Ear stimulation cut rebound pain after interscalene block from 43% to 20%

The edition in brief

In 120 adults having arthroscopic shoulder surgery under single-shot interscalene block, perioperative transcutaneous auricular vagus nerve stimulation reduced rebound pain within 24 hours from 43.3 per cent to 20.0 per cent — absolute risk reduction 23.3 per cent (95% CI 7.2 to 39.5), relative risk 0.46 (0.26 to 0.82), number needed to treat 4.3. Resting and movement-evoked pain scores were lower by about half a point, quality of recovery and sleep were better, opioid consumption did not differ significantly, and no stimulation-related adverse events occurred. A meta-analysis of 10 trials found perioperative intravenous lidocaine reduced 24-hour pain after spine surgery (mean difference −0.83, 95% CI −1.36 to −0.30, I-squared 89 per cent) and opioid use by 11.64 mg morphine equivalents, with a post-hoc subgroup difference: clinically meaningful after instrumented fusion (−1.23) and negligible after decompression (−0.20). In 80 patients having thoracoscopic radical lung resection, perioperative esketamine lowered day-one pulmonary complications from 72.5 to 37.5 per cent with no difference at day 3 or 7 or in any secondary outcome. A French national study of 830 children found anaesthesia teleconsultation succeeded in 73 per cent of cases, with 91 per cent of failures technical; no pre-connection test raised failure odds more than sixfold and using a tablet or phone rather than a computer more than doubled them. And a randomised trial in 78 ultrasound novices found brief AI-assisted nerve tracking did not improve independent identification of the median nerve or brachial plexus once the AI was switched off.