Minerva anestesiologica最新文献

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: Traditional pain assessment tools such as the Visual Analog Scale (VAS) rely heavily on patients' cognitive ability to quantify pain, which may not effectively capture the complexity of the pain experience. This study investigates the use of artificial intelligence (AI)-generated visuals as an alternative method for postoperative pain assessment.

Methods: This prospective, single-center study enrolled 400 postoperative patients aged 18 years and older. Patients first evaluated their pain using VAS and then selected from five AI-generated images depicting various pain intensities. After both assessments, participants completed a survey comparing the two methods in terms of clarity, ease of use, and perceived usefulness.

Results: Image-based assessment was preferred by 73.5% of participants, while 25.5% favored VAS (P=0.001). Paired t-tests showed that image-based assessment scored significantly higher for ease of interpretation (66.49±25.17 vs. 36.23±28.21), clarity (67.59±25.36 vs. 38.10±29.40), and usefulness (67.59±25.62 vs. 37.79±29.38), all with P<0.001. High image selection accuracy was observed for mild (VAS 1-2, 93.3%) and severe (VAS 9-10, 95.1%) pain levels, with moderate accuracy in mid-range scores.

Conclusions: AI-generated visuals offer a promising, patient-friendly alternative to traditional numeric pain scales. This novel approach demonstrated higher user satisfaction and more intuitive pain communication, particularly at pain extremes. Further refinement and validation are needed to optimize mid-range pain visuals and explore broader clinical applicability.

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.

Background: Video-assisted thoracoscopic surgery (VATS) involves unique physiological challenges, including single-lung ventilation, that may amplify the effects of reduced oxygen-carrying capacity in anemic patients. Despite the minimally invasive nature of VATS, the specific impact of preoperative anemia on outcomes following these procedures remains inadequately characterized.

Methods: We conducted a multi-institutional retrospective cohort study using TriNetX research network data (2010-2024). Adults undergoing VATS with preoperative hemoglobin measurements were included. The anemia group (hemoglobin 8-12 g/dL) was compared to the control group (hemoglobin ≥12 g/dL) using 1:1 propensity score matching.

Results: After matching, 8,346 pairs of patients were analyzed. Patients with preoperative anemia had significantly higher 30-day mortality (odds ratio [OR] 3.20, 95% confidence interval [CI] 2.33-4.39, P<0.0001) (primary outcome), intensive care unit admission (OR 1.46, 95% CI 1.27-1.67, P<0.0001), acute kidney injury (AKI) (OR 1.92, 95% CI 1.58-2.32, P<0.0001), pneumonia/respiratory failure (OR 1.73, 95% CI 1.53-1.95, P<0.0001), and sepsis (OR 1.79, 95% CI 1.36-2.36, P<0.0001). These associations remained consistent in sensitivity analyses restricted to academic medical centers, patients without blood transfusions, and those with stable hemoglobin levels throughout the perioperative period. Sex-specific analyses revealed higher risks of respiratory complications, AKI, sepsis, and deep vein thrombosis in males, while females with anemia demonstrated higher mortality risk. Even mild anemia was associated with significantly increased complications.

Conclusions: Preoperative anemia is strongly associated with adverse outcomes following VATS, with an over threefold increased mortality risk. These findings highlight the importance of preoperative anemia assessment and management in patients undergoing VATS.

Background: The aim of the study was to compare the effects of three different types of injection methods used in supraclavicular blocks on levels of phrenic nerve blocking with diaphragm thickening fraction (DTF).

Methods: The study was designed as prospective, randomized, controlled, and double-blind. Patients presenting for elective upper extremity surgery were divided into three groups according to the injection method for the supraclavicular block (The multi-injected GM group (N.=28), the GD group given two equal injections intracluster and the corner pocket (N.=29), and the GC group (N.=28), who were given local anesthetic only to the corner pocket). The primary outcome was to demonstrate the differences in DTF. The secondary outcomes included sensory block level, block success, and additional procedures during the operation.

Results: In terms of the DTF difference before and after the block (ΔDTF), a statistically significant difference was observed (P=0.001). Median ΔDTF was found to be 62% (IQR: 47%) in the GM group, 38% (IQR: 61%) in the GD group, and 20% (IQR: 47%) in the GC group. A successful block was detected in 100% of the GM group, 97% in the GD group, and 82% in the GC group, with a statistically significant difference (P=0.022).

Conclusions: The method with two equal injections intracluster and the corner pocket shows a more acceptable diaphragm involvement rate compared to the multi-injection method and a high block success rate close to the multi-injection method.