Acta Anaesthesiologica Scandinavica最新文献

{"title":"Mortality in Patients With Pulmonary Embolism in Danish Emergency Departments Before and During the COVID-19 Pandemic: A Multicenter Retrospective Cohort Study.","authors":"K W Hansen, H Kierkegaard, S V Leth, M Lisby","doi":"10.1111/aas.70099","DOIUrl":"10.1111/aas.70099","url":null,"abstract":"<p><strong>Background: </strong>In Central Denmark Region, early management of COVID-19 patients was delegated to emergency departments. This study aims to evaluate the mortality of patients admitted with pulmonary embolism, before and during the pandemic, as symptoms could mimic COVID-19.</p><p><strong>Methods: </strong>In this multicenter retrospective cohort study, we included all patients with the action diagnosis of pulmonary embolism admitted to emergency departments in Central Denmark Region between March 1, 2019, and February 28, 2021. The inclusion period defined two equivalent periods before (pre-COVID) and during the COVID-19 pandemic (COVID). The COVID period was used as exposure. 30-day mortality was the primary outcome, while 7-day mortality and transfer to intensive care units were two of the secondary outcomes.</p><p><strong>Results: </strong>A total of 328 and 300 patients with pulmonary embolism were admitted to an emergency department in Central Denmark Region pre and during COVID, respectively. There were no significant associations between admission during COVID and death within 30 days from admission date compared to pre-COVID patients (OR 1.63, 95% CI: 0.88-3.05). Comparing COVID to pre-COVID there were no significant differences in severity upon arrival to hospital (simplified pulmonary Embolism Severity Index 0 or ≥ 1 point(s), p = 0.759) or number of patients transferred to intensive care unit (6 vs. 9, p = 0.340).</p><p><strong>Conclusion: </strong>We found no differences in mortality or in transfer to ICU for patients with pulmonary embolism admitted in Central Denmark Region before or during the COVID-19 pandemic. This study addressed hospital resource management adjustments during the COVID-19 pandemic, and how cases with emergency admission diagnosis of pulmonary embolism fared during the pandemic period compared to other periods outside of the pandemic. For this Danish cohort analysis, pandemic conditions were not associated with different outcomes or ICU access compared to comparison periods.</p>","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":"69 8","pages":"e70099"},"PeriodicalIF":2.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144870792","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":"Dexmedetomidine Versus Midazolam for Propofol Sparing in Procedural Sedation of Children With Leukemia: A Consecutive Case Series.","authors":"Domenica Squillaci, Karen Console, Lara Colussi, Valentina Kiren, Marco Rabusin, Gabriele Stocco, Antonella Longo, Paolo Dalena, Egidio Barbi","doi":"10.1111/aas.70107","DOIUrl":"10.1111/aas.70107","url":null,"abstract":"<p><strong>Introduction: </strong>Propofol is commonly used in procedural sedation in oncology due to its rapid sedative effect and favorable recovery profile. However, several preclinical and clinical studies have demonstrated a dose-dependent neurotoxic effect of this drug. Dexmedetomidine and midazolam are potential adjuvants that, if used as premedication, could reduce the required dose of propofol. This study compares the use of dexmedetomidine and midazolam in terms of propofol dose reduction during procedural sedation in oncology patients.</p><p><strong>Methods: </strong>This one-year retrospective study compared the outcomes of procedural sedation, in terms of propofol-sparing, in 24 pediatric oncology patients who received midazolam (MP group, 52 procedures) or dexmedetomidine (DP group, 51 procedures) as premedication combined with propofol during bone marrow aspiration and/or lumbar puncture procedures. Data on propofol dosage, awakening time, vital parameters, and adverse events were examined.</p><p><strong>Results: </strong>Premedication with dexmedetomidine was associated with a significantly lower dose of propofol than midazolam (2.51 vs. 4.00 mg/kg, p < 0.001). Wake-up times were longer in the DP group (92 vs. 65 min; p = 0.045). Adverse events were very rare in both groups.</p><p><strong>Conclusions: </strong>Dexmedetomidine demonstrates superior propofol-sparing effects compared to midazolam, although it requires longer recovery times. These results support dexmedetomidine as a promising alternative in sedation protocols in pediatric oncology.</p><p><strong>Editorial comment: </strong>This retrospectively analysis of a single center series compared procedural sedation strategies for children involving propofol after standardized intravenous premedication with dexmedetomidine or midazolam. The findings demonstrated that dexmedetomidine in those doses and in combination with propofol confirmed sedative potency and duration more than that of the chosen midazolam premedication dosing.</p>","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":"69 8","pages":"e70107"},"PeriodicalIF":2.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12311750/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144752041","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":"Respiratory Rate as a Predictor of Clinical Deterioration and Mortality: A Scoping Review.","authors":"Sol Agnete Stene Aglen, Henriette Flesland Simonsen, Tørris Efskin Sjøset, Ib Jammer","doi":"10.1111/aas.70113","DOIUrl":"10.1111/aas.70113","url":null,"abstract":"<p><strong>Introduction: </strong>Respiratory rate (RR) is a critical vital sign for assessing a patient's respiratory and overall health status. Despite its importance, RR is often underutilized and inconsistently measured in clinical practice. Monitoring RR can identify early signs of clinical deterioration, as it is often the first vital sign to deviate when a patient's condition worsens. This scoping review aims to map the current evidence on the role of RR monitoring in predicting mortality among hospitalized adult patients. We also evaluate the association of RR monitoring with early detection of clinical deterioration.</p><p><strong>Method: </strong>A scoping review was performed using a structured search strategy across MEDLINE Ovid, EMBASE Ovid, and PubMed. The search was structured using the PICO framework, with mortality defined as the primary outcome of interest. Inclusion criteria were randomized controlled trials, cohort, cross-sectional, and observational studies in English, involving adults aged ≥ 16 years. Exclusion criteria included reviews, meta-analyses, and nonhuman studies. Two independent reviewers screened articles, with disagreements resolved by a third reviewer. Data extraction included study design, outcomes, and study-reported limitations.</p><p><strong>Results: </strong>The literature search identified 881 records, with 562 studies screened after removing duplicates. After final screening, 21 studies were included, with sample sizes ranging from 34 to 556,848 patients. Most studies were observational, including 6 retrospective, 10 prospective, 1 case-control, and 2 comparative cohort studies. RR was reported to be frequently associated with mortality and clinical deterioration; though findings varied depending on clinical context and measurement method. Continuous monitoring detected more cases of sustained respiratory abnormalities than intermittent measurements and could hypothetically lead to earlier clinical interventions; though clinical impact requires further investigation.</p><p><strong>Conclusion: </strong>RR was commonly identified as a predictor of mortality and clinical deterioration, with continuous monitoring showing higher detection rates of respiratory abnormalities compared with intermittent monitoring. However, variations in outcomes and study design highlight the need for standardized measurement.</p><p><strong>Editorial comment: </strong>This scoping review presents current knowledge about how respiratory rate monitoring and assessment can inform about clinical deterioration with acute illness requiring hospitalization.</p>","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":"69 8","pages":"e70113"},"PeriodicalIF":2.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144870793","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":"Correction to \"Plasma Trough Concentrations of Beta-Lactam Antibiotics in the Early Phase of Septic Shock\".","authors":"","doi":"10.1111/aas.70090","DOIUrl":"10.1111/aas.70090","url":null,"abstract":"","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":"69 7","pages":"e70090"},"PeriodicalIF":2.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12481636/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144564285","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":"Effects of Continuous Versus Intermittent Glucose Monitoring in Intensive Care Unit Patients: Protocol for a Systematic Review With Meta-Analysis.","authors":"Christian Gantzel Nielsen, Milda Grigonyte-Daraskeviciene, Mathias Maagaard Blem, Peter Lommer Kristensen, Ulrik Pedersen-Bjergaard, Mikkel Thor Olsen, Kirsten Nørgaard, Anders Perner, Johan Mårtensson, Morten Hylander Møller, Morten Heiberg Bestle","doi":"10.1111/aas.70086","DOIUrl":"10.1111/aas.70086","url":null,"abstract":"<p><strong>Background: </strong>Glucose management in intensive care unit (ICU) patients is challenging, and dysglycemia is associated with increased morbidity and mortality. Continuous glucose monitoring (CGM) could be a potential tool to improve clinical and glycemic outcomes compared with current practice which relies on intermittent glucose measurements.</p><p><strong>Aim: </strong>The aim of this systematic review and meta-analysis is to assess the effects of CGM compared with point of care (POC) glucose measurements on clinical patient-important and glycemic outcomes in ICU patients.</p><p><strong>Methods: </strong>This protocol is based on the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guideline. We will include all randomized clinical trials in ICU patients. The primary outcome is mortality at the longest follow-up, and the main-secondary outcome is the number of hypoglycemic events. Additional outcomes include both patient-important and glycemic outcomes. We will systematically search: PubMed, Embase, Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature, and Web of Science Core Collection. We will assess risk of bias using the Cochrane Risk of Bias 2 tool and conduct a Trial Sequential Analysis for the primary and main-secondary outcome. Clinical heterogeneity will be assessed using the Clinical Diversity in meta-analyses tool, and the certainty of evidence will be assessed using the Grading of Recommendation Assessment, Development, and Evaluation approach.</p><p><strong>Discussion: </strong>This systematic review with meta-analysis will provide an updated overview and synthesis of the effect of CGM versus POC glucose monitoring to inform clinical practice and future trials.</p>","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":"69 6","pages":"e70086"},"PeriodicalIF":1.9,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12184883/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144473712","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":"Intraoperative Clonidine in Spine Surgery: A Randomised Controlled Trial.","authors":"Stine Birkebæk, Niels Juul, Mikkel Mylius Rasmussen, Peter Gaarsdal Uhrbrand, Lone Nikolajsen","doi":"10.1111/aas.70048","DOIUrl":"10.1111/aas.70048","url":null,"abstract":"<p><p>Patients undergoing spine surgery often experience post-operative pain. In this context, clonidine, an alpha-2 agonist, may be relevant due to its analgesic properties. We conducted a randomised, double-blinded, placebo-controlled trial to evaluate the effect of a single dose of intraoperative intravenous clonidine on post-operative opioid consumption, pain intensity and side effects. Patients undergoing spine surgery at Aarhus University Hospital, Denmark, were randomised to receive intraoperative clonidine (3 μg/kg) or placebo. The primary outcome was opioid consumption within the first 3 h after surgery. Secondary outcomes included opioid consumption within the first 6 h, pain intensity at rest and during coughing, post-operative nausea and vomiting (PONV), and sedation in the post-anaesthesia care unit (PACU). Additional outcomes included time to discharge from the PACU, length of hospital stay and daily opioid consumption after 1 month. Data from 120 patients (49 females, 71 males, mean age 65 ± 14 years) were available for analysis; 61 received clonidine and 59 received placebo. Post-operative intravenous morphine equivalents within 3 h were similar in the clonidine group 5 mg (0-15) and the placebo group 10 mg (0-15) (p = 0.58). Pain intensity at rest was 4 (0-5.5) in the clonidine group and 3 (0-5) in the placebo group upon arrival at the PACU (p = 0.20). No differences were observed between the clonidine and placebo groups regarding any secondary outcomes, except for hypotension, which was more frequent in the clonidine group (24 vs. 13 patients). A single dose of intraoperative clonidine did not reduce post-operative opioid consumption or pain intensity in patients undergoing spine surgery.</p>","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":"69 6","pages":"e70048"},"PeriodicalIF":1.9,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12056682/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143967690","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":"Laryngotracheal Pathologies and Symptoms Associated to Airway Management of Critically Ill COVID-19 Patients at One-Year Follow Up: An Observational Study.","authors":"Svenberg Lind Clara, Karlsson Agneta, Marsk Elin, Kåhlin Jessica, Von Beckerath Mathias, Mårtensson Johan, Wanecek Michael, Vlastos Andrea, Hynning Boel, Aspelund Liljequist Amalia, Söderin Louise, Wales Jeremy","doi":"10.1111/aas.70074","DOIUrl":"10.1111/aas.70074","url":null,"abstract":"<p><strong>Background: </strong>The European laryngological society predicted an increased incidence of laryngotracheal complications as a result of the COVID-19 pandemic. During the first pandemic wave in the Stockholm region, 31% of critically ill COVID-19 patients were tracheotomized by an open surgical (OST) or a percutaneous tracheotomy (PCT). The aim of this study was to investigate the incidence of visible laryngotracheal pathologies in tracheotomized and long-term intubated COVID-19 survivors ≥ 12 months after initial intubation, to examine whether these pathologies were symptomatic and to assess possible associated factors.</p><p><strong>Methods: </strong>Study participants underwent laryngotracheoscopy under local anaesthesia, and tracheostomy skin and soft tissue scars were photo documented. Patient-reported outcome measures - the Voice Handicap Index-10 (VHI-10), the Eating Assessment Tool-10 (EAT-10) and the Dyspnea Index (DI), and demographics were retrospectively extracted from patient medical records.</p><p><strong>Results: </strong>Of 73 included study participants (40 OST, 24 PCT and 9 long-term intubated), 58% had visible laryngotracheal pathologies. Tracheostomy tube size and the number of days with tracheostomy were associated with skin and soft tissue pathology and tracheal pathology (p < 0.05). The results of the VHI-10 and EAT-10 were congruent with both laryngeal and skin and soft tissue pathologies. Participants with the highest DI scores, indicating breathing difficulties, had both laryngeal and tracheal pathologies followed by tracheal pathology alone.</p><p><strong>Conclusions: </strong>A high incidence of visible laryngotracheal pathologies, two airway management-related factors, and symptom-pathology associations for VHI-10 and EAT-10 scores were found in a cohort of COVID-19 survivors ≥ 12 months after critical care.</p>","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":"69 6","pages":"e70074"},"PeriodicalIF":1.9,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12177439/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144324134","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 Influence of Opioids on Pupil Initial Diameter and Pupillary Dilation Velocity in ICU Patients.","authors":"Valdemar Oskar Ingemann Sørensen, Stine Uhrenholt, Jannik Stokholm, Thomas Christensen, Morten Heiberg Bestle","doi":"10.1111/aas.70080","DOIUrl":"10.1111/aas.70080","url":null,"abstract":"<p><strong>Background: </strong>Pupillary light reflex assessment is a promising modality for assessing autonomic nervous system status, given that it is fast, noninvasive, and provides quantitative results. Opioid therapy influences the pupil and is frequently used in the intensive care unit (ICU). We investigated the effect of opioids on pupillary size and dilation velocity in the pupillary light reflex in critically ill patients.</p><p><strong>Methods: </strong>This is a sub-study on 55 patients from a prospective observational study acutely admitted to an ICU. All patients had daily blood samples and pupillary light reflex measurements. Blood samples were analyzed for opioids using mass spectrometry. Linear mixed models were used to estimate the possible association for each detected opioid to pupillary size and dilation velocity in the pupillary light reflex.</p><p><strong>Results: </strong>The pupil size before a light stimulus was closely associated to the dilation velocity after the light stimulus. The increase in the dilation velocity was 0.2 mm/s per 1 mm increase in pupil diameter before the light stimulus, 95% confidence interval [0.2-0.3], p < 0.001. Presence of fentanyl was associated with a smaller pupil size and a slower pupillary dilation velocity.</p><p><strong>Conclusions: </strong>The presence of fentanyl in blood samples from a mixed ICU population is associated with a slower pupillary dilation velocity in a concentration-dependent matter.</p><p><strong>Editorial comment: </strong>This study assesses the relation of observed opioid levels and light reflex pupillary size speed of change in an ICU cohort where there can be multiple classes of drugs present which influence autonomic nerve system function. Findings for different opioids, though most specifically fentanyl, show that opioid plasma concentrations have clear association with slower pupillary dilation velocity with light reflex response.</p>","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":"69 6","pages":"e70080"},"PeriodicalIF":1.9,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12185176/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144473715","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":"Plasma Trough Concentrations of Beta-Lactam Antibiotics in the Early Phase of Septic Shock.","authors":"Malin Hägglund, Magnus Brink, Ulrika Snygg Martin, Daniel Bremell, Carl Johan Svensson","doi":"10.1111/aas.70050","DOIUrl":"10.1111/aas.70050","url":null,"abstract":"<p><strong>Introduction: </strong>Septic shock necessitates timely antibiotic therapy, often with broad-spectrum beta-lactam antibiotics (ß-LA). To our knowledge, no previous study has examined antibiotic concentrations repeatedly during the initial phase of treatment. This observational study aimed to assess early-phase plasma concentrations of ß-LA in patients with septic shock.</p><p><strong>Method: </strong>Prospective observational study of patients with septic shock, according to the SEPSIS-3 criteria, who received cefotaxime, piperacillin/tazobactam, or meropenem in accordance with Swedish practice. Demographic and clinical data were recorded for each patient. Consecutive blood samples were obtained during the first 24 h of treatment, and total antibiotic concentrations were measured using liquid chromatography mass spectrometry. Target concentrations were defined as 100% of the time that free (unbound) antibiotic concentrations remained above the minimal inhibitory concentration (fT > MIC).</p><p><strong>Results: </strong>Twenty-two patients were included, 15 (68%) were male and the median age was 65.5 years (IQR 46.3-65.5). In-hospital mortality was 7/22 (32%). Antibiotic exposure exceeding 100% fT > MIC was achieved in 16 (73%) of the patients. Four patients did not receive the recommended additional dose between the first and second doses of antibiotics; two of them still achieved 100% fT > MIC, whereas the other two attained 66% and 33% fT > MIC, respectively. Among the patients who received the additional dose, four did not achieve 100% fT > MIC. No relationship between mortality and fT > MIC was observed. Significant associations with achieving 100% fT > MIC were observed for older age (p = 0.045) and illness severity (SAPS3, p = 0.025).</p><p><strong>Conclusion: </strong>Our findings demonstrate considerable variability in antibiotic exposure during the initial 24 h of septic shock treatment, highlighting a critical gap in understanding the clinical relevance of sub-optimal serum antibiotic concentrations and their potential impact on patient outcomes.</p><p><strong>Editorial comment: </strong>Therapeutic drug monitoring of antimicrobials is increasingly being used in research and clinical practice.</p>","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":"69 6","pages":"e70050"},"PeriodicalIF":1.9,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12047412/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143954950","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":"Ultrasound-Guided Nerve Blocks Improve Success Rate of Closed Reduction of Colles' Fractures: A Randomised Controlled Trial.","authors":"Anette B Christensen, Christine IIkjær, Torben K Laustrup, Esben Sejer, Camilla Rønnøw, Kaj V Døssing, Troels B Jensen, Jacob K Andersen, Christoffer G Sølling","doi":"10.1111/aas.70063","DOIUrl":"10.1111/aas.70063","url":null,"abstract":"<p><strong>Background: </strong>The initial treatment for distal forearm fractures, including Colles' fractures, involves closed reduction, for which effective pain management is essential. In Colles' fractures, achieving a satisfactory closed reduction may eliminate the need for surgical intervention. While ultrasound-guided nerve blocks are effective, hematoma blocks (HB) are often favored due to their feasibility in the emergency care setting. Further research comparing treatment outcomes is warranted.</p><p><strong>Methods: </strong>In a multicentre randomised controlled trial, adults with distal forearm fractures were assigned to either ultrasound-guided blocks of the radial and median nerves (US) or HB for closed fracture reduction. The primary endpoint was satisfactory fracture reduction. Secondary endpoints were secondary fracture dislocation, self-reported pain, and time spent in the emergency department.</p><p><strong>Results: </strong>Among 238 patients with Colles' fracture, 117 received US and 121 received HB. Satisfactory fracture reduction was achieved in 73 (62%) and 49 (40%) patients, respectively (p = 0.01). Surgical correction was conducted in 61 (52%) patients in the US group, contrasting 80 (66%) patients in the HB group (p = 0.03). During the fracture reduction, no difference in self-reported pain was observed (p = 0.21) for patients with distal forearm fractures (n = 247). The median time from block application to fracture reduction was 45 min in the US group and 25 min in the HB group (p < 0.01).</p><p><strong>Conclusion: </strong>Ultrasound-guided median and radial nerve blocks had a higher success rate for Colles' fracture reduction than the hematoma block group. The influence of anesthetic techniques on the eventual need for surgery requires further investigation.</p>","PeriodicalId":6909,"journal":{"name":"Acta Anaesthesiologica Scandinavica","volume":"69 6","pages":"e70063"},"PeriodicalIF":1.9,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12178230/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144324135","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}