Regional Anesthesia and Pain Medicine最新文献

{"title":"Is vertebral augmentation a form of basivertebral ablation?","authors":"Philip Kim","doi":"10.1136/rapm-2025-107209","DOIUrl":"https://doi.org/10.1136/rapm-2025-107209","url":null,"abstract":"","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145139360","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":"Balancing the controversy: long-term outcomes of amputation in patients with complex regional pain syndrome (CRPS) - an infographic.","authors":"Daniël P C van der Spek, Julian Ghantous, Tjebbe Hagenaars, Marieke A Paping, Frank J P M Huygen, Maaike Dirckx","doi":"10.1136/rapm-2025-107141","DOIUrl":"https://doi.org/10.1136/rapm-2025-107141","url":null,"abstract":"","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145132751","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":"Advanced science step-by-step: the evolution of regional anesthesia techniques for midshaft clavicle fractures.","authors":"Hipolito Labandeyra, Ryan S D'Souza, Luis Fernando Valdés-Vilches","doi":"10.1136/rapm-2025-107174","DOIUrl":"https://doi.org/10.1136/rapm-2025-107174","url":null,"abstract":"","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145139374","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":"Outpatient continuous adductor canal block (CACB) for total knee arthroplasty: a double-blinded randomized placebo-controlled trial.","authors":"Yehoshua Gleicher, Hermann Dos Santos Fernandes, Sharon Peacock, Christine Ma, Fernanda Septimio Lanza Oliveira, Divya Mahajan, Carlson Asanghanwa, David Carrasco Guariento, Javiera Vargas, Jesse Wolfstadt, Miki Peer, Xiang Y Ye, Naveed Siddiqui","doi":"10.1136/rapm-2025-106991","DOIUrl":"10.1136/rapm-2025-106991","url":null,"abstract":"<p><strong>Background: </strong>Total knee arthroplasty (TKA) is a widely performed procedure, with postoperative pain presenting as a major barrier to early mobilization and patient satisfaction. While single-injection adductor canal blocks (SACB) offer effective short-term analgesia, their limited duration often leads to rebound pain. Continuous adductor canal blocks (CACB) extend analgesic effects but are underexplored in outpatient settings. The objective of this study is to assess whether CACB improves quality of recovery and analgesia, in comparison to SACB in an outpatient or short-stay setting for TKA patients.</p><p><strong>Methods: </strong>Double-blind randomized controlled trial comparing the Quality of Recovery-15 (QoR-15) score on postoperative day (POD) 2 (primary outcome) and opioid consumption, pain scores, hospital length-of-stay, and complications (secondary outcomes), between patients receiving CACB and SACB, when undergoing primary TKA.</p><p><strong>Results: </strong>60 patients were enrolled and randomized to two treatment groups: CACB (30) and SACB (30). Patients in the CACB group had significantly higher QoR-15 scores at PODs 1 (128.83±12.36 vs 109.00±15.90, p<0.001), 2 (131.27±10.23 vs 110.86±15.37, p<0.001) and 3 (131.97±13.94 vs 111.18±18.28, p<0.001). They also had lower opioid consumption and pain scores at rest and with movement during the first three PODs. No major complications or signs of local anesthetic systemic toxicity were observed.</p><p><strong>Conclusions: </strong>In our study, CACB significantly enhanced early postoperative recovery and analgesia following TKA in an outpatient or short-stay setting, compared with SACB, and these results support its broader adoption in fast-track TKA pathways.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145042254","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":"Augmented reality-guided craniofacial and airway nerve block training for anesthesiology residents.","authors":"David Zheng, Cheyenne N Mercer, Nathan Lau, John Francis Ryan, Amir Moradi, Steven Howe, Preetham Suresh, Geoffroy Noel","doi":"10.1136/rapm-2025-106776","DOIUrl":"https://doi.org/10.1136/rapm-2025-106776","url":null,"abstract":"<p><p>The acquisition of craniofacial and airway nerve block (ANB) skills is hindered by the complex anatomy involved, reliance on landmark-guided techniques, and the absence of simulation-based training tools. Augmented reality offers a promising platform for procedural training by providing real-time visual feedback, yet its potential to improve accuracy in ANBs has not been evaluated. This exploratory study assessed the feasibility of AR guidance for improving nerve block performance among anesthesiology faculty and residents.20 participants performed infraorbital, inferior alveolar, superior laryngeal, and glossopharyngeal nerve blocks with and without AR guidance using volumetric Digital Imaging and Communications in Medicine (DICOM) reconstructions superimposed on body donor heads via Hololens headset, from Microsoft Corporation and SurgicalAR software from Medivis. AR guidance included a localizer instrument for real-time tracking of a physical needle along a premapped virtual needle path. Performance was assessed by dissection-based accuracy (proximity of methylene blue to the nerve) and procedure time.Overall clinical acceptability was similar between AR and non-AR conditions (65.0% vs 55.0%, McNemar's p=0.754). There were no differences in performance when stratified by level of training (McNemar p=0.219 for residents; McNemar p=0.625 for faculty). However, AR significantly increased procedure time (overall 49.9±8.4 vs 14.5±2.6 s, Wilcoxon p<0.001) and time increases were consistent across training levels (faculty: +34.9 s, p=0.016; residents: +36.0 s, p=0.062). Additionally, there was no difference in nerve block success or procedure length between an overlay mode with the DICOM superimposed onto the body donor and a detached mode with the DICOM floating above or next to the body donor.In this small, exploratory study, AR did not significantly impact the rates of clinically acceptable nerve blocks when performed by faculty or resident anesthesiologists; however, AR significantly increased the amount of time required to perform the procedures. This proof-of-concept study successfully demonstrated the feasibility of using AR to learn and/or perform various craniofacial and ANBs using commercially available technology.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145139351","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":"Gabapentinoids: better at clouding minds than easing backs?","authors":"Ellis Muggleton","doi":"10.1136/rapm-2025-107166","DOIUrl":"https://doi.org/10.1136/rapm-2025-107166","url":null,"abstract":"","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145132734","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":"Alternative and more clinically applicable approach to the standardized mean difference effect size for meta-analysis of differentially scaled pain outcome data in anesthesia and pain medicine.","authors":"George A Kelley, Kristi S Sharpe Kelley","doi":"10.1136/rapm-2025-107020","DOIUrl":"https://doi.org/10.1136/rapm-2025-107020","url":null,"abstract":"<p><strong>Background/purpose: </strong>The production of systematic reviews with meta-analysis in the field of analgesia and pain medicine has increased dramatically over the years and is increasingly used to guide clinical practice as well as decisions by others (policymakers, etc). A common metric for pooling data from studies that use different scales to assess the outcome of interest, for example, pain, is to convert the results from each study using the standardized mean difference (SMD) effect size. However, this is problematic because the SMD is not easy to interpret by the non-statistician. In this brief technical report, we describe how to easily rescale data into a common and more easily interpretable metric, including the provision of an easy-to-use Excel worksheet for rescaling one's own data.</p><p><strong>Methods: </strong>Data from a previous meta-analysis of randomized controlled trials that examined the effects of transcutaneous electrical nerve stimulation on pain, assessed using different pain scales, were used. Using an Excel spreadsheet and selected formulas, data for each study were rescaled to a metric commonly used to assess pain in the clinical setting, 0-10. Results were then pooled using the inverse-variance heterogeneity model.</p><p><strong>Results: </strong>Rescaling pain data to 0-10 were easily accomplished using this 'real-world' dataset.</p><p><strong>Conclusion: </strong>Rescaling data into a more understandable metric intended for a wider variety of audiences is plausible. It is the hope that future systematic reviews that include a meta-analysis will use this approach when the results for an outcome of interest such as pain are reported using different scales.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145132731","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":"Pecto-intercostal fascial plane block with or without rectus sheath block in cardiac surgery: a prospective, randomized, double-blind placebo-controlled study.","authors":"Anne L Castro, Hemanckur Makker, Laura S Gonzalez, Audrey Jensen, Sergey S Tarima, Adam Pagryzinski, Rozalin Thapa, Ali Qureshi, Christopher Fadumiye, Krystal Weierstahl, Paul Pearson, Julie K Freed","doi":"10.1136/rapm-2025-106954","DOIUrl":"https://doi.org/10.1136/rapm-2025-106954","url":null,"abstract":"<p><strong>Background: </strong>Median sternotomy and chest tube sites drive pain following cardiac surgery. Prior research has demonstrated that pecto-intercostal fascial plane blocks (PIFBs) reduce median sternotomy pain after cardiac surgery. Prior studies examining the addition of a rectus sheath block (RSB) to localize the insertion site of subxiphoid chest tubes have had mixed results.</p><p><strong>Methods: </strong>In this single-center, randomized, double-blind, placebo-controlled trial, 62 patients undergoing cardiac surgery with median sternotomy and subxiphoid chest tubes were randomized to receive PIFB and RSB with local anesthetic versus PIFB with local anesthetic and RSB with saline placebo. The primary outcome was pain at rest and with deep breathing in the first 24 hours after surgery. Secondary outcomes included total opioid consumption at 24 and 48 hours, performance on incentive spirometry in the first 24 hours, time to extubation, hospital and intensive care unit length of stay, and Quality of Recovery-15 score.</p><p><strong>Results: </strong>There was no statistically significant difference between groups for the primary outcome, with mean area under the curve (AUC) for pain at rest in the first 24 hours 93.37±41.38 (sample mean±sample SD) in the placebo group versus 86.11±42.78 in the bupivacaine group (p=0.51), and mean AUC for pain with deep breathing 135.55±43.74 in the placebo group versus 128.78±47.08 in the bupivacaine group (p=0.57). There were no differences in secondary outcomes between groups.</p><p><strong>Conclusions: </strong>Adding bilateral RSB to bilateral PIFB did not improve pain control or other outcomes for patients undergoing cardiac surgery.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145126582","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 selectively blocks C-fiber conduction in different species, including humans.","authors":"Sven Christian Engler, Stanislav Koulchitsky, Andelain Erickson, Tali Hoffmann, Idil Toklucu, Raya Bott, Jannis Körner, Ralf Hausmann, Karl Messlinger, Natja Haag, Justus P Beier, Robert Brunkhorst, Maike F Dohrn, Angelika Lampert, Roberto DeCol, Barbara Namer","doi":"10.1136/rapm-2025-106791","DOIUrl":"https://doi.org/10.1136/rapm-2025-106791","url":null,"abstract":"<p><strong>Background: </strong>Phentolamine is a non-selective competitive α-adrenergic antagonist clinically used to treat different vascular-related diseases. Since recent data suggest an antagonistic effect of phentolamine on voltage-gated sodium channels (VGSCs), further electrophysiological analysis is essential to understand its effects on peripheral sensory nerves.</p><p><strong>Methods: </strong>We examined the effects of phentolamine on the amplitude of the stimulus-evoked compound action potential (CAP) of A- and C-type nerve fibers derived from mice, pigs, and humans compared with the effects of lidocaine. To explore potential mechanisms of phentolamine action, we performed single nerve fiber recordings using skin-nerve preparations from wild-type and Na_V1.8/Na_V1.9 double knockout mice, along with manual and automated whole-cell patch-clamp electrophysiology on ND7/23 or HEK293 cells with heterologously expressed VGSCs.</p><p><strong>Results: </strong>Phentolamine decreased CAP amplitudes in a concentration-dependent manner, with significantly lower concentrations needed to affect C-fibers compared with A-fibers. Co-application of the α-adrenergic agonist (R)-(-)-phenylephrine did not alter this effect, suggesting that α-adrenergic receptors do not mediate phentolamine's action in this case. Phentolamine (100 µM) inhibited the electrically evoked action potentials (AP) in the majority of single-unit cutaneous C-fibers, while the same concentration did not provoke AP extinction in A-fibers. C-fibers from Na_V1.8/Na_V1.9 double knockout mice were significantly less sensitive to phentolamine than those from wild types. In patch-clamp experiments, phentolamine concentration-dependently blocked VGSCs, whereas Na_V1.8 showed the highest sensitivity (IC₅₀=10 µM).</p><p><strong>Conclusions: </strong>Suppressing AP conduction and inhibiting VGSCs, phentolamine exhibits features reminiscent of local anesthetics, but with a stronger effect on C-fibers, which may be attributed to its stronger action on tetrodotoxin-resistant VGSCs. However, due to its markedly higher affinity for α-adrenergic receptors compared with VGSCs, systemic administration of phentolamine is limited by its adrenergic side effects. These findings suggest that phentolamine could be useful for exploring C-fiber function and provide a basis for the development of more selective and potent antinociceptive agents.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145126221","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":"Simplifying ultrasound suprascapular notch exploration for regional anesthesia.","authors":"Pierre Goffin, Jean-Pierre Lecoq, Alberto Prats-Galino, Xavier Sala-Blanch","doi":"10.1136/rapm-2025-107054","DOIUrl":"https://doi.org/10.1136/rapm-2025-107054","url":null,"abstract":"<p><strong>Background: </strong>The suprascapular nerve block at the notch level is commonly performed. However, ultrasound identification of the notch remains challenging due to significant anatomical variability. We conducted a combined ultrasound and dry bone anatomical study to better characterize the suprascapular notch and develop a simplified classification system tailored for anesthesiologists.</p><p><strong>Methods: </strong>We performed an observational anatomical study on 71 dry scapulae. The shape of the suprascapular notch was assessed using the Rengachary classification. We also measured the maximum depth (the deepest point of the notch) and the superior transverse diameter (the maximum distance between the edges of the notch). Additionally, an ultrasound observational study was conducted on 108 healthy volunteers to evaluate notch shape and determine the same measurements.</p><p><strong>Results: </strong>Based on ultrasound findings, the most common notch types were type III (34%, n=70), type II (31%, n=63), and type IV (20%, n=42). Non-parametric analysis revealed no significant association between notch type and participant age, sex, height, or weight. Furthermore, the distribution of notch types did not differ significantly between the left and right sides. For types II-IV, the median maximum depth was 5 mm [4-6], and the median superior transverse diameter was 18 mm [15-20]. Similar results were observed in the dry scapula analysis, though a high degree of variability in notch types was noted.</p><p><strong>Conclusions: </strong>Our findings revealed that notch types II-IV, according to the Rengachary classification, are the most prevalent. Nonetheless, the suprascapular notch shows substantial anatomical diversity. To address this, we propose a simplified ultrasound-based classification, centered on the presence or absence of a clearly identifiable notch. This system aims to support clinical decision-making in regional anesthesia and enhance consistency in practice.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145126248","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}