Anesthesiology Research Analysis
November’s anesthesiology literature emphasized biomarker-guided perioperative risk, highlighted by mechanistic evidence that suPAR directly drives kidney-specific vasoconstriction. Comparative regional anesthesia studies advanced patient-centered recovery, including a high-quality RCT supporting ESPB as a practical alternative to paravertebral block and a large pragmatic cluster-RCT showing no benefit of routine PECS I addition in mastectomy. Diagnostic stewardship gained momentum with device-s
Summary
November’s anesthesiology literature emphasized biomarker-guided perioperative risk, highlighted by mechanistic evidence that suPAR directly drives kidney-specific vasoconstriction. Comparative regional anesthesia studies advanced patient-centered recovery, including a high-quality RCT supporting ESPB as a practical alternative to paravertebral block and a large pragmatic cluster-RCT showing no benefit of routine PECS I addition in mastectomy. Diagnostic stewardship gained momentum with device-specific viscoelastic testing thresholds (ClotPro) and integration of routine biomarkers into perioperative workflows. System-level stewardship and survivorship research (e.g., opioid persistence after ICU discharge) emerged as actionable priorities.
Selected Articles
1. Soluble urokinase receptor is a kidney-specific vasoconstrictor.
A translational program across human cohorts and multi-species models shows suPAR directly induces renal vasoconstriction, reduces renal blood flow and glomerular perfusion, and associates with lower baseline eGFR—linking innate immunity to perioperative AKI risk.
Impact: Provides causal, cross-species evidence that an immune-derived soluble mediator alters renal hemodynamics, reframing perioperative AKI beyond tubular injury and opening biomarker-guided prevention.
Clinical Implications: Consider perioperative suPAR measurement in high-risk populations and prioritize trials of suPAR-lowering or vasomodulatory strategies within kidney-protective pathways.
Key Findings
- Higher suPAR associated with lower baseline eGFR in a propensity-matched cardiac surgery cohort.
- Ex vivo porcine perfusion and intravital mouse imaging demonstrated afferent arteriolar constriction and reduced glomerular perfusion with suPAR.
- Supports suPAR as both a risk stratifier and potential therapeutic target for perioperative AKI.
2. Erector spinae plane block versus paravertebral block and placebo for recovery quality after percutaneous nephrolithotomy: A randomized controlled trial.
In 120 adults undergoing PCNL, ESPB improved 24-hour QoR-15 over placebo and met non-inferiority to thoracic paravertebral block, reducing pain and opioid use without increasing complications.
Impact: High-quality, patient-centered comparative effectiveness evidence positioning ESPB as a practical alternative where PVB expertise or feasibility is limited.
Clinical Implications: Integrate ESPB into multimodal analgesia protocols for PCNL, especially in settings with limited PVB expertise, to enhance recovery and reduce opioids.
Key Findings
- ESPB improved 24-hour QoR-15 versus placebo and achieved non-inferiority to TPVB.
- ESPB and TPVB each reduced pain scores and morphine equivalents by roughly 40% versus placebo.
- No increase in block-related adverse events was observed.
3. Paravertebral or serratus anterior plane block combined with PECS I (interpectoral) blocks versus paravertebral block for mastectomy: A cluster-randomized trial of 1507 patients.
In a pragmatic cluster-RCT of 1,507 patients undergoing bilateral mastectomy with expander reconstruction, adding PECS I to PVB or SAPB did not reduce high postoperative opioid use or improve secondary outcomes versus PVB alone.
Impact: Large, practice-defining negative trial guiding rational use of block combinations in breast surgery.
Clinical Implications: Avoid routine PECS I addition solely for opioid-sparing in mastectomy with expander reconstruction; tailor block strategy to anatomy, safety, and expertise.
Key Findings
- Rates of high postoperative opioid use were similar across strategies; no statistically significant reduction with PECS I combinations.
- Secondary outcomes (pain, antiemetic use, discharge timing, chronic pain, QoR) were not improved by adding PECS I.
- Pragmatic cluster design enhances external validity across institutions and time blocks.
4. Device-specific viscoelastic testing thresholds on ClotPro for early trauma hemostasis: A multicenter validation and implementation study.
A multicenter evaluation indicates that ClotPro requires device-specific thresholds distinct from other VET platforms to optimize early detection of trauma-associated coagulopathy and guide targeted transfusion algorithms.
Impact: Aligns diagnostic thresholds with platform-specific performance, improving early hemostatic decision-making.
Clinical Implications: Update local VET-guided transfusion protocols to incorporate ClotPro-specific cut-offs and ensure staff training for device interpretation.
Key Findings
- ClotPro demonstrates platform-specific kinetics necessitating tailored thresholds rather than direct ROTEM/TEG transfer.
- Applying device-specific cut-offs improves early identification of coagulopathy and alignment with transfusion needs.
- Implementation frameworks facilitate protocol adoption and quality assurance across centers.
5. New persistent opioid use after ICU discharge: A multicenter cohort analysis and stewardship implications.
A multicenter cohort of ICU survivors identified new persistent opioid use among previously opioid-naïve patients and highlighted inpatient exposure, mental health comorbidity, and discharge prescribing patterns as modifiable risk factors.
Impact: Links critical illness survivorship to post-discharge opioid trajectories, defining targets for perioperative and ICU stewardship programs.
Clinical Implications: Implement risk-stratified discharge prescribing, early deprescribing pathways, and mental health screening to reduce new persistent opioid use.
Key Findings
- A measurable fraction of opioid-naïve ICU survivors developed new persistent opioid use after discharge.
- Higher inpatient opioid exposure and mental health comorbidity were associated with persistence risk.
- Discharge prescribing often exceeded anticipated analgesic needs, indicating stewardship gaps.