There is significant controversy regarding the influence of video laryngoscopy on the intubation outcomes in emergency and critical patients. This systematic review and meta-analysis was designed to determine whether video laryngoscopy could improve the intubation outcomes in emergency and critical patients. We searched the Cochrane Central Register of Controlled Trials, PubMed, Embase, and Scopus databases from database inception until 15 February 2017. Only randomized controlled trials comparing video and direct laryngoscopy for tracheal intubation in emergency department, intensive care unit, and prehospital settings were selected. The primary outcome was the first-attempt success rate. Review Manager 5.3 software was used to perform the pooled analysis and assess the risk of bias for each eligible study. The GRADE (Grading of Recommendations Assessment, Development and Evaluation) system was used to assess the quality of evidence for all outcomes. Twelve studies (2583 patients) were included in the review for data extraction. Pooled analysis did not show an improved first-attempt success rate using video laryngoscopy (relative risk [RR], 0.93; P = 0.28; low-quality evidence). There was significant heterogeneity among studies (I 2 = 91%). Subgroup analyses showed that, in the prehospital setting, video laryngoscopy decreased the first-attempt success rate (RR, 0.57; P < 0.01; high-quality evidence) and overall success rate (RR, 0.58; 95% CI, 0.48–0.69; moderate-quality evidence) by experienced operators, whereas in the in-hospital setting, no significant difference between two devices was identified for the first-attempt success rate (RR, 1.06; P = 0.14; moderate-quality evidence), regardless of the experience of the operators or the types of video laryngoscopes used (P > 0.05), although a slightly higher overall success rate was shown (RR, 1.11; P = 0.03; moderate-quality evidence). There were no differences between devices for other outcomes (P > 0.05), except for a lower rate of esophageal intubation (P = 0.01) and a higher rate of Cormack and Lehane grade 1 (P < 0.01) when using video laryngoscopy. On the basis of the results of this study, we conclude that, compared with direct laryngoscopy, video laryngoscopy does not improve intubation outcomes in emergency and critical patients. Prehospital intubation is even worsened by use of video laryngoscopy when performed by experienced operators.

The posterior cervical area exhibits a complex anatomy comprising fascia, nerves, and muscles. With the widespread adoption of ultrasound in regional anesthesia, numerous posterior cervical interfascial plane block techniques have been developed in recent years. The injectate spreads along the fascial plane, blocking nerves that traverse the interfascial space after being injected into the target plane. The posterior cervical interfascial blocks have been manifesting the great potential for perioperative analgesia and chronic pain management in the head, neck, and shoulder regions. However, a comprehensive review of these methods as well as their indications, contraindications, and complications remain lacking. This article summarizes the anatomy of the posterior cervical musculofascial layers, highlighting the characteristics of interfascial plane block techniques and their potential limitations. By using the fascial anatomy as an entry point for studying interfascial plane blocks, it enhances our understanding of the mechanisms underlying the efficacy and complications of these block techniques. It not only reviews well-studied blocks such as trapezius plane (TP), multifidus cervicis plane (MCP), inter-semispinal plane (ISP), and erector spinae plane (ESP) block but also includes recently developed techniques from the past 5 years, such as the retrolaminar cervical block, serratus posterior superior intercostal plane (SPSIP) block, and C2 dorsal root ganglion (DRG) “three-in-one” block. The available evidence suggests that while posterior cervical interfascial plane blocks effectively target the dorsal rami of cervical nerves, non-posterior cervical block techniques also exhibit analgesic potential for the posterior cervical region. This review aims to provide insights for further exploration of novel approaches in this emerging field. In conclusion, posterior cervical interfascial plane blocks demonstrate significant clinical value and warrant further development and optimization.

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.

Introduction: Laparoscopic donor nephrectomy (LDN) is the standard procedure for donor nephrectomy for living kidney transplantation. Compared with traditional open surgery, the laparoscopic techniques have been developed to significantly reduce postoperative pain and accelerate postoperative recovery; however, most donors still experience more than moderate pain after surgery. Ensuring maximum perioperative safety and postoperative pain control for donors remains a top priority for LDN. Our group reported a novel blockade technique that allows local anesthetic to be injected directly to reach the low thoracic paravertebral space under direct laparoscopic observation via the arcuate ligament to achieve somatic and visceral pain analgesia; this technique has been successfully applied to patients undergoing retroperitoneal laparoscopic nephrectomy. We hypothesized that compared with the transversus abdominis plane (TAP) block, low thoracic paravertebral block (TPVB) via the arcuate ligament under direct vision would reduce the consumption of postoperative opioids and improve the quality of postoperative recovery of donors after LDN. Methods/Analysis: This study is a prospective blind, randomized, controlled clinical trial with a concealed allocation of donors scheduled to undergo elective LDN 1:1 to receive either a low TPVB via the arcuate ligament under direct vision or a TAP block. This study will recruit a total of 82 living kidney donors. The primary outcome is the 15-item recovery quality scale (QoR-15) score at 24 hours after surgery. Ethics and Dissemination: This trial was approved by the Ethics Committee of Beijing Friendship Hospital, Capital Medical University. This trial study protocol was approved on 30 November 2024. The trial started recruiting patients after being registered on the Chinese Clinical Trial Registry. Trial Registration Number: ChiCTR2400094612.

Introduction: While laparoscopic radical distal gastrectomy (LRDG) has been widely adopted for its minimally invasive benefits in the treatment of gastric cancer, acute postoperative pain, comprising both somatic incisional pain and visceral discomfort, remains a clinical challenge that can affect patients’ perioperative comfort and the rehabilitation process. Consequently, optimizing postoperative analgesic strategies remains essential for enhanced recovery. The modified thoracoabdominal nerves block through a perichondrial approach (M-TAPA) has been introduced as an emerging regional analgesic technique for upper abdominal incisions. In the regard of effective management of visceral pain, oxycodone is a unique agonist at κ-opioid receptors and potentially influences inhibiting visceral nociceptive transmission better than sufentanil. Therefore, this study aims to evaluate whether the combination of M-TAPA with oxycodone-based patient-controlled intravenous analgesia (PCIA) is more effective to provide analgesia efficacy and facilitate gastrointestinal recovery compared to a sufentanil-based analgesic regimen. Methods/Analysis: This single-center, prospective, double-blind, randomized controlled trial will enroll 96 patients scheduled for elective laparoscopic radical distal gastrectomy. Eligible patients will be randomly assigned at a 1:1 ratio to receive either Oxycodone PCIA (Group O) or Sufentanil PCIA (Group S). Both groups will receive bilateral ultrasound-guided M-TAPA before surgical incision. The primary outcome is the Quality of Recovery-15 (QoR-15) score assessed at 24 hours postoperatively. Secondary outcomes include static and dynamic numeric rating scale (NRS) pain scores, cumulative opioid consumption (converted to intravenous morphine equivalents), clinical recovery milestones, and the incidence of adverse events such as postoperative nausea and vomiting (PONV) and respiratory depression. Ethics and Dissemination: This trial was approved by the Ethics Committee of Beijing Friendship Hospital, Capital Medical University on August 28, 2025. The trial started recruiting patients after being registered on the Chinese Clinical Trial Registry. Trial Registration Number: ChiCTR2600119394.