Purpose: Ketamine is a N-methyl-D-aspartate (NMDA) antagonist with strong analgesic properties. Its addition to the treatment of neuropathic pain may reduce pain intensity and improve overall quality of life. A systematic review and meta-analysis of randomized controlled trials was performed to investigate the addition of ketamine to the treatment of patients with neuropathic pain. Patients and Methods: GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach was used to rate the overall certainty of the evidence for each outcome. Eighteen (18) randomized controlled trials including 706 participants were included for further analysis. Results: Ketamine addition to standard treatment of neuropathic pain (NP) resulted in a statistically significant reduction of pain intensity at one week after the end of treatment with ketamine (MD − 2.14, 95% CI − 2.65 to − 1.63; p< 0.00001) and after 30 days after the end of treatment with ketamine (MD − 1.68, 95% CI − 2.25 to − 1.12; p< 0.00001) and a statistically significant increase in discomfort (RR 4.06; 95% CI 1.18 to 13.95; p=0.03), and psychedelic effects (RR 4.94; 95% CI 2.76 to 8.84; p< 0.00001). Conclusion: There is a statistically significant pain reduction by adding ketamine to the treatment of chronic NP when compared to the standard treatment. However, such pain reduction comes at the expense of adverse outcomes, especially psychedelic effects related to the administration of ketamine. However, the overall quality of certainty of evidence is low due to the clinical heterogeneity among the intervention characteristics of the trials analyzed (different administration routes, dosing regimen, therapy durations, different clinical characteristics of the population investigated). Future large multi-centered trials are necessary to confirm or not the results of the present review.

Background: Enhanced Recovery After Surgery (ERAS) programs are increasingly recognized as effective pathways to improve perioperative outcomes, yet their implementation across Latin America and the Caribbean remains poorly mapped. Understanding current strategies, clinical results, and economic implications is essential to identify regional gaps and guide evidence‐based surgical improvement. Methods: This scoping review followed Joanna Briggs Institute (JBI) methodology and PRISMA‐ScR reporting guidelines. Searches were conducted in MEDLINE/PubMed, Web of Science, LILACS, and CENTRAL, complemented by gray literature and reference screening. Eligible studies were investigations evaluating perioperative optimization interventions in any surgical population within Latin America and the Caribbean. Data extraction included study characteristics, ERAS components, implementation strategies, clinical outcomes, and economic impact. Results: Forty‐five studies published between 2006 and 2025 were included, predominantly from Brazil ( n = 28), Mexico ( n = 9), Argentina ( n = 4), and Chile ( n = 3). Most studies implemented multimodal perioperative pathways, with the most frequent ERAS strategies being preoperative fasting abbreviation ( n = 26), early refeeding ( n = 22), early mobilization ( n = 22), opioid‐sparing anesthesia ( n = 19), preoperative education ( n = 16), and restrictive intravenous fluids ( n = 16). Clinical outcomes consistently demonstrated reductions in postoperative length of stay and complications. Only five studies reported economic data, all focused on hospital‐level costs, showing decreased expenditures primarily driven by shorter hospitalization. Conclusions: ERAS initiatives are increasing across Latin America and the Caribbean, with evidence suggesting reductions in hospital stay and costs. Nevertheless, adoption remains uneven and concentrated in a few countries. Expanding implementation will require addressing structural disparities and generating stronger economic and implementation‐focused evidence to support broader regional uptake.

Background: Pediatric regional anesthesia has been driven by the gradual rise in the adoption of opioid-sparing strategies and the growing concern over the possible adverse effects of general anesthetics on neurodevelopment. Nonetheless, performing regional anesthesia studies in a pediatric population is challenging and accounts for the scarce evidence. This study aimed to review the scientific foundation of studies in cadavers to assess regional anesthesia techniques in children. Methods: We searched the following databases MEDLINE, EMBASE, and Web of Science. We included anatomical cadaver studies assessing peripheral nerve blocks in children. The core data collected from studies were included in tables and comprised block type, block evaluation, results, and conclusion. Results: The search identified 2409 studies, of which, 16 were anatomical studies on the pediatric population. The techniques evaluated were the erector spinae plane block, ilioinguinal/iliohypogastric nerve block, sciatic nerve block, maxillary nerve block, paravertebral block, femoral nerve block, radial nerve block, greater occipital nerve block, infraclavicular brachial plexus block, and infraorbital nerve block. Conclusion: Regional anesthesia techniques are commonly performed in children, but the lack of anatomical studies may result in reservations regarding the dispersion and absorption of local anesthetics. Further anatomical research on pediatric regional anesthesia may guide the practice.

Background: Opioid‐free anesthesia (OFA) has been proposed as a strategy to reduce opioid exposure and opioid‐related adverse events in laparoscopic surgery. However, evidence from randomized trials remains heterogeneous regarding pain control, postoperative nausea and vomiting (PONV), and opioid consumption. Methods: We performed a systematic review and meta‐analysis of randomized controlled trials (RCTs) comparing OFA with opioid‐based anesthesia (OBA) in adult patients undergoing elective laparoscopic surgery. Primary outcomes included postoperative pain scores (0–10 scale), PONV, and 24‐h opioid consumption. Secondary outcomes included hemodynamic events, recovery quality, and hospital length of stay. Results: Sixteen RCTs ( n = 1322) were included. OFA reduced PONV by approximately 40% (RR 0.60; 95% confidence interval [CI] 0.48–0.75) and modestly decreased postoperative opioid use by 6.4 mg morphine equivalents (95% CI −9.1 to −3.7). Pain scores during the first 24 h were similar between OFA and OBA (MD −0.3 on a 0–10 scale; 95% CI −0.7 to +0.1). Hemodynamic instability (bradycardia and hypotension) occurred more frequently with dexmedetomidine‐based regimens but was transient and clinically manageable. No differences were observed in recovery time or hospital length of stay. Conclusion: OFA provides clinically meaningful reductions in PONV and opioid exposure without compromising postoperative analgesia. These findings support OFA as a safe and effective alternative to OBA in laparoscopic surgery and a potential component of enhanced recovery pathways.

Background: Non‐pharmacological interventions are essential to reduce procedural anxiety in pediatric care. Fidget and sensory toys are widely used for distraction and self‐regulation, yet evidence on their effectiveness remains fragmented. This scoping review mapped the evidence on fidget and sensory toys across general pediatric settings, with a focus on perioperative outcomes—such as anxiety, distress, and pain—to highlight relevant gaps in care. Methods: This scoping review followed the Joanna Briggs Institute (JBI) methodology and the PRISMA‐ScR guidelines. Searches were conducted in MEDLINE/PubMed, EMBASE, Scopus, Web of Science, and Cochrane CENTRAL, complemented by trial registries, gray literature, citation tracking, and reference screening. Studies involving children (0–18 years) evaluating fidget or sensory toys in any setting were eligible. Two independent reviewers performed study selection and data extraction. Findings: Fifteen studies published between 2017 and 2026 met the inclusion criteria. Fidget spinners were the most frequently investigated device ( n = 9), followed by stress balls ( n = 3). Studies were conducted in educational ( n = 8) and healthcare settings ( n = 7). Educational studies generally reported limited or no benefits for attention, engagement, behavior, or academic performance. In contrast, healthcare studies generally suggested reductions in anxiety, pain, fear, and procedural distress, although findings were heterogeneous, and outcome measures varied substantially. Conclusions: Current evidence does not support the routine use of fidget toys to improve attention or academic performance in educational settings. Evidence from healthcare and procedural settings suggests that fidget and sensory toys may be feasible distraction tools for selected pediatric patients, but evidence is insufficient to support routine perioperative use. Further high‐quality randomized controlled trials are needed to establish standardized intervention protocols and identify the pediatric populations and clinical settings most likely to benefit.

Objective: to study the effectiveness of type II pectoral nerve block (PEC II) for breast augmentation with submuscular implants by assessing opioid consumption and pain scale in the immediate postoperative period, from the post-anesthesia care unit (PACU) to 24 h postoperatively. Methods: A prospective, controlled, randomized, and double-blind study. Thirty-four patients were analyzed during the perioperative period and in the PACU, with one group receiving bilateral PEC II combined with general anesthesia and the control group receiving only general anesthesia. Results: There was no difference between the groups regarding demographic data, surgical and anesthetic times, or intraoperative opioid use. Opioid consumption in the control group was consistently higher at all the time intervals studied, with an average morphine consumption 38.7% greater. The largest variation in morphine consumption occurred at the fourth and sixth hours postoperatively. The greatest difference in postoperative pain was 36% higher in the control group compared to the intervention group. Conclusions: patients who underwent general anesthesia combined with PEC II had lower opioid consumption and a lower postoperative pain score without associated complications, confirming the effectiveness of the procedure.