Daily Anesthesiology Research Analysis

BACKGROUND: Choosing the most effective pain management is important for enhancing functional recovery after surgery. The fascia iliaca compartment block (FICB) is recommended for analgesia after THA, but whether liposomal bupivacaine is more effective for this application remains uncertain. QUESTIONS/PURPOSES: (1) Did a single-injection suprainguinal FICB using liposomal bupivacaine provide superior pain control by a clinically important margin? (2) What was the effect of liposomal bupivacaine on perioperative opioid consumption? (3) How did liposomal bupivacaine affect the duration of the sensory block and quadriceps motor weakness in the operated limb? METHODS: This was a prospective, parallel-group, assessor-blinded, single-center, randomized controlled clinical trial. Patients who underwent unilateral primary THA via the posterolateral approach were included in the study. Exclusion criteria included a BMI of > 32.5 kg/m2 (which is the diagnostic criterion for moderate obesity in China), contraindications to peripheral nerve block, known allergy to study medications, psychiatric or cognitive disorders that could interfere with pain assessment, severe hepatic or renal dysfunction, and chronic pain necessitating long-term opioid therapy. According to these criteria, 76% (60 of 79) of screened patients met eligibility requirements and were subsequently randomized into either the liposomal bupivacaine group or the control group. All patients received an ultrasound-guided, single-injection, suprainguinal FICB. The patients in the liposomal bupivacaine group were administered a solution consisting of 10 mL of 1.33% liposomal bupivacaine combined with 20 mL of 0.25% bupivacaine hydrochloride, whereas the control group received 30 mL of 0.5% ropivacaine with the addition of 5 mg dexamethasone. There were no dropouts, and all patients were analyzed in the groups to which they were assigned. The groups did not differ in important ways with respect to baseline characteristics or relevant surgical and anesthesia parameters. The outcomes were (1) static (at rest) and dynamic (during passive hip flexion to 45°) numeric rating scale (NRS) scores measured at 6, 12, 24, 48, and 72 hours postoperatively, (2) cumulative opioid consumption expressed as intravenous morphine equivalents intraoperatively and within 72 hours postoperatively, and (3) sensory block duration and quadriceps motor weakness in the operated limb assessed at 24 and 48 hours postoperatively. Postoperative rebound pain, rescue analgesia, and adverse events were also recorded. The minimum clinically important difference was predefined as 1.5 for static NRS scores, 1.8 for dynamic NRS scores, and 10 mg of intravenous morphine equivalents for opioid consumption. RESULTS: Although we found no clinically important between-group differences in either static or dynamic NRS scores at any time point, we found that the group treated with liposomal bupivacaine consumed fewer morphine equivalents in the first 72 hours after surgery than did patients treated without liposomal bupivacaine in the block (median [IQR] 10 mg [7 to 16] versus 24 mg [20 to 28], difference of medians -12; p < 0.001). Likewise, the sensory block lasted longer in the liposomal bupivacaine group (median [IQR] 71 hours [66 to 77] versus 12 hours [10 to 17], difference of medians 58; p < 0.001). However, there were no differences in the number of patients with quadriceps motor weakness at 24 hours and 48 hours after surgery between the two groups. Postoperative rebound pain, rescue analgesia, and adverse events likewise did not differ between the groups. CONCLUSION: In this randomized trial, we found a clinically relevant reduction in opioid consumption within the first 72 hours after posterolateral THA with the use of liposomal bupivacaine in a single-injection suprainguinal FICB. Furthermore, the prolonged block duration with liposomal bupivacaine was not associated with an increased risk of quadriceps motor weakness. Based on these findings, we recommend the routine use of liposomal bupivacaine for this application. Future trials should focus on the use of liposomal bupivacaine in combined regional anesthesia methods. LEVEL OF EVIDENCE: Level I, therapeutic study.

PURPOSE: Postoperative sore throat (POST) is highly prevalent following double-lumen endobronchial tube (DLT) intubation and negatively impacts recovery. Cheek acupuncture, a micro-needle therapy, provides targeted analgesia through specific acupoint stimulation. This study aimed to evaluate the efficacy of cheek acupuncture in mitigating POST in patients undergoing thoracoscopic lung surgery with DLT intubation. PATIENTS AND METHODS: Eighty-eight patients were equally randomized to receive either cheek acupuncture (CA group) at bilateral cervical, upper energizer, and upper cervical points for 30 minutes before surgery completion, or sham acupuncture at identical acupoints (CT group). The primary outcome was overall POST incidence within postoperative 48 hours, and secondary outcomes included POST severity, wound pain, rescue analgesic consumption, postoperative nausea and vomiting (PONV) incidence, time to first flatus, postoperative pulmonary complications, adverse events, satisfaction scores, and hospitalization duration. RESULTS: The overall 48-hour postoperative POST incidence was 34.1% in the CA group versus 65.9% in the CT group (risk ratio: 0.517, 95% confidential interval: 0.326 to 0.821, CONCLUSION: A single intraoperative session of cheek acupuncture reduces the incidence of early POST after DLT intubation for thoracoscopic lung surgery, with a favorable safety profile.

BACKGROUND: Postoperative delirium and delayed neurocognitive recovery are common and consequential complications of anesthesia and surgery. Maintenance of general anesthesia with propofol-based intravenous drugs may reduce postoperative neurocognitive complications compared with volatile anesthesia. METHODS: Major databases were searched through November 2025. The primary outcome was postoperative delirium within 7 postoperative days. Secondary outcomes included delayed neurocognitive recovery (formerly termed postoperative cognitive decline) and Mini-Mental State Examination scores on postoperative days 1, 3, and 7 (range 0 to 30, higher scores better, with 2 points being meaningful). RESULTS: Across 29 trials (N = 11,896 patients), the incidence of postoperative delirium was similar with volatile and intravenous anesthesia RR: 0.94 [95% CI, 0.71 to 1.25]. Volatile anesthesia provoked delayed neurocognitive recovery RR: 1.35; 95% CI, 1.07 to 1.70), although effects were inconsistent across assessment periods. Postoperative MMSE scores were slightly lower with volatile anesthesia (mean difference: -1.4 points [95% CI, -2.2 to -0.6]), a difference we did not consider clinically meaningful. Both delayed neurocognitive recovery and Mini-Mental State Examination scores analyses displayed substantial heterogeneity. Trial sequential analysis indicated that more trials are needed for each outcome. CONCLUSIONS: The incidence of postoperative delirium was similar with volatile and intravenous anesthesia. Volatile anesthesia provoked small, heterogeneous, and time-dependent differences in delayed neurocognitive recovery, but not of a meaningful magnitude. Current evidence suggests that intravenous anesthesia does not meaningfully improve postoperative neurocognitive outcomes; however, available information remains limited, heterogeneous, and imprecise.