Anesthesiology

Intrathecal morphine plus TAP block improves recovery after laparoscopic colorectal surgery

Adults in an ERAS pathway for elective laparoscopic colorectal surgery received liposomal bupivacaine TAP blocks and were randomized to intrathecal morphine 3 µg/kg or saline. Intrathecal morphine increased 24-hour QoR-15 scores by about 12 points, reflecting better global early recovery. Systemic opioid requirements were roughly halved, with lower mean morphine consumption than controls. Nausea occurred less often with intrathecal morphine, but pruritus was substantially more frequent. These data support adding intrathecal morphine to TAP-based ERAS protocols when pruritus is acceptable. 1

Network meta-analysis compares ultrasound-guided blocks for total hip arthroplasty

This Bayesian network meta-analysis pooled 18 RCTs including 1424 total hip arthroplasty patients receiving various ultrasound-guided blocks or periarticular injection. Periarticular injection, pericapsular nerve group block, and quadratus lumborum block significantly reduced movement-evoked pain within 12–24 hours versus saline control. Rest pain scores did not differ meaningfully across techniques, suggesting benefit is greatest for mobilization pain. Quadratus lumborum block produced the lowest morphine consumption within 24 hours and during hospitalization in bupivacaine-based regimens. Regional techniques overall reduced PONV compared with placebo, but no single block dominated across all outcomes. 2

Extended individualized goal-directed therapy after oesophagectomy shows no outcome benefit

This single-centre RCT randomized 100 oesophagectomy patients to extended goal-directed fluid and blood pressure therapy versus standard care from intubation to 07:00 next morning. The individualized protocol optimized cardiac output and targeted mean arterial pressure at each patient’s nighttime baseline. Intervention patients received more fluid, higher norepinephrine doses, and maintained slightly higher mean arterial pressures. Despite these hemodynamic differences, 30-day Comprehensive Complication Index scores were almost identical between groups. Intensifying and prolonging goal-directed therapy did not translate into fewer complications after oesophagectomy. 3

Difficult airways are common but poorly labeled and planned in UK ICUs

In 106 UK ICUs, 1965 adults were prospectively screened for known or predicted difficult airway features and for labeling and management plans. Among 1519 patients with intubation data, 16.1% had a known difficult airway based on documented difficulty with ventilation, laryngoscopy, or intubation. Only about one-third of these known difficult airway patients were clearly identifiable as at risk, and similar proportions had airway plans. Among those without known difficulty, predicted difficult airways were frequent, yet most were neither clearly labeled nor supported by plans. The study reveals substantial missed opportunities for standardized difficult airway identification and planning in critical care. 4