Frontiers in Surgery最新文献

{"title":"Advances in astrocytes in aneurysmal subarachnoid haemorrhage.","authors":"Jiahui Liu, Kun Sun, Qiushi Chen, Lianshu Ding","doi":"10.3389/fsurg.2025.1511242","DOIUrl":"10.3389/fsurg.2025.1511242","url":null,"abstract":"<p><p>Aneurysmal subarachnoid haemorrhage (aSAH) represents a subtype of stroke with a high incidence of morbidity and mortality. Astrocytes, the most abundant cell type in the central nervous system, play a pivotal role in brain injury and recovery following aSAH. They participate in synaptic remodelling, blood-brain barrier injury and the activation of the glial-mesenchymal-cervical lymphatic system. In this paper, we review the physiopathological functions and pathological changes of astrocytes after aSAH, exploring their mechanism of action in aSAH. We also summarise the evidence of therapeutic approaches to modulate astrocyte function after aSAH complications, and provide some new clues for future translational therapies to mitigate injury after aSAH.</p>","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"12 ","pages":"1511242"},"PeriodicalIF":1.6,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12162669/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144301772","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A machine learning-based predictive model for the occurrence of lower extremity deep vein thrombosis after laparoscopic surgery in abdominal surgery.","authors":"Su-Zhen Yang, Ming-Hui Peng, Quan Lin, Shi-Wei Guan, Kai-Lun Zhang, Hai-Bo Yu","doi":"10.3389/fsurg.2025.1502944","DOIUrl":"10.3389/fsurg.2025.1502944","url":null,"abstract":"<p><strong>Background & aims: </strong>Deep vein thrombosis, a common complication after laparoscopic surgery, can negatively affect patients' limb motor function and even seriously threaten their lives. Therefore, it is crucial to accurately identify patients at high risk of lower extremity deep vein thrombosis. Thus, the aim of this study was to develop a model to predict the occurrence of deep vein thrombosis in patients after laparoscopy.</p><p><strong>Methods: </strong>We retrospectively analyzed the clinical data of patients who underwent laparoscopic surgery at Wenzhou Central Hospital's Hepatobiliary Surgery Department. Patients with postoperative deep vein thrombosis composed the observation group, while others composed the control group. Eleven key features were identified through group comparisons and used for model development. Twenty machine learning algorithms were evaluated, and the top five algorithms were used to build the final model by stacking.</p><p><strong>Results: </strong>A total of 335 patients underwent laparoscopic abdominal surgery. Patients with deep vein thrombosis (9.9%) differed significantly in age, history of tumor, hemoglobin, red blood cell counts, preoperative blood pressure, duration of the surgery, activated partial thromboplastin time, D-dimer, total protein, albumin, and calcium. According to our model, the most important features influencing the predictions were tumor history, age, time to surgery, and D-dimer level. We employed two interpretability methods: decomposition interpretation and Shapley additive explanation. Decomposition analysis revealed that the three study characteristics with the strongest predictive effect for deep vein thrombosis occurrence after laparoscopy were, in descending order, the time of surgery, patient age, and tumor history. Conversely, for ruling out deep vein thrombosis, the most important features were tumor history, hemoglobin level, and age. Shapley additive explanation revealed that tumor history, age, and time of surgery were the most important factors for predicting and ruling out deep vein thrombosis following laparoscopy. We additionally selected 114 patients for external validation, and the results showed that the ROC of validation set for the LASDVT model was 0.9293 and the AUPRC was 0.6497. The effect of the LASDVT model was statistically different (delong test, <i>p</i> = 0.0047) and superior to the Caprini score.</p><p><strong>Conclusion: </strong>We present a model for predicting deep vein thrombosis in laparoscopic surgery patients. This model outperformed the Caprini score in predicting the incidence of deep vein thrombosis.</p>","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"12 ","pages":"1502944"},"PeriodicalIF":1.6,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12162540/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144301771","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is negative urine culture necessary for PCNL safety? Experience from a large-volume stone center.","authors":"Xiao Bo, Xue Zeng, Gang Zhang, Chaoyue Ji, Song Jin, Wenjie Bai, Yuzhe Tang, Bixiao Wang, Jianxing Li","doi":"10.3389/fsurg.2025.1571963","DOIUrl":"10.3389/fsurg.2025.1571963","url":null,"abstract":"<p><strong>Objectives: </strong>To present our large single-center experience in managing patients with positive urine cultures and kidney stones with total ultrasound-guided percutaneous nephrolithotomy (PNL) and to redefine the role of urine culture in modifying these patients' treatment plans.</p><p><strong>Patients and methods: </strong>We retrospectively reviewed the charts of patients who had undergone PNL in our department from January 2016 to December 2020 and identified 422 eligible patients. These patients were allocated to two groups according to pre-operative urine culture results: negative (Group 1, <i>n</i> = 278) and positive (Group 2, <i>n</i> = 144). All procedures were ultrasound-guided. Standard access was achieved in all patients. Relevant patient characteristics, operative variables, and postoperative data were collected and analyzed, focusing on infection-related data, particularly sepsis.</p><p><strong>Results: </strong>Successful renal access and stone fragmentation were achieved in all patients. At least one standard (24F) tract was established and a negative suction system introduced in every case. <i>Escherichia coli</i> was the most common bacterium in positive urine culture patients. Preoperative serum creatinine differed significantly between Groups 1 and 2 (1.2 ± 0.2 mg/dl vs. 2.0 ± 0.7 mg/dl, <i>p</i> = 0.02). Durations of surgery (79.2 ± 22.2 min) and post-operative hospitalization (7.6 ± 2.1 days) were longer in Group 2 than in Group 1 (58.2 ± 17.2 min) and (5.6 ± 1.1 days), respectively. Group 1 required fewer renal accesses than did Group 2 (1.1 ± 0.2 vs. 1.7 ± 0.2). The immediate stone-free rate was significantly greater in Group 1 (249; 89.2%) than in Group 2 (108; 75%).</p><p><strong>Conclusions: </strong>Ultrasound guided PNL with standard access reveals a safe and acceptable results in positive urine culture patients. Preoperative infected urine is not a risk factor for severe septic complications after PNL under controlled conditions.</p>","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"12 ","pages":"1571963"},"PeriodicalIF":1.6,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12162969/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144301774","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biportal endoscopic bilateral decompression in lumbar spinal stenosis: a 3-year retrospective cohort study.","authors":"Dongyue Li, Yunzhong Cheng, Peng Yin, Qingjun Su","doi":"10.3389/fsurg.2025.1601944","DOIUrl":"10.3389/fsurg.2025.1601944","url":null,"abstract":"<p><strong>Background: </strong>Biportal endoscopic bilateral decompression (BEBD) has gained recognition for treating lumbar spinal stenosis (LSS) through preservation of posterior spinal structures while achieving bilateral neural decompression. However, the relationship between postoperative radiographic findings and clinical outcomes remains unclear. This study investigates clinical efficacy, radiographic findings, and their potential correlations following BEBD.</p><p><strong>Methods: </strong>A retrospective cohort analysis of 51 LSS patients undergoing BEBD (January 2020-December 2021) was conducted. Intraoperative parameters, complications, and clinical outcomes [Visual Analog Scale (VAS), Oswestry Disability Index (ODI), Modified Macnab criteria] were evaluated preoperatively, at 1 month, and final follow-up. Radiographic parameters included medial facetectomy surface angle (MFSA), facet joint preservation rate (FJPR), lateral recess decompression rate (LRDR), dural sac cross-sectional area expansion rate (DSCAER), and segmental range of motion (SROM).</p><p><strong>Results: </strong>The procedure demonstrated the mean operative time of 93.6 ± 13.7 min, with follow-up 36-60 months (mean 42.5 ± 6.7 months). Clinically, lower back pain (VAS: 5.9 ± 0.9-2.3 ± 0.6 at 1 month; 0.6 ± 0.5 final) and leg pain (6.8 ± 0.9-1.7 ± 0.6 at 1 month; 0.5 ± 0.6 final) showed sustained, statistically significant reductions (<i>P</i> < 0.05). Functional recovery was marked by ODI improvements from 64.5 ± 7.5 preoperatively to 26.1 ± 2.8 (1 month) and 11.0 ± 2.3 (final) (<i>P</i> < 0.05), with 88.24% (45/51) achieving excellent/good outcomes by modified Macnab criteria. Radiographically, MFSA remained <90°, FJPR exceeded 70%, and DSCAER expanded by 95.19 ± 22.5% (<i>P</i> < 0.05), while SROM stability was preserved (<i>P</i> > 0.05). Notably, no radiographic findings correlated with clinical outcomes stratification (<i>P</i> > 0.05), underscoring the multifactorial nature of postoperative success.</p><p><strong>Conclusions: </strong>BEBD demonstrates significant clinical improvement in LSS patients, with marked DSCA expansion and preserved FJ stability. The technique achieves effective bilateral decompression with preserved biomechanical stability. Radiographic findings showed no correlation with clinical success, indicating multifactorial postoperative influences.</p>","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"12 ","pages":"1601944"},"PeriodicalIF":1.6,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12162478/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144301773","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient recall of postoperative protocols following hand surgery does not differ by information provider: a randomized clinical trial.","authors":"Dhruv Mendiratta, Rohan Singh, Aleksandra McGrath","doi":"10.3389/fsurg.2025.1559161","DOIUrl":"10.3389/fsurg.2025.1559161","url":null,"abstract":"<p><p>Understanding of postoperative care is limited in patients who undergo ambulatory surgery. This study compares patients' recall of information regarding postoperative self-care when being verbally informed by either a surgeon or assistant nurse postoperatively prior to discharge. Secondary objectives for this study are to compare differences in patients' level of \"feeling that they understood the information\", stress, and satisfaction. A non-blinded randomized single-center controlled trial was conducted at a hand surgical unit in Northern Sweden (Trial Registration ID: NCT03893968). Patients were randomized into a control (surgeon) or intervention group (assistant nurse). Patients were asked seven questions about postoperative self-care one week postoperatively via telephone call, yielding a maximum score of seven points. Thirty-nine patients were informed by assistant nurses, and thirty-three patients were informed by surgeons. There was no difference in recall between the two groups (4.95 vs. 5.15, <i>p</i> = 0.5). Patients from both groups lacked knowledge on postoperative outcomes (41.0% vs. 42.4%). The mean scores for \"feeling of having understood the information\" (mean of 9.23 for patients informed by assistant nurses vs. mean of 9.45 for patients informed by surgeons) and satisfaction (9.69 vs. 9.45, respectively) was high, while mean scores for stress was low (1.38 vs. 1.18, respectively). Few patients answered all questions correctly: 8.3% of the patients answered all questions correctly, and 37.5% of the patients answered six or more questions correctly. The findings suggest that surgeons and assistant nurses are equally good at verbally informing patients regarding postoperative hand-surgical self-care. More effort is needed to make patients understand symptoms of postoperative infections.</p>","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"12 ","pages":"1559161"},"PeriodicalIF":1.6,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12162562/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144301775","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lower cervical C6/C7 andersson lesion with upper cervical C1/C2 fracture in ankylosing spondylitis: a case report and literature review.","authors":"Han Qiao, Xiaofei Cheng, Haijun Tian, Changqing Zhao, Xiaojiang Sun, Jie Zhao","doi":"10.3389/fsurg.2025.1568553","DOIUrl":"10.3389/fsurg.2025.1568553","url":null,"abstract":"<p><p>Cervical andersson lesions (ALs) are rare in patients with ankylosing spondylitis (AS), and even more rare in patients with simultaneous superior cervical atlantoaxial fracture and dislocation. Here, we present a case of C1 Jefferson fracture (C1 bilateral posterior arch fracture), C2 odontoid, lateral mass, vertebral fracture (nonclassic C2 hangman fracture), traumatic posterior atlantoaxial dislocation (AAD) and C6/C7 AL in a long-standing AS cervical spine. The patient with traumatic AS-related cervical fractures underwent a two-stage surgery. The stage I surgery involved a posterior atlantoaxial reduction and fixation surgery combined with C5/C6/T1/T2 posterior pedicle screw fixation plus C6/C7 decompression. One week later, C6/C7 anterior cervical corpectomy decompression and fusion (ACCF) with long anterior plate stabilization combined with iliac crest bone graft transplantation was performed for stage II surgery. The patient recovery observed during follow-up was satisfactory. Nine-month postoperative radiological images revealed fracture union of the upper and lower cervical spine with optimal reduction of the atlantoaxial segment. In conclusion, lower cervical ALs with simultaneous upper cervical C1/C2 fractures in the AS are very rare. Posterior C1-C2 fixation combined with C6-C7 AL corpectomy/fusion and posterior pedicle screw fixation may offer a desirable alternative approach for this complex case of cervical trauma. During treatment, complete decompression, effective reduction, and potent stabilization can comprehensively improve the clinical prognosis.</p>","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"12 ","pages":"1568553"},"PeriodicalIF":1.6,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12148836/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144266040","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The preliminary application of electromyography in unilateral biportal endoscopy with general anesthesia for lumbar disc herniation.","authors":"Shaolong Tang, Yutian Liao, Juan Pan, Dayong Chen, Dan Pan","doi":"10.3389/fsurg.2025.1498878","DOIUrl":"10.3389/fsurg.2025.1498878","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the clinical efficacy of electromyography (EMG) in unilateral biportal endoscopy (UBE) with general anesthesia in the treatment of lumbar disc herniation.</p><p><strong>Methods: </strong>A total of 78 patients with lumbar disc herniation were enrolled. They underwent UBE discectomy under general anesthesia, with the entire procedure of EMG monitoring. Recorded potentials were displayed on the monitoring screen, and electromyographic activity was audibly relayed via speakers. Clinical treatment outcomes were assessed using Visual Analog Scale (VAS) and Oswestry Disability Index (ODI).</p><p><strong>Results: </strong>All 78 patients successfully completed the procedure, with significant improvement in symptoms postoperatively. Preoperative and 3-month postoperative VAS scores were 4-9 (mean 6.65 ± 1.53) and 0-4 (mean 1.40 ± 1.23), respectively. Preoperative and 3-month postoperative ODI scores were 36-88 (mean 59.56 ± 13.81) and 4-29 (mean 14.82 ± 6.68), respectively, with statistically significant differences (<i>P</i> < 0.05). Abnormal EMG changes, including spike, burst, or tonic electromyographic discharges, occurred in 12 patients during surgery, with an incidence of 15.38%. Ten patients experienced radicular burning pain and abnormal lower limb sensations postoperatively, while two patients had no significant postoperative neuralgia, resulting in a false positive rate of 16.67%. Patients without abnormal EMG responses during surgery had no significant postoperative neuralgia, yielding a false negative rate of zero.</p><p><strong>Conclusion: </strong>General anesthesia combined with UBE monitord by intraoperative EMG is a safe and feasible approach for the treatment of lumbar disc herniation.</p>","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"12 ","pages":"1498878"},"PeriodicalIF":1.6,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12148880/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144266043","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Misdiagnosis of tuberculous infection as pseudo-bursa cyst after total hip arthroplasty: a case report.","authors":"Zhen Jia, Zhengqi Chang, Shiyong Wan","doi":"10.3389/fsurg.2025.1612055","DOIUrl":"10.3389/fsurg.2025.1612055","url":null,"abstract":"<p><p>This article reports and analyzes a case of postoperative tuberculosis infection in an 80-year-old female after total hip arthroplasty, which was misdiagnosed and mistreated due to imaging findings resembling a pseudo-bursa cyst. The patient had a history of right femoral neck fracture, underwent right total hip arthroplasty 4 years ago, and developed a lump on the posterior side of the right thigh 1 year ago. Initial MRI at another hospital diagnosed it as a pseudo-bursa cyst and underwent excision surgery, but recurred 2 months later. Upon admission, repeated fluid aspiration, biochemical analysis of the fluid (showing high protein, high specific gravity, and positive Rivalta test), PPD, and T-SPOT.TB tests all indicated active tuberculosis infection. Cheese-like necrosis and granuloma formation were found during surgery, confirming postoperative tuberculosis infection. The patient underwent local debridement surgery combined with 9 months of standard HRZE anti-tuberculosis treatment (isoniazid, rifampicin, pyrazinamide, and ethambutol). Follow-up at 9 months showed the lump had disappeared, inflammatory markers returned to normal, and the prosthetic joint remained stable with improved joint function. This case highlights the challenge of tuberculosis infection being masked by common postoperative complications, emphasizing the importance of multidimensional examination and comprehensive diagnosis of diseased tissues to reduce misdiagnosis rates, improve treatment success rates, and enhance patient quality of life.</p>","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"12 ","pages":"1612055"},"PeriodicalIF":1.6,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12148853/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144266041","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical outcomes of closed reduction vs. small-incision-assisted open reduction with intramedullary nailing in complex comminuted femoral shaft fractures (AO/OTA 32-C): a retrospective cohort study.","authors":"Qingwei Li, Jianqiang Wang, Chunyan Sun, Lintao Lu, Zongyou Mu, Xubin Zhang","doi":"10.3389/fsurg.2025.1550063","DOIUrl":"10.3389/fsurg.2025.1550063","url":null,"abstract":"<p><strong>Background: </strong>Intramedullary nailing (IMN) is the preferred treatment owing to its minimally invasive nature, high healing rates, and reduced stress shielding. However, the optimal reduction method for complex comminuted fractures (AO/OTA 32-C) has been controversial. Closed reduction preserves blood supply but requires extensive fluoroscopy and technical expertise. Small-incision-assisted open reduction enhances visualisation and facilitates reduction but entails slightly increased soft tissue exposure.</p><p><strong>Methods: </strong>This retrospective cohort study analysed 70 patients with AO/OTA 32-C femoral shaft fractures treated with intramedullary nailing. Patients were categorised into a Closed reduction group (<i>n</i> = 35) and Small-incision-assisted open reduction group (<i>n</i> = 35). Outcomes assessed included operative time, fluoroscopy usage, blood loss, infection rates, hospital stay duration, and functional outcomes at 3, 6, and 12 months postoperatively.</p><p><strong>Results: </strong>The Small-incision-assisted open reduction group had shorter operative times (45.09 ± 5.67 vs. 78.34 ± 5.71 min, <i>P</i> < 0.05) and lower fluoroscopy usage (6.03 ± 1.51 vs. 22.33 ± 5.99, <i>P</i> < 0.05). While blood loss and incision length were higher, infection rates and hospital stays were comparable between the groups. Functional outcomes at 3 and 6 months were significantly better in the Small-incision-assisted open reduction group, with no differences at 12 months. The Small-incision-assisted open reduction group also had a higher excellent-to-good fracture healing rate (88.6% vs. 60.0%, <i>P</i> < 0.05).</p><p><strong>Conclusions: </strong>Small-incision-assisted open reduction reduces operative time, fluoroscopy usage, and improves early functional outcomes. It is a safe and efficient alternative to closed reduction, but larger multi-centre studies are needed for broader validation.</p>","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"12 ","pages":"1550063"},"PeriodicalIF":1.6,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12149108/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144266039","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analgesic efficacy of continuous serratus anterior plane block versus intercostal nerve block and their combination in VATS lobectomy: results from a prospective randomized trial.","authors":"Hyun Ah Lim, Gongmin Rim, Kwanyong Hyun, Yong Jin Chang, Deog Gon Cho","doi":"10.3389/fsurg.2025.1607150","DOIUrl":"10.3389/fsurg.2025.1607150","url":null,"abstract":"<p><strong>Background: </strong>Effective postoperative pain management following video-assisted thoracoscopic surgery (VATS) lobectomy is essential to optimize recovery and minimize opioid consumption. This study aimed to compare the analgesic efficacy of ultrasound-guided continuous serratus anterior plane block (SAPB), intercostal nerve block (INB), and their combination (SAPB + INB) in patients undergoing VATS lobectomy.</p><p><strong>Methods: </strong>In this single-center, single-blinded, randomized controlled trial, 90 patients undergoing VATS lobectomy for confirmed or suspected lung cancer were randomly assigned to one of three groups: INB (<i>n</i> = 30), continu.ous SAPB (<i>n</i> = 30), or SAPB + INB (<i>n</i> = 30). The primary outcome was postoperative pain assessed using the visual analog scale (VAS) at 24 h. Secondary outcomes included VAS scores at 1, 3, 6, 12, 48, and 72 h postoperatively, cumulative opioid consumption, length of hospital stay, and postoperative complications.</p><p><strong>Results: </strong>No significant differences in VAS scores were observed among the three groups at 24 h postoperatively. All groups maintained acceptable pain levels (VAS < 4) throughout the study. However, opioid consumption was significantly lower in both the SAPB and SAPB + INB groups compared to the INB group at all time points (<i>p</i> < 0.01).</p><p><strong>Conclusions: </strong>Continuous SAPB, INB, and SAPB + INB were all effective for postoperative pain management after VATS lobectomy. However, INB alone was associated with significantly higher opioid use. Given its technical simplicity, prolonged analgesic effect, and opioid-sparing properties, continuous SAPB represents a valuable component of multimodal analgesia in enhanced recovery protocols.</p><p><strong>Clinical trial registration: </strong>Identifier KCT0009683.</p>","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"12 ","pages":"1607150"},"PeriodicalIF":1.6,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12148914/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144266038","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}