Regional Anesthesia and Pain Medicine最新文献

{"title":"My half-century love affair with regional anesthesia: hard lessons from war to microanatomy to acute pain medicine and beyond.","authors":"André P Boezaart","doi":"10.1136/rapm-2026-107718","DOIUrl":"https://doi.org/10.1136/rapm-2026-107718","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":"147700705","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":"High levels of persistent pain among adolescents recovering from anterior cruciate ligament reconstruction: a single-center cohort study.","authors":"Elizabeth O'Brien, Wallis T Muhly, Michael J Kallan, Tori N Sutherland","doi":"10.1136/rapm-2025-107537","DOIUrl":"https://doi.org/10.1136/rapm-2025-107537","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":"147700745","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":"Classification and stratification of patient pain archetypes following total knee arthroplasty: a machine learning approach.","authors":"Justin Chew, Junying Wang, Renee Ren, Daniel Maalouf, Stavros G Memtsoudis, Jashvant Poeran, Alexandra Sideris, Jiabin Liu","doi":"10.1136/rapm-2026-107626","DOIUrl":"https://doi.org/10.1136/rapm-2026-107626","url":null,"abstract":"<p><strong>Background: </strong>Up to 20% of total knee arthroplasty (TKA) patients experience significant postoperative pain that delays recovery and increases risk of chronic pain. Early identification of high-risk patients may allow for timely targeted interventions. Prior studies on postoperative pain trajectories have been limited by small cohorts and restricted methodology. This exploratory study characterized postoperative pain archetypes using machine learning and developed a perioperative predictive model to identify patients at higher risk for postoperative pain.</p><p><strong>Methods: </strong>This single-center retrospective study analyzed 17,200 primary unilateral TKAs (2021-2024), randomly divided into 80% training (n=13,760) and 20% testing (n=3,440) sets. Pain scores (Numeric Rating Scale (NRS) 0-10) collected 0-72 hours postoperatively were modeled using long short-term memory with contrastive learning and K-means clustering. Least Absolute Shrinkage and Selection Operator regression was applied to 107 preoperative and intraoperative variables for feature selection, and selected variables were used to train an eXtreme Gradient Boosting (XGBoost) model. Model performance was assessed using accuracy and area under the receiver operating characteristic curve (ROC-AUC).</p><p><strong>Results: </strong>Two distinct pain archetypes were identified on the training set: a \"low pain\" (n=7,082) and \"high pain\" cluster (n=6,678). The high pain cluster had higher mean postoperative NRS scores, greater cumulative pain burden, higher opioid consumption, and more chronic pain consultations. XGBoost predicted high-pain cluster membership with 64% accuracy and ROC-AUC of 0.68, with key predictors included younger age, ambulatory surgery, higher mode of tolerable NRS score, genicular block, and higher Patient-Reported Outcomes Measurement Information System-10 pain scores. Clustering using NRS data from only the first 12 or 24 postoperative hours showed moderate concordance with 72-hour results (61.3% and 62.4%, respectively).</p><p><strong>Conclusions: </strong>Machine learning identified distinct postoperative pain trajectories after TKA, and early pain data predicted later pain patterns. Incorporating early pain profiles into perioperative care may support proactive, individualized pain management.</p>","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":"147700750","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 axillary approach for axillary nerve block: a cadaveric study.","authors":"Akira Imanaka, Shimpei Kurata, Keisuke Tsujimura, Kazuya Inoue, Apichat Sinthubua, Pasuk Mahakkanukrauh, Kenji Kawamura","doi":"10.1136/rapm-2025-107503","DOIUrl":"https://doi.org/10.1136/rapm-2025-107503","url":null,"abstract":"<p><strong>Background: </strong>Interscalene brachial plexus block is widely used for pain management in shoulder surgery. However, because of the risk of phrenic nerve palsy, combined suprascapular and axillary nerve blocks (ANBs) are increasingly being used. Although the posterior approach is often used for ANB, several studies have reported on the axillary approach. The purpose of this study was to perform ANB using the axillary approach under ultrasound (US) guidance to investigate the injection point and spread of the solution.</p><p><strong>Methods: </strong>18 fresh-frozen cadaveric specimens (8 male and 10 female specimens) were used in this study, with a mean age of 67.2 years (range, 37-92 years). The cadavers were placed in the lateral position with the upper limb in abduction. The transducer was placed on the axillary fold, and the axillary nerve (AN) was identified in the superficial layer of the humeral head underneath the teres major muscle. Using the in-plane technique, a block needle was inserted posterior to the anterior. 0.1 mL of blue latex solution was injected into 12 specimens (12 shoulders) to confirm the needle tip position, and 10 mL of saline solution colored with methylene blue (MB) was injected into six specimens (six shoulders) to evaluate the spread of the solution.</p><p><strong>Results: </strong>In all cases, the AN was identified by US, and block manipulation was possible. The bifurcation of the anterior and posterior branches of the AN within the quadrilateral space was stained with blue latex solution. The anterior branch of the AN, posterior branch to the deltoid muscle, and posterior branch to the teres minor muscle were stained with MB in all cases.</p><p><strong>Conclusion: </strong>The anterior and posterior branches of the AN were accurately blocked using an US-guided axillary approach. The axillary approach is an effective alternative to the posterior approach.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147678356","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 trans-quadrangular space (TQS) approach to axillary nerve block: evaluation of dye spread after simulated cadaveric injections.","authors":"Michelle Chong, Jason Ivanusic, David Burns, Philip Peng","doi":"10.1136/rapm-2026-107774","DOIUrl":"https://doi.org/10.1136/rapm-2026-107774","url":null,"abstract":"<p><strong>Introduction: </strong>Axillary nerve blockade contributes to selective shoulder analgesia while minimizing phrenic nerve involvement. However, reliable ultrasound-guided approaches remain undefined. We evaluated dye spread following a novel ultrasound-guided trans-quadrangular space approach targeting the axillary nerve in a cadaveric simulation study.</p><p><strong>Methods: </strong>12 ultrasound-guided trans-quadrangular space injections using 7 mL of methylene blue were performed in six fresh, unembalmed cadavers positioned laterally. The needles were inserted into the quadrangular space with a posterior approach. Dissections were conducted 15 min after injection using a standardized protocol. The primary outcome was the frequency and degree of staining of the axillary nerve trunk and its anterior and posterior divisions. Secondary outcomes included staining of the radial nerve, musculocutaneous nerve, and posterior cord.</p><p><strong>Results: </strong>The main axillary nerve trunk demonstrated consistent staining in 100% (12/12) of injections. At the branching point, the anterior and posterior divisions were stained in 83% (10/12) and 90% (11/12) of injections, respectively. The radial nerve was lightly stained in 25% (3/12) of injections. No staining of the musculocutaneous nerve or posterior cord was observed. In all injections, dye tracking extended longitudinally within the quadrangular space and slightly beyond the nerve's entrance at anterior quadrangular space.</p><p><strong>Conclusion: </strong>The ultrasound-guided trans-quadrangular space approach consistently stained the axillary nerve trunk and divisions with minimal unintended spread. This posterior technique, performed in the lateral position without shoulder abduction, demonstrates anatomical feasibility and may support further clinical investigation of selective axillary nerve blockade.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147663309","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":"Imaging of selective nerves in the lower extremity using wideband linear array ultrasound.","authors":"Alastair E Moody, Jacob Whittle, Erika Mendoza, Jeffrey D Swenson","doi":"10.1136/rapm-2026-107592","DOIUrl":"https://doi.org/10.1136/rapm-2026-107592","url":null,"abstract":"<p><p>Peripheral nerve blockade of the lower extremity focuses on two major nerves: the sciatic and femoral. Both nerves lie near large vascular structures and can require significant volumes of injectate to produce a reliable analgesic blockade. Moreover, blockade of these nerves leads to corresponding muscle weakness that can be unnecessary or even undesirable for recovery following surgery.New-generation, high-resolution ultrasound (US) probes facilitate the visualization of selective nerves in the lower extremity. Therefore, blockade of these nerves can be performed at multiple locations that can be individualized for specific patients undergoing forefoot and midfoot surgeries. This article describes an educational approach for selective lower extremity blocks of the saphenous, tibial, sural, superficial peroneal, and deep peroneal nerves with corresponding clinical applications for common forefoot and midfoot surgeries. These techniques are presented in a stepwise approach with surface and corresponding US anatomy. Cadaveric dissections are also included with some of the described techniques to emphasize the anatomical relationships. Each of these techniques, in this educational review, begins with easily identifiable surface landmarks and follows a stepwise approach.Understanding of these lower extremity selective nerve blocks allows for targeted low-volume blockade of specific sensory distributions, individualized to each patient.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147647519","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":"10.1136/rapm-2024-106088","url":null,"abstract":"","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":"484"},"PeriodicalIF":3.5,"publicationDate":"2026-04-02","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":"Comparing risks in brachial plexus blocks: what you need to know - an infographic.","authors":"Hipolito Labandeyra, Ryan S D'Souza","doi":"10.1136/rapm-2024-106313","DOIUrl":"10.1136/rapm-2024-106313","url":null,"abstract":"","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":"473"},"PeriodicalIF":3.5,"publicationDate":"2026-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142967135","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":"Efficacy and safety of intrathecal adjuvants for perioperative management of cesarean delivery: a systematic review and network meta-analysis of randomized controlled trials.","authors":"Martina Ollosu, Vincenzo Francesco Tripodi, Alessandro Bonu, Guglielmo Cittadini, Mario Musu, Mariachiara Ippolito, Andrea Cortegiani, Gabriele Finco, Salvatore Sardo","doi":"10.1136/rapm-2024-106345","DOIUrl":"10.1136/rapm-2024-106345","url":null,"abstract":"<p><strong>Background: </strong>Cesarean section (CS) rates have increased globally, necessitating effective anesthesia management. Single-shot spinal anesthesia has limitations due to its duration and the dose-limiting adverse effects of local anesthetics.</p><p><strong>Objectives: </strong>To evaluate the effectiveness and safety of intrathecal adjuvants combined with local anesthetics in the perioperative management of CS pain.</p><p><strong>Design: </strong>Systematic review with network meta-analysis.</p><p><strong>Data sources: </strong>PubMed, Cochrane Library for Clinical Trials, and Embase.</p><p><strong>Eligibility criteria: </strong>We included women undergoing CS under single-shot spinal anesthesia with any intrathecal drug or placebo added to a long-acting local anesthetic. We selected single- or double-blind, parallel-group, randomized controlled trials (RCTs) reported in English. We excluded crossover, non-randomized, up-and-down dose-finding studies and clinical trials comparing the same drugs in all study arms.</p><p><strong>Results: </strong>We included 166 RCTs with 14 925 patients assigned to 32 interventions. Buprenorphine and diamorphine were the highest-ranked treatments for reducing pain intensity at 24 hours, though not statistically significant. Morphine alone or in combination with meperidine, neostigmine, epinephrine, or nalbuphine significantly increased the duration of effective analgesia and reduced opioid consumption. Dexmedetomidine and morphine significantly prolonged the motor block duration. The safety profile of intrathecal adjuvants was generally adequate.</p><p><strong>Conclusions: </strong>While the strength of evidence, overall, was very low to low, our study suggests that while none of the interventions significantly reduced pain intensity at 24 hours, several significantly prolonged effective analgesia and reduced postoperative opioid consumption. Dexmedetomidine and morphine prolonged the duration of motor block. None of the intrathecal adjuvants evaluated significantly increased the occurrence of severe adverse events. Future large-scale RCTs are essential to provide more robust evidence.</p><p><strong>Prospero registration number: </strong>CRD42024479424.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":"385-403"},"PeriodicalIF":3.5,"publicationDate":"2026-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143733253","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":"Human versus artificial intelligence: evaluating ChatGPT's performance in conducting published systematic reviews with meta-analysis in chronic pain research.","authors":"Anam Purewal, Kalli Fautsch, Johana Klasova, Nasir Hussain, Ryan S D'Souza","doi":"10.1136/rapm-2024-106358","DOIUrl":"10.1136/rapm-2024-106358","url":null,"abstract":"<p><strong>Introduction: </strong>Artificial intelligence (AI), particularly large-language models like Chat Generative Pre-Trained Transformer (ChatGPT), has demonstrated potential in streamlining research methodologies. Systematic reviews and meta-analyses, often considered the pinnacle of evidence-based medicine, are inherently time-intensive and demand meticulous planning, rigorous data extraction, thorough analysis, and careful synthesis. Despite promising applications of AI, its utility in conducting systematic reviews with meta-analysis remains unclear. This study evaluated ChatGPT's accuracy in conducting key tasks of a systematic review with meta-analysis.</p><p><strong>Methods: </strong>This validation study used data from a published meta-analysis on emotional functioning after spinal cord stimulation. ChatGPT-4o performed title/abstract screening, full-text study selection, and data pooling for this systematic review with meta-analysis. Comparisons were made against human-executed steps, which were considered the gold standard. Outcomes of interest included accuracy, sensitivity, specificity, positive predictive value, and negative predictive value for screening and full-text review tasks. We also assessed for discrepancies in pooled effect estimates and forest plot generation.</p><p><strong>Results: </strong>For title and abstract screening, ChatGPT achieved an accuracy of 70.4%, sensitivity of 54.9%, and specificity of 80.1%. In the full-text screening phase, accuracy was 68.4%, sensitivity 75.6%, and specificity 66.8%. ChatGPT successfully pooled data for five forest plots, achieving 100% accuracy in calculating pooled mean differences, 95% CIs, and heterogeneity estimates (<i>I²</i> score and tau-squared values) for most outcomes, with minor discrepancies in tau-squared values (range 0.01-0.05). Forest plots showed no significant discrepancies.</p><p><strong>Conclusion: </strong>ChatGPT demonstrates modest to moderate accuracy in screening and study selection tasks, but performs well in data pooling and meta-analytic calculations. These findings underscore the potential of AI to augment systematic review methodologies, while also emphasizing the need for human oversight to ensure accuracy and integrity in research workflows.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":"437-442"},"PeriodicalIF":3.5,"publicationDate":"2026-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13151432/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143434384","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}