Search Results (94)

Background: This study aims to assess the effectiveness and safety of modified parasternal nerve block (MPSB) in providing perioperative analgesia and improving postoperative recovery in patients undergoing off-pump coronary artery bypass grafting (OPCABG). Methods: Sixty-five patients scheduled for OPCABG were randomly assigned to either the intervention group (MPSB group), which received a preoperative modified parasternal block, or the control group. The primary outcome measured was intraoperative opioid consumption. Secondary outcomes included levels of inflammatory markers, postoperative pain scores (assessed using the Visual Analog Scale, VAS), incidence of postoperative nausea and vomiting (PONV), total plasma ropivacaine concentration, gastrointestinal recovery parameters, mobilization metrics, intensive care unit (ICU) parameters (mechanical ventilation duration, ICU length of stay, requirement for rescue analgesics), length of hospital stay, incidence of postoperative pulmonary complications (PPCs), and chronic pain. Results: Intraoperative sufentanil consumption was significantly reduced in the MPSB group (130.0 [IQR, 110.0–167.5] μg vs. 280.0 [IQR, 192.5–327.5] μg; p < 0.01). Inflammatory markers were consistently lower in the MPSB group. Pharmacokinetic analysis revealed a mean peak plasma ropivacaine concentration of 0.88 μg/mL, with the maximum individual concentration reaching 1.76 μg/mL at 5 min post-administration. The MPSB group demonstrated superior postoperative outcomes, including lower VAS pain scores, earlier return of gastrointestinal function, reduced duration of mechanical ventilation, decreased rescue analgesic requirements in the ICU, shorter hospital stays, and lower incidence of PPCs. Conclusions: Preoperative modified parasternal block significantly reduced perioperative opioid consumption in cardiac surgery patients. This intervention demonstrated benefits in facilitating rapid postoperative recovery. The conventional ropivacaine dosing regimen was a safe and effective analgesic approach, associated with a low risk of local anesthetic systemic toxicity. Full article

Background and Objectives: Immediately after thyroidectomy, retching driven by postoperative nausea and vomiting (PONV) may cause wound rupture, severe bleeding, and airway obstruction. Although inhaled anesthetics are widely used in thyroidectomy, they may increase the postoperative risk of PONV. Therefore, this study aimed to compare PONV incidence and recovery patterns according to the characteristics of sevoflurane (Sevo) and desflurane (Des) when remifentanil was continuously infused until extubation. Materials and Methods: This retrospective cohort study involved 70 female patients undergoing elective thyroidectomy, who were categorized into the Sevo (n = 35) and Des (n = 35) groups. Remifentanil was administered at an effect-site concentration of 2 ng/mL during emergence. Results: PONV incidence during emergence was 20% in both groups (p = 1.000). The Des group had shorter times to recovery of consciousness and extubation than the Sevo group (p < 0.001 and p < 0.001, respectively). At 5 min after extubation, patients in the Des group were more alert (p = 0.001), with 54.3% awake and responsive. Postanesthesia care unit stay was also shorter in the Des group (16.89 ± 3.22 vs. 23.74 ± 4.80; p < 0.001). Additionally, perioperative hemodynamic status, surgical site pain, and residual sedation did not differ between inhaled anesthetics. Conclusions: When remifentanil was infused until extubation after thyroidectomy, the choice of inhaled anesthetics did not affect the incidence of acute PONV. Des provided faster early recovery without additional side effects than Sevo; nonetheless, acute recovery profiles did not differ between inhaled anesthetics. Full article

Background/Objectives: Postoperative nausea and vomiting (PONV) is a frequent complication following general anesthesia. Ramosetron is a standard prophylactic agent for PONV; the efficacy of adjunctive dexamethasone in this specific population is not well established. We aimed to evaluate whether adding dexamethasone to ramosetron enhances antiemetic efficacy across diverse surgical procedures. Methods: This prospective, randomized, double-blind, multicenter trial enrolled adults undergoing gynecological, orthopedic, otolaryngologic, general, or plastic surgery managed without postoperative patient-controlled analgesia. We randomized 385 patients into two groups. Group D received 5 mg of dexamethasone immediately after anesthesia induction and ramosetron (0.3 mg) at the end of surgery, whereas Group C received only ramosetron. We assessed the incidence and severity of nausea and vomiting, pain scores, rescue antiemetic and analgesic requirements, and adverse events immediately after surgery and at 6 and 24 h postoperatively. Results: At 6 h, the incidence of nausea was significantly lower in Group D than in Group C (41.7% vs. 58.3%; p = 0.047). Group D also exhibited lower pain scores (VAS: 3.0 ± 1.8 vs. 3.5 ± 1.7; p = 0.012) and reduced consumption of additional analgesics (44.1% vs. 55.9%; p = 0.028). At 24 h, there were no significant differences between the two groups in the incidence of nausea, pain scores, or consumption of additional analgesics. Multivariable logistic regression analysis identified dexamethasone administration as an independent predictor of reduced postoperative nausea at 6 h (odds ratio 0.575; 95% confidence interval 0.344–0.962; p = 0.035). Conclusions: Low-dose dexamethasone to ramosetron substantially reduced postoperative nausea and improved analgesic profiles at 6 h in patients managed without PCA. However, no significant between-group differences were observed at 24 h. Full article

Background/Objectives: Postoperative nausea and vomiting (PONV) remain frequent after breast surgery despite prophylaxis. This single-center, parallel-group randomized controlled trial evaluated whether intraoperative opioid-sparing anesthesia using dexmedetomidine and lidocaine reduced 48 h PONV compared with opioid-based anesthesia. Methods: Adult women undergoing elective breast surgery were randomized 1:1 to opioid-sparing anesthesia with dexmedetomidine and lidocaine or conventional opioid-based anesthesia with remifentanil. Participants and postoperative outcome assessors were blinded to group allocation; attending anesthesiologists were not blinded. All patients received standardized sevoflurane anesthesia, dexamethasone, ramosetron, quantitative neuromuscular monitoring, and postoperative fentanyl patient-controlled analgesia. The primary outcome was PONV within 48 h after surgery. Results: Among 68 randomized patients, 67 were analyzed (opioid-sparing group, n = 33; control group, n = 34). PONV within 48 h occurred in 8 patients (24.2%) in the opioid-sparing group and 28 patients (82.4%) in the control group (risk ratio, 0.29; 95% confidence interval, 0.16–0.55; p < 0.001; absolute risk reduction, 58.1%; number needed to treat, 1.7). Rescue antiemetic use was lower in the opioid-sparing group in the postanesthesia care unit and at 1 h postoperatively. Pain scores and cumulative opioid consumption were comparable. No Clavien–Dindo grade III or higher complications occurred. Conclusions: Intraoperative opioid-sparing anesthesia was associated with lower 48 h PONV after breast surgery without apparent compromise in analgesia. These single-center findings, from a trial registered after enrollment of one participant, require confirmation in larger prospectively registered multicenter trials. Trial Registration: Clinical Research Information Service (CRIS), KCT0009829. Registered on 10 October 2024. Full article

Background and Objectives: The insertion of a throat pack is a routine practice during anesthesia in maxillofacial and upper airway surgeries to prevent the aspiration of blood and secretions. However, this technique is associated with postoperative adverse effects such as pharyngitis and nausea. The objective of this systematic review and meta-analysis was to analyze the clinical evidence regarding the effect of throat packs on the incidence of Postoperative Nausea and Vomiting (PONV), throat pain, and gastric volume. Materials and Methods: Conducted according to PRISMA 2020 and registered in PROSPERO (CRD420251027016), an exhaustive search was performed in PubMed, Scopus, WOS, and Cochrane Library. Randomized Controlled Trials (RCTs) comparing throat pack use versus non-use under general anesthesia were included. Quality was assessed using Cochrane RoB 2. Meta-analyses utilized Standardized Mean Difference (SMD) and Mean Difference (MD) through a random-effects model. Results: Fourteen articles (2002–2024) involving 1147 patients were included. Methodological quality predominantly raised “some concerns”, with only 7.1% of studies assessed at low risk of bias. Statistical analysis of pain intensity (k = 6) revealed a significant increase in the intervention group (SMD = 0.35; 95% CI: 0.09 to 0.62; p = 0.01). Regarding PONV (k = 3), no statistically significant differences were observed between groups (SMD = −0.47; 95% CI: −1.51 to 0.58; p = 0.38). Ultrasound measurements showed significant increases in gastric parameters in the throat pack group, including anteroposterior diameter (MD = −3.67 mm; p = 0.002) and antral cross-sectional area (MD = −223.10 mm²; p = 0.005). Conclusions: Current evidence does not demonstrate a clear benefit for the routine use of oropharyngeal packing in maxillofacial and upper airway surgeries, and suggests a possible increase in postoperative throat discomfort. While acknowledging the limited number of studies, clinical heterogeneity, and the influence of perioperative co-interventions, these results should be interpreted with caution. Full article

Background: Patient-controlled analgesia (PCA) is widely used for postoperative pain control after total knee arthroplasty (TKA). Although postoperative nausea and vomiting (PONV) has been extensively studied, early discontinuation of PCA—representing failure to sustain an opioid-based analgesic strategy—has not been adequately investigated as a distinct, decision-relevant outcome. Methods: We conducted a single-center retrospective observational study of 1188 patients undergoing primary TKA who received PCA for postoperative pain management. The primary aim was to develop interpretable machine learning models for predicting early PCA discontinuation using routinely available perioperative variables. A secondary aim was to evaluate the incremental predictive value of hierarchical feature sets reflecting progressively available clinical information. Results: Early PCA discontinuation occurred in approximately 10% of patients, reflecting a relatively low-frequency clinical event associated with class imbalance. Female sex and PONV-related susceptibility factors, including prior nausea/vomiting intolerance, were more common among patients with early PCA discontinuation. The random forest Step 3 model demonstrated acceptable discriminative performance (AUC: 0.77; PR-AUC: 0.38), good calibration accuracy (Brier score: 0.065), and favorable clinical utility on decision curve analysis. Explainable analyses showed that patient-level susceptibility factors—such as prior intolerance to nausea or vomiting and baseline clinical characteristics—contributed more strongly to early PCA discontinuation than perioperative management or procedural variables. Conclusions: Early PCA discontinuation after TKA represents a distinct, decision-based clinical endpoint that is not captured by symptom-focused outcomes such as PONV. Interpretable machine learning models may help identify patients at increased risk of early PCA discontinuation after TKA, which may support informed counseling and proactive planning of individualized postoperative pain management strategies. However, external validation is required before routine clinical implementation. Full article

Background: Intrathecal morphine (ITM) is a widely used reference approach for post-caesarean analgesia but is associated with neuraxial opioid-related side effects, particularly pruritus and nausea. The transversalis fascia plane (TFP) block is a relatively recent regional technique targeting the transversalis fascia; however, comparative effectiveness data in the obstetric setting remain limited. This study aimed to evaluate whether TFP block provides analgesic outcomes broadly similar to those observed with ITM with respect to 24 h rescue analgesic requirement following elective caesarean delivery under spinal anesthesia, and to compare patient-centered recovery quality. Methods: This prospective, single-center, observational comparative cohort study was conducted in a tertiary obstetric unit. Sixty American Society of Anesthesiologists (ASA) physical status II parturients undergoing elective caesarean delivery under spinal anesthesia were included. Postoperative analgesic strategy was determined according to routine clinical practice, with patients receiving either ITM (100 µg) or bilateral ultrasound-guided TFP block with 0.25% bupivacaine. The primary outcome was cumulative tramadol consumption within the first 24 h postoperatively. Secondary outcomes included Numerical Rating Scale (NRS) pain scores at rest and on movement at 0, 3, 6, 12, and 24 h; postoperative nausea and vomiting (PONV) and pruritus scores; and Obstetric Quality of Recovery-11 (ObsQoR-11) scores at 24 and 48 h. A non-inferiority analytical framework was applied to the primary outcome. Results: Both groups had a median tramadol consumption of 0 mg (interquartile range (IQR) 0–0). Rescue analgesic rates were 23.3% (ITM) versus 16.7% (TFP; OR 0.66, 95% CI 0.18–2.36; p = 0.748). Within an exploratory observational non-inferiority analytical framework, the findings were consistent with non-inferiority of TFP block; however, these analyses should be interpreted as hypothesis-generating rather than confirmatory (risk difference −6.7 percentage points; upper 95% CI +13.5% relative to a prespecified margin of +15%). TFP block was associated with higher ObsQoR-11 scores at 24 h (median 96 vs. 88; p = 0.010; Cliff’s δ = −0.39) and 48 h (median 96 vs. 91; p = 0.017; Cliff’s δ = −0.36). Pruritus at 6 and 12 h was nominally lower in the TFP group. Conclusions: In this prospective observational cohort, TFP block was associated with analgesic outcomes broadly similar to those observed with ITM, with exploratory differences in patient-centered recovery measures. Within the applied exploratory observational analytical framework, these findings were broadly consistent with non-inferiority; however, given the observational design, results should be interpreted cautiously, and the present study does not establish formal non-inferiority or equivalence. TFP block may represent a potential opioid-sparing option warranting confirmation in adequately powered randomized studies. Full article

Postoperative nausea and vomiting (PONV) remain a leading preventable perioperative complication despite advances in anesthetic and surgical care, significantly affecting recovery within Enhanced Recovery After Surgery (ERAS) pathways. ERAS protocols provide a structured, multidisciplinary framework for perioperative optimization; however, variability in the implementation of PONV prevention strategies persists. This narrative review synthesizes current evidence on perioperative strategies for PONV prevention within ERAS pathways, focusing on patient risk stratification, multimodal pharmacologic prophylaxis, anesthetic techniques, and adjunctive non-pharmacologic interventions. We evaluate validated risk prediction tools, including the Apfel score, and highlight the importance of individualized prophylactic strategies based on patient, surgical, and anesthetic risk factors. Multimodal antiemetic regimens, opioid-sparing anesthesia, total intravenous anesthesia (TIVA), and regional techniques are discussed as key components of perioperative management. In addition, non-pharmacologic interventions such as optimized fluid therapy, early mobilization, and supportive perioperative care are reviewed as integral elements of ERAS-based recovery pathways. Complementing existing consensus guidelines, this review provides a practical, workflow-based framework spanning preoperative risk assessment, intraoperative decision-making, and postoperative monitoring for direct application within ERAS protocols. Full article

Background/Objectives: Postoperative nausea and vomiting (PONV) is a common complication that may negatively affect patient comfort and recovery following procedures performed under sedation. Although gastrointestinal endoscopic procedures are widely performed, data on the incidence and risk factors of PONV after esophagogastroduodenoscopy (EGD) remain limited. This study aimed to determine the incidence of PONV following EGD under sedation and to identify factors associated with its development. Methods: This single-center retrospective study included adult patients who underwent elective EGD under sedation between June and November 2023. Demographic and clinical data, Apfel risk scores, sedative agents, procedure duration, and macroscopic endoscopic findings were obtained from electronic medical records. PONV was assessed based on documentation during the post-anesthesia care unit stay. Patients were categorized into PONV-positive and PONV-negative groups and compared using appropriate statistical tests. Results: A total of 152 patients were included, and PONV occurred in 13 patients (8.6%). Female sex (p = 0.020), higher body mass index (BMI) (p = 0.009), preoperative nausea or vomiting (p = 0.002), thyroid disease (p = 0.004), oral antidiabetic drug use (p = 0.003), and higher Apfel risk scores (p = 0.008) were significantly associated with PONV. Age, American Society of Anesthesiologists (ASA) score, procedure duration, sedative agents, and macroscopic endoscopic findings showed no significant association. Conclusions: PONV following EGD under sedation was relatively uncommon. Patient-related factors, particularly female sex, higher BMI, preoperative nausea, thyroid disease, oral antidiabetic drug use, and higher Apfel scores, were associated with increased risk. Full article

Background and Objectives: Vaginal natural orifice transluminal endoscopic surgery, vNOTES, has become an increasingly preferred minimally invasive option for benign hysterectomy. General anesthesia is still the routine choice, yet regional methods such as combined spinal epidural anesthesia may support a smoother postoperative course. Although the use of vNOTES is expanding, comparative information on anesthetic approaches remains limited, and its unique physiologic setting requires dedicated evaluation. To compare combined spinal epidural anesthesia with general anesthesia for benign vNOTES hysterectomy, focusing on postoperative nausea and vomiting, recovery quality, and intraoperative physiologic safety. Materials and Methods: This retrospective cohort study was conducted in a single center and identified women who underwent benign vNOTES hysterectomy between March 2024 and August 2025 from electronic medical records. Participants received either combined spinal epidural anesthesia or general anesthesia according to routine clinical practice. All patients were managed within an enhanced recovery pathway that incorporated standardized analgesia and prophylaxis for postoperative nausea and vomiting. The primary outcome was the incidence of postoperative nausea and vomiting during the first day after surgery. Secondary outcomes included time to discharge from the recovery unit, pain scores at set postoperative intervals, early functional recovery, patient satisfaction and physiologic parameters extracted from intraoperative monitoring records. Analyses were performed according to the anesthesia group documented in the medical files. Results: One hundred forty patients met inclusion criteria and were included in the analysis. Combined spinal epidural anesthesia was linked to a lower incidence of postoperative nausea and vomiting, a shorter stay in the post-anesthesia care unit, and reduced pain scores in the first 24 h (adjusted odds ratio 0.32, ninety five percent confidence interval 0.15 to 0.68). Early ambulation and oral intake were reached sooner in the combined spinal epidural group, with higher overall satisfaction also noted. Adherence to ERAS elements was similar between groups, with no meaningful differences in early feeding, mobilization, analgesia protocols or PONV prophylaxis. During the procedure, combined spinal epidural anesthesia produced more episodes of hypotension and bradycardia, while general anesthesia was linked to higher airway pressures and lower oxygen saturation. Complication rates within the first month were low in both groups. Conclusions: In this observational cohort study, combined spinal epidural anesthesia was associated with lower postoperative nausea, earlier recovery milestones and greater patient comfort compared with general anesthesia. Hemodynamic instability occurred more often with neuraxial anesthesia but was transient and manageable. While these findings point to potential recovery benefits for some patients, the observational nature of the study and the modest scale of the differences necessitate a cautious interpretation. They should be considered exploratory rather than definitive. The choice of anesthesia should therefore be individualized, weighing potential recovery benefits against the risk of transient hemodynamic effects. Larger and more diverse studies are needed to better define patient selection and clarify the overall risk benefit balance. These findings should be interpreted cautiously and viewed as hypothesis-generating rather than definitive evidence supporting one anesthetic strategy over another. Full article

Background/Objectives: Postoperative nausea and vomiting (PONV) remains a frequent and clinically relevant complication following open lumbar discectomy (OLD) under general anesthesia. The present study represents a secondary, post hoc analysis of a randomized controlled trial originally designed to investigate the effects of infiltration anesthesia (IA) on postoperative pain perception and opioid consumption. The objective of this analysis was to explore the incidence of PONV in patients undergoing OLD under adequacy of anesthesia (AoA)-guided general anesthesia, with or without IA. Methods: This secondary analysis included 94 patients undergoing OLD under AoA-guided general anesthesia with fentanyl titration based on the surgical pleth index (SPI). Patients were randomized to receive IA with 0.2% ropivacaine (RF) or bupivacaine (BF) plus 50 µg fentanyl, or no IA (control). PONV was assessed as early (in the post-anesthesia care unit), late (in the neurosurgical ward), and overall (within 48 h postoperatively). Opioid consumption and Apfel risk scores were also analyzed. All analyses related to PONV were exploratory. Results: PONV occurred in 12.8% of patients, with no significant differences between study groups. Postoperative morphine consumption was significantly lower in the RF group than in the control group (2.7 ± 5.3 mg vs. 7.1 ± 5.9 mg; p < 0.05). Higher pre-induction SPI values were observed in patients who experienced early PONV (73.1 ± 9.7 vs. 59.5 ± 17.2; p < 0.05); however, this exploratory finding requires confirmation in larger studies. Conclusions: In this secondary, post hoc analysis, no significant differences in PONV incidence were observed between anesthetic groups in patients undergoing OLD under AoA-guided general anesthesia. The observed association between pre-induction SPI values and early PONV should be interpreted cautiously and requires confirmation in adequately powered prospective studies. Full article

Background: The aim of the study is (1) to assess safety of opioids in nursing mothers after cesarean delivery and in breastfed infants and (2) to evaluate the role of CYP2D6 genetics in maternal and infant clinical outcomes after cesarean delivery. Methods: A total of 210 mother–infant dyads were enrolled after cesarean delivery. Oxycodone 5 mg orally was administered every 4–6 h as needed as part of a standardized opioid-sparing ERAS protocol. Primary outcomes were opioid-related adverse effects, including maternal respiratory depression (RD) and postoperative nausea and vomiting (PONV) and neonatal composite side effects (i.e., RD monitoring, sedation, and limpness). Results: In total, 77% of mothers received opioids during postpartum hospital stay, none experienced respiratory depression, 13% reported PONV, and composite opioid-related side effects were observed in 13% of neonates. Compared to mothers without opioid consumption, higher in-hospital opioid consumption was borderline significantly associated with a higher risk of neonatal composite side effects (adjusted relative risk, aRR = 3.79; 95%CI: 1.01–14.28; p = 0.07), with a similar trend toward higher risk in maternal PONV (aRR = 2.56; 95%CI: 0.70–9.29; p = 0.36). Mothers with a CYP2D6 ultra-rapid metabolizer phenotype also showed higher rates of PONV and neonatal composite side effects compared with normal or intermediate phenotypes, although these associations were not statistically significant. Conclusions: Higher maternal in-hospital opioid consumption is associated with a higher risk of neonatal composite side effects. Using the lowest effective doses of opioids as needed could reduce the risk of opioid-related side effects in neonates. Preoperative genotyping may help identify mothers and breastfed neonates at increased risk for opioid-related adverse outcomes. Additional studies are needed to evaluate preoperative genotyping and to evaluate the causality of increased neonatal adverse outcomes. Full article

Background: This randomised, single-centre study and original research manuscript aimed to evaluate whether perioperative hypnosis and acupuncture can reduce postoperative nausea and vomiting (PONV), opioid use, and other complications in spinal surgery compared to standard pharmacological management. Methods: In total, 60 patients undergoing spinal surgery were divided into three groups regarding antiemetic prevention: Hypnosis and acupuncture (HG), hypnosis, acupuncture, and antiemetic (HAG), and standard control with antiemetic (CG). Hypnosis was performed one day before surgery, or patients received premedication with midazolam on the day of surgery. Anaesthesia was induced and maintained with propofol and remifentanil. Acupuncture was performed bilaterally at points LI4 and PC6 after induction of anaesthesia. Postoperatively, the consumption of opioids and antiemetics, satisfaction and well-being, length of stay and complications were recorded. Results: In all groups, additional opioids were administered in the first hour after surgery (p = 0.4). In the ICU, only one patient in the HAG and two patients in the CG and HG required additional analgesics (p = 0.8). Overall satisfaction (9/9/0 vs. 10/6/4 vs. 9/7/3; p = 0.4) and well-being scores (10/8/0 vs. 13/5/2 vs. 13/5/1; p = 0.5) were high across all groups, with no significant differences. Two patients in CG experienced mild complications. The length of hospitalisation was similar (3 days in CG vs. 4 days in HAG and HG (p = 0.7). Only one patient in the HG required antiemetics; none were needed in CG or HAG (p = 0.4). Conclusions: Within the constraints of this exploratory single-centre trial, hypnosis appeared to provide anxiolytic benefits comparable to benzodiazepines, and intraoperative acupuncture did not increase PONV despite reduced pharmacological prophylaxis. No significant differences were detected in opioid and antiemetic consumption. Larger, adequately powered studies are needed to confirm these findings and optimise the timing and modality of non-pharmacological interventions. Full article

Background and Objectives: Effective early postoperative pain control is essential for optimal recovery following total knee arthroplasty (TKA). In addition to pharmacological pain management, the choice of anesthetic agents and surgical technique can significantly impact postoperative outcomes. Remimazolam and robotic-assisted TKA (RA-TKA) have recently gained attention due to their potential advantages. This study aims to evaluate the effects of remimazolam and RA-TKA on acute postoperative pain compared with conventional TKA (C-TKA) and standard anesthetic protocols. Materials and Methods: In this retrospective observational study, 460 patients undergoing elective unilateral TKA were divided in to four groups based on surgical technique and anesthetic agents; RA-TKA with remimazolam (Group RR, n = 115), C-TKA with remimazolam (Group CR, n = 134), RA-TKA with conventional anesthesia (Group RC, n = 79), and C-TKA with conventional anesthesia (Group CC, n = 152). Remimazolam was administered at 6 mg/kg/h for induction and 1 mg/kg/h for maintenance, whereas conventional anesthesia was induced with propofol (1.5 mg/kg) and maintained with sevoflurane (1.5~2.0 vol%). The primary endpoint was acute postoperative pain, assessed via patient-controlled analgesia (PCA) consumption and supplemental analgesic use on the day of surgery. Secondary endpoints included total PCA consumption and additional analgesic use during the first 72 h, recovery room stay, discharge scores, and the incidence of postoperative nausea and vomiting (PONV). Results: Group RR required significantly fewer additional analgesics on the day of surgery than the other groups. Although group RR and group CR exhibited prolonged recovery room stay and lower discharge scores, these outcomes were not correlated with PCA consumption or supplementary analgesic use. RA-TKA was associated with approximately a 31% reduction in additional analgesic use compared with C-TKA, indicating a major contribution of the surgical technique to early postoperative pain control. Remimazolam alone did not demonstrate an independent effect on acute pain management. Conclusions: RA-TKA combined with remimazolam significantly reduced the need for additional analgesics on the day of surgery, highlighting a synergistic effect of the anesthetic and surgical approach. These findings support RA-TKA with remimazolam as an effective strategy for managing early postoperative pain following TKA. Full article

Background/Objectives: Postoperative nausea and vomiting (PONV) are common after general anesthesia (GA) and, in patients undergoing vitreoretinal surgery, may be triggered by the oculocardiac reflex (OCR) leading to the oculoemetic reflex (OER). Inadequate dosing of intravenous rescue opioid analgesics may further provoke OCR. Adequacy of Anesthesia (AoA) monitoring enables optimized titration of intravenous rescue opioid analgesics, while preemptive intravenous or peribulbar analgesia may reduce opioid use. This study evaluated the impact of preemptive paracetamol or peribulbar block (PBB) combined with AoA-guided GA on the incidence of PONV, OCR, and OER in patients undergoing vitreoretinal surgery. Methods: A total of 185 patients were randomized to four groups: GA with AoA-guided intraoperative rescue opioid analgesia plus a single intravenous dose of paracetamol 1 g, or PBB using 1% ropivacaine, 0.5% bupivacaine, or a 1:1 mixture of 0.5% bupivacaine/2% lidocaine. Data from 175 patients were analyzed. Results: AoA-guided GA yielded an OCR incidence of 11.4% and PONV incidence of 4%. PBB, regardless of anesthetic solution, did not significantly reduce intraoperative rescue opioid analgesia requirements or the incidence of PONV, OCR, or OER compared with intravenous paracetamol. Notably, no PONV occurred in patients with three Apfel risk factors (predicted risk ≈ 61%) who received PBB. Conclusions: No overall advantage of PBB over intravenous paracetamol was observed. It may, however, benefit patients at high PONV risk. Full article