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Although improving, 'harms reporting' in analgesic clinical trials is generally poor. On average the 101 studied analgesic trials met only 60% of harms reporting recommendations.
Smith SM, Daniel R, Pereira A et al. Adherence to CONSORT harms-reporting recommendations in publications of recent analgesic clinical trials: an ACTTION systematic review. Pain. 2012 Dec 1;153(12):2415-21.
  Daniel Jolley
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Sedation with TCI remifentanil targeting effect site concentration of 3 ng/mL resulted in detectable aspiration in almost 50% of the study participants after 1 hour.
Savilampi J, Ahlstrand R, Magnuson A et al. Aspiration Induced by Remifentanil: A Double-blind, Randomized, Crossover Study in Healthy Volunteers. Anesthesiology. 2014 Jul 1;121(1):52-8.
  Daniel Jolley
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Interesting to note that not only did the pudendal nerve block group experience better analgesia than the caudal block group, they were also exposed to a much smaller absolute dose of bupivacaine (0.75 mg/kg vs 2.5 mg/kg). This is important not only because of the safety implications, but also because allows extra LA for top-up if the block is inadequate or fails.
Naja ZM, Ziade FM, Kamel R et al. The effectiveness of pudendal nerve block versus caudal block anesthesia for hypospadias in children. Anesth. Analg. 2013 Dec 1;117(6):1401-7.
  Daniel Jolley
summary
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Despite increasing the likelihood of a Cormack-Lehane grade 1 view, pooled results from the studies showed no difference between the Pentax Airway Scope and standard Macintosh laryngoscope for:
• Rate of intubation on first attempt.
• Time for intubation.
• Incidence of oral or pharyngeal injury.
Hoshijima H, Kuratani N, Hirabayashi Y et al. Pentax Airway Scope(®) vs Macintosh laryngoscope for tracheal intubation in adult patients: a systematic review and meta-analysis. Anaesthesia. 2014 Aug 1;69(8):911-8.
  Daniel Jolley
summary
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Real-time ultrasound guidance of central line insertion dramatically reduces the incidence of procedural failure (RR 0.18), arterial puncture (RR 0.25), haematoma (RR 0.30), pneumothorax (RR 0.21), and haemothorax (RR 0.10). Studies specifically investigating children and infants were however too small to make significant conclusions.
Wu SY, Ling Q, Cao LH et al. Real-time two-dimensional ultrasound guidance for central venous cannulation: a meta-analysis. Anesthesiology. 2013 Feb 1;118(2):361-75.
  Daniel Jolley
comment
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Although this Cochrane review supports the belief that epidural and paravertebral blocks may reduce persistent-surgical pain after thoracotomy or breast cancer surgery respectively, the authors highlight the low total number of subjects (only 339 patients) in the five trials analysed. This is enough evidence to consider the PSP-benefits of regional anesthesia, but far from enough to be conclusive or change practice.
Andreae MH Andreae DA. Regional anaesthesia to prevent chronic pain after surgery: a Cochrane systematic review and meta-analysis. Br J Anaesth. 2013 Nov 1; 111 (5): 711-20.
  Daniel Jolley
summary
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Tatsioni found that earlier disproven observational studies were still positively cited in 50% or more of peer reviewed publications, despite the existence of well-established contrary evidence.
Tatsioni A, Bonitsis NG, Ioannidis JP. Persistence of contradicted claims in the literature. JAMA. 2007 Dec 5;298(21):2517-26.
  Daniel Jolley
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To explore the future contradiction of highly-cited research Ioannidis investigated just under 50 of the most significant and highly regarded medical research findings from 1990 to 2003. Of 45 that concluded their interventions were effective, 34 had had their hypothesis retested. Of these 34, over 40% (14) were subsequently shown to be incorrect or exaggerated. Forty percent of some of the most highly regarded, practice-changing medical evidence from the 20th century subsequently disproven!
Ioannidis JP. Contradicted and initially stronger effects in highly cited clinical research. JAMA. 2005 Jul 13;294(2):218-28.
  Daniel Jolley
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Ioannidis demonstrated that 80% of non-randomized studies were wrong, and among randomized controlled studies 25% were incorrect. Even large, multicenter, randomized clinical trials were predictably wrong in 10% of studies.
Ioannidis JP. Why most published research findings are false. PLoS Med. 2005 Aug 1; 2 (8): e124e124.
  Daniel Jolley
comment
1
Note that this was firstly a retrospective trial, and secondly that it was a re-analysis of data from an earlier study, the 'Vitamins In Nitrous Oxide trial', and as such not designed with assessment of this article's end point in mind.
Nonetheless an interesting and relevant finding that calls in to question the idea that intra-operative N2O has post-operative analgesia benefit via it's known NMDA antagonism. As with many things, *further studies are required"...
Duma A, Helsten D, Brown F et al. The Effect of Nitrous Oxide Anesthesia on Early Postoperative Opioid Consumption and Pain. Reg Anesth Pain Med. 2014 Jan 1; 39 (1): 31-6.
  Daniel Jolley