European Journal of Anaesthesiology最新文献

{"title":"Oxygen reserve index as a peri-operative guide for alveolar recruitment manoeuvre during Whipple's surgical procedure: A randomised controlled trial.","authors":"Yasmin Kamel, Amira Elkholy, Ashraf Eskandr, Ahmed A Metwally, Khaled Ahmed Yassen","doi":"10.1097/EJA.0000000000002207","DOIUrl":"10.1097/EJA.0000000000002207","url":null,"abstract":"","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":"851-854"},"PeriodicalIF":6.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144233603","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":"Minimum effective volume 90% for ultrasound-guided selective trunk block: A quantal bioassay.","authors":"Ranjith Kumar Sivakumar, Manoj Kumar Karmakar, Rosinni S L Wong, Winnie Samy","doi":"10.1097/EJA.0000000000002160","DOIUrl":"10.1097/EJA.0000000000002160","url":null,"abstract":"<p><strong>Background: </strong>Selective trunk block (SeTB) targets the three trunks of the brachial plexus and produces surgical anaesthesia of the entire upper extremity, including the shoulder. However, the optimal dose of local anaesthetic (LA) required for a SeTB is not known.</p><p><strong>Objective: </strong>This study aimed to evaluate the minimum effective volume 90% (MEV90) of LA required for a SeTB.</p><p><strong>Design: </strong>Quantal bioassay.</p><p><strong>Setting: </strong>Single-centre, University hospital in Hong Kong S.A.R, China.</p><p><strong>Patients: </strong>After ethical approval, 25 ASA I to III patients, aged 18 to 75 years, undergoing upper extremity surgery under an ultrasound-guided (USG) SeTB were included.</p><p><strong>Intervention: </strong>The volume of the LA (1 : 1 mixture of 2% lidocaine with 5 μg ml -1 epinephrine and 0.5% levobupivacaine) used, starting with 21 ml, was assigned by either increasing or decreasing 3 ml (1 ml each trunk), based on the modified Narayana sequential design.</p><p><strong>Main outcome measures: </strong>Readiness for surgery (sensory score ≤30 and motor score ≤1) at or within 30 min after the injection was the primary outcome measure. A successful block was defined as achieving readiness for surgery within 30 min and completing the intended surgery without rescue analgesia or conversion to general anaesthesia. The MEV90 was estimated using centred isotonic regression.</p><p><strong>Results: </strong>The MEV90 of the LA mixture for USG SeTB was 24.7 [95% confidence interval (CI), 23.8 to 28.9] ml. The median [IQR] time to 'readiness for surgery' and 'complete anaesthesia' was 6.6 [5 to 12.3] and 15 [7.3 to 18] minutes, respectively.</p><p><strong>Conclusion: </strong>The MEV90 of a 1 : 1 LA mixture for USG SeTB to produce surgical anaesthesia of the entire upper extremity (except for the T2 dermatome), using readiness for surgery as the success criterion, is 24.7 ml (95% CI, 23.8 to 28.9) ml.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov, Trial Registration No: NCT04773405.</p>","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":"800-807"},"PeriodicalIF":6.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143604518","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":"Association between pre-operative borderline anaemia in women and outcome after coronary artery bypass grafting: data from the Netherlands Heart Registration.","authors":"Yannick J J M Hazen, Peter G Noordzij, Joost M A A Van Der Maaten, Susanne Eberl, Maarten Ter Horst, Saskia Houterman, Remco R Berendsen, R Arthur Bouwman, Johannes S E Haenen, Jan Hofland, Marieke F Kingma, Jan Van Klarenbosch, Toni Klok, Marcel P J De Korte, Alexander J Spanjersberg, Nicobert E Wietsma, Bastiaan M Gerritse, Thierry V Scohy, Nardo J M van der Meer, Elise Y Sarton, Thijs C D Rettig","doi":"10.1097/EJA.0000000000002202","DOIUrl":"10.1097/EJA.0000000000002202","url":null,"abstract":"<p><strong>Background: </strong>Haemoglobin concentration thresholds differ between men and women, with borderline anaemia (haemoglobin ≥ 12.1 and < 13.1 g dl -1 ) considered normal in women. However, this haemoglobin range may increase the risk of postoperative adverse outcomes after cardiac surgery.</p><p><strong>Objectives: </strong>To determine if pre-operative borderline anaemia in women is associated with increased postoperative mortality and morbidity following coronary artery bypass grafting (CABG).</p><p><strong>Design: </strong>A retrospective observational cohort study.</p><p><strong>Setting: </strong>Data from The Netherlands Heart Registration, a national cardiac surgery registry, were used to analyse patients undergoing CABG from January 2013 to December 2020.</p><p><strong>Patients: </strong>A cohort of 7802 women undergoing CABG was analysed, of whom 25% ( n  = 1963) had pre-operative borderline anaemia. Inclusion criteria were adult women undergoing isolated CABG; exclusion criteria included patients with severe anaemia or non-CABG procedures.</p><p><strong>Main outcome measures: </strong>The primary outcome was 120-day mortality. Secondary outcomes included postoperative renal failure and need for packed red blood cell (PRBC) transfusion.</p><p><strong>Results: </strong>Borderline anaemia in women was not significantly associated with 120-day mortality (adjusted odds ratio [AOR] 1.2; 95% CI 0.8 to 1.9; P  = 0.366). However, it was associated with an increased risk of renal failure (AOR 2.2; 95% CI 1.1 to 4.2; P  = 0.031) and PRBC transfusion (AOR 2.1; 95% CI 1.8 to 2.3; P  < 0.001).</p><p><strong>Conclusions: </strong>Borderline anaemia, present in one-fourth of women undergoing CABG, does not increase mortality risk but is associated with higher postoperative morbidity, specifically renal failure and transfusion requirements.</p>","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":"817-825"},"PeriodicalIF":6.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144119110","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":"Association of plasma biomarkers of lung injury with positive end expiratory pressure and postoperative pulmonary complications in obese surgical patients: A substudy of the PROBESE randomised controlled trial.","authors":"Thomas Bluth, Eva Rivas, Manuel López-Baamonde, Josep Martí Sanahuja, Antonio López-Hernández, Jaume Balust, Toby N Weingarten, Felix Girrbach, Philipp Simon, Hermann Wrigge, Jakob Wittenstein, Katharina Birr, Robert Teichmann, Robert Huhle, Niklas Melchior, Luigi Vivona, Thea Koch, Harish Ramakrishna, Sorin Brull, Ary Serpa Neto, Marcus J Schultz, Juraj Sprung, Martin Scharffenberg, Marcelo Gama de Abreu","doi":"10.1097/EJA.0000000000002221","DOIUrl":"10.1097/EJA.0000000000002221","url":null,"abstract":"<p><strong>Background: </strong>The effect of positive end expiratory pressure (PEEP) on postoperative pulmonary complications (PPCs) in obese patients remains controversial.</p><p><strong>Objective: </strong>To test, whether intra-operative PEEP or PPCs are associated with plasma levels of biomarkers of lung injury.</p><p><strong>Design: </strong>A prospective substudy of a multicentre randomised controlled trial (PROBESE).</p><p><strong>Setting: </strong>Operating rooms of six tertiary care centres in the United States and Europe.</p><p><strong>Patients: </strong>Obese patients at risk for PPCs undergoing abdominal surgery.</p><p><strong>Intervention: </strong>Intra-operative low tidal volume ventilation with high PEEP (12 cmH 2 O) and recruitment manoeuvres, or low PEEP (4 cmH 2 O).</p><p><strong>Main outcome measures: </strong>The primary endpoint was the association between absolute postoperative plasma levels of receptor for advanced glycation end-products (RAGE) and intra-operative PEEP; secondary endpoints included pre and postoperative plasma concentrations as well as the relative changes of interleukin-6, IL-8, tumour necrosis factor-α, surfactant protein D, mucin-1, clara cell protein-16, intercellular adhesion molecule-1 and vascular cell adhesion molecule. PPCs were assessed as a 'collapsed composite' of adverse pulmonary events. The predictive ability of biomarkers for PPCs was assessed with the receiver operating curve-area under the curve (ROC-AUC).</p><p><strong>Results: </strong>A total of 96 patients received low PEEP, and 95 patients high PEEP. Postoperative plasma concentrations of RAGE and other biomarkers did not differ between groups. The relative increase of RAGE during surgery was more pronounced with low than high PEEP; median [IQR], 1.2 [1.0 to 1.6] vs. 1.1 [0.9 to 1.3], P  = 0.012. Patients who developed PPCs showed higher postoperative plasma levels and relative increase of IL-6; 26.3 [12.6 to 139.5] vs. 15.1 [3.7 to 38.7] fold change. The ROC-AUC was less than 0.7 for all biomarkers.</p><p><strong>Conclusions: </strong>In this subgroup, choice of PEEP did not affect postoperative biomarkers of lung injury. Irrespective of PEEP, PPCs were associated with an increase in plasma levels of these biomarkers, but their predictive capability was poor.</p><p><strong>Trial registration: </strong>Clinicaltrials.gov, identifier: NCT02148692.</p>","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":"840-850"},"PeriodicalIF":6.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144474383","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":"Shared decision-making for older adults in the peri-operative setting: A narrative review.","authors":"Yotam Weiss, Shiri Zarour, Mark D Neuman, Mary C Politi, Victoria L Tang, Mia Gisselbaek, Joana Berger-Estilita, Sarah Saxena","doi":"10.1097/EJA.0000000000002224","DOIUrl":"10.1097/EJA.0000000000002224","url":null,"abstract":"<p><p>Older adults undergoing surgery often face numerous challenges to healthcare decisions due to frailty, comorbidities and varying personal priorities. Shared decision-making (SDM) is a patient-centred approach that enhances peri-operative care by aligning medical decisions with individual values and preferences. When considering surgery for an older adult, SDM can ensure that the surgical treatment plan focuses on what older adults find important, such as quality of life (QOL), functional independence, long-term well being and survival. This narrative review explores the role of SDM in peri-operative care of older adults and strategies for increasing SDM in this context. SDM fosters collaboration between patients, families and healthcare teams; as a result, it can lead to improved patient satisfaction, reduced decisional conflict and greater trust between patients and their medical teams. However, integrating SDM into routine practice remains complex due to cognitive impairment, communication barriers, time constraints and gaps in evidence. Effective SDM strategies include enhancing interdisciplinary collaboration, improving clinician and staff training, developing decision aids tailored to older adults considering surgery and leveraging technology to support patient engagement. Future efforts should focus on expanding SDM research, refining implementation frameworks and advocating for policy changes that facilitate patient-centred surgical decision-making in older adults. As the global population ages, prioritising SDM in peri-operative care will be critical to optimising patient outcomes, ensuring ethical, informed decision-making and aligning care plans with the patient's goals and values.</p>","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":"767-773"},"PeriodicalIF":6.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144474397","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":"Preventing pulmonary complications after laparoscopic colorectal surgery: a lung-protective protocol vs. standard care: A randomised controlled trial.","authors":"Tao Yan, Hui-Xian Li, Yu-Lin Sun, Yi Liu, Rong Chen, Rong-Hui Peng, Zhao-Xu Zheng, Shi-Ning Qu, Fei Wang, Wei Tang, Lin Zhang, Shi-Jing Wei, Bao-Na Wang, Li Sun, Hui Zheng","doi":"10.1097/EJA.0000000000002161","DOIUrl":"10.1097/EJA.0000000000002161","url":null,"abstract":"<p><strong>Background: </strong>Placing patients in the steep Trendelenburg position with a pressurised pneumoperitoneum during laparoscopic colorectal surgery increases pulmonary airway pressure, increasing the risks of lung injury and postoperative pulmonary complications, even in patients with healthy lungs.</p><p><strong>Objectives: </strong>The aim was to determine whether an integrated anaesthesia protocol was superior to traditional protective ventilation in terms of preventing pulmonary complications.</p><p><strong>Design: </strong>This study used a randomised, controlled, parallel-group design.</p><p><strong>Setting: </strong>This single-centre trial was conducted at the National Cancer Centre/Cancer Hospital of the Chinese Academy of Medical Sciences from January to May 2023.</p><p><strong>Patients: </strong>A total of 120 patients who underwent laparoscopic surgery for colorectal cancer with intermediate to high risk of pulmonary complications, as determined by the Assess Respiratory Risk in Surgical Patients in Catalonia (ARISCAT) score.</p><p><strong>Interventions: </strong>Participants were randomly assigned to either lung protective ventilation with a tidal volume of 6 ml kg -1 of predicted body weight + deep neuromuscular block (a train-of-four count of 0 and post tetanic of 1 to 2) + low peritoneal pressure (10 mmHg) or conventional pulmonary ventilation with a tidal volume of 8 ml kg -1 of predicted body weight + moderate neuromuscular block (a train-of-four count of 1 to 2) + standard peritoneal pressure (15 mmHg).</p><p><strong>Main outcome measurements: </strong>The primary outcome was the incidence of pulmonary complications within 30 postoperative days. The secondary outcomes included serological biomarkers of lung injury.</p><p><strong>Results: </strong>The lung protective group had a significantly lower incidence of pulmonary complications (15.0%) than the conventional group (38.3%; hazard ratio, 0.332; 95% CI, 0.153 to 0.718; P  = 0.003). There were no significant differences in the plasma biomarker levels of soluble receptor for advanced glycation end products and angiopoietin-2 for lung injury between the groups. The treatment-by-covariate interactive analysis revealed that the lung-protective strategy conferred considerable benefits for males and individuals aged 60 years or above. A nomogram that predicted pulmonary complications incorporating four variables exhibited a strong discriminative performance, and the results of the decision curve analysis revealed the potential clinical value of this nomogram.</p><p><strong>Conclusion: </strong>Compared with traditional strategies, the integrated lung-protective approach may mitigate pulmonary complications without causing lung injury in intermediate to high-respiratory-risk patients undergoing laparoscopic colorectal surgery.</p><p><strong>Trial registration: </strong>Chinese Clinical Trial Register Identifier: ChiCTR2100054215.</p>","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":"826-839"},"PeriodicalIF":6.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143751670","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":"Intravenous dexmedetomidine as addition to dexamethasone for interscalene brachial plexus block for postoperative analgesia after arthroscopic shoulder surgery: A randomised, double-blinded, single centre trial.","authors":"Hervé Vanden Eede, Sophie Noels, Marco Vreven, Jo Dujardyn, Martin Vanden Eede, Jordi Branders, Lise Vanden Eede, Gilles De Herdt, Isabelle Noels, Jason Bouziotis, Vera Saldien","doi":"10.1097/EJA.0000000000002196","DOIUrl":"10.1097/EJA.0000000000002196","url":null,"abstract":"<p><strong>Background: </strong>The co-administration of intravenous dexamethasone and dexmedetomidine is reported to prolong the duration of analgesia after single-shot interscalene brachial plexus block. The most effective dose with minimal side effects remains undetermined.</p><p><strong>Objectives: </strong>To evaluate the difference in time to first analgesic request in patients receiving different doses of intravenous dexmedetomidine after an interscalene brachial plexus block undergoing arthroscopic shoulder surgery.</p><p><strong>Design: </strong>A double-blind, randomised controlled study.</p><p><strong>Setting: </strong>A single-centre study from November 2021 to December 2023.</p><p><strong>Patients: </strong>Two hundred and eighteen patients undergoing arthroscopic shoulder surgery were included.</p><p><strong>Interventions: </strong>Patients were randomly assigned to one of four groups using blocked randomisation: intravenous 0.9% saline (group 1) or intravenous dexmedetomidine: 1.0 (group 2), 1.5 (group 3) and 2.0 (group 4) μg kg -1 .</p><p><strong>Main outcome measures: </strong>The primary outcome was the time to first analgesic request in hours.</p><p><strong>Results: </strong>There was no significant difference in the time to first analgesic request: group 1 (18.8 ± 6.3 h), group 2 (18.7 ± 5.1 h), group 3 (17.7 ± 5.6 h) and group 4 (19.5 ± 5.0 h). There was no significant difference in postoperative nausea and vomiting, patient satisfaction and quality of sleep in the first 24 h. There were significant differences in the incidences of intra-operative hypotension and bradycardia between the control group and all the dexmedetomidine groups combined; however, this study was not powered for this analysis. The time to extubation was statistically significantly higher in group 4 with a prolonged time to extubation (>14 min) when the duration of surgery was shorter (OR 0.98, 95% CI 0.96 to 0.99).</p><p><strong>Conclusions: </strong>Administering high doses of intravenous dexmedetomidine may not yield additional analgesic benefits after single-shot interscalene brachial plexus block while potentially increasing haemodynamic risks and prolonging time to extubation.</p><p><strong>Trial registration: </strong>EudraCT 2021-004686-12.</p>","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":"808-816"},"PeriodicalIF":6.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143963263","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":"QUAdratus Lumborum block in Caesarean Section (QUALICS) study: A randomised clinical trial comparing intrathecal morphine, quadratus lumborum block and the combination of both for postoperative analgesia in caesarean sections.","authors":"Hermann Dos Santos Fernandes, Shirley Andrade Santos, Thiago Camargo Ferreira, Cristian Arzola, Amanda Tiemi Nakamura, Heloisa Souza Del Frari, Joaquim Edson Vieira, Rossana Pulcineli Vieira Francisco, Fernando Souza Nani","doi":"10.1097/EJA.0000000000002205","DOIUrl":"10.1097/EJA.0000000000002205","url":null,"abstract":"","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":"855-857"},"PeriodicalIF":6.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144119029","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":"Comparison of different bolus delivery speeds of a programmed intermittent epidural bolus combined with dural puncture epidural block during labour analgesia: A randomised controlled study.","authors":"Yilu Zhou, Ruijing Ma, Jian Tang, Yujie Song, Zhiqiang Liu, Zhendong Xu","doi":"10.1097/EJA.0000000000002214","DOIUrl":"10.1097/EJA.0000000000002214","url":null,"abstract":"<p><strong>Background: </strong>Dural puncture epidural block (DPE) with programmed intermittent epidural bolus (PIEB) delivery provides effective analgesia for labour pain; however, it poses a risk of a high level of block.</p><p><strong>Objective: </strong>To investigate the effect different pump speeds for a PIEB on maternal sensory block after DPE.</p><p><strong>Design: </strong>A prospective, double-blind, randomised controlled study.</p><p><strong>Setting: </strong>An Obstetrics and Gynaecology Hospital, China, from June 2023 to December 2023.</p><p><strong>Participants: </strong>Labour analgesia was administered to 120 nulliparous women with a singleton pregnancy during the first stage of labour.</p><p><strong>Intervention: </strong>After DPE insertion, women using labour analgesia were randomly allocated into a low-speed group (120 ml h -1 ), a medium-speed group (240 ml h -1 ) or a high-speed group (360 ml h -1 ). Epidural catheters were placed at L3/4 or L4/5, and epidural analgesia was maintained with a PIEB; 10 ml every 60 min using 0.1% ropivacaine with 0.3 μg ml -1 sufentanil.</p><p><strong>Main outcome measure: </strong>The primary outcome was the highest level of upper sensory block from administering DPE combined with PIEB until delivery.</p><p><strong>Results: </strong>A total of 143 parturients were approached and 120 were randomised to three groups of 40. There were no statistically significant differences between the three groups at any time in either the highest sensory block ( P  = 0.14) or the upper sensory block ( P  = 0.27). Lower sensory ( P  = 0.20) and sacral blocks ( P  = 0.84) did not differ between groups. Nevertheless, the highest visual analogue pain scores (> 3) after labour anaesthesia was statistically different between the three groups ( P  = 0.023). Satisfaction with labour analgesia was significantly different between groups ( P  = 0.006). No differences in other secondary outcomes were noted.</p><p><strong>Conclusion: </strong>DPE with PIEB delivery of 360 ml h -1 did not produce higher sensory block levels than either 240 ml h -1 or 120 ml h -1 . However, in secondary outcomes, the high speed delivery did provide more effective labour analgesia and higher satisfaction than low speed delivery.</p>","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":"783-790"},"PeriodicalIF":6.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144474395","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":"Double dural puncture epidural improves quality of labour analgesia without increasing adverse effects in primipara: A randomised controlled trial.","authors":"Huan Yu, Jin-Feng Wang, Shu Wang, Yun Wang, Gang Tang, Yu-E Sun, Yin-Ming Zeng, Wei Cheng","doi":"10.1097/EJA.0000000000002198","DOIUrl":"10.1097/EJA.0000000000002198","url":null,"abstract":"<p><strong>Background: </strong>Neuraxial anaesthesia is considered a routine method of reducing labour pain. Over the past few decades, several improvements in neuraxial labour analgesia have been studied and evaluated.</p><p><strong>Objective: </strong>This trial compared the analgesic effects and adverse effects between double dural puncture epidural (DDPE) and epidural for labour analgesia, and analysed the feasibility and safety of using DDPE for labour analgesia.</p><p><strong>Design: </strong>A single-centre, prospective, single-blind, randomised controlled trial.</p><p><strong>Setting: </strong>Huai'an First People's Hospital, affiliated to Nanjing Medical University, from June 2023 to March 2024.</p><p><strong>Patients: </strong>One hundred and twenty primipara were randomised to the epidural group or the DDPE group.</p><p><strong>Intervention: </strong>The DDPE group underwent two needle punctures of the dura/arachnoid membranes with a 25-gauge Whitacre needle introduced via the epidural needle: one cephalad and one caudad.</p><p><strong>Main outcome measures: </strong>The primary outcome measure was the proportion of patients with adequate analgesia (VAS pain score ≤ 30 mm) 10 min after the neuraxial block (T1). Secondary outcome measures included block quality, adverse effects and maternal outcomes.</p><p><strong>Results: </strong>DDPE had a higher percentage of adequate analgesia than epidural at T1 (75.0 vs. 40.0%, P  < 0.001) and at T3 (98.3 vs. 85.0%, P  = 0.017). Compared with epidural, lower DDPE pain VAS scores were also observed at T1 and T4: 26 [20 to 34.5] vs. 48 [26 to 59.5], P  < 0.001; and 36.5 [29 to 48.5] vs. 44.5 [30 to 59.8], P  = 0.01, respectively. In addition, compared with epidural, DDPE showed a faster onset of sacral coverage, 9 [8 to 13.5] vs. 16 [12 to 18] min, P  < 0.001; less need for additional analgesia, 8.3 vs. 25%, P  = 0.014; and lower drug consumption, 70 [50 to 90] vs. 80 [60 to 110] ml, P  = 0.005. Under the conditions of this study, there was no significant difference in adverse reactions between the DDPE and epidural groups ( P  > 0.05).</p><p><strong>Conclusion: </strong>Compared with the epidural technique, DDPE showed significant advantages for the onset of labour analgesia and demonstrated good efficacy in sacral coverage, which may improve the quality of the neuraxial block and better meet the demand for rapid analgesia in labouring women. In terms of future research directions, comparative studies between DDPE and a single dural puncture epidural, and between DDPE and combined spinal epidural are areas worthy of further investigation.</p><p><strong>Trial registration: </strong>Chinese Clinical Trials Registry (ChiCTR2300072727) https://www.chictr.org.cn .</p>","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":"774-782"},"PeriodicalIF":6.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144119025","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}