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Response to: Correspondence on “Incidence of chronic postsurgical pain after cardiac surgery and the effect of bilateral erector spinae plane block: a randomized controlled trial” by Zhao et al
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Analgesic Efficacy of External Oblique Intercostal Block in Laparoscopic Sleeve Gastrectomy: A Systematic Review and Meta-Analysis
No full textBackground: Laparoscopic sleeve gastrectomy (LSG) is associated with significant postoperative pain despite being minimally invasive. External oblique intercostal block (EOIB) has emerged as a novel regional anesthesia technique targeting upper abdominal wall innervation. In this systematic review and meta-analysis with trial sequential analysis (TSA), we aimed to systematically assess the analgesic efficacy of EOIB in patients undergoing LSG, focusing on opioid consumption, pain scores, rescue analgesia use, and recovery outcomes. Methods: We systematically searched PubMed, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), Scopus, and Web of Science (from inception to until 22 May 2025). The primary outcome was 24-h opioid consumption. Secondary outcomes included pain scores, postoperative nausea and vomiting (PONV), and rescue analgesic use. Risk of bias was assessed using RoB 2, and the certainty of evidence was evaluated using the GRADE approach. Results: Four RCTs (n = 249) were included. EOIB significantly reduced 24-h morphine milligram equivalent (MME) consumption (MD − 12.76 mg; 95% CI − 16.76 to − 8.77; p < 0.001). EOIB also lowered postoperative pain scores and decreased rescue analgesic use (OR 0.20; 95% CI 0.09–0.45). PONV incidence was reduced, but not statistically significant. TSA demonstrated that the current evidence is sufficient to confirm a statistically significant effect, with no further trials required. Conclusions: EOIB appears to be a safe and effective component of multimodal analgesia in LSG, with TSA results supporting the robustness of current evidence
Efficacy of anterior subcostal quadratus lumborum block for postoperative analgesia in laparoscopic colorectal surgery: a randomized controlled trial
No full textIntroduction Variants in the RCBTB1 gene have recently been described in patients with inherited retinal disease; so far, there is limited knowledge about this entity, differential diagnoses, and disease progression. Here, we report a novel splice variant in RCBTB1 and describe the associated retinopathy. Methods Clinical assessment included multimodal imaging with optical coherence tomography, blue-light fundus autofluorescence, and near-infrared fundus autofluorescence. Atrophy progression was evaluated over time. Genetic testing was conducted by next-generation sequencing, pathogenicity was assessed by in silico analysis. Results A 54-year-old woman presented with a best-corrected visual acuity of 20/50 in the right and 20/63 in the left eye, respectively. Fundus examination showed macular and peripapillary atrophy with foveal sparing, as well as granular alterations extending to the mid-peripheral retina. Genetic testing revealed a novel splice variant (c.1325-2A>G) in intron 11 of RCBTB1. Discussion We confirm that RCBTB1-associated retinal dystrophy shares phenotypic similarities with mitochondrial retinopathy. Multimodal retinal imaging is vital to assess disease progression and may facilitate a better understanding of this pathology
Unilateral subcostal anterior quadratus lumborum block versus intrathecal morphine for postoperative pain in laparoscopic nephrectomy: a randomized controlled trial
No full textBackground: Intrathecal morphine (ITM) offers effective analgesia after laparoscopic nephrectomy but may cause side effects. The anterior subcostal quadratus lumborum (QL) block has been proposed as a safer alternative. This study evaluated whether anterior subcostal QL block is non-inferior to ITM in reducing postoperative opioid use. Methods: This single-center, randomized, observer-blinded, non-inferiority trial allocated 80 adult patients undergoing elective laparoscopic nephrectomy to receive single-injection unilateral anterior subcostal QL block (0.25% bupivacaine (0.4 mL/kg) containing epinephrine 1:400,000) or spinal anesthesia with 5 mcg/kg ITM (maximum 200 mcg) plus 7.5 mg isobaric bupivacaine. The primary outcome was the 24-hour cumulative intravenous morphine milligram equivalent (MME). Pain scores were recorded at rest and during activity at 0, 3, 6, 12, and 24 hours postoperatively. Patient satisfaction, recovery quality, and adverse effects were also evaluated. Results: The median difference in 24 hours intravenous MME consumption between anterior subcostal QL block and ITM was 9.5 mg (95% CI 7 to 12; p<0.001), exceeding the non-inferiority margin. Patients with ITM reported lower pain scores and greater satisfaction at 24 hours (median (Q1-Q3), ITM 108 (102.25-113.5) vs anterior subcostal QL block 75.5 (58-100)) and discharge (ITM 117 (115-123.75) vs anterior subcostal QL block 94 (77-110); p<0.001). However, no between-group differences were observed in 30-day complication rates, including the Clavien-Dindo and Comprehensive Complication Index scores. Adverse effects, such as nausea, pruritus, and respiratory events, were comparable. Conclusions: Although designed as a non-inferiority trial, anterior subcostal QL block did not meet the threshold. While ITM resulted in lower opioid use, the study was not powered to establish superiority. Anterior subcostal QL block may be considered for patients at risk of ITM-related respiratory depression; however, its inconsistent cranial spread and limited visceral analgesia may explain its lower efficacy. Caution is also required in anticoagulated patients because of the deep anatomical location of the block. Trial registration number: ClinicalTrials.gov: NCT06630858
Efficacy of Superficial versus Deep Parasternal Intercostal Plane Blocks in Cardiac Surgery: A Systematic Review and Meta-Analysis
No full textObjectives: To compare the analgesic efficacy of superficial parasternal intercostal plane (S-PIP) block and deep parasternal intercostal plane (D-PIP) to determine which technique provides superior pain relief in cardiac surgery. Design: A systematic search of MEDLINE (via PubMed), Scopus, Embase, Cochrane Library, Web of Science, Google Scholar, and ClinicalTrials.gov from inception until January 18, 2025. Eligible studies included randomized controlled trials (RCTs) and observational studies that compared the S-PIP and D-PIP blocks in patients undergoing cardiac surgery. The primary outcome of the study was postoperative opioid consumption of morphine milligram equivalent (MME) at 24 hours. Secondary outcomes included resting and movement pain scores at 0, 6, 12 and 24 hours, time to first analgesics, incidence of postoperative nausea and vomiting (PONV), extubation time, length of stay (LOS) in the intensive care unit (ICU), and the number of patients requiring rescue analgesics. Main Results: Seven RCTs and 1 observational study, including a total of 510 patients, were identified. The findings demonstrated no statistically significant difference in MME at 24 hours between the S-PIP and D-PIP block groups (mean difference, -1.23; 95% confidence interval, -2.51 to 0.05; p = 0.061). Additionally, there were no significant differences in pain scores, PONV incidence, time to rescue analgesics, extubation time, or ICU LOS of stay between the 2 techniques. Conclusions: S-PIP and D-PIP blocks provide comparable postoperative analgesic efficacy in patients undergoing cardiac surgery
The Enduring Table 1 Fallacy: A Meta-research Study of Baseline Testing in Anesthesiology and Pain Trials
No full textBackground: Randomized controlled trials (RCTs) are designed to achieve balanced distribution of baseline characteristics across study arms through random allocation, rendering null-hypothesis significance testing on these characteristics unnecessary and potentially misleading. Despite longstanding guidance discouraging this practice, its prevalence and patterns within anesthesiology and pain medicine literature remain unclear. Methods: The authors conducted a meta-research study of parallel-group RCTs published from 1996 to 2025 across 101 journals indexed under the "Anesthesiology and Pain Medicine" category in Scopus (Elsevier, The Netherlands). Data extraction included study characteristics, reporting of baseline testing, number of variables tested, and statistical significance. Multivariable logistic regression was used to identify factors associated with baseline testing, and a binomial test assessed whether the observed rate of significant findings exceeded the expected false-positive rate under the null hypothesis. Results: Of 2,453 eligible RCTs, 1,186 (48.3%) reported statistical testing of baseline characteristics. Among studies performing such testing, 228 (19.2%) reported at least one statistically significant difference, and 58 (25.4%) discussed it as a study limitation. A total of 11,516 variables were tested, with 424 (3.7%) reported as statistically significant-below the 5% expected by chance ( P < 0.001). Larger author teams were associated with lower odds of baseline testing (odds ratio, 0.95; 95% CI, 0.93 to 0.97), while a higher number of variables tested increased the odds of finding at least one significant difference (odds ratio, 1.10; 95% CI, 1.07 to 1.12). Conclusions: Despite methodologic guidance and Consolidated Standards of Reporting Trials (CONSORT) recommendations, statistical testing of baseline characteristics remains common in anesthesiology RCTs and has not declined over time. This practice likely reflects persistent misunderstanding of randomization and may lead to misinterpretation of study validity. Education and stronger editorial policies are needed to align reporting behavior with best practices and improve trial transparency
Incidence of chronic postsurgical pain after cardiac surgery and the effect of bilateral erector spinae plane block: a randomized controlled trial
No full textBackground The effects of the erector spinae plane (ESP) block on chronic postsurgical pain (CPSP) after cardiac surgery remain unclear. This study evaluated the efficacy of bilateral ESP block in reducing the incidence and severity of CPSP after cardiac surgery. Methods This prospective, randomized, controlled, single-blind trial included 63 patients aged 18-80 years with American Society of Anesthesiologists physical status II-III, scheduled for elective cardiac surgery via median sternotomy. Participants received a bilateral ultrasound-guided ESP block or standard care without regional anesthesia. The primary outcome was the Brief Pain Inventory (BPI) score at 3 months postoperatively. Secondary outcomes included morphine consumption in the first 24 hours; Numerical Rating Scale (NRS) scores during rest/activity at 0, 3, 6, 12, and 24 hours; BPI scores at 6 months postoperatively; and Douleur Neuropathique 4 (DN4) and Hospital Anxiety and Depression Scale (HADS) scores at 3 and 6 months postoperatively. Results The BPI scores of the two groups did not differ significantly at 3 months postoperatively (median (IQR): 0(26) vs 12 (31), p=0.166). However, 24 hours postoperative morphine consumption (8 mg vs 10.5 mg, p<0.001) and NRS scores at multiple time points were significantly lower in the ESP block group. No significant differences were observed between the groups in terms of the BPI, DN4, or HADS scores at three or 6 months. Conclusions The ESP block effectively reduced acute pain and opioid consumption; however, it had no significant effect on the incidence or severity of CPSP at 3 and 6 months
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