Regional Anesthesia and Pain Medicine最新文献

{"title":"Gastric point-of-care ultrasound in patients on GLP-1 receptor agonists: additional evidence for residual gastric content but not for pulmonary aspiration.","authors":"Nils Vlaeminck","doi":"10.1136/rapm-2026-108307","DOIUrl":"https://doi.org/10.1136/rapm-2026-108307","url":null,"abstract":"","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148852068","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":"Continuous femoral nerve blocks versus adductor canal blocks for anterior cruciate ligament surgery: a double-blind, superiority randomized controlled trial.","authors":"Justin Christopher Chen, Claudia Florez Denoue, Audrey Horn, Ksenia Kasimova, Zackary Vaughn, Jean-Louis Horn","doi":"10.1136/rapm-2026-107940","DOIUrl":"10.1136/rapm-2026-107940","url":null,"abstract":"<p><strong>Background: </strong>Peripheral nerve blockade is a common analgesic technique in anterior cruciate ligament (ACL) reconstruction. The comparative opioid-sparing and functional outcomes of continuous femoral nerve block (CFNB) versus continuous adductor canal block (CACB) are unclear.</p><p><strong>Methods: </strong>In this single-center, double-blind, prospective, superiority randomized controlled trial, 60 adults undergoing ACL reconstruction were randomized to receive either CFNB or CACB. All patients received a 20 mL loading dose of 0.5% ropivacaine and were discharged with a 0.2% ropivacaine infusion (5 mL/hour basal, 5 mL demand bolus, 30 min lockout). The primary outcome was average numeric rating scale (NRS) pain scores analyzed using a linear mixed-effects repeated-measures model over 48 hours. Secondary outcomes included cumulative morphine milligram equivalents (MME), continuous passive motion (CPM) usage, CPM compliance, and Quality of Recovery-15 (QoR-15) scores.</p><p><strong>Results: </strong>57 patients completed the study (CFNB n=28; CACB n=29). Mixed-effects repeated-measures analysis of average NRS pain scores at 24 and 48 hours showed no significant difference between CFNB and CACB. The estimated overall treatment effect for CFNB versus CACB was -0.31 NRS points (p=0.58, 95% CI -1.39 to 0.77), with no significant treatment-by-time interaction (p=0.97). Current NRS pain scores were lower for CFNB on postoperative day 0 (POD0) (p<i>=</i>0.02, 95% CI 6.44×10^-6 to 2.00). In an exploratory analysis, fewer CFNB patients required more than 50 MME during the 48-hour follow-up period compared with CACB (CFNB: 5/28 vs CACB: 13/29; p<i>=</i>0.045, 95% CI 0.08 to 0.93). The absolute risk difference was 0.27 (95% CI -0.08 to 0.54). There were no differences in CPM use or compliance, bolus volume, or QoR-15.</p><p><strong>Conclusions: </strong>CFNB was not superior to CACB on the primary pain outcome over 48 hours. In secondary analysis, CFNB catheters were associated with lower immediate postoperative pain. In exploratory analyses, fewer patients required more than 50 MME over 48 hours. This finding is hypothesis-generating and requires confirmation in an adequately powered trial. There were no differences in quality of recovery or CPM compliance. Whether any opioid-related differences between techniques outweigh concerns about motor blockade warrants further investigation.</p><p><strong>Trial registration number: </strong>NCT03208478.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148551564","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":"Integrated local anesthetic delivery with peripheral nerve stimulation using perineural catheter: a welcome extension of prior findings.","authors":"Rakesh V Sondekoppam, Ban C H Tsui, Vivian H Y Ip","doi":"10.1136/rapm-2026-108416","DOIUrl":"10.1136/rapm-2026-108416","url":null,"abstract":"","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148801668","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":"PTP1B in dorsal root ganglion nociceptors drives neuropathic pain via a presynaptic Src/GluN2B signaling pathway.","authors":"Xiao-Qin Li, Shu-Jin Wu, Rui-Li Sun, Wen-Jing Li, Yu-Hang Yang, Xi-Wu Liao, Zi-Yan Huang, Jia-Wei Zhang, Fan Sun","doi":"10.1136/rapm-2026-107766","DOIUrl":"https://doi.org/10.1136/rapm-2026-107766","url":null,"abstract":"<p><strong>Background: </strong>Neuropathic pain, a debilitating chronic condition, remains a major clinical challenge due to its complex pathogenesis and limited treatment options. Protein tyrosine phosphatase 1B (PTP1B), a key regulator of tyrosine phosphorylation, has been implicated in various diseases, yet its specific role and mechanism in nociceptive processing within the dorsal root ganglion (DRG) are poorly understood.</p><p><strong>Methods: </strong>To investigate this, we used peripheral nerve injury models to assess PTP1B expression in the DRG. We employed nociceptor-specific overexpression and targeted knockdown of PTP1B to evaluate its effect on neuropathic pain-like behaviors, including mechanical allodynia and negative affect. Furthermore, we used electrophysiological recordings of miniature excitatory postsynaptic currents and pharmacological inhibition targeting Src kinase and N-methyl-D-aspartate (NMDA) receptor GluN2B to delineate the underlying molecular mechanisms.</p><p><strong>Results: </strong>Peripheral nerve injury induced a sustained upregulation of PTP1B predominantly in non-peptidergic nociceptors of the DRG. Mimicking this upregulation through nociceptor-specific overexpression elicited robust neuropathic pain-like behaviors. Conversely, targeted PTP1B knockdown therapeutically reversed established pain hypersensitivity. Mechanistically, PTP1B interacted with and activated Src kinase by dephosphorylating its inhibitory site at Tyr529. This led to enhanced phosphorylation of the NMDA receptor GluN2B subunit at Tyr1472, increasing presynaptic glutamate release in the spinal dorsal horn, as evidenced by elevated miniature excitatory postsynaptic currents. Consequently, pharmacological inhibition of either GluN2B or Src largely reversed PTP1B-driven pain sensitization.</p><p><strong>Conclusions: </strong>Our findings identified PTP1B in DRG nociceptors as a critical upstream regulator of the presynaptic Src/GluN2B pathway, establishing it as a promising therapeutic target for the treatment of neuropathic pain.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148801641","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":"The five-in-two (FIT) ankle block for outpatient foot surgery: a proof-of-concept anatomical and observational study.","authors":"Lucas Deffontis, Matthias Herteleer, Corentin Roger, Olivier Choquet, Mathieu Capdevila, Wayan Hebrard, Anne Gourari, Aurélien Bonnal, Sophie Bringuier, Xavier Capdevila","doi":"10.1136/rapm-2026-108097","DOIUrl":"https://doi.org/10.1136/rapm-2026-108097","url":null,"abstract":"<p><strong>Introduction: </strong>Regional anesthesia for foot surgery commonly relies on a five-injection ankle block, a technique associated with technical complexity and patient discomfort. We developed an ultrasound-guided five-in-two (FIT) ankle block based on an anatomical rationale, to provide complete foot anesthesia with only two punctures.</p><p><strong>Methods: </strong>A dual-injection ankle block technique was defined through an anatomical study, consisting of a mid-calf injection targeting the superficial and deep fibular nerves and a distal transverse injection 5 cm above the medial malleolus targeting the tibial, saphenous, and sural nerves. The technique was assessed in a bicentric prospective observational study of adult patients undergoing outpatient foot surgery, with surgical anesthesia as the primary outcome. Secondary outcomes assessed block performance, perioperative pain intensity, 24-hour rescue analgesic consumption, patient-reported experience, and block-related safety.</p><p><strong>Results: </strong>80 patients received a FIT ankle block, with successful surgical anesthesia achieved in 77 cases (96%). Median sensory and motor block durations were 554 (420-758) and 600 (444-882) minutes, respectively. Pain was minimal, with median Visual Analogue Scale scores of 0 (0-7) during block placement and 0 (0-4) on arrival in the post-anesthesia care unit. Intravenous rescue analgesia was required in 5% of patients. The median Echelle du Vécu de l'Anesthésie LocoRégionale global score was 88 (80-97), and the complication rate was 0% (95% CI 0 to 3.75%).</p><p><strong>Conclusions: </strong>The anatomically guided FIT ankle block is an effective proximal motor-sparing regional anesthesia technique for outpatient foot surgery, providing reliable anesthesia, excellent analgesia, and well-tolerated perioperative outcomes.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148801725","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":"Multiparameter urine reagent strips for bedside identification of cerebrospinal fluid in epidural catheter aspirates: a proof-of-concept observation.","authors":"Rajangam Hariharan, Hemanth Kumar V R, Sekar Loganathan, Iriventi Sar Chandra Sarma","doi":"10.1136/rapm-2026-108280","DOIUrl":"https://doi.org/10.1136/rapm-2026-108280","url":null,"abstract":"","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148801728","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":"Glutamatergic neurons in the nucleus accumbens represent a distinct functional population that gates pain.","authors":"Tian-En Si, Zhi-Xiao Li, Yingying Zhang, Wei Meng, Jing Cao, Weidong Zang","doi":"10.1136/rapm-2026-107870","DOIUrl":"https://doi.org/10.1136/rapm-2026-107870","url":null,"abstract":"<p><strong>Background: </strong>The nucleus accumbens (NAc) integrates affective and sensory information crucial for pain processing. While canonically viewed as a predominantly GABAergic structure, the potential existence and function of non-canonical excitatory populations remain poorly understood. We hypothesized that a distinct subpopulation of vesicular glutamate transporter 2 (VGluT2) neurons in the NAc exists and actively drives inflammatory pain and related anxiety behaviors.</p><p><strong>Methods: </strong>In this controlled laboratory in vivo study using male mice, we identified and characterized NAc VGluT2 neurons using patch-clamp electrophysiology. A persistent inflammatory pain model was established via intraplantar complete Freund's adjuvant (CFA) injection. To determine functionality, we used viral-mediated chemogenetics to selectively inhibit these neurons. Main outcome measures included mechanical paw withdrawal frequency (PWF), thermal paw withdrawal latency (PWL), and pain-related anxiety evaluated via the open field test (OFT) and elevated plus maze (EPM).</p><p><strong>Results: </strong>NAc VGluT2 neurons constitute a unique, non-GABAergic population, with >90% displaying intrinsic burst-firing. These neurons became significantly hyperexcitable under CFA-induced inflammatory pain conditions. Chemogenetic inhibition of NAc VGluT2 neurons successfully alleviated pain hypersensitivity. Furthermore, modulating this neuronal population bidirectionally regulated pain-related anxiety-like behaviors.</p><p><strong>Conclusions: </strong>VGluT2 neurons in the NAc represent a functionally distinct, burst-firing population that critically gates inflammatory pain and comorbid anxiety. Inhibiting this specific microcircuit provides a novel, precise target for treating persistent pain.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148714763","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":"Limited predictive utility of spinal cord stimulation trial pain metrics for post-implant outcomes.","authors":"Alexander David Keith, Jason S Kilgore, David Anthony Provenzano","doi":"10.1136/rapm-2026-108028","DOIUrl":"https://doi.org/10.1136/rapm-2026-108028","url":null,"abstract":"<p><strong>Background: </strong>This study evaluated the predictive value of pain outcomes reported during spinal cord stimulation (SCS) trialing for short-term, intermediate-term, and long-term post-implantation pain relief, and whether baseline patient characteristics modify these relationships.</p><p><strong>Methods: </strong>A retrospective review identified 124 patients who underwent SCS trial and implantation between 2015 and 2022 with a minimum of 6-months follow-up. Pain outcomes included numeric rating scale pain score (NRS), patient-reported percent pain relief (PR-PPR), and calculated percent pain relief (C-PPR) post-trial and at short-term (ST) 1-6 months (>1 to ≤6 months), intermediate term (IT) 6-15 months (>6 to ≤15 months), long-term (LT) 15-24 months (>15 to ≤24 months), and extended long-term (ELT) 24-36 months (>24 to ≤36 months) post-implantation. Univariable linear and logistic regression assessed predictive value, while Bland-Altman analysis and Lin's concordance correlation coefficient (CCC) evaluated agreement between PR-PPR and C-PPR. Interaction modeling assessed effect modification of baseline covariates.</p><p><strong>Results: </strong>Patients experienced significant pain reduction following trial (∆NRS 4.7; 95% CI 4.3 to 5.2), with sustained, but attenuating, benefit through 36 months. ∆NRS demonstrated the strongest predictive value (peak R²=0.32 at 15-24 months), though overall explanatory power was modest. In adjusted models, post-trial NRS was the strongest predictor of achieving ≥50% long-term pain relief (OR 0.70, p=0.002). Bland-Altman analysis showed a mean difference of 10 percentage points between PR-PPR and C-PPR (95% limits of agreement -36% to +56%) with poor overall agreement (CCC=0.36). Greater than 50% PR-PPR was maintained in 81.5% at 1-6 months and 70.2% at 24-36 months, with no significant differences between high and moderate trial responders. Covariate interaction modeling did not identify any consistent patient-specific modifiers.</p><p><strong>Conclusions: </strong>Trial-phase pain metrics demonstrated limited utility in explaining short, intermediate, and long-term pain relief. NRS-based measures showed the most consistent predictive value, while disagreement between PR-PPR and C-PPR raises concerns regarding the reproducibility of percentage-based metrics. These findings emphasize the need for refinement of reliable SCS trial predictors for post-implant pain relief outcomes.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148708346","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":"Childhood trauma history and response to behavioral treatments for chronic low back pain.","authors":"Samsuk Kim, Dokyoung Sophia You, Sean Mackey, Beth D Darnall","doi":"10.1136/rapm-2026-108047","DOIUrl":"https://doi.org/10.1136/rapm-2026-108047","url":null,"abstract":"","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148686776","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":"Impact of epinephrine on ropivacaine pharmacokinetics in TAP blocks: a randomized controlled trial.","authors":"Romain Rozier, Yann Le Guennec, Xavier Capdevila, Eric Le Louarn, Juliette Balbo, Thibaud Lavrut, Patrick Baque, Olivier Perus, Alexandre Destere, Axel Maurice-Szamburski","doi":"10.1136/rapm-2025-106500","DOIUrl":"10.1136/rapm-2025-106500","url":null,"abstract":"<p><strong>Background: </strong>Ropivacaine is commonly used in abdominal wall blocks due to its safety profile, and the addition of epinephrine is hypothesized to prolong analgesic duration and reduce systemic absorption. However, previous studies have been limited by non-weight-adjusted dosing and potential pharmacokinetic interactions, and inadequate investigation of the free form of ropivacaine.</p><p><strong>Objective: </strong>To characterize and compare the pharmacokinetics of total and free ropivacaine administered at a weight-adjusted dose of 1 mg/kg in Transversus Abdominis Plane (TAP) blocks, with and without epinephrine (1:200 000; 5 µg/mL).</p><p><strong>Methods: </strong>In this randomized controlled trial, 40 patients undergoing laparoscopic colectomy received bilateral TAP blocks with ropivacaine alone (TAP/E-) or ropivacaine with epinephrine (TAP/E+). Pharmacokinetic parameters, including maximum plasma concentration (Cmax), time to Cmax (Tmax), and area under the concentration-time curve, were assessed over 240 min. Secondary outcomes included α₁-acid glycoprotein (AGP), analgesia, safety, and mean plasma concentration (Cmean).</p><p><strong>Results: </strong>The mean Cmax in the TAP/E+ group (0.531±0.245 µg/mL) was not significantly different from that in the TAP/E- group (0.746±0.428 µg/mL). Epinephrine significantly prolonged Tmax (165 vs 55.9 min in TAP/E-, p<0.001) and reduced Cmean (p=0.005). No serious adverse events occurred, though QT interval prolongation was observed in both groups.</p><p><strong>Conclusion: </strong>This study demonstrates that adding epinephrine did not alter the Cmax of ropivacaine in TAP blocks, but did prolong the time to reach Cmax. These findings support the routine inclusion of epinephrine in TAP blocks and provide a basis for multimodal analgesia strategies.</p><p><strong>Trial registration number: </strong>NCT04959123.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":"911-917"},"PeriodicalIF":4.0,"publicationDate":"2026-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143652051","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}