Yun Wang

Neuropathic pain is a prevalent and debilitating chronic condition with complex and incompletely understood mechanisms. Growing evidence has uncovered astrocytes as active and dynamic regulators in both the initiation and persistence of neuropathic pain. Beyond their classical supportive roles, astrocytes undergo profound morphological and functional remodeling following nerve injury and engage in extensive bidirectional communication with neurons. Through direct physical contacts, gliotransmitter release, and complex intercellular signaling networks, astrocytes critically shape synaptic plasticity, neuroinflammatory cascades, and neuronal excitability, ultimately driving maladaptive pain processing. In this review, we provide an updated and integrative overview of astrocyte-neuron cross-talk in neuropathic pain, with a particular focus on the molecular and cellular mechanisms by which astrocytic signaling modulates synaptic remodeling and pain sensitization. A deeper understanding of these astrocyte-mediated interactions may open new avenues for the development of precise and targeted therapeutic strategies for neuropathic pain.

To evaluate the efficacy of ultrasound-guided thyroid cartilage plane block (TCPB) on postoperative sore throat (POST) in patients undergoing suspension laryngoscopy vocal cord polypectomy (SLVCP). Ninety patients scheduled for elective SLVCP were randomized to either the TCPB group (general anesthesia + ultrasound-guided TCPB) or the C group (conventional GA), with 45 patients in each. The primary outcome was the incidence of POST at 2 h after extubation. Secondary outcomes included the incidence and severity of POST at 0.5, 2, 6, 12, and 24 h after extubation; the incidence and severity of hoarseness at 0.5, 2, 6, 12, and 24 h after extubation; and cough response during emergence. The incidence of POST was significantly higher in the C group compared to the TCPB group at 0.5 h (93% vs. 67%, RR = 0.20, 95% CI [0.06-0.64]; P = 0.003), 2 h (78% vs. 47%, RR = 0.42, 95% CI [0.23-0.77]; P = 0.004), and 6 h (64% vs. 27%, RR = 0.49, 95% CI [0.32-0.77]; P = 0.001) after extubation. No significant difference in the incidence and severity of hoarseness between the groups at any time point. During extubation, the incidence of cough response in the C group was 60%, significantly higher than the 20% in the TCPB group (RR = 0.50, 95% CI [0.34-0.74]; P = 0.001). Ultrasound-guided TCPB significantly reduces the incidence and severity of POST and cough response in SLVCP patients. This trial was registered in the Chinese Clinical Trial Registry (ChiCTR2500100227) on April 7, 2025 (https://www.chictr.org.cn/).

The thoracoabdominal nerves block using the perichondrial approach (TAPA) was first described by Tulgar et al. as a trunk nerve block technique designed to provide analgesia for abdominal surgery. Subsequently, the modified TAPA (M-TAPA) was proposed, in which a local anesthetic was injected only at the lower aspect of the costal cartilage. More recently, a re-modified TAPA was developed to achieve a more consistent blockade of the lateral cutaneous nerve branches. Despite increasing clinical adoption of the TAPA and its modifications, many important details remain insufficiently understood. In this review, we provide a comprehensive update on the available cadaveric and clinical studies of the TAPA and its modifications. The PubMed, Embase, and Web of Science databases were searched, and 276 studies of interest were identified. After excluding irrelevant articles, 75 studies were finally included in the review. The literature indicated that, among these techniques, the M-TAPA has been extensively studied. The anterior sensory coverage achieved by the M-TAPA was marginally better and more stable than its lateral coverage. The TAPA and its modifications are applicable to surgery in the abdominal and inguinal regions. Single-shot and continuous infusions have been described. To date, no complications associated with these blocks have been reported. Thus, the various TAPA blocks are promising techniques. Randomized controlled trials of high methodological quality are required to elucidate the roles of these techniques further.

Spinal anesthesia-induced hypotension (SAIH) complicates 50–70% of cesarean deliveries, posing maternal-fetal risks. This prospective, single-center observational study (ClinicalTrials.gov: ChiCTR2300077480) evaluated whether pre-induction positional change in carotid corrected flow time (δcFT) predicts SAIH in term parturients. In this single-center prospective observational study, 54 healthy term parturients (≥37 weeks, ASA I–II), high-resolution carotid Doppler measured corrected flow time (cFT) and respiratory variation in peak velocity (δVpeak) in supine and left-lateral positions immediately before neuraxial block. The primary outcome was SAIH incidence within 15 minutes post-induction. Of 54 participants analyzed, 34 developed SAIH (63%). The SAIH group exhibited significantly shorter supine cFT (330.30±18.44 vs 351.14±19.57 ms, P<0.001) and greater positional cFT increase (δcFT: 22.55±14.29 vs 0.23±13.30 ms, P<0.001). δcFT demonstrated superior discriminatory accuracy (AUC 0.872, 95% CI 0.772–0.972, P<0.001) compared with supine cFT (AUC 0.769) and δVpeak (AUC 0.50–0.52). Optimal δcFT threshold was 6.49 ms (sensitivity 94.1%, specificity 75.0%). Exploratory multivariable logistic regression analysis suggested that δcFT was associated with SAIH after adjustment for prespecified covariates (OR 1.125 per 1-ms increase, 95% CI 1.049–1.206, P=0.001), whereas higher supine cFT was associated with a lower risk (OR 0.934, P=0.002). δcFT correlated significantly with the magnitude of blood pressure decrease (r=0.437, P=0.001). Interobserver reliability was excellent (ICC 0.969). Pre-induction δcFT could be a promising noninvasive predictor of SAIH. Bedside assessment of positional changes in cFT might identify high-risk parturients and guide targeted prophylactic strategies. δVpeak lacked predictive utility in spontaneously breathing patients. Further external validation studies are warranted.

Background: Post‐stroke seizures are a common and debilitating complication with limited therapeutic options, underscoring the need to identify novel molecular targets. Disruption of chloride homeostasis via impaired potassium chloride cotransporter 2 (KCC2) activity is a key driver of neuronal hyperexcitability. While microglia are a predominant source of brain‐derived neurotrophic factor (BDNF) in the acute phase after brain injury, the role of microglial BDNF and its signaling in KCC2 dysregulation and early post‐stroke seizure susceptibility remain poorly defined. Methods: Using a middle cerebral artery occlusion‐reperfusion (MCAO‐R) mouse model and oxygen–glucose deprivation/reoxygenation (OGD/R) in hippocampal neurons, we assessed KCC2 function, neuronal excitability, and seizure susceptibility. Pharmacological tools, including the microglial inhibitor minocycline, the TrkB antagonist K252a, the loop diuretic furosemide (FUR), repurposed here as a KCC2‐stabilizing agent, and the KCC2 activator CLP290, were employed. Techniques included immunofluorescence, Western blotting, patch‐clamp electrophysiology, electroencephalography (EEG), and behavioral seizure assessment. Results: MCAO‐R and OGD/R significantly reduced membrane KCC2 expression, leading to a depolarizing shift in the GABA equilibrium potentials ( E _GABA ), diminished GABAergic inhibition, and increased neuronal excitability. Preventing KCC2 downregulation with FUR or CLP290 suppressed epileptiform activity in vitro and increased seizure thresholds in vivo. Ischemia induced robust microglial activation and increased BDNF release. Pharmacological inhibition of microglia (minocycline) or TrkB (K252a) effectively restored KCC2 expression, normalized E _GABA , and reduced post‐stroke seizure severity. Conclusion: Our findings identify microglia‐derived BDNF/TrkB signaling as a critical upstream pathway mediating KCC2 dysfunction in early post‐stroke seizure. Targeting this axis by inhibiting microglial activation, blocking TrkB, or directly enhancing KCC2 function with activators like CLP290 represents a promising therapeutic strategy for stroke‐related epilepsy.

To compare the effectiveness of ultrasound (US) guidance alone versus combined nerve stimulation (NS) and US in subcostal quadratus lumborum block (SQLB) for patients undergoing laparoscopic nephrectomy. Eighty-four patients scheduled for laparoscopic nephrectomy were randomized to receive a SQLB with either US alone (US group) or combined US and NS guidance (US-NS group). Each patient received 25 mL of 0.5% ropivacaine for the block. The primary endpoint was the block success rate within 5 minutes after block. Secondary endpoints included the extent of sensory block, intravenous morphine equivalent consumption, NRS scores, frequency of rescue analgesia administration, puncture time, number of needle insertion attempts, ultrasonic images quality, and incidence of adverse reactions and complications. The US-NS group demonstrated significantly higher block success rate compared to the US group (92.5% vs 62.5%, P < 0.05). Additionally, the US-NS group exhibited lower opioid requirements and fewer rescue analgesia interventions within the initial 24-hour postoperative period, broader sensory block coverage at 5, 10, and 15 minutes following injection, and lower NRS scores both at rest and during coughing at 6, 12, 24, and 48 hours post-surgery. However, the US-NS group required a longer puncture duration and more attempts to complete the SQLB. No significant differences were found between the two groups regarding the quality of ultrasound images and the incidence of adverse effects. Dual guidance with NS and US was superior to US alone for performing SQLB, resulting in higher block success rates and improved analgesic efficacy for laparoscopic nephrectomy.

Anatomical variations in nerves are common and can significantly impact ultrasound-guided regional anesthesia. They directly influence needle trajectory, local anesthetic spread, and block efficacy, contributing to procedural failure or complications. However, the literature specifically addressing the clinical implications of neural variations for regional anesthesia remains limited. This narrative review synthesizes evidence on three key aspects: (1) variations of common peripheral nerves and their clinical significance in regional anesthesia (including the terminal branches of the trigeminal nerve, suprascapular nerve, phrenic nerve, lumbar plexus, saphenous nerve, obturator nerve, and sciatic nerve); (2) variations of major vessels relevant to regional anesthesia and their clinical significance in regional anesthesia (including the Adamkiewicz artery and vertebral artery); (3) variations of the spine and spinal nerve roots and their clinical significance in regional anesthesia. This review systematically synthesizes current evidence on these anatomical variations and introduces practical resources, including regional ultrasound guidance and tables correlating specific variants with technical modifications, to enhance ultrasound recognition and clinical decision-making, thereby serving as a valuable reference for clinicians.

The analgesic efficacy of transmuscular quadratus lumborum block (TQLB) as a means of decreasing the need for opioid use following laparoscopic nephrectomy has been demonstrated in several studies, but the effect of the lower thoracic paravertebral block via posterior pathway of medial arcuate ligament under direct visualization (LTPB-MAL) in this surgical context remains to be clearly elucidated. To juxtapose the pain-relieving potency of the TQLB and the LTPB-MAL in individuals receiving laparoscopic nephrectomy. A randomized controlled study. University-affiliated tertiary care hospital. One hundred and two individuals slated for laparoscopic nephrectomy under general anesthesia were assigned to acquire either TQLB or LTPB-MAL by chance, with both groups receiving 25 ml of 0.5% ropivacaine post-surgery. The primary outcome was the total intravenous morphine equivalent doses consumed within the first day post-operatively. Secondary outcomes included pain intensity; interval to first opioids request; rescue analgesics use; and occurrence of nausea/vomiting; time to first ambulation; hospital duration and satisfaction scores. The patients receiving LTPB-MAL consumed significantly less intravenous morphine equivalent doses than those receiving TQLB in the first 24 h after surgery, with a mean (SD) of 23.5 (7.6) mg versus 33.6 (10.2) mg, P < 0.001, respectively. Time to the first opioid request in the LTPB-MAL group was significantly prolonged compared with the TQLB group, P < 0.001. No considerable discrepancy was observed in pain intensity, rescue pain consumption, satisfaction scores, incidence of nausea or vomiting, or ambulation and length of hospital stay within the two groups. LTPB-MAL significantly reduces postoperative opioids usage in the first 24 h after surgery and delays the initial opioid request, endorsing it as an enhanced strategy for multimodal analgesia in laparoscopic nephrectomy. The Ethics Committee of Beijing Chaoyang Hospital granted ethical approval for our study protocol on May 10, 2022 (2022-ke-447). The study was officially registered with the Chinese Clinical Trial Registry (ChiCTR2200060507) on June 3, 2022.

Background: We proposed that the L3 paravertebral block (PVB) combined with the retro-psoas compartment block (RPCB) would provide a better postoperative analgesia for total knee arthroplasty (TKA) than the femoral nerve block (FNB) alone. Materials and Methods: A total of 66 patients scheduled for TKA were randomly allocated to receive either FNB or L3 PVB-RPCB. Postoperative patient-controlled analgesia with intravenous sufentanil was administered. The primary endpoint was the total sufentanil consumption within the first 24 hour postoperative. Secondary outcomes assessed included pain intensity, sensory dermatomal coverage 20 min after administering the blocks, rescue analgesia requests, satisfaction scores, and the incidence of nausea, vomiting, itching, and posterior knee pain. Results: Patients in the L3 PVB-RPCB group consumed significantly less sufentanil in the first 24-hour post-surgery compared to those who received an FNB, with intake measuring 30 [28 to 33] ug versus 43 [37 to 46] ug, respectively, ( P < 0.01). Furthermore, the pain scores were significantly lower in patients with L3 PVB-RPCB at 6 hour and 12 hours at rest ( P < 0.01), and at 12 hours on movement ( P < 0.01). This group also showed a reduced need for rescue analgesia and experienced less posterior knee pain ( P < 0.01). There were no significant differences in satisfaction scores or in the occurrence of opioid-related side effects. Conclusion: The reduction of sufentanil consumption within the initial 24 hour after TKA demonstrates a beneficial effect of L3 PVB-RPCB over the FNB in providing the postoperative analgesia.