Regional Anesthesia and Pain Medicine最新文献

{"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}

{"title":"Cryoanalgesia to treat phantom limb pain following a trans-femoral (above-knee) amputation: a randomized, sham-controlled pilot study.","authors":"Brian M Ilfeld, John J Finneran, Baharin Abdullah, Sabeeca Vadakkan, Rafael A Alkabalan, Rodney A Gabriel","doi":"10.1136/rapm-2025-107116","DOIUrl":"10.1136/rapm-2025-107116","url":null,"abstract":"<p><strong>Background: </strong>A previous clinical trial applied percutaneous cryoneurolysis to lower limb amputees with phantom pain. The primary outcome measure was negative, but a secondary analysis suggested that patients with a below-knee amputation (BKA) improved, while the opposite was true for above-knee amputations (AKA). We theorized two potential reasons for this difference: cryoneurolysis was inadequate for the larger sciatic nerve in the upper thigh for AKA versus the lower thigh for BKA; and BKA is innervated by only two nerves, both of which were treated while AKA involved two additional nerves left untreated.</p><p><strong>Methods: </strong>Participants with an existing AKA and intractable phantom pain had four nerves treated with ultrasound-guided percutaneous cryoneurolysis in the upper thigh: sciatic, femoral, obturator, lateral femoral cutaneous. For the larger nerves, we used an argon-based machine capable of inducing temperatures as low as -100°C and producing a relatively large ice ball. The sciatic nerve was treated both on the anterior and posterior aspects (5.5 min each). Participants were randomized to receive active or sham treatment with the option to return 4-6 months later for a crossover treatment. Participants and assessors were masked to treatment group allocation. Percutaneously inserted thermocouples were used to measure tissue temperature. Statistical analysis was not performed due to the limited sample size of this pilot study.</p><p><strong>Results: </strong>After 1-month, average phantom limb pain intensity (primary outcome) was 5.0 (5.0, 6.0) in patients given cryoneurolysis (n=11) vs 5.0 (4.8, 5.3) for sham (n=5). Patients' Global Impression of Change and the Brief Pain Inventory (interference subscale) similarly suggested no improvement in either group after the initial post-treatment week. Tissue 3 mm from the cryoprobe required 2.5 min to reach -20°C and did not reach -40°C by the end of the freeze cycle.</p><p><strong>Conclusions: </strong>We found no evidence that percutaneous cryoneurolysis of the four major nerves of the thigh with an argon-based machine improved lower extremity phantom pain 1 month following treatment. Due to the limited sample size and probable lack of therapeutically low temperatures across the entire sciatic nerve, these results should be viewed as preliminary and used to help guide future preclinical and clinical investigations.</p><p><strong>Trial registration number: </strong>NCT06071715.</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":"145208420","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":"RAPM disclosure recommendations for AI use in writing and publishing.","authors":"Michael R Fettiplace, Ryan S D'Souza, Vivian H Y Ip, Anuj Bhatia","doi":"10.1136/rapm-2025-106979","DOIUrl":"https://doi.org/10.1136/rapm-2025-106979","url":null,"abstract":"","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145182391","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":"Phentolamine: more than just an adrenergic blocker - a pathway to a potential analgesic?","authors":"Ryan S D'Souza, Sven Engler, Hipolito Labandeyra","doi":"10.1136/rapm-2025-107193","DOIUrl":"https://doi.org/10.1136/rapm-2025-107193","url":null,"abstract":"","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145182328","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":"Transversus abdominis plane block enhances analgesia and reduces opioid use after laparoscopic donor hepatectomy with intrathecal morphine: a randomized controlled trial.","authors":"RyungA Kang, Yu Jeong Bang, Justin Sangwook Ko, Jong Man Kim, Gyu-Seong Choi, Ji Seon Jeong, Gaab Soo Kim","doi":"10.1136/rapm-2025-106943","DOIUrl":"https://doi.org/10.1136/rapm-2025-106943","url":null,"abstract":"<p><strong>Introduction: </strong>Intrathecal morphine (ITM) provides effective analgesia for pure laparoscopic donor hepatectomy (PLDH); however, its analgesic effect may be insufficient during the immediate postoperative period. We evaluated whether adding bilateral transversus abdominis plane block (TAPB) to ITM enhances analgesia and recovery in living liver donors undergoing PLDH.</p><p><strong>Methods: </strong>This randomized controlled trial was conducted at a single center in Korea between 9 May 2023 and 9 October 2024. 80 living liver donors scheduled for PLDH were prospectively randomized into two groups: a control group receiving ITM alone and a TAPB group receiving bilateral TAPB plus ITM. The primary outcome was the worst pain score recorded at rest in the postanesthesia care unit (PACU).</p><p><strong>Results: </strong>The worst pain score at rest during the PACU stay was significantly lower in the TAPB group than in the control group (median difference: 3; 95% CI 2 to 4; p<0.001). Lower pain scores persisted in the TAPB group for up to 4 hour postoperatively and were accompanied by significantly decreased cumulative opioid consumption at 1, 4 and 24 hours postoperatively (p=0.029, p=0.023, and p=0.018, respectively). At 24 hours postoperatively, the TAPB group reported a higher Quality of Recovery-15K score than the control group (p=0.030). Incidence of opioid-related complications was comparable between groups.</p><p><strong>Conclusions: </strong>Bilateral TAPB combined with ITM significantly enhanced analgesia and reduced opioid requirements during the immediate postoperative period after PLDH in living liver donors. Additionally, TAPB improved the Quality of Recovery at 24 hours postoperatively.</p><p><strong>Trial registration: </strong>Clinical research information service identifier: KCT0008406.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145180345","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":"Validating a home-based proxy- and self-administered quantitative sensory testing in youth and young adults undergoing regional anesthesia for orthopedic procedures.","authors":"Ayatt Elawad, Don Daniel Ocay, Meghan Halpin, Kimberly Lobo, Nicholas Larsen, Walid Alrayashi, Charles B Berde","doi":"10.1136/rapm-2025-107027","DOIUrl":"https://doi.org/10.1136/rapm-2025-107027","url":null,"abstract":"<p><strong>Introduction: </strong>Laboratory-based quantitative sensory testing (lab-QST) is a valuable tool for assessing sensory function but is limited by high costs, logistical constraints, and the need for trained personnel. This study aimed to validate a home-based proxy- and self-administered QST (proxy-/self-QST) toolkit in youth and young adults undergoing regional anesthesia for orthopedic procedures.</p><p><strong>Methods: </strong>Patients aged 8-25 scheduled for orthopedic surgery with regional anesthesia were enrolled. Each participant underwent lab-QST followed by self-QST before surgery. Proxy-QST was then conducted in the postanesthesia care unit and on postoperative days 1, 2, and 3. Measures included mechanical or thermal detection and pain thresholds. Agreement between proxy-/self-QST and lab-QST was evaluated using Bland-Altman and correlation analyses. Reliability was assessed using intraclass correlation coefficients, and sensory changes were analyzed using non-parametric tests.</p><p><strong>Results: </strong>15 participants completed mechanical sensory testing, while another 15 participants completed thermal sensory testing. Proxy-/self-QST showed agreement with lab-QST for most parameters, particularly for vibration detection and pressure pain thresholds. Inter and intrarater reliability were moderate-to-excellent across most sensory measures. The toolkit detected sensory loss immediately after surgery and heightened sensitivity to pain by day 3. Acceptability was high among participants and proxies, with no adverse events reported. Feedback highlighted ease of use and advantages, though minor improvements were suggested.</p><p><strong>Conclusions: </strong>Proxy-/self-QST is a feasible and reliable method for assessing sensory function in youth postoperatively. It offers a cost-effective alternative to lab-QST, enabling remote monitoring of sensory changes and expanding accessibility in research and clinical contexts.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145180283","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":"Crystallization of local anesthetic and adjuvant mixtures: a chemical analysis of the crystal precipitate composition.","authors":"Elisabeth Gasteiger, Benedikt Schwarz, Matthias Harder, Lukas Gasteiger, Matthias Rainer, Christian W Huck, Ottokar Stundner","doi":"10.1136/rapm-2025-106981","DOIUrl":"https://doi.org/10.1136/rapm-2025-106981","url":null,"abstract":"<p><strong>Introduction: </strong>Local anesthetics are often mixed with other local anesthetics or adjuvants to enhance block duration and/or speed of onset. Recent studies described the appearance of significant microscopic crystallization in such mixtures. However, the impact of precipitation on solute concentration, as well as the chemical composition of these crystals, remained unclear.</p><p><strong>Methods: </strong>Eight commonly used mixtures of local anesthetics and adjuvants, which have previously been found to cause significant crystallization, were assessed using a high-performance liquid chromatography-ultraviolet system to detect changes in solute concentration for 800 min (13.3 hours) after admixtures. In a second step, liquid chromatography-mass spectrometry was used to investigate the composition of precipitates formed in lidocaine+sodium bicarbonate and lidocaine+ropivacaine+sodium bicarbonate mixtures.</p><p><strong>Results: </strong>The concentration of the assessed mixtures remained constant over time, indicating that precipitation did not significantly affect the concentration of local anesthetics in the mix. The precipitates appearing in lidocaine+sodium bicarbonate and lidocaine+ropivacaine+sodium bicarbonate mixtures are composed of pure local anesthetics.</p><p><strong>Discussion: </strong>Our study reveals that no effect on local anesthetic concentration in the solution was apparent. Moreover, the precipitates forming in lidocaine/ropivacaine/sodium bicarbonate mixtures are composed of pure local anesthetics. Our findings might facilitate the design of future in vivo studies assessing the behavior of local anesthetics crystals.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145180301","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":"Response to 'Single versus two-level superficial parasternal intercostal plane block: cadaveric evaluation of injectate spread with needle tip position on anterior surface of costal cartilage'.","authors":"Jon Christensen, Matthew Ritter, Rachel Douglas, Punnose Kattil, Nirusha Lachman, William J Mauermann","doi":"10.1136/rapm-2025-106922","DOIUrl":"https://doi.org/10.1136/rapm-2025-106922","url":null,"abstract":"","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145180286","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":"Percutaneous analgesic device enabling both local anesthetic delivery and electrical stimulation (neuromodulation) of peripheral nerves: a pilot feasibility study (case series).","authors":"Brian M Ilfeld, Engy T Said, Brian H Park, Sanjay K Sinha, Bryan Leek, Matthew J Meunier, Ian M Foran, Andrew Hurvitz, William T Kent, Alexandra K Schwartz, Baharin Abdullah, Rafael Alkabalan, Nathan Lau, John J Finneran","doi":"10.1136/rapm-2025-107029","DOIUrl":"https://doi.org/10.1136/rapm-2025-107029","url":null,"abstract":"<p><strong>Background: </strong>A novel device integrating both local anesthetic delivery and peripheral nerve stimulation (PNS) to treat postoperative pain is under development. The device uses a catheter-over-needle design that permits ultrasound-guided percutaneous insertion. An integrated electrode and pulse generator enable PNS for up to 28 days. Such an approach may represent a paradigm shift in postoperative pain management by enabling the delivery of (1) a single-injection peripheral nerve block, (2) a continuous peripheral nerve block, and (3) neuromodulation-all through a single system that can be placed in a timeframe comparable with that of a traditional single-injection nerve block. The current prospective pilot study was executed under a US Food and Drug Investigational Device Exemption to develop insertion and management protocols, as well as assess the feasibility and safety of using the device to treat postoperative pain.</p><p><strong>Methods: </strong>Preoperatively, adults (n=20) undergoing moderate-to-severely painful ambulatory shoulder or foot/ankle surgery had a device (RELAY, Gate Science, Moultonborough, NH) inserted under ultrasound guidance adjacent to the brachial plexus or sciatic nerve, respectively. Accurate insertion was confirmed with a 10 mL bolus of lidocaine <i>via</i> the catheter followed by bupivacaine (10 mL). If a continuous infusion was indicated, a portable pump was used to infuse ropivacaine (6-8 mL/h, 500 mL reservoir). Electric current was delivered using the integrated pulse generator for 7 days, followed by removal at home. Participants were contacted for data collection on postoperative days 1-5, 7, 8, and 14.</p><p><strong>Results: </strong>During the first seven postoperative days, the median (IQR) \"average\" daily <i>pain intensity</i> as measured with the numeric rating scale (NRS) was 2 [0, 3]. Following postoperative day 1, daily average and maximum/worst NRS was less than 2 and 5, respectively. Regarding the \"worst\" (maximum) pain level over the entire study period of Days 0-14, 7 (35%) experienced mild pain (NRS<4), 10 (50%) moderate pain (NRS 4-7), and 3 (15%) severe pain (NRS>7). Cumulative oxycodone consumption the first week was a median of 43 (18, 73) mg.</p><p><strong>Conclusions: </strong>This novel device successfully delivered a single-injection local anesthetic bolus, a continuous perineural infusion, and concurrent/subsequent electrical current. A randomized, sham-controlled clinical trial appears warranted. CLINICALTRIALSGOV : NCT06818708.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145180277","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":"On the nomenclature of obturator nerve block approach.","authors":"Takayuki Yoshida, Tatsuo Nakamoto","doi":"10.1136/rapm-2025-107144","DOIUrl":"https://doi.org/10.1136/rapm-2025-107144","url":null,"abstract":"","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145180289","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}