Regional Anesthesia and Pain Medicine最新文献

{"title":"Validation of a novel point-of-care ultrasound method to assess diaphragmatic excursion.","authors":"Diogo Da Conceicao, Anahi Perlas, Laura Giron Arango, Kim Wild, Qixuan Li, Ella Huszti, Jayanta Chowdhury, Vincent Chan","doi":"10.1136/rapm-2023-104983","DOIUrl":"10.1136/rapm-2023-104983","url":null,"abstract":"<p><strong>Introduction: </strong>Point-of-care ultrasound can assess diaphragmatic function and rule in or rule out paresis of the diaphragm. While this is a useful bedside tool, established methods have significant limitations. This study explores a new method to assess diaphragmatic motion by measuring the excursion of the uppermost point of the zone of apposition (ZOA) at the mid-axillary line using a high-frequency linear ultrasound probe and compares it with two previously established methods: the assessment of the excursion of the dome of the diaphragm (DOD) and the thickening ratio at the ZOA.</p><p><strong>Methods: </strong>This is a single-centre, prospective comparative study on elective surgical patients with normal diaphragmatic function. Following research ethics board approval and patient written consent, 75 elective surgical patients with normal diaphragmatic function were evaluated preoperatively. Three ultrasound methods were compared: (1) assessment of the excursion of the DOD using a curvilinear probe through an abdominal window; (2) assessment of the thickening fraction of the ZOA; and (3) assessment of the excursion of the ZOA. The last two methods performed with a linear probe on the lateral aspect of the chest.</p><p><strong>Results: </strong>Seventy-five patients were studied. We found that the evaluation of the excursion of the ZOA was more consistently successful (100% bilaterally) than the evaluation of the excursion of the DOD (98.7% and 34.7% on the right and left sides, respectively). The absolute values of the excursion of the ZOA were greater than and well correlated with the values of the DOD.</p><p><strong>Conclusion: </strong>Our preliminary data from this exploratory study suggest that the evaluation of the excursion of the ZOA on the lateral aspect of the chest using a linear probe is consistently successful on both right and left sides. Future studies are needed to establish the distribution of normal values and suggest diagnostic criteria for diaphragmatic paresis or paralysis.</p><p><strong>Trial registration number: </strong>NCT03225508.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":"800-804"},"PeriodicalIF":5.1,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71523392","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 anterior quadratus lumborum block with ropivacaine on the immune response after laparoscopic surgery in colon cancer: a substudy of a randomized clinical trial.","authors":"Lukas Balsevicius, Paulo C M Urbano, Rune Petring Hasselager, Ahmed Abdirahman Mohamud, Maria Olausson, Melina Svraka, Kirsten L Wahlstrøm, Carolin Oppermann, Dilara Seyma Gögenur, Emma Rosenkrantz Hølmich, Britt Cappelen, Susanne Gjørup Sækmose, Katrine Tanggaard, Thomas Litman, Jens Børglum, Susanne Brix, Ismail Gögenur","doi":"10.1136/rapm-2023-104896","DOIUrl":"10.1136/rapm-2023-104896","url":null,"abstract":"<p><strong>Background: </strong>Surgery induces a temporal change in the immune system, which might be modified by regional anesthesia. Applying a bilateral preoperative anterior quadratus lumborum block has proven to be a safe and effective technique in pain management after abdominal and retroperitoneal surgery, but the effect on the immune response is not thoroughly investigated.</p><p><strong>Methods: </strong>This study is a substudy of a randomized, controlled, double-blinded trial of patients undergoing laparoscopic hemicolectomy due to colon cancer. Twenty-two patients were randomized to undergo either a bilateral anterior quadratus lumborum nerve block with a total of 60 mL ropivacaine 0.375% or placebo with corresponding isotonic saline injections. The main objective of this exploratory substudy was to investigate the systemic immune response in the first postoperative day by examining changes in blood transcript levels (n=750) and stimulated secretion of cytokines (n=17) on ex vivo activation with microbial ligands and anti-CD3/CD28.</p><p><strong>Results: </strong>Using unsupervised data analysis tools, we observed no effect of the bilateral anterior quadratus lumborum nerve block on gene expression in immune cells (permutational multivariate analysis of variance using distance matrices: F=0.52, p=0.96), abundances of major immune cell populations (Wilcoxon rank-sum test: p>0.05), and stimulated cytokine secretion (Wilcoxon rank-sum test: p>0.05).</p><p><strong>Conclusions: </strong>Our study provides evidence that administration of bilateral anterior quadratus lumborum nerve block as a part of a multimodal analgesic regimen in an enhanced recovery after surgery for laparoscopic hemicolectomy in this cohort does not alter the systemic immune response. Trial registration number NCT03570541.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":"805-814"},"PeriodicalIF":5.1,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72016177","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":"Association of thoracic epidural analgesia and hospital length of stay for patients undergoing thoracotomy: a retrospective cohort analysis.","authors":"Michael Armaneous, Austin L Du, Rodney A Gabriel, Engy T Said","doi":"10.1136/rapm-2023-104611","DOIUrl":"10.1136/rapm-2023-104611","url":null,"abstract":"<p><strong>Introduction: </strong>Regional anesthesia has been shown to be efficacious for analgesia in patients who underwent thoracotomies. The objective of this study was to analyze the association of epidurals and peripheral regional anesthesia with time to hospital discharge for these patients.</p><p><strong>Methods: </strong>This was a retrospective cohort study using National Surgical Quality Improvement Program dataset from 2014 to 2020. Propensity-matched cohorts were assembled based on use of regional anesthesia, peripheral regional anesthesia, or epidural. Fine-Gray competing risk regressions were used to explore the association between regional anesthesia use and rate of discharge. The subdistribution hazard ratio (HR) represented relative discharge rates, and in-hospital death was a competing event. A sensitivity analysis was subsequently performed in which patients with American Society of Anesthesiologists score ≥4 were removed.</p><p><strong>Results: </strong>There were 4350 patients included in this analysis, in which 472 (10.8%) received a peripheral regional anesthesia nerve block and 565 (13.0%) received thoracic epidural analgesia. The subdistribution HR for rate of discharge in the epidural versus non-epidural cohort was 1.09 (95% CI 1.01 to 1.18), thus epidurals were associated with an increased rate of discharge over time. However, this benefit was no longer apparent with the sensitivity analysis. The subdistribution HR for rate of discharge in the peripheral regional anesthesia versus no regional anesthesia cohort was 1.26 (95% CI 1.15 to 1.39), thus peripheral regional anesthesia was associated with an increased rate of discharge over time. This benefit remained even with the sensitivity analysis.</p><p><strong>Conclusions: </strong>Thoracic epidural use when compared with no regional anesthesia was associated with decreased length of stay following thoracotomy in our primary analysis. The difference was no longer apparent with the sensitivity analysis. Peripheral regional anesthesia was associated with decreased length of stay even after sensitivity analysis.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":"815-820"},"PeriodicalIF":5.1,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71523389","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":"Primary spoken language and regional anaesthesia use in total joint arthroplasty.","authors":"Hayley E Raymond, Husni Alasadi, Nicole Zubizarreta, Brett L Hayden, Darwin Chen, Garrett W Burnett, Chang Park, Samuel DeMaria, Jashvant Poeran, Calin S Moucha","doi":"10.1136/rapm-2022-103828","DOIUrl":"10.1136/rapm-2022-103828","url":null,"abstract":"","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":"847-848"},"PeriodicalIF":5.1,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10618770","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":"Precision in nomenclature: blocks and injections.","authors":"Ban C H Tsui","doi":"10.1136/rapm-2023-104908","DOIUrl":"10.1136/rapm-2023-104908","url":null,"abstract":"","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":"849"},"PeriodicalIF":5.1,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49685063","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":"Negative trials as a compass.","authors":"Ban C H Tsui, Steven F Abboud","doi":"10.1136/rapm-2023-105059","DOIUrl":"10.1136/rapm-2023-105059","url":null,"abstract":"","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":"850"},"PeriodicalIF":5.1,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"61566127","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":"GFAP palmitoylcation mediated by ZDHHC23 in spinal astrocytes contributes to the development of neuropathic pain.","authors":"Xiaoqing Fan, Siyu Zhang, Suling Sun, Wenxu Bi, Shuyang Li, Wei Wang, Xueran Chen, Zhiyou Fang","doi":"10.1136/rapm-2023-104980","DOIUrl":"10.1136/rapm-2023-104980","url":null,"abstract":"<p><strong>Background: </strong>Cancer pain has a significant impact on patient's quality of life. Astrocytes play an important role in cancer pain signaling. The direct targeting of astrocytes can effectively suppress cancer pain, however, they can cause many side effects. Therefore, there is an urgent need to identify the specific signaling pathways or proteins involved within astrocytes in cancer pain as targets for treating pain.</p><p><strong>Methods: </strong>A neuropathic cancer pain (NCP) model was established by inoculating mouse S-180 sarcoma cells around the right sciatic nerve in C57BL/6 mice. Spontaneous persistent pain and paw withdrawal thresholds were measured using <i>von</i> Frey filaments. The NCP spinal cord dorsal horn (L4-L6) and mouse astrocyte cell line MA-C were used to study protein palmitoylation using acyl-biotin exchange, real-time polymerase chain reaction, ELISA, western blotting, and immunofluorescent staining.</p><p><strong>Results: </strong>In a cancer pain model, along with tumor growth, peripheral nerve tissue invasion, and cancer pain onset, astrocytes in the dorsal horn of the spinal cord were activated and palmitoyltransferase ZDHHC23 expression was upregulated, leading to increased palmitoylation levels of GFAP and increased secretion of inflammatory factors, such as (C-X-C motif) ligand (CXCL)10 (CXCL-10), interleukin 6, and granulocyte-macrophage colony-stimulating factor. These factors in turn activate astrocytes by activating the signal transducer and activator of transcription 3 (STAT3) signaling pathway. A competitive peptide targeting GFAP palmitoylations was designed to effectively alleviate morphine tolerance in cancer pain treatment as well as cancer pain signaling and inflammatory factor secretion.</p><p><strong>Conclusions: </strong>In a rodent model, targeting GFAP palmitoylation appears to be an effective strategy in relieving cancer pain and morphine tolerance. Human translational research is warranted.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":"821-830"},"PeriodicalIF":5.1,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138483454","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":"Taking a hard look at the 2024 match: a critical moment for the future of pain medicine training.","authors":"Scott Pritzlaff, Chinar Sanghvi, Naileshni Singh","doi":"10.1136/rapm-2024-106088","DOIUrl":"https://doi.org/10.1136/rapm-2024-106088","url":null,"abstract":"","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2024-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142569997","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":"Obturator canal block: an anatomical study.","authors":"Hipolito Labandeyra, Pierre Goffin, Rita Riera, Andrea Vallejo, Alberto Prats-Galino, Xavier Sala-Blanch","doi":"10.1136/rapm-2024-105901","DOIUrl":"https://doi.org/10.1136/rapm-2024-105901","url":null,"abstract":"<p><strong>Background: </strong>Different approaches to the obturator nerve have been described. However, few have focused on the injection point inferior the iliopubic ramus, specifically at the exit of the obturator canal. This study aims to anatomically evaluate the ultrasound-guided obturator nerve block at the exit of the obturator canal, detailing anatomical landmarks and solution distribution.</p><p><strong>Methods: </strong>This anatomical study was conducted using 10 cadavers to generate 20 hemipelvis samples. Ultrasound references were utilized to identify the obturator canal, iliopubic ramus, pectineus and external obturator muscles, and the obturator membrane. An ultrasound-guided obturator nerve block was performed using a low-frequency convex probe for initial identification and a high-frequency linear transducer for the injection of a methylene blue solution. Subsequent dissections were performed to evaluate the distribution of the dye within the obturator nerve.</p><p><strong>Results: </strong>The injection of methylene blue consistently stained the common trunk and anterior branch of the obturator nerve in 100% of the cases and the posterior branch in 80% of the samples. Intrapelvic staining was observed in 65% of the specimens, indicating effective diffusion of the dye. Key anatomical landmarks, such as the iliopubic ramus and the obturator membrane, were crucial for accurate identification and injection.</p><p><strong>Conclusion: </strong>In conclusion, sagittal approaches using the iliopubic ramus as an anatomical reference achieve the most complete obturator nerve block. Our anatomical study details the structures of the obturator canal and access to the obturator nerve at its exit. Future studies are needed to confirm its safety and efficacy.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2024-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142570090","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":"Radiofrequency treatments for lumbar facet joint syndrome: a systematic review and network meta-analysis.","authors":"Soyoon Park, Ji-Hoon Park, Ni Sokpeou, Jae Ni Jang, Young Uk Kim, Young-Soon Choi, Sukhee Park","doi":"10.1136/rapm-2024-105883","DOIUrl":"https://doi.org/10.1136/rapm-2024-105883","url":null,"abstract":"<p><strong>Background: </strong>Lumbar facet joint syndrome (FJS) is a common cause of chronic low back pain (LBP). Radiofrequency treatments are commonly used to treat chronic LBP-related FJS that is refractory to conservative treatment, although evidence supporting this treatment is controversial.</p><p><strong>Objective: </strong>We explored the therapeutic effects of radiofrequency on FJS using a network meta-analysis (NMA).</p><p><strong>Evidence review: </strong>A comprehensive systematic search of multiple databases was conducted to identify randomized controlled trials (RCTs) that compared radiofrequency with other treatments (sham procedures, facet joint corticosteroid injection, and conservative treatment) for FJS. We searched PubMed, Embase, Web of Science, the Cochrane Database, and handsearching. The primary outcomes were pain score and Oswestry Disability Index (ODI). Statistical analysis included conventional pairwise meta-analysis and NMA using the frequentist method.</p><p><strong>Findings: </strong>The treatments were ranked using surface under the cumulative ranking curve (SUCRA) values. The search yielded 25 RCTs (1969 patients) and a mixed quality regarding the risk of bias, with most studies exhibiting a low risk of bias for most domains. Endoscopic neurotomy consistently ranked highest in terms of pain reduction and ODI score improvement at 1, 3, 6, and 12 months. At 1 and 6 months, endoscopic neurotomy had the highest SUCRA value for pain reduction (0.833 and 0.860, respectively), followed by medial branch thermal radiofrequency.</p><p><strong>Conclusions: </strong>This NMA demonstrates that endoscopic neurotomy is the most effective treatment for lumbar FJS, providing superior and sustained pain relief and functional improvement compared with other treatments. Further, high-quality RCTs are needed to confirm these findings and address the existing limitations.</p><p><strong>Prospero registration number: </strong>CRD42024524657.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142559450","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}