Intranasal dexmedetomidine the night before joint replacement matched a pre-induction infusion for delirium

The edition in brief

A single-centre Chinese non-inferiority trial of 316 older adults having hip or knee arthroplasty found intranasal dexmedetomidine the night before surgery was non-inferior to an intravenous pre-induction infusion for delirium within three days (9.5% vs 7.6%, difference 0.02, 95% CI −0.04 to 0.08), with better pre-operative sleep, less anxiety and fewer adverse events. A sham-controlled trial of 120 patients having shoulder arthroscopy under single-shot interscalene block found transcutaneous auricular vagus nerve stimulation reduced rebound pain in the first 24 hours from 43.3% to 20.0% (NNT 4.3). A trial of 80 patients having thoracoscopic lung resection found perioperative esketamine lowered pulmonary complications on day 1 (37.5% vs 72.5%) but not on days 3 or 7. A systematic review of 30 studies (28 295 women) found chronic pain after caesarean was associated with interference in activity early and in mood later, with depression common. An in vitro ultrasound study found every local anaesthetic–adjuvant mixture tested produced crystals, most with ropivacaine, lidocaine and bicarbonate. Today's pearl covers lipid emulsion for local anaesthetic systemic toxicity.