The edition · Anaesthesiology
IPACK and a selective tibial nerve block gave the same analgesia after knee replacement
A triple-blinded trial found no difference in morphine use but peroneal motor block with the tibial approach, more than half of emergency Caesareans in Europe still need general anaesthesia, and videolaryngoscopy in infants underperformed in real-world use.
The edition in brief
In a triple-blinded trial of 90 patients having total knee arthroplasty under spinal anaesthesia with a femoral triangle block (Anaesthesia, 18 October 2026), IPACK and a selective tibial nerve block gave similar day-1 morphine use (6 vs 5 mg; p = 0.36), pain and function, but 9% of tibial blocks caused common peroneal motor block. A prospective study of 9,989 Caesarean deliveries in 361 centres across 31 European countries (BJA, 9 October 2026) found general anaesthesia in 14.8% overall and 54.0% of emergency cases; conversion from neuraxial occurred in 7.7%, including 6.1% of elective cases. In the Japanese paediatric airway registry, videolaryngoscopy in neonates and infants was associated with lower first-attempt success (aRR 0.89) and more desaturation (aRR 2.18) than direct laryngoscopy. An observational analysis found preoperative GLP-1 receptor agonist use associated with lower 14-day mortality than metformin or DPP-4 inhibitors and no excess aspiration. Pearl: test the neuraxial block to T4 before incision.
General anaesthesia for Caesarean delivery in Europe: 15% overall, over half of emergencies
Expect general anaesthesia in over half of emergency Caesareans and audit your neuraxial conversion rate.
Videolaryngoscopy in infants was linked to lower first-pass success in real-world use
Videolaryngoscopy in infants needs structured training to deliver first-pass success; the view alone is not enough.
Preoperative GLP-1 receptor agonist use was not linked to more aspiration in a large matched analysis
This observational analysis found no excess aspiration with preoperative GLP-1 receptor agonists, but it does not replace current perioperative guidance.
Test the neuraxial block before the first incision for Caesarean delivery
Test and document the block level before every Caesarean incision.
IPACK matched a selective tibial nerve block for posterior knee pain, without peroneal weakness
IPACK and a selective tibial nerve block gave equal analgesia after knee replacement; consider IPACK to avoid peroneal motor block.
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