A recent Anaesthetics digest,
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Study Type: Triple-blinded, single-centre-style randomised controlled trial (n=90; centre number not stated in abstract)

Key Question: Does IPACK provide superior analgesia to selective tibial nerve block after total knee arthroplasty under spinal anaesthesia with a femoral triangle block?

Key Findings:

• Day 1 cumulative IV morphine (primary outcome) did not differ: IPACK 6 (SD 7) mg vs tibial block 5 (SD 6) mg; p = 0.36. The superiority hypothesis was not supported.
• No differences in pain scores at rest or on movement (days 1-3) or in functional outcomes (quadriceps strength, walking distance, range of motion).
• Common peroneal nerve motor block occurred in 4/45 (9%) of the selective tibial group.

Clinical Relevance: Either technique is a reasonable posterior knee analgesic option within a multimodal TKA pathway, so choice can be guided by operator familiarity, block time and peroneal motor block risk.

Limitations: Opioid consumption was very low in both arms, so the trial may be unable to discriminate between techniques; the abstract reports no sample size justification or non-inferiority/equivalence margin.

Study Type: Clinical practice guideline (evidence-based, consensus panel; qualitative evidence synthesis).

Key Question: What are the indications, frequency, technical conduct, image-guidance requirements and complication management for common diagnostic and therapeutic spinal interventions in chronic spinal pain?

Key Findings:

• The panel produced 15 key recommendations plus good clinical practice statements covering cervical, lumbar and sacroiliac joint procedures.
• Recommendations were graded A to D, or I (insufficient), using USPSTF criteria, with certainty rated high, medium or low; consensus required at least 75% panel agreement.
• The abstract does not report the specific recommendations, grades or procedure-level effect sizes.

Clinical Relevance: Provides a structured benchmark for UK pain services to compare against current practice, though it is a Canadian guideline and UK services follow NICE and local commissioning policy.

Limitations: Evidence was synthesised qualitatively rather than by formal meta-analysis, and the abstract gives no detail on search methods or the strength of individual recommendations, so the full text is needed before applying them.

Study Type: Pre-planned, embedded descriptive process evaluation within the multicentre ADAPT-Sepsis RCT (2760 adults, 41 UK critical care units).

Key Question: How well were procalcitonin- and CRP-guided antibiotic discontinuation protocols delivered, and how closely did clinicians adhere to the advice?

Key Findings:

• PCT guidance produced "strong stop" advice 1.7 days earlier than CRP (95%CI -2.5 to -0.9); CRP guidance generated more standard care advice (-9.1%, 95%CI -10.9 to -7.3).
• Overall adherence was higher with CRP than PCT (-6.8%, 95%CI -9.0 to -4.5), driven by more standard care advice and higher adherence to its later stop advice (-14.3%, 95%CI -21.8 to -6.8).
• Non-adherence reasons were similar between arms: fixed-duration microbiology guidance, illness severity, persistent fever, and raised routine inflammatory markers.

Clinical Relevance: For UK intensivists, PCT may offer greater stewardship potential through earlier stopping, but this depends on clinicians accepting shorter courses than usual practice.

Limitations: This is a descriptive evaluation of process, not outcomes, so it cannot show whether earlier stopping or higher adherence affects patient safety or antibiotic exposure.

Study Type: Retrospective single-population cohort study (n=118 ICU patients).

Key Question: Does the time elapsed from onset of brainstem areflexia signs affect the sensitivity of cerebral CTA for confirming cerebral circulatory arrest in determination of death using neurological criteria?

Key Findings:

• Overall sensitivity was 87.3% (95% CI 79.6-92.5%); CTA failed to confirm circulatory arrest in 15/118 (13%).
• 93.3% of false negatives occurred within 12 h of onset of brainstem areflexia.
• Sensitivity was 67.4% (95% CI 51.3-80.5%) when performed ≤12 h versus 98.7% (95% CI 91.8-100%) when performed >12 h (p<0.001).

Clinical Relevance: Early CTA may under-detect cerebral circulatory arrest, so teams considering ancillary imaging in UK brainstem death testing should be aware that timing affects reliability, and a negative early scan does not exclude circulatory arrest.

Limitations: The retrospective design and the post hoc 12 h threshold (derived from the data, not prespecified) limit confidence, and the study evaluates sensitivity only, with no reference standard stated in the abstract.

Study Type: Systematic review with procedure-specific (PROSPECT) consensus recommendations; 30 RCTs and 7 systematic reviews/meta-analyses included from 1809 screened.

Key Question: What is the optimal multimodal analgesic regimen for adults undergoing total shoulder arthroplasty?

Key Findings:

• Evidence supported paracetamol, NSAIDs, IV dexamethasone (8-10 mg), and interscalene block (local infiltration analgesia as an alternative) for improved postoperative analgesia.
• Evidence was conflicting for continuous interscalene catheters and for liposomal bupivacaine (in block or infiltration); no evidence favoured any specific surgical technique.
• Recommended regimen: paracetamol, peri- and postoperative NSAID, dexamethasone, single-shot interscalene block with bupivacaine or ropivacaine (not liposomal), and opioids for rescue only.

Clinical Relevance: Provides an evidence-graded template for shoulder arthroplasty analgesia that can inform UK enhanced recovery pathways and local protocol development, including a fallback where block expertise is unavailable.

Limitations: The abstract gives no effect sizes or certainty-of-evidence grading, and the recommendations rest on RCTs of variable quality and heterogeneous comparators.

Study Type: Systematic review and meta-analysis of randomised and non-randomised studies (33 studies, 580,197 children).

Key Question: Does the incidence of pulmonary aspiration differ between liberal (<2 h) and conventional (≥2 h) pre-operative clear fluid fasting in children undergoing general anaesthesia or sedation?

Key Findings:

• Pooled aspiration incidence was identical at 0.03% (95%CI 0.01–0.09%) under both policies; pooled RR from 14 studies was 0.77 (95%CI 0.40–1.47).
• Vomiting without aspiration was similar: 0.76% (liberal) vs 0.99% (conventional), with overlapping wide confidence intervals.
• Certainty of evidence was very low for both outcomes.

Clinical Relevance: Supports the safety of shortened clear fluid fasting in paediatric lists, which may reduce fasting-related distress and dehydration, though it does not by itself justify departing from current UK guidance (1 h clear fluids is already endorsed by APAGBI/ESAIC-aligned policies).

Limitations: Aspiration is extremely rare and the evidence is very low certainty, so the wide confidence interval around the RR cannot exclude a clinically meaningful difference.

Study Type: Cluster-randomised, double-blind, sham-controlled trial (operating rooms randomised in 4-week blocks)

Key Question: Does supplemental operating room air purification reduce surgical wound infection, infection-related complications, or death within 30 days of surgery?

Key Findings:

• Primary composite (inpatients, n=58,938): 8.1% active vs 8.2% sham; OR 0.98 (95% CI 0.92–1.05), P=0.609.
• Secondary composite (inpatients and outpatients, n=107,334 analysed): 5.5% vs 5.6%; OR 0.98 (95% CI 0.93–1.05), P=0.669.
• Stopped early for futility at the third interim analysis; no variation in effect over time.

Clinical Relevance: Supports not investing in supplemental air-purification units for SSI prevention and prioritising measures targeting direct wound contamination (e.g. NICE-aligned SSI bundles).

Limitations: Only one purification technology was tested (industry-funded, though the funder was not involved in data acquisition, analysis or manuscript preparation), so the findings may not generalise to other filtration systems or theatre ventilation designs.

Study Type: Ambidirectional cohort study (n=77, aged 9-11 years) with exploratory latent profile analysis.

Key Question: Is childhood general anaesthesia (GA) exposure for surgery associated with differences in executive function or visuo-spatial attention?

Key Findings:

• No difference in overall executive function between GA-exposed (mean age at exposure 4.5 ± 3.0 years) and unexposed children (χ²(1)=0.01, p=0.92).
• Exploratory latent profile analysis identified "Efficient" and "Vulnerable" executive control profiles. GA exposure was associated with lower odds of Efficient profile membership (OR 0.71; reported 95% CI 0.705-0.710).
• GA-exposed children showed higher global-local precedence (estimate 0.53, 95% CI 0.04-1.01, p=0.036).

Clinical Relevance: Supports reassurance that a single early GA exposure is not linked to broad executive deficits, though subtle phenotypic differences remain hypothesis-generating for paediatric anaesthesia counselling in the UK.

Limitations: Small sample with exploratory profile analysis (the implausibly narrow CI suggests possible model instability), and the ambidirectional design with no stated adjustment for surgical indication or confounders limits causal inference.