Weekly Anesthesiology Research Analysis
This week’s anesthesiology literature highlights three high-impact directions: molecularly defined nociceptor targets (OSMR/SST) enabling translational neuropathic-pain strategies; scalable perioperative digital interventions (extended reality, mobile apps) that improve patient-reported outcomes; and randomized evidence supporting dexamethasone as an effective adjuvant to prolong pediatric ESPB analgesia and reduce opioid exposure. Together these papers span mechanistic targets, systems-level pe
Summary
This week’s anesthesiology literature highlights three high-impact directions: molecularly defined nociceptor targets (OSMR/SST) enabling translational neuropathic-pain strategies; scalable perioperative digital interventions (extended reality, mobile apps) that improve patient-reported outcomes; and randomized evidence supporting dexamethasone as an effective adjuvant to prolong pediatric ESPB analgesia and reduce opioid exposure. Together these papers span mechanistic targets, systems-level perioperative improvements, and actionable clinical anesthesia practice changes.
Selected Articles
1. Molecular architecture of human dermal sleeping nociceptors.
Using Patch‑seq and cross-species transcriptomics with translational human volunteer modulation, the study identifies OSMR and SST as marker genes for mechano-insensitive C-fiber nociceptors (CMis) and shows that oncostatin M selectively modulates these fibers. The work defines a targetable human nociceptor subtype and provides a mechanistic basis for novel neuropathic pain interventions.
Impact: First molecular characterization and selective human modulation of CMis nociceptors provides actionable targets (OSMR/SST) for neuropathic-pain therapeutics and patient stratification—high translational impact.
Clinical Implications: Enables biomarker-driven trials and development of agents or neuromodulation targeting OSMR/SST-expressing nociceptors; may inform perioperative neuropathic pain prevention and chronic pain management strategies.
Key Findings
- OSMR and SST identified as marker genes for mechano-insensitive C-fiber nociceptors via Patch-seq and integrated transcriptomics.
- Dermal oncostatin M (OSMR ligand) selectively modulates CMis in human volunteers, demonstrating translational modulation.
2. Digital health interventions for perioperative patient-reported outcomes: a network meta-analysis.
A network meta-analysis of 56 randomized trials (n=6,154) comparing digital health modalities found extended reality (XR) most effective for reducing perioperative anxiety, while mobile apps and XR likely reduce postoperative pain and 2D video improved quality-of-life metrics. Evidence certainty ranged moderate-to-high, guiding comparative selection of digital interventions.
Impact: Provides comparative, high-certainty evidence across digital modalities—actionable for hospitals deciding which digital tools to deploy for anxiety, pain, and QoL improvements at scale.
Clinical Implications: Health systems can prioritize XR for perioperative anxiety reduction, consider mobile apps/XR for postoperative pain programs, and deploy simple 2D educational videos for QoL and satisfaction gains—implement with fidelity and cost-effectiveness evaluation.
Key Findings
- Extended reality reduced perioperative anxiety (SMD 0.60; moderate-certainty).
- Mobile applications (SMD 0.64) and XR (SMD 0.51) probably reduced postoperative pain; 2D video improved QoL most (SMD 0.99).
3. Dexamethasone as an Adjuvant to Erector Spinae Plane Block Is Associated With Improved Neuromonitoring Parameters and Analgesia in Pediatric Spine Surgery.
A prospective, randomized, double-blind trial in 60 adolescents undergoing posterior spinal fusion found that adding dexamethasone (0.1 mg/kg) to ropivacaine ESPB prolonged time to first rescue opioid (mean ~13 h vs 5 h), reduced 48-hour opioid consumption, and lowered pain scores without increasing metabolic or neurological adverse events; intra- and postoperative neurophysiological measures were more favorable in the dexamethasone group.
Impact: High-quality RCT providing pragmatic, actionable evidence to extend ESPB analgesia and reduce opioid exposure in pediatric spine surgery, with neuromonitoring data supporting safety.
Clinical Implications: Consider adding dexamethasone (0.1 mg/kg) to ESPB in pediatric posterior spinal fusion as part of multimodal analgesia to prolong block duration and reduce opioid consumption, while maintaining neurophysiological monitoring and glucose surveillance; multicenter validation advisable.
Key Findings
- Time to first rescue opioid: mean 13.0 ± 2.1 h (DEX) vs 5.2 ± 1.6 h (no DEX); p<0.0001.
- Total 48-hour opioid consumption lower with dexamethasone (18.1 ± 3.8 mg vs 27.3 ± 4.4 mg morphine equivalents; p<0.0001); lower pain scores at 8, 12, 24 h.
- No increase in perioperative blood glucose or neurological complications; postoperative MEP and ENG parameters more favorable with dexamethasone.