Minerva anestesiologica最新文献

Introduction: This network meta-analysis (NMA) was performed to assess the relative efficacy and safety of various regional analgesic techniques used in patients undergoing partial nephrectomy or nephrectomy.

Evidence acquisition: Randomized controlled trials (RCTs) evaluating different regional analgesia techniques in patients underwent partial nephrectomy or nephrectomy were retrieved from databases, including PubMed, Embase, Web of Science, and the Cochrane Library, from inception to January 2024. The NMA was made by using Stata 15.1 softwares. The certainty of evidence was assessed by using CINeMA.

Evidence synthesis: We included 27 trials with 1852 patients and 14 techniques. Postoperative resting pain scores within 24 hours were decreased by erector spinae plane block (ESPB), thoracic paravertebral block (TPVB), intrathecal morphine (IM), retrolaminar block (RLB). Postoperative movement pain scores within 24 hours were decreased by ESPB, TPVB, lateral quadratus lumborum block (QLB-L), transversus abdominis plane block. Postoperative opiates consumption within 24 hours were decreased most by QLB-L, followed by transmuscular QLB (QLB-TM), TPVB, and IM. Postoperative nausea and vomiting (PONV) were decreased by RLB, anterior QLB approach at the lateral supra-arcuate ligament (QLB-LSAL). Length of hospital stay were decreased by TPVB, ESPB.

Conclusions: This available evidence suggests that ESPB and TPVB are more likely to reduce pain scores within 24 hours and shorten the length of hospital stay. QLB-L and QLB-TM are more likely to reduce the cumulative opiates consumption within 24 hours. RLB and QLB-LSAL are more likely to decrease the incidence of PONV. The wound infiltration (WI), intraperitoneal instillation (IPI), and WI+IPI are less likely to be effective.

Background: Emergence agitation (EA) is non-purposeful agitation that occurs during the early stages of general anesthesia recovery. This randomized, double-blinded trial aimed to compare the effect of dexmedetomidine, ketamine, and magnesium sulfate on the severity of EA following sevoflurane-based anesthesia in pediatric cardiac catheterization. We examined the fixed doses and assessed the severity of agitation using the Pediatric Anesthesia Emergence Delirium Scale (PAED) score.

Methods: One hundred children undergoing heart catheterization without local anesthetic in the skin were randomly divided into four groups. The Dexmedetomidine (D) Group (N.=25) received dexmedetomidine 1 μg/kg IV over 10 min, then 0.5 μg/kg/h. The Magnesium Sulfate (M) Group (N.=25) received 15 mg/k MgSo4 IV over 10 min and then 10 mg/kg/h. The Ketamine (K) Group (N.=25) received 1 mg/kg ketamine over 10 min, then 1 mg/kg/h. The Control (C) Group (N.=25) received 0.9% saline at the same rate as other groups. All medications were diluted in 50 mL 0.9% saline.

Results: The dexmedetomidine group exhibited a 0% incidence of EA, compared to 4% in the ketamine group, 12% in the MgSO4 group, and 40% in the control groups (P<0.001). Dexmedetomidine significantly reduced the PAED Scale and pain scores compared to the other groups. The effects of ketamine and MgSO4 on PAED and pain scores were comparable, with both treatments demonstrating significantly lower scores than the control group.

Conclusions: Dexmedetomidine exhibited higher efficacy than ketamine and magnesium sulfate in reducing the severity of postoperative EA. However, ketamine and magnesium sulfate demonstrated comparable efficacy, exceeding that of the control group.

Background: Total hip arthroplasty, commonly performed to alleviate hip pain and enhance functionality in elderly patients, requires effective postoperative pain management to reduce opioid consumption and its associated side effects. A novel regional anaesthesia technique, the sacral erector spinae plane block, has the potential to enhance the quality of postoperative recovery significantly.

Methods: This prospective, randomized, controlled multicenter study investigated the effects of the sacral erector spinae plane block on recovery quality in patients undergoing total hip arthroplasty. The study comprised 50 patients, divided into Group S (patients receiving patients receiving sacral erector spinae plane block [S-ESPB]) and Group C (patients getting just multimodal analgesia). The primary outcome measured was the Quality of Recovery-15 score 24 hours post-surgery. Secondary outcomes included postoperative numerical rating scale scores (A score of 0 indicates no pain, while 10 indicates the most severe pain), total consumption of rescue analgesics, time to first rescue analgesic administration, patient satisfaction, time to first ambulation, the occurrence of complications, and the need for antiemetics.

Results: Group S had markedly higher quality of recovery-15 scores compared to Group C (Group S: median 117 percentiles [97-121]; Group C: median 89 percentiles [75-96]; P<0.001). Group S scored higher in postoperative pain, physical comfort, support, emotional state, and general quality of recovery-15 (P<0.001). Nevertheless, the physical independence category ratings were comparable across both groups (P=0.286).

Conclusions: Sacral erector spinae plane block is a promising analgesic technique that enhances postoperative recovery and patient comfort in total hip arthroplasty.

Introduction: In recent years, numerous studies have been published on the diagnostic performance of circulating IL-6 levels in adult sepsis, but the conclusions are not consistent. This meta-analysis aims to systematically evaluate the accuracy of circulating IL-6 in the diagnosis of adult sepsis.

Evidence acquisition: Literature on the diagnostic value of circulating IL-6 in adult sepsis published on CNKI, Wanfang Data, PubMed, Embase, Cochrane Library, and Web of Science were searched up to December 2023. QUADAS-2 scale was used to evaluate the quality of the included literature. Stata 15.0 statistical software was used for data processing. The pooled sensitivity, specificity, diagnostic odds ratio (DOR), positive likelihood ratio (PLR), and negative likelihood ratio (NLR) were calculated. The summary receiver operating characteristic curve (SROC) was drawn, with the area under the curve (AUC) calculated.

Evidence synthesis: A total of 31 articles were included in this meta-analysis. The results of the meta-analysis showed that the combined sensitivity, specificity, DOR, PLR, and NLR of circulating IL-6 for the diagnosis of adult sepsis were 0.74 (95%CI: 0.69-0.78), 0.73 (95%CI: 0.68-0.78), 7.71 (95%CI: 5.66-10.52), 2.77 (95%CI: 2.29-3.35), 0.36 (95%CI: 0.30-0.43), respectively. The AUC was 0.80 (95%CI: 0.76-0.83).

Conclusions: Circulating IL-6 has a good diagnostic value in adult sepsis, with moderate sensitivity and specificity. Therefore, IL-6 can provide a basis for the diagnosis of adult sepsis.