Pub Date : 2026-01-01Epub Date: 2025-11-15DOI: 10.1016/j.bjane.2025.844712
Wagner Nedel , Luis Valmor Portela
{"title":"Association between troponin and NT-proBNP levels, cytokines, and clinical outcomes in early sepsis response: a cohort study","authors":"Wagner Nedel , Luis Valmor Portela","doi":"10.1016/j.bjane.2025.844712","DOIUrl":"10.1016/j.bjane.2025.844712","url":null,"abstract":"","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"76 1","pages":"Article 844712"},"PeriodicalIF":1.9,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145544056","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01Epub Date: 2025-12-25DOI: 10.1016/j.bjane.2025.844720
Britta S. von Ungern-Sternberg , Aine Sommerfield
{"title":"Therapeutic misconceptions: the protective role of the perioperative team","authors":"Britta S. von Ungern-Sternberg , Aine Sommerfield","doi":"10.1016/j.bjane.2025.844720","DOIUrl":"10.1016/j.bjane.2025.844720","url":null,"abstract":"","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"76 1","pages":"Article 844720"},"PeriodicalIF":1.9,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145846915","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01Epub Date: 2025-10-24DOI: 10.1016/j.bjane.2025.844692
Karam Azem , Roussana Aranbitski , Safo Awad , Omer Shpack , Alexander Peres , Rotem Argov , Omer Kaplan , Anatoliy Artyukh , Andrey Khinchuk , Michael Yohay Stav , Philip Heesen , Sharon Orbach-Zinger , Eviatar Nesher , Shai Fein
Background
Effective pain management following renal transplantation is crucial. While various regional analgesic techniques have been studied, the optimal approach remains unclear. We compared the additive value of Transversus Abdominis Plane (TAP) and External Oblique Intercostal Plane (EOIP) blocks to Standard Care (SC) on postoperative pain and opioid consumption.
Methods
This retrospective study included 237 renal transplant recipients (127 SC, 75 TAP, 35 EOIP) between January 2023 and December 2024. Multivariable regression analysis assessed the association of block type on postoperative pain and opioid consumption.
Results
TAP block was associated with significantly lower pain scores than SC during the first eight postoperative hours (5.0 vs. 7.0, p < 0.001). Pre-incision TAP block demonstrated the most significant reduction in both pain scores (β = -2.21, 95% CI -3.38 to -1.05, p < 0.001) and opioid consumption (β = -13.56, 95% CI: -21.59 to -5.52, p = 0.001). EOIP block showed no significant advantages over SC and was associated with higher opioid consumption compared to TAP block.
Conclusion
Pain predominantly manifested in the first eight postoperative hours. TAP block, particularly when administered pre-incision, was associated with superior pain control compared to SC or EOIP block. Living donor recipients experienced significantly higher pain scores regardless of technique, warranting further investigation.
{"title":"Comparative effectiveness of TAP block, EOIP block, and standard care for postoperative analgesia in renal transplantation: a retrospective study","authors":"Karam Azem , Roussana Aranbitski , Safo Awad , Omer Shpack , Alexander Peres , Rotem Argov , Omer Kaplan , Anatoliy Artyukh , Andrey Khinchuk , Michael Yohay Stav , Philip Heesen , Sharon Orbach-Zinger , Eviatar Nesher , Shai Fein","doi":"10.1016/j.bjane.2025.844692","DOIUrl":"10.1016/j.bjane.2025.844692","url":null,"abstract":"<div><h3>Background</h3><div>Effective pain management following renal transplantation is crucial. While various regional analgesic techniques have been studied, the optimal approach remains unclear. We compared the additive value of Transversus Abdominis Plane (TAP) and External Oblique Intercostal Plane (EOIP) blocks to Standard Care (SC) on postoperative pain and opioid consumption.</div></div><div><h3>Methods</h3><div>This retrospective study included 237 renal transplant recipients (127 SC, 75 TAP, 35 EOIP) between January 2023 and December 2024. Multivariable regression analysis assessed the association of block type on postoperative pain and opioid consumption.</div></div><div><h3>Results</h3><div>TAP block was associated with significantly lower pain scores than SC during the first eight postoperative hours (5.0 vs. 7.0, <em>p</em> < 0.001). Pre-incision TAP block demonstrated the most significant reduction in both pain scores (β = -2.21, 95% CI -3.38 to -1.05, <em>p</em> < 0.001) and opioid consumption (β = -13.56, 95% CI: -21.59 to -5.52, <em>p</em> = 0.001). EOIP block showed no significant advantages over SC and was associated with higher opioid consumption compared to TAP block.</div></div><div><h3>Conclusion</h3><div>Pain predominantly manifested in the first eight postoperative hours. TAP block, particularly when administered pre-incision, was associated with superior pain control compared to SC or EOIP block. Living donor recipients experienced significantly higher pain scores regardless of technique, warranting further investigation.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"76 1","pages":"Article 844692"},"PeriodicalIF":1.9,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145623830","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01Epub Date: 2025-10-31DOI: 10.1016/j.bjane.2025.844701
Getúlio Rodrigues de Oliveira Filho, Miguel Angelo Fabrin, Victor Medeiros Benincá, Ian Novy Quadri, Gabriel Resun Gomes da Silva
{"title":"Feasibility of early rapid sequence induction and intubation training and the role of a cognitive aid on-demand reader in medical students: lessons from a pilot randomized study","authors":"Getúlio Rodrigues de Oliveira Filho, Miguel Angelo Fabrin, Victor Medeiros Benincá, Ian Novy Quadri, Gabriel Resun Gomes da Silva","doi":"10.1016/j.bjane.2025.844701","DOIUrl":"10.1016/j.bjane.2025.844701","url":null,"abstract":"","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"76 1","pages":"Article 844701"},"PeriodicalIF":1.9,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145433237","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01Epub Date: 2025-11-28DOI: 10.1016/j.bjane.2025.844716
Hesham Elsharkawy , Ece Yamak Altinpulluk , Tetsuya Shimada , Ilker Ince , Guangmei Mao , Nicolas Mario Mas D Alessandro , Loran Mounir Soliman , Nair Harsha , Marta Kelava , Richard Drake , Xuan Pu , Daniel I. Sessler , Alparslan Turan
Background
Paravertebral blocks provide analgesia for a range of thoracoabdominal surgeries. However, visualizing the needle tip during the procedure can be challenging, especially for clinicians with limited experience, because the target is deep. We therefore tested the primary hypothesis that needle guidance by the Infiniti Plus system improves ultrasound visualization of the needle tip during thoracic paravertebral blocks performed by novice residents.
Methods
Nineteen clinical anesthesia residents each performed 20 bilateral ultrasound-guided thoracic paravertebral blocks (T2–T11) on 17 unembalmed cadavers, with and without the use of a fixed-angle mechanical needle guide in a randomized crossover design. The primary outcome, percent perfect needle visibility, was compared between guided and unguided methods using a paired t-test. Secondary outcomes, including time to needle visualization, number of needle insertion attempts, and subjective ease-of-use ratings, were analyzed using paired t-tests and Wilcoxon signed-rank tests, respectively. Inter-rater reliability for overall perception ratings was assessed using the Intraclass Correlation Coefficient (ICC).
Results
There were no significant differences in needle-target visualization (62% ± 17% with guidance vs. 64% ± 18% without, p = 0.15), time to target (HR = 1.00 [95% CI 0.86–1.16], p = 0.99), procedural difficulty scores, or number of insertion attempts between guided and unguided blocks.
Conclusion
The Infiniti Plus mechanical needle guide did not demonstrate improved ultrasound needle tip visualization during thoracic paravertebral blocks performed by novice clinicians in cadavers.
背景：椎旁阻滞为一系列胸腹外科手术提供镇痛。然而，在手术过程中可视化针尖可能具有挑战性，特别是对于经验有限的临床医生来说，因为目标很深。因此，我们验证了最初的假设，即在新手住院医师进行胸椎旁阻滞时，Infiniti Plus系统的针头引导可以改善针尖的超声可视化。方法：采用随机交叉设计，19名临床麻醉住院医师分别在17具非防腐尸体上进行了20次双侧超声引导下的胸椎旁阻滞（T2-T11），使用和不使用固定角度机械导针。使用配对t检验比较引导和非引导方法的主要结果，完美针头可见度百分比。次要结果，包括针的可视化时间、针插入次数和主观易用性评分，分别使用配对t检验和Wilcoxon符号秩检验进行分析。使用类内相关系数（ICC）评估整体感知评分的评分者间信度。结果：两组患者在针靶可见性（有引导组62%±17% vs无引导组64%±18%，p = 0.15）、到达靶点时间（HR = 1.00 [95% CI 0.86-1.16], p = 0.99）、手术难度评分、有引导和无引导组插入次数均无显著差异。结论：在新手临床医生对尸体进行胸椎旁阻滞时，Infiniti Plus机械导针器并没有显示出更好的超声针尖可视化。
{"title":"Mechanical needle guidance for ultrasound-guided parasagittal oblique in-plane paravertebral blocks: a cadaveric study","authors":"Hesham Elsharkawy , Ece Yamak Altinpulluk , Tetsuya Shimada , Ilker Ince , Guangmei Mao , Nicolas Mario Mas D Alessandro , Loran Mounir Soliman , Nair Harsha , Marta Kelava , Richard Drake , Xuan Pu , Daniel I. Sessler , Alparslan Turan","doi":"10.1016/j.bjane.2025.844716","DOIUrl":"10.1016/j.bjane.2025.844716","url":null,"abstract":"<div><h3>Background</h3><div>Paravertebral blocks provide analgesia for a range of thoracoabdominal surgeries. However, visualizing the needle tip during the procedure can be challenging, especially for clinicians with limited experience, because the target is deep. We therefore tested the primary hypothesis that needle guidance by the Infiniti Plus system improves ultrasound visualization of the needle tip during thoracic paravertebral blocks performed by novice residents.</div></div><div><h3>Methods</h3><div>Nineteen clinical anesthesia residents each performed 20 bilateral ultrasound-guided thoracic paravertebral blocks (T2–T11) on 17 unembalmed cadavers, with and without the use of a fixed-angle mechanical needle guide in a randomized crossover design. The primary outcome, percent perfect needle visibility, was compared between guided and unguided methods using a paired <em>t</em>-test. Secondary outcomes, including time to needle visualization, number of needle insertion attempts, and subjective ease-of-use ratings, were analyzed using paired <em>t</em>-tests and Wilcoxon signed-rank tests, respectively. Inter-rater reliability for overall perception ratings was assessed using the Intraclass Correlation Coefficient (ICC).</div></div><div><h3>Results</h3><div>There were no significant differences in needle-target visualization (62% ± 17% with guidance vs. 64% ± 18% without, p = 0.15), time to target (HR = 1.00 [95% CI 0.86–1.16], p = 0.99), procedural difficulty scores, or number of insertion attempts between guided and unguided blocks.</div></div><div><h3>Conclusion</h3><div>The Infiniti Plus mechanical needle guide did not demonstrate improved ultrasound needle tip visualization during thoracic paravertebral blocks performed by novice clinicians in cadavers.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"76 1","pages":"Article 844716"},"PeriodicalIF":1.9,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145650171","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01Epub Date: 2025-10-29DOI: 10.1016/j.bjane.2025.844697
Luis Alberto Rodrigues Linares , Victória Regina da Silva Oliveira , Lais Helena Navarro e Lima , Rodrigo Moreira e Lima , Camila Squarzoni Dale
{"title":"Preoperative pulmonary ultrasound: a valuable tool for managing post-COVID-19 sequelae","authors":"Luis Alberto Rodrigues Linares , Victória Regina da Silva Oliveira , Lais Helena Navarro e Lima , Rodrigo Moreira e Lima , Camila Squarzoni Dale","doi":"10.1016/j.bjane.2025.844697","DOIUrl":"10.1016/j.bjane.2025.844697","url":null,"abstract":"","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"76 1","pages":"Article 844697"},"PeriodicalIF":1.9,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145423243","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01Epub Date: 2025-10-15DOI: 10.1016/j.bjane.2025.844688
Cristina González Ramírez, Rocío Pérez Bocanegra, Carlos Armando Sánchez-Navarro
{"title":"Correlation between impostor phenomenon and burnout syndrome in medical residents: a single-center study","authors":"Cristina González Ramírez, Rocío Pérez Bocanegra, Carlos Armando Sánchez-Navarro","doi":"10.1016/j.bjane.2025.844688","DOIUrl":"10.1016/j.bjane.2025.844688","url":null,"abstract":"","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"76 1","pages":"Article 844688"},"PeriodicalIF":1.9,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145314166","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01Epub Date: 2025-11-07DOI: 10.1016/j.bjane.2025.844699
Julien Raft , Anne-Sophie Lamotte , Cécile Huin Schohn , Caroline Fritz , Philippe Richebé
Background
Single-injection Paravertebral Block (PVB) is commonly used for analgesia in major breast surgery; however, its sensory effectiveness may be variable. This study investigated whether intraoperative changes in the Analgesia Nociception Index (ANI) are associated with PVB effectiveness.
Methods
This prospective observational study included 100 women scheduled for total mastectomy. A single-injection PVB was performed preoperatively under ultrasound guidance at the T3 level. Sensory testing was performed from T1 to T10, but block effectiveness was evaluated in the surgical field (T2–T6). PVBs were classified as effective (complete loss of cold sensation in all T2‒T6 dermatomes) or incomplete (partial cold sensation in this range). ANI variations, intraoperative remifentanil consumption, postoperative pain scores, and morphine use were compared.
Results
Ninety-three patients were analyzed. PVB was effective in 75% and incomplete in 25%. The mean ANI variation was significantly greater in the effective group (+1.4 ± 10.3) compared to the incomplete group (-11.0 ± 7.1), with a mean difference of 12.4 (95% CI: 8.8 to 16.0; p < 0.0001). Remifentanil consumption was higher in the incomplete group (0.072 ± 0.018 µg.kg−1.min−1 vs. 0.054 ± 0.008 µg.kg−1.min−1), mean difference 0.018 (95% CI: 0.010 to 0.026; p < 0.0001). Pain score and morphine consumption were significantly higher for patients with incomplete PVB.
Conclusion
In this observational study, a significant decrease in ANI values following skin dissection was associated with incomplete PVB. Early ANI monitoring may help identify insufficient regional block during total mastectomy, thus guiding intraoperative analgesic adjustment to improve patient comfort.
背景：单次注射椎旁阻滞（PVB）是乳房大手术中常用的镇痛方法；然而，它的感官效果可能是可变的。本研究探讨术中镇痛伤害感觉指数（ANI）的变化是否与PVB的有效性相关。方法：这项前瞻性观察研究包括100名计划进行全乳切除术的妇女。术前在超声引导下在T3水平进行单次PVB注射。从T1到T10进行感觉测试，但在手术野（T2-T6）评估阻滞效果。pvb被分为有效（所有T2-T6皮节完全失去冷感觉）和不完全（在这个范围内部分失去冷感觉）。比较ANI变化、术中瑞芬太尼用量、术后疼痛评分和吗啡使用情况。结果：对93例患者进行分析。PVB有效率75%，不完全率25%。有效组的ANI平均值（+1.4±10.3）明显大于不完全组（-11.0±7.1），平均差异为12.4 （95% CI: 8.8 ~ 16.0; p < 0.0001）。不完全组瑞芬太尼消耗量更高（0.072±0.018µg.kg-1）。Min-1 vs. 0.054± 0.008µg.kg-1。min-1)，平均差异0.018 （95% CI: 0.010 ~ 0.026; p < 0.0001）。不完全性PVB患者的疼痛评分和吗啡用量均显著增高。结论：在这项观察性研究中，皮肤剥离后ANI值的显著下降与PVB不完全性有关。早期ANI监测有助于发现全乳切除术中区域阻滞不足，从而指导术中镇痛调整，提高患者舒适度。
{"title":"Analgesia nociception index as a tool to assess the effectiveness of paravertebral block in total mastectomy: a prospective cohort study","authors":"Julien Raft , Anne-Sophie Lamotte , Cécile Huin Schohn , Caroline Fritz , Philippe Richebé","doi":"10.1016/j.bjane.2025.844699","DOIUrl":"10.1016/j.bjane.2025.844699","url":null,"abstract":"<div><h3>Background</h3><div>Single-injection Paravertebral Block (PVB) is commonly used for analgesia in major breast surgery; however, its sensory effectiveness may be variable. This study investigated whether intraoperative changes in the Analgesia Nociception Index (ANI) are associated with PVB effectiveness.</div></div><div><h3>Methods</h3><div>This prospective observational study included 100 women scheduled for total mastectomy. A single-injection PVB was performed preoperatively under ultrasound guidance at the T3 level. Sensory testing was performed from T1 to T10, but block effectiveness was evaluated in the surgical field (T2–T6). PVBs were classified as effective (complete loss of cold sensation in all T2‒T6 dermatomes) or incomplete (partial cold sensation in this range). ANI variations, intraoperative remifentanil consumption, postoperative pain scores, and morphine use were compared.</div></div><div><h3>Results</h3><div>Ninety-three patients were analyzed. PVB was effective in 75% and incomplete in 25%. The mean ANI variation was significantly greater in the effective group (+1.4 ± 10.3) compared to the incomplete group (-11.0 ± 7.1), with a mean difference of 12.4 (95% CI: 8.8 to 16.0; p < 0.0001). Remifentanil consumption was higher in the incomplete group (0.072 ± 0.018 µg.kg<sup>−1</sup>.min<sup>−1</sup> vs. 0.054 ± 0.008 µg.kg<sup>−1</sup>.min<sup>−1</sup>), mean difference 0.018 (95% CI: 0.010 to 0.026; p < 0.0001). Pain score and morphine consumption were significantly higher for patients with incomplete PVB.</div></div><div><h3>Conclusion</h3><div>In this observational study, a significant decrease in ANI values following skin dissection was associated with incomplete PVB. Early ANI monitoring may help identify insufficient regional block during total mastectomy, thus guiding intraoperative analgesic adjustment to improve patient comfort.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"76 1","pages":"Article 844699"},"PeriodicalIF":1.9,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145483963","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Magnesium Sulfate (MS) maintains physiological functions in the body. Studies suggest its safety in regional anesthesia, despite off-label perineural use. We conducted a systematic review and meta-analysis to evaluate MS efficacy as an adjuvant in supraclavicular brachial plexus block.
Methods
The study was registered in PROSPERO (CRD42025641627) on 01/21/2025. We searched PUBMED, Embase, Cochrane, clinicaltrials.gov and gray literature for eligible studies. We included RCTs that: enrolled adult patients; involved orthopedic surgery with supraclavicular block; compared LA alone versus LA with MS; and reported primary outcomes. Primary outcomes were duration of sensory and motor block, while secondary outcomes included onset of sensory and motor block, PONV and rescue analgesia needs postoperatively. RoB2 tool and GRADE assessed bias risk and evidence certainty. Variables were examined using DerSimonian-Laird random-effects model.
Results
Analysis included 10 studies and 734 patients. The intervention group showed longer sensory and motor block than controls. The Mean Difference (MD) was 180.84 minutes (95% CI [154.09, 207.59], 95% PI [71.67, 289.77], p < 0.00001, I² = 97%) and 151.26 minutes (95% CI [99.78, 202.74], 95% PI [-23.12, 325.63], p < 0.00001, I² = 99%). The magnesium group showed statistical difference in onset of sensory and motor blockade and rescue analgesia needs, with no difference in PONV. Evidence certainty was rated low to moderate. Risk of bias “high” in three studies, “some concerns” in four studies and “low” in three studies.
Conclusion
Our meta-analysis supports MS as adjuvant in supraclavicular block. Further research is needed due to high heterogeneity.
PROSPERO registration
CRD42025641627.
背景：硫酸镁（Magnesium Sulfate， MS）在体内维持生理功能。研究表明它在区域麻醉中的安全性，尽管在标签外的神经周围使用。我们进行了一项系统回顾和荟萃分析，以评估MS作为锁骨上臂丛神经阻滞的辅助治疗效果。方法：该研究于2025年1月21日在PROSPERO注册（CRD42025641627）。我们检索了PUBMED、Embase、Cochrane、clinicaltrials.gov和灰色文献，寻找符合条件的研究。我们纳入的随机对照试验包括：入组成年患者；伴锁骨上阻滞的累及骨科手术；比较LA单独与LA合并MS；并报告了主要结果。主要结局是感觉和运动阻滞的持续时间，次要结局包括感觉和运动阻滞的发生、PONV和术后抢救镇痛需求。RoB2工具和GRADE评估偏倚风险和证据确定性。变量检验采用dersimonan - laird随机效应模型。结果：纳入10项研究，734例患者。干预组表现出较长时间的感觉和运动阻滞。MD分别为180.84分钟（95% CI [154.09, 207.59], 95% PI [71.67, 289.77], p < 0.00001, I² = 97%）和151.26分钟（95% CI [99.78, 202.74], 95% PI [-23.12, 325.63], p < 0.00001, I² = 99%）。镁组在感觉和运动阻断的发生及救援性镇痛需要方面有统计学差异，而PONV无统计学差异。证据确定性被评为低至中等。3项研究偏倚风险为“高”，4项研究偏倚风险为“一些关注”，3项研究偏倚风险为“低”。结论：我们的荟萃分析支持MS作为锁骨上阻滞的辅助治疗。异质性高，有待进一步研究。普洛斯彼罗注册：CRD42025641627。
{"title":"Efficacy of magnesium sulfate as an adjuvant to local anesthetics in supraclavicular brachial plexus block: a meta-analysis of randomized trials","authors":"Willyam Barros Saraiva , Isadora Eloy Candido , Roberta Ribeiro Brandão Caldas , Fabiano Timbó Barbosa","doi":"10.1016/j.bjane.2025.844689","DOIUrl":"10.1016/j.bjane.2025.844689","url":null,"abstract":"<div><h3>Background</h3><div>Magnesium Sulfate (MS) maintains physiological functions in the body. Studies suggest its safety in regional anesthesia, despite off-label perineural use. We conducted a systematic review and meta-analysis to evaluate MS efficacy as an adjuvant in supraclavicular brachial plexus block.</div></div><div><h3>Methods</h3><div>The study was registered in PROSPERO (CRD42025641627) on 01/21/2025. We searched PUBMED, Embase, Cochrane, clinicaltrials.gov and gray literature for eligible studies. We included RCTs that: enrolled adult patients; involved orthopedic surgery with supraclavicular block; compared LA alone versus LA with MS; and reported primary outcomes. Primary outcomes were duration of sensory and motor block, while secondary outcomes included onset of sensory and motor block, PONV and rescue analgesia needs postoperatively. RoB2 tool and GRADE assessed bias risk and evidence certainty. Variables were examined using DerSimonian-Laird random-effects model.</div></div><div><h3>Results</h3><div>Analysis included 10 studies and 734 patients. The intervention group showed longer sensory and motor block than controls. The Mean Difference (MD) was 180.84 minutes (95% CI [154.09, 207.59], 95% PI [71.67, 289.77], p < 0.00001, I² = 97%) and 151.26 minutes (95% CI [99.78, 202.74], 95% PI [-23.12, 325.63], p < 0.00001, I² = 99%). The magnesium group showed statistical difference in onset of sensory and motor blockade and rescue analgesia needs, with no difference in PONV. Evidence certainty was rated low to moderate. Risk of bias “high” in three studies, “some concerns” in four studies and “low” in three studies.</div></div><div><h3>Conclusion</h3><div>Our meta-analysis supports MS as adjuvant in supraclavicular block. Further research is needed due to high heterogeneity.</div></div><div><h3>PROSPERO registration</h3><div>CRD42025641627.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"76 1","pages":"Article 844689"},"PeriodicalIF":1.9,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145318936","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01Epub Date: 2025-11-17DOI: 10.1016/j.bjane.2025.844710
Saul Dominici , Italo C. Martins , Breno Dias L. Ribeiro , Victor Arthur Ohannesian , Brunno Braga Sauaia , Abdias Rocha Santos , Caio Márcio Barros de Oliveira , Plínio da Cunha Leal
Background
Ciprofol has emerged as a potential alternative sedative with improved safety and efficacy. However, comparative data for colonoscopy sedation remain limited.
Methods
A systematic search in PubMed, Embase, Cochrane Library, and Web of Science identified RCTs published through August 2025. Studies included patients undergoing colonoscopy using ciprofol or propofol, reporting relevant efficacy or safety outcomes. Risk Ratios (RRs) and Mean Differences (MDs) were calculated using the Mantel-Haenszel random-effects model and 95% Confidence Intervals. The heterogeneity was assessed with I² statistics and Cochrane Q test. Primary outcomes were procedure success rate and patient satisfaction (assessed on a 1-to-10 scale). Secondary outcomes included sedation onset time(s), respiratory depression, injection pain, and hemodynamic adverse events (hypotension and bradycardia). The statistical analyses were performed in R software (version 4.4.1.)
Results
Three RCTs with 645 patients were included. Colonoscopy success rates were similar between ciprofol and propofol (RR = 1.005; 95% CI 0.992–1.019). Ciprofol showed a lower risk of respiratory depression (RR = 0.24; 95% CI 0.08–0.71), injection pain (RR = 0.04; 95% CI 0.01–0.15), and hypotension (RR = 0.85; 95% CI 0.75–0.96). Patient satisfaction was slightly higher with ciprofol (MD = 0.18; 95% CI 0.08–0.29). No significant differences were found in sedation onset time (s) (MD = 2.49s; 95% CI -3.77–8.74) or bradycardia (RR = 0.88; 95% CI 0.44–1.77).
Conclusion
Ciprofol provides comparable efficacy to propofol for colonoscopy sedation, with a lower incidence of respiratory depression, injection pain, and hypotension. Patient satisfaction was slightly higher with ciprofol, while bradycardia occurrence was similar. These findings suggest ciprofol as a promising alternative, though further large-scale studies are needed to confirm its clinical benefits.
背景：环丙酚已成为一种潜在的替代镇静剂，具有更好的安全性和有效性。然而，结肠镜镇静的比较数据仍然有限。方法：系统检索PubMed、Embase、Cochrane Library和Web of Science，确定到2025年8月发表的rct。研究包括使用环丙酚或异丙酚进行结肠镜检查的患者，报告相关的疗效或安全性结果。采用Mantel-Haenszel随机效应模型和95%置信区间计算风险比（rr）和平均差异（md）。采用I²统计量和Cochrane Q检验评估异质性。主要结果是手术成功率和患者满意度（以1到10的量表评估）。次要结局包括镇静起效时间(s)、呼吸抑制、注射疼痛和血流动力学不良事件（低血压和心动过缓）。采用R软件（4.4.1版）进行统计分析。结果：纳入3项随机对照试验，共645例患者。环丙酚和异丙酚结肠镜检查成功率相似（RR = 1.005;95% CI 0.992-1.019）。环丙酚出现呼吸抑制（RR = 0.24;95% CI 0.08-0.71）、注射疼痛（RR = 0.04;95% CI 0.01-0.15）和低血压（RR = 0.85;95% CI 0.75-0.96）的风险较低。环丙酚组患者满意度略高（MD = 0.18;95% CI 0.08-0.29）。镇静起效时间(s) （MD = 2.49s; 95% CI -3.77-8.74）或心动缓（RR = 0.88;95% CI 0.44-1.77）无显著差异。结论：环丙酚用于结肠镜镇静的疗效与异丙酚相当，呼吸抑制、注射疼痛和低血压的发生率较低。环丙酚的患者满意度略高，而心动过缓的发生率相似。这些发现表明环丙酚是一种很有希望的替代品，尽管需要进一步的大规模研究来证实其临床益处。
{"title":"Ciprofol versus propofol for sedation in colonoscopy: a systematic review and meta-analysis of randomized controlled trials","authors":"Saul Dominici , Italo C. Martins , Breno Dias L. Ribeiro , Victor Arthur Ohannesian , Brunno Braga Sauaia , Abdias Rocha Santos , Caio Márcio Barros de Oliveira , Plínio da Cunha Leal","doi":"10.1016/j.bjane.2025.844710","DOIUrl":"10.1016/j.bjane.2025.844710","url":null,"abstract":"<div><h3>Background</h3><div>Ciprofol has emerged as a potential alternative sedative with improved safety and efficacy. However, comparative data for colonoscopy sedation remain limited.</div></div><div><h3>Methods</h3><div>A systematic search in PubMed, Embase, Cochrane Library, and Web of Science identified RCTs published through August 2025. Studies included patients undergoing colonoscopy using ciprofol or propofol, reporting relevant efficacy or safety outcomes. Risk Ratios (RRs) and Mean Differences (MDs) were calculated using the Mantel-Haenszel random-effects model and 95% Confidence Intervals. The heterogeneity was assessed with <em>I</em>² statistics and Cochrane Q test. Primary outcomes were procedure success rate and patient satisfaction (assessed on a 1-to-10 scale). Secondary outcomes included sedation onset time(s), respiratory depression, injection pain, and hemodynamic adverse events (hypotension and bradycardia). The statistical analyses were performed in <em>R</em> software (version 4.4.1.)</div></div><div><h3>Results</h3><div>Three RCTs with 645 patients were included. Colonoscopy success rates were similar between ciprofol and propofol (RR = 1.005; 95% CI 0.992–1.019). Ciprofol showed a lower risk of respiratory depression (RR = 0.24; 95% CI 0.08–0.71), injection pain (RR = 0.04; 95% CI 0.01–0.15), and hypotension (RR = 0.85; 95% CI 0.75–0.96). Patient satisfaction was slightly higher with ciprofol (MD = 0.18; 95% CI 0.08–0.29). No significant differences were found in sedation onset time (s) (MD = 2.49s; 95% CI -3.77–8.74) or bradycardia (RR = 0.88; 95% CI 0.44–1.77).</div></div><div><h3>Conclusion</h3><div>Ciprofol provides comparable efficacy to propofol for colonoscopy sedation, with a lower incidence of respiratory depression, injection pain, and hypotension. Patient satisfaction was slightly higher with ciprofol, while bradycardia occurrence was similar. These findings suggest ciprofol as a promising alternative, though further large-scale studies are needed to confirm its clinical benefits.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"76 1","pages":"Article 844710"},"PeriodicalIF":1.9,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145558305","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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