Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
Showing 3 appraisals
Computer assisted surgery (Abingdon, England)
DMRNet: a dynamic multi-scale residual network for Shamrock view and lumbar plexus segmentation
Lumbar plexus block (LPB) is a regional anesthesia technique widely used for hip and knee surgeries. However, despite the assistance of ultrasound guidance, the complex anatomical structure of the lumbar plexus poses significant challenges for anesthesiologists during the procedure. To accurately identify the lumbar plexus located in the posterior third of the psoas major in the Shamrock view, a deep learning-based segmentation model named DMRNet was proposed. This model is designed to precisely delineate muscles, nerves, and bony structures in Shamrock view ultrasound images. DMRNet integrates several innovative modules, including Adaptive Multi-Scale Dilated (AMD) Module that enhances the model's ability to capture multi-scale features; Dense Attention Residual (DAR) Module that adaptively selects salient feature regions; Attention-Enhanced Hybrid (AEH) Module that emphasizes critical features while suppressing irrelevant ones; and two attention mechanisms, Boundary-Aware Spatial Attention Mechanism (BASA) and the Enhanced Residual Multi-Head Attention Mechanism (ER-MHA), that improve the model's capacity to recognize complex contextual patterns. Experimental results demonstrated that DMRNet achieved a mean Intersection over Union of 0.863 and a mean Dice coefficient of 0.926 across all target structures, outperforming other state-of-the-art models. These findings suggest that DMRNet may serve as a useful assistive tool for sonoanatomical recognition in Shamrock view ultrasound images and may provide educational support for ultrasound-guided LPB training. A dynamic multi-scale residual network is proposed for lumbar lexus (LP) segmentation.Two attention mechanisms were improved, and three modules were proposed to improve downsampling, skip connection, and upsampling.We built our own Shamrock view ultrasound database containing the lumbar plexus nerves, and the Anesthesiologist physician of the anesthesiology department annotated it using Labelme.External validation was performed using the Ultrasonic Brachial Plexus Dataset (UBPD).
14 June 2026
Read appraisal →PloS one
Comparison between two different concentrations of ropivacaine in pericapsular nerve group block for patients undergoing total hip arthroplasty: A randomized clinical trial
Effective pain control during spinal anesthesia positioning remains a clinical challenge in elderly patients undergoing total hip arthroplasty. The pericapsular nerve group block, a novel ultrasound-guided regional anesthesia technique, has shown promise for alleviating hip pain, yet the optimal concentration of local anesthetics for this approach remains unclear. In this randomized, observer-blinded clinical trial involving 102 patients, we compared the analgesic efficacy of two concentrations of ropivacaine (0.375% vs. 0.5%) administered via pericapsular nerve group block prior to spinal anesthesia. Patients receiving 0.5% ropivacaine reported significantly lower pain scores during positioning and demonstrated prolonged postoperative analgesia up to 48 hours, without a corresponding increase in adverse events. Both concentrations improved positioning quality, reduced opioid requirements, and enhanced recovery compared to controls who received standard intravenous analgesic supplementation (including preoperative midazolam and ketorolac, and postoperative sufentanil PCA), though the higher concentration yielded modest additional benefits. These findings suggest that a 0.5% ropivacaine pericapsular nerve group block may offer superior perioperative analgesia for hip arthroplasty without compromising safety, while highlighting the need to balance analgesic potency with potential motor effects. This study informs optimization of nerve block protocols to improve perioperative outcomes in a high-risk surgical population. This study informs optimization of nerve block protocols to improve perioperative outcomes in a high-risk surgical population. The trial was registered with the Chinese Clinical Trial Registry (registration number: ChiCTR2400089440).
23 May 2026
Read appraisal →Regional anesthesia and pain medicine
Efficacy and safety of intrathecal adjuvants for perioperative management of cesarean delivery: a systematic review and network meta-analysis of randomized controlled trials
BACKGROUND: Cesarean section (CS) rates have increased globally, necessitating effective anesthesia management. Single-shot spinal anesthesia has limitations due to its duration and the dose-limiting adverse effects of local anesthetics. OBJECTIVES: To evaluate the effectiveness and safety of intrathecal adjuvants combined with local anesthetics in the perioperative management of CS pain. DESIGN: Systematic review with network meta-analysis. DATA SOURCES: PubMed, Cochrane Library for Clinical Trials, and Embase. ELIGIBILITY CRITERIA: We included women undergoing CS under single-shot spinal anesthesia with any intrathecal drug or placebo added to a long-acting local anesthetic. We selected single- or double-blind, parallel-group, randomized controlled trials (RCTs) reported in English. We excluded crossover, non-randomized, up-and-down dose-finding studies and clinical trials comparing the same drugs in all study arms. RESULTS: We included 166 RCTs with 14 925 patients assigned to 32 interventions. Buprenorphine and diamorphine were the highest-ranked treatments for reducing pain intensity at 24 hours, though not statistically significant. Morphine alone or in combination with meperidine, neostigmine, epinephrine, or nalbuphine significantly increased the duration of effective analgesia and reduced opioid consumption. Dexmedetomidine and morphine significantly prolonged the motor block duration. The safety profile of intrathecal adjuvants was generally adequate. CONCLUSIONS: While the strength of evidence, overall, was very low to low, our study suggests that while none of the interventions significantly reduced pain intensity at 24 hours, several significantly prolonged effective analgesia and reduced postoperative opioid consumption. Dexmedetomidine and morphine prolonged the duration of motor block. None of the intrathecal adjuvants evaluated significantly increased the occurrence of severe adverse events. Future large-scale RCTs are essential to provide more robust evidence. PROSPERO REGISTRATION NUMBER: CRD42024479424.
4 Apr 2026
Read appraisal →