Regional Anesthesia and Pain Medicine最新文献

{"title":"Acute pain management after vaginal delivery with perineal tears or episiotomy.","authors":"Xavier Luxey, Adrien Lemoine, Geertrui Dewinter, Girish P Joshi, Camille Le Ray, Johan Raeder, Marc Van de Velde, Marie-Pierre Bonnet","doi":"10.1136/rapm-2024-105478","DOIUrl":"10.1136/rapm-2024-105478","url":null,"abstract":"<p><strong>Background: </strong>A vaginal delivery may be associated with acute postpartum pain, particularly after perineal trauma. However, pain management in this setting remains poorly explored.</p><p><strong>Objective: </strong>The aim of this systematic review was to evaluate the literature and to develop recommendations for pain management after a vaginal delivery with perineal trauma.</p><p><strong>Evidence review: </strong>MEDLINE, Embase, and Cochrane databases were searched for randomized controlled trials (RCTs) and systematic reviews assessing pain after a vaginal delivery with perineal tears or episiotomy until March 2023. Cochrane Covidence quality assessment generic tool and the RoB Vis 2 tool were used to grade the quality of evidence.</p><p><strong>Findings: </strong>Overall, 79 studies (69 RCTs and 10 systematic reviews and meta-analyses) of good quality of evidence were included. Acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs) are recommended as first-line treatment. Epidural morphine (≤2 mg) is recommended among women with labor epidural analgesia and severe perineal tears, with adequate respiratory monitoring. Local anesthetic infiltration, topical local anesthetic, ointment application, and pudendal nerve block are not recommended due to insufficient or lack of evidence. Ice or chemical cold packs are recommended for postpartum pain first-line treatment due to their simplicity of use. Transcutaneous nerve stimulation and acupuncture are recommended as adjuvants. When a perineal suture is indicated, a continuous suture compared with an interrupted suture for the repair of episiotomy or second-degree perineal tears is recommended for the outcome of pain. For women with first-degree or second-degree perineal tears, no suturing or glue compared with suturing is recommended for the outcome of pain.</p><p><strong>Conclusions: </strong>Postpartum pain management after a vaginal delivery with perineal trauma should include acetaminophen, NSAIDs, and ice or chemical cold packs. Epidural morphine should be reserved for severe perineal tears. A surgical repair technique should depend on perineal tear severity.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":"503-513"},"PeriodicalIF":5.1,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141077332","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":"Relationship of pain relief with catastrophizing following interventional pain procedures for low back pain.","authors":"Kanishka Rajput, Benjamin A Howie, Julius Araash Danesh, Xiwen Zhao, Hung-Mo Lin, David Yanez, Robert Chow","doi":"10.1136/rapm-2023-105247","DOIUrl":"10.1136/rapm-2023-105247","url":null,"abstract":"<p><strong>Introduction: </strong>Catastrophizing is associated with worse pain outcomes after various procedures suggesting its utility in predicting response. However, the stability of pain catastrophizing as a static predictor has been challenged. We assess, among patients undergoing steroid injections for chronic low back pain (cLBP), whether catastrophizing changes with the clinical response to pain interventions.</p><p><strong>Methods: </strong>This prospective study enrolled patients undergoing fluoroscopic-guided injections for cLBP. Patients filled out Brief Pain Inventory (BPI) and Pain Catastrophizing Scale (PCS) at baseline and 1-month follow-up. We assessed the change in PCS scores from pre-injection to post-injection and examined its predictors. We also examined the correlation of various domains of BPI, such as pain severity and effect on Relationships, Enjoyment, and Mood (REM), with PCS scores at baseline and follow-up.</p><p><strong>Results: </strong>128 patients were enrolled. Mean (SD) PCS and pain severity scores at baseline were 22.38 (±13.58) and 5.56 (±1.82), respectively. Follow-up PCS and pain severity scores were 19.76 (±15.25) and 4.42 (±2.38), respectively. The change in PCS pre-injection to post-injection was not significant (p=0.12). Multiple regression models revealed baseline PCS and REM domain of BPI as the most important predictors of change in PCS after injection. Pain severity, activity-related pain, age, sex, insurance status, depression, prior surgery, opioid use, or prior interventions did not predict change in PCS score. In correlation analysis, change in PCS was moderately correlated with change in pain (r=0.38), but weakly correlated with baseline pain in all pain domains.</p><p><strong>Conclusions: </strong>PCS showed non-significant improvement following steroid injections; the study was not powered for this outcome. Follow-up PCS scores were predicted by the REM domain of BPI, rather than pain severity. Larger studies are needed to evaluate a statistically significant and clinically meaningful change in catastrophizing scores following pain interventions.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":"489-494"},"PeriodicalIF":5.1,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140922674","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":"Review of bleeding risk associated with prophylactic enoxaparin and indwelling paravertebral catheters: a pediatric retrospective study.","authors":"Jacob Pickle, Scott Licata, Daniel Lavage, Mihaela Visoiu","doi":"10.1136/rapm-2023-104492","DOIUrl":"10.1136/rapm-2023-104492","url":null,"abstract":"","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":"514-516"},"PeriodicalIF":5.1,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10119595","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":"Response to: \"Regional anesthesia in the patient receiving antithrombotic or thrombolytic therapy: American Society of Regional Anesthesia and Pain Medicine Evidence-Based Guidelines (fifth edition)\" by Kopp <i>et al</i>.","authors":"Sandra Kopp, Erik Vandermeulen, Robert D McBane, Anahi Perlas, Lisa Leffert, Terese Horlocker","doi":"10.1136/rapm-2025-106881","DOIUrl":"https://doi.org/10.1136/rapm-2025-106881","url":null,"abstract":"","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144250808","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":"https://doi.org/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":""},"PeriodicalIF":5.1,"publicationDate":"2025-06-08","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":"Chronic lower back pain effects of music on fluoroscopic guided (CLEF) interventional pain procedures: a randomized controlled trial.","authors":"Heather Ann Columbano, David S Shbeeb, Evan D Youshock, R Miller Ligon, Anthony A Wachnik, Greg Russell, Brandon L Williams, Jessica Meister-Berger, Naucika DeSouza, Robert W Hurley","doi":"10.1136/rapm-2024-106250","DOIUrl":"https://doi.org/10.1136/rapm-2024-106250","url":null,"abstract":"<p><strong>Introduction: </strong>Music medicine has shown promise in reducing anxiety and pain during medical procedures, but its effects during interventional pain procedures without sedation remain unexplored. Although previous studies have examined music medicine with procedural sedation, to our knowledge, no published research has yet explored music medicine during procedures without sedation in the chronic pain population, underscoring the novelty of our investigation. This study aimed to evaluate the impact of music medicine on pain intensity, unpleasantness, and anxiety during lumbar medial branch blocks (LMBB) performed without sedation.</p><p><strong>Methods: </strong>This prospective, randomized controlled trial included 150 patients undergoing first-time LMBB. Participants were randomized to either a music medicine group (n=74) or a control group (n=76). Primary outcomes were changes in pain scores before and after the procedure. Secondary outcomes included changes in patient anxiety, satisfaction, hemodynamic parameters, pain catastrophizing, and progression to radiofrequency ablation.</p><p><strong>Results: </strong>There were no significant differences in postprocedure pain intensity (p=0.32) or unpleasantness (p=0.4) between groups. However, the music medicine group showed a significant reduction in anxiety scores (p=0.049), particularly in patients with higher baseline Pain Catastrophizing Scale scores. No significant differences were observed in hemodynamic parameters, patient satisfaction, or desire for repeat procedures between groups.</p><p><strong>Conclusions: </strong>While music medicine during LMBB did not significantly impact pain intensity or unpleasantness, it demonstrated a notable reduction in patient anxiety, especially in those with higher pain catastrophizing tendencies. These findings suggest that music medicine may be a valuable, nonpharmacological intervention for managing anxiety during interventional pain procedures.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144250806","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":"Anticoagulation guidelines for anesthesiologists who perform lumbar punctures: a nebulous gray area.","authors":"Ammar Siddiqui, Nitin K Sekhri, Amir Steinberg, Richard Smiley","doi":"10.1136/rapm-2025-106732","DOIUrl":"https://doi.org/10.1136/rapm-2025-106732","url":null,"abstract":"","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144250805","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 or sedation? A randomized clinical trial of impact on procedural pain and satisfaction during regional block placement, and the moderating effect of pain catastrophizing.","authors":"Yun-Yun Kathy Chen, Jenna M Wilson, Sheila R Gokul, Patrick W Collins, Martin Kiik, Kamen Vlassakov, Kristin L Schreiber","doi":"10.1136/rapm-2025-106644","DOIUrl":"https://doi.org/10.1136/rapm-2025-106644","url":null,"abstract":"<p><strong>Background: </strong>Preoperative peripheral nerve block placement can involve both procedural pain and psychological distress, which practitioners treat using both sedation and education/reassurance. The experience of pain may be potently modulated by baseline pain catastrophizing (presence of rumination, magnification, and helplessness). This randomized clinical trial assessed whether the treatment effect of sedation vs education/reassurance on procedural nerve block pain and satisfaction varied for patients with different baseline pain catastrophizing scores.</p><p><strong>Methods: </strong>At baseline, patients completed the Pain Catastrophizing Scale (PCS), were stratified into low-PCS (<10) or high-PCS (≥10) groups, and then randomized to receive sedation or education/reassurance during nerve block placement. Patients reported maximum and average procedural pain and satisfaction, immediately after the procedure and recalled in the postanesthesia care unit (PACU). Generalized estimating equations examined main effects of treatment and baseline PCS group on maximum procedural pain and the interaction between them.</p><p><strong>Results: </strong>Maximal procedural pain immediately after the procedure was similar between treatment groups (n=72), but a significant treatment×PCS group interaction (B=0.8, 95% CI (0.04, 1.5), p=0.04) indicated that among patients with high PCS, sedation was associated with less pain (2.3±2.2 vs 4.3±2.5, p=0.01). Exploratory findings indicate sedation being associated with lower recalled procedural pain in PACU than education/reassurance (0.3±0.7 vs 2.2±2.4, p<0.001), and education being associated with higher satisfaction among those with lower PCS.</p><p><strong>Discussion: </strong>Our findings suggest that patients with high PCS may disproportionately benefit from sedation during nerve block, reporting less pain, whereas patients with low PCS may have a slight preference for education/reassurance, reporting higher satisfaction.</p><p><strong>Trial registration number: </strong>NCT05579509.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144235965","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":"Surgical incisional injury to discrete small cutaneous nerves is a significant contributor to chronic postsurgical pain.","authors":"Siska Bjørn, Thomas Dahl Nielsen, Niels Dalsgaard Nielsen, Christian Jessen, Thomas Fichtner Bendtsen","doi":"10.1136/rapm-2025-106714","DOIUrl":"https://doi.org/10.1136/rapm-2025-106714","url":null,"abstract":"","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144227654","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":"Application of preoperative bilateral erector spinae plane block in preventing chronic postsurgical pain after cardiac surgery.","authors":"Dan Zhao, Ting Ye, Chunzhi Gong","doi":"10.1136/rapm-2025-106855","DOIUrl":"https://doi.org/10.1136/rapm-2025-106855","url":null,"abstract":"","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144227652","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}