British journal of anaesthesia最新文献

Background: Chronic postsurgical pain (CPSP) persists beyond the expected healing period after surgery, imposing a substantial burden on overall patient well-being. Unfortunately, CPSP often remains underdiagnosed and undertreated. To better understand the mechanism of CPSP development, we aimed to identify genetic variants associated with CPSP.

Methods: A genome-wide association study was conducted in a cohort of 95,931 individuals from the UK Biobank who had undergone different surgical procedures. Three analyses were performed: (1) case-control analysis (2923 cases with CPSP and 93,008 controls), (2) ordinal analysis in three groups based on time of analgesics use (n=95,931), and (3) a meta-analysis combining our dataset with a recent publication (n=97,281).

Results: In the case-control analysis, one genetic locus within GLRA3 displayed a genome-wide significant (P<2.5×10^-8) association with CPSP, and nine loci displayed suggestively significant associations (P<1×10^-6). The ordinal analysis aligned with the case-control analysis, with an additional locus (rs140330443) reaching genome-wide significance. In the meta-analysis with the recently published dataset, the single nucleotide polymorphism (SNP) rs17298280 in the GLRA3 gene remained significant (P=2.19×10^-9).

Conclusions: This study contributes new insights into the genetic factors associated with CPSP. The top hit GLRA3 is known for involvement in prostaglandin E2-induced pain processing pathways. Our study provides a foundation for future investigations into the function of these risk variants and the mechanisms underlying CPSP by offering summary statistics. However, further validation in other cohorts is required to confirm these findings.

Background: Moderate-to-severe pain is common after cardiac surgery, peaking during the first and second postoperative days. Several nerve blocks for sternotomy have been described; however, the optimal location for continuous catheters has not been established. This study assessed the feasibility of a larger trial evaluating the efficacy of serratus anterior plane (SAP) catheter analgesia for sternotomy pain.

Methods: This double-blinded trial included patients undergoing cardiac surgery via sternotomy. Bilateral SAP catheters were placed in all participants, and randomised to ropivacaine or placebo. We assessed feasibility based on predetermined endpoints: (1) average recruitment rate >4 per month; (2) protocol adherence rate >90%; (3) primary outcome measurement rate >90%; and (4) significant catheter-related adverse event rate ≤2%. The quality of recovery index (QoR-15) was compared using an independent t-test.

Results: Of 52 participants randomised, feasibility data were available for 50. A definitive study was deemed 'not feasible' in our standalone centre owing to a low recruitment rate (2.4 per month) and a high adverse event rate (pneumothorax rate 12%). There were no major protocol deviations but minor deviations in 12% of participants. Pain, opioid consumption, complications, and quality of recovery were not different between groups. Long-term pain at 3 months was low in both groups.

Conclusions: A single-centre trial was deemed not feasible for our setting. With limited data, the quality of recovery was not different with ropivacaine dosing of bilateral SAP catheters for sternotomy pain.

Clinical trial registration: NCT04648774.

Background: Frailty is a predictor of morbidity and mortality in older patients. This study aimed to investigate the influence of frailty status on likelihood, rate, duration, and severity of intraoperative hypotension (IOH), which can lead to severe organ dysfunction.

Methods: Surgical patients (≥70 yr old) with preoperative frailty assessment were analysed retrospectively. Frailty status was defined as robust, prefrail, or frail based on modified Fried criteria. IOH was defined as mean arterial pressure <65 mm Hg. For likelihood, rate, duration, and severity of IOH, logistic and Poisson regression were used.

Results: We included 2495 patients. There was no significant difference in likelihood of IOH. An increase of 9% in rate of IOH during surgery for prefrail (incidence rate ratio [IRR] 1.09 [95% CI 1.03-1.16], P=0.002), and 16% increase for frail patients (IRR 1.16 [1.04-1.29], P=0.007) was observed. During anaesthesia induction, prefrail patients exhibited a 28% increase in IOH (IRR 1.28 [1.12-1.47], P<0.001). Although there were no differences in the severity of IOH if surgery or anaesthesia induction duration was taken into account, frailty status was associated with a 15% longer time-weighted duration of IOH during anaesthesia induction (IRR 1.15 [1.06-1.24], P=0.001). Mediator analysis revealed that frailty status accounted for >90% after considering number of measured blood pressures and surgical duration and >70% after accounting for total propofol dose.

Conclusions: Prefrail and frail patients aged ≥70 yr experienced up to 16% more IOH during surgery and 28% more during anaesthesia induction compared with robust patients. Preoperative optimisation (prehabilitation) and modification of intraoperative management (e.g. invasive blood pressure management) have the potential to reduce IOH in prefrail and frail patients.