Background: Peripheral and truncal nerve blocks provide effective analgesia facilitating perioperative care. However, thresholds for clinically relevant effects remain undetermined and are left for clinicians to choose. These choices are fundamental for sample size calculations and interpretation of study results. This systematic scoping review aimed to create an overview of primary outcomes and anticipated effect sizes in randomised clinical trials assessing peripheral and truncal nerve blocks.
Methods: We searched Cochrane Library's CENTRAL, Medline, and Embase for randomised trials in English in 10 major anaesthesia journals investigating single-injection ultrasound-guided peripheral and truncal nerve blocks for adults undergoing surgery. The primary outcome was the anticipated effect sizes for primary outcomes. Secondary outcomes included reporting of sample size calculations and statistically significant primary outcomes below anticipated effect sizes.
Results: The most frequently reported primary outcomes were postoperative pain, analgesic consumption, quality of recovery, mobilisation, and block performance. Median anticipated effect sizes were: 0-24 h opioid consumption: 9 mg i.v. morphine equivalents; pain at rest and during movement: 2 points on Numeric Rating Scale 0-10; quality of recovery: 10 points on Quality of Recovery-40 scale and 8 points on Quality of Recovery-15 scale. Adequate sample size calculations were reported in 85% (156/183) and 91% (29/32) of trials assessing continuous outcomes and dichotomous outcomes, respectively. Statistically significant primary outcomes failed to reach anticipated effect sizes in 24% (24/99) of trials, and only one trial addressed this disparity in the trial conclusion.
Conclusions: The presented outcomes and effect sizes from published trials on peripheral and truncal nerve block literature can be used in future trials to increase homogeneity in regional anaesthesia research.
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http://dx.doi.org/10.1016/j.bja.2024.09.029 | DOI Listing |
Lung Cancer
December 2024
Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy; Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
Background: The upfront treatment of non-oncogene-addicted NSCLC relies on immunotherapy alone (ICI) or in combination with chemotherapy (CT-ICI). Genomic aberrations such as KRAS, TP53, KEAP1, SMARCA4, or STK11 may impact survival outcomes.
Methods: We performed an observational study of 145 patients treated with first-line IO or CT-ICI for advanced non-squamous (nsq) NSCLC at our institution tested with an extensive lab-developed NGS panel.
Expert Rev Respir Med
December 2024
Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada.
Introduction: Cystic fibrosis (CF) is an autosomal recessive disorder caused by mutations in the CF transmembrane regulator (CFTR) gene, leading to progressive lung disease and systemic complications. Lung disease remains the primary cause of morbidity and mortality, making early detection of lung function decline crucial. The Lung Clearance Index (LCI), derived from the multiple breath washout (MBW) test, has emerged as a sensitive measure for identifying early airway disease.
View Article and Find Full Text PDFDisabil Rehabil
December 2024
Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.
Purpose: Chronic pain is prevalent among breast cancer survivors. Bio-psychosocial factors interplay in its exacerbation and maintenance. Therefore, prevention and treatment require an interdisciplinary response and the integration of various approaches.
View Article and Find Full Text PDFOtolaryngol Head Neck Surg
December 2024
Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania, USA.
Objective: This study aimed to examine differences in postoperative outcomes between patients requiring postactivation adjustment and those who do not, within a cohort of patients undergoing hypoglossal nerve stimulation (HGNS) for obstructive sleep apnea (OSA).
Study Design: Retrospective database analysis.
Setting: Single-institution, academic center.
Knee Surg Sports Traumatol Arthrosc
December 2024
Department of Orthopedics, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Purpose: To explore if recentering the humeral head could improve shoulder abduction in shoulders with irreparable massive rotator cuff tears (IMRCTs).
Methods: Nine fresh-frozen cadaveric shoulders were used to simulate the intact condition and IMRCTs as controls. Four 'recenter' interventions were then sequentially applied: subacromial interposition (SI) using 4- and 8-mm spacers and superior capsule reconstruction (SCR) using two- and four-layer fascia lata grafts.
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