30-Second Takeaway
- Regional techniques in pediatric cardiac surgery modestly reduce opioids and ICU stay, but evidence is low certainty and heterogeneous.
- Routine opioid prescribing after day-case surgery correlates with ongoing day-7 use and worse patient-reported outcomes, highlighting stewardship gaps.
- Multicomponent non-pharmacologic bundles and dexmedetomidine both lower delirium risk in older surgical patients, though data quality is limited.
- Oliceridine during propofol hysteroscopy sedation halves hypoxia incidence versus sufentanil, with less propofol use and better satisfaction.
- Lung-protective ventilation must be strictly PBW-based, especially in shorter women, as higher tidal volumes are linked to higher ICU mortality.
Week ending April 4, 2026
Focused updates in perioperative analgesia, ventilation, delirium, and organ support
Regional analgesia in pediatric cardiac surgery: modest benefits with low-certainty evidence
Across 31 RCTs (2245 children), adjunct regional analgesia reduced intraoperative fentanyl and 24-hour morphine requirements versus systemic analgesia alone. Regional techniques were associated with shorter time to extubation, slightly reduced ICU length of stay, and longer time to first rescue analgesia. Effects varied by outcome and subgroup, with very high heterogeneity and imprecision across trials. Overall certainty was very low to low, so potential benefits must be balanced against neuraxial and deep plane block risks.
Opioid use after day-case surgery: persistent day-7 use and system burden
In this UK national prospective cohort of 7839 day-case adults, one-quarter used opioids preoperatively, often for chronic pain. Postoperatively, 46% received opioids and 26% reported still taking opioids on day 7 after surgery. Almost one-quarter of those prescribed opioids never used them, suggesting substantial overprescribing at discharge. Patients taking postoperative opioids reported higher pain, worse quality of recovery, lower satisfaction, and more frequent need for additional help. Nearly one in five patients sought further pain management support, predominantly from primary care, adding community workload.
Delirium prevention in older adults: multicomponent bundles and dexmedetomidine stand out
This meta-analysis of 87 RCTs (19,289 patients ≥65 years) evaluated delirium prevention strategies outside the ICU. Multicomponent non-pharmacologic interventions reduced delirium versus usual care (RR 0.56), with benefit in medical and non-cardiac surgical cohorts. Single-component non-pharmacologic measures produced mixed or inconclusive results. Dexmedetomidine reduced delirium in non-cardiac surgical patients (RR 0.49), while evidence for other drugs was sparse or inconsistent. Certainty was low to very low overall, supporting multicomponent bundles but underscoring the need for higher-quality perioperative trials.
Oliceridine halves hypoxia versus sufentanil during propofol-sedated hysteroscopy
In this double-blind RCT of 482 hysteroscopy patients under propofol sedation, oliceridine was compared with sufentanil as the opioid adjunct. Intraoperative hypoxia occurred in 9.8% with oliceridine versus 19.5% with sufentanil (RR 0.50, 95% CI 0.32–0.79). Oliceridine patients had higher nadir oxygen saturation, required less propofol, and showed lower postoperative PaCO2 and base excess. Patient and surgeon satisfaction were higher with oliceridine, without excess adverse events reported in the abstract. These data suggest oliceridine may offer a more respiratory-stable option than sufentanil for short gynecologic procedures under deep sedation.
References
Numbered in order of appearance. Click any reference to view details.
Additional Reads
Optional additional studies from this edition.