This meta-analysis aimed to determine whether peripheral nerve blocks (PNB) reduce postoperative delirium (POD) in elderly patients undergoing hip surgery. This study was registered in the International Prospective Register of Systematic Reviews (PROSPERO; CRD42022328320). The PubMed, EMBASE, Web of Science, and Cochrane Library databases were searched for randomized controlled trials (RCTs) on 26 April 2022. A total of 19 RCTs with 1977 participants were included. Perioperative PNB lowered the POD incidence on the third postoperative day (OR: 0.59, 95% CI [0.40 to 0.87], p = 0.007, I² = 35%), in patients without underlying cognitive impairment (OR: 0.47, 95% CI [0.30 to 0.74], p = 0.001, I² = 30%), and when a fascia iliaca compartment block (OR: 0.58, 95% CI [0.37 to 0.91], p = 0.02, I² = 0%) or a femoral nerve block (OR: 0.33, 95% CI [0.11 to 0.99], p = 0.05, I² = 66%) were performed. The pain score was also reduced (SMD: −0.83, 95% CI [−1.36 to −0.30], p = 0.002, I² = 95%) after PNB. Perioperative PNB can lower the POD incidence and pain scores up to the third postoperative day. However, considering the wide variety of PNBs performed, more trials are needed to identify the effects of each PNB on POD.

Pediatric patients usually experience high levels of pain and distress due to venipuncture. This randomised study aimed to evaluate the effects of virtual reality-based preprocedural education in comparison with video-based education in terms of pain and distress experienced by children scheduled to undergo venipuncture. Ninety children aged 4–8 years who were scheduled to undergo venipuncture surgery were randomly assigned to either a video or virtual reality group. Children in the video group received preprocedural education on venipuncture via a video displayed on a tablet and those in the virtual reality group received the same education via a head-mounted virtual reality display unit. The educational content for the two groups was identical. An independent assessor blinded to the group assignment observed the children’s behavior and determined their Children’s Hospital of Eastern Ontario Pain Scale scores, parental satisfaction score, procedure-related outcomes, venipuncture time, number of repeated procedures and difficulty score for the procedure. The virtual reality group experienced less pain and distress, as indicated by their Children’s Hospital of Eastern Ontario Pain Scale scores compared with the video group (5.0 [5.0–8.0] vs. 7.0 [5.0–9.0], P = 0.027). There were no significant intergroup differences in parental satisfaction scores or procedure-related outcomes. For pediatric patients scheduled to undergo venipuncture, preprocedural education via a head-mounted display for immersive virtual reality was more effective compared with video-based education via a tablet in terms of reducing pain and distress.

Background/Objectives: Albumin is commonly given during craniotomy to support intravascular volume and limit cerebral oedema, but randomised data in traumatic brain injury have suggested harm. Its association with survival after craniotomy is unknown. Methods: Using Korean National Health Insurance Service claims, we identified adults who underwent craniotomy in 2022–2023. Exposure was albumin prescription on the day of surgery, and the primary endpoint was 30-day mortality. We used propensity score overlap weighting with hospital fixed effects. Results: Of 25,097 patients, 3168 (12.6%) received albumin. In the overlap-weighted cohort, albumin was associated with higher 30-day mortality (6.6% vs. 3.8%; odds ratio [OR] 1.81, 95% confidence interval [CI] 1.44–2.29; absolute difference 2.9 percentage points, 95% CI 0.9–4.8) and in-hospital mortality (OR 1.96, 95% CI 1.53–2.52). The association was observed for intracranial neoplasm, cerebrovascular disease and traumatic brain injury. Albumin dose was not associated with mortality (OR per 10 g 0.99, 95% CI 0.96–1.01). Conclusions: Perioperative albumin was associated with higher mortality after craniotomy, without a dose–response relationship. Residual confounding by indication and a direct adverse effect could not be distinguished. These findings should not change practice or be cited as evidence of harm, but they provide no support for routine albumin use.