Frontiers in anesthesiology最新文献

{"title":"The role of the rectus sheath block in modern perioperative care for midline laparotomy: a review of the evidence.","authors":"Marcus Abbawy, David Okoh, Arundhati Binuraj, Finlay Holden, Benjamin Fox, Rajneesh Sachdeva, Jagtar Pooni, Manpreet Singh, Thomas Allen, Saibal Ganguly, Fang Gao-Smith, Tonny Veenith","doi":"10.3389/fanes.2026.1725241","DOIUrl":"10.3389/fanes.2026.1725241","url":null,"abstract":"<p><p>Perioperative management of pain is crucial in optimising patient outcomes after laparotomy. This review focuses on the rectus sheath block (RSB) and its use in midline laparotomies. This article will examine the current evidence on the clinical efficacy of this method, comparing it to alternative anaesthetic methods and outlining the numerous benefits of its use. The future of the RSB is considered, with an emphasis on where advancements may be achieved and the areas that require further research. We refer to the complications associated with RSB, which are uncommon. If a rectus sheath block is performed in accordance with the evidence-based steps outlined in this review, the likelihood of complications should be minimal.</p>","PeriodicalId":521030,"journal":{"name":"Frontiers in anesthesiology","volume":"5 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7618876/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147464728","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 multimodal pain management: a narrative review of current practices, clinical and educational gaps, and future directions.","authors":"Braden M Lopez, Brent M Lee, Michael D Miller, Mohab M Ibrahim, Todd W Vanderah, Arthur C Riegel","doi":"10.3389/fanes.2025.1709252","DOIUrl":"10.3389/fanes.2025.1709252","url":null,"abstract":"<p><p>Pain is among the most commonly reported side effects following surgical interventions; however, its management remains a significant challenge due to its multifaceted nature, with studies indicating that up to 80% of surgical patients experience inadequate pain control. Although multimodal pain management (MMPM) is widely recommended as a tool to help mitigate the ongoing opioid epidemic, a universally standardized approach for pain management is lacking and highly dependent on individual clinician practices. Pain perception is inherently subjective, and while objective measurement tools are emerging, self-reported pain scales continue to dominate clinical practice. Differences in pain perception, further complicate efforts to standardize care, demonstrating the need for personalized approaches. Notably, there is a deficiency in surgical education regarding formalized training in postoperative pain management, which leaves medical students and residents without a concrete foundation in evidence-based pain management strategies. This narrative review explores the pathophysiology of pain, evaluates current recommendations in surgery, and emphasizes preoperative optimization. It also argues for, and underscores the necessity for, comprehensive and structured pain management education across all surgical specialties. Furthermore, the review identifies future directions, particularly in pain prediction and the development of surgical guidelines that can facilitate a comprehensive pain management framework while accommodating patient-specific modifications.</p>","PeriodicalId":521030,"journal":{"name":"Frontiers in anesthesiology","volume":"4 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13183406/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147978596","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":"Towards a precision approach to anesthetic/analgesic immunomodulation in cancer.","authors":"Hersh V Gupta, Kay S Tan, Gregory W Fischer, Joshua S Mincer","doi":"10.3389/fanes.2024.1464004","DOIUrl":"10.3389/fanes.2024.1464004","url":null,"abstract":"<p><strong>Background: </strong>Immunomodulation is widely invoked to explain possible effects of anesthetic/analgesic drugs on recurrence and survival in cancer patients. By analogy with immune checkpoint inhibitors, which enhance anti-tumor actions of immune cells in the tumor microenvironment (TME), we aim to develop a precision approach to immunomodulation by anesthetic/analgesic drugs. We explore biomarkers predictive of immunotherapy response [tumor mutational burden (TMB)] and resistance [fraction genome altered (FGA)] in relation to anesthetic/analgesic dose to survival response and the expression of drug target receptor genes.</p><p><strong>Methods: </strong>Two local clinical cohorts [lung adenocarcinoma (LUAD) and colon adenocarcinoma (COAD) patients] were analyzed retrospectively to yield statistical interactions between drugs, outcomes, and TMB/FGA (extending previously reported results). Bulk tumor gene expression data for solid tumors from 6,488 patients across 18 solid tumor types was obtained from The Cancer Genome Atlas (TCGA) and normalized by tumor type. TMB and FGA for each TCGA patient sample was extracted from cBioPortal. DeSeq was employed to quantify differential gene expression of target receptors of 79 common anesthetic/analgesic drugs for high/low TMB and FGA. Localization of these receptors to specific immune cells was estimated using CIBERSORT.</p><p><strong>Results: </strong>Increased TMB and FGA magnified opioid pro-tumor effects on overall survival in LUAD, while increased TMB reduced ketamine anti-tumor effects on recurrence and did not affect ketorolac anti-tumor effects on recurrence. In COAD, increased TMB (DNA mismatch repair deficiency) magnified opioid anti-tumor effects on recurrence. Drug target receptor gene expression (and immune cell-type specificity) correlated with both TMB and FGA as a function of cancer type.</p><p><strong>Conclusions: </strong>TMB and FGA may have utility as biomarkers predictive of individual cancer patient response to anesthetic/analgesic dose effects on survival due to immunomodulation. Correlation across cancer types of anesthetic/analgesic target receptor gene expression with TMB and FGA and with TME immune cell types suggests molecular/omics level targets for further mechanistic exploration. A precision oncoanalgesia approach in the cancer patient may ultimately be warranted to optimize oncological outcomes.</p>","PeriodicalId":521030,"journal":{"name":"Frontiers in anesthesiology","volume":"3 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12407147/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145002697","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}