perioperative safety framework.
Limitations
- Evidence is limited to two cases without a comparator group, so effectiveness and safety cannot be estimated.
- The report does not define standardized imaging thresholds or objective criteria for selecting patients for endoscopic decompression.
- Findings may not generalize across different causes or degrees of esophageal dilatation.
Future Directions: Prospective multicenter studies should evaluate the incidence of esophageal pooling, compare imaging modalities, establish risk-stratification criteria, and assess whether pre-induction decompression reduces regurgitation and aspiration. Studies should also define procedural risks, required expertise, timing, and resource implications.
BACKGROUND: Perioperative regurgitation of gastric or esophageal contents remains a severe complication during anesthesia. While standard fasting protocols and rapid sequence induction (RSI) are routinely employed, esophageal dilatation creates a hidden reservoir for retained food and secretions that conventional methods often fail to mitigate. Furthermore, standard gastric ultrasound lacks the field of view to detect mid-to-proximal esophageal pooling. CASE PRESENTATION: We present two parallel cases emphasizing this critical challenge. Case 1 involves a 68-year-old male with esophageal carcinoma who experienced massive regurgitation of white foam during RSI, despite five days of preoperative fasting. Airway security was ultimately achieved after intensified suctioning. Case 2 describes a 42-year-old female with achalasia and marked esophageal dilatation. Informed by preoperative computed tomography (CT) and barium swallow imaging, she was safely managed using targeted pre-anesthetic conscious endoscopic suctioning, leading to an uneventful induction and peroral endoscopic myotomy (POEM).