Regional Anesthesia and Pain Medicine最新文献

{"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":"https://doi.org/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":""},"PeriodicalIF":5.1,"publicationDate":"2025-06-04","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":"Effect of virtual reality (VR) therapy on pain sensation in patients undergoing hand surgery under ultrasound-guided regional anesthesia: a randomized controlled trial.","authors":"Kristof Nijs, Thibault Treunen, Hassanin Jalil, Mathijs Lensen, Helena Wintmolders, Bram Keunen, Maarten Vanloon, Ina Callebaut, Laurien Geebelen, Marc Van de Velde, Björn Stessel","doi":"10.1136/rapm-2025-106418","DOIUrl":"https://doi.org/10.1136/rapm-2025-106418","url":null,"abstract":"<p><strong>Background and objectives: </strong>During ultrasound-guided regional anesthesia and surgery, patients receive sensory input, which combined with stress and anxiety, can exacerbate or cause pain. Virtual reality therapy could provide digital sedation. Our aim is to assess the effect of virtual reality therapy on pain levels during the placement of regional anesthesia and surgery.</p><p><strong>Methods: </strong>This prospective randomized controlled superiority trial enrolled 120 patients undergoing elective hand surgery to investigate the effect of perioperative virtual reality therapy, consisting of a visual and audible three-dimensional, passive program. Patients were randomized to virtual reality therapy (n=60) or no virtual reality therapy (n=60) during regional anesthesia block placement and surgical procedure. Mean pain score (11-point numerical rating scale) during ultrasound-guided regional anesthesia placement was the primary outcome. Secondary outcomes were the mean pain score during surgery, heart rate variation during ultrasound-guided regional anesthesia placement and surgery, perioperative opioid use, anxiety (11-point numerical rating scale where 0=no anxiety at all and 10=extremely anxious), virtual reality immersion and presence (Igroup Presence Questionnaire), adverse events and patient satisfaction (11-point numerical rating scale where 0=not satisfied at all and 10=extremely satisfied).</p><p><strong>Results: </strong>Mean pain scores during ultrasound-guided regional anesthesia placement were 3.9±2.4 in the control group and 3.6±2.4 in the virtual reality group, with a mean difference of -0.3 (95% CI -1.2 to 0.5; p=0.22). Heart rate variation during ultrasound-guided regional anesthesia placement and surgery was non-significantly different. Anxiety during ultrasound-guided regional anesthesia placement showed no significant difference; however, it was significantly different during surgery (control: 1.5 (0.0, 4.0) vs virtual reality: 0.0 (0.0, 2.0), p<0.01). Virtual reality immersion showed a total mean score of 4.2±0.9. Seven patients (11.9%) suffered from adverse virtual reality effects. Patient satisfaction during surgery and perioperative opioid use showed no significant difference. Satisfaction with virtual reality was high: 9.0 (8.0, 10.0).</p><p><strong>Conclusion: </strong>Our results show that the use of virtual reality therapy during ultrasound-guided regional anesthesia placement and hand surgery does not result in lower pain scores. A perioperative significant positive effect on anxiety was measured, combined with a clinically significant effect on perioperative anxiety. The clinical influence of different virtual reality therapy systems on pain and anxiety should be further investigated in (other) elective procedures.</p><p><strong>Trial registration number: </strong>NCT05183412.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144200856","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":"Non-neurodestructive ganglion impar blocks for coccydynia and related disorders: a systematic review and meta-analysis.","authors":"David S Jevotovsky, Harman Chopra, Daniel J Pak, Eric A Grin, Adhith Palla, Shravani Durbhakula, Sidharth Sahni, Tariq AlFarra, Mustafa Y Broachwala, Anuj Shah, Richard Lau, Alexander Shustorovich, Michael Flamm, Melissa Murphy, Timothy Deer, Amitabh Gulati, Vwaire Orhurhu","doi":"10.1136/rapm-2024-106055","DOIUrl":"10.1136/rapm-2024-106055","url":null,"abstract":"<p><strong>Background/importance: </strong>Chronic coccydynia is a challenging condition to manage. Conflicting evidence exists regarding the role of the ganglion impar in coccygeal nociception. When conservative treatments fail, minimally invasive interventions at the ganglion impar may be effective in providing relief.</p><p><strong>Objectives: </strong>To evaluate the effectiveness and safety of ganglion impar blocks (GIBs) for the management of chronic coccydynia.</p><p><strong>Evidence review: </strong>A systematic review and meta-analysis was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Relevant studies were identified through a comprehensive literature search of PubMed, Embase Classic+ Embase, CINAHL and the Web of Science in February 2024. Data on patient characteristics, intervention details, pain outcomes (measured by Visual Analog Scale and Numerical Pain Rating Scale) and adverse events were extracted. Meta-analysis was performed using standardized mean differences (SMDs) on scale of 0 to 10.</p><p><strong>Findings: </strong>Seventeen studies described 625 coccydynia patients treated with GIB. All studies reported some level of improvement of pain after GIB. The meta-analysis included 11 studies totaling 391 patients with a baseline pain score of 7.93 (7.81 to 8.04 95% CI). GIBs were effective in reducing coccygeal pain at short-term (up to 3 months), intermediate-term (3-6 months) and long-term (greater than 6 months) follow-up. SMDs were -2.73 (95% CI -3.45 to -2.01), -2.13 (95% CI -2.82 to -1.45), -1.86 (95% CI -2.58 to -1.15) at 3 months, 3-6 months and >6 months, respectively. No serious adverse events were noted. Grading of Recommendations Assessment, Development and Evaluation assessment indicated 'very low' certainty of evidence across all outcomes.</p><p><strong>Conclusions: </strong>Non-neurodestructive GIB may be a safe and potentially effective treatment option for patients with chronic, refractory coccydynia.</p><p><strong>Prospero registration number: </strong>CRD42024506056.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143626824","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":"Do cervical medial branch blocks have a therapeutic role? a prospective cohort study.","authors":"Roderick J Finlayson, John-Paul B Etheridge, Rebecca Godard, Kimberley Kaseweter, Jonathan P Etheridge, Michele Curatolo","doi":"10.1136/rapm-2025-106457","DOIUrl":"https://doi.org/10.1136/rapm-2025-106457","url":null,"abstract":"<p><strong>Background: </strong>Cervical medial branch blocks (CMBB) are used for the diagnosis of facet joint-related pain. There have been several reports suggesting that they can provide a benefit that significantly outlasts the expected duration of diagnostic blocks. We undertook this study to determine the frequency and extent of this effect in clinical practice.</p><p><strong>Methods: </strong>179 patients undergoing 830 individual block levels and who had previously reported 50% relief following a CMBB were recruited using a prospective cohort design and blocks were performed in an outpatient setting. Outcomes monitored at baseline and every 2 weeks for 12 weeks included numerical pain scores, Neck Disability Index and Patient Global Impression of Change. In addition, the Pain Catastrophizing Scale, Generalized Anxiety Disorder 7 and Patient Health Questionnaire 9 were completed every 4 weeks.</p><p><strong>Results: </strong>Statistically significant differences were found for all measures of pain, emotional and physical functioning, when comparing 2 and 12-week measurements to baseline. At 2 weeks, 62.2% of patients reported a 30% or greater decrease in pain scores, which decreased to 22.7% at 12 weeks. Exploratory analysis found no association between age, opioid use, pain etiology, previous surgery, levels treated (upper vs lower cervical) and change in Numerical Rating Score between weeks 0 and 2, as well as between weeks 2 and 12.</p><p><strong>Conclusion: </strong>Our findings suggest that a proportion of patients undergoing CMBB may experience clinical benefits that exceed the expected duration of local anesthetics. Further research is required to determine the potential clinical applications of these findings.</p><p><strong>Trial registration number: </strong>NCT04852393.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144183405","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":"Comment on: Guidelines for use and safety of corticosteroid injections in joints and musculoskeletal soft tissue.","authors":"Pranjali Kurhekar, Raghuraman M Sethuraman, Neeta Parlikar","doi":"10.1136/rapm-2025-106774","DOIUrl":"https://doi.org/10.1136/rapm-2025-106774","url":null,"abstract":"","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144156","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":"Reply to: Comment on: Guidelines for use and safety of corticosteroid injections in joints and musculoskeletal soft tissue.","authors":"Honorio T Benzon, Dmitri Souza, Ameet Nagpal, Christine Hunt, David Anthony Provenzano, John D FitzGerald","doi":"10.1136/rapm-2025-106815","DOIUrl":"https://doi.org/10.1136/rapm-2025-106815","url":null,"abstract":"","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144338","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":"Low incidence of transient neurological syndrome with intrathecal lidocaine: could baricity be the key?","authors":"Stephen Sharp, Julia Scott, Leigh D White","doi":"10.1136/rapm-2025-106808","DOIUrl":"https://doi.org/10.1136/rapm-2025-106808","url":null,"abstract":"","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144129541","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":"Ultrasound-guided proximal intercostal block for cervicothoracic sympathetic blockade: a proof-of-concept cadaveric study.","authors":"Kamen Vlassakov, Nantthasorn Zinboonyahgoon, Napakorn Sangchay, Ratthaya Chandawan, Pawinee Pangthipampai, Panya Luksanapruksa, Borriwat Santipas, Lattawat Eauchai, Caixia Li","doi":"10.1136/rapm-2025-106546","DOIUrl":"https://doi.org/10.1136/rapm-2025-106546","url":null,"abstract":"<p><strong>Background: </strong>The ultrasound-guided proximal intercostal block (PICB) is a regional anesthesia technique used for thoracic surgeries and sympathetic blockade in refractory ventricular arrhythmias. However, the anatomical extent of injectate spread to specific targets when PICB is performed at the upper thoracic levels has not been studied comprehensively. This cadaveric study aims to evaluate the spread of moderate-volume injections at the upper thoracic level, focusing on the cervicothoracic sympathetic chain and proposing possible mechanisms of the PICB effects in patients with refractory ventricular arrhythmias.</p><p><strong>Methods: </strong>Seven PICBs were performed in five soft-embalmed cadavers. Radiographic contrast mixed with methylene blue was injected at the proximal segment of the first intercostal space (ICS-1). Fluoroscopy and dissection were performed to examine the injectate spread.</p><p><strong>Results: </strong>In the six successful PICBs, both fluoroscopy and dissection revealed injectate spread within the ipsilateral ICS-1 (T1-2) with direct anteromedial fascial spread and consistent coverage of the upper thoracic and/or inferior cervical sympathetic chain in all specimens. Injectate spread to the adjacent paravertebral space was observed in 67% of specimens by fluoroscopy (2-6 segments) and 83% by dissection (1-4 segments). Limited spread to the epidural space was observed in 33% of specimens by fluoroscopy (2-5 segments) and 67% by dissection (2-6 segments).</p><p><strong>Conclusions: </strong>Ultrasound-guided PICB at PICS-1 produced consistent injectate spread to the adjacent cervicothoracic sympathetic chain in all specimens. The inconsistent paravertebral and epidural spread suggests that direct interfascial spread to the sympathetic chain is likely to be the main mechanism of sympathetic block for refractory ventricular arrhythmia.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144129547","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":"Novel implantable anesthetic for spine fixation surgery: phase Ib safety results of a sustained-release formulation of bupivacaine.","authors":"Hein Jonkman, Floris Rudolf van Tol, Suzanne Bruins, Jasper Gerard Steverink, Lorin Michael Benneker, Ruth Geuze, Paul de Baat, Maroeska Rovers, Bas Jeroen Oosterman, Jorrit-Jan Verlaan","doi":"10.1136/rapm-2025-106551","DOIUrl":"https://doi.org/10.1136/rapm-2025-106551","url":null,"abstract":"","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144112837","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":"Comparison of 10 mL 0.15% vs 20 mL 0.25% bupivacaine boluses for continuous adductor canal block in total knee arthroplasty: a randomized non-inferiority trial.","authors":"Wirinaree Kampitak, Aree Tanavalee, Srihatach Ngarmukos, Nattanit Wanasrisant, Wanlaya Homsuwan","doi":"10.1136/rapm-2025-106587","DOIUrl":"https://doi.org/10.1136/rapm-2025-106587","url":null,"abstract":"<p><strong>Objectives: </strong>Different concentrations and volumes of local anesthetic boluses are used for continuous adductor canal block. We hypothesized that a 10 mL 0.15% bupivacaine bolus would provide non-inferior pain relief to a 20 mL 0.25% bupivacaine bolus for continuous adductor canal block as part of comprehensive multimodal analgesia.</p><p><strong>Methods: </strong>140 patients undergoing total knee arthroplasty were randomly allocated to receive either a 20 mL bolus of 0.25% bupivacaine (20/0.25 bupi group) or a 10 mL bolus of 0.15% bupivacaine (10/0.15 bupi group). Both groups received continuous adductor canal block with 0.15% bupivacaine (5 mL/hour), local infiltration analgesia, and interspace between the popliteal artery and capsule of the knee block. The primary outcomes were average knee-pain scores 6 and 12 hours postoperatively; the non-inferiority margin was a score difference of 1. Secondary outcomes included rest and movement pain scores, morphine consumption, and time to first rescue analgesia.</p><p><strong>Results: </strong>The median knee-pain scores for the 20/0.25 and 10/0.15 bupi groups were 0 (0 to 1) and 0 (0 to 2), respectively, after 6 hours and 2 (1 to 2) and 2 (1 to 3), respectively, after 12 hours. The median treatment difference (10/0.15 bupi ̶ 20/0.25 bupi) was 0 (95% CI -0.45 to 0.45) at both time points, with neither interval exceeding the non-inferiority margin. No clinical differences were observed in secondary outcomes.</p><p><strong>Discussion: </strong>A 10 mL 0.15% bupivacaine bolus in continuous adductor canal block offers comparable average knee-pain relief 6 and 12 hours after total knee arthroplasty to a 20 mL 0.25% bupivacaine bolus.</p><p><strong>Trial registration number: </strong>NCT06179628.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144112834","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}