Preanesthesia consultation can be an effective tool for reducing anxiety scores in patients scheduled for elective surgery. Anxiety can cause perioperative complications.
Objective
Determine the impact of preanesthesia consultation on anxiety scores.
Patients and methods
A single-center, observational study was carried out, with a descriptive, cross-sectional design and primary source. The anxiety score assessed using the APAIS scale (Amsterdam Preoperative Anxiety and Information Scale) was evaluated in adult participants before and after the pre-anesthetic consultation during the period December 2024 to April 2025. Statistical analysis was performed using the Wilcoxon, McNemar and chi-square tests. A P value < 0.05 was considered significant.
Results
A total of 190 participants were interviewed, of whom 180 were ultimately analyzed; 76.7% were women, and the mean age was 41.6 years. The most frequent procedures were general surgery and gynecological procedures. 86.7% had previously received anesthesia. The prevalence of pre-consultation anxiety was 68.3%, decreasing to 47.2% after the consultation (p = 0.001). All interviewees between the ages of 18 and 25 reported anxiety before the pre-anesthesia consultation (p = 0.031). The anesthetic technique that generated the greatest fear was general anesthesia (42.8%), with the most frequently reported cause being fear of death (15.6%).
Conclusion
Preoperative anxiety is highly prevalent, and preanesthetic consultation could be an effective intervention to significantly reduce it.
{"title":"Impacto de la consulta preanestésica en la ansiedad prequirúrgica valorada mediante la Amsterdam Preoperative Anxiety and Information Scale","authors":"M.M. Ureña Consuegra, Y.V. Llaverías Guzmán, L.R. Peralta Henson, S.E. Tejada Estrella, V.M. Cepeda Santos","doi":"10.1016/j.redar.2025.502005","DOIUrl":"10.1016/j.redar.2025.502005","url":null,"abstract":"<div><h3>Background</h3><div>Preanesthesia consultation can be an effective tool for reducing anxiety scores in patients scheduled for elective surgery. Anxiety can cause perioperative complications.</div></div><div><h3>Objective</h3><div>Determine the impact of preanesthesia consultation on anxiety scores.</div></div><div><h3>Patients and methods</h3><div>A single-center, observational study was carried out, with a descriptive, cross-sectional design and primary source. The anxiety score assessed using the APAIS scale (Amsterdam Preoperative Anxiety and Information Scale) was evaluated in adult participants before and after the pre-anesthetic consultation during the period December 2024 to April 2025. Statistical analysis was performed using the Wilcoxon, McNemar and chi-square tests. A P value <<!--> <!-->0.05 was considered significant.</div></div><div><h3>Results</h3><div>A total of 190 participants were interviewed, of whom 180 were ultimately analyzed; 76.7% were women, and the mean age was 41.6 years. The most frequent procedures were general surgery and gynecological procedures. 86.7% had previously received anesthesia. The prevalence of pre-consultation anxiety was 68.3%, decreasing to 47.2% after the consultation (p<!--> <!-->=<!--> <!-->0.001). All interviewees between the ages of 18 and 25 reported anxiety before the pre-anesthesia consultation (p<!--> <!-->=<!--> <!-->0.031). The anesthetic technique that generated the greatest fear was general anesthesia (42.8%), with the most frequently reported cause being fear of death (15.6%).</div></div><div><h3>Conclusion</h3><div>Preoperative anxiety is highly prevalent, and preanesthetic consultation could be an effective intervention to significantly reduce it.</div></div>","PeriodicalId":46479,"journal":{"name":"Revista Espanola de Anestesiologia y Reanimacion","volume":"73 2","pages":"Article 502005"},"PeriodicalIF":0.8,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146135735","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}
Pub Date : 2026-01-01Epub Date: 2025-12-22DOI: 10.1016/j.redar.2025.501990
J. Ripollés-Melchor , Á.V. Espinosa , A. Abad-Motos , A. Abad-Gurumeta , P. Galán-Menéndez , A. Zorrilla-Vaca , R. Navarro-Pérez , A. Ruiz-Escobar , J. Fernanz-Antón , A. Suárez-de-la-Rica , C. Aldecoa , el Grupo de investigadores de EuroPOWER
Background
Enhanced Recovery After Surgery (ERAS) protocols improve outcomes after colorectal surgery, but adherence remains variable and may interact with patient risk. Traditional compliance scores lack granularity to explore these dynamics. We aimed to use interpretable machine learning to quantify the contribution of individual ERAS items and clinical features to postoperative complications, and to identify data-driven ERAS phenotypes.
Methods
This was a secondary analysis of the EuroPOWER cohort (NCT04889798), a prospective European study including 2,841 adults undergoing elective colorectal surgery. Two Extreme Gradient Boosting models were trained to predict in-hospital complications: a complete model (clinical variables + 23 ERAS items) and an ERAS-only model. Both were interpreted using Shapley Additive Explanations (SHAP). In the complete model, SHAP matrices were clustered to derive phenotypes. Feature importance, adherence, and complication rates were compared descriptively.
Results
The complete model achieved an AUC of 0.627. SHAP analysis identified frailty, ASA class, BMI, and age as leading predictors, followed by early mobilisation, nutritional care, and thromboprophylaxis. Three phenotypes were identified, with complication rates of 17.7%, 27.1%, and 41.1%, corresponding to robust, intermediate, and frail profiles. The ERAS-only model showed similar discrimination (area under the curve 0.642), but reduced interpretability. SHAP redundancy analysis supported inclusion of all ERAS items.
Conclusions
The clinical effect of ERAS adherence appears to be modulated by baseline vulnerability and implementation patterns. SHAP-based models enable transparent risk attribution and phenotype identification, supporting more targeted ERAS strategies and future development of automated quality monitoring tools.
{"title":"Más allá del cumplimiento: riesgo del paciente, adherencia a ERAS y resultados postoperatorios mediante aprendizaje automatizado explicable","authors":"J. Ripollés-Melchor , Á.V. Espinosa , A. Abad-Motos , A. Abad-Gurumeta , P. Galán-Menéndez , A. Zorrilla-Vaca , R. Navarro-Pérez , A. Ruiz-Escobar , J. Fernanz-Antón , A. Suárez-de-la-Rica , C. Aldecoa , el Grupo de investigadores de EuroPOWER","doi":"10.1016/j.redar.2025.501990","DOIUrl":"10.1016/j.redar.2025.501990","url":null,"abstract":"<div><h3>Background</h3><div>Enhanced Recovery After Surgery (ERAS) protocols improve outcomes after colorectal surgery, but adherence remains variable and may interact with patient risk. Traditional compliance scores lack granularity to explore these dynamics. We aimed to use interpretable machine learning to quantify the contribution of individual ERAS items and clinical features to postoperative complications, and to identify data-driven ERAS phenotypes.</div></div><div><h3>Methods</h3><div>This was a secondary analysis of the EuroPOWER cohort (NCT04889798), a prospective European study including 2,841 adults undergoing elective colorectal surgery. Two Extreme Gradient Boosting models were trained to predict in-hospital complications: a complete model (clinical variables + 23 ERAS items) and an ERAS-only model. Both were interpreted using Shapley Additive Explanations (SHAP). In the complete model, SHAP matrices were clustered to derive phenotypes. Feature importance, adherence, and complication rates were compared descriptively.</div></div><div><h3>Results</h3><div>The complete model achieved an AUC of 0.627. SHAP analysis identified frailty, ASA class, BMI, and age as leading predictors, followed by early mobilisation, nutritional care, and thromboprophylaxis. Three phenotypes were identified, with complication rates of 17.7%, 27.1%, and 41.1%, corresponding to robust, intermediate, and frail profiles. The ERAS-only model showed similar discrimination (area under the curve 0.642), but reduced interpretability. SHAP redundancy analysis supported inclusion of all ERAS items.</div></div><div><h3>Conclusions</h3><div>The clinical effect of ERAS adherence appears to be modulated by baseline vulnerability and implementation patterns. SHAP-based models enable transparent risk attribution and phenotype identification, supporting more targeted ERAS strategies and future development of automated quality monitoring tools.</div></div>","PeriodicalId":46479,"journal":{"name":"Revista Espanola de Anestesiologia y Reanimacion","volume":"73 1","pages":"Article 501990"},"PeriodicalIF":0.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145915379","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}
Pub Date : 2026-01-01Epub Date: 2025-12-19DOI: 10.1016/j.redar.2025.501995
A. De Cassai , B. Dost , Y.E. Karapinar , M.A. Yilmaz , E.I. Turan , E. Sarikaya Ozel
Background
The Erector Spinae Plane (ESP) block is a regional anaesthesia technique with a growing range of clinical applications due to its short learning curve, low complication rate, and effectiveness. However, publication bias can distort the perceived efficacy of interventions, especially when studies with negative or inconclusive results remain unpublished. The real extent of publication bias in ESP-related clinical research currently remains unclear.
Methods
We searched ClinicalTrials.gov on 2 February 2025 using the terms «Erector Spinae Plane Block» and «ESP block», and obtained 671 records. After excluding duplicates, irrelevant, and ongoing studies, 500 records were eventually included. Study characteristics and publication status were determined using a multi-step search strategy that included PubMed®, Scopus®, Embase®, and Central®. Data were analysed using appropriate statistical tests on R (v3.4.0).
Results
Of the 500 studies included, 361 (72.2%) were complete, 102 (20.4%) had unknown status, and 37 (7.4%) had been suspended, terminated, or withdrawn. Only 211 studies (42.2%) were published, and included data from 14374 of 32,600 intended patients. Published studies were registered significantly earlier than unpublished ones (median year 2020 vs 2021; P=.004). No significant differences were found between published and unpublished studies in terms of main outcome, continent, surgical setting, study design, or sample size.
Conclusions
A substantial proportion of ESP block studies remain unpublished, indicating potential publication bias. Although earlier registration was associated with publication, other study characteristics were not. These findings highlight the need for increased transparency and for clinical trial results to be published regardless of outcome in order to ensure that the evidence base is unbiased.
{"title":"¿Perdido en la presentación? Investigación del sesgo de publicación en anestesia regional: estudio de un caso piloto de bloqueo en el plano del músculo erector de la columna","authors":"A. De Cassai , B. Dost , Y.E. Karapinar , M.A. Yilmaz , E.I. Turan , E. Sarikaya Ozel","doi":"10.1016/j.redar.2025.501995","DOIUrl":"10.1016/j.redar.2025.501995","url":null,"abstract":"<div><h3>Background</h3><div>The Erector Spinae Plane (ESP) block is a regional anaesthesia technique with a growing range of clinical applications due to its short learning curve, low complication rate, and effectiveness. However, publication bias can distort the perceived efficacy of interventions, especially when studies with negative or inconclusive results remain unpublished. The real extent of publication bias in ESP-related clinical research currently remains unclear.</div></div><div><h3>Methods</h3><div>We searched ClinicalTrials.gov on 2 February 2025 using the terms «Erector Spinae Plane Block» and «ESP block», and obtained 671 records. After excluding duplicates, irrelevant, and ongoing studies, 500 records were eventually included. Study characteristics and publication status were determined using a multi-step search strategy that included PubMed®, Scopus®, Embase®, and Central®. Data were analysed using appropriate statistical tests on R (v3.4.0).</div></div><div><h3>Results</h3><div>Of the 500 studies included, 361 (72.2%) were complete, 102 (20.4%) had unknown status, and 37 (7.4%) had been suspended, terminated, or withdrawn. Only 211 studies (42.2%) were published, and included data from 14374 of 32,600 intended patients. Published studies were registered significantly earlier than unpublished ones (median year 2020 vs 2021; <em>P</em>=.004). No significant differences were found between published and unpublished studies in terms of main outcome, continent, surgical setting, study design, or sample size.</div></div><div><h3>Conclusions</h3><div>A substantial proportion of ESP block studies remain unpublished, indicating potential publication bias. Although earlier registration was associated with publication, other study characteristics were not. These findings highlight the need for increased transparency and for clinical trial results to be published regardless of outcome in order to ensure that the evidence base is unbiased.</div></div>","PeriodicalId":46479,"journal":{"name":"Revista Espanola de Anestesiologia y Reanimacion","volume":"73 1","pages":"Article 501995"},"PeriodicalIF":0.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145915359","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}
Pub Date : 2026-01-01Epub Date: 2025-12-22DOI: 10.1016/j.redar.2025.501986
M.A. Hernández-Govea , G.F. Álvarez-Orenday , M. Guerra-Hernández , V.B. Kway , A.M. Castro-Alemán
Background
Currently, no standardized tool accurately predicts the success of supraclavicular brachial plexus block (SBPB) in the shortest time possible. This study aimed to evaluate the early predictive value of muscle tone loss and perfusion index in predicting SBPB success. This is the first study to report the use of this device for objective assessment of nerve block success.
Methods
A prospective observational pilot study was conducted at”Dr. Ignacio Morones Prieto” Central Hospital, Mexico, involving 33 patients (ASA 1, 2, 3) requiring surgery on the distal third of the upper limb with ultrasound-guided SBPB. Exclusion criteria included infections at the puncture site, local anesthetic allergies, coagulopathies, restrictive pulmonary pathologies, oxygen dependency, brachial plexus radiculopathy, and uncontrolled diabetes. The motor block was assessed with a conductive ink flexion sensor (FS), and the sympathetic block was evaluated with perfusion index via pulse oximeter at 3, 5, 10, and 15 minutes. Block success was defined as a Numerical Rating Scale (NRS) for pain < 2 during surgical stimulation. Statistical comparisons were made between successful and unsuccessful blocks, with ROC curve analysis identifying optimal cutoff points for predictive variables.
Results
Of the 33 patients, 24 had a successful block, and 9 did not. At 5 minutes, a PI >196.07 showed 100% sensitivity, 87.5% specificity, and AUC 92% (p < 0.001). A 27.38% loss in muscle strength showed 100% sensitivity, 87.5% specificity, and AUC 95% (p < 0.001). Combined, these parameters had a 100% predictive value (p < 0.005).
Conclusion
PI and muscle strength loss are reliable early predictors of SBPB success, offering a valuable tool for optimizing anesthetic strategies.
{"title":"Valor predictivo de la pérdida de tono muscular y el índice de perfusión para el éxito del bloqueo del plexo braquial supraclavicular: estudio piloto","authors":"M.A. Hernández-Govea , G.F. Álvarez-Orenday , M. Guerra-Hernández , V.B. Kway , A.M. Castro-Alemán","doi":"10.1016/j.redar.2025.501986","DOIUrl":"10.1016/j.redar.2025.501986","url":null,"abstract":"<div><h3>Background</h3><div>Currently, no standardized tool accurately predicts the success of supraclavicular brachial plexus block (SBPB) in the shortest time possible. This study aimed to evaluate the early predictive value of muscle tone loss and perfusion index in predicting SBPB success. This is the first study to report the use of this device for objective assessment of nerve block success.</div></div><div><h3>Methods</h3><div>A prospective observational pilot study was conducted at”Dr. Ignacio Morones Prieto” Central Hospital, Mexico, involving 33 patients (ASA 1, 2, 3) requiring surgery on the distal third of the upper limb with ultrasound-guided SBPB. Exclusion criteria included infections at the puncture site, local anesthetic allergies, coagulopathies, restrictive pulmonary pathologies, oxygen dependency, brachial plexus radiculopathy, and uncontrolled diabetes. The motor block was assessed with a conductive ink flexion sensor (FS), and the sympathetic block was evaluated with perfusion index via pulse oximeter at 3, 5, 10, and 15<!--> <!-->minutes. Block success was defined as a Numerical Rating Scale (NRS) for pain <<!--> <!-->2 during surgical stimulation. Statistical comparisons were made between successful and unsuccessful blocks, with ROC curve analysis identifying optimal cutoff points for predictive variables.</div></div><div><h3>Results</h3><div>Of the 33 patients, 24 had a successful block, and 9 did not. At 5<!--> <!-->minutes, a PI<!--> <!-->>196.07 showed 100% sensitivity, 87.5% specificity, and AUC 92% (p <<!--> <!-->0.001). A 27.38% loss in muscle strength showed 100% sensitivity, 87.5% specificity, and AUC 95% (p <<!--> <!-->0.001). Combined, these parameters had a 100% predictive value (p <<!--> <!-->0.005).</div></div><div><h3>Conclusion</h3><div>PI and muscle strength loss are reliable early predictors of SBPB success, offering a valuable tool for optimizing anesthetic strategies.</div></div>","PeriodicalId":46479,"journal":{"name":"Revista Espanola de Anestesiologia y Reanimacion","volume":"73 1","pages":"Article 501986"},"PeriodicalIF":0.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145915377","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}
Pub Date : 2026-01-01Epub Date: 2025-12-22DOI: 10.1016/j.redar.2025.501983
J.M. Blanco Flores, A.M. Oubiña López, A. San Antonio Gil, M. Reina Molina, P. Ramos Curado, M. Echevarría Moreno
We report the case of a 42-year-old primiparous woman who developed severe postpartum hemorrhage due to uterine atony after an instrumental delivery, requiring massive transfusion and Bakri balloon placement. Despite initial hemodynamic stabilization, she progressed to persistent anuria and acute kidney injury. Imaging revealed bilateral renal cortical necrosis. In the presence of anemia, thrombocytopenia, complement consumption, and ADAMTS13 activity >10%, atypical hemolytic uremic syndrome (aHUS) was suspected. Treatment with eculizumab and renal replacement therapy was initiated, achieving good hematologic response.
This case highlights a rare postpartum complication in which early suspicion enables prompt targeted therapy. Anesthesiologists play a key role in initial hemodynamic management and in identifying warning signs suggestive of thrombotic microangiopathies.
{"title":"De la atonía uterina al SHUa: un caso de microangiopatía trombótica posparto","authors":"J.M. Blanco Flores, A.M. Oubiña López, A. San Antonio Gil, M. Reina Molina, P. Ramos Curado, M. Echevarría Moreno","doi":"10.1016/j.redar.2025.501983","DOIUrl":"10.1016/j.redar.2025.501983","url":null,"abstract":"<div><div>We report the case of a 42-year-old primiparous woman who developed severe postpartum hemorrhage due to uterine atony after an instrumental delivery, requiring massive transfusion and Bakri balloon placement. Despite initial hemodynamic stabilization, she progressed to persistent anuria and acute kidney injury. Imaging revealed bilateral renal cortical necrosis. In the presence of anemia, thrombocytopenia, complement consumption, and ADAMTS13 activity >10%, atypical hemolytic uremic syndrome (aHUS) was suspected. Treatment with eculizumab and renal replacement therapy was initiated, achieving good hematologic response.</div><div>This case highlights a rare postpartum complication in which early suspicion enables prompt targeted therapy. Anesthesiologists play a key role in initial hemodynamic management and in identifying warning signs suggestive of thrombotic microangiopathies.</div></div>","PeriodicalId":46479,"journal":{"name":"Revista Espanola de Anestesiologia y Reanimacion","volume":"73 1","pages":"Article 501983"},"PeriodicalIF":0.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145915375","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}
Pub Date : 2026-01-01Epub Date: 2025-12-05DOI: 10.1016/j.redar.2025.501982
J. Mateos-Granados , L.E. Fernández-Rodríguez , M.M. Hernández-García , F. Martínez-Martínez , V. Roqués-Escolar
Peripheral neurostimulators may be used for treatment of neuropathic pain, and their use has increased with the use of ultrasound for its placement. Superficial radial nerve neuropathy is common, and distal humeral implants have been described with adequate pain relief, but not all patients present a positive test block in this site, which is needed for the implant. We present a case of ultrasound-guided implant of a peripheral neurostimulator in the radial spiral groove as treatment of superficial radial nerve neuropathy with adequate pain relief, although after one year the electrode suffered a fracture and had to be removed and reimplanted surgically. This new technique may be an effective alternative in selected patients, but further studies are needed.
{"title":"Implante ecoguiado de un neuroestimulador periférico en el canal de torsión radial. A propósito de un caso","authors":"J. Mateos-Granados , L.E. Fernández-Rodríguez , M.M. Hernández-García , F. Martínez-Martínez , V. Roqués-Escolar","doi":"10.1016/j.redar.2025.501982","DOIUrl":"10.1016/j.redar.2025.501982","url":null,"abstract":"<div><div>Peripheral neurostimulators may be used for treatment of neuropathic pain, and their use has increased with the use of ultrasound for its placement. Superficial radial nerve neuropathy is common, and distal humeral implants have been described with adequate pain relief, but not all patients present a positive test block in this site, which is needed for the implant. We present a case of ultrasound-guided implant of a peripheral neurostimulator in the radial spiral groove as treatment of superficial radial nerve neuropathy with adequate pain relief, although after one year the electrode suffered a fracture and had to be removed and reimplanted surgically. This new technique may be an effective alternative in selected patients, but further studies are needed.</div></div>","PeriodicalId":46479,"journal":{"name":"Revista Espanola de Anestesiologia y Reanimacion","volume":"73 1","pages":"Article 501982"},"PeriodicalIF":0.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145915374","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}
Pub Date : 2026-01-01Epub Date: 2025-12-19DOI: 10.1016/j.redar.2025.501989
A. Bachtiar Effendi , F. Cahya Ramadhan , G.D. Ica Manohara , R.M. Laksono
Background
Opioid-free anaesthesia (OFA) is increasingly recognized as a perioperative approach that may offer effective pain control with reduced risk of adverse effects. Considering that orthopaedic surgeries often lead to at least moderate postoperative pain, we assessed the effectiveness and safety of OFA in orthopaedic procedures.
Methods
We searched PubMed, ScienceDirect, ProQuest, and EuropePMC for relevant randomised controlled trials (RCT) and supplemented the data with citation tracking. Data were analysed using RevMan version 5.4. The risk of bias and the certainty of evidence were evaluated using the Cochrane Risk of Bias 2.0 tool and the GRADE approach. The study was registered on PROSPERO (CRD420251048348).
Results
Seven RCTs involving 408 patients were included. The intensity of postoperative pain measured in the post-anaesthesia care unit (mean difference [MD]: −0.08), at 24 hours (MD: −0.06), and at 48 hours (MD: −0.26) was not statistically significant. OFA reduced the risk of postoperative nausea and vomiting (PONV) (RR: 0.37; P = .00001) and prolonged the time to first request for analgesia (MD: 25.60 minutes; P = .00001). Twenty-four-hour morphine consumption was comparable across groups (MD: −0.28; P = .76). OFA reduced the incidence of intraoperative hypotension (risk ratio [RR]: 0.56; P = .02) but increased the risk of intraoperative bradycardia (RR: 1.86; P = .04).
Conclusions
In orthopaedic surgery, OFA provides comparable pain control to opioid-based anaesthesia. It also reduced the incidence of postoperative nausea and vomiting and intraoperative hypotension, and prolonged the time to the first request for analgesia (statistically, but not clinically). However, the potential risk of bradycardia should be considered when using dexmedetomidine-based analgesics.
无阿片类药物麻醉（OFA）越来越被认为是一种围手术期的方法，可以有效地控制疼痛，降低不良反应的风险。考虑到骨科手术经常导致至少中度的术后疼痛，我们评估了OFA在骨科手术中的有效性和安全性。方法检索PubMed、ScienceDirect、ProQuest和EuropePMC，检索相关的随机对照试验（RCT），并进行引文跟踪。数据采用RevMan 5.4进行分析。使用Cochrane risk of bias 2.0工具和GRADE方法评估偏倚风险和证据的确定性。该研究已在PROSPERO注册（CRD420251048348）。结果纳入7项随机对照试验，共408例患者。麻醉后护理单元测量的术后疼痛强度（平均差值[MD]:−0.08）、24小时（MD:−0.06）和48小时（MD:−0.26）无统计学意义。OFA降低了术后恶心和呕吐（PONV）的风险（RR: 0.37; P = 0.00001），延长了首次请求镇痛的时间（MD: 25.60分钟；P = 0.00001）。两组间24小时吗啡用量具有可比性（MD: - 0.28; P = 0.76）。OFA降低了术中低血压的发生率（危险比[RR]: 0.56; P = 0.02），但增加了术中心动过缓的风险（危险比[RR]: 1.86; P = 0.04）。结论在骨科手术中，OFA的镇痛效果与阿片类药物麻醉相当。降低了术后恶心呕吐和术中低血压的发生率，延长了第一次要求镇痛的时间（统计上，但临床上没有）。然而，当使用右美托咪定镇痛药时，应考虑心动过缓的潜在风险。
{"title":"Efecto de la anestesia libre de opioides en el dolor postoperatorio en cirugía ortopédica: revisión sistemática y metaanálisis de ensayos controlados aleatorizados","authors":"A. Bachtiar Effendi , F. Cahya Ramadhan , G.D. Ica Manohara , R.M. Laksono","doi":"10.1016/j.redar.2025.501989","DOIUrl":"10.1016/j.redar.2025.501989","url":null,"abstract":"<div><h3>Background</h3><div>Opioid-free anaesthesia (OFA) is increasingly recognized as a perioperative approach that may offer effective pain control with reduced risk of adverse effects. Considering that orthopaedic surgeries often lead to at least moderate postoperative pain, we assessed the effectiveness and safety of OFA in orthopaedic procedures.</div></div><div><h3>Methods</h3><div>We searched PubMed, ScienceDirect, ProQuest, and EuropePMC for relevant randomised controlled trials (RCT) and supplemented the data with citation tracking. Data were analysed using RevMan version 5.4. The risk of bias and the certainty of evidence were evaluated using the Cochrane Risk of Bias 2.0 tool and the GRADE approach. The study was registered on PROSPERO (CRD420251048348).</div></div><div><h3>Results</h3><div>Seven RCTs involving 408 patients were included. The intensity of postoperative pain measured in the post-anaesthesia care unit (mean difference [MD]: −0.08), at 24<!--> <!-->hours (MD: −0.06), and at 48<!--> <!-->hours (MD: −0.26) was not statistically significant. OFA reduced the risk of postoperative nausea and vomiting (PONV) (RR: 0.37; <em>P</em> <!-->=<!--> <!-->.00001) and prolonged the time to first request for analgesia (MD: 25.60<!--> <!-->minutes; <em>P</em> <!-->=<!--> <!-->.00001). Twenty-four-hour morphine consumption was comparable across groups (MD: −0.28; <em>P</em> <!-->=<!--> <!-->.76). OFA reduced the incidence of intraoperative hypotension (risk ratio [RR]: 0.56; <em>P</em> <!-->=<!--> <!-->.02) but increased the risk of intraoperative bradycardia (RR: 1.86; <em>P</em> <!-->=<!--> <!-->.04).</div></div><div><h3>Conclusions</h3><div>In orthopaedic surgery, OFA provides comparable pain control to opioid-based anaesthesia. It also reduced the incidence of postoperative nausea and vomiting and intraoperative hypotension, and prolonged the time to the first request for analgesia (statistically, but not clinically). However, the potential risk of bradycardia should be considered when using dexmedetomidine-based analgesics.</div></div>","PeriodicalId":46479,"journal":{"name":"Revista Espanola de Anestesiologia y Reanimacion","volume":"73 1","pages":"Article 501989"},"PeriodicalIF":0.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145915378","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}
Pub Date : 2026-01-01Epub Date: 2025-12-18DOI: 10.1016/j.redar.2025.501985
A. Vázquez Lima, M. Vidal Lopo
Glucagon-like peptide type 1 analogues (aGLP1) are a group of drugs capable of stimulating the GLP1 receptor, a key peptide in glycaemic homeostasis through its actions at the pancreatic and gastric level.
This narrative review summarises the possible implications of the perioperative use of this group of drugs. The pancreatic and extrapancreatic effects of aGLP1s determine their anaesthetic implications and perioperative management. The repercussions of their long-term suspension and their effects on the immune system have not yet been sufficiently clarified. The perioperative use of GLP1 agonists is associated with better glycaemic control without a significant increase in complications. However, their use involves a delay in gastric emptying dependent on multiple factors, which may increase the risk of bronchoaspiration.
At present, we can conclude that the perioperative maintenance of GLP1 agonists optimises glycaemic control and avoids disruptions to the potential benefits of treatment without demonstrating an increase in postoperative complications. Delayed gastric emptying and possible bronchoaspiration require measures to minimise risk and ensure patient safety.
{"title":"Análogos del receptor GLP1 y consideraciones en el manejo perioperatorio: una revisión narrativa","authors":"A. Vázquez Lima, M. Vidal Lopo","doi":"10.1016/j.redar.2025.501985","DOIUrl":"10.1016/j.redar.2025.501985","url":null,"abstract":"<div><div>Glucagon-like peptide type 1 analogues (aGLP1) are a group of drugs capable of stimulating the GLP1 receptor, a key peptide in glycaemic homeostasis through its actions at the pancreatic and gastric level.</div><div>This narrative review summarises the possible implications of the perioperative use of this group of drugs. The pancreatic and extrapancreatic effects of aGLP1s determine their anaesthetic implications and perioperative management. The repercussions of their long-term suspension and their effects on the immune system have not yet been sufficiently clarified. The perioperative use of GLP1 agonists is associated with better glycaemic control without a significant increase in complications. However, their use involves a delay in gastric emptying dependent on multiple factors, which may increase the risk of bronchoaspiration.</div><div>At present, we can conclude that the perioperative maintenance of GLP1 agonists optimises glycaemic control and avoids disruptions to the potential benefits of treatment without demonstrating an increase in postoperative complications. Delayed gastric emptying and possible bronchoaspiration require measures to minimise risk and ensure patient safety.</div></div>","PeriodicalId":46479,"journal":{"name":"Revista Espanola de Anestesiologia y Reanimacion","volume":"73 1","pages":"Article 501985"},"PeriodicalIF":0.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145915531","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}
Pub Date : 2026-01-01Epub Date: 2025-12-08DOI: 10.1016/j.redar.2025.501997
A. Ojeda, T. Cuñat, O. Comino-Trinidad, J. Aliaga, M. Arias, A. Calvo
{"title":"Respuesta a la Carta al Editor sobre «Dolor neuropático y crónico de nueva aparición en supervivientes de COVID-19 grave: análisis secundario del ensayo PAIN-COVID»","authors":"A. Ojeda, T. Cuñat, O. Comino-Trinidad, J. Aliaga, M. Arias, A. Calvo","doi":"10.1016/j.redar.2025.501997","DOIUrl":"10.1016/j.redar.2025.501997","url":null,"abstract":"","PeriodicalId":46479,"journal":{"name":"Revista Espanola de Anestesiologia y Reanimacion","volume":"73 1","pages":"Article 501997"},"PeriodicalIF":0.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145915361","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}
Pub Date : 2026-01-01Epub Date: 2025-12-08DOI: 10.1016/j.redar.2025.501991
M.A. Fernández-Vaquero , C.A. Puga-Carrasco , J.A. Sastre
{"title":"Análogos GLP-1: el nuevo reto silencioso en la seguridad de la vía aérea","authors":"M.A. Fernández-Vaquero , C.A. Puga-Carrasco , J.A. Sastre","doi":"10.1016/j.redar.2025.501991","DOIUrl":"10.1016/j.redar.2025.501991","url":null,"abstract":"","PeriodicalId":46479,"journal":{"name":"Revista Espanola de Anestesiologia y Reanimacion","volume":"73 1","pages":"Article 501991"},"PeriodicalIF":0.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145915376","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}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号