Jun 8, 2026 · 15 min · 10 segments
In this episode, we unpack a massive 2026 systematic review and network meta-analysis covering nearly 15,000 patients and 166 clinical trials on intrathecal adjuvants used during cesarean delivery…
[Instrumental music] Um, as an anesthesiologist, you know the exact scenario we're talking about today.
Oh, absolutely.
The single-shot spinal wears off after a C-section, and suddenly you're just, you know, racing the clock.
Right.
Racing to manage the mother's pain without falling back on heavy opioids.
And, I mean, we've spent years mixing spinal cocktails to prevent this.
Yeah, constantly tweaking the recipe.
Exactly.
Well, today we are discussing an article that challenges a lot of that, the Olusu 2026 network meta-analysis.
It is a massive data set.
It's huge.
And our mission today is to figure out the ultimate combination of spinal adjuvants, specifically the ones added to long-acting local anesthetics during C-sections.
Right.
Because we naturally assume that adding a heavy hitter, like buprenorphine or diamorphine, will lower overall pain scores down the line.
Right.
But the data says no.
Okay, let's unpack this.
It's kind of like putting premium gas in a car expecting a higher top speed tomorrow.
Mm-hmm.
It just doesn't work that way.
No, it doesn't.
None of the adjuvants significantly reduced pain intensity at twenty-four hours compared to the control.
Not a single one.
Not one.
[Instrumental music] Um, as an anesthesiologist, you know the exact scenario we're talking about today.
Oh, absolutely.
The single-shot spinal wears off after a C-section, and suddenly you're just, you know, racing the clock.
Right.
Racing to manage the mother's pain without falling back on heavy opioids.
And, I mean, we've spent years mixing spinal cocktails to prevent this.
Yeah, constantly tweaking the recipe.
Exactly.
Well, today we are discussing an article that challenges a lot of that, the Olusu 2026 network meta-analysis.
It is a massive data set.
It's huge.
And our mission today is to figure out the ultimate combination of spinal adjuvants, specifically the ones added to long-acting local anesthetics during C-sections.
Right.
Because we naturally assume that adding a heavy hitter, like buprenorphine or diamorphine, will lower overall pain scores down the line.
Right.
But the data says no.
Okay, let's unpack this.
It's kind of like putting premium gas in a car expecting a higher top speed tomorrow.
Mm-hmm.
It just doesn't work that way.
No, it doesn't.
None of the adjuvants significantly reduced pain intensity at twenty-four hours compared to the control.
Not a single one.
Not one.
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