Open research questions in Anesthesia and Pain Management

What the literature leaves open

• Despite these limitations, this study provides valuable local epidemiological data regarding chronic postoperative inguinal pain in a Mexican secondary care setting, an area in which published evidence remains limited. Future multicenter studies with larger sample sizes and longer follow-up periods are warranted to better characterize risk factors associated with chronic postoperative inguinal pain and to evaluate strategies aimed at preventing this complication.

  Chronic postoperative inguinal pain after open inguinal hernioplasty: prevalence and clinical characteristics in a Mexican secondary care hospital · 2026 · DOI

• Within the limitations of this study, clinically meaningful reduction in pain scores was not observed in most analgesic techniques following THA.

  Comparative efficacy of analgesic techniques in total hip arthroplasty · 2026 · DOI

• Future research should focus on standardizing ketamine administration protocols, including optimal dosing, timing, and route of delivery. Future investigations should also examine patient-centered outcomes, including functional recovery, quality of recovery, length of hospital stay, and persistent postoperative opioid use. Comparative studies evaluating different ketamine formulations and administration strategies are needed to clarify its role in perioperative care. Additionally, longitudinal studies assessing subacute and chronic pain outcomes would help define the broader clinical impact of perioperative ketamine use.

  Opioid-Sparing Effects of Perioperative Ketamine With Inconsistent Analgesic Benefit in Orthopedic Surgery: A Systematic Review of Controlled Trials · 2026 · DOI

• Abstract Purpose While guidelines emphasize the benefits of multimodal anesthesia for hysterectomy procedures, including regional anesthesia (RA), utilization rates remain understudied.

  Regional anesthesia for hysterectomies across a large healthcare system: location matters · 2026 · DOI

• Second, although the 426 7-day follow-up period was sufficient to assess POCD, it was insufficient to evaluate 427 long-term cognitive decline or dementia.

  BIS-guided light versus deep general anesthesia on postoperative cognitive dysfunction in older patients with regional nerve block: a randomised controlled trial · 2026 · DOI

• intervals rather A- Implement structured regular pain assessment protocols in PACU and wards. B- All patients should undergo standardized pain assessment at regular than only upon patient complaint. C- Enhance PACU staff communication and empathy training. D- Hospitals should introduce targeted training programs for PACU nurses and anesthesiologists focusing on empathetic communication, active listening, and clear explanation of pain management plans. 1 (4.2) 20 (83.3) 9 (37.5) 6 (25) 2 (8.3) 1 (4.2) 2 (8.3) 1 (4.2) 0 (0) 0 (0) 1 (4.2) 0 (0) 0 (0) 0 (0) 2 (8.3) 2 (8.3) 2 (8.3) 0 (0) 0 (0) 3 (12.5) 9 (37.5) 1 (4.2) 1 (4.2) 0 (0) 4 (16.7) 6 (25) 0 (0) 7 (29.2) 10 (41.7) 1 (4.2) 0.605 0.173 0.948 0.273 0.072 0.347 1 1 1 1 0.251 1 1 1 0.026 0.317 0.673 1 1 0.215 0.105 1 1 1 0.173 0.645 37 (3.7) 697 (70.5) 377 (38.2) 165 (16.7) 17 (1.7) 125 (12.7) 91 (9.2) 64 (6.5) 29 (2.9) 19 (1.9) 11 (1.1) 6 (0.6) 2 (0.2) 11 (1.1) 9 (0.9) 46 (4.7) 66 (6.7) 3 (0.3) 6 (0.6) 65 (6.6) 38 (3.8) 717 (70.8) 386 (38.1) 171 (16.9) 19 (1.9) 126 (12.5) 93 (9.2) 65 (6.4) 29 (2.9) 19 (1.9) 12 (1.2) 6 (0.6) 2 (0.2) 11 (1.1) 11 (1.1) 48 (4.7) 68 (6.7) 3 (0.3) 6 (0.6) 68 (6.7) 230 (23.3) 239 (23.6) 55 (5.6) 41 (4.1) 7 (0.7) 291 (29.5) 169 (17.1) 12 (1.2) 404 (40.9) 383 (38.8) 20 (2) 56 (5.5) 42 (4.2) 7 (0.7) 295 (29.2) 175 (17.3) 12 (1.2) 411 (40.6) 393 (38.8) 21 (2.1) E- Adopt proactive multimodal and opioid-sparing pain management. F- Move from reactive (“on-demand”) analgesia to scheduled multimodal regimens (acetaminophen + NSAIDs + regional blocks when feasible) with clear patient education about expected pain levels and available treatments. Special attention should be given to managing patient expectations and promptly addressing perceived under-treatment, which was independently associated with dissatisfaction.

  Patient satisfaction and postoperative pain management in ambulatory surgery: a prospective questionnaire-based observational cohort study at a Tertiary University Hospital · 2026 · DOI

• Rialta Hamda1, Rahma Yulia Putri2, Annisa Lidra Maribeth3 1Department of Anesthesiology, Faculty of Medicine, Baiturrahmah University, Padang, Indonesia 2Biomedical Science, Fakulty of Medicine, Andalas University, Padang, Indonesia 3Department of Public Health, Faculty of Medicene, Baiturrahmah University, Padang, Indonesia Email…

  Opioid-Free Anesthesia: Current Evidence, Clinical Applications, and Future Perspectives · 2026 · DOI

• 13,14 Randomized comparisons have yielded mixed results: in thoracic surgery with erector spinae plane block, dexmedetomidine (≈1 µg/kg) sometimes prolonged sensory block and lowered early pain scores vs. 17 For chest-wall fascial plane/parasternal blocks in cardiac surgery specifically, direct dexamethasone- dexmedetomidine head-to-head data remain scarce; available reports primarily compare a single adjuvant to control or evaluate block vs.

  Dexamethasone <i>versus</i> dexmedetomidine as adjuncts for parasternal block in cardiac surgery: a retrospective comparative study · 2026 · DOI

• The present study has several limitations. It was a singlecenter observational study with a relatively modest sample size and no parallel control group, thereby limiting causal inference. In addition, the favorable results observed may reflect the broader multimodal perioperative care pathway rather than the infiltration protocol alone. Longer followup with patient-reported outcome measures would also strengthen interpretation. Nevertheless, the study reflects real-world arthroplasty practice and provides pragmatic data on a reproducible periarticular LIA regimen.

  Periarticular local infiltration analgesia and early recovery after primary total knee arthroplasty: a prospective observational study · 2026 · DOI

• Ultrasound-guided pharmacopuncture has demonstrated promising analgesic effects, yet the optimal needle length for deep interfascial targeting remains unclear, particularly in procedures involving the Quadratus Lumborum–Psoas–Iliocostalis (QPI) space.

  Comparative evaluation of short vs. long needles in deep ultrasound-guided pharmacopuncture for acute low back pain: study protocol · 2026 · DOI

• There is limited data supporting the use of benzodiazepines, but there may be populations in which these medications should be used, and more nuanced data is needed to provide recommendations. Finally, much of the available data focuses on pain con- trol after surgery for AIS, with limited information in the neuromuscular scoliosis population, for which ideal pain control may differ given increased presence of muscle spasms and in some cases an inability to verbally commu- nicate a need for pain medication. There is early data in sup- port of methadone for pain control, but further research on this topic is needed.

  An Update on Pain Management in Pediatric Spine Surgery · 2026 · DOI

• Although the use of regional anaesthesia is increasing, high-quality evidence remains limited, with insufficient randomised controlled trial (RCT) evaluating the effectiveness of the pericapsular nerve group (PENG) block in the emergency department (ED).

  Ultrasound-guided pericapsular nerve group block versus intravenous morphine for pain management in older adults with hip fractures: a randomised controlled trial in the emergency department · 2026 · DOI

• for Non Steroidal Anti-inflammatory Drugs: Consensus Document Elaborated by Nominated Experts of Three Scientific Associations (SER-SEC-AEG). Reumatología Clínica 10(2):68–84. https:/ /doi.or g/10.10 16/j. reumae.2013.10.008 5. Lindsay SE, Philipp T, Ryu WHA et al (2023) Nonsteroidal Antiinflammatory Drugs in the Acute Post-operative Period Are Associated with an Increased Incidence of Pseudarthrosis, Hardware Failure, and Revision Surgery Following Single-level Spinal Fusion. Spine (Phila Pa 1976) 48(15):1057–1063. h t t p s: / / d o i. o r g / 1 0. 1 0 9 7 / B R S. 0 0 0 0 0 0 0 0 0 0 0 0 4 6 9 5 6. Kim KH, Abdi S (2014) Rediscovery of nefopam for the treatment of neuropathic pain. Korean J Pain 27(2):103–111. h t t p s: / / d o i. o r g / 1 0. 3 3 4 4 / k j p. 2 0 1 4. 2 7. 2. 1 0 3 7. Heel RC, Brogden RN, Pakes GE et al (1980) Nefopam: A Review of its Pharmacological Properties and Therapeutic Efficacy. Drugs 19(4):249–267. h t t p s: / / d o i. o r g / 1 0. 2 1 6 5 / 0 0 0 0 3 4 9 5 - 1 9 8 0 1 9 0 4 0 - 0 0 0 0 1 8. Yoon S, Lee H, Bin, Na KJ et al (2022) Effect of Continuous Infusion of Intravenous Nefopam on Postoperative Opioid Consumption After Video-assisted Thoracic Surgery: A Double-blind Randomized Controlled Trial. Pain Physician 25(6):491–500 9. Pinsornsak P, Sukkarnkosol S, Boontanapibul K (2022) Does Nefopam Provide Analgesic Effect and Reduce Morphine Consumption After Primary Total Knee Arthroplasty? A Prospective, Double-Blind, Randomized Controlled Trial. J Arthroplasty 37(5):845–850. https:/ /doi.or g/10.10 16/j. arth.2022.01.079 10. Zhao T, Shen Z, Sheng S (2018) The efficacy and safety of nefopam for pain relief during laparoscopic cholecystectomy: A metaanalysis. Med (Baltim) 97(10):e0089. h t t p s: / / d o i. o r g / 1 0. 1 0 9 7 / m d. 0 0 0 0 0 0 0 0 0 0 0 1 0 0 8 9 11. Du Manoir B, Aubrun F, Langlois M et al (2003) Randomized prospective study of the analgesic effect of nefopam after orthopaedic surgery. Br J Anaesth 91(6):836–841. h t t p s: / / d o i. o r g / 1 0. 1 0 9 3 / b j a / a e g 2 6 4 12. Mimoz O, Incagnoli P, Josse C et al (2001) Analgesic efficacy and safety of nefopam vs. propacetamol following hepatic resection. Anaesthesia 56(6):520–525. h t t p s: / / d o i. o r g / 1 0. 1 0 4 6 / j. 1 3 6 5 - 2 0 4 4. 2 0 0 1. 0 1 9 8 0. x 13. Lee JY, Sim WS, Cho NR, Kim BW, Moon JY, Park HJ (2020) The antiallodynic effect of nefopam on vincristine-induced neuropathy in mice. J Pain Res 13:323–329. h t t p s: / / d o i. o r g / 1 0. 2 1 4 7 / J P R. S 2 2 4 4 7 8 14.

  The safety and efficacy of perioperative nefopam for analgesia in spine surgery: A systematic review and meta-analysis of randomised controlled trials · 2026 · DOI

• The principal limitations of this report are its single-case design and the clinical rather than dermatomal assessment of block completeness. Postoperative analgesia required repeat block performance on day 1 as single-injection coverage resolved; prospective consideration of perineural catheter placement for continuous local anesthetic infusion may provide more durable analgesia in future cases of comparable complexity.

  Ultrasound-Guided Peripheral Nerve Block as the Sole Anesthetic for Above-Knee Amputation in a Patient With Severe Cardiopulmonary Comorbidities · 2026 · DOI

• Further large-scale multicentre studies with standardized operator training and cost–benefit analyses are recommended to confirm these findings and support the integration of UGT into standard clinical practice guidelines. Further large-scale multicentre randomized controlled trials are warranted to validate these findings and assess their applicability across diverse clinical settings. Future studies should incorporate standardized operator training, evaluation of learning curves, long-term postoperative outcomes, and cost- Copyright Author (s) 2026. Distributed under Creative Commons CC-BY 4.0 Received: 02-04-2026 - Accepted: 01-06-2026 - Published: 08-06-2026 1520 effectiveness analyses to provide a more comprehensive assessment of the role of ultrasound-guided regional anaesthesia and to inform future clinical practice guidelines. Alqalam Journal of Medical and Applied Sciences.

  Comparative study of Ultrasound-Guided versus Anatomic Landmark-Guided Techniques for Nerve Block Anesthesia · 2026 · DOI

• Despite the multicentre design and inclusion of a range of orthopaedic procedures, several limitations should be acknowledged. The sample size was relatively small, which may have limited the ability to detect differences in some outcomes. In addition, operator experience was not formally assessed, although it may have influenced procedural performance, complication rates, and block characteristics. Furthermore, long- term postoperative outcomes were not evaluated, limiting the assessment of the sustained clinical benefits of the two techniques.

  Comparative study of Ultrasound-Guided versus Anatomic Landmark-Guided Techniques for Nerve Block Anesthesia · 2026 · DOI

• Spinal anaesthesia should be considered as a elective technique laparoscopic cholecystectomy in low-risk, non-obese patients. Future large-scale, multicenter randomized controlled trials with long-term follow-up are recommended to validate these findings and establish standardized protocols. REFERENCES 1. Agresta, Ferdinando, et al. "Laparoscopic cholecystectomy: consensus conferencebased guidelines." Langenbeck's archives of surgery 400.4 (2015): 429-453. 2. Özdemir-van Brunschot, Denise MD, et al. "What is the evidence for the use of lowpressure pneumoperitoneum? A systematic review." Surgical Endoscopy 30.5 (2016): 2049-2065. 3. Gan, Tong J., et al. "Fourth consensus guidelines for the management of postoperative nausea and vomiting." Anesthesia & Analgesia 131.2 (2020): 411-448. Shoman, Mohammed Mohiuddin, et al.

  Comparison of Efficacy between Spinal Anaesthesia and General Anaesthesia for Laparoscopic Cholecystectomy · 2026 · DOI

• This was a retrospective single-service HEMS analysis using clinician-completed electronic records entered after patient care, and is therefore vulnerable to documentation bias, incomplete recording, and some recall error. The cohort denominator was cases in which IMF was selected and delivered to support manipulation/reduction, rather than all traumatic limb injuries attended by the service. In addition, there was no prospective protocol mandating IMF as first-line therapy. The database does not contain sufficient searchable fields to allow reliable retrospective ascertainment of all limb injuries potentially suitable for IMF. As a result, confounding by indication (clinician case selection) is likely, and the reported associations may under- or overestimate effects if interpreted beyond this IMF-selected cohort. Associations observed in these data (including pre-medication) should not be interpreted as causal because of clinician selection and residual confounding. Clinical intent also had to be inferred from free-text documentation. Consequently, IMF’s role may have been misclassified in some cases (for example, where methoxyflurane was given as analgesia before procedural sedation rather than as a genuine attempt at IMF-facilitated reduction), which may underestimate the apparent success of the IMF-assisted pathway. Although equivocal cases were reviewed in detail by more than one investigator, reasons for unsuccessful reduction or escalation (e.g., pain-limited procedure, mechanical difficulty, or elective escalation) were not documented consistently enough to permit reliable subgroup categorisation. Timing of concomitant analgesia was also inconsistently recorded, limiting inference regarding sequencing or co-administration. Finally, several subgroup analyses (including anatomical location) contained small numbers, resulting in imprecise estimates and wide confidence intervals. These findings should therefore be interpreted cautiously and considered hypothesis-generating. Dowsing et al.

  Inhaled methoxyflurane for fracture reduction in prehospital extremity trauma: an observational review of HEMS clinical practice · 2026 · DOI

• The optimal local anesthetic concentration, dose, and volume for ultrasound-guided regional nerve blocks in orthopedic patients with varying comorbidities and on antithrombotic therapy requires systematic investigation. Current evidence focuses on single parameters (e.g., mepivacaine volume in axillary blocks) rather than multivariate optimization for orthopedic patient populations.

  Precision and pitfalls: evolving role of ultrasound-guided nerve blocks in Orthopedic perioperative pathway—a perspective · 2026 · DOI

• Perineural catheter infection risk with ultrasound-guided continuous peripheral nerve blocks in orthopedic perioperative pathways has been identified as a concern, but prospective surveillance data stratified by block type, duration of catheter placement, and orthopedic procedure type (total knee arthroplasty, hip arthroplasty) are limited.

  Precision and pitfalls: evolving role of ultrasound-guided nerve blocks in Orthopedic perioperative pathway—a perspective · 2026 · DOI

• The impact of regional anesthesia on systemic stress response has been investigated, but comparative effectiveness data between different ultrasound-guided peripheral nerve block techniques (femoral, adductor canal, paravertebral) on perioperative opioid requirements and stress markers in orthopedic surgery are inconsistently reported across studies.

  Precision and pitfalls: evolving role of ultrasound-guided nerve blocks in Orthopedic perioperative pathway—a perspective · 2026 · DOI

• While ultrasound guidance reduces local anesthetic systemic toxicity risk compared to electrical neurostimulation, the relationship between needle-related ultrasound artifacts and inadvertent intravascular injection rates in orthopedic procedures remains inadequately studied. Specific artifact patterns that should trigger procedural halting or technique modification need systematic characterization.

  Precision and pitfalls: evolving role of ultrasound-guided nerve blocks in Orthopedic perioperative pathway—a perspective · 2026 · DOI

• The minimum number of ultrasound-guided regional anesthesia blocks required for novices to achieve competency in ultrasound needle visualization has been studied in cadaver models, but the learning curve for clinical practice in orthopedic perioperative settings remains incompletely characterized. Specific competency thresholds and proficiency metrics for ultrasound-guided nerve blocks in orthopedic patients need prospective validation.

  Precision and pitfalls: evolving role of ultrasound-guided nerve blocks in Orthopedic perioperative pathway—a perspective · 2026 · DOI

• The use of validated pain and sedation scales remains inherently subjective and dependent on behavioral interpretation, which may introduce variability and limit the precision of outcome measurements.

  Erector spinae plane block with bupivacaine contributes to intraoperative opioid sparing but provides limited postoperative pain control in cats undergoing elective ovariohysterectomy under continuous propofol infusion · 2026 · DOI

• The anatomical spread and potential visceral coverage of thoracic ESP injections in cats have not been investigated, limiting definitive conclusions regarding the capacity of this technique to provide consistent visceral analgesia in feline abdominal surgery.

  Erector spinae plane block with bupivacaine contributes to intraoperative opioid sparing but provides limited postoperative pain control in cats undergoing elective ovariohysterectomy under continuous propofol infusion · 2026 · DOI

Most-cited papers in Anesthesia and Pain Management

• Peripheral nerve blocks in the management of postoperative pain: challenges and opportunities · Journal of Clinical Anesthesia · 2016 · 232 citations
• Assisted Vaginal Birth · BJOG An International Journal of Obstetrics & Gynaecology · 2020 · 125 citations
• Analgesic efficacy of erector spinae plane block in lumbar spine surgery: A systematic review and meta-analysis · Journal of Clinical Anesthesia · 2022 · 120 citations
• Effectiveness of sucrose analgesia in newborns undergoing painful medical procedures · Canadian Medical Association Journal · 2008 · 87 citations
• Opioid-free anesthesia: A systematic review and meta-analysis · Journal of Clinical Anesthesia · 2023 · 86 citations
• New horizons in rib fracture management in the older adult · Age and Ageing · 2019 · 71 citations
• Perioperative ketamine for postoperative pain management in patients with preoperative opioid intake: A systematic review and meta-analysis · Journal of Clinical Anesthesia · 2022 · 62 citations
• Tapentadol Versus Tramadol: A Narrative and Comparative Review of Their Pharmacological, Efficacy and Safety Profiles in Adult Patients · Drugs · 2021 · 56 citations
• Transversus abdominis plane block versus local anesthetic wound infiltration for optimal analgesia after laparoscopic cholecystectomy: A systematic review and meta-analysis with trial sequential analysis · Journal of Clinical Anesthesia · 2021 · 56 citations
• Post-Thoracotomy Pain: Current Strategies for Prevention and Treatment · Drugs · 2020 · 45 citations

Most recent work

• Regional analgesia techniques as adjuncts to general anesthesia in pediatric cardiac surgery: an updated systematic review and meta-analysis of randomized controlled trials · Regional Anesthesia & Pain Medicine · 2026
• Pericapsular Nerve Group Block Improves Pain Control Compared With No Block in Patients Undergoing Hip Arthroscopy Surgery: A Systematic Review · Arthroscopy · 2026
• Remifentanil patient-controlled analgesia for labour analgesia: guidance from the obstetric anaesthetists’ association · European Journal of Anaesthesiology · 2026
• Norepinephrine in Major Abdominal Surgery: Comment · Anesthesiology · 2026
• Superficial intercostal plane blocks for post-sternotomy pain control rationale and design for the EPOCH CardioLink-10 randomized clinical trial · Current Opinion in Cardiology · 2026
• Maintenance of maternal blood pressure targets after spinal anaesthesia for caesarean delivery · Anaesthesia · 2026
• Mode of anaesthesia and persistent postoperative opioid use · Anaesthesia · 2026
• Open Radical Cystectomy Under Combined Spinal-Thoracic Epidural Anesthesia in High-Risk Patients: A Multicenter Retrospective Cohort Study · Société Internationale d’Urologie Journal · 2026
• Thoracic epidural anesthesia is considered the “gold standard” of regional anesthesia for thoracic surgery — but is it always truly effective? · EMERGENCY MEDICINE · 2026
• Inhaled methoxyflurane for fracture reduction in prehospital extremity trauma: an observational review of HEMS clinical practice · Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine · 2026

Related topics in Medicine