Daily Anesthesiology Research Analysis
Analyzed 16 papers and selected 3 impactful papers.
Summary
The most impactful studies were a randomized non-inferiority trial of rhomboid intercostal block for thoracoscopic surgery, multidisciplinary evidence-based guidelines for perioperative liver resection, and a randomized dose-finding trial of dexmedetomidine in transversus abdominis plane block after cesarean delivery. Together, these studies address safer regional analgesia, standardized perioperative care, and optimization of analgesic efficacy versus adverse effects.
Research Themes
- Regional anesthesia and postoperative analgesia
- Evidence-based perioperative guidelines
- Dose optimization and safety of anesthetic adjuncts
Selected Articles
1. Comparison of ultrasound-guided two-point block of the rhomboid intercostal
In this randomized controlled non-inferiority trial of 68 analyzed patients, ultrasound-guided two-point rhomboid intercostal block provided 24-hour resting analgesia that was non-inferior to two-point thoracic paravertebral block after three-port thoracoscopic surgery. The mean between-group difference in the 24-hour resting numerical rating scale score was 0.088, with a 95% confidence interval of -0.377 to 0.553.
Impact: The study provides randomized evidence supporting a potentially simpler alternative to thoracic paravertebral block for postoperative analgesia in multi-port thoracoscopic surgery. Its non-inferiority design directly addresses whether a newer block can replace an established technique.
Clinical Implications: Two-point rhomboid intercostal block may be considered as an alternative regional analgesic technique for three-port thoracoscopic surgery when clinicians seek effective analgesia with a potentially more superficial and technically accessible approach. Rescue analgesia requirements should still be monitored because they were numerically higher with rhomboid intercostal block.
Key Findings
- The final analysis included 34 patients in each group.
- The 24-hour resting pain score confirmed non-inferiority of rhomboid intercostal block, with a mean difference of 0.088 and 95% CI of -0.377 to 0.553.
- Rhomboid intercostal block showed numerically greater rescue analgesic use than thoracic paravertebral block.
Methodological Strengths
- Randomized controlled comparison with a prespecified non-inferiority margin of 1 numerical rating scale point.
- Multiple postoperative pain time points and the Quality of Recovery-40 score were assessed.
Limitations
- The sample size was small, with 68 patients included in the final analysis.
- The study was limited to three-port thoracoscopic pulmonary resection, so generalizability to other procedures is uncertain.
Future Directions: Larger multicenter trials should compare block success, local anesthetic spread, opioid consumption, adverse events, and recovery outcomes across different thoracic procedures. Cost-effectiveness and training requirements should also be evaluated before broad adoption.
BACKGROUND: The anesthetic characteristics of ultrasound-guided two-point rhomboid intercostal block (RIB) have not been fully established. This study compared the analgesic efficacy of ultrasound-guided two-point RIB with that of two-point thoracic paravertebral block (TPVB) for postoperative pain control and recovery in patients undergoing three-port thoracoscopic surgery. METHODS: Seventy patients aged 18-80 years scheduled for three-port thoracoscopic pulmonary resection were block-randomized in a 1:1 ratio to receive either TPVB or RIB.
2. Guidelines 2025: perioperative management of adult patients undergoing liver resection.
A multidisciplinary French panel developed perioperative liver resection guidelines using structured PICO questions, a literature search conducted according to PRISMA principles, and the GRADE framework. Forty recommendations were produced across 14 questions; 7 had high-quality evidence, 23 had low-quality evidence, and 10 were based on expert opinion, while no recommendation could be made for 4 questions.
Impact: This guideline integrates anesthesia, hepatology, and hepatobiliary surgery perspectives into a single perioperative framework. It identifies both actionable consensus recommendations and important evidence gaps, which is valuable for standardizing care and prioritizing future trials.
Clinical Implications: The recommendations can support institutional protocols for preoperative risk assessment, intraoperative management, and postoperative care in adult liver resection. Because most recommendations were supported by low-quality evidence or expert opinion, local implementation should include audit, multidisciplinary review, and adaptation to patient risk and institutional resources.
Key Findings
- The guideline addressed 14 clinical questions across preoperative, intraoperative, and postoperative management.
- Forty recommendations achieved strong agreement after two rounds of voting and revisions.
- Only 7 recommendations were supported by high-quality evidence; 23 were supported by low-quality evidence and 10 represented expert opinion.
Methodological Strengths
- Multidisciplinary development involving anesthesia, hepatology, and hepatobiliary surgery organizations.
- Use of PICO questions, PRISMA-based literature searching, GRADE evidence assessment, conflict-of-interest disclosure, and formal voting.
Limitations
- Most recommendations were based on low-quality evidence or expert opinion rather than high-quality comparative trials.
- The guideline was developed by French expert societies, so applicability may require adaptation to other healthcare systems and patient populations.
Future Directions: Future research should prioritize prospective multicenter studies and randomized trials addressing the four unanswered questions and the recommendations currently supported only by low-quality evidence or expert opinion. Implementation studies should determine whether guideline adherence improves complications, recovery, and resource use after liver resection.
OBJECTIVE: The French Society of Anesthesia and Intensive Care (SFAR), the French Society for the Study of the Liver (AFEF), and the Association for Hepato-Biliary-Pancreatic Surgery and Liver Transplantation (ACHBPT) jointly developed guidelines for the perioperative management of liver resection surgery. DESIGN: A multidisciplinary panel of French experts from the SFAR, the AFEF, and the ACHBPT was convened. All potential conflicts of interest were officially declared before initiation of the recommendation development process, which was conducted independently of any industry funding. The authors used the GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology to assess the quality of evidence in the literature. METHODS: Three areas were defined: (1) preoperative assessment; (2) optimization of intraoperative management; and (3) optimization of postoperative management.
3. Ultrasound-guided transversus abdominis plane block using ropivacaine and different doses of perineural dexmedetomidine for analgesia after cesarean section: a randomized controlled clinical trial.
In this five-arm randomized clinical trial, 138 patients undergoing cesarean delivery were analyzed after allocation to ropivacaine TAP block with 0, 0.25, 0.50, 0.75, or 1.00 μg/kg perineural dexmedetomidine. Increasing doses prolonged time to first rescue analgesia and reduced sufentanil consumption, with 0.75 μg/kg identified as the most favorable balance between analgesic benefit and safety.
Impact: The study addresses a clinically relevant dosing uncertainty for a commonly used regional analgesic adjunct after cesarean delivery. Its dose-response design helps move practice beyond empiric dexmedetomidine dosing toward a more evidence-informed regimen.
Clinical Implications: A perineural dexmedetomidine dose of 0.75 μg/kg with ropivacaine may be considered for TAP block after cesarean delivery, subject to institutional protocols and monitoring for sedation, hemodynamic effects, and other adverse events. The findings should not be interpreted as establishing universal dosing across different local anesthetics, block techniques, or patient populations.
Key Findings
- Of 150 enrolled patients, 138 remained in the final analysis after 12 protocol violations.
- Increasing dexmedetomidine doses prolonged time to first rescue analgesia from 5.42 ± 2.29 hours to 11.26 ± 2.48 hours.
- A dose of 0.75 μg/kg appeared to provide the most favorable balance of analgesic efficacy and safety.
Methodological Strengths
- Five parallel randomized dose groups enabled assessment of a dose-response relationship.
- Co-primary outcomes included both duration of analgesia and 48-hour sufentanil consumption.
Limitations
- The final sample size was modest, with 138 patients analyzed.
- The study was conducted under combined spinal・epidural anesthesia and used a specific ropivacaine TAP block regimen, limiting generalizability.
Future Directions: Larger multicenter trials should confirm the 0.75 μg/kg dose, characterize sedation and hemodynamic outcomes in greater detail, and compare perineural with systemic dexmedetomidine. Studies should also assess breastfeeding-related outcomes, maternal functional recovery, and neonatal safety.
BACKGROUND: Dexmedetomidine is frequently combined with ropivacaine in ultrasound-guided transversus abdominis plane (TAP) block for analgesia after cesarean section (CS), but is associated with adverse effects. The ideal dose of dexmedetomidine as local anesthetic adjuvant has not been determined. This study aimed to explore the dose of perineural dexmedetomidine for ensuring analgesic efficacy while minimizing adverse effects. METHODS: Patients undergoing CS under combined spinal-epidural anesthesia were randomly allocated to five groups: DR (0.00 μg/kg dexmedetomidine), DR1 (0.25 μg/kg), DR2 (0.50 μg/kg), DR3 (0.75 μg/kg), and DR4 (1.00 μg/kg), all combined with ropivacaine for TAP block.