BJA open最新文献

{"title":"Analgesia using intrathecal morphine to improve quality of recovery after minimally invasive major abdominal surgery (AIM Trial): study protocol for a multicentre randomised controlled trial","authors":"Katrina Pirie ,&nbsp;Emily Traer ,&nbsp;Noam Winter ,&nbsp;Wendy Brown ,&nbsp;Bernhard Riedel ,&nbsp;Paul S. Myles","doi":"10.1016/j.bjao.2025.100386","DOIUrl":"10.1016/j.bjao.2025.100386","url":null,"abstract":"<div><h3>Background</h3><div>Evidence to support the effectiveness of intrathecal morphine in patients undergoing minimally invasive abdominal surgery is largely based on small, single-centre studies. We therefore designed a large, multi-centre clinical trial to investigate the effect of intrathecal morphine with local anaesthetic on patient postoperative quality of recovery. The primary objective is to compare quality of recovery on postoperative Day 1. The secondary objectives are to compare opioid consumption, pain scores, and opioid-related adverse events.</div></div><div><h3>Methods</h3><div>This multi-centre, prospective, randomised controlled trial will recruit 280 adult patients undergoing minimally invasive major abdominal surgery. The intervention group will receive 200 mcg of intrathecal morphine with local anaesthetic, as part of a multimodal analgesic strategy. Following safety analysis after the first 100 patients the dose of ITM will increase to 300 mcg. The control group will receive non-neuraxial multimodal analgesia.</div></div><div><h3>Conclusions</h3><div>This trial is expected to provide evidence on the effectiveness and the safety of two different ITM doses with local anaesthetic in major minimally invasive abdominal surgery.</div></div><div><h3>Clinical trial registration</h3><div>ACTRN12623001347651 (ANZCTR Registry Number).</div></div><div><h3>Protocol version number and date</h3><div>1.0, May 2, 2024.</div></div>","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"14 ","pages":"Article 100386"},"PeriodicalIF":0.0,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143685749","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":"The use of intrathecal morphine in non-abdominal surgery: a scoping review","authors":"Aart Jan W. Teunissen ,&nbsp;Lieke van Gastel ,&nbsp;Robert J. Stolker ,&nbsp;Seppe A. Koopman","doi":"10.1016/j.bjao.2025.100387","DOIUrl":"10.1016/j.bjao.2025.100387","url":null,"abstract":"<div><h3>Background</h3><div>Intrathecal morphine can reduce pain and opioid requirements needed for postoperative pain relief. It can potentially aid in the effectiveness of enhanced recovery protocols in non-abdominal surgery. However, concerns about side-effects may have hindered its use. This scoping review evaluates the effectiveness, appropriate dosage, and adverse effects of intrathecal morphine in non-abdominal surgery.</div></div><div><h3>Methods</h3><div>We systematically searched for randomised controlled trials examining the use of intrathecal morphine in non-abdominal surgery.</div></div><div><h3>Results</h3><div>The search identified 75 trials involving 4685 patients. We undertook a scoping review of these randomised controlled trials, including bias assessments, to comprehensively analyse the effectiveness and side-effects of intrathecal morphine. The findings indicate that intrathecal morphine reduced postoperative pain and opioid consumption after spinal surgery, thoracic surgery, and orthopaedic lower extremity surgery. However, it was associated with an increased incidence of itching, postoperative nausea and vomiting, and urinary retention, particularly in orthopaedic procedures. Delayed respiratory depression was absent with low to moderate doses (&lt;500 μg) in the reviewed studies.</div></div><div><h3>Conclusions</h3><div>This review supports the effectiveness of intrathecal morphine in non-abdominal surgery. However, the benefits must be carefully weighed against potential side-effects that could lead to prolonged hospital stays.</div></div><div><h3>Clinical trial registration</h3><div>PROSPERO-registry CRD42021233936.</div></div>","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"14 ","pages":"Article 100387"},"PeriodicalIF":0.0,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143685748","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":"Adductor canal block in total knee arthroplasty: a scoping review of the literature","authors":"Nikhil Agarwal ,&nbsp;Robert Kay ,&nbsp;Andrew D. Duckworth ,&nbsp;Nicholas D. Clement ,&nbsp;David M. Griffith","doi":"10.1016/j.bjao.2025.100381","DOIUrl":"10.1016/j.bjao.2025.100381","url":null,"abstract":"<div><h3>Background</h3><div>An adductor canal block is commonly used to reduce pain after total knee arthroplasty. Practice varies in terms of site of injection, local anaesthetic, and adjuncts used, with poor consensus in relation to the best approach. The aim of this scoping review was to assess the evidence for efficacy and safety of adductor canal block, determine variation in the technique used, type and dose of medication, and compare the efficacy of adductor canal block with other nerve block techniques.</div></div><div><h3>Methods</h3><div>Four databases were searched to identify relevant studies (Medline, Embase, Cochrane, and <span><span>ClinicalTrials.gov</span><svg><path></path></svg></span>). A total of 285 articles were found, and data was extracted from 130 randomised controlled trials.</div></div><div><h3>Results</h3><div>Adductor canal block is a safe and potentially effective peripheral nerve block for reducing postoperative pain after total knee arthroplasty while preserving motor function. Of all adjuncts to adductor canal block assessed, either dexamethasone or dexmedetomidine provide additional analgesic benefit. Adductor canal block combined with peri-articular local anaesthetic injection provides the best outcomes. Continuous infusion of local anaesthetic through a catheter placed in the adductor canal provides no additional benefit over a single injection. The site of injection used for adductor canal block does not seem to affect efficacy. There was no evidence to support the superiority of any single local anaesthetic agent.</div></div><div><h3>Conclusion</h3><div>This scoping review has identified variation in the use of medications, doses, techniques, and adjuncts for adductor canal block. As such, definitive conclusions regarding the most effective practice for adductor canal block cannot be made.</div></div>","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"14 ","pages":"Article 100381"},"PeriodicalIF":0.0,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143643122","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":"Impact of perioperative dexmedetomidine treatment on 1-year mortality in patients undergoing orthotopic heart transplantation","authors":"Carolin Torregroza ,&nbsp;Carla L. Endreß ,&nbsp;René M'Pembele ,&nbsp;Sebastian Roth ,&nbsp;Alexandra Stroda ,&nbsp;Hug Aubin ,&nbsp;Artur Lichtenberg ,&nbsp;Giovanna Lurati Buse ,&nbsp;Ragnar Huhn ,&nbsp;Udo Boeken","doi":"10.1016/j.bjao.2025.100389","DOIUrl":"10.1016/j.bjao.2025.100389","url":null,"abstract":"<div><h3>Background</h3><div>Heart transplantation remains the gold standard treatment of end stage heart failure. The prognosis of heart transplantation has continuously improved, with a 10-yr survival of 53%. Dexmedetomidine is commonly used as a sedative in cardiac patients. Recently its clinical use has been limited because it was associated with increased mortality in the SPICE 3 trial. The impact of perioperative dexmedetomidine treatment on patients undergoing heart transplantation has not been examined yet. Therefore, this study investigated the influence of dexmedetomidine treatment on 1-yr mortality in patients undergoing heart transplantation.</div></div><div><h3>Methods</h3><div>This retrospective cohort study included patients who underwent heart transplantation at the University Hospital Duesseldorf between 2011 and 2021. The main exposure was perioperative dexmedetomidine treatment. The primary endpoint was 1-yr mortality after surgery. Kaplan–Meier analysis and multivariate cox regression with adjustment for risk index for mortality prediction after cardiac transplantation (IMPACT) and packed red blood cells were performed.</div></div><div><h3>Results</h3><div>A total of 267 patients were screened. To avoid a potential selection bias, patients who needed postoperative treatment with extracorporeal life support system were excluded, leaving 169 patients included in the analysis. Out of 169 patients, 85 received perioperative dexmedetomidine treatment and 84 were not treated with dexmedetomidine. Overall, 1-yr mortality was 10.3% (dexmedetomidine 4.9% <em>vs</em> no dexmedetomidine 15.5%, <em>P</em>=0.025). After adjustment for IMPACT score and packed red blood cells, dexmedetomidine treatment was independently associated with lower 1-yr mortality after heart transplantation (hazard ratio: 0.25, 95% confidence interval 0.07–0.93, <em>P</em>=0.03).</div></div><div><h3>Conclusion</h3><div>Perioperative dexmedetomidine treatment appears to be safe regarding 1-yr mortality in patients undergoing orthotopic heart transplantation.</div></div>","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"14 ","pages":"Article 100389"},"PeriodicalIF":0.0,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143628922","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":"The ED95 of lidocaine and prilocaine for ultrasound-guided brachial plexus blocks for surgical anaesthesia: a randomised controlled clinical trial","authors":"Anurag Vats ,&nbsp;Pawan K. Gupta ,&nbsp;Andrew Berrill ,&nbsp;Sarah Zohar ,&nbsp;Philip M. Hopkins","doi":"10.1016/j.bjao.2025.100385","DOIUrl":"10.1016/j.bjao.2025.100385","url":null,"abstract":"<div><h3>Background</h3><div>Our trial addresses the gaps in the current literature by directly estimating the ED₉₅ of short-acting local anaesthetics for ultrasound-guided axillary and supraclavicular brachial plexus blocks for surgical anaesthesia.</div></div><div><h3>Methods</h3><div>Four double-blind prospective studies were organized in two separate arms. Patients were randomised between studies A (lidocaine 1% with adrenaline) and B (lidocaine 2% with adrenaline) for axillary blocks and between studies C (prilocaine 1%) and D (lidocaine 1% with adrenaline) for supraclavicular blocks. All statistical modelling and analysis were performed using the modified continual reassessment method. The primary endpoint of the studies was the loss of cold and pin-prick sensations in the sensory distributions of the median, musculocutaneous, radial, and ulnar nerves.</div></div><div><h3>Results</h3><div>For axillary blocks, the estimated ED₉₅ of lidocaine 1% with adrenaline was 40 ml (95% credibility interval: 89.5–99.2%), and lidocaine 2% with adrenaline was 15 ml (95% credibility interval: 87.4–97.5%) (studies A and B: 41 and 40 patients, respectively). The ED₉₅ could not be determined for supraclavicular blocks as it fell outside the dose range considered in the studies (studies C and D: 31 and 42 patients, respectively).</div></div><div><h3>Conclusions</h3><div>We achieved a 95% success rate for axillary blocks using lidocaine (1% and 2%) with adrenaline within our dosing limits. For supraclavicular blocks, &gt;40 ml of prilocaine 1% or lidocaine 1% with adrenaline may be required to consistently achieve a 95% success rate. Our studies highlight the continual reassessment method as a credible methodology for dose-finding studies in regional anaesthesia.</div></div><div><h3>Clinical trial registration</h3><div>EudraCT ref: 2010-018466-22.</div></div>","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"14 ","pages":"Article 100385"},"PeriodicalIF":0.0,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143621486","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":"Improved pointer in auditory alarms enhances response accuracy","authors":"Michelle Shin ,&nbsp;Ian Grant ,&nbsp;Ramez Mikhail ,&nbsp;Alexandra Lee ,&nbsp;Tiffany-Chau Le ,&nbsp;Alexandra Bruder ,&nbsp;Judy Edworthy ,&nbsp;Joshua Shive ,&nbsp;Joseph J. Schlesinger","doi":"10.1016/j.bjao.2025.100379","DOIUrl":"10.1016/j.bjao.2025.100379","url":null,"abstract":"<div><h3>Background</h3><div>Auditory alarms are crucial in clinical settings, alerting clinicians to events requiring immediate attention. However, multitasking can lead to missed alarms and disrupt patient care. Enhancing auditory alarms can improve patient safety and clinician satisfaction.</div></div><div><h3>Methods</h3><div>In a controlled laboratory study, we recruited 26 clinicians (residents, fellows, advanced practice providers) and 19 non-clinicians (undergraduate students) to compare our previously validated alarm with an improved design. The improved alarm incorporates a ‘pointer’ (a short sound burst indicating acuity levels) enriched with harmony, intervallic change, roughness, and glissando to provide additional information to users. We measured response accuracy (correct alarm identification) and response time (seconds to respond).</div></div><div><h3>Results</h3><div>A total of 26 clinicians and 19 non-clinicians were recruited and all participants met inclusion criteria for analysis. A mixed analysis of variance revealed a large main effect of the pointer on response accuracy (F(1,44)=9.11, <em>P</em>=0.004, η²_<em>p</em>=0.17). Accuracy was higher for our improved pointer (M=0.90, 95% confidence interval [CI; 0.84–0.95]) than for our previous design (M=0.80, 95% CI [0.74–0.87]). Ascending alarms representing hypertension yielded a mean response accuracy of 0.89 (95% CI 0.84–0.94) and descending alarms representing hypotension yielded a mean response accuracy of 0.81 (95% CI 0.75–0.88). Low acuity ascending alarms resulted in slower response times compared with other combinations, where acuity of change was conveyed through intervallic difference of two-note harmonies.</div></div><div><h3>Conclusions</h3><div>Improved pointers demonstrated statistically significant accuracy improvement for clinicians and non-clinicians without compromising response time—a design advantage that can influence the revision of the international alarm standard and improve patient safety.</div></div>","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"14 ","pages":"Article 100379"},"PeriodicalIF":0.0,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143621487","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":"Neurodevelopment at 10 months and 2–3 years old after early and prolonged anaesthesia in infancy: General Anaesthesia & Brain Activity study (GABA) secondary analysis","authors":"Laura Cornelissen ,&nbsp;Siobhan Coffman ,&nbsp;Isabelle Kim ,&nbsp;Ellen Underwood ,&nbsp;Alice Tao ,&nbsp;Maria G. Maloney ,&nbsp;Carolina Donado ,&nbsp;Kimberly Lobo ,&nbsp;Charles A. Nelson ,&nbsp;Takao K. Hensch ,&nbsp;Laurel J. Gabard-Durnam ,&nbsp;Charles B. Berde","doi":"10.1016/j.bjao.2025.100383","DOIUrl":"10.1016/j.bjao.2025.100383","url":null,"abstract":"<div><h3>Background</h3><div>Effects of early and prolonged exposure to general anaesthesia on the developing brain are unclear. The study objective was to examine developmental outcomes at 10 months and 2–3 yr of age after general anaesthesia planned for &gt;2 h in the first 2 months of life.</div></div><div><h3>Methods</h3><div>This is a secondary analysis of the General Anaesthesia &amp; Brain Activity (GABA) study—a prospective, single-centre, longitudinal observational study. The final dataset included 59 children who were unexposed and 31 children who were exposed to early prolonged general anaesthesia who completed the primary outcome measure, Bayley Scales of Infant and Toddler Development-III (BSID) assessments at 10 months, at 2–3 yr old, or both. Analyses used adjusted Welch's <em>t</em>-tests, linear regression, and linear mixed effects models.</div></div><div><h3>Results</h3><div>BSID composite scores for cognition were similar between general anaesthesia and unexposed cohorts at 10 months (<em>P</em>_adj=0.566, standardised mean difference [SMD]=0.27) and at 2–3 yr (<em>P</em>_adj=0.651, SMD=0.25). Motor and language scores were similar between cohorts at 10 months (motor: <em>P</em>_adj=1, SMD=0.13; language: <em>P</em>_adj=0.806, SMD=0.19) and fell within typical reference ranges. Linear regression analysis found no association between BSID cognition scores and cumulative hours of general anaesthesia at 10 months (<em>R</em>=0.06, <em>P</em>=0.635) or at 2–3 yr (<em>R</em>=−0.13, <em>P</em>=0.293).</div></div><div><h3>Conclusions</h3><div>Children with early prolonged general anaesthesia showed BSID scores comparable to age-matched controls. This analysis provides additional preliminary support for the safety of general anaesthesia on the developing brain even when general anaesthesia is prolonged, repeated, or administered very early in life.</div></div>","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"14 ","pages":"Article 100383"},"PeriodicalIF":0.0,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143579222","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 acute kidney injury is associated with persistent renal dysfunction: a multicentre propensity-matched cohort study","authors":"Blaine Stannard ,&nbsp;Richard H. Epstein ,&nbsp;Eilon Gabel ,&nbsp;Girish N. Nadkarni ,&nbsp;Yuxia Ouyang ,&nbsp;Hung-Mo Lin ,&nbsp;Valiollah Salari ,&nbsp;Ira S. Hofer","doi":"10.1016/j.bjao.2025.100384","DOIUrl":"10.1016/j.bjao.2025.100384","url":null,"abstract":"<div><h3>Background</h3><div>The risk of developing a persistent reduction in renal function after postoperative acute kidney injury (pAKI) is not well established. The goal of this investigation was to evaluate whether patients who develop pAKI have a greater decline in long-term renal function than patients who do not.</div></div><div><h3>Methods</h3><div>In this multicentre retrospective propensity-matched study, anaesthesia data warehouses at three tertiary care hospitals were queried. Adult patients undergoing surgery with available preoperative and postoperative creatinine results and without baseline haemodialysis requirements were included. Patients were stratified by occurrence of pAKI as defined by the Acute Kidney Injury Network classification. The primary outcome was a decline in follow-up glomerular filtration rate (GFR) of 40% relative to baseline, based on follow-up outpatient visits from 0 to 36 months after hospital discharge. A propensity score-matched sample was used in Kaplan–Meier analysis and a piecewise Cox model to compare the time to reach a 40% decline in GFR for patients with and without pAKI.</div></div><div><h3>Results</h3><div>In 95 213 patients, the rate of pAKI ranged from 9.9% to 13.7%. In the piecewise Cox model, pAKI was associated with a significantly increased hazard of a 40% decline in GFR. The common-effect hazard ratio was 13.35 (95% confidence interval [CI] 10.79–16.51, <em>P</em>&lt;0.001) for 0–6 months, 7.07 (5.52–9.05, <em>P</em>&lt;0.001) for 6–12 months, 6.02 (4.69–7.74, <em>P</em>&lt;0.001) for 12–24 months, and 4.32 (2.65–7.05, <em>P</em>&lt;0.001) for 24–36 months.</div></div><div><h3>Conclusions</h3><div>pAKI is associated with a significantly increased hazard of a 40% decline in GFR up to 36 months after surgery across three institutions.</div></div>","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"14 ","pages":"Article 100384"},"PeriodicalIF":0.0,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143562277","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":"The association between elevated preoperative red cell distribution width and worsening kidney function after noncardiac operation. A propensity score and competing risk weighted retrospective cohort study","authors":"Halldór B. Olafsson ,&nbsp;Sigurbergur Karason ,&nbsp;Magnus K. Magnusson ,&nbsp;Olafur S. Indridason ,&nbsp;Thorir E. Long ,&nbsp;Martin I. Sigurðsson","doi":"10.1016/j.bjao.2025.100380","DOIUrl":"10.1016/j.bjao.2025.100380","url":null,"abstract":"<div><h3>Background</h3><div>Elevated red cell distribution width (RDW) is associated with increased postoperative mortality, but less is known about kidney outcomes. This study investigated the association between elevated preoperative RDW and postoperative worsening of long-term kidney function and incidence of acute kidney injury.</div></div><div><h3>Methods</h3><div>This retrospective cohort study included patients ≥18 yr undergoing noncardiac operation at Landspitali—The National University Hospital of Iceland between 2005 and 2018. Outcomes were compared between groups with elevated preoperative RDW (13.3–14.0%, 14.0–14.7%, 14.7–15.8%) and a propensity score-matched cohort (RDW ≤13.3%) using Fine–Gray competing risk regression analysis, with death as a competing event. The primary outcome was time to worsening of at least one estimated glomerular filtration rate (eGFR) category sustained for 3 months. Secondary outcomes were acute kidney injury, length of hospital stay, and 30-day readmission rate.</div></div><div><h3>Results</h3><div>Out of 63 056 operations included in this study, 55 724 were available for propensity score-matched analysis. The hazard of long-term eGFR worsening was higher for patients with RDW between 14.0% and 14.7%: hazard ratio (HR) 1.23 (95% confidence interval [CI] 1.13–1.35), 14.7% and 15.8%: HR 1.20 (95% CI 1.07–1.34), and &gt;15.8%: HR 1.16 (95% CI 1.00–1.34) compared with matched controls (RDW &lt;13.3%), adjusted for death as a competing event. For secondary outcomes there was no difference in acute kidney injury, but increased risk of readmission for patients with RDW of 14.0–14.7% (9.8% <em>vs</em> 8.5%, <em>P</em>=0.01), 14.7–15.8% (12.2% <em>vs</em> 10.1%, <em>P</em>=0.001), and &gt;15.8% (14.9% <em>vs</em> 11.4%, <em>P</em>&lt;0.001).</div></div><div><h3>Conclusions</h3><div>Elevated preoperative RDW was associated with long-term worsening of eGFR category after operation.</div></div>","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"13 ","pages":"Article 100380"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143509573","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":"Premedication with intranasal dexmedetomidine in patients undergoing total knee arthroplasty under spinal anaesthesia (TKADEX)—a prospective, double-blinded, randomised controlled trial","authors":"Suvi-Maria Tiainen ,&nbsp;Heta Heinonen ,&nbsp;Atte Koskinen ,&nbsp;Sanna Mäkelä ,&nbsp;Ruut Laitio ,&nbsp;Eliisa Löyttyniemi ,&nbsp;Keijo Mäkelä ,&nbsp;Teijo I. Saari ,&nbsp;Panu Uusalo","doi":"10.1016/j.bjao.2025.100382","DOIUrl":"10.1016/j.bjao.2025.100382","url":null,"abstract":"<div><h3>Background</h3><div>Previous studies have shown that perioperative use of adjuvants, such as the alpha-2 agonist dexmedetomidine, may reduce postoperative pain and opioid requirements. However, information about optimal dosing is lacking. We investigated if premedication with intranasal dexmedetomidine compared with placebo reduces postoperative pain in patients undergoing total knee arthroplasty under spinal anaesthesia.</div></div><div><h3>Methods</h3><div>This single-centre, double-blind, two-arm study compared premedication with intranasal dexmedetomidine (single 1 μg kg⁻¹ dose) to intranasal saline in 101 consecutive elective patients undergoing total knee arthroplasty under spinal anaesthesia. The primary outcome was postoperative pain measured with the numerical rating scale during the first 24 h. Secondary outcomes were postoperative opioid requirement, perioperative haemodynamic variables, requirement of additional intraoperative sedation, incidence of postoperative nausea and vomiting, and patient satisfaction at 30 days after surgery.</div></div><div><h3>Results</h3><div>Patients in the dexmedetomidine group had lower numerical rating scale scores [median (interquartile range) 2.0 (0.0–3.0)] at 3 h when compared with the control group [3.0 (2.0–4.0)] (<em>P</em>=0.037). Cumulative 24 h opioid requirements (in morphine equivalents) did not differ between dexmedetomidine [45 mg (30–68 mg)] and control groups [53 mg (38–88 mg)] (<em>P</em>=0.334). More patients in the dexmedetomidine group were satisfied with pain management in the ward (<em>P</em>=0.0013). The groups did not differ in the incidence of postoperative nausea and vomiting (<em>P</em>=0.310) or haemodynamic adverse events (<em>P</em>&gt;0.27 for all).</div></div><div><h3>Conclusions</h3><div>Our results indicate that intranasal dexmedetomidine may reduce postoperative pain and the requirement for additional sedation and increase short-term patient satisfaction in patients undergoing total knee arthroplasty.</div></div><div><h3>Clinical trial registration</h3><div>ClinicalTrials.gov (NCT 04859283).</div></div>","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"13 ","pages":"Article 100382"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143529133","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}