Indian Journal of Anaesthesia最新文献

Background and aims: Rotator cuff (RC) disorders have a varied range of treatment. Multiple interventional, non-surgical treatments are often opted for by patients. This study evaluates the effectiveness of dextrose prolotherapy in treating RC pathologies.

Methods: A comprehensive review of databases (PubMed, Google Scholar, Embase, Scopus, and Cochrane databases) from 2000 to June 2025 identified 13 relevant studies involving 936 patients. The randomised clinical trials, which compared dextrose prolotherapy with interventions such as platelet-rich plasma, steroids, physiotherapy, or placebos, were included in the systematic review. A risk-of-bias analysis was conducted using the Risk of Bias Visualisation Tool. It indicated that seven studies had low bias. Studies with a high risk of bias were excluded from the meta-analysis. The protocol was registered beforehand (PROSPERO ID: CRD42024520747).

Results: Review Manager software was used to analyse the data and generate the plots. The analysis showed that prolotherapy significantly reduced pain (MD = -0.76; 95% CI: -1.26, -0.27; P = 0.003), improved functional outcomes (shoulder pain and disability index (MD = -8.58; 95% confidence interval (CI): -13.00, -4.17; P = 0.0001)), and enhanced ultrasonography features. No major adverse effects were reported, indicating that the treatment is safe.

Conclusions: This systematic review and meta-analysis suggests that dextrose prolotherapy may be a feasible and effective alternative for RC disorders, and it can be considered for patients with limited treatment options. However, to reach the required information size, further trials are required. Uniformity in protocols, intervention strategies, and outcome reporting is necessary for longer follow-up periods to facilitate more effective evidence synthesis. This study received no external funding.

Background and aims: The sacral erector spinae plane block (SESPB) is emerging as a promising ultrasound-guided regional anaesthesia technique for postoperative pain management in various surgical procedures. This systematic review and meta-analysis aimed to investigate the efficacy of SESPB when used in combination with spinal anaesthesia.

Methods: We conducted a search of PubMed/MEDLINE, EMBASE, ClinicalTrials.gov and the Cochrane Central Register of Controlled Trials, covering literature up to April 2025. Our analysis included randomised controlled trials (RCTs) that compared the outcomes of SESPB used with spinal anaesthesia against spinal anaesthesia alone in patients undergoing elective surgeries. The primary endpoint was the need for rescue opioid analgesics in the postoperative period. Secondary outcomes included postoperative pain levels at 12 and 24 h after surgery, the total amount of opioids consumed in the postoperative period and the time to the first opioid requirement after surgery.

Results: We identified and included three RCTs in the quantitative analysis. The pooled data indicated that SESPB combined with spinal anaesthesia significantly reduced the need for rescue opioid analgesics compared with spinal anaesthesia alone (odds ratio = 0.05; 95% confidence interval = 0.02,0.16; P < 0.00001; I ² = 14%). Additionally, the use of SESPB was associated with improved postoperative pain management at 24 h, although it did not yield a statistically significant reduction in the total amount of opioid consumed in the postoperative period and the timing of rescue opioid administration.

Conclusions: This meta-analysis of RCTs indicated that the use of SESPB in conjunction with spinal anaesthesia results in a reduced need for rescue opioid analgesics and improved postoperative pain management at 24 h for patients undergoing elective surgery.

Background and aims: Regional anaesthesia for clavicle surgery focuses on site-specific nerve blocks to minimise the drug volume, prevent unnecessary nerve block, and reduce complications. This study aimed to compare the effectiveness and dynamics of selectively blocking supraclavicular (SC) nerves and upper trunk (UT) of the brachial plexus (SCUT block) with clavipectoral fascial plane (CPF) block as a site-specific regional anaesthesia strategy for clavicle surgery.

Methods: In this single-centre, double-blinded, randomised study, 50 patients undergoing clavicle surgeries were given either SCUT block or CPF block with SC nerve block under ultrasound guidance with 20 mL of 0.5% ropivacaine. The primary outcome was the total duration of analgesia. The secondary outcomes were onset of sensory blockade, motor impairment, degree of diaphragmatic excursion, visual analogue scale (VAS) score, and patient satisfaction score. Statistical analysis included Student's t-test, Chi-square test, and Mann-Whitney U-test as appropriate, with statistical significance set at P < 0.05.

Results: The mean duration of postoperative analgesia was 10.34 [standard deviation (SD): 1.20] h in the SCUT group and 8.45 (SD: 0.67) h in the CPF group (P < 0.001) [mean difference: 1.89 (95% CI: 1.15, 1.29)]. The SCUT group exhibited lower VAS scores but higher motor impairment and reduced diaphragmatic excursion than the CPF group. However, the differences in the onset of sensory block and patient satisfaction scores were not statistically significant.

Conclusion: The SCUT block and CPF block with SC nerve block are effective site-specific regional anaesthesia strategies for clavicle surgery.

Background and aims: As gynaecological laparoscopic minimally invasive surgery continues to advance, it becomes essential to explore how inhalation anaesthesia and intravenous anaesthesia affect the recovery of gastrointestinal function after surgery. The objective was to compare the effects of total intravenous anaesthesia (TIVA) and inhalation anaesthesia on the time of the first defecation and the time of consuming solid food for patients following laparoscopic total hysterectomy.

Methods: This research involved 134 female participants aged 18-65 years, classified as American Society of Anesthesiologists physical status I-II, who were scheduled to undergo elective laparoscopic hysterectomy procedures. Participants were randomly allocated into two cohorts: one receiving TIVA (Group P) (underwent TIVA induction with propofol, remifentanil, and rocuronium administration, supplemented by ongoing administration of propofol-remifentanil infusions), and the other group was administered inhalational anaesthesia (Group S) (using sevoflurane delivered through precise tidal volume ventilation alongside rocuronium, with maintenance achieved through combined sevoflurane inhalation and remifentanil infusion). The primary outcome was the time to initial defecation and tolerance of solid food (SF + D), while the final outcome was determined by the longer duration required to achieve these two outcomes. The I-FEED (intake, feeling nauseated, emesis, physical examination, and duration of symptoms) score, the numeric rating scale score for pain, and the numeric rating scale score for postoperative nausea and vomiting, the time to first flatus, gastric antral motility index, and intestinal peristalsis rate within 1 minute determined by bedside ultrasound were also recorded.

Results: The mean to first defecation + hard food tolerance (SF + D) was 51 [standard deviation (SD: 8.47)] in Group S and 47 (SD: 9.45) in Group P (P = 0.02), and the mean difference between the groups was - 4.46 (95% CI: 0.20, 7.00). None of the I-FEED scores were statistically significant (P = 0.074, Z = -1.79). Patients in Group P experienced superior analgesic effects and more stable haemodynamics.

Conclusion: The postoperative recovery of gastrointestinal function can be enhanced by employing total intravenous anaesthesia instead of inhalation anaesthesia.

Background and aims: Postoperative delirium (POD) is a transient but serious complication that affects cognition and recovery. It may develop immediately after anaesthesia or following an otherwise uneventful emergence. As POD is associated with increased mortality and prolonged hospitalisation, identifying perioperative risk factors is essential. This study aimed to evaluate anaesthetic factors influencing POD during postoperative intensive care unit (ICU) stay.

Methods: After ethics approval, we retrospectively reviewed ICU-admitted patients who underwent propofol- or desflurane-based general anaesthesia between January and December 2020. Patients who were intentionally sedated or mechanically ventilated postoperatively were excluded. Of 1,040 eligible patients, the POD was assessed using the Confusion Assessment Method for the ICU. Patients were classified into POD and non-POD groups. Demographics, surgical variables, and anaesthetic factors were compared using the Chi-square test, goodness-of-fit test, and Student's t-test. Multivariate logistic regression was used to identify significant risk factors (P < 0.05).

Results: POD occurred in 43 patients (4.1%). Affected patients were older, in poorer preoperative health, and had longer anaesthesia and surgery times. Univariate analysis showed associations between POD and age, American society of Anesthesiologists-Physical Status (ASA-PS), dementia, surgery duration, and intraoperative tracheostomy. Multivariate analysis identified age, ASA-PS, surgical site, anaesthesia time, and tracheostomy as independent predictors.

Conclusion: Prolonged anaesthesia was found to be a modifiable risk factor for POD. Identifying at-risk patients and minimising anaesthesia time may help reduce POD incidence. Persistent delirium beyond 72 hours postoperatively warrants further evaluation.