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Transversus abdominis plane catheter infusions after major abdominal surgery in morbidly obese patients: reply to comments.
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Update on Selective Regional Analgesia for Hip Surgery Patients
No full text: In hip surgery, regional anesthesia offers benefits in pain management and recovery. There are a wide range of regional analgesic options; none have shown to be superior. Lumbar plexus block, femoral nerve block, and fascia iliaca block are the most supported by published literature. Other techniques, such as selective obturator and/or lateral femoral cutaneous nerve blocks, represent alternatives. Newer approaches, such as quadratus lumborum block and local infiltration analgesia, require rigorous studies. To realize long-term outcome benefits, postoperative regional analgesia must be tailored to the individual patient and last longer
Herniorraphy, prevention and risk management of persistent postsurgical pain : preliminary results of a randomized study
No full textNebulization of local anaeshetics in laparoscopic surgery : a new tool for postoperative analgesia
No full textLaparoscopic procedures have been associated to moderate or severe pain that may require opioids and almost all patients referred shoulder pain. Intraperitoneal instillation of local anaesthetics, as part of a multimodal approach analgesia program, reduces pain intensity and morphine consumption after laparoscopic cholecystectomy. However, direct local anesthetic instillation is not enough to eliminate visceral and shoulder pain. Heated and humidified gas may produce positive effects such as reduction of postoperative pain. Intraperitoneal nebulization, a new technique of drug administration, provides homogeneous spread of drugs allowing a better distribution of local anaesthetics throughout the peritoneum. This technique combines the effects of gas conditioning and the analgesic benefits of local anaesthetic instillation. Nebulization of local anaesthetics during different laparoscopic procedures reduced postoperative pain, morphine consumption and allowed earlier mobilization. Future studies should determine, the optimal dose of local anaesthetics, the effect of local anaesthetic nebulization in different clinical settings and its importance on long term clinical outcome
Safety of clonidine and dexmedetomidine in peripheral nerve blocks: a systematic review of preclinical evidence
No full textBackground: Perineural α2-adrenergic receptor agonists, particularly clonidine and dexmedetomidine, can be used to prolong peripheral nerve block duration. Although clinical studies suggest enhanced analgesia, concerns remain regarding their neurotoxicity or neuroprotective potential, especially in compromised nerves. We aimed to synthesise preclinical evidence on the safety of these agents. Methods: A systematic search of PubMed, CENTRAL, Embase, and Scopus was conducted up to July 13, 2025, supplemented by reference screening and large language model queries. Preclinical in vivo and in vitro studies examining perineural clonidine or dexmedetomidine were included. Outcomes assessed included indicators of neurotoxicity (e.g. apoptosis, demyelination, axonal degeneration) and neuroprotection (e.g. anti-inflammatory effects, neuronal preservation). Risk of bias was evaluated using the SYRCLE tool and narrative assessment. Results: Twenty-five studies (19 in vivo, six in vitro) were included. High-dose α2-agonists can induce direct toxicity in vitro, but no evidence of neurotoxicity has been demonstrated in vivo, even at doses exceeding those used clinically. Conversely, α2-agonists have been shown to reduce apoptosis, axonal degeneration, and inflammation compared with untreated groups, although such protective effects are observed at clinically relevant concentrations only after intraneural injection. In contrast, in models with pre-existing nerve injury, α2-agonists have been associated with exacerbated demyelination and inflammation. Conclusions: Preclinical evidence suggests that perineural α2-adrenergic receptor agonists are safe at clinically relevant doses on healthy nerves. While they probably do not offer a clinically significant neuroprotective effect at therapeutic doses (≤2 μg kg−1), they can increase neurotoxicity in compromised nerves. These data should not be directly extrapolated to clinical practice. Careful patient and dose selection and further high-quality preclinical and clinical studies are warranted
Inflammation-Based Scores: A New Method for Patient-Targeted Strategies and Improved Perioperative Outcome in Cancer Patients
No full textSystemic inflammatory response (SIR) has actually been shown as an important prognostic factor associated with lower postoperative survival in several types of cancer. Thus, the challenge for physicians is to find specific, low-cost, and highly reliable inflammatory markers, clearly correlated with prognosis and able to preoperatively stratify patient's risk. Inflammation is a promising target to improve perioperative outcome, and data show that anti-inflammation techniques have a great potential in the perioperative period of cancer surgery. Inflammation scores could be useful to stratify patients with a potential better response to anti-inflammation strategies. Furthermore, inflammation scores could prevent failure of clinical trials by a better definition of patients to be included in such trials; inflammation scoring could clarify the real role of different drugs and techniques on outcome after cancer surgery, defining if different therapies are required for different patients. The role of this review is to focus on the currently available scores, in order to clarify their rationale and to analyze the actual evidence and limits, providing physicians with an updated overview of the possible inflammation-based prognostic scores for cancer patients undergoing surgery
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