Pub Date : 2025-11-01DOI: 10.1016/j.redare.2025.501926
J. Ripollés-Melchor , A. Zorrilla-Vaca , A. León-Bretscher , A. Abad-Motos , P. Galán-Menéndez , J.L. Muñoz-Rodés , D. Zapata , Á. Ramiro-Ruiz , C. Aldecoa , V. Molnar , L. Jordá-Sanz , A. Cuéllar-Martínez , H. Berges-Gutiérrez , A. Landaluce-Olavarria , R. Fernández-García , N. Aracil-Escoda , A.M. Pacual-Bellosta , M. Ubré-Lorenzo , M. Logroño-Ejea , A.B. Serrano Romero , A. Abad-Gurumeta
Introduction/objectives
Colorectal cancer (CRC) remains a leading cause of cancer-related mortality. While Enhanced Recovery After Surgery (ERAS) programs optimize perioperative care, their effect on oncologic prognosis requires further validation. This study evaluates ERAS adherence and five-year survival through a post-hoc analysis of the POWER Study.
Methods
This sub-analysis included 901 patients from 32 hospitals with available 5-year follow-up data. Patients undergoing elective CRC resection were stratified based on ERAS adherence (≥70%). Primary outcomes included overall survival and recurrence rates analysed using Cox proportional hazards models adjusted for clinical variables. Kaplan–Meier curves and subgroup analyses were also performed to assess stage-specific differences.
Results
No significant differences were observed in 5-year overall survival (ERAS 66% vs. non-ERAS 60%; HR: 1.14, 95% CI: 0.88-1.49; P = 0.32) or recurrence rates (ERAS 25% vs. non-ERAS 25%; HR: 0.91, 95% CI: 0.68–1.22; P = 0.53). Kaplan–Meier curves showed overlapping survival trajectories, and subgroup analyses confirmed no stage-specific disparities. While ERAS promotes early postoperative recovery and facilitates timely adjuvant therapy initiation, its effect on long-term oncologic outcomes remains inconclusive.
Conclusions
These findings support ERAS as a safe perioperative strategy that enhances short-term recovery without compromising oncologic safety. However, limitations such as the post-hoc design and incomplete long-term data warrant further research. Future studies should investigate ERAS’s impact on perioperative stress, immune function, and recurrence prevention to better elucidate its role in long-term CRC outcomes.
{"title":"Enhanced recovery after surgery and long-term oncologic outcomes: Post-hoc analysis of the POWER study","authors":"J. Ripollés-Melchor , A. Zorrilla-Vaca , A. León-Bretscher , A. Abad-Motos , P. Galán-Menéndez , J.L. Muñoz-Rodés , D. Zapata , Á. Ramiro-Ruiz , C. Aldecoa , V. Molnar , L. Jordá-Sanz , A. Cuéllar-Martínez , H. Berges-Gutiérrez , A. Landaluce-Olavarria , R. Fernández-García , N. Aracil-Escoda , A.M. Pacual-Bellosta , M. Ubré-Lorenzo , M. Logroño-Ejea , A.B. Serrano Romero , A. Abad-Gurumeta","doi":"10.1016/j.redare.2025.501926","DOIUrl":"10.1016/j.redare.2025.501926","url":null,"abstract":"<div><h3>Introduction/objectives</h3><div>Colorectal cancer (CRC) remains a leading cause of cancer-related mortality. While Enhanced Recovery After Surgery (ERAS) programs optimize perioperative care, their effect on oncologic prognosis requires further validation. This study evaluates ERAS adherence and five-year survival through a post-hoc analysis of the POWER Study.</div></div><div><h3>Methods</h3><div>This sub-analysis included 901 patients from 32 hospitals with available 5-year follow-up data. Patients undergoing elective CRC resection were stratified based on ERAS adherence (≥70%). Primary outcomes included overall survival and recurrence rates analysed using Cox proportional hazards models adjusted for clinical variables. Kaplan–Meier curves and subgroup analyses were also performed to assess stage-specific differences.</div></div><div><h3>Results</h3><div>No significant differences were observed in 5-year overall survival (ERAS 66% vs. non-ERAS 60%; HR: 1.14, 95% CI: 0.88-1.49; P = 0.32) or recurrence rates (ERAS 25% vs. non-ERAS 25%; HR: 0.91, 95% CI: 0.68–1.22; P = 0.53). Kaplan–Meier curves showed overlapping survival trajectories, and subgroup analyses confirmed no stage-specific disparities. While ERAS promotes early postoperative recovery and facilitates timely adjuvant therapy initiation, its effect on long-term oncologic outcomes remains inconclusive.</div></div><div><h3>Conclusions</h3><div>These findings support ERAS as a safe perioperative strategy that enhances short-term recovery without compromising oncologic safety. However, limitations such as the post-hoc design and incomplete long-term data warrant further research. Future studies should investigate ERAS’s impact on perioperative stress, immune function, and recurrence prevention to better elucidate its role in long-term CRC outcomes.</div></div>","PeriodicalId":94196,"journal":{"name":"Revista espanola de anestesiologia y reanimacion","volume":"72 9","pages":"Article 501926"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145006965","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 : 2025-11-01DOI: 10.1016/j.redare.2025.501904
Y. Li , Z. Jin , L. Beiping , A. Xiaolei
Objective
This study aims to investigate the effects of anaesthesia and surgical procedures on the cognitive function of both young and aged mice. It will also explore the role and mechanisms of c-Fos expression in altering hippocampal neuron excitability and its relationship with perioperative neurocognitive disorders in mice.
Methods
In this study, we used a murine laparotomy model to assess cognitive behavioural changes in both young and aged mice at 1, 3, and 7 days post-surgery. We used immunofluorescence techniques to evaluate c-Fos expression in the dorsal hippocampus of aged mice following laparotomy. We also used a chemical genetic approach, injecting a virus into the dorsal hippocampus to modulate neuronal excitability, and subsequently analysed changes in object location memory (OLM) and temporal order memory (TOM). Furthermore, we used Golgi staining to observe the density of dendritic spines in the dorsal hippocampal region of aged mice following anaesthesia and viral injection.
Results
No significant cognitive differences were observed between young mice and aged mice administered anaesthesia alone, compared to their respective control groups. However, only the aged mice that underwent surgery displayed significant deficits in (OLM) and T-maze (TOM) tasks one day post-surgery (one-way ANOVA: OLM: F = 27.507, p < 0.001; TOM: F = 12.196, p < 0.001), while the OLM recognition index showed no significant change (one-way ANOVA: F = 0.057, p = 0.982). Furthermore, c-Fos positive neurons in the dorsal hippocampus of aged mice decreased significantly one day after surgery (one-way ANOVA: F = 0.057, p = 0.0048). The application of a chemical-genetic method to enhance the excitability of neurons in the dorsal hippocampus effectively reversed surgery-induced cognitive impairment (one-way ANOVA: OLM: F = 0.032, p = 0.021; TOM: F = 0.024, p = 0.019) and depletion of dendritic spine density (p < 0.01).
Conclusion
Temporal and spatial memory functions are impaired in aged mice following surgery, while object recognition memory remains unaffected. Surgical procedures result in a decrease in the number of c-Fos positive neurons and neuronal excitability in the dorsal hippocampus of aged mice. Furthermore, enhancing neuronal excitability in the dorsal hippocampus alleviates postoperative cognitive impairment in aged mice. Additionally, increasing neuronal excitability in the dorsal hippocampus can counteract the surgery-induced reduction in dendritic spine density.
目的:本研究旨在探讨麻醉和手术对幼龄和老年小鼠认知功能的影响。探讨c-Fos表达在改变小鼠海马神经元兴奋性中的作用和机制及其与围手术期神经认知障碍的关系。方法:在本研究中,我们使用小鼠剖腹手术模型来评估术后1、3和7天幼龄和老年小鼠的认知行为变化。我们采用免疫荧光技术检测老年小鼠剖腹手术后海马背侧c-Fos的表达。我们还使用了化学遗传方法,向海马背侧注射病毒来调节神经元的兴奋性,随后分析了物体位置记忆(OLM)和时间顺序记忆(TOM)的变化。此外,我们用高尔基染色法观察麻醉和注射病毒后老年小鼠海马背区树突棘的密度。结果:与各自的对照组相比,单独麻醉的年轻小鼠和老年小鼠之间没有明显的认知差异。然而,只有接受手术的老年小鼠在术后1天的OLM和T-maze任务中表现出明显的缺陷(单因素方差分析:OLM: F = 27.507, P)。结论:手术后老年小鼠的时空记忆功能受损,而物体识别记忆未受影响。手术导致老年小鼠海马背侧c-Fos阳性神经元数量减少,神经元兴奋性降低。此外,增强海马背侧神经元兴奋性可减轻老年小鼠术后认知功能障碍。此外,海马背侧神经元兴奋性的增加可以抵消手术引起的树突棘密度的减少。
{"title":"Effects of anaesthesia on cognitive function in young and aged mice: Role of c-Fos expression in hippocampal neuron excitability","authors":"Y. Li , Z. Jin , L. Beiping , A. Xiaolei","doi":"10.1016/j.redare.2025.501904","DOIUrl":"10.1016/j.redare.2025.501904","url":null,"abstract":"<div><h3>Objective</h3><div>This study aims to investigate the effects of anaesthesia and surgical procedures on the cognitive function of both young and aged mice. It will also explore the role and mechanisms of c-Fos expression in altering hippocampal neuron excitability and its relationship with perioperative neurocognitive disorders in mice.</div></div><div><h3>Methods</h3><div>In this study, we used a murine laparotomy model to assess cognitive behavioural changes in both young and aged mice at 1, 3, and 7 days post-surgery. We used immunofluorescence techniques to evaluate c-Fos expression in the dorsal hippocampus of aged mice following laparotomy. We also used a chemical genetic approach, injecting a virus into the dorsal hippocampus to modulate neuronal excitability, and subsequently analysed changes in object location memory (OLM) and temporal order memory (TOM). Furthermore, we used Golgi staining to observe the density of dendritic spines in the dorsal hippocampal region of aged mice following anaesthesia and viral injection.</div></div><div><h3>Results</h3><div>No significant cognitive differences were observed between young mice and aged mice administered anaesthesia alone, compared to their respective control groups. However, only the aged mice that underwent surgery displayed significant deficits in (OLM) and T-maze (TOM) tasks one day post-surgery (one-way ANOVA: OLM: F = 27.507, p < 0.001; TOM: F = 12.196, p < 0.001), while the OLM recognition index showed no significant change (one-way ANOVA: F = 0.057, p = 0.982). Furthermore, c-Fos positive neurons in the dorsal hippocampus of aged mice decreased significantly one day after surgery (one-way ANOVA: F = 0.057, p = 0.0048). The application of a chemical-genetic method to enhance the excitability of neurons in the dorsal hippocampus effectively reversed surgery-induced cognitive impairment (one-way ANOVA: OLM: F = 0.032, p = 0.021; TOM: F = 0.024, p = 0.019) and depletion of dendritic spine density (p < 0.01).</div></div><div><h3>Conclusion</h3><div>Temporal and spatial memory functions are impaired in aged mice following surgery, while object recognition memory remains unaffected. Surgical procedures result in a decrease in the number of c-Fos positive neurons and neuronal excitability in the dorsal hippocampus of aged mice. Furthermore, enhancing neuronal excitability in the dorsal hippocampus alleviates postoperative cognitive impairment in aged mice. Additionally, increasing neuronal excitability in the dorsal hippocampus can counteract the surgery-induced reduction in dendritic spine density.</div></div>","PeriodicalId":94196,"journal":{"name":"Revista espanola de anestesiologia y reanimacion","volume":"72 9","pages":"Article 501904"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145008620","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 : 2025-11-01DOI: 10.1016/j.redare.2025.501903
L. Arce Gálvez , J.M. Mancera Álzate
Post traumatic headache is a common condition that can be managed with pharmacologic interventions or analgesic procedures; however, most evidence is derived from patients with mild trauma, leaving a large gap with regard to patients with moderate or severe trauma who present complex pain. Botulinum toxin plays an increasingly important role in pain management. This neurotoxin acts on different receptors, ranging from TRPV1 (transient receptor potential vanilloid type 1) to CGRP (calcitonin gene-related peptide). This is the first case report of the use of perineural botulinum toxin in a patient with moderate post-traumatic headache who responded poorly to standard interventional measures.
{"title":"Perineural botulinum toxin in the management of post-traumatic headache: A case report","authors":"L. Arce Gálvez , J.M. Mancera Álzate","doi":"10.1016/j.redare.2025.501903","DOIUrl":"10.1016/j.redare.2025.501903","url":null,"abstract":"<div><div>Post traumatic headache is a common condition that can be managed with pharmacologic interventions or analgesic procedures; however, most evidence is derived from patients with mild trauma, leaving a large gap with regard to patients with moderate or severe trauma who present complex pain. Botulinum toxin plays an increasingly important role in pain management. This neurotoxin acts on different receptors, ranging from TRPV1 (transient receptor potential vanilloid type 1) to CGRP (calcitonin gene-related peptide). This is the first case report of the use of perineural botulinum toxin in a patient with moderate post-traumatic headache who responded poorly to standard interventional measures.</div></div>","PeriodicalId":94196,"journal":{"name":"Revista espanola de anestesiologia y reanimacion","volume":"72 9","pages":"Article 501903"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145016917","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 : 2025-11-01DOI: 10.1016/j.redare.2025.501925
A. Choudhary , S. Singh , V. Kumar , H. Kumar , K. Parasar
Background
It is crucial to assess a patient's quality of recovery after major surgery. This study aims to compare the effect of neuraxial morphine and bilateral erector spinae plane block on quality of recovery in the first 48 postoperative hours in patients undergoing open upper abdominal surgeries.
Methods
This prospective, triple-arm, randomized study was performed to compare the effect of neuraxial morphine (intrathecal morphine, thoracic epidural) and erector spinae plane block on postoperative recovery. The primary outcome was the Quality of Recovery-15 (QoR-15) score at 24 h. Secondary objectives were pain severity rated on the numerical rating scale (NRS) score over 24 h after surgery, time to first rescue analgesia, and adverse effects.
Results
We enrolled 117 adult patients undergoing open upper abdominal surgeries who were randomly allocated to the intrathecal morphine (ITM) group, thoracic epidural (TEM) group, or the bilateral low volume erector spinae plane block (LV-ESPB) group. The 24-h QoR-15 scores (mean ± standard deviation) were comparable in the ITM (115.83 ± 4.0) and TEM (113.51 ± 4.36) groups, but were significantly lower in the LV-ESPB group (104.58 ± 4.05) (p < 0.001). NRS scores were comparable at all time points in all 3 groups, except at 24 h (p - 0.002). The time to first rescue analgesia was comparable in all 3 groups. The incidence of nausea and pruritus was statistically significant in the ITM group vs the TEM and LV-ESPB groups (p < 0.001 and 0.019, respectively).
Conclusions
The study demonstrated that neuraxial morphine achieved better quality of recovery in the first 24 h after major abdominal surgery vs bilateral erector spinae plane block.
{"title":"Comparison of single-shot neuraxial morphine and erector spinae plane block on quality of recovery after major open gastrointestinal surgeries: A prospective, randomized trial","authors":"A. Choudhary , S. Singh , V. Kumar , H. Kumar , K. Parasar","doi":"10.1016/j.redare.2025.501925","DOIUrl":"10.1016/j.redare.2025.501925","url":null,"abstract":"<div><h3>Background</h3><div>It is crucial to assess a patient's quality of recovery after major surgery. This study aims to compare the effect of neuraxial morphine and bilateral erector spinae plane block on quality of recovery in the first 48 postoperative hours in patients undergoing open upper abdominal surgeries.</div></div><div><h3>Methods</h3><div>This prospective, triple-arm, randomized study was performed to compare the effect of neuraxial morphine (intrathecal morphine, thoracic epidural) and erector spinae plane block on postoperative recovery. The primary outcome was the Quality of Recovery-15 (QoR-15) score at 24 h. Secondary objectives were pain severity rated on the numerical rating scale (NRS) score over 24 h after surgery, time to first rescue analgesia, and adverse effects.</div></div><div><h3>Results</h3><div>We enrolled 117 adult patients undergoing open upper abdominal surgeries who were randomly allocated to the intrathecal morphine (ITM) group, thoracic epidural (TEM) group, or the bilateral low volume erector spinae plane block (LV-ESPB) group. The 24-h QoR-15 scores (mean ± standard deviation) were comparable in the ITM (115.83 ± 4.0) and TEM (113.51 ± 4.36) groups, but were significantly lower in the LV-ESPB group (104.58 ± 4.05) (<em>p</em> < 0.001). NRS scores were comparable at all time points in all 3 groups, except at 24 h (<em>p</em> - 0.002). The time to first rescue analgesia was comparable in all 3 groups. The incidence of nausea and pruritus was statistically significant in the ITM group vs the TEM and LV-ESPB groups (<em>p</em> < 0.001 and 0.019, respectively).</div></div><div><h3>Conclusions</h3><div>The study demonstrated that neuraxial morphine achieved better quality of recovery in the first 24 h after major abdominal surgery vs bilateral erector spinae plane block.</div></div>","PeriodicalId":94196,"journal":{"name":"Revista espanola de anestesiologia y reanimacion","volume":"72 9","pages":"Article 501925"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145016945","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 : 2025-11-01DOI: 10.1016/j.redare.2025.501913
C. Barreiros , J. Mejía , I. García-Rojas , X. Sala-Blanch
{"title":"Quality of training in ultrasound-guided regional anaesthesia in teaching hospitals in Catalonia: An opinion survey of residents and tutors","authors":"C. Barreiros , J. Mejía , I. García-Rojas , X. Sala-Blanch","doi":"10.1016/j.redare.2025.501913","DOIUrl":"10.1016/j.redare.2025.501913","url":null,"abstract":"","PeriodicalId":94196,"journal":{"name":"Revista espanola de anestesiologia y reanimacion","volume":"72 9","pages":"Article 501913"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145008656","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 : 2025-11-01DOI: 10.1016/j.redare.2025.501901
M.A.R. Nasr, A. Ahmed, N. Ahmed, S. Soaida, M. Waheb
Introduction
The transverse short-axis in-plane is the standard approach for ultrasound-guided perineural catheter insertion and threading during adductor canal block (BCA). We hypothesized that the oblique short-axis in-plane approach could simplify and speed up catheter insertion and threading by eliminating some technical difficulties.
Methods
We included 50 patients aged ≥18 years, ASA I and II, who were scheduled for unilateral knee arthroscopy under spinal anesthesia. We planned to use BCA with a perineural catheter for postoperative analgesia. After administering spinal anesthesia, the patients were randomly assigned to the oblique (oblique short-axis in-plane approach) or transverse (stamdard short-axis in-plane approach) groups. The primary endpoint was catheter insertion time. The secondary endpoints were catheter threading difficulty, and incidence of vascular puncture and catheter migration.
Results
The catheter insertion time was significantly shorter in the oblique group vs the transverse group (113.8 ± 49.2 s vs 185.8 ± 46.7 s, respectively, P < 0.001). Catheter threading was significantly easier in the oblique group, as shown by the lower threading difficulty score compared to the transverse group. Both groups were comparable in terms of the incidence of vascular puncture and catheter migration.
Conclusion
In patients who underwent knee arthroscopy under spinal anesthesia, the oblique short-axis in-plane approach for catheter insertion during BCA was faster and less technically challenging than the standard transverse short-axis in-plane approach.
简介:横向短轴平面内入路是超声引导下内收管阻滞(BCA)术中围神经导管插入和穿线的标准入路。我们假设斜短轴平面内入路可以通过消除一些技术困难来简化和加快导管的插入和穿线。方法:我们纳入50例年龄≥18岁,ASA I和II级的患者,计划在脊髓麻醉下进行单侧膝关节镜检查。我们计划使用BCA配合神经周导管进行术后镇痛。给予脊髓麻醉后,将患者随机分为斜(斜短轴平面内入路)组和横(标准短轴平面内入路)组。主要终点为导管插入时间。次要终点是导管穿线困难、血管穿刺和导管移位的发生率。结果:斜位组置管时间明显短于横位组(113.8±49.2 s vs 185.8±46.7 s) P结论:腰麻下行膝关节镜患者行BCA时斜位短轴平面内入路置管速度快,技术难度小。
{"title":"Ultrasound-guided oblique short-axis adductor canal block: Can the oblique approach facilitate perineural catheter insertion? A randomized controlled trial","authors":"M.A.R. Nasr, A. Ahmed, N. Ahmed, S. Soaida, M. Waheb","doi":"10.1016/j.redare.2025.501901","DOIUrl":"10.1016/j.redare.2025.501901","url":null,"abstract":"<div><h3>Introduction</h3><div>The transverse short-axis in-plane is the standard approach for ultrasound-guided perineural catheter insertion and threading during adductor canal block (BCA). We hypothesized that the oblique short-axis in-plane approach could simplify and speed up catheter insertion and threading by eliminating some technical difficulties.</div></div><div><h3>Methods</h3><div>We included 50 patients aged ≥18 years, ASA I and II, who were scheduled for unilateral knee arthroscopy under spinal anesthesia. We planned to use BCA with a perineural catheter for postoperative analgesia. After administering spinal anesthesia, the patients were randomly assigned to the oblique (oblique short-axis in-plane approach) or transverse (stamdard short-axis in-plane approach) groups. The primary endpoint was catheter insertion time. The secondary endpoints were catheter threading difficulty, and incidence of vascular puncture and catheter migration.</div></div><div><h3>Results</h3><div>The catheter insertion time was significantly shorter in the oblique group vs the transverse group (113.8 ± 49.2 s vs 185.8 ± 46.7 s, respectively, P < 0.001). Catheter threading was significantly easier in the oblique group, as shown by the lower threading difficulty score compared to the transverse group. Both groups were comparable in terms of the incidence of vascular puncture and catheter migration.</div></div><div><h3>Conclusion</h3><div>In patients who underwent knee arthroscopy under spinal anesthesia, the oblique short-axis in-plane approach for catheter insertion during BCA was faster and less technically challenging than the standard transverse short-axis in-plane approach.</div></div>","PeriodicalId":94196,"journal":{"name":"Revista espanola de anestesiologia y reanimacion","volume":"72 9","pages":"Article 501901"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144762898","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 : 2025-11-01DOI: 10.1016/j.redare.2025.501931
J.L. Jover Pinillos , R. Ferrandis Comes , J.V. Llau Pitarch , D. Zamudio Penko , M. Basora Macaya , M.J. Colomina Soler , A. Abad Gurumeta , J. García Fernández
Introduction
Standard pre-operative coagulation tests are insensitive to certain haemostatic abnormalities, yet they continue to be ordered routinely. Given the lack of clear guidance in Spain, we used Delphi methodology to develop a series of consensus recommendations on ordering these tests.
Material and methods
We conducted a 3-round, online, multicentre Delphi study in which 10 expert anaesthesiologists were asked to recruit colleagues to form a panel of 59 anaesthesiologists, 50 of which completed all rounds. The panel rated 46 statements on a 1–9 Likert scale. Consensus was achieved when ≥70% of questions scored ≥7 in the third round. Accepted statements were classified as Weak (70%–79%), Moderate (80%–89%) or Strong (90%–100%) agreement.
Results
Twenty-nine statements were accepted. These were synthesized into 21 statements that were grouped into 6 categories: general indication, patient risk factors, procedure characteristics, global assessment, paediatric patients, and special cases. Agreement was strong for 14 statements, moderate for 5, and weak for 2. Key recommendations were: (1) avoid universal testing; (2) base testing on medical history, standard bleeding-risk questionnaires, and specific risk factors (anticoagulation, liver disease, kidney failure, haematopoietic disorders); (3) order tests before high-complexity or high-bleeding-risk procedures; and (4) use specific tests in patients receiving direct oral anticoagulants.
Conclusions
Pre-operative coagulation testing is indicated in patients that present bleeding disorders and/or are scheduled for a high-bleeding-risk procedure.
{"title":"Consensus document on ordering preoperative coagulation tests","authors":"J.L. Jover Pinillos , R. Ferrandis Comes , J.V. Llau Pitarch , D. Zamudio Penko , M. Basora Macaya , M.J. Colomina Soler , A. Abad Gurumeta , J. García Fernández","doi":"10.1016/j.redare.2025.501931","DOIUrl":"10.1016/j.redare.2025.501931","url":null,"abstract":"<div><h3>Introduction</h3><div>Standard pre-operative coagulation tests are insensitive to certain haemostatic abnormalities, yet they continue to be ordered routinely. Given the lack of clear guidance in Spain, we used Delphi methodology to develop a series of consensus recommendations on ordering these tests.</div></div><div><h3>Material and methods</h3><div>We conducted a 3-round, online, multicentre Delphi study in which 10 expert anaesthesiologists were asked to recruit colleagues to form a panel of 59 anaesthesiologists, 50 of which completed all rounds. The panel rated 46 statements on a 1–9 Likert scale. Consensus was achieved when ≥70% of questions scored ≥7 in the third round. Accepted statements were classified as Weak (70%–79%), Moderate (80%–89%) or Strong (90%–100%) agreement.</div></div><div><h3>Results</h3><div>Twenty-nine statements were accepted. These were synthesized into 21 statements that were grouped into 6 categories: general indication, patient risk factors, procedure characteristics, global assessment, paediatric patients, and special cases. Agreement was strong for 14 statements, moderate for 5, and weak for 2. Key recommendations were: (1) avoid universal testing; (2) base testing on medical history, standard bleeding-risk questionnaires, and specific risk factors (anticoagulation, liver disease, kidney failure, haematopoietic disorders); (3) order tests before high-complexity or high-bleeding-risk procedures; and (4) use specific tests in patients receiving direct oral anticoagulants.</div></div><div><h3>Conclusions</h3><div>Pre-operative coagulation testing is indicated in patients that present bleeding disorders and/or are scheduled for a high-bleeding-risk procedure.</div></div>","PeriodicalId":94196,"journal":{"name":"Revista espanola de anestesiologia y reanimacion","volume":"72 9","pages":"Article 501931"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145152541","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 : 2025-11-01DOI: 10.1016/j.redare.2025.501902
M. Mohammed ALseoudy , M. Abd el-Ghaffar Saleh , S. Saleh Elbalka , T. Elmetwally Farahat , D. Abdellatif Elebedy , S. Elsayed Ahmed
Background and aims
Ultrasound-guided deep serratus anterior plane (SAP) block has recently gained popularity as an analgesic technique in breast surgery. However, the effectiveness of ultrasound depends largely on the quality of the equipment used, and the technique can be complicated by patient-related factors such as obesity. We hypothesized that the simpler open approach to deep SAP block would be non-inferior to the ultrasound-guided approach in providing analgesia for modified radical mastectomy.
Method
A non-inferiority, randomized controlled study was performed in 100 patients aged 18–60 years who underwent modified radical mastectomy. In the open approach group (n = 50), 30 ml of 0.25% bupivacaine was injected deep to the serratus anterior muscle after breast resection and rib palpation. In the ultrasound-guided group (n = 50), 30 ml of 0.25% bupivacaine was injected deep to the serratus anterior muscle under ultrasound guidance before the skin incision. The primary outcome was total morphine consumption in the first 24 postoperative hours. Secondary outcome measures included time to first request for rescue analgesia (duration of SAP block), postoperative visual analogue scale (VAS) score, and the incidence of adverse effects.
Results
Median (interquartile range) morphine requirement in the first 24 h was similar in both groups (P = 0.81), and the time to first request for analgesia was also similar (P = 0.81). Evaluation of VAS scores during the initial 24 h after surgery showed no statistically significant differences between groups (P > 0.05), except at 4 postoperative hours, when the score was significantly higher in the ultrasound group (P < 0.001). No complications were observed in either group.
Conclusion
The open approach to deep SAP block is comparable to the ultrasound-guided approach in providing postoperative analgesia in female patients undergoing modified radical mastectomy.
{"title":"An open approach versus ultrasound approach for deep serratus anterior plane block for postoperative analgesia after modified radical mastectomy: A randomized controlled trial","authors":"M. Mohammed ALseoudy , M. Abd el-Ghaffar Saleh , S. Saleh Elbalka , T. Elmetwally Farahat , D. Abdellatif Elebedy , S. Elsayed Ahmed","doi":"10.1016/j.redare.2025.501902","DOIUrl":"10.1016/j.redare.2025.501902","url":null,"abstract":"<div><h3>Background and aims</h3><div>Ultrasound-guided deep serratus anterior plane (SAP) block has recently gained popularity as an analgesic technique in breast surgery. However, the effectiveness of ultrasound depends largely on the quality of the equipment used, and the technique can be complicated by patient-related factors such as obesity. We hypothesized that the simpler open approach to deep SAP block would be non-inferior to the ultrasound-guided approach in providing analgesia for modified radical mastectomy.</div></div><div><h3>Method</h3><div>A non-inferiority, randomized controlled study was performed in 100 patients aged 18–60 years who underwent modified radical mastectomy. In the open approach group (n = 50), 30 ml of 0.25% bupivacaine was injected deep to the serratus anterior muscle after breast resection and rib palpation. In the ultrasound-guided group (n = 50), 30 ml of 0.25% bupivacaine was injected deep to the serratus anterior muscle under ultrasound guidance before the skin incision. The primary outcome was total morphine consumption in the first 24 postoperative hours. Secondary outcome measures included time to first request for rescue analgesia (duration of SAP block), postoperative visual analogue scale (VAS) score, and the incidence of adverse effects.</div></div><div><h3>Results</h3><div>Median (interquartile range) morphine requirement in the first 24 h was similar in both groups (P = 0.81), and the time to first request for analgesia was also similar (P = 0.81). Evaluation of VAS scores during the initial 24 h after surgery showed no statistically significant differences between groups (P > 0.05), except at 4 postoperative hours, when the score was significantly higher in the ultrasound group (P < 0.001). No complications were observed in either group.</div></div><div><h3>Conclusion</h3><div>The open approach to deep SAP block is comparable to the ultrasound-guided approach in providing postoperative analgesia in female patients undergoing modified radical mastectomy.</div></div>","PeriodicalId":94196,"journal":{"name":"Revista espanola de anestesiologia y reanimacion","volume":"72 9","pages":"Article 501902"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145008645","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 : 2025-11-01DOI: 10.1016/j.redare.2025.501916
E. Maseda , T. Peláez , G. Aguilar , I. Martín-Loeches , A. Benítez-Cano , A. Rodríguez , R. Zaragoza , J. Guinea , C. Aldecoa , A. Suárez-de-la-Rica
Intra-abdominal candidiasis (IAC) is a highly prevalent infectious syndrome and a significant cause of mortality in Intensive Care Units (ICUs). The Working Group on Perioperative Infections of the Spanish Society of Anesthesiology, Resuscitation, and Pain Management (GTIPO-SEDAR) has promoted the development of recommendations based on the experience of a multidisciplinary panel of experts from various medical specialties, aiming to optimize the diagnosis and treatment of severe infectious processes such as IAC. These recommendations have been formulated through a rigorous critical appraisal of the currently available scientific evidence. This document provides guidance for optimizing the therapeutic approach to IAC, incorporating the latest findings in microbiology, recent therapeutic advances, pharmacokinetic and pharmacodynamic considerations in critically ill patients with intra-abdominal candidiasis, special therapeutic considerations for patients undergoing extracorporeal membrane oxygenation (ECMO) and continuous renal replacement therapies (CRRT), the appropriateness of empirical versus targeted therapy, and strategies for improving and reducing the duration of treatment.
{"title":"Expert opinion-based recommendations promoted by GTIPO-SEDAR to optimize the therapeutic management of intra-abdominal candidiasis","authors":"E. Maseda , T. Peláez , G. Aguilar , I. Martín-Loeches , A. Benítez-Cano , A. Rodríguez , R. Zaragoza , J. Guinea , C. Aldecoa , A. Suárez-de-la-Rica","doi":"10.1016/j.redare.2025.501916","DOIUrl":"10.1016/j.redare.2025.501916","url":null,"abstract":"<div><div>Intra-abdominal candidiasis (IAC) is a highly prevalent infectious syndrome and a significant cause of mortality in Intensive Care Units (ICUs). The Working Group on Perioperative Infections of the Spanish Society of Anesthesiology, Resuscitation, and Pain Management (GTIPO-SEDAR) has promoted the development of recommendations based on the experience of a multidisciplinary panel of experts from various medical specialties, aiming to optimize the diagnosis and treatment of severe infectious processes such as IAC. These recommendations have been formulated through a rigorous critical appraisal of the currently available scientific evidence. This document provides guidance for optimizing the therapeutic approach to IAC, incorporating the latest findings in microbiology, recent therapeutic advances, pharmacokinetic and pharmacodynamic considerations in critically ill patients with intra-abdominal candidiasis, special therapeutic considerations for patients undergoing extracorporeal membrane oxygenation (ECMO) and continuous renal replacement therapies (CRRT), the appropriateness of empirical <em>versus</em> targeted therapy, and strategies for improving and reducing the duration of treatment.</div></div>","PeriodicalId":94196,"journal":{"name":"Revista espanola de anestesiologia y reanimacion","volume":"72 9","pages":"Article 501916"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145067146","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}