Regional Anesthesia and Pain Medicine最新文献

{"title":"Impact of preoperative opioid exposure on cost of care and workplace productivity loss after elective surgery.","authors":"Christina Lynn Shabet, Dominic Alessio, Brooke Kenney, Mark C Bicket, Chad M Brummett, Jennifer F Waljee","doi":"10.1136/rapm-2024-106199","DOIUrl":"10.1136/rapm-2024-106199","url":null,"abstract":"<p><strong>Introduction: </strong>A high proportion of surgical patients has previous opioid exposure, which is associated with poorer recovery and increased morbidity. However, much less is known regarding the direct and indirect costs that are associated with healthcare utilization among individuals on preoperative opioid therapy.</p><p><strong>Methods: </strong>We analyzed The Merative MarketScan Commercial Database linked with the Merative MarketScan Health and Productivity Management Database to include all adult patients admitted and discharged from common elective surgeries between January 1, 2018 and June 30, 2021. Patients were clustered by preoperative opioid exposure and estimates for total direct payments (in USD) generated and workplace absenteeism were assessed for a 6-month period.</p><p><strong>Results: </strong>10 737 patients were included in our cohort; 17.0% classified as 'low' preoperative opioid use (median oral morphine equivalents (IQR)=126 (75-225)), 5.0% as 'medium' (370 (225-640)) and 3.0% as 'high' (4500 (2120-10 908)). Compared with opioid naive or low preoperative use, individuals with high preoperative use had significantly higher estimated payments for care at 6 months ($4212 for high vs $2706 for naive (p=0.007) and $3059 for low (p=0.045)), while utilizing increased ambulatory care including clinic and outpatient visits after surgery. There was no significant difference in workplace absenteeism between groups.</p><p><strong>Conclusion: </strong>High preoperative opioid use is associated with increased healthcare utilization and costs following common elective surgery. Future efforts should focus on this patient population to explore interventions that could optimize value-based care by improving outcomes and reducing costs.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":"539-546"},"PeriodicalIF":3.5,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12310985/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143076369","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}

{"title":"Paravertebral analgesia versus wound infiltration in children recovering from cardiac surgery: a randomized controlled trial.","authors":"Jingfei Guo, Yuan Jia, Lijuan Tian, Wenying Kang, Yanyan Zhao, Su Yuan, Daniel I Sessler","doi":"10.1136/rapm-2025-106506","DOIUrl":"10.1136/rapm-2025-106506","url":null,"abstract":"<p><strong>Introduction: </strong>Optimal analgesia for thoracotomies remains unclear. Paravertebral blocks are more complex than local anesthetic infiltration but may be more effective. We therefore tested the hypothesis that paravertebral blocks provide better postoperative analgesia than local anesthetic infiltration in children recovering from cardiac surgery thoracotomies.</p><p><strong>Methods: </strong>This was a single-center randomized double-blind trial. We recruited children aged 6-14 years with atrial or ventricular septal defects scheduled for cardiac surgery with cardiopulmonary bypass via thoracotomy were recruited. 100 patients were enrolled and randomized to either postoperative paravertebral blocks (n=50) or local anesthetic wound infiltration (n=50). We recorded opioid consumption during the initial 24 hours after surgery, along with pain scores at 6 hour intervals. Complications including postoperative nausea and vomiting and respiratory failure were also recorded.</p><p><strong>Results: </strong>100 patients (mean 7 years, 43% male) were included in the analysis. The only postoperative opioid used was sufentanil. Total sufentanil consumption in the first 24 hours postsurgery was 0.3±0.4 µg/kg for those receiving paravertebral blocks, significantly lower than the 0.6±0.5 µg/kg for wound infiltration (p=0.002). Faces Pain Scale-Revised pain scores were consistently lower in the paravertebral block group across all measured time points (6, 12, 18, and 24 hours), with the most pronounced difference observed at 6 hours postoperatively (1.7±2.2 vs 3.3±2.2; p<0.001). Postoperative mechanical ventilation time, ICU stay, hospitalization, and incidence of postoperative nausea and vomiting were comparable.</p><p><strong>Conclusion: </strong>Paravertebral blocks reduced opioid consumption and pain during the first postoperative day in pediatric cardiac thoracotomies but did not accelerate recovery.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":"584-590"},"PeriodicalIF":3.5,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13151476/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144082079","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}

{"title":"Erector spinae plane block and spread to ventral rami: a nuanced discussion is needed.","authors":"Alessandro De Cassai, Burhan Dost, Giulia Aviani Fulvio, Esra Turunc, Paolo Navalesi","doi":"10.1136/rapm-2024-105952","DOIUrl":"10.1136/rapm-2024-105952","url":null,"abstract":"","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":"600"},"PeriodicalIF":3.5,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142755919","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":"Cryoanalgesia to treat phantom limb pain following a trans-femoral (above-knee) amputation: a randomized, sham-controlled pilot study.","authors":"Brian M Ilfeld, John J Finneran, Baharin Abdullah, Sabeeca Vadakkan, Rafael A Alkabalan, Rodney A Gabriel","doi":"10.1136/rapm-2025-107116","DOIUrl":"10.1136/rapm-2025-107116","url":null,"abstract":"<p><strong>Background: </strong>A previous clinical trial applied percutaneous cryoneurolysis to lower limb amputees with phantom pain. The primary outcome measure was negative, but a secondary analysis suggested that patients with a below-knee amputation (BKA) improved, while the opposite was true for above-knee amputations (AKA). We theorized two potential reasons for this difference: cryoneurolysis was inadequate for the larger sciatic nerve in the upper thigh for AKA versus the lower thigh for BKA; and BKA is innervated by only two nerves, both of which were treated while AKA involved two additional nerves left untreated.</p><p><strong>Methods: </strong>Participants with an existing AKA and intractable phantom pain had four nerves treated with ultrasound-guided percutaneous cryoneurolysis in the upper thigh: sciatic, femoral, obturator, lateral femoral cutaneous. For the larger nerves, we used an argon-based machine capable of inducing temperatures as low as -100°C and producing a relatively large ice ball. The sciatic nerve was treated both on the anterior and posterior aspects (5.5 min each). Participants were randomized to receive active or sham treatment with the option to return 4-6 months later for a crossover treatment. Participants and assessors were masked to treatment group allocation. Percutaneously inserted thermocouples were used to measure tissue temperature. Statistical analysis was not performed due to the limited sample size of this pilot study.</p><p><strong>Results: </strong>After 1-month, average phantom limb pain intensity (primary outcome) was 5.0 (5.0, 6.0) in patients given cryoneurolysis (n=11) vs 5.0 (4.8, 5.3) for sham (n=5). Patients' Global Impression of Change and the Brief Pain Inventory (interference subscale) similarly suggested no improvement in either group after the initial post-treatment week. Tissue 3 mm from the cryoprobe required 2.5 min to reach -20°C and did not reach -40°C by the end of the freeze cycle.</p><p><strong>Conclusions: </strong>We found no evidence that percutaneous cryoneurolysis of the four major nerves of the thigh with an argon-based machine improved lower extremity phantom pain 1 month following treatment. Due to the limited sample size and probable lack of therapeutically low temperatures across the entire sciatic nerve, these results should be viewed as preliminary and used to help guide future preclinical and clinical investigations.</p><p><strong>Trial registration number: </strong>NCT06071715.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":"524-532"},"PeriodicalIF":3.5,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13151512/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145208420","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}

{"title":"Subpectoral plexus block to enhance surgical anesthesia produced by a multilevel thoracic paravertebral block for primary breast cancer surgery: a prospective randomized double-blind study.","authors":"Manoj Kumar Karmakar, Jatuporn Pakpirom, Banchobporn Songthamwat, Ranjith Kumar Sivakumar, Winnie Samy","doi":"10.1136/rapm-2024-106126","DOIUrl":"10.1136/rapm-2024-106126","url":null,"abstract":"<p><strong>Background and objectives: </strong>The efficacy of a multilevel thoracic paravertebral block (6m-TPVB at T1-T6), as the sole anesthetic, for primary breast cancer surgery (PBCS) has been questioned. Current literature suggests that a significant number of patients may report pain during various stages of surgery, notably during the detachment of the breast base from the pectoralis major muscle and its fascia. Given that the pectoral muscles are innervated by nerves from the subpectoral plexus (C5-T1), which are not affected by a 6m-TPVB alone, we propose that an additional \"subpectoral plexus block\" (SPPB) may enhance the surgical anesthesia.</p><p><strong>Methods: </strong>60 patients undergoing PBCS under a 6m-TPVB were randomized to receive an SPPB (Gp-A, n=30) or a sham block (Gp-B, n=30). Midazolam (1-3 mg) and ketamine (10-20 mg) were administered intravenously for sedation and analgesia before the block placement and an infusion of dexmedetomidine (0.1-0.5 mcg/kg/h) was used to maintain conscious sedation during surgery. The 6m-TPVB was ultrasound guided, and 4-5 mL of 0.5% ropivacaine with 1:200 000 epinephrine was injected at each vertebral level (total volume used 25 mL). The SPPB was also ultrasound guided, and 5 mL of 0.25% ropivacaine was injected each near the origin of the thoracoacromial artery in the pectoserratus plane and between the two pectoral muscles (interpectoral plane) in Gp-A, at the level of the third rib. In Gp-B, 3-5 mL of normal saline (sham block) was injected into the pectoralis major muscle. Surgery commenced about 25-30 min after the completion of the SPPB. Ketamine (10-20 mg IV bolus) was used for rescue analgesia (our primary outcome variable) if the patient complained of pain during surgery to an arbitrary maximum of 100 mg, or the anesthesia was deemed inadequate, after which it was converted to general anesthesia.</p><p><strong>Results: </strong>The two study groups were comparable with respect to demographic data, total dose of midazolam and dexmedetomidine used, duration of surgery, and overall patient satisfaction. Ketamine, as rescue analgesia, was required to complete surgery in both study groups, but fewer patients in Gp-A (56.7%) required rescue analgesia than in Gp-B (93.3%, p=0.002). Ketamine requirement (median (IQR)) was also significantly lower (p<0.001) in Gp-A (10 (0-40) mg) than in Gp-B (50 (20-70) mg). The surgeons were more (p=0.02) satisfied (mean±SD numeric rating scale, 0-100) with surgical conditions in Gp-A (77.29±10.63) than in Gp-B (65.83±21.38).</p><p><strong>Conclusion: </strong>A SPPB enhances the surgical anesthesia produced by a 6m-TPVB for primary breast cancer surgery.</p><p><strong>Trial registration number: </strong>https://www.chictr.org.cn/showprojEN.html?proj=5368, Trial ID No: ChiCTR-TRC-14004200; Date of Registration: 25 January 2014, Study commencement date: 28 February 2014.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":"568-578"},"PeriodicalIF":3.5,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143124006","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":"Incidence of transient neurologic symptoms in patients receiving lidocaine spinal anesthesia for outpatient joint arthroplasty.","authors":"Sara Amaral, Emily Chen, Amanda H Kumar, David B MacLeod, W Michael Bullock, Neil Ray, Erin Manning, Hector Martinez-Wilson, Joshua Dooley, Brian Ohlendorf, Jeff Gadsden","doi":"10.1136/rapm-2025-106541","DOIUrl":"10.1136/rapm-2025-106541","url":null,"abstract":"<p><strong>Background: </strong>Spinal anesthesia is commonly administered for lower limb total joint arthroplasty, but the prolonged motor and sympathetic block associated with bupivacaine can delay recovery. In contrast, lidocaine, with its swift onset and intermediate duration, is an attractive alternative that is well-tailored for outpatient lower limb surgery. It has historically been associated with transient neurologic symptoms (TNS), a self-limiting but potentially distressing pain syndrome. The incidence of TNS reported in older studies varies widely, often exceeding 20%, which has led to a decline in the use of lidocaine for spinal anesthesia.</p><p><strong>Objective: </strong>This study aimed to evaluate the contemporary incidence of TNS following lidocaine spinal anesthesia in the context of an established multimodal analgesic protocol for total knee and hip arthroplasty.</p><p><strong>Findings: </strong>A retrospective review of 1026 patients undergoing knee and hip arthroplasty with lidocaine spinal anesthesia was conducted. We queried our postoperative block database, which included questions specifically related to TNS, including the onset of new non-surgical back or thigh pain following resolution of the spinal block and any other associated symptoms related to TNS. Of the 1011 patients included in the final analysis, only two (0.2%, 95% CI 0.02 to 0.71%) were diagnosed with TNS, both of whom had mild, self-limited symptoms that resolved within 48-72 hours. No cases of prolonged motor or sensory block, cauda equina syndrome, or other significant complications were observed. The low incidence of TNS in this cohort contrasts sharply with historical reports and may be attributable to concurrent administration of comprehensive multimodal analgesics, including acetaminophen, non-steroidal anti-inflammatory drug, intravenous ketamine, and dexamethasone.</p><p><strong>Conclusions: </strong>Lidocaine spinal anesthesia for total joint arthroplasty is associated with a negligible incidence of TNS in the setting of multimodal analgesia. These findings challenge historical concerns regarding the safety of spinal lidocaine and support its use as a viable alternative for outpatient joint replacement surgery.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":"579-583"},"PeriodicalIF":3.5,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144034564","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":"Trends in preoperative self-reported cannabis use in orthopedic surgical patients: an institutional retrospective study.","authors":"William Chan, Marlena Komatz, Thomas Ramos, Mark Trentalange, Fay Rim, Kathryn DelPizzo, Seth Waldman, Alexandra Sideris","doi":"10.1136/rapm-2024-106160","DOIUrl":"10.1136/rapm-2024-106160","url":null,"abstract":"","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":"591-593"},"PeriodicalIF":3.5,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142822832","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":"Clinical implication of regional osteopenia in complex regional pain syndrome: a retrospective comparative study.","authors":"Jeongsoo Kim, Hyungsang Rho, Yongjae Yoo, Joon Cha, Sunghoon Park, Hangaram Kim, Sanihah Che Omar, Jee Youn Moon","doi":"10.1136/rapm-2024-106111","DOIUrl":"10.1136/rapm-2024-106111","url":null,"abstract":"<p><strong>Background: </strong>Despite the significant role of impaired bone metabolism in complex regional pain syndrome (CRPS), the clinical implications of osteopenia remain a focal point of investigation. We examined the prevalence and risk factors of affected limb osteopenia in CRPS and its association with the response to sympathetic blockade.</p><p><strong>Methods: </strong>167 patients with CRPS who underwent CT of their affected limbs were retrospectively reviewed. After conducting univariable analyses where regional osteopenia determined by CT was dependent and other clinical factors were independent variables, the first multivariable analysis assessed risk predictors associated with regional osteopenia in CRPS. Next, after conducting univariable analyses where sympathetic block response was dependent and others, including regional osteopenia, were independent variables, the second multivariable model predicted factors associated with the response to sympathetic blockades, followed by receiver operating characteristic curve analysis.</p><p><strong>Results: </strong>Among 116 patients, regional osteopenia was identified in 72.2% early (<1 year) and 52.5% persistent CRPS. In the first multivariable analysis adjusted for age, sex, body mass index (BMI), and other variables with p values<0.1 from initial univariable analyses, older age (OR 1.06; 95% CI 1.02 to 1.10) and positive three-phase bone scintigraphy (TPBS) (OR 3.94; 95% CI 1.46 to 10.66) were significantly associated with regional osteopenia. In the second multivariable model adjusted for age, sex, BMI, and other variables with p values<0.1 from univariable analyses, early phase (OR 5.49; 95% CI 1.44 to 20.88), regional osteopenia (OR 5.11; 95% CI 1.49 to 17.53), and positive TPBS (OR 6.30; 95% CI 2.21 to 17.93) were significantly associated with positive responses to sympathetic blockade in CRPS, showing excellent performance characteristics with a predicted probability>0.358 (sensitivity 0.86; specificity 0.76).</p><p><strong>Conclusion: </strong>Regional osteopenia in the affected limb can anticipate positive responses to sympathetic blockade when combined with TPBS in early CRPS.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":"547-553"},"PeriodicalIF":3.5,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143442747","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":"Developing a method for ultrasound estimation of gastric volume in patients with previous gastric sleeve.","authors":"Jacob R Wrobel, Justin C Magin, Yuka Koyama, David Gaston Sanders, Minakshi Pillai, Xinming An, Stuart Alan Grant, Alexander S Doyal","doi":"10.1136/rapm-2025-106570","DOIUrl":"10.1136/rapm-2025-106570","url":null,"abstract":"<p><strong>Background and aims: </strong>Ultrasound estimation of gastric volume is useful preoperatively for identifying those at increased risk of aspiration; however, studies to date have excluded subjects with prior gastric surgeries. We aimed to assess the performance of the current equation used in non-pregnant adults for patients who had undergone gastric sleeve and develop a new equation for this population if necessary. Secondarily, we determined if a 2-hour fast from clear fluids is sufficient to empty the stomach in this population.</p><p><strong>Methods: </strong>37 subjects who had undergone a gastric sleeve in the last 10 years were randomly assigned to drink 100, 200 or 300 mL of water after fasting 8 hours from solids and 2 hours from clear fluids. Pre-drink and 0, 30, 60, 90 and 120 min post-drink scans measured antral grade and cross-sectional area. Subjects participated in up to three study visits drinking different volumes.</p><p><strong>Results: </strong>The existing equation was statistically suboptimal. A new equation was created with variables identified by LASSO regression (Volume (mL)=15.5×CSA (cm²)-0.28×Weight (kg)-0.75×Height (cm)+97.9) with a mean bias of <1 mL (95% limits of agreement -51.2 to 51.2 mL). After 120 min, 93.2% of post-drink scans were grade 0, and all had a calculated volume <1.5 mL/kg.</p><p><strong>Conclusions: </strong>The existing equation is likely still best suited for clinical use; however, the equation proposed here has superior accuracy in patients with prior gastric sleeve. A 2-hour fast from clear fluids is sufficient in this population.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":"485-490"},"PeriodicalIF":3.5,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144227653","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":"Percutaneous analgesic device enabling both local anesthetic delivery and electrical stimulation (neuromodulation) of peripheral nerves: a pilot feasibility study (case series).","authors":"Brian M Ilfeld, Engy T Said, Brian H Park, Sanjay K Sinha, Bryan Leek, Matthew J Meunier, Ian M Foran, Andrew Hurvitz, William T Kent, Alexandra K Schwartz, Baharin Abdullah, Rafael Alkabalan, Nathan Lau, John J Finneran","doi":"10.1136/rapm-2025-107029","DOIUrl":"10.1136/rapm-2025-107029","url":null,"abstract":"<p><strong>Background: </strong>A novel device integrating both local anesthetic delivery and peripheral nerve stimulation (PNS) to treat postoperative pain is under development. The device uses a catheter-over-needle design that permits ultrasound-guided percutaneous insertion. An integrated electrode and pulse generator enable PNS for up to 28 days. Such an approach may represent a paradigm shift in postoperative pain management by enabling the delivery of (1) a single-injection peripheral nerve block, (2) a continuous peripheral nerve block, and (3) neuromodulation-all through a single system that can be placed in a timeframe comparable with that of a traditional single-injection nerve block. The current prospective pilot study was executed under a US Food and Drug Investigational Device Exemption to develop insertion and management protocols, as well as assess the feasibility and safety of using the device to treat postoperative pain.</p><p><strong>Methods: </strong>Preoperatively, adults (n=20) undergoing moderate-to-severely painful ambulatory shoulder or foot/ankle surgery had a device (RELAY, Gate Science, Moultonborough, NH) inserted under ultrasound guidance adjacent to the brachial plexus or sciatic nerve, respectively. Accurate insertion was confirmed with a 10 mL bolus of lidocaine <i>via</i> the catheter followed by bupivacaine (10 mL). If a continuous infusion was indicated, a portable pump was used to infuse ropivacaine (6-8 mL/h, 500 mL reservoir). Electric current was delivered using the integrated pulse generator for 7 days, followed by removal at home. Participants were contacted for data collection on postoperative days 1-5, 7, 8, and 14.</p><p><strong>Results: </strong>During the first seven postoperative days, the median (IQR) \"average\" daily <i>pain intensity</i> as measured with the numeric rating scale (NRS) was 2 [0, 3]. Following postoperative day 1, daily average and maximum/worst NRS was less than 2 and 5, respectively. Regarding the \"worst\" (maximum) pain level over the entire study period of Days 0-14, 7 (35%) experienced mild pain (NRS<4), 10 (50%) moderate pain (NRS 4-7), and 3 (15%) severe pain (NRS>7). Cumulative oxycodone consumption the first week was a median of 43 (18, 73) mg.</p><p><strong>Conclusions: </strong>This novel device successfully delivered a single-injection local anesthetic bolus, a continuous perineural infusion, and concurrent/subsequent electrical current. A randomized, sham-controlled clinical trial appears warranted. CLINICALTRIALSGOV : NCT06818708.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":"498-503"},"PeriodicalIF":3.5,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13151445/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145180277","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}