Minerva anestesiologica最新文献

Introduction: Iliopsoas plane block (IPB), as an emerging regional anesthesia technique, shows promising applications in analgesia for hip surgery. This review aims to elucidate the anatomical basis and mechanism of action of IPB, systematically assess its clinical efficacy, procedural techniques, and recent research progress in hip surgery, analyze its advantages and disadvantages compared to traditional regional blocking techniques, and explore its role in multimodal analgesic regimens and future development directions.

Evidence acquisition: This article systematically searched the PubMed and Web of Science databases for all published literature related to IPB from its inception until September 2025.

Evidence synthesis: Recent studies indicate that IPB, by injecting local anesthetics in the iliopsoas plane, can selectively block the sensory branches of the femoral nerve supplying the hip joint capsule, providing effective analgesia while significantly preserving motor function. Compared to traditional femoral nerve block, IPB reduces the incidence of quadriceps weakness and lowers the risk of falls in patients, particularly in elderly individuals undergoing hip surgery. The application of ultrasound guidance further enhances the accuracy and safety of IPB. However, high-quality clinical evidence supporting IPB is still limited, and its clinical effectiveness remains controversial. Further exploration of its mechanisms of action, optimal techniques, and ideal injection doses is needed, along with more basic research and clinical trials.

Conclusions: IPB is a safe and effective postoperative analgesic technique for hip surgery. The motor function preservation characteristics of IPB align with enhanced recovery after surgery principles, making it a promising candidate to become the preferred analgesic technique for perioperative pain management in hip surgery. Future research requires more standardized, homogeneous controlled studies and exploration of its potential in chronic pain management.

Introduction: Oropharyngeal leak pressure (OPLP) is an objective measure of the airway seal provided by a supraglottic airway (SGA) around the glottis. While under-vision insertion techniques improve the anatomic placement of SGAs vs. blind insertion techniques, evidence regarding their impact on OPLP remains inconclusive.

Evidence acquisition: Electronic databases were searched until 31^st March 2025. Randomized controlled trials (RCTs) comparing blind insertion techniques vs. under-vision placement of SGAs in anesthetized adults reporting OPLP were included. The primary objective was to compare the OPLP between under-vision and blind placement of SGAs. Secondary objectives included comparison of SGA positioning, insertion time, first-attempt success rates, peak inspiratory pressures (PIP), ease of SGA and gastric tube insertion, and postoperative complications.

Evidence synthesis: Ten RCTs involving 1,089 patients were included. Under-vision placement of SGAs was associated with significantly higher OPLP (27.88 vs. 24.7 cmH2O; mean difference: 3.18 cmH2O; 95% confidence interval (CI): 2.42 to 3.94; P<0.00001; I²=44.33%). Under-vision techniques also demonstrated better anatomical positioning with fiberoptic bronchoscopy (log odds ratio: 1.90; 95% CI: 0.76 to 3.03; P<0.00001). Meta-regression to quantify heterogeneity of OPLP was not significant for either the type of SGAs (P=0.205) or the type of laryngoscope used (P=0.404). Lower PIP and improved ease of gastric tube insertion were noted in the under-vision groups, though a longer time was required to place the SGAs. No differences were noted in other outcomes.

Conclusions: Under-vision placement of SGAs results in higher OPLP vs. blind insertion techniques, but the clinical significance remains uncertain.

Background: We aimed to evaluate the analgesic effects of erector spinae plane (ESP) block compared to oblique subcostal transversus abdominis plane (TAP) block in patients undergoing emergency laparotomy.

Methods: This randomized controlled trial included adults undergoing emergency laparotomy with midline incision. Participants were randomized to receive either ESP or oblique subcostal TAP block before the surgery. Postoperatively, static and dynamic numerical rating scale (NRS) were assessed at 1, 2, 4, 8, 12, 18, and 24 h. The primary outcome was 24 h analgesic consumption. Secondary outcomes included time to first postoperative analgesic request, NRS, time to independent movement, return of bowl function, and patient satisfaction.

Results: Seventy patients were included in the final analysis. The ESP block group had lower analgesic consumption than the TAP block group (median: 3 [IQR: 3, 3] vs. 6 [IQR: 3, 6] morphine equivalent in mg; P value <0.001) with longer time to first analgesic consumption and lower early postoperative NRS scores. Time to independent movement and number of patients who passed flatus during the first 24 h were comparable between the groups. Patient satisfaction was higher in the ESP block group than in the TAP block group at 24 h postoperatively.

Conclusions: In patients undergoing emergency laparotomy with a midline incision, both ESP block and TAP blocks provided effective postoperative analgesia with similar profiles in terms of return of bowel function and time to ambulation. ESP block provided a modestly better early postoperative analgesia and higher overall patient satisfaction than TAP block.