Bupivacaine 375mg/300ml (0.125%) / Fentanyl 600micrograms/300ml infusion bags

BACKGROUND: The Erector Spinae Plane Block (ESPB) is a well-known regional anesthesia technique in adults. However, its effectiveness and analgesic efficiency have yet to be fully established in children. This meta-analysis aimed to determine the analgesic efficacy of ESPB in pediatric surgery. METHODS: Following PRISMA guidelines, we conducted a meta-analysis of prospective randomized clinical trials that compared the effects of ESPB versus the control group or different peripheral nerve blocks in pediatric surgery. RESULTS: Ten randomized controlled trials, involving 651 pediatric patients, were included in the synthesis following critical appraisal. Compared to no-block analgesia, ESPB significantly prolonged the time to the first rescue analgesia (SMD 1.30, 95% CI 0.38 to 2.22; p = 0.005) and reduced postoperative opioid consumption at 24 h (SMD -1.08, 95% CI -2.03 to -0.13; p = 0.03). ESPB also significantly lowered pain scores at 4 h (p = 0.008) and 6 h (p = 0.0003) postoperatively compared to no-block analgesia. However, ESPB did not significantly reduce intraoperative fentanyl consumption (SMD -0.21, 95% CI -1.14 to 0.71; p = 0.65). CONCLUSION: ESPB improved analgesic efficacy in pediatric surgery, particularly compared with caudal or no-block analgesia; however, the overall certainty of evidence ranged from low to moderate according to the GRADE approach. Further high-quality, methodologically robust RCTs are required. TRIAL REGISTRATION: The study was registered in the International Register of Systematic Reviews (PROSPERO) and is available online ( www.crd.york.uk/prospero , CRD42023483105).

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Background/Objectives: Subarachnoid anaesthesia is widely preferred for caesarean delivery due to its rapid onset, reliability, and safety. The addition of adjuvants to intrathecal hyperbaric bupivacaine has been shown to enhance the quality of anaesthesia and prolong postoperative analgesia. Opioids are among the most frequently used intrathecal adjuvants; however, their administration is associated with adverse effects. Nalbuphine, a mixed opioid agonist-antagonist, may be a promising agent for obstetric use due to its favourable pharmacodynamic properties. This study aimed to systematically review and, where feasible, meta-analyse the evidence comparing nalbuphine with other intrathecal opioid adjuvants to hyperbaric bupivacaine 0.5% for caesarean section, with a primary focus on efficacy and safety. Methods: A systematic review and meta-analysis of controlled trials was conducted. Web of Science Core Collection, MEDLINE (PubMed), Scopus, the Library of Congress, and LISTA (EBSCO) were systematically searched to identify eligible studies. Pooled mean difference (MD) and risk ratio (RR) were calculated using random-effects model. Results: Ten studies encompassing 1095 parturients were included. Compared with fentanyl, intrathecal nalbuphine was associated with a modest prolongation of effective analgesia. However, this finding was accompanied by substantial heterogeneity and very low certainty of evidence. In contrast, morphine provided a longer duration of analgesia than nalbuphine. Overall, nalbuphine and fentanyl demonstrated comparable block characteristics, with only minimal and clinically insignificant differences in onset and duration. Importantly, nalbuphine was associated with fewer adverse effects, particularly shivering and PONV. Conclusions: Subarachnoid nalbuphine may serve as a potential alternative adjuvant to 0.5% hyperbaric bupivacaine in caesarean section anaesthesia. It may provide an analgesic efficacy comparable to fentanyl and, although less potent than morphine, it may demonstrate a more favourable safety profile.

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BackgroundBreast cancer surgeries remain the cornerstone of treatment for early-stage disease. Nonetheless, a substantial proportion of patients experience moderate-to-severe acute or chronic postoperative pain, adversely affecting quality of life and functional recovery. Regional anesthetic techniques have emerged as effective strategies for perioperative pain control. This study compares the erector spinae plane block (ESPB) and the thoracic paravertebral block (PVB) in breast cancer surgeries.MethodsFour databases were systematically searched for randomized controlled trials (RCTs) using ESPB and PVB in breast cancer surgeries. Primary extracted outcomes include post-operative morphine consumption, analgesia duration, resting and dynamic pain scores. Methodological quality was assessed using the ROB-2 tool, while data were pooled using the R software, Version 4.4.2.ResultsNineteen RCTs reporting on 1527 patients were included. Postoperative morphine consumption, PONV incidence, and intraoperative fentanyl use were comparable in both groups. Similarly, pain scores at rest and movement reported no significant differences. The two techniques also demonstrated similar results regarding the number of patients requiring rescue analgesia and analgesia duration. ESPB was associated with a significant, however clinically negligent, shorter surgery duration compared to PVB [MD -0.04, 95% CI; -0.07 to 0.00, P = 0.023].ConclusionESPB and PVB provide comparable analgesic efficacy and perioperative outcomes in breast cancer surgeries. ESPB may offer a shorter surgical duration, supporting its use as a simpler yet equally effective alternative to PVB, however this must be taken cautiously.

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BackgroundPostoperative nausea and vomiting (PONV) still often occurs after surgery, which adversely affects recovery and patient satisfaction. Serratus anterior plane block (SAPB) has been proposed as a regional anesthesia technique that may reduce PONV indirectly by improving postoperative analgesia and decreasing perioperative opioid requirements.MethodsA systematic review and meta-analysis of the randomized controlled trial (RCT) was conducted to evaluate the impact of SAPB on PONV. From its establishment to April 20, 2026, the central register of PubMed, Embase, CNKI and Cochrane controlled trials was searched. Eligible studies include adults who underwent surgery under general anesthesia with a control group (placebo or no intervention). The main results are the incidence of postoperative nausea and vomiting; the secondary results include postoperative opioid consumption, pain score (visual analog scale, VAS), hospitalization time, the time of first rescue analgesia, and the incidence of headache or hypotension. Random effect element analysis was carried out to gather risk differences (RD) and standardized mean differences (SMD) with 95% confidence intervals (CI). Use GRADE to evaluate the certainty of evidence and apply test sequence analysis (TSA) to evaluate robustness.ResultsTwenty RCTs involving 1,651 patients were included. Compared with control treatment, SAPB was associated with a reduced incidence of postoperative nausea (RD = -0.17; 95% CI: -0.23 to -0.11; I 2 = 67%; moderate-certainty evidence). SAPB may also reduce postoperative vomiting, although this finding was borderline and should be interpreted cautiously (RD = -0.13; 95% CI: -0.25 to -0.00; I 2 = 79%; moderate-certainty evidence). SAPB reduced fentanyl consumption (SMD = -1.08; 95% CI: -1.86 to -0.31) and remifentanil consumption (SMD = -2.14; 95% CI: -3.25 to -1.03), whereas sufentanil consumption was not significantly reduced. SAPB also improved postoperative pain scores, shortened hospital stay, prolonged the time to first rescue analgesia, and reduced headache incidence. Funnel plot inspection and Egger's and Begg's tests did not suggest significant small-study effects for postoperative nausea. Risk-of-bias concerns were mainly related to insufficient reporting of allocation concealment and blinding procedures.ConclusionSAPB appears to reduce postoperative opioid requirements and improve analgesia in patients undergoing breast and thoracic surgery. These benefits are associated with a reduced incidence of postoperative nausea and may contribute to enhanced recovery. However, the current evidence does not establish an independent direct antiemetic effect of SAPB, and the effect on postoperative vomiting should be interpreted cautiously. Further high-quality RCTs with standardized opioid and antiemetic protocols are needed to clarify the causal pathway between SAPB, opioid reduction, and PONV.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/CRD420261373467, identifier CRD420261373467.

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BackgroundIncreasing high-altitude travel and habitation drive demand for care in these environments. High altitude presents unique challenges to anaesthetic administration as hypobaric hypoxia affects physiology, pharmacology, and equipment performance, yet no guidelines exist. This scoping review aimed to identify anaesthetics used at HA, evaluate the impact of high altitude on anaesthetic use, and highlight research gaps.MethodsThis review followed Arksey and O'Malley's methodological framework and is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. MEDLINE, Embase, and Web of Science were searched (October 2024 to May 2025). English-language studies, published after 1980, involving human participants receiving any anaesthetic agent above 1500 m were included. Critical appraisal is undertaken using Critical Appraisal Skills Programme checklists.ResultsA total of 21 articles (14 original studies, three case reports/series, and four letters to the editor; n=3162) were included. Mean study altitude was 2922 m (95% confidence interval [CI] 2412-3432), with a range of 1610-4500 m. Participants were predominantly female (78.9%) with a mean age of 20.7 years. CIs for sex distribution and age could not be calculated because participant-level variance data were not consistently reported. Techniques included general, neuraxial, analgesic, and local modalities. Inhalational agents showed unreliable performance, whereas propofol-fentanyl and ketamine were safe when titrated. Neuraxial anaesthesia required higher doses. Methoxyflurane was effective. Sensitivity to nitrous oxide, opioids, and benzodiazepines seems increased. Lidocaine half-life was prolonged.ConclusionsAnaesthesia at high altitude remains complex and high-risk. Evidence indicates general anaesthesia should be avoided where possible; Total i.v. anaesthesia may be a practical option where general anaesthesia is required, although the available evidence is limited. Neuraxial techniques are effective in-hospital but impractical pre-hospital. Methoxyflurane and ketamine seem promising for field use at high altitude, whereas nitrous oxide, opioids, and benzodiazepines may carry increased risks. Altitude-specific research and expert consensus are urgently required.

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BackgroundLaparoscopic cholecystectomy (LC) is the gold standard for gallstone disease, but postoperative pain remains a challenge. Erector spinae plane block (ESPB) has emerged as a promising regional anesthesia technique; however, its comparative efficacy versus established methods such as transversus abdominis plane block (TAPB), port-site infiltration (PSI), or no block (NB) is not fully clarified.Materials and methodsThis meta-analysis followed PRISMA and AMSTAR guidelines. Thirty-six randomized controlled trials (RCTs) published between 2018 and 2025, including adult patients who had LC were analyzed. ESPB was compared with TAPB (12 RCTs), PSI (5 RCTs), and NB (24 RCTs) with respect to pain scores, opioid consumption, time to rescue analgesia, intraoperative fentanyl use, and postoperative nausea and vomiting (PONV). Fixed- or random-effects models were used according to heterogeneity (I 2 threshold 50%).ResultsESPB significantly reduced postoperative pain at rest and on movement compared with NB at all time points, with the greatest effect observed at 1-2 hours (MD: -1.82; P ConclusionsESPB provides superior analgesia with reduced opioid consumption after LC, with additional benefits of prolonged pain relief and lower PONV rates. It should be considered an effective component of multimodal pain management in this setting.

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BACKGROUND Kidney transplantation (KT) is frequently associated with substantial postoperative pain, while opioid use in these patients increases the risk of adverse outcomes. Peripheral nerve blocks (PNBs) have been proposed as opioid-sparing strategies; however, evidence in kidney transplant recipients remains inconsistent, likely due to heterogeneity in block techniques, variability in perioperative analgesic regimens, and differences in study design and methodological rigor. This systematic review and meta-analysis aimed to evaluate the impact of PNBs on postoperative analgesia in kidney transplant recipients. MATERIAL AND METHODS A systematic search of PubMed, EMBASE, the Cochrane Library, and Web of Science was conducted through April 2025 following the Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies reporting 24-h postoperative opioid consumption in adult kidney transplant recipients were included. The primary outcome was cumulative opioid use within 24 hours after surgery, expressed as intravenous morphine or fentanyl. RESULTS Twelve studies met the inclusion criteria, of which 10 contributed to the quantitative synthesis. Pooled analysis showed that PNBs significantly reduced 24-h morphine consumption compared with control analgesia (pooled mean difference=-16.20 mg of intravenous morphine equivalents, 95% confidence interval -24.66 to -7.74; P=0.0002). Heterogeneity was high (I²=99%), but no study reported higher opioid use or increased adverse events in the PNB groups. CONCLUSIONS PNBs appear to be an effective opioid-sparing adjunct for postoperative analgesia in kidney transplant recipients. However, the available evidence remains limited, and further well-designed comparative trials are needed to define their role within multimodal analgesic strategies in this population.

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