Anesthesiology:

This educational article discusses the current understanding of the pericaspular nerve group block (PENG) of the hip regarding its mechanism of action and spread patterns, as well as plausible explanations for postblock quadriceps weakness. Finally, we will discuss the recent evidence of PENG block as an analgesic block in hip fractures and in different hip surgeries.

INTRODUCTION: Transition-related surgery is an effective treatment for gender dysphoria, but the perioperative analgesic management of transgender patients is nuanced and potentially complicated by higher rates of mood and substance use disorders. Regional anesthetic techniques are known to reduce pain severity and opioid requirements; however, little is known regarding the relative analgesic effectiveness of regional anesthesia for transgender patients undergoing transition-related surgery.

CONCLUSIONS: Multimodal analgesia is associated with reductions in opioid charges-specifically inpatient setting-but not various other outcomes.

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Tracheal extubation is an integral part of airway management. Even though available data indicated that the incidence of complications immediately after tracheal extubation may be higher than during tracheal intubation, it is significantly underexplored in the scientific literature in comparison with tracheal intubation. Failure to re-secure the airway during or immediately after tracheal extubation may have fatal consequences. Closed claims analyses have highlighted the seriousness of adverse events occurring postextubation. Consequently, a well-planned strategy for tracheal extubation is as important as for the intubation and is correctly regarded as a logical extension of an intubation strategy. This narrative review focusses on the challenges of tracheal extubation and complications of routine and 'at-risk' extubation in adults. It provides the reader with a risk stratification before extubation. Guidelines for tracheal extubation including advanced techniques for tracheal extubation of patients 'at-risk' are followed by a detailed step-by-step approach for video-assisted tracheal tube exchange in patients with a difficult airway.

PURPOSE: Provision of anesthesia care must go hand in hand with surgical care to equitably widen surgical coverage of underserved populations, especially the rural segments of low- and middle-income countries. The aim of this study was to assess the availability of key items and infrastructure needed for anesthesia care.

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OBJECTIVES: High-impact chronic pain (HICP), affecting 36.4% of individuals with chronic pain, significantly limits work, social, and self-care activities. Effective treatments for HICP remain elusive. In addition to pain catastrophizing, growing evidence suggests that pain self-efficacy may be a treatment target for HICP. Our study examines the relative contributions of pain self-efficacy and catastrophizing to health outcomes in patients with HICP.

BACKGROUND: While propofol remains widely used for endoscopic sedation, its cardiovascular depression and injection pain limitations have prompted exploration of novel agents (remimazolam, ciprofol). This study aimed to compare their safety and efficacy profiles systematically.

BACKGROUND: There are significant racial and ethnic differences in healthcare outcomes, including pain treatment.

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.

INTRODUCTION: Tonsillectomy, a common childhood surgery, is associated with difficult postoperative recovery. Previous reviews provided low-grade evidence that honey may improve recovery. The BEE PAIN FREE study investigated whether honey alongside multimodal analgesia improved the recovery trajectory in children following tonsillectomy.

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The intertransverse process block (ITPB) is a general term for a class of novel thoracic paraspinal nerve block techniques proposed in recent years, which can be divided into the mid-point transverse process to pleura block, multiple-injection costotransverse block, costotransverse foramen block and the subtransverse process interligamentary plane block. The four types of ITPB all target the retro-superior costotransverse ligament space, but slightly differ in terms of needle entry approach and needle tip target. ITPB is easy to locate, quick to perform, and provides reliable analgesic effects. Furthermore, this technique can effectively reduce the risk of pneumothorax, hematoma and intraspinal injection. Thus, it has been gradually used for anesthesia and analgesia in breast, cardiothoracic, abdominal and spinal surgeries, as well as for pain relief in trauma patients. However, due to the limited evidence base, its safety and efficacy remain inadequately understood, and few clinicians are proficient in performing ITPB. Further large-scale randomized controlled trials are required to validate its feasibility and superiority. This narrative review will summarize the anatomical basis, mechanism, operation methods, clinical application and shortcomings of ITPB to provide new ideas for multimodal analgesia.

Perioperative care transitions or handoffs represent a high-risk period frequently compromised by communication failures and the loss of essential patient information. Handoffs play a pivotal role in mitigating these risks. A comprehensive assessment of implementation and clinical outcomes is essential to identify protocols that enhance patient safety, improve care quality, and support reproducibility. This study identifies and synthesizes existing evidence on handoff strategies, evaluating their impact on both implementation success and clinical outcomes. A systematic search of PubMed, EMBASE, and CINAHL databases was conducted to identify observational and descriptive studies addressing preoperative, intraoperative, and postoperative handoffs. Eligible studies were published in peer-reviewed, English-language journals. The selection process followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and study quality was evaluated using the Quality Scoring System. Eleven studies evaluating the impact of handoff interventions on both implementation and clinical outcomes were included. Key implementation outcomes, including sustainability and acceptability, were commonly assessed through staff satisfaction surveys. Clinical outcomes included length of stay, duration of mechanical ventilation, and pain scores. All studies incorporated a structured preimplementation planning phase and reported significant improvements in at least 1 implementation outcome, with acceptability being the most consistently improved measure. Each study demonstrated meaningful improvements in at least 1 implementation outcome, while 7 of 11 studies reported significant enhancements in clinical outcomes. The consistent success of various methodologies-whether through expert consultation, frontline involvement, or quality improvement strategies-indicates that a tailored, site-specific approach may be more critical to success than the specific intervention strategy used.

Traumatic Brain Injury (TBI) is a major cause of mortality and disability worldwide. Clinical research is a cornerstone to improve patients' outcomes. The empowerment of patients and relatives in research initiatives is now recommended to improve the relevance of trials. We performed an online survey in collaboration with the French National Association of Patients with Brain Injury (France Cérébrolésion) from November to December 2024, to understand their point of view regarding potential outcomes that could qualify hypertonic saline perfusion as relevant in the coming multicentric randomized-controlled COSMOS trial involving 760 moderate-to-severe TBI. 32 persons responded (19 (59.4%) relatives and 13 (40.6%) former patients). Using a 5-grade Likert scale, 23 (71.9%) responders rather agreed or entirely agreed that mortality was a relevant outcome; 26 (81.3%) rated activities of daily living as relevant; 27 (84.4%) rated cognitive function as relevant; 30 (93.7%) rated memory function as relevant; 17 (53.2%) rated functional outcome as relevant; 26 (81.3%) rated anxiety and depression symptoms as relevant; 27 (84.4%) rated quality of life as relevant. Ten (31.3%) responders could not understand the concept of functional outcome. The highest-ranked outcomes were mortality (16 responders gave the highest mark of 7), activities in daily living (14 responders), and memory (11 responders). Although this survey does not have the value of a consensus and further studies are needed to encompass other stakeholders' opinions, we have modified the primary outcomes in COSMOS: functional outcome has been replaced by a hierarchy with 1/ survival and 2/activities in daily living.

CONCLUSIONS: SSAPB significantly reduces postoperative pain for up to 24 h and decreases analgesic use in children undergoing ear reconstruction with costal cartilage harvest, enhancing pain management and patient satisfaction without increasing adverse effects.

CONCLUSIONS: These results suggest that the CSF complement and coagulation cascades may play a role in patients who develop postpartum pain or PPD 3 months later.

CONCLUSIONS: In total knee arthroplasty with spinal anesthesia, VRH reduces the requirement for intraoperative pharmacological sedation, without a change in the quality of recovery.