Anesthesiology

OFACAR RCT: opioid‑free anesthesia reduced 30‑day composite complications after CPB cardiac surgery

In 320 adults undergoing elective cardiac surgery with cardiopulmonary bypass, an opioid‑free protocol (ketamine, dexamethasone, lidocaine, magnesium) was compared with sufentanil‑based anesthesia. The primary composite 30‑day outcome occurred in 75.4% (120/159) OFA versus 84.5% (136/161) control (RR 0.90; P = 0.049). OFA reduced cardiovascular complications (64.2% vs. 75.2%) and digestive complications (2.5% vs. 11.2%), and there were no deaths in OFA versus six in control. The primary endpoint has a fragility index of 1, so findings are hypothesis‑generating and require larger confirmatory trials. 1

SSEA preserves neuraxial homeostasis and greatly lowers intraprocedural neurological symptoms

In 740 parturients randomized to sequential spinal‑epidural (SSEA) versus needle‑through‑needle CSEA, SSEA markedly reduced intraprocedural neurological symptoms (1.36% vs. 23.12%). Among 624 vaginal deliveries, SSEA also lowered 48‑hour neurological symptoms (0.32% vs. 2.56%), back pain, and one‑week persistent paresthesia. Analgesic efficacy (pain scores) was similar between groups, while overall maternal satisfaction was higher with SSEA. These results support considering SSEA when procedure‑related neurological symptoms are a priority, balancing local expertise and workflow. 2

ESPB yields modest early pain relief and faster extubation after median sternotomy

A meta‑analysis of 19 RCTs (N = 1344) found ESPB after median sternotomy reduced 24‑hour pain by MD −0.65 (95% CI −1.14 to −0.16) on a 0–10 scale. ESPB was also associated with lower intraoperative and 24‑hour opioid use and shorter time to extubation (MD −1.28 hours) in the sternotomy subgroup. Heterogeneity was substantial (I2 > 85%) and prediction intervals crossed the null, indicating effect variability across centers. Certainty of evidence was low to very low, so ESPB may help in some settings but is not universally reliable. 3