Journal of Clinical Anesthesia最新文献

Background: Cervical interlaminar epidural injection (CIEI) is a commonly performed neuraxial intervention in anesthetic and pain management practice for the treatment of neck and radicular pain. Accurate identification of the epidural space is essential to avoid serious complications. Although fluoroscopy is considered the reference standard for confirming epidural placement, epidural access in anesthetic practice is typically achieved using the loss-of-resistance technique. Preprocedural estimation of epidural depth using ultrasonography (US) and magnetic resonance imaging (MRI) may enhance procedural control and optimize fluoroscopic use.

Methods: This prospective observational study, included 90 patients undergoing CIEI at the C7-T1 level. Epidural depth was estimated preprocedurally using ultrasonography (US-PED) and cervical magnetic resonance imaging (MRI-PED) and compared with contrast-confirmed epidural depth under fluoroscopic guidance (CCED). Accuracy was defined as measurements within ±0.3 cm of the CCED. Associations and agreement between measurement methods were assessed using Spearman correlation and Bland-Altman analyses. In addition, relationships between CCED, patient demographic characteristics, and the number of lateral fluoroscopic images (NLFI) were analyzed.

Results: The CCED was measured at 6.01 ± 0.84 cm. Mean ultrasonography-predicted (US-PED) and MRI-predicted epidural depths (MRI-PED) were 5.92 ± 0.77 cm and 5.93 ± 0.97 cm, respectively. Within an error margin of ±0.3 cm, 60.0% of US-PED and 67.8% of MRI-PED measurements accurately predicted the CCED. The two methods demonstrated strong positive correlations with CCED (US-PED: r = 0.80; MRI-PED: r = 0.94; p < 0.001 for both), with narrower limits of agreement for MRI on Bland-Altman analysis. CCED showed a moderate positive correlation with the number of lateral fluoroscopic images (NLFI) (r = 0.46; p < 0.001), while no significant associations were observed with age, gender, or body mass index.

Conclusion: Epidural depth in CIEIs can be predicted with clinically meaningful accuracy using both MRI and ultrasonography, with MRI demonstrating superior accuracy. Although these modalities do not replace fluoroscopy, preprocedural depth estimation may enhance procedural safety and improve planning of lateral fluoroscopic imaging as reflected by the NLFI. Further studies are needed to confirm these findings in broader patient populations.

Objectives: To evaluate the analgesic efficacy of the erector spinae plane (ESP) block in adults undergoing vertebral surgery and to determine whether the available evidence is sufficient to support definitive conclusions.

Methods: We conducted an updated systematic review and meta-analysis of randomized controlled trials (PROSPERO: CRD42025117873). The primary outcome was 24-h postoperative opioid consumption (morphine milligram equivalents [MME]). Secondary outcomes included pain scores at rest and during movement (0-48 h), rescue analgesia requirement, time to first rescue analgesic, time to mobilization, postoperative nausea and vomiting (PONV), hospital length of stay (LOS), quality of recovery, and chronic postsurgical pain. Random-effects models were used; publication bias was assessed with Egger's test when applicable. Risk of bias was assessed using RoB 2 and certainty using GRADE. Prespecified subgroup analyses, sensitivity analysis, meta-regression for the primary outcome, and trial sequential analysis (TSA) were performed.

Results: Sixty trials (n = 4167, ESP block 2081, control 2086) were included. The ESP block was associated with a modest reduction in 24-h opioid consumption (MD -8.89 mg MME, 95% CI -11.44 to -6.33; p < 0.001, I² = 97.8%), accompanied by substantial unexplained heterogeneity. Early postoperative pain scores and rescue analgesic use favored the ESP block, while the most consistent effect was a reduced incidence of PONV (OR 0.40; I² = 0%). Evidence certainty was low for opioid and pain outcomes, moderate for rescue analgesia, and high for PONV. TSA indicated that the required sample size for opioid consumption was reached.

Conclusions: There is low-certainty evidence supporting a modest reduction in 24-h opioid consumption and early postoperative pain with ESP block in patients undergoing vertebral surgery. In contrast, high-certainty evidence supports a significant reduction in the incidence of PONV.