Korean Journal of Anesthesiology最新文献

Background: As the characteristics of the intertruncal approach to the supraclavicular block (IA-SCB) are uncertain, we aimed to compare its effect on sensory-motor blockade with that of the classical approach (CA) within 30 min post-block.

Methods: In total, 122 patients undergoing elbow, forearm, wrist, or hand surgery were randomly assigned to receive CA-SCB or IA-SCB. Both groups received identical local anesthetic agents (1% lidocaine and 0.5% ropivacaine) in 25 ml total. The IA-SCB group received 15 ml between the middle and inferior trunks and 10 ml between the superior and middle trunks, while the CA-SCB group received 15 ml in the corner pocket and 10 ml in the center of the neural clusters. Sensory-motor blockade of all four terminal nerves was assessed every 5 min for 30 min. The non-inferiority threshold aimed to exclude the possibility that the IA-SCB was > 5% inferior to the CA-SCB in terms of the proportion of patients with complete sensory blockade at 20 min post-block.

Results: Complete sensory blockade at 20 min post-block was 79.3% and 72.7% with the CA-SCB and IA-SCB, respectively, exceeding the non-inferiority margin of -5% (-6.6%, 95% CI [-22.3% to 9.1%]; P value for non-inferiority = 0.206). Additionally, the IA-SCB showed an inferior musculocutaneous nerve blockade, longer performance time, and higher incidence of hemidiaphragmatic paresis.

Conclusions: Our findings do not confirm the non-inferiority of the IA-SCB to the CA-SCB in achieving complete sensory blockade at 20 min post-block. Further research may be necessary to establish its efficacy in regional anesthesia.

Background: This study aimed to explore the efficacy and safety of the hip pericapsular nerve block (hip-PNB), which combines the anterior pericapsular nerve group (PENG) and posterior pericapsular deep-gluteal (PPD) blocks, on postoperative pain and functional outcomes after total hip arthroplasty (THA) via the posterolateral approach.

Methods: Seventy patients undergoing THA were allocated to either the nerve block group (Group N, hip-PNB + sham local infiltration analgesia [LIA]) or the control group (Group C, sham hip-PNB + LIA). The primary outcome was cumulative morphine consumption in the first 24 h postoperatively. Secondary outcomes included visual analog scale pain scores at rest and during movement postoperatively, time to first rescue analgesia, cumulative morphine consumption during hospitalization, opioid consumption during surgery, postoperative recovery, and postoperative complications.

Results: Compared with Group C, Group N consumed significantly less morphine in the first 24 h (10 [0, 10] mg vs. 10 [10, 20] mg; P < 0.001) and throughout hospitalization (10 [0, 20] mg vs. 20 [20, 30] mg; P < 0.001) and had less opioid consumption perioperatively. Group N also had significantly lower pain scores at rest and during movement in the first 24 h, required rescue analgesia later, and had faster recovery postoperatively than Group C. No significant intergroup differences were observed in quadriceps muscle strength or postoperative complication rates.

Conclusions: Compared to LIA, hip-PNB has better postoperative analgesia and enhances recovery in patients undergoing THA.

Background: Emergence agitation (EA) occurs in preschool children after ophthalmic surgery as eye shields induce visual disturbance. We aimed to investigate the efficacy of light-transmitting eye shields as an alternative to traditional medical gauze eye shields for wound dressing in terms of EA incidence following strabismus surgery.

Methods: We randomly assigned 70 preschool children undergoing bilateral strabismus surgery to receive either light-transmitting (LT group, n = 35) or medical gauze (MG group, n = 35) eye shields upon the completion of surgery. The primary outcome was the difference in EA incidence between the groups.

Results: After adjusting the data for age and sex, children in the LT group were less likely to develop EA than those in the MG group (5 of 35 children [14.3%] vs. 15 of 35 children [42.9%]; adjusted odds ratio: 0.28, 95% CI [0.08-0.94], P = 0.040). Compared with the MG group, a significant reduction in the median score of the peak Aono's four-point scale was observed in the LT group (P = 0.024; Benjamini-Hochberg [BH] critical value = 0.050). Additionally, the incidences of agitation (peak Pediatric Anesthesia Emergence Delirium score ≥ 16) and propofol administration in the LT group were significantly lower than those in the MG group (P = 0.022; BH critical value = 0.038 and P = 0.017; BH critical value = 0.025, respectively).

Conclusions: The application of light-transmitting eye shields for wound dressing could help prevent EA after pediatric bilateral strabismus surgery under sevoflurane anesthesia.

Background: Different field block methods are used for analgesia following abdominal surgery. In this study, we evaluated the efficacy of a modified thoracoabdominal nerve block via the perichondrial approach (M-TAPA) and that of an external oblique and rectus abdominis plane (EXORA) block for anterolateral upper abdominal analgesia.

Methods: This study included 90 patients undergoing laparoscopic cholecystectomy. Patients were divided into three groups (n = 30 per group): a control group, which received intravenous patient-controlled analgesia (IV-PCA); an EXORA block group, which received an EXORA block with 0.25% bupivacaine + IV-PCA; and an M-TAPA block group, which received an M-TAPA with 0.25% bupivacaine + IV-PCA. The primary outcome was postoperative pain (at rest and on movement), evaluated using numerical rating scale (NRS) scores at 2, 4, 6, 12, and 24 h postoperatively. Secondary outcomes included tramadol use, the side effect profile, dermatomal spread, and additional analgesic use at 12 h and 24 h postoperatively.

Results: NRS scores as well as the mean tramadol consumption at 12 h and 24 h postoperatively were significantly lower in the EXORA and M-TAPA groups than in the control group (all P < 0.001). Sensory block was recorded in the lateral and anterior abdomen from T7 to T11 after both EXORA block and M-TAPA application.

Conclusions: EXORA block and M-TAPA application provided similar levels of analgesia to the upper abdominal wall after laparoscopic cholecystectomy. Further data should be obtained from cadaveric and other types of studies.

Background: Remimazolam is a novel short-acting benzodiazepine. We investigated the effects of low doses of volatile anesthetic agents on motor evoked potentials (MEPs) and somatosensory evoked potentials (SSEPs) during remimazolam-remifentanil anesthesia.

Methods: Thirty-nine patients undergoing cervical spine surgery were randomly assigned to either the sevoflurane (n = 20) or desflurane (n = 19) groups. Volatile anesthetic agents were administered at 0.3, 0.6, and 0.8 minimum alveolar concentrations (MACs) during remimazolam-remifentanil anesthesia. Significant changes were considered as more than 50% amplitude suppression and more than 10% latency increase from baseline values. The primary outcome was MEP amplitude change. Secondary outcomes included MEP latency, SSEP amplitude and latency, and group comparisons.

Results: The MEP amplitudes were slightly reduced at 0.3 MAC; however, a suppression of more than 50% from baseline values at 0.3 MAC, particularly in the upper limbs, was observed in a notable proportion of participants; 30.0% and 47.4% in the sevoflurane and desflurane groups, respectively. The corresponding percentages for the lower limbs were 15.0% and 15.8%, respectively. MEP amplitude suppression was more than 50% in the majority of participants at 0.6 and 0.8 MAC. No significant difference was observed between the groups. SSEPs exhibited no significant amplitude suppression or latency prolongation across all MAC levels.

Conclusions: Notable MEP amplitude suppression was observed in many patients when 0.3 MAC volatile anesthetics were used as adjuncts. Therefore, even low doses of volatile anesthetics must be added cautiously to remimazolam-based anesthesia to prevent confounding. The SSEPs were relatively preserved, regardless of MAC.

Analysis of covariance (ANCOVA) is a statistical method used to assess mean differences between groups by considering factors such as covariates or fixed effects and is often used to assess efficacy endpoints in clinical trials. When performing ANCOVA, the slope of the regression model should be the same for all treatment groups, with no interaction between the group and the covariate. Therefore, before analysis, the significance of the full ANCOVA model with interactions must be tested. If the interaction in the full model is statistically significant, the model that includes the interaction should be used; otherwise, ANCOVA using a reduced model without the interaction should be performed. If the ANCOVA model is not significant, this analysis method is not appropriate and a multivariate analysis or individual regression line estimation can be considered. If the difference in means between the groups is tested by ANCOVA, the confidence interval for the adjusted mean (least-squares mean) should be calculated and tested. Because the results may change depending on the covariates used in the ANCOVA model, the covariates should be predefined before performing the analysis. If a new covariate must be defined after a clinical trial is initiated, it should be specified in the statistical analysis plan. This is considered a major amendment; thus, the covariates must be redefined before clinical trial completion and must be described in the clinical study report. A clear report describing whether the redefinition of the covariates affected the sample size or decision-making is also necessary.

Background: Despite strong preclinical evidence, clinical studies have reported minimal effects of early anesthesia on neurodevelopment. This discrepancy may be due to limitations of preclinical studies, including the absence of clear criteria for appropriate anesthetic depth, lack of physiological monitoring, and absence of a surgical insult. Therefore, we aimed to evaluate the effects of sevoflurane in a more clinically relevant setting by addressing these known limitations.

Methods: After confirming robust burst suppression (BS) at 2.5% sevoflurane, postnatal day 17 (PND17) mice were assigned to three groups: a Control group, no intervention; BS (-) group, surgery with 1.4% sevoflurane; and a BS (+) group, surgery with 1.4%-2.5% sevoflurane. Total duration of anesthesia was 2 h, and blood pressure was non-invasively measured in a subset of mice. Long-term behavioral changes were evaluated from PND56 to PND62 at a two-day interval.

Results: We found subtle but significant changes in anxiety and sociability only in BS (+) group mice. Change in anxiety level was observed in the light/dark box test, with the number of transitions between chambers significantly lower in the BS (+) group (P = 0.025). Reduced sociability was observed in the three-chamber test, as mice in the BS (+) group did not significantly prefer the chamber containing a stranger mouse (P = 0.065).

Conclusions: Both surgery and excessive anesthesia depth are necessary to induce subtle yet long-term behavioral changes in young mice. Future preclinical studies should reconsider sevoflurane concentration and account for surgical trauma as a significant factor when investigating anesthesia-induced neurotoxicity.