Cardiothoracic Surgery

ESPB yields modest early analgesic and recovery benefits after median sternotomy with high heterogeneity

In 19 RCTs (N = 1344), erector spinae plane block (ESPB) vs standard analgesia modestly reduced 24‑hour pain after median sternotomy (MD -0.65 on 0–10 scale). ESPB also reduced intraoperative and 24‑h opioid consumption and shortened time to extubation by 1.28 hours in the sternotomy subgroup. No consistent benefit was seen in minimally invasive cardiac surgery within ERAS pathways. Certainty was low to very low and heterogeneity was very high, so effect sizes may differ substantially between centers. 1

Technology-enhanced PEEP optimization associated with lower 28‑day mortality but very low-certainty evidence

Thirty-four randomized studies (2951 patients) of seven technologies were pooled to compare technology-guided PEEP optimization with usual care. Pooled analysis suggested lower 28‑day mortality (RR 0.69, 95% CI 0.52–0.93) but no reduction in ventilation duration (mean difference -0.06 days). Evidence certainty was very low and only 172 patients contributed ventilation-duration data, limiting conclusions about clinical implementation. No pediatric data or cost-effectiveness analyses were reported. 2

Protocol: RCT of AI-assisted education for older head and neck cancer patients

This single-center RCT will randomize 100 postoperative head and neck cancer patients aged ≥60 to AI-driven personalized education versus standardized SMS over 12 months. Primary aims are to assess effects on mental health, social support, and quality of life using repeated validated measures. The protocol plans intention-to-treat analysis with linear mixed models and five assessment timepoints up to 12 months. Generalisability may be limited by single-center design and reliance on self-reported outcomes. 3