Regional Anesthesia and Pain Medicine最新文献

{"title":"Buprenorphine versus full agonist opioids for acute postoperative pain management: an infographic.","authors":"Thomas R Hickey, Gabriel P A Costa, Victor Javier Avila-Quintero, Joao P De Aquino","doi":"10.1136/rapm-2024-106304","DOIUrl":"10.1136/rapm-2024-106304","url":null,"abstract":"","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":"594-595"},"PeriodicalIF":3.5,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13151492/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142967132","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transversus abdominis plane block in minimally invasive colon surgery: a multicenter three-arm randomized controlled superiority and non-inferiority clinical trial.","authors":"Christopher Blom Salmonsen, Kai Henrik Wiborg Lange, Jakob Kleif, Rasmus Krøijer, Lea Bruun, Martynas Mikalonis, Peter Dalsgaard, Karen Busk Hesseldal, Jon Emil Philip Olsson, Claus Anders Bertelsen","doi":"10.1136/rapm-2024-105712","DOIUrl":"10.1136/rapm-2024-105712","url":null,"abstract":"<p><strong>Background and objectives: </strong>The transversus abdominis plane (TAP) block is the most widely used abdominal field block in colorectal surgery with a postoperative enhanced recovery pathway. We aimed to determine whether the laparoscopic-assisted and ultrasound-guided TAP (US-TAP) blocks provide superior pain relief compared with placebo. We separately investigated whether the laparoscopic-assisted technique was non-inferior to the ultrasound-guided technique in providing pain relief, with a non-inferiority margin of 10 mg morphine dose equivalents.</p><p><strong>Methods: </strong>340 patients undergoing elective minimally invasive colon surgery were randomly allocated to one of three groups: (1) US-TAP block, (2) laparoscopic-assisted TAP (L-TAP) block, or (3) placebo. Superiority and non-inferiority were tested for the primary outcome: 24-hour postoperative morphine equivalent consumption. Secondary outcomes, including patient-reported quality of recovery, were included in the superiority analysis.</p><p><strong>Results: </strong>127 patients were included in each block group and 86 in the placebo group. The US-TAP block was no different from placebo at -1.4 mg morphine (97.5% CI -6.8 to 4.0 mg; p=0.55). The L-TAP block was superior to placebo at -5.9 mg morphine (97.5% CI -11.3 to -0.5 mg; p=0.01) and non-inferior to the US-TAP block at -4.5 mg morphine (98.75% CI -10.0 to 1.1 mg).</p><p><strong>Conclusion: </strong>The L-TAP block was superior to placebo and non-inferior to the US-TAP block. However, neither met our predetermined estimate of the minimal clinically important difference of 10 mg morphine.</p><p><strong>Trial registration number: </strong>NCT04311099.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":"558-567"},"PeriodicalIF":3.5,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13151517/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142632786","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","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":"512-523"},"PeriodicalIF":3.5,"publicationDate":"2026-05-05","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":"Novel implantable anesthetic for spine fixation surgery: phase Ib safety results of a sustained-release formulation of bupivacaine.","authors":"Hein R 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":"10.1136/rapm-2025-106551","url":null,"abstract":"","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-05-04","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":"Changes in the clinical backgrounds of pain medicine fellows in ACGME-accredited programs, 2020-2024.","authors":"Vasanth Selvam, Nivetha Srinivasan, Alejandro Hallo-Carrasco, Aditi Master, Jean D Eloy, Christine Hunt","doi":"10.1136/rapm-2026-107786","DOIUrl":"https://doi.org/10.1136/rapm-2026-107786","url":null,"abstract":"","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147846190","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":"General versus spinal anesthesia and early functional and discharge outcomes after geriatric total joint arthroplasty: an NSQIP database retrospective cohort study.","authors":"Ghulam Saadat, Taruna Penmetcha, Gunar Subieta-Benito, Amelia Lerch, Joel C Williams","doi":"10.1136/rapm-2025-107561","DOIUrl":"https://doi.org/10.1136/rapm-2025-107561","url":null,"abstract":"<p><strong>Background: </strong>Older adults undergoing total joint arthroplasty (TJA) are particularly vulnerable to postoperative functional decline, yet the impact of anesthetic technique on recovery remains uncertain. This study examined whether spinal anesthesia (SA), compared with general anesthesia (GA), is associated with early functional decline and non-home discharge in geriatric patients undergoing elective total hip arthroplasty (THA) or total knee arthroplasty (TKA).</p><p><strong>Methods: </strong>We performed a retrospective cohort study using the 2021-2023 American College of Surgeons National Surgical Quality Improvement Program database. Patients aged ≥75 years undergoing THA or TKA were included. The primary outcome was functional status decline, defined as any reduction in activities of daily living independence from preoperative status to hospital discharge. The secondary outcome was discharge disposition, categorized as home versus non-home. Multivariable logistic regression was used to estimate adjusted ORs (aORs) for associations between anesthetic type and outcomes.</p><p><strong>Results: </strong>The cohort included 62 338 cases (GA: 30 296; SA: 32 042). GA was associated with higher rates of functional decline (38.5% vs 30.2%; p<0.001) and non-home discharge (22.6% vs 11.0%; p<0.001). After adjustment, GA remained independently associated with increased odds of functional decline (aOR 1.32; 95% CI 1.28 to 1.37; p<0.001) and non-home discharge (aOR 1.70; 95% CI 1.63 to 1.78; p<0.001). Findings were consistent across THA and TKA subgroups.</p><p><strong>Conclusion: </strong>In patients aged 75 years or older undergoing elective total joint arthroplasty, general anesthesia was associated with significantly higher odds of early functional decline and discharge to a non-home setting compared with spinal anesthesia. These findings suggest that anesthetic choice may be a modifiable perioperative factor for optimizing recovery in geriatric total hip arthroplasty patients.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147845678","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":"Interpreting non-inferiority in a prematurely terminated trial: concerns regarding cooled versus standard radiofrequency ablation for facetogenic low back pain.","authors":"Ding Heng Lu","doi":"10.1136/rapm-2026-107852","DOIUrl":"https://doi.org/10.1136/rapm-2026-107852","url":null,"abstract":"","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147823466","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":"Dose-dependent dorsal column activation drives analgesic effects of spinal cord stimulation in a rat model of neuropathic pain.","authors":"Eline M Versantvoort, Kimberley Ladner, Dave Mugan, Darayus Nanavati, Daniel Parker, Quoc C Vuong, Birte E Dietz, Ilona Obara","doi":"10.1136/rapm-2026-107607","DOIUrl":"https://doi.org/10.1136/rapm-2026-107607","url":null,"abstract":"<p><strong>Background: </strong>Spinal cord stimulation (SCS) is typically dosed to the perception threshold, defined as the onset of stimulation-induced sensations. The evoked compound action potential threshold (ECAPT) is an objective marker of dorsal column fiber activation onset. It approximates the perception threshold, and ECAPT-guided dosing improves clinical outcomes. Preclinical models are valuable for investigating the mechanisms of SCS, yet dosing strategies in animal studies commonly rely on motor threshold-based stimulation intensities, with limited translational relevance. Here, we establish a causal relationship between ECAPT, dorsal column activation, and analgesic efficacy, demonstrating for the first time that ECAPT provides a clinically comparable marker to guide preclinical SCS dosing based on neural activation.</p><p><strong>Methods: </strong>Adult male Sprague-Dawley rats with spared nerve injury (SNI)-induced neuropathic pain (n=25) were implanted epidurally with an eight-contact lead covering T12-L2. SCS (50 Hz, 100 µs) was delivered at individualized doses of 0×ECAPT, 0.5×ECAPT (open loop), or 1.1-1.4×ECAPT (closed loop). Additional SNI and sham controls (n=6 each) received no lead implantation or stimulation. Analgesic efficacy was assessed by paw withdrawal responses to mechanical (von Frey filaments) and cold (acetone) stimuli.</p><p><strong>Results: </strong>ECAPT-based SCS doses of 1.2-1.3×ECAPT achieved the most sustained reduction in mechanical and cold hypersensitivity, whereas 1.1×ECAPT was less effective and 1.4×ECAPT provided no additional benefit. Subthreshold doses (0-0.5×ECAPT) were ineffective.</p><p><strong>Conclusions: </strong>These findings validate ECAP as a translationally relevant measure of neural activation and demonstrate that dorsal column fiber recruitment is a key driver of SCS-induced analgesia, supporting ECAPT-guided dosing to enhance the clinical relevance and standardization of preclinical stimulation protocols.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147789526","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":"Mechanism-informed pain care: rebalancing procedural care toward better patient selection and outcomes.","authors":"Joana Barroso, Steven Paul Cohen","doi":"10.1136/rapm-2026-107822","DOIUrl":"https://doi.org/10.1136/rapm-2026-107822","url":null,"abstract":"","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147700700","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":"Online questions and information quality surrounding the novel non-opioid analgesic suzetrigine: analysis of publicly available web content.","authors":"Renee Ren, Junying Wang, Tina Chen, Charles Williams, Maaz Shah Khan, Meghan Kirksey, Daniel Maalouf, Jashvant Poeran, Alexandra Sideris","doi":"10.1136/rapm-2026-107803","DOIUrl":"https://doi.org/10.1136/rapm-2026-107803","url":null,"abstract":"","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147700667","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}