Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
Showing 5 appraisals
Annals of medicine
Impact on analgesia, diaphragmatic function, and recovery between erector spinae plane block versus superior trunk block in arthroscopic shoulder surgery: a randomized controlled trial
BACKGROUND: Effective analgesia and preservation of diaphragmatic function are key considerations in analgesia for shoulder surgery. The superior trunk block provides analgesia with reduced phrenic nerve involvement, while the erector spinae plane block offers minimal impact on diaphragm motion. This randomized controlled trial compared the analgesic efficacy, impact on diaphragmatic motion, and postoperative recovery between the two blocks. METHODS: Sixty patients undergoing arthroscopic shoulder surgery were randomized to receive either erector spinae plane block or superior trunk block. Primary outcomes were postoperative VAS and changes in diaphragmatic excursion. Secondary outcomes included Quality of Recovery-15 (QoR-15) scores, morphine-equivalent consumption, and the handgrip strength motor blockade. RESULTS: The superior trunk block resulted in significantly lower dynamic VAS at 1-h postoperatively (0.1 [0.0, 0.2] vs. 5.7 [4.0, 7.6]; p < 0.001) and reduced 24-h morphine consumption (7.8 [2.5, 15.0] mg vs. 12.7 [7.5, 17.3] mg; p = 0.038) compared to the erector spinae plane block. However, diaphragmatic excursion was better preserved in the erector spinae plane block group (8.37% ± 20.7% vs. -20.09% ± 22.2%; p < 0.001), with a lower incidence of partial hemidiaphragm paresis (3.3% vs. 46.7%; p < 0.001). At 24 h postoperatively, QoR-15 scores were higher in the superior trunk block group (p = 0.047), and no patient in either group developed handgrip motor blockade. CONCLUSIONS: Superior trunk block offers superior early postoperative analgesia and better overall recovery, while erector spinae plane block minimizes diaphragmatic impairment. However, the erector spinae plane block may represent an option only in carefully selected patients at high respiratory risk, acknowledging its significantly poorer early analgesic profile.
15 May 2026
Read appraisal →Journal of investigative surgery : the official journal of the Academy of Surgical Research
Meta-Analysis of PENG+LFCN versus FICB on ERAS-Related Outcomes: Postoperative Pain, Motor Function and Recovery in Hip Surgery
OBJECTIVE: To compare pericapsular nerve group block combined with lateral femoral cutaneous nerve block (PENG+LFCN) with fascia iliaca compartment block (FICB) for postoperative analgesia and functional recovery after hip surgery within Enhanced Recovery After Surgery (ERAS) pathways. METHODS: PubMed, Embase, the Cochrane Library, CNKI, Wanfang Data, and CQVIP were searched through January 2026. Comparative studies of PENG+LFCN versus FICB in hip surgery were included. Data were pooled using a random-effects model, with assessment of bias, heterogeneity, and publication bias. RESULTS: Sixteen studies were included. The PENG+LFCN group had significantly lower resting VAS (MD = -0.54; p < 0.00001) and dynamic VAS (MD = -0.98; p < 0.00001) scores. It also showed a lower incidence of postoperative muscle weakness (OR = 0.10; p = 0.0001), better preservation of quadriceps muscle strength, shorter time to first ambulation (MD = -9.22 h; p < 0.0001), and reduced length of stay (MD = -0.75 days; p < 0.00001). Additionally, morphine consumption (MD = -24.22 mg; p = 0.001) and PCA pump activations (MD = -2.46; p < 0.00001) were lower in the PENG+LFCN group. CONCLUSION: PENG+LFCN may be a more favorable regional analgesic strategy than FICB for hip surgery within ERAS pathways. PROTOCOL REGISTRATION: This systematic review and meta-analysis was registered at PROSPERO https://www.crd.york.ac.uk/PROSPERO/view/CRD420261295309.
13 May 2026
Read appraisal →PloS one
High-versus conventional-volume pericapsular nerve group (PENG) block for total hip arthroplasty: A randomized, controlled trial
BACKGROUND: Currently, the optimal volume of pericapsular nerve group (PENG) block for analgesia after total hip arthroplasty (THA) has not been clarified. In this trial, we investigated whether a high-volume PENG block has a superior analgesic effect than a conventional PENG block for primary THA. METHODS: Forty patients receiving primary THA under spinal anesthesia were enrolled and randomly divided into the high-volume PENG group (40 mL of 0.375% ropivacaine) and the conventional-volume PENG group (20 mL of 0.375% ropivacaine). Dexamethasone (5 mg) was added to the local anesthetic in both groups. A blinded researcher performed pain scores and lower limb sensory and motor block assessments at 3, 6, and 24 h after surgery. The time of first walking, time of first opioid consumption, total opioid consumption within 48 h, nerve block, opioid-related complications, and length of hospital stay were recorded. The primary outcome was the dynamic pain scores at 6 h post-surgery. RESULTS: Thirty-seven patients were included in the final analysis, among whom 18 were in the high-volume group and 19 in the conventional-volume group. There were no significant differences between the two groups in dynamic pain scores at 6h after surgery [median and interquartile range (p25, p75) 5(4,6) vs 4 (4,5)] and other secondary outcomes. CONCLUSIONS: The high-volume PENG block is not superior to conventional-volume PENG block in improving post-operative analgesia in patients undergoing primary THA and does not increase the risk of quadriceps weakness. TRIAL REGISTRATION: Chinese Clinical Trial Registry (ChiCTR, https://www.chictr.org.cn). Clinical trial registration number: ChiCTR2300077281.
18 Apr 2026
Read appraisal →Medical science monitor : international medical journal of experimental and clinical research
Ultrasound-Guided Modified Clavipectoral Fascial Plane Block With Superficial Cervical Plexus Block for Midshaft Clavicular Surgery: A Prospective Randomized Controlled Trial
BACKGROUND This study evaluated the efficacy and safety of modified clavipectoral fascial plane block (mCPB) plus superficial cervical plexus block (SCPB) compared with interscalene brachial plexus block (ISBP) in midshaft clavicular fracture surgery. MATERIAL AND METHODS Fifty-six patients scheduled for midshaft clavicular surgery under regional anesthesia were randomly allocated to a control (ultrasound-guided ISBP plus SCPB) or experimental (mCPB plus SCPB) group at a 1: 1 ratio. The primary outcome was the Numerical Rating Scale (NRS) score at 12 hours postoperatively. Secondary outcomes were NRS scores at 4, 8, and 24 hours; rescue analgesic administration frequency; block success rate; procedural and onset times; and hemidiaphragmatic paralysis incidence. RESULTS Block success was 100% in both groups, without differences in performance time or onset time. A significant group × time interaction was observed (P<0.001). Compared with the control group, the experimental group had significantly lower NRS scores at 12 hours (estimated mean difference -1.29; P<0.001) and 24 hours (estimated mean difference -2.36; P<0.001). No significant differences occurred at 4 or 8 hours. Rescue analgesic requirements within 24 hours were significantly reduced in the experimental group (P=0.002). Hemidiaphragmatic paralysis incidences were 71.4% in the control group and 0% in the experimental group (P<0.001). CONCLUSIONS In midshaft clavicular fracture surgery, mCPB plus SCPB provided effective anesthesia with procedural characteristics comparable to ISBP, while avoiding hemidiaphragmatic paralysis and demonstrating superior analgesia at 12 and 24 hours. These findings require validation in larger multicenter trials.
8 Apr 2026
Read appraisal →Medicine
Comparison of costoclavicular with infraclavicular block for upper limb surgeries: A meta-analysis
BACKGROUND: The influence of costoclavicular versus infraclavicular nerve block on the analgesia for upper limb surgeries remains elusive. This meta-analysis and systematic review aim to study the analgesic efficacy of costoclavicular versus infraclavicular nerve block for upper limb surgeries. METHODS: We have searched several databases, including PubMed, Embase, Web of Science, EBSCO, and Cochrane Library databases from inception to January 2024, and randomized controlled trials (RCTs) assessing the effect of costoclavicular versus infraclavicular nerve block for upper limb surgeries were included. The inclusion criteria were presented as follows: study design was RCT, patients underwent upper limb surgeries, and intervention treatments were costoclavicular nerve block versus infraclavicular nerve block. Studies without English abstracts were excluded. The methodological quality of the included studies was evaluated by the modified Jadad scale. Standard mean difference with 95% confidence interval (CI) was used to assess continuous outcomes, while odds ratio (OR) with 95% CI was applied to evaluate dichotomous outcomes. RESULTS: Six RCTs and 434 patients were included in this meta-analysis. Compared with infraclavicular nerve block for upper limb surgeries, costoclavicular nerve block was able to significantly decrease block onset time (SMD = -0.29; 95% CI = -0.53 to -0.05; P = .02), but demonstrated no influence on performance time (SMD = -0.26; 95% CI = -0.85 to 0.34; P = .40), number of passes (SMD = -0.08; 95% CI = -0.40 to 0.24; P = .61), vascular puncture (OR = 0.25; 95% CI = 0.04 to 1.56; P = .14) or Horner syndrome (OR = 1.02; 95% CI = 0.04 to 27.64; P = .99). CONCLUSION: Costoclavicular nerve block may need shorter block onset time for upper limb surgeries compared to infraclavicular nerve block, but more RCTs were needed to confirm these findings.
5 Apr 2026
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