Regional & acute pain

QL and TAP blocks cut 24-hour opioid use after kidney transplant; pain gains fall short of the clinical threshold

A Bayesian meta-analysis of 14 trials (903 participants) found quadratus lumborum and transversus abdominis plane blocks lowered pain at every pooled time point, but no pain comparison reached 80% probability of exceeding the 1.0-point MCID. Opioid use at 24 h fell by 15.5 MME with QL (95% CrI -23.6 to -6.7) and 10.5 MME with TAP (-14.4 to -5.5).

Why it matters. Suggests the main measurable benefit of these blocks in kidney recipients is opioid sparing; no technique was preferred.

Limitation. Certainty of evidence was very low, 12 eligible registered trials were unpublished, and graft function data were too sparse to pool.

PROSPECT: single-shot interscalene block plus paracetamol, NSAID and dexamethasone for shoulder arthroplasty

An ESRA PROSPECT review of 30 RCTs and 7 systematic reviews recommends paracetamol, a perioperative NSAID continued after surgery, IV dexamethasone (8-10 mg) and a single-injection interscalene block with a long-acting local anesthetic. Local infiltration analgesia is the alternative; liposomal bupivacaine is not recommended.

Why it matters. Gives a procedure-specific, evidence-graded analgesic bundle for total shoulder arthroplasty.

Limitation. Evidence on continuous interscalene catheters was conflicting, so the panel called for further studies rather than recommending them.

Serratus anterior plane catheters after sternotomy linked to more pneumothoraces (12% vs 3%)

Comparing 50 trial patients who received continuous serratus anterior plane catheters with 989 propensity-matched historical patients, pneumothorax occurred in 12% vs 3% (OR 5.3; 95% CI 2.1-13.6). ICU readmission, ventilation time and length of stay did not differ.

Why it matters. A safety signal for teams adding continuous chest-wall catheters to enhanced recovery pathways after cardiac surgery.

Limitation. Historical comparison; the authors note causality is unclear and closer trial monitoring may have detected more pneumothoraces.

Role of Perineural Catheter in Pain Control and Opioid Consumption After Major Amputation of Lower Limb

Phase 4 trial planning 96 participants, sponsored by Aga Khan University. Status: not yet recruiting. Conditions: Phantom Limb Pain After Amputation, Stump Pain.

Dexmedetomidine Use for Greater Occipital Nerve Block in Pediatric Posterior Fossa Tumor Surgery

Phase 3 trial planning 260 participants, sponsored by Children's Cancer Hospital Egypt 57357. Status: recruiting. Conditions: Posterior Fossa Tumor.

Intraoperative Methadone for the Management of Postoperative Pain in Patients With Head and Neck Cancers

Phase 4 trial planning 58 participants, sponsored by OHSU Knight Cancer Institute. Status: recruiting. Conditions: Head and Neck Carcinoma.