The hypotension prediction index was no better than a proactive MAP trigger of 73 mmHg

The edition in brief

In a two-centre open-label trial of 100 adults having major noncardiac surgery with arterial lines, management guided by the Hypotension Prediction Index (treating at an index of 85 or more) was not superior to a protocol treating whenever mean arterial pressure fell to 73 mmHg or below. Time-weighted hypotension below 65 mmHg was low in both groups (median 0.07 vs 0.16 mmHg, P = 0.12), with no difference in hypertension, noradrenaline dose, stay or 30-day mortality. In 258,624 Ontario patients after hip or knee replacement, the 12% who filled a new extended-release opioid prescription had slightly higher odds of persistent opioid use (aOR 1.08), readmission (aOR 1.09) and emergency visits (aOR 1.16). A triple-blind trial in 80 patients having ACL reconstruction with a femoral triangle block found IPACK and a selective tibial nerve block gave similar 24-hour morphine use (12 vs 16 mg, P = 0.07) and function. The FDA lists an ongoing Class II recall, dated 16 September 2026, of a compounded fentanyl 10 mcg/mL infusion bag from OurPharma LLC after a complaint about conflicting expiry dates; it is a labelling problem, not a contamination finding. The pearl covers the first minutes of local anaesthetic systemic toxicity.