European Journal of Anaesthesiology最新文献

{"title":"A novel cricoid pressure sensor device enhances the efficacy of oesophageal occlusion during Sellick's manoeuvre: A randomised controlled trial.","authors":"Abhilasha Mishra, Vighnesh Ashok, Goverdhan D Puri, Neelesh Kumar, Preethy J Mathew","doi":"10.1097/EJA.0000000000002097","DOIUrl":"10.1097/EJA.0000000000002097","url":null,"abstract":"<p><strong>Background: </strong>The inability to measure the force applied during cricoid pressure is an important limitation in clinical practice. We developed a novel device to measure this force and provide real-time feedback to the operator.</p><p><strong>Objectives: </strong>To test the hypothesis of superior oesophageal occlusion during cricoid pressure when guided by the novel device as compared with conventional practice.</p><p><strong>Design: </strong>A prospective randomised controlled trial.</p><p><strong>Setting: </strong>Tertiary University Hospital, May to December 2021.</p><p><strong>Patients: </strong>Sixty-five ASA I/II adult patients of either sex scheduled for elective surgery under general anaesthesia requiring tracheal intubation. Patients with comorbidities involving the neck, those at risk of pulmonary aspiration, anticipated difficult airway and BMI at least 35 kg  m -2 were excluded.</p><p><strong>Intervention: </strong>Operators applied cricoid pressure with their fingers in both groups. Participants were randomised into 'feedback group' where the operator adjusted this force based on the force measured by the novel device, and 'control group' where the force measured by the device was shielded from the operator.</p><p><strong>Main outcome measures: </strong>The primary outcome was the rate of occlusion of oesophageal opening assessed by whether a 12 CH orogastric tube could be inserted into the oesophageal entrance during videolaryngoscopy. Secondary outcomes included the magnitudes of force measured during cricoid pressure, oesophageal diameter measured ultrasonographically during cricoid pressure and intubation parameters.</p><p><strong>Results: </strong>Sixty-four patients completed the study. The oesophageal opening was occluded in significantly more patients in the feedback group compared with the control group (94 vs. 6%; P  = 0.001). The mean ± SD force (N) applied was significantly better and consistent at all time points in the feedback group compared to the control group (22.65 ± 7.81 vs. 14.57 ± 11.13, P  < 0.001). The median [IQR] anteroposterior diameter of the oesophagus during cricoid pressure was less in the feedback group compared to the control group (0.49 [0.36 to 0.56] vs. 0.57 [0.48 to 0.65], P  = 0.006).</p><p><strong>Conclusions: </strong>The use of the novel sensor device achieved a significantly high rate of oesophageal occlusion during application of cricoid pressure.</p><p><strong>Trial registration: </strong>Clinical Trial Registry of India (CTRI/2021/05/033484).</p>","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":"265-274"},"PeriodicalIF":4.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142602301","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":"Anaesthesia practice in Europe: A survey of the National Anaesthesiologists Societies Committee of the European Society of Anaesthesiology and Intensive Care.","authors":"Fulvio Pinelli, Stefano Romagnoli, Sweta Singh, Pierre Albaladejo, Carla Nau, Federico Bilotta","doi":"10.1097/EJA.0000000000002110","DOIUrl":"10.1097/EJA.0000000000002110","url":null,"abstract":"<p><strong>Background: </strong>Similar to other continents, Europe is experiencing a shortage of anaesthesia workforce, which profoundly impacts the national healthcare systems of affected countries.</p><p><strong>Objective: </strong>To assess the current landscape of the anaesthesia workforce, organisational practices, rules and responsibilities of anaesthesiologists and other anaesthesia providers in operating rooms.</p><p><strong>Design: </strong>Survey.</p><p><strong>Setting: </strong>Thirty-nine out of 41 European countries were surveyed between April 2022 and April 2023.</p><p><strong>Participants: </strong>Delegates of the National Anaesthesiologists Societies Committee (NASC) of the European Society of Anaesthesiology and Intensive Care (ESAIC).</p><p><strong>Intervention: </strong>A faculty of experts from France, Germany and Italy, selected by the Chair of NASC, developed a survey consisting of 16 questions, which was sent to the NASC delegates of all European countries.</p><p><strong>Main outcome measures: </strong>Responses from the NASC delegates.</p><p><strong>Results: </strong>The anaesthesia workforce, composition, roles and duties of anaesthesia teams vary significantly among European countries. The majority of respondents reported a workforce shortage, with variable trends, exacerbated in some cases by an increased loss of anaesthesiologists following the COVID-19 pandemic. Significant differences in anaesthesiologists' salaries exist across countries. A one-to-one anaesthesiologist-to-patient ratio during general anaesthesia maintenance, neuraxial and peripheral blocks is the most common; however, in a notable number of cases, this ratio decreases to one-to-two or even less. In such instances, residents or nonphysician anaesthesia personnel (NPAs) play a crucial role, enabling anaesthesiologists to supervise more than one patient simultaneously. Differences in the training of anaesthesia team members, as well as rules regulating anaesthesia team composition and the autonomy of its members, were also evident.</p><p><strong>Conclusion: </strong>The survey provides data on the current anaesthesia practice in Europe. The availability, composition and organisation of anaesthesia team members differ among European countries. The study highlights areas for further focus in operating room organisation and anaesthesia team composition, particularly regarding safety, efficacy and cost-effectiveness.</p>","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":"189-202"},"PeriodicalIF":4.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142834824","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":"Gastric ultrasound for the monitoring of enteral nutrition in ventilated intensive care unit patients: A prospective cohort.","authors":"Maxime Nguyen, Ayoub Ouharani, Pierre-Grégoire Guinot, Bélaid Bouhemad","doi":"10.1097/EJA.0000000000002086","DOIUrl":"10.1097/EJA.0000000000002086","url":null,"abstract":"","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":"282-283"},"PeriodicalIF":4.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142893174","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":"Subcostal transversus abdominis plane block for epigastric cardiac pacemaker operation: A randomised controlled trial.","authors":"Jin-Tae Kim, Jooncheol Min, Jung-Bin Park, Young-Eun Jang","doi":"10.1097/EJA.0000000000002092","DOIUrl":"10.1097/EJA.0000000000002092","url":null,"abstract":"","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":"275-278"},"PeriodicalIF":4.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142497445","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":"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":"https://doi.org/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 were stimuli 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":""},"PeriodicalIF":4.2,"publicationDate":"2025-02-25","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}

{"title":"The immunomodulatory effect of sugammadex in vitro and after total hip arthroplasty: A randomised controlled pilot and retrospective cohort study.","authors":"Veerle Bijkerk, Lotte M C Jacobs, Jetze Visser, Esmee V van Helden, Christiaan Keijzer, Leonie S Helder, Kim I Albers, Michiel C Warlé","doi":"10.1097/EJA.0000000000002132","DOIUrl":"https://doi.org/10.1097/EJA.0000000000002132","url":null,"abstract":"<p><strong>Background: </strong>Postoperative immunosuppression is a well known phenomenon associated with infectious complications. Peri-operative immune dysregulation is likely induced by surgical damage and anaesthetics, but remains far from comprehensively characterised. To address this, the effects of individual drugs on immune function must be explored. Sugammadex, a cyclodextrin that encapsulates rocuronium, also binds other drugs and structures and may influence the inflammatory response.</p><p><strong>Objective: </strong>Investigate the potential immunomodulatory effect of sugammadex.</p><p><strong>Design: </strong>An in-vitro experiment, randomised controlled pilot study and retrospective cohort study.</p><p><strong>Setting: </strong>Tertiary teaching hospital.</p><p><strong>Patients: </strong>Twelve healthy donors, 20 adults undergoing total hip arthroplasty and 1000 major abdominal surgery patients.</p><p><strong>Intervention: </strong>In vitro: isolated peripheral blood mononuclear cells were exposed to sugammadex and rocuronium before stimulation with Escherichia coli lipopolysaccharides (LPS).Pilot study: patients undergoing total hip arthroplasty under single shot spinal anaesthesia randomised to sugammadex (8 mg kg-1) or placebo at the end of surgery.</p><p><strong>Main outcome measure: </strong>In vitro: TNF, IL-1β and IL-6 production capacity.Pilot study: Ex-vivo cytokine production capacity after whole blood stimulation with LPS.Retrospective cohort: sugammadex as a predictor of postoperative infectious complications.</p><p><strong>Results: </strong>In vitro: rocuronium suppressed TNF and IL-1β production capacity. Higher doses of sugammadex (100 and 1000 μg ml-1; 100 μg ml-1 corresponds to plasma concentration reached upon 8 mg kg-1 sugammadex) restored suppression of TNF and IL-1β.Pilot study: no differences in ex-vivo cytokine production capacity between the sugammadex and placebo group at the end of surgery or on postoperative day 1.Retrospective cohort study: no association between sugammadex and postoperative infectious complications (OR = 1.000, 95% CI 0.998 to 1.002).</p><p><strong>Conclusion: </strong>Sugammadex preserved cytokine production capacity of TNF and IL-1β in vitro. The clinical pilot study and retrospective cohort study revealed no early postoperative immunomodulatory effects for sugammadex in the clinically used dosing range.</p><p><strong>Trial registration: </strong>clinicaltrials.gov identifier: NCT05723406 and NCT05244655.</p>","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143432783","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":"https://doi.org/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":""},"PeriodicalIF":4.2,"publicationDate":"2025-02-12","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}

{"title":"Is there a benefit of intravenous lidocaine during liver surgery?: A propensity-score weighting analysis.","authors":"Florianne Le Goulven, Alexandre Mansour, Helene Beloeil, Pauline Rouxel","doi":"10.1097/EJA.0000000000002088","DOIUrl":"10.1097/EJA.0000000000002088","url":null,"abstract":"","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":"176-178"},"PeriodicalIF":4.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142497442","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":"Midclavicle block: An anatomical study.","authors":"Hipólito Labandeyra, Luis F Váldes-Vilches, Alberto Prats-Galino, Xavier Sala-Blanch","doi":"10.1097/EJA.0000000000002079","DOIUrl":"10.1097/EJA.0000000000002079","url":null,"abstract":"<p><strong>Background: </strong>Recent studies indicate that clavipectoral fascia plane block (CPB) efficacy may stem from injectate distribution to the anterosuperior clavicular periosteum. We conducted an anatomical study combining the CPB with injection within the subclavius muscle.</p><p><strong>Objective: </strong>Our hypothesis was that the anaesthetic injectate would fully cover both the anterosuperior and posteroinferior surfaces of the clavicular periosteum in the midclavicular region.</p><p><strong>Design: </strong>Observational human cadaver study.</p><p><strong>Setting: </strong>Laboratory of Surgical Neuroanatomy, Unit of Anatomy and Human Embryology of the Faculty of Medicine and Health Sciences, University of Barcelona.</p><p><strong>Participants: </strong>Five fresh human cadavers.</p><p><strong>Interventions: </strong>The cadavers received both a CPB and subclavius muscle injections under ultrasound guidance in 10 clavicular regions.</p><p><strong>Main outcome measures: </strong>After the procedures on the cadaveric models, an anatomical dissection by planes was performed to evaluate the distribution pattern of methylene blue on the clavicular periosteum. A probabilistic map of the colour spectrum and staining temperature on the clavicular surfaces was generated.</p><p><strong>Results: </strong>Methylene blue stained 37 ± 16% of the anterosuperior surface and 23 ± 13% of the posteroinferior surface of the clavicular periosteum, particularly in the middle third of each surface. Although the staining did not achieve complete circumferential coverage or perfect alignment between the surfaces, the areas exhibited a close relationship, indicating significant distribution and relevant coverage.</p><p><strong>Conclusion: </strong>Our anatomical study demonstrates that the midclavicular block achieves effective distribution around the middle third of the clavicle, although complete circumferential anaesthesia of the clavicular periosteum was not achieved. Although this block may provide periosteal and bone anaesthesia, it does not address other sources of pain, such as muscle spasms and skin components. Additional clinical studies are needed to evaluate the overall efficacy of this dual block technique for clavicle surgery.</p>","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":"122-130"},"PeriodicalIF":4.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142497444","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":"Comparative study of labour analgesia onset with injection of loading dose through epidural needle versus catheter: A prospective, double-blinded, randomised clinical trial.","authors":"XiaoPing Chen, YingYing Tang, QingQing Yu, LiHong Sun, Hua Li, LuYang Wang, Cuicui Jiao, XinZhong Chen","doi":"10.1097/EJA.0000000000002077","DOIUrl":"10.1097/EJA.0000000000002077","url":null,"abstract":"<p><strong>Background: </strong>Rapid onset of epidural analgesia is an important concern for the parturient. Commonly, the local anaesthetic mixture is administered through the epidural catheter. Drugs administered through the epidural needle might decrease the onset time and enhance the spread of medication within the epidural space.</p><p><strong>Objectives: </strong>The primary aim of this study was to compare the onset time of analgesia when a loading dose of dilute local anaesthetic opioid mixture was injected through either the Tuohy needle or a single end-hole epidural catheter.</p><p><strong>Design: </strong>A prospective, double-blinded, randomised clinical trial.</p><p><strong>Setting: </strong>Single university hospital, from November 2022 to August 2023.</p><p><strong>Participants: </strong>A total of 200 healthy nulliparous women who requested epidural analgesia for labour were randomly allocated to the needle group (n = 100) or the catheter group (n = 100).</p><p><strong>Interventions: </strong>In the needle group, after identification of the epidural space, a test dose of 3 ml 0.1% ropivacaine with 0.3 μg ml-1 sufentanil was injected through the Tuohy needle followed 3 min later by a 15 ml loading dose of the same mixture over 30 s. Then the catheter was inserted into the epidural space. In the catheter group, after identification of the epidural space, a catheter was advanced into the epidural space and the ropivacaine/sufentanil mixture was injected in an identical manner though the catheter.</p><p><strong>Main outcome mearsures: </strong>The primary outcome was the onset time of labour analgesia (defined as the time from drug administration to adequate analgesia). Adequate analgesia was defined as a visual analogue score 10 mm or less during uterine contractions.</p><p><strong>Results: </strong>Median [IQR] onset time of labour analgesia did not differ significantly between the two groups (needle group: 20 [16 to 30] minutes; catheter group: 20 [15 to 25] minutes, P = 0.232).</p><p><strong>Conclusion: </strong>Compared with bolus injection though a single end-hole epidural catheter, injection through the epidural needle did not shorten the analgesia onset time for adequate labour analgesia.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov (NCT05594771).</p>","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":"42 2","pages":"113-121"},"PeriodicalIF":4.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11676590/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142914039","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}