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Anesthesiology/Pain MedicineA Portrait, Porcelain Teeth, and a Pivotal Role
June 09, 2026: 145(1):181-181
Anesthesiology/Pain MedicineDeep versus Broad: Why Small-scale Qualitative Research Can and Should Inform Our Thinking
June 09, 2026: 145(1):4-5
Anesthesiology/Pain MedicineProtocolizing Propofol Emergence: Turning “Milk of Amnesia” into Designer Dreams?
June 09, 2026: 145(1):1-3- Anesthesiology/Pain Medicine
Instructions for Obtaining Anesthesiology Continuing Medical Education (CME) Credit
June 09, 2026: 145(1):A12-A12
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Anesthesiology/Pain Medicine2026 American Society of Anesthesiologists Practice Guideline on Perioperative Pain Management Using Local and Regional Analgesia for Cardiothoracic Surgeries, Mastectomy, and Abdominal Surgeries
Anesthesiology. December 09, 2025: 144(1):19-43This practice guideline addresses perioperative pain management using local and regional anesthesia for cardiothoracic, mastectomy, and abdominal surgery in adults and children. For adults, the American Society of Anesthesiologists (Schaumburg, Illinois) Task Force on Perioperative Pain Management strongly recommends fascial plane blocks to reduce pain and/or opioid requirements in the first 24 h postoperatively for open cardiothoracic, abdominal, retroperitoneal, and pelvic surgeries and mastectomy. Fascial plane blocks are also recommended in adults to reduce pain and/or opioid requirements after minimally invasive abdominal procedures. The Task Force conditionally recommends use of fascial plane blocks for minimally invasive cardiothoracic surgeries and open hernia repair to reduce pain in the first 24 h postoperatively. For children, the Task Force strongly recommends use of fascial plane blocks to reduce pain/and or opioid use after open cardiac or thoracic surgeries. Fascial plane blocks are conditionally recommended to reduce pain the first 24 h in children undergoing open hernia repair. Overall, data analysis for this practice guideline was limited by low methodologic quality, inconsistencies in outcome measurements, and small sample sizes from individual centers. Future research in regional anesthesia and analgesia needs to address these pervasive limitations.
Anesthesiology/Pain Medicine2022 American Society of Anesthesiologists Practice Guidelines for Management of the Difficult Airway*
Anesthesiology. November 11, 2021: 136(1):31-81The American Society of Anesthesiologists; All India Difficult Airway Association; European Airway Management Society; European Society of Anaesthesiology and Intensive Care; Italian Society of Anesthesiology, Analgesia, Resuscitation and Intensive Care; Learning, Teaching and Investigation Difficult Airway Group; Society for Airway Management; Society for Ambulatory Anesthesia; Society for Head and Neck Anesthesia; Society for Pediatric Anesthesia; Society of Critical Care Anesthesiologists; and the Trauma Anesthesiology Society present an updated report of the Practice Guidelines for Management of the Difficult Airway.
Anesthesiology/Pain MedicineLiposomal Bupivacaine, Plain Bupivacaine, and Saline for Transversus Abdominis Plane Blocks: The CLEVELAND Randomized Trial
Anesthesiology. December 01, 2025: 144(3):546-558Background:
Enhanced Recovery After Surgery pathways recommend transversus abdominis plane (TAP) blocks, but their efficacy is controversial and limited by the duration of local anesthetics. Liposomal bupivacaine is commonly used in single-injection TAP blocks to extend analgesia, although its effectiveness remains unclear. Therefore, two coprimary hypotheses were tested: first, that opioid consumption during the initial 24 postoperative hours is higher with saline than plain bupivacaine or liposomal bupivacaine; and second, that opioid consumption between 24 to 48 h after surgery is comparable or greater with saline or plain bupivacaine than with liposomal bupivacaine.
Methods:
Patients having major abdominal surgery (e.g., colorectal, gynecological, hernia repairs) were enrolled and randomly assigned 1:1:1 to bilateral four-quadrant TAP blocks with liposomal bupivacaine (40 ml plain bupivacaine 0.25% with 20 ml liposomal bupivacaine and 20 ml saline), plain bupivacaine (50 ml plain bupivacaine 0.5% with 30 ml normal saline), and placebo (80 ml normal saline). Patient-controlled intravenous opioids were used as needed. Patients, clinicians who adjusted opioid analgesia, ward nurses who evaluated pain scores, and study investigators who evaluated local anesthetic effects were blinded to treatment groups.
Results:
In the modified intention-to-treat cohort of 261 patients, opioid requirements during the first 24 h were median [interquartile range] 26 [18, 48] milligram morphine equivalents (MME) for liposomal bupivacaine (n = 89), 33 [13, 75] MME for plain bupivacaine (n = 84), and 31 [17, 53] MME for placebo (n = 88). The estimated ratio of geometric means was 0.86 (97.7% CI, 0.60 to 1.24; P = 0.355) between liposomal bupivacaine and placebo groups, and 0.91 (97.7% CI, 0.63 to 1.32; P = 0.578) between plain bupivacaine and placebo groups. Opioid requirements between 24 and 48 h were also comparable across groups. Secondary outcomes, including time to sensation return, pain scores, and opioid requirements from 48 to 72 h, were similar across all groups, with no significant differences observed.
Conclusions:
Single-shot, four-quadrant TAP blocks performed with liposomal bupivacaine, plain bupivacaine, or normal saline before incision for various open and laparoscopic abdominal procedures resulted in similar postoperative opioid consumption and pain scores at 24, 48, and 72 h. Absence of early benefit suggests that routine preincision, single-shot TAP blocks in this mixed surgical population provide little analgesia.
