A totally implantable venous access device (TIVAD) provides reliable, long-term vascular access and improves patients’ quality of life. The wide use of TIVADs is associated with important complications. A meta-analysis was undertaken to compare the internal jugular vein (IJV) with the subclavian vein (SCV) as the percutaneous access site for TIVAD to determine whether IJV has any advantages. All randomized controlled trials (RCTs) and cohort studies assessing the two access sites, IJV and SCV, were retrieved from PubMed, Web of Science, Embase, and OVID EMB Reviews from their inception to December 2015. Random-effects models were used in all analyses. The endpoints evaluated included TIVAD-related infections, catheter-related thrombotic complications, and major mechanical complications. Twelve studies including 3905 patients published between 2008 and 2015, were included. Our meta-analysis showed that incidences of TIVAD-related infections (odds ratio [OR] 0.71, 95 % confidence interval [CI] 0.48–1.04, P = 0.081) and catheter-related thrombotic complications (OR 0.76, 95 % CI 0.38–1.51, P = 0.433) were not significantly different between the two groups. However, compared with SCV, IJV was associated with reduced risks of total major mechanical complications (OR 0.38, 95 % CI 0.24–0.61, P < 0.001). More specifically, catheter dislocation (OR 0.43, 95 % CI 0.22–0.84, P = 0.013) and malfunction (OR 0.42, 95 % CI 0.28–0.62, P < 0.001) were more prevalent in the SCV than in the IJV group; however, the risk of catheter fracture (OR 0.47, 95 % CI 0.21–1.05, P = 0.065) were not significantly different between the two groups. Sensitivity analyses using fixed-effects models showed a decreased risk of catheter fracture in the IJV group. The IJV seems to be a safer alternative to the SCV with lower risks of total major mechanical complications, catheter dislocation, and malfunction. However, a large-scale and well-designed RCT comparing the complications of each access site is warranted before the IJV site can be unequivocally recommended as a first choice for percutaneous implantation of a TIVAD.

Background: Postoperative pain in thoracic surgery often requires opioids, yet can be poorly managed with short‐acting anesthetics. Liposomal bupivacaine (LB) offers prolonged analgesia, potentially improving pain control and reducing opioid use. This study evaluates LB’s effectiveness and safety in thoracic postoperative pain management, aiming to provide an alternative to current practices. Methods: In this single‐center, double‐blind, prospective, randomized controlled trial, patients undergoing uniportal lobectomy, segmentectomy, or wedge resection from November 2023 to May 2024 were enrolled. Participants were randomly assigned in a 1:1 ratio to receive either 0.375% ropivacaine (control group, n = 57) or LB (LB group, n = 56) for intercostal nerve blocks (ICNBs). Postoperative visual analog scale (VAS) scores, opioid consumption, overall benefit of analgesia score (OBAS), chest tube duration, length of hospital stay, and adverse events (AEs) were recorded and analyzed. Results: Data from 57 patients in the control group and 56 patients in the LB group were included in the analysis, with no significant demographic differences between the groups. The LB group demonstrated lower VAS scores at rest and during activity ( p > 0.05), reduced opioid consumption ( p = 0.021), and higher OBAS ( p < 0.01) compared with the control group. No significant differences were observed in chest tube duration, length of hospital stay, or AEs between the groups. Conclusion: LB is safe and effective for ICNB, providing significant postoperative pain relief for patients undergoing uniportal thoracoscopic surgery. Trial Registration: Chinese Registry of Clinical Trials: chiCTR2300075463

Mochi Guo, Zongming Jiang, Yonghao Chen, Fei Wang, and Zhifeng Wang. Korean J Pain 2021;34:176-84. https://doi.org/10.3344/kjp.2021.34.2.176

Blood pressure (BP) is a basic determinant for organ blood flow supply. Insufficient blood supply will cause tissue hypoxia, provoke cellular oxidative stress, and to some extent lead to organ injury. Perioperative BP is labile and dynamic, and intraoperative hypotension is common. It is unclear whether there is a causal relationship between intraoperative hypotension and organ injury. However, hypotension surely compromises perfusion and causes harm to some extent. Because the harm threshold remains unknown, various guidelines for intraoperative BP management have been proposed. With the pending definitions from robust randomized trials, it is reasonable to consider observational analyses suggesting that mean arterial pressures below 65 mmHg sustained for more than 15 minutes are associated with myocardial and renal injury. Advances in machine learning and artificial intelligence may facilitate the management of hemodynamics globally, including fluid administration, rather than BP alone. The previous mounting studies concentrated on associations between BP targets and adverse complications, whereas few studies were concerned about how to treat and multiple factors for decision‐making. Hence, in this narrative review, we discussed the way of BP measurement and current knowledge about baseline BP extracting for surgical patients, highlighted the decision‐making process for BP management with a view to providing pragmatic guidance for BP treatment in the clinical settings, and evaluated the merits of an automated blood control system in predicting hypotension.