Brazilian Journal of Anesthesiology最新文献

{"title":"Effectiveness of the hypotension prediction index in non-cardiac surgeries: a systematic review, meta-analysis and trial sequential analysis","authors":"Vitor Alves Felippe ,&nbsp;Ana C. Pinho ,&nbsp;Lucas M. Barbosa ,&nbsp;Ivo Queiroz ,&nbsp;Arthur H. Tavares ,&nbsp;Rodrigo Diaz ,&nbsp;Carlos Darcy Bersot ,&nbsp;Jean-Louis Vincent","doi":"10.1016/j.bjane.2025.844649","DOIUrl":"10.1016/j.bjane.2025.844649","url":null,"abstract":"<div><h3>Background</h3><div>The efficacy of the Hypotension Prediction Index (HPI) for reducing Intraoperative Hypotension (IOH) among patients undergoing non-cardiac surgeries remains unclear. We aimed to perform a systematic review, meta-analysis, and trial sequential analysis to determine whether the HPI is effective for adult patients undergoing non-cardiac surgeries. This study was prospectively registered in the PROSPERO database (CRD42024571931).</div></div><div><h3>Methods</h3><div>PubMed, Embase, and Cochrane were systematically searched for Randomized Controlled Trials (RCTs) comparing HPI-guided therapy with standard care in non-cardiac surgeries. We computed Mean Difference (MD) and Risk Ratios (RR) for continuous and binary outcomes, respectively, with 95 % Confidence Intervals (95 % CI). Statistical analyses were performed using R Software, version 4.2.3.</div></div><div><h3>Results</h3><div>We included 11 RCTs, comprising a total of 789 patients, of whom 395 (50.1 %) received HPI-guided management. HPI significantly reduced the Time-Weighted Average (TWA) of Mean Arterial Pressure (MAP) &lt; 65 mmHg (MD = -0.23 mmHg.min^-1; 95 % CI -0.35 to -0.10; <em>p</em> &lt; 0.01) and the Area Under the Curve (AUC) of MAP &lt; 65 mmHg (MD = -97.2 mmHg.min^-1; 95 % CI -143.4 to -50.98; <em>p</em> &lt; 0.01). HPI also decreased the duration of MAP &lt; 65 mmHg (MD = -16.22 min; 95 % CI -25.87 to -6.57; <em>p</em> &lt; 0.01) and the number of hypotensive episodes per patient (MD = -3.38; 95 % CI -5.38 to -1.37; <em>p</em> &lt; 0.01). No significant differences were observed in the number of hypotensive events, phenylephrine use, or AKI incidence (<em>p</em> &gt; 0.05).</div></div><div><h3>Conclusion</h3><div>In adult patients undergoing non-cardiac surgeries, HPI use was associated with a reduction in the duration and severity of IOH, with no significant difference for adverse events. Limitations include significant heterogeneity across studies, differences in HPI implementation, and lack of long-term outcome data.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 5","pages":"Article 844649"},"PeriodicalIF":1.7,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144287408","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of propofol and sevoflurane anesthesia on the optic nerve sheath: systematic review and meta-analysis","authors":"Rodolfo Otávio Tomaz Bertti ,&nbsp;Luiz Antonio Vane ,&nbsp;José Mariano Soares de Moraes ,&nbsp;Paulo do Nascimento Junior ,&nbsp;Lucas Fachini Vane ,&nbsp;Norma Sueli Pinheiro Módolo ,&nbsp;Matheus Fachini Vane","doi":"10.1016/j.bjane.2025.844646","DOIUrl":"10.1016/j.bjane.2025.844646","url":null,"abstract":"<div><h3>Background</h3><div>To facilitate the surgical view, laparoscopic and robotic pelvic surgeries require a pneumoperitoneum with the Trendelenburg position, which may result in elevated Intracranial Pressure (ICP). The choice of anesthetic agents may also influence ICP. Ultrasonographic evaluation of the Optic Nerve Sheath Diameter (ONSD) is a promising way to evaluate ICP. In this systematic review, we aimed to evaluate the ONSD, as an indirect estimation of ICP, in patients undergoing laparoscopic/robotic surgeries under pneumoperitoneum and Trendelenburg position.</div></div><div><h3>Methods</h3><div>A literature search was performed to identify prospective randomized clinical trials in which the primary endpoint was the evaluation of the ONSD using sevoflurane or propofol anesthesia after the onset of pneumoperitoneum and Trendelenburg position. The mean and the standard deviation of the ONSD in each intervention group were extracted from the included trials for analysis. Mean difference with 95% Confidence Interval (95% CI) was calculated.</div></div><div><h3>Results</h3><div>Five randomized controlled trials, with 277 subjects, were allocated to this study. Compared with the baseline, there was an increase in ONSD from 0.5h to 3 hours (p &lt; 0.05) in both propofol and sevoflurane groups. Furthermore, propofol reduced the ONSD compared to sevoflurane (mean difference: -0.23 mm, 95% CI: -0.37 to -0.10; studies = 5; I² = 23%).</div></div><div><h3>Conclusion</h3><div>There is evidence indicating, through ultrasonographic analysis of the ONSD, that propofol probably reduces ICP compared to sevoflurane in robotic and laparoscopic pelvic surgeries.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 5","pages":"Article 844646"},"PeriodicalIF":1.7,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144251104","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Serratus posterior superior intercostal plane block versus thoracic paravertebral block for pain management after video-assisted thoracoscopic surgery: a randomized prospective study","authors":"Güvenç Doğan ,&nbsp;Onur Küçük ,&nbsp;Selçuk Kayır ,&nbsp;Gökçe Çiçek Dal ,&nbsp;Bahadır Çiftçi ,&nbsp;Musa Zengin ,&nbsp;Ali Alagöz","doi":"10.1016/j.bjane.2025.844647","DOIUrl":"10.1016/j.bjane.2025.844647","url":null,"abstract":"<div><h3>Background</h3><div>Video-Assisted Thoracoscopic Surgery (VATS) is a minimally invasive procedure associated with faster recovery and fewer complications compared to open thoracotomy. Effective postoperative pain management is important for optimizing recovery. This study compares the analgesic efficacy of the Serratus Posterior Superior Intercostal Plane Block (SPSIPB) and Thoracic Paravertebral Block (TPVB) for postoperative pain following VATS.</div></div><div><h3>Methods</h3><div>In this randomized, prospective, double-blind study, 70 patients aged 18–65 years (ASA I–III) undergoing VATS were randomly assigned to Group TPVB (n = 35) or Group SPSIPB (n = 35). The primary outcome was the 24-hour postoperative Visual Analog Scale (VAS) pain score at rest. Secondary outcomes included VAS pain scores during coughing, time to first opioid request, total opioid consumption within 24 hours, patient satisfaction, and Quality of Recovery-15 (QoR-15) scores. Opioid consumption was assessed using intravenous tramadol through Patient-Controlled Analgesia (PCA), with additional morphine, if required.</div></div><div><h3>Results</h3><div>The mean age of the patients was 52 ± 11 years, and 64.2% were male. VAS pain scores were evaluated at 24 hours and at seven time points. There was no significant difference between groups (p &gt; 0.05) except at 1 hour postoperatively, where the TPVB group had a significantly lower resting VAS score (19 [8–28] vs. 26 [18.5–33], p = 0.031). The total 24 hour tramadol consumption was 220 mg (135–260) in the TPVB group versus 150 mg (110–230) in the SPSIPB group (p = 0.129). The proportion of patients requiring additional analgesia was 25.7% in the TPVB group versus 28.5% in the SPSIPB group (p = 0.788). Preoperative and postoperative QoR-15 scores were similar between the groups (preoperative: 137 vs. 136, p = 0.878; postoperative: 133 vs. 132, p = 0.814). Patient satisfaction scores were also comparable (8 [7–10] vs. 9 [7–10], p = 0.789).</div></div><div><h3>Conclusion</h3><div>SPSIPB provides analgesic efficacy similar to TPVB for VATS, with comparable pain scores, opioid consumption, and recovery outcomes. Given its ease of use and safety profile, SPSIPB represents a promising alternative to TPVB in multimodal analgesia for minimally invasive thoracic surgery.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 5","pages":"Article 844647"},"PeriodicalIF":1.7,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144236097","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Keeping it in the family: Malignant Hyperthermia - how we predict, recognise and treat it","authors":"Jonathan G. Bilmen,&nbsp;Pawan K. Gupta","doi":"10.1016/j.bjane.2025.844645","DOIUrl":"10.1016/j.bjane.2025.844645","url":null,"abstract":"","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 4","pages":"Article 844645"},"PeriodicalIF":1.7,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144188567","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of pericapsular nerve group block and anterior quadratus lumborum block for hip fracture surgery: a randomized clinical trial","authors":"Mustafa Aslan ,&nbsp;Alper Kilicaslan ,&nbsp;Funda Gök ,&nbsp;Ahmet Fevzi Kekec ,&nbsp;Tahsin Sami Colak","doi":"10.1016/j.bjane.2025.844643","DOIUrl":"10.1016/j.bjane.2025.844643","url":null,"abstract":"<div><h3>Objective</h3><div>This study compared the Pericapsular Nerve Group (PENG) block combined with the Lateral Femoral Cutaneous Nerve (LFCN) block to the anterior Quadratus Lumborum Block (QLB) in patients undergoing Total Hip Arthroplasty (THA).</div></div><div><h3>Methods</h3><div>In this prospective, double-blind trial, 80 adults scheduled for THA under spinal anesthesia were randomized to receive either an anterior QLB (n = 40) with 30 mL of 0.25% bupivacaine or a combined PENG + LFCN block (n = 40) using 25 mL of 0.25% bupivacaine for PENG and 5 mL for LFCN. The primary outcome was cumulative 24 hour postoperative intravenous morphine consumption. Secondary outcomes included pain scores, quadriceps strength, patient satisfaction and side effects.</div></div><div><h3>Results</h3><div>No significant differences were observed between the groups in morphine consumption or pain scores during the first 12 hours (p &gt; 0.05). At 24 hours, the PENG + LFCN group demonstrated significantly lower morphine consumption (p = 0.027) and resting VAS scores (p &lt; 0.001). Quadriceps weakness occurred in 15% (6/40) of anterior QLB patients at 6 hours (p = 0.026), whereas no weakness was observed in the PENG + LFCN group within 24 hours. Patient satisfaction and the incidence of complications were comparable between the groups.</div></div><div><h3>Conclusion</h3><div>Both anterior QLB and PENG + LFCN blocks provide effective analgesia for up to 12 hours post-THA. However, the PENG + LFCN combination offers prolonged analgesia, reduced opioid requirements and better preservation of quadriceps strength.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 5","pages":"Article 844643"},"PeriodicalIF":1.7,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144668","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of automatic versus constant CPAP in elderly patients after major abdominal surgery: a randomized noninferiority trial","authors":"Nguyen Dang Thu ,&nbsp;Nguyen Thi Thuy ,&nbsp;Le Sau Nguyen ,&nbsp;Cong Quyet Thang ,&nbsp;Nguyen Ngoc Thach ,&nbsp;Nguyen Trung Kien","doi":"10.1016/j.bjane.2025.844642","DOIUrl":"10.1016/j.bjane.2025.844642","url":null,"abstract":"<div><h3>Background</h3><div>Geriatric patients undergoing major open abdominal surgery are at high risk for postoperative pulmonary complications and hypoxemia. Continuous Positive Airway Pressure (CPAP) after surgery may improve postoperative lung function. This randomized controlled trial compared two CPAP techniques ‒ automatic via nasal mask and constant via facial mask ‒ regarding pulmonary function and patient tolerance.</div></div><div><h3>Methods</h3><div>Sixty patients (≥ 60 years) were randomized (1:1) to receive either automatic CPAP (2–10 cm H₂O) via a nasal mask (Group A) or constant CPAP (7.5 cm H₂O) via a facial mask (Group C) upon arrival in the post-anesthesia care unit. Oxygenation (PaO₂, PaO₂/FiO₂, SpO₂) and spirometry (FVC, FEV₁, PEF) were assessed preoperatively, postoperatively, and one hour after treatment. Comfort scores (0–10, with 0 indicating the best comfort) and complications were recorded.</div></div><div><h3>Results</h3><div>PaO₂/FiO₂ improvement was lower in Group A (32.6 ± 26.3 mmHg) than in Group C (52.9 ± 40.1 mmHg; p = 0.023). FVC improvement was also lower in Group A (3.7% ± 4.0%) than in Group C (6.7% ± 4.9%; p = 0.012). However, Group A had better tolerance, with lower comfort scores (2 [2–3] vs. 3 [2–4], p = 0.002). Pulmonary function benefits were more pronounced in patients over 70 and those undergoing upper abdominal surgery.</div></div><div><h3>Conclusion</h3><div>Both CPAP techniques prevent pulmonary decline in geriatric patients post-surgery. While automatic CPAP provides better comfort, constant CPAP improves oxygenation. Although our findings are short-term, they suggest that CPAP mode selection should be tailored based on patient-specific needs.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 5","pages":"Article 844642"},"PeriodicalIF":1.7,"publicationDate":"2025-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144102902","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The expanding role of the erector spinae plane block: from concept to clinical integration","authors":"João Pedro Fernandes Gonçalves ,&nbsp;Anita Perpétua Carvalho Rocha de Castro ,&nbsp;Luiz Gustavo Albuquerque ,&nbsp;Thiago Ramos Grigio ,&nbsp;Durval Campos Kraychete","doi":"10.1016/j.bjane.2025.844644","DOIUrl":"10.1016/j.bjane.2025.844644","url":null,"abstract":"","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 4","pages":"Article 844644"},"PeriodicalIF":1.7,"publicationDate":"2025-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144103030","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of biological sex in neurophysiological associations of patients with chronic osteoarthritis pain: a prospective cross-sectional study","authors":"Kevin Pacheco-Barrios ,&nbsp;Marcel Simis ,&nbsp;Paulo S. de Melo ,&nbsp;Ingrid Rebello-Sanchez ,&nbsp;Karen Vasquez-Avila ,&nbsp;Sara Barbosa Franco ,&nbsp;Paola Gonzalez-Mego ,&nbsp;Linamara Battistella ,&nbsp;Marta Imamura ,&nbsp;Felipe Fregni","doi":"10.1016/j.bjane.2025.844639","DOIUrl":"10.1016/j.bjane.2025.844639","url":null,"abstract":"<div><h3>Background</h3><div>This study aims to explore the role of sex as a confounder and effect modifier in the associations of clinical outcomes, pain-related outcomes, and neurophysiological measurements in chronic knee OA pain subjects.</div></div><div><h3>Methods</h3><div>Sociodemographic, clinical, and neurophysiological data were extracted from 113 knee OA subjects with chronic pain. We performed exploratory multivariate regression models assessing the association of physiological outcomes (Quantitative Sensory Testing [QST], Electroencephalography [EEG], and Transcranial Magnetic Stimulation [TMS]) and clinical characteristics (pain, anxiety, and motor function). In each independent model we tested the role of biological sex as confounder and effect modifier (adding the interaction term).</div></div><div><h3>Results</h3><div>Females reported higher pain intensity, lower quality of life, diminished pain thresholds, and less EEG alpha power compared to males. Sex negatively confounded the association between pain interference and pain intensity with pain threshold confounding (ranged between -19% to -125%). Moreover, sex acted as an effect modifier, predominantly influencing the relationship between pain interference and frontocentral alpha-delta power in EEG. Similarly, sex modified the association between pain interference and pain threshold. In females EEG and PPT variables explained less variability of pain interference compared to males.</div></div><div><h3>Conclusions</h3><div>Our study suggests that sex is a confounder and effect modifier mainly in the relationship between neurophysiological variables and pain-related outcomes in a chronic OA pain population. Females may have weaker associations between pain intensity and mechanistic outcomes (EEG and QST). Thus, the use of these biomarkers in females requires further optimization. We therefore reinforce the need for accounting for biological sex in the analysis, not only as a confounder, but as an effect modifier in further randomized trials and observational studies in the field of pain.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 4","pages":"Article 844639"},"PeriodicalIF":1.7,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144096051","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Venous saturation guided postoperative care for pediatric cardiac surgical patients: the body wants oxygen!","authors":"Rohit S. Loomba","doi":"10.1016/j.bjane.2025.844641","DOIUrl":"10.1016/j.bjane.2025.844641","url":null,"abstract":"","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 4","pages":"Article 844641"},"PeriodicalIF":1.7,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144096052","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Erector spinae plane block versus caudal epidural block in pediatric surgery: a systematic review and meta-analysis of randomized clinical trials","authors":"Barbara Bombassaro Masiero ,&nbsp;Deivyd Cavalcante ,&nbsp;Fatemeh Akbarpoor ,&nbsp;Capela António Dicazeco Pascoal ,&nbsp;Lubna Al-Sharif ,&nbsp;Fellipe Feijó Halfeld ,&nbsp;Lucas Cael Azevedo Ramos Bendaham ,&nbsp;Patricia Viana ,&nbsp;Jesslyn N. Haryianto ,&nbsp;Maria Luiza de Souza Rasia ,&nbsp;Mariana Copetti de Almeida Cunha ,&nbsp;Ana Djulia Tesche ,&nbsp;Júlia Caletti Roth de Oliveira ,&nbsp;Rafael Arsky Lombardi","doi":"10.1016/j.bjane.2025.844640","DOIUrl":"10.1016/j.bjane.2025.844640","url":null,"abstract":"<div><h3>Background</h3><div>Caudal Epidural Block (CEB) is a well-established regional anesthesia technique for abdominal and sub-abdominal pediatric surgeries. However, it has a short duration, often leading to additional analgesic administration. Erector Spinae Plane Block (ESPB), for instance, is an emerging technique that, like CEB, provides analgesic effect to a specific dermatome of the body during surgery and in the postoperative period. Therefore, we performed this systematic review with meta-analysis to compare both techniques.</div></div><div><h3>Methods</h3><div>We searched PubMed, Embase and Cochrane Central for Randomized Controlled Trials (RCTs) comparing ESPB versus CEB in pediatric patients undergoing abdominal and sub-abdominal surgeries. The primary outcome was the time to first analgesic request. Secondary outcomes were I) FLACC score; II) Postoperative nausea and vomiting, and III) Urinary retention.</div></div><div><h3>Results</h3><div>Nine randomized controlled trials encompassing 507 patients were included in this analysis (1‒9). The patients were predominantly male and under 10 years of age. There was an equal distribution between the two groups regarding the number of patients and patients’ baseline characteristics. The main results were: time to first analgesic request (MD = 3.71; 95% CI: -1.88–9.29; <em>I²</em> = 99%; p = 0.19); FLACC scores at 2 hours (MD = 0.15; 95% CI: -0.30–0.59; <em>I²</em> = 0%; p = 0.52); FLACC scores at 24 hours (MD = -0.17; 95% CI: -0.39–0.05; <em>I²</em> = 41%; <em>I²</em> = 41%; p = 0.13); urinary retention events (RR = 0.12; 95% CI: 0.02–0.94; <em>I²</em> = 0%; p = 0.04); and Postoperative Nausea and Vomiting (PONV) which was null in both groups in three studies. However, it is important to clarify that some limitations were identified, such as significant heterogeneity in the following outcomes: time to first analgesic request and FLACC score at 24h, possibly due to different age groups, different types of surgeries, different background analgesia administration, and a relatively small sample size. As for the risk of bias, two studies were found to have some concerns in “bias due to deviations from intended interventions” (8,9).</div></div><div><h3>Conclusion</h3><div>Our findings suggest that the administration of ESPB did not statistically differ from CEB regarding the time to first analgesic request. FLACC scores also did not show a statistically significant difference between groups. The ESPB group, however, experienced minor urinary retention events compared to the CEB group.</div></div><div><h3>Quality of evidence</h3><div>According to the GRADE assessment, all outcomes evaluated in this study were classified as high-quality evidence. Quality assessment is detailed in <span><span>Supplementary Table 1</span></span>.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 4","pages":"Article 844640"},"PeriodicalIF":1.7,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144095983","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}