Regional Anesthesia and Pain Medicine最新文献

{"title":"Use of fascial plane blocks for traumatic rib fractures: a scoping review.","authors":"Ahtsham U Niazi, Max Solish, Aneurin Moorthy, Faizan Niazi, Antonio Hermes Abate, Catherine Devion, Stephen Choi","doi":"10.1136/rapm-2024-106366","DOIUrl":"https://doi.org/10.1136/rapm-2024-106366","url":null,"abstract":"<p><strong>Background: </strong>The primary cause of morbidity and mortality in traumatic rib fractures is respiratory complications due to compromised respiratory mechanics secondary to pain and opioid-related respiratory depression. Thoracic epidural analgesia (TEA) provides effective analgesia but may not be possible in patients due to spinal cord injuries, thoracic vertebral fractures, and coagulopathy. New thoracic fascial plane blocks provide new options for patients with multiple rib fractures (MRFs).</p><p><strong>Objective: </strong>Our primary objective was to assess the effectiveness of thoracic fascial plane blocks for patients with MRFs by looking at pain control, opioid consumption, and respiratory function postblock compared with preblock.</p><p><strong>Evidence review: </strong>Literature was searched using keywords and controlled terms, based on the two concepts \"rib fractures\" and \"fascial plane blocks\". Terms were searched in PubMed, Embase, Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews, Web of Science, Scopus, Google Scholar and ClinicalTrials.gov from inception to October 11, 2023, using medical subject headings (MeSH) and free-text terms without date or language restrictions. The terms included rib fractures, thoracic trauma, chest injuries, fascial plane blocks, PEC 1, PEC 2, PEC 3, pectoralis plane, serratus anterior plane (SAPB) and erector spinae plane block.</p><p><strong>Findings: </strong>The available evidence shows that erector spinae plane block and SAPB are effective blocks to provide analgesia and reduce opioid requirements in patients with unilateral or bilateral rib fractures.</p><p><strong>Conclusions: </strong>More randomized control studies are needed to compare these blocks with paravertebral block or TEA to see if they provide analgesia, improve respiratory function, and reduce opioid requirements.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143665256","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Accuracy of patient-reported opioid use to verified prescription fills before and after surgery.","authors":"Siddartha Simha, Ralph Lamonge, Jennifer F Waljee, Yen-Ling Lai, Vidhya Gunaseelan, Michael J Englesbe, Chad M Brummett, Mark C Bicket","doi":"10.1136/rapm-2024-106090","DOIUrl":"https://doi.org/10.1136/rapm-2024-106090","url":null,"abstract":"<p><strong>Objective: </strong>To determine the correlation of patient-reported opioid use as compared to fills verified in a prescription drug monitoring program (PDMP) before and after surgery.</p><p><strong>Background: </strong>Correctly determining prescription opioid use before and after surgery is critical to develop effective policies and care pathways for opioid stewardship perioperatively. While many surgical teams, health systems, and patient registries rely on patients to report their use of prescription opioids, the accuracy of this reporting is unclear.</p><p><strong>Methods: </strong>Patient-reported data on opioid use from 12 225 adult patients who underwent surgical procedures between 1 January 2018 and 31 October 2019 across 70 participating hospitals in Michigan Surgical Quality Collaborative were compared to the reference standard of the state PDMP. The primary outcome was patient-reported opioid fill in the 30 days after surgery compared to PDMP-verified prescription fill, and the secondary outcomes were patient-reported use in the 30-day and 1-year period prior to surgery compared to PDMP data. Accuracy, sensitivity, specificity, and other predictive values were calculated.</p><p><strong>Results: </strong>Among 12 225 patients (58% women, 19.2% non-white, mean (SD) age 15.6 (16.3)), the patient report had acceptable accuracy (83.2%, 95% CI 82.5% to 83.9%) and sensitivity (91.2%, 95% CI 90.6% to 91.8%) compared to 30-day postoperative opioid fills in the PDMP, while less than half of patients without PDMP-verified fills accurately reported not filling an opioid prescription (specificity 43.1%, 95% CI 40.9% to 45.3%). For 30-day and 1-year periods before surgery, patient-reported opioid use had acceptable accuracy (86.8% (95% CI 86.1% to 87.4%) and 77.9% (95% CI 77.2% to 78.7%), respectively) and specificity (90.0% (95% CI 89.4% to 90.5%) and 90.8% (95% CI 90.2% to 91.4%), respectively), while only slightly above half of patients with PDMP-verified opioid fills reported opioid use before surgery (sensitivity 58.9% (95% CI 56.2% to 61.7%) and 47.3% (95% CI 45.7% to 49.0%), respectively).</p><p><strong>Conclusions: </strong>For perioperative opioid fills and use, the patient report appears to align with PDMP data. The patient report may also complement PDMP data by identifying persons who may report opioid prescription fills or use without corresponding data in the PDMP, especially in the postoperative period.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143652050","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of epinephrine on ropivacaine pharmacokinetics in TAP blocks: a randomized controlled trial.","authors":"Romain Rozier, Yann Le Guennec, Xavier Capdevila, Eric Le Louarn, Juliette Balbo, Thibaud Lavrut, Patrick Baque, Olivier Perus, Alexandre Destere, Axel Maurice-Szamburski","doi":"10.1136/rapm-2025-106500","DOIUrl":"https://doi.org/10.1136/rapm-2025-106500","url":null,"abstract":"<p><strong>Background: </strong>Ropivacaine is commonly used in abdominal wall blocks due to its safety profile, and the addition of epinephrine is hypothesized to prolong analgesic duration and reduce systemic absorption. However, previous studies have been limited by non-weight-adjusted dosing and potential pharmacokinetic interactions, and inadequate investigation of the free form of ropivacaine.</p><p><strong>Objective: </strong>To characterize and compare the pharmacokinetics of total and free ropivacaine administered at a weight-adjusted dose of 1 mg/kg in Transversus Abdominis Plane (TAP) blocks, with and without epinephrine (1:200 000; 5 µg/mL).</p><p><strong>Methods: </strong>In this randomized controlled trial, 40 patients undergoing laparoscopic colectomy received bilateral TAP blocks with ropivacaine alone (TAP/E-) or ropivacaine with epinephrine (TAP/E+). Pharmacokinetic parameters, including maximum plasma concentration (Cmax), time to Cmax (Tmax), and area under the concentration-time curve, were assessed over 240 min. Secondary outcomes included α₁-acid glycoprotein (AGP), analgesia, safety, and mean plasma concentration (Cmean).</p><p><strong>Results: </strong>The mean Cmax in the TAP/E+ group (0.531±0.245 µg/mL) was not significantly different from that in the TAP/E- group (0.746±0.428 µg/mL). Epinephrine significantly prolonged Tmax (165 vs 55.9 min in TAP/E-, p<0.001) and reduced Cmean (p=0.005). No serious adverse events occurred, though QT interval prolongation was observed in both groups.</p><p><strong>Conclusion: </strong>This study demonstrates that adding epinephrine did not alter the Cmax of ropivacaine in TAP blocks, but did prolong the time to reach Cmax. These findings support the routine inclusion of epinephrine in TAP blocks and provide a basis for multimodal analgesia strategies.</p><p><strong>Trial registration number: </strong>NCT04959123.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143652051","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cooled radiofrequency ablation provides extended clinical utility in the management of chronic sacroiliac joint pain: 12-month follow-up results from the observational phase of a randomized, multicenter, comparative-effectiveness crossover study.","authors":"Steven Paul Cohen, Leonardo Kapural, Lynn Kohan, Sean Li, Robert Hurley, Richard Vallejo, Yashar Eshraghi, Pradeep Dinakar, Shravani Durbhakula, Douglas P Beall, Mehul J Desai, David Reece, Sandy Christiansen, Min Ho Chang, Adam J Carinci, Michael DePalma","doi":"10.1136/rapm-2024-106315","DOIUrl":"https://doi.org/10.1136/rapm-2024-106315","url":null,"abstract":"<p><strong>Introduction: </strong>Sacroiliac joint (SIJ) pain comprises up to 30% of cases of mechanical low back pain (LBP), the leading cause of disability worldwide. Despite sacral lateral branch cooled radiofrequency ablation (CRFA) showing efficacy in clinical trials, there is a lack of comparative-effectiveness long-term follow-up.</p><p><strong>Methods: </strong>In this randomized, multicenter, comparative-effectiveness study, 210 patients with injection-confirmed SIJ pain who responded to prognostic lateral branch blocks were randomly assigned to receive CRFA of the L5 dorsal ramus and S1-S3/4 lateral branches or standard medical management (SMM) consisting of pharmacotherapy, physical therapy, injections, and integrative therapies. Patients were followed up at 1, 3, 6, 9, and 12 months, with participants reporting unsatisfactory SMM outcomes being allowed to crossover (XO) and receive CRFA at 3 months. The primary outcome measure was the mean change in average LBP score on a 0-10 Numeric Rating Scale (NRS), with secondary outcomes including measures of quality of life (QoL) and function. A responder was defined as a participant who experienced a ≥30% or ≥2-point decrease in average daily NRS pain score coupled with a score ≥5 out of 7 (moderately better) on the Patient Global Impression of Change scale.</p><p><strong>Results: </strong>At 12 months, the mean NRS pain score declined from a baseline of 6.4±1.4 to 3.5±2.6, with 57.4% (35/61) of participants in the randomized CRFA cohort experiencing a ≥2-point or 30% decrease in average LBP from baseline. In the crossover cohort, 35/63 (55.6%) subjects had the same experience 12 months following the XO procedure; in the XO group, the mean LBP decreased from 6.1±1.5 to 3.4±2.5. Patients also experienced clinically meaningful improvements in QoL via EuroQoL-5D-5L at 12 months (mean change of +0.22±0.27 in the originally-treated CRFA group and +0.21±0.33 in the XO group). Oswestry Disability Index (ODI) scores also improved by 12.4%±14.7 (CRFA) and 13.7%±17.1 (XO) from baseline at study-end. No serious adverse events related to the CRFA procedure were reported.</p><p><strong>Conclusion: </strong>CRFA in patients with SIJ pain provided clinically significant and sustained improvements for 12 months following a single CRFA treatment, regardless of previous SMM treatment.</p><p><strong>Trial registration number: </strong>NCT03601949.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143634998","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Redefining needle placement and pressure monitoring in regional anesthesia: insights from advanced imaging and innovative technologies.","authors":"Graeme A McLeod, Xavier Sala-Blanch, Dihan van Niekerk, Miguel Angel Reina","doi":"10.1136/rapm-2024-106356","DOIUrl":"https://doi.org/10.1136/rapm-2024-106356","url":null,"abstract":"","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143631052","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Can a single-shot abdominal wall nerve block for unexpected open surgery be done without specific consent?","authors":"Lana Joudeh, Alexander B Stone, Philipp Gerner","doi":"10.1136/rapm-2025-106496","DOIUrl":"https://doi.org/10.1136/rapm-2025-106496","url":null,"abstract":"<p><p>Abdominal wall blocks are simple and safe opioid-sparing adjuncts for abdominal procedures that are generally well tolerated. These blocks have been shown to be effective for open abdominal surgeries, though their utility in laparoscopic or robotic surgery has been questioned. The unanticipated conversion from laparoscopic to open surgery may pose a challenge for the anesthesiologist, if regional anesthesia was not discussed before the start of the case as part of the pain-control regimen. Inability to offer an abdominal wall block leads to increased use of opioid medications and less-than-ideal analgesia during emergence and the immediate postoperative period, often until consent can be obtained and a nerve block offered. In this discourse, we discuss if a single-shot abdominal wall block is within the scope of a typical general anesthetic or if specific consent is needed prior to performance.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143631050","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of corticosteroids for adult chronic pain interventions: sympathetic and peripheral nerve blocks, trigger point injections - guidelines from the American Society of Regional Anesthesia and Pain Medicine, the American Academy of Pain Medicine, the American Society of Interventional Pain Physicians, and the International Pain and Spine Intervention Society.","authors":"Honorio T Benzon, Dalia Elmofty, Hariharan Shankar, Maunak Rana, Andrea L Chadwick, Shalini Shah, Dmitri Souza, Ameet S Nagpal, Salahadin Abdi, Christian Rafla, Alaa Abd-Elsayed, Tina L Doshi, Maxim S Eckmann, Thanh D Hoang, Christine Hunt, Carlos A Pino, Jessica Rivera, Byron J Schneider, Alison Stout, Angela Stengel, Maged Mina, John D FitzGerald, Joshua A Hirsch, Ajay D Wasan, Laxmaiah Manchikanti, David Anthony Provenzano, Samer Narouze, Steven P Cohen, Timothy P Maus, Ariana M Nelson, Harsha Shanthanna","doi":"10.1136/rapm-2024-105593","DOIUrl":"10.1136/rapm-2024-105593","url":null,"abstract":"<p><strong>Background: </strong>There is potential for adverse events from corticosteroid injections, including increase in blood glucose, decrease in bone mineral density and suppression of the hypothalamic-pituitary axis. Published studies note that doses lower than those commonly injected provide similar benefit.</p><p><strong>Methods: </strong>Development of the practice guideline was approved by the Board of Directors of American Society of Regional Anesthesia and Pain Medicine with several other societies agreeing to participate. The scope of guidelines was agreed on to include safety of the injection technique (landmark-guided, ultrasound or radiology-aided injections); effect of the addition of the corticosteroid on the efficacy of the injectate (local anesthetic or saline); and adverse events related to the injection. Based on preliminary discussions, it was decided to structure the topics into three separate guidelines as follows: (1) sympathetic, peripheral nerve blocks and trigger point injections; (2) joints; and (3) neuraxial, facet, sacroiliac joints and related topics (vaccine and anticoagulants). Experts were assigned topics to perform a comprehensive review of the literature and to draft statements and recommendations, which were refined and voted for consensus (≥75% agreement) using a modified Delphi process. The United States Preventive Services Task Force grading of evidence and strength of recommendation was followed.</p><p><strong>Results: </strong>This guideline deals with the use and safety of corticosteroid injections for sympathetic, peripheral nerve blocks and trigger point injections for adult chronic pain conditions. All the statements and recommendations were approved by all participants after four rounds of discussion. The Practice Guidelines Committees and Board of Directors of the participating societies also approved all the statements and recommendations. The safety of some procedures, including stellate blocks, lower extremity peripheral nerve blocks and some sites of trigger point injections, is improved by imaging guidance. The addition of non-particulate corticosteroid to the local anesthetic is beneficial in cluster headaches but not in other types of headaches. Corticosteroid may provide additional benefit in transverse abdominal plane blocks and ilioinguinal/iliohypogastric nerve blocks in postherniorrhaphy pain but there is no evidence for pudendal nerve blocks. There is minimal benefit for the use of corticosteroids in trigger point injections.</p><p><strong>Conclusions: </strong>In this practice guideline, we provided recommendations on the use of corticosteroids in sympathetic blocks, peripheral nerve blocks, and trigger point injections to assist clinicians in making informed decisions.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141635881","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Wnt5a in keratinocytes contributes to complex regional pain syndrome through the activation of NR2B and MMP9 in rats.","authors":"He Zhu, Bei Wen, Jijun Xu, Li Xu, Yuguang Huang","doi":"10.1136/rapm-2024-106139","DOIUrl":"https://doi.org/10.1136/rapm-2024-106139","url":null,"abstract":"<p><strong>Background: </strong>Complex regional pain syndrome (CRPS) is a chronic pain condition characterized by inflammatory features, though the underlying mechanisms remain partly understood. Our study examined whether Wnt5a in skin keratinocytes contributes to CRPS-related pain hypersensitivity by activating downstream N-methyl-D-aspartate receptor subunit 2B (NR2B) and matrix metalloproteinase-9 (MMP9) signaling in rats.</p><p><strong>Methods: </strong>We developed a cell-culture model to mimic the local inflammation of CRPS and a rat model to mimic the chronic post-ischemia pain experienced by CRPS patients. Mechanical and heat pain thresholds in the hind paw were measured using an electronic von Frey apparatus and a radiant heat device. Western blotting and immunofluorescence were used to examine the expressions of NR2B and MMP9 in the skin and dorsal root ganglion (DRG), and immunofluorescence staining of connexin 43 (Cx43) and protein gene product 9.5 (PGP9.5) were conducted to explore the interaction between keratinocytes and nerve fibers in the skin.</p><p><strong>Results: </strong>In cell culture, Wnt5a was expressed in keratinocytes and contributed to cellular injury by increasing the levels of NR2B and MMP9. The mechanical and heat pain thresholds measured in the hind paw were decreased in CRPS rats, indicating increased pain sensitivity. The inhibition of Wnt5a alleviated these CRPS-related pain hypersensitivities. High levels of Cx43 and PGP9.5 staining were observed in the epidermis of CRPS rats, suggesting an interaction between keratinocytes and nerve fibers that may contribute to CRPS. Additionally, upregulations of NR2B and MMP9 in the DRG may further exacerbate pain.</p><p><strong>Conclusions: </strong>Skin keratinocytes may play an essential role in the pathophysiology of CRPS. Wnt5a signaling may increase pain sensitivity by upregulating downstream NR2B and MMP9, thereby contributing to CRPS.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143626830","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use and safety of corticosteroid injections in joints and musculoskeletal soft tissue: guidelines from the American Society of Regional Anesthesia and Pain Medicine, the American Academy of Pain Medicine, the American Society of Interventional Pain Physicians, and the International Pain and Spine Intervention Society.","authors":"Honorio T Benzon, David Anthony Provenzano, Ameet Nagpal, Dmitri Souza, Maxim S Eckmann, Ariana M Nelson, Maged Mina, Alaa Abd-Elsayed, Dalia Elmofty, Andrea L Chadwick, Tina L Doshi, Carlos A Pino, Maunak Rana, Shalini Shah, Hariharan Shankar, Alison Stout, Elizabeth Smith, Salahadin Abdi, Steven P Cohen, Joshua A Hirsch, Byron J Schneider, Laxmaiah Manchikanti, Timothy P Maus, Samer Narouze, Harsha Shanthanna, Ajay D Wasan, Thanh D Hoang, Jessica Rivera, Christine Hunt, John D FitzGerald","doi":"10.1136/rapm-2024-105656","DOIUrl":"10.1136/rapm-2024-105656","url":null,"abstract":"<p><strong>Background: </strong>Intra-articular corticosteroid (IACS) injection and peri-articular corticosteroid injection are commonly used to treat musculoskeletal conditions. Results vary by musculoskeletal region, but most studies report short-term benefit with mixed results on long-term relief. Publications showed adverse events from single corticosteroid injections. Recommended effective doses were lower than those currently used by clinicians.</p><p><strong>Methods: </strong>Development of the practice guideline for joint injections was approved by the Board of Directors of the American Society of Regional Anesthesia and Pain Medicine and the participating societies. A Corticosteroid Safety Work Group coordinated the development of three guidelines: peripheral nerve blocks and trigger points; joints; and neuraxial, facet, and sacroiliac joint injections. The topics included safety of the technique in relation to landmark-guided, ultrasound-guided, or radiology-aided injections; effect of the addition of the corticosteroid on the efficacy of the injectate; and adverse events related to the injection. Experts on the topics were assigned to extensively review the literature and initially develop consensus statements and recommendations. A modified version of the US Preventive Services Task Force grading of evidence and strength of recommendation was followed. A modified Delphi process was adhered to in arriving at a consensus.</p><p><strong>Results: </strong>This guideline focuses on the safety and efficacy of corticosteroid joint injections for managing joint chronic pain in adults. The joints that were addressed included the shoulder, elbow, hand, wrist, hip, knee, and small joints of the hands and feet. All the statements and recommendations were approved by all participants and the Board of Directors of the participating societies after four rounds of discussion. There is little evidence to guide the selection of one corticosteroid over another. Ultrasound guidance increases the accuracy of injections and reduces procedural pain. A dose of 20 mg triamcinolone is as effective as 40 mg for both shoulder IACS and subacromial subdeltoid bursa corticosteroid injections. The commonly used dose for hip IACS is 40 mg triamcinolone or methylprednisolone. Triamcinolone 40 mg is as effective as 80 mg for knee IACS. Overall, IACS injections result in short-term pain relief from a few weeks to a few months. The adverse events include an increase in blood glucose, adrenal suppression, detrimental effect on cartilage lining the joint, reduction of bone mineral density, and postoperative joint infection.</p><p><strong>Conclusions: </strong>In this practice guideline, we provided specific recommendations on the role of corticosteroids in joint, bursa, and peritendon injections for musculoskeletal pain.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143525284","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Non-neurodestructive ganglion impar blocks for coccydynia and related disorders: a systematic review and meta-analysis.","authors":"David S Jevotovsky, Harman Chopra, Daniel J Pak, Eric A Grin, Adhith Palla, Shravani Durbhakula, Sidharth Sahni, Tariq AlFarra, Mustafa Y Broachwala, Anuj Shah, Richard Lau, Alexander Shustorovich, Michael Flamm, Melissa Murphy, Timothy Deer, Amitabh Gulati, Vwaire Orhurhu","doi":"10.1136/rapm-2024-106055","DOIUrl":"https://doi.org/10.1136/rapm-2024-106055","url":null,"abstract":"<p><strong>Background/importance: </strong>Chronic coccydynia is a challenging condition to manage. Conflicting evidence exists regarding the role of the ganglion impar in coccygeal nociception. When conservative treatments fail, minimally invasive interventions at the ganglion impar may be effective in providing relief.</p><p><strong>Objectives: </strong>To evaluate the effectiveness and safety of ganglion impar blocks (GIBs) for the management of chronic coccydynia.</p><p><strong>Evidence review: </strong>A systematic review and meta-analysis was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Relevant studies were identified through a comprehensive literature search of PubMed, Embase Classic+ Embase, CINAHL and the Web of Science in February 2024. Data on patient characteristics, intervention details, pain outcomes (measured by Visual Analog Scale and Numerical Pain Rating Scale) and adverse events were extracted. Meta-analysis was performed using standardized mean differences (SMDs) on scale of 0 to 10.</p><p><strong>Findings: </strong>Seventeen studies described 625 coccydynia patients treated with GIB. All studies reported some level of improvement of pain after GIB. The meta-analysis included 11 studies totaling 391 patients with a baseline pain score of 7.93 (7.81 to 8.04 95% CI). GIBs were effective in reducing coccygeal pain at short-term (up to 3 months), intermediate-term (3-6 months) and long-term (greater than 6 months) follow-up. SMDs were -2.73 (95% CI -3.45 to -2.01), -3.22 (95% CI -2.82 to -1.45), -1.86 (95% CI -2.58 to -1.15) at 3 months, 3-6 months and >6 months, respectively. No serious adverse events were noted. Grading of Recommendations Assessment, Development and Evaluation assessment indicated 'very low' certainty of evidence across all outcomes.</p><p><strong>Conclusions: </strong>Non-neurodestructive GIB may be a safe and potentially effective treatment option for patients with chronic, refractory coccydynia.</p><p><strong>Prospero registration number: </strong>CRD42024506056.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143626824","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}