Regional Anesthesia and Pain Medicine最新文献

{"title":"Do-not-resuscitate status and regional analgesia utilization for fracture pain: a comfort paradox?","authors":"Ammar Siddiqui, Gabriel Rodriguez, Rebecca Hu, Taylor Choi, Kathryn Jano, Nitin Manohara, Cameron Marshall, Ivor S Douglas, Jeff L Xu","doi":"10.1136/rapm-2026-108372","DOIUrl":"https://doi.org/10.1136/rapm-2026-108372","url":null,"abstract":"<p><strong>Background: </strong>Do-not-resuscitate orders are intended to prioritize patient comfort, but do-not-resuscitate patients may receive fewer procedural interventions. Regional analgesia is recommended for rib and hip fractures and may provide superior pain control to systemic analgesics. However, utilization remains low. Whether do-not-resuscitate status is associated with the utilization of comfort-enhancing regional analgesia has not been studied.</p><p><strong>Methods: </strong>This was a cross-sectional study using the National Inpatient Sample of adult (≥18 years) hospitalizations for rib and hip fractures identified using International Classification of Diseases, 10th Revision codes from January 1, 2016, through December 31, 2022. The primary exposure was do-not-resuscitate status. The primary outcome was receipt of regional analgesia.</p><p><strong>Results: </strong>298,343 rib fracture and 462,796 hip fracture hospitalizations met inclusion criteria, of which 8,568 (2.9%) and 13,730 (3.0%) received regional analgesia, respectively. Do-not-resuscitate status was present in 31,882 (10.7%) of rib fracture and 77,255 (16.7%) hip fracture hospitalizations.In adjusted analyses, do-not-resuscitate status was associated with lower odds of regional analgesia for rib fractures (OR 0.76; 95% CI 0.6<u>9</u> to 0.8<u>3</u>), but not hip fractures (OR 1.00; 95% CI 0.94 to 1.06). In frailty-stratified analyses, the association between do-not-resuscitate status and lower rates of regional analgesia utilization was strongest among the least frail rib fracture hospitalizations (OR 0.34; 95% CI 0.25 to 0.48).</p><p><strong>Conclusions: </strong>Do-not-resuscitate status is associated with lower regional analgesia utilization for rib fractures but not hip fractures. Prospective studies are needed to confirm these findings.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148892833","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":"Single-injection adductor canal block with perineural dexamethasone versus continuous adductor canal catheter for total knee arthroplasty: a randomized controlled trial.","authors":"David H Kim, Jonathan Beathe, Douglas S Wetmore, Enrique Goytizolo, Stephen C Haskins, Cephas Swamidoss, Julia F Reichel, Lisa Reisinger, Prashant Rao, Stavros G Memtsoudis, Jiabin Liu","doi":"10.1136/rapm-2026-107719","DOIUrl":"10.1136/rapm-2026-107719","url":null,"abstract":"<p><strong>Background: </strong>The adductor canal block (ACB), known for its motor-sparing properties, has gained popularity as part of the multimodal analgesic regimen in total knee arthroplasty (TKA) patients. However, the duration of single-injection blocks is limited, potentially contributing to rebound pain after the first 24 hours. This study evaluates whether extending block duration using a continuous peripheral nerve catheter reduces opioid consumption during the 24-48 hour period following TKA.</p><p><strong>Methods: </strong>This participant-blinded and assessor-blinded randomized controlled trial included 94 patients undergoing primary, unilateral TKA. Patients were randomized into two groups: the single-injection group received a single-injection ACB (15 mL of 0.25% bupivacaine) with 2 mg perineural dexamethasone; the continuous infusion group received a single-injection ACB (15 mL of 0.25% bupivacaine) followed by a continuous adductor canal catheter infusing 0.2% ropivacaine at 8 mL/hour for 50 hours. Both groups received a standardized multimodal analgesic regimen, including iPACK (infiltration between the popliteal artery and posterior capsule of the knee) block, periarticular infiltration (PAI), and oral pain medications. The primary outcome was opioid consumption during the 24-48 hour postoperative period. Post-anesthesia care unit (PACU) opioid consumption was the single prespecified secondary outcome registered at ClinicalTrials.gov; all other outcomes were pre-planned exploratory analyses prespecified in the Institutional Review Board protocol.</p><p><strong>Results: </strong>There was no statistically significant difference in opioid consumption during the 24-48 hour postoperative period between the continuous infusion and single-injection groups (median (IQR) 30 (15-60) mg vs 38.8 (22.9-69.4) mg; 95% CI of the median difference -22.50 to 7.00 mg; p=0.213). For the prespecified secondary outcome, opioid consumption in the PACU also did not differ significantly between groups (22.5 (16.2-30) mg vs 15 (15-30) mg; 95% CI of the median difference 0.00 to 13.50 mg; p=0.081). Catheter-associated buckling occurred in 7% of the continuous infusion group versus 0% in the single-injection group; all events were transient. No statistically significant differences were observed in patient satisfaction, length of hospital stay, or functional recovery.</p><p><strong>Conclusions: </strong>Continuous adductor canal catheter infusion, initiated at the resolution of spinal anesthesia, did not reduce opioid consumption in the 24-48 hour postoperative period following primary TKA within a comprehensive multimodal analgesic regimen including perineural dexamethasone, iPACK block, PAI, oral pain medications, and continuous telemedicine-based pain consultation.</p><p><strong>Trial registration number: </strong>NCT03747146.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148165643","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":"Perioperative peripheral nerve blocks for elective below-knee amputations and phantom limb syndrome: an exploratory multicenter retrospective cohort study.","authors":"Eric Hoang Nguyen, Kevin Hoffman, Sunny Gotewal, Ashley Wetzig, Alexander Wetzig, Andrzej Kwater, Adebukola Owolabi, Cassius Mensah, Gavin Ovsak, Anvinh Nguyen, Edward H Tsai","doi":"10.1136/rapm-2026-108118","DOIUrl":"https://doi.org/10.1136/rapm-2026-108118","url":null,"abstract":"<p><strong>Background: </strong>Phantom limb syndrome (PLS) is a common complication following below-knee amputations (BKA) causing painful and/or nonpainful sensations in the absent limb. Peripheral nerve blocks (PNBs) are used for perioperative analgesia, but their association with PLS risk remains unclear. This study sought to evaluate potential associations regarding PLS incidence after BKA with and without PNBs.</p><p><strong>Methods: </strong>This retrospective cohort study was conducted using Epic Cosmos data from 2016 to 2025. Adults undergoing elective BKA were identified using Current Procedural Terminology codes 27880-27889 and categorized by PNBs versus none. The primary outcome was PLS diagnosis within 12 months of surgery using International Classification of Diseases, 10th Revision, Clinical Modification codes (G54.6, G54.7). Relative risks (RRs) were estimated using Mantel-Haenszel stratification adjusted for age, sex, and race only, with subgroup analysis by comorbidity burden. Secondary outcomes included length of stay (LOS).</p><p><strong>Results: </strong>Among 38 433 patients, 7430 (19.3%) received perioperative PNBs and 31 003 (80.7%) did not. PLS diagnosis coding occurred in 18.8% of the PNB group versus 15.1% of the non-block group (absolute difference 3.7%). Analysis adjusted for age, sex, and race only did not change the association (Mantel-Haenszel RR 1.24, 95% CI 1.20 to 1.28). PNBs were associated with a shorter LOS. All estimates should be considered exploratory associations.</p><p><strong>Conclusions: </strong>In this multicenter electronic health record-based cohort, exploratory analysis showed that perioperative PNB use was associated with increased rates of documented PLS coding across subgroups. However, the overall RR increase is modest. The observed association may reflect residual confounding by indication and differential surveillance rather than a causal effect. PNBs still remain appropriate for improving acute pain and reducing LOS. Prospective studies are needed to clarify causality and inform prevention strategies.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148892823","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":"When gastric point-of-care ultrasound changes management: a research letter.","authors":"Stephen C Haskins, Yuriy Bronshteyn, Cristian Arzola, Hari Kalagara, David Hardman, Oliver Panzer, Marissa M Weber, Eric Heinz, Jan Boublik, Javier Cubillos, Nadia Hernandez, Joshua Zimmerman, Anahi Perlas","doi":"10.1136/rapm-2026-108226","DOIUrl":"https://doi.org/10.1136/rapm-2026-108226","url":null,"abstract":"<p><p>Gastric point-of-care ultrasound (POCUS) is increasingly used to assess aspiration risk, but studies differ in whether ultrasound is used to validate the technique, characterize gastric contents in populations, or guide bedside clinical decisions. We performed a focused secondary analysis of 65 studies from the study-level extraction associated with a previously published ASRA Pain Medicine narrative review to determine how often gastric POCUS studies evaluated or reported changes in management. Studies were categorized by primary study purpose as foundational/validation/diagnostic-performance/reliability, clinical POCUS/decision-impact, or population/intervention research. Of 65 studies, 2 were clinical POCUS/decision-impact studies, 9 were foundational/validation studies, and 54 were population/intervention studies. Management-change status was reported or extractable in 8 studies and prespecified in 3; all 8 reported at least one actual management change, with rates ranging from 0.4% to 46%. Both clinical POCUS studies prespecified a management change, with reported change rates of 5.0% and 18.9%, respectively. Reported changes included rapid sequence induction, airway modification, postponement or cancellation, conversion to local/regional anesthesia, and more liberal or conservative aspiration-risk management. No study clearly linked management change to patient-centered outcomes. Future clinical gastric POCUS studies should prospectively define the indication, pre-scan plan, scan findings and decision thresholds, post-scan decision, and reason for change or non-change, while evaluating downstream patient-centered outcomes, resource utilization, and potential harms.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148892742","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":"Prolonging peripheral ropivacaine nerve block with an in situ-formed hydrogel carrier: randomized controlled trial in an ovine model.","authors":"Hans Vangsnes Vingen, Ana Ćuk, Axel R Sauter, Olav Spigset, Finn Andersen, Fredrik Strebel Skedsmo, Marianne Hiorth, Marija T Garvin, Tor Å Myklebust, Audun Stubhaug, Henning A Haga","doi":"10.1136/rapm-2026-108092","DOIUrl":"https://doi.org/10.1136/rapm-2026-108092","url":null,"abstract":"<p><strong>Background: </strong>Local anesthetics are effective for regional anesthesia but have a relatively short duration of action. This motivates the development of sustained-release delivery systems. The aim of this study was to evaluate whether an in situ-forming hydrogel composed of poloxamers and alginate could prolong the duration of ropivacaine-induced sensory and motor blockade.</p><p><strong>Methods: </strong>In this randomized and blinded two-period cross-over study, 10 female sheep received ultrasound-guided sciatic nerve injections of either 200 mg ropivacaine poloxamer-alginate hydrogel (Rop-HG) or 200 mg, as a control, plain ropivacaine solution (Rop-C). Sensory and motor functions were assessed repeatedly using a standardized clinical scoring system. Plasma ropivacaine concentrations were measured over time, and postmortem histopathological evaluation of the sciatic nerve and surrounding tissues was performed.</p><p><strong>Results: </strong>Rop-HG markedly prolonged block duration compared with Rop-C, increasing the median (IQR) sensory block from 24 hours (IQR 16-36) to 60 hours (IQR 60-72) and the median motor block from 16 hours (IQR 16-18) to 60 hours (IQR 36-72). Pharmacokinetic analysis showed a sharp early peak for Rop-C (median C_max 5101 nmol/L and median T_max 0.33 hours), whereas Rop-HG produced a lower and delayed profile (median C_max 558 nmol/L and median T_max 8 hours). Histopathology revealed more pronounced and persistent local tissue reactions in Rop-HG-treated limbs, characterized by degeneration, necrosis, and inflammation.</p><p><strong>Conclusion: </strong>Ultrasound-guided perineural injections of 200 mg Rop-HG substantially prolonged the clinical duration of sciatic nerve block and reduced early systemic exposure compared with a 200 mg plain ropivacaine solution. However, the formulation was associated with severe local tissue degeneration, necrosis, and inflammation. Consequently, it remains unclear whether the prolonged clinical effect resulted from a sustained pharmacological release of ropivacaine or from the local tissue toxicity. Further optimization of the formulation is required before clinical translation.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148888878","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":"Procedure-specific effects of intravenous lidocaine in adult spine surgery: a systematic review and meta-analysis of randomized controlled trials.","authors":"Vitor A Felippe, Carlos D A Bersot, Gabriel L Gonzalez, Gustavo R M Wegner, Estevao L C Braga, Carolina C C Silva, Giulia D Matheus, Bruno V M Santiago, Leonardo B Santos, Marcos A Lessa","doi":"10.1136/rapm-2026-108266","DOIUrl":"https://doi.org/10.1136/rapm-2026-108266","url":null,"abstract":"<p><strong>Background and objectives: </strong>Perioperative intravenous lidocaine infusion has been proposed as an opioid-sparing analgesic adjunct in spine surgery, but previous meta-analyses pooled heterogeneous procedures and may have obscured procedure-specific treatment effects. We evaluated the analgesic and opioid-sparing effects of perioperative intravenous lidocaine in adult spine surgery and whether efficacy differs by procedure type.</p><p><strong>Methods: </strong>We searched PubMed, Embase, Web of Science, and the Cochrane Library from inception through June 2026 for randomized controlled trials comparing perioperative intravenous lidocaine infusion with placebo or standard care in adults undergoing spine surgery. The primary outcome was postoperative pain intensity at 24 hours. Secondary outcomes were opioid consumption, postoperative nausea and vomiting (PONV), and hospital length of stay (LOS). Random-effects meta-analyses, a post hoc subgroup analysis by procedure type, and meta-regression were performed.</p><p><strong>Results: </strong>10 randomized trials were included. Intravenous lidocaine reduced postoperative pain at 24 hours (9 trials, 655 patients; mean difference (MD), -0.83; 95% CI -1.36 to -0.30; p=0.002; I²=89%, 95% CI 81% to 93%; prediction interval, -2.69 to 1.02; moderate certainty) and opioid consumption (9 trials; MD, -11.64 mg intravenous morphine equivalents; 95% CI -16.14 to -7.14; p<0.001). In a post hoc exploratory analysis, the analgesic effect differed by procedure type (test for subgroup differences, p=0.005): the reduction was clinically meaningful after instrumented fusion or complex spine surgery (MD, -1.23; 95% CI -1.81 to -0.64), exceeding the minimal clinically important difference of 1.0 point, but minimal after decompression (MD, -0.20; 95% CI -0.61 to 0.21). Baseline pain severity explained approximately 53% of between-study heterogeneity, whereas lidocaine infusion rate did not modify the treatment effect (p=0.97). No significant effects were observed for PONV or LOS.</p><p><strong>Conclusions: </strong>There is moderate-certainty evidence that perioperative intravenous lidocaine reduces postoperative pain and opioid consumption after adult spine surgery. Its analgesic benefit appeared procedure-specific, with the greatest benefit after instrumented fusion and complex procedures; this difference emerged from a post hoc, exploratory analysis and should be regarded as hypothesis-generating.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148889408","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":"<i>In Reply to</i> \"Integrated local anesthetic delivery with peripheral nerve stimulation using perineural catheter: A welcome extension of prior findings\".","authors":"Brian M Ilfeld, Engy T Said, Brian H Park, Sanjay K Sinha, John J Finneran","doi":"10.1136/rapm-2026-108457","DOIUrl":"https://doi.org/10.1136/rapm-2026-108457","url":null,"abstract":"","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148889400","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":"When gastric point-of-care ultrasound is indeterminate: an educational review and suggested reporting framework.","authors":"Stephen C Haskins, Cristian Arzola, Yuriy Bronshteyn, Hari Kalagara, David Hardman, Oliver Panzer, Marissa M Weber, Eric Heinz, Jan Boublik, Javier Cubillos, Nadia Hernandez, Joshua Zimmerman, Anahi Perlas","doi":"10.1136/rapm-2026-108202","DOIUrl":"https://doi.org/10.1136/rapm-2026-108202","url":null,"abstract":"<p><p>Gastric point-of-care ultrasound (POCUS) is increasingly used to support aspiration-risk assessment when fasting history, comorbidities, medication exposure, or procedural urgency make clinical assessment uncertain. Its value depends on more than identifying gastric contents when images are clear. A useful examination must be attempted, completed, interpreted, and connected to a safe clinical decision. This article uses a focused secondary analysis of the 65 studies included in the original narrative review of gastric POCUS in medically complex patients to examine how indeterminate and non-interpretable examinations are reported. In the 65-study narrative-review evidence base, 32 studies reported at least one indeterminate or non-interpretable examination, 24 reported no or zero such examinations, and nine had unclear or non-numeric reporting. The main reporting concern is that studies often do not clearly identify scans that were not performed, scans that were started but not completed, images that were technically inadequate, results that were uncertain despite visualization, and interpretable diagnostic findings. Clinically, an indeterminate gastric POCUS examination is non-diagnostic and should cause the clinician to either rely on the original aspiration-risk assessment and management plan or choose a more cautious plan when the clinical situation warrants. A clearer reporting pathway can make future gastric POCUS studies easier to interpret, compare, teach, and apply safely.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148882541","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":"Wrong-site procedure reporting in the USA: a 51-jurisdiction analysis centered on wrong-site blocks.","authors":"Uchenna O Umeh, Zachary Li, Chang Lu, Kellie Jaremko, Jinlei Li, Bridget P Pulos","doi":"10.1136/rapm-2026-108245","DOIUrl":"https://doi.org/10.1136/rapm-2026-108245","url":null,"abstract":"","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148852112","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":"New persistent opioid use: a case for defining the problem.","authors":"Duncan Taylor Ritchie","doi":"10.1136/rapm-2026-108287","DOIUrl":"https://doi.org/10.1136/rapm-2026-108287","url":null,"abstract":"","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148852137","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}