Regional Anesthesia and Pain Medicine最新文献

{"title":"Oblique subcostal transverse abdominis plane block for postoperative pain control in patients undergoing open sublay mesh hernia repair: a prospective double-blind randomized placebo-controlled clinical trial.","authors":"Marius Keller, Friederike Dinkel, Johann Jacoby, Barbara Kraft, Anne Haas, Peter Rosenberger, Rainer Meierhenrich","doi":"10.1136/rapm-2024-105596","DOIUrl":"10.1136/rapm-2024-105596","url":null,"abstract":"<p><strong>Background: </strong>A bilateral oblique subcostal transverse abdominis plane block may help provide perioperative analgesia and reduce opioid use in patients undergoing sublay mesh hernia repair, but its clinical value is unclear.</p><p><strong>Methods: </strong>In a single-centre, prospective, placebo-controlled, double-blind study, patients scheduled for sublay mesh hernia repair were randomized to receive oblique subcostal transverse abdominis plane blocks with either 60 ml of 0.375% ropivacaine (n=19) or isotonic saline (placebo, n=17). The primary outcome was patient-controlled total morphine consumption at 8:00 p.m. on the second postoperative day (POD), while secondary outcomes included the total morphine consumption during the post-anesthesia care unit stay and the occurrence of adverse events.</p><p><strong>Results: </strong>Total morphine consumption at 8:00 p.m. on the second POD was higher in patients receiving ropivacaine (39 mg, IQR 22, 62) compared with placebo (24 mg, IQR 7, 39), p value = 0.04. In contrast, the ropivacaine group received 2 mg less morphine during the post-anesthesia care unit stay (4 mg, IQR: 4, 9 mg vs 2 mg, IQR: 2,6 mg, p = 0.04). Patients receiving ropivacaine used more morphine (8:00 p.m. on the first POD until 8:00 a.m. on the second POD: 8 mg, IQR: 4, 18 mg vs 2 mg, IQR: 0, 9 mg, p = 0.01) and reported higher maximum pain scores since the last assessment (8:00 a.m. on the second POD: 5, IQR: 4, 7 vs 4, IQR: 3, 5, p = 0.03). There were no differences in adverse events between groups.</p><p><strong>Conclusions: </strong>Bilateral oblique subcostal transverse abdominis plane blocks in patients undergoing sublay mesh hernia repair were not associated with a prolonged reduction in patient-controlled total morphine consumption in the evening of the second POD in this study. Rebound pain might explain the additional excess opioid required by the ropivacaine group.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":"786-793"},"PeriodicalIF":3.5,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141560357","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":"Development of a low-cost three-dimensional model for the pericapsular nerve group (PENG) block.","authors":"Bassam Termos, Reva Ramlogan, Shefali Thakore, Yuqi Gu","doi":"10.1136/rapm-2025-106941","DOIUrl":"https://doi.org/10.1136/rapm-2025-106941","url":null,"abstract":"","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145245845","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":"Assessment of catheter position using chest CT in adults undergoing erector spinae plane analgesia for rib fractures: a retrospective cohort study.","authors":"Maylyn Wu, Charbel Barrak, Patrick Forrest, Derek Rizzo, Carlos Eduardo Guerra-Londono","doi":"10.1136/rapm-2024-105673","DOIUrl":"10.1136/rapm-2024-105673","url":null,"abstract":"<p><strong>Background: </strong>Continuous erector spinae plane (ESP) analgesia is a common adjuvant for patients with traumatic rib fracture pain and success relies on the ESP catheter remaining within the correct fascial plane for the duration of its placement. However, knowledge on postplacement position of indwelling ESP catheters is largely absent. We hypothesized that migration of over-the-needle ESP catheters was common and detectable with coincidental postprocedure CT.</p><p><strong>Methods: </strong>In this single-center retrospective cohort study, adults admitted to the surgical intensive care unit for traumatic rib fractures between January 2020 and July 2022 were screened. Those receiving continuous ESP analgesia via indwelling catheter and undergoing subsequent chest CT were included. The primary outcome was the proportion of catheters that migrated outside the ESP. The secondary outcome was the distance between the catheter tip and the nearest transverse process (TP) or fascial plane.</p><p><strong>Results: </strong>160 medical records were screened for eligibility and 15 patients (18 catheters) met the inclusion criteria. 16 of 18 catheters reviewed were found outside the ESP. Furthermore, catheter position was reported as intramuscular in 14 catheters and subcutaneous in 4 catheters. The median distance between catheter tip and the nearest TP (or the ESP) was 23.20 mm sagittally and 25.05 mm axially.</p><p><strong>Conclusions: </strong>Most ESP catheters were found superficial to the fascial plane in the days following their placement. The median distance between the catheter and the ESP is between 23 and 25 mm. Prospective studies should address catheter migration concerns and propose solutions to this common issue.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":"779-785"},"PeriodicalIF":3.5,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141538937","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":"Dural puncture epidural: further research may be warranted.","authors":"Jing Xu","doi":"10.1136/rapm-2024-105709","DOIUrl":"10.1136/rapm-2024-105709","url":null,"abstract":"","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":"842"},"PeriodicalIF":3.5,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141725090","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":"Insights into the pathophysiology and response of persistent spinal pain syndrome type 2 to spinal cord stimulation: a human genome-wide association study.","authors":"Gustavo Fabregat-Cid, David L Cedeno, José De Andrés, Anushik Harutyunyan, Vicente Monsalve-Dolz, Ana Mínguez-Martí, Natalia Escrivá-Matoses, Juan Marcos Asensio-Samper, Thiago Carnaval, Jesús Villoria, Raquel Rodríguez-López, Ricardo Vallejo","doi":"10.1136/rapm-2024-105517","DOIUrl":"10.1136/rapm-2024-105517","url":null,"abstract":"<p><strong>Background: </strong>Spinal cord stimulation (SCS) provides pain relief for some patients with persistent spinal pain syndrome type 2 (PSPS 2), but the precise mechanisms of action and prognostic factors for a favorable pain response remain obscure. This in vivo human genome-wide association study provides some pathophysiological clues.</p><p><strong>Methods: </strong>We performed a high-density oligonucleotide microarray analysis of serum obtained from both PSPS 2 cases and pain-free controls who had undergone lower back spinal surgery at the study site. Using multivariate discriminant analysis, we tried to identify different expressions between mRNA transcripts from PSPS 2 patients relative to controls, SCS responders to non-responders, or SCS responders to themselves before starting SCS. Gene ontology enrichment analysis was used to identify the biological processes that best discriminate between the groups of clinical interest.</p><p><strong>Results: </strong>Thirty PSPS 2 patients, of whom 23 responded to SCS, were evaluated together with 15 pain-free controls. We identified 11 significantly downregulated genes in serum of PSPS 2 patients compared with pain-free controls and two significantly downregulated genes once the SCS response became apparent. All were suggestive of enhanced inflammation, tissue repair mechanisms and proliferative responses among the former. We could not identify any gene differentiating patients who responded to SCS from those who did not respond.</p><p><strong>Conclusions: </strong>This study points out various biological processes that may underlie PSPS 2 pain and SCS therapeutic effects, including the modulation of neuroimmune response, inflammation and restorative processes.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":"806-814"},"PeriodicalIF":3.5,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141499650","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":"How predictive is peer review for gauging impact? The association between reviewer rating scores, publication status, and article impact measured by citations in a pain subspecialty journal.","authors":"Aidan S Weitzner, Matthew Davis, Andrew H Han, Olivia O Liu, Anuj B Patel, Brian D Sites, Steven P Cohen","doi":"10.1136/rapm-2024-105490","DOIUrl":"10.1136/rapm-2024-105490","url":null,"abstract":"<p><strong>Background: </strong>Peer review represents a cornerstone of the scientific process, yet few studies have evaluated its association with scientific impact. The objective of this study is to assess the association of peer review scores with measures of impact for manuscripts submitted and ultimately published.</p><p><strong>Methods: </strong>3173 manuscripts submitted to <i>Regional Anesthesia & Pain Medicine (RAPM)</i> between August 2018 and October 2021 were analyzed, with those containing an abstract included. Articles were categorized by topic, type, acceptance status, author demographics and open-access status. Articles were scored based on means for the initial peer review where each reviewer's recommendation was assigned a number: 5 for 'accept', 3 for 'minor revision', 2 for 'major revision' and 0 for 'reject'. Articles were further classified by whether any reviewers recommended 'reject'. Rejected articles were analyzed to determine whether they were subsequently published in an indexed journal, and their citations were compared with those of accepted articles when the impact factor was <u><</u>1.4 points lower than <i>RAPM</i>'s 5.1 impact factor. The main outcome measure was the number of Clarivate citations within 2 years from publication. Secondary outcome measures were Google Scholar citations within 2 years and Altmetric score.</p><p><strong>Results: </strong>422 articles met inclusion criteria for analysis. There was no significant correlation between the number of Clarivate 2-year review citations and reviewer rating score (r=0.038, p=0.47), Google Scholar citations (r=0.053, p=0.31) or Altmetric score (p=0.38). There was no significant difference in 2-year Clarivate citations between accepted (median (IQR) 5 (2-10)) and rejected manuscripts published in journals with impact factors <u>></u>3.7 (median 5 (2-7); p=0.39). Altmetric score was significantly higher for <i>RAPM</i>-published papers compared with <i>RAPM</i>-rejected ones (median 10 (5-17) vs 1 (0-2); p<0.001).</p><p><strong>Conclusions: </strong>Peer review rating scores were not associated with citations, though the impact of peer review on quality and association with other metrics remains unclear.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":"820-827"},"PeriodicalIF":3.5,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141472691","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":"Spinal cord stimulation plus conventional medical management versus conventional medical management alone for severe, non-surgical, refractory back pain: a randomized clinical trial followed by crossover.","authors":"James North, Aaron Calodney, Drew Trainor, Zachary L McCormick, Julio Paez, Eric Loudermilk, Anne Christopher, John Noles, Gregory Phillips, Suneil Jolly, Michael I Yang, Maged Guirguis, Daniel Kloster, Daniel J Pak, Jeffery Peacock, Mitchell Engle, Binit Shah, Derron Wilson, Magdalena Anitescu, Joseph Atallah, John Chatas, Tim Leier, Steven Rosen, Edward Goldberg","doi":"10.1136/rapm-2024-106335","DOIUrl":"https://doi.org/10.1136/rapm-2024-106335","url":null,"abstract":"<p><strong>Introduction: </strong>Chronic low back pain is a major contributor to long-term disability. Many patients lack a clearly identifiable source for their pain on physical examination or imaging or present with multiple pain generators. This subset of patients, who do not have surgical pathology, relies on conservative medical management (CMM) in the absence of effective and lasting treatment alternatives. For those who fail to respond to CMM, spinal cord stimulation (SCS) should be considered as an effective adjunctive therapy for improving pain, disability and health-related quality of life.</p><p><strong>Methods: </strong>SOLIS is a prospective, multicenter trial that randomized patients with non-surgical, refractory back pain (with or without leg pain) to receive either SCS combined with CMM or CMM alone. The primary endpoint at 3 months compared the proportion of patients with ≥50% overall pain relief without an increase in mean daily opioid use between the SCS+CMM and CMM groups. Three months after treatment activation, patients initially randomized to receive CMM alone had the option to cross over and add SCS to their pain management regimen. Patients in both randomized groups underwent 12-month follow-up visits to assess long-term effects on pain relief, disability, health-related quality of life, global impression of change, and treatment satisfaction.</p><p><strong>Results: </strong>147 patients were randomized to SCS+CMM (n=79) or CMM alone (n=68). At the 3-month follow-up, 89.5% of patients who received SCS+CMM (including subperception and paresthesia-based programming modalities) and 8.1% who received CMM alone were classified as study responders (≥50% pain relief without an increase in mean daily opioid use; modified intention-to-treat analysis, p<0.0001). The level of disability due to low back pain improved significantly: the Oswestry Disability Index score decreased by -27.5±15.9 points in the SCS+CMM group versus -7.2±9.9 points in the CMM alone group (p<0.0001). Health-related quality of life also improved at 3 months: the EuroQol 5 Dimension 5 Level questionnaire index score increased by 0.247±0.164 points in the SCS+CMM group versus 0.031±0.151 points in the CMM alone group (p<0.0001). The benefits of SCS were sustained until the 12-month visit. Seven patients experienced serious adverse events related to SCS, including 5 (3.6%) implant site infections resulting in explant.</p><p><strong>Conclusion: </strong>SCS relieved pain and resulted in clinically significant improvements in functional disability and health-related quality of life in patients with non-surgical, refractory back pain with or without accompanying leg pain.</p><p><strong>Trial registration number: </strong>NCT04676022.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145234119","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":"Standardized ketamine infusion protocol for chronic refractory pain: a retrospective study of preliminary effectiveness and treatment completion.","authors":"Hallie Tankha, Sara Davin, Brittany Lapin, Yadi Li, Austin Kennemer, Andrew Schuster, Jijun Xu, Raghavan Gopalakrishnan, Pavan Tankha","doi":"10.1136/rapm-2025-106907","DOIUrl":"https://doi.org/10.1136/rapm-2025-106907","url":null,"abstract":"<p><strong>Background: </strong>Chronic refractory pain presents limited treatment options and diminished quality of life. While ketamine treatment shows promise, protocol variations and safety concerns have hindered widespread adoption. This study evaluated preliminary effectiveness and rate of treatment completion for a standardized low-dose ketamine infusion therapy (KIT) protocol.</p><p><strong>Methods: </strong>This retrospective observational study examined adult patients with chronic refractory pain who received KIT between May 2021 and October 2024 at the Cleveland Clinic's outpatient multidisciplinary pain clinic. Patients received a standardized protocol of 0.5 mg/kg ketamine infused over 40 min for five consecutive days. We measured effectiveness using patient-reported outcomes (PROs) at baseline, last infusion, and 3-month and 6-month post-treatment, and rate of treatment completion. The primary outcome of interest was the proportion of patients achieving clinically meaningful improvement on validated measures.</p><p><strong>Results: </strong>Among 1034 patients (mean age 50.4±15.2 years; 71.8% female; 83.3% of white ethnicity), treatment completion was high, with 890 (86.1%) patients completing 5+ infusions. No adverse events were reported. Baseline measures reflected moderate impairment in pain interference, global physical health, fatigue, physical function, and depression. Between 20.3% and 46.4% of patients achieved clinically meaningful improvement on PROs from baseline to last infusion, with similar proportions maintained at 3-month and 6-month follow-up. Statistically significant mean improvements were observed across multiple domains; however, the majority of individual outcomes did not reach clinically meaningful thresholds. Patients demonstrated significant mean improvements in fatigue, pain interference, and social role satisfaction (mean change -2.1±7.7, -2.0±5.8, and 2.0±7.7, respectively), with improvements in depression, social role satisfaction, pain interference, self-efficacy, global health, and pain catastrophizing sustained through 6 months post-treatment.</p><p><strong>Discussion: </strong>This standardized low-dose ketamine protocol demonstrated therapeutic benefit and high completion rates within a multidisciplinary care model. Future randomized controlled trials are warranted to confirm findings and explore treatment response factors across pain conditions.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145234182","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":"Effect of perineural dexamethasone versus dexmedetomidine as adjuvants to ropivacaine on analgesic duration in pediatric popliteal sciatic nerve blocks: a randomized, triple-blinded, placebo-controlled trial.","authors":"Tomasz Reysner, Pawel Pietraszek, Milud Shadi, Bartosz Musielak, Grzegorz Kowalski, Przemysław Daroszewski, Malgorzata Reysner","doi":"10.1136/rapm-2025-107096","DOIUrl":"https://doi.org/10.1136/rapm-2025-107096","url":null,"abstract":"<p><strong>Background: </strong>Concerns about opioid-related adverse effects and local anesthetic toxicity often limit effective postoperative pain management in pediatric patients. This study aimed to compare the analgesic efficacy and systemic effects of perineural dexamethasone (DEX) versus dexmedetomidine (DEM) when used as adjuvants to ropivacaine in pediatric popliteal sciatic nerve blocks.</p><p><strong>Methods: </strong>In this triple-blinded, randomized controlled trial, 90 children aged 3 months to 7 years (American Society of Anesthesiologists (ASA) I-III) undergoing elective foot or ankle surgery at a single academic center were randomized to receive ultrasound-guided popliteal sciatic nerve blocks with 0.2% ropivacaine combined with either DEX (0.1 mg/kg), DEM (0.1 µg/kg), or saline (placebo). The primary outcome was time to first rescue opioid administration. Secondary outcomes included total opioid consumption (µg/kg nalbuphine), Face-Legs-Activity-Cry-Consolability (FLACC) pain scores at predefined intervals (4-48 hours) and systemic inflammatory markers (neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio). Statistical analysis included Kruskal-Wallis and Fisher's exact tests with Bonferroni correction.</p><p><strong>Results: </strong>Mean time to first opioid use was 19.4 ± 2.0 hours for DEX, 18.4 ± 1.7 hours for DEM, and 8.5 ± 1.2 hours for placebo (p < 0.0001); the difference between DEX and DEM was 1.0 hour (95% CI 0.04 to 2.06; p=0.0400). Nalbuphine was required in 23.3% of DEX, 33.3% of DEM, and 90% of placebo patients. Total opioid consumption was lower in adjuvant groups (DEX, 40.0 ± 77.0 µg/kg; DEM, 46.7 ± 73.0 µg/kg) compared with placebo (123.3 ± 62.6 µg/kg). FLACC scores were significantly reduced at 6, 8, and 12 hours in both adjuvant groups. NLR at 48 hours was significantly lower in the dexamethasone group (p=0.0136). No nerve injuries or hemodynamic complications occurred.</p><p><strong>Conclusions: </strong>Both adjuvants prolonged analgesia and reduced opioid requirements. Although DEX produced slightly longer analgesia than DEM, the clinical significance of this difference may be limited. Larger studies are needed to confirm safety.</p><p><strong>Trial registration number: </strong>ClinicalTrials.gov Identifier: NCT06233565.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145226415","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":"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":""},"PeriodicalIF":3.5,"publicationDate":"2025-10-01","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}