Minerva anestesiologica最新文献

Postoperative analgesia is a crucial component in optimized postoperative recovery protocols, especially in laparoscopic surgery, a minimally invasive technique that reduces surgical trauma and accelerates recovery. The transversus abdominis plane block has been proposed as an alternative to thoracic epidural analgesia, which, although effective, is associated with significant side effects such as hypotension, urinary retention, and muscle weakness. However, the current literature lacks a systematic synthesis directly comparing these two analgesic techniques following laparoscopic surgery of the abdomen. This study aims to evaluate the effectiveness of transversus abdominis plane block to thoracic epidural analgesia in postoperative pain control, with a particular focus on functional outcomes and hospital length of stay. A systematic review and meta-analysis were conducted according to PRISMA guidelines and registered in the PROSPERO database (CRD42024508473). Randomized controlled trials (RCTs) comparing the transversus abdominis plane block and thoracic epidural analgesia in adult patients undergoing laparoscopic surgery were selected. The primary outcome analyzed was static pain at 24 hours, while secondary outcomes included static pain at 0-2 hours, dynamic pain at 0-2 and 24-36 hours, opioid consumption, time to first mobilization, time to first flatus, and hospital length of stay. A total of 264 articles were identified, of which five RCTs (N.=400 patients) met the inclusion criteria. The analysis showed no significant differences in pain control between the transversus abdominis plane block and thoracic epidural analgesia in the first 24 postoperative hours (Cohen's d=-0.12, 95% CI: -0.48; 0.24) or in total opioid consumption (Cohen's d=-0.09, 95% CI: -0.45; 0.26). However, the transversus abdominis plane block was associated with faster functional recovery, with a significant reduction in time to first flatus (Cohen's d=-0.61, 95% CI: -1.15; -0.07, P=0.027) and time to first mobilization (Cohen's d=-0.76, 95% CI: -1.25; -0.27, P=0.003). No significant differences were found in hospital length of stay (Cohen's d=-0.14, 95% CI: -0.50; 0.22). The transversus abdominis plane block provides effective analgesia and promotes faster functional recovery compared to thoracic epidural analgesia. Given these advantages, it may represent a valid alternative in optimized postoperative recovery protocols. However, further high-quality studies are needed to confirm its efficacy and define standardized guidelines for its use in laparoscopic surgery.

Background: This single center study analyzed epidemiology, outcomes, and three-year quality of life (QoL) of critically ill COVID-19 patients requiring a possibly life-saving VV-ECMO.

Methods: Demographics, clinical and technical data from adult critical COVID-19 VV-ECMO patients were prospectively analyzed (March 2020-January 2022). QoL was yearly assessed by the 'Medical Outcomes Study 36-item Short Form Health Survey' (SF-36) questionnaire. Hospital Anxiety and Depression Scales were measured. Return to work (RTW) was monitored. Multivariate linear regression analyzed factors influencing SF-36 physical (PCS) and mental component summary (MCS) scores.

Results: Forty-eight patients were included, median age was 51 [42.8-57.2] years. Clinical Frailty Scores were 1(33%), 2(44%) or 3(23%). At ECMO initiation, median SOFA score was 11.0 [9.0-12.0]. ECMO support lasted for a median duration of 16 [11.8-28.8] days. Median ICU and hospital stay was 32.0 [21.0-45.0] and 67.0 [58.0-130.0] days. One-year mortality was 33.3% without additional mortality after three years. PCS scores were lower than in general healthy population at one (P<0.001), two (P=0.037) and three (P<0.010) years. MCS scores were equivalent and higher at three years (P=0.015). Anxiety was present in 10/29 (34.5%) and 4/29 (13.8%) had symptoms of depression three years after ECMO initiation. RTW was possible in 13 out of 23 (56,5%), working prior to critical COVID-19.

Conclusions: Three-year mortality after VV-ECMO for critical COVID-19 was 33.3%. Physical health was impaired, but mental health remained comparable to the general population, with relatively low anxiety and depression levels. RTW was possible in 56.5%.

Background: Adequate postoperative pain management is an important part of perioperative care in terms of patient comfort and faster recovery. Unfortunately, pediatric patients frequently experience high levels of postoperative pain, also at home after outpatient surgery. Assessment and management of pain could be achieved through a smartphone application. However, it is uncertain whether children and their caregivers see benefit in such an application.

Methods: This prospective cohort study included children, aged one month to 18 years, who required ENT, urological or orthopedic surgery in ambulatory care over a 12-week period. Participants received a questionnaire, consisting of smartphone application-related questions and questions about pain in the week following surgery. One week after the operation, the participants were called to submit their responses to this questionnaire.

Results: Of 244 eligible participants, 129 were included of which 107 remained for analysis. More than 80% of participants indicated that a smartphone application could help them estimate and treat their child's postoperative pain at home. Regarding potential components, the ability to contact the hospital seemed to be most important. Regarding the incidence of pain, at day 1, 65.4% of all patients had moderate to severe pain. By the end of the first week, this percentage is still 15.9%.

Conclusions: It seems necessary to pay more attention to the assessment and treatment of postoperative pain in children. A smartphone application may help managing this common problem after outpatient surgery. Future studies should focus on developing a smartphone application tailored to the need of young patients and their caregivers, and evaluating the outcomes for improving pain management.

Background: Anterior cervical discectomy and fusion (ACDF) is one of the effective surgical treatments for cervical spondylosis. However, this condition is associated with moderate postoperative pain. Appropriate pain management is crucial to enhance patients' postoperative recovery quality. We aimed to compare the effects of intermediate cervical plexus block (ICPB) and superficial cervical plexus block (SCPB) on the postoperative recovery quality of patients undergoing ACDF.

Methods: In this single-center randomized controlled trial, 90 eligible patients (ASA I-II) were screened; 80 were randomized to ICPB (N.=40) or SCPB (N.=40) group after exclusions. Following general anesthesia induction, patients received either ICPB or SCPB with 10 mL 0.25% ropivacaine. The primary outcome measure was recovery quality at 24 h postoperatively, assessed using the Quality of Recovery scale (QoR-15) scale. Secondary outcomes included post-anesthesia care unit (PACU) discharge time, resting/movement pain (Numeric Rating Scale [NRS] 0-10) at 2, 6, 12 and 24 h, intraoperative remifentanil consumption, time to first rescue analgesia, postoperative butorphanol use and nausea/vomiting incidence.

Results: The ICPB group demonstrated significantly higher 24 h QoR-15 scores (mean: 126.1±6.1 vs. 120.5±7.8; mean difference: 5.6; 95% CI: 2.4 to 8.7; P<0.001), prolonged time to first analgesia request (13.6 vs. 11.8 hours; P=0.010), reduced butorphanol consumption (1 vs. 1.5 mg; P=0.020), and lower movement NRS scores at all timepoints (P<0.05). Postoperative nausea and vomiting incidence was lower with ICPB (15% vs. 35%; P=0.039). No significant differences occurred in resting pain or PACU stay.

Conclusions: Compared with those who had SCPB, patients who received ICPB experienced a mild but statistically significant improvement in the quality of postoperative recovery, particularly in terms of reduced movement-related pain, decreased analgesic use, and lower incidence of nausea and vomiting.

Background: Extended delays in non-elective surgeries have been associated with suboptimal outcomes. The SARS-CoV-2 pandemic forced healthcare systems to adapt their setups for unscheduled procedures, leading, in our institution, to a reorganization from a setup with two dedicated operating rooms (ORs) at a central facility without dedicated teams to a temporary one with both dedicated teams and ORs during lockdown phase. This study evaluates the impact of this transitions on the time to surgery considering unscheduled procedures.

Methods: We considered three periods: a historical cohort from the year preceding the first French lockdown, the lockdown period, and a post-lockdown era covering the four weeks immediately afterward. The ideal time to surgery (iTTS) was retrospectively determined using the non-elective surgery triage classification. The primary outcome focused on the proportion of patients operated after their iTTS.

Results: Over study periods, 435 patients underwent non-scheduled surgery: 137,198 and 100 in the historical cohort, the lockdown, and post-lockdown period respectively. The proportion of out-timed patients was significantly lower during lockdown period than in the historical cohort (36.5% vs. 55.3%, P<0.001), driven by the less urgent patients (i.e., NEST 5-6 patients, 25.6% during lockdown vs. 58.2% in historical cohort). There was no significant difference between the lockdown era and the post-lockdown phase.

Conclusions: Our findings suggest that dedicated teams and surgical suite may reduce time to surgery for non-scheduled procedures, particularly for less urgent cases. However, the retrospective monocentric design and our limited statistical power limit the extend of our conclusions.

Background: Transversus abdominis plane (TAP) block is a common analgesic technique in robotic-assisted laparoscopic radical prostatectomy (RALP). However, its necessity in the framework of an opioid-free anesthesia (OFA) strategy has not yet been evaluated. Our aim was to assess if TAP block is essential for optimal pain management under OFA strategy in RALP.

Methods: A retrospective quasi-experimental study was conducted involving 40 adult patients undergoing RALP between March 2024 and March 2025. All patients received an OFA strategy (continuous intravenous [IV] infusion of lidocaine, dexmedetomidine, and ketamine). Both groups followed the same postoperative multimodal analgesic protocol. The primary outcome was perioperative opioid requirements from the start of surgery until 48 hours postoperatively (expressed as IV milligram morphine equivalents [MME]). Secondary outcomes were Numerical Rating Scale (NRS) scores, start to sitting and ambulation, postoperative complications and length of hospital stay.

Results: Of 40 patients, 17 (42.5%) patients underwent ultrasound-guided TAP block (TAP group -control group-), while 23(57.5%) did not (non-TAP group). Perioperative opioid requirements were similar and extremely low (TAP and non-TAP group: median 0 (IQR:0-0) IV MME; P=0.962), as well as NRS scores (median ≤ 1) at 1, 2, 4, 6, 12, 18, 24 and 48 h (P>0.05). Multivariate analysis showed no independent association between perioperative IV MME and TAP block (median difference -0.1, 95% CI: -0.6 to 0.5, P=0.741). Start to sitting and ambulation, postoperative complications or length of hospital-stay did not show statistical differences.

Conclusions: In our single-center study, when extraperitoneal RALP was performed, the TAP block under OFA strategy did not offer clinical analgesic benefit.

Spinal anesthesia is a fundamental and widely adopted technique in modern clinical practice. However, its application in patients with abnormal spinal anatomy remains contentious due to heightened risks of technical failure, neurological injury, and hemodynamic instability. This review synthesizes recent advances in the use of spinal anesthesia in this complex patient population, providing clinical insights and practical recommendations derived from a comprehensive analysis of over 40 studies retrieved from the PubMed and Web of Science databases. Findings suggest that subarachnoid block may offer higher success rates than epidural block in patients with a history of spinal surgery. Among individuals with scoliosis, the failure rate of neuraxial block was markedly higher in those with a Cobb angle greater than 50° (26.9%) compared to those with milder deformities (7.5%). Furthermore, symmetrical bilateral spread of local anesthetics was more frequently observed in patients with left-sided scoliosis (52.9%) than in those with right-sided curvature (28.1%). To optimize puncture success, a needle insertion angle of 4.1±2.45° from the midline is recommended for patients with Cobb angles less than 50°, and 9.14±2.45° for those with Cobb angles exceeding 50°. In cases of ankylosing spondylitis, the paramedian approach, in combination with electromagnetic needle tracking systems such as SonixGPS^®, has shown improved procedural efficacy. Despite these promising developments, large-scale, multicenter clinical trials are urgently required to establish standardized protocols, refine anesthetic dosing strategies, and reduce the incidence of neurological complications in patients with altered spinal anatomy.