Deep neuromuscular block cut 3-month chronic pain after lumbar fusion, but not at 6 months

The edition in brief

In 180 patients having posterior lumbar interbody fusion, deep neuromuscular block reduced chronic postsurgical pain at three months compared with moderate block (19.1% vs 34.8%; RR 0.6), with less early muscle injury and less opioid use, but the difference was no longer significant at six months (14.6% vs 19.1%). In 185,455 noncardiac anaesthetics, lower mean intraoperative end-tidal CO2 was associated with higher in-hospital mortality (adjusted OR 1.63 per 5 mmHg fall from the median), independent of hypotension and minute ventilation; this is an association, not proof that raising ETCO2 helps. A regression discontinuity analysis of 7,270 older adults found routine echocardiography triggered by turning 75 did not clearly reduce intraoperative hypotension or improve outcomes, though estimates were imprecise. In a secondary analysis of the A2B ICU sedation trial, dexmedetomidine was associated with higher recalled awareness than propofol, with no difference in frightening memories or satisfaction. The FDA lists a Class II recall of one 5% lidocaine ointment for failed content uniformity; it is a quality defect, not a safety signal for lidocaine.