Daily Anesthesiology Research Analysis

In this double-blind, placebo-controlled multicenter trial across 23 French hospitals, 1,210 patients undergoing elective curative digestive cancer surgery were randomized to intravenous methylprednisolone 20 mg/kg or placebo. Among 1,188 patients with 30-day follow-up, major postoperative complications occurred in 23% versus 20%, respectively, without a statistically significant difference, and no secondary outcome was improved.

Impact: This large, rigorous trial directly addresses a controversial perioperative intervention and provides practice-changing negative evidence. Its results argue against routine preoperative high-dose corticosteroids in elective digestive cancer surgery, preventing ineffective treatment and potential steroid-related harm.

Clinical Implications: Routine administration of a preoperative pulse dose of methylprednisolone 20 mg/kg should not be recommended for elective digestive cancer surgery solely to reduce postoperative complications or inflammation. Clinicians should continue to use corticosteroids only for established indications and weigh procedure-specific risks and benefits.

Future Directions: Future research should determine whether selected subgroups, specific procedures, or different corticosteroid regimens have distinct effects, while incorporating longer-term oncologic, infectious, and patient-reported outcomes. Current work should prioritize implementation studies that reduce unnecessary perioperative steroid use.

This registered randomized noninferiority trial randomized 72 adults undergoing elective unilateral percutaneous nephrolithotomy to anterior quadratus lumborum block or thoracic paravertebral block. The quadratus lumborum block was noninferior for 24-hour Quality of Recovery-15 scores, while also prolonging time to first analgesia, reducing 24-hour morphine consumption and pain burden, and showing less hypotension.

Impact: The study evaluates patient-centered recovery rather than pain alone and supports a technically accessible regional anesthesia alternative. The combination of noninferior recovery, opioid reduction, and fewer observed hypotensive events may influence block selection for percutaneous nephrolithotomy.

Clinical Implications: Anterior quadratus lumborum block may be considered as an alternative to thoracic paravertebral block for analgesia during percutaneous nephrolithotomy, particularly when minimizing hypotension or opioid exposure is desirable. The secondary benefits should be interpreted cautiously until confirmed in larger trials.

Future Directions: Larger multicenter randomized trials should assess the reproducibility of the hypotension and opioid-sparing findings, compare block techniques across diverse surgical and patient-risk profiles, and evaluate recovery beyond 24 hours, including mobilization, discharge readiness, and patient-reported outcomes.

This prospective cohort study across five Chinese tertiary hospitals evaluated 2,200 adults aged 65 years or older undergoing elective major noncardiac surgery using repeated RASS-gated CAM-ICU assessments. PACU delirium occurred in 19.2% of patients and was predominantly hypoactive, while adding nursing-sensitive variables to conventional risk factors produced statistically detectable but clinically limited improvement in discrimination, with the signal concentrated in urinary catheterization.

Impact: The study quantifies a frequently overlooked but clinically important PACU complication in a large multicenter cohort and highlights the predominance of hypoactive delirium. It translates epidemiologic findings into practical priorities: repeated screening and minimization of potentially modifiable catheter exposure.

Clinical Implications: PACU protocols for older adults should include repeated delirium screening, with attention to hypoactive presentations that may not be behaviorally obvious. Catheter necessity should be reassessed early, although the modest incremental predictive value of nursing-sensitive variables does not justify use of the model as a standalone bedside prediction tool.

Future Directions: Future studies should externally validate the findings in different health systems, test targeted catheter-minimization and delirium-prevention bundles, and assess whether repeated PACU screening leads to earlier treatment and improved postoperative outcomes.