BMC Anesthesiology最新文献

{"title":"Medication errors and adverse drug events in peri-operative pediatric anesthetic care over twenty years: a retrospective observational study.","authors":"Shemila Abbasi, Muhammad Azhar Sharafat, Fauzia Khan","doi":"10.1186/s12871-025-03109-8","DOIUrl":"10.1186/s12871-025-03109-8","url":null,"abstract":"<p><strong>Background: </strong>Children are at an increased risk of medication errors (MEs) during perioperative care compared to adult patients. This study aimed to critically look at medication errors and determine the frequency of adverse drug events and corrective measures taken for medication errors reported over 20 years in pediatric anesthetic care in the anesthesia department of a tertiary care teaching institution in a lower middle-income country (LMIC).</p><p><strong>Methods: </strong>Two investigators conducted a retrospective review of all critical incident forms received between January 2001 and December 2020 and identified medication errors related to patients aged 18 years or less. In the second phase of the audit, these medication errors were assessed in detail and adverse drug events were identified using a standardized protocol. We also analyzed the strategies that were employed to prevent such incidents in the future.</p><p><strong>Results: </strong>One hundred and ninety-six pediatric medication errors were identified. 40% of errors were reported in children between 13 and 72 months of age and 58% at induction. The majority of events took place during administration, preparation, and dispensing i.e., 45%, 41%, and 6% respectively. The adverse drug events occurred in 27 (1.2%) reports and life-threatening events in only one report.</p><p><strong>Conclusion: </strong>13% of the medication errors progressed to adverse drug events (ADE) and half of those were serious and life-threatening. Reinforcement of standard practice in departmental critical incident meetings, patient safety workshops and lessons to learn e-mails were some low-cost strategies to enhance medication safety during anesthesia.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"247"},"PeriodicalIF":2.3,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12083096/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144076044","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of prone position on cerebral hemodynamics and noninvasive intracranial pressure assessed using transcranial Doppler in patients undergoing spine surgeries: a prospective observational study.","authors":"Yaseen Taj, Navneh Samagh, Shashank Umesh Paliwal, Venkata Ganesh, Ankita Dey, Varun Aggarwal","doi":"10.1186/s12871-025-03116-9","DOIUrl":"10.1186/s12871-025-03116-9","url":null,"abstract":"<p><strong>Background: </strong>The prone position, frequently used in spine surgeries for optimal surgical access, induces physiological changes in cardiovascular and respiratory parameters. Increased intraabdominal and intrathoracic pressures lead to elevated central venous pressure (CVP). Along with raised intrathoracic pressure, positive end-expiratory pressure (PEEP) results in elevated CVP, impeding venous blood flow from the brain and potentially affecting intracranial pressure (ICP).¹ Transcranial Doppler (TCD) ultrasound is a non-invasive method commonly used to measure cerebral hemodynamic parameters, including peak systolic velocity (PSV/ MCAv_peak), mean flow velocity (MFV/MCAv_mean), pulsatility index (PI) and resistivity index (RI), which are associated with cerebral vascular resistance, intracranial pressure, and cerebral perfusion pressure (CPP).</p><p><strong>Method: </strong>Thirty-three patients undergoing spine surgery were assessed. The vital and TCD parameters PSV/MCAv_peak, MFV/MCAv_mean, PI, and RI were noted in the supine position. (T_a). General anaesthesia was administered, and TCD measurements were repeated after induction. (T_s). Patients were then positioned prone, and TCD measurements were repeated at intervals T_p0 - immediately after the prone position, T_p15 -15 min of the prone position, T_p30 -30 min, T_p45 -45 min and T_p60 - 60 min. Vital parameters were noted at the above-mentioned time points. Non-invasive ICP (nICP) was calculated.</p><p><strong>Results: </strong>There was a statistically significant decrease in the heart rate (HR) compared to the supine position at T_p45 and T_p45 as compared to T_p0. There was a statistically significant decrease in systolic blood pressure (SBP) as compared to T_a at T_p0 (p < 0.001), T_p15 (p < 0.001), T_p30 (p = 0.003), T_p45 (p = 0.001), and T_p60 (p = 0.018). The study found no statistically significant changes in cerebral hemodynamic parameters (PSV/MCAv_peak, MFV/MCAv_mean, PI and RI) and nICP at various time points.</p><p><strong>Conclusion: </strong>Our findings suggest that the prone position does not cause significant changes in cerebral hemodynamics and nICP.</p><p><strong>Trial registration: </strong>CTRI/2023/06/053677 dated 08/06/2023.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"242"},"PeriodicalIF":2.3,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12079893/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144076026","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"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 different doses of remifentanil combined with sevoflurane anesthesia on postoperative analgesia and hemodynamics in pediatric patients undergoing laparoscopic inguinal hernia repair.","authors":"Jinben Ma, Yu Wang, Zhifei Liu, Shaoxian Han","doi":"10.1186/s12871-025-03104-z","DOIUrl":"10.1186/s12871-025-03104-z","url":null,"abstract":"<p><strong>Background: </strong>Laparoscopic inguinal hernia repair (LIHR) has the characteristics of a clear surgical field and short operation time, but it has high requirements for anesthesia. We investigated the impacts of different doses of remifentanil combined with sevoflurane anesthesia on postoperative analgesia and hemodynamics of pediatric LIHR.</p><p><strong>Methods: </strong>This randomized, double-blind and controlled study included 310 pediatric patients accepting LIHR. Excluding those failed to meet the inclusion or met the exclusion criteria, 280 patients were enrolled and randomized into the control group (sevoflurane) and the low-dose remifentanil & sevoflurane (LRS), medium-dose remifentanil & sevoflurane (MRS) and high-dose remifentanil & sevoflurane (HRS) groups (0.10, 0.20 and 0.25 µg/kg). The Behavior Pain Scale (BPS) (main observation index), Ramsay Sedation Scale (RSS), and Paediatric Anaesthesia Emergence Delirium (PAED) scores were evaluated at 1 h (T4), 3 h (T5), 6 h (T6), 8 h (T7) and 12 h (T8) postoperatively. The dynamic process of BPS, RSS and PAED scores over time was evaluated by analyzing the changes in the area under the curve (AUC) of each score during T4-T8. The changes in mean arterial pressure (MAP), heart rate (HR) and oxygen saturation (SpO₂) before the start of anesthesia (T0), 10-min after the start of surgery (T1), at the time of extubation (T2) and 30-min post-surgery (T3) and postoperative adverse reaction incidence were recorded.</p><p><strong>Results: </strong>Remifentanil & sevoflurane reduced postoperative BPS and PAED scores and increased RSS score in pediatric patients during T4-T8. The AUC_BPS and AUC_PAED in the LRS, MRS and HRS groups decreased as the remifentanil dose increased, and the AUC_RSS increased as the remifentanil dose rose. During T0-T3, MAP, HR and SpO₂ fluctuated greatly in the control group, but maintained good stability in the LRS, MRS and HRS groups, and the fluctuation in the HRS group was smaller. The HRS group had a lower adverse reaction incidence than the control and LRS groups.</p><p><strong>Conclusions: </strong>Remifentanil & sevoflurane may have better effects on postoperative pain, sedation and agitation, and may be more conducive to stabilizing hemodynamics. Especially, 0.25 mg/kg remifentanil & sevoflurane have the best anesthetic effect and a low adverse reaction incidence.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"244"},"PeriodicalIF":2.3,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12079937/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144076029","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety of remimazolam in deep sedation during flexible fiberoptic bronchoscopy: a prospective, randomized controlled trial.","authors":"Pingping Luo, Jimin Wu, Haiyan Lan, Qiaomin Xu, Gongchen Duan","doi":"10.1186/s12871-025-03117-8","DOIUrl":"10.1186/s12871-025-03117-8","url":null,"abstract":"<p><strong>Background: </strong>Remimazolam is a novel ultrashort-acting sedative and anesthetic drug. Numerous recent studies have demonstrated its sedative effect, however, research has yet to be conducted to explore the safety of remimazolam in deep sedation flexible fiberoptic bronchoscopy (FFB) in elderly patients.</p><p><strong>Methods: </strong>Sixty-six elderly patients who underwent FFB were randomly assigned to either the remimazolam (Group R) or propofol (Group P) group. Initially, both groups received an intravenous injection of 10 µg/kg alfentanil. Subsequently, both groups were administered experimental drugs intravenously: (1) Group R received 0.2 mg/kg remimazolam, and (2) Group P received 1.5 mg/kg propofol. Throughout the FFB, patients were maintained in a state of deep sedation (modified observer's assessment of alertness/sedation score ≤ 1) by titrating the experimental drugs as needed. The primary outcome measured was the incidence of hypoxemia during the FFB. Secondary outcomes included other safety outcomes, effectiveness outcomes, and procedural characteristics.</p><p><strong>Results: </strong>Group R had a lower incidence of hypoxemia compared to Group P (9.1% vs. 45.5%) (RR, 0.20 [95% CI, 0.06-0.63], P = 0.001). The Minimum SpO₂ and minimum MAP in Group R was higher than in Group P (93.1 ± 3.8 vs. 89.0 ± 6.7, P = 0.004) (82.8 ± 12.4 vs. 72.8 ± 14.1, P = 0.003); ΔMAP and ΔHR in Group R was lower than in Group P (15.9 ± 5.2 vs. 28.8 ± 12.4, P < 0.001), (14.9 ± 3.2 vs. 17.8 ± 4.2, P = 0.003); the incidence of hypotension in Group R was lower than in Group P (9.1% vs. 30.3%, P = 0.030); the incidence of injection pain in Group R was lower than in Group P (0% vs. 27.3%, P = 0.001).</p><p><strong>Conclusions: </strong>During the maintenance of elderly patients under deep sedation with FFB, remimazolam exhibited superior safety than propofol, particularly in terms of respiratory depression and cardiovascular inhibition.</p><p><strong>Trial registration: </strong>The trial was registered, before patient enrollment, in the Chinese Clinical Trial Registry ( www.chictr.org.cn ) (clinical trial number: ChiCTR2400083383; Principal Investigator: Gongchen Duan; date of registration: 23 April 2024).</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"246"},"PeriodicalIF":2.3,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12083095/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144076047","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A novel approach to ultrasound-guided L3-4 thoracolumbar fascia injection for chronic pain after spine surgery: a prospective pilot study.","authors":"Yingying Lv, Junzhen Wu, Yongming Xu, Shaofeng Pu, Chen Li, Dongping Du","doi":"10.1186/s12871-025-03046-6","DOIUrl":"10.1186/s12871-025-03046-6","url":null,"abstract":"<p><strong>Background: </strong>Fascial tissues have been overlooked in the past, and there are only few studies on the thoracolumbar fascia and its treatment methods. The present study aimed to investigate the effectiveness and safety of ultrasound-guided bilateral L3-4 thoracolumbar fascia injection in treating postoperative low back pain.</p><p><strong>Methods: </strong>A prospective pilot study was conducted at a university hospital. Twenty-six patients with postoperative low back pain resistant to conservative therapies and US-guided bilateral L3-4 medial branch block (MBB) were included as participants. They were treated with US-guided L3-4 mid-thoracolumbar fascia injection. Using real-time fluoroscopy, we monitored the contrast medium's diffusion range and double-checked the needle tips' positions throughout the procedures. The pain numeric rating scales (NRS), lumbar anteflexion range of motion (ROM), and Oswestry disability index (ODI) were assessed through telephone interviews one, four, and twelve weeks after the procedures. All data were processed by SPSS software version 23.0 (IBM Corp., New York).</p><p><strong>Results: </strong>Compared with NRS at baseline, pain scores decreased throughout the observation period. Lumbar anteflexion range of motion of US-guided bilateral L3-4 mid-thoracolumbar fascia injection continuously improved during the first, fourth, and twelfth week. No intravascular injections or neurologic injuries were observed.</p><p><strong>Conclusion: </strong>The US-guided bilateral L3-4 mid-thoracolumbar fascia injection facilitated a uniform dispersion of the medication, akin to the gentle spread of a goose feather, between the erector spinalis and quadratus lumborum muscles across the affected lumbar vertebrae. This technique demonstrated substantial clinical effectiveness in patients who were unresponsive to standard US-guided MBB.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"243"},"PeriodicalIF":2.3,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12079813/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144076021","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between combinations of preoperative comorbidities and postoperative delirium in older patients: a matched cohort study.","authors":"Ao Li, Yuxiang Song, Wenzhu Shi, Weidong Mi, Jingsheng Lou, Jing Liu","doi":"10.1186/s12871-025-03110-1","DOIUrl":"10.1186/s12871-025-03110-1","url":null,"abstract":"<p><strong>Background: </strong>The current study aimed to investigate which one or certain combinations of preoperative comorbidities were associated with higher risk of postoperative delirium.</p><p><strong>Methods: </strong>This propensity-score-matched cohort study analyzed a retrospective dataset of elderly patients undergoing surgery at the First Medical Center of the Chinese PLA General Hospital from January 2014 to April 2019. Univariate risk factors were selected by logistic regression, and then the combinations of these univariate factors were compared.</p><p><strong>Results: </strong>We identified 1034 older patients developed postoperative delirium (POD) within seven days after surgery, and 3102 patients without POD were matched by propensity score matching analysis at a ratio of 1:3 for those with POD. Eight preoperative comorbidities, including hypertension, diabetes, atrial fibrillation, cerebrovascular disease, Parkinson's disease, epilepsy, depression, and chronic obstructive pulmonary disease (COPD) were more common in patients diagnosed with POD after surgery than those without POD. Patients with POD were more likely to concurrently suffer from the combinations of hypertension and cerebrovascular disease, or hypertension and COPD.</p><p><strong>Conclusions: </strong>Several preoperative comorbidities are associated with a higher risk of POD in older surgical patient. Those suffering from combinations of preoperative comorbidities were more likely to develop POD, and hypertension plays a central role in these combinations.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"245"},"PeriodicalIF":2.3,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12082919/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144076025","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Low-dose Esketamine combined with Propofol in microscopic pediatric strabismus surgery: a randomized controlled study.","authors":"Yaping Shen, Bo Shi, Yu Mo, Junhe Wu, Zhentao Sun","doi":"10.1186/s12871-025-03095-x","DOIUrl":"10.1186/s12871-025-03095-x","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To observe the effect of low-dose esketamine combined with propofol in pediatric strabismus surgery.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A total of 84 children aged 3-15 years, regardless of gender, with a BMI of 13-26 kg/m&lt;sup&gt;2&lt;/sup&gt;, ASA grade I or II, were selected for elective microscopic strabismus surgery and divided into two groups based on the randomized numerical table: esketamine group (group E) and propofol group (group C), with 42 patients in each group. Group E was pre-injected with esketamine 0.2 mg/kg, and propofol 2.5 mg/kg was slowly injected after one minute. Group C was pre-treated with an equal volume of saline, and propofol 2.5 mg/kg was administered slowly after one minute. The occurrence of propofol injection pain was assessed using the Verbal Rating Scale (VRS). HR and MAP were recorded in the two groups at 5 min before induction, after induction, at the start of the procedure, and at the end of the procedure. operative time, extubation time and post-anesthesia care unit (PACU) stay were recorded. The Pain Behaviour Scale for Children (Face, Legs, Activity, Cry, Consolability, FLACC) scores at the time of discharge from the PACU and at 1day, 3days and 7days postoperatively were recorded. perioperative tachycardia, emergence agitation, oculocardiac reflex, extubation cough and other adverse reactions were also recorded.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Compared with Group C, Group E exhibited significantly lower rates of propofol injection pain(cases (%), 87.5% VS 56.1%, P = 0.002), and moderate-to-severe pain during induction(75.0% VS 24.4%, P&lt;0.001), reduced FLACC scores at PACU discharge(median and interquartile spacing [M(IQR)], 3.50(4) VS 3.00(2), P = 0.039) and 1 day postoperatively(M(IQR), 5.00(3) VS 3.00(2), P&lt;0.001), and decreased incidences of adverse events including emergence agitation(32.5% VS 12.2%, P = 0.028), oculocardiac reflex(35.0% VS 14.6%, P = 0.034), and extubation cough(25.0% VS 7.3%, P = 0.030). However, no statistically significant differences were observed between the two groups in operative duration, extubation time, PACU stay duration, FLACC scores at 3 and 7 days postoperatively, or heart rate and mean arterial pressure at any measured time point.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;General anesthesia with low-dose esketamine combined with propofol for pediatric strabismus correction surgery effectively alleviates propofol injection pain, reduces FLACC scores at PACU discharge and 1 day postoperatively, and decreases the incidence of adverse reactions such as emergence agitation, oculocardiac reflex, and extubation cough, demonstrating its safety for use in this procedure.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Trial registration: &lt;/strong&gt;This study was approved by the Scientific Research and Clinical Trials Ethics Committee of The First Affiliated Hospital of Zhengzhou University (Approval No. 2023-KY-1509), registered in the Chinese Clinical Trial Registry (Registration No. ChiCTR2400092266,","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"241"},"PeriodicalIF":2.3,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12079985/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144076030","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of hydromorphone combined with ropivacaine in serratus anterior plane block on postoperative pain in patients undergoing video-assisted thoracoscopic pulmonary lobectomy: a randomized, double-blind clinical trial.","authors":"Xuefeng Chen, Weifeng Zhang, Lin Wang, Weibing Wang, Yuhong Li","doi":"10.1186/s12871-025-03101-2","DOIUrl":"10.1186/s12871-025-03101-2","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to assess the effects of hydromorphone as an adjuvant to ropivacaine serratus anterior plane block (SAPB) on postoperative analgesia and inflammatory responses in patients undergoing video-assisted thoracoscopic surgery (VATS).</p><p><strong>Methods: </strong>This was a prospective, randomized, double-blind clinical trial. A total of 120 lung cancer patients, aged 20-75 years, with an American Society of Anesthesiologists classification of I or II and a body mass index of 18-28 kg/m², were randomly assigned to three groups: ropivacaine combined with hydromorphone SAPB (HR group), ropivacaine SAPB (R group), and control (C group). Ultrasound-guided deep SAPB was used to inject medications. The main observed indicators were postoperative visual analog scale (VAS) pain scores, serum inflammatory markers (C-reactive protein (CRP), IL-6, TNF-α), intraoperative medication dosage, postoperative complication rates, and analgesic effects.</p><p><strong>Results: </strong>Postoperative VAS pain scores were significantly reduced in the HR and R groups compared to the C group, especially at 6 h postoperatively. The median VAS score in the HR group was 2.00 (inter-quartile ratio (IQR): 2.00, 2.00), which was significantly lower than that of the C group's score of 3.00 (IQR: 3.00, 3.00; P < 0.001). The CRP levels at 24 and 48 h postoperatively in the HR group were 23.80 mg/L and 21.65 mg/L, respectively, significantly lower than the C group's levels of 56.65 mg/L and 82.75 mg/L, P < 0.001. The levels of IL-6 and TNF-α were also significantly lower in the HR group than in the C group. Intraoperative propofol and remifentanil dosages in the HR group were reduced to 5.22 mg/kg/h and 7.59 µg/kg/h, respectively, lower than the C group's dosages of 5.93 mg/kg/h and 5.74 µg/kg/h, P < 0.001. The incidence of postoperative nausea and vomiting in the HR group was 12.5%, which was lower than that in Group C (35.7%, P = 0.032).</p><p><strong>Conclusion: </strong>Ropivacaine adjuvant with hydromorphone in SAPB reducing postoperative pain and inflammatory in patients undergoing VATS, which contributed to rapid recovery. However, future studies should explore the long-term benefits and concenntration of hydromorphone of SAPB before it taken into clinical use.</p><p><strong>Trial registration: </strong>Chinese Clinical Trial Register on August 19, 2021, NCT number ChiCTR2100053893.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"237"},"PeriodicalIF":2.3,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12065182/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143970926","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Programmed intermittent bolus for erector spinae plane block versus intercostal nerve block in minimally invasive direct coronary artery bypass surgery: a randomized controlled trial.","authors":"Tian Wang, Xuedong Wang, Zhuoying Yu, Yanhan Lyu, Jing Yang, Ye Jiang, Dongsheng Yang, Yunpeng Ling, Min Li","doi":"10.1186/s12871-025-03103-0","DOIUrl":"10.1186/s12871-025-03103-0","url":null,"abstract":"<p><strong>Objective: </strong>Continuous intercostal nerve block (ICNB) has been shown to offer effective pain relief after minimally invasive direct coronary artery bypass (MIDCAB). The erector spinae plane block (ESPB) could represent a viable alternative approach. This study aimed to compare the analgesic effect of programmed intermittent bolus(PIB) for ESPB to ICNB in patients undergoing MIDCAB.</p><p><strong>Methods: </strong>A prospective, open-label, randomized controlled trial was conducted. Eighty patients scheduled for MIDCAB were randomized into two groups (n = 40 per group). ESPB using a PIB injection was performed in the ESPB group, while ICNB was performed in the ICNB group. The primary outcome was numerical rating scale (NRS) pain scores at movement immediately after extubation. Secondary outcomes included the cumulative area under the curve (AUC) of the pain scores, perioperative analgesic consumption, adverse events and recovery data.</p><p><strong>Results: </strong>A total of 73 patients were included in the modified intention-to-treat analysis and 71 patients in the per-protocol analysis. There was no significant difference in numeric rating scale (NRS) scores at rest or movement between the two groups immediately after extubation, at 8, 24 and 48 h. The cumulative area under the curve (AUC) of the time NRS curve until 48 h after extubation and the necessity of rescue analgesics did not differ to a statistically significant degree between the two groups. Compared with the ICNB group, the ESPB group had significantly lower usage of intraoperative sufentanil (93.8 ± 33.6 vs. 128.9 ± 48.4 µg; p = 0.001).</p><p><strong>Conclusions: </strong>Postoperative analgesic effect between ESPB and ICNB did not differ in patients after MIDCAB.</p><p><strong>Trial registration: </strong>Chinese Clinical Trial Registry (ChiCTR1900022388, retrospectively registered on Apr 09, 2019).</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"239"},"PeriodicalIF":2.3,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12065311/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143973089","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intraperitoneal local anesthetics for postoperative pain management following intra-abdominal surgery: a systematic review and meta-analysis.","authors":"Mélissa Boulianne, Michael Verret, Sarah O'Connor, Xavier Savard, Xavier Neveu, Camille Marcoux, Olivier Costerousse, Marc-Aurèle Gagnon, Huixin Zhang, Laurence Beaulé, Frédérique Lamothe-Boucher, Alexis F Turgeon","doi":"10.1186/s12871-025-03105-y","DOIUrl":"10.1186/s12871-025-03105-y","url":null,"abstract":"<p><strong>Importance: </strong>Although intraperitoneal local anesthetics are commonly used following intra-abdominal surgical procedures, the level of evidence supporting their use for postoperative pain management remains uncertain.</p><p><strong>Objective: </strong>To evaluate the effect of intraperitoneal local anesthetics on postoperative pain following intra-abdominal surgery.</p><p><strong>Data sources: </strong>Medline (PubMed), Embase (Embase.com), CENTRAL, Web of science and ClinicalTrials.gov databases were searched from their inception to July 15th, 2022.</p><p><strong>Trial selection: </strong>Randomized controlled trials comparing IPLA to placebo, usual care or other analgesic regimens among patients of any age undergoing any type of surgery.</p><p><strong>Data extraction and synthesis: </strong>Trial selection, data extraction, risk of bias assessment and the certainty of evidence were conducted in duplicate independently. Meta-analyses were performed using random effect models.</p><p><strong>Main outcomes and measures: </strong>The co-primary outcomes were abdominal pain intensity at 6, 12, 24, 48, and 72 h after surgery. Secondary outcomes included postoperative nausea and vomiting, opioid use, recovery of gastrointestinal transit, length of hospital stay, postoperative chronic pain, persistent postoperative opioid use, quality of recovery and adverse events.</p><p><strong>Results: </strong>A total of 150 trials (n = 11,821 participants were included in our systematic review (97% of trials among adults). Intraperitoneal local anesthetics reduced postoperative pain intensity at 6 h (-0.86 point [95%CI -1.02 to -0.70]), 12 h (-0.74 point [95%CI -0.93 to -0.55]), 24 h (-0.65 point [95%CI -0.82 to -0.48]), and 48 h (-0.51 point [95%CI -0.70 to -0.31]), but not at 72 h (-0.38 point [95%CI -1.04 to 0.27]), with very low to low certainty of evidence. Modelled risk difference for achieving the clinically important effect and subgroup analyses among participants with moderate or high pain showed potential clinically significant effect from IPLA. Opioid use at 24 h (-10.4 mg of oral morphine equivalent [95% CI -13.1 to -7.6]), postoperative nausea and vomiting (RR 0.79 [95% CI -0.71 to 0.88]), and time to gastrointestinal transit recovery (-3.80 h [95% CI -7.54 to -0.07]) were also reduced. We found no association for other outcomes.</p><p><strong>Conclusion and relevance: </strong>Intraperitoneal local anesthetics may be associated with a small analgesic effect following intra-abdominal surgery. Considering the low to very low level of evidence supporting these findings, along with the limited data on adverse effects and long-term outcomes, their adoption as a standard of care intervention cannot be recommended at this stage.</p><p><strong>Registration number: </strong>CRD42018115062.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"235"},"PeriodicalIF":2.3,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12065176/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144062336","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}