Minerva anestesiologica最新文献

Background: Epidural analgesia (EA) is a commonly employed and effective technique of providing pain relief during labor. Transcutaneous electrical acupoint stimulation (TEAS) is a cost-effective and safe non-pharmacological option for pain relief, but it has not previously been studied as an adjunct to EA. This study was designed to evaluate the efficacy of TEAS as an adjunctive therapy in patients undergoing epidural labor analgesia.

Methods: In this study, 70 full-term primiparous women were randomly divided into two groups of 35. The TEAS group received true TEAS on specific acupoints, while the sham TEAS group received sham treatment. Both groups received a continuous epidural infusion of 0.1% ropivacaine and 0.5 μg/mL sufentanil at 10 mL/h for labor EA, with patient-controlled epidural analgesia (PCEA) boluses of 5 mL and a lockout interval of 15 minutes. The primary outcome was hourly mean consumption of the ropivacaine and sufentanil mixture.

Results: The mean drug consumption per hour was significantly lower in the TEAS group compared to the sham TEAS group (9.5±0.6 mL/h vs. 11.3±1.3 mL/h, P<0.001). The requirement for oxytocin was also significantly lower in the TEAS group compared to the sham TEAS group (11.4% vs. 31.4%, P=0.041). The incidence of pruritus was lower in the TEAS group compared to the sham TEAS group (0.0% vs. 17.1%, P=0.033).

Conclusions: TEAS is a safe and effective non-pharmacological adjuvant for epidural labor analgesia.

Introduction: The external oblique intercostal block (EOIB) is a novel regional anesthesia technique targeting the anterior and lateral branches of the lower thoracoabdominal nerves (T6-T10). It has gained popularity for upper abdominal laparoscopic procedures, but its overall efficacy remains to be quantified. We performed a systematic review and meta-analysis to evaluate the analgesic efficacy and safety of EOIB in laparoscopic surgery.

Evidence acquisition: Following PRISMA 2020 guidelines, we searched PubMed, Scopus, Web of Science, and Cochrane CENTRAL for randomized controlled trials (RCTs) comparing EOIB with no block, systemic analgesia, local anesthetic infiltration (LI), or other regional techniques in adults undergoing laparoscopic surgery. The primary outcome was 24-hour cumulative opioid consumption. Secondary outcomes included postoperative pain scores (at rest and during movement, at early [0-6 hours] and late [12-24 hours] intervals), time to first rescue analgesia, quality of recovery (QoR-15), and adverse events.

Evidence synthesis: EOIB significantly reduced 24-hour opioid consumption compared to control groups (SMD: -1.12; 95% CI: -2.22 to -0.02; P=0.0467), with the greatest opioid-sparing effect observed when EOIB was compared to no block or LI. Postoperative pain scores at rest and during movement were significantly lower in the EOIB group compared to control groups at 6, 12, and 24 hours after surgery. There were no statistically significant differences between the EOIB and control groups in terms of time to first analgesic request, QoR-15 scores, or the incidence of adverse events.

Conclusions: EOIB offers effective postoperative analgesia in laparoscopic surgery, reducing pain for up to 24 hours and decreasing opioid requirements without increasing adverse events. High-quality RCTs with standardized techniques and extended follow-up are needed to clarify its optimal perioperative role.

Introduction: Rebound pain after peripheral nerve block is a frequent problem that compromises recovery and patient satisfaction. Whether ketamine or esketamine can prevent this phenomenon remains uncertain.

Evidence acquisition: We performed a systematic review and meta-analysis of randomized controlled trials evaluating ketamine or esketamine, given intravenously or perineurally, compared with placebo or no intervention. The primary outcome was rebound pain; secondary outcomes included postoperative pain scores, opioid use, and adverse events.

Evidence synthesis: Six trials including 884 patients were analyzed. Ketamine/esketamine reduced the incidence of rebound pain (RR 0.48; 95% CI, 0.38-0.60). Subgroup analyses showed consistent effects across intravenous and perineural routes, with stronger evidence for esketamine. Postoperative pain scores at 12, 24, and 48 hours were lower in the intervention group. No significant differences were found in opioid consumption or in adverse events such as nausea, dizziness, delirium, or nightmares.

Conclusions: Esketamine, administered intravenously or perineurally, appears to lower the risk of rebound pain and improve analgesia without increasing side effects. However, these conclusions are tempered by the limited number of studies and some clinical heterogeneity. Therefore, the current analysis serves more as a working hypothesis generating interest for future large, high-quality trials, which are needed to confirm these results and define optimal dosing strategies before clear clinical recommendations can be made.

Background: There are no data showing that remimazolam can mitigate circulatory inhibition after cardiopulmonary bypass. We investigated whether remimazolam reduced the requirement of vasoactive agents compared with sevoflurane in cardiac patients.

Methods: Cardiac patients who underwent cardiopulmonary bypass surgery between May 2021 and April 2024 were reviewed. Patients who received remimazolam were matched with those who received sevoflurane using propensity scores in a 1:1 ratio. The primary outcome was overall incidence of inotrope and vasopressor infusion. The secondary outcome included ventilation time, duration of intensive care unit (ICU), hospital mortality, and changes in mean arterial pressure and heart rate.

Results: Among 276 patients, 100 remained after the matching. Intraoperative use of dobutamine was lower in the remimazolam group than in the sevoflurane group (12% and 92%, respectively, P<0.001). Additionally, noradrenaline was administered less frequently in the remimazolam group (56% and 96%, respectively, P<0.001). Despite less use of vasoactive agents, mean arterial pressure after cardiopulmonary bypass was significantly higher in the remimazolam group. Upon ICU admission, the ratio of patients receiving dobutamine and noradrenaline was also lower in the remimazolam group. The ventilation times tended to be shorter in the remimazolam group, but there were no differences in ICU stay durations and in-hospital deaths between two groups.

Conclusions: Remimazolam use was associated with a reduced need for inotrope and vasopressor after cardiopulmonary bypass. However, no improvements in clinical outcomes were observed. Prospective studies are required to verify whether remimazolam is preferable to conventional anesthetics during cardiac surgery.

Background: Intraperitoneal local anesthetic may reduce early postoperative pain after laparoscopic surgery, but evidence in ambulatory settings is inconsistent.

Methods: Prospective, randomized, double-blind, placebo-controlled trial including 113 adults undergoing ambulatory laparoscopic cholecystectomy. After pneumoperitoneum and before surgical manipulation, patients received 20 mL 0.25% ropivacaine or saline intraperitoneally. Primary outcomes: VAS pain at 0, 4, 6, 12 h and opioid use in the recovery room. Pain was analyzed with a linear mixed-effects model. Chronic pain was assessed at 3 and 6 months.

Results: Ropivacaine lowered VAS at 0 h (3.1±2.4 vs. 5.1±2.6), 4 h (1.5±1.8 vs. 2.8±2.3) and 6 h (1.7±1.7 vs. 3.5±2.6; all P<0.001). Group×time interaction was significant (P=0.008). Opioid consumption was reduced (mean difference -3.3 mg piritramide; 95% CI -5.0 to -1.6; P<0.001). No difference at 12 h or in chronic pain at 3-6 months; no serious adverse events.

Conclusions: Early intraperitoneal ropivacaine improves immediate postoperative analgesia and reduces opioids after ambulatory laparoscopic cholecystectomy. It is a simple, safe adjunct to multimodal analgesia.