Anesthesiology and Pain Medicine, Critical Care and Intensive Care Medicine
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Scopus Publications
Scopus Publications
Diagnostic Imaging Challenges During Extracorporeal Membrane Oxygenation Matteo Rossetti, Paolo Capuano, Giuseppe Mamone, Salman Abdulaziz, Praveen Ghisulal, Giovanna Panarello, Gennaro Martucci, Sung‐Min Cho, Roberto Lorusso Artificial Organs, 2026 Background Extracorporeal membrane oxygenation (ECMO) is a critical life support therapy for severe cardiac and respiratory failure, but it is associated with thromboembolic, hemorrhagic, and neurological complications. Diagnostic imaging is essential for early detection and management of these events; however, conventional modalities such as contrast enhanced computed tomography (CT) are often limited by the risks of transporting unstable patients and by ECMO related hemodynamic alterations that may distort contrast distribution, particularly in peripheral veno arterial (VA‐ECMO). Aim This review aims to evaluate current diagnostic imaging strategies and emerging non invasive technologies that may improve the detection and management of ECMO related complications, with a focus on contrast enhanced CT, bedside echocardiography, and novel neuroradiological tools. Methods A narrative synthesis was conducted examining diagnostic approaches applicable to ECMO patients, including contrast enhanced CT, transesophageal echocardiography (TEE), low field bedside magnetic resonance imaging (MRI), and electrical impedance tomography. The review emphasizes physiological considerations, technical limitations, and potential clinical applications. Results TEE enables real time assessment of cardiac–ECMO interactions and identification of the watershed zone in VA‐ECMO, supporting individualized flow optimization. Low field bedside MRI reduces transport related risks and may enhance early detection of cerebral complications. Electrical impedance tomography provides dynamic, radiation free monitoring of regional ventilation in ARDS patients on veno venous VV‐ECMO. Despite promising performance characteristics, these technologies remain underutilized in routine practice. Conclusion Integrating advanced bedside imaging modalities with traditional diagnostic tools may significantly improve the safety and accuracy of monitoring in ECMO patients. Broader adoption and further technological refinement could enhance early complication detection and support more personalized ECMO management.
Incidence, kinetics, and clinical impact of thrombocytopenia in venovenous ECMO: insights from the multicenter observational PROTECMO study Nina Buchtele, Kenichi Tanaka, Fabio Tuzzolino, Cara Agerstrand, Ali Ait Hssain, Jordi Riera, Peter Schellongowski, Matthieu Schmidt, Raj Ramanan, Martin Balik, Lars Mikael Broman, Nicolo Rizzitello, Konstanty Szułdrzyński, Whitney D. Gannon, Vito Fanelli, Brian Trethowan, Hergen Buscher, Huda Alfoudri, Marco Giani, Alain Combes, Giacomo Grasselli, Roberto Lorusso, Antonio Arcadipane, Daniel Brodie, Gennaro Martucci, PROTECMO Study group, Marco Barbara, Paolo Capuano, Claudia Costantino, Gennaro Martucci, Nicolò Rizzitello, Monica Rizzo, Matteo Rossetti, Antonio Pesenti, Matteo Brioni, Gennaro De Pascale, Luca Montini, Giuseppe Foti, Emanuele Rezoagli, Luca Brazzi, Pierfrancesco Curcio, Eugenio Garofalo, Luis Martin-Villen, Raquel Garcìa-Álvarez, Marta Lopez Sanchez, Nuno Principe, Violeta Chica Saez, Juan Ignacio Chico, Vanesa Gomez, Joaquin Colomina-Climent, Andres Francisco Pacheco, Camilo Bonilla, Eduard Argudo, María Martínez-Martínez, María Martínez-Pla, Pau Torrella, Bet Gallart, Vojka Gorjup, Julien Goutay, Duburcq Thibault, Mariusz Kowalewski, Philipp Eller, Elisabeth Lobmeyr, Peter Schellongowski, Silvia Mariani, Marco Vito Ranieri, Pavel Suk, Michal Maly, Jakob Forestier, Nicolò Rizzitello, Marco Barbara, Monica Rizzo, Tyler Holsworth, Alexis Serra, Darryl Abrams, Yiorgos Alexandros Cavayas, Ali Tabatabai, Jay Menaker, Samuel Galvagno, Whitney D Gannon, Todd W Rice, Wilson E Grandin, Jose Nunez, Collette Cheplic, Ryan Rivosecchi, Harikesh Subramanian, Young-Jae Cho, Sarah Buabbas, Kyeongman Jeon, Ming Chit Kwan, Hend Sallam, Joy Ann Villanueva, Jeffrey Aliudin, Kota Hoshino, Yoshitaka Hara, Kollengode Ramanathan, Graeme Maclaren Critical Care, 2025 Thrombocytopenia is a recognized risk factor for bleeding during extracorporeal membrane oxygenation (ECMO). This study determines the incidence, risk factors, and clinical relevance of thrombocytopenia and platelet transfusions during venovenous (VV) ECMO. The multicenter, prospective observational PROTECMO study included 652 adult patients who received VV ECMO for respiratory failure. Thrombocytopenia was classified as mild (100–149·109/L), moderate (50–99·109/L), or severe (< 50·109/L). Bleeding events were evaluated using a modified Bleeding Academy Research Consortium score. Cox proportional hazards and logistic regression analyses were done to identify predictors, and quantify the association between platelet counts and bleeding risk. A total of 182 patients (27.9%) had thrombocytopenia at baseline (mild in 14.7%, moderate in 8.7%, and severe in 4.4%). Thrombocytopenia during ECMO, at least once in 80.2% of patients, was mild in 21.3% of cases, moderate in 32.2%, and severe in 26.7%. A 10·109/L decrease in platelet count was associated with a 3.7% (95% CI: 2.4–5.0%) increase in risk of bleeding. There was no strong evidence of nonlinear relationship within the platelet count range between 25,000 and 300,000. This relation remained consistent across all ECMO weeks. Mild thrombocytopenia increased the risk of experiencing a bleeding event by 61% (hazard ratio (HR) 1.611, 95% CI 1.230–2.109, p = 0.0005), while moderate and severe thrombocytopenia increased the risk by roughly 90% (moderate: HR 1.944 (CI 1.484–2.545), p < 0.0001; severe: HR 1.876 (CI 1.275–2.7680), p = 0.0014). The risk for thrombocytopenia < 100·109/L during ECMO significantly increased with ICU days prior to ECMO start, postoperative admission, immunocompromised state, renal replacement therapy, septic shock, low hemoglobin, and circuit exchange. Thrombocytopenia is highly prevalent in VV ECMO, and associated with a significant increase in the risk of bleeding, and a reduction in 6-month survival, particularly at platelet counts below 100·109/L. Further research is needed to better define the outcomes associated with specific thresholds for transfusion of platelets.
Erector Spinae Plane Block in Pediatric Patients: A Case Report of Caution Paolo Capuano, Gaetano Burgio, Gennaro Martucci A and A Practice, 2025 This case report describes the use of an erector spinae plane block (ESPB) for postoperative analgesia in a 4-year-old patient undergoing Meso-Rex shunt surgery. After anesthesia induction, the ESPB was performed using ultrasound guidance. During the procedure, Doppler imaging revealed nearby vascular structures, which required careful attention to avoid injury. A single injection of ropivacaine was administered, along with a catheter for continuous analgesia. The patient experienced effective pain control without the need for additional analgesics. This case highlights the importance of Doppler imaging in ensuring ESPB safety, particularly in pediatric patients.
Single-Shot Thoracic Spinal Anesthesia and Serratus Anterior Plane Block for Awake Nonintubated Thoracic Surgery: A Case Report Mario Tedesco, Giuseppe Sepolvere, Danilo Canzio, Aurora Tamburello, Paolo Capuano A and A Practice, 2025 Awake nonintubated thoracic surgery (NITS) is a valuable approach for patients at high risk of complications from general anesthesia. We present a case of a 67-year-old patient with cholangiocarcinoma and pulmonary metastases undergoing left lingular wedge resection. Given significant hepatic impairment, single-shot thoracic spinal anesthesia (TSA) and a serratus anterior plane block (SAPB) were used to ensure intraoperative and postoperative analgesia. The procedure was well tolerated, demonstrating TSA’s potential advantages in minor thoracic surgery. This fusion approach may represent a safe and effective alternative to general anesthesia, reducing invasiveness and improving patient outcomes.
Rectus Sheath and Transversus Abdominis Plane Blocks for Preaponeurotic Endoscopic Repair: Is the Double Block the Solution for Postoperative Pain Management? Antonio Toscano, Luca Domenico Bonomo, Paolo Capuano, Luca Cremascoli, Filippo Castelli, Mattia Puppo, Fabrizio Aprà, Alberto Jannaci, Salvatore Cuccomarino Surgical Laparoscopy Endoscopy and Percutaneous Techniques, 2025 Background: Diastasis recti abdominis (DRA) is a prevalent postpartum condition characterized by the separation of the rectus abdominis muscles with an interrectal distance >2.5 cm, often leading to symptoms like back pain, constipation, and urinary incontinence. Preaponeurotic endoscopic repair (REPA) is a novel, minimally invasive surgical approach for DRA, offering an alternative to traditional abdominoplasty. Despite its minimally invasive nature, REPA surgery poses significant postoperative pain challenges, typically managed with opioids, which carry numerous side effects. Materials and Methods: This retrospective study evaluates the efficacy of combining 2 ultrasound-guided abdominal wall blocks, rectus sheath block (RSB) and transversus abdominis plane block (TAPB), to manage postoperative pain in 55 DRA patients who underwent REPA surgery. We performed lateral TAPB in 28 cases, whereas 27 received an association of TAPB and RSB. Results: At 6 hours postsurgery, 61% of patients in the TAPB group reported significant pain (Numeric Rating Scale >3), compared with 19% in the TAPB-RSB group (P = 0.001). The TAPB-RSB group also required fewer analgesic rescue doses (P = 0.042) and showed earlier recovery, with faster initiation of oral intake and mobility. Conclusion: The combination of TAPB and RSB significantly reduces opioid consumption, postoperative pain, and the need for rescue analgesia compared with TAPB alone. The dual-block approach, providing a multi-dermatomal sensory block, suggests a promising strategy for improving postoperative pain management in REPA surgery.
Efficacy of Spinal Analgesia for Pain Management in Living Donor Hepatectomy: A Systematic Review Paolo Capuano, Gennaro Martucci, Yaroslava Longhitano, Raymond M. Planinsic, Gaetano Burgio Journal of Intensive Care Medicine, 2025 Background Living donor hepatectomy is a major surgical procedure associated with significant postoperative pain. Effective analgesia is essential to enhance recovery and ensure donor safety. Traditional approaches such as epidural analgesia are effective but may raise safety concerns due to perioperative coagulopathy. Spinal analgesia using intrathecal morphine (ITM) has emerged as a potential alternative, providing long-lasting pain relief with a favorable safety profile. Methods This systematic review was conducted following PRISMA guidelines and registered in PROSPERO (CRD420251149887). PubMed and EMBASE were searched from January 2000 to September 2025 for randomized and observational studies evaluating spinal analgesia in living donor hepatectomy. Outcomes included pain intensity, opioid consumption, and complications. Study quality was assessed using the Oxford Centre for Evidence-Based Medicine (OCEBM) levels and the RoB 2 tool. Results The initial search revealed a total of 937 publications. After duplicate removal, 932 articles were eligible for screening from title and abstract, and 920 were excluded . The remaining 12 articles were then eligible for full-text review. Among these, 4 studies were excluded (abstract N = 1; letter to the editor or commentaries N = 1; no full text available N = 1; review N = 1). Eight studies involving 698 patients were included (seven randomized trials and one retrospective study). Spinal analgesia, mainly using 300–400 µg ITM, provided effective pain relief and reduced opioid consumption compared with intravenous patient-controlled analgesia, thoracic epidural analgesia, wound infiltration, and some fascial plane blocks. Adverse effects such as pruritus, nausea, and vomiting were common but mild and self-limiting; respiratory depression was rare. Conclusions Intrathecal morphine provides effective and durable postoperative analgesia in living liver donors, reducing opioid use and avoiding the risks of epidural catheterization. Despite promising results, evidence remains limited by small sample sizes and study heterogeneity. High-quality multicenter trials are needed to define optimal dosing and integrate spinal analgesia into multimodal enhanced recovery protocols for donor hepatectomy.
Right Ventricular Myxoma Presenting in a Patient With Known Arteriovenous Malformations in the Brain: A Case Report Matthew Kocher, Maria Scarlata, Paolo Capuano, Eleonora Bonicolini, Alberto Piacentini, Pamela Asaro, Marco Morsolini, Giovanna Panarello, Gaetano Burgio, Michele Pilato Annals of Cardiac Anaesthesia, 2025 Cardiac myxomas extending from the right ventricle are uncommon and this rare condition is potentially associated with several risks and poor outcomes. We report the case of a patient with a right ventricular myxoma who had a recent haemorrhagic stroke due to an arteriovenous malformation. The preoperative and intraoperative managements were challenging and required several difficult choices by the medical team and consequently, a multidisciplinary approach and a benefit-risk evaluation were necessary to determinate timely surgical resection in an urgent situation, simultaneously avoiding delayed or improper treatments, achieving a successful outcome in a very high-risk situation.
Erector spinae plane block for cancer pain relief: a systematic review Paolo Capuano, Antonietta Alongi, Gaetano Burgio, Gennaro Martucci, Antonio Arcadipane, Andrea Cortegiani Journal of Anesthesia Analgesia and Critical Care, 2024 Background Despite advances in pain management, cancer-related pain remains a critical issue for many patients. In recent years, there has been a growing interest in the use of fascial plane blocks, such as the Erector Spinae Plane Block (ESPB), for managing chronic pain, including in the oncology field. We conducted a systematic review to synthetize existing evidence on the use of ESPB for cancer pain management. Methods We selected studies published between January 2016 to April 2024. A systematic search in Pubmed and Embase databases was performed. The search strategy included the following keywords and/or MeSH terms according to the controlled vocabulary of the databases sought: ((erector spinae plane block) OR (ESP block) OR (ESPB) AND ((cancer pain). We considered eligible Randomized, nonrandomized studies, case series and case reports reporting data on the use of ESPB in patients with cancer pain. Results The search revealed 34 studies. Among these, we found one RCT, three retrospective studies, two case series, and 28 case reports for a total of 135 patients. Studies included described the use of ESPB for the management of various types of cancer pain across different conditions, including chronic thoracic cancer-related pain, abdominal visceral pain and pain related to bone metastases. Single-shot ESPB was performed in 26 studies while continuous ESPB and the use of a peripheral nerve catheter for continuous analgesia were described in 8 studies. Neurolytic ESPB was performed in 6 studies for a total of 10 patients There was a high clinical heterogeneity in terms of technique, drugs, and use of adjuvants. The lack of comparators was a major flaw, together with the low level of evidence in the majority of the included studies. Conclusions The evidence supporting the use of ESPB for cancer pain management is currently scarce, heterogeneous, and of low quality. To better understand its potential and provide robust clinical guidance, future research needs to focus on rigorous comparative studies, standardization of techniques and larger sample sizes.
Fascial plane blocks for cardiothoracic surgery: a narrative review Paolo Capuano, Giuseppe Sepolvere, Antonio Toscano, Paolo Scimia, Simona Silvetti, Mario Tedesco, Luca Gentili, Gennaro Martucci, Gaetano Burgio Journal of Anesthesia Analgesia and Critical Care, 2024 In recent years, there has been a growing awareness of the limitations and risks associated with the overreliance on opioids in various surgical procedures, including cardiothoracic surgery.This shift on pain management toward reducing reliance on opioids, together with need to improve patient outcomes, alleviate suffering, gain early mobilization after surgery, reduce hospital stay, and improve patient satisfaction and functional recovery, has led to the development and widespread implementation of enhanced recovery after surgery (ERAS) protocols.In this context, fascial plane blocks are emerging as part of a multimodal analgesic in cardiac surgery and as alternatives to conventional neuraxial blocks for thoracic surgery, and there is a growing body of evidence suggesting their effectiveness and safety in providing pain relief for these procedures. In this review, we discuss the most common fascial plane block techniques used in the field of cardiothoracic surgery, offering a comprehensive overview of regional anesthesia techniques and presenting the latest evidence on the use of chest wall plane blocks specifically in this surgical setting.
Recommendations for fast-track extubation in adult cardiac surgery patients: a consensus statement Simona SILVETTI, Gianluca PATERNOSTER, Domenico ABELARDO, Valentina AJELLO, Tommaso ALOISIO, Massimo BAIOCCHI, Paolo CAPUANO, Alessandro CARUSO, Paolo A. DEL SARTO, Fabio GUARRACINO, Giovanni LANDONI, Daniele MARIANELLO, Christopher M. MÜNCH, Marina PIERI, Filippo SANFILIPPO, Giuseppe SEPOLVERE, Lucia TORRACCA, Antonio TOSCANO, Mario ZACCARELLI, Marco RANUCCI, Sabino SCOLLETTA Minerva Anestesiologica, 2024
Anterior and Posterior Abdominal Wall Anatomy Paolo Capuano, Mario Tedesco, Andrea Tognù, Giuseppe Sepolvere Fast Track in Cardiac Anesthesia Cardiac Surgery in the Era of Eras, 2024
Ministernotomy Paolo Capuano, Tarek Senussi, Giulio Carinci, Antonio De Bellis, Francesco Santini Fast Track in Cardiac Anesthesia Cardiac Surgery in the Era of Eras, 2024
