Trends in Anaesthesia and Critical Care最新文献

英文中文

Mechanical ventilation in Mounier-Kuhn syndrome: Hybrid-HFJV for dead space ventilation challenge Mounier-Kuhn综合征的机械通气：混合hfjv治疗死腔通气挑战

IF 1.4 Q3 ANESTHESIOLOGY

Trends in Anaesthesia and Critical Care

Pub Date : 2025-05-07 DOI: 10.1016/j.tacc.2025.101562

Mehmet Murat Sayın , Fatma Kavak Akelma , Ceyda Özhan Çaparlar , İbrahim Kuzu , Burak Nalbant , Jülide Ergil

引用次数: 0

Modulation of postoperative inflammatory response in total knee arthroplasty: Impact of iPACK block on neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios in a randomized controlled trial 全膝关节置换术后炎症反应的调节：在一项随机对照试验中，iPACK阻滞对中性粒细胞-淋巴细胞和血小板-淋巴细胞比率的影响

IF 1.4 Q3 ANESTHESIOLOGY

Trends in Anaesthesia and Critical Care

Pub Date : 2025-04-25 DOI: 10.1016/j.tacc.2025.101551

Tomasz Reysner , Grzegorz Kowalski , Aleksander Mularski , Monika Grochowicka , Przemysław Daroszewski , Malgorzata Reysner

Background

The neutrophil-to-lymphocyte ratio (NLR) is a marker of systemic inflammation and surgical stress. This randomized controlled trial (RCT) evaluated the effect of the infiltration between the popliteal artery and the capsule of the knee (iPACK) block with ropivacaine on postoperative NLR and analgesic outcomes in total knee arthroplasty (TKA) under spinal anesthesia.

Methods

Sixty TKA patients were randomized to receive either a sham block (control, n = 30) or an iPACK block with 20 mL of 0.2 % ropivacaine (n = 30). The primary outcome was NLR at 12 h postoperatively. Secondary outcomes included NLR at 24 and 48 h, platelet-to-lymphocyte ratio (PLR), opioid consumption, time to first rescue analgesia, and numeric rating scale (NRS) pain scores at multiple postoperative time points.

Results

The iPACK group had significantly lower NLR at 12 h (16.87 ± 4.41 vs. 23.95 ± 8.03, p < 0.0001), 24 h (2.27 ± 0.83 vs. 4.22 ± 0.59, p < 0.0001), and 48 h (1.80 ± 0.78 vs. 2.81 ± 1.16, p = 0.0002). PLR was lower at all time points (p < 0.0001), opioid use was reduced (4.6 ± 1.0 mg/kg vs. 14.2 ± 1.9 mg/kg, p < 0.0001), and time to first rescue analgesia was prolonged (7.0 ± 1.6 vs. 3.6 ± 0.7 h, p < 0.0001). NRS scores were significantly lower up to 24 h (p < 0.0001), with the greatest difference at 12 h (−1.8 ± 0.2, 95 % CI -2.1 to −1.4, p < 0.0001).

Conclusions

The iPACK block with 0.2 % ropivacaine significantly reduces postoperative inflammation, improves pain control, and decreases opioid consumption in TKA. These findings support its inclusion in multimodal analgesia protocols to enhance recovery and reduce systemic inflammation.

Trial registration

Registered at ClinicalTrials.gov (NCT06304298)

中性粒细胞与淋巴细胞比率（NLR）是全身性炎症和手术应激的标志。本随机对照试验（RCT）评估了罗哌卡因阻滞腘动脉与膝关节囊间浸润（iPACK）对脊柱麻醉下全膝关节置换术（TKA）术后NLR和镇痛效果的影响。方法60例TKA患者随机分为假阻断组（对照组，n = 30）和iPACK阻断组（含20ml 0.2%罗哌卡因，n = 30）。术后12小时的主要预后指标为NLR。次要结果包括24和48小时NLR、血小板与淋巴细胞比率（PLR）、阿片类药物消耗、首次抢救镇痛时间和术后多个时间点的数字评定量表（NRS）疼痛评分。结果iPACK组12 h NLR显著低于对照组(16.87±4.41∶23.95±8.03,p <；0.0001)、24小时(2.27±0.83和4.22±0.59,p & lt;0.0001), 48小时(1.80±0.78和2.81±1.16,p = 0.0002)。各时间点PLR均较低(p <；0.0001),阿片类药物的使用是减少(4.6±1.0毫克/公斤和14.2±1.9毫克/公斤,p & lt;0.0001)，首次抢救镇痛时间延长(7.0±1.6∶3.6±0.7 h, p <；0.0001)。NRS评分显著低于24h (p <；0.0001)，在12 h时差异最大(- 1.8±0.2,95% CI -2.1至- 1.4,p <；0.0001)。结论0.2%罗哌卡因的iPACK阻滞可显著减少TKA术后炎症，改善疼痛控制，减少阿片类药物的消耗。这些发现支持将其纳入多模式镇痛方案，以促进恢复和减少全身炎症。注册：ClinicalTrials.gov （NCT06304298）

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引用次数: 0

Poppy seed allergy and anesthesia – A narrative review of literature 罂粟籽过敏与麻醉——文献综述

IF 1.4 Q3 ANESTHESIOLOGY

Trends in Anaesthesia and Critical Care

Pub Date : 2025-04-21 DOI: 10.1016/j.tacc.2025.101552

Sarah Jackson , Abhijit Biswas , Alla Iansavichene , Kamal Kumar

引用次数: 0

Perfusion index as an indicator of successful caudal epidural block in anaesthestized children: an observational study 灌注指数作为麻醉儿童尾侧硬膜外阻滞成功的指标：一项观察性研究

IF 1.4 Q3 ANESTHESIOLOGY

Trends in Anaesthesia and Critical Care

Pub Date : 2025-04-18 DOI: 10.1016/j.tacc.2025.101550

A.R. Ajay Saran, Anju R. Bhalotra

Purpose

It is often difficult to assess the success of caudal epidural block in children under general anaesthesia. We hypothesized that increase in lower limb perfusion index after caudal anaesthesia indicates a successful block and aimed to study changes in lower limb perfusion index after caudal block in children under general anaesthesia.

Methods

This prospective observational study was conducted in children aged 2–12 years. The primary outcome was changes in lower limb perfusion index for 20 min after caudal block. Secondary outcomes included upper limb perfusion index at the same times, differences in lower and upper limb perfusion index, haemodynamic parameters and the correlation of perfusion index with heart rate and blood pressure.

Results

After caudal block, lower limb perfusion index increased within 1 min (31.28 %), was 100 % higher at 5 min and reached a maximum (153.18 %) increase at 15 min. The maximum increase in upper limb perfusion index was 35.13 %. There was a fall in heart rate (8.79 %), systolic blood pressure (8.77 %), diastolic blood pressure (14.16) and mean arterial pressure (11.43 %) which were maximum at 20 min. We found a positive correlation, r = 0.97, p = .001, between perfusion index and heart rate and perfusion index and diastolic blood pressure, r = 0.82, p = .043.

Conclusion

There were significant and immediate increases in lower limb perfusion index after successful caudal block. Haemodynamic changes were less marked and delayed. Perfusion index was found to be an objective, sensitive and early indicator of successful caudal block in children under general anaesthesia.

目的：在全麻状态下对儿童进行尾侧硬膜外阻滞的成功率往往难以评估。我们假设尾侧麻醉后下肢灌注指数的增加表明阻滞成功，旨在研究全麻下儿童尾侧麻醉后下肢灌注指数的变化。方法本前瞻性观察研究在2-12岁儿童中进行。主要观察终点是尾侧阻滞后20分钟下肢灌注指数的变化。次要结局包括同期上肢灌注指数、上下肢灌注指数差异、血流动力学参数及灌注指数与心率、血压的相关性。结果尾侧阻滞后，下肢灌注指数在1 min内升高（31.28%），5 min时升高100%，15 min时达到最大值（153.18%），上肢灌注指数最大升高35.13%。心率（8.79%）、收缩压（8.77%）、舒张压（14.16%）、平均动脉压（11.43%）在20 min时下降幅度最大。血流灌注指数与心率、血流灌注指数与舒张压呈正相关，r = 0.97, p = 0.001, r = 0.82, p = 0.043。结论尾侧阻滞成功后，下肢灌注指数立即显著升高。血流动力学变化不明显且延迟。灌注指数是一个客观、敏感和早期的指标，成功的尾侧阻滞儿童在全身麻醉。

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引用次数: 0

Association between physical activity and stress among Portuguese Anaesthetists 葡萄牙麻醉师体力活动与压力的关系

IF 1.4 Q3 ANESTHESIOLOGY

Trends in Anaesthesia and Critical Care

Pub Date : 2025-04-11 DOI: 10.1016/j.tacc.2025.101549

José Correia , Vítor Rodrigues , Patrícia Santos , Margarida Barbosa

Introduction

Anaesthetists face significant daily stress, which can impact their health and clinical performance. While regular physical exercise has been shown to reduce stress, there is a lack of research on this topic among Portuguese anaesthetists. This study aims to: (1) assess physical activity and perceived stress levels among Portuguese anaesthetists and establish a relationship between them in this group, and (2) identify potential professional or personal barriers to exercise.

Methods

This cross-sectional study used an anonymous online survey distributed to Portuguese anaesthetists registered with the Portuguese Society of Anaesthesiology. The questionnaire collected sociodemographic data and included the short form of the International Physical Activity Questionnaire (IPAQ) and the Perceived Stress Scale (PSS-10).

Results

A total of 252 participants were analysed. The majority (49.2 %) engaged in moderate physical activity; 24.2 % reported high levels, and 26.6 % had low levels. Most participants (57.1 %) reported moderate stress, 34.1 % low stress, and 8.7 % high stress. A weak negative correlation was found between physical activity and stress (rho = −0.187, p = 0.003), suggesting higher physical activity may be associated with lower stress. However, ANOVA did not show significant differences in stress levels across activity categories (p = 0.0732).

Conclusions

Although a weak inverse correlation was observed, findings suggest physical activity alone may not determine stress levels. Given the high workload and burnout risk, institutional strategies promoting well-being, such as structured exercise programmes and workload management, should be considered.

麻醉师面临着巨大的日常压力，这可能会影响他们的健康和临床表现。虽然有规律的体育锻炼已被证明可以减轻压力，但在葡萄牙麻醉师中缺乏这方面的研究。本研究旨在：(1)评估葡萄牙麻醉师的身体活动和感知压力水平，并建立这一群体中他们之间的关系；(2)确定潜在的专业或个人运动障碍。方法：本横断面研究采用匿名在线调查，调查对象为在葡萄牙麻醉学会注册的葡萄牙麻醉师。问卷收集了社会人口学数据，包括国际体育活动问卷（IPAQ）和感知压力量表（PSS-10）。结果共分析了252名参与者。大多数人（49.2%）从事适度体育活动；24.2%报告高水平，26.6%报告低水平。大多数参与者（57.1%）报告中等压力，34.1%报告低压力，8.7%报告高压力。体力活动与压力之间呈弱负相关（rho = - 0.187, p = 0.003），表明体力活动越多，压力越低。然而，方差分析没有显示不同活动类别的压力水平有显著差异（p = 0.0732）。结论：虽然观察到微弱的负相关，但研究结果表明，体育活动本身可能不能决定压力水平。鉴于高工作量和倦怠风险，应考虑促进福利的体制战略，如有组织的锻炼方案和工作量管理。

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引用次数: 0

Flexible bronchoscope versus video-laryngoscope for nasotracheal intubation in patients with anticipated difficult airway under topical anesthesia and dexmedetomidine infusion: A randomized controlled trial 柔性支气管镜与视频喉镜在表面麻醉和右美托咪定输注下预期气道困难患者的鼻气管插管：一项随机对照试验

IF 1.4 Q3 ANESTHESIOLOGY

Trends in Anaesthesia and Critical Care

Pub Date : 2025-04-01 DOI: 10.1016/j.tacc.2025.101547

Aritra Kundu , Nishant Patel , Dalim Kumar Baidya , Arshad Ayub , Devalina Goswami , Kanil Ranjith Kumar , Rakesh Kumar , Shailendra Kumar , Ajoy Roychoudhury

Background

Managing difficult airways with restricted mouth opening remains a challenge. In this regard, flexible bronchoscopes (FB) are considered the gold standard, offering precise tube placement. However, they require expertise and can be time-consuming. Video-laryngoscopes (VLs), such as the CMAC D-blade, provide enhanced glottic visualization and may reduce intubation time. While VLs are gaining popularity, data comparing them with FBs in this setting are limited. This study evaluates whether the CMAC D-blade VL can reduce intubation time compared to FB while maintaining similar success rates.

Methods

In this randomized controlled trial, 100 adult patients scheduled for elective head and neck or oral and maxillofacial surgery with anticipated difficult airways were randomized to receive awake nasotracheal intubation using either an FB or CMAC D-blade VL. The primary outcome was intubation time. Secondary outcomes included first-attempt success rate, overall success rate, and satisfaction scores.

Results

Out of 100 patients, 97 patients completed the study (FB: n = 49, VL: n = 48). Median intubation time was significantly shorter in the VL group (62 [53–71] sec) compared to the FB group (118 [107–134] sec; p < 0.0001). Success rates and intubation scores were similar, but anesthesiologist and patient satisfaction scores were better in the FB group.

Conclusion

The CMAC D blade video-laryngoscope reduces intubation time while maintaining similar success rates compared to the flexible bronchoscope for awake nasotracheal intubation with limited mouth opening. Despite the time advantage, the flexible bronchoscope was preferred by anesthesiologists and patients had more comfort.

背景：限制开口的困难气道管理仍然是一个挑战。在这方面，柔性支气管镜（FB）被认为是金标准，提供精确的管道放置。然而，它们需要专业知识，而且可能很耗时。视频喉镜（VLs），如CMAC D-blade，提供增强的声门可视化，并可能减少插管时间。虽然vl越来越受欢迎，但在这种情况下将它们与fb进行比较的数据是有限的。本研究评估CMAC D-blade VL与FB相比是否可以减少插管时间，同时保持相似的成功率。方法在本随机对照试验中，100例计划择期头颈部或口腔颌面手术且预期气道困难的成年患者随机接受清醒鼻气管插管，使用FB或CMAC D-blade VL。主要观察指标为插管时间。次要结果包括第一次尝试成功率、总成功率和满意度得分。结果100例患者中，97例患者完成研究（FB: n = 49, VL: n = 48）。VL组中位插管时间（62[53-71]秒）明显短于FB组（118[107-134]秒）；p & lt;0.0001)。成功率和插管评分相似，但麻醉医师和患者满意度评分在FB组更好。结论CMAC D刀片式视频喉镜与柔性支气管镜相比，在限制开口的清醒鼻气管插管中缩短了插管时间，同时保持了相似的成功率。尽管有时间优势，但麻醉医师更喜欢柔性支气管镜，患者也更舒适。

{"title":"Flexible bronchoscope versus video-laryngoscope for nasotracheal intubation in patients with anticipated difficult airway under topical anesthesia and dexmedetomidine infusion: A randomized controlled trial","authors":"Aritra Kundu , Nishant Patel , Dalim Kumar Baidya , Arshad Ayub , Devalina Goswami , Kanil Ranjith Kumar , Rakesh Kumar , Shailendra Kumar , Ajoy Roychoudhury","doi":"10.1016/j.tacc.2025.101547","DOIUrl":"10.1016/j.tacc.2025.101547","url":null,"abstract":"<div><h3>Background</h3><div>Managing difficult airways with restricted mouth opening remains a challenge. In this regard, flexible bronchoscopes (FB) are considered the gold standard, offering precise tube placement. However, they require expertise and can be time-consuming. Video-laryngoscopes (VLs), such as the CMAC D-blade, provide enhanced glottic visualization and may reduce intubation time. While VLs are gaining popularity, data comparing them with FBs in this setting are limited. This study evaluates whether the CMAC D-blade VL can reduce intubation time compared to FB while maintaining similar success rates.</div></div><div><h3>Methods</h3><div>In this randomized controlled trial, 100 adult patients scheduled for elective head and neck or oral and maxillofacial surgery with anticipated difficult airways were randomized to receive awake nasotracheal intubation using either an FB or CMAC D-blade VL. The primary outcome was intubation time. Secondary outcomes included first-attempt success rate, overall success rate, and satisfaction scores.</div></div><div><h3>Results</h3><div>Out of 100 patients, 97 patients completed the study (FB: n = 49, VL: n = 48). Median intubation time was significantly shorter in the VL group (62 [53–71] sec) compared to the FB group (118 [107–134] sec; p < 0.0001). Success rates and intubation scores were similar, but anesthesiologist and patient satisfaction scores were better in the FB group.</div></div><div><h3>Conclusion</h3><div>The CMAC D blade video-laryngoscope reduces intubation time while maintaining similar success rates compared to the flexible bronchoscope for awake nasotracheal intubation with limited mouth opening. Despite the time advantage, the flexible bronchoscope was preferred by anesthesiologists and patients had more comfort.</div></div>","PeriodicalId":44534,"journal":{"name":"Trends in Anaesthesia and Critical Care","volume":"61 ","pages":"Article 101547"},"PeriodicalIF":1.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143792724","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Navigating the anaesthetic maze: The VATS challenge in an infant with anterior mediastinal mass 导航麻醉迷宫：VATS在婴儿前纵隔肿块中的挑战

IF 1.4 Q3 ANESTHESIOLOGY

Trends in Anaesthesia and Critical Care

Pub Date : 2025-04-01 DOI: 10.1016/j.tacc.2025.101545

Amrita Rath, Babli Kumari, Reena, Steffi Dua, Premkumar T.

The anterior mediastinal mass (AMM) is a rare but life-threatening entity in an infant. The symptoms mostly depend on the size and the extent of the tumour and its relationship with the surrounding structures. Anaesthetic challenges are multi-fold when such a child is posted for video assisted thoracoscopic surgery (VATS): risk of airway or cardiovascular collapse during anaesthesia, supine positioning, one lung ventilation in the setting of difficult airway, pneumo-mediastinum in a small child with a space occupying lesion in thorax leading to further lowering of venous return and cardiac output, development of hypercarbia and challenges in maintaining lung protective ventilatory strategy, risk of major bleeding and collapse. Definitive management requires a team of experts in a well-equipped centre with clear cut management strategy and open discussion with family members. We describe one such challenging case of infant AMM posted for VATS which was successfully managed at our institute.

前纵隔肿块（AMM）是一种罕见但危及生命的婴儿实体。症状主要取决于肿瘤的大小和范围及其与周围结构的关系。当这样的孩子被送到视频辅助胸腔镜手术（VATS）时，麻醉挑战是多方面的：麻醉期间气道或心血管衰竭的风险，仰卧位，气道困难情况下的单肺通气，胸腔占位性病变导致静脉回流和心排血量进一步降低的幼儿肺纵隔，高碳血症的发展和维持肺保护性通气策略的挑战，大出血和衰竭的风险。最终的管理需要一个专家团队，在一个设备齐全的中心，有明确的管理策略，并与家庭成员公开讨论。我们描述了一个这样一个具有挑战性的婴儿AMM张贴在VATS的案例，该案例在我们研究所成功管理。

引用次数: 0

From algorithms to airways: Applying artificial intelligence to enhance airway assessment, management, and training 从算法到气道：应用人工智能增强气道评估、管理和培训

IF 1.4 Q3 ANESTHESIOLOGY

Trends in Anaesthesia and Critical Care

Pub Date : 2025-04-01 DOI: 10.1016/j.tacc.2025.101548

Mingzhu Guo, Yongheng Hou, Yan Liu, Bo Yang, Chuhan Qiao, Jian Li

Artificial intelligence(AI) is advancing airway management applications, especially for airway assessment, clinical decision support, and training. Traditional assessment methods struggle with time and precision as complex airway disorders become more common. AI's powerful data processing and pattern recognition capabilities can assess patient imaging and clinical characteristics using deep learning algorithms to predict airway complications. In dynamic clinical environments, AI-assisted management solutions can improve airway control safety and efficiency by providing unique decision support. Additionally, AI systems using virtual reality and simulation training technologies can customize training programs for healthcare professionals based on airway difficulty, improving learning curves and clinical competencies in complex airway scenarios. AI in airway management shows its potential in assessment, clinical decision-making, and medical education. In clinical applications, we must also weigh AI's advantages and disadvantages. This review examines AI technology's current uses, future potential, and limitations in clinical practice and medical education.

人工智能（AI）正在推进气道管理应用，特别是在气道评估、临床决策支持和培训方面。随着复杂的气道疾病变得越来越普遍，传统的评估方法在时间和精度上存在问题。人工智能强大的数据处理和模式识别能力可以利用深度学习算法评估患者的影像学和临床特征，以预测气道并发症。在动态的临床环境中，人工智能辅助管理解决方案可以通过提供独特的决策支持来提高气道控制的安全性和效率。此外，使用虚拟现实和模拟培训技术的人工智能系统可以根据气道困难度为医疗保健专业人员定制培训计划，改善复杂气道场景的学习曲线和临床能力。人工智能在气道管理中显示出其在评估、临床决策和医学教育方面的潜力。在临床应用中，我们也必须权衡人工智能的利弊。本文综述了人工智能技术的当前用途、未来潜力以及在临床实践和医学教育中的局限性。

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引用次数: 0

Volume status and volume responsiveness assessment: A literature review of systematic reviews 容量状态和容量反应性评估：系统评价的文献综述

IF 1.4 Q3 ANESTHESIOLOGY

Trends in Anaesthesia and Critical Care

Pub Date : 2025-04-01 DOI: 10.1016/j.tacc.2025.101546

Mansoureh Fatahi , Azam Mohammadi , Mahdi Foroughian

Intravenous fluid administration is an essential and life-saving procedure in every hospital setting. Balancing fluid resuscitation could be challenging due to the risk associated with both hypovolemia and hypervolemia. We conducted an extensive literature review on systematic reviews related to this topic to examine the effectiveness of various invasive and non-invasive methods for assessing volume status and fluid responsiveness. Traditional invasive methods, including central venous pressure measurements, have limited predictive values. Noninvasive sonographic measurements of the inferior vena cava, internal jugular vein, and carotid artery have the potential to be reliable alternatives for assessing volume status. Measuring cardiac output with echocardiographic methods provides valuable information. Volume responsiveness can be evaluated reliably through stroke volume and pulse pressure variations, as well as the end-expiratory occlusion test in patients under mechanical ventilation.

静脉输液在每家医院都是必不可少的救命程序。由于低血容量和高血容量相关的风险，平衡液体复苏可能具有挑战性。我们对与该主题相关的系统综述进行了广泛的文献回顾，以检查各种侵入性和非侵入性方法评估容量状态和液体反应性的有效性。传统的侵入性方法，包括中心静脉压测量，预测价值有限。下腔静脉、颈内静脉和颈动脉的无创超声测量可能是评估容量状态的可靠选择。用超声心动图方法测量心输出量提供了有价值的信息。在机械通气下，容量反应性可以通过脑卒中容量和脉压变化以及呼气末闭塞试验可靠地评估。

引用次数: 0

Dorsal penile nerve block versus caudal block for circumcision in pediatric patients: A systematic review and meta-analysis 小儿包皮环切术患者阴茎背侧神经阻滞与尾侧神经阻滞：一项系统综述和荟萃分析

IF 1.4 Q3 ANESTHESIOLOGY

Trends in Anaesthesia and Critical Care

Pub Date : 2025-03-11 DOI: 10.1016/j.tacc.2025.101543

Dora Alexandra Carreira de Oliveira , Rafael Oliva Morgado Ferreira , Susimar Picado-Loaiza , Matheus Pedrotti , Eric Pasqualotto , Sara Amaral

Background

The efficacy of dorsal penile nerve block versus caudal block among children undergoing circumcision has been studied in several trials with conflicting results. We aimed to perform an updated systematic review and meta-analysis comparing both techniques in children undergoing circumcision under general anesthesia.

Methods

MEDLINE, Embase, and Cochrane Library were systematically searched for studies comparing dorsal penile nerve block versus caudal block in children undergoing circumcision. We computed mean differences (MD) or standardized mean difference (SMD) for continuous outcomes and risk ratios (RR) for binary outcomes, with 95 % confidence intervals (CIs). Heterogeneity was assessed using I² statistics. Statistical analyses were performed using R Software, version 4.2.3.

Results

We included 14 studies, comprising 1425 participants, of whom 645 (45.3 %) underwent dorsal penile nerve block. There were no significant differences between groups in time to first analgesic requirement (MD -14.79 min; 95 % CI -59.42 to 29.83; p = 0.52), and postoperative pain at 1h (SMD 0.10; 95 % CI -0.60 to 0.79; p = 0.79), 3h (SMD 0.00; 95 % CI -0.98 to 0.99; p = 0.99), and 24h (SMD 0.30; 95 % CI -2.57 to 3.17; p = 0.84). Dorsal penile nerve block was associated with a shorter time to first walk (MD -30.28 min; 95 % CI -44.50 to −16.05; p < 0.01) and length of hospital stay (MD -28.61 min; 95 % CI -42.13 to −15.10; p < 0.01).

Conclusions

In children undergoing circumcision, dorsal penile nerve block and caudal block had similar times to first rescue analgesic and postoperative pain scores within 24h, although dorsal penile nerve block was associated with a shorter time to first walk and length of hospital stay.

背景：在接受包皮环切术的儿童中，对阴茎背侧神经阻滞与尾侧神经阻滞的疗效进行了几项研究，结果相互矛盾。我们的目的是进行一项更新的系统综述和荟萃分析，比较两种技术在全身麻醉下接受包皮环切术的儿童中的应用。方法系统检索medline、Embase和Cochrane图书馆，比较行包皮环切术儿童阴茎背侧神经阻滞和尾侧神经阻滞的研究。我们计算了连续结局的平均差异（MD）或标准化平均差异（SMD），以及二元结局的风险比（RR），置信区间为95% （ci）。采用I2统计量评估异质性。采用R软件4.2.3版本进行统计分析。结果纳入14项研究，1425名受试者，其中645名（45.3%）接受了阴茎背神经阻滞。两组患者到达首次镇痛需要的时间差异无统计学意义(MD -14.79 min；95% CI -59.42 ~ 29.83；p = 0.52)，术后1h疼痛(SMD 0.10；95% CI -0.60 ~ 0.79；p = 0.79), 3h (SMD 0.00；95% CI -0.98 ~ 0.99；p = 0.99)， 24小时(SMD 0.30；95% CI -2.57 - 3.17；p = 0.84)。阴茎背侧神经阻滞与首次行走时间缩短相关(MD -30.28 min；95% CI -44.50 ~ - 16.05；p & lt;0.01)、住院时间(MD -28.61 min；95% CI -42.13 ~ - 15.10；p & lt;0.01)。结论在行包皮环切术的患儿中，阴茎背侧神经阻滞和尾侧神经阻滞在24h内与首次救援镇痛和术后疼痛评分相似，尽管阴茎背侧神经阻滞与首次行走时间和住院时间较短有关。

{"title":"Dorsal penile nerve block versus caudal block for circumcision in pediatric patients: A systematic review and meta-analysis","authors":"Dora Alexandra Carreira de Oliveira , Rafael Oliva Morgado Ferreira , Susimar Picado-Loaiza , Matheus Pedrotti , Eric Pasqualotto , Sara Amaral","doi":"10.1016/j.tacc.2025.101543","DOIUrl":"10.1016/j.tacc.2025.101543","url":null,"abstract":"<div><h3>Background</h3><div>The efficacy of dorsal penile nerve block versus caudal block among children undergoing circumcision has been studied in several trials with conflicting results. We aimed to perform an updated systematic review and meta-analysis comparing both techniques in children undergoing circumcision under general anesthesia.</div></div><div><h3>Methods</h3><div>MEDLINE, Embase, and Cochrane Library were systematically searched for studies comparing dorsal penile nerve block versus caudal block in children undergoing circumcision. We computed mean differences (MD) or standardized mean difference (SMD) for continuous outcomes and risk ratios (RR) for binary outcomes, with 95 % confidence intervals (CIs). Heterogeneity was assessed using I<sup>2</sup> statistics. Statistical analyses were performed using R Software, version 4.2.3.</div></div><div><h3>Results</h3><div>We included 14 studies, comprising 1425 participants, of whom 645 (45.3 %) underwent dorsal penile nerve block. There were no significant differences between groups in time to first analgesic requirement (MD -14.79 min; 95 % CI -59.42 to 29.83; p = 0.52), and postoperative pain at 1h (SMD 0.10; 95 % CI -0.60 to 0.79; p = 0.79), 3h (SMD 0.00; 95 % CI -0.98 to 0.99; p = 0.99), and 24h (SMD 0.30; 95 % CI -2.57 to 3.17; p = 0.84). Dorsal penile nerve block was associated with a shorter time to first walk (MD -30.28 min; 95 % CI -44.50 to −16.05; p < 0.01) and length of hospital stay (MD -28.61 min; 95 % CI -42.13 to −15.10; p < 0.01).</div></div><div><h3>Conclusions</h3><div>In children undergoing circumcision, dorsal penile nerve block and caudal block had similar times to first rescue analgesic and postoperative pain scores within 24h, although dorsal penile nerve block was associated with a shorter time to first walk and length of hospital stay.</div></div>","PeriodicalId":44534,"journal":{"name":"Trends in Anaesthesia and Critical Care","volume":"61 ","pages":"Article 101543"},"PeriodicalIF":1.4,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143643819","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

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