Brazilian Journal of Anesthesiology最新文献_第3页

Ciprofol versus propofol for sedation in colonoscopy: a systematic review and meta-analysis of randomized controlled trials 环丙酚与异丙酚在结肠镜检查中的镇静作用：随机对照试验的系统回顾和荟萃分析。

IF 1.9 4区医学 Q2 ANESTHESIOLOGY

Brazilian Journal of Anesthesiology

Pub Date : 2026-01-01 Epub Date: 2025-11-17 DOI: 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。

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引用次数: 0

Effect of lidocaine and magnesium sulfate on rocuronium onset time: a randomized controlled experimental study 利多卡因和硫酸镁对罗库溴铵起效时间的影响：一项随机对照实验研究

IF 1.9 4区医学 Q2 ANESTHESIOLOGY

Brazilian Journal of Anesthesiology

Pub Date : 2026-01-01 Epub Date: 2025-10-24 DOI: 10.1016/j.bjane.2025.844696

Michele Cocenza Varrichio Crispim , Denise Aya Otsuki , Yuri Ferreira Vicentini , Danielly Roberta Penedo Rodrigues , Milena Gomes Parzianello Egúsquiza , José Otavio Costa Auler Junior

Background

Neuromuscular blockers such as succinylcholine are widely used for airway management in critically ill patients; but their use may be contraindicated due to adverse effects. In rapid sequence intubation, the onset time of the neuromuscular blocker is critical and should be as short as possible. This study investigates whether lidocaine and magnesium sulfate could reduce the onset time of rocuronium bromide in an experimental model.

Method

Eighteen animals were randomly assigned to three groups and treated with lidocaine, magnesium sulfate, or saline before receiving rocuronium bromide (3 mg.kg^-1). After 10 minutes of neuromuscular blockade, reversal was performed with sugammadex (9 mg.kg^-1). Onset and reversal times were measured by acceleromyography. Doses were standardized in a pilot study with four animals. Data were tested for normality using the Shapiro-Wilk and Anderson-Darling tests. Onset times are tested with a one-way ANOVA, followed by Fisher’s (LSD) post hoc test, and mean arterial pressure and heart rate with a two-way ANOVA, followed by Tukey’s post hoc test. Statistical significance was set at p ≤ 0.05.

Results

The results showed that lidocaine and magnesium sulfate significantly reduced the onset time of rocuronium bromide compared to the saline solution (p < 0.05) and did not affect the onset time of reversal with sugammadex (p > 0.05). Both adjuvants caused hypotension, with a more significant effect observed with magnesium sulfate; however, blood pressure returned to baseline values.

Conclusion

In conclusion, lidocaine and magnesium sulfate facilitate airway access by reducing the onset time of rocuronium bromide.

Animal Ethics Committee approved 1749/2022.

神经肌肉阻滞剂如琥珀酰胆碱被广泛用于危重病人的气道管理；但由于不良反应，它们的使用可能是禁忌的。在快速序贯插管中，神经肌肉阻滞剂的起效时间至关重要，应尽可能短。本研究在实验模型中探讨利多卡因和硫酸镁是否能缩短罗库溴铵的起效时间。方法18只动物随机分为3组，分别给予利多卡因、硫酸镁或生理盐水治疗，然后给予罗库溴铵（3mg .kg-1）。神经肌肉阻断10分钟后，用糖马德（9 mg.kg-1）进行逆转。用加速肌图测定起病时间和逆转时间。在4只动物的初步研究中，剂量被标准化了。使用Shapiro-Wilk和Anderson-Darling检验数据的正态性。发病时间采用单因素方差分析，随后进行Fisher （LSD）事后检验，平均动脉压和心率采用双因素方差分析，然后进行Tukey事后检验。p≤0.05为差异有统计学意义。结果与生理盐水相比，利多卡因和硫酸镁可显著缩短罗库溴铵的起效时间（p < 0.05），而对糖马德逆转的起效时间无影响（p > 0.05）。两种佐剂均可引起低血压，硫酸镁的效果更显著；然而，血压恢复到基线值。结论利多卡因和硫酸镁可通过缩短罗库溴铵起效时间促进气道通路。动物伦理委员会批准1749/2022。

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引用次数: 0

Intranasal dexmedetomidine for procedural sedation in children: a systematic review and meta-analysis 鼻内右美托咪定用于儿童手术镇静：一项系统回顾和荟萃分析。

IF 1.9 4区医学 Q2 ANESTHESIOLOGY

Brazilian Journal of Anesthesiology

Pub Date : 2026-01-01 Epub Date: 2025-12-05 DOI: 10.1016/j.bjane.2025.844717

Kelvin Oliveira Rocha , Ellen Renata Ferreira de Araújo Santos , Mariana Madureira Pombeiro , Márcia Nayara da Silva Leite Fidelis , Fabiana Maria Kakehasi , Daniela Caldas Teixeira

Background

Intranasal Dexmedetomidine (IN-DEX) is a promising agent for pediatric procedural sedation due to its non-invasive route and favorable safety profile. However, a comprehensive synthesis quantifying its clinical timeline and safety as monotherapy is lacking. This meta-analysis assesses the efficacy and adverse events of IN-DEX as a standalone sedative in children.

Methods

Following PRISMA 2020 guidelines and PROSPERO registration (CRD420250652456), this meta-analysis systematically searched PubMed, ScienceDirect, and SciELO for intranasal dexmedetomidine monotherapy in children under 18 years from January 1, 2003, to July 1, 2025. Key outcomes included sedation success, onset, and duration. Data were pooled using a random-effects model, with risk-of-bias assessed via RoB2. We performed sensitivity and subgroup analyses and evaluated evidence certainty using the GRADE approach.

Results

Twenty-eight RCTs were included. The overall pooled mean onset time was 18.9 minutes and duration was 60.3 minutes, though both had very low evidence certainty due to high heterogeneity (I² > 99%). The overall success rate was 79.58%. Notably, in a subgroup of low-to-moderate risk-of-bias studies, a dose of [2, 3) mcg.kg^-1 achieved an 84.04% success rate, supported by high-quality evidence (GRADE: High, I² = 0%). The pooled proportions for key adverse events were hypotension (8.24%), bradycardia (5.08%), and desaturation (2.76%).

Conclusion

IN-DEX is an effective monotherapy for pediatric procedural sedation. Doses of [2, 3) mcg.kg^-1 are associated with high success rates, supported by high-quality evidence. While IN-DEX demonstrates a favorable respiratory profile with low desaturation rates, its use requires vigilant hemodynamic monitoring due to the risks of hypotension and bradycardia.

背景：鼻内右美托咪定（IN-DEX）由于其无创途径和良好的安全性，是一种很有希望用于儿科手术镇静的药物。然而，缺乏对其临床时间和单药安全性的综合评价。本荟萃分析评估了in - dex作为儿童独立镇静剂的疗效和不良事件。方法：本荟萃分析遵循PRISMA 2020指南和PROSPERO注册（CRD420250652456），系统检索PubMed、ScienceDirect和SciELO中2003年1月1日至2025年7月1日期间18岁以下儿童右美托咪定鼻内单药治疗的研究。主要结局包括镇静成功、发作和持续时间。使用随机效应模型汇总数据，并通过RoB2评估偏倚风险。我们进行敏感性和亚组分析，并使用GRADE方法评估证据确定性。结果：纳入28项随机对照试验。总体合并平均发病时间为18.9分钟，持续时间为60.3分钟，但由于异质性高（I²> 99%），两者的证据确定性都很低。总成功率为79.58%。值得注意的是，在低至中等偏倚风险研究的亚组中，[2,3]mcg的剂量。kg-1的成功率为84.04%，有高质量的证据支持（GRADE：高，I² = 0%）。主要不良事件的合并比例为低血压（8.24%）、心动过缓（5.08%）和去饱和（2.76%）。结论：IN-DEX是一种有效的儿科手术镇静单药。剂量为[2,3]mcg。高质量证据支持Kg-1与高成功率相关。虽然IN-DEX显示出良好的呼吸特征和低去饱和率，但由于低血压和心动过缓的风险，使用它需要警惕的血流动力学监测。

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引用次数: 0

Letter to the Editor regarding lateral versus posterior quadratus lumborum block in children undergoing open orchiopexy: a double-blind randomized clinical trial 致编辑的信：关于接受开放性睾丸切除术的儿童腰方肌外侧与后侧阻滞：一项双盲随机临床试验。

IF 1.9 4区医学 Q2 ANESTHESIOLOGY

Brazilian Journal of Anesthesiology

Pub Date : 2026-01-01 Epub Date: 2025-11-21 DOI: 10.1016/j.bjane.2025.844713

Parth Aphale, Himanshu Shekhar, Shashank Dokania

引用次数: 0

Between oceans and deserts: fluid balance and outcomes after liver transplantation 在海洋和沙漠之间：肝移植后的体液平衡和结果。

IF 1.9 4区医学 Q2 ANESTHESIOLOGY

Brazilian Journal of Anesthesiology

Pub Date : 2026-01-01 Epub Date: 2026-01-10 DOI: 10.1016/j.bjane.2026.844721

Sergio Henrique Loss , Edino Parolo , Felippe Leopoldo Dexheimer Neto

引用次数: 0

Evolution of patients with chronic pain undergoing standard treatment: a prospective longitudinal follow-up study 接受标准治疗的慢性疼痛患者的演变：一项前瞻性纵向随访研究。

IF 1.9 4区医学 Q2 ANESTHESIOLOGY

Brazilian Journal of Anesthesiology

Pub Date : 2026-01-01 Epub Date: 2025-11-01 DOI: 10.1016/j.bjane.2025.844700

Camila Cavalcante Castro , Sandro Max C. Silva , Martha Moreira C. Castro , Durval Campos Kraychete , Carla Daltro

Introduction

Chronic pain greatly affects quality of life and, consequently, impacts the psychological state, a condition that needs to be addressed. A 30% reduction in pain intensity is clinically significant. The objective of this study was to describe the clinical and psychological aspects of individuals with chronic pain undergoing standard treatment.

Methods

Descriptive longitudinal study involving individuals with chronic pain undergoing treatment at the Pain Outpatient Clinic of the Federal University of Bahia, in Salvador, Bahia, between June 2016 and December 2017. The variables studied were pain intensity, quality of life, sleep disorders, stress level, and the presence of anxiety and depression symptoms. Descriptive statistics were performed, and Student's t-test, and Fisher's Chi-Square test were used to compare the groups.

Results

We studied 134 individuals with a mean (standard deviation) age of 50 (10) years, 89.6% of whom were female. There was an improvement in quality of life and sleep, anxiety and depressive symptoms, and 58.2% of patients showed a 30% reduction in pain intensity. Among the factors associated with pain reduction, having a partner was a significant factor (73.7% vs. 52.1%; p = 0.030). However, symptoms of anxiety (81.6% vs. 75.0%; p = 0.436), symptoms of depression (63.2% vs. 58.3%; p = 0.718), and stress (92.1% vs. 87.5%; p = 0.846) were not associated with pain reduction.

Conclusion

This study suggests that multidisciplinary treatment can reduce pain intensity in chronically affected patients, as most patients exhibited a clinically significant response, accompanied by global improvement.

慢性疼痛极大地影响生活质量，从而影响心理状态，这是一个需要解决的问题。疼痛强度降低30%具有临床意义。本研究的目的是描述慢性疼痛接受标准治疗的个体的临床和心理方面。方法：描述性纵向研究涉及2016年6月至2017年12月在巴伊亚州萨尔瓦多巴伊亚联邦大学疼痛门诊接受治疗的慢性疼痛患者。研究的变量包括疼痛强度、生活质量、睡眠障碍、压力水平以及焦虑和抑郁症状的存在。采用描述性统计，采用Student’st检验和Fisher’s卡方检验进行组间比较。结果：我们研究了134例平均（标准差）年龄为50（10）岁的个体，其中89.6%为女性。患者的生活质量、睡眠质量、焦虑和抑郁症状均有所改善，58.2%的患者疼痛强度减轻了30%。在与疼痛减轻相关的因素中，有伴侣是显著因素（73.7% vs. 52.1%; p = 0.030）。然而，焦虑症状（81.6% vs. 75.0%; p = 0.436）、抑郁症状（63.2% vs. 58.3%; p = 0.718）和压力（92.1% vs. 87.5%; p = 0.846）与疼痛减轻无关。结论：本研究表明，多学科治疗可以减轻慢性疼痛患者的疼痛强度，因为大多数患者表现出显著的临床反应，并伴有整体改善。

{"title":"Evolution of patients with chronic pain undergoing standard treatment: a prospective longitudinal follow-up study","authors":"Camila Cavalcante Castro , Sandro Max C. Silva , Martha Moreira C. Castro , Durval Campos Kraychete , Carla Daltro","doi":"10.1016/j.bjane.2025.844700","DOIUrl":"10.1016/j.bjane.2025.844700","url":null,"abstract":"<div><h3>Introduction</h3><div>Chronic pain greatly affects quality of life and, consequently, impacts the psychological state, a condition that needs to be addressed. A 30% reduction in pain intensity is clinically significant. The objective of this study was to describe the clinical and psychological aspects of individuals with chronic pain undergoing standard treatment.</div></div><div><h3>Methods</h3><div>Descriptive longitudinal study involving individuals with chronic pain undergoing treatment at the Pain Outpatient Clinic of the Federal University of Bahia, in Salvador, Bahia, between June 2016 and December 2017. The variables studied were pain intensity, quality of life, sleep disorders, stress level, and the presence of anxiety and depression symptoms. Descriptive statistics were performed, and Student's t-test, and Fisher's Chi-Square test were used to compare the groups.</div></div><div><h3>Results</h3><div>We studied 134 individuals with a mean (standard deviation) age of 50 (10) years, 89.6% of whom were female. There was an improvement in quality of life and sleep, anxiety and depressive symptoms, and 58.2% of patients showed a 30% reduction in pain intensity. Among the factors associated with pain reduction, having a partner was a significant factor (73.7% vs. 52.1%; p = 0.030). However, symptoms of anxiety (81.6% vs. 75.0%; p = 0.436), symptoms of depression (63.2% vs. 58.3%; p = 0.718), and stress (92.1% vs. 87.5%; p = 0.846) were not associated with pain reduction.</div></div><div><h3>Conclusion</h3><div>This study suggests that multidisciplinary treatment can reduce pain intensity in chronically affected patients, as most patients exhibited a clinically significant response, accompanied by global improvement.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"76 1","pages":"Article 844700"},"PeriodicalIF":1.9,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145440271","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}

引用次数: 0

Effect of intravenous dexmedetomidine on sensory block duration in spinal anesthesia for lower limb surgery: a randomized controlled trial 静脉注射右美托咪定对下肢手术脊髓麻醉感觉阻滞持续时间的影响：一项随机对照试验。

IF 1.9 4区医学 Q2 ANESTHESIOLOGY

Brazilian Journal of Anesthesiology

Pub Date : 2025-11-01 Epub Date: 2025-08-27 DOI: 10.1016/j.bjane.2025.844672

Simran Chahal, Anju R. Bhalotra, Rahil Singh, Shweta Dhiman, Snigdha Singh

Study objective

To study the effect of Intravenous (IV) dexmedetomidine during spinal anesthesia on duration of sensory block and postoperative analgesia in patients undergoing lower limb orthopedic surgery.

Design

Prospective randomized double blind controlled trial.

Intervention

Patients in intervention (DX) group received 0.5 mcg.kg^-1 IV dexmedetomidine over 10 min. Spinal anesthesia was administered and an infusion of dexmedetomidine 0.5 mcg.kg^-1.h^-1 was given throughout surgery.

Measurements

Onset time of sensory and motor block, maximum height of sensory block and duration of sensory and motor block were assessed. Intraoperative Heart Rate (HR), Blood Pressure (BP), Peripheral Oxygen Saturation (SpO₂), sedation scores, postoperative pain scores, time to requirement of first analgesic and analgesic consumption over first 24h were noted.

Results

Data of 58 ASA I/II adults was analyzed. Duration of sensory block, defined as time to two-dermatome regression, was 137.03 ± 25.02 min in DX group and 79.45 ± 11.27 min in the NS group (p = 0.000). Onset of sensory and motor block and maximum height of sensory block were similar. Postoperative VAS scores were lower in the DX group at 4h and 24h (p = 0.001, p 0.0001) and comparable at 0h, 8h and 12h. Time to requirement of postoperative analgesia was longer in the DX group (p < 0.001) and requirement of postoperative analgesics was higher in the NS group. Sedation scores and incidence of bradycardia were higher in the DX group, but hypotension was similar.

Conclusion

IV dexmedetomidine (0.5 mcg.kg^-1 followed by 0.5 mcg.kg^-1.h^-1) resulted in extended sensory and motor block, prolonged postoperative analgesia and reduced postoperative analgesic consumption with minimal side effects.

研究目的：探讨脊髓麻醉时静脉注射右美托咪定对下肢骨科手术患者感觉阻滞持续时间及术后镇痛的影响。设计：前瞻性随机双盲对照试验。干预：干预（DX）组患者口服0.5 mcg。右美托咪定静脉注射超过10分钟。术中给予脊髓麻醉，并输注右美托咪定0.5 mg .kg-1.h-1。测量方法：评估感觉和运动阻滞发生时间、感觉阻滞最大高度、感觉和运动阻滞持续时间。记录术中心率（HR）、血压（BP）、外周血氧饱和度（SpO2）、镇静评分、术后疼痛评分、首次使用镇痛药所需时间及24小时内镇痛药消耗情况。结果：对58例ASA I/II型成人的资料进行分析。DX组感觉阻滞持续时间为137.03±25.02 min， NS组感觉阻滞持续时间为79.45±11.27 min （p = 0.000）。感觉阻滞和运动阻滞的发生时间和最大阻滞高度相似。DX组术后VAS评分在4h和24h较低（p = 0.001,p 0.0001），在0h、8h和12h比较。DX组到术后需要镇痛的时间较长（p < 0.001）， NS组术后需要镇痛药的时间较高。DX组镇静评分和心动过缓发生率较高，但低血压相似。结论：静脉注射右美托咪定（0.5 mcg）。Kg-1和0.5 mg （Kg-1 .h-1）可延长感觉和运动阻滞，延长术后镇痛时间，减少术后镇痛用量，副作用最小。

{"title":"Effect of intravenous dexmedetomidine on sensory block duration in spinal anesthesia for lower limb surgery: a randomized controlled trial","authors":"Simran Chahal, Anju R. Bhalotra, Rahil Singh, Shweta Dhiman, Snigdha Singh","doi":"10.1016/j.bjane.2025.844672","DOIUrl":"10.1016/j.bjane.2025.844672","url":null,"abstract":"<div><h3>Study objective</h3><div>To study the effect of Intravenous (IV) dexmedetomidine during spinal anesthesia on duration of sensory block and postoperative analgesia in patients undergoing lower limb orthopedic surgery.</div></div><div><h3>Design</h3><div>Prospective randomized double blind controlled trial.</div></div><div><h3>Intervention</h3><div>Patients in intervention (DX) group received 0.5 mcg.kg<sup>-1</sup> IV dexmedetomidine over 10 min. Spinal anesthesia was administered and an infusion of dexmedetomidine 0.5 mcg.kg<sup>-1</sup>.h<sup>-1</sup> was given throughout surgery.</div></div><div><h3>Measurements</h3><div>Onset time of sensory and motor block, maximum height of sensory block and duration of sensory and motor block were assessed. Intraoperative Heart Rate (HR), Blood Pressure (BP), Peripheral Oxygen Saturation (SpO<sub>2</sub>), sedation scores, postoperative pain scores, time to requirement of first analgesic and analgesic consumption over first 24h were noted.</div></div><div><h3>Results</h3><div>Data of 58 ASA I/II adults was analyzed. Duration of sensory block, defined as time to two-dermatome regression, was 137.03 ± 25.02 min in DX group and 79.45 ± 11.27 min in the NS group (p = 0.000). Onset of sensory and motor block and maximum height of sensory block were similar. Postoperative VAS scores were lower in the DX group at 4h and 24h (p = 0.001, p 0.0001) and comparable at 0h, 8h and 12h. Time to requirement of postoperative analgesia was longer in the DX group (p < 0.001) and requirement of postoperative analgesics was higher in the NS group. Sedation scores and incidence of bradycardia were higher in the DX group, but hypotension was similar.</div></div><div><h3>Conclusion</h3><div>IV dexmedetomidine (0.5 mcg.kg<sup>-1</sup> followed by 0.5 mcg.kg<sup>-1</sup>.h<sup>-1</sup>) resulted in extended sensory and motor block, prolonged postoperative analgesia and reduced postoperative analgesic consumption with minimal side effects.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 6","pages":"Article 844672"},"PeriodicalIF":1.9,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144980591","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}

引用次数: 0

Efficacy of pectoserratus plane block versus erector spinae plane block on acute and chronic pain after mastectomy: randomized clinical trial 胸锯肌平面阻滞与竖脊肌平面阻滞对乳房切除术后急性和慢性疼痛的疗效：随机临床试验

IF 1.9 4区医学 Q2 ANESTHESIOLOGY

Brazilian Journal of Anesthesiology

Pub Date : 2025-11-01 Epub Date: 2025-10-24 DOI: 10.1016/j.bjane.2025.844691

Fabrício T. Mendonça, Marcus Alexandre B. de Aviz, Ana Paula S. Bezerra, Lucas G. Silva, Estefane E. Gaspar, Bárbara N. Terol, Lucianna R. e Silva, Liliana M. Andrade

Objectives

To compare Pectoserratus Plane Block (PSPB) and Erector Spinae Plane (ESP) block regarding perioperative opioid consumption and chronic pain risk among women undergoing elective mastectomy.

Methods

Single-blind (patients), randomized (1:1) trial. The primary outcome was the composite measure defined as the use of fentanyl intraoperatively or tramadol postoperatively. Secondary outcomes encompassed intraoperative hemodynamics, short (24h), medium (3 months) and long-term (6 months) postoperative pain intensity and complications.

Results

99 patients were randomized (50 in the PSPB group and 49 in the ESP block group). Of these, 93 patients had complete data for the primary outcome. Use of either fentanyl or tramadol was required for 20 of 47 patients (43%) in the PSPB group and 28 of 46 patients (61%) in the ESP block group (Relative Risk [RR] 0.70, 95% Confidence interval [95% CI] 0.47‒1.05, p = 0.09). PSPB-treated patients had a lower risk of tramadol (RR = 0.31, 95% CI 0.12-0.77, p = 0.01) and dipyrone (RR = 0.60, 95% CI 0.39‒0.92, p = 0.02) consumption than ESP block-treated patients. PSPB lowered chronic pain risk at 3 months (RR = 0.66, 95% CI 0.47‒0.92, p = 0.02), with lower scores for the Short-Form McGill Pain Questionnaire (Mean Difference [MD] -2.55, 95% CI -4.31 to -0.78, p = 0.005) and the Douleur Neuropathique 4 Questions questionnaire (MD = -1.08, 95% CI -2.05 to -0.11, p = 0.03). By 6 months, pain outcomes were statistically comparable between groups. Hemodynamic variables and complications were comparable between groups.

Conclusion

PSPB and ESP block resulted in similar overall opioid consumption among women undergoing mastectomy. However, PSPB was associated with lower postoperative tramadol consumption.

目的比较胸锯肌平面阻滞（PSPB）和竖棘平面阻滞（ESP）对择期乳房切除术妇女围手术期阿片类药物消耗和慢性疼痛风险的影响。方法单盲（患者）、随机（1:1）试验。主要终点是术中芬太尼或术后曲马多使用的综合指标。次要结果包括术中血流动力学、短期（24小时）、中期（3个月）和长期（6个月）术后疼痛强度和并发症。结果99例患者随机分组，其中PSPB组50例，ESP阻滞组49例。其中，93例患者具有完整的主要结局数据。PSPB组47例患者中有20例（43%）需要使用芬太尼或曲马多，ESP阻断组46例患者中有28例（61%）需要使用芬太尼或曲马多（相对危险度[RR] 0.70, 95%可信区间[95% CI] 0.47-1.05, p = 0.09）。pspb治疗组服用曲马多（RR = 0.31, 95% CI 0.12-0.77, p = 0.01）和双吡隆（RR = 0.60, 95% CI 0.39-0.92, p = 0.02）的风险低于ESP阻滞治疗组。PSPB降低了3个月时的慢性疼痛风险（RR = 0.66, 95% CI 0.47-0.92, p = 0.02），短形式McGill疼痛问卷（平均差异[MD] -2.55, 95% CI -4.31至-0.78,p = 0.005）和Douleur神经病变4个问题问卷（MD = -1.08, 95% CI -2.05至-0.11,p = 0.03）得分较低。6个月时，两组疼痛结果具有统计学上的可比性。两组间血流动力学变量和并发症具有可比性。结论pspb和ESP阻断导致乳房切除术妇女阿片类药物的总体消耗相似。然而，PSPB与术后曲马多用量降低有关。

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引用次数: 0

The use of ketamine on emergence agitation in children: a systematic review and meta-analysis 氯胺酮治疗儿童突发性躁动：一项系统回顾和荟萃分析。

IF 1.9 4区医学 Q2 ANESTHESIOLOGY

Brazilian Journal of Anesthesiology

Pub Date : 2025-11-01 Epub Date: 2025-08-28 DOI: 10.1016/j.bjane.2025.844675

Ka Ting Ng , Jun Chuen Hui , Wan Yi Teoh , Ina Ismiarti Shariffuddin , Mohd Fitry Zainal Abidin

Background

Ketamine is believed to reduce the incidence of emergence agitation in children after surgery. However, recent studies reported contradictory findings. Thus, the primary objective of this review and meta-analysis was to investigate the use of ketamine in the reduction of emergence agitation in children undergoing surgery or procedure.

Methods

MEDLINE, EMBASE and CENTRAL were systematically searched from their inception date until March 2024. Randomized controlled trials comparing intravenous ketamine and placebo in children were sought. Observational studies, editorial letters or case reports were excluded.

Results

Seventeen studies (1515 patients) were included. Children who received ketamine were reported to have a significantly lower incidence of emergence agitation (OR = 0.27, 95% Confidence Interval: 0.16 to 0.45, p < 0.00001, I² = 61%, certainty of evidence: very low). As compared to placebo, the ketamine group had a significantly lower postoperative pain score (MD = -2.28, 95% Confidence Interval -3.68 to -0.87, p = 0.001, I² = 91%, certainty of evidence: very low). However, no significant differences were observed in the incidence of postoperative nausea and vomiting, desaturation, and laryngospasm.

Conclusion

This meta-analysis highlights the potential benefits of ketamine in the reduction of emergence agitation in children undergoing surgery or diagnostic procedures. However, high degrees of heterogeneity and low certainty of evidence limit the recommendations of the routine use of ketamine in the prevention of emergence agitation in children. Further high-quality randomized controlled trials are warranted before routine use can be recommended.

PROSPERO registration

CRD42024523680.

背景：氯胺酮被认为可以减少手术后儿童出现躁动的发生率。然而，最近的研究报告了相互矛盾的结果。因此，本综述和荟萃分析的主要目的是调查氯胺酮在减少接受手术或手术的儿童出现躁动中的应用。方法：系统检索MEDLINE、EMBASE和CENTRAL自建立之日起至2024年3月。随机对照试验比较儿童静脉注射氯胺酮和安慰剂。观察性研究、社论或病例报告被排除在外。结果：纳入17项研究（1515例患者）。据报道，接受氯胺酮治疗的儿童出现性躁动的发生率显著降低（OR = 0.27,95%可信区间：0.16 ~ 0.45,p < 0.00001, I2 = 61%，证据确定性极低）。与安慰剂组相比，氯胺酮组术后疼痛评分明显降低（MD = -2.28,95%可信区间-3.68 ~ -0.87,p = 0.001,I2 = 91%，证据确定性极低）。然而，术后恶心、呕吐、去饱和和喉痉挛的发生率没有显著差异。结论：本荟萃分析强调了氯胺酮在减少接受手术或诊断程序的儿童出现躁动方面的潜在益处。然而，证据的高度异质性和低确定性限制了氯胺酮在预防儿童出现性躁动中的常规使用。在推荐常规使用之前，需要进一步进行高质量的随机对照试验。普洛斯彼罗注册：CRD42024523680。

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引用次数: 0

Lateral versus posterior quadratus lumborum block in children undergoing open orchiopexy: a double-blind randomized clinical trial 接受开放性睾丸切除术的儿童腰方肌外侧与后侧阻滞：一项双盲随机临床试验。

IF 1.9 4区医学 Q2 ANESTHESIOLOGY

Brazilian Journal of Anesthesiology

Pub Date : 2025-11-01 Epub Date: 2025-07-05 DOI: 10.1016/j.bjane.2025.844661

Ozgecan P. Zanbak Mutlu, Pinar Kendigelen, Ayse C. Tutuncu

Background

Quadratus Lumborum Block (QLB) has recently become an effective analgesic regional technique frequently used in abdominal surgeries. However, due to the heterogeneity in studies regarding block approaches, a direct comparison of QLB types is needed. In this double-blind prospective randomized trial, we aimed to compare the effects of lateral and posterior approaches of QLB on pain and analgesic use in children undergoing orchiopexy.

Methods

Patients aged 6 months – 12 years undergoing elective unilateral open orchiopexy were included in the study. Patients were randomized into two groups using the closed-envelope method. Lateral or posterior QLB was applied under ultrasonography with 0.4 mL/kg 0.25% bupivacaine for both groups before the surgery. The primary outcome was the assessment of postoperative pain for 24 hours. Analgesic usage, parental satisfaction, and complications were recorded as secondary outcomes.

Results

Analyses were conducted on 80 patients. Both study groups achieved clinically adequate analgesia, and no significant pain score distinctions were observed within 24 hours (Total mean scores: FLACC [lateral QLB: 2.86 ± 4.69 vs. posterior QLB: 2.87 ± 3.71, p = 0.466], Wong-Baker [lateral QLB: 0.86 ± 2.03 vs. posterior QLB: 1.24 ± 1.85, p = 0.151]). No significant interaction effect between groups and postoperative time intervals on pain scores was observed (FLACC score p-interaction: 0.425, Wong-Baker score p-interaction: 0.451). There were no statistical differences in the number of patients necessitating intraoperative and postoperative analgesics. Parental satisfaction exhibited similarity between the groups, and no perioperative complications were observed in either group.

Conclusion

Lateral and posterior QLB provided similar perioperative analgesia in pediatric patients undergoing orchiopexy.

Clinical trial registration number

NCT05056038.

Date of registration

02 June 2021.

背景：腰方肌阻滞（QLB）近年来已成为腹部手术中常用的一种有效的局部镇痛技术。然而，由于块方法研究的异质性，需要对QLB类型进行直接比较。在这项双盲前瞻性随机试验中，我们旨在比较QLB侧入路和后路入路对接受睾丸切除术的儿童疼痛和止痛药使用的影响。方法：选取年龄6个月~ 12岁的择期单侧开放睾丸切除术患者为研究对象。采用闭包法将患者随机分为两组。术前，两组均在超声检查下应用0.4 mL/kg 0.25%布比卡因治疗QLB外侧或后部。主要结果是术后24小时疼痛的评估。镇痛药使用、父母满意度和并发症被记录为次要结局。结果：对80例患者进行分析。两组患者均达到临床充分镇痛，24小时内疼痛评分无明显差异（总平均评分：FLACC[侧位QLB: 2.86±4.69 vs后位QLB: 2.87±3.71,p = 0.466]，Wong-Baker[侧位QLB: 0.86±2.03 vs后位QLB: 1.24±1.85,p = 0.151]）。各组和术后时间间隔对疼痛评分无显著交互作用（FLACC评分p-interaction: 0.425， Wong-Baker评分p-interaction: 0.451）。术中术后需要镇痛的患者数量无统计学差异。两组患者的父母满意度相似，两组患者均未出现围手术期并发症。结论：侧边和后方QLB在小儿睾丸切除术患者围术期镇痛效果相似。临床试验注册号：NCT05056038。注册日期：2021年6月2日。

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