Objectives: This study aimed to investigate the effectiveness of transcutaneous auricular vagal nerve stimulation (taVNS) in alleviating postoperative pain following thoracoscopic lobectomy. Methods: In this randomized controlled trial, 70 adult patients were randomly assigned in a 1:1 ratio to receive either active or sham taVNS. Stimulation was initiated in the preoperative room, maintained throughout surgery, and discontinued after extubation in the post-anesthesia care unit, at which point the device was removed. Additional 2-hour sessions were conducted each morning on postoperative days 1 and 2. Patient-controlled intravenous analgesia and serratus anterior plane block were provided to all the patients. The primary outcome was sufentanil consumption during the first 24 hours after surgery. Results: A total of 67 participants completed the study. Sufentanil consumption showed no statistically significant difference between the active group (33 ± 13 μg) and the sham group (32 ± 9 μg) (mean difference=1.20, 95% confidence interval=−4.23 to 6.63, P-value=0.661). Compared to the sham group, taVNS produced a statistically significant reduction in the numerical rating scale for resting pain (P-value=0.001) and deep breathing pain (P-value<0.001) postoperatively. taVNS also significantly reduced the incidence of rebound pain (58% vs. 18%; P-value=0.001) and chronic postsurgical pain at three months (27% vs. 6%; P-value=0.018). Discussion: taVNS did not reduce postoperative opioid consumption but alleviated acute postoperative pain, lowered the incidence of rebound pain and chronic postsurgical pain. These preliminary findings have uncertain clinical significance and require further investigation. Clinical Trial Registration: Chinese Clinical Trial Registry (ChiCTR2400081062).

Background: Postoperative atrial fibrillation (POAF) is a common complication after esophagectomy and is associated with adverse outcomes. This study investigated whether preoperative stellate ganglion block (SGB) could reduce the incidence of POAF and improve postoperative recovery. Methods: In this single-center, randomized, double-blind, placebo-controlled trial, 100 patients undergoing esophagectomy were randomly assigned to receive ultrasound-guided right-sided SGB with 7 mL of either 0.5% ropivacaine (SGB group) or normal saline (control group). The primary outcome was the incidence of POAF within 72 hours postoperatively. Secondary outcomes included the timing and duration of POAF, heart rate variability, other arrhythmias, sufentanil consumption, pain scores, vital signs, sleep quality, gastrointestinal recovery, length of hospital stay, complications and mortality. Results: The incidence of POAF was 10% in both groups (OR = 1.0, 95% CI: 0.27– 3.69, p > 0.99). However, patients in the SGB group experienced significantly fewer premature atrial contractions (97 vs 347; p = 0.038), lower pain scores (VAS at rest: B = – 0.60, p < 0.001; during movement: B = – 0.67, p < 0.001) and lower heart rate on postoperative day 1 (B = – 4.29, p = 0.026). Regarding gastrointestinal recovery, the SGB group showed significantly shorter times to first flatus (p = 0.001) and first semi-liquid intake (p = 0.027). Sleep disturbances were also less frequent in the SGB group (4% vs 21%, OR = 0.08, p = 0.039). No significant differences were observed between the groups in terms of length of hospital stay, incidence of postoperative complications or mortality. Conclusion: Although SGB did not reduce the incidence of POAF, it was associated with improved postoperative recovery. These findings suggest that SGB may serve as a beneficial adjunct to optimize recovery following esophagectomy.

Background/Objectives: Ropivacaine is primarily metabolized by the liver. High doses of ropivacaine, combined with altered pharmacokinetics due to hepatectomy, raise concerns about potential drug toxicity. We investigated the impact of LMH (laparoscopic major hepatectomy) on the pharmacokinetics of high-dose ropivacaine. Methods: Ten patients undergoing LMH received a BD-TAP (bilateral dual transversus abdominis plane) block with a high dose of ropivacaine (3 mg·kg⁻¹ in 60 mL). Plasma concentrations of total and free ropivacaine and AAG (alpha-1 acid glycoprotein) levels were measured. Liver volumes were calculated using three-dimensional liver reconstruction technology. Results: The peak total ropivacaine concentration occurred 45 min after the block, reaching 2031.5 (876.0) ng·mL⁻¹, with a tendency to exceed the toxicity threshold in patients with a CFLV (cut functional liver volume) exceeding 199.24 mL or a CFLV/TFLV (total functional liver volume) ratio surpassing 18.61%. The peak free ropivacaine concentration, 111.5 (31.3) ng·mL⁻¹, was observed 90 min after the block, potentially exceeding the toxicity threshold when CFLV exceeded 452.33 mL or the CFLV/TFLV ratio was greater than 42.16%. Plasma AAG levels increased approximately 1.5 times within 24 h, from 1519.7 (422.6) μg·mL⁻¹ preoperatively to 2253.6 (460.4) μg·mL⁻¹ postoperatively, effectively reducing the toxicity risk associated with free ropivacaine. Conclusions: Preoperative administration of high-dose ropivacaine can be safely utilized in patients undergoing major hepatectomy. The increased plasma AAG concentration due to surgical stress reduces free ropivacaine levels, enhancing patient tolerance to the drug. The CFLV and CFLV/TFLV ratio may be supplementary indicators for predicting ropivacaine toxicity.

Background: Stellate ganglion block (SGB) may reduce postoperative atrial fibrillation (POAF) by modulating the autonomic nervous system. This study evaluated the efficacy of preoperative SGB in preventing POAF following cardiac surgery. Methods: In this single‐center, randomized, double‐blind, placebo‐controlled trial, 140 patients undergoing valve surgery with cardiopulmonary bypass were assigned (1:1) to ultrasound‐guided right SGB with 7 mL of 0.5% ropivacaine or 7 mL of normal saline. The primary outcome was the incidence of POAF from postoperative day 0 to day 7 or until discharge. Results: A total of 132 patients completed the study and were included in the modified intention‐to‐treat population (SGB group: n=65; saline group: n=67). POAF occurred in 43% of the SGB group and 40% of the saline group (odds ratio [OR], 0.99 [95% CI, 0.46–2.15], adjusted P =0.989). The SGB group demonstrated a lower incidence of intraoperative ventricular fibrillation/ventricular tachycardia requiring defibrillation after aortic cross‐clamp release (6% versus 19%; OR, 0.21 [95% CI, 0.06–0.80]; adjusted P =0.022), lower postoperative high‐sensitivity troponin I levels (median difference: −2562 ng/L [95% CI, −4301 to −45]; P =0.045), and a reduced risk of postoperative acute kidney injury (5% versus 18%; OR, 0.24 [95% CI, 0.06–0.98]; adjusted P =0.046). Conclusions: While preoperative SGB did not reduce the incidence of POAF, it was associated with potential benefits, including a lower requirement for intraoperative defibrillation attributable to ventricular arrhythmias, attenuated myocardial injury (as indicated by lower high‐sensitivity troponin I levels), and a decreased risk of postoperative acute kidney injury. Registration: URL: https://www.chictr.org.cn ; URL Identifier: ChiCTR2300068572.