Pub Date : 2025-07-01Epub Date: 2025-04-19DOI: 10.1016/j.bjane.2025.844622
Helga Cristina Almeida da Silva , Maria Anita Costa Spindola , José Luiz Gomes do Amaral
{"title":"Malignant hyperthermia and surnames: ethical dilemmas and diagnostic pitfalls","authors":"Helga Cristina Almeida da Silva , Maria Anita Costa Spindola , José Luiz Gomes do Amaral","doi":"10.1016/j.bjane.2025.844622","DOIUrl":"10.1016/j.bjane.2025.844622","url":null,"abstract":"","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 4","pages":"Article 844622"},"PeriodicalIF":1.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143907048","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 : 2025-07-01Epub 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":"2025-07-01","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 : 2025-07-01Epub Date: 2025-04-22DOI: 10.1016/j.bjane.2025.844623
Solange C. Gimenez , Milene C. Carrilho , Isabela M. Malbouisson , Marcelo Gama de Abreu , Jean-Jacques Rouby , Luiz Marcelo Sá Malbouisson
Background
Loss of lung aeration is frequently observed in adult patients following cardiac surgery with cardiopulmonary bypass. Yet, in children, changes in lung aeration following surgical repair of congenital heart defects, and the effects of Positive End-Expiratory Pressure (PEEP), remain uncertain.
Methods
Changes in lung aeration were investigated using volumetric computed tomography in 12 children with congenital acianogenic heart diseases and increased pulmonary flow who underwent total surgical repair under cardiopulmonary bypass. Computed tomography of the lungs was obtained preoperatively during spontaneous breathing and postoperatively during mechanical ventilation with positive end-expiratory pressure of 0, 5 and 10 cm H2O. Gas and tissue lung volume and mass, as well non-aerated, poorly aerated and normally aerated lung compartments were measured.
Results
Median age of patients was 18.3 months, (4 to 24 months), weight was 9.3 ± 2.3 kg. Cardiopulmonary bypass duration was 77 ± 26 minutes. Preoperatively, pulmonary volume was 545 mL (237‒753 mL), whereby tissue and gas volumes were 48.4% (41.7%‒59.6%), and 51.6% (40.4%‒58.3%), respectively. Non-aerated and normally aerated compartments accounted for 15% and 47.9% of lung tissue, respectively. Postoperatively, at zero PEEP, the non-aerated compartment increased to 27%, while normally-aerated compared decreased to 38.5%. Stepwise PEEP application restored normally aerated lung volume to preoperative levels but did not significantly reduce non-aerated parenchyma.
Conclusion
Loss of lung aeration was pronounced after surgical correction of congenital heart defects. PEEP up to 10 cm H2O restored gas volume but failed to recruit the collapsed parenchyma. Ethical Approval CAPPesq n° 854/01.
背景：在心脏手术合并体外循环的成人患者中经常观察到肺通气不足。然而，在儿童中，先天性心脏缺陷手术修复后肺通气量的变化以及呼气末正压（PEEP）的效果仍不确定。方法：对12例先天性无源性心脏病患儿行体外循环全手术修复后肺流量增加的肺通气量变化进行了体积计算机断层扫描。术前自主呼吸和术后机械通气，呼气末正压分别为0、5和10 cm H2O时，分别进行肺部计算机断层扫描。测量气体和组织肺的体积和质量，以及不通气、不通气和正常通气的肺室。结果：患者中位年龄18.3个月，（4 ~ 24个月），体重9.3±2.3 kg。体外循环时间为77±26分钟。术前肺容积545 mL (237 ~ 753 mL)，其中组织容积48.4%(41.7% ~ 59.6%)，肺气量51.6%（40.4% ~ 58.3%）。不通风和正常通风的隔间。分别占肺组织的15%和47.9%。术后，在零PEEP时，未充气的腔室增加到27%，而正常充气的腔室减少到38.5%。逐步应用PEEP使正常通气的肺容量恢复到术前水平，但没有显著减少未通气的实质。结论：先天性心脏缺损手术矫治后肺通气量明显减少。高达10 cm H2O的PEEP恢复了气体体积，但未能恢复塌陷的实质。伦理批准CAPPesq n°854/01。
{"title":"Effect of PEEP on lung aeration in pediatric patients after cardiac surgery: a CT-Based study","authors":"Solange C. Gimenez , Milene C. Carrilho , Isabela M. Malbouisson , Marcelo Gama de Abreu , Jean-Jacques Rouby , Luiz Marcelo Sá Malbouisson","doi":"10.1016/j.bjane.2025.844623","DOIUrl":"10.1016/j.bjane.2025.844623","url":null,"abstract":"<div><h3>Background</h3><div>Loss of lung aeration is frequently observed in adult patients following cardiac surgery with cardiopulmonary bypass. Yet, in children, changes in lung aeration following surgical repair of congenital heart defects, and the effects of Positive End-Expiratory Pressure (PEEP), remain uncertain.</div></div><div><h3>Methods</h3><div>Changes in lung aeration were investigated using volumetric computed tomography in 12 children with congenital acianogenic heart diseases and increased pulmonary flow who underwent total surgical repair under cardiopulmonary bypass. Computed tomography of the lungs was obtained preoperatively during spontaneous breathing and postoperatively during mechanical ventilation with positive end-expiratory pressure of 0, 5 and 10 cm H<sub>2</sub>O. Gas and tissue lung volume and mass, as well non-aerated, poorly aerated and normally aerated lung compartments were measured.</div></div><div><h3>Results</h3><div>Median age of patients was 18.3 months, (4 to 24 months), weight was 9.3 ± 2.3 kg. Cardiopulmonary bypass duration was 77 ± 26 minutes. Preoperatively, pulmonary volume was 545 mL (237‒753 mL), whereby tissue and gas volumes were 48.4% (41.7%‒59.6%), and 51.6% (40.4%‒58.3%), respectively. Non-aerated and normally aerated compartments accounted for 15% and 47.9% of lung tissue, respectively. Postoperatively, at zero PEEP, the non-aerated compartment increased to 27%, while normally-aerated compared decreased to 38.5%. Stepwise PEEP application restored normally aerated lung volume to preoperative levels but did not significantly reduce non-aerated parenchyma.</div></div><div><h3>Conclusion</h3><div>Loss of lung aeration was pronounced after surgical correction of congenital heart defects. PEEP up to 10 cm H<sub>2</sub>O restored gas volume but failed to recruit the collapsed parenchyma. Ethical Approval CAPPesq n° 854/01.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 4","pages":"Article 844623"},"PeriodicalIF":1.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144051498","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 : 2025-07-01Epub Date: 2025-05-01DOI: 10.1016/j.bjane.2025.844635
Pedro Victor Fernandes Ferreira , Heitor J.S. Medeiros , Hugo de Santana Ribeiro Dantas , Eduardo Venancio Teixeira , Lucas Pereira Trevisan , Fernanda de Castro Teixeira , Fernanda Cunha Soares , Raphael Klênio Confessor de Souza , Wallace Andrino da Silva
{"title":"Incidence and risk factors for acute kidney injury after cardiac surgery in a Brazilian University Hospital: a retrospective cross-sectional study","authors":"Pedro Victor Fernandes Ferreira , Heitor J.S. Medeiros , Hugo de Santana Ribeiro Dantas , Eduardo Venancio Teixeira , Lucas Pereira Trevisan , Fernanda de Castro Teixeira , Fernanda Cunha Soares , Raphael Klênio Confessor de Souza , Wallace Andrino da Silva","doi":"10.1016/j.bjane.2025.844635","DOIUrl":"10.1016/j.bjane.2025.844635","url":null,"abstract":"","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 4","pages":"Article 844635"},"PeriodicalIF":1.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144052999","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 : 2025-07-01Epub 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":"2025-07-01","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 : 2025-07-01Epub 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":"2025-07-01","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 : 2025-07-01Epub Date: 2025-03-09DOI: 10.1016/j.bjane.2025.844606
Mariana AbdElSayed Mansour , Saeed Baradwan , Ahmed Abdelaziz Shama , Mohamed Ali Mahmoud , Ayman Salah Abouelnour , Ayman Mohamed AbdelWahed Mohamed , Ahmed Fathi Hassan Elkhouly , Abdelkarem Hussiny Ismail Elsayed , Zaky Ftouh Rashed , Ahmed Mohamed Abdelhakim , Mrooj Mabruk Almutairi , Mohamed A. Lotfy , Ahmed Goda Ahmed
Background
Peripheral abdominal nerve blocks are key components of multimodal analgesia, enhancing recovery after cesarean sections. This systematic review and meta-analysis aimed to assess analgesic efficacy of Erector Spinae Plane Block (ESPB) versus Transversus Abdominis Plane Block (TAPB) under ultrasound guidance following Cesarean Section (CS) under spinal anesthesia.
Methods
A comprehensive search was conducted across PubMed, Scopus, Cochrane Library, and ISI Web of Science to identify relevant trials. The inclusion criteria followed the PICOS framework: Population (women undergoing elective cesarean delivery), Intervention (ESPB), Comparator (TAPB), Outcomes (postoperative pain, opioid consumption, analgesic duration, and satisfaction), and Study Design (randomized controlled trials).
Results
Seven RCTs (380-patients) met the inclusion criteria. The ESPB group had significantly lower postoperative pain scores at rest and during movement, reduced 24-hour opioid consumption (MD = -2.62 MME; 95% CI -4.11 to -1.13; p = 0.006), and longer analgesic duration (SMD = 1.77; 95% CI 1.11 to 2.44; p < 0.001) than the TAPB group. Patient satisfaction was also significantly higher in the ESPB group (OR = 4.75; 95% CI 2.26 to 9.99; p < 0.001). While most outcomes demonstrated low heterogeneity, significant variability was observed in analgesic duration (I2 = 83%), requiring cautious interpretation.
Conclusions
The ESP block offers superior pain relief, reduces opioid use, and enhances satisfaction compared to the TAP block in cesarean sections. These findings suggest that the implementation of the ESP block in postoperative analgesia protocols could significantly improve patient outcomes, potentially leading to enhanced recovery and reduced reliance on opioids.
背景：腹外周神经阻滞是剖宫产术后多模式镇痛的关键组成部分。本系统综述和荟萃分析旨在评价超声引导下脊柱麻醉下剖宫产（CS）术后应用竖脊平面阻滞（ESPB）与腹横平面阻滞（TAPB）的镇痛效果。方法：通过PubMed、Scopus、Cochrane Library和ISI Web of Science进行综合检索，以确定相关试验。纳入标准遵循PICOS框架：人群（选择性剖宫产妇女）、干预（ESPB）、比较物（TAPB）、结局（术后疼痛、阿片类药物消耗、镇痛持续时间和满意度）和研究设计（随机对照试验）。结果：7项rct（380例患者）符合纳入标准。ESPB组术后休息和运动时疼痛评分明显降低，24小时阿片类药物消耗减少(MD = -2.62 MME；95% CI -4.11 ~ -1.13；p = 0.006)，且镇痛持续时间较长(SMD = 1.77；95% CI 1.11 ~ 2.44；p < 0.001)。ESPB组患者满意度也显著高于ESPB组(OR = 4.75；95% CI 2.26 ~ 9.99；P < 0.001)。虽然大多数结果显示低异质性，但在镇痛持续时间方面观察到显著的变异性（I2 = 83%），需要谨慎解释。结论：在剖宫产术中，与TAP阻滞相比，ESP阻滞能更好地缓解疼痛，减少阿片类药物的使用，并提高满意度。这些发现表明，在术后镇痛方案中实施ESP阻滞可以显著改善患者的预后，有可能促进恢复并减少对阿片类药物的依赖。
{"title":"Erector spinae plane block versus transversus abdominis plane block for analgesia after cesarean section: a systematic review and meta-analysis","authors":"Mariana AbdElSayed Mansour , Saeed Baradwan , Ahmed Abdelaziz Shama , Mohamed Ali Mahmoud , Ayman Salah Abouelnour , Ayman Mohamed AbdelWahed Mohamed , Ahmed Fathi Hassan Elkhouly , Abdelkarem Hussiny Ismail Elsayed , Zaky Ftouh Rashed , Ahmed Mohamed Abdelhakim , Mrooj Mabruk Almutairi , Mohamed A. Lotfy , Ahmed Goda Ahmed","doi":"10.1016/j.bjane.2025.844606","DOIUrl":"10.1016/j.bjane.2025.844606","url":null,"abstract":"<div><h3>Background</h3><div>Peripheral abdominal nerve blocks are key components of multimodal analgesia, enhancing recovery after cesarean sections. This systematic review and meta-analysis aimed to assess analgesic efficacy of Erector Spinae Plane Block (ESPB) versus Transversus Abdominis Plane Block (TAPB) under ultrasound guidance following Cesarean Section (CS) under spinal anesthesia.</div></div><div><h3>Methods</h3><div>A comprehensive search was conducted across PubMed, Scopus, Cochrane Library, and ISI Web of Science to identify relevant trials. The inclusion criteria followed the PICOS framework: Population (women undergoing elective cesarean delivery), Intervention (ESPB), Comparator (TAPB), Outcomes (postoperative pain, opioid consumption, analgesic duration, and satisfaction), and Study Design (randomized controlled trials).</div></div><div><h3>Results</h3><div>Seven RCTs (380-patients) met the inclusion criteria. The ESPB group had significantly lower postoperative pain scores at rest and during movement, reduced 24-hour opioid consumption (MD = -2.62 MME; 95% CI -4.11 to -1.13; p = 0.006), and longer analgesic duration (SMD = 1.77; 95% CI 1.11 to 2.44; p < 0.001) than the TAPB group. Patient satisfaction was also significantly higher in the ESPB group (OR = 4.75; 95% CI 2.26 to 9.99; p < 0.001). While most outcomes demonstrated low heterogeneity, significant variability was observed in analgesic duration (I<sup>2</sup> = 83%), requiring cautious interpretation.</div></div><div><h3>Conclusions</h3><div>The ESP block offers superior pain relief, reduces opioid use, and enhances satisfaction compared to the TAP block in cesarean sections. These findings suggest that the implementation of the ESP block in postoperative analgesia protocols could significantly improve patient outcomes, potentially leading to enhanced recovery and reduced reliance on opioids.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 4","pages":"Article 844606"},"PeriodicalIF":1.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143607299","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-01Epub Date: 2025-05-02DOI: 10.1016/j.bjane.2025.844634
Rohan Magoon
{"title":"Revisiting risk-profiling in pediatric cardiac anesthesia: a commentary on troponin-based outcome measures*","authors":"Rohan Magoon","doi":"10.1016/j.bjane.2025.844634","DOIUrl":"10.1016/j.bjane.2025.844634","url":null,"abstract":"","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 4","pages":"Article 844634"},"PeriodicalIF":1.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143993657","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 : 2025-07-01Epub 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":"2025-07-01","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 : 2025-07-01Epub 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":"2025-07-01","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}
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