Journal of Clinical Anesthesia最新文献

{"title":"Opioid-sparing anesthesia based on opioid-free principles for early recovery after total knee arthroplasty: A randomized controlled trial","authors":"Jingwang Liu,&nbsp;Jiaxin Liu,&nbsp;Peng Liu,&nbsp;Wenzhi Li,&nbsp;Mingjie Wang,&nbsp;Jinru Li,&nbsp;Shuhong Yang,&nbsp;Shuang Zhao,&nbsp;Xiuli Wang","doi":"10.1016/j.jclinane.2026.112307","DOIUrl":"10.1016/j.jclinane.2026.112307","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate whether an opioid-sparing anesthesia strategy (OSA), based on opioid-free anesthesia (OFA), improves early postoperative recovery quality and optimizes functional outcomes after total knee arthroplasty (TKA), compared with conventional opioid-based anesthesia (OBA).</div></div><div><h3>Design</h3><div>A randomized controlled trial with blinding of patients, surgeons, and outcome assessors.</div></div><div><h3>Setting</h3><div>Single center, July 2025 to February 2026.</div></div><div><h3>Patients</h3><div>98 adult patients scheduled for elective unilateral TKA.</div></div><div><h3>Intervention</h3><div>Patients were randomized to the OSA or OBA group. The OSA regimen used esketamine and dexmedetomidine as the primary analgesic backbone, whereas the OBA regimen was opioid-based. Both groups received preoperative femoral nerve block and were administered oxycodone at skin incision and closure. Postoperatively, both groups received the same multimodal analgesia and patient-controlled analgesia.</div></div><div><h3>Measurements</h3><div>The primary outcome was the 24-h postoperative Quality of Recovery-15 (QoR-15) score. Secondary outcomes included 48-h QoR-15; Oxford Knee Score (OKS) and EQ-5D-3L at 1 and 3 months; high pain at 1 month and chronic postsurgical pain at 3 months. Exploratory outcomes included postoperative C-reactive protein (CRP), and postoperative nausea and vomiting (PONV), among others.</div></div><div><h3>Results</h3><div>At 24 h postoperatively, QoR-15 was higher in the OSA group than in the OBA group (118.4 ± 11.5 vs 113.3 ± 12.2; adjusted difference 5.12, 95% CI 0.51–9.74; <em>P</em> = 0.029), and this advantage persisted at 48 h (adjusted difference 5.54, 95% CI 1.57–9.52; <em>P</em> = 0.007). The OSA group had a lower incidence of PONV (<em>P</em> = 0.025) and lower postoperative CRP levels (<em>P</em> = 0.001). At 1 month, OKS was higher in the OSA group (adjusted difference 2.31, 95% CI 0.34–4.27; <em>P</em> = 0.022), with no significant differences in other secondary outcomes.</div></div><div><h3>Conclusion</h3><div>In TKA, this OFA-based OSA strategy improved early postoperative QoR-15 scores. However, the QoR-15 difference did not reach the minimal clinically important difference, so its clinical relevance remains uncertain.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"114 ","pages":"Article 112307"},"PeriodicalIF":6.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148793886","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}

{"title":"Association of serratus anterior and pectoserratus plane blocks with persistent shoulder dysfunction after modified radical mastectomy in older breast cancer patients","authors":"Merve Tokocin,&nbsp;Mehmet Olcum,&nbsp;Kayra Cangoz,&nbsp;Adnan Gundogdu","doi":"10.1016/j.jclinane.2026.112303","DOIUrl":"10.1016/j.jclinane.2026.112303","url":null,"abstract":"<div><h3>Background</h3><div>Postoperative shoulder dysfunction is a frequent and disabling complication following modified radical mastectomy (MRM), particularly in geriatric patients. Although pectoserratus plane block (PSPB) and serratus anterior plane blocks are well established for acute postoperative analgesia, their impact on long-term shoulder function remains unclear.</div></div><div><h3>Methods</h3><div>This retrospective cohort study included 147 women aged ≥65 years who underwent MRM for breast cancer. Patients who received PSPB combined with serratus anterior plane blocks formed the block group (<em>n</em> = 78), while those managed without regional anesthesia formed the control group (<em>n</em> = 69). Shoulder function at 6 months was assessed using Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) and Constant-Murley scores, and active range of motion. Secondary outcomes included persistent shoulder stiffness and chronic pain interference assessed by the Brief Pain Inventory (BPI) interference subscale.</div></div><div><h3>Results</h3><div>At 6 months, the block group demonstrated significantly better shoulder function with lower QuickDASH scores (7.8 ± 9.3 vs. 18.7 ± 8.8, <em>p</em> &lt; 0.001) and flexion (138.9° ± 16.8 vs. 133.9° ± 17.1, <em>p</em> = 0.027), and abduction (131.1° ± 19.1 vs. 126.9° ± 18.1, <em>p</em> = 0.049) were also improved and persistent shoulder stiffness was significantly less frequent (42.3% vs. 69.6%, <em>p</em> = 0.002). Multivariable logistic regression analyses identified regional blockade as an independent protective factor against persistent stiffness (odds ratio 0.29, 95% CI 0.14–0.59, <em>p</em> = 0.001). Constant-Murley scores at 6 months did not differ significantly between groups (83.4 ± 6.9 vs. 84.0 ± 6.4, <em>p</em> = 0.682).</div></div><div><h3>Conclusion</h3><div>Routine use of ultrasound-guided PSPB and serratus anterior plane blocks was associated with lower rates of long-term shoulder dysfunction after MRM in geriatric breast cancer patients. These findings suggest a potential association between regional anesthesia and improved postoperative functional recovery; however, causality cannot be established due to the retrospective design.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"114 ","pages":"Article 112303"},"PeriodicalIF":6.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148813208","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":"Intraoperative EEG power spectrum alterations in patients with malignant brain tumors","authors":"Duygu Aydin,&nbsp;Kasandra Albarran,&nbsp;Christopher Miciotto,&nbsp;Huong Brown,&nbsp;Steven Zheng,&nbsp;Benjamin J. Heller,&nbsp;Muskaan Chaturvedi,&nbsp;Emily Lachmann,&nbsp;Hee Jae Hong,&nbsp;Sourav Patnaik,&nbsp;Toral Patel,&nbsp;Ankur Patel,&nbsp;Gerhard Schneider,&nbsp;Matthias Kreuzer,&nbsp;Ulrike Hoffmann","doi":"10.1016/j.jclinane.2026.112304","DOIUrl":"10.1016/j.jclinane.2026.112304","url":null,"abstract":"<div><h3>Background</h3><div>Intraoperative electroencephalography (EEG) is increasingly used to guide anesthetic management. However, potential differences in EEG features remain poorly understood in patients with central nervous system pathologies, including brain tumors, leaving a critical knowledge gap regarding how structural brain lesions alter the anesthetic-induced EEG changes.</div></div><div><h3>Methods</h3><div>In this prospective observational pilot study, EEG data from patients undergoing craniotomies for the removal of malignant brain tumors (<em>n</em> = 21), benign brain tumors (<em>n</em> = 20), and from a control group of non-neurological surgeries (<em>n</em> = 32) were evaluated. The incidence of visually identified burst suppression during induction and maintenance as well as the power spectra from two artifact-free, burst suppression-free EEG episodes at the beginning and end of the maintenance were compared.</div></div><div><h3>Results</h3><div>Both benign and malignant tumor patients did not exhibit a significantly higher incidence of burst suppression during induction or maintenance compared to non-neurological controls. Malignant tumor patients had significantly lower absolute and relative beta band-power than benign tumor and control patients.</div></div><div><h3>Conclusions</h3><div>The EEG patterns of patients with malignant brain tumors differed significantly from those of patients with benign tumors and non-neurological controls. Further studies are needed to better characterize the EEG alterations and their clinical implications in this vulnerable patient population.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"114 ","pages":"Article 112304"},"PeriodicalIF":6.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148840406","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}

{"title":"Intravenous magnesium sulfate for analgesia in spinal surgery: a systematic review and meta-analysis of randomized controlled trials","authors":"Yao Huang,&nbsp;Peng Yuan,&nbsp;Lei Cao,&nbsp;Xueshan Dong","doi":"10.1016/j.jclinane.2026.112306","DOIUrl":"10.1016/j.jclinane.2026.112306","url":null,"abstract":"<div><h3>Study objective</h3><div>To evaluate the effects of perioperative intravenous magnesium sulfate on postoperative pain, opioid consumption, recovery, and adverse events in patients undergoing spinal surgery.</div></div><div><h3>Design</h3><div>Systematic review with meta-analysis.</div></div><div><h3>Setting</h3><div>Perioperative setting.</div></div><div><h3>Patients</h3><div>Twenty-one randomized controlled trials including 1271 adult patients.</div></div><div><h3>Interventions</h3><div>Perioperative intravenous magnesium sulfate.</div></div><div><h3>Measurements</h3><div>Two researchers independently evaluated the risk of bias of included randomized controlled trials using the Cochrane Risk-of-Bias Tool 2.0 (RoB 2). Disagreements were settled by discussion or consultation with a third reviewer. We used funnel plots to detect publication bias when at least 10 studies were available, and adopted the leave-one-out sensitivity analysis to verify the robustness of pooled results. The certainty of evidence for each outcome was rated via the GRADE framework from five dimensions, with evidence classified into four grades: high, moderate, low and very low.</div></div><div><h3>Main results</h3><div>Perioperative intravenous administration of magnesium sulfate can reduce postoperative 24-h pain scores (MD: -0.55, 95% CI: −1.01 to − 0.10, <em>P</em> = 0.02) and opioid consumption (MD: −4.95 mg, 95% CI: −8.74 to − 1.15 mg, <em>P</em> = 0.01). Furthermore, effect was more pronounced in the subgroup receiving a loading dose plus a maintenance dose. Perioperative intravenous magnesium administration significantly reduced intraoperative opioid consumption. Compared to the control group, magnesium sulfate was associated with a lower incidence of postoperative nausea and vomiting, but a higher incidence of hypotension. Meanwhile, intraoperative intravenous administration of magnesium sulfate appears to prolong the time to follow commands and the time to recovery of orientation.</div></div><div><h3>Conclusions</h3><div>Perioperative magnesium sulfate improves analgesia and reduces opioid consumption in spinal surgery, especially with a bolus-plus-infusion regimen. However, it may delay emergence and increase hypotension risk. Careful hemodynamic monitoring is recommended for high-risk patients.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"114 ","pages":"Article 112306"},"PeriodicalIF":6.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148850873","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":"Editorial Board w/barcode","authors":"","doi":"10.1016/S0952-8180(26)00192-3","DOIUrl":"10.1016/S0952-8180(26)00192-3","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"114 ","pages":"Article 112313"},"PeriodicalIF":6.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148935326","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}

{"title":"Corrigendum to “Incidence of phosphate abnormalities after cardiac surgery and their association with lactic acidosis: A cohort study from the Multicenter Perioperative Outcomes Group” [J Clin Anesth. 2026 Apr:111:112157. doi:10.1016/j.jclinane.2026.112157]","authors":"Dominik T. Steck,&nbsp;Willis L. Silliman,&nbsp;Rui Li,&nbsp;Vikas N. O'Reilly-Shah,&nbsp;Michael Mathis,&nbsp;Karen Domino,&nbsp;Kei Togashi,&nbsp;Srdjan Jelacic","doi":"10.1016/j.jclinane.2026.112295","DOIUrl":"10.1016/j.jclinane.2026.112295","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"114 ","pages":"Article 112295"},"PeriodicalIF":6.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148793932","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}

{"title":"On the Cover - J. Perdomo-Linares et al.","authors":"","doi":"10.1016/S0952-8180(26)00190-X","DOIUrl":"10.1016/S0952-8180(26)00190-X","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"114 ","pages":"Article 112311"},"PeriodicalIF":6.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148935325","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":"Corrigendum to “Effect of midodrine on orthostatic intolerance after hip and knee arthroplasty: A randomized controlled trial (the MOBiLE study)” [Journal of Clinical Anesthesia, Volume 113 (2026), 112261]","authors":"Monica Skarin,&nbsp;Jill Collier,&nbsp;David Rice,&nbsp;Peter McNair,&nbsp;Michal Kluger","doi":"10.1016/j.jclinane.2026.112264","DOIUrl":"10.1016/j.jclinane.2026.112264","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"114 ","pages":"Article 112264"},"PeriodicalIF":6.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148316866","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}

{"title":"Retraction notice to ‘The effect of play distraction on anxiety prior to pre-medication administration: A randomized trial’ [Journal of Clinical Anesthesia 36 (2017) 27–31]","authors":"Gözde Bumin Aydın MD (Associate Professor),&nbsp;Serhat Yüksel MD,&nbsp;Jülide Ergil MD (Associate Professor),&nbsp;Reyhan Polat MD,&nbsp;Fatma Kavak Akelma MD,&nbsp;Musa Ekici MD,&nbsp;Murat Sayın MD (Associate Professor),&nbsp;Öner Odabaş MD (Professor)","doi":"10.1016/j.jclinane.2026.112262","DOIUrl":"10.1016/j.jclinane.2026.112262","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"114 ","pages":"Article 112262"},"PeriodicalIF":6.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148361172","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}

{"title":"Editorial Board w/barcode","authors":"","doi":"10.1016/S0952-8180(26)00164-9","DOIUrl":"10.1016/S0952-8180(26)00164-9","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"113 ","pages":"Article 112286"},"PeriodicalIF":6.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148651183","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}