Anesthesiology Manual:
Best Practices and Case Management

A new phase 4 clinical study published in Pain and Therapy reports promising findings for suzetrigine, a first-in-class, non-opioid analgesic targeting the voltage-gated sodium channel NaV1.8, in patients undergoing laparoscopic or arthroscopic surgical procedures. The study, led by Ashraf S. Habib and colleagues, found that 76.1% of patients recovered without requiring postoperative oral rescue opioids, while 90.9% reported good, very good, or excellent pain control when suzetrigine was incorporated into a multimodal analgesic regimen. The study provides preliminary clinical evidence supporting the potential role of suzetrigine in reducing postoperative opioid requirements across several minimally invasive surgical procedures. However, because the investigation was small, open-label, and lacked a control group, the findings cannot establish that suzetrigine itself caused the observed reduction in opioid use. Key findings at a glance 76.1% required no postoperative oral rescue opioids during treatment 90.9% rated pain control good, very good, or excellent 2.2 mean rescue opioid tablets among patients who needed them 47 patients enrolled across laparoscopic and arthroscopic procedures The need for effective non-opioid postoperative analgesia Effective postoperative pain management remains a fundamental component of surgical recovery. Despite advances in regional anesthesia, minimally invasive surgery, and multimodal analgesia, opioids continue to play an important role in managing moderate-to-severe acute postoperative pain. However, opioid analgesics are associated with several clinically significant adverse effects, including: Respiratory depression and excessive sedation. Postoperative nausea and vomiting. Constipation and gastrointestinal dysfunction. Dizziness and impaired mobilization. Potential development of opioid dependence or opioid use disorder. These concerns have increased interest in opioid-sparing and opioid-free postoperative analgesic strategies. Multimodal analgesia combines medications and techniques acting through different mechanisms to improve pain control while limiting reliance on individual drugs, particularly opioids. Suzetrigine represents a potentially important addition to this approach because it targets peripheral nociceptive signaling rather than central opioid receptors. How does […]

A comprehensive systematic review and meta-analysis published in Anesthesiology challenges the assumption that maintaining higher intraoperative arterial pressures necessarily improves postoperative outcomes. The study, led by Katie Chiou and colleagues, analyzed 15 randomized controlled trials involving 15,603 patients undergoing elective noncardiac surgery under general anesthesia. The findings suggest that targeting higher mean arterial pressure (MAP) values provides no additional protection against major postoperative complications when compared with routine blood pressure management. Importantly, although higher targets consistently reduced intraoperative hypotension, this physiological improvement did not translate into a measurable reduction in acute kidney injury or myocardial injury. Why intraoperative blood pressure management matters Maintaining adequate organ perfusion during general anesthesia is a fundamental component of perioperative care. Numerous observational studies have demonstrated associations between the severity and duration of intraoperative hypotension and postoperative complications, including: Acute kidney injury (AKI) Myocardial injury after noncardiac surgery Cerebrovascular complications Postoperative mortality Postoperative neurocognitive complications These observations have contributed to contemporary recommendations to maintain intraoperative MAP at approximately 60–65 mmHg or higher. However, an important clinical question remains: Does increasing MAP beyond these routinely recommended thresholds provide additional protection against organ injury? Observational associations do not necessarily establish causality. Patients who experience intraoperative hypotension may also have underlying cardiovascular disease, greater surgical complexity, or other factors contributing to postoperative complications. Randomized controlled trials are therefore essential to determine whether actively targeting higher arterial pressures improves patient-centered outcomes. Study design: 15 randomized trials evaluated Chiou and colleagues conducted a systematic review following PRISMA recommendations, searching PubMed, Cochrane CENTRAL, Scopus, and Embase through April 2026. The analysis included adult patients undergoing elective noncardiac surgery under general anesthesia. Researchers compared two strategies: Higher blood pressure targets: Fixed MAP thresholds, commonly between 70 and 100 mmHg, or individualized targets based on preoperative blood pressure. Routine blood pressure management: Standard […]