Han-Yu Lin

Background and Objectives: Optimal pain control after radius fracture surgery is critical for recovery and reducing opioid exposure. While brachial plexus block (BPB) offers analgesic benefits, its additive effect alongside general anesthesia remains underexplored. Materials and Methods: We conducted a retrospective cohort study of adults undergoing open reduction and internal fixation for radius fractures under general anesthesia between July 2020 and September 2025. Patients receiving preoperative ultrasound-guided BPB were matched 1:1 to those without BPB using propensity score matching. Pain scores, hemodynamic changes, and anesthesia-to-incision time were compared using paired t-tests or Wilcoxon signed-rank tests. Perioperative opioid consumption and breakthrough morphine use were analyzed using conditional logistic regression, Kaplan–Meier survival analysis, and stratified Cox regression. Results: Among 707 eligible patients, 205 who received BPB were matched to 205 controls. In the matched cohort (n = 410), BPB was associated with lower intraoperative fentanyl use [16.1% vs. 43.4%; odds ratio (OR) = 0.23; 95% confidence interval (CI): 0.13–0.40; p < 0.001], reduced rescue analgesic use in the postanesthesia care unit (10.2% vs. 53.2%; OR = 0.06; 95% CI: 0.03–0.16; p < 0.001), and decreased total opioid use (mean morphine milligram equivalents: 2.3 ± 3.4 vs. 6.7 ± 5.6; p < 0.001). Pain scores were lower (visual analogue scale: 2.9 ± 1.4 vs. 3.9 ± 1.9; p < 0.001). Breakthrough morphine use was delayed and less frequent in the BPB group (19.0% vs. 28.3%; hazard ratio = 0.47; 95% CI: 0.29–0.78; p = 0.003). BPB attenuated hemodynamic responses (mean arterial pressure area under curve: 707.2 ± 512.5 vs. 979.3 ± 636.5; p < 0.001). Conclusions: Preoperative BPB improves perioperative analgesia, lowers opioid use, and stabilizes hemodynamics in radius fracture surgery.

Neurogenic detrusor overactivity (NDO) is a complex condition associated with detrusor overactivity, reduced bladder compliance, and high intravesical pressures, potentially leading to urinary tract infections (UTIs) and renal impairment. This retrospective study evaluated the safety and potential efficacy of intravesical botulinum toxin A (BoNT/A) injections in children with NDO at a single institution. Eighteen pediatric patients (median age: 8.1 years) were followed for a median of 6.3 years. At follow-up, 77.8% achieved a global response assessment (GRA) score of ≥2. A statistically significant improvement was found in cystometric bladder capacity (p = 0.041), but it did not remain significant after Bonferroni correction, while other urodynamic trends were not statistically significant. Adverse events were infrequent, with only 11.8% experiencing mild febrile UTIs. While some patients with poorer baseline bladder conditions reported greater subjective improvement, no statistically significant predictors of success were identified. Overall, intravesical BoNT/A injection appears to be a safe and potentially effective option for managing pediatric NDO, though larger prospective studies are needed to confirm these findings.

The inferior vena cava distensibility index (dIVC) has been proposed as an alternative dynamic parameter for predicting fluid responsiveness (FR) in mechanically ventilated patients. This study explored the correlation between dIVC and commonly used FR indicators in patients undergoing robotic‐assisted off‐pump coronary artery bypass (OPCAB) surgery. Thirty‐two patients were prospectively enrolled, and hemodynamic parameters, including stroke volume variation (SVV), pulse pressure variation (PPV), central venous pressure (CVP), pulmonary capillary wedge pressure (PCWP), and the right ventricular end‐diastolic volume index (RVEDVI), were recorded at four intraoperative time points. These time points were selected to represent distinct physiological phases during surgery: two‐lung ventilation (TLV), one‐lung ventilation (OLV), capnothorax, and mini‐thoracotomy. dIVC showed a weak but significant positive correlation with SVV ( r = 0.28, p < 0.001) and PPV ( r = 0.28, p < 0.001), whereas no significant correlation was observed with static preload indicators (CVP, PCWP, and RVEDVI). Given that transesophageal echocardiography (TEE) is routinely employed in OPCAB surgery, dIVC measured via TEE may serve as a valuable adjunct for FR assessment when the SVV and PPV are unreliable, such as in patients with irregular heartbeats. However, using dIVC to predict intraoperative FR should be approached with caution, considering factors such as ventilator settings, inspiratory efforts, cardiopulmonary conditions, and intraabdominal hypertension.

The pulmonary artery catheter (PAC)—despite its invasiveness—remains the gold standard for cardiac output (CO) monitoring. The FloTrac system, a less invasive hemodynamic monitor has been developed, which estimates CO using arterial pressure waveform analysis without external calibration. Recently, an upgraded version of FloTrac system with improved algorithm to follow changes in vascular resistance was introduced into the market. The aim of this study was to assess the reliability of the CO estimated from the fourth-generation FloTrac/EV1000 system (CO_FT) compared to that measured with PAC using the thermodilution method (CO_PAC) during robotic-assisted off-pump coronary artery bypass (OPCAB) surgery. CO_FT and CO_PAC were obtained simultaneously at 4 predefined time points during robotic-assisted OPCAB: 5 min after the induction of general anesthesia (T1), after starting one-lung ventilation (T2), after capnothorax (T3), and after mini-thoracotomy was performed (T4). The agreement of data was investigated by Bland–Altman analysis. Thirty-four patients were initially enrolled. After exclusion, 32 patients and a total of 128 paired CO measurements were obtained. The overall bias was 1.46 L/min, the 95% limits of agreements were − 3.40 to 6.33 L/min, and the percentage error was 72.98%. Regression analysis of the systemic vascular resistance index (SVRI) and the bias between CO_PAC and CO_FT showed that the bias was moderately correlated with the SVRI (r² = 0.43; p < 0.0001). Despite a software upgrade, the reliability of the fourth-generation FloTrac/EV1000™ system during robotic-assisted OPCAB to estimate CO was not acceptable, especially in patients with low SVRI.

Intraocular pressure (IOP) is crucial to the well-being of eyes. During anesthesia, the administration of succinylcholine and endotracheal intubation are associated with an increase in IOP, which may be attenuated by short-acting opioids. However, the drug of choice among the commonly used short-acting opioids is unclear. This study aimed to evaluate the effects of fentanyl, sufentanil, alfentanil, and remifentanil on IOP measured after the administration of succinylcholine and after endotracheal intubation in patients undergoing general anesthesia. Five databases were searched. Randomized controlled trials (RCTs) that compared short-acting opioids and reported at least one of the clinical outcomes of interest were included. Nine RCTs with 357 patients were included. Remifentanil (1 μg kg⁻¹) more effectively alleviated the increase in IOP than the placebo after the administration of succinylcholine [mean difference (MD) of IOP, −3.64; confidence interval (CI), −5.47 to −1.81 and after endotracheal intubation (MD, −9.71; CI, −11.91 to −7.51). Remifentanil (1 μg kg⁻¹) ranked the best in terms of both attenuating the increase in IOP after the administration of succinylcholine [surface under the cumulative ranking curve (SUCRA), 0.91; normalized entropy (NE), 0.47; and after endotracheal intubation (SUCRA, 0.89; NE, 0.54) among all of the treatments. Remifentanil (1 μg kg⁻¹) should be considered the drug of choice in the circumstances where increased IOP is a great concern.

With the development of medical equipment and techniques in labor anesthesia, it is a major issue to investigate the risks and treatment effects among techniques such as continuous epidural infusion (CEI) and intermittent epidural bolus (IEB). However, there is a controversial result regarding two techniques. This study was conducted through meta-analysis of randomized controlled trials (RCTs) for labor analgesia between the CEI and IEB techniques. The pooled results were presented as weighted mean differences (WMDs) together with 95% confidence intervals (CIs) and odds ratios (ORs) together with 95% CIs, respectively. Eleven RCTs were included in this meta-analysis. Four hundred sixty-five parturients accepted CEI, whereas 473 parturients accepted IEB labor analgesia. Elven identified low- risk bias studies were recruited for meta-analysis. The results presented no statistical difference in cesarean delivery rate between IEB and CEI (OR, 0.96; 95% CI, 0.67–1.37) and duration of second stage of labor (WMD, −3.82 min; 95% CI, −8.28 to 0.64). IEB had statistically significant lessened risk of instrumental delivery (OR, 0.59; 95% CI, 0.39–0.90) and for the use in local anesthetic (WMD, −1.71 mg bupivacaine equivalents per hour; 95% CI, −1.88 and −1.55). Accepted IEB had a higher score of maternal satisfaction (WMD, −6.95 mm; 95% CI, −7.77 to −6.13). Based on evidence, IEB showed a greater benefit for slightly reducing the use in local anesthetic, reduced risk of instrumental delivery, and improved maternal satisfaction for the requirement of labor epidural analgesia for healthy women. In the future, more studies need to be conducted to practice the IEB regimen and explore its influence on labor analgesia.

Vasculitic peripheral neuropathy (VPN) is characterized by acute-to-subacute onset of painful sensory and motor disturbances that result from inflammatory obliteration of nerve blood vessels and subsequent ischaemic injury. Endoplasmic reticulum (ER) stress has been implicated in the pathogenesis of various peripheral neuropathies, and 4-phenylbutyric acid (4-PBA) is a chemical chaperone that inhibits ER stress signaling. We investigated the effects of 4-PBA on neuropathic pain associated with VPN induced by ischaemia–reperfusion (IR) and its underlying mechanisms. Male Sprague-Dawley rats were allocated to one of the following groups: sham, sham + 4-PBA, IR, and IR + 4-PBA. IR was achieved by occluding the femoral artery for 4 h followed by reperfusion. The behavioral parameters were assessed, and the expression of ER stress markers and nuclear factor (NF)-κB in sciatic nerves was measured. The behavioral data confirmed that VPN induced by IR leads to hindpaw mechano-allodynia and heat hyperalgesia as well as impaired hindpaw grip strength, indicating the development of neuropathic pain and debilitating symptoms of VPN. The molecular data revealed that VPN induced by IR activated ER stress sensors and effector molecules as well as NF-κB in the sciatic nerves, indicating the involvement of ER stress and NF-κB-mediated neuroinflammation. Notably, 4-PBA significantly reduced the expression of all these markers and improved all behavioral changes induced by IR. This study demonstrated that ER stress and NF-κB-mediated neuroinflammation contribute to VPN induced by IR and that 4-PBA has protective potential against neuropathic pain associated with VPN.

Vasculitic peripheral neuropathy (VPN) arises from an inflammatory obstruction in the blood vessels supplying peripheral nerves and subsequent ischaemic insults, which exhibits the clinical features of neuropathic pain and impaired peripheral nerve function. VPN induced by ischaemia–reperfusion (IR) has been reported to involve nuclear factor‐κB (NF‐κB)‐mediated neuroinflammation. Recent studies have suggested that endoplasmic reticulum (ER) stress has been implicated in the development of peripheral neuropathies. Resveratrol possesses a potent anti‐inflammatory capacity. We hypothesized that resveratrol may exert a protective effect against VPN through modulating the interrelated ER stress and NF‐κB pathways. Male Sprague‐Dawley rats were allocated into five groups: sham, sham + resveratrol 40 mg/kg (R40), IR, IR + R20 and IR + R40. VPN was induced by occluding the right femoral artery for 4 hours followed by reperfusion. Our data have shown that VPN induced by IR led to hind paw mechanical allodynia, heat hyperalgaesia, and impaired motor nerve conduction velocity (MNCV). With resveratrol intervention, the behavioural parameters were improved in a dose‐dependent manner and the MNCV levels were increased as well. The molecular data revealed that VPN induced by IR significantly increased the expression of NF‐κB as well as the ER stress sensor proteins, protein kinase RNA‐like endoplasmic reticulum kinase, inositol‐requiring enzyme 1 and activating transcription factor 6 in the sciatic nerves. More importantly, resveratrol significantly attenuated the expression of NF‐κB and the ER stress sensor proteins after IR. In conclusion, resveratrol alleviates VPN induced by IR. The mechanisms may involve modulating NF‐κB‐mediated neuroinflammation via suppressing ER stress.