Minerva anestesiologica最新文献

Background: This study investigated the effects of high-flow nasal cannula (HFNC) and Procedural Oxygen Mask^™ (POM^™) on oxygenation during endoscopic retrograde cholangiopancreatography (ERCP) performed under sedation in the semi-prone position.

Methods: In this prospective, randomized, parallel-group trial, 198 patients scheduled for ERCP between March 7^th and June 3^rd, 2025, were assessed; 150 were randomized to receive oxygen via HFNC or POM^™ (75 each). The primary outcome was the incidence of hypoxemia (SpO2<90% for ≥10 seconds) during ERCP. Secondary outcomes included the duration of hypoxemia, the number of hypoxemic episodes per patient, and the lowest recorded SpO2, along with the incidence of airway interventions, the incidence of procedure-disrupting body motions, hemodynamic changes, and satisfaction scores from both gastroenterologists and patients.

Results: Hypoxemia occurred in five patients (6.7%) in the HFNC group and in one patient (1.3%) in the POM^™ group; however, this difference was not statistically significant (P=0.209). No significant differences were found in any secondary outcomes between the groups (P>0.003). In multiple logistic regression analysis, only weight was significantly associated with hypoxemia risk (aOR=1.091; 95% CI: 1.001-1.189; P=0.048), while no significant difference was found between the HFNC and POM^TM groups (aOR=9.357; 95% CI: 0.815-107.447; P=0.073).

Conclusions: POM^™ appears to be a practical alternative to HFNC for oxygen supplementation during ERCP under sedation in the semi-prone position, with comparable hypoxemia incidence and airway-related outcomes. These results suggest that POM^™ can be effectively used in this clinical setting.

Background: Patients undergoing Transcatheter Aortic Valve Replacement (TAVR) are at risk for delirium. In Italy, the perioperative management of TAVR lacks standardization: this survey aims to investigate TAVR management across the country, focusing on delirium.

Methods: A multiple-choice survey was conducted anonymously among 40 high-volume cardiac surgery centers in Italy: questions addressed logistics, surgical procedures, anesthetic management and delirium assessment.

Results: The response rate was 68%. Low-volume centers were excluded, resulting in a final sample of 22 hospitals, including 7 of the top 10 highest-volume TAVR centers in Italy. Only 36% of the participating centers routinely assessed delirium onset after TAVR, and just 18% utilized a validated delirium diagnostic scale. Only one-third of the hospitals systematically assessed patient frailty in the preoperative period. Fast-track protocols for TAVR patients were implemented in 68% of the centers. The transfemoral approach was consistently the first choice, with conscious sedation being the preferred anesthetic strategy (82%). Invasive blood pressure monitoring with a dedicated line was routinely performed in 91% of centers, while urinary catheters were used in half of the hospitals, including 47% of those with fast-track protocols. Postoperatively, 55% of patients were admitted to a Subacute or Coronary Care Unit, while 41% were managed in the Cardiology ward. In most cases, the hospital length of stay was three days or more.

Conclusions: This survey reveals substantial heterogeneity in perioperative management, delirium prevention and assessment after TAVR in Italy. This heterogeneity may contribute to differences in hospital stay and clinical outcomes.

Introduction: Hip arthroplasty is a frequently performed surgery that requires effective multimodal analgesia for optimal recovery and adherence to enhanced recovery after surgery protocols. Traditionally, spinal anesthesia with opioids has been the mainstay for postoperative pain management, but side effects have prompted increased use of peripheral nerve blocks. The fascia iliaca block (FIB) is a well-established technique recommended by PROSPECT guidelines, while the erector spinae plane block (ESPB) has recently emerged as a potential alternative. This systematic review and meta-analysis aimed to compare the efficacy of FIB and ESPB in patients undergoing hip arthroplasty.

Evidence acquisition: A comprehensive search of PubMed, Cochrane, and Embase identified six randomized controlled trials (RCTs) including 348 patients, evenly distributed between ESPB and FIB groups. Primary outcomes included incidence of motor block, cumulative opioid consumption, time to first rescue analgesia, and postoperative pain scores.

Evidence synthesis: The analysis revealed that ESPB significantly reduced the incidence of quadriceps motor block compared to FIB, with a relative risk (RR) of 0.25 (95% CI, 0.13-0.49; P<0.001). Motor block occurred in 8.7% of ESPB patients versus 38.4% of FIB patients. However, there were no statistically significant differences between groups in 24-hour cumulative opioid consumption, time to first rescue analgesia, or pain scores at rest or during movement.

Conclusions: ESPB offers a clear advantage over FIB in preserving motor function without compromising analgesic efficacy. These findings support ESPB as a viable alternative to FIB in hip arthroplasty pain management protocols.

Introduction: Percutaneous nephrolithotomy (PCNL) is a common surgical procedure for the removal of kidney stones. Adequate postoperative analgesia is crucial for enhancing recovery and minimizing complications. Peripheral nerve blocks (PNBs) have emerged as a promising method for managing postoperative pain in PCNL patients. This systematic review and network meta-analysis (NMA) aim to evaluate the efficacy of various PNBs for analgesia after PCNL.

Evidence acquisition: A comprehensive literature search was conducted in electronic databases including PubMed, Embase, Web of Science, and the Cochrane Library up to April 2025. Randomized controlled trials (RCTs) that compared different PNBs or PNBs with no block after PCNL were included. The primary outcome was the total morphine consumption within the first 24 hours postoperatively. The NMA was performed using Stata 15.1 software.

Evidence synthesis: We included 38 RCTs involving 2,339 patients and assessed seven analgesic techniques. The total morphine consumption was most significantly reduced by intercostal nerve block (ICNB), followed by peritubal infiltration (PI) and erector spinae plane block (ESPB). At six hours postoperatively, the resting Visual Analog Scale (VAS) scores were lower with ICNB, followed by PI and ESPB. At 12 hours, resting VAS scores decreased with paravertebral block (PVB), followed by ICNB and PI. At 24 hours, resting VAS scores were reduced by PVB, then epidural block (EB), and ICNB. For dynamic-induced pain at six hours, VAS scores were decreased by quadratus lumborum block (QLB), followed by ICNB and PI. At 12 hours, dynamic VAS scores were lower with ESPB, followed by ICNB and PI. At 24 hours, dynamic VAS scores decreased with PVB, followed by EB and ICNB. Postoperative nausea and vomiting (PONV) were reduced by ICNB, followed by PI and PVB. The time to first rescue analgesia was prolonged with ICNB, followed by QLB and PI. The number of patients requiring additional analgesics were decreased with ICNB, followed by PI and QLB.

Conclusions: The NMA indicated that ICNB was likely the optimal technique for postoperative analgesia in patients undergoing PCNL. In contrast, the TAPB appears to be less effective.

Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) is considered the standard of care for the treatment of primary and secondary peritoneal malignancies. Based on the combination of intravenous and hyperthermic intraperitoneal chemotherapy following surgical removal of the macroscopic tumor, CRS with HIPEC is associated with increased survival and reduced five-year mortality. However, CRS with HIPEC induces pathophysiological changes that require rigorous intraoperative management. Thus, CRS with HIPEC remains a challenge for anesthesiologists in the preoperative (e.g. patients selection, prehabilitation), perioperative (e.g. hemodynamic monitoring, ventilation) and postoperative periods. Unfortunately, there are few recent articles discussing intraoperative aspects and guidelines based on a standardized expert consensus process. Based on the most recent studies and expert consensus available on the subject, this review summarizes the challenges faced by anesthesiologists and intensivists regarding the pathophysiology and changes induced by CRS in HIPEC during the perioperative period.

Introduction: Cesarean section is commonly linked to significant postoperative pain, which may hinder maternal recovery. Transversalis fascia plane block (TFPB) has emerged as a regional anesthesia technique that may enhance pain control and reduce opioid requirements. This study assesses the efficacy and safety of TFPB through a systematic review and meta-analysis of randomized controlled trials.

Evidence acquisition: Following PRISMA guidelines and registered in PROSPERO (CRD420251000597), a systematic search of five databases was conducted up to March 7, 2025. Included studies were randomized controlled trials comparing TFPB with placebo, no block, or other regional techniques such as transversus abdominis plane block, quadratus lumborum block, or ilioinguinal-iliohypogastric nerve blocks. Outcomes reflecting analgesic efficacy included time to first analgesic request, pain scores (at rest and during movement), 24-hour opioid consumption, and the proportion of patients requiring rescue analgesia. Opioid-related side effects were also assessed.

Evidence synthesis: Ten randomized controlled trials were included. TFPB significantly prolonged the time to first analgesic request compared to control or alternative techniques (SMD=2.328; 95% CI: 0.487 to 4.169; P=0.003) and reduced the need for rescue analgesia (OR=0.373; 95% CI: 0.172 to 0.81; P=0.013). Although the reduction in 24-hour opioid consumption was not statistically significant overall (SMD=-1.052; 95% CI: -2.549 to 0.445; P=0.169), subgroup analyses indicated benefit in selected settings. At 12 hours postoperatively, TFPB significantly reduced pain scores compared to placebo, both at rest (MD: -1.00; 95% CI: -1.756 to -0.244) and during movement (MD: -1.000; 95% CI: -1.749 to -0.251).

Conclusions: TFPB offers effective postoperative analgesia and reduces opioid use after cesarean section, with a safety profile comparable to other regional techniques.

Background: Adding adjuvants to local anesthetics can improve the efficacy of peripheral nerve blocks. However, the literature supporting the advantages of esketamine on peripheral nerve blocks remains limited. This study aims to assess whether adjunctive esketamine enhances the duration of postoperative analgesia when added to ropivacaine in supraclavicular brachial plexus block (SBPB).

Methods: In this randomized controlled trial, 117 adult patients scheduled for distal radius fracture surgery received either 30 mL of 0.4% ropivacaine alone or 30 mL of 0.4% ropivacaine with 25 mg of esketamine in the SBPB. The primary outcome was the analgesic duration of SBPB, defined as the first time a patient experienced pain postoperatively. Secondary outcomes included the SBPB onset time, motor block duration, and pain scores 48 h after surgery. The incidence of adverse events was recorded.

Results: No significant difference in analgesic duration was found between the two groups (11.3 [10.1, 12.4] h vs. 10.8 [9.4, 12.2] h, median difference = 0.3, 95% confidence interval, -0.4-1.0, P=0.344). Meanwhile, no significant differences were found in SBPB onset time, motor block duration, or pain scores between the groups. The incidences of Horner syndrome, hoarseness, postoperative nausea and vomiting were comparable between the groups.

Conclusions: Adding 25 mg esketamine to 30 mL of 0.4% ropivacaine did not improve the analgesic efficacy of SBPB in patients undergoing distal radius fracture surgery. These findings suggest that the limited benefits of esketamine in peripheral nerve blocks such as SBPB warrant further investigation to optimize agent design.