Resumo em Inglês:

Abstract Background Effective pain management following renal transplantation is crucial. While various regional analgesic techniques have been studied, the optimal approach remains unclear. We compared the additive value of Transversus Abdominis Plane (TAP) and External Oblique Intercostal Plane (EOIP) blocks to Standard Care (SC) on postoperative pain and opioid consumption. Methods This retrospective study included 237 renal transplant recipients (127 SC, 75 TAP, 35 EOIP) between January 2023 and December 2024. Multivariable regression analysis assessed the association of block type on postoperative pain and opioid consumption. Results TAP block was associated with significantly lower pain scores than SC during the first eight postoperative hours (5.0 vs. 7.0, p < 0.001). Pre-incision TAP block demonstrated the most significant reduction in both pain scores (β = -2.21, 95% CI -3.38 to -1.05, p < 0.001) and opioid consumption (β = -13.56, 95% CI: -21.59 to -5.52, p = 0.001). EOIP block showed no significant advantages over SC and was associated with higher opioid consumption compared to TAP block. Conclusion Pain predominantly manifested in the first eight postoperative hours. TAP block, particularly when administered pre-incision, was associated with superior pain control compared to SC or EOIP block. Living donor recipients experienced significantly higher pain scores regardless of technique, warranting further investigation.

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Abstract Background Neuromuscular blockers such as succinylcholine are widely used for airway management in critically ill patients; but their use may be contraindicated due to adverse effects. In rapid sequence intubation, the onset time of the neuromuscular blocker is critical and should be as short as possible. This study investigates whether lidocaine and magnesium sulfate could reduce the onset time of rocuronium bromide in an experimental model. Method Eighteen animals were randomly assigned to three groups and treated with lidocaine, magnesium sulfate, or saline before receiving rocuronium bromide (3 mg.kg-1). After 10 minutes of neuromuscular blockade, reversal was performed with sugammadex (9 mg.kg-1). Onset and reversal times were measured by acceleromyography. Doses were standardized in a pilot study with four animals. Data were tested for normality using the Shapiro-Wilk and Anderson-Darling tests. Onset times are tested with a one-way ANOVA, followed by Fisher’s (LSD) post hoc test, and mean arterial pressure and heart rate with a two-way ANOVA, followed by Tukey’s post hoc test. Statistical significance was set at p ≤ 0.05. Results The results showed that lidocaine and magnesium sulfate significantly reduced the onset time of rocuronium bromide compared to the saline solution (p < 0.05) and did not affect the onset time of reversal with sugammadex (p > 0.05). Both adjuvants caused hypotension, with a more significant effect observed with magnesium sulfate; however, blood pressure returned to baseline values. Conclusion In conclusion, lidocaine and magnesium sulfate facilitate airway access by reducing the onset time of rocuronium bromide. Animal Ethics Committee approved 1749/2022.

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Abstract Background Single-injection Paravertebral Block (PVB) is commonly used for analgesia in major breast surgery; however, its sensory effectiveness may be variable. This study investigated whether intraoperative changes in the Analgesia Nociception Index (ANI) are associated with PVB effectiveness. Methods This prospective observational study included 100 women scheduled for total mastectomy. A single-injection PVB was performed preoperatively under ultrasound guidance at the T3 level. Sensory testing was performed from T1 to T10, but block effectiveness was evaluated in the surgical field (T2–T6). PVBs were classified as effective (complete loss of cold sensation in all T2‒T6 dermatomes) or incomplete (partial cold sensation in this range). ANI variations, intraoperative remifentanil consumption, postoperative pain scores, and morphine use were compared. Results Ninety-three patients were analyzed. PVB was effective in 75% and incomplete in 25%. The mean ANI variation was significantly greater in the effective group (+1.4 ± 10.3) compared to the incomplete group (-11.0 ± 7.1), with a mean difference of 12.4 (95% CI: 8.8 to 16.0; p < 0.0001). Remifentanil consumption was higher in the incomplete group (0.072 ± 0.018 µg.kg−1.min−1 vs. 0.054 ± 0.008 µg.kg−1.min−1), mean difference 0.018 (95% CI: 0.010 to 0.026; p < 0.0001). Pain score and morphine consumption were significantly higher for patients with incomplete PVB. Conclusion In this observational study, a significant decrease in ANI values following skin dissection was associated with incomplete PVB. Early ANI monitoring may help identify insufficient regional block during total mastectomy, thus guiding intraoperative analgesic adjustment to improve patient comfort.

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Abstract Introduction Chronic pain greatly affects quality of life and, consequently, impacts the psychological state, a condition that needs to be addressed. A 30% reduction in pain intensity is clinically significant. The objective of this study was to describe the clinical and psychological aspects of individuals with chronic pain undergoing standard treatment. Methods Descriptive longitudinal study involving individuals with chronic pain undergoing treatment at the Pain Outpatient Clinic of the Federal University of Bahia, in Salvador, Bahia, between June 2016 and December 2017. The variables studied were pain intensity, quality of life, sleep disorders, stress level, and the presence of anxiety and depression symptoms. Descriptive statistics were performed, and Student's t-test, and Fisher's Chi-Square test were used to compare the groups. Results We studied 134 individuals with a mean (standard deviation) age of 50 (10) years, 89.6% of whom were female. There was an improvement in quality of life and sleep, anxiety and depressive symptoms, and 58.2% of patients showed a 30% reduction in pain intensity. Among the factors associated with pain reduction, having a partner was a significant factor (73.7% vs. 52.1%; p = 0.030). However, symptoms of anxiety (81.6% vs. 75.0%; p = 0.436), symptoms of depression (63.2% vs. 58.3%; p = 0.718), and stress (92.1% vs. 87.5%; p = 0.846) were not associated with pain reduction. Conclusion This study suggests that multidisciplinary treatment can reduce pain intensity in chronically affected patients, as most patients exhibited a clinically significant response, accompanied by global improvement.

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Abstract Background: Paravertebral blocks provide analgesia for a range of thoracoabdominal surgeries. However, visualizing the needle tip during the procedure can be challenging, especially for clinicians with limited experience, because the target is deep. We therefore tested the primary hypothesis that needle guidance by the Infiniti Plus system improves ultrasound visualization of the needle tip during thoracic paravertebral blocks performed by novice residents. Methods: Nineteen clinical anesthesia residents each performed 20 bilateral ultrasound-guided thoracic paravertebral blocks (T2–T11) on 17 unembalmed cadavers, with and without the use of a fixed-angle mechanical needle guide in a randomized crossover design. The primary outcome, percent perfect needle visibility, was compared between guided and unguided methods using a paired t-test. Secondary outcomes, including time to needle visualization, number of needle insertion attempts, and subjective ease-of-use ratings, were analyzed using paired t-tests and Wilcoxon signed-rank tests, respectively. Inter-rater reliability for overall perception ratings was assessed using the Intraclass Correlation Coefficient (ICC). Results There were no significant differences in needle-target visualization (62% ± 17% with guidance vs. 64% ± 18% without, p = 0.15), time to target (HR = 1.00 [95% CI 0.86–1.16], p = 0.99), procedural difficulty scores, or number of insertion attempts between guided and unguided blocks. Conclusion The Infiniti Plus mechanical needle guide did not demonstrate improved ultrasound needle tip visualization during thoracic paravertebral blocks performed by novice clinicians in cadavers.

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Abstract Background Magnesium Sulfate (MS) maintains physiological functions in the body. Studies suggest its safety in regional anesthesia, despite off-label perineural use. We conducted a systematic review and meta-analysis to evaluate MS efficacy as an adjuvant in supraclavicular brachial plexus block. Methods The study was registered in PROSPERO (CRD42025641627) on 01/21/2025. We searched PubMed, Embase, Cochrane, clinicaltrials.gov and gray literature for eligible studies. We included RCTs that: enrolled adult patients; involved orthopedic surgery with supraclavicular block; compared LA alone versus LA with MS; and reported primary outcomes. Primary outcomes were duration of sensory and motor block, while secondary outcomes included onset of sensory and motor block, PONV and rescue analgesia needs postoperatively. RoB2 tool and GRADE assessed bias risk and evidence certainty. Variables were examined using DerSimonian-Laird random-effects model. Results Analysis included 10 studies and 734 patients. The intervention group showed longer sensory and motor block than controls. The Mean Difference (MD) was 180.84 minutes (95% CI [154.09, 207.59], 95% PI [71.67, 289.77], p < 0.00001, I² = 97%) and 151.26 minutes (95% CI [99.78, 202.74], 95% PI [-23.12, 325.63], p < 0.00001, I² = 99%). The magnesium group showed statistical difference in onset of sensory and motor blockade and rescue analgesia needs, with no difference in PONV. Evidence certainty was rated low to moderate. Risk of bias “high” in three studies, “some concerns” in four studies and “low” in three studies. Conclusion Our meta-analysis supports MS as adjuvant in supraclavicular block. Further research is needed due to high heterogeneity. PROSPERO registration CRD42025641627.

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Abstract Background Ciprofol has emerged as a potential alternative sedative with improved safety and efficacy. However, comparative data for colonoscopy sedation remain limited. Methods A systematic search in PubMed, Embase, Cochrane Library, and Web of Science identified RCTs published through August 2025. Studies included patients undergoing colonoscopy using ciprofol or propofol, reporting relevant efficacy or safety outcomes. Risk Ratios (RRs) and Mean Differences (MDs) were calculated using the Mantel-Haenszel random-effects model and 95% Confidence Intervals. The heterogeneity was assessed with I² statistics and Cochrane Q test. Primary outcomes were procedure success rate and patient satisfaction (assessed on a 1-to-10 scale). Secondary outcomes included sedation onset time(s), respiratory depression, injection pain, and hemodynamic adverse events (hypotension and bradycardia). The statistical analyses were performed in R software (version 4.4.1.) Results Three RCTs with 645 patients were included. Colonoscopy success rates were similar between ciprofol and propofol (RR = 1.005; 95% CI 0.992–1.019). Ciprofol showed a lower risk of respiratory depression (RR = 0.24; 95% CI 0.08–0.71), injection pain (RR = 0.04; 95% CI 0.01–0.15), and hypotension (RR = 0.85; 95% CI 0.75–0.96). Patient satisfaction was slightly higher with ciprofol (MD = 0.18; 95% CI 0.08–0.29). No significant differences were found in sedation onset time (s) (MD = 2.49s; 95% CI -3.77–8.74) or bradycardia (RR = 0.88; 95% CI 0.44–1.77). Conclusion Ciprofol provides comparable efficacy to propofol for colonoscopy sedation, with a lower incidence of respiratory depression, injection pain, and hypotension. Patient satisfaction was slightly higher with ciprofol, while bradycardia occurrence was similar. These findings suggest ciprofol as a promising alternative, though further large-scale studies are needed to confirm its clinical benefits.

Resumo em Inglês:

Abstract Background Intranasal Dexmedetomidine (IN-DEX) is a promising agent for pediatric procedural sedation due to its non-invasive route and favorable safety profile. However, a comprehensive synthesis quantifying its clinical timeline and safety as monotherapy is lacking. This meta-analysis assesses the efficacy and adverse events of IN-DEX as a standalone sedative in children. Methods Following PRISMA 2020 guidelines and PROSPERO registration (CRD420250652456), this meta-analysis systematically searched PubMed, ScienceDirect, and SciELO for intranasal dexmedetomidine monotherapy in children under 18 years from January 1, 2003, to July 1, 2025. Key outcomes included sedation success, onset, and duration. Data were pooled using a random-effects model, with risk-of-bias assessed via RoB2. We performed sensitivity and subgroup analyses and evaluated evidence certainty using the GRADE approach. Results Twenty-eight RCTs were included. The overall pooled mean onset time was 18.9 minutes and duration was 60.3 minutes, though both had very low evidence certainty due to high heterogeneity (I2 > 99%). The overall success rate was 79.58%. Notably, in a subgroup of low-to-moderate risk-of-bias studies, a dose of [2, 3) mcg.kg-1 achieved an 84.04% success rate, supported by high-quality evidence (GRADE: High, I2 = 0%). The pooled proportions for key adverse events were hypotension (8.24%), bradycardia (5.08%), and desaturation (2.76%). Conclusion IN-DEX is an effective monotherapy for pediatric procedural sedation. Doses of [2, 3) mcg.kg-1 are associated with high success rates, supported by high-quality evidence. While IN-DEX demonstrates a favorable respiratory profile with low desaturation rates, its use requires vigilant hemodynamic monitoring due to the risks of hypotension and bradycardia.