Thomas Tschoellitsch, Sophie Kaltenleithner, Alexander Maletzky, Philipp Moser, Philipp Seidl, Carl Böck, Stefan Thumfart, Michael Giretzlehner, Sepp Hochreiter, Jens Meier
{"title":"Mean arterial pressure is all you need in a machine learning model for mean arterial pressure prediction.","authors":"Thomas Tschoellitsch, Sophie Kaltenleithner, Alexander Maletzky, Philipp Moser, Philipp Seidl, Carl Böck, Stefan Thumfart, Michael Giretzlehner, Sepp Hochreiter, Jens Meier","doi":"10.1097/EJA.0000000000002238","DOIUrl":"https://doi.org/10.1097/EJA.0000000000002238","url":null,"abstract":"<p><strong>Background: </strong>Anaesthesiology and intensive care use monitoring to identify patients in danger of deterioration. Traditionally, trends and early warning scores allow clinicians to predict deterioration with moderate reliability. Reduced mean arterial blood pressure has been associated with complications, and models have been sought to predict its value. Machine learning methods with complex inputs have been used for predictive monitoring in hospital care.</p><p><strong>Objectives: </strong>This study evaluates whether machine learning can predict mean arterial pressure (MAP) from previous values.</p><p><strong>Design: </strong>This is a monocentre, retrospective, exploratory, observational cohort study using the MIMIC-III-WDB, VitalDB and an internal study centre dataset, training machine learning models on adult patients with invasively measured blood pressure (IBP) as input during an observation window up to 20 min before the prediction horizon (5 to 20 min).</p><p><strong>Setting: </strong>Kepler University Hospital, Linz, Austria.</p><p><strong>Participants: </strong>Two thousand three hundred and forty-six patients from the internal dataset, 4741 patients from MIMIC-III-WDB and 3357 patients from VitalDB were analysed.</p><p><strong>Main outcome measures: </strong>The primary endpoint was model performance in predicting whether MAP would fall below 65 mmHg in a given time frame. In a secondary analysis, we restricted the input set to stable patients with current MAP above 65 mmHg.</p><p><strong>Results: </strong>Models using the complete training data achieved receiver operating characteristic area under the curves (ROC AUCs) of 0.963, 0.946, 0.934 and 0.923 on the internal dataset for 5, 10, 15 and 20 min of prediction horizon, respectively, and 0.856, 0.837, 0.821 and 0.804 in the secondary analysis. The maximum difference of ROC AUC to baseline measurement (ROC AUC of last measured MAP as trivial estimator) was 0.006 for the complete training data and 0.051 for stable patients. The prediction of MAP may allow clinicians to intervene in time before MAP deterioration becomes clinically relevant.</p><p><strong>Conclusion: </strong>Predicting MAP below 65 mmHg within 5, 10, 15 and 20 min for patients with and without a MAP above 65 mmHg is possible and requires only MAP as input for machine learning models.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov (NCT05471193).</p>","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":""},"PeriodicalIF":6.8,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144728982","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sigrun Asgeirsdottir, Elias K Karlsson, Theodor Sigurdsson
{"title":"'The trachea heals but the hypoxia does not' an emergency front-of-neck access in a 4-year-old with foreign body airway obstruction.","authors":"Sigrun Asgeirsdottir, Elias K Karlsson, Theodor Sigurdsson","doi":"10.1097/EJA.0000000000002230","DOIUrl":"https://doi.org/10.1097/EJA.0000000000002230","url":null,"abstract":"<p><p>'Can't Intubate Can't Oxygenate' (CICO) situation is a life-threatening emergency, and an uncommon event in the healthy paediatric population. In children without anatomical airway anomalies, this scenario is most often due to laryngospasm or airway obstruction and can in most cases, be reversed with appropriate medical treatment or removal of the foreign body. This case report describes an emergency front-of-neck surgical airway (eFONA) with a scalpel-bougie-tube method, during cardiopulmonary resuscitation in a 4-year-old child due to foreign body airway obstruction.</p>","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144575104","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Phillip Hoppe, Yuan Chang, Tobias Schwarz, Alina Bergholz, Kristen K Thomsen, Alina Kröker, Moritz Flick, Linda Krause, Daniel I Sessler, Bernd Saugel
{"title":"New-onset postoperative hypotension in patients recovering from noncardiac surgery: A prospective observational study.","authors":"Phillip Hoppe, Yuan Chang, Tobias Schwarz, Alina Bergholz, Kristen K Thomsen, Alina Kröker, Moritz Flick, Linda Krause, Daniel I Sessler, Bernd Saugel","doi":"10.1097/EJA.0000000000002227","DOIUrl":"https://doi.org/10.1097/EJA.0000000000002227","url":null,"abstract":"<p><strong>Background: </strong>It remains unknown whether postoperative mean arterial pressures less than 65 mmHg constitute clinically important hypotension for individual patients, or might be within their normal pressure range.</p><p><strong>Objective: </strong>We aimed to evaluate postoperative arterial pressure in patients recovering from noncardiac surgery and determine the proportion of patients in whom a mean arterial pressure less than 65 mmHg constitutes new-onset postoperative hypotension.</p><p><strong>Design: </strong>A prospective observational study.</p><p><strong>Setting: </strong>German university medical centre between October 2020 and September 2021.</p><p><strong>Patients: </strong>Patients with elevated cardiovascular risk recovering on general wards from noncardiac surgery under general anaesthesia.</p><p><strong>Main outcome measures: </strong>Before and after surgery, we automatically measured arterial pressure at 30-min intervals for about 24 h. We considered patients to have new-onset postoperative hypotension when they had a postoperative mean arterial pressure less than 65 mmHg, and their lowest postoperative mean arterial pressure was at least 5 mmHg below their lowest pre-operative mean arterial pressure.</p><p><strong>Results: </strong>We enrolled 307 patients and included 248 in the final analysis. The median [IQR] duration of surgery was 62 [40 to 90] min. Postoperative mean arterial pressure was less than 65 mmHg at least once in 101 patients (41%). In 44 of these 101 patients (44%; 18% of all 248 patients), postoperative mean arterial pressures less than 65 mmHg constituted new-onset postoperative hypotension. In 57 of these 101 patients (56%; 23% of all 248 patients), postoperative mean arterial pressures less than 65 mmHg did not constitute new-onset postoperative hypotension.</p><p><strong>Conclusion: </strong>About 40% of our patients recovering from noncardiac surgery on general wards had at least one postoperative mean arterial pressure less than 65 mmHg, and about half of these patients had new-onset postoperative hypotension.</p>","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144607862","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Juan R Castaño-Asins, Alberto Barceló-Soler, Estíbaliz Royuela-Colomer, Juan P Sanabria-Mazo, Vanesa García, Randy Neblett, Antonio Bulbena, Víctor Pérez-Solà, Antonio Montes-Pérez, Gerard Urrútia, Albert Feliu-Soler, Juan V Luciano
{"title":"Effectiveness of peri-operative psychological interventions for the reduction of postsurgical pain intensity, depression, anxiety and pain catastrophising: A systematic review and meta-analysis.","authors":"Juan R Castaño-Asins, Alberto Barceló-Soler, Estíbaliz Royuela-Colomer, Juan P Sanabria-Mazo, Vanesa García, Randy Neblett, Antonio Bulbena, Víctor Pérez-Solà, Antonio Montes-Pérez, Gerard Urrútia, Albert Feliu-Soler, Juan V Luciano","doi":"10.1097/EJA.0000000000002157","DOIUrl":"10.1097/EJA.0000000000002157","url":null,"abstract":"<p><strong>Background: </strong>Evidence suggests that psychological interventions during the peri-operative period can help reduce the development of chronic postsurgical pain (CPSP); however, there is no evidence of their effects on other important pain-related variables.</p><p><strong>Objectives: </strong>This systematic review and meta-analysis evaluated the effectiveness of peri-operative psychological interventions for the reduction of postsurgical pain intensity, depression, anxiety, stress and pain catastrophising.</p><p><strong>Study design: </strong>Systematic review of randomised controlled trials (RCTs) with meta-analyses (registration number: CRD42023403384). The search for studies was carried out in Web of Science, PsychINFO, MEDLINE and CINAHL up to March 2023.</p><p><strong>Eligibility criteria: </strong>RCTs comparing peri-operative psychological interventions with usual care or nonpsychological control interventions in adult patients with any type of surgery. The main outcome was pain intensity reduction after surgery. Secondary outcomes included patient-reported depression, anxiety, stress and pain catastrophising after surgery.</p><p><strong>Results: </strong>Twenty-seven RCTs (psychological intervention: 1462 patients; control: 1528 patients) were included in the systematic review and 17 studies for the meta-analysis. Random-effect models were used to combine the effect sizes of the studies. Compared with usual care or control interventions, psychological interventions reduced pain intensity, d = -0.45 95% CI, (-0.77 to -0.13) and anxiety, d = -0.33 95% CI, (-0.54 to -0.11) after surgery. Moderator analyses revealed that psychological interventions delivered by a psychologist were more effective than those delivered by other professionals. CBT seemed the most beneficial for surgical patients. The findings in other moderator analyses were heterogeneous.</p><p><strong>Conclusions: </strong>Moderate-quality evidence exists that peri-operative psychological interventions can significantly reduce pain intensity and anxiety postsurgery. However, results should be interpreted with caution because of the presence of a high risk of bias in many trials.</p>","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":"42 7","pages":"609-625"},"PeriodicalIF":4.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144215336","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Elisabeth A Rieff, Tom G Jacobs, Nicolaas H Sperna Weiland, Caroline van der Marel, Nicole Hunfeld
{"title":"Waste and cost assessment of total intravenous anaesthesia in the context of environmental sustainability: Insights from a Dutch academic hospital.","authors":"Elisabeth A Rieff, Tom G Jacobs, Nicolaas H Sperna Weiland, Caroline van der Marel, Nicole Hunfeld","doi":"10.1097/EJA.0000000000002176","DOIUrl":"10.1097/EJA.0000000000002176","url":null,"abstract":"","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":"655-657"},"PeriodicalIF":4.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12147722/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143973790","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Nathalie M Malewicz-Oeck, Nic Skorupka, Felix Bartholmes, Adeline Dombrowski, Melanie Ebel, Peter K Zahn, Christine H Meyer-Frießem
{"title":"Pupillary dilation to monitor nociception in awake volunteers: A stimuli-randomised placebo-controlled study.","authors":"Nathalie M Malewicz-Oeck, Nic Skorupka, Felix Bartholmes, Adeline Dombrowski, Melanie Ebel, Peter K Zahn, Christine H Meyer-Frießem","doi":"10.1097/EJA.0000000000002143","DOIUrl":"10.1097/EJA.0000000000002143","url":null,"abstract":"<p><strong>Background: </strong>Pupillary reflex dilation (PRD) quantifies nociception in anaesthetised patients, enabling tailored opioid administration, which in turn reduces catecholamine levels and postoperative pain intensity. However, its utility in objectively assessing pain in awake individuals remains challenging.</p><p><strong>Objective: </strong>To investigate whether PRD can differentiate between painful and nonpainful stimuli in awake volunteers.</p><p><strong>Design: </strong>This was a randomised, placebo-controlled, stimuli-randomised study conducted after ethical approval and registration (DRKS00024791).</p><p><strong>Setting: </strong>This single-centre study was performed at BG University Hospital Bergmannsheil Bochum, Germany, between November 2021 and January 2022.</p><p><strong>Volunteers: </strong>Thirty healthy volunteers (25 ± 2 years, 50% male) were included in the study.</p><p><strong>Interventions: </strong>After a rest, the following stimuli were applied to one ventral forearm: an unannounced electric pain stimulus (UPS) and a randomised sequence of either an announced painful stimulus (APS), a placebo or a nonpainful stimulus (NPS).</p><p><strong>Main outcome measures: </strong>Pupil dilatation was measured as PRD (%) for 60 s during the experimental condition \"rest\", and during and after each stimulus application using an AlgiScan device. The participants rated stimulus pain intensity via a numeric rating scale (NRS: 0 = no pain, 10 = most intense pain imaginable). Statistics: Paired t -test, rmANOVA, Spearman's correlation and receiver operating characteristics (ROC), P < 0.05.</p><p><strong>Results: </strong>The subjective pain intensity ratings were higher after APS (6.0 ± 1.9) than after UPS (5.5 ± 1.7, P = 0.007), placebo (0.0 ± 0.0, P = 0.027) and NPS (0.0 ± 0.0, P = 0.001). Similarly, objective pupillary reaction to the stimuli measured using PRD was higher for APS: 13 (97.6% CI, 10.0 to 19.0)% vs. NPS 13 (97.6% CI, 7.0 to 20.0), P = 0.024). UPS elicited the highest PRD of 25 (95.7% CI, 18.0 to 30.0)% vs. rest, P < 0.001; significantly greater than placebo at 13.5 (96.4% CI, 10.0 to 22.0)%, P < 0.001); and NPS at 13 (97.6% CI, 7.0 to 20.0)%, P < 0.0001). However, no significant differences in PRD were observed between APS and UPS despite their electrical similarity. PRD correlated with pain intensity ( r = 0.35, P < 0.0001).</p><p><strong>Conclusions: </strong>In awake volunteers, PRD differentiates between painful and nonpainful stimuli and correlates with pain intensity. Noninvasive PRD measurement may be suitable for nociception monitoring in awake individuals.</p><p><strong>Trial registration: </strong>Prospectively DRKS00024791, March 2021.</p>","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":"587-598"},"PeriodicalIF":4.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143491353","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Anders H Springborg, Claus Varnum, Niklas I Nielsen, Lasse E Rasmussen, Per Kjærsgaard-Andersen, Lina Pleckaitiene, Kirill Gromov, Anders Troelsen, Henrik Kehlet, Nicolai B Foss
{"title":"Repeat-dose dexamethasone to prevent pain relapse after total knee arthroplasty in high-pain-response patients: A randomised, double-blind, placebo-controlled superiority trial.","authors":"Anders H Springborg, Claus Varnum, Niklas I Nielsen, Lasse E Rasmussen, Per Kjærsgaard-Andersen, Lina Pleckaitiene, Kirill Gromov, Anders Troelsen, Henrik Kehlet, Nicolai B Foss","doi":"10.1097/EJA.0000000000002189","DOIUrl":"10.1097/EJA.0000000000002189","url":null,"abstract":"<p><strong>Background: </strong>Peri-operative glucocorticoids reduce pain after total knee arthroplasty, with evidence suggesting potential benefits of increased dosing in specific patient groups. However, the impact of repeat-dose glucocorticoids has not been studied in high-pain-response patients receiving pre-operative high-dose glucocorticoids.</p><p><strong>Objective: </strong>To investigate the effect on pain of an oral dose of dexamethasone after total knee arthroplasty in selected high-pain-response patients who had received a pre-operative high dose of intravenous dexamethasone (1 mg kg -1 ).</p><p><strong>Design: </strong>Randomised, double-blind, placebo-controlled superiority study.</p><p><strong>Setting: </strong>A multicentre study conducted at two major arthroplasty centres in Denmark from November 2021 to March 2024.</p><p><strong>Patients: </strong>One hundred and ten patients undergoing total knee arthroplasty who had received multimodal analgesia including pre-operative intravenous dexamethasone 1 mg kg -1 . Selection criteria included a Pain Catastrophising Scale score greater than 20 and moderate-to-severe pain (VAS >30) during walking 24 h postoperatively.</p><p><strong>Intervention: </strong>Patients were randomised to either oral dexamethasone 24 mg or placebo on postoperative day 1.</p><p><strong>Main outcome measures: </strong>The primary outcome was the proportion of patients experiencing moderate-to-severe pain during walking at 48 h postoperatively. Secondary outcomes included pain scores at various time points within 1 week postoperatively, rescue analgesics, quality of sleep, length of hospital stay and morbidity with follow-up at 30 days.</p><p><strong>Results: </strong>At 48 h postoperatively, 65% of patients in the dexamethasone group and 79% in the placebo group reported moderate-to-severe pain during walking: odds ratio 0.48 [95% confidence interval (CI), 0.20 to 1.16]; P = 0.100. The mean ± SD Visual Analogue Scale (VAS) at 48 h during walking was 43 ± 21 in the dexamethasone group and 51 ± 22 in the placebo group ( P = 0.051). There were no differences between the groups regarding secondary pain outcomes or the use of rescue analgesics.</p><p><strong>Conclusion: </strong>The administration of a high oral dose of dexamethasone following an initial pre-operative dose of 1 mg kg -1 intravenously in selected high-pain-response patients had no effect on postoperative pain following total knee arthroplasty.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov identifier NCT05563155.</p>","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":"599-608"},"PeriodicalIF":4.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143973785","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sarah Saxena, Mia Gisselbaek, Joana Berger-Estilita, Alain F Kalmar
{"title":"CO 2 -equivalent emissions of a Bispectral Index electrode.","authors":"Sarah Saxena, Mia Gisselbaek, Joana Berger-Estilita, Alain F Kalmar","doi":"10.1097/EJA.0000000000002175","DOIUrl":"10.1097/EJA.0000000000002175","url":null,"abstract":"","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":"653-655"},"PeriodicalIF":4.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143700055","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Paravertebral block is not superior to the interpectoral and pectoserratus plane block for patients undergoing breast surgery: An updated meta-analysis of randomised controlled trials with meta-regression and trial sequential analysis.","authors":"Burhan Dost, Dario Bugada, Yunus Emre Karapinar, Eleonora Balzani, Muzeyyen Beldagli, Giulia Aviani Fulvio, Mirac Selcen Ozkal Yalin, Esra Turunc, Nicolò Sella, Alessandro De Cassai","doi":"10.1097/EJA.0000000000002148","DOIUrl":"10.1097/EJA.0000000000002148","url":null,"abstract":"<p><strong>Background: </strong>Breast surgery is frequently associated with significant acute postoperative pain, necessitating effective pain management strategies. Both thoracic paravertebral block (PVB) and interpectoral plane and pectoserratus plane (IP+PS) blocks have been used to relieve pain after breast surgery.</p><p><strong>Objective: </strong>In this systematic review and meta-analysis with trial sequential analysis, we aimed to identify the optimal analgesic technique for achieving effective pain relief in breast surgery. The primary outcome of this study was postoperative opioid consumption expressed as morphine milligram equivalent (MME) at 24 h. Secondary outcomes included resting and movement pain scores at 0, 6, 12 and 24 h, postoperative nausea and vomiting (PONV), and rescue analgesic requirements within the first 24 h.</p><p><strong>Design: </strong>A meta-analysis of randomised controlled trials (RCTs) with meta-regression and trial sequential analysis (TSA).</p><p><strong>Data search: </strong>We systematically searched Pubmed, Scopus, the Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, Google Scholar, Medline (from inception to until 1 October 2024).</p><p><strong>Eligibility criteria: </strong>RCTs that include patients undergoing breast surgery with PVB or IP+PS block, with no language restriction.</p><p><strong>Results: </strong>Eighteen RCTs with 924 patients were included. No significant difference in MME consumption at 24 h was observed between the two techniques; mean difference (MD) -1.94 (95% confidence interval (CI) -4.27 to 0.38, P = 0.101). Subgroup analyses revealed a minor advantage for IP+PS in patients without axillary involvement; MD -2.42 (95% CI -3.56 to -1.29, P < 0.001), though below the threshold of clinical significance. Secondary outcomes, including pain scores, PONV incidence and rescue analgesic requirements were comparable. Trial sequential analysis (TSA) confirmed sufficient sample size, suggesting further studies may not alter conclusions.</p><p><strong>Conclusion: </strong>PVB and IP+PS blocks offer comparable analgesic efficacy and opioid-sparing effects after breast surgery, with no meaningful differences in 24-h MME consumption, pain scores, or PONV incidence.</p>","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":"637-648"},"PeriodicalIF":4.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143398678","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}