Regional Anesthesia and Pain Medicine最新文献

{"title":"Danger, Danger, Gaston Labat! Does zero-shot artificial intelligence correlate with anticoagulation guidelines recommendations for neuraxial anesthesia?","authors":"Andrew D Fisher, Gabrielle Fisher","doi":"10.1136/rapm-2024-105405","DOIUrl":"10.1136/rapm-2024-105405","url":null,"abstract":"","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":"73-74"},"PeriodicalIF":5.1,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139991813","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":"Education guide to decision-making in neuraxial pathology and regional anesthesia: the use of CT/MRI scans to determine conus medullaris level and the utility of preoperative plain X-rays.","authors":"Richard Davies","doi":"10.1136/rapm-2024-105396","DOIUrl":"10.1136/rapm-2024-105396","url":null,"abstract":"","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":"71"},"PeriodicalIF":5.1,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139934181","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":"Education guide to decision-making in neuraxial pathology and regional anesthesia: the use of CT/MRI scans to determine conus medullaris level and the utility of preoperative plain X-rays.","authors":"Martin Avellanal, Irene Riquelme, Antonio Ferreiro, André P Boezaart, Miguel A Reina","doi":"10.1136/rapm-2024-105432","DOIUrl":"10.1136/rapm-2024-105432","url":null,"abstract":"","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":"74"},"PeriodicalIF":5.1,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140121411","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":"Buprenorphine versus full agonist opioids for acute postoperative pain management: a systematic review and meta-analysis of randomized controlled trials.","authors":"Thomas R Hickey, Gabriel P A Costa, Debora Oliveira, Alexandra Podosek, Audrey Abelleira, Victor Javier Avila-Quintero, Joao P De Aquino","doi":"10.1136/rapm-2024-106014","DOIUrl":"https://doi.org/10.1136/rapm-2024-106014","url":null,"abstract":"<p><strong>Background/importance: </strong>Opioids continue to play a key role in managing acute postoperative pain, but their use contributes to adverse outcomes. Buprenorphine may offer effective analgesia with a superior safety profile.</p><p><strong>Objective: </strong>To compare the efficacy and safety of buprenorphine with other opioids for acute postoperative pain management in adults.</p><p><strong>Evidence review: </strong>MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and Web of Science were searched from inception to February 2024. Randomized controlled trials comparing buprenorphine with other opioids for acute postoperative pain management in adults were included. Of 2421 records identified, 58 studies met inclusion criteria. Two reviewers independently extracted data and assessed risk of bias. Random-effects meta-analysis was performed using Stata/BE V.18. The primary outcome was pain intensity. Secondary outcomes included rescue analgesia use, duration of analgesia, and adverse effects.</p><p><strong>Findings: </strong>Analysis of 41 comparisons (2587 participants) showed buprenorphine significantly reduced pain intensity compared with all other opioids (Hedges's g=-0.36, 95% CI=-0.59 to -0.14, p<0.001, 95% prediction interval (PI)=-1.70 to 0.97). This effect persisted when compared with full agonist opioid (FAO) alone (standardized mean difference -0.34, 95% CI=-0.59 to -0.10, p<0.001, 95% PI=-1.76 to 1.07). Patients receiving buprenorphine were less likely to require rescue analgesia (OR=0.40, 95% CI=0.26 to 0.63, p<0.001, 95% PI=0.12 to 1.36). Mean duration of analgesia was 8.5 hours (SD 1.84). There were no significant differences in other adverse effects including nausea and respiratory depression. Inconsistency was significant for pain intensity (I²=86.28%, 95% CI=81.55% to 88.99%) and moderate for rescue analgesia (I²=38.93%, 95% CI=1.44% to 64.37%). Risk of bias was low in 19 studies, with some concerns in 37 studies, and high in two studies.</p><p><strong>Conclusions: </strong>Buprenorphine demonstrated superior efficacy in managing acute postoperative pain compared with FAOs, with a favorable safety profile and longer duration of action. These findings support the use of buprenorphine as a first-line opioid analgesic for acute postoperative pain management requiring opioid analgesia, potentially reducing opioid-related harm in the postoperative period.</p><p><strong>Prospero registration number: </strong>CRD42023447715.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142928777","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-inferiority: egregious infractions or conclusion confused?","authors":"Martin Vedel Nielsen, Christian Kruse Hansen, Jens Børglum","doi":"10.1136/rapm-2024-106308","DOIUrl":"https://doi.org/10.1136/rapm-2024-106308","url":null,"abstract":"","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142928778","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":"Thoracic cutaneous sensory loss in volunteers: are we adequately assessing non-inferiority?","authors":"Fabricio Andres Lasso Andrade, Rami Adel Kamel, Mauricio Forero","doi":"10.1136/rapm-2024-106167","DOIUrl":"https://doi.org/10.1136/rapm-2024-106167","url":null,"abstract":"","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142928780","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":"Revisiting human nerve fascicle penetrability: a further response to Orebaugh and Ligocki.","authors":"Andre Boezaart, Miguel Angel Reina, Graeme A McLeod, Dihan van Niekerk, Anna Server, Xavier Sala-Blanch","doi":"10.1136/rapm-2024-106286","DOIUrl":"https://doi.org/10.1136/rapm-2024-106286","url":null,"abstract":"","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142911100","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":"Anesthetic approaches and 2-year recurrence rates in non-muscle invasive bladder cancer: a randomized clinical trial.","authors":"Jang Hee Han, Hyeong Dong Yuk, Seung-Hwan Jeong, Chang Wook Jeong, Cheol Kwak, Jin-Tae Kim, Ja Hyeon Ku","doi":"10.1136/rapm-2024-105949","DOIUrl":"https://doi.org/10.1136/rapm-2024-105949","url":null,"abstract":"<p><strong>Background: </strong>The effect of anesthesia methods on non-muscle invasive bladder cancer (NMIBC) recurrence post-resection remains uncertain. We aimed to compare the oncological outcomes of spinal anesthesia (SA) and general anesthesia (GA) in patients with NMIBC.</p><p><strong>Methods: </strong>This prospective randomized controlled trial recruited 287 patients with clinical NMIBC at Seoul National University Hospital from 2018 to 2020. The patients underwent transurethral resection of the bladder tumor within 4 weeks of randomization. Intrathecal hyperbaric bupivacaine (0.5%) and a mixture of propofol (1-2 mg/kg) and fentanyl (50-100 μg/kg) were used as induction agents in the SA and GA groups, respectively, with desflurane or sevoflurane used for maintaining anesthesia. The primary and secondary outcome measures were disease recurrence and disease progression, respectively, at 2 years after resection. Cumulative incidence of outcomes was compared between the two groups using time-to-event analyses.</p><p><strong>Results: </strong>15 patients required alternative anesthesia owing to clinical needs such as SA failure or significant obturator reflex, resulting in a modified intention-to-treat (ITT) population of 272 patients. Time-to-event analysis showed a significantly lower recurrence of NMIBC in the SA group than in the GA group, in both ITT (27.4% vs 39.8%) and modified ITT populations (26.8% vs 39.6%). Disease progression occurred more frequently in the GA than in the SA group (15.2% vs 7.8%), although the difference was not statistically significant.</p><p><strong>Conclusions: </strong>A notable reduction in the 2-year recurrence rate was observed in patients who underwent SA than in those who underwent GA. Thus, SA may be considered the preferred anesthetic approach.</p><p><strong>Trial registration number: </strong>NCT03597087.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142911092","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":"Risk profiles of common brachial plexus block sites: results from the net-ra registry.","authors":"Christine Kubulus, Maral Saadati, Lukas M Müller-Wirtz, William M Patterson, Andre Gottschalk, Rene Schmidt, Thomas Volk","doi":"10.1136/rapm-2024-105862","DOIUrl":"https://doi.org/10.1136/rapm-2024-105862","url":null,"abstract":"<p><strong>Introduction: </strong>Regional anesthesia is frequently used for upper limb surgeries and postoperative pain control. Different approaches to brachial plexus blocks are similarly effective but may differ in the frequency and severity of iatrogenesis. We, therefore, examined large-scale registry data to explore the risks of typical complications among different brachial plexus block sites for regional anesthesia.</p><p><strong>Methods: </strong>26,947 qualifying adult brachial plexus blocks (2007-2022) from the Network for Safety in Regional Anesthesia and Acute Pain Therapy registry were included in a retrospective cohort analysis. Interscalene, supraclavicular, infraclavicular, and axillary approaches were compared for block failure and bloody punctures using generalized estimating equations. For continuous procedures, we analyzed the influence of the approach on catheter failure, neurological disorders, and infections.</p><p><strong>Results: </strong>The axillary plexus block had the highest risk of block failure (adjusted OR, 2.3; 95% CI 1.02 to 5.1; p=0.04), catheter failure (adjusted OR, 1.4; 95% CI 1.1 to 2.0; p=0.02), and neurological dysfunction (adjusted OR, 3.0; 95% CI 1.5 to 5.9; p=0.002). There was no statistically significant difference among block sites for bloody punctures, while infraclavicular blocks had the highest odds for catheter-related infections.</p><p><strong>Discussion: </strong>The axillary approach to the brachial plexus had the highest odds for block failure and neurological dysfunction after catheter placement, as well as a significant risk for catheter failure. However, considering that the axillary approach precludes other complications such as pneumothorax, none of the four common approaches to the brachial plexus has a fundamentally superior risk profile.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142911106","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":"Mapping axillary sensory cutaneous nerves for enhanced analgesic approaches in axillary surgery: a cadaveric study.","authors":"Brittany Zurkan, Timothy D Wilson, Abhijit Biswas","doi":"10.1136/rapm-2024-106061","DOIUrl":"https://doi.org/10.1136/rapm-2024-106061","url":null,"abstract":"<p><strong>Background: </strong>Innervation of the breast includes branches of thoracic intercostal nerves, the superficial cervical plexus, the brachial plexus, and the intercostobrachial nerve (ICBN). Commonly used blocks for breast surgery provide incomplete analgesia of the axillary region. This cadaveric study aims to identify and map the axillary sensory cutaneous nerves.</p><p><strong>Methods: </strong>We conducted nine axillary dissections on cadavers of both sexes with cadavers in supine position and upper limbs abducted. Incisions along the anterolateral thorax and superior clavicle created laterally reflecting skin flaps, allowing visualization of the ICBN and brachial plexus. Photographs were taken during dissections to enabled three-dimensional reconstruction using imaging software 3D Slicer.</p><p><strong>Results: </strong>In all dissections, an ICBN and a branch of the posterior cord were identified entering axillary subcutaneous tissue. A branch of the medial cord was identified entering axillary tissue in 5/9 (56%) cadavers. The ICBN remained localized to the anterior axillary base but demonstrated various extrathoracic branching patterns. The posterior cord branch arose from the proximal posterior cord before penetrating the axillary base at its posterior margin in all cadavers. When present, the medial cord branch arose from the proximal medial cord before penetrating the axillary base along the midaxillary line.</p><p><strong>Conclusion: </strong>In addition to the ICBN, two branches of the brachial plexus were identified entering axillary subcutaneous tissue. These branches are not currently considered when providing analgesia for breast surgery and may contribute to pain following surgery that involves axillary dissection.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142911097","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}