Journal of Clinical Anesthesia最新文献

{"title":"Mild cognitive impairment and postsurgical pain in older adults: A call for research.","authors":"Miklos D Kertai, Todd B Monroe, Ronald L Cowan, Stephen Bruehl","doi":"10.1016/j.jclinane.2024.111669","DOIUrl":"https://doi.org/10.1016/j.jclinane.2024.111669","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":" ","pages":"111669"},"PeriodicalIF":5.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142563503","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Re: Recovery and safety with prolonged high-frequency jet ventilation for catheter ablation of atrial fibrillation: A hospital registry study from a New England healthcare network","authors":"Adrien Maseri, Quentin Delhez, Michael Hardy","doi":"10.1016/j.jclinane.2024.111667","DOIUrl":"10.1016/j.jclinane.2024.111667","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"99 ","pages":"Article 111667"},"PeriodicalIF":5.0,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142554675","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of various perioperative semaglutide interruption intervals on residual gastric content assessed by esophagogastroduodenoscopy: A retrospective single center observational study","authors":"Leonardo Barbosa Santos MD ,&nbsp;Glenio B. Mizubuti MD, PhD ,&nbsp;Leopoldo Muniz da Silva MD, PhD ,&nbsp;Saullo Queiroz Silveira MD ,&nbsp;Rafael Souza Fava Nersessian MD ,&nbsp;Arthur de Campos Vieira Abib MD ,&nbsp;Fernando Nardy Bellicieri MD ,&nbsp;Helidea de Oliveira Lima MD, MSc ,&nbsp;Anthony M.-H. Ho MD ,&nbsp;Gabriel Silva dos Anjos BS ,&nbsp;Diogo Turiani Hourneaux de Moura MD, PhD ,&nbsp;Eduardo Guimarães Hourneuax de Moura MD, PhD ,&nbsp;Joaquim Edson Vieira MD, PhD","doi":"10.1016/j.jclinane.2024.111668","DOIUrl":"10.1016/j.jclinane.2024.111668","url":null,"abstract":"<div><h3>Background</h3><div>Recent evidence suggests that perioperative semaglutide use is associated with increased residual gastric content (RGC) and risk of bronchoaspiration under anesthesia. We compared the occurrence of increased RGC in semaglutide users and non-users undergoing esophagogastroduodenoscopy to define the time interval at which RGC becomes comparable between groups.</div></div><div><h3>Methods</h3><div>This was a single-center retrospective electronic chart review at a tertiary hospital. Patients undergoing esophagogastroduodenoscopy under deep sedation/general anesthesia between July/2021–July/2023 were included and divided into two (SG = semaglutide, NSG = non-semaglutide) groups, according to whether they had received semaglutide within 30 days prior to the esophagogastroduodenoscopy. Univariate and multivariate logistic regression were performed to explore which factors were associated with increased RGC, defined as any amount of solid content, or &gt; 0.8 mL/Kg (measured from the aspiration/suction canister) of fluid content.</div></div><div><h3>Results</h3><div>Among the 1094 (SG = 123; NSG = 971) patients included, increased RGC was observed in 56 (5.12%), being 25 (20.33%) in the SG and 31 (3.19%) in the NSG (<em>p</em> <em>&lt;</em> 0.001). Following weighted analysis, the presence of ongoing digestive symptoms (nausea/vomiting, dyspepsia, and/or bloating/abdominal distension) pre-esophagogastroduodenoscopy [OR = 15.1 (95% confidence interval (CI) 9.85–23.45)] and the time intervals of preoperative semaglutide interruption &lt; 8 days [OR 10.0 (95%CI 6.67–15.65)] and 8–14 days [4.59 (95%CI 2.91–7.37)] remained significantly associated with increased RGC. Following inverse probability treatment weighting adjustment including a composite variable ‘time intervals of semaglutide interruption’ versus ‘presence of ongoing digestive symptoms’, only time intervals &gt; 14 days and without digestive symptoms showed no association with increased RGC [OR = 0.77 (95%CI 0.22–2.01)].</div></div><div><h3>Conclusions</h3><div>Perioperative semaglutide use is associated with increased RGC in patients undergoing elective esophagogastroduodenoscopy. Preoperative discontinuation of &gt; 21 days and &gt; 14 days in patients with and without ongoing digestive symptoms, respectively, resulted in RGC similar to non-semaglutide users.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"99 ","pages":"Article 111668"},"PeriodicalIF":5.0,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142545763","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Overcoming age: Slow anesthesia induction may prevent geriatric patients from developing burst suppression and help developing intraoperative EEG signatures of a younger brain","authors":"D.P. Obert ,&nbsp;P.O. Sepúlveda ,&nbsp;V. Adriazola ,&nbsp;F. Zurita ,&nbsp;J. Brouse ,&nbsp;G. Schneider ,&nbsp;M. Kreuzer","doi":"10.1016/j.jclinane.2024.111672","DOIUrl":"10.1016/j.jclinane.2024.111672","url":null,"abstract":"<div><div>Elderly patients are prone to develop postoperative neurocognitive deficits potentially precipitated by inadequate anesthetic management. To investigate the potential of EEG-guided individualized anesthetic titration we evaluated the effect of the patient's age on the spectral composition of the EEG during slow propofol induction.</div><div>Twenty-six young (&lt;65 years) and 25 old (≥65 years) patients received propofol until loss of responsiveness (LOR). After LOR, we switched from a flow rate-based to a target-controlled infusion mode keeping the calculated effect-site concentration at LOR stable. We recorded a frontal EEG and calculated the power spectral density (PSD) and the band powers. For the comparison of the spectral composition of old and young patients, we used an effect size, the area under the receiver operating characteristic curve.</div><div>The older patients received significantly less propofol (<em>p</em> &lt; 0.001). No patient showed a burst suppression pattern. Whereas the absolute power in all frequency bands decreased significantly with the patient's age, the spectral composition did not change throughout the extended induction period.</div><div>Slow anesthesia induction may be a suitable approach for geriatric patients to preserve spectral composition patterns typically found in younger brains and to individually identify anesthetic requirements reducing the risk of excessive anesthetic effects.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"99 ","pages":"Article 111672"},"PeriodicalIF":5.0,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142554674","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical outcome after endovascular stroke Thrombectomy: Association with pre-reperfusion blood pressure","authors":"Andreas Ranft M.D. ,&nbsp;Sebastian Berger M.S. ,&nbsp;Martin Schubert M.D. ,&nbsp;Silke Wunderlich M.D. ,&nbsp;Tobias Boeckh-Behrens M.D. ,&nbsp;Gerhard Schneider M.D. ,&nbsp;Alexander Hapfelmeier M.S.","doi":"10.1016/j.jclinane.2024.111665","DOIUrl":"10.1016/j.jclinane.2024.111665","url":null,"abstract":"<div><h3>Study Objective</h3><div>Blood pressure drops during endovascular treatment of acute ischemic stroke have been associated with worse outcomes for stroke patients. We aimed to evaluate this observation in our patient population.</div></div><div><h3>Design</h3><div>Retrospective study.</div></div><div><h3>Setting</h3><div>University hospital.</div></div><div><h3>Patients</h3><div>Records from patients who underwent endovascular treatment of acute ischaemic stroke under general anaesthesia at a university hospital from 2017 to 2020 were screened. 586 patients aged 78 years (interquartile range [IQR] 67–84) with a mean National Institutes of Health Stroke Scale score of 15 (IQR 8–19) were included.</div></div><div><h3>Interventions</h3><div>None.</div></div><div><h3>Measurements</h3><div>Good functional outcome was defined as a three-month modified Rankin Scale (mRS) value between 0 and 2, or a mRS value less than or equal to the pre-stroke baseline.</div></div><div><h3>Main Results</h3><div>In addition to well-established predictors, blood pressure before reperfusion was found to be associated with good functional outcomes. Per five minutes that systolic arterial pressure spent below 140 mmHg, the odds of good outcome decreased by 11.1 %.</div></div><div><h3>Conclusions</h3><div>In this retrospective study of general anaesthesia for endovascular stroke therapy, blood pressure drops during the intervention were associated with reduced odds of a good functional outcome three months later. Before a clinical recommendation can be made, a prospective study must clarify effective and safe target ranges of blood pressure support and augmentation.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"99 ","pages":"Article 111665"},"PeriodicalIF":5.0,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142545753","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Corrigendum to \"Comprehensive perioperative blood management in patients undergoing elective bypass cardiac surgery: Benefit effect of health care education and systematic correction of iron deficiency and anemia on red blood cell transfusion\" [J Clin Anesth. 2024 Nov:98:111560. doi:10.1016/j.jclinane.2024.111560. Epub 2024 Aug 14].","authors":"Hélène Charbonneau, Stéphanie Savy, Nicolas Savy, Marie Pasquié, Nicolas Mayeur","doi":"10.1016/j.jclinane.2024.111666","DOIUrl":"https://doi.org/10.1016/j.jclinane.2024.111666","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":" ","pages":"111666"},"PeriodicalIF":5.0,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142545752","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The influence of anesthetic drug strategy on the incidence of post induction hypotension in elective, non-cardiac surgery – A prospective observational cohort study","authors":"Lotte E. Terwindt MD ,&nbsp;Johan T.M. Tol MD ,&nbsp;Ward H. van der Ven MD ,&nbsp;Vincent C. Kurucz MD ,&nbsp;Sijm H. Noteboom MSc ,&nbsp;Jennifer S. Breel MSc ,&nbsp;Björn J.P. van der Ster PhD ,&nbsp;Eline Kho PhD ,&nbsp;Rogier V. Immink MD, PhD ,&nbsp;Jimmy Schenk PhD ,&nbsp;Alexander P.J. Vlaar MD, PhD ,&nbsp;Markus W. Hollmann MD, PhD ,&nbsp;Denise P. Veelo MD, PhD","doi":"10.1016/j.jclinane.2024.111671","DOIUrl":"10.1016/j.jclinane.2024.111671","url":null,"abstract":"<div><h3>Study objectives</h3><div>To identify the influence of modifiable factors in anesthesia induction strategy on post-induction hypotension (PIH), specifically the type, dosage and speed of administration of induction agents. A secondary aim was to identify patient related non-modifiable factors associated with PIH.</div></div><div><h3>Design</h3><div>Single-center, prospective observational cohort study.</div></div><div><h3>Setting</h3><div>Operating room.</div></div><div><h3>Patients</h3><div>Adult, ASA I-IV patients undergoing elective, non-cardiac surgery under general anesthesia (GA).</div></div><div><h3>Interventions</h3><div>None.</div></div><div><h3>Measurements</h3><div>Continuous non-invasive blood pressure using finger-cuff technology. PIH was defined as mean arterial pressure (MAP) &lt;65 mmHg ≥1 min, and, separately, as a &gt; 30 % decrease from baseline MAP ≥1 min.</div></div><div><h3>Main results</h3><div>Study measurements were performed in 760 patients, of which 720 were suitable for analysis. A total of 238 patients (33.1 %) experienced PIH according to the 65 mmHg threshold, and 287 (39.9 %) using the 30 % decrease in MAP threshold. Remifentanil administration was associated with increased risk of PIH according to either definition (MAP &lt;65 mmHg: OR 1.88, 95 %CI 1.31–2.69, <em>p</em> &lt; 0.001, 30 % MAP decrease: OR 1.66, 95 %CI 1.15–2.40, <em>p</em> = 0.007). Pre-emptive vasopressor use (before or during first minute of GA) was associated with reduced risk of PIH (MAP &lt;65 mmHg: OR 0.65, 95 %CI 0.45–0.95, <em>p</em> = 0.027, MAP 30 % decrease: OR 0.58, 95 %CI 0.40–0.84, <em>p</em> = 0.004). Speed of propofol bolus administration, propofol bolus dose, and esketamine use were not associated with PIH in multivariable analysis. Propofol bolus dose decreased with increasing age and American Society of Anesthesiologists physical status classification.</div></div><div><h3>Conclusions</h3><div>PIH was common in this patient cohort, regardless of the definition used. Two of the five examined modifiable factors were associated with PIH: remifentanil infusion was associated with an increased risk, and pre-emptive vasopressor use was associated with a decreased risk of PIH. No association between propofol dose and PIH was found, most likely due dose adjustment based on clinical assessment rather than a true absence of effect.</div></div><div><h3>Clinical registration number</h3><div>This study was registered in the Dutch Medical Research in Humans (OMON) register on 18 June 2019 (ID: NL7810). The study was approved by the Medical Ethics Committee of the Amsterdam UMC, location AMC, the Netherlands in December 2018 (NL 6748.018.18; 2018).</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"99 ","pages":"Article 111671"},"PeriodicalIF":5.0,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142539405","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rebound pain prevention after peripheral nerve block: A network meta-analysis comparing intravenous, perineural dexamethasone, and control","authors":"Zih-Sian Yang ,&nbsp;Hou-Chuan Lai ,&nbsp;Hong-Jie Jhou ,&nbsp;Wei-Hung Chan ,&nbsp;Po-Huang Chen","doi":"10.1016/j.jclinane.2024.111657","DOIUrl":"10.1016/j.jclinane.2024.111657","url":null,"abstract":"<div><h3>Study objective</h3><div>Peripheral nerve blocks (PNBs) are widely used for postoperative analgesia, but rebound pain following block resolution poses a significant clinical challenge. Dexamethasone, administered either intravenously (IV) or perineurally, has shown promise in reducing rebound pain incidence, but the optimal route remains unclear. This network meta-analysis (NMA) aims to compare the effectiveness of different routes of dexamethasone administration, including IV, perineural, and control, in reducing the incidence of rebound pain following PNBs.</div></div><div><h3>Design</h3><div>Network meta-analysis.</div></div><div><h3>Setting</h3><div>Operating room, postoperative recovery area and ward.</div></div><div><h3>Patients</h3><div>Seven randomized controlled trials involving 561 patients undergoing peripheral nerve block for postoperative pain management.</div></div><div><h3>Interventions</h3><div>Intravenous and perineural dexamethasone compared to control for preventing rebound pain.</div></div><div><h3>Measurements</h3><div>The primary outcome was the incidence of rebound pain. Secondary outcomes included median time to first analgesic request, rebound pain resolution time, difference in pain scores before and after PNB resolution, and nausea/vomiting.</div></div><div><h3>Main results</h3><div>Both IV and perineural dexamethasone significantly reduced the incidence of rebound pain following peripheral nerve blocks compared to the control group. IV dexamethasone ranked first based on P-score (OR, 0.13; 95 % CI, 0.07–0.23; P-score, 0.92). Secondary outcomes, including time to the first analgesic request, pain score difference, and nausea/vomiting, also favored both IV and perineural dexamethasone over the control group.</div></div><div><h3>Conclusion</h3><div>Both IV and perineural dexamethasone are preferred over no dexamethasone for preventing rebound pain after PNBs, with IV dexamethasone being the more effective route. Despite limitations, these findings provide valuable insights for clinical decision-making in postoperative pain management.</div><div><strong>Systematic review registration:</strong> PROSPERO CRD42024530943.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"99 ","pages":"Article 111657"},"PeriodicalIF":5.0,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142501297","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of deep neuromuscular blockade on intraoperative NOL-guided remifentanil requirement during desflurane anesthesia in laparoscopic colorectal surgeries: A randomised controlled trial","authors":"Louis Morisson ,&nbsp;Hakim Harkouk ,&nbsp;Alexandra Othenin-Girard ,&nbsp;Walid Oulehri ,&nbsp;Pascal Laferrière-Langlois ,&nbsp;Marie-Eve Bélanger ,&nbsp;Moulay Idrissi ,&nbsp;Nadia Godin ,&nbsp;Olivier Verdonck ,&nbsp;Louis-Philippe Fortier ,&nbsp;Madeleine Poirier ,&nbsp;Margaret Henri ,&nbsp;Jean-François Latulippe ,&nbsp;Jean-François Tremblay ,&nbsp;Jean-Sebastien Trépanier ,&nbsp;Yves Bendavid ,&nbsp;Julien Raft ,&nbsp;Philippe Richebé","doi":"10.1016/j.jclinane.2024.111659","DOIUrl":"10.1016/j.jclinane.2024.111659","url":null,"abstract":"<div><h3>Study objective</h3><div>Evaluate the impact of deep neuromuscular blockade on intraoperative nociception Deep neuromuscular blockade has been shown to improve surgical conditions and postoperative outcomes compared to moderate neuromuscular blockade in laparoscopic surgery. Still, its impact on intraoperative nociception and opioid requirement has never been assessed.</div></div><div><h3>Design</h3><div>Monocentric randomised controlled trial.</div></div><div><h3>Setting</h3><div>Operating room.</div></div><div><h3>Patients</h3><div>We included 100 ASA I to III patients who underwent colorectal laparoscopic surgery with desflurane-remifentanil anesthesia.</div></div><div><h3>Interventions</h3><div>Patients were randomised into two groups to achieve either moderate (1–3 train of four response) or deep (1–2 post-tetanic count) neuromuscular block (NMB) with repeated boluses of rocuronium. The Nociception Level (NOL) index guided intraoperative remifentanil administration in both groups.</div></div><div><h3>Measurements</h3><div>The primary endpoint was total intraoperative remifentanil administration per hour of surgery. Secondary endpoints included, Leiden Surgical Rating Scale (L-SRS), intra-abdominal pressure, postoperative pain scores and opioids' consumption.</div></div><div><h3>Main results</h3><div>Ninety-three patients were analysed. Forty-five in the deep group and 48 patients in moderate group. Intraoperative administration of remifentanil was 348 (228–472) μg.h⁻¹ in the deep NMB group compared to 494 (392–618) μg.h⁻¹ in the moderate NMB group (<em>P</em> &lt; 0.001). Lowest L-SRS was 5 (4–5) in the deep NMB group versus 3 (2–5) (P &lt; 0.001) in the moderate NMB group. Mean intra-abdominal pressure was 11.9 (1.3) in the deep NMB group versus 13 (1.3) (P &lt; 0.001) in the moderate NMB group. Secondary postoperative outcomes including pain scores and analgesics administration were not significantly different.</div></div><div><h3>Conclusions</h3><div>This study shows that deep neuromuscular blockade reduces intraoperative NOL-guided administration of remifentanil in colorectal laparoscopic surgeries. It also improves surgical conditions.</div></div><div><h3>Trial registration</h3><div>The study was registered at <span><span>ClinicalTrials.gov</span><svg><path></path></svg></span> under <span><span>NCT03910998</span><svg><path></path></svg></span>.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"99 ","pages":"Article 111659"},"PeriodicalIF":5.0,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142501295","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and safety of neuraxial hydromorphone: A systematic review and meta-analysis with trial sequential analysis","authors":"Sina Grape ,&nbsp;Kariem El-Boghdadly ,&nbsp;Cécile Jaques ,&nbsp;Eric Albrecht","doi":"10.1016/j.jclinane.2024.111664","DOIUrl":"10.1016/j.jclinane.2024.111664","url":null,"abstract":"<div><h3>Study objective</h3><div>Neuraxial hydromorphone provides postoperative pain relief. However, the magnitude of this effect and the optimal dose remain unknown. The objective of this study is to clarify these uncertainties.</div></div><div><h3>Design</h3><div>Systematic review and meta-analysis with trial sequential analysis.</div></div><div><h3>Setting</h3><div>Postoperative recovery area and ward, up to 24 h.</div></div><div><h3>Patients</h3><div>Any patient undergoing any type of surgery or being in labor.</div></div><div><h3>Interventions</h3><div>Neuraxial hydromorphone versus control.</div></div><div><h3>Measurements</h3><div>Our primary outcome was rest pain score (analogue scale, 0–10) at 24 h according to route of administration (epidural versus spinal) and type of surgery (orthopedic versus other). Secondary outcomes included rest pain score at 0–4 and 8–12 h; rates of postoperative nausea and vomiting, and pruritus at 24 h.</div></div><div><h3>Main results</h3><div>Six trials, including 436 patients, were identified. Rest pain score at 24 postoperative hours was significantly reduced in the hydromorphone group, with a mean difference (95 %CI) of −0.4 (−0.8 to −0.1), I² = 74 %, <em>p</em> = 0.01. Neuraxial hydromorphone did not increase postoperative nausea and vomiting (risk ratio [95 %CI]: 1.2 [0.8–1.8], I² = 27 %, <em>p</em> = 0.47), but increases pruritus (risk ratio [95 %CI]: 3.1 [1.6–5.9], I² = 0 %, <em>p</em> = 0.0005). The quality of evidence was very low for our primary and secondary outcomes. In conclusion, there is very low level of evidence that neuraxial hydromorphone provides effective analgesia after surgery or labor, at the expense of an increased rate of pruritus. The improvement in pain scores appears to be clinically insignificant. With only six trials published over a period of 30 years, we were unable to perform a meta-regression.</div></div><div><h3>Conclusions</h3><div>If neuraxial hydromorphone is to be used regularly, trials focusing on the optimal dose and side-effects should be performed before widely administering this medication into the neuraxial space.</div><div>More trials focusing on the optimal dose and side-effects should be performed before widely administering this medication into the neuraxial space.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"99 ","pages":"Article 111664"},"PeriodicalIF":5.0,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142501294","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}