Local Anesthesia Research Articles

Laser hemorrhoidoplasty in focus: A modern alternative to conventional surgical techniques for symptomatic hemorrhoids

Hemorrhoidal disease is a prevalent anorectal condition causing significant morbidity, affecting approximately 4% of the general population with incidence increasing with age and sedentary lifestyle. While conventional excisional hemorrhoidectomy techniques such as Milligan-Morgan and Ferguson remain standard for long-term efficacy, they are often associated with substantial postoperative pain and prolonged recovery. This narrative review evaluates the comparative clinical outcomes of laser hemorrhoidoplasty (LHP) versus conventional surgical interventions in the treatment of grade II and III symptomatic hemorrhoids. A comprehensive analysis of comparative studies, randomized controlled trials, and meta-analyses published between 2020 and 2025 was conducted, with primary outcomes including postoperative pain, recovery time, operative duration, complication rates, and recurrence. Key findings from studies by Maloku et al and Hassan et al. were analyzed to contextualize real-world LHP use. Across multiple high-quality studies, LHP was consistently associated with significantly lower postoperative pain scores, reduced analgesic requirements, and faster return to daily activities. Maloku et al demonstrated a shorter mean operative time (15.9 minutes) and reduced pain compared to open techniques (26.8 minutes; P < 0.01). Hassan et al confirmed these benefits in a cohort of 40 patients treated under local anesthesia. Operative time was generally comparable or shorter, and vessel ligation was suggested as an adjunct to improve outcomes in select cases. Complication rates were low and similar between groups, with LHP demonstrating minimal risk for major complications such as anal stenosis or incontinence. However, recurrence rates were higher with LHP in some studies, particularly in grade III disease. LHP offers a minimally invasive, low-morbidity alternative to excisional hemorrhoidectomy for appropriately selected patients. Despite superior short-term recovery profiles, potential for higher recurrence underscores the importance of patient selection and long-term follow-up. The role of local anesthesia and adjunctive vessel ligation merits further prospective evaluation.

Minimally Invasive and Proactive Approaches for Treatment of Acute Traumatic Brain Injury in Elderly Patients

The elderly population in Japan was 29.3% in 2024, the highest in the world, making medical care for elderly patients an urgent social issue. There are challenges in providing care for elderly patients with head injury, since the buffering effect of the expansion of the subdural space due to brain atrophy masks the neurological symptoms caused by a hematoma, making detection difficult. However, brain damage can be detected with high sensitivity and specificity using blood D-dimer as a biomarker without the need for head computed tomography (CT). Also, about 30% of elderly patients with traumatic brain injury (TBI) are taking antithrombotic drugs, and the effects of these drugs on TBI may include an increase in intracranial hematomas and an increased risk of deterioration. Reversal therapy is used as a countermeasure to prevent hematoma expansion, but this requires the administration of a reversal agent early after injury and before hematoma expansion. In decompression surgery, the use of a mini-craniotomy with neuroendoscopic assistance under local anesthesia can reduce invasiveness, and this method significantly reduces intraoperative bleeding and operation times compared to a major craniotomy. These innovations have improved mortality for TBI in elderly patients, but there is still a need for improvements in functional outcomes.

Unilateral Biportal Endoscopic Decompression for Degenerative Lumbar Spinal Stenosis Under Local Anesthesia in Elderly Patients with Medical Comorbidities.

Conventional Unilateral Biportal Endoscopic (UBE) surgery usually requires general anesthesia (GA), which introduces additional risks to patients with significant medical comorbidities. This article explores the use of UBE decompression under local anesthesia (LA) in elderly patients with severe medical comorbidities treated at our institution, providing valuable clinical insights for the application of this technique. A retrospective analysis was conducted on patients clinically diagnosed with lumbar spinal stenosis (LSS) at our center between November 2021 and March 2024, who underwent UBE decompression surgery under local LA. The data collected included demographics, visual analog scale (VAS) scores for leg pain, oswestry disability index (ODI), and modified Macnab grades. The UBE decompression procedure was divided into seven key steps, and intraoperative pain and the effectiveness of LA were assessed using patient self-reported VAS scores at each step. Data comparisons between the preoperative, postoperative, and follow-up time points were conducted using paired sample t-tests. Eighteen patients (5 males and 13 females) with an average age of 77.1 ± 5.0 years were included in the study, with 83.3% (15 patients) having medical comorbidities. The average follow-up period was 14.8 ± 7.9 months. At 3 months postoperative and final follow-up, both VAS scores for leg pain (p < 0.001) and ODI scores (p < 0.001) showed significant improvement. According to the modified Macnab criteria, outcomes were rated as excellent in 13 patients (72.2%), good in one (5.6%), fair in two (11.1%), and poor in one (5.6%), yielding an excellent-good rate of 77.8%. None of the patients voluntarily requested surgery termination because of unbearable intraoperative pain. For elderly patients with medical comorbidities, UBE decompression under LA is a viable and effective treatment option, yielding favorable clinical outcomes.

Anal Verrucous Carcinoma: A Case Report and a Systematic Review of the Literature.

Αn uncommon variant of squamous cell carcinoma is represented by verrucous carcinoma. Regarding the anal and perianal area, verrucous carcinoma is rarely described in the literature. A systematic PubMed and Scopus search was performed, a propos of a case report. A 39-year-old man presented to our proctology practice, complaining of a palpable, perianal lump. A small size of the lesion was decided to be excised, under local anaesthesia. Pathology revealed the presence of verrucous carcinoma. Thirty patients from 17 studies were included. The mean age of the patients was 47.4years (range: 33-77). The majority of them were males (24 out of 30, 80%). Considering the comorbidities of the included patients, only in 4 patients were mentioned to have a history of multiple perianal fistulas due to Crohn's disease, colorectal cancer, heart-lung transplantation and hidradenitis suppurativa, respectively. The most frequent symptoms at the time of presentation were painless perianal mass (7 out of 30, 23.3%), perianal pain (5 out of 30, 16.7%), ulcerated / exophytic mass (4 out of 30, 13.3%), pruritus ani (2 out of 30, 6.7%), perianal sepsis (1 out of 30, 10%) and bleeding (1 out of 30, 10%). The duration of the symptoms ranged between 2months and 14years. Regarding the surgical treatment of the included patients, local excision was the most common surgical option (76.7%). Combined chemoradiotherapy was administered in 5 out of 30 patients (16.7%). Recurrence of the disease was reported in 5 out of 30 patients (16.7%). Death was reported in 3 out of 30 cases (10%). Αnal verrucous carcinoma (VC) is an extremely rare neoplasm of the perianal area. In most of the cases, early diagnosis of VC is difficult due to the fact that its appearance and its symptoms commonly mimic benign conditions. Histopathological confirmation is the principal requisite in any further therapeutic treatment. In general, the prognosis is relatively good, especially when an early and radical excision is performed.

Efficacy of Ultrasound-Guided Brachial Plexus Blocks Performed by Pediatric Emergency Physicians for the Reduction of Forearm Fractures​​​​​: A Retrospective Cohort Study.

Ultrasound-guided nerve blocks are commonly used in pediatric anesthesia and have excellent safety profiles. This study aims to compare outcomes of forearm fracture reductions that were performed using regional anesthesia with ultrasound-guided brachial plexus nerve blocks (UBPB) versus those performed using nitrous oxide (N2O) sedation with hematoma block or sedation with ketamine or propofol. This single-center retrospective cohort study included patients under 15 years of age who underwent closed forearm fracture reduction in a tertiary care pediatric emergency department from 2019 to 2024. Data were extracted from electronic health records and analyzed for demographic, clinical, and radiographic variables. The primary outcome was the association between sedation method and the likelihood of an unacceptable fracture reduction, adjusted for confounder variables. Three hundred forty-one patients were included in the analysis, and 89 (26.1%) received UBPBs. Unacceptable fracture reduction occurred in 14.8% of cases using N2O, 7.9% using UBPB, and 8.5% using ketamine/propofol sedation. Relative to N2O, UBPB and ketamine/propofol were associated with adjusted odds ratios of 0.3 (95% CI: 0.1-0.9) and 0.4 (95% CI: 0.1-1.6), respectively, for unacceptable reduction. Our findings indicate that UBPB performed by pediatric emergency physicians is associated with a reduced risk of unacceptable reductions relative to standard methods of sedation. However, prospective studies are necessary to confirm these results.

Bronchial Tuberculosis in Elderly Patients Complicating Respiratory Tuberculosis: Four Years of Experience of the Endoscopy Department

The objective: to analyze clinical, radiological, and endoscopic manifestations of bronchial tuberculosis in elderly patients with respiratory tuberculosis.Subjects and Methods. Endoscopic examinations conducted in Endoscopy Department of Central Tuberculosis Research Institute from July 1, 2020 to June 30, 2024 were retrospectively analyzed. 4,429 respiratory tuberculosis patients above 18 years old (all HIV-negative) underwent bronchoscopic examinations. Expert-class endoscopes were used: Olympus BF H190 (Olympus CV-190 video system (Olympus Japan)), Pentax EB15 J10 (DEFINA video system (HOYA Corporation Pentax Life Care Division, Japan)), and Fujifilm EB-580S (Fujifilm ELUXEO 7000 video system, Japan) under local or intravenous anesthesia (sedation). Combined rigid bronchoscopy and video bronchoscopy were performed under total intravenous anesthesia with high-frequency mechanical ventilation.Results. 7 patients with bronchial tuberculosis aged 65 years and older were included in the study, 3/7 (42.9%) of them had a relapse of bronchial tuberculosis. In all cases, diagnosis verification was preceded by a prolonged period of clinical symptoms (median time before diagnosis made 34 (27-59) weeks). Untimely administration of anti-tuberculosis therapy due to late diagnosis led to a prolonged course of bronchial tuberculosis and widespread and deep damage to the walls of the trachea and bronchi. Chronic tuberculosis inflammation led to metaplastic degeneration of the ciliary epithelium, up to grade II dysplasia and the formation of scar stenosis of the trachea, and grades II-III dysplasia of main and lobar bronchi.

ASRA pain medicine narrative review and expert practice recommendations for gastric point-of-care ultrasound to assess aspiration risk in medically complex patients undergoing regional anesthesia and pain procedures: infographic

ASRA pain medicine narrative review and expert practice recommendations for gastric point-of-care ultrasound to assess aspiration risk in medically complex patients undergoing regional anesthesia and pain procedures: infographic

Hemodynamic Fluctuations During Tooth Extraction Under Local Anesthesia

ABSTRACT Background: Effective management of intraoperative and perioperative pain is crucial for the success of dental practices. The use of anesthetic agents and vasoconstrictors can lead to hemodynamic alterations during surgical procedures. Aims and Objective: To observe hemodynamic changes during routine dental extraction done under lignocaine with adrenaline. Materials and Methods: This prospective, observational study was done on OPD patients requiring dental extraction. Fifty subjects in the age range of 18–65 years were evaluated for systolic blood pressure, diastolic blood pressure (DBP), heart rate (HR), and peripheral oxygen saturation before, during, and after tooth extraction. Data was evaluated using SPSS software. Results: Both systolic and DBP increased during anesthetic administration and extraction but decreased during postoperative period. This increase was noted more among females compared to males. HR decreased below preoperative values after extraction. This finding was similar among genders. SPO2 values did not fluctuate much during and/or after the procedure. Conclusion: The current findings of increased blood pressure and HR during tooth extraction warrant the use of meditation or anxiolytic drugs in anxious and hypertensive patients.

SEDATION AND PAIN MANAGEMENT IN PEDIATRIC INTENSIVE CARE : SYSTEMATIC REVIEW

Introduction : Sedation and pain management are critical in pediatric intensive care units (PICU), ensuring patient comfort, minimizing distress, and preventing complications related to mechanical ventilation and prolonged hospitalization. Sedation protocols vary, incorporating opioids, benzodiazepines, dexmedetomidine, ketamine, and non-pharmacological methods. However, excessive sedation may lead to iatrogenic withdrawal syndrome (IWS), prolonged PICU stays, and adverse neurodevelopmental effects. This systematic review evaluates various sedation strategies, their efficacy, and associated risks in pediatric patients. Method : A systematic search was conducted using Google Scholar, PubMed, and ScienceDirect (2020–2025) with keywords (“sedation” OR “analgesia” OR “pain management”) AND (“pediatric intensive care” OR “PICU” OR “critically ill children”) AND (“opioids” OR “benzodiazepines” OR “dexmedetomidine” OR “propofol” OR “ketamine”). Studies were screened per PRISMA guidelines, with inclusion limited to RCTs, cohort, and observational studies. Literature reviews, case reports, and inaccessible articles were excluded. Discussion : The included studies highlight the varying efficacy of sedation techniques. Ketamine demonstrated reduced mechanical ventilation time and opioid dependence, while midazolam vs. propofol studies showed differing pain scores and recovery times. Continuous sedation led to longer PICU stays and sedation-related complications, reinforcing the need for structured sedation protocols. Non-pharmacological methods like music therapy effectively reduced pain scores and sedation dependency. Multimodal analgesia, combining opioids with regional anesthesia or adjuvant analgesics, optimized pain control while minimizing opioid use. Conclusion : Optimizing sedation in PICU requires a balanced multimodal approach integrating pharmacological and non-pharmacological methods. Minimizing opioid reliance, implementing sedation weaning protocols, and incorporating supportive therapies improve patient outcomes. Further long-term studies are needed to establish standardized sedation guidelines for critically ill pediatric patients.

Comparison of TAP and II/IH Nerve Blocks for Postoperative Analgesia in Abdominal Surgeries under Spinal Anesthesia

ABSTRACT Background: Managing pain after lower abdominal surgery is important for smooth recovery. Regional anesthesia techniques, like the transversus abdominis plane (TAP) block and ilioinguinal–iliohypogastric (II/IH) nerve block, help reduce opioid use. This study compares the effectiveness of these two blocks in pain control, time to first rescue dose, hemodynamic stability, and side effects. Materials and Methods: A comparative study was done on 100 patients having lower abdominal surgeries under spinal anesthesia. Patients were divided into two groups: Group A (n = 50): Received bilateral TAP block with 20 ml of 0.375% ropivacaine per side. Group B (n = 50): Received bilateral II/IH block with the same drug and volume. Pain scores (VAS) were noted at different time points up to 48 hours. Time to first rescue analgesia, vitals, and side effects were recorded. Results: VAS scores at 4 to 24 hours were lower in the TAP group. Time to first rescue dose was longer in the TAP Group A (9.35 ± 0.47 hours) vs. the II/IH Group B (6.97 ± 1.16 hours). Hemodynamics and side effects were similar. Conclusion: TAP block offers better pain relief and longer duration than II/IH block in abdominal surgeries.

Optimal multimodal analgesia combinations to reduce pain and opioid use following non-cardiac surgery: an instrumental variable analysis.

Multimodal analgesia (MMA) is a perioperative pain management strategy that targets various pain pathways, resulting in reduced postoperative pain and opioid use. Unfortunately, the optimal combinations of pain medications to use with perioperative MMA remain uncertain. Our goal was to estimate the treatment effect of MMA on postoperative pain and opioid use and identify optimal non-opioid medication combinations to enhance MMA benefits. The study population includes all patients undergoing elective non-cardiac surgery with general anesthesia between 1 January 2017 and 31 December 2022 at six geographically similar Veterans Health Administration hospitals. An instrumental variable (IV) analysis was conducted using the anesthesiologist as the instrument to emulate randomization to receiving specific pain medication combinations. Outcomes were self-reported pain and opioid use after surgery. Of the 23 238 procedures included in the study, 46.1% received MMA. MMA was more common in younger patients, females and those with a lower probability of mortality. With IV analysis, inpatients with MMA required 6.8 fewer oral morphine equivalents (OMEs, 95% CI -10.2, to -3.4) in the postoperative period, and outpatients with MMA reported postoperative pain scores that were, on average, 1.0 unit lower than patients who did not receive MMA (95% CI -1.6 to -0.4). Combinations of non-steroidal anti-inflammatory drugs (NSAIDs) plus dexamethasone or regional anesthesia resulted in the greatest reductions in postoperative opioid use (mean reduction -29.5 OMEs, 95% CI -36.9 to -19.5 and mean reduction -28.4 OMEs, 95% CI -40.1 to -16.8, respectively). Our findings further support existing evidence on the effectiveness of MMA in reducing postoperative pain and opioid use following non-cardiac surgery. Importantly, our study highlights that dexamethasone and NSAIDs, not acetaminophen, which is almost universally used in MMA regimens, resulted in the greatest reduction of postoperative pain and postoperative opioid use. This has significant implications for the continued use of NSAIDs and dexamethasone in MMA protocols and underscores the need for future studies exploring the independent effect of intravenous acetaminophen on postoperative pain.

Glanular ischemia following glans penis augmentation: A rare case report

Introduction: Premature ejaculation is a common problem in men and filler injection into the glans penis has become a prevalent practice in treatment. Since the glans penis augmentation is an invasive treatment method, it also carries the risk of complications. Herein, we aimed to present a case of glans penis ischemia due to hyaluronic acid filler injection. Case Presentation: The patient was a 29-year-old male with premature ejaculation. The physical examination was normal, and sensory testing with a biothesiometer revealed vibration perception threshold values of 5.3V for the glans, 4.1V for the frenulum, and 3.9V for the penile shaft. Under local anesthesia, hyaluronic acid filler was applied with the multiple puncture technique, 2 ml in total, 0.2 ml per injection. One day after the procedure, the patient referred with complaints of discoloration of the glans penis. The physical examination revealed blackening at the distal tip of the glans with a visible demarcation line. Hyaluronidase was applied for the treatment of glanular glans penis ischemia secondary to hyaluronic acid filler injection. A significant improvement in the glans penis color was observed after hyaluronidase injection. The patient was prescribed 100 mg of aspirin, a warm saline dressing, and a nitroglycerin-containing cream and was discharged for daily follow-up. Conclusion: Although vascular complications are rare after hyaluronic acid filling into the glans penis, early diagnosis and treatment are crucial. Patients should be informed about possible adverse events. The main treatment method for vascular complications is urgent hyaluronidase injection. In addition, prevention of clot propagation with oral aspirin and vasodilatation treatments should be applied. In the glans penis ischemia after hyaluronic acid injection, early diagnosis and immediate hyaluronidase administration can reverse ischemia without necrosis or surgical intervention.

Measuring Stress Reduction in Patients Receiving Multimedia Entertainment During Vascular Surgery Under Regional Anesthesia: Protocol for a Randomized Controlled Study.

This study explores the treatment of internal carotid artery stenosis in patients with a high risk for cardiovascular events. The use of regional anesthesia permits ongoing neurological monitoring and enhances patient safety during the procedure. However, the operation can be stressful and lengthy, highlighting the need for strategies to alleviate patient discomfort. This study evaluates audiovisual distractions such as video goggles to potentially improve patient experiences during carotid surgeries, a topic that has not yet been comprehensively researched. We aimed to (1) determine whether there is a benefit for patients regarding stress reduction when using video goggles during vascular surgery of the carotid artery and (2) determine whether any parameters can effectively measure such a potential benefit. This prospective, randomized study at the University Hospital Augsburg is evaluating the use of HappyMed video goggles by patients undergoing carotid endarterectomy under regional anesthesia. Participants are randomized into either the intervention group, which receives the video goggles, or the control group, which does not. The surgical and anesthetic procedures remain consistent across both groups. Patients are eligible if they meet the surgical criteria, are able to lie supine, and are cooperative. Patients are excluded if they are receiving corticosteroids, have dementia, or have a language barrier. The study uses questionnaires and vital/laboratory parameters, including cortisol levels and heart rate, to assess stress and anxiety. To monitor potential motion sickness, the occurrence of nausea or vomiting is documented. Both patients and surgical staff will evaluate the experience postoperatively to determine the goggles' impact on patient experience and stress management during surgery. The study has been approved by the local ethics committee and is registered at ClinicalTrials.gov. Patient inclusion started in September 2022 and should be completed within 3 to 4 years. This paper presents a study protocol that was finalized and approved by the local ethics committee in September 2022. At the time of this protocol's final submission for publication, approximately 90% of the recruitment had been completed. Following completion of recruitment and data acquisition, the results are intended to be published within one year. This study aims to improve patient comfort and perioperative care during vascular surgery. Therefore, our study aims to investigate if the use of video goggles during surgery is feasible and if there are parameters that indicate a benefit for patients. This study is being conducted as a pilot trial to provide a foundation for future research aimed at improving patient comfort during carotid artery surgery under local anesthesia. ClinicalTrials.gov NCT06704230; https://clinicaltrials.gov/study/NCT06704230. DERR1-10.2196/70597.

Mechanisms of Improving Feeding Function With Capsaicin Following Local Anesthesia in Infant Pigs.

Sensory deficits are detrimental to feeding performance, whereas sensory stimulation can improve feeding. Capsaicin is one sensory intervention that improves swallowing in adult humans and alters feeding in an infant animal model. This study assessed the role of the inferior alveolar nerve (IAN) in infant feeding, and determined whether capsaicin reversed or compensated for deficits associated with IAN anesthesia. Data were collected using simultaneous videofluoroscopy and electromyography (EMG) in an infant pig model (n = 360 swallows, 6 pigs). Variables of interest included swallow frequency, sucks per swallow, milk acquired per suck, bolus size, degree of airway compromise, excursions of the tongue and thyroid cartilage, and activity of the digastric, genioglossus, and thyrohyoid. The repeated measures data were analyzed with a three- or four-level linear mixed model and (doubly) nested subsamples. IAN anesthetization decreased feeding efficiency as evidenced by decreased swallow frequency (p = 0.013), increased sucks per swallow (p = 0.016), decreased milk per suck (p = 0.008), and decreased bolus sizes (p = 0.036). Airway protection improved (p = 0.045) and tongue excursion was altered (p = 0.016), while digastric and genioglossus EMG were unchanged. Capsaicin application restored some, but not all variables, to baseline values, while either partially restoring or not affecting others. The reduced efficiency following IAN anesthetization decreased instances of airway compromise, highlighting the tradeoff between feeding efficiency and airway protection. Subsequent capsaicin administration affected feeding physiology yet did not simply reverse deficits associated with impaired sensation. As such, capsaicin may be useful in treating some etiologies of dysphagia, but not others. NA.

Blood transfusion trends and risk factors in primary and revision shoulder arthroplasty: a single centre analysis.

Management of blood transfusion in the peri-operative period of joint arthroplasties is often difficult and although associated risk factors and practice trends help ease this process, for shoulder arthroplasty, these aspects have not been explored as widely as other procedures. The purposes of the current study were to identify the incidence, risk factors and trends of blood transfusion in shoulder arthroplasty patients over a 25-year period in a single, high-volume centre. We retrospectively reviewed all patients undergoing hemi-, total and reverse shoulder arthroplasties, including revision procedures, between 1997 and 2021. Overall rate of blood transfusion, procedure and patient related risk factors, and transfusion trends over time were evaluated. A total of 3,168 patients were included in the analysis and overall rate of blood transfusion was 1.8%. Multivariate analysis revealed revision procedure (p < 0.001), prior revision (p = 0.035), regional anaesthesia (p = 0.004), history of hypertension (p = 0.043), history of myocardial infarction (p = 0.004), history of renal insufficiency (p = 0.045), and alcohol abuse (p = 0.033) were independent risk factors for transfusion. Although transfusion rates were observed to be increased after 2007, from 0.6 to 0.8 to over 2%, this trend did not demonstrate statistical significance. Revision procedures and regional anaesthesia as well as hypertension, myocardial infarction, renal insufficiency and alcohol abuse can be regarded as independent risk factors for blood transfusion in shoulder arthroplasty. It is imperative to implement advanced blood conservation protocols for patients with these risk factors.

Efficacy of erector spinae plane block versus caudal block for postoperative analgesia in paediatric surgery: A systematic review and meta-analysis

Background and Aims: Regional anaesthesia is a component of multimodal analgesia in paediatric surgery, providing effective pain relief. Traditional techniques, such as the caudal block (CB) and, more recently, fascial plane blocks, such as the erector spinae plane block (ESPB), have gained popularity. This systematic review and meta-analysis compares CB and ESPB in paediatric surgeries involving the lower abdomen or lower limbs. It aims to clarify mixed outcomes from recent trials regarding the variability in analgesic efficacy of both techniques for future practices. Methods: This review, registered with the International Prospective Register of Systematic Reviews (PROSPERO), includes eight randomised controlled trials (RCTs) comparing postoperative analgesia between ESPB and CB in paediatric lower abdominal or lower limb surgeries. We searched the ScienceDirect, Google Scholar, Scopus, ProQuest, and PubMed databases. The meta-analysis assessed the proportion of patients requiring rescue analgesia and postoperative pain intensity. Grading of Recommendations Assessment, Development, and Evaluation (GRADE) guidelines were applied to assess the quality of evidence. Result: Eight RCTs (575 patients) were included in the review. A meta-analysis of four RCTs (217 patients) showed no statistically significant difference (inconclusive) between ESPB and CB groups regarding the proportion of patients requiring rescue analgesia [Relative Risk (RR) =0.83, 95% confidence interval (CI): 0.29, 2.40, P = 0.73], while six RCTs (360 patients) found lower pain intensity score (standardised mean difference = −0.37; 95% CI: −0.71, −0.02; P = 0.04) in the ESPB group when compared to CB group. Both outcomes exhibited considerable heterogeneity (I² = 88% for rescue analgesia; I² = 62% for pain intensity), further emphasising the robustness of the findings. Conclusion: We conclude that ESPB provides better postoperative analgesia than CB in children undergoing lower abdominal or lower limb surgeries. ESPB reduces postoperative pain intensity scores and analgesic requirements compared to CB.

Management of analgesia in cardiac surgery.

Pain management in cardiac surgery remains a critical component of perioperative care, influencing recovery, patient satisfaction, and outcomes. Traditional opioid-based analgesia is associated with significant adverse effects, prompting the exploration of multimodal strategies, including regional anesthesia (RA), non-opioid analgesics, and enhanced recovery after surgery (ERAS) protocols.This review evaluates the evolution of cardiac surgery pain management, from conventional opioid-based regimens to multimodal approaches with regional anesthesia. A comprehensive analysis of existing literature was conducted, assessing the efficacy, safety, and integration of different pain management strategies in cardiac surgery on PubMed, Google Scholar, MEDLINE, UpToDate, Embase and Web of Science until 1 November 2024. Studies on opioids, adjunct analgesics (e.g. NSAIDs, acetaminophen, ketamine, dexmedetomidine), RA techniques, and ERAS frameworks were reviewed to provide a comparative perspective. Multimodal analgesia significantly reduces opioid consumption, enhances pain control, and minimizes complications such as respiratory depression and postoperative nausea. RA techniques, including fascial plane blocks, offer promising opioid-sparing benefits. ERAS protocols further optimize recovery, yet challenges remain in standardizing approaches across institutions. The future of cardiac surgery pain management lies in individualized, multimodal strategies following ERAS principles. Standardized guidelines and further research are needed to refine these protocols for widespread adoption.

Effect of general anesthesia on postoperative pulmonary embolism

Background The influence of anesthesia type and duration on the occurrence of pulmonary embolism (PE) after surgery remains controversial. This study investigates the association between anesthesia type and duration with postoperative PE. Methods A retrospective cohort of adult patients undergoing surgery from May 2020 to August 2024 at large-scale general hospitals was analyzed. Multivariable logistic regression models were employed to adjust for potential confounders, and sensitivity analyses (using overlap weighting and array approach) were performed to validate the findings. Results A total of 178,052 patients were included in the analysis, of whom 91 developed PE after surgery. The median duration of general anesthesia (GA) was 1.72 h, with an interquartile range (IQR) of 1.17–2.52 h. The median duration of regional anesthesia was 1.54 h, with an IQR of 1.20–2.03 h. Anesthesia type and the duration of regional anesthesia were not associated with PE occurrence (adjusted odds ratio [aOR] [95% confidence interval, CI], 1.148 [0.671–2.098], p = 0.631), (aOR [95% CI], 1.117 [0.498–1.557], p = 0.738). The rates of PE consistently increased with GA prolongation (aOR [95% CI], 1.308 [1.176–1.432], p < 0.001). Compared with GA durations < 3 h, prolonged anesthesia was significantly associated with increased PE incidence (aOR [95% CI], 4.398 [2.585–7.565], p < 0.001). These findings were also confirmed by sensitivity analyses. Conclusions Our study demonstrates that prolonged GA, particularly > 3 h, significantly increases the risk of PE.

Neurodevelopmental Impact of prenatal regional or general anaesthesia: an ambidirectional pilot cohort study.

Neurodevelopmental Impact of prenatal regional or general anaesthesia: an ambidirectional pilot cohort study.

Peripheral Nerve Injuries from Regional Anesthesia: A Narrative Review

Peripheral nerve injury is defined as a condition determined at least 48 hours after regional blockade in the form of sensory and/or motor disturbances in the area of innervation of the affected nerve, confirmed by the results of neurological examination. The incidence of transient neuropathies associated with peripheral nerve blockade is 2.2%, with permanent neurologic deficits ranging from 2 to 4 per 10,000 blockades. Although postoperative nerve injury is rare, when such complications do occur, they present significant problems for both the patient and the anesthesiologist. The aim of the work was to summarize the data presented in modern scientific literature on the prevention and treatment of peripheral nerve injuries during regional anesthesia. We searched for publications for the period from 2014 to 2024 by keywords in Russian and English: peripheral nerve, injuries, regional anesthesia, neurological complications, prevention of nerve injuries in PubMed, Elibrary, and CyberLeninka. The search revealed 383 publications, of which 433 were excluded because they described peripheral nerve injuries no associated with regional anesthesia. The remaining 50 publications formed the basis of this review. The review presents the anatomy of peripheral nerves, classification of their injuries, details mechanical, intraneural, ischemic and neurotoxic mechanisms of nerve injury. Methods of prevention of nerve injuries are outlined. It is shown that the combined use of neurostimulation, which helps to identify the nerves, ultrasound navigation, which helps to visualize the nerve, pressure monitor during injection, which helps to avoid nerve injury, are the key to safe regional anesthesia. The diagnosis of nerve injuries is described, which includes, in addition to the clinical signs, computed tomography and electrophysiologic examinations. The algorithm of observation of a patient with suspected nerve injury after regional anesthesia is given. The methods of treatment of peripheral nerve injury, including physiotherapy, drug treatment, low-frequency electrical stimulation, low-intensity ultrasound, and phototherapy, are described in detail. Peripheral nerve injuries during regional blockade is rare and is more often neuropraxic in nature, hence transient and has a favorable prognosis. The combined use of neurostimulation, ultrasound navigation and pressure monitoring during injection are the key to successful and safe regional blockade. Treatment of nerve injuries requires a multidisciplinary. The development of national recommendations for the prevention of nerve injuries during regional blockade will help anesthesiologists to reduce the risk of complications.