Pub Date : 2025-11-18DOI: 10.1016/j.jclinane.2025.112071
N. Patel , R. Brull , E.M. Yung , N. Hussain , T. Got , T. Dwyer , R. Urman , F.W. Abdallah
Background
The subacromial-subdeltoid bursa block (SBB) has been reported to provide postoperative pain relief following arthroscopic shoulder surgery, although evidence of its efficacy remains unclear. This meta-analysis evaluates the analgesia efficacy of adding SBB to systemic analgesia compared to systemic analgesia alone.
Methods
Literature was searched for randomized controlled trials comparing SBB and systemic analgesia to systemic analgesia alone (Control). Post-operative analgesic consumption, measured in oral morphine equivalents over the first 24 h post-operatively, was the primary outcome. Secondary outcomes included pain scores up to 48 h post-operatively, patient satisfaction, functional outcomes, opioid-related side effects, and block-related complications.
Results
Fifteen trials (679 patients) were included. Compared to systemic analgesia alone, the addition of single injection SBB reduced 24-h post-operative morphine consumption by 58.98 mg [−100.14, −17.81] (p = 0.005) over the first 24 h. SBB also reduced pain scores up to 18 h post-operatively. In contrast, continuous SBB did not reduce opioid consumption, with a mean difference of −40.36 mg [−81.77, 1.06] (p = 0.06). Additionally, continuous SBB did not improve pain control at any time point. The addition of SBB did not yield any differences in patient satisfaction, functional scores, or adverse events compared to systemic analgesia alone.
Conclusions
Compared to systemic analgesia alone, this meta-analysis suggests that for arthroscopic shoulder surgery, the addition of single-injection SBB can reduce postoperative pain and opioid consumption for up to 18 and 24 h, respectively. In contrast, continuous SBB does not seem to improve any of the analgesic outcomes. Single-injection SBB may be considered an effective analgesic technique for arthroscopic shoulder surgery when proximal brachial plexus blockade is contraindicated or otherwise undesirable.
{"title":"The analgesic efficacy of subacromial bursa block for arthroscopic shoulder surgery: A systematic review and meta-analysis","authors":"N. Patel , R. Brull , E.M. Yung , N. Hussain , T. Got , T. Dwyer , R. Urman , F.W. Abdallah","doi":"10.1016/j.jclinane.2025.112071","DOIUrl":"10.1016/j.jclinane.2025.112071","url":null,"abstract":"<div><h3>Background</h3><div>The subacromial-subdeltoid bursa block (SBB) has been reported to provide postoperative pain relief following arthroscopic shoulder surgery, although evidence of its efficacy remains unclear. This meta-analysis evaluates the analgesia efficacy of adding SBB to systemic analgesia compared to systemic analgesia alone.</div></div><div><h3>Methods</h3><div>Literature was searched for randomized controlled trials comparing SBB and systemic analgesia to systemic analgesia alone (Control). Post-operative analgesic consumption, measured in oral morphine equivalents over the first 24 h post-operatively, was the primary outcome. Secondary outcomes included pain scores up to 48 h post-operatively, patient satisfaction, functional outcomes, opioid-related side effects, and block-related complications.</div></div><div><h3>Results</h3><div>Fifteen trials (679 patients) were included. Compared to systemic analgesia alone, the addition of single injection SBB reduced 24-h post-operative morphine consumption by 58.98 mg [−100.14, −17.81] (<em>p</em> = 0.005) over the first 24 h. SBB also reduced pain scores up to 18 h post-operatively. In contrast, continuous SBB did not reduce opioid consumption, with a mean difference of −40.36 mg [−81.77, 1.06] (<em>p</em> = 0.06). Additionally, continuous SBB did not improve pain control at any time point. The addition of SBB did not yield any differences in patient satisfaction, functional scores, or adverse events compared to systemic analgesia alone.</div></div><div><h3>Conclusions</h3><div>Compared to systemic analgesia alone, this meta-analysis suggests that for arthroscopic shoulder surgery, the addition of single-injection SBB can reduce postoperative pain and opioid consumption for up to 18 and 24 h, respectively. In contrast, continuous SBB does not seem to improve any of the analgesic outcomes. Single-injection SBB may be considered an effective analgesic technique for arthroscopic shoulder surgery when proximal brachial plexus blockade is contraindicated or otherwise undesirable.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"108 ","pages":"Article 112071"},"PeriodicalIF":5.1,"publicationDate":"2025-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145557017","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}
Pub Date : 2025-11-18DOI: 10.1016/j.jclinane.2025.112070
Alan Gabriel Ortega-Macías , Alexis Vargas-Del Toro , Niloy Ghosh , Gicel Jacklin Aguilar , Tomas Escobar , Rafael Mancero Montalvo , Andrea Iturralde Carrillo , Vannya Marisol Ortega-Macías , Gulshan Parasher , Abu Baker Sheikh , Sergio A. Sánchez-Luna
Introduction
Endoscopic submucosal dissection (ESD) is a minimally invasive organ-preserving procedure indicated for the removal of precancerous and cancerous areas in the gastrointestinal (GI) tract. It is highly valuable due to its ability to achieve high en-bloc resection rates and reduced local recurrence. Nevertheless, postoperative pain has been an often-overlooked complication, previous studies found that the incidence of moderate to severe pain after ESD can be as high as 44.9–62.8 %, leading to decreased patient satisfaction. Dexmedetomidine, a selective and potent α2-receptor agonist, has gained recognition in clinical practice for its sedative, analgesic, and anxiolytic properties, with the advantage of not causing respiratory depression as seen with opioids.
Methods
Following the PRISMA guidelines, a systematic review and meta-analysis were performed to determine the impact of dexmedetomidine on endoscopic submucosal dissection postoperative pain in adult patients with gastrointestinal neoplasias. Primary outcomes were postoperative pain, sedation time and adverse event rate. Data were analyzed using R version 4.2.2. The risk of bias was assessed by the Robins-I and RoB 2 tool. The quality of evidence was graded using the GRADE scale and Newcastle-Ottawa guidelines.
Results
Five randomized clinical trials and one observational studies described the postprocedural pain level of dexmedetomidine vs control for gastrointestinal neoplasia dissection, totaling 643 patients. The meta-analysis demonstrated a significant reduction in postoperative pain with dexmedetomidine (RR = 0.50; 95 % CI = [0.35; 0.70]; p < 0.01). No significant difference was found in terms of adverse event rate between –groups (RR = 1.04; 95 % CI = [0.55; 1.98]; p = 0.85). Similarly, regarding sedation time, two randomized clinical trials and one observational study totaling 249 patients showed no significant difference between groups (SMD = 0.27; 95 % CI = [−0.62; 1.17]; p = 0.32). The risk of bias was low with moderate-to-high quality of evidence among the included studies.
Discussion
Our updated systematic review and meta-analysis demonstrated a significant difference in the postoperative pain level in the group with concomitant dexmedetomidine and midazolam sedation compared to midazolam alone for the endoscopic dissection of superficial gastrointestinal neoplasias. Importantly, our analysis did not include objective data regarding post procedure opioid consumption nor patient satisfaction; these variables would be valuable for future analysis. Further large-scale randomized control trials are warranted currently to help confirm these findings and to explore the optimal dosing regimens and administration protocols for dexmedetomidine in ESD.
{"title":"Addition of dexmedetomidine to anesthesia regimen reduces pain level after endoscopic submucosal dissection: A systematic review and meta analysis","authors":"Alan Gabriel Ortega-Macías , Alexis Vargas-Del Toro , Niloy Ghosh , Gicel Jacklin Aguilar , Tomas Escobar , Rafael Mancero Montalvo , Andrea Iturralde Carrillo , Vannya Marisol Ortega-Macías , Gulshan Parasher , Abu Baker Sheikh , Sergio A. Sánchez-Luna","doi":"10.1016/j.jclinane.2025.112070","DOIUrl":"10.1016/j.jclinane.2025.112070","url":null,"abstract":"<div><h3>Introduction</h3><div>Endoscopic submucosal dissection (ESD) is a minimally invasive organ-preserving procedure indicated for the removal of precancerous and cancerous areas in the gastrointestinal (GI) tract. It is highly valuable due to its ability to achieve high en-bloc resection rates and reduced local recurrence. Nevertheless, postoperative pain has been an often-overlooked complication, previous studies found that the incidence of moderate to severe pain after ESD can be as high as 44.9–62.8 %, leading to decreased patient satisfaction. Dexmedetomidine, a selective and potent α2-receptor agonist, has gained recognition in clinical practice for its sedative, analgesic, and anxiolytic properties, with the advantage of not causing respiratory depression as seen with opioids.</div></div><div><h3>Methods</h3><div>Following the PRISMA guidelines, a systematic review and meta-analysis were performed to determine the impact of dexmedetomidine on endoscopic submucosal dissection postoperative pain in adult patients with gastrointestinal neoplasias. Primary outcomes were postoperative pain, sedation time and adverse event rate. Data were analyzed using R version 4.2.2. The risk of bias was assessed by the Robins-I and RoB 2 tool. The quality of evidence was graded using the GRADE scale and Newcastle-Ottawa guidelines.</div></div><div><h3>Results</h3><div>Five randomized clinical trials and one observational studies described the postprocedural pain level of dexmedetomidine vs control for gastrointestinal neoplasia dissection, totaling 643 patients. The meta-analysis demonstrated a significant reduction in postoperative pain with dexmedetomidine (RR = 0.50; 95 % CI = [0.35; 0.70]; <em>p</em> < 0.01). No significant difference was found in terms of adverse event rate between –groups (RR = 1.04; 95 % CI = [0.55; 1.98]; <em>p</em> = 0.85). Similarly, regarding sedation time, two randomized clinical trials and one observational study totaling 249 patients showed no significant difference between groups (SMD = 0.27; 95 % CI = [−0.62; 1.17]; <em>p</em> = 0.32). The risk of bias was low with moderate-to-high quality of evidence among the included studies.</div></div><div><h3>Discussion</h3><div>Our updated systematic review and meta-analysis demonstrated a significant difference in the postoperative pain level in the group with concomitant dexmedetomidine and midazolam sedation compared to midazolam alone for the endoscopic dissection of superficial gastrointestinal neoplasias. Importantly, our analysis did not include objective data regarding post procedure opioid consumption nor patient satisfaction; these variables would be valuable for future analysis. Further large-scale randomized control trials are warranted currently to help confirm these findings and to explore the optimal dosing regimens and administration protocols for dexmedetomidine in ESD.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"108 ","pages":"Article 112070"},"PeriodicalIF":5.1,"publicationDate":"2025-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145557009","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}
Pub Date : 2025-11-17DOI: 10.1016/j.jclinane.2025.112068
Zheng Fang, Xin-qi Cheng
{"title":"Response to: Letter to the editor regarding “Unpacking the Bundled Intervention and Interpreting the Outcomes in the Individualized Blood Pressure Strategy Trial”","authors":"Zheng Fang, Xin-qi Cheng","doi":"10.1016/j.jclinane.2025.112068","DOIUrl":"10.1016/j.jclinane.2025.112068","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"108 ","pages":"Article 112068"},"PeriodicalIF":5.1,"publicationDate":"2025-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145549625","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}
Pub Date : 2025-11-16DOI: 10.1016/j.jclinane.2025.112075
Oya Gumuskaya , Hailey R. Donnelly , Nick Glenn , Julee McDonagh , Anita Skaros , Sophie Liang , Brett G. Mitchell , Luke Bendle , Sarah Aitken , Emile Belramoul , Mitchell Sarkies
Background
Preoperative oral carbohydrate loading is thought to reduce postoperative nausea and vomiting (PONV). However, it is unknown if the benefit of carbohydrate loading is maintained in the presence of total intravenous anaesthesia (TIVA). The aim of this systematic review was to determine whether oral carbohydrate loading reduced PONV compared to overnight fasting between adult elective surgery patients receiving TIVA or inhalational general anaesthesia.
Methods
A search of seven databases was conducted until March 2024. Randomised controlled trials conducted with patient aged 18 years or older were included. Two reviewers independently screened titles, abstracts and full texts, and assessed risk of bias using the Cochrane ROB-2 Tool. Study data was pooled using random effects meta-analyses.
Results
We included 26 studies in this review, and 25 in the meta-analyses (n = 2491). Preoperative oral carbohydrate loading reduced the overall risk (log RR: –0.35, 95 % CI: −0.62 to −0.08, I2 = 51.11 %) and severity (SMD: -0.46, 95 % CI: −0.68 to −0.24, I2 = 62.09 %) of PONV, and pain severity (MD: -0.69, 95 % CI: −1.13 to −0.25, I2 = 83.98 %) compared to prolonged fasting when pooled across both anaesthesia approaches. The risk of PONV was reduced in patients receiving inhalational anaesthesia, but not in those receiving TIVA, while the reduction in severity was more significant in TIVA.
Conclusion
Oral carbohydrate loading reduces the severity of PONV and pain, regardless of the anaesthesia approach, compared to prolonged fasting. These findings support the clinical advantages of oral carbohydrate loading for postoperative outcomes, regardless of anaesthesia approach.
{"title":"The effectiveness of preoperative oral carbohydrate loading on postoperative nausea and vomiting in adults receiving total intravenous anaesthesia compared to inhalational anaesthesia: A systematic review and meta-analysis","authors":"Oya Gumuskaya , Hailey R. Donnelly , Nick Glenn , Julee McDonagh , Anita Skaros , Sophie Liang , Brett G. Mitchell , Luke Bendle , Sarah Aitken , Emile Belramoul , Mitchell Sarkies","doi":"10.1016/j.jclinane.2025.112075","DOIUrl":"10.1016/j.jclinane.2025.112075","url":null,"abstract":"<div><h3>Background</h3><div>Preoperative oral carbohydrate loading is thought to reduce postoperative nausea and vomiting (PONV). However, it is unknown if the benefit of carbohydrate loading is maintained in the presence of total intravenous anaesthesia (TIVA). The aim of this systematic review was to determine whether oral carbohydrate loading reduced PONV compared to overnight fasting between adult elective surgery patients receiving TIVA or inhalational general anaesthesia.</div></div><div><h3>Methods</h3><div>A search of seven databases was conducted until March 2024. Randomised controlled trials conducted with patient aged 18 years or older were included. Two reviewers independently screened titles, abstracts and full texts, and assessed risk of bias using the Cochrane ROB-2 Tool. Study data was pooled using random effects meta-analyses.</div></div><div><h3>Results</h3><div>We included 26 studies in this review, and 25 in the meta-analyses (<em>n</em> = 2491). Preoperative oral carbohydrate loading reduced the overall risk (log RR: –0.35, 95 % CI: −0.62 to −0.08, I<sup>2</sup> = 51.11 %) and severity (SMD: -0.46, 95 % CI: −0.68 to −0.24, I<sup>2</sup> = 62.09 %) of PONV, and pain severity (MD: -0.69, 95 % CI: −1.13 to −0.25, I<sup>2</sup> = 83.98 %) compared to prolonged fasting when pooled across both anaesthesia approaches. The risk of PONV was reduced in patients receiving inhalational anaesthesia, but not in those receiving TIVA, while the reduction in severity was more significant in TIVA.</div></div><div><h3>Conclusion</h3><div>Oral carbohydrate loading reduces the severity of PONV and pain, regardless of the anaesthesia approach, compared to prolonged fasting. These findings support the clinical advantages of oral carbohydrate loading for postoperative outcomes, regardless of anaesthesia approach.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"108 ","pages":"Article 112075"},"PeriodicalIF":5.1,"publicationDate":"2025-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145541026","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}
Pub Date : 2025-11-14DOI: 10.1016/j.jclinane.2025.112072
Sangeeta Kumaraswami MD , Shital Patel , James Tom DDS , Rita Agarwal MD, FASA
{"title":"Why Do Deaths and Catastrophic Injury From Anesthesia in the Dental Office-Based Setting Still Occur?","authors":"Sangeeta Kumaraswami MD , Shital Patel , James Tom DDS , Rita Agarwal MD, FASA","doi":"10.1016/j.jclinane.2025.112072","DOIUrl":"10.1016/j.jclinane.2025.112072","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"108 ","pages":"Article 112072"},"PeriodicalIF":5.1,"publicationDate":"2025-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145526057","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}
Pub Date : 2025-11-10DOI: 10.1016/j.jclinane.2025.112066
J. Ross Renew , Maria Estevez , Mariel Maramba , Michael G. Heckman , Zhihui J. Fang , Sorin J. Brull , Richard H. Epstein
Background
The use of quantitative neuromuscular monitoring during induction of anesthesia to establish a baseline neuromuscular response and ensure paralysis of the vocal cords during laryngoscopy and tracheal intubation has yet to become standard practice. The current study compared intubating conditions based on quantitative measurements (train-of-four count) with intubating conditions based on the time since rocuronium administration.
Methods
Consenting adult patients undergoing general anesthesia requiring neuromuscular block were randomized into 2 groups. Following placement of a quantitative electromyographic neuromuscular monitor, general anesthesia was induced with propofol 1–1.5 mg/kg followed by rocuronium 0.6 mg/kg. In one group, intubation commenced 2 min after rocuronium administration (Time Group). In the other, intubation commenced when the first train-of-four (TOF) count was ≤1 (Count Group). Video laryngoscopy was used in both groups and the intubating conditions were noted. A Wilcoxon rank sum test or Fisher's exact test was used to compare intubating conditions between the 2 groups. Spearman's rank correlation test was used to describe the relationship between intubation conditions and the ratio of the amplitude of the first twitch of the TOF sequence, T1, to the control T1 amplitude (T1/Tc).
Results
There were 84 patients in the Count Group and 83 in the Time Group. More patients had ideal intubating conditions (relaxed jaw, abducted vocal cords, and no response to tracheal intubation) in the Count Group (61/84, 73 %) than the Time Group (47/83, 57 %, P = 0.036). The mean composite intubating score was better (lower) in the Count Group than in the Time Group (3.5 vs. 3.9, respectively, P = 0.016). The T1/Tc at intubation correlated with the composite intubating conditions score (Spearman's ρ = 0.34, P < 0.001).
Conclusion
Intubating conditions were better when the timing of intubation was guided by quantitative neuromuscular monitoring to ensure a TOF count ≤1 versus waiting a fixed time interval of 2 min following administration of rocuronium.
{"title":"Intubating conditions based on the time from rocuronium administration versus the train-of-four count: A randomized, prospective, clinical trial","authors":"J. Ross Renew , Maria Estevez , Mariel Maramba , Michael G. Heckman , Zhihui J. Fang , Sorin J. Brull , Richard H. Epstein","doi":"10.1016/j.jclinane.2025.112066","DOIUrl":"10.1016/j.jclinane.2025.112066","url":null,"abstract":"<div><h3>Background</h3><div>The use of quantitative neuromuscular monitoring during induction of anesthesia to establish a baseline neuromuscular response and ensure paralysis of the vocal cords during laryngoscopy and tracheal intubation has yet to become standard practice. The current study compared intubating conditions based on quantitative measurements (train-of-four count) with intubating conditions based on the time since rocuronium administration.</div></div><div><h3>Methods</h3><div>Consenting adult patients undergoing general anesthesia requiring neuromuscular block were randomized into 2 groups. Following placement of a quantitative electromyographic neuromuscular monitor, general anesthesia was induced with propofol 1–1.5 mg/kg followed by rocuronium 0.6 mg/kg. In one group, intubation commenced 2 min after rocuronium administration (Time Group). In the other, intubation commenced when the first train-of-four (TOF) count was ≤1 (Count Group). Video laryngoscopy was used in both groups and the intubating conditions were noted. A Wilcoxon rank sum test or Fisher's exact test was used to compare intubating conditions between the 2 groups. Spearman's rank correlation test was used to describe the relationship between intubation conditions and the ratio of the amplitude of the first twitch of the TOF sequence, T<sub>1</sub>, to the control T<sub>1</sub> amplitude (T<sub>1</sub>/T<sub>c</sub>).</div></div><div><h3>Results</h3><div>There were 84 patients in the Count Group and 83 in the Time Group. More patients had ideal intubating conditions (relaxed jaw, abducted vocal cords, and no response to tracheal intubation) in the Count Group (61/84, 73 %) than the Time Group (47/83, 57 %, <em>P</em> = 0.036). The mean composite intubating score was better (lower) in the Count Group than in the Time Group (3.5 vs. 3.9, respectively, <em>P</em> = 0.016). The T<sub>1</sub>/T<sub>c</sub> at intubation correlated with the composite intubating conditions score (Spearman's <em>ρ</em> = 0.34, <em>P</em> < 0.001).</div></div><div><h3>Conclusion</h3><div>Intubating conditions were better when the timing of intubation was guided by quantitative neuromuscular monitoring to ensure a TOF count ≤1 versus waiting a fixed time interval of 2 min following administration of rocuronium.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"108 ","pages":"Article 112066"},"PeriodicalIF":5.1,"publicationDate":"2025-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145495599","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}
Aspiration of gastric content is a serious complication of anesthesia, associated with high mortality and morbidity. Recent studies demonstrated that fasting status can be assessed accurately by gastric ultrasound. However, there is still a lack of evidence regarding the application of this technique by inexperienced examiners. We aimed to determine the accuracy of gastric ultrasound performed by medical students after a standardized training sequence.
Outcome
Accuracy of identifying the fasting status by gastric ultrasound performed by inexperienced examiners.
Methods
In this prospective observational cohort study, five medical students performed 80 gastric ultrasound examinations on healthy, non-obese volunteers. Standardized training consisted of blended online training, one plenary lecture, and 2 h of hands-on-training. Volunteers were randomized in a 2:1:1 ratio to "fasted", "non-fasted, fluid", and "non-fasted, solid" with the examiners being blinded to the fasting status. The examiners determined the fasting status using gastric ultrasound and recorded the gastric cross-sectional area. Beforehand, an expert examiner also conducted all examinations for comparison. Sensitivity, specificity, positive and negative predictive values were calculated from the acquired data. The cross-sectional area was pooled for the expert and non-experts and the results plotted and interrater reliability assessed by the intraclass correlation coefficient (ICC).
Results
Data from 80 individuals were analyzed. The inexperienced examiners correctly identified all non-fasted volunteers (sensitivity 1.00,95 % CI: 0.91–1.00). They wrongly classified 18 out of 40 fasted volunteers as "non-fasted" (specificity 0.55, 95 % CI: 0.40–0.69). Positive predictive value was 0.69 (95 % CI: 0.56–0.79) and negative predictive value 1.00 (95 % CI: 0.85–1.00). The overall ICC was 0.72 (95 % CI 0.57–0.82), and 0.30 (95 % CI -0.32–0.63), 0.66 (95 % CI -0.16–0.87), and 0.27 (95 % CI -0.82–0.71), for the "fasted", "non-fasted, fluid", and "non-fasted, solid" states, respectively.
Conclusions
Examiners with limited experience in ultrasound diagnostics may accurately identify a full stomach in normal-weight volunteers after a standardized training sequence. However, the detected specificity of 0.63 was low, and more focused training on the ultrasound anatomy of an empty stomach may be needed to rule out an empty stomach in a clinical scenario.
背景：胃内容物误吸是麻醉的严重并发症，死亡率和发病率高。最近的研究表明，胃超声可以准确地评估空腹状态。然而，关于没有经验的审查员应用该技术的证据仍然缺乏。我们的目的是确定医学生在标准化训练后进行胃超声检查的准确性。结果：没有经验的检查人员通过胃超声检查确定禁食状态的准确性。方法：在这项前瞻性观察队列研究中，五名医学生对健康的非肥胖志愿者进行了80次胃超声检查。标准化培训包括混合在线培训、一次全体讲座和2小时的实践培训。志愿者按2:1:1的比例随机分为“禁食”、“非禁食、流质”和“非禁食、固体”，审查员对禁食状态不知情。检查人员使用胃超声确定空腹状态并记录胃横截面积。在此之前，一名专家审查员也进行了所有的检查以进行比较。根据获得的数据计算敏感性、特异性、阳性预测值和阴性预测值。将专家和非专家的横截面积汇总，绘制结果，并通过类内相关系数（ICC）评估组间信度。结果：分析了80例个体的数据。没有经验的检查人员正确地识别出所有未禁食的志愿者（灵敏度1.00,95% CI: 0.91-1.00）。他们错误地将40名禁食志愿者中的18人归类为“非禁食”（特异性0.55,95% CI: 0.40-0.69）。阳性预测值为0.69 (95% CI: 0.56 ~ 0.79)，阴性预测值为1.00 （95% CI: 0.85 ~ 1.00）。对于“禁食”、“非禁食、流质”和“非禁食、固体”状态，总体ICC分别为0.72 （95% CI 0.57-0.82）、0.30 （95% CI -0.32-0.63）、0.66 （95% CI -0.16-0.87）和0.27 （95% CI -0.82-0.71）。结论：超声诊断经验有限的检查人员可以在标准化的训练序列后准确地识别正常体重志愿者的饱胃。然而，0.63的检测特异性较低，可能需要对空腹超声解剖进行更集中的培训，以排除临床场景中的空腹。
{"title":"Trust your gut? Evaluating non-expert gastric ultrasound performance – A prospective observational cohort study","authors":"Sarah Baumann , Firmin Kamber MD , Thierry Girard MD , Eckhard Mauermann MD, PhD, M.Sc , Reza Kaviani MD","doi":"10.1016/j.jclinane.2025.112053","DOIUrl":"10.1016/j.jclinane.2025.112053","url":null,"abstract":"<div><h3>Background</h3><div>Aspiration of gastric content is a serious complication of anesthesia, associated with high mortality and morbidity. Recent studies demonstrated that fasting status can be assessed accurately by gastric ultrasound. However, there is still a lack of evidence regarding the application of this technique by inexperienced examiners. We aimed to determine the accuracy of gastric ultrasound performed by medical students after a standardized training sequence.</div></div><div><h3>Outcome</h3><div>Accuracy of identifying the fasting status by gastric ultrasound performed by inexperienced examiners.</div></div><div><h3>Methods</h3><div>In this prospective observational cohort study, five medical students performed 80 gastric ultrasound examinations on healthy, non-obese volunteers. Standardized training consisted of blended online training, one plenary lecture, and 2 h of hands-on-training. Volunteers were randomized in a 2:1:1 ratio to \"fasted\", \"non-fasted, fluid\", and \"non-fasted, solid\" with the examiners being blinded to the fasting status. The examiners determined the fasting status using gastric ultrasound and recorded the gastric cross-sectional area. Beforehand, an expert examiner also conducted all examinations for comparison. Sensitivity, specificity, positive and negative predictive values were calculated from the acquired data. The cross-sectional area was pooled for the expert and non-experts and the results plotted and interrater reliability assessed by the intraclass correlation coefficient (ICC).</div></div><div><h3>Results</h3><div>Data from 80 individuals were analyzed. The inexperienced examiners correctly identified all non-fasted volunteers (sensitivity 1.00,95 % CI: 0.91–1.00). They wrongly classified 18 out of 40 fasted volunteers as \"non-fasted\" (specificity 0.55, 95 % CI: 0.40–0.69). Positive predictive value was 0.69 (95 % CI: 0.56–0.79) and negative predictive value 1.00 (95 % CI: 0.85–1.00). The overall ICC was 0.72 (95 % CI 0.57–0.82), and 0.30 (95 % CI -0.32–0.63), 0.66 (95 % CI -0.16–0.87), and 0.27 (95 % CI -0.82–0.71), for the \"fasted\", \"non-fasted, fluid\", and \"non-fasted, solid\" states, respectively.</div></div><div><h3>Conclusions</h3><div>Examiners with limited experience in ultrasound diagnostics may accurately identify a full stomach in normal-weight volunteers after a standardized training sequence. However, the detected specificity of 0.63 was low, and more focused training on the ultrasound anatomy of an empty stomach may be needed to rule out an empty stomach in a clinical scenario.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"108 ","pages":"Article 112053"},"PeriodicalIF":5.1,"publicationDate":"2025-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145495632","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}
Various adjuvants can be added to local anesthetics (LAs) to prolong the duration of regional anesthesia. This network meta-analysis (NMA) aimed to compare the relative efficacy of commonly used adjuvants in transversus abdominis plane (TAP) blocks following cesarean delivery (CD).
Methods
A comprehensive literature search was performed in PubMed, Embase, CENTRAL, web of science, and Wanfang data. Eligible studies were randomized controlled trials comparing the effects of adding an adjuvant to LA versus LA alone or versus another adjuvant in a single-shot TAP block after CD. The primary outcome was time to first analgesia request. Bayesian random-effects NMAs were performed using the LA alone group as the comparator.
Results
Thirty-nine studies involving five adjuvants were included. None of the studies administered intrathecal morphine. Compared to LA alone, time to first analgesic request was significantly prolonged with clonidine (6.9 h, 95 % CrI 4.5–9.4 h), dexamethasone (5.8 h, 95 % CrI 4.2–7.4 h), dexmedetomidine (4.1 h, 95 % CrI 2.7–5.5 h) and magnesium sulfate (3.2 h, 95 % CrI 0.9–5.7 h). Clonidine ranked first, followed by dexamethasone, dexmedetomidine, and magnesium. However, in the outlier analysis and the subgroup analysis of women receiving basic analgesics, dexamethasone ranked first, while magnesium was ineffective. Overall, adjuvants had minimal clinical impact on postoperative opioid consumption or pain scores. Notably, high heterogeneity was observed, and the quality of evidence was rated as low or very low.
Conclusions
With the high heterogeneity and the low or very low quality of the evidence, clonidine, dexamethasone, and dexmedetomidine may prolong analgesia after CD without intrathecal morphine when used as adjuvants in TAP blocks. Furthermore, dexamethasone and dexmedetomidine appear preferable when basic analgesics are administered. Nevertheless, these results should be interpreted with caution.
{"title":"Adjuvants in transversus abdominis plane blocks to prolong analgesia duration following cesarean delivery: A systematic review and network meta-analysis","authors":"Li-Zhong Wang, Jia-Yue Huang, Xiang-Yang Chang, Feng Xia","doi":"10.1016/j.jclinane.2025.112067","DOIUrl":"10.1016/j.jclinane.2025.112067","url":null,"abstract":"<div><h3>Background</h3><div>Various adjuvants can be added to local anesthetics (LAs) to prolong the duration of regional anesthesia. This network meta-analysis (NMA) aimed to compare the relative efficacy of commonly used adjuvants in transversus abdominis plane (TAP) blocks following cesarean delivery (CD).</div></div><div><h3>Methods</h3><div>A comprehensive literature search was performed in PubMed, Embase, CENTRAL, web of science, and Wanfang data. Eligible studies were randomized controlled trials comparing the effects of adding an adjuvant to LA versus LA alone or versus another adjuvant in a single-shot TAP block after CD. The primary outcome was time to first analgesia request. Bayesian random-effects NMAs were performed using the LA alone group as the comparator.</div></div><div><h3>Results</h3><div>Thirty-nine studies involving five adjuvants were included. None of the studies administered intrathecal morphine. Compared to LA alone, time to first analgesic request was significantly prolonged with clonidine (6.9 h, 95 % CrI 4.5–9.4 h), dexamethasone (5.8 h, 95 % CrI 4.2–7.4 h), dexmedetomidine (4.1 h, 95 % CrI 2.7–5.5 h) and magnesium sulfate (3.2 h, 95 % CrI 0.9–5.7 h). Clonidine ranked first, followed by dexamethasone, dexmedetomidine, and magnesium. However, in the outlier analysis and the subgroup analysis of women receiving basic analgesics, dexamethasone ranked first, while magnesium was ineffective. Overall, adjuvants had minimal clinical impact on postoperative opioid consumption or pain scores. Notably, high heterogeneity was observed, and the quality of evidence was rated as low or very low.</div></div><div><h3>Conclusions</h3><div>With the high heterogeneity and the low or very low quality of the evidence, clonidine, dexamethasone, and dexmedetomidine may prolong analgesia after CD without intrathecal morphine when used as adjuvants in TAP blocks. Furthermore, dexamethasone and dexmedetomidine appear preferable when basic analgesics are administered. Nevertheless, these results should be interpreted with caution.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"108 ","pages":"Article 112067"},"PeriodicalIF":5.1,"publicationDate":"2025-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145495573","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}
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