Daily ReportNov 5, 2026
Anesthesiology, November 5 edition
We read 47 papers and selected 3.
Summary
Today’s most impactful anesthesiology studies included a randomized trial showing that pneumatic leg compression reduced post-induction hypotension in severe traumatic brain injury, a large multicenter trial finding that paravertebral blockade did not prevent chronic post-thoracotomy pain compared with thoracic epidural, and a randomized trial reporting improved early recovery with oliceridine versus sufentanil after gynecologic laparoscopic surgery. Together, these studies provide clinically actionable evidence while also clarifying where established assumptions are not supported.
Research Themes
- Peri-induction hemodynamic optimization in neurotrauma
- Comparative regional anesthesia for thoracic surgery and chronic pain prevention
- Opioid-sparing and patient-centered postoperative recovery
Selected Articles
1. Thoracic epidural versus paravertebral blockade for reducing chronic post-thoracotomy pain (TOPIC-2): open label, parallel group, superiority, multicentre, randomised controlled trial.
Among 737 patients in the modified intention-to-treat population, chronic post-thoracotomy pain at six months occurred in 22% with paravertebral blockade and 16% with thoracic epidural; the difference was not statistically significant. Epidural analgesia provided slightly better day-1 acute pain control, whereas paravertebral blockade caused less hypotension and pruritus but more urinary retention.
Impact: This large, multicenter randomized trial directly tests a widely held assumption that paravertebral blockade may prevent chronic post-thoracotomy pain better than thoracic epidural. Its neutral primary result is clinically important because it supports individualized selection of either technique rather than routine replacement of epidural analgesia.
Clinical Implications: Both thoracic epidural and paravertebral blockade remain reasonable analgesic strategies for thoracotomy. Epidural may be favored when maximal day-1 analgesia is prioritized, whereas paravertebral blockade may be attractive when reducing hypotension and pruritus is important, with attention to urinary retention.
Key Findings
- At six months, chronic post-thoracotomy pain was 22% after paravertebral blockade versus 16% after thoracic epidural, with no significant difference.
- Paravertebral blockade produced higher day-1 worst and average pain scores than epidural analgesia.
- Paravertebral blockade reduced hypotension and pruritus but increased urinary retention.
Methodological Strengths
- Large multicenter randomized trial conducted across 15 thoracic centers.
- The study assessed both chronic pain at six months and early analgesic efficacy and complications.
Limitations
- The trial was open label, allowing performance and assessment biases.
- Only 564 of 737 modified intention-to-treat participants contributed six-month pain data, creating potential attrition bias.
Future Directions: Future research should examine patient-centered selection criteria, procedure-specific effects, longer-term neuropathic pain outcomes, and enhanced recovery pathways combining regional anesthesia with multimodal analgesia.
OBJECTIVES: To evaluate the effectiveness of paravertebral blockade versus thoracic epidural during the perioperative period in reducing chronic post-thoracotomy pain. DESIGN: Open label, parallel group, superiority, multicentre, randomised controlled trial. SETTING: 15 thoracic centres in the UK. PARTICIPANTS: Adult patients undergoing thoracotomy randomised (1:1) to either paravertebral blockade or thoracic epidural using a web based service between January 2019 and September 2023. INTERVENTIONS: Participants in the paravertebral group received three single-shot paravertebral injections of local anaesthetic before incision followed by placement of a paravertebral catheter. Participants in the epidural group had a thoracic epidural catheter placed and loaded with local anaesthetic before incision.
2. Effect of pneumatic leg compression on post-induction hypotension in adult patients with isolated traumatic brain injury undergoing decompressive craniotomy: a randomised, double-blind, controlled trial.
In 89 analyzed patients, post-induction hypotension occurred in 33.3% with active pneumatic compression versus 59.1% with inactive compression (risk ratio 0.56; P=0.015). Active compression also reduced mephentermine and phenylephrine use, increased early time-weighted systolic blood pressure, and caused no device-related complications.
Impact: This is a prospective, randomized, double-blind trial addressing a high-risk and immediately modifiable anesthetic problem in severe neurotrauma. It evaluates a low-cost, widely deployable intervention that may protect cerebral perfusion during induction, although neurological benefit remains unproven.
Clinical Implications: Pre-induction pneumatic leg compression may be considered as an adjunct to reduce early hypotension and vasopressor requirements during decompressive craniotomy for severe traumatic brain injury. It should complement, not replace, careful induction, arterial pressure monitoring, and established cerebral perfusion strategies.
Key Findings
- Post-induction hypotension occurred in 33.3% of the pneumatic compression group versus 59.1% of the control group.
- Pneumatic compression reduced mephentermine use from 40.9% to 15.9% and phenylephrine use from 36.4% to 8.9%.
- No device-related complications were observed through 72 hours, but cerebral perfusion and neurological outcomes were not directly measured.
Methodological Strengths
- Prospective randomized double-blind controlled design with modified intention-to-treat analysis.
- Clinically relevant primary outcome with prespecified hemodynamic and safety outcomes.
Limitations
- The study was single-center with a small sample of 89 analyzed patients.
- The primary effect was hemodynamic; improvement in cerebral perfusion, neurological recovery, or mortality was not established.
Future Directions: Larger multicenter trials should evaluate cerebral oxygenation, intracranial pressure, neurological outcomes, and mortality, while comparing compression protocols and identifying patients most likely to benefit.
BACKGROUND: Post-induction hypotension is common after induction of general anaesthesia, and in traumatic brain injury even a brief fall in systemic pressure can compromise cerebral perfusion when autoregulation is already impaired. Pneumatic leg compression augments venous return and has reduced post-induction hypotension in obstetric and urological surgery, but has not been examined in neurotrauma patients undergoing decompressive craniotomy. METHODS: In this prospective, randomised, double-blind trial, adults aged 18-65 years with isolated traumatic brain injury and radiological features of severity (midline shift ≥5 mm with basal cistern effacement) undergoing decompressive craniotomy were allocated 1:1 to a pneumatic compression device activated before induction (Group PC) or an identical device left inactive (Group NC).
3. Impacts of Oliceridine versus Sufentanil on the Quality of Postoperative Recovery in Elective Gynecological Laparoscopic Surgery: A Randomized Controlled Trial.
In 136 relatively young patients undergoing gynecologic laparoscopic surgery, oliceridine-based patient-controlled intravenous analgesia produced a 11.94-point higher postoperative day-1 Quality of Recovery-15 score than sufentanil, exceeding the reported minimal clinically important difference. Oliceridine was also associated with improved early gastrointestinal and mobilization recovery, shorter hospitalization, and fewer opioid-related adverse events.
Impact: The trial evaluates recovery quality rather than analgesic intensity alone and reports a treatment difference exceeding the minimal clinically important difference. It supports further investigation of pathway-selective opioid agonism as a strategy to improve functional recovery, although generalizability remains limited.
Clinical Implications: Oliceridine may be considered as an alternative to sufentanil for patient-controlled intravenous analgesia in selected patients undergoing gynecologic laparoscopic surgery, particularly when early recovery and opioid-related adverse effects are priorities. Cost, availability, respiratory safety, and confirmation in broader populations should be considered before routine adoption.
Key Findings
- The adjusted postoperative day-1 QoR-15 score was 11.94 points higher with oliceridine than with sufentanil.
- Oliceridine improved time to first flatus, time to first ambulation, hospital stay, and recovery scores on postoperative days 2 and 3.
- The oliceridine group had fewer opioid-related adverse events in this single-center population.
Methodological Strengths
- Randomized controlled design with a prespecified patient-centered primary outcome.
- Primary analysis used intention-to-treat principles with multiple imputation and adjusted for baseline recovery score.
Limitations
- The study was single-center and enrolled relatively young, healthy female patients undergoing one surgical category.
- The abstract does not establish comparative long-term safety, cost-effectiveness, or superiority in high-risk patients.
Future Directions: Multicenter pragmatic trials should compare oliceridine with commonly used opioids across diverse surgeries and risk groups, incorporating respiratory depression, delirium, cost-effectiveness, persistent opioid use, and functional recovery as outcomes.
BACKGROUND: Oliceridine is a novel μ-opioid receptor agonist selectively activating the G protein signaling pathway. This study aimed to explore the influences of patient-controlled intravenous analgesia (PCIA) employing oliceridine and sufentanil on the postoperative recovery of patients undergoing elective laparoscopic gynecological surgery. METHODS: This study included 136 patients aged 18-65 years who were randomized to receive elective gynecological laparoscopic surgery under general anaesthesia with administering PCIA with oliceridine or sufentanil. The primary outcome was the Quality of Recovery - 15 (QoR-15) score on postoperative day 1 (POD 1). Secondary outcome measures comprised: the overall benefit of analgesic score (OBAS) on POD 1; time to first flatus; time to first ambulation; postoperative hospital stay; QoR-15 score on POD 2 and 3; PCIA total injected drugs; the number of patients requiring rescue analgesia and rescue antiemetics; VAS scores from T1 to T6, and MOAA/S scores from T1 to T5;