Pub Date : 2025-06-04DOI: 10.1016/j.bjane.2025.844646
Rodolfo Otávio Tomaz Bertti , Luiz Antonio Vane , José Mariano Soares de Moraes , Paulo do Nascimento Junior , Lucas Fachini Vane , Norma Sueli Pinheiro Módolo , Matheus Fachini Vane
Background
To facilitate the surgical view, laparoscopic and robotic pelvic surgeries require a pneumoperitoneum with the Trendelenburg position, which may result in elevated Intracranial Pressure (ICP). The choice of anesthetic agents may also influence ICP. Ultrasonographic evaluation of the Optic Nerve Sheath Diameter (ONSD) is a promising way to evaluate ICP. In this systematic review, we aimed to evaluate the ONSD, as an indirect estimation of ICP, in patients undergoing laparoscopic/robotic surgeries under pneumoperitoneum and Trendelenburg position.
Methods
A literature search was performed to identify prospective randomized clinical trials in which the primary endpoint was the evaluation of the ONSD using sevoflurane or propofol anesthesia after the onset of pneumoperitoneum and Trendelenburg position. The mean and the standard deviation of the ONSD in each intervention group were extracted from the included trials for analysis. Mean difference with 95% Confidence Interval (95% CI) was calculated.
Results
Five randomized controlled trials, with 277 subjects, were allocated to this study. Compared with the baseline, there was an increase in ONSD from 0.5h to 3 hours (p < 0.05) in both propofol and sevoflurane groups. Furthermore, propofol reduced the ONSD compared to sevoflurane (mean difference: -0.23 mm, 95% CI: -0.37 to -0.10; studies = 5; I2 = 23%).
Conclusion
There is evidence indicating, through ultrasonographic analysis of the ONSD, that propofol probably reduces ICP compared to sevoflurane in robotic and laparoscopic pelvic surgeries.
背景：为了方便手术视野，腹腔镜和机器人骨盆手术需要Trendelenburg体位气腹，这可能导致颅内压（ICP）升高。麻醉药物的选择也可能影响颅内压。超声检查视神经鞘直径（ONSD）是一种很有前途的评估ICP的方法。在本系统综述中，我们旨在评估在气腹和Trendelenburg体位下接受腹腔镜/机器人手术的患者的ONSD，作为ICP的间接估计。方法：通过文献检索，以评估气腹和Trendelenburg体位发生后使用七氟醚或异丙酚麻醉的ONSD为主要终点的前瞻性随机临床试验。从纳入的试验中提取每个干预组的ONSD的平均值和标准差进行分析。计算95%置信区间（95% CI）的平均差值。结果：本研究共纳入5项随机对照试验，共277名受试者。与基线相比，异丙酚组和七氟醚组的ONSD从0.5h增加到3 h （p < 0.05）。此外，与七氟醚相比，异丙酚降低了ONSD(平均差异：-0.23 mm, 95% CI: -0.37至-0.10；研究 = 5;I2 = 23%)。结论：有证据表明，通过超声对ONSD的分析，在机器人和腹腔镜盆腔手术中，与七氟醚相比，异丙酚可能降低了ICP。
{"title":"Effect of propofol and sevoflurane anesthesia on the optic nerve sheath: systematic review and meta-analysis","authors":"Rodolfo Otávio Tomaz Bertti , Luiz Antonio Vane , José Mariano Soares de Moraes , Paulo do Nascimento Junior , Lucas Fachini Vane , Norma Sueli Pinheiro Módolo , Matheus Fachini Vane","doi":"10.1016/j.bjane.2025.844646","DOIUrl":"10.1016/j.bjane.2025.844646","url":null,"abstract":"<div><h3>Background</h3><div>To facilitate the surgical view, laparoscopic and robotic pelvic surgeries require a pneumoperitoneum with the Trendelenburg position, which may result in elevated Intracranial Pressure (ICP). The choice of anesthetic agents may also influence ICP. Ultrasonographic evaluation of the Optic Nerve Sheath Diameter (ONSD) is a promising way to evaluate ICP. In this systematic review, we aimed to evaluate the ONSD, as an indirect estimation of ICP, in patients undergoing laparoscopic/robotic surgeries under pneumoperitoneum and Trendelenburg position.</div></div><div><h3>Methods</h3><div>A literature search was performed to identify prospective randomized clinical trials in which the primary endpoint was the evaluation of the ONSD using sevoflurane or propofol anesthesia after the onset of pneumoperitoneum and Trendelenburg position. The mean and the standard deviation of the ONSD in each intervention group were extracted from the included trials for analysis. Mean difference with 95% Confidence Interval (95% CI) was calculated.</div></div><div><h3>Results</h3><div>Five randomized controlled trials, with 277 subjects, were allocated to this study. Compared with the baseline, there was an increase in ONSD from 0.5h to 3 hours (p < 0.05) in both propofol and sevoflurane groups. Furthermore, propofol reduced the ONSD compared to sevoflurane (mean difference: -0.23 mm, 95% CI: -0.37 to -0.10; studies = 5; I<sup>2</sup> = 23%).</div></div><div><h3>Conclusion</h3><div>There is evidence indicating, through ultrasonographic analysis of the ONSD, that propofol probably reduces ICP compared to sevoflurane in robotic and laparoscopic pelvic surgeries.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 5","pages":"Article 844646"},"PeriodicalIF":1.7,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144251104","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 : 2025-06-03DOI: 10.1016/j.bjane.2025.844647
Güvenç Doğan , Onur Küçük , Selçuk Kayır , Gökçe Çiçek Dal , Bahadır Çiftçi , Musa Zengin , Ali Alagöz
Background
Video-Assisted Thoracoscopic Surgery (VATS) is a minimally invasive procedure associated with faster recovery and fewer complications compared to open thoracotomy. Effective postoperative pain management is important for optimizing recovery. This study compares the analgesic efficacy of the Serratus Posterior Superior Intercostal Plane Block (SPSIPB) and Thoracic Paravertebral Block (TPVB) for postoperative pain following VATS.
Methods
In this randomized, prospective, double-blind study, 70 patients aged 18–65 years (ASA I–III) undergoing VATS were randomly assigned to Group TPVB (n = 35) or Group SPSIPB (n = 35). The primary outcome was the 24-hour postoperative Visual Analog Scale (VAS) pain score at rest. Secondary outcomes included VAS pain scores during coughing, time to first opioid request, total opioid consumption within 24 hours, patient satisfaction, and Quality of Recovery-15 (QoR-15) scores. Opioid consumption was assessed using intravenous tramadol through Patient-Controlled Analgesia (PCA), with additional morphine, if required.
Results
The mean age of the patients was 52 ± 11 years, and 64.2% were male. VAS pain scores were evaluated at 24 hours and at seven time points. There was no significant difference between groups (p > 0.05) except at 1 hour postoperatively, where the TPVB group had a significantly lower resting VAS score (19 [8–28] vs. 26 [18.5–33], p = 0.031). The total 24 hour tramadol consumption was 220 mg (135–260) in the TPVB group versus 150 mg (110–230) in the SPSIPB group (p = 0.129). The proportion of patients requiring additional analgesia was 25.7% in the TPVB group versus 28.5% in the SPSIPB group (p = 0.788). Preoperative and postoperative QoR-15 scores were similar between the groups (preoperative: 137 vs. 136, p = 0.878; postoperative: 133 vs. 132, p = 0.814). Patient satisfaction scores were also comparable (8 [7–10] vs. 9 [7–10], p = 0.789).
Conclusion
SPSIPB provides analgesic efficacy similar to TPVB for VATS, with comparable pain scores, opioid consumption, and recovery outcomes. Given its ease of use and safety profile, SPSIPB represents a promising alternative to TPVB in multimodal analgesia for minimally invasive thoracic surgery.
背景：视频辅助胸腔镜手术（VATS）是一种微创手术，与开胸手术相比，恢复更快，并发症更少。有效的术后疼痛管理对于优化恢复非常重要。本研究比较了锯肌后上肋间平面阻滞（SPSIPB）和胸椎旁阻滞（TPVB）对VATS术后疼痛的镇痛效果。方法：在这项随机、前瞻性、双盲研究中，70例年龄在18-65岁（ASA I-III）接受VATS的患者被随机分为TPVB组（n = 35）和SPSIPB组（n = 35）。主要终点是术后24小时视觉模拟评分（VAS）休息时疼痛评分。次要结局包括咳嗽时VAS疼痛评分、到第一次请求阿片类药物的时间、24小时内阿片类药物总消耗、患者满意度和恢复质量-15 （QoR-15）评分。通过患者自控镇痛（PCA）静脉注射曲马多来评估阿片类药物的消耗，如果需要，额外使用吗啡。结果：患者平均年龄52±11岁，男性占64.2%。分别在24小时和7个时间点评估VAS疼痛评分。两组间差异无统计学意义（p > 0.05），但术后1小时TPVB组静息VAS评分显著低于对照组（19[8-28]比26 [18.5-33],p = 0.031）。TPVB组24小时曲马多总消耗量为220 mg(135-260)，而SPSIPB组为150 mg (110-230) （p = 0.129）。TPVB组需要额外镇痛的患者比例为25.7%，而SPSIPB组为28.5% （p = 0.788）。术前和术后QoR-15评分各组间相似(术前：137 vs. 136, p = 0.878；术后：133 vs 132， p = 0.814)。患者满意度评分也具有可比性（8[7-10]对9 [7-10]，p = 0.789）。结论：SPSIPB对VATS的镇痛效果与TPVB相似，疼痛评分、阿片类药物消耗和恢复结果相似。鉴于其易用性和安全性，SPSIPB在微创胸外科手术的多模态镇痛中有望取代TPVB。
{"title":"Serratus posterior superior intercostal plane block versus thoracic paravertebral block for pain management after video-assisted thoracoscopic surgery: a randomized prospective study","authors":"Güvenç Doğan , Onur Küçük , Selçuk Kayır , Gökçe Çiçek Dal , Bahadır Çiftçi , Musa Zengin , Ali Alagöz","doi":"10.1016/j.bjane.2025.844647","DOIUrl":"10.1016/j.bjane.2025.844647","url":null,"abstract":"<div><h3>Background</h3><div>Video-Assisted Thoracoscopic Surgery (VATS) is a minimally invasive procedure associated with faster recovery and fewer complications compared to open thoracotomy. Effective postoperative pain management is important for optimizing recovery. This study compares the analgesic efficacy of the Serratus Posterior Superior Intercostal Plane Block (SPSIPB) and Thoracic Paravertebral Block (TPVB) for postoperative pain following VATS.</div></div><div><h3>Methods</h3><div>In this randomized, prospective, double-blind study, 70 patients aged 18–65 years (ASA I–III) undergoing VATS were randomly assigned to Group TPVB (n = 35) or Group SPSIPB (n = 35). The primary outcome was the 24-hour postoperative Visual Analog Scale (VAS) pain score at rest. Secondary outcomes included VAS pain scores during coughing, time to first opioid request, total opioid consumption within 24 hours, patient satisfaction, and Quality of Recovery-15 (QoR-15) scores. Opioid consumption was assessed using intravenous tramadol through Patient-Controlled Analgesia (PCA), with additional morphine, if required.</div></div><div><h3>Results</h3><div>The mean age of the patients was 52 ± 11 years, and 64.2% were male. VAS pain scores were evaluated at 24 hours and at seven time points. There was no significant difference between groups (p > 0.05) except at 1 hour postoperatively, where the TPVB group had a significantly lower resting VAS score (19 [8–28] vs. 26 [18.5–33], p = 0.031). The total 24 hour tramadol consumption was 220 mg (135–260) in the TPVB group versus 150 mg (110–230) in the SPSIPB group (p = 0.129). The proportion of patients requiring additional analgesia was 25.7% in the TPVB group versus 28.5% in the SPSIPB group (p = 0.788). Preoperative and postoperative QoR-15 scores were similar between the groups (preoperative: 137 vs. 136, p = 0.878; postoperative: 133 vs. 132, p = 0.814). Patient satisfaction scores were also comparable (8 [7–10] vs. 9 [7–10], p = 0.789).</div></div><div><h3>Conclusion</h3><div>SPSIPB provides analgesic efficacy similar to TPVB for VATS, with comparable pain scores, opioid consumption, and recovery outcomes. Given its ease of use and safety profile, SPSIPB represents a promising alternative to TPVB in multimodal analgesia for minimally invasive thoracic surgery.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 5","pages":"Article 844647"},"PeriodicalIF":1.7,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144236097","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 : 2025-05-28DOI: 10.1016/j.bjane.2025.844645
Jonathan G. Bilmen, Pawan K. Gupta
{"title":"Keeping it in the family: Malignant Hyperthermia - how we predict, recognise and treat it","authors":"Jonathan G. Bilmen, Pawan K. Gupta","doi":"10.1016/j.bjane.2025.844645","DOIUrl":"10.1016/j.bjane.2025.844645","url":null,"abstract":"","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 4","pages":"Article 844645"},"PeriodicalIF":1.7,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144188567","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 : 2025-05-23DOI: 10.1016/j.bjane.2025.844643
Mustafa Aslan , Alper Kilicaslan , Funda Gök , Ahmet Fevzi Kekec , Tahsin Sami Colak
Objective
This study compared the Pericapsular Nerve Group (PENG) block combined with the Lateral Femoral Cutaneous Nerve (LFCN) block to the anterior Quadratus Lumborum Block (QLB) in patients undergoing Total Hip Arthroplasty (THA).
Methods
In this prospective, double-blind trial, 80 adults scheduled for THA under spinal anesthesia were randomized to receive either an anterior QLB (n = 40) with 30 mL of 0.25% bupivacaine or a combined PENG + LFCN block (n = 40) using 25 mL of 0.25% bupivacaine for PENG and 5 mL for LFCN. The primary outcome was cumulative 24 hour postoperative intravenous morphine consumption. Secondary outcomes included pain scores, quadriceps strength, patient satisfaction and side effects.
Results
No significant differences were observed between the groups in morphine consumption or pain scores during the first 12 hours (p > 0.05). At 24 hours, the PENG + LFCN group demonstrated significantly lower morphine consumption (p = 0.027) and resting VAS scores (p < 0.001). Quadriceps weakness occurred in 15% (6/40) of anterior QLB patients at 6 hours (p = 0.026), whereas no weakness was observed in the PENG + LFCN group within 24 hours. Patient satisfaction and the incidence of complications were comparable between the groups.
Conclusion
Both anterior QLB and PENG + LFCN blocks provide effective analgesia for up to 12 hours post-THA. However, the PENG + LFCN combination offers prolonged analgesia, reduced opioid requirements and better preservation of quadriceps strength.
{"title":"Comparison of pericapsular nerve group block and anterior quadratus lumborum block for hip fracture surgery: a randomized clinical trial","authors":"Mustafa Aslan , Alper Kilicaslan , Funda Gök , Ahmet Fevzi Kekec , Tahsin Sami Colak","doi":"10.1016/j.bjane.2025.844643","DOIUrl":"10.1016/j.bjane.2025.844643","url":null,"abstract":"<div><h3>Objective</h3><div>This study compared the Pericapsular Nerve Group (PENG) block combined with the Lateral Femoral Cutaneous Nerve (LFCN) block to the anterior Quadratus Lumborum Block (QLB) in patients undergoing Total Hip Arthroplasty (THA).</div></div><div><h3>Methods</h3><div>In this prospective, double-blind trial, 80 adults scheduled for THA under spinal anesthesia were randomized to receive either an anterior QLB (n = 40) with 30 mL of 0.25% bupivacaine or a combined PENG + LFCN block (n = 40) using 25 mL of 0.25% bupivacaine for PENG and 5 mL for LFCN. The primary outcome was cumulative 24 hour postoperative intravenous morphine consumption. Secondary outcomes included pain scores, quadriceps strength, patient satisfaction and side effects.</div></div><div><h3>Results</h3><div>No significant differences were observed between the groups in morphine consumption or pain scores during the first 12 hours (p > 0.05). At 24 hours, the PENG + LFCN group demonstrated significantly lower morphine consumption (p = 0.027) and resting VAS scores (p < 0.001). Quadriceps weakness occurred in 15% (6/40) of anterior QLB patients at 6 hours (p = 0.026), whereas no weakness was observed in the PENG + LFCN group within 24 hours. Patient satisfaction and the incidence of complications were comparable between the groups.</div></div><div><h3>Conclusion</h3><div>Both anterior QLB and PENG + LFCN blocks provide effective analgesia for up to 12 hours post-THA. However, the PENG + LFCN combination offers prolonged analgesia, reduced opioid requirements and better preservation of quadriceps strength.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 5","pages":"Article 844643"},"PeriodicalIF":1.7,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144668","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 : 2025-05-17DOI: 10.1016/j.bjane.2025.844642
Nguyen Dang Thu , Nguyen Thi Thuy , Le Sau Nguyen , Cong Quyet Thang , Nguyen Ngoc Thach , Nguyen Trung Kien
Background
Geriatric patients undergoing major open abdominal surgery are at high risk for postoperative pulmonary complications and hypoxemia. Continuous Positive Airway Pressure (CPAP) after surgery may improve postoperative lung function. This randomized controlled trial compared two CPAP techniques ‒ automatic via nasal mask and constant via facial mask ‒ regarding pulmonary function and patient tolerance.
Methods
Sixty patients (≥ 60 years) were randomized (1:1) to receive either automatic CPAP (2–10 cm H2O) via a nasal mask (Group A) or constant CPAP (7.5 cm H2O) via a facial mask (Group C) upon arrival in the post-anesthesia care unit. Oxygenation (PaO2, PaO₂/FiO₂, SpO2) and spirometry (FVC, FEV1, PEF) were assessed preoperatively, postoperatively, and one hour after treatment. Comfort scores (0–10, with 0 indicating the best comfort) and complications were recorded.
Results
PaO₂/FiO2 improvement was lower in Group A (32.6 ± 26.3 mmHg) than in Group C (52.9 ± 40.1 mmHg; p = 0.023). FVC improvement was also lower in Group A (3.7% ± 4.0%) than in Group C (6.7% ± 4.9%; p = 0.012). However, Group A had better tolerance, with lower comfort scores (2 [2–3] vs. 3 [2–4], p = 0.002). Pulmonary function benefits were more pronounced in patients over 70 and those undergoing upper abdominal surgery.
Conclusion
Both CPAP techniques prevent pulmonary decline in geriatric patients post-surgery. While automatic CPAP provides better comfort, constant CPAP improves oxygenation. Although our findings are short-term, they suggest that CPAP mode selection should be tailored based on patient-specific needs.
背景：接受腹部大手术的老年患者术后出现肺部并发症和低氧血症的风险很高。术后持续气道正压通气（CPAP）可改善术后肺功能。这项随机对照试验比较了两种CPAP技术——自动通过鼻罩和持续通过面罩——对肺功能和患者耐受性的影响。方法：60例患者（≥60岁）随机（1:1）在到达麻醉后护理单元后接受自动CPAP （2-10 cm H2O）通过鼻罩（a组）或持续CPAP （7.5 cm H2O）通过面罩（C组）。术前、术后及治疗后1小时分别评估氧合（PaO2、PaO₂/FiO₂、SpO2）和肺活量（FVC、FEV1、PEF）。记录舒适度评分（0-10分，0分为最佳舒适度）和并发症。结果：A组PaO₂/FiO2改善（32.6±26.3 mmHg）低于C组（52.9±40.1 mmHg）； = 0.023页)。A组FVC改善率（3.7%±4.0%）低于C组（6.7%±4.9%）； = 0.012页)。然而，A组耐受性较好，舒适度评分较低（2[2-3]对3 [2-4]，p = 0.002）。肺功能的改善在70岁以上和接受上腹部手术的患者中更为明显。结论：两种CPAP技术均可预防老年患者术后肺功能衰退。虽然自动CPAP提供更好的舒适性，但持续的CPAP可以改善氧合。虽然我们的研究结果是短期的，但它们表明CPAP模式的选择应根据患者的具体需求进行调整。
{"title":"Comparison of automatic versus constant CPAP in elderly patients after major abdominal surgery: a randomized noninferiority trial","authors":"Nguyen Dang Thu , Nguyen Thi Thuy , Le Sau Nguyen , Cong Quyet Thang , Nguyen Ngoc Thach , Nguyen Trung Kien","doi":"10.1016/j.bjane.2025.844642","DOIUrl":"10.1016/j.bjane.2025.844642","url":null,"abstract":"<div><h3>Background</h3><div>Geriatric patients undergoing major open abdominal surgery are at high risk for postoperative pulmonary complications and hypoxemia. Continuous Positive Airway Pressure (CPAP) after surgery may improve postoperative lung function. This randomized controlled trial compared two CPAP techniques ‒ automatic via nasal mask and constant via facial mask ‒ regarding pulmonary function and patient tolerance.</div></div><div><h3>Methods</h3><div>Sixty patients (≥ 60 years) were randomized (1:1) to receive either automatic CPAP (2–10 cm H<sub>2</sub>O) via a nasal mask (Group A) or constant CPAP (7.5 cm H<sub>2</sub>O) via a facial mask (Group C) upon arrival in the post-anesthesia care unit. Oxygenation (PaO<sub>2</sub>, PaO₂/FiO₂, SpO<sub>2</sub>) and spirometry (FVC, FEV<sub>1</sub>, PEF) were assessed preoperatively, postoperatively, and one hour after treatment. Comfort scores (0–10, with 0 indicating the best comfort) and complications were recorded.</div></div><div><h3>Results</h3><div>PaO₂/FiO<sub>2</sub> improvement was lower in Group A (32.6 ± 26.3 mmHg) than in Group C (52.9 ± 40.1 mmHg; p = 0.023). FVC improvement was also lower in Group A (3.7% ± 4.0%) than in Group C (6.7% ± 4.9%; p = 0.012). However, Group A had better tolerance, with lower comfort scores (2 [2–3] vs. 3 [2–4], p = 0.002). Pulmonary function benefits were more pronounced in patients over 70 and those undergoing upper abdominal surgery.</div></div><div><h3>Conclusion</h3><div>Both CPAP techniques prevent pulmonary decline in geriatric patients post-surgery. While automatic CPAP provides better comfort, constant CPAP improves oxygenation. Although our findings are short-term, they suggest that CPAP mode selection should be tailored based on patient-specific needs.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 5","pages":"Article 844642"},"PeriodicalIF":1.7,"publicationDate":"2025-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144102902","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 : 2025-05-17DOI: 10.1016/j.bjane.2025.844644
João Pedro Fernandes Gonçalves , Anita Perpétua Carvalho Rocha de Castro , Luiz Gustavo Albuquerque , Thiago Ramos Grigio , Durval Campos Kraychete
{"title":"The expanding role of the erector spinae plane block: from concept to clinical integration","authors":"João Pedro Fernandes Gonçalves , Anita Perpétua Carvalho Rocha de Castro , Luiz Gustavo Albuquerque , Thiago Ramos Grigio , Durval Campos Kraychete","doi":"10.1016/j.bjane.2025.844644","DOIUrl":"10.1016/j.bjane.2025.844644","url":null,"abstract":"","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 4","pages":"Article 844644"},"PeriodicalIF":1.7,"publicationDate":"2025-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144103030","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 : 2025-05-16DOI: 10.1016/j.bjane.2025.844639
Kevin Pacheco-Barrios , Marcel Simis , Paulo S. de Melo , Ingrid Rebello-Sanchez , Karen Vasquez-Avila , Sara Barbosa Franco , Paola Gonzalez-Mego , Linamara Battistella , Marta Imamura , Felipe Fregni
Background
This study aims to explore the role of sex as a confounder and effect modifier in the associations of clinical outcomes, pain-related outcomes, and neurophysiological measurements in chronic knee OA pain subjects.
Methods
Sociodemographic, clinical, and neurophysiological data were extracted from 113 knee OA subjects with chronic pain. We performed exploratory multivariate regression models assessing the association of physiological outcomes (Quantitative Sensory Testing [QST], Electroencephalography [EEG], and Transcranial Magnetic Stimulation [TMS]) and clinical characteristics (pain, anxiety, and motor function). In each independent model we tested the role of biological sex as confounder and effect modifier (adding the interaction term).
Results
Females reported higher pain intensity, lower quality of life, diminished pain thresholds, and less EEG alpha power compared to males. Sex negatively confounded the association between pain interference and pain intensity with pain threshold confounding (ranged between -19% to -125%). Moreover, sex acted as an effect modifier, predominantly influencing the relationship between pain interference and frontocentral alpha-delta power in EEG. Similarly, sex modified the association between pain interference and pain threshold. In females EEG and PPT variables explained less variability of pain interference compared to males.
Conclusions
Our study suggests that sex is a confounder and effect modifier mainly in the relationship between neurophysiological variables and pain-related outcomes in a chronic OA pain population. Females may have weaker associations between pain intensity and mechanistic outcomes (EEG and QST). Thus, the use of these biomarkers in females requires further optimization. We therefore reinforce the need for accounting for biological sex in the analysis, not only as a confounder, but as an effect modifier in further randomized trials and observational studies in the field of pain.
{"title":"The role of biological sex in neurophysiological associations of patients with chronic osteoarthritis pain: a prospective cross-sectional study","authors":"Kevin Pacheco-Barrios , Marcel Simis , Paulo S. de Melo , Ingrid Rebello-Sanchez , Karen Vasquez-Avila , Sara Barbosa Franco , Paola Gonzalez-Mego , Linamara Battistella , Marta Imamura , Felipe Fregni","doi":"10.1016/j.bjane.2025.844639","DOIUrl":"10.1016/j.bjane.2025.844639","url":null,"abstract":"<div><h3>Background</h3><div>This study aims to explore the role of sex as a confounder and effect modifier in the associations of clinical outcomes, pain-related outcomes, and neurophysiological measurements in chronic knee OA pain subjects.</div></div><div><h3>Methods</h3><div>Sociodemographic, clinical, and neurophysiological data were extracted from 113 knee OA subjects with chronic pain. We performed exploratory multivariate regression models assessing the association of physiological outcomes (Quantitative Sensory Testing [QST], Electroencephalography [EEG], and Transcranial Magnetic Stimulation [TMS]) and clinical characteristics (pain, anxiety, and motor function). In each independent model we tested the role of biological sex as confounder and effect modifier (adding the interaction term).</div></div><div><h3>Results</h3><div>Females reported higher pain intensity, lower quality of life, diminished pain thresholds, and less EEG alpha power compared to males. Sex negatively confounded the association between pain interference and pain intensity with pain threshold confounding (ranged between -19% to -125%). Moreover, sex acted as an effect modifier, predominantly influencing the relationship between pain interference and frontocentral alpha-delta power in EEG. Similarly, sex modified the association between pain interference and pain threshold. In females EEG and PPT variables explained less variability of pain interference compared to males.</div></div><div><h3>Conclusions</h3><div>Our study suggests that sex is a confounder and effect modifier mainly in the relationship between neurophysiological variables and pain-related outcomes in a chronic OA pain population. Females may have weaker associations between pain intensity and mechanistic outcomes (EEG and QST). Thus, the use of these biomarkers in females requires further optimization. We therefore reinforce the need for accounting for biological sex in the analysis, not only as a confounder, but as an effect modifier in further randomized trials and observational studies in the field of pain.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 4","pages":"Article 844639"},"PeriodicalIF":1.7,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144096051","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 : 2025-05-16DOI: 10.1016/j.bjane.2025.844641
Rohit S. Loomba
{"title":"Venous saturation guided postoperative care for pediatric cardiac surgical patients: the body wants oxygen!","authors":"Rohit S. Loomba","doi":"10.1016/j.bjane.2025.844641","DOIUrl":"10.1016/j.bjane.2025.844641","url":null,"abstract":"","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 4","pages":"Article 844641"},"PeriodicalIF":1.7,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144096052","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 : 2025-05-16DOI: 10.1016/j.bjane.2025.844640
Barbara Bombassaro Masiero , Deivyd Cavalcante , Fatemeh Akbarpoor , Capela António Dicazeco Pascoal , Lubna Al-Sharif , Fellipe Feijó Halfeld , Lucas Cael Azevedo Ramos Bendaham , Patricia Viana , Jesslyn N. Haryianto , Maria Luiza de Souza Rasia , Mariana Copetti de Almeida Cunha , Ana Djulia Tesche , Júlia Caletti Roth de Oliveira , Rafael Arsky Lombardi
Background
Caudal Epidural Block (CEB) is a well-established regional anesthesia technique for abdominal and sub-abdominal pediatric surgeries. However, it has a short duration, often leading to additional analgesic administration. Erector Spinae Plane Block (ESPB), for instance, is an emerging technique that, like CEB, provides analgesic effect to a specific dermatome of the body during surgery and in the postoperative period. Therefore, we performed this systematic review with meta-analysis to compare both techniques.
Methods
We searched PubMed, Embase and Cochrane Central for Randomized Controlled Trials (RCTs) comparing ESPB versus CEB in pediatric patients undergoing abdominal and sub-abdominal surgeries. The primary outcome was the time to first analgesic request. Secondary outcomes were I) FLACC score; II) Postoperative nausea and vomiting, and III) Urinary retention.
Results
Nine randomized controlled trials encompassing 507 patients were included in this analysis (1‒9). The patients were predominantly male and under 10 years of age. There was an equal distribution between the two groups regarding the number of patients and patients’ baseline characteristics. The main results were: time to first analgesic request (MD = 3.71; 95% CI: -1.88–9.29; I2 = 99%; p = 0.19); FLACC scores at 2 hours (MD = 0.15; 95% CI: -0.30–0.59; I2 = 0%; p = 0.52); FLACC scores at 24 hours (MD = -0.17; 95% CI: -0.39–0.05; I2 = 41%; I2 = 41%; p = 0.13); urinary retention events (RR = 0.12; 95% CI: 0.02–0.94; I2 = 0%; p = 0.04); and Postoperative Nausea and Vomiting (PONV) which was null in both groups in three studies. However, it is important to clarify that some limitations were identified, such as significant heterogeneity in the following outcomes: time to first analgesic request and FLACC score at 24h, possibly due to different age groups, different types of surgeries, different background analgesia administration, and a relatively small sample size. As for the risk of bias, two studies were found to have some concerns in “bias due to deviations from intended interventions” (8,9).
Conclusion
Our findings suggest that the administration of ESPB did not statistically differ from CEB regarding the time to first analgesic request. FLACC scores also did not show a statistically significant difference between groups. The ESPB group, however, experienced minor urinary retention events compared to the CEB group.
Quality of evidence
According to the GRADE assessment, all outcomes evaluated in this study were classified as high-quality evidence. Quality assessment is detailed in Supplementary Table 1.
{"title":"Erector spinae plane block versus caudal epidural block in pediatric surgery: a systematic review and meta-analysis of randomized clinical trials","authors":"Barbara Bombassaro Masiero , Deivyd Cavalcante , Fatemeh Akbarpoor , Capela António Dicazeco Pascoal , Lubna Al-Sharif , Fellipe Feijó Halfeld , Lucas Cael Azevedo Ramos Bendaham , Patricia Viana , Jesslyn N. Haryianto , Maria Luiza de Souza Rasia , Mariana Copetti de Almeida Cunha , Ana Djulia Tesche , Júlia Caletti Roth de Oliveira , Rafael Arsky Lombardi","doi":"10.1016/j.bjane.2025.844640","DOIUrl":"10.1016/j.bjane.2025.844640","url":null,"abstract":"<div><h3>Background</h3><div>Caudal Epidural Block (CEB) is a well-established regional anesthesia technique for abdominal and sub-abdominal pediatric surgeries. However, it has a short duration, often leading to additional analgesic administration. Erector Spinae Plane Block (ESPB), for instance, is an emerging technique that, like CEB, provides analgesic effect to a specific dermatome of the body during surgery and in the postoperative period. Therefore, we performed this systematic review with meta-analysis to compare both techniques.</div></div><div><h3>Methods</h3><div>We searched PubMed, Embase and Cochrane Central for Randomized Controlled Trials (RCTs) comparing ESPB versus CEB in pediatric patients undergoing abdominal and sub-abdominal surgeries. The primary outcome was the time to first analgesic request. Secondary outcomes were I) FLACC score; II) Postoperative nausea and vomiting, and III) Urinary retention.</div></div><div><h3>Results</h3><div>Nine randomized controlled trials encompassing 507 patients were included in this analysis (1‒9). The patients were predominantly male and under 10 years of age. There was an equal distribution between the two groups regarding the number of patients and patients’ baseline characteristics. The main results were: time to first analgesic request (MD = 3.71; 95% CI: -1.88–9.29; <em>I<sup>2</sup></em> = 99%; p = 0.19); FLACC scores at 2 hours (MD = 0.15; 95% CI: -0.30–0.59; <em>I<sup>2</sup></em> = 0%; p = 0.52); FLACC scores at 24 hours (MD = -0.17; 95% CI: -0.39–0.05; <em>I<sup>2</sup></em> = 41%; <em>I<sup>2</sup></em> = 41%; p = 0.13); urinary retention events (RR = 0.12; 95% CI: 0.02–0.94; <em>I<sup>2</sup></em> = 0%; p = 0.04); and Postoperative Nausea and Vomiting (PONV) which was null in both groups in three studies. However, it is important to clarify that some limitations were identified, such as significant heterogeneity in the following outcomes: time to first analgesic request and FLACC score at 24h, possibly due to different age groups, different types of surgeries, different background analgesia administration, and a relatively small sample size. As for the risk of bias, two studies were found to have some concerns in “bias due to deviations from intended interventions” (8,9).</div></div><div><h3>Conclusion</h3><div>Our findings suggest that the administration of ESPB did not statistically differ from CEB regarding the time to first analgesic request. FLACC scores also did not show a statistically significant difference between groups. The ESPB group, however, experienced minor urinary retention events compared to the CEB group.</div></div><div><h3>Quality of evidence</h3><div>According to the GRADE assessment, all outcomes evaluated in this study were classified as high-quality evidence. Quality assessment is detailed in <span><span>Supplementary Table 1</span></span>.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 4","pages":"Article 844640"},"PeriodicalIF":1.7,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144095983","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 : 2025-05-12DOI: 10.1016/j.bjane.2025.844638
Elisa Duarte Candido , DurvalCampos Kraychete
{"title":"Perceived stress among Brazilian anesthesiologists before and after a mindfulness-based program: preliminary findings","authors":"Elisa Duarte Candido , DurvalCampos Kraychete","doi":"10.1016/j.bjane.2025.844638","DOIUrl":"10.1016/j.bjane.2025.844638","url":null,"abstract":"","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 5","pages":"Article 844638"},"PeriodicalIF":1.7,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144082566","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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