Indian Journal of Anaesthesia最新文献

{"title":"Efficacy of erector spinae plane block versus caudal block for postoperative analgesia in paediatric surgery: A systematic review and meta-analysis.","authors":"Raksha Kundal, Ankita Mahajan, Uppu Praveen, Medha Shukla, Vijay Kundal, Sunana Gupta","doi":"10.4103/ija.ija_1249_24","DOIUrl":"10.4103/ija.ija_1249_24","url":null,"abstract":"<p><strong>Background and aims: </strong>Regional anaesthesia is a component of multimodal analgesia in paediatric surgery, providing effective pain relief. Traditional techniques, such as the caudal block (CB) and, more recently, fascial plane blocks, such as the erector spinae plane block (ESPB), have gained popularity. This systematic review and meta-analysis compares CB and ESPB in paediatric surgeries involving the lower abdomen or lower limbs. It aims to clarify mixed outcomes from recent trials regarding the variability in analgesic efficacy of both techniques for future practices.</p><p><strong>Methods: </strong>This review, registered with the International Prospective Register of Systematic Reviews (PROSPERO), includes eight randomised controlled trials (RCTs) comparing postoperative analgesia between ESPB and CB in paediatric lower abdominal or lower limb surgeries. We searched the ScienceDirect, Google Scholar, Scopus, ProQuest, and PubMed databases. The meta-analysis assessed the proportion of patients requiring rescue analgesia and postoperative pain intensity. Grading of Recommendations Assessment, Development, and Evaluation (GRADE) guidelines were applied to assess the quality of evidence.</p><p><strong>Result: </strong>Eight RCTs (575 patients) were included in the review. A meta-analysis of four RCTs (217 patients) showed no statistically significant difference (inconclusive) between ESPB and CB groups regarding the proportion of patients requiring rescue analgesia [Relative Risk (RR) =0.83, 95% confidence interval (CI): 0.29, 2.40, <i>P</i> = 0.73], while six RCTs (360 patients) found lower pain intensity score (standardised mean difference = -0.37; 95% CI: -0.71, -0.02; <i>P</i> = 0.04) in the ESPB group when compared to CB group. Both outcomes exhibited considerable heterogeneity (I² = 88% for rescue analgesia; I² = 62% for pain intensity), further emphasising the robustness of the findings.</p><p><strong>Conclusion: </strong>We conclude that ESPB provides better postoperative analgesia than CB in children undergoing lower abdominal or lower limb surgeries. ESPB reduces postoperative pain intensity scores and analgesic requirements compared to CB.</p>","PeriodicalId":13339,"journal":{"name":"Indian Journal of Anaesthesia","volume":"69 8","pages":"759-769"},"PeriodicalIF":1.9,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12338468/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144834915","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ultrasound-guided external oblique intercostal plane block versus thoracic erector spinae block for post-thoracotomy pain: A randomised double-blinded non-inferior clinical study.","authors":"Saad A Moharam, Mohammed S ElSharkawy, Mhmoud A Almohasseb, Khaled Hamama, Mohamed A Mahmoud, Marwa A Abogabal","doi":"10.4103/ija.ija_3_25","DOIUrl":"10.4103/ija.ija_3_25","url":null,"abstract":"<p><strong>Background and aims: </strong>Regional techniques are preferred for controlling post-thoracotomy pain due to lower complication rates. This study aimed to compare the analgesic efficacy and safety of ultrasound-guided external oblique intercostal block (EOIB) with thoracic erector spinae plane block (ESPB) for post-thoracotomy pain.</p><p><strong>Methods: </strong>This randomised, double-blind, non-inferior clinical study involved 60 cases scheduled for thoracic surgery. Cases were randomly allocated into two groups: ESPB and EOIB groups. Using 30 mL 0.25% bupivacaine at the level of the thoracic vertebrae 5, both blocks were performed after induction of general anaesthesia. The primary outcome was morphine consumption in the first 24 hours postoperatively. The secondary outcomes were time to first rescue analgesic request postoperatively, numerical rating scale (NRS) score during rest and with coughing, and occurrence of complications. The non-parametric Wilcoxon test was used for non-normally distributed variables, the Student's <i>t</i>-test was used for normally distributed variables, and the Chi-square/Fisher's exact test was used for qualitative variables. The significance level was set at <i>P</i> ≤ 0.05.</p><p><strong>Results: </strong>Patients who required intraoperative fentanyl, time of first request for analgesia, total morphine consumption, and pain score within the first 24 hours post-surgery were comparable between the two groups (<i>P</i> = 0.347, 0.085, and 0.354, respectively). Both groups exhibited comparable incidences of hypotension and bradycardia (<i>P</i> = 0.353 and <i>P</i> > 0.99, respectively). Local anaesthetic systemic toxicity (LAST) and pneumothorax did not occur in any patient in either group.</p><p><strong>Conclusion: </strong>The analgesic effect of EOIB was non-inferior to ESPB for post-thoracotomy pain, as evidenced by comparable total opioid consumption, time of first request for analgesia, and pain score in the first 24 hours post-surgery. Additionally, EOIB demonstrated the same level of safety as ESPB.</p>","PeriodicalId":13339,"journal":{"name":"Indian Journal of Anaesthesia","volume":"69 8","pages":"809-815"},"PeriodicalIF":1.9,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12338484/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144834926","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Role of artificial intelligence in enhancing mechanical ventilation - A peek into the future.","authors":"Neeraj Pal Singh, Masood Ali Mujawar, Akash Golani","doi":"10.4103/ija.ija_995_24","DOIUrl":"10.4103/ija.ija_995_24","url":null,"abstract":"<p><p>This article explores recent advancements in the role of artificial intelligence (AI) in enhancing mechanical ventilation (MV), accentuating its potential to mitigate risks such as ventilator-induced lung injury, ventilator-associated pneumonia and asynchronies. The integration of AI, including machine learning, natural language processing and predictive analytics, into MV is reshaping the landscape of critical care, offering advanced solutions to enhance patient outcomes with real-time monitoring, personalised ventilation strategies, early detection of complications and also increased operational efficiency. Key practical issues surrounding the implementation of AI into existing clinical workflows, including data quality, data sharing and privacy, data standardisation, seamless integration with existing healthcare systems, transparency of algorithms, interoperability across multiple platforms, patient safety and addressing ethical concerns, remain. As we advance, a collaborative approach between AI and healthcare professionals will be essential to ensure optimal patient safety.</p>","PeriodicalId":13339,"journal":{"name":"Indian Journal of Anaesthesia","volume":"69 7","pages":"722-728"},"PeriodicalIF":2.9,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12244455/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144626123","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ultrasound-guided supine lateral CAPS (crosswise approach to popliteal sciatic) block for below-knee surgeries in high-risk patients: A retrospective case series.","authors":"Shruti S Patil, Devangi A Parikh, Ruchi A Jain","doi":"10.4103/ija.ija_21_25","DOIUrl":"10.4103/ija.ija_21_25","url":null,"abstract":"<p><p>Ultrasound (US)-guided popliteal sciatic nerve block (PSNB) with a femoral nerve block (FNB) provides adequate surgical analgesia for below-knee (BK) debridements and amputations. This retrospective review of 16 American Society of Anesthesiologists physical status III and IV patients describes a US-guided distal transverse (crosswise) approach to perform supine lateral PSNB (CAPS) with FNB with the limb in the neutral position. The median visibility score was 4. The median block performance time was 8 min. The median time to achieve sensory and motor block was 20 and 25 min, respectively. CAPS block with FNB is a reliable combination for BK amputation and debridement.</p>","PeriodicalId":13339,"journal":{"name":"Indian Journal of Anaesthesia","volume":"69 7","pages":"729-732"},"PeriodicalIF":2.9,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12244463/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144626127","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of frailty with postoperative outcomes in patients undergoing elective non-malignant abdominal surgeries under general or neuraxial anaesthesia: A prospective observational cohort study.","authors":"Rinu Raju, Pooja Singh, Pranita Mandal, Vaishali Waindeskar, Sunaina Tejpal Karna","doi":"10.4103/ija.ija_903_24","DOIUrl":"10.4103/ija.ija_903_24","url":null,"abstract":"<p><strong>Background and aims: </strong>Modified frailty index (mFI) is a valuable tool for predicting postoperative complications (POCs). We aimed to determine the association of frailty using mFI and the technique of anaesthesia, with POCs as the primary outcomes in patients undergoing non-malignant abdominal surgeries under general or neuraxial anaesthesia.</p><p><strong>Methods: </strong>After ethical approval, 125 patients of either gender, aged ≥18 years and scheduled to undergo general or neuraxial anaesthesia were enroled. Preoperatively, the mFI score was calculated for all the patients. Patients with mFI ≥0.27 were considered 'significantly frail'. The patients were followed up from the immediate postoperative period to 30 days after surgery, and POCs as per the Clavien-Dindo (CD) classification during their hospital stay were recorded. After discharge, patients were followed up telephonically every 15 days within 30 days to monitor for readmission or mortality.</p><p><strong>Results: </strong>The sensitivity and specificity of the mFI score to predict major POC were 86.11% and 88.76%, respectively, with a high negative predictive value of 94.05%. In mFI scores ≤0.27 and ≥0.27, the odds of POC were 1.74 and 2.33 times higher with general anaesthesia than with neuraxial anaesthesia, respectively. In mFI ≥0.27, the odds of 30-day readmission were 29.04 (95% confidence interval: 6.26, 34.68) with a longer hospital stay (<i>P</i> < 0.001).</p><p><strong>Conclusion: </strong>Higher mFI scores consistently predict more severe postoperative complications, particularly in CD grades II and IV and intensive care unit. The anaesthesia technique showed no significant association with postoperative complications, except in the higher mFI group.</p>","PeriodicalId":13339,"journal":{"name":"Indian Journal of Anaesthesia","volume":"69 7","pages":"693-699"},"PeriodicalIF":2.9,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12244454/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144626189","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of BlockBuster^® Laryngeal Mask Airway and Air-Q^® Intubating Laryngeal Airway as a conduit for fibreoptic bronchoscopy-guided tracheal intubation in paediatric patients: A randomised comparative study.","authors":"Kanika Chauhan, Sukhyanti Kerai, Kirti N Saxena, Lalit Gupta, T H Prathap, Sonia Wadhawan","doi":"10.4103/ija.ija_942_24","DOIUrl":"10.4103/ija.ija_942_24","url":null,"abstract":"<p><strong>Background and aims: </strong>The available supraglottic devices (SGDs) used as conduits for fibreoptic bronchoscope-guided intubation (FOI) in children have shown no difference in terms of time taken for tracheal intubation or success rate on the first attempt. However, several difficulties have been reported during the removal of the SGD after FOI. This study aimed to compare the feasibility of the safe removal of conduits after FOI through BlockBuster^® Laryngeal Mask Airway (BlockBuster) and Air-Q^® Intubating Laryngeal Airway (Air-Q) in paediatric patients.</p><p><strong>Methods: </strong>This was a randomised comparative study conducted on 66 children between the ages of 1 and 8 years undergoing elective surgeries under general anaesthesia. FOI was performed using BlockBuster or Air-Q as a conduit in study groups. The primary outcome was the time taken and the ease of removing the conduit after FOI. The secondary outcomes included adverse events during conduit removal. We also compared the number of attempts and time taken for the successful placement of these SGDs, as well as for FOI utilising them as conduits. An independent samples <i>t</i>-test was used for normally distributed variables, and a Chi-square test for qualitative variables, with statistical significance set at <i>P</i> < 0.05.</p><p><strong>Results: </strong>The ease of removing the conduit was comparable in both groups (<i>P</i> = 0.21). The mean time taken to remove the conduit was lower in the Blockbuster group [28.03 [standard deviation (SD: 5.90] [95% confidence interval (CI): 26.01, 30.04] seconds] compared to the control group (30.27 (SD: 5.54) (95% CI: 28.38, 32.16) seconds; <i>P</i> = 0.03). There were no adverse events during conduit removal in the BlockBuster and the Air-Q group. The number of attempts (<i>P</i> = 0.317) and time taken for the successful placement of SGDs (<i>P</i> = 0.054) in the study groups and FOI through them was found to be comparable (<i>P</i> = 0.692).</p><p><strong>Conclusion: </strong>For FOB-guided tracheal intubation in paediatric patients, BlockBuster is comparable to Air-Q, and it may be a useful alternative.</p>","PeriodicalId":13339,"journal":{"name":"Indian Journal of Anaesthesia","volume":"69 7","pages":"687-692"},"PeriodicalIF":2.9,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12244462/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144626192","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postoperative subclinical AKI is frequent and is linked to a poor long-term prognosis in critically ill patients.","authors":"Louis Boutin, Christos Chadjichristos, Alexandre Mebazaa, François Dépret","doi":"10.4103/ija.ija_207_25","DOIUrl":"10.4103/ija.ija_207_25","url":null,"abstract":"","PeriodicalId":13339,"journal":{"name":"Indian Journal of Anaesthesia","volume":"69 7","pages":"736-738"},"PeriodicalIF":2.9,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12244449/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144626122","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of prophylactic phenylephrine versus norepinephrine on foeto-maternal outcomes in caesarean delivery under neuraxial anaesthesia: A systematic review and meta-analysis with trial sequential analysis.","authors":"Anjishnujit Bandyopadhyay, Chhavi Sawhney, Partha Haldar, Sharmishtha Pathak","doi":"10.4103/ija.ija_1063_24","DOIUrl":"10.4103/ija.ija_1063_24","url":null,"abstract":"<p><strong>Background and aims: </strong>The prevention of hypotension in parturients scheduled for caesarean section is of utmost importance for improving foeto-maternal outcomes. We compared the prophylactic use of phenylephrine (PE) and norepinephrine (NE) on foeto-maternal outcomes in women undergoing caesarean delivery under neuraxial anaesthesia. Umbilical artery (UA) pH was the primary objective, and umbilical vein (UV) pH, APGAR scores, incidence of bradycardia, hypotension, and hypertension were secondary objectives.</p><p><strong>Methods: </strong>PubMed, EMBASE, Web of Science, Google Scholar, and CENTRAL databases were searched to identify all relevant randomised controlled trials (RCTs) published up to April 2023, further updated till May 2025. Our review was prospectively registered with PROSPERO (ID: CRD42023429328). The effect of PE and NE on UA pH was our primary outcome. The quality of evidence of outcomes was graded using the GRADE methodology. Only RCTs involving term pregnant females undergoing caesarean section under neuraxial anaesthesia were included.</p><p><strong>Results: </strong>Seventeen trials (2138 patients) were included in the final analysis. NE and PE were comparable in terms of UA and UV pH, with standardised mean difference (SMD) of 0.18 [95% confidence interval (CI): -0.09; 0.45] (I² = 81%, <i>P</i> < 0.01) and -0.39 (95% CI: -0.82; 0.04) (I² = 91%, <i>P</i> < 0.01), respectively. NE group had significantly lesser episodes of bradycardia [Relative Risk (RR): 0.44 (95% CI: 0.34; 0.56) (I² = 28%, <i>P</i> = 0.15)] and hypertension [RR: 0.54 (95% CI: 0.33; 0.90) (I² = 0%, <i>P</i> = 0.62)], but incidence of hypotension was comparable between groups [RR: 0.99 (95% CI: 0.82; 1.18) (I² = 18%, <i>P</i> = 0.25)]. Trial sequential analysis revealed that the required information size was reached for the outcome of bradycardia only.</p><p><strong>Conclusion: </strong>There is insufficient evidence to recommend using NE preemptively to improve foetal outcomes. Further studies are recommended to validate its effect.</p>","PeriodicalId":13339,"journal":{"name":"Indian Journal of Anaesthesia","volume":"69 7","pages":"638-649"},"PeriodicalIF":2.9,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12244457/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144626116","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of ephedrine on the nociception level and analgesia nociception index: A prospective observational study.","authors":"Masahiro Kuroki, Yu Onodera, Masayuki Okada, Masaki Nakane","doi":"10.4103/ija.ija_322_25","DOIUrl":"10.4103/ija.ija_322_25","url":null,"abstract":"","PeriodicalId":13339,"journal":{"name":"Indian Journal of Anaesthesia","volume":"69 7","pages":"739-741"},"PeriodicalIF":2.9,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12244447/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144626117","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Consigning the Mapleson F Circuit to Anaesthesia's historical archives.","authors":"Mukul C Kapoor","doi":"10.4103/ija.ija_440_25","DOIUrl":"10.4103/ija.ija_440_25","url":null,"abstract":"","PeriodicalId":13339,"journal":{"name":"Indian Journal of Anaesthesia","volume":"69 7","pages":"635-637"},"PeriodicalIF":2.9,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12244445/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144626193","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}