Regional Anesthesia and Pain Medicine最新文献

{"title":"Neurocognitive vigilance in gabapentinoid therapy: a call for age-stratified assessment.","authors":"Antonio Alcántara Montero","doi":"10.1136/rapm-2025-107015","DOIUrl":"https://doi.org/10.1136/rapm-2025-107015","url":null,"abstract":"","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144755131","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":"Pulsed radiofrequency of lumbar dorsal root ganglion versus epidural neuroplasty for lumbar radicular pain: a systematic review and network meta-analysis.","authors":"Ji-Hoon Park, Jae Ni Jang, Soyoon Park, Young-Soon Choi, Dae Kyun Ryu, Rakib Miah, Sukhee Park","doi":"10.1136/rapm-2025-106723","DOIUrl":"https://doi.org/10.1136/rapm-2025-106723","url":null,"abstract":"<p><strong>Background: </strong>Lumbar radicular pain (LRP) and/or lower back pain is a challenging condition, particularly in cases refractory to conservative treatments like epidural steroid injections (ESI). Pulsed radiofrequency (PRF) to the dorsal root ganglion and epidural neuroplasty techniques are emerging as alternative interventional treatments. However, there are no direct comparison studies between PRF and epidural neuroplasty, leading to uncertainty in optimal treatment selection.</p><p><strong>Objective: </strong>This network meta-analysis (NMA) aims to indirectly compare the efficacy of PRF and epidural neuroplasty techniques in managing LRP.</p><p><strong>Evidence review: </strong>We conducted a systematic review and NMA of randomized controlled trials (RCTs) comparing PRF, epidural neuroplasty, and conservative treatments, including ESI and sham procedures. Data sources included PubMed, Cochrane Central, Embase, and Web of Science up to December 31, 2024. Inclusion criteria comprised RCTs evaluating adult patients with lumbar radicular pain from disc herniation, spinal stenosis, or failed back surgery syndrome. Two reviewers independently extracted data on study design, interventions, outcomes, and risk of bias. The primary outcome was pain reduction at 1, 3, 6, and 12 months post-treatment. The secondary outcome was disability reduction, measured by the Oswestry Disability Index (ODI). A frequentist random-effects model was used for data synthesis, and the certainty of evidence was assessed using the Grading of Recommendation, Assessment, Development and Evaluation approach. Prediction intervals were not calculated due to data limitations, which is acknowledged as a limitation.</p><p><strong>Findings: </strong>14 RCTs comprising 1229 patients were included. At 1 month, there was no significant difference between PRF and epidural neuroplasty. At 3 months, epidural neuroplasty showed significant advantages over PRF (mean difference: -1.47, 95% CI -2.73 to -0.46); however, the certainty of evidence for this comparison was rated low. Similar trends were observed at 6 and 12 months, but the confidence in these estimates remained low to very low. For ODI, no significant differences were found at time points, and the certainty of evidence was moderate to very low across comparisons.</p><p><strong>Conclusion: </strong>PRF and epidural neuroplasty may offer comparable long-term pain and disability outcomes for patients with lumbar radicular pain, but the overall certainty of evidence was low to very low, limiting confident clinical recommendations. These findings highlight the need for high-quality, head-to-head trials to better inform interventional treatment strategies for LRP.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144709869","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":"Addition of liposomal bupivacaine in brachial plexus blocks: a systematic review and meta-analysis of randomized controlled trials.","authors":"Chung Hin Shing, Fengfeng Wang, Pui Ming Lam, Omar Wai Kiu Tsui, Timmy Chi Wing Chan, Stanley Sau Ching Wong","doi":"10.1136/rapm-2025-106583","DOIUrl":"https://doi.org/10.1136/rapm-2025-106583","url":null,"abstract":"<p><strong>Background: </strong>Adding liposomal bupivacaine to brachial plexus block may improve postoperative analgesia after upper limb surgery.</p><p><strong>Objective: </strong>This study aimed to assess the postoperative analgesic efficacy of adding liposomal bupivacaine to brachial plexus block compared with non-liposomal local anesthetic.</p><p><strong>Evidence review: </strong>A systematic literature search was conducted in PubMed, Web of Science, EMBASE, ClinicalTrials.gov, and the Cochrane Library up to June 30, 2024. Randomized controlled trials (RCTs) that evaluated the postoperative pain scores in patients who received liposomal bupivacaine via brachial plexus block were identified. The primary outcome was resting pain scores (Numerical Rating Scale, 0-10) at 24 hours after nerve block injection derived from the random effects model. A mean difference (MD) of 1/10 was considered to represent a minimal clinically important difference in pain scores. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework was applied to examine the level of evidence.</p><p><strong>Findings: </strong>21 RCTs (1478 participants) were included. Liposomal bupivacaine was associated with statistically significant reduction in resting pain scores at 24 hours after nerve block injection compared with non-liposomal local anesthetic (MD=-1.04, 95% CI=-1.54 to -0.53, p<0.001, 95% prediction interval=-3.05 to 0.98). This was associated with significant heterogeneity (Q=107, p<0.001, I²=81%, tau²=1.0, 95% CI=0.42 to 2.07) and a low-GRADE rating. Liposomal bupivacaine was also associated with a statistically significant reduction in resting pain scores at 48 hours and 72 hours. Opioid consumption at 0-24 hours, 25-48 hours and 49-72 hours was lower in the liposomal bupivacaine group with statistical significance (p values <0.05). Liposomal bupivacaine was associated with a lower incidence of nausea.</p><p><strong>Conclusions: </strong>There is low-level evidence that liposomal bupivacaine in brachial plexus block may reduce pain intensity after upper limb surgery, but the clinical significance may be limited.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144700290","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":"Trial within the trial: my journey of growth as a first-time principal investigator.","authors":"Clinton F Pillow","doi":"10.1136/rapm-2025-106910","DOIUrl":"https://doi.org/10.1136/rapm-2025-106910","url":null,"abstract":"","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144692479","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":"The impact of local anesthetic systemic toxicity advisories on reporting to the National Poison Data System (NPDS).","authors":"Michael Fettiplace, Guy Weinberg, Heather Nixon, Alexandra Barabanova, Christopher Chiang, Marina Gitman","doi":"10.1136/rapm-2025-106464","DOIUrl":"https://doi.org/10.1136/rapm-2025-106464","url":null,"abstract":"<p><strong>Introduction: </strong>In 2010, multiple anesthesia societies introduced recommendations for treating local anesthetic systemic toxicity, but the impact of those recommendations is uncertain.</p><p><strong>Objective: </strong>To test the hypothesis that reports of local anesthetic-related poisoning and mortality have declined since the publication of advisories in 2010.</p><p><strong>Methods: </strong>We analyzed reports of local anesthetic poisoning and mortality from the American Poison Centers National Poison Data System (NPDS) spanning 1983-2022. We conducted a case-non-case disproportionality analysis using the reporting odds ratio (ROR) to evaluate the effect of the 2010 recommendations on reports of poisoning and death to the NPDS by comparing reports of poisoning and death from 2011 to 2022 relative to 2001-2010. Multiple linear regression and Poisson regression were used for confirmation, together with exploratory analyses of individual cases of mortality.</p><p><strong>Results: </strong>In the decade following the introduction of recommendations (2011-2022), reports of local anesthetic poisoning decreased relative the prior decade (2001-2010, ROR=0.77, 95% CI 0.76 to 0.78, p<0.0001), driven by a decrease in non-lidocaine-related reports. Conversely, reports of lidocaine poisoning and reports of lidocaine mortality increased after 2010 (ROR=2.7 95% CI 1.3 to 5.6, p=0.0094). Case analysis revealed a decrease in reports of death in the operating room from 47% before 2010 to 15% after 2010, but an increase in reports of death from intravenous lidocaine delivery (3% to 27%, respectively).</p><p><strong>Discussion: </strong>The decrease in poisoning reports aligns with the implementation of professional recommendations and advancements, such as ultrasound-guided nerve blocks and lipid emulsion therapy. However, the rise in reports of lidocaine-related deaths-primarily in emergency settings-underscores significant risks. These findings emphasize the need for improved guidance on lidocaine use and dosing strategies to prevent lidocaine-related mortality.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144683607","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":"ASRA Pain Medicine Consensus Practice Infection Control guidelines.","authors":"David Anthony Provenzano, Christine Hunt, Hari Kalagara, Vishal Uppal","doi":"10.1136/rapm-2025-106770","DOIUrl":"https://doi.org/10.1136/rapm-2025-106770","url":null,"abstract":"","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144692478","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":"ASRA Pain Medicine consensus practice infection control guidelines for regional anesthesia and pain medicine.","authors":"David Anthony Provenzano, Michael Hanes, Christine Hunt, Honorio T Benzon, Jay S Grider, Kelly Cawcutt, Tina L Doshi, Salim Hayek, Bryan Hoelzer, Rebecca L Johnson, Hari Kalagara, Sandra Kopp, Randy W Loftus, Alan James Robert Macfarlane, Ameet S Nagpal, Stephanie A Neuman, Amit Pawa, Amy C S Pearson, Julie Pilitsis, Eellan Sivanesan, Rakesh V Sondekoppam, Jan Van Zundert, Samer Narouze","doi":"10.1136/rapm-2024-105651","DOIUrl":"10.1136/rapm-2024-105651","url":null,"abstract":"<p><strong>Background: </strong>To provide recommendations on risk mitigation, diagnosis and treatment of infectious complications associated with the practice of regional anesthesia, acute and chronic pain management.</p><p><strong>Methods: </strong>Following board approval, in 2020 the American Society of Regional Anesthesia and Pain Medicine (ASRA Pain Medicine) commissioned evidence-based guidelines for best practices for infection control. More than 80 research questions were developed and literature searches undertaken by assigned working groups comprising four to five members. Modified US Preventive Services Task Force criteria were used to determine levels of evidence and certainty. Using a modified Delphi method, >50% agreement was needed to accept a recommendation for author review, and >75% agreement for a recommendation to be accepted. The ASRA Pain Medicine Board of Directors reviewed and approved the final guidelines.</p><p><strong>Results: </strong>After documenting the incidence and infectious complications associated with regional anesthesia and interventional pain procedures including implanted devices, we made recommendations regarding the role of the anesthesiologist and pain physician in infection control, preoperative patient risk factors and management, sterile technique, equipment use and maintenance, healthcare setting (office, hospital, operating room), surgical technique, postoperative risk reduction, and infection symptoms, diagnosis, and treatment. Consensus recommendations were based on risks associated with different settings and procedures, and keeping in mind each patient's unique characteristics.</p><p><strong>Conclusions: </strong>The recommendations are intended to be multidisciplinary guidelines for clinical care and clinical decision-making in the regional anesthesia and chronic interventional pain practice. The issues addressed are constantly evolving, therefore, consistent updating will be required.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143016631","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":"Optimal multimodal analgesia combinations to reduce pain and opioid use following non-cardiac surgery: an instrumental variable analysis.","authors":"Laura A Graham, Samantha Illarmo, Sherry M Wren, Seshadri C Mudumbai, Michelle C Odden","doi":"10.1136/rapm-2025-106720","DOIUrl":"10.1136/rapm-2025-106720","url":null,"abstract":"<p><strong>Background: </strong>Multimodal analgesia (MMA) is a perioperative pain management strategy that targets various pain pathways, resulting in reduced postoperative pain and opioid use. Unfortunately, the optimal combinations of pain medications to use with perioperative MMA remain uncertain. Our goal was to estimate the treatment effect of MMA on postoperative pain and opioid use and identify optimal non-opioid medication combinations to enhance MMA benefits.</p><p><strong>Methods: </strong>The study population includes all patients undergoing elective non-cardiac surgery with general anesthesia between 1 January 2017 and 31 December 2022 at six geographically similar Veterans Health Administration hospitals. An instrumental variable (IV) analysis was conducted using the anesthesiologist as the instrument to emulate randomization to receiving specific pain medication combinations. Outcomes were self-reported pain and opioid use after surgery.</p><p><strong>Results: </strong>Of the 23 238 procedures included in the study, 46.1% received MMA. MMA was more common in younger patients, females and those with a lower probability of mortality. With IV analysis, inpatients with MMA required 6.8 fewer oral morphine equivalents (OMEs, 95% CI -10.2, to -3.4) in the postoperative period, and outpatients with MMA reported postoperative pain scores that were, on average, 1.0 unit lower than patients who did not receive MMA (95% CI -1.6 to -0.4). Combinations of non-steroidal anti-inflammatory drugs (NSAIDs) plus dexamethasone or regional anesthesia resulted in the greatest reductions in postoperative opioid use (mean reduction -29.5 OMEs, 95% CI -36.9 to -19.5 and mean reduction -28.4 OMEs, 95% CI -40.1 to -16.8, respectively).</p><p><strong>Conclusion: </strong>Our findings further support existing evidence on the effectiveness of MMA in reducing postoperative pain and opioid use following non-cardiac surgery. Importantly, our study highlights that dexamethasone and NSAIDs, not acetaminophen, which is almost universally used in MMA regimens, resulted in the greatest reduction of postoperative pain and postoperative opioid use. This has significant implications for the continued use of NSAIDs and dexamethasone in MMA protocols and underscores the need for future studies exploring the independent effect of intravenous acetaminophen on postoperative pain.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144638716","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":"ASRA pain medicine narrative review and expert practice recommendations for gastric point-of-care ultrasound to assess aspiration risk in medically complex patients undergoing regional anesthesia and pain procedures: infographic.","authors":"Stephen C Haskins, Hari Kalagara, Yuriy S Bronshteyn, Anahi Perlas","doi":"10.1136/rapm-2025-106926","DOIUrl":"https://doi.org/10.1136/rapm-2025-106926","url":null,"abstract":"","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144644155","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":"Navigating current controversies in radiofrequency ablation of the genicular nerves for chronic knee pain in osteoarthritis: a daring discourse.","authors":"Nuno Ferreira-Silva, Guilherme Ferreira-Dos-Santos, Tomás Cuñat, Tomas Ribeiro-da-Silva, Philip Peng","doi":"10.1136/rapm-2025-106518","DOIUrl":"https://doi.org/10.1136/rapm-2025-106518","url":null,"abstract":"<p><p>Chronic knee joint pain affects millions worldwide, with radiofrequency ablation (RFA) of genicular nerves emerging as a potential treatment in the last 15 years. Despite its growing popularity, with studies demonstrating its efficacy in pain reduction for up to 12 months, recent randomized controlled trials have questioned the efficacy of RFA. Discrepancies in study results may partially be explained by the heterogeneity of patient selection and technical protocols.This daring discourse aims to explore and critically analyze the ongoing debates surrounding RFA of the genicular nerves, addressing key controversies, namely: (1) Is there a role for performing prognostic blocks prior to RFA?; (2) What are the optimal target sites for final cannulae placement for the classical targets?; (3) Which and how many nerves should be targeted in RFA procedures?; (4) What are the comparative benefits of using ultrasound versus fluoroscopy guidance, and whether a combined technique may be advantageous?; (5) Is there a potential role for pulsed radiofrequency of the genicular nerves?; (6) Should genicular nerve RFA be performed after total knee arthroplasty?Through this in-depth discussion, we aim to guide pain medicine clinicians in informed decision-making and encourage further research in this field.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144644156","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}