- Analgesia post-caesarean section (CS) is of global importance, as both the most frequently performed surgical procedure, and one that is commonly associated with significant pain, impacting maternal experience.
- Fascial blocks, such as the transversus abdominis plane (TAP) and quadratus lumborum block (QLB), have been advocated for use in reducing post-CS pain. This network meta-analysis confirms the equivalent benefit of either block in improving post-operative pain in the absence of using intrathecal morphine.
- Although the QLB is advocated for its potential to reduce both somatic and visceral pain, unlike the TAP block, comparing studies investigating either block did not reveal any significant benefit of TAP over QLB.
- No analgesic benefit was found for either when intrathecal morphine is used (although TAP block may be associated with lower incidence of nausea, vomiting & sedation, in the presence of IT morphine).
- As is common to many meta-analyses, these conclusions are somewhat undermined by the moderate-to-low levels of evidence in the included studies.
Use of the AnaConDa (Anaesthetic Conserving Device, Sedana Medical) is feasible for short procedures utilising open circuits & high FGF, and yet still allows low volatile consumption.
Intraoperative caffeine does not reduce postoperative morphine consumption after laparoscopic abdominal surgery.
In children undergoing general anaesthesia age 1-3 years & emergency procedures, are associated with increased incidence of regurgitation and aspiration. Significant clinical sequelae are nevertheless rare.
Shortening clear fluid fasting to 1 hour in children is not associated with increased aspiration incidence.
Use of succinylcholine is associated with an increased risk of post-operative respiratory complications in a dose-dependent manner.
Significant CO2 accumulation occurs during apneic oxygenation with high-flow nasal oxygen, potentially limiting safety during prolonged apnea.
Although liberal clear-fluid fasting is likely safe for children, similar evidence is still lacking to confirm safety in adults.
Although epidural analgesia results in a small improvement in acute post-abdominal surgery pain compared to transversus abdominis plane block, the magnitude is small and associated with post-op hypotension.
Transversus abdominis plane & quadratus lumborum block both offer equivalent analgesia benefit following caesarean section in the absence of intrathecal morphine, although little or know benefit if intrathecal morphine is used.