Journal of clinical anesthesia
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Meta Analysis Comparative Study
Local anesthetics and regional anesthesia versus conventional analgesia for preventing persistent postoperative pain in adults and children: A Cochrane systematic review and meta-analysis update.
Regional anesthesia appears to reduce persistent post-surgical pain in adults after thoracotomy, breast cancer surgery and cesarean section, although evidence is of modest quality.
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Randomized Controlled Trial
The effects of dexamethasone, light anesthesia, and tight glucose control on postoperative fatigue and quality of life after major noncardiac surgery: A randomized trial.
Why is this important?
Post-operative fatigue (POF) is common and has significant effects on post-operative recovery and quality of life.
Past studies have linked post-operative fatigue to the pro-inflammatory effects of surgery and anesthesia. Other studies have suggested anti-inflammatory benefits of steroids, tight glucose control and avoiding deep anesthesia.
What did they do?
Abdelmalak and team randomized 381 patients using a 3-factorial design for the three interventions. 306 patients were analysed for POF outcome.
Surgical interventions covered a wide range of major non-cardiac procedures, with mean surgical length just under 5 hours and 75% of patients being ASA 3 or 4.
And they found?
No difference for any of the interventions for either fatigue or quality of life.
Hang on...
While it may be that post-operative inflammation is not the causative factor for POF, more likely the study interventions had insufficient impact on inflammation to change fatigue outcomes.
For minor and moderate surgery of shorter duration in lower-acuity patients (ASA 1 & 2) who have experienced significant POF previously, these simple interventions may still be beneficial.
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Comparative Study
Comparison of supraglottic airway devices in laparoscopic surgeries: A network meta-analysis.
When using supraglottic airways for laparoscopic surgery, the Ambu AuraGain® offers the highest oropharyngeal leak pressure before pneumoperitoneum, and the i-gel® the highest after pneumonperitoneum.
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