Search

Purpose: The effects of sufentanil-ropivacaine combination on the parturient women and the course of labor have been well documented. However, there is little information regarding the time-dependent pharmacokinetic characteristics of sufentanil after epidural administration in laboring women. We aimed to develop a population PK model for epidural sufentanil in laboring women to evaluate the sufentanil placental transfer quantitatively., Patients and Methods: Forty-one participants who underwent epidural labor analgesia were recruited into this study. Patients received a continuous epidural infusion of sufentanil 0.3 µg/mL with ropivacaine 0.1%. Maternal venous blood samples and umbilical venous blood samples were collected for population PK analysis. The trends of sufentanil blood concentrations in the mothers and umbilical cord were predicted by the model., Results: Sufentanil disposition after continuous epidural administration in laboring women followed a two-compartment pharmacokinetic model. The estimated sufentanil central clearance (CL), central volume of distribution (V1), clearance between central compartment and umbilical cord compartment (CL2), and umbilical cord volume of distribution (V2) were 176 L/h, 519 L, 0.0134 L/h, and 0.187 L. The absolute level of sufentanil in placental circulation is low after epidural administration. A slow decline in placental sufentanil concentration was predicted by the final PK model after epidural infusion was discontinued., Conclusion: A slow decline in placental sufentanil concentration is predicted by the final two-compartment PK model after epidural infusion was discontinued. This suggests that very large doses of epidural sufentanil should be avoided during labor analgesia., Trial Registration: https://www.chictr.org.cn, No: ChiCTR1800018810., Competing Interests: The authors have no conflicts of interest to declare., (© 2025 Nie et al.)

Objective: To determine whether high flow nasal cannula (HFNC) oxygenation can reduce the incidence of hypoxia during sedated gastrointestinal endoscopy in patients with obesity., Design: Multicentre, randomised, parallel group trial., Setting: Three tertiary hospitals in Shanghai, China., Participants: 1000 adult patients with obesity (body mass index ≥28) who were scheduled for gastrointestinal endoscopy., Interventions: Participants were randomly allocated to receive regular nasal cannula oxygenation or HFNC oxygenation during a sedated procedure with propofol and low dose sufentanil., Main Outcome Measures: The primary outcome was the incidence of hypoxia (75%≤SpO 2 <90% for <60 s) during the procedure. Secondary outcomes included the incidences of subclinical respiratory depression (90%≤SpO 2 <95% for any duration) and severe hypoxia (SpO 2 <75% for any duration or 75%≤SPO 2 <90% for >60 s) during the procedure., Results: From 6 May 2021 to 26 May 2023, 984 patients (mean age 49.2 years; 36.9% (n=363) female) completed the study and were analysed. Compared with regular nasal cannula oxygenation, HFNC oxygenation reduced the incidence of hypoxia from 21.2% (103/487) to 2.0% (10/497) (difference -19.14, 95% confidence interval -23.09 to -15.36; P<0.001), subclinical respiratory depression from 36.3% (177/487) to 5.6% (28/497) (difference -30.71, -35.40 to -25.92; P<0.001), and severe hypoxia from 4.1% (20/487) to 0% (0/497) (difference -4.11%, -6.26 to -2.48; P<0.001). Other sedation related adverse events did not differ between the two groups., Conclusions: In patients with obesity, oxygenation via HFNC during sedated gastrointestinal endoscopy significantly reduced the incidences of hypoxia, subclinical respiratory depression, and severe hypoxia without increasing other adverse events., Trial Registration: ClinicalTrials.gov NCT04500392., Competing Interests: Competing interests: All authors have completed the ICMJE uniform disclosure form at https://www.icmje.org/disclosure-of-interest/ and declare: support from the National Natural Science Foundation of China, Shanghai Municipal Science and Technology Commission Founding, Renji Hospital Clinical Innovation Foundation, Shanghai municipal Education Commission-Gaofeng Clinical Medicine Support, Shanghai Shenkang Founding, Shanghai Municipal Health Commission Key Support Project, Key Specialty Construction Project of Pudong Health and Family Planning Commission of Shanghai, Shanghai Municipal Key Clinical Specialty, and Shanghai Engineering Research Center of Peri-operative Organ Support and Function Preservation; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; and no other relationships or activities that could appear to have influenced the submitted work., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Sufentanil-induced cough (SIC) is a common but irritating phenomenon during general anesthesia (GA) induction; studies have reported that high doses of dezocine can effectively prevent it. The aim is to explore the efficacy and safety of low-dose dezocine in preventing SIC during GA induction in coronary artery bypass grafting (CABG) surgery., Methods: 81 elective CABG surgery patients were randomly and equally divided into 2 dezocine groups of different doses and 1 control group. Before GA induction, the patients received "pre-injection" solution: 0.1 mg/kg dezocine in the high-dose (HD) group, 0.05 mg/kg dezocine in the low-dose (LD) group or an equal volume of saline in the control (C) group. The primary outcome was the incidence of SIC within 1 minute after sufentanil administration. The secondary outcomes included the severity of SIC, the adverse reactions within 1 minute after injection of the "pre-injection" solution, and the vital signs at various time points., Results: One patient had moderate SIC in the HD group (3.7%), 3 patients (11.1%) had SIC (1 mild and 2 severe) in the LD group, and 8 patients (29.6%) had SIC (3 mild, 1 moderate, and 4 severe) in the C group. The difference between the HD and the C groups was statistically significant (P = .01). In contrast, in comparing the LD and the C groups, the LD and the HD groups had no statistically significant difference (P > .017)., Conclusion: The current study suggested that pretreatment of 0.05 mg/kg dezocine neither prevented SIC occurrence nor attenuated SIC severity during GA induction in CABG surgery, but 0.1 mg/kg dezocine did., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2025 the Author(s). Published by Wolters Kluwer Health, Inc.)

Background: The purpose of this study is to evaluate the effect of oxycodone and sufentanil on postoperative analgesia and immune function in patients with laparoscopic resection of colorectal cancer (CRC), as well as the serum level of inflammatory cytokine., Methods: 40 patients from August 2023 to August 2024 in Shenzhen Nanshan Hospital undergoing laparoscopic resection of CRC were randomly divided into Group O (n = 20) and Group S (n = 20). The visual analog scale (VAS) score and serial blood samples were assessed during perioperative period. The primary outcomes were VAS scores and immune indicators (including IL-2, C 3 , C 4 , IgG, IgA, IgE, IgM, CD3 + , CD4 + , CD8 + and CD4 + /CD8 + ) at 24 h and 72 h post-surgery at 24 h and 72 h after surgery. The secondary outcomes were inflammatory markers (including IL-4, IL-6, IL-10, TNF-a and INF-y) at 24 h and 72 h after surgery., Results: The VAS scores at cough in Group O at 24 h and 72 h postoperative were lower than those in Group S (p < 0.001). No significant difference was found in VAS scores at rest between the two groups (P > 0.05). The immune indicators did not show significant changes after using oxycodone or sufentanil for patient-controlled intravenous analgesia (PCIA), respectively. There was no significant difference in inflammatory factors at 24 h and 72 h after surgery between the Group O and Group S., Conclusion: Oxycodone is more effective than sufentanil in alleviating visceral pain, although it does not surpass sufentanil in managing cutting pain. In addition, there is no significant superiority in the effects of oxycodone on immune function and inflammatory cytokine release compared to sufentanil., Trial Registration: Chinese Clinical Trial Registry (ChiCTR2400089072)., Competing Interests: Declarations. Ethics approval and consent to participate: The project was performed by the Declaration of Helsinki and was approved by the review committee of the Shenzhen Nanshan Hospital (Shenzhen, China). Informed consent was acquired from the subjects after understanding the process and possible consequences of the study. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Background: The perioperative use of esketamine may reduce opioid use and their adverse effects. We aimed to evaluate the intraoperative safety and efficacy of weak opioidized anesthesia with low-dose esketamine in the treatment of elderly patients with lumbar spinal stenosis undergoing total laminectomy with complete decompression and interbody implant fusion., Methods: In total, 90 elderly patients were randomized into three groups: the esketamine HS group (0.2 mg/kg induction, 0.25 mg/(kg·h) infusion), the esketamine LS group (0.2 mg/kg induction, 0.125 mg/(kg·h) infusion), and the control group (group C receiving an equal volume of saline). The primary outcome was the cumulative dose of sufentanil administered during the perioperative period. Pain (VAS rest and movement scores) on preoperative day 1 (POD-1), postoperative day 1 (POD1), postoperative day 3 (POD3), and postoperative day 7 (POD7), and serum levels of tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), interleukin-6 (IL-6), and interleukin-10 (IL-10) on POD-1, POD1, POD3, and POD7 were the secondary outcomes. We also measured mean arterial pressure and the heart rate of the three groups at each time point before anesthesia (T0), immediately after intubation (T1), 5 min after intubation (T2), at the time of surgical skin incision (T3), at the time of extubation (T4), and 30 min after surgery (T5), intraoperative propofol and remifentanil dosage, and the incidence of adverse reactions within 5 days postoperatively, etc. RESULTS: The cumulative perioperative sufentanil dosage and the number of patients undergoing postoperative PACU remedial analgesia were significantly lower in the HS and LS groups compared to the C group (P < 0.05). Cumulative perioperative sufentanil use was lower in the HS group compared with the LS group (P < 0.01). The VAS dynamic and static pain scores were significantly lower in the HS group at POD1 compared to the C and LS groups. There was no significant difference in VAS dynamic and static pain scores among the three groups at POD3 and POD7 (P > 0.05). At POD1, the VAS dynamic and static pain scores were significantly lower in the HS group compared to the C and LS groups. VAS static pain scores were lower in the LS group at POD1 compared to group C (P < 0.05), whereas VAS dynamic pain scores did not differ compared to group C (P > 0.05). Compared with group C, the serum levels of TNF-α, IL-1β, and IL-6 were significantly lower in the HS and LS groups at POD1, POD3, and POD7. At POD1 and POD3, the serum levels of TNF-α, IL-1β, and IL-6 were lower in the HS group than in the LS group (P < 0.05). Serum IL-10 levels were significantly increased at POD1, POD3, and POD7 in the HS and LS groups compared with group C (P < 0.05). The incidence of intraoperative hypotension was significantly lower in the HS and LS groups compared with group C (P < 0.05). At T2 and T4, the HS and LS groups had significantly lower levels of MAP and HR decline than the C group. At T5, the MAP and HR of the C group were significantly higher than those of the HS and LS groups (P < 0.05). The HR at T3 was reduced in the LS group compared with the C and HS groups (P < 0.05). The incidence of postoperative respiratory depression was reduced in the HS and LS groups compared to the C group (P < 0.05). There was no significant difference between the three groups in terms of postoperative psychiatric adverse reactions, such as hallucinations, nightmares, diplopia, somnolence, and dizziness (P > 0.05)., Conclusion: Low-dose esketamine is used for its anti-inflammatory and analgesic effects in lumbar spine surgery of elderly patients. It is beneficial to hemodynamic stabilization and can reduce the incidence of postoperative respiratory depression in elderly patients. Among them, 0.2 mg/kg induction and 0.25 mg/(kg-h) infusion were more effective., Competing Interests: Declarations. Ethics approval and consent to participate: The authors declared that all the study patients provided written informed consent and that this study was conducted in accordance with the Declaration of Helsinki. This trial was approved by the ethics committee of the current hospital (No. 2022–021-01). Consent for publication: All the authors have read this article and gave agreements to publish it. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Background: Rapid onset of epidural analgesia is an important concern for the parturient. Commonly, the local anaesthetic mixture is administered through the epidural catheter. Drugs administered through the epidural needle might decrease the onset time and enhance the spread of medication within the epidural space., Objectives: The primary aim of this study was to compare the onset time of analgesia when a loading dose of dilute local anaesthetic opioid mixture was injected through either the Tuohy needle or a single end-hole epidural catheter., Design: A prospective, double-blinded, randomised clinical trial., Setting: Single university hospital, from November 2022 to August 2023., Participants: A total of 200 healthy nulliparous women who requested epidural analgesia for labour were randomly allocated to the needle group (n = 100) or the catheter group (n = 100)., Interventions: In the needle group, after identification of the epidural space, a test dose of 3 ml 0.1% ropivacaine with 0.3 μg ml-1 sufentanil was injected through the Tuohy needle followed 3 min later by a 15 ml loading dose of the same mixture over 30 s. Then the catheter was inserted into the epidural space. In the catheter group, after identification of the epidural space, a catheter was advanced into the epidural space and the ropivacaine/sufentanil mixture was injected in an identical manner though the catheter., Main Outcome Mearsures: The primary outcome was the onset time of labour analgesia (defined as the time from drug administration to adequate analgesia). Adequate analgesia was defined as a visual analogue score 10 mm or less during uterine contractions., Results: Median [IQR] onset time of labour analgesia did not differ significantly between the two groups (needle group: 20 [16 to 30] minutes; catheter group: 20 [15 to 25] minutes, P = 0.232)., Conclusion: Compared with bolus injection though a single end-hole epidural catheter, injection through the epidural needle did not shorten the analgesia onset time for adequate labour analgesia., Trial Registration: ClinicalTrials.gov (NCT05594771)., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the European Society of Anaesthesiology.)

Purpose: The aim of this study was to evaluate the effect of remifentanil pretreatment on sufentanil-induced cough during general anesthesia induction., Design: This experimental research was conducted as a single-center, randomized, parallel-group trial., Methods: A total of 120 patients scheduled for elective surgery were equally randomized into two groups (remifentanil and control). The incidence and severity of coughing in both groups were recorded after sufentanil administration during general anesthesia induction. The mean arterial pressure, heart rate, and pulse oxygen saturation were recorded at T 1 (before the injection of remifentanil or normal saline), T 2 (1 minute after remifentanil administration), T 3 (before intubation), and T 4 (1 minute after intubation). Additionally, the incidences of adverse events, including dizziness, nausea, apnea, truncal rigidity, bradycardia, or other adverse effects were also recorded., Findings: The incidence of sufentanil-induced cough in the remifentanil group was significantly decreased when compared with the control group (5.0% vs 35.0%, respectively; P < .001). No statistical differences were found in mean arterial pressure, heart rate, pulse oxygen saturation, and the incidences of other side effects between the two groups at T 1 , T 2 , T 3 , and T 4 (P > .05)., Conclusions: Pretreatment with remifentanil at a dose of 0.5 mcg/kg can effectively and safely suppress the incidence and severity of sufentanil-induced coughing, providing a reference for medication during general anesthesia induction., Competing Interests: Declaration of Competing Interest None to report., (Copyright © 2024 The American Society of PeriAnesthesia Nurses. Published by Elsevier Inc. All rights reserved.)

Introduction: Nociception monitoring has recently gained recognition as a valuable tool for guiding intraoperative opioid administration. Several nociception monitors, including the Surgical Pleth Index, the Index of Consciousness (IoC) and the Nociception Level, have been introduced for managing intraoperative analgesia. While these technologies show promise in initial applications, the effectiveness of IoC2 in guiding pain management during anaesthesia, particularly in elderly patients who require precise opioid use, remains unclear. This study aims to evaluate the effectiveness of IoC2 in guiding intraoperative opioid use in elderly patients., Methods and Analysis: We will conduct a prospective, randomised, controlled, single-blind, single-centre study with recruitment carried out from 1 February to 30 November 2025. Patients will be randomly assigned to either the IoC2 group or the control group. In the IoC2 group, sufentanil dosing will be guided by intraoperative IoC2 measurements, while in the control group, it will be guided by haemodynamic parameters. The primary outcome will be to compare intraoperative sufentanil consumption between the two groups to assess the potential role of IoC2 in optimising perioperative analgesia in elderly patients., Ethics and Dissemination: This study has been approved by the ethics committee of China-Japan Friendship Hospital (2024-KY-148-3) and registered in the Chinese Clinical Trial Registry (ChiCTR2400089115). The findings will be disseminated through academic presentations and peer-reviewed journal publications, providing valuable data and insights into the role of IoC2 in guiding intraoperative pain management., Trial Registration Number: ChiCTR2400089115., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.)

Purpose: To evaluate the efficacy and safety of esketamine-based patient-controlled intravenous analgesia following total hip arthroplasty., Methods: A total of 135 total hip arthroplasty patients were randomly assigned to one of the three treatment groups: esketamine, sufentanil or continuous fascia iliaca compartment block (FICB) group. The primary endpoint was the postoperative visual analogue scale (VAS) pain scores at rest and on movement. Secondary endpoints included preoperative 1-day and postoperative 7-day Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS) scores, the satisfaction of patients and surgeons, postoperative 1-month and 3-month Harris function scores, the incidence of adverse reactions., Results: At 48 h post-surgery, the VAS pain scores in the esketamine and FICB groups at rest and on movement were significantly lower than those in the sufentanil group (P < 0.05). The satisfaction of patients in the esketamine group was higher than that in the sufentanil and FICB groups (P = 0.014). The satisfaction of surgeons in the esketamine and FICB groups was higher than that in the sufentanil group (P = 0.002). At postoperative day 7, the SAS scores and SDS scores in the esketamine group were significantly lower than those in the sufentanil and FICB groups (P < 0.05). Compared with the sufentanil group, the postoperative nausea and vomiting, dizziness and total adverse reactions in the esketamine group and FICB group were lower (P < 0.05)., Conclusion: Patient-controlled intravenous analgesia with esketamine has the potential to provide good postoperative analgesia for total hip arthroplasty patients, reduce the incidence of adverse reactions after the operation, improve the satisfaction of patients and surgeons, and significantly improve patients' postoperative mood., Trial Registration: ChiCTR2300069632 ( https://www.chictr.org.cn/ ) (March 22th, 2023)., Competing Interests: Declarations. Ethical approval and consent to Participate: This study was approved by the Research Ethics Committees of Gansu Provincial Hospital (Ethical code: 2022 − 423) and was registered at the Chinese Clinical Trial Registry ( https://www.chictr.org.cn/ , identifier: ChiCTR2300069632) on March 22th, 2023. Written informed consent was obtained from the patients to publish this article in accordance with the journal’s patient consent policy. The study was conducted in accordance with the Declarations of Helsinki, and adhered to the CONSORT guidelines. Consent for publication: N/A. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Purpose: To determine the effect of dexmedetomidine on the ED 50 and ED 95 of sufentanil in patient-controlled intravenous analgesia (PCIA) after cesarean section., Patients and Methods: Parturients who underwent elective cesarean section (n = 80) were randomly assigned to either the sufentanil group (S group) or the dexmedetomidine-sufentanil combination group (DS group). Patients in the S group received a combination of sufentanil, 5 mg of tropisetron, and saline, whereas patients in the DS group were administered 1.5µg/kg of dexmedetomidine in addition to sufentanil, 5 mg of tropisetron, and saline. The ED 50 and ED 95 of sufentanil were determined by Dixon sequential method. We used probit regression to calculate the ED 50 , ED 95 , and 95% confidence intervals for sufentanil in each group., Results: The ED 50 and ED 95 for sufentanil in the S group were 1.634 (95% CI: 1.476-1.810)µg/kg and 2.035 (95% CI: 1.841-3.312)µg/kg, respectively. The ED 50 and ED 95 for sufentanil in the DS group were 1.275 (95% CI: 1.187-1.353)µg/kg and 1.503 (95% CI: 1.406-1.824)µg/kg. The VAS scores with rest at t 5 and with movement at t 4 - t 5 were lower in the DS group ( P < 0.05). The t 2 -t 5 Ramsay scores in the DS group were higher than those in the S group ( P < 0.05). The doses of sufentanil and tramadol were markedly reduced in the DS group, while the onset of first lactation occurred significantly earlier in the DS group ( P < 0.05). Compared with the S group, the DS group had a lower incidence of nausea, vomiting, and skin itching ( P < 0.05), and lower frequency of patient-controlled analgesia (PCA) episodes ( P < 0.05), and better postoperative pain satisfaction ( P < 0.05)., Conclusion: The 1.5µg/kg dexmedetomidine can significantly decrease the ED 50 and ED 95 of sufentanil in patient-controlled intravenous analgesia after cesarean section, provide good postoperative analgesia and sedation, and promote the earlier occurrence of first lactation., Competing Interests: The authors declare no conflicts of interest in this work., (© 2025 Li et al.)

Background: Sufentanil is commonly used to induce general anaesthesia due to its rapid onset of action, strong analgesic effect, long-lasting effect, and stable haemodynamics; however, it often induces cough, increasing the risk of anaesthesia. This study aimed to investigate the preventive effect of low-dose esketamine on sufentanil-induced cough., Methods: This randomised, double-blind, placebo-controlled clinical study was conducted at the Air Force Medical Center between September 2023 and May 2024. A total of 100 adult patients (ASA of Anaesthesiologists class I-II) required general anaesthesia for elective surgery. The patients were randomly assigned to two groups: the esketamine group (Group E, n = 50), receiving 0.2 mg/kg esketamine intravenously, and the control group (Group C, n = 50), receiving an equal volume of normal saline. The incidence and severity of sufentanil-induced cough were assessed 1 min after administering of 0.5 μg/kg sufentanil intravenously. Heart rate (HR), mean arterial pressure (MAP), and adverse reactions were recorded at four time points: before esketamine administration (T0), 3 min after esketamine administration (T1), 1 min after endotracheal intubation (T2), and 3 min after endotracheal intubation (T3). The results were analyzed using appropriate statistical methods., Results: A total of 100 eligible patients were screened, of which 99 participated in this study (1 patient refused to participate), 50 in Group E, and 49 in Group C. The incidence of cough in Group E (6.0%) was significantly lower than that in Group C (34.7%) (P < 0.001), and the severity of cough was also significantly milder than that in Group C (P = 0.038). The differences in the HR and MAP levels at T 0 , T 1 , T 2 , and T 3 between the two groups were not statistically significant (P > 0.05). Two patients in Group C experienced chest wall stiffness, while no adverse reactions were observed in Group E. The difference in the incidence of adverse reactions between the two groups was not statistically significant (P > 0.05)., Conclusion: Low-dose esketamine (0.2 mg/kg) can significantly reduce the incidence of sufentanil-induced cough during the induction of general anaesthesia in patients, with a small impact on haemodynamics, no adverse reactions, and good safety., Competing Interests: Declarations. Ethics approval and consent to participate: This study was approved by the Ethics Committee of Air Force Medical Center (2022-115-YJ01). The written informed consent was signed by all participants in the study. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Background: Remimazolam is a novel intravenous sedative/anesthetic drug that belongs to the ultra-short-acting class of benzodiazepines. The purpose of this study was to evaluate the effectiveness of postoperative use of remimazolam in preventing emergence agitation (EA) in adults following nasal surgery., Methods: Patients who underwent nasal surgery were randomly divided into Group R and Group C. Propofol, sufentanil, and cis-atracurium were used for the induction of anesthesia, and 1.5-3.5% sevoflurane was used for the maintenance of anesthesia. At the end of the surgery, patients were randomly assigned to receive either remimazolam 0.1 mg kg - 1 (Group R, n = 43) or 0.9% saline (Group C, n = 43). The primary outcome was the incidence of EA, which was defined as a Riker Sedation-Agitation Scale score > 4. The secondary outcomes included the incidence of severe EA, anesthesia, surgery characteristics, adverse events, mean arterial pressure, and heart rate (at different time points)., Results: A total of 86 adult patients completed the study. The incidence of EA was lower in Group R than in Group C (21% vs. 49%, P = 0.007). The incidence of severe EA was also lower in Group R than in Group C (2% vs. 19%, P = 0.035). The maximal Sedation-Agitation Scale score during emergence was lower in Group R 4 [range 4 to 4] than in Group C 5 [range 4 to 6] (P < 0.001). In addition, the incidence of hypertension and grade of cough in Group R were lower than in Group C (P = 0.024). During emergence, the mean arterial pressure and heart rate of group R showed more stability than those in group C., Conclusions: Postoperative intravenous infusion of 0.1 mg/kg remimazolam into adult patients undergoing nasal surgery can reduce the incidence of EA and severe EA, and provide stable hemodynamics., Trial Registration: The trial was registered, before patient enrollment, in the Chinese Clinical Trial Registry ( www.chictr.org.cn ) (clinical trial number: ChiCTR2300075300; Principal Investigator: Gongchen Duan; date of registration: 31 August 2023; https://www.chictr.org.cn/bin/project/edit?pid=203928 )., Competing Interests: Declarations. Ethics approval and consent to participate: This trial was performed in accordance with the Declaration of Helsinki and the Chinese Clinical Trial Specifications. The study was approved by the Medical Ethics Committee of Lishui People’s Hospital ( Wenzhou Medical University Lishui Hospital ) (approval No. 2023 − 137), and was registered in the Chinese Clinical Trial Registry ( www.chictr.org.cn ; registration number: ChiCTR2300075300). Written informed consent was obtained from all participants. The study protocol followed the CONSORT guidelines. The study protocol was performed in the relevant guidelines. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Objective: There is a lack of research on epidural esketamine for labor analgesia. The purpose of this research is to compare the efficacy of epidural esketamine and sufentanil on labor analgesia and postpartum depression., Methods: A total of 187 cephalic full-term parturients with single-fetus vaginal delivery were collected in this retrospective study from Jan 2022 to Jan 2023. Parturients were categorized into two groups according to anesthetics: the esketamine group (Group KR, n = 97) with patient-controlled epidural analgesia with 0.3 mg/ml esketamine and 0.083% ropivacaine in 240 ml of normal saline and the Sufentanil group (Group SR, n = 90) with 0.3 µg/ml sufentanil and 0.083% ropivacaine in 240 ml of normal saline. The Visual Analogue Scale, Ramsay Sedation Scale, and Modified Bromage Score were recorded before, 5, 10, and 30 min after analgesia, when the uterine orifice was fully opened, and after delivery. The Edinburgh Postnatal Depression Scale(EPDS) scores at 3 and 42 days after delivery were recorded. The maternal and infant outcomes and occurrence of maternal adverse reactions were recorded., Results: The VAS scores after analgesia at 5,10,30 min and when the cervix was fully opened were higher in Group KR than Group SR (all P < 0.05). RSS scores at 5,10,30 min after analgesia in group KR were lower in Group KR than Group SR (all P < 0.05). Compared with group SR, significant decreases were shown in the EPDS and the incidence of postpartum depression at 42 days after delivery in Group KR (all P < 0.05). Group KR has considerably decreased rates of pruritus compared to Group SR (P < 0.05). The other adverse effects showed no significant difference (all P > 0.05). The maternal and neonatal outcomes were not significantly different between the two groups (all P > 0.05)., Conclusions: In comparison to sufentanil, epidural esketamine for labor analgesia may exhibit a better sedative effect, and a low incidence of pruritus, but a limited analgesic effect. It may be associated with a lower risk of postpartum depression. Further exploration of the optimal regimen and dosage of esketamine for epidural labor analgesia would be necessary., Competing Interests: Declarations. Ethics approval and consent to participate: This study was authorized by the Ethics Committee of the Third Affiliated Hospital of Zhengzhou University (No. 2022-089-01), and all parturients signed informed consent forms. The study followed the principles of the Helsinki Declaration. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Introduction: Remifentanil is a short-acting opioid and can be administered during surgery without the risk of delayed postoperative recovery but concerns about hyperalgesia and the shortages of remifentanil lead anesthetists to consider long-acting opioids for Total Intravenous Anesthesia (TIVA). Sufentanil is a more potent opioid with a longer context-sensitive half-life but can promote good postoperative analgesia due to its residual effect. This meta-analysis aimed to compare the recovery profile of remifentanil and sufentanil for TIVA., Methods: The search strategy was performed in PubMed, CENTRAL, and Web of Science for RCTs comparing sufentanil and remifentanil as part of TIVA in adults undergoing noncardiac surgery. Risk of bias and the quality of evidence were performed using RoB2 and GRADEpro, respectively. The primary outcome was time to tracheal extubation. Secondary analyses included postoperative analgesia, respiratory depression, and Postoperative Nausea and Vomiting (PONV)., Results: Sufentanil increases the time to extubate, MD = 4.29 min; 95% CI: 2.33 to 6.26; p = 0.001. It also reduces the need for postoperative rescue analgesia, logOR = -1.07; 95% CI: -1.62 to -0.52; p = 0.005. There were no significant differences between both opioids for PONV, logOR = 0.50; 95% CI: -0.10 to 1.10; p = 0.10 and respiratory depression, logOR = 1.21; 95% CI: -0.42 to 2.84; p = 0.15., Conclusion: Sufentanil delays the time to tracheal extubation compared with remifentanil but is associated with a reduced need for postoperative rescue analgesia. No significant differences were observed between the two opioids in terms of postoperative respiratory depression or PONV., Competing Interests: Conflicts of interest The authors declare no conflicts of interest., (Copyright © 2024 Sociedade Brasileira de Anestesiologia. Published by Elsevier España S.L.U. All rights reserved.)

Objective: To investigate the impact of dexmedetomidine-ropivacaine combination versus sufentanil-ropivacaine combination for epidural labour analgesia on neonatal and maternal outcomes and test the feasibility of a future large, randomised trial., Design: A randomised, double-blind, pilot clinical trial from 16 March 2023 to 15 June 2023., Setting: A tertiary-care hospital in Beijing, China., Participants: 200 women aged≥18 years who had full-term single pregnancy and were scheduled for vaginal delivery with epidural analgesia., Interventions: Eligible participants were randomly assigned in a 1:1 ratio to receive self-controlled epidural labour analgesia using ropivacaine supplemented with either dexmedetomidine (0.45 µg/mL for induction and 0.36 µg/mL for maintenance) or sufentanil (0.45 µg/mL for induction and 0.36 µg/mL for maintenance)., Main Outcomes and Measures: The primary endpoint was a composite of neonatal morbidity, including 1- or 5 min Apgar score<7, umbilical artery PH<7.1, requirement for immediate assisted ventilation and admission to neonatal ward or intensive care unit within 24 hours. Secondary and other endpoints included effect of analgesia and occurrence of adverse events. The feasibility of implementing the protocol was evaluated., Results: All 200 women were included in the intention-to-treat analysis. Composite neonatal morbidity occurred in 14.0% (14/100) of women with dexmedetomidine versus 17.0% (17/100) of women with sufentanil: relative risk 0.82, 95% CI 0.43 to 1.58. Women in the dexmedetomidine group had a comparable area under curve of pain intensity (median difference -2.0 point⋅h, 95% CI -9.9 to 5.9, p=0.638), required more self-controlled boluses (median difference two boluses, 95% CI 0 to 3, p=0.040) and epidural analgesics (median difference 17 mL, 95% CI 4 to 29, p=0.007), and experienced less pruritus (0.0% (0/100) vs 30.0% (30/100), p<0.001) but more lower limb weakness (13.0% (13/100) vs 1.0% (1/100), p<0.001). Recruitment rate was satisfactory (87.7%); the protocol was well accepted by anaesthesiologists and nurses., Conclusions: Compared with sufentanil-ropivacaine combination, use of dexmedetomidine-ropivacaine combination for epidural labour analgesia was associated with a 18% decrease in composite neonatal endpoint and deserve further investigation. The dexmedetomidine-ropivacaine combination provided comparable analgesia but increased mild motor block. The conduct of a large, randomised trial using same protocol requires careful re-evaluation., Trial Registration Number: NCT05698407., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.)

Background: Intravenous administration of sufentanil during anesthesia induction induces cough (SIC), sometimes triggers a severe reaction. We wanted to investigate the inhibitory effect of low-dose esketamine on cough induced by sufentanil during the induction of general anesthesia, as well as its postoperative impact on mental status (MMSE score, RSS, and VAS-A)., Methods: A total of 256 adult patients were randomly allocated to receive either esketamine (Group EK) or normal saline (Group C). One minute before the administration of sufentanil, Group EK and Group C were injected with esketamine (0.05 mg/kg, diluted with normal saline to 3 ml) and normal saline (3 ml), respectively. The primary outcomes were the incidence (the basis of the presence or absence of cough) and severity (the frequency of cough episodes) of cough within 2 min after sufentanil injection.The secondary outcomes included hemodynamic variables (MAP, HR, and SPi), mental status (MMSE score, RSS, and VAS-A) and postoperative events (time to awareness, duration of orientation recovery and degree of satisfaction with anesthesia)., Results: A total of 236 adult patients were randomized into two groups (n = 236): Group EK (n = 118) and Group C (n = 118). The incidence of cough in Group EK (21.2%) was significantly lower than that in Group C (40.7%) (P < 0.05). The incidence rates for each grade were as follows: 9.3% and 16.9% for Grade 2, and 0% and 4.2% for Grade 3, respectively.The differences had statistical senses.The MAP and HR at T4 (during tracheal intubation) and T5 (1 min post-intubation) were significantly lower in Group EK (P < 0.05). There were no significant differences in MMSE score, RSS, and VAS-A, time to awareness, duration of orientation recovery or satisfaction with anesthesia., Conclusion: Pretreatment with low-dose esketamine can reduce the incidence and severity of cough induced by sufentanil and maintain hemodynamic stability during anesthesia induction without increasing mental status (MMSE score, RSS, and VAS-A)., Trial Registration: Chinese Clinical Trial Registry (ChiCTR2400084940, date of registration: 05/28/2024)., Competing Interests: Declarations. Ethics approval and consent to participate: The study followed the Consolidated Standards of Reporting Trials statement and the Declaration of Helsinki. This work was registered in the Chinese Clinical Trials Registry (ChiCTR2400084940) on 05/28/2024, and The Ethics Committee of the First Affiliated Hospital of Soochow University (LunShen (2022)076 and (2022)076 − 1) approved the study. All participants provided written informed consents. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Background: Ciprofol, a novel intravenous anesthetic, exhibits similar sedation mechanisms and pharmacokinetic properties to propofol. However, ciprofol demonstrates greater potency and is associated with reduced injection pain compared to propofol. Given the varying sensitivities to anesthetic agents across different age groups, this study aims to determine the median effective dose (ED 50 ) of ciprofol required to suppress the laryngeal mask airway (LMA) insertion response in both young and older adult patients, as well as to assess its potential adverse reactions., Methods: In this study, 46 patients scheduled for surgery under general anesthesia with LMA insertion were recruited. Upon entering the operating room, patients were intravenously administered ciprofol (0.4 mg·kg - 1 ) and sufentanil (0.3 µg·kg - 1 ), followed by LMA insertion after three minutes. To derive robust confidence intervals for both ED 50 and ED 95 , we performed an analysis using a logistic regression model combined with bootstrap resampling., Results: In the young adult group, the ED 50 and ED 95 of ciprofol for suppressing the LMA insertion response were 0.38 mg·kg - 1 (95% CI, 0.35-0.41) and 0.46 mg·kg - 1 (95%CI, 0.40-0.56), respectively. In the older adult group, the respective ED 50 and ED 95 were 0.29 mg·kg - 1 (95% CI, 0.26-0.32) and 0.37 mg·kg - 1 (95% CI, 0.30-0.78). Regarding adverse reactions, although there were differences in the incidence of injection pain, hypotension, and bradycardia between the young and older groups, no statistically significant differences were observed between the two groups., Conclusion: In this study, significant differences were observed in the ED 50 of ciprofol for suppressing the LMA insertion response between young and older adult patients. The ED 50 of ciprofol for young adult patients was 0.38 mg·kg - 1 (95% CI, 0.35-0.41), while for older adult patients it was0.29 mg·kg - 1 (95% CI, 0.26-0.32)., Trial Registration: This study was registered on February 17, 2024, with the China Clinical Trial Registration Center ( www.chictr.org.cn ; Registration Number: ChiCTR2400080891)., Competing Interests: Declarations. Ethics approval and consent to participate: This study obtained approval from the Medical Ethics Committee of Nanchong Central Hospital (Reference Number: 2023-070) on August 23, 2023, and written informed consent was obtained from all participants involved in the trial. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Background: Interval time, defined as the period of time that effective analgesia can be achieved without the need for patient-controlled epidural analgesia (PCEA), has been investigated as an important parameter for the design of programmed intermittent epidural bolus (PIEB) approaches to labor analgesia. PCEA approaches offer flexibility in the management of labor-related pain while minimizing the risk of patient overdose. Here, the optimal interval between PIEB boluses of 0.1% ropivacaine and 0.5 μg/mL sufentanil was evaluated while using revised criteria to define effective analgesia that allowed for the administration of a rescue PCEA bolus during these intervals., Methods: Participants were assigned at random to five different groups with PIEB intervals that ranged from 35 to 55 minutes. Labor epidural analgesia was initiated by administering 15mL of 0.1% ropivacaine with 0.5 μg/mL sufentanil over a 2-minute period. Analgesia was considered effective if there was no additional requirement for manual analgesia or an additional PCEA bolus beyond a maximum of one PCEA bolus between intervals during the first stage of labor. Probit regression analyses were used to estimate the effective PIEB intervals that achieved 50% (EI50) and 90% (EI90) success rates in patients., Results: The final analysis included 142 patients who underwent PIEB for maintaining analgesia during labor. Intervals of 55, 50, 45, 40, and 35 minutes were associated with analgesia efficacy odds of 82.8% (24/29), 86.2% (25/29), 96.3% (26/27), 100% (29/29), and 100% (28/28), respectively. The respective EI50 and EI90 intervals associated with patients not suffering from breakthrough pain were 62.9 (95% CI 57.2-91.8) and 50.4 (95% CI 45.3-54.9) minutes., Conclusion: Under the condition of this study, the optimal PIEB interval for the administration of 10 mL boluses of 0.1% ropivacaine and 0.5 μg/mL sufentanil is approximately 50 minutes., Competing Interests: The authors declare that they have no competing interests., (© 2024 Xu et al.)

Emergence agitation (EA) is more commonly observed after thoracic surgeries and can lead to serious complications. This study aimed to evaluate the effectiveness of serratus anterior plane block (SAPB) combined with oxycodone for transitional analgesia in preventing EA after video-assisted thoracoscopic surgery (VATS). A total of 121 adult patients scheduled for VATS under one-lung ventilation anesthesia were enrolled and randomly divided into three groups: preoperative SAPB without opioids for transitional analgesia near the end of the surgery (SAPB + SAL group, n = 39); preoperative SAPB with sufentanil at 0.1 µg/kg for transitional analgesia (SAPB + SF group, n = 42); and preoperative SAPB with oxycodone at 0.1 mg/kg for transitional analgesia (SAPB + OCD group, n = 40). In primary outcomes, the incidences of EA in the SAPB + SAL, SAPB + SF, and SAPB + OCD groups were 38.5%, 28.6%, and 7.5% respectively. There was a statistically significant difference in EA incidence between the SAPB + OCD and SAPB + SF groups (P = 0.0136). In secondary outcomes, compared to the SAPB + SF group, the SAPB + OCD group experienced shorter tracheal extubation time [15(9, 25) min vs. 21.5(14.5, 32.5) min; P = 0.0473] and PACU stay [67.5(55.0, 85.0) min vs. 87.5(70.0, 110.0) min; P = 0.0026]; lower NRS scores at 15 min and 2 h post-extubation (P < 0.01), and higher Quality of Recovery-15 (QoR-15) scores post-surgery [113(98, 123) vs. 102(88, 112); P = 0.0122]. Our results suggest SAPB combined with oxycodone for transitional analgesia, compared with sufentanil, is more effective in preventing EA after VATS and conductive to rapid recovery postoperatively.Trial registration: Chinese Clinical Trial Registry, identifier: ChiCTR2300077473, Date: 09/11/2023., Competing Interests: Declarations. Competing interests: The authors declare no competing interests. Ethics approval and consent to participate: The protocol was approved by the Scientific Research and New Technology of Wannan Medical College Yijishan Hospital IRB (Ethical Approval Number: 2023.65) on June 20, 2023. All methods were performed in accordance with relevant guidelines and regulations and with CONSORT recommendations. The study was registered in the Chinese Clinical Trial Registry (Identifier: ChiCTR2300077473, Date: 09/11/2023). Before participation, all patients and/or their legal guardians provided written informed consent., (© 2024. The Author(s).)

Purpose: This study aims to investigate the effects of combining esketamine with sufentanil for postoperative patient-controlled intravenous analgesia (PCIA) in patients undergoing elective impacted tooth surgery or open reduction and internal fixation., Methods: In this single-center, prospective, double-blinded, randomized, parallel-controlled trial, 91 patients were randomly divided into two groups. The experimental group (group ES, n = 46) received a combination of sufentanil 1.5 µg/kg and esketamine 1.0 mg/kg, while the control group (group S, n = 45) received sufentanil 2 µg/kg alone for PCIA after surgery. Primary outcome was assessed using the Visual Analogue Scale (VAS) for patients at rest and during mouth opening at 6 h, 12 h, 24 h, and 48 h post-surgery. Secondary outcomes included the Ramsay Sedation Scale (RSS) scores, the Quality of Recovery-15 (QoR-15) scores, patient satisfaction with analgesia, and the occurrence of adverse events within 48 h post-surgery. The frequency of PCIA button presses and the number of patients requiring rescue analgesia were also recorded., Results: The resting VAS scores and the mouth-opening VAS scores at 6 h, 12 h, 24 h, and 48 h post-surgery were significantly lower in Group ES than in Group S (P < 0.05). Additionally, the RSS scores were significantly higher at 6 h (P = 0.032) and 12 h (P = 0.021) post-surgery in Group ES. The frequency of PCIA postoperative use within 48 h post-surgery decreased (P = 0.021) in Group ES, while satisfaction with analgesia and QoR-15 scores increased (P = 0.001 and P < 0.001, respectively). The incidences of postoperative dizziness and nausea/vomiting reduced (P = 0.045 and P = 0.036, respectively) in Group ES, but one adverse event of nightmare was observed. There was no significant difference in rescue analgesia between the two groups., Conclusion: The use of esketamine combined with sufentanil in patients undergoing third molar surgery and maxillofacial trauma can alleviate short-term postoperative pain, and improve the quality of postoperative recovery. Esketamine is worth promoting in the clinical application of oral and maxillofacial surgery., Trial Registration: The study was retrospectively registered in chictr.org.cn with the identifier: ChiCTR2400086662 on 08/07/2024., Competing Interests: Declarations. Ethics approval and consent to participate: Approval for this study was obtained from the ethics committee of the Affiliated Lianyungang Hospital of Xuzhou Medical University on November 16, 2023 (KY-20231013001–01). The trial was retrospectively registered at the Chinese Clinical Trial Registry (ChiCTR2400086662; date of registration:8 July 2024). All patients provided written informed consent before enrolment in the study. Consent for publication: Not applicable. Conflicts of interests: The authors declare no competing interests., (© 2024. The Author(s).)

Background: It remains unclear whether opioid-free anesthesia (OFA), when compared to opioid-sparing anesthesia (OSA), reduces postoperative opioid consumption while still providing adequate pain control. We thus tested the hypothesis that patients having an OFA strategy during laparoscopic colectomy would require less postoperative opioids when compared to an OSA strategy., Methods: This single-center, prospective randomized controlled superiority trial, randomly allocated consecutive patients undergoing laparoscopic colectomy to receive either sevoflurane-dexmedetomidine anesthesia with a continuous infusion of lidocaine and ketamine (OFA group) or sevoflurane-sufentanil boluses anesthesia with a continuous infusion of lidocaine (OSA group). Both groups received multimodal antinociception with boluses of dexamethasone, lidocaine, and ketamine during anesthesia induction, as well as acetaminophen, ketoprofen, and nefopam before the end of the surgery. OFA patients also received a dose of magnesium sulfate during induction. The primary outcome was cumulative opioid consumption at 48 h after surgery, expressed in oral morphine equivalents (OME). Secondary exploratory outcomes were pain scores, opioid-related adverse events, and patient quality of life (WHODAS score)., Results: Of the 160 randomized patients, 155 were included in a modified intention-to-treat analysis. Median [Q1-Q3] OME consumption at 48 h after surgery did not differ between groups (9 [0-30] mg for OFA vs. 14 [0-30] mg for OSA; p = 0.861). Key secondary outcomes were not different between groups except a three time higher incidence of bradycardia in the OFA group., Conclusions: In patients undergoing laparoscopic colectomy with a multimodal antinociception protocol, OFA, when compared to OSA, did not decrease postoperative opioid consumption., Clinical Trial Registry and Number: NCT05031234., Competing Interests: Declaration of competing interest Alexandre Joosten is consultant for Edwards Lifesciences, Irvine, CA, USA. Sean Coekelenbergh has received honoraria for presentations from Medtronic, Medasense, and Med—Storm. The other authors have no conflicts of interest to declare., (Copyright © 2024 Société française d'anesthésie et de réanimation (Sfar). Published by Elsevier Masson SAS. All rights reserved.)

Objective: To investigate whether continuous erector spinae plane block (ESPB) improves the quality of recovery (QoR) and decreases postoperative acute and chronic pain in patients undergoing minimally invasive cardiac surgery., Methods: This was a single-center, double-blind, prospective, randomized, placebo-controlled trial. A total of 120 patients were randomized to groups at a 1:1 ratio. They received general anaesthesia and an ESP catheter (ropivacaine or normal saline) before surgery, and received patient-controlled intravenous analgesia with sufentanil and continuous ESPB with a pulse injection of 8 mL (ropivacaine or normal saline) per h after 20 mL of the experimental drug was administered at the end of surgery. The primary outcome was the 15-item quality of recovery scale (QoR-15) score at 24 h after surgery. The secondary outcomes included the severity of pain, sufentanil consumption, incidence of rescue analgesia, and proportion of patients with chronic pain., Results: The QoR-15 score was greater in the ESPB group than in the control group at 24 h after surgery [112 (108-118) vs. 109 (101-114), P=0.023]. ESPB was associated with a lower cough visual analogue scale (VAS) score (44 vs. 47, P=0.001), resting VAS score (28 vs. 35.5, P=0.003), sufentanil consumption (104.8 µg vs. 145.5 µg, P=0.000), and incidence of rescue analgesia (20.0% vs. 43.3%, P=0.006)., Conclusion: Continuous ESPB mildly improved the QoR-15 score in patients undergoing minimally invasive cardiac surgery and reduced postoperative pain scores, opioid consumption, and the incidence of rescue analgesia., Competing Interests: Conflict of Interest Statement. The authors declare that they have no competing interests., (© 2024. Huazhong University of Science and Technology.)

Background: Visceral pain is common in cesarean sections conducted under combined spinal-epidural anesthesia (CSE). Epidural volume extension (EVE) is a technique for enhancing the effect of intrathecal blocks by inducing epidural fluid boluses in the CSE. Whether EVE that uses different drugs can reduce visceral pain during cesarean sections is rarely studied., Objectives: In this study, we compared the effect of EVE that used low-dose sufentanil, either alone or combined with low-concentration ropivacaine, on visceral pain during cesarean sections under CSE., Study Design: A prospective, randomized controlled study., Setting: The study was performed in the Jiaxing University Affiliated Women and Children Hospital., Methods: We randomly allocated 100 healthy patients to 4 groups to receive spinal hyperbaric bupivacaine followed by EVE with 10 mL of 0.9% saline (Group NS), 10 mL of 0.15% ropivacaine (Group R), 10 mL of 10 mu-g sufentanil (Group S), or a combination of 10 mL of 0.15% ropivacaine and 10 mu-g sufentanil (Group RS) through the epidural catheter 15 minutes thereafter. The primary outcome was the incidence of visceral pain. Each occurrence of visceral pain during the procedure was recorded. Every patient's pain level was evaluated on the visual analog scale (VAS). The consumption of sufentanil during patient-controlled intravenous analgesia (PCIA) and patient satisfaction scores under anesthesia were recorded within 48 hours after surgery. Maximum sensory block levels, segmental increases after EVE, time for sensory regression to the tenth thoracic dermatome (T10), and time for motor recovery to modified Bromage 0 were compared among each group., Results: Visceral pain occurred in 60% (15/25), 56% (14/25), 24% (6/25) and 12% (3/25) of patients in the NS, R, S, and RS groups, respectively. The incidence of visceral pain was significantly lower in the RS group than in the NS or R groups (P < 0.05) but not significantly different from the S group. The S and RS groups have significantly lower VAS scores compared to the NS and R groups (P < 0.05). Sufentanil consumption during PCIA in the R and RS groups was significantly lower than in the NS group. Patients' overall intraoperative satisfaction scores were significantly higher in the S and RS groups than in the NS or R groups., Limitations: This study has limitations in its sample size, time point of EVE implementation, absence of laboratory indicators, and lack of assessment of postoperative visceral pain, necessitating future studies to address these issues., Conclusions: EVE at 15 minutes after spinal anesthesia with a 10 mL combination of low-dose sufentanil (10 mu-g) and low-concentration (0.15%) ropivacaine can effectively reduce the incidence and severity of visceral pain in cesarean sections under CSE. At the same time, using EVE in this way can reduce postoperative opioid consumption and improve intraoperative satisfaction.

Purpose: Opioids are frequently used to treat pain in neonatal intensive care units (NICU) with fentanyl, morphine and sufentanil being mainly used agents. Equianalgesic potency between opioids is not clearly described in the neonatal population. The aim of this study was to compare theoretical and actual equipotent conversion ratios between morphine, sufentanil and fentanyl based on prescriptions., Methods: In this observational, multicentric, pharmacoepidemiologic study, prescriptions' data (doses, duration of use, patients' characteristics) were collected and analyzed for all neonates hospitalized in one of the 30 Level III French NICUs using the same prescription software (Logipren®) and who received at least one prescription of morphine, sufentanil or fentanyl as continuous infusion during a 6-year period (2014-2020)., Results: Among 65,555 neonates, 8361 (12.8%) received a prescription of continuous opioid infusion in one of the 30 French NICUs: 5054 (60.4%) received sufentanil, 2413 (28.9%) morphine and 894 (10.7%) fentanyl. After conversion to equipotent morphine doses using theoretical conversions ratios of 50:1 for morphine/fentanyl ratio and 500:1 for morphine/sufentanil ratio, prescribed mean maintenance doses of fentanyl and sufentanil were two times and five times higher than morphine doses, respectively. In this cohort, potency conversion ratios between the different opioids were 20:1 for morphine/fentanyl ratio and 100:1 for morphine/sufentanil ratio, and 4:1 for fentanyl/sufentanil ratio (theoretical conversion ratio of 7: 1)., Conclusion: In a large cohort of neonates treated with continuous opioids in NICU, fentanyl and sufentanil doses used were significantly higher than morphine doses when using theoretical conversion ratios., Competing Interests: Declarations. Ethics approval and consent to participate: Authorization to use the data was obtained from the National Commission for Data Protection and Privacy (CNIL: DE-2015–099, DE-2017–410). Parents were informed of data collection and consent is not required for studies on data according to French regulation (MR-004). Competing interests: The authors declare no competing interests., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objective: In part I, measure the EC50 of sufentanil in obese and non-obese parturients combined with 0.1% ropivacaine and compare the differences. Similarly, in part II, measure the EC50 of ropivacaine in obese and non-obese parturients combined with 0.5 µg/ml sufentanil and compare the differences., Methods: This study comprises two parts, with an initial intention to enroll 120 full-term primiparous women who underwent vaginal delivery and sought epidural analgesia. Each part includes an obese group (OA group, Obese Adults, defined as prepartum BMI≥29 kg/m 2 ) and a non-obese group (CON group, Control group, defined as 18.52 ), with 30 participants in each. Both parts, for both obese and non-obese women, utilized an initial concentration of 0.1% ropivacaine with 0.5 µg /ml sufentanil. The initial concentration of sufentanil is 0.5 µg/ml. When the NRS score is ≤3 within 30min after analgesia, it is considered effective analgesia, and the concentration of sufentanil in the next parturients decreases by 0.05 µg/ml. Otherwise, the concentration of sufentanil in the next parturient will increase by 0.05 µg/ml. The second part uses the same method to measure the EC50 of ropivacaine (increase or decrease by 0.01%) in the OA group and CON group combined with 0.5 µg/ml sufentanil, with 30 participants in each group. EC50 measurements were performed through up-and-down sequential allocation, with effective analgesia defined as an NRS score ≤3, 30 min post-analgesia., Results: In part I, the EC50 of epidural sufentanil in the OA group was 0.090 µg/ml (95% CI, 0.061~0.115µg/ml), and in the CON group, it was 0.170µg/ml (95% CI, 0.117~0.219µg/ml). In part II, the EC50 of epidural ropivacaine in the OA group was 0.048% (95% CI, 0.041~0.053%), and in the CON group, it was 0.070% (95% CI, 0.064~0.075%). The secondary outcomes in both parts of the study showed no statistically significant differences., Conclusion: Obese parturients exhibited significantly lower EC50 values for ropivacaine and sufentanil compared to non-obese parturients. Lower concentrations of both agents can be considered for labor analgesia in obese parturients., Competing Interests: Declarations. Competing interests: The authors declare no competing interests., (© 2025. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objective: Effective postoperative pain management is critical for pediatric craniotomies. Scalp nerve block (SNB) interventions present a potential solution, yet their comparative benefits in preoperative and postoperative settings remain unclear. This study investigated the analgesic effects of SNB in pediatric craniotomy patients by comparing preoperative versus postoperative administration., Methods: This randomized trial included 180 children (1-12 years) who underwent elective craniotomy and were assigned to the preoperative, postoperative, or nonblocking control group. The outcomes included cumulative sufentanil use, pain scores (1, 2, 4, 24, 48 h postoperation), rescue medicine utilization, postoperative complications (24, 48 h), and hospitalization length. The primary outcome was total sufentanil use within 24 h postsurgery., Results: Total sufentanil use (µg·kg - 1 ) in the postoperative block group was significantly lower than that in the nonblocking control group at 1 h (P < 0.001, 95% CI [-0.024 to -0.006]), 2 h (P < 0.001, 95% CI [-0.054 to -0.020]), 4 h (P < 0.001, 95% CI [-0.089 to -0.032]), 24 h (P < 0.001, 95% CI [-0.192 to -0.047]), and 48 h (P = 0.010, 95% CI [-0.208 to -0.022]) postoperation. Additionally, sufentanil use in the preoperative block group was significantly lower than that in the nonblocking control group at 1 h (P = 0.004, 95% CI [-0.021 to -0.003]), 2 h (P < 0.001, 95% CI [-0.043 to -0.010]), and 4 h (P = 0.002, 95% CI [-0.069 to -0.013]). Within 24 h postoperation, the use of sufentanil in the postoperative block group was significantly lower than that in the preoperative block group (P = 0.014, 95% CI [-0.157 to -0.013])., Conclusion: Compared with preoperative SNB or nonblocking, postoperative SNB significantly reduces postoperative sufentanil use within 24 h for pediatric patients undergoing craniotomy, highlighting its potential as an effective analgesic intervention in this population., Trial Registration: The trial was registered at the Chinese Clinical Trial Registry (ChiCTR1800017386) on 27/07/2018, under the title "A study of scalp nerve block for neurosurgical analgesia in children with craniotomy.", Competing Interests: Declarations. Ethics approval and consent to participate: This single-center, prospective, double-blinded, randomized controlled trial received approval from the Institutional Review Board of Beijing Tiantan Hospital, Capital Medical University (IRB No. KY 2018-078-02; August 23, 2018). The study period spanned from September 2018 to October 2020, with the first patient recruited on September 13, 2018. All children obtained written informed consent from their guardians, and school-aged children aged 7 years and older also provided their own informed consent. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Purpose: Minimally invasive rotary resection (MIRR) is crucial for diagnosing and treating breast tumors, but the optimal intravenous anesthesia regimen is unclear. Esketamine, an NMDA receptor antagonist with anesthetic, analgesic, and sympathomimetic properties, may provide an ideal adjunct to propofol sedation. This study aims to compare the safety and efficacy of esketamine versus sufentanil as adjuncts to propofol for analgesia and sedation during breast MIRR., Patients and Methods: A total of 90 patients undergoing elective breast MIRR were randomly assigned to receive either sufentanil-propofol or esketamine-propofol for analgesia and sedation. The primary outcome was the occurrence of hypoxia (SpO 2 < 92% for >10s or exhibiting a persistent downward trajectory). Other outcomes included incidence of subclinical respiratory depression (92% ≤ SpO 2 < 95% for >10s), number of airway interventions, awakening time, satisfaction scores, postoperative exhaust time, hemodynamic parameters, and side events., Results: Finally, 41 patients were assigned to the sufentanil group and 40 to the esketamine group. The occurrence of hypoxia was significantly lower in the esketamine group (17.5%) than in the sufentanil group (39%) (P = 0.032). Subclinical respiratory depression occurred in 32.5% of the esketamine group and 56.1% of the sufentanil group (P = 0.033). The sufentanil group required more airway interventions than the esketamine group (P = 0.032), and patients in the sufentanil group experiencing hypoxia received more mask-assisted ventilation (P = 0.029). Hemodynamic stability was better in the esketamine group. No significant differences were observed in awakening time, satisfaction score, postoperative exhaust time, or side events between groups., Conclusion: Esketamine-propofol anesthesia significantly reduces the risk of hypoxia (SpO 2 < 92%) compared to sufentanil-propofol, while maintaining similar awakening time, satisfaction, postoperative exhaust time, and side events. Its hemodynamic advantages make it valuable for clinical use, especially in procedures requiring respiratory and hemodynamic stability., Competing Interests: The authors report no conflicts of interest in this work., (© 2024 Li et al.)

Background: As a fascial plane block technique, further exploration is needed to determine the safety and efficacy of a peri-capsular nerve group (PENG) block in elderly patients with intertrochanteric femur fractures. We aimed to evaluate whether opioid consumption during a PENG block is better than a conventional opioid-based program for postoperative pain management after proximal femoral nail anti-rotation (PFNA)., Methods: We conducted a prospective, randomized, controlled trial comparing the efficacy of the PENG block with the control group for elderly patients undergoing primary PFNA under general anesthesia. The primary outcome was the cumulative administration of sufentanil during the first 48 h after surgery., Results: 110 participants (55 in each group) were included in the analysis. Cumulative Sufentanil consumption between the PENG group and the control group at 48 h was 132.6 ± 12.3 vs. 141.0 ± 15.3, with a difference of -8.4; 95% CI, -13.6 to -3.1, P = 0.002. Sufentanil consumption at 24 h was 78.3 ± 6.1 vs. 94.0 ± 10.2, with a difference of -15.7; 95% CI, -18.9 to -12.5, P < 0.001. There were statistical differences in the visual analogue scale score trajectories between the two groups at 48 h postoperatively (P < 0.001). The median time to first remedial analgesia was lower in the PENG block group than in the control group (P < 0.001). However, there was no difference in the time to first standing., Conclusion: Incorporating the PENG block into a multimodal analgesia regimen can decrease opioid consumption among elderly patients undergoing PFNA under general anesthesia., Trial Registration: The study was registered in the Chinese Clinical Trial Registry (ChiCTR2100054290, principal investigator: Xiao-dan, Wu, 13/12/2021)., Competing Interests: Declarations. Ethics approval and consent to participate: The study was approved by the institutional review board of Fujian Provincial Hospital (April 30, 2021; K2021-04–080) and was registered in the Chinese Clinical Trial Registry (ChiCTR2100054290) on December 13, 2021. This study followed the CONSORT guidelines and Declarations of Helsinki. Written informed consent was obtained from all participants in this study. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Background: Erector spinae plane block (ESPB) is a promising technique for effective analgesia. It is still uncertain if ESPB offers the same opioid-sparing effect as thoracic paravertebral block (PVB) in midline incision for upper abdominal surgery., Methods: The study is a prospective, bi-center, randomized, controlled, non-inferior trial. One hundred fifty-eight patients scheduled for upper abdominal surgery will be randomly assigned to receive bilateral ESPB or PVB before surgery. The primary outcome will be the equivalent cumulative analgesia dosage of sufentanil during the surgery, which is defined as the total dosage of sufentanil from anesthesia induction to tracheal extubation. The main secondary outcomes include postoperative complications and the quality of recovery-15 score at 24 h, 48 h, and 30 days after surgery., Discussion: This study will assess the opioid-sparing efficacy of ESPB and PVB, complications, and the quality of recovery of two blocks., Trial Registration: ChiCTR2300073030 ( https://www.chictr.org.cn/ ). Registered on 30 June 2023., Competing Interests: Declarations Ethics approval and consent to participate {24} This manuscript reported a study protocol involving human participants and human data. The institutional Ethics Committee of Changhai Hospital of Shanghai (CHEC2023-135) and Public Health Clinical Center of Shanghai(2023-S079-02) approved this registered trial. This trial was registered on the Clinical Trial Registry of China (Registration No: ChiCTR2300073030, June 30, 2023.). Written informed consent will be obtained from all the participants. Results will be disseminated via an international peer-reviewed publication. Consent for publication {32} Not applicable. Competing interests {28} The authors declare that they have no competing interests., (© 2024. The Author(s).)

Background: Pericapsular nerve group (PENG) block has emerged as a reliable analgesia technique for hip arthroplasty (HA). However, the effects of PENG block on perioperative neurocognitive disorder (PND) after HA has not yet been assessed. The present study aimed to investigate the effects of PENG block on early postoperative cognitive function in older people undergoing hip arthroplasty., Methods: Sixty older patients undergoing HA under spinal anesthesia were randomly assigned to group P (n = 30) receiving PENG block with ropivacaine and patient-controlled intravenous analgesia (PCIA) pump with sufentanil after surgery or group C (n = 30) only receiving PCIA pump with sufentanil after surgery. The primary outcome was the Mini-Mental State Examination (MMSE) score at 7 days postoperatively. Secondary outcomes consisted of the incidence of PND 7 days postoperatively, the static VAS pain scores at 6, 12, 24, and 48 h postoperatively; cumulative sufentanil consumption and the requirement of rescue analgesia during the 0-24 h period after surgery; quality of recovery-15 (QoR-15) scale scores at 24 h postoperatively; and the plasma levels of high mobility group box protein 1 (HMGB1) preoperatively and 1 day after surgery, and adverse events., Results: After surgery, the PENG block group had higher MMSE score than the control group at 7 days postoperatively (27.0 ± 1.8 vs. 26.1 ± 1.7, P = 0.048), with a mean difference of 0.9 (95%CI, 0.1-0.9). The incidence of PND at 7 days postoperatively was 6.7% in group P, lower than that of 30% in group C (P = 0.044). In group P, the static VAS scores at 6, 12, and 24 h postoperatively were significantly lower than those in group C (all P < 0.05). Compared with group C, the cumulative sufentanil consumption and the number of patients required rescue analgesia during the 0-24 h period after surgery were significantly lower in group P (all P < 0.05). The scores of QoR-15 scale were higher in group P at 24 h postoperatively than those in group C (P < 0.05). Patients in group P showed lower plasma levels of HMGB1 than group C at 1 day after surgery (P < 0.05), and the rate of complications didn't differ between both groups., Conclusions: Older people undergoing HA receiving a PENG block for perioperative analgesia experience improved early postoperative cognitive function, reduced postoperative pain, higher quality of recovery, and less postoperative inflammatory response., Trial Registration: Chictr.org.cn identifier ChiCTR2200061055 (Date of registry: 15/06/2022, prospectively registered)., Competing Interests: Declarations Ethics approval and consent to participate This study was approved by the Medical Ethics Committee of the Affiliated LiHuiLi Hospital of Ningbo University, China (KY2022PJ126), and the protocol was registered at the Chinese Clinical Trial Registry (ChiCTR2200061055) (prospectively registered). The initial registration date was 15/06/2022. All procedures performed in this study involving human participants were in accordance with the Ethical Standards of the Institutional Ethics Committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. All patients signed written informed consent before surgery. Consent for publication Not applicable. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Background: Labor analgesia can be achieved by different approaches. The efficacy and safety of combined dural puncture epidural (DPE) with program intermittent epidural bolus (PIEB) are not well characterized. This study aimed to compare the efficacy and safety of DPE combined with PIEB vs epidural (EP) combined with PIEB for labor analgesia., Methods: We performed a prospective, randomized, double-blind, parallel-group, controlled clinical trial. Eligible pregnant nulliparous women received either DPE combined with PIEB (group D) or epidural combined with PIEB (group E) for labor analgesia. Analgesia was initiated with 0.1% ropivacaine + 0.3 µg/mL sufentanil and maintained with PIEB at 12 mL/h. Primary outcome was the proportion of women with adequate analgesia within 10 minutes after the initiation of analgesics. Secondary outcomes (time to achieve analgesia, time to first request for additional analgesic, proportion of women required additional analgesic or epidural catheter adjustment and resetting, total labor duration, total analgesic consumption, level of anesthesia, and motor block), side effects, and patient satisfaction were also documented., Results: Out of 174 enrolled women, 160 were included in the analysis. Baseline characteristics were comparable. The proportion of women who achieved adequate analgesia in group D was significantly greater than that in group E (38.8% vs 20.0%, P < .05). Compared with group E, group D also showed advantages in faster adequate analgesic achievement, more likely to reach adequate analgesia, a longer time to maintain analgesia, lesser requirements for additional analgesic, and better sensory blocks. There were no significant inter-group differences in other outcome measures., Conclusions: Compared with epidural and PIEB mode, DPE and PIEB mode achieved better analgesia without increasing maternal or neonatal side-effects during labor., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

Purpose: Typically, labor analgesia is initiated with a manual loading dose. The programmed intermittent epidural bolus (PIEB) effectively maintains labor analgesia. However, no PIEB method has been studied for the initial loading dose. This study aimed to compare the effectiveness of loading doses administered via a PIEB versus a manual bolus., Patients and Methods: In total, 164 full-term singleton parturients were randomly assigned to receive a 12 mL loading dose (0.1% ropivacaine and 0.3 μg·mL -1 sufentanil) via manual or pump-driven injection. A standardized maintenance protocol was employed. The primary outcome was the percentage of parturients with adequate analgesia 20 min after the initial epidural injection. Adequate analgesia was defined as a numeric rating score (NRS) of ≤3 during two consecutive uterine contractions, without an additional analgesia request. Kaplan-Meier survival curves were constructed for the time interval needed to achieve adequate analgesia. A non-inferiority analysis was conducted by comparing the 90% confidence interval of the pain score difference with the non-inferiority margin., Results: The percentage of parturients achieving adequate analgesia was comparable (75.61% manual injection vs 76.83% pump injection, P =0.05 for non-inferiority). The median NRS was similar, except at 2 min (7 [5-8] manual injection vs 8 [6-9] pump injection, P =0.04). Median time to adequate analgesia, median ropivacaine consumption, median duration of epidural analgesia, incidence of requests for patient-controlled epidural analgesia (PCEA), median number of PCEA boluses, percentage of bilateral S 2 blocks at 20 min, incidence of breakthrough pain, percentage of highest block level ≥T6 at 20 min, adverse effects, and obstetric and neonatal outcomes were similar between the groups., Conclusion: Within 20 min of administering a loading dose through a PIEB pump, non-inferior analgesia comparable to that achieved with manual injection was observed. This hands-free approach could help mitigate the impact of individual operational differences on analgesic efficacy., Registration: This trial was registered at chictr.org.cn (ChiCTR2300074063)., Competing Interests: The authors report no conflicts of interest in this work., (© 2024 Lu et al.)

Aims: We explored whether esketamine anesthesia during hysteroscopic surgery can reduce intraoperative hemodynamic fluctuations and improve patient benefit., Methods: A total of 170 patients undergoing hysteroscopic surgery were enrolled, and 151 patients were finally included in the analysis, among which 19 used vasoactive drugs during surgery. Patients were randomly assigned to either the esketamine anesthesia group (E group) or the sufentanil anesthesia group (S group). The primary outcomes were blood pressure and heart rate during the surgery. Secondary outcomes included resistance to laryngeal mask insertion, demand for propofol and remifentanil, nausea and vomiting, Richmond Agitation and Sedation Scale (RASS), dizziness and pain intensity after resuscitation, vasoactive medication treatment, hospitalization time and expenses., Results: E group had a more stable heart rate, systolic blood pressure, diastolic blood pressure and mean blood pressure than the S group (p < 0.001). Patients in E group had a higher demand for propofol (p < 0.001) but better RASS scores (p < 0.001) after resuscitation. The incidence of intraoperative vasoactive medication use was higher in the S group (18.4% vs. 6.7%, p = 0.029). There were no statistically significant differences in terms of resistance to laryngeal mask insertion, remifentanil demand, time required for resuscitation, postoperative pain, dizziness, nausea or vomiting., Conclusions: Compared with sufentanil, esketamine-induced anesthesia during hysteroscopic surgery can reduce intraoperative hemodynamic fluctuations and the incidence of intraoperative vasoactive medication. Although esketamine-induced anesthesia may increase the demand for propofol during surgery, it does not affect the anesthesia recovery time and the quality of patient recovery is better., (© 2024 British Pharmacological Society.)

Background: Minor but painful medical procedures are often handled at the operating room. If safe and effective treatment options are available many procedures may be performed outside of the operating room., Objective(s): The objective of this study is to assess the adverse events of intranasal s-ketamine and/or sufentanil alone or as part of a multimodal analgesic regime for medical procedures outside of the operating room. Secondary outcomes included analgesic effect, doses and indications for use., Design: Retrospective observational study., Setting: Tertiary care paediatric hospital., Patients: Children 1 year up till 18 years., Intervention(s): Intranasal (IN) sufentanil (S), intranasal s-ketamine (K) or the free combination of the two drugs (SK)., Main Outcome Measure(s): The frequency of adverse events including serious adverse events reported by intervention., Results: Between 2004 and 2014, 2185 medical procedures were registered, including 652 procedures with IN SK, 1469 procedures with IN S and 64 procedures with IN K. The children's median age was 5.6 years (range 1.0-17.9). Medical procedures with at least one adverse event were 18% with IN SK, 25% with IN K and 18% with IN S. Common adverse events included episodes of vomiting (9%), nausea (8%) and dizziness (3%). In two patients receiving IN S, serious adverse events occurred. One patient had respiratory depression and bronchospasm and another patient with cerebral palsy had a seizure. Both were handled immediately and did not result in any sequelae. The median doses of intranasal sufentanil were 38% lower when combined with s-ketamine (IN SK free combination: sufentanil dose 0.5 μg/kg (range 0.2-1.3) and s-ketamine dose 0.5 mg/kg (range 0.2-1.5). IN S monotherapy, sufentanil dose 0.8 μg/kg (range 0.2-2.7)). Similar analgesic effect was reported for S and SK., Conclusions: Intranasal sufentanil and/or s-ketamine are feasible for the treatment of procedural pain in an ambulatory setting with appropriate per- and post-procedural observations and trained staff., (© 2024 The Author(s). Acta Anaesthesiologica Scandinavica published by John Wiley & Sons Ltd on behalf of Acta Anaesthesiologica Scandinavica Foundation.)

Hemorrhage is a leading cause of death in the prehospital setting. Since trauma-induced pain often accompanies a hemorrhagic insult, the administered pain medication must not interfere with critical autonomic regulation of arterial blood pressure and vital organ perfusion. The purpose of this study was to test two unrelated hypotheses: 1 ) sublingual sufentanil (Dsuvia) impairs tolerance to progressive central hypovolemia and 2 ) sublingual sufentanil attenuates pain sensation and the accompanying cardiovascular responses to a noxious stimulus. Twenty-nine adults participated in this double-blinded, randomized, crossover, placebo-controlled trial. After sublingual administration of sufentanil (30 μg) or placebo, participants completed a progressive lower-body negative pressure (LBNP) challenge to tolerance ( aim 1 ). After a recovery period, participants completed a cold pressor test (CPT; aim 2 ). Addressing the first aim, tolerance to LBNP was not different between trials ( P = 0.495). Decreases in systolic blood pressure from baseline to the end of LBNP also did not differ between trials (time P < 0.001, trial P = 0.477, interaction P = 0.587). Finally, increases in heart rate from baseline to the end of LBNP did not differ between trials (time P < 0.001, trial P = 0.626, interaction P = 0.424). Addressing the second aim, sufentanil attenuated perceived pain ( P < 0.001) in response to the CPT, though the magnitude of the change in mean blood pressure during the CPT ( P = 0.078) was not different between trials. These data demonstrate that sublingual sufentanil does not impair tolerance to progressive central hypovolemia. Additionally, sublingual sufentanil attenuates perceived pain, but not the accompanying mean blood pressure responses to the CPT. NEW & NOTEWORTHY Addressing two unique aims, we observed that sublingual sufentanil administration does not impair tolerance or cardiovascular responses to lower-body negative pressure (LBNP)-induced progressive central hypovolemia. Second, despite pain perception being reduced, sublingual sufentanil did not attenuate mean blood pressure responses to a cold pressor test (CPT).

Background: We explored the efficacy and safety of esketamine combined with propofol for conscious sedation in painless colonoscopy., Methods: A total of 195 patients who underwent painless colonoscopy surgery were randomly divided into three groups: the propofol deep sedation group (group DS), the sufentanil combined with propofol for conscious sedation (group CS 1 ) and the esketamine combined with propofol for conscious sedation (group CS 2 ). The primary outcomes of this study included the incidence of hypoxemia, hypotension, hypertension, and bradycardia and excellent and good rates of anaesthesia during colonoscopy. The secondary outcomes included perioperative changes in vital signs (MAP, HR, and SpO 2 ), anaesthesia induction time, dischargeable time, patient and endoscopist satisfaction scores, and incidence of postoperative nausea and vomiting (PONV), drowsiness, dizziness, propofol injection pain, assisted ventilation and vasoactive medications., Results: The incidence of intraoperative hypoxemia in the DS group was significantly greater than that in the CS 1 and CS 2 groups (χ2 = 7.081, P = 0.029). The incidence of hypotension in the CS 2 group was significantly lower than that in the DS and CS 1 groups (χ2 = 16.278, P < 0.001). The risk of hypoxemia was 5.727 times higher in Group DS than in Group CS 2 (OR 5.727; 95%CI 1.203-27.273), and the risk of hypotension was 9.864 times higher in Group DS than in Group CS 2 (OR 9.864; 95%CI 2.770-35.120). The risk of hypotension in Group CS 1 was 5.167 times that in Group CS 2 (OR 5.167; 95%CI 1.396-19.117). The incidence of propofol injection pain, assisted ventilation, ephedrine usage and drowsiness in the DS group was significantly greater than that in the CS 1 and CS 2 groups (χ2 = 57.618, P < 0.001; χ2 = 9.544, P = 0.008; χ2 = 14.820, P = 0.001; χ2 = 37.257, P < 0.001). The incidence of dizziness during recovery in the CS 1 group was significantly greater than that in the DS and CS 2 groups (χ2 = 6.594, P = 0.037). The dischargeable time in the DS group was significantly greater than that in the CS 1 and CS 2 groups (F = 53.039, P < 0.001). The satisfaction scores of the endoscopist and patients in the DS group were significantly lower than those in the CS 1 and CS 2 groups (F = 17.390, P < 0.001; F = 19.282; P < 0.001)., Conclusions: In conclusion, esketamine combined with propofol for conscious sedation can be safely and effectively used for painless colonoscopy and has fewer complications.It is recommended for painless colonoscopy., (© 2024. The Author(s).)

Background: Perioperative neurocognitive disorder and postoperative depressive symptoms are significant complications after surgery. Studies have indicated that esketamine possesses neuroprotective and antidepressant qualities., Methods: This trial included 209 patients aged 60 to 86 years undergoing tumor resection who received esketamine (Group E) or not (Group C) during and after surgery. In group E, patients were given an intravenous dose of 0.5 mg/kg of esketamine 10 minutes after induction of general anaesthesia. In addition, esketamine (2 mg/kg) in combination with sufentanil was used for PCIA during 48 hours postoperatively. On the other hand, saline was used as a substitute for esketamine in group C. Cognitive function was evaluated using neuropsychological tests and telephone interview for cognitive status-modified, and symptoms of depression were assessed using Hamilton Depression Rating Scale 17., Results: Compared to Group C, patients in Group E exhibited lower rates of depressive symptoms at 3, 7, and 90 days post-surgery (53.9% vs 67.7%, 26.3% vs 47.9%, and 13.3% vs 28.4%). Group E also showed decreased time for Trail Making Test on days 7 and 90. However, there were no significant differences in the incidence of delirium 1 to 5 days post-surgery or cognitive impairment 90 days post-surgery between the 2 groups (12.1% vs 10.9% and 8.4% vs 9.7%)., Conclusions: Intraoperative low-dose esketamine and postoperative low-dose esketamine combined with sufentanil for patient-controlled intravenous analgesia has been shown to improve postoperative analgesia, alleviate postoperative depressive symptoms, and aid in the recovery of social executive ability. However, this approach did not reduce the incidence of postoperative delirium or postoperative cognitive dysfunction., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

Rationale: Managing anesthesia in patients with severe pulmonary conditions involves complex considerations, especially when dealing with high baseline CO2 levels. We present a case that demonstrates the challenges and complexities of anesthesia and postoperative analgesia in a patient with severe pulmonary hypertension and a history of lung disease exacerbated by the interactions of protein-bound drugs., Patient Concerns: A 37-year-old woman at 38 weeks of gestation presented with recurrent chest tightness, shortness of breath, and worsening symptoms over a week, which required emergency medical attention., Diagnosis: The patient was diagnosed with severe pulmonary hypertension, and echocardiography revealed a pulmonary artery pressure of 106 mm Hg upon admission. Postoperative complications included sudden unconsciousness after low dose (2 µg) sufentanil administration, indicative of carbon dioxide narcosis that could compound pharmacological interactions and her underlying condition., Interventions: The patient underwent a cesarean section under spinal anesthesia, which was complicated postoperatively by respiratory depression, requiring naloxone administration and intensive care., Outcomes: Despite initial postoperative challenges, the patient's condition stabilized, allowing eventual discharge., Lessons: The clinical course highlighted the need for careful monitoring and prompt intervention in anesthesia in patients with severe pulmonary hypertension, particularly when administering multiple protein-bound drugs. Drug interactions can exacerbate the underlying condition, necessitating diligent oversight to prevent severe complications such as carbon dioxide narcosis., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

Objectives: Intrathecal opioids delivered by implanted pumps are used to treat malignant or nonmalignant chronic pain. In this study, we 1) review a case in which intrathecal infusions of sufentanil along with other adjuvants were used and after an extended period led to an intrathecal mass and 2) compared and contrasted the potential mechanisms for these phenomena., Materials and Methods: A woman aged 66 years with a history of scoliosis and multiple spine surgeries was treated with an implantable drug delivery system for treating persistent pain after laminectomy. The patient received intrathecal medication comprising sufentanil, bupivacaine, and clonidine., Results: Intrathecal therapy over approximately ten years served to reduce pain and improve function over the treatment period. After the extended treatment interval, the patient developed an intrathecal mass that was associated with impairment. The mass was surgically removed. Systematic histopathology revealed the space-occupying mass to largely comprise fibroblasts and some inflammatory cells embedded in a collagen mass located proximally to the catheter tip., Conclusions: To our knowledge, this is the first published case report of sufentanil causing this complication. The science and mechanism of intrathecal catheter tip-associated mass formation and associated clinical research correlates are reviewed in detail, and explanations for this phenomenon are proposed based on histochemical analysis of the patient's pathology findings., Competing Interests: Conflict of Interest Tony L. Yaksh reports consulting fees from Medtronic. The remaining authors reported no conflict of interest., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Purpose: The aim of this study was to compare the analgesic effect and adverse events of hydromorphone patient-controlled intravenous analgesia (PCIA) without background dose versus sufentanil PCIA with background dose in patients after surgery., Design: A retrospective analysis., Methods: From June 2020 to May 2021, 1,594 eligible postoperative patients who received PCIA were included in this study. According to the types of opioids, patients were divided into two groups: the sufentanil group and the hydromorphone group. The Numerical Rating Scale, Functional Activity Scale, and Level of Sedation were used to evaluate the analgesic effects between the two groups. In addition, total patient-controlled analgesia (PCA) use, effective number of PCA compressions, and adverse effects of PCIA were compared between the two groups., Findings: At 24 hours (h) after surgery, the Functional Activity Scale score in the sufentanil group was higher than that in the hydromorphone group (P < .05). Compared with the sufentanil group, total PCA use, total number of PCA compressions and effective number of PCA consumptions were significantly decreased in the hydromorphone group during a 48 hours period (P < .05). There were no statistical differences in Numerical Rating Scale score, Level of Sedation score, and adverse events between two groups at 24 hours and 48 hours after surgery., Conclusions: Compared with sufentanil PCIA with a background dose, under a similar analgesic effect, hydromorphone PCIA without a background dose provided lower PCA use. Our findings may provide useful evidence for more future studies related to postoperative analgesia., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The American Society of PeriAnesthesia Nurses. Published by Elsevier Inc. All rights reserved.)

Objectives: The transversus abdominis plane (TAP) block has proven efficacy and is an important component of multimodal analgesia in laparoscopic cholecystectomy (LC). The external oblique intercostal (EOI) block can provide a dermatomal sensory blockade of T6 to T10 using an anterior axillary line injection. The bilateral rectus sheath (RS) block can significantly reduce early postoperative pain caused by umbilical or periumbilical incisions. The current study aimed to compare the analgesic efficacies of ultrasound-guided subcostal TAP (UG-TAP) combined with the RS block and ultrasound-guided EOI (UG-EOI) combined with the RS block for LC., Methods: Patients were randomly assigned to TAP or EOI group. Patients in TAP group received UG-TAP combined with an RS block. Patients in EOI group received UG-EOI combined with an RS block. The primary outcome was postoperative 24-hour sufentanil consumption., Results: A total of 49 patients were included in the final analysis. The postoperative 24-hour sufentanil consumption in the EOI group was significantly lower than that in the TAP group (9.79±10.22 vs. 18.67±12.58 µg; P [noninferiority] <0.01; noninferiority confirmed). Fewer patients in the EOI versus TAP group had a numerical rating score of >3 during motion. Furthermore, the mean postoperative 48-hour sufentanil consumption was lower in the EOI versus TAP group (11.54±11.70 vs. 23.04±17.10 µg; P =0.01). The mean postoperative 24-hour Quality of Recovery-15 score was higher in the EOI versus TAP group (135.21±4.40 vs. 131.91±5.11; P =0.02)., Discussion: These findings suggest that UG-EOI combined with an RS block was superior to UG-TAP combined with an RS block for postoperative pain management in patients undergoing LC., Competing Interests: This study was funded by the Shenzhen Fundamental Research Program (JCYJ20220530 144608019). The authors declare no conflict of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

This study analyzed the application effect of remimazolam besylate combined with sufentanil on percutaneous vertebroplasty (PVP). Forty elderly patients with osteoporotic vertebral compression fractures (OVCF) were randomly divided into sufentanil (A group) and remimazolam besylate + sufentanil groups (B group). A group was given sufentanil anesthesia, B group was given remimazolam besylate combined with sufentanil anesthesia. Heart rate (HR), mean arterial pressure (MAP), saturation of pulse oxygen (SpO2) and Ramsay sedation score were recorded at different time points, including T0 (before administration), T1 (beginning of surgery), T2 (perfusion of bone cement) and T3 (end of surgery). HR, MAP, SpO2 were continuously monitored by electrocardiogram monitor. The visual analogue scale (VAS) pain scores of the two groups were recorded at before anesthesia and immediately after surgery. The adverse reactions (AR) were observed, including respiratory depression, nausea and vomiting, and restlessness during the recovery period. Compared with group A, MAP was increased at T2 and T3 time points in group B. Ramsay sedation scores at T2 time points in group B were higher than that in group A. The VAS score of immediately after operation and incidence of AR of group B was lower than that of group A. In elderly patients undergoing PVP, remimazolam besylate combined with sufentanil has no obvious effect on patients' respiratory parameters, with clear analgesic and sedative effects and low incidence of AR, which is worthy of promotion.

Sufentanil is frequently used as an anesthetic agent in cardiac surgery owing to its cardiovascular safety and favorable pharmacokinetics. However, the pharmacokinetics profiles of sufentanil in patients undergoing cardiopulmonary bypass (CPB) surgery remain less understood, which is crucial for achieving the desired level of anesthesia and mitigating surgical complications. Therefore, this study aimed to develop a population pharmacokinetic model of sufentanil in patients undergoing CPB surgery and elucidate the clinical factors affecting its pharmacokinetic profile. Adult patients who underwent cardiac surgery with CPB and were administered sufentanil for anesthesia were enrolled. Arterial blood samples were collected to quantify plasma concentrations of sufentanil and clinical laboratory parameters, including inflammatory cytokines. A population pharmacokinetic model was established using nonlinear mixed-effects modeling. Simulations were performed using the pharmacokinetic parameters of the final model. Overall, 20 patients were included in the final analysis. Sufentanil pharmacokinetics were modeled using a two-compartment model, accounting for CPB effects. Sufentanil clearance increased 2.80-fold during CPB and warming phases, while the central compartment volume increased 2.74-fold during CPB. CPB was a significant covariate affecting drug clearance and distribution volume. No other significant covariates were identified despite increased levels of the inflammatory cytokines, including IL-6, IL-8, and TNF-α during CPB. The simulation indicated a 30 μg loading dose and 40 μg/h maintenance infusion for target-controlled infusion. Additionally, a bolus dose of 60 μg was added at CPB initiation to adjust for exposure changes during this phase. Considering the target sufentanil concentrations, a uniform dosing regimen was acceptable for effective analgesia., (© 2024 The Author(s). CPT: Pharmacometrics & Systems Pharmacology published by Wiley Periodicals LLC on behalf of American Society for Clinical Pharmacology and Therapeutics.)

Aims: This study is designed to identify risk factors of postoperative nausea and vomiting (PONV) in patients after gynecologic laparoscopic surgery and establish a nomogram model., Methods: In this retrospective and multicenter study, we collected and analyzed data from 1233 patients who underwent gynecologic laparoscopic surgery. The Lasso algorithm was used to optimize the selection of independent variables in the development group. Multivariate logistic regression analysis was used to explore the risk factors of PONV to develop the predictive nomogram model. Finally, we used an internal and external verification group and machine learning (ML) to evaluate the accuracy and clinical applicability of the model., Results: The dosage of sufentanil in patient-controlled intravenous analgesia (PCIA), the dosage of remifentanil, the use of neostigmine, duration of surgery and the maximum value of the P ET CO 2 were risk factors of PONV in patients after gynecologic laparoscopic surgery. In contrast, the dosage of propofol during the surgery and the use of steroids were protective factors. The nomogram was then established to predict the incidence of PONV in these patients based on the above eight indicators. The C-index of the development group, internal, and external verification groups are 0.802, 0.857, and 0.966, respectively., Conclusion: A nomogram model was developed to predict the incidence of PONV in patients after gynecologic laparoscopic surgery. This model was found to be reliable and of high clinical value., (© 2024. The Author(s).)

Introduction: Pain is common in patients receiving mechanical ventilation in the intensive care unit (ICU). Intravenous opioids are recommended as first-line therapy for pain management; however, opioids have adverse side effects. Based on low-quality evidence, low-dose ketamine is therefore recommended as an opioid adjunct to reduce opioid consumption. Esketamine is an alternative to ketamine with greater efficacy and fewer side effects. However, evidence on the use of esketamine in patients receiving mechanical ventilation is lacking. This study investigates the efficacy and safety of esketamine as an adjunct to sufentanil for analgesic therapy in non-surgical ICU patients under mechanical ventilation., Methods and Analysis: This ongoing multicentre, single-blind, randomised controlled trial is being conducted at six ICUs in China. 132 non-surgical patients under mechanical ventilation will be randomly assigned to the standard care and S-ketamine groups at a 1:1 ratio. Patients in the standard care group received a minimal dose of sufentanil as the sole analgesic agent. Patients in the S-ketamine group received a minimal dose of sufentanil in addition to an esketamine infusion at a fixed rate of 0.2 mg/kg/hour for analgesia. The primary outcome is mean hourly sufentanil consumption during the treatment period., Ethics and Dissemination: This study was approved by the Ethics Committee of Chongqing University Cancer Hospital (CZLS2022067-A). Participants are required to provide informed consent. The results of this trial will be reported in peer-reviewed journals and presented at conferences., Trial Registration Number: ChiCTR2200058933., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

The aim of this study was to evaluate the efficacy of fast-track cardiac anesthesia using target-controlled infusion of sufentanil and propofol in valve replacement surgery. The clinical data of 88 patients with rheumatic heart disease undergoing valve replacement surgery were retrospectively analyzed and grouped based on different treatment methods. Among them, 44 cases received fast-track cardiac anesthesia using target-controlled infusion of fentanyl and propofol from November 2019 to July 2021 were set as the control group, and 44 cases received fast-track cardiac anesthesia using target-controlled infusion of sufentanil and propofol from August 2021 to February 2022 were set as the study group. The study group showed shorter postoperative awakening time, extubation time, and hospital stay duration, and lower dosage of dopamine and nitroglycerin consumption compared to the control group (P < .05). At T5 and T6, both groups exhibited higher ACTH, cortisol (Cor), and C3a than at T0, and the study group showed significantly lower ACTH, Cor, and C3a at T5 and T6 than the control group (P < .05). At T7, the control group showed higher ACTH, Cor, and C3a than at T0, and ACTH, Cor, and C3a were significantly lower in the study group than in the control group at T7 (P < .05). Fast-track cardiac anesthesia using target-controlled infusion of sufentanil and propofol in valve replacement surgery has demonstrated favorable application effects, which stabilizes hemodynamics, alleviates myocardial damage, suppresses endocrine stress responses, and does not increase adverse reactions, thereby exhibiting good safety., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

Background:  There are few studies on continuous intercostal nerve block after single operation hole thoracoscopic surgery, that is, two-port thoracoscopic surgery., Objective:  To evaluate the analgesic effect of continuous intercostal nerve block after thoracoscopic surgery., Methods:  A total of 80 patients who underwent single operation hole thoracoscopic surgery in our hospital between September 2020 and June 2021 were enrolled and divided into two groups. Based on basic analgesia, an intercostal catheter was placed during the operation for continuous intercostal block analgesia after the operation in the experimental group (group A, n  = 40). The control group (group B, n  = 40) was treated with sufentanil intravenous analgesia after surgery, which is namely "basic analgesia." The postoperative pain scores, restlessness during the recovery period, effect on reducing opioid use, postoperative chest complications, patient satisfaction, etc., were compared between the two groups., Results:  The pain scores of patients in group A were significantly lower compared with those in group B at 12, 24, 36, and 48 hours after surgery (3.325 ± 1.163 vs. 4.550 ± 1.176, 2.650 ± 1.001 vs. 4.000 ± 1.038, 2.325 ± 0.917 vs. 3.700 ± 0.966, and 1.775 ± 1.050 vs. 3.150 ± 1.075, p  < 0.001, respectively). Sufentanil consumption in group A was significantly lower than in group B at 48 hours after surgery (98.625 ± 4.158 vs. 106.000 ± 7.228, p  < 0.001)., Conclusion:  Multimodal analgesia is ideal for early pain control after thoracotomy. A continuous intercostal nerve block can effectively reduce postoperative pain in patients., Competing Interests: None declared., (Thieme. All rights reserved.)

Study Objective: We compared the analgesic effects of erector spinae plane block versus quadratus lumborum block following laparoscopic nephrectomy., Design: A randomized controlled trial., Setting: A tertiary hospital in Beijing, China., Patients: Patients scheduled for elective laparoscopic nephrectomy., Interventions: A total of 110 patients were enrolled and randomized to receive either erector spinae plane block (n = 55) or quadratus lumborum block (n = 55) under ultrasound guidance. Patient-controlled sufentanil analgesia was provided after surgery., Measurements: Our primary outcome was cumulative opioid consumption within 24 h after surgery. Secondary outcomes included postoperative pain intensity, subjective sleep quality, and quality of recovery., Main Results: All 110 patients (mean 53 years, 57.3% female) were included in the intention-to-treat analysis. Cumulative sufentanil equivalent within 24 h was lower in patients given erector spinae plane block (median 13 μg, interquartile range 4 to 33) than in those given quadratus lumborum block (median 25 μg, interquartile range 13 to 39; median difference - 8 μg, 95% CI -15 to 0, P = 0.041). Pain intensity (0-10 range where 0 = no pain and 10 = the worst pain) at 2, 6, 12, and 24 h after surgery was lower with erector spinae plane block (at rest: median differences -1 point, all P ≤ 0.009; with movement: median differences -2 to -1 points, all P < 0.001). Subjective sleep quality on the night of surgery (the Richards-Campbell Sleep Questionnaire: 0-100 range, higher score better; median difference 12, 95% CI 2 to 23, P = 0.018) and quality of recovery at 24 h (the Quality of Recovery-15: 0-150 range, higher score better; median difference 8, 95% CI 2 to 15, P = 0.012) were better with erector spinae plane block. No procedure-related adverse events occurred., Conclusions: Compared with quadratus lumborum block, erector spinae plane block provided better analgesia as manifested by lower opioid consumption and pain intensity for up to 24 h after laparoscopic nephrectomy., Competing Interests: Declaration of competing interest The authors report no conflicts of interest in this work., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: The potential benefits of Analgesia Nociception Index guided intra-operative analgesia on intra-operative opioid consumption remains to be demonstrated in paediatric anaesthesia., Objectives: This study aimed to explore the effects of Analgesia Nociception Index guided analgesia on sufentanil consumption during anaesthesia and postoperative pain scores in paediatric patients with moyamoya disease., Design: A prospective randomised controlled study., Setting: Seoul National University Children's Hospital, Seoul, Republic of Korea., Patients: A total of 40 children scheduled for encephaloduroarteriosynangiosis., Main Outcome Measures: The primary outcome was total intra-operative sufentanil consumption, and the secondary outcomes included postoperative pain scores and incidence of opioid-related adverse events., Results: The Analgesia Nociception Index group showed lower intra-operative sufentanil consumption (in μg kg -1  h -1 ) compared with the Standard group (0.30 ± 0.12 and 0.39 ± 0.17, respectively; mean difference, -0.09; 95% confidence interval, -0.19 to 0.00; P  = 0.049). Postoperatively, compared with the Standard group, the Analgesia Nociception Index group reported lower median pain scores at 18 and 24 h and maximum pain within 24 h (1 [0 to 2] vs. 3 [2 to 5]; P  = 0.004, 1 [0 to 2] vs. 3 [1 to 4]; P  = 0.041, and 4 [3 to 5] vs. 5 [4 to 7]; P  = 0.045, respectively), with fewer patients experiencing nausea (3 [15%] vs. 10 [50%], P  = 0.043)., Conclusion: The Analgesia Nociception Index guided analgesic protocol can reduce intra-operative sufentanil consumption and postoperative pain within 24 h with fewer nausea symptoms in paediatric patients with moyamoya disease who undergo encephaloduroarteriosynangiosis., Trial Registration Number: NCT05672212., (Copyright © 2024 European Society of Anaesthesiology and Intensive Care. Unauthorized reproduction of this article is prohibited.)

Introduction: For several years, ropivacaine has been the standard-of-care for establishing postoperative femoral nerve block in total knee arthroplasty (TKA) setting and is still widely in use but new approaches such as the patient-controlled administration of sublingual sufentanil tablets system (SSTS) seem to offer good clinical results. Our aim is to compare the SSTS to single shot peri-nervous injection of ropivacaine (single shot) after TKA in terms of effectiveness in pain management and of time to recovery., Materials and Methods: A total of 165 patients undergoing TKA were enrolled. Eighty-four patients were randomly allocated in the SSTS group and 81 patients in the single shot group. The primary objective of the study was to evaluate performance of Timed Up and Go test. Secondary objectives were to measure the length of stay, NRS pain scale, the adherence to the prescribed plan, the joint mobility, the frequency of rescue analgesic use, side effects and patients' satisfaction., Results: Of all patients of the single shot group, 64 were withdrawn from the study as they unable to achieve pain control; only one patient was withdrawn from the SSTS group. Times for the "Timed Up and Go" test on the 3rd postoperative day were 8.4 ± 1.6 and 11.8 ± 3.6 in the SSTS group (n = 83) and single shot group (n = 17), respectively (p < .001)., Conclusions: SSTS provides better pain management when compared to peri-nervous ropivacaine single shot injection after TKA., (© 2024. The Author(s), under exclusive licence to Istituto Ortopedico Rizzoli.)