Regional Anesthesia & Pain Medicine最新文献_第3页

Correction: Pathophysiology and etiology of nerve injury following peripheral nerve blockade 更正：外周神经阻滞术后神经损伤的病理生理学和病因学

Regional Anesthesia & Pain Medicine Pub Date : 2024-05-01 DOI: 10.1136/aap.0000000000000125corr1

BMJ Publishing Group Ltd

引用次数: 0

Regional versus general anesthesia for total hip and knee arthroplasty: a nationwide retrospective cohort study 全髋关节和膝关节置换术的区域麻醉与全身麻醉：一项全国性回顾性队列研究

Regional Anesthesia & Pain Medicine Pub Date : 2024-04-30 DOI: 10.1136/rapm-2024-105440

Tak Kyu Oh, In-Ae Song

{"title":"Regional versus general anesthesia for total hip and knee arthroplasty: a nationwide retrospective cohort study","authors":"Tak Kyu Oh, In-Ae Song","doi":"10.1136/rapm-2024-105440","DOIUrl":"https://doi.org/10.1136/rapm-2024-105440","url":null,"abstract":"Introduction We aimed to determine whether regional anesthesia (RA) has any advantages over general anesthesia (GA) in total joint arthroplasty (TJA) in terms of mortality and postoperative complications. Methods This population-based retrospective cohort study included data of adults who underwent total knee or hip arthroplasty under RA or GA between 2016 and 2021 from the National Health Insurance Service of South Korea. RA included spinal or epidural anesthesia or a combination of both. Endpoints were 30-day mortality, 90-day mortality, and postoperative complications. Propensity score (PS) matching was used for statistical analysis. Results We included 517 960 patients (RA, n=380 698; GA, n=137 262) who underwent TJA. After PS matching, 186 590 patients (93 295 in each group) were included in the final analysis. In the logistic regression analyses using the PS-matched cohort, the RA group compared with the GA group showed 31% (OR: 0.69; 95% CI, 0.60 to 0.80; p<0.001) and 22% (OR: 0.78; 95% CI, 0.72 to 0.85; p<0.001) lower 30-day and 90-day mortality rates, respectively. However, the total postoperative complication rate did not differ significantly between the two groups (p=0.105). Conclusion RA compared with GA was associated with improved 30-day and 90-day survival outcomes in patients who underwent TJA. However, the postoperative complication rate did not differ significantly. Therefore, our results should be interpreted with caution, and more well-designed future studies are needed to clarify the most appropriate type of anesthesia for TJA. Data are available upon reasonable request.","PeriodicalId":21046,"journal":{"name":"Regional Anesthesia & Pain Medicine","volume":"40 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140835253","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Postsurgical opioid prescribing among veterans using community care for orthopedic surgery at non-VA hospitals compared to a VA hospital with a transitional pain service: a retrospective cohort study 在非退伍军人医院接受骨科手术的退伍军人在手术后使用阿片类药物的情况与在退伍军人医院接受过渡性疼痛服务的退伍军人相比：一项回顾性队列研究

Regional Anesthesia & Pain Medicine Pub Date : 2024-04-27 DOI: 10.1136/rapm-2023-105162

Michael Jacob Buys, Zachary Anderson, Kimberlee Bayless, Chong Zhang, Angela P Presson, Julie Hales, Benjamin Sands Brooke

{"title":"Postsurgical opioid prescribing among veterans using community care for orthopedic surgery at non-VA hospitals compared to a VA hospital with a transitional pain service: a retrospective cohort study","authors":"Michael Jacob Buys, Zachary Anderson, Kimberlee Bayless, Chong Zhang, Angela P Presson, Julie Hales, Benjamin Sands Brooke","doi":"10.1136/rapm-2023-105162","DOIUrl":"https://doi.org/10.1136/rapm-2023-105162","url":null,"abstract":"Background The USA provides medical services to its military veterans through Veterans Health Administration (VHA) medical centers. Passage of recent legislation has increased the number of veterans having VHA-paid orthopedic surgery at non-VHA facilities. Methods We conducted a retrospective cohort study among veterans who underwent orthopedic joint surgery paid for by the VHA either at the Salt Lake City VHA Medical Center (VAMC) or at non-VHA hospitals between January 2018 and December 2021. 562 patients were included in the study, of which 323 used a non-VHA hospital and 239 patients the VAMC. The number of opioid tablets prescribed at discharge, the total number prescribed by postdischarge day 90, and the number of patients still filling opioid prescriptions between 90 and 120 days after surgery were compared between groups. Results Veterans who underwent orthopedic surgery at a non-VHA hospital were prescribed more opioid tablets at discharge (median (IQR)); (40 (30–60) non-VHA vs 30 (20–47.5) VAMC, p<0.001) and in the first 90 days after surgery than patients who had surgery at the Salt Lake City VAMC (60 (40–120) vs 35 (20–60), p<0.001). Patients who had surgery at Salt Lake City VAMC were also significantly less likely to fill opioid prescriptions past 90 days after hospital discharge (OR (95% CI) 0.06 (0.01 to 0.48), p=0.007). Conclusion These results suggest that veterans who have surgery at a veterans affairs hospital with a transitional pain service are at lower risk for larger opioid prescriptions both at discharge and within 90 days after surgery as well as persistent opioid use beyond 90 days after discharge than if they have surgery at a community hospital. Data are available upon reasonable request.","PeriodicalId":21046,"journal":{"name":"Regional Anesthesia & Pain Medicine","volume":"34 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140806426","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Anesthesia start time documentation accuracy where peripheral nerve block is the primary anesthetic 以周围神经阻滞为主要麻醉方式时，麻醉开始时间记录的准确性

Regional Anesthesia & Pain Medicine Pub Date : 2024-04-19 DOI: 10.1136/rapm-2024-105292

Alexander B Stone, Andrés Zorrilla Vaca, Philipp Lirk, Philipp Gerner, Kamen Vlassakov

{"title":"Anesthesia start time documentation accuracy where peripheral nerve block is the primary anesthetic","authors":"Alexander B Stone, Andrés Zorrilla Vaca, Philipp Lirk, Philipp Gerner, Kamen Vlassakov","doi":"10.1136/rapm-2024-105292","DOIUrl":"https://doi.org/10.1136/rapm-2024-105292","url":null,"abstract":"Introduction When used as the primary anesthetic, nerve blocks are not billed as separate procedures. In this scenario, the anesthesia start (A Start ) time should include the block procedural time. We measured how often A Start time was documented before the nerve block was placed in the preoperative area, and compared cases where a block team performed the nerve block and cases where the intraoperative anesthesia attending supervised the nerve block. We hypothesized that the involvement of a regional anesthesia team would lead to more accurate documentation of A Start . We also estimated the lost revenue due to inaccurate start time documentation. Methods The study population were patients undergoing surgery with a peripheral nerve block as the primary anesthetic. For this analysis, A Start occurring less than 10 min before the in-operating room time was defined as potentially inaccurate. Lost potential revenue was estimated by taking the difference between the documented time of local anesthetic administration and the documented A Start time. Results A total of 745 cases were analyzed. Overall, 439 cases (58%) cases were identified as having potentially inaccurate start times. There were higher rates of inaccurate A Start documentation by the block team (316/482, 65.5%) compared with blocks supervised by the in-room anesthesia attendings (123/263, 46.7%, p<0.001). Overall, the estimated loss in billable revenue during the study period was a total of $70 265. Conclusions The performance of primary regional anesthesia procedure by a block team increased the incidence of inaccurate documentation and uncaptured potential revenue. There is need for education about accurate nerve block documentation for anesthesiologists, especially when separate teams are used. No data are available.","PeriodicalId":21046,"journal":{"name":"Regional Anesthesia & Pain Medicine","volume":"98 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140631096","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Multisite prospective study of perioperative pain management practices for anterior cruciate ligament reconstruction in adolescents: Society for Pediatric Anesthesia Improvement Network (SPAIN) Project Report 青少年前十字韧带重建术围手术期疼痛管理实践的多点前瞻性研究：儿科麻醉改进网络学会（SPAIN）项目报告

Regional Anesthesia & Pain Medicine Pub Date : 2024-04-18 DOI: 10.1136/rapm-2024-105381

Kesavan Sadacharam, James S Furstein, Steven J Staffa, Galaxy Li, Rami Karroum, Jocelyn M Booth, Eugene Kim, Suzanne M McCahan, Wallis T Muhly, Vidya Chidambaran

{"title":"Multisite prospective study of perioperative pain management practices for anterior cruciate ligament reconstruction in adolescents: Society for Pediatric Anesthesia Improvement Network (SPAIN) Project Report","authors":"Kesavan Sadacharam, James S Furstein, Steven J Staffa, Galaxy Li, Rami Karroum, Jocelyn M Booth, Eugene Kim, Suzanne M McCahan, Wallis T Muhly, Vidya Chidambaran","doi":"10.1136/rapm-2024-105381","DOIUrl":"https://doi.org/10.1136/rapm-2024-105381","url":null,"abstract":"Introduction Although 200 000 adolescents undergo anterior cruciate ligament reconstruction (ACLR) surgery annually, no benchmarks for pediatric post-ACLR pain management exist. We created a multicenter, prospective, observational registry to describe pain practices, pain, and functional recovery after pediatric ACLR. Methods Participants (n=519; 12–17.5 years) were enrolled from 15 sites over 2 years. Data on perioperative management and surgical factors were collected. Pain/opioid use and Lysholm scores were assessed preoperatively, on postoperative day 1 (POD1), POD3, week 6, and month 6. Descriptive statistics and trends for opioid use, pain, and function are presented. Results Regional analgesia was performed in 447/519 (86%) subjects; of these, adductor canal single shot was most frequent (54%), nerve catheters placed in 24%, and perineural adjuvants used in 43%. On POD1, POD3, week 6, and month 6, survey response rates were 73%, 71%, 61%, and 45%, respectively. Over these respective time points, pain score >3/10 was reported by 64% (95% CI: 59% to 69%), 46% (95% CI: 41% to 52%), 5% (95% CI: 3% to 8%), and 3% (95% CI: 1% to 6%); the number of daily oxycodone doses used was 2.8 (SD 0.19), 1.8 (SD 0.13), 0, and 0. There was considerable variability in timing and tests for postdischarge functional assessments. Numbness and weakness were reported by 11% and 4% at week 6 (n=315) and 16% and 2% at month 6 (n=233), respectively. Conclusion We found substantial variability in the use of blocks to manage post-ACLR pain in children, with a small percentage experiencing long-term pain and neurological symptoms. Studies are needed to determine best practices for regional anesthesia and functional assessments in this patient population. Data are available upon reasonable request.","PeriodicalId":21046,"journal":{"name":"Regional Anesthesia & Pain Medicine","volume":"17 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140629797","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Orally administered ketamine and postoperative opioid use in colorectal surgery: a retrospective cohort study 口服氯胺酮与结直肠手术术后阿片类药物的使用：一项回顾性队列研究

Regional Anesthesia & Pain Medicine Pub Date : 2024-04-16 DOI: 10.1136/rapm-2023-105218

Aria Lucchesi, Eric S Schwenk, Eric R Silverman

引用次数: 0

Age and pain: are pain management clinicians keeping up with the increasing Medicare population? 年龄与疼痛：疼痛管理临床医生是否跟上了医疗保险人口增长的步伐？

Regional Anesthesia & Pain Medicine Pub Date : 2024-04-10 DOI: 10.1136/rapm-2023-104556

Aditya Khurana, Layth Mahdi, Christopher Wie, Natalie H Strand

引用次数: 0

Fluoroscopy-guided high-intensity focused ultrasound neurotomy of the lumbar zygapophyseal joints: a prospective, open-label study 透视引导下的腰椎颧骨关节高强度聚焦超声神经切除术：一项前瞻性开放标签研究

Regional Anesthesia & Pain Medicine Pub Date : 2024-04-05 DOI: 10.1136/rapm-2024-105345

Michael Gofeld, Kevin J Smith, Anuj Bhatia, Vladimir Djuric, Suzanne Leblang, Niv Rebhun, Ron Aginsky, Eric Miller, Brian Skoglind, Arik Hananel

{"title":"Fluoroscopy-guided high-intensity focused ultrasound neurotomy of the lumbar zygapophyseal joints: a prospective, open-label study","authors":"Michael Gofeld, Kevin J Smith, Anuj Bhatia, Vladimir Djuric, Suzanne Leblang, Niv Rebhun, Ron Aginsky, Eric Miller, Brian Skoglind, Arik Hananel","doi":"10.1136/rapm-2024-105345","DOIUrl":"https://doi.org/10.1136/rapm-2024-105345","url":null,"abstract":"Objective The objective of this study is to investigate safety and effectiveness of a fluoroscopy-guided high-intensity focused ultrasound (HIFU) system for thermal ablation of the lumbar medial branch nerves. Methods This dual center prospective cohort study enrolled 30 participants with lumbar zygapophyseal joint syndrome. Each participant previously had a positive response to either a single diagnostic analgesic block or radiofrequency ablation (RFA). The primary effectiveness outcome was individual responder rate, defined as a reduction of two points or more on the pain intensity numerical rating scale without an increase in opioid intake, or a reduction in opioid intake without an increase in pain at 6 months after the intervention. The primary safety outcome was procedure-related or device-related adverse events (AEs). Secondary outcome variables included MRI evidence of tissue ablation, Oswestry Disability Index, 12-Item Short Form Health Survey, Brief Pain Inventory, and Patient Global Impression of Change. Results The individual responder rate was 89.7% at 2 days, 89.7% at 7 days, 72.4% at 14 days, 82.1% at 30 days, 59.3% at 90 days and 82.6% at 180 days. The average Numeric Rating Scale for pain severity decreased from 7.1 at baseline to 3.0 (N=29) after 2 days, 3.0 (N=29) after 7 days, 3.1 (N=29) after 14 days, 3.2 (N=28) after 30 days, 4.3 (N=27) after 90 days, and 3.3 (N=23) after 180 days. All participants tolerated the procedure well with no significant side effects or complications. Conclusions Fluoroscopy-guided HIFU neurotomy achieved clinical responses comparable with RFA, and there were no significant device-related or procedure-related AEs. Trial registration number [NCT04129034][1]. Data are available on reasonable request. [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT04129034&atom=%2Frapm%2Fearly%2F2024%2F04%2F04%2Frapm-2024-105345.atom","PeriodicalId":21046,"journal":{"name":"Regional Anesthesia & Pain Medicine","volume":"32 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140597968","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Incomplete sensorimotor paresis after upper abdominal surgery with TEA and spinal epidural lipomatosis: a case report 上腹部手术伴 TEA 和脊髓硬膜外脂肪瘤病后的不完全感觉运动麻痹：病例报告

Regional Anesthesia & Pain Medicine Pub Date : 2024-04-05 DOI: 10.1136/rapm-2024-105342

Marco Richard Zugaj, Oliver Gutzeit, Victoria Louise Mayer, Basem Ishak, Christoph Gumbinger, Markus Alexander Weigand, Jens Keßler

{"title":"Incomplete sensorimotor paresis after upper abdominal surgery with TEA and spinal epidural lipomatosis: a case report","authors":"Marco Richard Zugaj, Oliver Gutzeit, Victoria Louise Mayer, Basem Ishak, Christoph Gumbinger, Markus Alexander Weigand, Jens Keßler","doi":"10.1136/rapm-2024-105342","DOIUrl":"https://doi.org/10.1136/rapm-2024-105342","url":null,"abstract":"Introduction This case report documents a postoperative, incomplete sensorimotor paraparesis from thoracic vertebral body 6 (Th6) after combined anesthesia for upper abdominal surgery in a patient who had a thoracic localization of spinal epidural lipomatosis (SEL). Case presentation The patient was treated in our clinic with a thoracic epidural catheter (TEA) for perioperative analgesia during a partial duodenopancreatectomy. Paraparetic symptoms occurred 20 hours after surgery. Initial MRI did not show bleeding, infection or spinal cord damage and the neurosurgeon consultants recommended observation. The neurological examination and the third follow-up MRI on 15th postoperative day showed ventrolateral damage of the spinal cord at level Th6. It is possible that local anesthetic compressed the spinal cord in addition to the existing lipomatosis and the thoracic kyphosis. The paraparesis improved during follow-up paraplegiologic treatment. Conclusion So far, only two uncomplicated lumbar epidural catheter anesthesias have been described in patients who had a lumbar SEL. Epidural catheter anesthesia is a safe and effective method of pain control. But it is important to carefully identify and stratify patients with risk factors during the premedication visit. In patients who had kyphosis and thoracic localization of SEL, TEA may only be used after a risk–benefit assessment.","PeriodicalId":21046,"journal":{"name":"Regional Anesthesia & Pain Medicine","volume":"48 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140597969","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Use of natural language processing method to identify regional anesthesia from clinical notes 使用自然语言处理方法从临床笔记中识别区域麻醉

Regional Anesthesia & Pain Medicine Pub Date : 2024-04-04 DOI: 10.1136/rapm-2024-105340

Laura A Graham, Samantha S Illarmo, Sherry M Wren, Michelle C Odden, Seshadri C Mudumbai

{"title":"Use of natural language processing method to identify regional anesthesia from clinical notes","authors":"Laura A Graham, Samantha S Illarmo, Sherry M Wren, Michelle C Odden, Seshadri C Mudumbai","doi":"10.1136/rapm-2024-105340","DOIUrl":"https://doi.org/10.1136/rapm-2024-105340","url":null,"abstract":"Introduction Accurate data capture is integral for research and quality improvement efforts. Unfortunately, limited guidance for defining and documenting regional anesthesia has resulted in wide variation in documentation practices, even within individual hospitals, which can lead to missing and inaccurate data. This cross-sectional study sought to evaluate the performance of a natural language processing (NLP)-based algorithm developed to identify regional anesthesia within unstructured clinical notes. Methods We obtained postoperative clinical notes for all patients undergoing elective non-cardiac surgery with general anesthesia at one of six Veterans Health Administration hospitals in California between January 1, 2017, and December 31, 2022. After developing and executing our algorithm, we compared our results to a frequently used referent, the Corporate Data Warehouse structured data, to assess the completeness and accuracy of the currently available data. Measures of agreement included sensitivity, positive predictive value, false negative rate, and accuracy. Results We identified 27,713 procedures, of which 9310 (33.6%) received regional anesthesia. 96.6% of all referent regional anesthesia cases were identified in the clinic notes with a very low false negative rate and good accuracy (false negative rate=0.8%, accuracy=82.5%). Surprisingly, the clinic notes documented more than two times the number of regional anesthesia cases that were documented in the referent (algorithm n=9154 vs referent n=4606). Discussion While our algorithm identified nearly all regional anesthesia cases from the referent, it also identified more than two times as many regional anesthesia cases as the referent, raising concerns about the accuracy and completeness of regional anesthesia documentation in administrative and clinical databases. We found that NLP was a promising alternative for identifying clinical information when existing databases lack complete documentation.","PeriodicalId":21046,"journal":{"name":"Regional Anesthesia & Pain Medicine","volume":"32 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140598074","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0