This Month in Anesthesiology

1085 Suzetrigine, a Nonopioid NaV1.8 Inhibitor for Treatment of Moderate-to-severe Acute Pain: Two Phase 3 Randomized Clinical TrialsImage: A. Johnson, Vivo Visuals Studio.The voltage-gated sodium channel 1.8 (NaV1.8) plays a role in transmitting nociceptive signals and is selectively expressed in peripheral sensory nerves. Suzetrigine is an oral nonopioid that selectively inhibits NaV1.8. In these two phase 3 studies, suzetrigine reduced moderate-to-severe acute pain over 48 h after abdominoplasty or bunionectomy as compared with placebo. Pain reduction with suzetrigine was similar to that with hydrocodone/acetaminophen and was associated with mild to moderate adverse effects. See the accompanying Editorial on page 989. 1009 Neuromuscular Blockade and Antagonism in Patients with Renal Impairment: A Multicenter Retrospective Cross-sectional StudyImage: J. P. Rathmell.The hypothesis that rocuronium–sugammadex would be the primary agonist–antagonist combination across all levels of renal impairment and its use would increase over time was tested in a retrospective observational study of patients with significant renal impairment undergoing noncardiac surgery under general anesthesia with neuromuscular block and tracheal intubation. Of 243,944 patients cared for by 5,133 attending anesthesiologists within 48 institutions between 2016 and 2022, 62.6% received rocuronium–sugammadex, 30.5% received rocuronium–neostigmine, and 6.9% received cisatracurium–neostigmine. The adjusted incidence of rocuronium–sugammadex use increased over time across all strata of chronic kidney disease, from 4.4% in 2016 to 95.2% in 2022. See the accompanying Editorial on page 977. 1025 Measuring Well-being Influencers: Development and Validation of the Well-Being Influencers Survey for Healthcare (WISH) InventoryImage: J. P. Rathmell.The investigators developed and validated the Well-Being Influencers Survey for Healthcare (WISH), an inventory that measures systemic factors (e.g., leadership support, psychologic safety, working conditions) in the workplace that affect well-being. The study provides initial validation and reliability evidence for WISH based on a survey of 223 healthcare professionals from a single large academic department of anesthesiology. The WISH instrument has the potential to identify system-level and cultural factors influencing healthcare professionals’ well-being that can be the focus of improvement efforts. See the accompanying Editorial on page 980. 1100 Global Trends in Analgesic Opioid Use in Pregnancy: A Retrospective Cohort StudyImage: J. P. Rathmell.Between 2000 and 2020, among more than 20 million pregnancies across 12 countries, 55 per 1,000 had at least one analgesic opioid dispensing or prescription. Analgesic opioid use varied widely. Between 2000 and 2020, opioid use decreased in Hong Kong; the U.S. publicly insured population; Finland; the U.S. privately insured population; Ontario, Canada; Denmark; and Sweden. There was a relative increase in opioid use in Iceland, the United Kingdom, New Zealand, and Norway. There was no net change in opioid use in New South Wales, Australia; Taiwan; and South Korea. See the accompanying Editorial on page 992. 1114 Efficacy of Cryoneurolysis on Chronic Pain in Patients with Knee Osteoarthritis: A Double-blinded Randomized Controlled Sham TrialImage: J. P. Rathmell.This randomized, double-blinded, sham-controlled study in 87 adults with painful knee osteoarthritis compared cryoablation of the anterior femoral cutaneous and infrapatellar branch of the saphenous nerves directed via nerve stimulation and ultrasound versus sham ablation, with both groups receiving a postintervention exercise program. No significant differences in pain severity, functional measures, or related outcomes were noted between groups at 2 weeks after treatment. Although minor 6-month improvements were observed, they were not robust or consistent over time. See the accompanying Editorial on page 995. 1127 Exploring the Additive or Synergistic Effects of the Systemic and Perineural Routes of Dexamethasone as Adjuncts to Supraclavicular Block: A Randomized Controlled TrialImage: J. P. Rathmell.In a randomized trial in adults having supraclavicular blocks for open reduction of distal radial fractures that compared intravenous dexamethasone, a combination of perineural and intravenous dexamethasone, or no dexamethasone (control), there was no difference in duration of sensory block between the intravenous dexamethasone alone group and the intravenous and perineural dexamethasone group. Both the intravenous dexamethasone alone group and the intravenous and perineural dexamethasone group had longer sensory blocks than the control group. No evidence of synergism between the perineural and systemic routes was identified, and combining them does not seem to yield incremental benefits. See the accompanying Editorial on page 999. 1047 Persistent Renal Hypoxia and Histologic Changes at 4 Weeks after Cardiopulmonary Bypass in SheepImage: J. P. Rathmell.This study assessed the duration and severity of renal tissue hypoxia after cardiopulmonary bypass (CPB) and whether this hypoxia was associated with histopathologic structural changes in the kidneys 4 weeks after CPB. This study was conducted using 12 adult female sheep that underwent CPB with a 2-h aortic cross clamp time. The authors assessed systemic and renal hemodynamics and oxygen delivery, kidney function, and renal tissue oxygenation before and during CPB, in the 48 h after CPB, and then weekly for 4 weeks. Four weeks after CPB, the authors observed sustained renal medullary and cortical tissue hypoxia and histopathologic renal injury. These findings suggest that exposure to CPB is associated with longer-term effects on kidney function, which may explain the transition of acute kidney injury to chronic kidney disease. See the accompanying Editorial on page 985. 1150 Systematic Review of Surgical Site Infection Prevention Guideline Recommendations for Maintenance of Homeostasis in the Perioperative PeriodImage: J. P. Rathmell.Surgical site infections increase patient harm and societal costs. This review highlights anesthesiologists’ role in perioperative infection prevention, identifies broad consensus regarding the importance of optimizing intraoperative homeostasis, and highlights the variability in surgical site infection prevention guidelines. High-quality trials are needed to strengthen surgical infection prevention strategies.

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