Regional Anesthesia and Pain Medicine最新文献

{"title":"Differences in the association between epidural analgesia and length of stay by surgery type: an observational study.","authors":"Anuj B Patel, Gerard J Kerins, Brian D Sites, Chloe Nadine M Duprat, Matthew Davis","doi":"10.1136/rapm-2023-105194","DOIUrl":"10.1136/rapm-2023-105194","url":null,"abstract":"<p><strong>Introduction: </strong>Despite a decline in the use of thoracic epidural analgesia related in part to concerns for delayed discharge, it is unknown whether changes in length of stay (LOS) associated with epidural analgesia vary by surgery type. Therefore, we determined the degree to which the association between epidural analgesia (vs no epidural) and LOS differed by surgery type.</p><p><strong>Methods: </strong>We conducted an observational study using data from 1747 patients who had either non-emergent open abdominal, thoracic, or vascular surgery at a single tertiary academic hospital. The primary outcome was hospital LOS and the incidence of a prolonged hospital LOS defined as 21 days or longer. Secondary endpoints included escalation of care, 30-day all-cause readmission, and reason for epidural not being placed. The association between epidural status and dichotomous endpoints was examined using logistic regression.</p><p><strong>Results: </strong>Among the 1747 patients, 85.7% (1499) received epidural analgesia. 78% (1364) underwent abdominal, 11.5% (200) thoracic, and 10.5% (183) vascular surgeries. After adjustment for differences, receiving epidural analgesia (vs no epidural) was associated with a 45% reduction in the likelihood of a prolonged LOS (p<0.05). This relationship varied by surgery type: abdominal (OR 0.42, 95% CI 0.23 to 0.79, p<0.001), vascular (OR 1.66, 95% CI 0.17 to 16.1, p=0.14), and thoracic (OR 1.07, 95% CI 0.20 to 5.70, p=0.93). Among abdominal surgical patients, epidural analgesia was associated with a median decrease in LOS by 1.4 days and a 37% reduction in the likelihood of 30-day readmission (adjusted OR 0.63, 0.41 to 0.97, p<0.05). Among thoracic surgical patients, epidural analgesia was associated with a median increase in LOS by 3.2 days.</p><p><strong>Conclusions: </strong>The relationship between epidural analgesia and LOS appears to be different among different surgical populations.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":"252-256"},"PeriodicalIF":5.1,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139577126","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":"Epidural analgesia after surgery: time to review the gold standard?","authors":"Karli M Spann, Amir L Butt, Danielle R Zabala, Aimee Pak","doi":"10.1136/rapm-2024-105439","DOIUrl":"10.1136/rapm-2024-105439","url":null,"abstract":"","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":"284-285"},"PeriodicalIF":5.1,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141077363","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":"Peripheral nerve block and the antimicrobial proprieties of local anesthetics.","authors":"Andreas Clipet-Jensen, Hans Fjeldsøe-Nielsen, Birgitte Berthelsen","doi":"10.1136/rapm-2024-105461","DOIUrl":"10.1136/rapm-2024-105461","url":null,"abstract":"","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":"284"},"PeriodicalIF":5.1,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141184950","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: 'Danger, Danger, Gaston Labat! Does zero-shot artificial intelligence correlate with anticoagulation guideline recommendations for neuraxial anesthesia?'","authors":"Nathan C Hurley, Rajnish K Gupta, Kristopher M Schroeder, Aaron S Hess","doi":"10.1136/rapm-2024-105441","DOIUrl":"10.1136/rapm-2024-105441","url":null,"abstract":"","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":"283-284"},"PeriodicalIF":5.1,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140133266","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 letter to the editor: Hidden influence? Unmasking conflicts of interest from randomized clinical trials on spinal cord stimulation for chronic pain.","authors":"Ryan S D'Souza, Johana Klasova, Nasir Hussain","doi":"10.1136/rapm-2024-106329","DOIUrl":"https://doi.org/10.1136/rapm-2024-106329","url":null,"abstract":"","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143525283","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":"Elevated 18:1 lysophosphatidylcholine contributes to neuropathic pain in peripheral nerve injury.","authors":"Jinxuan Ren, Lina Yu, Jiaqi Lin, Ying Liu, Longfei Ma, Yangyuxin Huang, Na Sun, Yutao Deng, Da Zhong, Binglin Zhou, Baochun Jiang, Min Yan","doi":"10.1136/rapm-2024-106195","DOIUrl":"https://doi.org/10.1136/rapm-2024-106195","url":null,"abstract":"<p><strong>Background: </strong>Neuropathic pain is a maladaptive and chronic condition with limited effective treatments. Although recent studies have suggested that certain lipid metabolites, like lysophosphatidylcholine (LPC), may contribute to chronic pain, their specific roles and mechanisms remain unclear.</p><p><strong>Objective: </strong>This study investigated the role and mechanism of LPC(18:1), a lipid subtype, in neuropathic pain caused by nerve injury.</p><p><strong>Methods: </strong>Using a mouse model of spinal nerve ligation, LPC(18:1) levels were measured in serum, dorsal root ganglion (DRG), spinal cord (SC) and cerebrospinal fluid (CSF). Nociception was assessed using von Frey and Hargreaves' methods, while molecular analyses explored inflammatory pathways and oxidative stress.</p><p><strong>Results: </strong>LPC(18:1) levels significantly increased in the serum, DRG and CSF after nerve injury. Administration of LPC(18:1) induced heightened pain responses and activated inflammatory pathways, including protein kinase C (PKC) and extracellular regulated protein kinase (ERK) in the DRG, as well as glial cells in the SC. The findings suggested that oxidative stress played a role in LPC(18:1) production, and its effects were mediated by G protein-coupled receptor 132 (GPR132).</p><p><strong>Conclusion: </strong>LPC(18:1) may serve as a potential biomarker and therapeutic target for managing neuropathic pain.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143525276","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":"Letter to the editor: Hidden influence? Unmasking conflicts of interest from randomized clinical trials on spinal cord stimulation for chronic pain.","authors":"Guy Henri Hans, Lisa Bernaerts, Ella Roelant, Maarten Moens","doi":"10.1136/rapm-2024-106181","DOIUrl":"https://doi.org/10.1136/rapm-2024-106181","url":null,"abstract":"","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143525281","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":"Infrapatellar branch of saphenous nerve: from anatomy, sonoanatomy to its clinical implications.","authors":"Michael Sj Peng, Steven R Clendenen, Glenn G Shi, Ban C H Tsui","doi":"10.1136/rapm-2025-106383","DOIUrl":"https://doi.org/10.1136/rapm-2025-106383","url":null,"abstract":"<p><p>The infrapatellar branch of the saphenous nerve (IPBSN) is implicated in nerve injury from different knee surgeries because of its intimate course relative to the knee joint capsule. Pain physicians encounter patients in their practice for the management of neuralgia of this nerve or in the context of advanced management of knee osteoarthritis. This article aims to provide a comprehensive review of the anatomy, sonoanatomy, and the intervention of the IPBSN in pain management of infrapatellar neuralgia and chronic knee pain.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143525278","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":"Perineuromal hydrodissection for acute postamputation pain? An observational study in a time of war.","authors":"Dmytro Dmytriiev, Winnie Liu, Maksym Barsa, Andreii Khomenko, Andreii Strokan, Paul F Pasquina, Steven P Cohen","doi":"10.1136/rapm-2024-106307","DOIUrl":"10.1136/rapm-2024-106307","url":null,"abstract":"<p><strong>Introduction: </strong>This exploratory study investigates the potential of perineuromal hydrodissection as an adjunct to opioid therapy for postamputation pain, specifically focusing on residual limb and phantom limb pain (PLP). Given the correlations between acute pain and the development of chronic pain, the primary aims were to estimate the effect size of early hydrodissection of scar tissue around residual limb neuroma(s) and to identify the best time frame for treatment.</p><p><strong>Methods: </strong>Seventy-four patients with war-related limb amputations and painful neuromas were included in this observational analysis. Thirty-eight Ukrainian patients with war-related limb amputation and a painful neuroma(s) who underwent hydrodissection and opioid therapy within 6 months of amputation were compared with 36 patients who received opioids alone. Co-primary outcome measures were median reduction from baseline in average residual limb and PLP at 12 weeks. The composite positive outcome was designated as a ≥2-point decrease or 30% reduction in average residual limb and PLP, satisfaction with treatment, and not requiring an increase in analgesics.</p><p><strong>Results: </strong>Hydrodissection as an add-on to opioids resulted in a greater reduction in average residual limb pain at 12 weeks (-2.00±1.00 vs -1.00±1.00; p<0.001) and earlier time periods, but PLP only through 4 weeks. At 12 weeks, Hospital Anxiety and Depression Scale anxiety (10.00±2.00 vs 11.00±1.00; p<0.001) but not depression score was lower in the hydrodissection group. Opioid use in the hydrodissection group significantly declined from 41.32±9.63 to 33.42±8.78 morphine equivalents per day (p=0.001) over the study, but not in the opioid-only group (p=0.20). Differences in 12-week satisfaction rates were not significant.</p><p><strong>Conclusions: </strong>This exploratory study suggests perineuromal hydrodissection may improve residual limb pain and to a lesser degree phantom limb pain, particularly when implemented early in the course of postamputation pain. The study provides preliminary effect size estimates and identifies acute pain as a potential characteristic of patients who may respond more favorably to this intervention. Randomized controlled trials are needed to confirm these findings and control for the confounding variables identified.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143460602","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":"Factors associated with poor pain experience after surgery.","authors":"Axel Maurice-Szamburski, Romain Rozier, Victor Gridel, Vladimir Radev, Emmanuelle Badia, Anderson Loundou, Pascal Auquier, Xavier Capdevila","doi":"10.1136/rapm-2024-106095","DOIUrl":"https://doi.org/10.1136/rapm-2024-106095","url":null,"abstract":"<p><strong>Objective: </strong>To identify factors associated with poor postoperative pain experience by examining patient-related and procedural variables.</p><p><strong>Methods: </strong>An exploratory secondary analysis was conducted on data from 971 adult patients undergoing elective surgery under general anesthesia across five French teaching hospitals. Preoperative anxiety was assessed using the Amsterdam Preoperative Anxiety and Information Scale (APAIS). Pain, sleep quality and well-being were measured preoperatively and postoperatively using visual analog scales (VAS). The primary endpoint was the patient experience measured by the Evaluation du Vécu de l'Anesthésie Generale (EVAN-G) questionnaire on postoperative day 1, with poor pain experience defined as a score below the 25th percentile on the EVAN-G pain dimension. Univariate and multivariate logistic regression analyses were performed to identify factors associated with poor pain experience.</p><p><strong>Results: </strong>Poor pain experience was reported by 271 patients (27.9%). Multivariate analysis identified intraoperative use of remifentanil and sufentanil as an independent predictor of poor pain experience with an OR of 26.96 (95% CI 2.17 to 334.23, p=0.01). Additionally, age (OR 0.97, p=0.003), absence of premedication (OR 0.49, p=0.035) and orthopedic surgery (OR 0.29, p=0.005) were associated with a lower likelihood of poor pain experience. Conversely, American Society of Anesthesiologists (ASA) 3 status (OR 5.09, p=0.028), postoperative anxiolytic use (OR 8.20, p<0.001), amnesia (OR 1.58, p=0.001), higher VAS pain (p<0.001) and lower well-being scores (p=0.007) on day 1 were predictors of poor pain experience.</p><p><strong>Conclusion: </strong>The intraoperative use of remifentanil and sufentanil is independently associated with poorer postoperative pain experience. These findings highlight the need to reassess intraoperative analgesic strategies to enhance patient outcomes and reduce postoperative complications.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143506006","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}