2 Minute Medicine Rewind October 12, 2026
1. Low-pressure pneumoperitoneum (LPP) at 8 mmHg did not significantly reduce visual analog scale (VAS) pain scores at 6 hours compared with 14 mmHg.
2. LPP was feasible without prolonging operative time, and the lower paracetamol use should be considered hypothesis-generating rather than definitive.
Evidence Rating Level: 1 (Excellent)
Low-pressure pneumoperitoneum (LPP) has been proposed to reduce postoperative pain after laparoscopic cholecystectomy, but existing evidence is heterogeneous and at high risk of bias. Safta et al. conducted a single-center, randomized, double-blind trial in Tunis (November 2024 to December 2025) comparing 8 mmHg (LPP) with 14 mmHg (standard pressure, SPP) insufflation in adults undergoing elective laparoscopic cholecystectomy for uncomplicated symptomatic gallstone disease (ASA I-II). The primary outcome was VAS pain at 6 hours, and the sample size of 160 (80 per group) was powered to detect a 1-point difference. Analysis was by intention-to-treat. Surgeons could not be blinded. Median VAS at 6 hours did not differ significantly between groups (3 vs. 4; p=0.221), nor at 12 hours (p=0.074) or 24 hours (p=0.128). A mixed-effects model showed no treatment effect or treatment-by-time interaction. Mean paracetamol doses in the first 24 hours were lower with LPP (1.04 vs. 1.35; p=0.014). Operative time was similar (p=0.880), and there were no laparotomy conversions or 30-day morbidity. Two SPP patients required pressure reduction for hypercapnia. The authors note that the paracetamol finding was a secondary outcome without multiplicity adjustment and is exploratory. The trial was not powered to assess rare complications.
1. A 10-minute repetitive peripheral magnetic stimulation (rPMS) protocol produced short-term improvements in pain, pressure sensitivity, and disability that were not significantly different from a 15-minute protocol, suggesting that shorter sessions may be a practical option.
Evidence Rating Level: 1 (Excellent)
Upper trapezius myofascial pain syndrome (MPS) is a common contributor to chronic neck pain, and repetitive peripheral magnetic stimulation (rPMS) is an emerging non-invasive treatment whose optimal session duration is unknown. Jongutchariya and colleagues conducted a single-centre, assessor-blinded randomized trial in Thailand comparing a 15-minute versus a 10-minute rPMS protocol in adults aged 18-55 with chronic (≥3 months) upper trapezius MPS and baseline VAS ≥4. Sixty-six participants were randomized 1:1 (33 per group) to receive weekly rPMS for four weeks alongside standardized stretching exercises. Both protocols shared an identical 5-minute trigger-point phase, differing only in the length of the scanning phase (10 versus 5 minutes). The primary outcome was VAS pain, with the Pressure Pain Threshold (PPT) and Neck Disability Index (NDI) as secondary outcomes, analyzed by intention-to-treat using linear mixed-effects models. Both groups improved significantly over time (all p<0.001). At week 4, VAS fell by 4.87 points, PPT rose by 2.51 kg/cm², and NDI fell by 9.15 points. There were no significant between-group differences, including the primary endpoint (VAS difference −0.27; 95% CI −0.95 to 0.40; p=0.43). No serious adverse events occurred. Limitations include the absence of a sham or stretching-only control, no participant blinding, four-week follow-up, a single centre, and a design not powered for equivalence.
1. Clinicians can improve preparation by assessing multimorbidity, simplifying education (for example, teach-back), offering early prehabilitation guidance, involving family and peers, and addressing patients’ emotional concerns
Evidence Rating Level: 3 (Average)
Approximately 20% of patients are dissatisfied after total knee arthroplasty (TKA), and traditional preoperative preparation often prioritizes physiological safety while overlooking patients’ psychological, informational, and social needs. Sun and colleagues (BMJ Open, 2026) conducted a descriptive qualitative study to explore what older patients perceive as shaping their preoperative self-preparation, using the Capability, Opportunity and Motivation-Behaviour (COM-B) model and the Theoretical Domains Framework. They conducted semi-structured interviews with 16 patients aged 60 years or older, one day before primary unilateral TKA at a tertiary hospital in China, and analysed the data using reflexive thematic analysis. Three themes emerged. First, capability was limited by multimorbidity, which amplified fear of surgical risk, and by poor understanding of surgical details, leading many patients to delegate preparation to family. Second, opportunity was constrained by uneven social support, limited access to busy clinicians, unmet prehabilitation needs, and difficulty navigating online or digital health information. Third, motivation was variable, driven by perceived benefits of preparation and the desire to resume social participation, alongside intertwined positive and negative emotions. The authors concluded that self-preparation is multifactorial and recommend optimizing preoperative protocols by strengthening capability, external support, and internal motivation.
Risk of dementia following gabapentin prescription in chronic low back pain patients
1. Gabapentin (Neurontin) prescription in adults with chronic low back pain was associated with a higher incidence of dementia and mild cognitive impairment over 10 years, with the strongest associations in non-elderly adults.
2. Greater prescription frequency was associated with higher risk, and the authors recommend monitoring cognition in gabapentin-treated patients, though causality remains unestablished.
Evidence Rating Level: 2 (Good)
Gabapentin is widely prescribed for chronic pain, but evidence on its link to dementia is mixed, and little is known about how age modifies any association. Eghrari and colleagues conducted a retrospective cohort study using the TriNetX national database to examine whether gabapentin prescription is associated with dementia and mild cognitive impairment (MCI) in adults with chronic low back pain. Patients diagnosed between 2004 and 2014 were included, while those with prior gabapentin use, dementia, epilepsy, stroke, or cancer were excluded. Patients with six or more gabapentin prescriptions were compared with those never prescribed gabapentin, using 1:1 propensity score matching for demographics, comorbidities, and concurrent pain medications. Outcomes were assessed over 10 years. Among 26,416 matched patients per group, gabapentin was associated with higher rates of dementia (RR 1.29; 95% CI 1.18–1.40) and MCI (RR 1.85; 95% CI 1.63–2.10). The association was strongest in non-elderly adults aged 18–64 (dementia RR 2.10; MCI RR 2.50) and was not significant in those aged 18–34. Patients with 12 or more prescriptions had higher risk than those with 3–11 prescriptions (dementia RR 1.40; MCI RR 1.65). Limitations include the lack of dose and duration data, possible residual confounding, and the inability to establish causality.
1. No statistically significant difference in urethrocutaneous fistula (UCF) formation was found between caudal and penile blocks, though the early termination and wide confidence intervals mean clinically important differences cannot be excluded.
2. Caudal block was associated with lower perioperative opioid requirements and lower early postoperative pain scores than penile block.
Evidence Rating Level: 1 (Excellent)
Retrospective studies have reported conflicting associations between caudal block and urethrocutaneous fistula (UCF) after hypospadias repair, often without adjusting for hypospadias severity. To address this, investigators conducted a multicenter, randomized, non-inferiority trial across 16 Pediatric Regional Anesthesia Network centers. Children aged 2 years or younger undergoing primary single-stage midshaft or distal hypospadias repair received general anesthesia with either a caudal block (group C) or a penile block (group P). The primary outcome was UCF formation within three postoperative months, and secondary outcomes included perioperative opioid use and postoperative FLACC pain scores. Of 210 enrolled patients, 161 (76.6%) completed follow-up. UCF occurred in 8.9% of the caudal group and 7.3% of the penile group, a difference that was not statistically significant (RR 0.98; 95% CI 0.35 to 2.76). A more proximal meatal position was associated with higher UCF risk (RR 2.8; 95% CI 1.48 to 5.30). The caudal group received less intraoperative opioid (33% vs 56%) and less rescue opioid (4.9% vs 15.7%), and had lower mean PACU FLACC scores (0.49 vs 1.14). The trial was terminated early, and incomplete enrollment, loss to follow-up, and wide confidence intervals limit precision. The authors therefore consider the findings exploratory.
Image: PD
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