Regional Anesthesia and Pain Medicine最新文献

{"title":"Incidence of chronic postsurgical pain after cardiac surgery and the effect of bilateral erector spinae plane block: a randomized controlled trial.","authors":"Burhan Dost, Elif Sarıkaya Ozel, Cengiz Kaya, Esra Turunc, Deniz Karakaya, Mustafa Kemal Demirag, Sezgin Bilgin, Alessandro De Cassai, Hesham Elsharkawy","doi":"10.1136/rapm-2025-106591","DOIUrl":"10.1136/rapm-2025-106591","url":null,"abstract":"<p><strong>Background: </strong>The effects of the erector spinae plane (ESP) block on chronic postsurgical pain (CPSP) after cardiac surgery remain unclear. This study evaluated the efficacy of bilateral ESP block in reducing the incidence and severity of CPSP after cardiac surgery.</p><p><strong>Methods: </strong>This prospective, randomized, controlled, single-blind trial included 63 patients aged 18-80 years with American Society of Anesthesiologists physical status II-III, scheduled for elective cardiac surgery via median sternotomy. Participants received a bilateral ultrasound-guided ESP block or standard care without regional anesthesia. The primary outcome was the Brief Pain Inventory (BPI) score at 3 months postoperatively. Secondary outcomes included morphine consumption in the first 24 hours; Numerical Rating Scale (NRS) scores during rest/activity at 0, 3, 6, 12, and 24 hours; BPI scores at 6 months postoperatively; and Douleur Neuropathique 4 (DN4) and Hospital Anxiety and Depression Scale (HADS) scores at 3 and 6 months postoperatively.</p><p><strong>Results: </strong>The BPI scores of the two groups did not differ significantly at 3 months postoperatively (median (IQR): 0(26) vs 12 (31), p=0.166). However, 24 hours postoperative morphine consumption (8 mg vs 10.5 mg, p<0.001) and NRS scores at multiple time points were significantly lower in the ESP block group. No significant differences were observed between the groups in terms of the BPI, DN4, or HADS scores at three or 6 months.</p><p><strong>Conclusions: </strong>The ESP block effectively reduced acute pain and opioid consumption; however, it had no significant effect on the incidence or severity of CPSP at 3 and 6 months.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":"878-885"},"PeriodicalIF":4.0,"publicationDate":"2026-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144052346","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":"Global usage of spinal cord stimulation therapy for chronic pain syndromes: a systematic review and meta-analysis.","authors":"Peter D Vu, Noushad Mamun, Lei Feng, Kathryn J Krause, Billy Huh, Ryan S D'Souza, Saba Javed","doi":"10.1136/rapm-2025-106806","DOIUrl":"10.1136/rapm-2025-106806","url":null,"abstract":"<p><strong>Background/importance: </strong>Spinal cord stimulation (SCS) is an established therapy for chronic pain conditions when conventional treatments fail. However, global research implementation varies significantly due to patient demographics, healthcare infrastructure, and economic factors, creating disparities in access that directly impact patient care and public health outcomes.</p><p><strong>Objective: </strong>To evaluate the global landscape of SCS research by analyzing patient demographics, geographic distribution, funding sources, and pain conditions treated across chronic pain populations aged 18 years and older, with primary focus on associations between geographic regions and patient age demographics.</p><p><strong>Evidence review: </strong>We conducted a systematic literature review and meta-analysis following Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines, searching five major databases through October 2024. Studies from 2000 onward reporting SCS in adults with chronic pain lasting 3 months or longer were included. We included randomized trials, comparative studies, and case series with at least 10 patients, excluding commentaries, reviews, and insurance databases.</p><p><strong>Findings: </strong>Analysis of 187 studies revealed heterogeneity in age distributions across geographic regions, with Asian studies showing higher mean ages compared to North America, while European showed lower mean ages. Research concentration was predominantly in high-income regions, with 57% of studies receiving industry funding and significant associations between funding source and geographic origin. Post-surgical pain syndrome-thoracolumbar emerged as the most prevalent condition globally, representing 44.9% of cases.</p><p><strong>Conclusions: </strong>Significant associations exist between geographic regions and patient demographics in SCS research, with notable disparities in research concentration highlighting the need for broader investigation in underrepresented areas to optimize global application of this chronic pain management therapy.</p><p><strong>Prospero registration number: </strong>CRD42025635147.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":"959-970"},"PeriodicalIF":4.0,"publicationDate":"2026-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144978922","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":"Tale of two approaches to ultrasound-guided interscalene brachial plexus block: a pro-con.","authors":"Robert Loren Owen, Beth A VanderWielen, Adam W Amundson, Rebecca L Johnson","doi":"10.1136/rapm-2025-106624","DOIUrl":"10.1136/rapm-2025-106624","url":null,"abstract":"<p><p>The interscalene brachial plexus block is a well-described and widely used peripheral nerve block effective for regional anesthesia and analgesia in orthopedic surgical procedures of the shoulder, upper arm, and clavicle. Conventionally, an in-plane ultrasound-guided approach has been the technique of choice, while the out-of-plane approach, though less described, has been gaining anecdotal momentum among a growing number of proceduralists. This pro-con discussion highlights the out-of-plane approach's goal of avoiding needle injuries to nerves that course through the middle scalene muscle and the in-plane approach's benefit of whole-shaft needle visualization and increased distance away from the plexus on entry. We aim to provide a comprehensive comparison to guide proceduralists in their clinical decision-making.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":"985-988"},"PeriodicalIF":4.0,"publicationDate":"2026-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144487125","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":"Effect of local anesthetic volume for popliteal plexus block on motor nerve conduction and muscle function in the leg: a randomized clinical trial in healthy volunteers.","authors":"Johan Kløvgaard Sørensen, Ulrik Grevstad, Erisela Qerama, Line Stenholt Bruun, Lone Nikolajsen, Charlotte Runge","doi":"10.1136/rapm-2025-106557","DOIUrl":"10.1136/rapm-2025-106557","url":null,"abstract":"<p><strong>Background and objectives: </strong>Popliteal plexus block (PPB) has shown moderate improvements in multimodal analgesia following total knee arthroplasty (TKA) while preserving motor function. However, the optimal analgesic volume for PPB remains unknown, and concerns exist regarding potential volume-dependent motor nerve involvement. This study investigates whether increasing the volume of local anesthetic for PPB affects muscle function and motor nerve involvement.</p><p><strong>Methods: </strong>In this randomized, controlled, blinded trial, 40 healthy volunteers received one active nerve block and one sham block in each leg. Participants were randomized into three PPB groups receiving 10 mL, 20 mL, or 30 mL of 1% lidocaine, with 20 observations per group. Additionally, 10 femoral nerve blocks and 10 sciatic nerve blocks were included as reference groups to confirm motor nerve involvement. The primary outcome was relative changes in maximum voluntary isometric contraction (MVIC) of ankle plantar- and dorsiflexion. Secondary outcomes included relative changes in MVIC of knee extension, relative changes in compound muscle action potential of the gastrocnemius, anterior tibial, vastus medialis, and vastus lateralis muscles and frequency of saphenous nerve involvement.</p><p><strong>Results: </strong>There were no significant differences in motor function between the three PPB groups for any MVIC measures (p≥0.1). Compound muscle action potential changes did not indicate clinically relevant motor nerve involvement across PPB groups. Saphenous nerve involvement was inconsistent, affecting 40% (10 mL), 40% (20 mL), and 60% (30 mL) of cases (p=0.3), suggesting ineffective sensory block of the femoral nerve's medial knee contributions.</p><p><strong>Conclusion: </strong>Increasing the volume of local anesthetic for PPB does not impair muscle function or significantly involve motor nerves, supporting its motor-sparing efficacy. PPB inconsistently affects the femoral nerve's sensory contributions to the knee, emphasizing its role as an adjunct to femoral triangle or adductor canal blocks in clinical practice. Concerns of muscle impairment should not hinder future clinical trials from exploration of the optimal analgesic volume for PPB.</p><p><strong>Trial registration number: </strong>NCT05464862.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":"924-930"},"PeriodicalIF":4.0,"publicationDate":"2026-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143789200","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":"Cervical sympathetic block to treat Long COVID: a scoping review.","authors":"Anna Maria Bombardieri, Claudia Florez Denoue","doi":"10.1136/rapm-2025-106879","DOIUrl":"10.1136/rapm-2025-106879","url":null,"abstract":"<p><strong>Background: </strong>Long COVID is a complex and poorly understood condition characterized by persistent symptoms such as autonomic dysfunction, fatigue, neurocognitive impairment, and olfactory disturbances. Current treatments offer limited and inconsistent benefits. Dysregulation of the sympathetic nervous system is increasingly recognized as a contributor to Long COVID pathophysiology. Cervical sympathetic block (CSB), a procedure that modulates sympathetic tone, has emerged as a potential therapeutic approach.</p><p><strong>Objective: </strong>To review the existing literature on CSB, for Long COVID, focusing on symptom outcomes, proposed mechanisms, and procedural considerations.</p><p><strong>Evidence review: </strong>A structured literature search across PubMed, Embase, Scopus, and Web of Science identified studies published between 2022 and March 2025 reporting on CSB in adults with Long COVID. Eligible articles included case reports, case series, observational studies, and one randomized controlled trial evaluating symptom outcomes after the procedure.</p><p><strong>Findings: </strong>Sixteen studies involving 224 patients were included. Most reported improvement in fatigue, brain fog, and autonomic symptoms, including reduced heart rate and enhanced orthostatic tolerance. Cognitive and psychiatric symptoms such as memory impairment, anxiety, and depression showed variable improvement. Olfactory recovery was inconsistent and appeared to depend on symptom severity. Symptom relief was observed after both unilateral and bilateral blocks, with some responses lasting up to 1 year. No serious complications were reported.</p><p><strong>Conclusions: </strong>CSB may offer symptom relief in Long COVID, particularly for fatigue, brain fog, and dysautonomia. However, the evidence remains preliminary and limited by small sample sizes and methodological heterogeneity. Controlled trials are needed to establish efficacy and patient selection criteria.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":"971-977"},"PeriodicalIF":4.0,"publicationDate":"2026-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144978930","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":"Current state of anesthesiology experience with buprenorphine for pain management: results of a nationwide survey.","authors":"Ryan Hopkins, R Ross MacLean, Brian Pittman, Andres Missair, Robert R Gaiser, Albert C Perrino, Thomas R Hickey","doi":"10.1136/rapm-2025-106692","DOIUrl":"10.1136/rapm-2025-106692","url":null,"abstract":"","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":"978-979"},"PeriodicalIF":4.0,"publicationDate":"2026-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144032544","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":"Yet another name for subscapularis plane block.","authors":"Raghuraman M Sethuraman","doi":"10.1136/rapm-2025-106405","DOIUrl":"10.1136/rapm-2025-106405","url":null,"abstract":"","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":"990"},"PeriodicalIF":4.0,"publicationDate":"2026-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143061536","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":"Regional anesthesia alone is associated with reduced intraoperative hypotension compared with combined general and regional anesthesia in shoulder arthroscopy performed in the beach-chair position.","authors":"Vladimir Cohen-Balaloum, Grégoire Ciais, Xavier Raingeval, Philippe Nguyen","doi":"10.1136/rapm-2025-106738","DOIUrl":"10.1136/rapm-2025-106738","url":null,"abstract":"<p><strong>Background: </strong>Shoulder arthroscopy in the beach-chair position is frequently associated with intraoperative hypotension, especially under general anesthesia (GA). Regional anesthesia (RA) alone may offer improved hemodynamic stability and facilitate ambulatory management. This study compared intraoperative hemodynamic effects of RA alone versus combined GA and RA.</p><p><strong>Methods: </strong>We conducted a monocentric, retrospective cohort study including all adult patients undergoing elective shoulder arthroscopy between October 1, 2023, and October 1, 2024, at a private surgical center in Paris, France. Patients received either RA alone (interscalene+superficial cervical plexus block) or combined GA+RA. The primary outcome was any intraoperative occurrence of mean arterial pressure (MAP) <65 mm Hg. Multiple logistic regression models were constructed with stepwise adjustment for demographic variables and comorbidities. Secondary outcomes included hypotension duration, vasopressor use, intraoperative fluid administration, and postanesthesia care metrics.</p><p><strong>Results: </strong>Among 482 patients, 417 (87%) received RA alone, and 65 (13%) received GA+RA. Hypotension occurred in 57% of patients with GA versus 13% with RA (p<0.001). GA was associated with hypotension (unadjusted OR 8.88 (95% CI 5.03 to 15.68); adjusted OR 10.25 (95% CI 5.51 to 19.08), p<0.001). This was confirmed in sensitivity analyses. GA patients had greater MAP reduction, longer hypotension duration, and higher vasopressor use. RA alone was associated with shorter operative time, reduced postanesthesia care unit stay (22 min vs 52 min), and more frequent same-day discharge (96% vs 75%, p<0.001).</p><p><strong>Conclusions: </strong>In elective shoulder arthroscopy, RA alone was associated with significantly greater hemodynamic stability, shorter recovery, and improved ambulatory outcomes compared with combined GA and RA.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":"947-953"},"PeriodicalIF":4.0,"publicationDate":"2026-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144250807","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":"Guidelines on neurostimulation for chronic pain: a compliance appraisal of reporting standards.","authors":"Ryan S D'Souza, Eliana Ege, Preston McMullin, Nasir Hussain","doi":"10.1136/rapm-2025-106389","DOIUrl":"10.1136/rapm-2025-106389","url":null,"abstract":"<p><strong>Introduction: </strong>The field of neuromodulation has experienced substantial growth, accompanied by an increase in clinical practice guidelines aimed at supporting evidence-based practice. However, adherence to reporting standards remains critical in the development of a comprehensive and transparent clinical practice guideline. This study evaluated the reporting quality of guidelines on neurostimulation for chronic pain by assessing compliance with the Reporting Items for Practice Guidelines in Healthcare (RIGHT) checklist and the Appraisal of Guidelines for Research and Evaluation (AGREE) checklist and explored predictors of reporting quality.</p><p><strong>Methods: </strong>A search strategy was conducted from database inception to April 17, 2024 to identify guideline articles on neurostimulation treatment (spinal cord stimulation, dorsal root ganglion stimulation, peripheral nerve stimulation) for chronic pain. Primary outcomes included the percentage of completed RIGHT and AGREE checklist items. Secondary outcomes included the identification of under-reported checklist items, predictors of reporting quality, and agreement between the two checklists.</p><p><strong>Results: </strong>A total of 24 guideline articles were included, with a mean percentage of completed items being 55.12%±12.68% for the RIGHT checklist and 52.16%±10.51% for the AGREE checklist. Items that were most frequently under-reported (<25% completion) included themes of population-specific considerations, cost/resource implications, guideline limitations, recommendation development process, magnitude of benefit versus magnitude of harm, and statement of competing interests and how they were managed. Secondary analysis revealed no significant associations between RIGHT/AGREE reporting quality and journal impact factor, year of publication, number of authors, or guideline themes. There was good inter-checklist agreement between the RIGHT and AGREE checklists (intraclass correlation coefficient 0.76, 95% CI 0.44 to 0.90), suggesting overlapping but distinct evaluation criteria.</p><p><strong>Conclusions: </strong>Current guidelines of neurostimulation for chronic pain exhibit significant variability in reporting items, with notable deficiencies in the description of key methodological areas. While adherence to established checklists such as RIGHT and AGREE remains poor and inconsistent, these tools provide a critical framework for enhancing comprehensiveness, transparency, and methodological rigor in future guideline development.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":"902-910"},"PeriodicalIF":4.0,"publicationDate":"2026-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144585629","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":"Influence of virtual reality with or without hypnosis on patient-related experience and functional recovery in outpatient foot surgery with regional anesthesia: a randomized controlled trial.","authors":"Michele Carella, Aminata Bicego, Florian Beck, Coraline Malta, Lorris Ardizzone, Vincent L Bonhomme, Audrey Vanhaudenhuyse","doi":"10.1136/rapm-2025-106678","DOIUrl":"10.1136/rapm-2025-106678","url":null,"abstract":"<p><strong>Introduction: </strong>Perioperative psychological stress significantly influences recovery after surgery. Sciatic nerve and ankle blocks are commonly used techniques for achieving postoperative analgesia in outpatient foot surgery. However, these procedures can cause discomfort for patients, potentially affecting their postoperative functional recovery. This study aims to assess the impact of virtual reality with or without hypnosis on patient satisfaction and postoperative functional recovery in patients undergoing peripheral nerve blocks for outpatient foot surgery.</p><p><strong>Methods: </strong>A prospective randomized clinical trial was conducted involving 57 patients scheduled for outpatient foot surgery with combined sciatic popliteal and ankle nerve blocks. Patients were randomly assigned to one of three groups: group C (usual care with intravenous midazolam), group VR (virtual reality immersion through glasses and headsets), or group VRH (virtual reality immersion with prerecorded hypnosis-sedation session). Patient satisfaction with the regional anesthesia experience (evaluated using the EVAN-LR score, Evaluation du Vécu de l'Anesthésie LocoRégionale Score) was assessed 4 hours after surgery. The quality of recovery 15-item and perioperative anxiety (Numeric Rate Scale (NRS) and six-item Spielberger State-Trait Anxiety Inventory (STAI-6)) were evaluated at fixed time points: 1 hour before and after surgery for NRS-anxiety and STAI-6 and 1 day before surgery, and at day 1 and day 3 postoperatively for Quality-of-Recovery-15 items.</p><p><strong>Results: </strong>Postoperative EVAN-LR scores were similar across groups (group C: 91 (86.5, 93.5) vs group VR: 90 (87.5, 93.5) vs group VRH: 91 (89, 93); p=0.64). There were no significant differences in the evolution of quality of recovery 15-item (p=0.25) nor perioperative anxiety (NRS and STAI-6: p=0.18 and p=0.14, respectively) among the groups.</p><p><strong>Discussion: </strong>Virtual reality with or without hypnosis did not significantly impact satisfaction with regional anesthesia techniques in outpatient foot surgery. Additionally, there were no differences observed among the groups in terms of functional recovery during the first three postoperative days.</p><p><strong>Trial registration number: </strong>NCT05558449.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":"931-939"},"PeriodicalIF":4.0,"publicationDate":"2026-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144369554","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}