Lucas Ferreira Gomes Pereira

Background: Non‐pharmacological interventions are essential to reduce procedural anxiety in pediatric care. Fidget and sensory toys are widely used for distraction and self‐regulation, yet evidence on their effectiveness remains fragmented. This scoping review mapped the evidence on fidget and sensory toys across general pediatric settings, with a focus on perioperative outcomes—such as anxiety, distress, and pain—to highlight relevant gaps in care. Methods: This scoping review followed the Joanna Briggs Institute (JBI) methodology and the PRISMA‐ScR guidelines. Searches were conducted in MEDLINE/PubMed, EMBASE, Scopus, Web of Science, and Cochrane CENTRAL, complemented by trial registries, gray literature, citation tracking, and reference screening. Studies involving children (0–18 years) evaluating fidget or sensory toys in any setting were eligible. Two independent reviewers performed study selection and data extraction. Findings: Fifteen studies published between 2017 and 2026 met the inclusion criteria. Fidget spinners were the most frequently investigated device ( n = 9), followed by stress balls ( n = 3). Studies were conducted in educational ( n = 8) and healthcare settings ( n = 7). Educational studies generally reported limited or no benefits for attention, engagement, behavior, or academic performance. In contrast, healthcare studies generally suggested reductions in anxiety, pain, fear, and procedural distress, although findings were heterogeneous, and outcome measures varied substantially. Conclusions: Current evidence does not support the routine use of fidget toys to improve attention or academic performance in educational settings. Evidence from healthcare and procedural settings suggests that fidget and sensory toys may be feasible distraction tools for selected pediatric patients, but evidence is insufficient to support routine perioperative use. Further high‐quality randomized controlled trials are needed to establish standardized intervention protocols and identify the pediatric populations and clinical settings most likely to benefit.

Objective: We aimed to evaluate whether deep neuromuscular blockade (DNMB) improves surgical conditions and facilitates low-pressure pneumoperitoneum compared with moderate neuromuscular blockade (MNMB) during minimally invasive surgery. Data Sources: PubMed/MEDLINE, EMBASE, Cochrane CENTRAL, Scopus, Web of Science, and LILACS were searched from inception through May 2026. Study Selection: Randomized controlled trials comparing DNMB versus MNMB in adults undergoing laparoscopic or robot-assisted surgery were included. Data Extraction: Two reviewers independently screened studies, extracted data, and assessed risk of bias using the revised Cochrane Risk of Bias tool (RoB 2). Certainty of evidence was evaluated using the GRADE approach. Primary Outcomes: Primary outcomes were surgical workspace quality and intra-abdominal pressure requirements. Secondary Outcomes: Secondary outcomes included postoperative abdominal pain at 24 h and referred shoulder pain. Data Synthesis: Seventeen randomized controlled trials involving 1512 patients were included. DNMB consistently improved surgical workspace conditions and facilitated lower pneumoperitoneum pressures compared with MNMB. Pooled analyses additionally suggested reductions in postoperative abdominal pain and referred shoulder pain in selected studies, although postoperative outcomes demonstrated greater heterogeneity across procedures and perioperative protocols. Conclusions: Current evidence suggests that the principal clinical value of DNMB during minimally invasive surgery is optimization of surgical exposure and facilitation of low-pressure pneumoperitoneum strategies. Benefits related to postoperative abdominal pain may occur in selected settings but appear less consistent across procedures.

Objective: To evaluate whether deep neuromuscular blockade (DNMB) improves surgical conditions and facilitates low-pressure pneumoperitoneum compared with moderate neuromuscular blockade (MNMB) during minimally invasive surgery. Data Sources PubMed/MEDLINE, EMBASE, Cochrane CENTRAL, Scopus, Web of Science, and LILACS were searched from inception through May 2026. Study Selection Randomized controlled trials comparing DNMB versus MNMB in adults undergoing laparoscopic or robot-assisted surgery were included. Data Extraction Two reviewers independently screened studies, extracted data, and assessed risk of bias using the revised Cochrane Risk of Bias tool (RoB 2). Certainty of evidence was evaluated using the GRADE approach. Primary Outcomes: Primary outcomes were surgical workspace quality and intra-abdominal pressure requirements. Secondary Outcomes: Secondary outcomes included postoperative pain at 24 hours and referred shoulder pain. Data Synthesis: Seventeen randomized controlled trials involving more than 1700 patients were included. DNMB consistently improved surgical workspace conditions and facilitated lower pneumoperitoneum pressures compared with MNMB. Pooled analyses additionally suggested reductions in postoperative pain and referred shoulder pain in selected studies, although postoperative outcomes demonstrated greater heterogeneity across procedures and perioperative protocols. Conclusions: Current evidence suggests that the principal clinical value of DNMB during minimally invasive surgery is optimization of surgical exposure and facilitation of low-pressure pneumoperitoneum strategies. Benefits related to postoperative pain may occur in selected settings but appear less consistent across procedures.

Background: Enhanced Recovery After Surgery (ERAS) programs are increasingly recognized as effective pathways to improve perioperative outcomes, yet their implementation across Latin America and the Caribbean remains poorly mapped. Understanding current strategies, clinical results, and economic implications is essential to identify regional gaps and guide evidence‐based surgical improvement. Methods: This scoping review followed Joanna Briggs Institute (JBI) methodology and PRISMA‐ScR reporting guidelines. Searches were conducted in MEDLINE/PubMed, Web of Science, LILACS, and CENTRAL, complemented by gray literature and reference screening. Eligible studies were investigations evaluating perioperative optimization interventions in any surgical population within Latin America and the Caribbean. Data extraction included study characteristics, ERAS components, implementation strategies, clinical outcomes, and economic impact. Results: Forty‐five studies published between 2006 and 2025 were included, predominantly from Brazil ( n = 28), Mexico ( n = 9), Argentina ( n = 4), and Chile ( n = 3). Most studies implemented multimodal perioperative pathways, with the most frequent ERAS strategies being preoperative fasting abbreviation ( n = 26), early refeeding ( n = 22), early mobilization ( n = 22), opioid‐sparing anesthesia ( n = 19), preoperative education ( n = 16), and restrictive intravenous fluids ( n = 16). Clinical outcomes consistently demonstrated reductions in postoperative length of stay and complications. Only five studies reported economic data, all focused on hospital‐level costs, showing decreased expenditures primarily driven by shorter hospitalization. Conclusions: ERAS initiatives are increasing across Latin America and the Caribbean, with evidence suggesting reductions in hospital stay and costs. Nevertheless, adoption remains uneven and concentrated in a few countries. Expanding implementation will require addressing structural disparities and generating stronger economic and implementation‐focused evidence to support broader regional uptake.

Background: Opioid‐free anesthesia (OFA) has been proposed as a strategy to reduce opioid exposure and opioid‐related adverse events in laparoscopic surgery. However, evidence from randomized trials remains heterogeneous regarding pain control, postoperative nausea and vomiting (PONV), and opioid consumption. Methods: We performed a systematic review and meta‐analysis of randomized controlled trials (RCTs) comparing OFA with opioid‐based anesthesia (OBA) in adult patients undergoing elective laparoscopic surgery. Primary outcomes included postoperative pain scores (0–10 scale), PONV, and 24‐h opioid consumption. Secondary outcomes included hemodynamic events, recovery quality, and hospital length of stay. Results: Sixteen RCTs ( n = 1322) were included. OFA reduced PONV by approximately 40% (RR 0.60; 95% confidence interval [CI] 0.48–0.75) and modestly decreased postoperative opioid use by 6.4 mg morphine equivalents (95% CI −9.1 to −3.7). Pain scores during the first 24 h were similar between OFA and OBA (MD −0.3 on a 0–10 scale; 95% CI −0.7 to +0.1). Hemodynamic instability (bradycardia and hypotension) occurred more frequently with dexmedetomidine‐based regimens but was transient and clinically manageable. No differences were observed in recovery time or hospital length of stay. Conclusion: OFA provides clinically meaningful reductions in PONV and opioid exposure without compromising postoperative analgesia. These findings support OFA as a safe and effective alternative to OBA in laparoscopic surgery and a potential component of enhanced recovery pathways.

Introduction: The relationship between the Enhanced Recovery After Surgery (ERAS) guidelines and inflammatory markers in laparoscopic surgery has garnered increasing attention. These recommendations are designed to minimize surgical stress and potentially improve recovery outcomes by modifying perioperative care. Objective: This scoping review aims to evaluate the impact of ERAS recommendations on inflammatory markers in patients undergoing laparoscopic surgeries, identifying current research gaps and consolidating findings from existing studies. Methods: Guided by the Cochrane Handbook for Systematic Reviews and adhering to the PRISMA-ScR guidelines, this review analyzed studies from databases like PubMed, Scopus, and Cochrane Library. We included both randomized controlled trials and observational studies that assessed inflammatory markers such as C-reactive protein (CRP), white blood cells (WBC), and Interleukin-6 (IL-6) in laparoscopic surgery patients managed with ERAS recommendations. Results: Out of 64 initial studies, 7 met the inclusion criteria, involving a total of 2,047 patients. Most of the studies focused on laparoscopic colorectal surgeries. Commonly assessed markers were CRP and WBC. The findings consistently showed that ERAS guideline could mitigate the inflammatory response, evidenced by reduced levels of CRP and IL-6, which correlated with fewer postoperative complications and expedited recovery. Conclusion: ERAS recommendations appear to beneficially modulate inflammatory responses in laparoscopic surgery, which suggests a potential for enhanced recovery outcomes. However, the evidence is currently limited by the small number of studies and inherent methodological biases. Further robust RCTs are required to strengthen the evidence base and refine these protocols for broader clinical application.

Objective: to study the effectiveness of type II pectoral nerve block (PEC II) for breast augmentation with submuscular implants by assessing opioid consumption and pain scale in the immediate postoperative period, from the post-anesthesia care unit (PACU) to 24 h postoperatively. Methods: A prospective, controlled, randomized, and double-blind study. Thirty-four patients were analyzed during the perioperative period and in the PACU, with one group receiving bilateral PEC II combined with general anesthesia and the control group receiving only general anesthesia. Results: There was no difference between the groups regarding demographic data, surgical and anesthetic times, or intraoperative opioid use. Opioid consumption in the control group was consistently higher at all the time intervals studied, with an average morphine consumption 38.7% greater. The largest variation in morphine consumption occurred at the fourth and sixth hours postoperatively. The greatest difference in postoperative pain was 36% higher in the control group compared to the intervention group. Conclusions: patients who underwent general anesthesia combined with PEC II had lower opioid consumption and a lower postoperative pain score without associated complications, confirming the effectiveness of the procedure.

Background: Pediatric regional anesthesia has been driven by the gradual rise in the adoption of opioid-sparing strategies and the growing concern over the possible adverse effects of general anesthetics on neurodevelopment. Nonetheless, performing regional anesthesia studies in a pediatric population is challenging and accounts for the scarce evidence. This study aimed to review the scientific foundation of studies in cadavers to assess regional anesthesia techniques in children. Methods: We searched the following databases MEDLINE, EMBASE, and Web of Science. We included anatomical cadaver studies assessing peripheral nerve blocks in children. The core data collected from studies were included in tables and comprised block type, block evaluation, results, and conclusion. Results: The search identified 2409 studies, of which, 16 were anatomical studies on the pediatric population. The techniques evaluated were the erector spinae plane block, ilioinguinal/iliohypogastric nerve block, sciatic nerve block, maxillary nerve block, paravertebral block, femoral nerve block, radial nerve block, greater occipital nerve block, infraclavicular brachial plexus block, and infraorbital nerve block. Conclusion: Regional anesthesia techniques are commonly performed in children, but the lack of anatomical studies may result in reservations regarding the dispersion and absorption of local anesthetics. Further anatomical research on pediatric regional anesthesia may guide the practice.

Purpose: Ketamine is a N-methyl-D-aspartate (NMDA) antagonist with strong analgesic properties. Its addition to the treatment of neuropathic pain may reduce pain intensity and improve overall quality of life. A systematic review and meta-analysis of randomized controlled trials was performed to investigate the addition of ketamine to the treatment of patients with neuropathic pain. Patients and Methods: GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach was used to rate the overall certainty of the evidence for each outcome. Eighteen (18) randomized controlled trials including 706 participants were included for further analysis. Results: Ketamine addition to standard treatment of neuropathic pain (NP) resulted in a statistically significant reduction of pain intensity at one week after the end of treatment with ketamine (MD − 2.14, 95% CI − 2.65 to − 1.63; p< 0.00001) and after 30 days after the end of treatment with ketamine (MD − 1.68, 95% CI − 2.25 to − 1.12; p< 0.00001) and a statistically significant increase in discomfort (RR 4.06; 95% CI 1.18 to 13.95; p=0.03), and psychedelic effects (RR 4.94; 95% CI 2.76 to 8.84; p< 0.00001). Conclusion: There is a statistically significant pain reduction by adding ketamine to the treatment of chronic NP when compared to the standard treatment. However, such pain reduction comes at the expense of adverse outcomes, especially psychedelic effects related to the administration of ketamine. However, the overall quality of certainty of evidence is low due to the clinical heterogeneity among the intervention characteristics of the trials analyzed (different administration routes, dosing regimen, therapy durations, different clinical characteristics of the population investigated). Future large multi-centered trials are necessary to confirm or not the results of the present review.

A psoríase é uma doença sistêmica e inflamatória que apresenta evolução de intensidades variadas, relaciona-se a um grande impacto físico e psicológico. Nos casos moderados a graves da enfermidade, o uso de imunobiológicos é a terapêutica de escolha uma vez que o tratamento tradicional não apresente resultados satisfatórios. No entanto, como o emprego destes medicamentos é relativamente recente nesta doença, devido aos efeitos colaterais ainda não totalmente esclarecidos e custo elevado, seu uso é recomendado por especialistas com cautela. Com o objetivo de estudar os efeitos adversos dos imunobiológicos (Etanercepte, Adalimumabe, Infliximabe, Efalizumabe e Ustekinumabe) foi realizada uma revisão integrativa da literatura, na qual foram selecionados, após a adequação aos critérios de inclusão e exclusão, 5 dos 66 artigos obtidos. Após a análise dos dados, concluiu-se que, ela deve ser usada com cautela e seguindo os protocolos nacionais e internacionais, devido a grande variedade de efeitos adversos encontrados.