A third of day-case patients still hurt at a week, and the adductor canal catheter added nothing to a single injection

The edition in brief

POPPY, a national UK prospective observational study, followed day-case surgical patients for seven days; 7,331 of 7,839 responded at day 7. A third (33.5%) had a poor pain outcome in the first week, and pain still impaired function in 26.3% at day 7. Associated factors were treatment for anxiety or depression, baseline chronic pain, frailty, greater surgical magnitude and head and neck surgery; increasing age and opioid naivety were associated with lower risk. In 612 propensity-matched pairs of adults aged 65 and over having major non-cardiac surgery, a preoperative autonomic vulnerability phenotype - diabetes or hypertension plus neuropathy, orthostatic hypotension, syncope or unexplained bradycardia - was associated with adjudicated ischaemic myocardial injury in 14.2% versus 8.7% (odds ratio 1.75, 95% CI 1.23-2.49). The association strengthened with intraoperative hypotension burden, reaching an odds ratio of 2.84 in the highest quartile. Across 10 randomised trials, perioperative intravenous lidocaine reduced 24-hour pain after spine surgery by 0.83 points and opioid use by 11.64 mg morphine equivalents. A post hoc subgroup analysis found the benefit clinically meaningful after instrumented fusion (-1.23) and negligible after decompression (-0.20). In 547 adults, a single induction dose of intravenous methadone was not associated with QTc prolongation; new QTcF above 500 ms occurred in 2.5% with methadone against 8.3% without. In 94 patients having total knee arthroplasty, a continuous adductor canal catheter did not reduce opioid consumption at 24-48 hours compared with a single injection containing perineural dexamethasone.