Total knee arthroplasty is one of the most commonly performed orthopedic operations worldwide, but it remains associated with substantial postoperative pain, impaired mobility and a risk of delayed recovery. A 2026 review published in BJA Education outlines how modern perioperative care is moving toward a more individualised, opioid-sparing and mobility-preserving approach. The article focuses on preoperative optimisation, the choice between neuraxial and general anesthesia, blood conservation, multimodal analgesia and motor-sparing regional anesthesia. The central message is clear: successful total knee arthroplasty depends not on a single anesthetic technique, but on a coordinated enhanced recovery pathway that starts before surgery and continues through rehabilitation. Why anesthesia for knee replacement is changing Patients undergoing total knee arthroplasty often have chronic pain, restricted movement and multiple comorbidities. At the same time, healthcare systems are increasingly performing knee replacement as a short-stay or same-day-discharge procedure in appropriately selected patients. This creates a clinical balancing act. Anesthesia and analgesia must provide sufficient surgical conditions and pain relief while also supporting: Early mobilisation Rapid return of motor function Reduced opioid exposure Lower rates of nausea and sedation Safe discharge Reduced risk of complications Long-term functional recovery The review places these goals within enhanced recovery after surgery, or ERAS, pathways. Preoperative optimisation is a key part of treatment The perioperative plan begins well before the patient enters the operating theatre. Preoperative education can reduce anxiety, improve engagement with care and help patients understand the importance of rehabilitation. The article also recommends identifying and addressing modifiable risk factors. Important areas include: Smoking cessation for at least four weeks before surgery Reduction of heavy alcohol consumption Assessment and treatment of anemia Optimisation of relevant medical comorbidities Identification of psychological and pain-related risk factors Preoperative anemia is particularly important because it is associated with perioperative complications, prolonged hospitalisation and increased […]

Traumatic brain injury (TBI) remains one of the leading causes of death and long-term disability worldwide. While the initial impact causes the primary injury, much of the neurological damage that follows occurs during the hours and days afterward. This secondary brain injury is driven by impaired cerebral blood flow, increased intracranial pressure, neuroinflammation, oxidative stress, and metabolic dysfunction. Preventing these secondary processes has become one of the most important goals in neurocritical care. A recently published pilot study by Kostadinov and colleagues, published in Regional Anesthesia & Pain Medicine, explores an intriguing therapeutic approach: ultrasound-guided stellate ganglion block (SGB). Although SGB has traditionally been used for chronic pain conditions, complex regional pain syndrome, vascular disorders, and post-traumatic stress disorder, growing evidence suggests it may also influence cerebral circulation and inflammatory pathways. By temporarily blocking cervical sympathetic nerve activity, SGB may reduce cerebrovascular resistance, improve cerebral perfusion, decrease intracranial pressure, and attenuate inflammatory responses following brain injury. These physiological effects make it an attractive candidate for limiting secondary brain damage. This prospective pilot study evaluated whether SGB could improve cerebral hemodynamics and reduce neuroinflammation in patients with moderate-to-severe TBI. While the study was relatively small, its findings provide encouraging early evidence that sympathetic modulation may represent a novel adjunctive therapy in neurocritical care. Study methods This was a prospective, single-center observational pilot study conducted in the intensive care unit of the University Medical Centre Ljubljana. Patient population 20 adults with moderate or severe TBI Glasgow Coma Scale ≤12 before intubation All patients underwent standard neurocritical care management Intervention Patients received: Ultrasound-guided stellate ganglion block Performed on the side of the most severely injured cerebral hemisphere 8 mL of 0.5% levobupivacaine injected at the C6 level Outcomes measured Researchers evaluated several physiological parameters before and after SGB, including: Middle cerebral artery blood […]