Regional Anesthesia and Pain Medicine最新文献

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Tale of two approaches to ultrasound-guided interscalene brachial plexus block: a pro-con. 超声引导下斜角肌间臂丛阻滞的两种方法:一种赞成和反对。
IF 4 2区 医学
Regional Anesthesia and Pain Medicine Pub Date : 2026-08-05 DOI: 10.1136/rapm-2025-106624
Robert Loren Owen, Beth A VanderWielen, Adam W Amundson, Rebecca L Johnson
{"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}
引用次数: 0
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. 腘神经丛阻滞局麻量对运动神经传导和腿部肌肉功能的影响:一项健康志愿者的随机临床试验。
IF 4 2区 医学
Regional Anesthesia and Pain Medicine Pub Date : 2026-08-05 DOI: 10.1136/rapm-2025-106557
Johan Kløvgaard Sørensen, Ulrik Grevstad, Erisela Qerama, Line Stenholt Bruun, Lone Nikolajsen, Charlotte Runge
{"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}
引用次数: 0
Cervical sympathetic block to treat Long COVID: a scoping review. 颈交感神经阻滞治疗长COVID:范围审查。
IF 4 2区 医学
Regional Anesthesia and Pain Medicine Pub Date : 2026-08-05 DOI: 10.1136/rapm-2025-106879
Anna Maria Bombardieri, Claudia Florez Denoue
{"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}
引用次数: 0
Current state of anesthesiology experience with buprenorphine for pain management: results of a nationwide survey. 丁丙诺啡用于疼痛管理的麻醉学经验现状:一项全国性调查的结果。
IF 4 2区 医学
Regional Anesthesia and Pain Medicine Pub Date : 2026-08-05 DOI: 10.1136/rapm-2025-106692
Ryan Hopkins, R Ross MacLean, Brian Pittman, Andres Missair, Robert R Gaiser, Albert C Perrino, Thomas R Hickey
{"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}
引用次数: 0
Yet another name for subscapularis plane block. 这是肩胛下肌平面块的另一个名字。
IF 4 2区 医学
Regional Anesthesia and Pain Medicine Pub Date : 2026-08-05 DOI: 10.1136/rapm-2025-106405
Raghuraman M Sethuraman
{"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}
引用次数: 0
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. 在沙滩椅位肩关节镜检查中,与全身和区域联合麻醉相比,单独区域麻醉可降低术中低血压。
IF 4 2区 医学
Regional Anesthesia and Pain Medicine Pub Date : 2026-08-05 DOI: 10.1136/rapm-2025-106738
Vladimir Cohen-Balaloum, Grégoire Ciais, Xavier Raingeval, Philippe Nguyen
{"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}
引用次数: 0
Guidelines on neurostimulation for chronic pain: a compliance appraisal of reporting standards. 慢性疼痛的神经刺激指南:报告标准的依从性评估。
IF 4 2区 医学
Regional Anesthesia and Pain Medicine Pub Date : 2026-08-05 DOI: 10.1136/rapm-2025-106389
Ryan S D'Souza, Eliana Ege, Preston McMullin, Nasir Hussain
{"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}
引用次数: 0
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. 有或没有催眠的虚拟现实对门诊足部手术区域麻醉患者相关体验和功能恢复的影响:一项随机对照试验
IF 4 2区 医学
Regional Anesthesia and Pain Medicine Pub Date : 2026-08-05 DOI: 10.1136/rapm-2025-106678
Michele Carella, Aminata Bicego, Florian Beck, Coraline Malta, Lorris Ardizzone, Vincent L Bonhomme, Audrey Vanhaudenhuyse
{"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}
引用次数: 0
Intravenous methocarbamol for acute pain after spine surgery: a target trial emulation. 静脉注射甲氨氨基酚治疗脊柱手术后急性疼痛:目标试验模拟。
IF 4 2区 医学
Regional Anesthesia and Pain Medicine Pub Date : 2026-08-05 DOI: 10.1136/rapm-2025-107010
Paul Potnuru, Adriana Baranov, Mohammad Khudirat, Alparslan Turan
{"title":"Intravenous methocarbamol for acute pain after spine surgery: a target trial emulation.","authors":"Paul Potnuru, Adriana Baranov, Mohammad Khudirat, Alparslan Turan","doi":"10.1136/rapm-2025-107010","DOIUrl":"10.1136/rapm-2025-107010","url":null,"abstract":"<p><strong>Background: </strong>Skeletal muscle relaxants are often included in multimodal analgesic regimens following spine surgery, but their actual effectiveness remains unclear due to limited and inconsistent evidence. We aimed to evaluate the effectiveness of intravenous methocarbamol in reducing acute postoperative pain and opioid consumption after elective spine surgery.</p><p><strong>Methods: </strong>This emulated target trial used electronic health record data from patients undergoing elective spine surgery (posterior spinal fusion, anterior cervical discectomy and fusion, laminectomy/laminotomy) between January 1, 2020 and December 31, 2023. The exposure was intravenous methocarbamol (≥500 mg) administered within 2 hours postoperatively compared with usual care without methocarbamol. The primary outcome was the time-weighted average pain score in the 6-hour follow-up window after treatment assignment. The secondary outcome was cumulative opioid use measured in oral morphine equivalents (OMEs) over the same period. We used 1:1 time-varying propensity score matching to adjust for confounding.</p><p><strong>Results: </strong>The matched cohort included 1270 patients (median (IQR) age, 61 (50-68) years; 765 (60.2%) female). Administration of intravenous methocarbamol was not associated with significant reductions in postoperative pain scores (adjusted mean difference, 0.1; 95% CI, -0.1 to 0.4) or opioid consumption (adjusted mean difference, 0.6 OME; 95% CI, -1.4 to 2.5) compared with controls. Sensitivity analyses generally confirmed primary results, except the marginal structural model indicated slightly increased pain scores in the methocarbamol group (adjusted mean difference, 0.5; 95% CI, 0.3 to 0.7), though this was not clinically meaningful.</p><p><strong>Conclusions: </strong>In this emulated target trial of elective spine surgery, intravenous methocarbamol did not reduce acute postoperative pain or opioid consumption. These findings suggest a lack of analgesic benefit from intravenous methocarbamol use after spine surgery.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":"940-946"},"PeriodicalIF":4.0,"publicationDate":"2026-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12602086/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145024750","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Transnasal spread of bupivacaine into the pterygopalatine fossa following endoscopically assisted cotton swab placement: a cadaveric study. 内窥镜辅助棉签放置后布比卡因经鼻扩散进入翼腭窝:一项尸体研究。
IF 4 2区 医学
Regional Anesthesia and Pain Medicine Pub Date : 2026-08-05 DOI: 10.1136/rapm-2025-106553
Simon Istenič, Anže Jerman, Luka Pušnik, Tatjana Stopar Pintarič, Nejc Umek
{"title":"Transnasal spread of bupivacaine into the pterygopalatine fossa following endoscopically assisted cotton swab placement: a cadaveric study.","authors":"Simon Istenič, Anže Jerman, Luka Pušnik, Tatjana Stopar Pintarič, Nejc Umek","doi":"10.1136/rapm-2025-106553","DOIUrl":"10.1136/rapm-2025-106553","url":null,"abstract":"<p><strong>Background: </strong>There are conflicting data on the efficacy of transnasal topical anesthetic approaches intended to achieve a pterygopalatine ganglion block, specifically regarding the extent to which local anesthetics reach the pterygopalatine fossa. This cadaveric study aims to determine whether bupivacaine can reach the pterygopalatine fossa following topical administration near the sphenopalatine foramen using endoscopically assisted cotton ball placement.</p><p><strong>Methods: </strong>Nine fresh cadavers underwent topical nasal administration of a solution containing bupivacaine, methylene blue, and iodine contrast. Under direct endoscopic visualization, an absorbent cotton ball was positioned intranasally adjacent to the sphenopalatine foramen. CT was used to confirm correct placement and measured relevant anatomical distances. Tissue biopsies from the pterygopalatine fossa were collected via a transmaxillary surgical approach and analyzed using high-performance liquid chromatography-mass spectrometry.</p><p><strong>Results: </strong>Bupivacaine was detected in all pterygopalatine fossa biopsy samples except one, which was the farthest (17.5 mm) from the sphenopalatine foramen. Concentrations exceeded 1.00 µg/g in 29% and 0.10 µg/g in 71% of samples. The concentration decreased exponentially with distance from the application site, following a one-phase decay model (R²=0.74).</p><p><strong>Conclusions: </strong>These findings demonstrate that bupivacaine can reach the pterygopalatine fossa from the nasal cavity when topically applied near the sphenopalatine foramen under endoscopic assistance, supporting the feasibility of such an approach. They also suggest the main mean of transport is simple diffusion, meaning that optimizing bupivacaine concentration, duration of application, and precise placement of the absorbent cotton ball are crucial for maximizing the block's clinical efficacy.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":"918-923"},"PeriodicalIF":4.0,"publicationDate":"2026-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13479633/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143733195","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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